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   2021| July-September  | Volume 10 | Issue 3  
    Online since March 17, 2022

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The styrene gas disaster – lessons to learn and the way forward
V Ramana Dhara, Raghunadharao Digumarti, GR Sridhar, Thomas H Gassert
July-September 2021, 10(3):117-128
The incident: A large amount of styrene gas was accidentally released from the LG Polymers India plant in Visakhapatnam, India, on 7 May 2020. The release resulted in 12 deaths and hundreds of injured persons in the nearby communities. This article reviews the potential causes and consequences of the accident on the people and the surrounding environment. Health Effects: The chemistry, toxicology, and exposure pathways of styrene are discussed to facilitate understanding the health effects on the exposed population. Lessons from the Bhopal disaster are discussed with a view to investigating and preventing future industrial disasters. The way forward: Using the experience of experts from the Bhopal Gas Tragedy, we propose the requisite methodology to monitor the exposed population using epidemiological research protocols that incorporate risk stratification and clinical investigation of the victims exposed to styrene.
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Histological conversion of seminoma of testis to metastatic choriocarcinoma in left cervical lymph node: An unusual phenomenon
Shirin Dasgupta, Debahuti Mohapatra
July-September 2021, 10(3):200-204
Germ cell tumors (GCT) of more than one histological subtype (although very rare) can be present in the same patient. We present a 29-year-old male who presented with a cervical lymph node swelling. The tissue received was a globular mass with a thick cystic wall and necrotic areas. A histopathological examination revealed the presence of residual lymphoid tissue in the form of lymphoid follicles, areas of hemorrhage and necrosis, tumor nests, and perivascular distribution of tumor cells. The neoplastic cells were arranged in a vague glandular pattern and also showed squamoid-like morphology on the basis of which a diagnosis of metastatic adenosquamous carcinoma was made. The patient was subjected to a whole-body positron emission tomography (PET) scan to look for primary on which a testicular mass was discovered; seminoma on histology. The sections of the cervical mass were revisited and trophoblastic cells were identified; they were also positive for β- human chorionic gonadotropin (hCG) on Immunohistochemistry. Therefore, a diagnosis of metastatic choriocarcinoma from seminoma testis was made. The direct derivative of germ cell neoplasia in situ/intratubular germ cell neoplasia being seminoma; it has the capacity for histological conversion to more differentiated forms (choriocarcinoma in this case).
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Abducens nerve palsy: A sole presentation of isolated cerebellar tuberculoma
Shivani Gupta, Shreya Arora, Samiksha Gupta, Gautam Jesrani, Monica Gupta
July-September 2021, 10(3):205-208
Tuberculomas constitute 5–30% of the space-occupying lesions of the central nervous system (CNS) in developing countries, and children and young adults are the most affected population. Most CNS tuberculomas include focal neurological signs with evidence of either meningeal exudates or hydrocephalus, but presentation as isolated sixth nerve palsy is very rare. We report a case of an immunocompetent female who presented with double vision, and was found to have isolated abducens nerve palsy of the right eye. On magnetic resonance imaging of the brain, solitary cerebellar tuberculoma was identified without any evidence of meningitis, basal exudate, or hydrocephalus. Despite the prompt initiation of anti-tubercular drugs and steroids, negligible improvement was noticed at 2 weeks of follow-up. This report highlights that isolated tuberculoma of any unrelated brain region can cause lateral rectus palsy, which may result in permanent disability.
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Hydrocephalus in pediatric patients: A clinical audit
Rahul Gupta, Pramila Sharma, Anu Bhandari, Vinita Chaturvedi, Arun K Gupta, Ramesh C Tanger, Arvind K Shukla, Gurudatt Raipuria, Praveen Mathur
July-September 2021, 10(3):138-143
Background: Ventriculoperitoneal (VP) shunt surgery is the most common procedure for treatment of hydrocephalus. The clinical outcomes of hydrocephalus patients following VP shunt surgery should be periodically appraised. Aims: To analyze and perform a clinical audit of management of hydrocephalus patients according to the standards of quality care; suggest interventions to make further improvements. Material and Methods: A retrospective study performed from January 2016 to December 2016. Pediatric patients with hydrocephalus who had undergone VP shunt surgery and those presenting with its complications were studied. Results: There were 142 pediatric patients with 103 males and 39 females (M:F = 2.64: 1). Age ranged from 1 day (youngest) to 12 years (oldest); 47.89% (68) of the patients were between ≥1 to <6 months. Out of 142, 72.54% (103) were new admissions and 27.46% (39) were admitted for shunt related complications. Congenital malformations were the most common (59.86%) reasons for admission. Meningomyelocele and Encephalocele were the most common (2.11%) major associated malformations. In 72.54% (103) patient's new VP shunt placement was performed, while in 8.45% (12) cases, complete revision by shunt placement on left side was performed. Low pressure type of VP shunt was the most common (77.39%) procedure. Conclusions: Approximately one fourth (27.46%) of the procedures performed for patients with hydrocephalus were for shunt related complications. Clinical audit helps to identify the complications and lacunae, develop effective methods for improvement in patient care. It gives an impetus to decrease the complications associated with it. We recommend a yearly clinical audit of pediatric patients managed with VP shunt surgery.
