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   2018| September-October  | Volume 31 | Issue 5  
    Online since June 24, 2019

 
 
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REVIEW ARTICLE
Eye donation and eye banking in India
Noopur Gupta, Praveen Vashist, Anita Ganger, Radhika Tandon, Sanjeev K Gupta
September-October 2018, 31(5):283-286
DOI:10.4103/0970-258X.261189  PMID:31267994
Corneal blindness is a priority condition under the National Programme for Control of Blindness and an important cause of avoidable blindness in India. A multipronged approach is needed to eliminate corneal blindness. Curable or treatable blindness requires a spectrum of care including medication, optical rehabilitation and corneal transplantation. Corneal transplantation is dependent on the availability of safe, donor eyes; however, there is scarcity of donor corneal tissues in India. To improve the eye banking system, the Government of India supports eye banks through recurring grants for operational costs and non-recurring grants for infrastructure costs. Strategic interventions by the government and non-governmental organizations include awareness by health promotion and education, community participation, sustainable source of donor cornea, quality medical standards, accreditation and endeavours to strengthen eye banking systems and procedures through training and research. A model eye banking system in India can be achieved only when it is linked with the targeted infrastructure proposed under ‘Vision 2020: Right to Sight- India’. Considering these targets, there is a requirement of at least 20 eye bank training centres, 200 eye banks with corneal transplant facility (collection of nearly 500 corneas per year) and 2000 eye donation centres in the country. This would become a reality if the Hospital Cornea Retrieval Programme is strengthened at all private and government hospitals, uniform medical standards are made mandatory for all eye banks and eye donation centres and the process of registration and eye donation is simplified to enhance community participation.
  9,735 889 9
MEDICINE AND SOCIETY
Western toilets, Indian society and public health
Anup Agarwal, Yogesh Jain
September-October 2018, 31(5):301-303
DOI:10.4103/0970-258X.261178  PMID:31268000
  2,614 348 1
ORIGINAL ARTICLES
Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi
Shaheer A Ahmed, Arvind Kumar, Prayas Sethi, Arti Kapil, RM Pandey, Naveet Wig
September-October 2018, 31(5):262-267
DOI:10.4103/0970-258X.261176  PMID:31267989
Background. We aimed to assess the impact of antibiotic optimization education along with understanding the antibiogram on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance and cost of antibiotics in a tertiary care hospital in New Delhi. Methods. We divided the study into 3 phases—before and after intervention and a phase of education in between. We collected data on demographics, indication for antibiotic prescription, appropriateness or reasons for inappropriate antibiotic uses, antibiotic consumption (i.e. the rate and duration of antibiotic use), bacterial resistance and antibiotic cost. Interventions included education, introduction of an antibiogram and use of antibiotic prescription forms. Similar data were collected for the post-interventional phase. The study was conducted at the Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Results. There was an improvement in the number of patients who underwent de-escalation of antibiotics, 21/100 v. 36/100 (p = 0.019); appropriate antibiotic usage, 25/ 100 v. 46/100 (p = 0.002); switching from intravenous to oral promptly, 16/52 v. 1 9/36 (p = 0.003) and decrease in expenditure, ₹24 207.5 v. ₹16 51 7.5 per patient (p = 0.001 ); in the post-interventional phase. Significant reductions in the incidence of infections due to Acinetobacter (60% v. 31%; p<0.001) and improvement in sensitivity pattern with cephalosporin sulbactam (80% v. 100%; p<0.001) were seen. Multivariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) score, hospital stay <10 days, ventilator-associated pneumonia and methicillin-resistant Staphylococcus aureus coverage were independent predictors of mortality with odds ratio of 1.14, 0.1, 9.7 and 1.14, respectively. Conclusion. Education and an antibiotic control programme constituted an effective and cost-saving strategy to optimise antibiotic use at a tertiary care centre.
