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   Table of Contents - Current issue
July-December 2022
Volume 7 | Issue 2
Page Nos. 171-330

Online since Tuesday, December 6, 2022

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A bird's eye view on Kantakari Avaleha: A polyherbal Ayurveda formulation for bronchial asthma p. 171
Sagar Mahendrabhai Bhinde, Sonam Sagar Bhinde, Virendra K Kori, Kalpna S Patel
Avaleha (linctus) is a unique dosage form of Ayurveda pharmaceutics, which is frequently used in various disorders and especially in respiratory disorders. Kantakari Avaleha (KA) is one such formulation being used extensively for Shwasa (asthma) and Kasa (cough) along with its classical use in various other disorders too. Because of its demand in clinical settings, many pharmaceutical companies are also preparing this, and hence freely available in market. This review was carried out to get thorough idea related to its composition, method of preparation, and therapeutic uses along with its pharmaceutical standards. For this review, classical and compiled texts having subject of Ayurveda pharmaceutics were screened from Central Library of Institute of Teaching and Research in Ayurveda, Jamnagar. Out of total 15 texts screened, 7 texts had mentioned KA, and hence reviewed for its ingredients, dose, Anupana, and therapeutic uses. Synonyms, Rasapanchaka (Ayurveda principles of drug action), and Dosha Karma (therapeutic action) of ingredients were compiled from Bhavaprakasha Nighantu. Pharmaceutical parameters of KA were compiled from original research articles from peer-reviewed journals through Google Scholar, PubMed, ResearchGate, and J-Gate portal. After review, it was found that Acharya Sharangdhara (12th Century) had described this formulation for the first time. There are four variations available in formulation composition. Milk or water should be the Anupana for this drug as per Ayurvedic Formulary of India and Pharmacopoeia of India (API). Almost all references have recommended its use in Shwasa and Kasa, along with Arati (distress), Shula (colicky pain), Gulma (a type of lump), Hikka (hiccup), and Hradroga (heart disease) mentioned in one and the other classics. Maximum ingredients of this formulation possess hot potency (12 out of 18 drugs) and pungent biotransformation property (11 out of 18 drugs). As per available original research works, two laboratory samples and one market sample of KA had fulfilled almost all analytical parameters, mentioned in API. The current review work may be helpful as stepping stone for various researches on KA such as network pharmacology, in silico, pharmacology, and longitudinal cross-sectional, clinical study.
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Middle ear myoclonus p. 179
Santosh Kumar Swain
Myoclonus is an involuntary, sudden jerking of a muscle or group of muscles. Middle ear myoclonus (MEM) is an idiopathic clinical entity attributed to causing abnormal repetitive contractions of the tensor tympani and/or stapedius muscles. MEM is an uncommon disorder produced by repetitive contractions of the middle ear muscles. In MEM, the objective tinnitus is produced by synchronous repetitive contraction of the tensor tympani and/or stapedius muscle. The exact etiology of MEM remains unclear. The diagnosis of MEM is often based on the history of rhythmic and involuntary clicking or buzzing tinnitus which is invariably unilateral. The important differential diagnosis of the MEM is palatal myoclonus while other local otological diseases must be excluded with careful clinical examination. Transcanal microscopic/endoscopic middle ear exploration with the injection of botulinum toxin into the tensor tympani and stapedius muscles is helpful to relieve the symptoms of MEM. This approach is both helpful as a diagnostic and therapeutic tool that allows temporary paralysis of the middle ear muscles before providing definitive surgical treatment. The surgical section of the middle ear muscles through tympanotomy is an excellent treatment option for MEM. There are not adequate research articles available concerning MEM and mainly case reports and few case series are available during the literature search. Proper methods for diagnosis and treatment of MEM are helpful to early resolution of the symptoms and enhance the quality of life. Here, this review article is attempting to discuss the etiopathology, clinical manifestations, diagnosis, and medical and surgical treatment of MEM. Literature search for MEM was done from the database of PubMed, MEDLINE, Scopus, and Google Scholar search with the use of the words MEM, middle ear muscles contractions, symptoms of MEM, diagnosis of MEM, and treatment of MEM.
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Assessment of clinical skill competency of medical postgraduate students – Recommendations for upcoming CBME curriculum for postgraduates p. 184
R Rajashree, Smita Kottagi, Triveni Jambale, Gajanan Channashetti
Direct observation of postgraduate medical trainees with actual patients by clinical faculty has traditionally been a standard tool to assess knowledge and skills in clinical subjects. By assessing and providing feedback to medical trainees performing a medical interview, physical examination, or counselling patients, faculty can facilitate budding physicians to have successful practice of medicine in their future. Despite the advances in clinical skills evaluation, direct observation has been a most popular and time tested method. However, observation of postgraduate medical students by faculty is very subjective and unfortunately often sporadic and non-standardized. Substantial amount of literature identifies several threats to its construct validity as an assessment tool. Although many tried to demonstrate methods to minimize those threats, there are many lacunae that remain inherent to direct observation method. Hence the need of the time is to relook at the observation as an assessment tool, instead of discarding the whole as inappropriate one. The authors initially made an effort to analyse the problems in present settings in India. After an extensive literature search authors advocate few additions and modifications to the existing system. Thus the present study not only highlights the pitfalls in the direct observation method but also suggests solutions for the problem.