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Study of serum procalcitonin in patients with sepsis, septic shock and systemic inflammatory response syndrome (SIRS)
Swaroopa Deme, Sravan K Appani, Bhaskar Kakarla, Goveen Manda, Y S N. Raju
July-September 2021, 10(3):144-149
Background: Sepsis is a complex syndrome caused by an uncontrolled systemic inflammatory response of infectious origin characterized by dysfunction or failure of one or more organs and even death. Procalcitonin (PCT) has been one of the promising markers in bacterial sepsis. Aim: This study was done to evaluate the diagnostic and prognostic value of PCT in systemic inflammatory response syndrome (SIRS), sepsis, and septic shock, and to assess its relation with sequential organ failure assessment (SOFA) Score and serum lactate. Materials and Methods: This is a prospective observational study carried out in our institute between May 2012 and September 2013. Patients with suspicion of sepsis and SIRS were included. PCT, SOFA Score, and serum lactate were assessed at admission or within 12 hours and analyzed. Results: A total of 114 patients with SIRS (n = 14), sepsis (n = 63), and septic shock (n = 29) were included. Urinary tract and respiratory tract infections were the common sources of sepsis in 28.1 and 26.3% of the patients, respectively. The PCT levels were elevated in 83 patients. The mean values of serum PCT in SIRS, sepsis, and septic shock were (in ng/mL) 0.36, 6.81, 26.7, respectively. The mean values of SOFA Score in SIRS, sepsis, and septic shock were 3.4, 6.1, and 12.2, respectively. The mean values of serum lactate of SIRS, sepsis, and severe sepsis were (in mmol/L) 1.6, 2.3, and 3.9, respectively. Conclusion: Serum PCT was 82.6% sensitive, 71.4% specific, and had a positive predictive value of 95.0% in diagnosing sepsis and showed no association with SIRS. It was positively associated with high mortality and higher SOFA levels.
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Andhra Pradesh's COVID-19 pandemic case fatality rate
Venkata Adapa Suresh Babu, Smitha Sree Adapa, Hanumanth Narni
July-September 2021, 10(3):150-157
Background: The first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China, in late 2019, the epicenter of the COVID-19 outbreak. In India on January 30, 2020 and in Andhra Pradesh on March 12, 2020 first case was reported. The case fatality rate (CFR) among diagnosed cases is generally about 2%–3% but varies by country. Aim: To estimate the CFR in Andhra Pradesh during the pandemic in different phases. Methods: All the secondary data were collected either from the covid19india website or github website or Indian government websites or Andhra Pradesh State government website or media quoting the government announcements January 30, 2020 to August 8, 2020. The CFR was estimated as per the Methods for Estimating the Case Fatality Ratio for a Novel, Emerging Infectious Disease. Results: In the pre-lockdown phase, the CFR of Andhra Pradesh was 0.00%, Uttarandhra, Central Andhra & Rayalaseema was Nil, and South Andhra it was ranging from Nil-0.00%, In lockdown phase, the CFR Andhra Pradesh was ranging from 1.34 to 42.31%, Uttarandhra - Nil -5.56%, Central Andhra - Nil-100.00%, South Andhra - 0.00-66.67%, and Rayalaseema - Nil-100.00%. In post-lockdown phase, the CFR Andhra Pradesh was ranging from 0.99 to 2.50%, Uttarandhra - 0.59 to 4.55%, Central Andhra - 0.82 to 14.33%, South Andhra - 1.05 to 2.30%, and Rayalaseema - 0.37-8.07%. Conclusions: The CFR of confirmed cases of COVID-19 in Andhra Pradesh and its districts was a downward trend except Prakasam district.