  2,185 601 1
IMAGES IN MEDICINE
Total penile necrosis as a manifestation of catastrophic antiphospholipid syndrome
Najib Kachouh, Cecile Philandrianos, Baptiste Bertrand, Dominique Casanova
September-October 2018, 31(5):309-309
DOI:10.4103/0970-258X.261175  PMID:31268004
  2,353 331 -
SHORT REPORT
Evaluation of sexual function and micro- testicular sperm extraction in men with mosaic Turner syndrome
Ahmet Salvarci, Aysegul Zamani
September-October 2018, 31(5):274-278
DOI:10.4103/0970-258X.261196  PMID:31267991
Background. Men with mosaic Turner syndrome (TS) having karyotype 45,X/46,XY are infrequently seen. Their sexual function and fertility potential are not well documented. We describe the sexual function and outcomes of sperm extraction in 5 such men who were evaluated between 2008 and 2017. Methods. Five phenotypic men diagnosed to have mosaic TS underwent detailed physical examination, semen analysis and evaluation of follicle-stimulating hormone, luteinizing hormone, prolactin and total testosterone. Blood, testis, oral mucosa and skin fluorescence in situ hybridization (FISH) analyses were done for evaluating the karyotype. Genomic DNA was extracted from peripheral blood for molecular analysis of azoospermic factor (AzF) deletions. Sexual function was assessed using the International Index of Erectile Function-5 (IIEF-5). One patient also underwent micro-testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI). Results. All 5 men had a mosaic 45,X/46,XY genotype and the sex-determining region (SRY) was positive in DYZ1- negative cells. None had a deletion in the AzF a, b or c regions. Sperm was detected in 3 patients through micro-TESE but ICSI could be done in only 1 patient. No embryo development was identified in time lapse (Embryoscope©) follow-up. It was observed that the rate of 46,XY was particularly high in gonadal tissues in the mosaic structure in patients detected to have sperms. Conclusion. Patients with TS having 45,X/46,XY, SRY( + ), with no AzF deletions, and a high percentage of 46,XY in the peripheral blood, especially in gonadal tissues, could have a healthy sexual life and possibly father a child through in vitro fertilization or ICSI upon detection of sperms with micro-TESE.
  1,853 426 -
ORIGINAL ARTICLES
Prevalence of disability and its association with sociodemographic factors and quality of life in a rural adult population of northern India
S Ramadass, Sanjay K Rai, Sanjeev Kumar Gupta, Shashi Kant, Sanjay Wadhwa, Mamta Sood, V Sreenivas
September-October 2018, 31(5):268-273
DOI:10.4103/0970-258X.261179  PMID:31267990
Background. Globally, around 1 billion persons are disabled as per the WHO report on disability in 2011. The bio-psycho-social model of disability was developed by the WHO as the International Classification of Functioning, Disability and Health. We studied the prevalence of disability and its association with sociodemographic factors and quality of life among adults in a rural area. Methods. We did a community-based, cross-sectional study among 418 randomly selected adult participants aged 18 years and above in a rural area of Ballabgarh, Haryana. Participants were interviewed by administering WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) for assessing disability and WHO Quality of Life-BREF (WHOQOL-BREF) scale for assessing quality of life. Multivariate analyses were done for the predictors of disability. Correlation was applied to find the association between disability and quality of life. Results. The prevalence of disability was 7.7% (95% confidence interval [CI]: 5.3%–10.6%) based on the cut-off > 40 summary score. More women (10.9%) than men (4.1 %) were disabled (p = 0.009). Being ≥60 years of age was independently associated with disability (adjusted odds ratio 12.3; 95% CI 4.45–33.97). The mean (SD) of the WHOQOL-BREF health-related quality of life (HRQOL) summary score was 67.6 (11.6) and the median was 66.43. HRQOL summary scores decreased as age increased. There was a negative correlation between summary scores of WHODAS 2.0 and WHOQOL-BREF (r –0.57, p<0.001). Conclusion. Prevalence of disability was higher than the estimate given by Census 2011. The elderly and women experience more disability. As age increases, quality of life decreases. Increase in the level of disability decreases the quality of life.
  1,716 459 2
CLINICAL CASE REPORTS
Tacrolimus-associated mania with psychotic symptoms in a child after renal transplant
Prashant Gupta, Jawahar Singh, Ananya Mahapatra, Pratap Sharan
September-October 2018, 31(5):281-282
DOI:10.4103/0970-258X.261183  PMID:31267993
Tacrolimus is one of the mainstays for post-transplant immunosuppression. A variety of neuropsychiatric adverse effects have been reported above the levels of its therapeutic use. Manic symptoms associated with its use have been rarely reported. We report possibly the first such case in a child post-renal transplantation and discuss the potential neuro-immunological basis of these symptoms.