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Effect of expired pharmaceutical dumping on ecological community p. 192
Dipanshu Kumar Vishwas
Most people usually throw unused or expired medicines at open landfill sites or isolated locations completely inadvertently due to the consequences and lack of drug disposal facilities. Thus, our field of investigation focuses on whether disposal medicine has any direct effect on various life forms, including humans. This investigation describes how medicinal metabolites develop through wastewater that continuously enters the aquifer and soil environment. Since the discharge of toxic drugs has antibacterial activity, loss of soil fertility, aquatic species have a feminizing effect in males, and bioaccumulation affects inland animals including humans promote global consequences, and thus food affects the chain. Thus, a review of this study might furnish a good conception on the issue of lapsed pharmaceutical wastage and its effect on biological networks. The work concludes with better knowledge about the current conditions of drug wastage around the world, including India, and how biologically active ingredients can have devastating effects on the metabolism of various life forms in the ecological community. This article can also be very useful for understanding, aware and cautioning about the future consequences of drugs by people carelessly in the environment, and turning the brain to the urgent need for a strict and complete proof policy on its safe dumping so that its harmful effects on the environment can be minimized.
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A comprehensive review of Trivanga bhasma (herbomineral trimetallic formulation) p. 198
Pravin Jawanjal, Swapnil Choudhary, Prashant Bedarkar, BJ Patgiri
BACKGROUND: Trivanga Bhasma, a herbomineral formulation prepared by incineration of Vanga (Tin), Naga (Lead), Yashada (zinc). In Rasa Kaumudi Trivanga bhasma is mentioned as Triloha bhasma. AIM: The aim of the present study was analysis of various pharmaceutical methods, doses, indications, of Trivanga Bhasma mentioned in Ayurveda texts. INTRODUCTION: Trivanga Bhasma is indicated in MutraRoga (disorders of urine), Madhumeha (Diabetes) and Vandhyatva (Infertility), Napunasakta (Impotency), Shaktivardhaka (Strength) Swetapradara (Leucorrhea). METHODS: Ancient Ayurvedic classics included Rasatantrasara Evam Siddhaprayoga Sangraha, Ayurvedeeya Oushadi Gunadharma Shastra, Siddhayoga Sangraha, Rasa Kaumudi, Bhasma Vigyana, Rasa Raj Mahodadhi, and other available translations in various languages were viewed. Marana (incineration) method of Trivanga Bhasma mentioned in classics were collected and analyzed. A comprehensive review of Trivanga Bhasma has been attempted by searching of published literatures in various database including Web of Science, PubMed, Scopus, Taylor and Francis, Google Scholar, and University Grants Commission care journals list. DISCUSSION: In classical texts, fourteen methods of preparation of Trivanga Bhasma were found and in texts-Rasa Kaumudi-1, Rasayansara-2, SiddhaYoga Samgraha-1, Rasaraj Mahodadhi-1, Ayurvediya Aushadhi Guna Dharma Shastra-1, Rasatantra Sara Evam Siddha Prayoga Samgraha-2, Bhasma Vigyana-5, and Ayurvedic Formulary India-1 methods are mentioned. In these methods, 9 methods were Jarana followed by Putapaka, Jarana in 3 methods, Damaru Yantra Kramangi paka in 2 methods. CONCLUSION: A total of 14 methods of Marana with 22 media are mentioned for Trivanga Bhasma.
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Effect of long-distance load marching on physiological responses at desert environment p. 204
Kavita Arya, Angad Yadav, Debojyoti Bhattacharyya, Subhojit Chatterjee, Madhusudan Pal
AIM: The present study was undertaken to examine the effect of long-distance load marching on the physiological responses, walking efficiency, and mobility of soldiers at sandy desert environment. METHODS: A total of nine physically fit soldiers (age, 30.00 [SE 0.9] years; height, 175.56 [SE 1.18] cm; and weight, 77.83 [SE 1.37] kg) volunteered for long-distance (6 km) load marching by self-selected speed when carrying 22 kg (28.27% of body weight [BW]) load and no load (NL). Heart rate (HR), respiratory frequency (RF), and core body temperature (CBT) were recorded. Relative workload (RWL) and Physiological Cost Index (PCI) were calculated to assess the work intensity and mobility. RESULTS: It was observed that HR (P = 0.01), RWL (P = 0.01), and PCI (P = 0.01) were significantly increased by 23.79, 39.71, and 77.73%, respectively, and mobility was significantly reduced (P = 0.01) by 18.56% during marching with 22 kg load as compared to NL. CONCLUSION: It may be that marching without external load at speed of 4.85 ± 0.54 km/h should not be continued for more than 2 h, whereas marching with load of 28.27% of BW at speed of 3.95 ± 0.55 km/h should be restricted to maximum 30 min. This combination of load, speed, and duration provides information about soldiers' routine load carriage tasks, which may help in optimizing the load carriage task to reduce the chances of cumulative carriage-related injuries and, therefore, may contribute to improved soldiers' operational readiness and mobility.