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Ectopic pregnancy: “THE MASQUERADER” -A challenge to medical fraternity
Kavitha Garikapati, Sajana Gogineni, Narra J L. Prasuna, Vijetha Eda
July-September 2021, 10(3):158-163
Background: Ectopic pregnancy is a medical emergency with incidence of about 1-2% of all reported pregnancies and is termed as a ''Masquerader'' due to variable presentation. Aims and Objectives: To study ectopic pregnancy cases with atypical presentation, diagnosis initially missed by attending physician. Objectives are to study the prevalence of ectopic pregnancies, variable presentations and outcome. Methods: It is a retrospective observational study done in the department of obstetrics and gynaecology of a rural tertiary centre for a period of four years (January 2016- January 2020). Study population is 36. Results are analysed by descriptive analysis. Results: Out of 5400 deliveries, 100 were ectopic pregnancies (2%) of which 36 cases presented with atypical presentation (36%). Two (5.5%) with heavy menstrual bleeding with severe anaemia, two (5.5%) with pain abdomen and distension, six (16.7%) with myalgia, six (16.7%) pain abdomen with normal cycles, six (16.7%) pain abdomen with spotting per vagina (p/v) on and off, four (11.1%) Intrauterine contraceptive device (IUCD) insitu, five (13.9%) chronic pelvic inflammatory disease (PID), four (11.1%) fainting attack with no missed period, one (2.8%) bad obstetric history, recurrent tubal ectopic with pregnancy of unknown location (PUL).
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Characteristics and outcomes of pregnant women with confirmed COVID-19 infection posted for cesarean section. A retrospective, Cohort study
KG Sreehari, T Jamuna, V Balasubramanyam, MN Ramesh, Vijaya K Yedoti, J Radha
July-September 2021, 10(3):164-171
Background and Aim of the Study: Clinical and epidemiological features of COVID-19 infection have been widely reported. However, clinical studies on maternal and neonatal outcomes of pregnant women with COVID-19 infection remain sparse. The aim of this study was to describe the characteristics and outcome of pregnant women with confirmed COVID-19 infection posted for cesarean section. Objectives: To describe demographic and clinical characteristics of pregnant women with confirmed COVID-19 infection. To analyze the data regarding indications for cesarean section, type of anesthesia administered, and incidence of perioperative complications. To document and analyze the data regarding maternal and neonatal outcomes. Method: Study Design: A cohort retrospective study was conducted in the Department of Anesthesiology, Institute of pregnant woman (IPW), Sri Venkateswara Medical College (SVMC), Tirupati. Retrospective review of medical records of pregnant women with confirmed COVID-19 infection posted for cesarean section admitted in IPW/SVMC, tertiary care teaching hospital in Tirupati during May 2020 to January 2021 (9 months) was done, and the data regarding maternal demographic and clinical characteristics, type of anesthesia administered, the incidence of perioperative complications, and outcomes were collected and analyzed. Results: A total of 197 patients had undergone cesarean section in our IPW/SVMC, tertiary care Teaching Hospital, Tirupati, AP, INDIA. Most of the women werere aged in the range of 20 to 30 years – 138 cases (70%). A total of 104 pregnant women (52%) were without co-morbidities. A total of 163 pregnant women (83%) were asymptomatic on admission. Most of the cesarean births occurred for indications other than maternal compromise due to COVID-19 infection. A total of 186 women (94%) gave birth at term and 5% gave birth at preterm. Outcomes of pregnant women with confirmed COVID-19 infection posted for cesarean section are as follows: the number of live births (including twins) was 197 (99%), 1 case of IUD, and 1 stillbirth occurred (1%). Out of 197 live births, 180 neonates (91%) were born with a birth weight of more than 2.5 kg, and 8% of them were low birth weight (< 2.5 kg) babies. Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score at 1 min and 5 min after birth (mean ± SD) were 9 ± 0. 5 and 10 ± 0.0, respectively. The type of anesthesia administered was spinal anesthesia in all the cases (100%), and there was no significant incidence of perioperative complications when compared to the general population. Most of the pregnant women were discharged well to home (n = 196), one patient needed COVID- ICU admission, and one patient died due to acute respiratory failure. Most of the neonates were discharged well to home. Conclusion: Most of the pregnant women with confirmed COVID-19 infection posted for cesarean section do not have severe illness, and there is no significant maternal morbidity and mortality related to SARS-CoV-2 (COVID-19) infection. Spinal anesthesia is the safest anesthesia procedure in pregnant women with confirmed COVID-19 infection posted for caesarean section.
