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   Table of Contents - Current issue
Coverpage
January-February 2021
Volume 34 | Issue 1
Page Nos. 1-64

Online since Tuesday, August 10, 2021

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EDITORIAL  

Covid-19 Vaccines: Several technologies at work Highly accessed article p. 1
Amita Aggarwal, Rakesh Aggarwal
DOI:10.4103/0970-258X.323453  PMID:34396995
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ORIGINAL ARTICLES Top

Text messaging improves diabetes-related knowledge of patients in India: A quasi-experimental study p. 4
Saurav Basu, Suneela Garg, Nandini Sharma, M Meghachandra Singh, Sandeep Garg
DOI:10.4103/0970-258X.323446  PMID:34396996
Background. Diabetes-related health education promotes patient efficacy for diabetes self-management. However, sub-optimal knowledge of diabetes in people with diabetes is recognized as a challenge in overcrowded public health facilities in India. We aimed to determine the effect of health education through mobile phone text messages (short messaging service [SMS]) on diabetes-related knowledge of patients with diabetes. Methods. From February 2016 to February 2017, we recruited adult patients with diabetes for this quasi-experimental study done in the outpatient setting of a major tertiary care government hospital in Delhi, India. Participants in the intervention group received a text message on diabetes self-care practices every alternate day for 90 days. We evaluated the patients’ knowledge of diabetes using the Spoken Knowledge in Low Literacy in Diabetes (SKILL-D) questionnaire and a self-designed diabetes knowledge questionnaire. Results. We enrolled 190 men and 160 women, of whom 52 (13.7%) were lost to follow-up. At baseline, mean diabetes knowledge scores were higher in the intervention group compared to the control group. After the intervention period of 3 months, the diabetes knowledge scores for SKILL-D and the patient diabetes knowledge questionnaire showed a statistically significant increase in the intervention group (mean difference 0.7 and 0.5, respectively; p<0.001, but there was no increase in the control group). Conclusion. The use of mobile phone technology for diabetes-related health education through mobile text-message (SMS) technology is an effective method for health promotion.
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Mitigation of in-hospital risk of coronavirus disease 2019: Experience from a haematology–oncology and stem cell transplant setting Highly accessed article p. 10
Suvir Singh, Davinder Paul, Kunal Jain, Jagdeep Singh
DOI:10.4103/0970-258X.315901  PMID:34396997
Background. Coronavirus disease 2019 (Covid-19) was first described in December 2019 and has evolved into an ongoing global pandemic. Cancer patients on chemotherapy are immunocompromised and are at the highest risk of Covid-19-related complications. We describe our experience with the management of haematology–oncology and stem cell transplant (SCT) patients receiving curative chemotherapy in a hospital with a high influx of Covid-19 patients. Methods. We did a prospective observational study at a 99-bedded cancer centre of a tertiary care teaching hospital from April 2020 to September 2020. Preventive measures taken were categorized as follows: (i) staff: screening, mandatory use of personal protective equipment (PPE), risk stratification of potential exposure and testing and isolation as needed; (ii) patients: mandatory viral polymerase chain reaction testing, segregation of positive and untested patients and testing of family members; and (iii) environment: mandatory regular cleaning, visitor restriction, telemedicine services and reassignment of priority to clinic visits. Treatment of the underlying conditions was continued with added precautions. Results. A total of 54 patients were included in the analysis, including 48 with haematological malignancies and 6 for stem cell therapy. Preventive measures were universally applied, and chemotherapy with a curative intent was initiated as per protocol. Three patients were detected to have Covid-19 infection before admission and one after the institution of chemotherapy. Nine patients died after the first cycle of chemotherapy, 2 due to severe Covid-19-related illness and 7 due to complications of chemotherapy or disease progression. Conclusions. In the wake of the Covid-19 pandemic, treatment for haematological malignancies must continue while balancing the risk of Covid-19 infections. Our report emphasizes the effectiveness of measures such as hand hygiene, social isolation, patient segregation, use of masks and PPE and universal pre-treatment testing for Covid-19 in reducing the risk of infection in a high-risk clinical setting.
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Relationship between sedentary time and central obesity in adult Korean men: Korean National Health and Nutrition Examination Survey, 2014 p. 15
Jae-Min Park, Yong-Jae Lee, Duk-Chul Lee
DOI:10.4103/0970-258X.323443  PMID:34396998
Background. We aimed to examine the association between sedentary time and central obesity in a nationally representative sample of adult Korean men. Methods. We included 1269 participants from the Korean National Health and Nutrition Examination Survey. Central obesity was defined as having a waist circumference (WC) ≥90 cm. The ORs and 95% CIs for central obesity were calculated using multiple logistic regression analysis. Results. The mean values of WC tended to increase proportionally with increasing sedentary time quartiles. The prevalence of central obesity increased significantly in accordance with sedentary time quartiles. Compared to individuals in the lowest sedentary time quartile (≤4 hours for a day), the OR for central obesity for individuals in the highest quartile (≥11 hours for a day) was 1.81 after adjusting for confounding variables. Conclusion. We confirmed a relationship between sedentary time and the risk prevalence of central obesity in a representative sample of adult Korean men. A public health intervention to reduce sedentary time is needed to prevent central obesity.
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Exploring the value of mindfulness for Saudi Arabian women mental health nurses p. 19
Seham Mansour Alyousef, Sami Abdulrahman Alhamidi
DOI:10.4103/0970-258X.323449  PMID:34396999
Background. Nurses engaged in mental health-related practice experience stress and burnout. We assessed the role of the practice of mindfulness in coping with these aspects of providing care in mental health settings. Methods. Mindfulness as a coping method was explored using qualitative methods to illuminate its impact on practice from the perspective of mental health nursing graduate students at the College of Nursing, King Saud University, Riyadh, Saudi Arabia. Data were obtained by semi-structured interviews in focus groups of these nurses. Results. The themes that emerged were (i) positive techniques; (ii) recognized stress; (iii) managing stress; (iv) acceptance; (v) psychological reaction; and (vi) physical responses. Conclusions. The themes that emerged in this study confirm the stresses faced by nurses practising in mental healthcare and suggest improved coping methods.
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CLINICAL CASE REPORTS Top

