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   Table of Contents - Current issue
January-February 2021
Volume 11 | Issue 1
Page Nos. 1-68

Online since Friday, February 19, 2021

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COVID-19 vaccines: Facts and controversies Highly accessed article p. 1
Dinesh Kaul
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Gasless laparoscopy and the working space in minimally invasive surgery p. 5
Vandana Soni
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Can spiral-shaped abdominal wall lift replace pneumoperitoneum in laparoscopic cholecystectomy? A randomised study p. 8
Shashi , Rajdeep Singh, Anurag Mishra, Lovenish Bains, PN Agarwal
Background: A new design of abdominal lift system for gasless laparoscopy has been introduced in rural areas. Aims and Objectives: To assess whether the new spiral design abdominal wall lift system has similar outcomes to standard pneumoperitoneum laparoscopic cholecystectomy. Materials and Methods: Sixty cases of symptomatic gallstone disease scheduled for laparoscopic cholecystectomy were randomly assigned to gasless spiral abdominal wall lift or to standard pressure pneumoperitoneum, followed by cholecystectomy. Post-operative abdominal and shoulder tip pain, duration and ease of surgery and surgical site complications were compared. Results: There was a significant difference in post-operative abdominal pain at 24 hours after surgery (P < 0.01). Shoulder tip pain was lower at 6 h (P < 0.01). The duration of surgery was comparable in both groups; the time taken decreased in the abdominal lift procedure with increasing experience. Conversion rate and surgical site complications were similar. There were comparable outcomes in terms of overall post-operative abdominal pain; shoulder tip pain; duration of surgery; conversions and post-operative complications between the two groups. Ease of surgery improved with number of cases over time. Conclusion: Abdominal lift may be a valid alternative to pneumoperitoneum cholecystectomy with comparable outcomes in resource constrained areas.
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Unite to end Tuberculosis – The need for public–private collaboration p. 13
Jency Koshy, Abel K Samuel Johnson, Bichu P Babu, Marina Rajan Joseph
Background: Despite effective diagnostic tools and drugs for tuberculosis , the disease still remains a public health threat. Financial insecurity, Social stigma, food insecurity, distance to nearest health facility and psychological stress play as hurdles in the diagnosis and completion of tuberculosis treatment. Early diagnosis and completion of treatment plays a key role in controlling tuberculosis. The public and the private sector in India together is trying hard to control this menace. The public sector in India has a wide network of institutions with uniform standardized treatment for TB treatment under the National tuberculosis program. The private sector is heterogeneous with limited or no extension centers in the peripheries. This makes it difficult for the private sector to follow up the patient. So the national program has extended the arms to join with the private partners to eliminate TB. This article attempts to highlight the need of collaborating with the national program to eliminate tuberculosis. Materials and Methods : All the tuberculosis patients diagnosed at a private institution prior to partnership with the national program were followed up to understand the treatment outcomes and understand the importance of public private collaboration. Results: A total of 131 patients were diagnosed with tuberculosis from the health facility during the study period. Out of the 131 patients, 30% (n = 39) could not be traced. Among the patients who were contacted, treatment interruption was observed in 6 (7%) patients. More than 1/4th of the traced patients (n = 62) completed their treatment. Death occurred to 08 (9%) traced patients. Conclusion: This study reiterate the need for Private public coordination in the treatment of TB. It is the responsibility of the health care professionals in the private sector to collaborate with the national tuberculosis program to make tuberculosis elimination a reality.
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Menopausal status and metabolic syndrome among women with cardiovascular diseases: A cross-sectional study in Bangladesh p. 18
Marjia Sultana, Towhid Hasan, Lincon Chandra Shill, Nafisa Habib Purba, Akibul Islam Chowdhury, Mahmudur Rahman, Md Asaduzzaman Lashkar, Md Kamrul Hasan
Background: There are currently no reports showing the relationship between metabolic syndrome (MetS) and menopause among Bangladeshi women with cardiovascular disease (CVD). Aim: The present study aims to examine the prevalence of MetS and evaluate the impact of menopausal status on the MetS among women with CVD in Bangladesh. Materials and Methods: Data for the present analysis were collected from a cross-sectional study of 355 cardiovascular patients seeking care at five tertiary care hospitals in Bangladesh. A total of 146 women were included for this secondary analysis. The MetS was identified based on the definition of the Adult Treatment Panel (ATP) III of the National Cholesterol Education Program (NCEP). Results: About 45.83% pre-menopausal and 59.02% post-menopausal women were noticed to have MetS. The mean waist circumference, systolic, and diastolic blood pressure, total cholesterol, LDL cholesterol, triglyceride, and random plasma glucose levels were higher in post-menopausal women whereas HDL cholesterol value was higher in pre-menopausal women. The multivariate-adjusted odds ratio showed that post-menopausal status (Adjusted odds ratio [AOR]: 1.72; 95% confidence interval [CI]: 1.04-4.94) and obesity (AOR: 8.20; 95% CI: 1.15-58.77) were significantly associated with the presence of the MetS among women with CVD. Conclusion: The high prevalence of MetS among women with CVD is evident, particularly post-menopausal women. Hence, the present findings can alert women from the earlier stages of the menopausal transition to prevent the appearance of MetS.
