Internship: A time to prioritise

Medical internship is a yearlong experience that is physically, mentally, and emotionally exhausting. After five years as students, the interns finally get close to achieving what they have always dreamt of. Most of the fundamental clinical knowledge and skills that a student learns are acquired during their internship. For the first time, students gain financial freedom, recognise the importance of a white coat, and are recognised as doctors. Internship helps a student to realise the mechanics of how a hospital operates, how patients are treated, how crises are managed, and most crucially, how to think and work productively in a chaotic yet effective atmosphere. Each obstacle encountered serves as a training ground. The key dilemmas are whether to prioritise learning clinical skills or study for the post-graduation entrance examinations, and which specialty to opt for. Conscientious mentors are vital to this whole process.

Depression in the elderly: Prevalence and associated factors in urban population

Introduction: Depression in elderly population is a serious public health concern but is often undetected and ignored as a medical problem, leading to poor quality of life. Aim and Objectives: The objectives of this study were to estimate the prevalence and degree of depression among the elderly population using a Geriatric Depression Scale (GDS?15) Short Form and to study some correlates associated with depression in them. Materials and Methods: A community-based cross-sectional study was conducted with a sample size of 100 elderly subjects using systematic random sampling technique. After getting informed consent, information was collected using GDS?15 Marathi version. Results: Of 100 respondents interviewed, 52 were 70 years and above and 54 were male. The prevalence of depression among the elderly was 84.0%. Sixteen (8 males and 8 females) were suffering from severe depression. Age, sex, death of spouse, education, occupation, and morbidity status were found to be significantly associated with depression. Conclusions: The prevalence of depression among the urban elderly was very high. By identifying risk factors for depression among the elderly population and screening them on time, we can go a long way in adding life to their years instead of years to life of the elderly.

Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India

Background & objectives: Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. Methods: This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. Results: The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. Interpretation & conclusions: The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.

Applications of Bioinformatics in Food Allergy: A Brief Review

This literature review mainly deals with the concepts of food science, food allergy, allergenomics, bioinformatics and its application in solving challenges pertaining to food allergy. When an after eating a certain food, the immune system gives out a reaction, it is defined as Food Allergy. It is a complex disease that has many challenging area related to its cure and is a worldwide problem. Bioinformatics help in providing solutions to these challenges. As allergens are mainly proteins. There are many allergy databases and tools available in the market that can be used to identify the differences between novel proteins and food allergens that could be the epicentre of multiple allergy syndromes. This review article talks about food allergenicity, allergy and computational approaches employed to solves issues related to it.

Comparative diagnostic utility of different urinary biomarkers during pre-albuminuric stages of non-hypertensive type 2 diabetic nephropathy

Background & objectives: Activation of renin-angiotensin system and tubulointerstitial damage might be seen in pre-albuminuria stage of diabetic nephropathy (DN). Here, diagnostic utility of four urinary biomarkers [Angiotensinogen (Angio), Interleukin (IL)-18, Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin] during pre-albuminuria stages of non-hypertensive type 2 diabetes patients was studied. Methods: A total of 952 type 2 diabetes mellitus (T2DM) patients were screened for nephropathy [estimated glomerular filtration rate (eGFR) ?120 ml/min and albumin–creatinine ratio (ACR) ?30], and 120 patients were followed up for one year. At one year, they were classified into hyperfiltration (43), normoalbuminuria (29) and microalbuminuria (48) groups. Another 63 T2DM patients without nephropathy were included as controls. Hypertension, patients on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, eGFR <60 ml/min/1.73 m2 and all proteinuric conditions were excluded. All were subjected to testing for urine protein, ACR, HbA1C, eGFR, along with urinary biomarkers (IL-18, cystatin-C, NGAL and AGT). Comparative analysis of all the diagnostic tests among different subgroups, correlation and logistic regression was done. Results: Urinary IL-18/Cr, cystatin/creatinine (Cr) and AGT/Cr levels were higher in groups of hyperfiltration (13.47, 12.11 and 8.43 mg/g), normoalbuminuria (9.24, 11.74 and 9.15 mg/g) and microalbuminuria (11.59, 14.48 and 10.24 mg/g) than controls (7.38, 8.39 and 1.26 mg/g), but NGAL/Cr was comparable. The area under receiver operating characteristic curve (AUC) and sensitivity of AGT to detect early CKD were higher than ACR and eGFR (0.91 and 90.4%, 0.6 and 40% and 0.6 and 37%, respectively). AUC values of other biomarkers, namely IL-18/Cr, cystatin/Cr and NGAL/Cr, were 0.65, 0.64 and 0.51, respectively. Angio/Cr and IL-18/ Cr showed correlation with log albuminuria (r=0.3, P=0.00, and r=0.28, P=0.00, respectively). NGAL showed correlation with log eGFR (r=0.28 P=0.00). Multivariate logistic analysis showed that odds ratio of developing nephropathy was 7.5 times with higher values of log Angio/Cr. Interpretation & conclusions: Urinary AGT showed a higher diagnostic value than ACR and eGFR followed by IL-18 and cystatin to diagnose DN during pre-albuminuric stages.