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Musculoskeletal Disorders: Prevalent predicaments among carpenters of West Bengal, India p. 211
Kanu Gopal Biswas, Piya Majumdar, Subhashis Sahu
BACKGROUND: Carpentry and related jobs are the major occupations for a large number of people in the rural and urban areas of India which is mainly unorganized. AIMS AND OBJECTIVES: Carpentry work is unorganized informal sectors, particularly in developed countries such as India, and there is a lack of data on musculoskeletal disorders and the issues are being undermined nowadays, so we intend to study and evaluate the prevalence of musculoskeletal disorders among carpenters, analyzing major causes behind such predicaments with a special emphasis on working posture. MATERIALS AND METHODS: For the present study, 148 male carpenters aged between 20-60 years were randomly taken from different wooden furniture manufacturing units in West Bengal, India, and 148 referent subjects from different working sectors with similar socioeconomic status who have been categorized depending upon their experience. Socio-demographic features along with physical measures, physiological status, working posture, and discomfort at different body parts were evaluated following standard protocol. RESULTS: Based on the observations, it was found that most of the carpenters were suffering from work-related health predicaments, mainly musculoskeletal problems due to awkward working posture. Some of the working postures adopted by carpenters were identified as very strenuous. They complain about pain during working hours and also during the rest period. It was observed that the head, neck, shoulder, arm, elbow, wrist, upper back, lower back, waist, leg, knee, and ankle were majorly affected areas due to their repetitive nature of work with awkward posture. Body part discomfort rating showed that the lower back was mostly stressed and the elbow and leg were least. It was also found that their working place and their working environment and unergonomic tools make work more strenuous. CONCLUSION: So, some ergonomic interventions are required to improve the quality of life of the carpenter work, and scheduled rest-pause may enable the workers to recover from strain.
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Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study p. 220
Sonali Desai, Rajiv Limbasiya
OBJECTIVES: Bell's palsy is a condition of unilateral facial paralysis with the recovery rate varying from person to person. Various factors influence the prognosis of Bell's palsy subjects. Hence, the aim of this research was to examine the relationship between recovery of Bell's palsy and demographic, anthropometric, and the presence of comorbid diseases. METHODOlOGY: A correlation study was conducted on a total of 70 (both male and female) subjects. Independent outcome measures were age, gender, side, height, weight, body mass index, presence of diabetes, hypertension, and dyslipidemia. Dependent outcome measure was Sunnybrook Facial Grading System which grades the recovery following Bell's palsy. Outcome measures were taken at baseline, after 20 days, and after 1 month. RESULTS: Statistical analysis indicates that age, weight, diabetes, hypertension, and dyslipidemia have a significant correlation with recovery in Bell's palsy patients. CONCLUSION: The positive correlation between weight and recovery indicated that low weight leads to delayed recovery. A negative correlation of recovery with age, diabetes, hypertension, and dyslipidemia indicates that increased age leads to delayed or incomplete recovery and the presence of comorbid diseases leads to delayed/incomplete recovery.
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Effectiveness of domiciliary rehabilitation, telerehabilitation, and home exercise program on pain, function, and quality of life in patients with total knee arthroplasty: A randomized controlled trial p. 225
Shrihari L Kulkarni, Sweta Kulkarni, Arvind D Patil, Shefali Anand Painginkar
BACKGROUND: Knee osteoarthritis (OA) is the major source of disability worldwide. OA of knee is a joint disease that affects the elderly. It is characterized by progressive articular cartilage damage which further causes pain and loss of function. Total knee replacement (TKR) is the standard treatment for severe OA knee. Telerehabilitation is one of the new treatment ways and is speedily growing as an alternative for therapies. OBJECTIVES: The objective of this study was to compare the effects of domiciliary rehabilitation, telerehabilitation, and home exercise program on pain, function, and quality of life (QOL) in patients with TKR. MATERIALS AND METHODS: A total of 108 individuals were enrolled as per eligibility criteria during the study period and then were randomly divided into three groups by computer-generated, randomized sequence numbers. The parameters were obtained preoperatively, postoperatively, and at the end of 1 month using the Visual Analog Scale (VAS), Knee Injury and Osteoarthritis Outcome Score, Quality of Well-being, methadone maintenance treatment (MMT), and knee range of motion (ROM) test. P < 0.05 was considered statistically significant. RESULTS: All the three groups showed a reduction in VAS scores and improved function in patients with TKR. QOL and MMT did not prove to be significant in any of the three groups. When ROM was considered, only Groups A and C showed statistical significance whereas Groups A and B showed clinical significance according to the mean difference values. CONCLUSION: All the three modes of rehabilitation among OA patients, i.e., domiciliary rehabilitation, telerehabilitation, and home-based exercise program, have shown similar effects on study variables including pain intensity, knee function, and QOL in patients with TKR. Therefore, we recommend to include telerehabilitation as one of the treatment approaches for patients with TKR whenever needed.
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Role of magnetic resonance imaging in assessment of extensor compartment abnormalities of knee joint – A cross-sectional study p. 232
Santosh D Patil, Vihag Raman, Pradeep Siddappa Goudar, Aravind D Patil, Priyanka Patil
INTRODUCTION: The patellofemoral joint (PFJ) is a complex joint structure with high functional and biomechanical requirements. The magnetic resonance imaging (MRI) is an effective tool for definition and characterization of knee pathology as it can accurately detect, localize, and characterize various pathologies of the knee joint. OBJECTIVES: (1) Evaluate MR images to identify different pathologies that are seen in the extensor compartment of the knee joint. (2) Quantitative assessment of patellofemoral measurements to determine predisposing risk factors that contribute to patellofemoral joint instability. METHODOLOGY: A cross-sectional study was conducted from January 2017 to December 2017 with a sample size of 30 in the Department of Radiodiagnosis at The KLE's Dr. Prabhakar Kore Hospital and MRC, Belagavi. The data were collected using a pretested semi-structured questionnaire. The pro forma included sociodemographic profile of the study subjects, clinical presentation MRI to identify different pathologies that are seen in extensor compartment of the knee joint and quantitative assessment of patellofemoral measurements to determine predisposing risk factors that contribute to patellofemoral joint instability. RESULTS: Among the study population majority of people had normal synovium, laterally subluxated/dislocated patella. Among the study population, the majority had normal lateral trochlear inclination angle, normal trochlear facet asymmetry, normal trochlear depth, normal sulcus angle, and trochlear dysplasia. Twenty-four (80%) people had normal Insall–Salvati index, 27 (90%) people had normal lateral patella femoral angle, 25 (83.30%) people had normal lateralization of the patella, 28 (93.30%) people had normal tibial tubercle to trochlear groove distance, majority, i.e., 11 (36.70%) had Hoffa's fat pad edema followed by chondromalacia patella, trochlear dysplasia, medial patellofemoral ligament tear, patella alta, synovial plicae, subluxated/dislocated patella, transient dislocated patella, Osgood–Schlatter disease, and patellar tendonitis. CONCLUSION: MRI has also been useful in identifying extensor compartment pathologies that lead to anterior knee pain.