Wiskott–Aldrich syndrome with possible congenital Cytomegalovirus infection: A diagnostic dilemma p. 24
Behnam Sobouti, Ahmad Bahrami, Farzaneh Rahmani, Saeed Talebi, Vida Sherafati, Maryam Vafapour, Nima Rezaei
DOI:10.4103/0970-258X.323441  PMID:34397000
Wiskott–Aldrich syndrome (WAS) is an X-linked recessive disorder, characterized by thrombocytopenia, eczema and recurrent infections. We report a 4-month-old boy who presented with respiratory distress, petechiae, organomegaly and eczema. He was admitted to the paediatric intensive care unit because of severe respiratory distress due to Cytomegalovirus (CMV) infection. As peripheral blood smear showed microthrombocytopenia, Sanger gene sequencing was performed, which confirmed the diagnosis of WAS. This rare combination of possible congenital CMV infection in the background of WAS, misled the initial diagnosis.
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A foreign body causing a spontaneous gastrojejunostomy in a young child p. 27
Jinyong Hao, Yanhu Feng, Xiaojun Huang
DOI:10.4103/0970-258X.323444  PMID:34397001
Foreign bodies in the digestive tract are a common cause of patients presenting to emergency departments. A 3-year-old boy who had accidentally swallowed magnetic beads while playing was admitted to the hospital. After failed endoscopic removal, he underwent laparoscopic removal. We found that the stomach and jejunum were tightly bound together by the magnetic beads, and this had caused perforations. The perforations had then connected to form a tract resulting in a spontaneous gastrojejunostomy. During the operation, four magnetic beads were removed from the stomach and eight from the jejunum.
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REVIEW ARTICLE Top

Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India p. 29
Anita Nath, Martina A.J. Shalini, Prashant Mathur
DOI:10.4103/0970-258X.323661  PMID:34397002
The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public–private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.
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SELECTED SUMMARIES Top

Population-based human papillomavirus testing: The new paradigm for cervical cancer screening p. 36
Anu N Joseph, Neerja Bhatla
DOI:10.4103/0970-258X.323447  PMID:34397003
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Interim positron emission tomography in limited-stage diffuse large B cell lymphoma: A modern will-o’-the-wisp? p. 37
Neha Pathak, Deepam Pushpam, Sameer Bakhshi
DOI:10.4103/0970-258X.323459  PMID:34397004
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MEDICAL EDUCATION Top