Generalised Pustular Psoriasis Masquerading as Lepromatous Leprosy: A Case Report

The relationship between psoriasis and leprosy is debatable since ages. The varied clinical manifestations of leprosy may resemble other skin diseases, but there is no documented literature of skin lesions of psoriasis mimicking leprosy. We report a case of generalised pustular psoriasis (GPP) presented with the lepromatous leprosy like clinical features in a 60 year old male. The histopathological examination confirmed the diagnosis. Patient was then treated with Methotrexate 7.5mg weekly and showed improvement in subsequent visits. We report this rare possibility to raise awareness among clinicians to allow accurate diagnosis since leprosy still carries stigma in society

The retinal vascular growth rate in babies with retinopathy of prematurity could indicate treatment need

Purpose: To analyze the weekly rate of retinal vascular growth in treatment?na飗e babies with various stages of retinopathy of prematurity (ROP) and validate if this could be a predictor of treatment need. Methods: Retrospective review of medical charts and retinal images of babies with various stages of ROP. The images were enhanced using red?green image enhancement software. Using the length of the horizontal disc diameter (DD) of each eye, the vessel growth was measured from the disc margin up to the vessel tip in fixed quadrants. The rate of vessel growth was the ratio of vessel length to the number of weeks it took to reach this length. The babies were divided into treatment warranting ROP (group 1), low?risk pre?threshold (type II) ROP (group 2,), and no?ROP (group 3) for analysis. The 搉o?ROP� group acted as normal control. Group 1 was further subdivided into 1A (threshold ROP), IB (aggressive posterior ROP), 1C (hybrid ROP), and ID (high?risk pre?threshold ROP). Results: Out of 436 eyes, groups 1, 2, and 3 had 238, 108, and 90 eyes, respectively. The mean rate of vascular outgrowth along with 95% confidence interval (CI) was 0.490 [0.487,0.520], 0.612 [0.599, 0.638], and 0.719 [0.703, 0.740] DD/week, respectively, for babies with 搕reatment warranting,� 搇ow risk pre?threshold� and 搉o ROP� groups, respectively. In our estimate, more than 80% of eyes with a vessel growth rate of 0.54 DD/week or less required treatment. Conclusion: A rate of retinal vascular growth less than 0.54 DD/week can be used to determine treatment requirements in babies with ROP

