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   2019| November-December  | Volume 32 | Issue 6  
    Online since December 15, 2020

 
 
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EDITORIAL
Providing Dialysis in India: Many pieces in the puzzle
Vivekanand Jha
November-December 2019, 32(6):321-324
DOI:10.4103/0970-258X.279969  PMID:33380623
  2,346 291 2
ORIGINAL ARTICLES
Prevalence of blindness in India: A systematic review and meta-analysis
Sumit Malhotra, Manya Prasad, Praveen Vashist, Mani Kalaivani, Sanjeev Kumar Gupta
November-December 2019, 32(6):325-333
DOI:10.4103/0970-258X.303612  PMID:33380624
Background. The National Programme for Control of Blindness and Visual Impairment modified the definition of blindness in 2017 in line with the internationally accepted definition. We did a systematic review and meta-analysis to compute pooled estimate of blindness in India among adults aged 50 years and above by using recent and old definitions of blindness. Methods. We retrieved population-based studies/surveys reporting the prevalence of blindness using recent (presenting vision <3/60 better eye) and previous (presenting vision <6/ 60 better eye) definitions in India during 1990–2017 from key search engines and grey literature. Two authors did an independent literature search and extracted relevant information. Pooled prevalence estimates were computed using Stata 12.0 by using the random effects model. Forest and funnel plots were generated. Stratification of results was also performed using two time periods: 1995–2005 and 2006–17. Results. A total of 18 published articles/reports were included for recent and 20 for previous definitions of blindness, involving 211 502 participants. The pooled prevalence (95% confidence interval [CI]) obtained for recent and previous definitions of blindness in India was found to be 6.11% (5.07%–7.14%) and 9.91% (8.57%–11.25%), respectively. The stratified pooled prevalence (95% CI) from rapid surveys was 4.81% (3.26%–6.35%) and 4.68% (2.91%–6.46%) for studies published during 1995–2005 and 2006–17, respectively, using the new definition. The corresponding figures for comprehensive surveys were 9.22% (95% CI 6.48%–11.96%) for the period 1995–2005 and 3.81% (95% CI 2.76%–4.84%) for the period 2006–17. Conclusion. There is a decrease in the prevalence of blindness in India using recent and previous definitions and a declining trend over time. High quantum of blindness remains an unfinished public health agenda for implementing programmes in larger populations to reduce its burden.
  1,965 253 -
CLINICAL CASE REPORTS
Cogan syndrome: An autoimmune eye and ear disease with systemic manifestations
Gurbir Singh Bhandari, Lalit Duggal, Neeraj Jain, Jeet Patel
November-December 2019, 32(6):349-351
DOI:10.4103/0970-258X.303611  PMID:33380629
Cogan syndrome (CS) is a rare vasculitis seen primarily in young adults. It predominantly affects eyes, ears and the heart with characteristic findings of interstitial keratitis, sensorineural hearing loss and vestibular dysfunction. A high index of suspicion is required to diagnose this rare disorder. It is one of the few vasculitis which can involve vessels of all sizes: small, medium and large. Coexistence of inflammatory bowel disease (IBD) in Cogan syndrome has been described in the literature. Immunosuppressive agents such as corticosteroids with or without steroid sparing agents are the standard of care. Early diagnosis and treatment are the cornerstone of treatment to prevent permanent damage to the ears and eyes. We describe a patient with Cogan syndrome with large vessel vasculitis and IBD. Our patient was treated with glucocorticoids and methotrexate.
  1,086 209 -
ORIGINAL ARTICLES
Optimal anthropometric measures to predict incidence of coronary heart disease in adults in Turkey
Günay Can, Altan Onat, Ugurcan Sayili, Mert I Hayiroglu, Evin Ademoglu, Eray Yurtseven
November-December 2019, 32(6):334-341
DOI:10.4103/0970-258X.303619  PMID:33380625
Background. We aimed to identify the most suited anthropometric measure for the prediction of risk for incident coronary heart disease (CHD) among the Turkish population. Methods. We collected data on body mass index, waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and a body shape index. We analysed these using both C-statistics and Cox regression models adjusted for age, systolic blood pressure, glucose and high-density lipoprotein (HDL)-cholesterol for assessing risk of incident CHD among 3203 Turkish Adult Risk Factor (TARF) study participants (mean [SD] age 48.5 [11] years). Results. Over a mean follow-up of 9.93 years, new CHD developed in 573 individuals. Multi-adjusted C-statistics were highest for WHtR followed by WC, in both sexes. Except WHR, all measures were significantly associated with incident CHD in combined sexes in the full model. There was a sex difference, however, in the mediation of the three risk factors for adiposity; these attenuated hazard ratios (HRs) in males, whereas in females, significant prediction of incident CHD persisted for each measure. WC (HR 1.36 [95% CI 1.13; 1.64]), followed by WHtR (HR 1.24 [95% CI 1.10; 1.40]), were in combined sex, as in females, the most informative surrogates of adiposity. Hip circumference did not protect, but rather conferred modest CHD risk, especially in females, rendering a low utility of predictive value for WHR. The CHD risk curve did not have a J shape. Conclusions. WC is the most suitable of five adiposity surrogates for CHD risk among Turkish adults, while in males, unmediated adiposity risk was similarly identified by WHtR. Retention of the large part of CHD risk in females perhaps reflects the underlying autoimmune activation.