  1,568 420 3
Orbital tuberculosis with involvement of the eyelid: An unusual presentation
Ajay K Verma, Anubhuti Singh, Kislay Kishore, Manoj Kumar Pandey, Surya Kant
September-October 2018, 31(5):279-280
DOI:10.4103/0970-258X.261198  PMID:31267992
Although cases of ocular tuberculosis (TB) are increasing, involvement of the eyelid and orbit are unusual. These cases occur secondary to the presence of TB elsewhere in the body, usually pulmonary TB. The primary infection of orbit or eyelid is a rare occurrence. We report a 4-year-old child with primary orbital TB and involvement of the eyelid. The diagnosis of TB should not be missed in patients with ocular symptoms (especially in India) as it is a treatable condition and delays in diagnosis or incorrect diagnosis can lead to serious sequelae.
  1,600 287 2
MEDICAL EDUCATION
Early clinical exposure through a vertical integration programme in physiology
D Savitha, Arpana Iyengar, H Devarbhavi, T Mathew, Kuttappa , S Rao, T Thomas, Anura V Kurpad
September-October 2018, 31(5):296-300
DOI:10.4103/0970-258X.261191  PMID:31267999
Background. Early clinical exposure is likely to be beneficial during the preclinical year. This pilot programme aimed to define a learning framework of introducing first year medical students to early clinical exposure through a vertical integration programme in the physiology course. The intent was to enhance the understanding of theoretical concepts and practical applications of physiology. Student and faculty perceptions were evaluated. Methods. First year MBBS students (n = 60) had bedside clinics conducted by 5 clinical departments, where the clinical context and applied physiological concepts were emphasized. Clinical sessions were synchronized with pedagogic highlights on related physiological concepts. The student’s perceptions were recorded through a semi-structured questionnaire, while qualitative feedback was obtained from the faculty. Results. All students ( 100%) reported that the programme was relevant and did not interfere with their physiology course. Most (91%) appreciated the synchronization of classroom knowledge with clinical exposures, and thought that integrated teaching helped in better understanding of practical applications of physiology (94%) with adequate discussions during the sessions (91 %). Fifty-nine (98%) students preferred integrated teaching over the isolated traditional classroom teaching. The clinicians involved also felt that the early clinical exposure was relevant. The students achieved a mean (SD) score of 13 (2.98) of 25 in the quiz consisting of multiple-choice questions that attempted to test their learning through early clinical exposures. Conclusion. This pilot exercise showed the utility of early clinical exposure integrated into the physiology course. It will be worthwhile to replicate this exercise at other institutions and among a larger student strength.
  1,448 436 1
MEDICINE AND SOCIETY
Medical Journals: Active or passive change agents?
K Srinath Reddy
September-October 2018, 31(5):304-305
DOI:10.4103/0970-258X.253350  PMID:31268001
  1,416 330 -
IMAGES IN MEDICINE
Tongue tremor: An unusual presentation of Parkinson disease
Deepak Kumar, Gopal Krishana Bohra, Madhulata Agarwal
September-October 2018, 31(5):308-308
DOI:10.4103/0970-258X.261182  PMID:31268003
  1,352 334 -
SELECTED SUMMARIES
Midostaurin in acute myeloid leukaemia with a FLT3 mutation: Testing the waters
Aparna Sharma, Sameer Bakhshi
September-October 2018, 31(5):288-290
DOI:10.4103/0970-258X.261188  PMID:31267996
  1,163 398 -
EDITORIAL
Solutions for India’s Leading Health Challenge: Adopting recommendations from the Disease Control Priorities Network
Shuchi Anand, Dorairaj Prabhakara
September-October 2018, 31(5):257-261
DOI:10.4103/0970-258X.261177  PMID:31267988
  1,150 371 1
MEDICAL EDUCATION
Performance of medical students in final professional examination: Can in-course continuous assessments predict students at risk?