AN EXPLORATORY STUDY ON KHADI AWARENESS AMONG YOUTH IN PANIPAT DISTRICT

Khadi is a nature friendly handloom fabric with less carbon foot print. The main aim of this research is to analyze the knowledge and awareness level of khadi consumers and to study that is youth satisfied with khadi clothing and on what parameters. Consumers are having positive attitude towards khadi but according to surveys and responses it was understood that youth demand more of stylish and fashionable clothing with comfort. Khadi makes wearer comfortable in every season but to target youth it needs to explore trendy side of khadi. The study was carried out in Panipat with sample size of 50 which included convenient sampling. Khadi represents itself as a symbol of self-reliance and youth is quiet sensitive to this and are ready to accept khadi but they are not ready to compromise with latest fashionable looks. KVIC has gone online and has launched e-portal and is targeting youth by exploring in different products also other than the clothing. Awareness of khadi cloth among youth is there but brand consciousness about khadi is definitely need to be built among youth

Harada-like syndrome post-Covishield vaccination: A rare adverse effect

Covishield is in wide use in India with about 80% efficacy. Serious side effects are still under study. A 30-year-old female presented to us 7 days post-vaccination with a 5-day history of sudden diminution of vision in both eyes. The clinical findings were suggestive of the Vogt-Koyanagi-Harada (VKH) syndrome. She was treated with high-dose oral steroids. At this juncture, the association was unclear. However, it was justified by an acute flare-up of uveitis on day 2 post the second dose of vaccination despite ongoing steroids. A direct correlation of Harada-like syndrome with the Covishield vaccine is observed here

Pachydermoperisotosis: A Rare Case Report

Pachydermoperiostosis (PDP) is a rare disorder with variable presentation and it is characterized by clubbing of the fingers (acropachia), skeletal changes (periostosis), thickening of the skin (pachyderma), and excessive sweating (hyperhidrosis). Clinical presentations of PDPcan be confused with secondary hypertrophic osteoarthropathy, psoriatic arthritis, rheumatoid arthritis, thyroid acropachy, and acromegaly. We report a patient with complete PDP.

Role of para-cervical block in reducing immediate postoperative pain after total laparoscopic hysterectomy: a prospective randomized placebo-controlled trial

Objective@#To study the efficacy and safety of 0.5% bupivacaine in paracervical block to reduce immediate postoperative pain after total laparoscopic hysterectomy. @*Methods@#A prospective, randomized, double-blind, placebo-controlled study was conducted at a tertiary referral center involving thirty women each in the treatment and placebo groups. Paracervical block with 10 mL of 0.5% bupivacaine (treatment group) or 0.9% saline (placebo group) was administered following general anesthesia and prior to proceeding with total laparoscopic hysterectomy. Visual analogue scale (VAS) scores at 30 and 60 minutes post extubation and mean VAS score (average VAS score at 30 and 60 minutes) were compared. Adequate pain control was defined as mean VAS score ≤5. Additional postoperative opioid requirement, hospital stay, and readmissions were also compared. @*Results@#Baseline variables such as age, previous history of cesarean section, operating time, and weight of the specimen were comparable in both groups. VAS scores at 30 (5.0±2.8 vs. 7.0±1.4) and 60 minutes (5.2±2.8 vs. 7.0±0.8) and the mean VAS score (5.1±2.7 vs. 6.8±0.9) were significantly lower in the treatment group. Adequate pain control (mean VAS score ≤5) was 57% higher and additional opioid consumption was 47% lower in the treatment group. No significant difference was found in the duration of hospital stay and readmission rate. @*Conclusion@#Paracervical block with bupivacaine was useful in reducing immediate postoperative pain with a 25% reduction in mean VAS score and a 47% reduction in opioid consumption in the first hour after total laparoscopic hysterectomy.