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Pulmonary function tests, fatigue levels and functional capacity in head and neck cancer patients undergoing cancer therapy: An evaluation study p. 241
Renu Pattanshetty, Varsha Huddar, Prasad Kharwandikar
BACKGROUND: The changes in pulmonary functions and fatigue; occurring in the months and years following cancer therapy have been well documented. The changes that occur in the hours of the cancer treatment are less clear. AIMS AND OBJECTIVES: The changes detected in the early stage of cancer treatment may help to prevent late pulmonary & associated complications. MATERIALS AND METHODS: The pre and post scores were taken after 3 days of treatment. PFT was recorded by vitalograph & peak flow meter, fatigue levels were assessed by FACIT-F scale and functional capacity was assessed by distance covered in 6- minute walk test. RESULTS: One hundred and seventeen patients with head and neck cancer were recruited 108 were males and 09 females with mean age of 52.2 years; there is a significant statistical reliable difference between the pre & post treatment values, with P-value is 0.001< 0.05. It justifies the deuteriations in health outcome post intervention. CONCLUSION: There is significant deterioration seen in the PFT, fatigue levels, functional capacity; could cause significant clinical problems. Early detection of all these changes can helps the patients as well as therapist to avoid or minimal late complications.
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Evaluation of quality of life using Sinonasal Outcome Test-22 among patients with chronic rhinosinusitis postendoscopic sinus surgery: A preliminary report p. 245
Abdulrahman O Afolabi, Kenechukwu Uche-Okonkwo, Nasiru Olalekan Shittu, Samuel O Ayodele, Nafeesat O Busari, Segun Segun-Busari, HK Omokanye, Saad O Idris, Biodun S Alabi, Adekunle D Dunmade, Foluwasayo E Ologe
BACKGROUND: The background of this study was to assess the quality of life (QoL) of patients with chronic rhinosinusitis (CRS) before and after endoscopic sinus surgery Sinonasal Outcome Test-22 (SNOT-22). MATERIALS AND METHODS: This was an observational prospective cohort study carried out at the Ear, Nose and Throat Department of Kogi State Specialist Hospital, Lokoja, and University of Ilorin Teaching Hospital, Ilorin. Both of which are tertiary-level hospitals in North-Central Nigeria offering advanced rhinology services after ethical approval was obtained. The total score for each subject was derived from the 22-item psychometrically validated self-administered SNOT-22 questionnaire. Lower scores postoperatively represent better health-related QoL (HRQOL). RESULTS: A preliminary report of 40 consecutive patients with rhinosinusitis were enrolled. There were 19 males and 21 females aged between 16 and 80 years (mean age: 34.95 ± 2.69 years). There was a significant improvement in SNOT-22 scores from the preoperative period: 37–88 (mean: 67.45 ± 15.10) to 22–43 (mean: 31.73 ± 5.61) 6 weeks after surgery, giving a percentage improvement of 52.97% (P = 0.0002), thus statistically significant. CONCLUSION: SNOT-22 tool is a valuable tool to evaluate the HRQOL of patients with CRS and endoscopic sinus surgery as surgical intervention improves the HRQOL of patients with reduction in the mean score of all items in the SNOT-22 in the postoperative state compared to the preoperative state.
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Knowledge and practice regarding menstrual hygiene and alternatives to sanitary pad among Indian undergraduate medical students: A cross-sectional study p. 252
YC Nalini, Sonal Gaonkar, IB Anjusha, Abhishekh Basavarajegowda
INTRODUCTION: While the availability and use of disposable sanitary pads have increased considerably in the last two decades, awareness about disposal and menstrual waste management has been neglected. This study was designed to determine the knowledge and practice of sanitary pad usage, disposal, and alternative methods of menstrual hygiene attitude toward menstrual leave among Indian undergraduate medical students. MATERIALS AND METHODS: The study participants were Indian undergraduate medical students. Self-administered online questionnaires were utilized, using Google Forms that requested personal details, menstrual history, usage and disposal of the sanitary pad, alternatives to the sanitary pad, and opinions about paid menstrual leave or sick leave policy. Quantitative data were summarized using mean and standard deviation, whereas qualitative data were summarized using percentages and frequencies. Data collected were analyzed using SPSS software version 20. RESULTS: Four hundred sixty-four students participated in the study. The mean age at menarche was 13 years. Menstrual bleeding lasted an average of 5.2 ± 1.6 days. Cycle length was 21–35 days in 92% of cases. Approximately 42.9% of respondents reported dysmenorrhea. 98% reported using the sanitary pad; among them, 48% reported they use a single pad (nonbio-degradable pads) for more than 6 h, and the most common mode of disposal is by wrapping in a newspaper. Menstrual cup followed by tampons is common alternatives to the sanitary pad. 48.7% reported that sometimes menstruation keeps them away from colleges. Eighty-two percent expressed menstrual leave policy of 1–2 days would be a positive and welcome move. CONCLUSIONS: Knowledge about sanitary pad disposal and alternatives is adequate among Indian undergraduate medical students but what is inadequate is the practice. Emphasis should be made on strategies that can be adopted to prevent the dumping of unsorted disposed of unsafe menstrual waste across the landfills resulting in a global health issue.