  1,015 204 -
MEDICAL EDUCATION
Perception of pathology as a career among undergraduate medical students
Anuradha Ananthamurthy, Bhavapriya Mani
November-December 2019, 32(6):369-372
DOI:10.4103/0970-258X.303617  PMID:33380636
Background. The choice of a postgraduate specialization in medicine is influenced by many factors. What motivates students to take up pathology as a career option or to reject the same remains unexplored. This study aimed to understand the perceptions of medical students from a college in southern India regarding the role played by pathologists in clinical practice and how this influenced their choice of pathology as a career. Methods. This qualitative study conducted personal interviews with 15 participants (13 undergraduates and 2 postgraduates in pathology) using a semi-structured interview guide. The data were transcribed and thematically analysed. Results. Although most of the participants acknowledged that pathologists play an important role in diagnosis, they were of the view that pathologists have minimal patient contact and do not play the main role in treating patients. They were also of the opinion that the undergraduate course and curriculum in pathology was inadequate in exposing them to the actual practice of pathology. Lower social status and earning potential were also stated as deciding factors in choosing a career in pathology. Pathology residents cited stress-free lifestyle as a motivating factor in choosing pathology as a career. Conclusions. A career in pathology can be rewarding and intellectually stimulating. The fact that a pathologist plays an important role in diagnosis and also patient management must be emphasized in the undergraduate medical curriculum. The medical student will then be able to take an informed decision about his or her career.
  1,004 131 1
SHORT REPORTS
Sexual assault and associated factors among the cases reported in a tertiary care hospital of Delhi
Akanksha Rathi, Sunil Naagar, Vikas Kumar, Panna Lal, Shelesh Kumar Goel
November-December 2019, 32(6):344-346
DOI:10.4103/0970-258X.303620  PMID:33380627
Background. Sexual assault is said to be an under-reported and under-researched crime worldwide. The high number of cases of sexual assault reported in India is the tip of the iceberg. We did this study to understand various factors associated with this crime. Methods. We did a retrospective analysis of 312 forensic examination reports of alleged sexual offenders, available from a tertiary care hospital of Delhi from January 2014 to December 2016. Results. Of the 312 victims of sexual assault, 62.9% were adults and 37.1% minors. The time of assault was mentioned in only 73 cases. Among these, about two-thirds of cases (60.3%) occurred during daytime. Among the 213 cases where the reporting time of the crime was mentioned, only 35.7% of cases were reported within 24 hours of the crime. Around 92% offenders were known to the victims. Conclusion. More than one-third of sexual assaults were against minors and in a majority of instances the alleged offenders were known to the victims. A major delay in reporting the crime was observed when the victim was known to the perpetrator.
  1,013 122 -
MEDICAL EDUCATION
History of medicine in undergraduate medical curriculum in India
Aftab Ahmad, Shashi Kant, Sanjeev Kumar Gupta
November-December 2019, 32(6):360-364
DOI:10.4103/0970-258X.303628  PMID:33380634
History of medicine is rich with the achievements and successes of years of research and development. The Medical Council of India incorporated teaching ‘History of Medicine’ in the undergraduate medical curriculum in India nearly a decade ago. Despite being included in the medical curriculum by the Medical Council of India, it is not yet a part of the teaching curriculum in the top-ranking medical institutions. Teaching ‘History of Medicine’ to undergraduate medical students may be a good divergence from the fact-based teaching of undergraduate medical curriculum. It will also help students cherish medical achievements of the past and inculcate in them a sense of pride and belongingness to the medical fraternity.