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study

Objective@#The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. @*Methods@#We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. @*Results@#We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. @*Conclusion@#In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Gynecological laparoscopic surgeries in the era of COVID-19 pandemic: a prospective study

Objective@#The novel coronavirus pandemic led to the suspension of elective surgeries and the diversion of resources and manpower towards pandemic control. However, gynecological emergencies and malignancies must be addressed despite the restricted resources and the need for protective measures against COVID-19. This study aimed to determine the types of gynecological surgeries performed, difficulties encountered, and their outcomes in the setting of the pandemic. @*Methods@#We performed a prospective cohort study over 6 months at a single tertiary center, including 60 women with gynecological complaints, categorized as emergencies and semi-emergencies, who underwent further surgery. Their surgical outcomes were measured through various parameters. @*Results@#We found that 68.3% were emergency cases, while the rest were classified as semi-emergencies. Fibroid and adenomyosis with failed medical management (48.3%), followed by cervical intraepithelial neoplasia (10%), and malignancies (10%) accounted for the semi-emergency cases, while ruptured ectopic pregnancies (13.3%) and torsion and ovarian cysts (18.4%) comprised the emergency cases. The decision to incision time between emergency and semi-emergency cases varied widely due to the safety prerequisites during the pandemic, ranging from 1 hour in emergency cases to 48 hours in semi-emergency cases. In addition, we studied the ease of preoperative preparation, patient satisfaction, and the average number of personnel available to run the operation theaters at these times. No serious perioperative adverse events were observed in the present study. @*Conclusion@#In conclusion, gynecological surgeries could continue to be safely performed with all precautions in place against COVID-19 infection and related morbidities.

Periorbital necrotizing fasciitis in a case of lid and conjunctival amyloidosis

Necrotizing fasciitis is a severe, progressive, rapidly spreading infection of the subcutaneous soft tissue and underlying fascia. Periorbital necrotizing fasciitis is rare owing to the excellent blood supply of the area. Ocular amyloidosis is relatively uncommon- that of the eyelid is typically associated with systemic associations whereas amyloidosis of the conjunctiva is often localised with no other associations. Authors report a case of a 40-year-old female with a 4-year history of eyelid and conjunctival amyloidosis who presented with necrotic ulcers and eschars in the upper and lower lid with purulent discharge, conjunctival mass and a dry looking cornea in the left eye. She was a known case of rheumatoid arthritis (RA) on treatment in the last 2 years. The presentation, investigations and management are described.

Traumatic avulsion of the eyeball: a case report

Ocular trauma is very common, but globe avulsion along with optic nerve avulsion is a rare clinical event. Blunt trauma during a road traffic accident can cause rupture or avulsion of the globe and the outcome can range from complete recovery on repositioning to visual loss because of globe perforation or optic nerve injury. Here, authors report a case of a 20-year-old male who presented with history of a road traffic accident causing severe facial injuries. The physical examination revealed oedema and ecchymoses over the right side of the face with avulsion of the right eyeball anteriorly outside the orbit along with avulsion of the optic nerve. The visual acuity in the injured eye was no perception of light and the direct pupillary response was absent. Computed tomography revealed fracture of the roof and lateral wall of the right orbit. As the eye was not salvageable, enucleation surgery was done. Insertion of an ocular prosthesis for rehabilitation was planned. The presentation, investigations, surgery and follow-ups are described.

Indian scenario and an institutional experience of fatalities in COVID-19: a narrative review

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing global pandemic that has devastated our globalized economic system. Apart from infecting 12,102,328 human beings and taking a toll of over 551,046 lives globally by the 11th of July 2020, it has fundamentally affected the way we live, work, travel, and relate to each other. Despite imposing early preventive measures, India has crossed a total caseload of 820,916 with a total death of 22,123 till-date, ranking third in the descending list of worst-affected nations. Although comparatively lower, the case fatality rate in India is 2.72% against the global fatality of 4.53%. It is an empirical fact that every process and institution must evolve to meet the needs of its time. A model for categorization of fatality among real-time reverse transcriptase-polymerase chain reaction (RT-PCR) positive COVID-19 patients has been developed at Uttar Pradesh University of Medical Sciences (UPUMS), to address the issue of patients being transferred very late in the course of the disease to level-3 facilities. The UPUMS model of categorization of fatalities of COVID-19 patients at level-3 center comprises of category-1 as ‘Institutional COVID-19 fatalities’, category-2 as ‘Imported COVID-19 fatalities’ and category-3 being ‘Imminent with Incidental COVID-19’ fatalities. This endeavor of categorizing COVID-19 fatalities is an opportunity to analyze facts and contemporary science to assess our response to this pandemic and thereby take lessons to prepare better for the future. Following proper analysis, we noted that most of these fatalities (64%) at the higher center are because of delayed referrals hence termed as imported fatalities, which need a modality of early attention and referral. However, there are fatalities which occur because of severe systemic illness like liver failure, cardiovascular accident (CVA), myocardial infarction (MI), etc. They need due treatment at a regional center. These constitute up to 18%. Authors found that actual COVID-19 deaths constitute only 18% of the total projected fatalities.