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COVID vaccines: A step towards ending the pandemic Highly accessed article p. 23
Atul Kakar, Atul Gogia, Shrayhans Sipani, Shipra Gulati, Tanvi Batra, Kamal Jain, Siddhant Jain, Shikhar Tripathi
COVID-19 pandemic has been associated with increased morbidity, mortality and economic loss globally. In the absence of definitive treatment, the only way to develop herd immunity and to curtail the spread of infection is through an effective vaccination programme. Under normal circumstances, a vaccine development would have taken 8–12 years; however, in case of COVID vaccine, this process has been reduced to 10 months. Since the lockdown, multiple countries have used various platforms to develop COVID vaccines at a war footing and recently close to five vaccines that have been approved for emergency use. This has lead to confusion, controversy and debate among the medical fraternity about the safety and efficacy of these vaccines. This articles gives an overview of the vaccines present, various trial results and adverse effects seen till now.
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Understanding statistical association and correlation p. 31
Ramesh Lal Sapra, Satish Saluja
In medical research, the word ‘association’ and ‘correlation’ between two attributes/variables are frequently used and many times interchanged. Simplifying these concepts may help the researchers in applying the appropriate test. The article makes an attempt to simplify the concept of statistical association and correlation, especially for the clinical practitioners and researchers. The article discusses various measures of association and relationship for testing and assessing the strength. It also includes discussion on three popular measures of association used in medical research, namely odds ratio (OR), relative risk (RR) and hazard ratio which measure association of outcome between the two groups. Pearson Chi-square test is the most common test and has been extensively used for studying the association without bothering about its limitations or strength. Many times, researchers take it granted that the OR and RR are one and the same thing. Our calculations suggest us that with probabilities of outcome of 0.5 and 0.1, the OR is 9, whereas RR is 5. Tools for studying the statistical association and correlation should be used cautiously and appropriate tests to be used, particularly when assumptions are violated. While studying the association, its strength should be assessed using the appropriate statistics. OR and RR measure the association for assessing the risk. However, we should avoid equating OR with RR, particularly when the probabilities of outcome are not small.
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Clash of the two titans - COVID-19 and type 2 diabetes mellitus p. 39
Priya Kaushik, Mithlesh Kumari, Sanjiv Kumar Bansal, Naveen Kumar Singh, Rajni Dawar, Mukesh Sharma, Arpita Suri
COVID-19 has infected more than 32 million people globally in more than 100 countries. Diabetes mellitus (DM) has emerged as an important factor involved in the fatal outcomes of COVID-19. Accumulating evidence suggests that that reciprocal relationship may exist between these two raging pandemics, thus making COVID-19 more challenging for people with diabetes. Furthermore, poorly managed glycaemia in diabetes patients leads to increased risk of severe complications and higher mortality rate. The association between COVID-19 severity and DM can be supported by several pathophysiological mechanisms, such as compromised innate immune system, deranged cell-mediated immunity and adipose tissue infiltration of pro-inflammatory macrophages. Exaggerated coagulation and pro-thrombotic milieu in diabetes can predispose to thromboembolic complications associated with fatal outcomes in diabetic patients with COVID-19. Impaired pulmonary function and elevated levels of furin associated with diabetes can increase the chances of COVID-19 infection in patients with diabetes. In addition, SARS-CoV-2 infection can trigger stress hyperglycaemia leading to augmented viral replication and severity of infection associated with poor clinical outcomes in diabetic patients with COVID-19. Endothelial dysfunction associated with virus-induced endothelialitis can lead to organ ischaemia and life-threatening complications associated with COVID-19 with underlying DM. Vitamin D deficiency and insulin resistance worsened by SARS-CoV2 can lead to higher mortality and morbidity observed in diabetic patients with COVID-19. Therefore, COVID-19 patients should be adequately monitored for the development of new-onset diabetes, due to deranged glycaemic control, owing to underlying COVID-19 disease, and diabetic patients with COVID-19 should be kept under strict glycaemic control to avoid life-threatening complications.
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Rare case of a floppy neonate: Joubert syndrome p. 47
Kumar Ankur, Aparna Prasad, Sanjeev Chetry, Rajni Farmania, Sachin Jain
Joubert syndrome presenting during the neonatal period is very rare. We report a term neonate who presented with perinatal asphyxia followed by episodic tachypnoea interspersed with apnoea and seizures. On physical examination, baby was alert; however, on neurological evaluation, there was generalised hypotonia with panting of dog-like breathing. Magnetic resonance imaging of the brain finding revealed typical molar tooth sign suggestive of Joubert syndrome and fundus examination revealed retinal colobomas.
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A renal unit saving approach to IgG4 related periureteral mass mimicking malignant ureteral tumor p. 50
Ankit Tyagi, Vipin Tyagi, Neeraj Jain
Immunoglobulin G4-related disease (IgG4-RD) is a rare disease with few cases mimicking ureteral tumour identified after the ablative surgery. We report a case of IgG4-RD that presented as a ureteral mass which was diagnosed prior to surgery and managed conservatively. A 63-year-old man presented with prior diagnosis of the right ureteric tumour but a radiological review suspected it could be something else. The patient underwent laparoscopic biopsy from the periureteric mass. Biopsy reported to be IgG-4 disease and managed conservatively. This case highlights the rare possibility of IgG4-disease mimicking ureter tumour and if diagnosed prior to extirpative surgery can result in salvage of the kidney.
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Guidelines for writing research protocol p. 53
Satish Saluja, Manoj Modi
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Telemedicine: An evolving practice in India p. 62
Udit Kakar, Shikhar Tripathi, Atul Gogia, Atul Kakar
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Dr . T. D. Chugh: A tribute to an inspiring mentor p. 65
RL Ichhpujani
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A Glimpse into Dr. V. Shanta's life p. 67
Ranga Rao Rangaraju
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