  858 121 -
SHORT REPORTS
Tumour bleeding: Efficacy and outcome of haemostatic radiotherapy
Pawan Kumar, Kartick Rastogi, Rohitashwa Dana, Amrita Rakesh, Subhash Chand Bairwa, Sandeep Bhaskar
November-December 2019, 32(6):342-344
DOI:10.4103/0970-258X.303621  PMID:33380626
Background. Management of tumour bleeding remains a challenge in oncology. With a number of methods available, radiotherapy still holds a crucial place. There are no standard guidelines for dose fractionation of haemostatic radiotherapy (HRT), and it varies from case to case. We aimed to study the effectiveness of HRT. Methods. We retrospectively analysed the effectiveness of HRT in 70 patients in terms of control of bleeding and overall survival, who presented to us with advanced cancers from July 2014 to June 2017. Results. The median age was 48 (range 23–76) years, and male to female ratio was 2.18:1. The most common malignancy encountered was lung and gynaecological (both 17.1%). Stage IV was the most common stage (48.6%) of the primary tumour. The site of bleeding was the primary tumour in 50 (71.4%) patients, whereas fungating regional nodes were the cause in the remaining. The median duration between initial diagnosis and HRT was 5 (range 0–19) months. Seventeen patients (24.3%) had a history of prior radiotherapy. Fifty-one patients (72.8%) required at least 1 unit of blood transfusion. Hypofractionated HRT schedules were used in all patients with the most common being 30 Gy in 10 daily fractions for 5 days a week (18, 25.7%). At the end of HRT, bleeding was effectively controlled in 53 patients (75.7%). The median survival was 13 (range 1–26) months. The 1- and 2-year survival rates were 55.7% and 4.3%, respectively. Conclusions. HRT is safe and effective in achieving haemostasis in advanced tumours presenting with bleeding from either the primary or the regional lymph nodes. Although optimal dose fractionation has not yet established, hypofractionated radiotherapy is preferred, with the total dose depending on several factors. However, the overall prognosis remains poor.
  843 126 -
CLINICAL CASE REPORTS
A case of refractory chronic lymphocytic leukaemia with an unusual course
Elif G Umit, Mehmet Baysal, Ali Caner Ozdöver, Onur Kirkizlar, Ahmet Muzaffer Demir
November-December 2019, 32(6):347-349
DOI:10.4103/0970-258X.303614  PMID:33380628
Chronic lymphocytic leukaemia (CLL) is a heterogeneous disease with uncertain course. Treatment should be tailored to the patient's disease as well as the prognostic subgroup. With the increased use of rituximab as well as other selective and non-selective immunomodulatory agents, the incidence of infectious complications and second malignancies has also increased. Progressive multifocal leucoencephalopathy (PML) is a complication of rituximab in HIV-negative patients. A 56-year-old male with CLL had been treated and relapsed four times in 6 years. Rituximab was added to the combination after the second relapse and repeated in the third relapse in combination with bendamustine. In the seventh year of diagnosis, relapse of CLL and an ulcerated tumorous lesion was observed in the left index finger, which progressed in 3 months and was later diagnosed as angiosarcoma. The cancer was treated with local radiotherapy and combination chemotherapy. One year after the last rituximab exposure, progressive muscle weakness developed and polyoma JC virus DNA was observed with increased titres in the cerebrospinal fluid, and the patient was diagnosed as having PML. The patient died 2 months later. Our patient had an unusual course of CLL over 8 years, with relapses, complicated with a secondary malignancy and an infectious complication.
  776 161 -
SPEAKING FOR OURSELVES
Electronic health and medical records for comprehensive primary healthcare in India
Nisha Mohan, Hemant Deepak Shewade, DM Shilpa, Samantha C Lobbo, Anupama G Patil, Vivek Gupta, Biju Soman, Arun K Aggarwal
November-December 2019, 32(6):373-374
DOI:10.4103/0970-258X.303610  PMID:33380637
  787 132 -
Do No Harm: The Hippocratic Oath
Sunny Singhal
November-December 2019, 32(6):375-375
DOI:10.4103/0970-258X.303624  PMID:33380638
  773 129 -
NEWS FROM HERE AND THERE
News from here and there

November-December 2019, 32(6):383-384
DOI:10.4103/0970-258X.287426  
  750 94 -
MEDICAL EDUCATION
Competency-based learning and training for medical postgraduates within regulatory guidelines in India: The SBV Competency-Based Learning and Training Model©
N Ananthakrishnan, KR Sethuraman, M Ravishankar, P Karthikeyan, P Jaganmohan
November-December 2019, 32(6):365-368
DOI:10.4103/0970-258X.303629  PMID:33380635
Postgraduate medical education in India is beset with many problems including lack of a uniform national syllabus, nonexistence of an accepted list of competencies across disciplines, lack of uniformity in teaching/learning methods between different institutions, a poor evaluation system which focuses on a day's performance rather than the whole course and lack of attention to attitude and professionalism both in the training and evaluation processes. Since there is no national-level quality control of the outgoing postgraduates, there is no uniformity either in knowledge or skill level among them. Regulatory control over the whole process inhibits institutions from making any changes. Furthermore, the summative examination process is entirely under regulatory guidelines, with little or no option to universities and institutions to change the same. In this scenario, Sri Balaji Vidyapeeth, Puducherry, introduced and implemented a competency-based training programme for medical postgraduates, which is now in the 4th year. This model is suitable for the Indian milieu as it can be implemented within the regulatory guidelines. The model has been described with details of the processes involved in preparation, implementation, monitoring and overcoming possible hurdles and pitfalls in the Indian context.