K Nagandla, E Das Gupta, T Motilal, CL Teng, S Gangadaran
September-October 2018, 31(5):293-295
DOI:10.4103/0970-258X.261197  PMID:31267998
Background. Assessment drives students’ learning. It measures the level of students’ understanding. We aimed to determine whether performance in continuous assessment can predict failure in the final professional examination results. Methods. We retrieved the in-course continuous assessment (ICA) and final professional examination results of 3 cohorts of medical students (n = 245) from the examination unit of the International Medical University, Seremban, Malaysia. The ICA was 3 sets of composite marks derived from course works, which includes summative theory paper with short answer questions and 1 of the best answers. The clinical examination includes end-of-posting practical examination. These examinations are conducted every 6 months in semesters 6, 7 and 8; they are graded as pass/fail for each student. The final professional examination including modified essay questions (MEQs), 1 8-question objective structured practical examination (OSPE) and a 16-station objective structured clinical examination (OSCE), were graded as pass/fail. Failure in the continuous assessment that can predict failure in each component of the final professional examination was tested using chi-square test and presented as odds ratio (OR) with 95% confidence interval (CI). Results. Failure in ICA in semesters 6-8 strongly predicts failure in MEQs, OSPE and OSCE of the final professional examination with OR of 3.8-14.3 (all analyses p< 0.001) and OR of 2.4-6.9 (p<0.05). However, the correlation was stronger with MEQs and OSPE compared to OSCE. Conclusion. ICA with theory and clinical examination had a direct relationship with students’ performance in the final examination and is a useful assessment tool.
  918 352 -
IMAGES IN MEDICINE
Prominent CV wave in severe tricuspid regurgitation
Krishna Kumar Mohanan Nair, Sanjay Ganapathi, Arun Gopalakrishnan, Ajitkumar Valaparambil
September-October 2018, 31(5):310-310
DOI:10.4103/0970-258X.261181  PMID:31268005
  1,103 118 -
SELECTED SUMMARIES
Severe acute respiratory distress syndrome: Does ECMO have a role?
Sandeep Chauhan
September-October 2018, 31(5):287-288
DOI:10.4103/0970-258X.261184  PMID:31267995
  918 158 -
SPEAKING FOR MYSELF
Compulsory training in ophthalmoscopy as part of undergraduate general medicine training: Need of the hour
Pradeep Venkatesh
September-October 2018, 31(5):306-307
DOI:10.4103/0970-258X.261174  PMID:31268002
  674 357 1
CORRESPONDENCE
Removing highly hazardous pesticides from Indian agriculture will reduce suicides
Leah Utyasheva, Michael Eddleston
September-October 2018, 31(5):317-318
DOI:10.4103/0970-258X.261186  PMID:31268008
  841 142 -
SELECTED SUMMARIES
Need-based approach for cost-effective tuberculosis control in India
S Ramadass, Sanjeev Kumar Gupta
September-October 2018, 31(5):290-292
DOI:10.4103/0970-258X.261173  PMID:31267997
  761 169 -
CORRESPONDENCE
Upward trend of caesarean sections in India: Incision over precision
Nonita Dhirar, Rajesh Kumar, Sankalp Dudeja
September-October 2018, 31(5):316-317
DOI:10.4103/0970-258X.261190  PMID:31268007
  763 152 -
On proxy guidance and ghost supervisors of dissertations
Santosh K Chaturvedi
September-October 2018, 31(5):318-318
DOI:10.4103/0970-258X.261195  PMID:31268009
  711 131 -
BOOK REVIEWS
Practical Algorithms in Paediatric Endocrinology
Suchit Gupta, Vijayalakshmi Bhatia
September-October 2018, 31(5):314-315
DOI:10.4103/0970-258X.261193  
  607 95 -
Bench to Bedside: An anthology of medical student narratives
Sunil K Pandya
September-October 2018, 31(5):313-313
DOI:10.4103/0970-258X.261180  
  615 74 -
LETTER FROM MUMBAI
Letter from Mumbai
Sunil K Pandya
September-October 2018, 31(5):311-312
DOI:10.4103/0970-258X.261192  PMID:31268006
  566 104 -
NEWS FROM HERE AND THERE
News from here and there

September-October 2018, 31(5):319-320
DOI:10.4103/0970-258X.261194  
  493 81 -
BOOK REVIEWS
Bipolar
Philip Abraham
September-October 2018, 31(5):313-314
DOI:10.4103/0970-258X.261185  
  476 74 -
The Senior Citizens’ Handbook
T Sudhakar Bhat
September-October 2018, 31(5):315-315
DOI:10.4103/0970-258X.261187  
  395 67 -