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Challenges faced by 1st phase MBBS students during online teaching of competency-based medical education curriculum – COVID times p. 258
B Persis Sofia, S Cynthia Subhaprada
BACKGROUND: Competency-based medical education (CBME) is a learner-centered, outcome-based approach which motivates self-learning. Currently, the world is experiencing COVID-19 pandemic which led to shutdown of colleges, and hence, online teaching has become a key component in the continuity of medical education. The main aim of the study is to analyze the impact of COVID-19 pandemic on online teaching among 1st-year MBBS students and to assess the challenges faced during this time. METHODS: After obtaining institutional ethics committee clearance, a mixed-method study design was used to collect data from 100 respondents among 1st-year MBBS students of Kurnool Medical College, Kurnool, during the month of September 2020. A prevalidated, semi-structured questionnaire was sent to the participants through Google Forms. The quantitative analysis was done through survey questions on a five-point Likert scale. RESULTS: The reported challenges to online medical education during COVID-19 pandemic were lack of in-person communication (57%), technical issues while attending online classes (49%), difficulty in time management (50%), confusion in understanding course expectations/competencies (44%), and more focused on theory than practicals (59%). Some of them stated that “having online classes is really helpful than not having any classes at all.” CONCLUSIONS: Hence, we conclude that though challenges mentioned above were faced during online teaching of CBME curriculum, effective leadership and student teamwork would be helpful in successful online teaching.
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Decreasing fertility trend in Sikkim: An area of concern p. 262
Bal Krishna Chauhan, Dechenla Tshering Bhutia
AIMS: Factors determining low fertility in Sikkim, India. PRIMARY OBJECTIVE: The primary objective was to determine the factors for the low fertility in Sikkim. SECONDARY OBJECTIVE: The secondary objective was to find out the prevalence of contraceptive use and its types in Sikkim. SUBJECTS AND METHODS: Study Setting: The study was conducted in the State of Sikkim. Study Period: The study period was 1 year (from February 2020 to January 2021). Study Population: The study population was female counterpart of the eligible couple. An eligible couple refers to a currently couple wherein the wife is in the reproductive age, which is between 15 and 49 years. Inclusion Criteria: Inclusion criteria were female counterparts of the eligible couple who consent to participate in the study. Exclusion Criteria: Exclusion criteria were male counterparts of the eligible couple. Study Tool: Structured pre-tested questionnaire was used to take the interview of the participants. Statistical Analysis Used: SPSS version 25 was used for statistical analysis. RESULTS: It was seen that having two or more children was higher for mothers who had married below 30 years than after 30 years with 14.9% and 6.9%, respectively (P = 0.03) and maximum mothers belonged to 30–34 years age group. The perception of the family size of the mother was that three-fourth (76.1%) responded to having two children, whereas 10.7% perceived one child to be sufficient and 13.2% mentioned having three or more. The overall contraceptive prevalence rate was found to be 73.8%. CONCLUSIONS: Causes for low fertility rate are multifactorial; some important ones are the perception and practice of concise and small family size and high contraceptive prevalence rate.
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Alterations of hand muscle strength in children due to schoolbag carriage p. 266
Ruchira Mukherjee, Koumi Dutta, Devashish Sen, Subhashis Sahu, Aparna Mukhopadhyay
BACKGROUND: Heavy schoolbag carriage induces pain and fatigue in children. It can alter the handgrip strength (HGS) in children – an important parameter given that most activities in school curriculum require hand dexterity. The purpose of this study is to explore if and how schoolbag carriage influence HGS in children. MATERIALS AND METHODS: Twenty-five healthy male participants (10–15 years) walked without schoolbag (0% load of bodyweight) or with schoolbags (weighing 4%, 8%, 12%, or 16% of their bodyweight) for 20 min on plane surface at preferred pace. The number of steps taken during walk was measured using pedometer. HGS was measured before and after each walk using dynamometer. The heart rate during walk was measured using Polar HR monitor. Pain occurrence in the entire body was mapped. RESULTS: HGS averaged for both hand decreased from 17.8 (±6.72) kg to 17.3 (±6.28) kg after 20-min walk (P = 0.033, paired sample t-test). The adopted speed and heart rate was higher when carrying a schoolbag but it portrayed no significant association with HGS. Occurrence of shoulder pain significantly associated with increasing in HGS of right hand after walking (Phi coefficient = 0.21[P = 0.030]). If shoulder pain was perceived during walk, there was a 2.5 times higher likelihood that the participants' HGS for right hand increased (odd's ratio = 2.515, 95% confidence interval = 1.086–5.825). CONCLUSION: Schoolbag carriage reduces HGS in children. Therefore, performing upper body conditioning exercises may help ameliorate the ill effects of heavy backpack carriage.