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Comparison of V3 sectional matrix and precontoured self adhesive matrix in class II cavities restored with composite resin: An in vivo study
Kakollu Sudha, DL Malini, Dunnala Lakshmi Sowjanya, Kasireddy Jyothsna, Mekala Ashwini, J Suvarna Sundar
July-September 2021, 10(3):172-177
Context: One of the challenges associated with the use of composite resin as a posterior restorative material is to create an intact and optimal proximal area. Aim: Aim of this in vivo study is to evaluate the proximal contacts in class II cavities restored with composite using V3 sectional matrix and precontoured self-adhesive matrix. Settings and Design: After determining the power (0.84) of the study, 40 patients who fulfill the inclusion criteria were divided into two groups. Methods and Material: In Group A Palodent V3 sectional matrix and in Group B precontoured self-adhesive matrix were used and evaluated for two outcomes, the primary outcome was proximal contact tightness, and the secondary outcome was proximal contour and overhangs of the restoration. Statistical Analysis: IBM SPSS (Version 21.0) software was used. Chi-square test and Spearman's rank correlation test were performed. Statistical significance was set at P value equal to or less than 0.05. Results: There was no statistically significant difference in contact tightness, contours, and overhangs between the two groups. Conclusions: Within the limitations of the study. • Both V3 sectional matrix and precontoured self-adhesive matrix showed similar performance in terms of proximal contact tightness, proximal contour, and overhangs of the restoration. • However, a well-designed randomized controlled study with long-term follow-up must be performed to give valid evidence.
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Knowledge and awareness of cervical cancer and attitude toward HPV vaccination among female undergraduate physiotherapy students in Belgaum, Karnataka
Renu Pattanshetty, Nikita Pawar
July-September 2021, 10(3):178-185
Background: Cervical cancer is the fourth leading cause of cancer mortality representing 7.5% of all female cancer deaths. In India, it is the second most frequent cancer among women and it usually occurs between 15 and 44 years of age. The key to prevent this cancer is early detection. Hence, awareness regarding cervical cancer and screening measures for cervical cancer should be spread widely in the community. This study was taken up to evaluate the knowledge of the symptoms, risk factors, and preventive measures for cervical cancer among undergraduate female physiotherapy students. Methods: This observational study was carried out over a period of 3 months among 154 female undergraduate physiotherapy students in Belagavi city, Karnataka, India. A pretested self-administered questionnaire was provided to evaluate their basic knowledge and awareness about cervical cancer. Statistical analysis was done using SPSS version. 23. Results: Knowledge regarding having multiple sexual partners as one of the risk factors for cervical cancer was the commonest among the undergraduate students (76.6%) and least for early menarche (24%). HPV vaccination as a preventive measure was known by only 20% of students. Only 9.7% knew the appropriate age to get vaccinated. Conclusion: The present study demonstrated that the undergraduate students had poor knowledge and awareness regarding risk factors for cervical cancer, human papillomavirus and its vaccination.
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Refractive errors and spectacle compliance among truckers in India
S G Prem Kumar, Asitkumar Jadhav, Sweta Patel, Pankaj Vishwakarma, Sabitra Kundu, Elizabeth Kurian
July-September 2021, 10(3):186-192
Introduction: Reliable data on eye health among Indian truckers are scanty. The purpose of this study was to assess the prevalence of refractive errors and the subsequent long-term spectacle compliance and suggest appropriate strategies to improve these in this population. Methods: A cross-sectional study was conducted between October 2017 and March 2018 among truckers. Gross ophthalmologic examination was performed, including visual acuity and refraction. Six months to one-year post provision of spectacles, follow-up with truckers was undertaken to understand the spectacle usage patterns and its compliance. Descriptive statistics and Chi-square tests were conducted to assess the association between the type of refractive errors, spectacle compliance, and select sociodemographic and clinical variables. Results: A total of 709 (78.8%) truckers completed interviews and gross eye examination. The prevalence of any refractive errors in the worst eye was 45.8% (95% CI 42.1%–49.6%). The prevalence of presbyopia with or without distance vision was 33% (95% CI 29.6%–36.6%) and myopia with or without astigmatism was 10% (95% CI 7.9%–12.5%). Among those who were prescribed spectacles, 27.1% needed distance correction, 33.8% needed near correction, and 39.1% needed both, at least in one eye. Long-term spectacle compliance was at 54.7%. The predominant barriers for spectacle compliance were “did not collect” (63.9%), followed by “discomfort” (20.8%). Conclusion: The prevalence of uncorrected refractive errors was high among truckers. Long-term spectacles compliance was moderate. There is an urgent need for tailor-made targeted interventions to address the eye health needs of truckers in India.