Establishing links between assessments and expected learning outcomes through curriculum mapping in a dental physiology curriculum p. 40
Asha Vashe, Vasudha Devi, K Raghavendra Rao, Reem Rachel Abraham
DOI:10.4103/0970-258X.323445  PMID:34397005
Background. The relevance of curriculum mapping to determine the links between expected learning outcomes and assessment is well stated in the literature. Nevertheless, studies confirming the usage of such maps are minimal. Methods. We assessed links through curriculum mapping, between assessments and expected learning outcomes of dental physiology curriculum of three batches of students (2012–14) at Melaka-Manipal Medical College (MMMC), Manipal. The questions asked under each assessment method were mapped to the respective expected learning outcomes, and students’ scores in different assessments in physiology were gathered. Students’ (n = 220) and teachers’ (n=15) perspectives were collected through focus group discussion sessions and questionnaire surveys. Results. More than 75% of students were successful (≥50% scores) in majority of the assessments. There was moderate (r=0.4–0.6) to strong positive correlation (r=0.7–0.9) between majority of the assessments. However, students’ scores in viva voce had a weak positive correlation with the practical examination score (r=0.230). The score in the assessments of problem-based learning had either weak (r=0.1–0.3) or no correlation with other assessment scores. Conclusions. Through curriculum mapping, we were able to establish links between assessments and expected learning outcomes. We observed that, in the assessment system followed at MMMC, all expected learning outcomes were not given equal weightage in the examinations. Moreover, there was no direct assessment of self-directed learning skills. Our study also showed that assessment has supported students in achieving the expected learning outcomes as evidenced by the qualitative and quantitative data.
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MEDICINE AND SOCIETY Top

What are the options to implement an undergraduate medical exit examination in India? p. 46
Siddharth Sarkar, Piyush Ranjan
DOI:10.4103/0970-258X.323450  PMID:34397006
Medical education and assessment processes in India are expected to undergo a paradigm shift with the introduction of the National Medical Commission Act, 2019. The Government of India intends to introduce a national exit test (NEXT) which is supposed to act as a single examination for graduation from medical school, granting licence to practice modern medicine, and allocating postgraduate residencies. As the nature, scope and stakes of these are different, various options regarding the content and conduct of the examination require careful consideration. We explore the options for implementation of this examination on a national scale. These options include theoretical (multiple assessment methods) with clinical examinations, multiple-choice question (MCQ)-based examination with separate clinical examination, only an MCQ-based examination, and multistep examination including screening followed by mixed assessment methods and clinical evaluation. We discuss the possible strengths and challenges of different options of implementing NEXT, and the caveats of the options.
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LETTER FROM MUMBAI Top

Letter from Mumbai p. 49
Sunil Pandya
DOI:10.4103/0970-258X.323460  PMID:34397007
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LETTER FROM GLASGOW Top

Letter from Glasgow p. 51
Harpreet S Kohli
DOI:10.4103/0970-258X.323442  PMID:34397008
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OBITUARIES Top

Mohit Singla p. 53
Jitender Sodhi
DOI:10.4103/0970-258X.323458  PMID:34397009
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V.S. Ajgaonkar p. 54
Madhuri D Patil
DOI:10.4103/0970-258X.323448  PMID:34397010
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IMAGES IN MEDICINE Top

Achalasia cardia presenting with tracheal compression p. 55
Saurabh Mittal, Karan Madan, Pawan Tiwari, Anant Mohan, Vijay Hadda
DOI:10.4103/0970-258X.323455  PMID:34397011
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Kernohan–Woltman phenomenon: A false localizing sign p. 56
Rohit Bhoil, Ajay Kumar Ahluwalia, Mukesh Surya, Sabina Bhoil
DOI:10.4103/0970-258X.323452  PMID:34397012
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CORRESPONDENCE Top

Simultaneous donning of goggles and face shield is an overkill and interferes with care of Covid-19 patients p. 57
Aditya Baksi, Srineil Vuthaluru
DOI:10.4103/0970-258X.323457  PMID:34397014
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Formative assessment during collection of attendance p. 57
Himel Mondal, Shaikat Mondal
DOI:10.4103/0970-258X.323456  PMID:34397013
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Lichen scrofulosorum and phlyctenular conjunctivitis p. 58
Siddharth Madan, Sarita Beri, Maansi Sethi, Taru Garg, Anita Nangia
DOI:10.4103/0970-258X.323451  PMID:34397015
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Improving quality and satisfaction in care of Covid-19: A patient-centric approach p. 59
Dalim Kumar Baidya, Souvik Maitra
DOI:10.4103/0970-258X.323454  PMID:34397016
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NEWS FROM HERE AND THERE Top

News from here and there p. 61

DOI:10.4103/0970-258X.323461  
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ACKNOWLEDGEMENTS Top

Acknowledgements p. 63
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