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Comparison of thoracic epidural and ultrasound guided erector spinae plane block in pediatric thoracic surgeries p. 271
N Vineela Reddy, Sandhya Ghodke, Ravishekar N Hiremath, Smita M Nimbannavar, Mahesh Krishna Kulkarni
OBJECTIVE: The objective of this study was to compare the efficacy of thoracic epidural and ultrasound-guided (USG) erector spinae plane block in pediatric thoracic surgeries. MATERIALS AND METHODS: Eight patients undergoing elective thoracic surgeries – videoscopic-assisted thoracic surgeries were divided into two groups, Group A – who received single-shot thoracic epidural using 0.125% bupivacaine in a dose of 0.5 ml/kg and Group B – who received USG erector spinae block (ESP block) using 0.125% bupivacaine in a dose of 0.5 ml/kg. Postprocedure visual analog scale (VAS) score was used to assess pain for the first 24 h. Pain assessment was done 6th hourly. Time of the first requirement of analgesics was noted and injection paracetamol 15 mg/kg intravenously was given as rescue analgesic. RESULTS: In Group A, VAS scores were higher compared to Group B. The duration of analgesia with single-shot epidural lasted for about 4–6 h postoperative whereas that with ESP block lasted for 8 or 10 h postoperatively. The time of the first requirement of analgesics was earlier in Group A compared to Group B. CONCLUSION: USG ESP block provides better analgesia compared to thoracic epidural.
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A comparative study on knowledge and awareness regarding type-2 diabetes mellitus and its complications among urban and rural patients p. 276
Surendra Babu Darivemula, G Vishwajeeth, G Pooja, G Prathyusha, G Pavani, G Sahithya, G Dharani, G Ravi Shankar, Sushma Katkuri
BACKGROUND: Type-2 diabetes mellitus (DM) is the most challenging public health problem. Most of the people are unaware of the disease and its preventive measures and complications. It is important to acknowledge the gap in the knowledge and awareness of the disease to prevent the disease and effectively plan public health care. METHODOLOGY: This was a cross-sectional study with the objective to assess the level of knowledge and awareness regarding type-2 DM and its complications among urban and rural population and to compare them. The sample size was calculated as 404 among >30 years of age with Type-2 DM with >1 year of duration with or without complications. Data was collected on demographic details, knowledge, awareness, complications and lifestyle modifications by using the structured questionnaire. The collected data was compared among urban and rural patients and the association was seen between different factors by appropriate statistical test. RESULTS: The knowledge on normal blood sugar was (45.6% and 27.2%) in urban and rural, HbA1C (63.8% and 49.5%), family history of diabetes (59.4% and 43.1%), whether DM2 is a multi system disorder, monitoring of blood sugar levels and frequency of monitoring and checkups were found to be more in the urban compare to the rural with P < 0.05. The awareness on complications like the rate of complications with increase in time (66.3% and 57.0%), awareness of diabetic foot (52.9% and 37.1%), prone to infections (67.3% and 58.9%), prone to COVID 19 infection (74.7% and 64.9%), most common organ involved as the complication arise was kidney (39.6% and 33.7%) with P < 0.05. CONCLUSION: The study suggests that there is a need to improve knowledge about DM and its complications, and there is a need for diabetes-specific health awareness campaigns on behavior and lifestyle changes, adherence to treatment and self-care.
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COVID-associated rhino-orbito-cerebral mucormycosis: A comparative study between computed tomography and magnetic resonance imaging for its early detection in suspected cases of rhino-orbito-cerebral mucormycosis p. 282
Priyanka C Megharaj, Vikram M Patil, Santosh Reddy
INTRODUCTION: Rhino-orbito-cerebral mucormycosis (ROCM), a life-threatening, acute fungal infection of the nasal cavities and paranasal sinuses, once considered a rare and lethal complication in immunocompromised patients, is now having a massive increase in ROCM incidence in India associated with COVID-19, i.e., COVID-associated mucormycosis with more than 15,000 cases as of May 2021. Early imaging by computed tomography (CT) and magnetic resonance imaging (MRI) is not only helpful in assessing the extent of involvement of this lethal disease but also helps in early diagnosis leading to prompt and aggressive treatment. The present study is aimed at determining and comparing the imaging findings on CT and MRI in ROCM patients, for early diagnosis in suspected cases of ROCM. MATERIALS AND METHODS: The present study is a comparative study of CT and MRI done on 11 patients suspected of ROCM, for 2 months from May to June 2021. RESULTS: Among 11 patients in the study group, ranging from 29 to 65 years of age, 45.4% belonged in 41–60 years of age group, with female predominance. 90.90% cases (10 patients) had maxillary sinus involvement among which 7 cases were diagnosed with ROCM, followed by 63.60% cases (7 patients) had ethmoidal sinus involvement among which 6 cases were diagnosed with ROCM. The involvement of retromaxillary space, pterygopalatine fossa space and masticator space, and cellulitis in premaxillary and preseptal spaces were findings seen only in diagnosed cases of ROCM. Erosions of bones were seen in ROCM cases, 27.20% cases (3 patients) had erosions of walls of maxillary sinus and lamina papyracea each. Orbital involvement in the form of intraconal space and extraocular muscles involvement was seen in 27.20% cases (3 patients) each. Optic nerve involvement was seen in 18.10% cases (2 patients) followed by extraconal space involvement in 9.01% cases (1 patient). Taking KOH staining and/or histopathology (HPR) as standard of reference, CT has a Sensitivity (Sn) of 71.40%, Specificity (Sp) of 100%, Positive predictive value (PPV) of 100%, Negative Predictive Value (NPV) of 66%, and Diagnostic accuracy (DA) of 81% as compared to MRI which has a Sn of 85.7%, Sp of 100%, PPV of 100%, NPV of 80%, and DA of 90.9%. CONCLUSIOIN: CT and MRI play a complementary role in diagnosis of ROCM, as CT is better in detecting bone erosions, whereas MRI is better in detecting soft tissue, orbital and central nervous system involvement. In the acute state of emergency as in the current pandemic with rising cases of ROCM and acute shortage of amphotericin-B, MRI is the single best modality for accurate detection of ROC, helping clinicians in the judicious use of Amphotericin-B.