Hearing Loss in Thalassemic Children on Chelation Therapy

Background: Thalassemia is a common genetic hematological disorder worldwide. It is also common in North India includingJammu region. These patients need lifelong repeated blood transfusions and iron chelation therapy for their survival. Chelationtherapy is known to be associated with various complications including sensorineural hearing loss (SNHL). Till now, no dataare available regarding SNHL in pediatric thalassemia major patients in Jammu region. Hence, we planned a study to assessthe prevalence of hearing loss in children with thalassemia major in the age group of 10–20 years.Methods: All the children with beta-thalassemia major in the age group of 10–20 years registered with Thalassemia Day CareCenter, Department of Pediatrics, SMGS Hospital, Government Medical College, Jammu, were enrolled in this cross-sectionalstudy. Hearing was assessed by pure tone audiometry. Clinical and demographic data of these patients were recorded onpretested pro forma and analyzed.Results: A total number of 34 children with thalassemia in the age group of 10–20 years were enrolled in this study whichcomprised 18 males and 16 females. Out of these 34 patients, 5 (14.7%) were found to have SNHL and 1 (2.9%) had conductivehearing loss. Four of the five patients in SNHL group had low- as well as high-frequency mild hearing loss (25–40 db) whileone patient had high-frequency mild hearing loss at 4000 HZ. Four out of these five patients had unilateral hearing loss on theleft side while one had bilateral SNHL. Two out of five patients in the SNHL group were taking chelation therapy in the form ofcombination of deferiprone and deferasirox at the dose of 75–100 mg/kg/day and 30–40 mg/kg/day, respectively, for more than5 years. The other three patients were taking only deferasirox at the dose of 30–40 mg/kg/day for more than 5 years.Conclusions: Regular blood transfusions and chelation therapy are essential for long-term survival of thalassemia majorpatients but are also associated with complications like SNHL.

A comparative study of transcervical foley’s catheter with intracervical PGE2 gel for pre-induction cervical ripening

Background: To compare the efficacy of transcervical foley’s catheter with intracervical PGE2 gel for pre -induction cervical ripening.Methods: It was a prospective interventional study conducted between April 2012 to April 2013 in the department of obstetrics and gynecology at L. L. R. M. medical college and S. V. B. P. hospital Meerut. A total of 80 pregnant women of ≥28 weeks of gestation with bishop score less than or equal to 4 and with various indications for induction of labour were randomly allocated to receive intracervical PGE2 gel (Group A) or transcervical foley’s catheter (Group B). Bishop score was repeated after 6 hours by the same person and the results were compared.Results: The groups were comparable with respect to maternal age, gestational age, indications of induction of labour and initial bishop’s score. The intragroup results were calculated by Wilcoxon signed rank test and intergroup results were calculated by Mann Whitney U-test. The change in bishop score in PGE2 group was 3 and in foley’s group was 3.25 after 6 hours of induction (interquartile range of median) which is significant. The mean change in bishops score was 2.65 in PGE2 group and 3.1 in foley’s group after 6 hours of induction and was significant, however the bishop’s score was comparable in both the groups and statistically insignificant.Conclusions: Both foley’s catheter and PGE2 gel are equally effective in pre-induction cervical ripening of cervix.