  672 101 1
CLINICAL CASE REPORTS
Intensive insulin therapy and plasma exchange in hypertriglyceridaemic acute pancreatitis with multiple organ dysfunction
Kiran Kumar Gudivada, Bhuvana Krishna
November-December 2019, 32(6):352-354
DOI:10.4103/0970-258X.303631  PMID:33380630
Acute pancreatitis (AP) is a common emergency in gastroenterology. After gallstone disease and alcoholism, hypertriglyceridaemia (HTG) is the next common cause for AP. The role of intensive insulin therapy (IIT) and plasma exchange (PE) in hypertriglyceridaemic acute pancreatitis (HTG-AP) is still debatable. We report a 56-year-old farmer with HTG-AP who presented with a recurrence of AP. On admission, his plasma triglycerides were 4773 mg/dl with a wide range of laboratory abnormalities. Over the course of his illness, he developed multiple organ failure. He received early IIT initially, and PE once haemodynamic stability was achieved. This approach improved the functioning of the organs. In haemodynamically unstable patients with HTG-AP, we suggest early initiation of IIT, followed by adjuvant PE after the resolution of shock, to ameliorate organ dysfunction and improve overall outcome.
  681 87 1
SELECTED SUMMARIES
Repeated versus single blood pressure measurement
Sanjana Bhaskar, Nitish Naik
November-December 2019, 32(6):357-358
DOI:10.4103/0970-258X.303613  PMID:33380632
  653 103 -
CORRESPONDENCE
Primary varicella zoster virus infection-related hemiparesis and fatal neurological complications in an immunocompetent girl
Avinash R Deoshatwar, Sthita Pragnya Behera, Niraj Kumar, Brij Ranjan Misra, Hirawati Deval, Vijay P Bondre, Mahima Mittal
November-December 2019, 32(6):381-382
DOI:10.4103/0970-258X.303630  PMID:33380643
  599 104 -
SELECTED SUMMARIES
Beta-blockers in cirrhosis: Do they have benefits beyond the prevention of variceal bleeding?
Senthamizh Selvan, Rakesh Aggarwal
November-December 2019, 32(6):355-356
DOI:10.4103/0970-258X.303615  PMID:33380631
  596 85 -
IMAGES IN MEDICINE
Casal's necklace
Sweta Subhadarshani, Pooja Sharma, Neena Khanna
November-December 2019, 32(6):378-378
DOI:10.4103/0970-258X.303626  PMID:33380641
  586 78 -
SPEAKING FOR OURSELVES
Reflections of an Intern: Clinical patient encounters
Vidya Sankar Viswanathan
November-December 2019, 32(6):376-376
DOI:10.4103/0970-258X.303616  PMID:33380639
  568 84 -
SELECTED SUMMARIES
Comparison between two surveillance methods, or feasibility of implementing the chosen surveillance method? Implications for study design and reporting
Vignesh Loganathan, Partha Haldar
November-December 2019, 32(6):358-359
DOI:10.4103/0970-258X.303625  PMID:33380633
  510 100 -
CORRESPONDENCE
Grey
BC Rao
November-December 2019, 32(6):382-382
DOI:10.4103/0970-258X.303618  PMID:33380644
  525 72 -
LETTER FROM CHENNAI
Letter from Chennai
MK Mani
November-December 2019, 32(6):379-380
DOI:10.4103/0970-258X.303622  PMID:33380642
  476 78 -
IMAGES IN MEDICINE
Secondary optic atrophy in a patient with miliary neurocysticercosis
Shreya Nayak, Pradeep Sharma, Nripen Gaur, Brijesh Takkar
November-December 2019, 32(6):377-377
DOI:10.4103/0970-258X.303627  PMID:33380640
  483 55 1