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Dental professional's understanding of COVID-19 management: Can they contribute to medical care? p. 289
Akanksha Juneja, Amina Sultan
BACKGROUND: The sudden appearance of the highly infectious novel coronavirus in December 2019 has created global havoc in a short time. In the present scenario where the cases are rising explosively and medical health care professionals are losing their lives to coronavirus disease 2019 (COVID-19), the role of dental surgeons needs to be redefined. OBJECTIVE: Keeping all these things into consideration; this questionnaire-based cross sectional survey was planned to understand how dental surgeons managed COVID-19 once they got infected, and how confident they are if in future they need to treat cases of COVID-19. MATERIALS AND METHODS: A cross-sectional survey was done to assess the knowledge of practising dental surgeons infected with COVID-19 of the disease and its management. RESULTS: One hundred and one respondents completed the questionnaire. Of those 81% were vaccinated while 19% were not vaccinated. Of these 50.5% felt confident that they had adequate knowledge regarding COVID-19 and can treat mild-to-moderate infections. 84.2% believed that short-term courses and workshops should be designed for dental surgeons to improve their knowledge, keeping in mind their future role in pandemic. CONCLUSION: Short-term courses need to be designed to improve the current knowledge of dental surgeons regarding COVID-19 and prepare them for future.
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Comparison of demographic, socioeconomic, and lifestyle determinants in infertile and fertile males and females from two big cities of Punjab p. 294
Simranpreet Kaur, Richa Ghay Thaman, Reena Sood, Vasudha Sambyal, IM S Sandhu, Archana Beri, MS Chawla
BACKGROUND: Infertility is an apparent failure of a couple to conceive. The demographic, socioeconomic, and lifestyle determinants in infertility and its related factors should be seen more realistically. Regional variations in the causes of infertility need a completely comprehensive approach that helps to dive deeper into the root cause of the disease and manage it holistically. MATERIALS AND METHODS: A study on selected risk factors of infertility among 100 infertile couples and 200 fertile males, females attending tertiary health-care centers and in vitro fertilization centers from two big cities of Punjab was conducted. The data were collected using semi-structured pro forma questionnaire. The data collected included the anthropometric measurements, demographic profile, lifestyle variables impacting infertility, and socioeconomic attributes. Data were analyzed to look out for risk factors and their association using the odds ratio. RESULTS: The findings of the study revealed that nonvegetarian diet, more tea and alcohol usage, smoking abuse, and duration of mobile phone usage were seen more in infertile couples which was statistically significant in relation to fertile participants. Occupation, physical activity, sleep, socioeconomic variables, and education status did not show any statistical significance when compared between the two groups. Interestingly, statistical significance was seen in the obese class II category only in infertile males in comparison to fertile males. CONCLUSION: An all-inclusive perspective is needed for the diagnosis, treatment, and management of infertility. Health-care professionals need to dive into aspects of infertility treatment other than medical interventions to provide an integrated treatment regimen for couples facing infertility.
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A tailor-made physical therapy protocol for a rare pediatric tumor p. 302
Renu B Pattanshetty, Nikita Nitin Pawar, Mounica Srinivas Rao
Solid pseudopapillary carcinoma of pancreas is a cystic exocrine tumor of the pancreas which is common in females in the third and fourth decades. This report presents a rare case of an 11-year-old girl who operated for Frantz tumor and was referred for physical therapy. The therapy was beneficial in reducing the pain, improving the range of motion, and overall quality of life of the patient. To the best of our knowledge, this is the first case report found in the medical literature that reports of physical therapy management in a rare reported case of pediatric solid pseudopapillary carcinoma of pancreas.
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A preliminary randomized, single-blinded, placebo-controlled clinical dose–response study to elucidate the effect of ongoing isometric contraction of muscles on the vital capacity of lungs on administering Blatta orientalis p. 306
Usha Kushwaha, G Supriya, Balakrishnan Nair, Kathika Chattopadhyay, Ashwini Nair, Sanjay Vishwakarma
INTRODUCTION: Blatta orientalis is an indicated remedy for asthma and other chronic obstructive pulmonary diseases in homeopathic medicine. Preclinical studies indicate that B. orientalis shows anti-asthmatic properties in animals when induced with bronchospasm using acetylcholine through nonselective anticholinergic and antihistaminic activities. However, no studies have explored the changes in the vital capacity of the lungs on administering the homeopathic remedy, B. orientalis. It is shown that isometric contraction of pectoral muscles enhances the vital capacity of lungs by increasing ventilation and decreasing alveolar partial pressure of carbon dioxide. It can act as a valuable tool for monitoring the vital capacity of the lungs before and after administration of B. orientalis. AIM: This preliminary research takes the first step toward exploring vital capacity through a randomized, placebo-controlled study elucidating the effects of ongoing isometric contraction of muscles on the vital capacity of lungs of healthy individuals on the administration of B. orientalis in different potencies. It aims to compare changes in the vital capacity of lungs in healthy participants during an acute bout of isometric contraction by handgrip dynamometer after administration of B. orientalis. MATERIALS AND METHODS: Eighteen participants who fulfilled the inclusion criteria gave voluntary consent to participate in this research study. The research team measured the Tmax (measured by handgrip dynamometer) and the vital capacity (measured by a vitalograph) of these participants at the baseline. The participants were then placed into three-medicine arms to administer medicine orally: Arm 1 – B. orientalis Q, Arm 2 – B. orientalis 30C, and Arm 3 – placebo, following allocation of six participants in each medicine arm. Lottery method was used for grouping participants randomly to each medicine arm. The participants were numbered from 1 to 18 using the lottery method, and it was made sure that each arm had one male and five females to have similar gender distribution. The research team blindfolded the participants with a cloth bandage (dupatta) before categorizing them into different medicine arms. The team measured each participant's Tmax and vital capacity, and then administered one dose of the assigned medicine. The team measured the Tmax and vital capacity of the participants after 10 min of administering the medicine. The process was repeated after every 24 h for 3 consecutive days. RESULTS: The effect of ongoing isometric contractions of the skeletal muscles on the vital capacity acted as a great tool to measure improvement in vital capacity. The vital capacity of the lungs was significantly decreased after oral administration of B. orientalis Q and B. orientalis 30C, whereas there was no significant effect found in the arm that received a placebo. CONCLUSION: This preliminary study shows that B. orientalis decreases the vital capacity of lungs in healthy subjects and calls for further exploration of its action in higher potencies and with wider experimental parameters. Following the Law of Similimum, this inference also adds to the research scope on the potential of this homeopathic medicine in patients with restrictive lung diseases where the vital lung capacity gets significantly decreased.