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Knowledge, attitude and practices towards COVID-19 among dental professionals: A cross-sectional survey
Alekhya Kanaparthi, Tejaswi Katne, Dukkireddy Divya, Srikanth Gotoor, Srikar Muppirala, Beedam Bhargavi
July-September 2021, 10(3):193-199
Background: Coronavirus disease (COVID-19) is an extremely alarming situation across the world. Researchers have identified it to be transmitted by direct/indirect contact through droplets from body fluids like saliva. Dental professionals are considered to be at high risk. Aim: The aim of the current study was to evaluate the knowledge, attitude, and practice regarding COVID-19 pandemic among dental professionals. Materials and Methodology: A self-administered, structured, pilot-tested close-ended 21 questionnaire was distributed among the dental professionals (Bachelor of Dental Surgery (BDS) students, internship, postgraduates, and practitioners. Data obtained was analyzed using SPSS 17.0 (SPSS Inc., Chicago, IL, USA) for descriptive analysis of the data. Results: A total of 513 participants completed the survey, of which 217 (42.2%) were BDS students, 64 (12.5%) were interns, 88 (17.2%) were postgraduates, and 144 (28.1%) were practitioners. Out of 513 respondents, 144 (71.9%) were males and 369 (28.1%) were females. Conclusion: All the respondents seem to have sufficient knowledge regarding COVID-19 and the adoption of World Health Organization and dental association guidelines. However, a difference in viewpoint was observed and the possible explanation could be the level of education and understanding. We believe that this survey may have reemphasized the importance of vigilance and practice by the dental care workers, in preventing the transmission of novel viral disease.
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Mass media and social media during COVID-19: A review
Shaik M Shameer
July-September 2021, 10(3):129-133
A novel coronavirus named as COVID-19 crop up in Wuhan, China, in December 2019. Quickly it spread to other countries worldwide to turn out to be a pandemic. Internationally, governments imposed quarantine and social distancing measures to put off the spread of the infection. Mass media and social media played a vital role in disseminating information regarding the COVID-19. Since little information and knowledge about COVID-19, various fake news, misinformation, and grapevine spread across the social media that scared people to make panic decisions. The swift spread of misinformation and stories through social media platforms such as Twitter, Facebook, and YouTube became a crucial concern of the government and public health authorities. Medical misinformation and unverifiable content about the COVID-19 pandemic were spread on social media at an unparalleled pace. Social media as a secondary medium should be utilized to convey important information. Besides, it allows citizens to address their queries directly. Several governments across the world have taken actions against misinformation spreaders. Yet, measures are to be needed to stop misinformation. Mass media especially electronic tried to disseminated information through doctors and scientist and allotted separate columns in newspapers. Due to misinformation about COVID-19, many people stopped subscription to newspapers. The advertisements revenue fall down. As a result, many newspapers reduced pages.
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Encouraging the use of crosswords to facilitate deep conceptual learning in medical education
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
July-September 2021, 10(3):134-137
Medicine is a complex specialty, wherein a freshly enrolled student is expected to master the knowledge aspect of multiple subjects and even show proficiency in skills, attitude, values, etc. The present review was carried out to explore the role of crosswords in the field of medical education to enhance learning. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 15 articles were selected based upon the suitability with the current review objectives and analyzed. Active engagement of students can be achieved by promotion of small group teaching, and thus employment of games and puzzles as a part of medical training represents an active form of learning. Crossword puzzles have been used in the field of medical education, nursing education and also as one of the strategies for the development of staff members. The employment of crosswords as a tool for teaching-learning has been linked with multiple benefits, such as development of diagnostic thinking, clinical reasoning skills, expansion of vocabulary, and mind stimulation. It is a must that an evaluation strategy should be developed to identify the utility of crosswords as a learning tool. To conclude, crossword puzzles in the field of medical education delivery are an effective and feasible approach to ensure critical thinking and better learning, recall and understanding of the key concepts. Thus, its use in all the specialty should be encouraged for the benefit of medical students.
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