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A rare case report of bilateral ruptured tubal ectopic pregnancy p. 314
Preeti Shankar Malapure, Rajasri G Yaliwal, Purushottam B Jaju, Gauri Bankapur
Implantation of the fertilized ovum outside the uterine cavity is called ectopic gestation. The common presenting symptoms are per vaginal bleeding till 12 weeks, pain in the lower abdomen, and absence of menses. ß-HCG level is increased (>1000IU/L) and transvaginal ultrasonography shows an empty uterus. These findings essentially confirm the diagnosis. In this, we have a 23-year-old, G2P1L1 with a history of 3 months of amenorrhea, presenting to the labor ward with a history of per vaginal bleeding and lower abdominal pain. The diagnosis was 10 weeks right-sided ruptured ectopic pregnancy and intraoperatively found to be ruptured ectopic pregnancy in both fallopian tubes which we managed successfully by performing emergency laparotomy with bilateral partial salpingectomy.
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Axillary lymphadenopathy in a case of breast carcinoma: Is it always metastatic? p. 317
Padmini Chitradurga Vijayasarathy, Panduranga Chikkannaiah, Netra M Sajjan, Vani B Ramalingaiah, Srinivasamurthy Venkataramanappa
Cancer and tuberculosis are the most common illnesses in the world; however, their coexistence is not uncommon and a challenge for pathologists and clinicians. The instances of mucinous carcinoma and disseminated tuberculosis are exceptional. Here, we present such a rare case of incidentally detected mucinous carcinoma of the breast with disseminated miliary tuberculosis in a 59-year-old female. The pertinent literature is being reviewed.
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Graded epidural anesthesia for fistulectomy with symptomatic obstructive hypertrophic cardiomyopathy p. 321
V Nivedha, R Brindha, S Vigneshwaran
Hemodynamic fluctuations can occur when fistulectomy is usually done under spinal anesthesia that can cause detrimental effects for a patient with obstructive cardiomyopathy. This is a case of 51-year-old male with fistula in ano sustaining obstructive hypertrophic cardiomyopathy as suggested by chest pain, palpitation, breathlessness on exertion was scheduled for fistulectomy. Electrocardiography (ECG) showed left ventricular hypertrophy with deep narrow Q waves in V1 to V6. Echo showed asymmetrical septal hypertrophy, grade 1 diastolic dysfunction, EF – 60%. Regional anesthesia technique such as graded epidural anesthesia can be safe and cost effective by prolonging the postoperative pain relief and thus also effective in blunting autonomic, somatic, and endocrine response triggered by surgical insult.
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Difficult airway management in a case of bilateral congenital torticollis p. 323
C Priyanka, S Shanu, R Brindha
Anatomical disorders of the head and neck pose a serious challenge to an anesthesiologist in terms of difficult intubation. Securing airway requires a detailed preanesthesia evaluation to assess any issues associated with the disease, especially concerning the airway. This is the case of a 46-year-old male with congenital bilateral torticollis posted for elective functional endoscopic sinus surgery. A detailed preanesthetic checkup was done and was anticipated a difficult airway situation, hence planned for an awake intubation. We performed a successful awake fiber-optic intubation. Excessive muscular atrophy and fibrosis characterize congenital bilateral torticollis, resulting in sternocleidomastoid tension and limited cervical motion. During intubation, asymmetry in the face caused a mismatch between the facial and cervical midlines, making sniffing difficult. Successful anesthetic management in a case of congenital bilateral torticollis requires thorough knowledge about the anatomical changes and also the expertise in fiber-optic bronchoscopy.
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Management strategies for tackling COVID-19 pneumonia in patients with lung cancer: Experience gained during the pandemic p. 325
Ravikanth Reddy
Chest imaging during the COVID-19 pandemic should ideally be reserved for patients with moderate-severe disease or in mild cases with worsening respiratory status. Lung cancer patients who contract COVID-19 have greater risk for severity, disease progression, early deterioration and high mortality as compared to the general population. Radiologists who are at the forefront of imaging technology have to take responsibility of notifying the managing physicians of the initial findings in lung cancer patients with suspected COVID-19 in order to implement precautionary measures. Optimal management strategies with intense surveillance measures have to be adopted in such patients during the pandemic to reduce disease burden and to achieve better prognostic outcomes related to lung cancer treatment
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Diagnostic criteria and role of multimodality imaging in complicated autosomal dominant polycystic kidney disease p. 327
Ravikanth Reddy
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The burden of the unnoticed rotational motion disorder p. 329
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
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