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   2020| May-June  | Volume 33 | Issue 3  
    Online since April 17, 2021

 
 
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HISTORY OF MEDICINE
The origin and evolution of the first modern hospital in India
J.M.V. Amarjothi, Jeyasudhahar Jesudasan, Villalan Ramasamy, Livin Jose
May-June 2020, 33(3):175-179
DOI:10.4103/0970-258X.314010  PMID:33904424
  2,376 55 -
REVIEW ARTICLE
Anti-interleukin-6 therapies for Covid-19: A systematic review, critical appraisal and meta-analysis
Arunmozhimaran Elavarasi, Ranjit Kumar Sahoo, Tulika Seth, Shalimar , Karan Madan, Neeraj Nischal, Manish Soneja, Atul Sharma, Pramod Garg, Kameshwar Prasad
May-June 2020, 33(3):152-157
DOI:10.4103/0970-258X.288119  PMID:33904419
Background. Coronavirus disease 2019 (Covid-19) has emerged as a pandemic by end-January 2020. Of the infected patients, 10%–15% may develop severe or critical illness. So far, no definite treatment is available for Covid-19. Cytokine release syndrome may underlie the pathogenesis of severe and critical disease. Anti-interleukin (IL)-6 therapies are being tried to improve clinical outcomes. Methods. We did a systematic review to identify the available literature on anti-IL-6 therapies in the treatment of Covid-19 and used the GRADE method to assess the quality of evidence. Results. Four case series and 10 case reports were identified. On critical assessment, we found that these studies reported some beneficial effect of anti-IL-6 therapy, but all the studies had a high risk of bias. The pooled estimate showed that 42% of patients improved but with a very wide confidence interval (CI) (95% CI 1%–91%) and substantial heterogeneity (I2 = 95%). The overall quality of evidence was graded as ‘very low’. Conclusions. Although promising, anti-IL-6 therapy for Covid-19 needs to be tested in randomized controlled trials to provide robust evidence.
  1,932 230 -
SELECTED SUMMARY
Adjuvant trastuzumab emtansine in human epidermal growth factor receptor 2-positive breast cancer: Take-home points from the KATHERINE trial
Ilavarasi Vanidassane, Ramavath Devendra Naik, Vinod Sharma, Sachin Khurana, Atul Batra
May-June 2020, 33(3):158-159
DOI:10.4103/0970-258X.314006  PMID:33904420
  474 90 -
ORIGINAL ARTICLES
Prevalence of dyslipidaemia and factors associated with dyslipidaemia among South Asian adults: The Center for Cardiometabolic Risk Reduction in South Asia Cohort Study
Zafar Fatmi, Dimple Kondal, Roopa Shivashankar, Romaina Iqbal, Adeel Ahmed Khan, Deepa Mohan, Rajendra Pradeepa, Ruby Gupta, Mohammed K Ali, Vamadevan S Ajay, Viswanathan Mohan, Muhammad Masood Kadir, K M Venkat Narayan, Dorairaj Prabhakaran, Nikhil Tandon
May-June 2020, 33(3):137-145
DOI:10.4103/0970-258X.314005  PMID:33904416
Background. The pattern of dyslipidaemia in South Asia is believed to be different from that in other parts of the world. Nonetheless, limited population-based data are available from the region. We assessed the prevalence, types of, and factors associated with dyslipidaemia among South Asians. Methods. We used baseline data (2010–11) of the Center for Cardiometabolic Risk Reduction in South Asia (CARRS) cohort of 16 287 representative urban adults aged ≥20 years from Chennai and Delhi in India and Karachi in Pakistan. Total cholesterol (TC) was measured by the enzymatic-cholesterol oxidase peroxidase method, high-density lipoprotein-cholesterol (HDL-C) by the direct homogeneous method and triglycerides (TG) by enzymatic methods. Low-density lipoprotein-cholesterol (LDL-C) was calculated using Friedewald’s formula. We defined high TC ≥200 mg/dl or on medication; hypertriglyceridaemia ≥150 mg/dl, high LDL-C ≥130 mg/dl or on medication and low HDL-C <40 mg/dl for males, <50 mg/dl for females. Multivariate logistic regression was carried out to assess the factors associated with dyslipidaemia. Results. The prevalence of any dyslipidaemia was 76.4%, 64.3% and 68.5% among males and 89.3%, 74.4% and 79.4% among females in Chennai, Delhi and Karachi, respectively. The prevalence of elevated TC was higher in Chennai compared to Delhi and Karachi (31.3%, 28.8% and 22.9%, respectively); males had a significantly greater prevalence of high TG, whereas females had a greater prevalence of low HDL-C in all the three cities. The most common lipid abnormality in all three cities was low HDL-C, which was seen in 67.1%, 49.7% and 61.3% in Chennai, Delhi and Karachi, respectively. Only 2% of the participants were on lipid-lowering drugs. Adjusted for other factors, dyslipidaemia was positively associated with age, female sex, obesity, hypertension, diabetes and tobacco use. Discussion. Overall, almost seven in ten adults in urban South Asia have some form of dyslipidaemia, and the predominant subtypes were low HDL-C and high TG.
  481 77 -
Prevalence and determinants of sleep disorders in a community in rural southern India
Gomathi Ramaswamy, Kariyarath Cheriyath Premarajan, Sitanshu Sekhar Kar, Sunil K Narayan, Pruthu Thekkur
May-June 2020, 33(3):132-136
DOI:10.4103/0970-258X.314002  PMID:33904415
Background. We assessed the prevalence of sleep disorders among people above 15 years of age from a rural area of Puducherry, south India. Methods. We did a community-based cross-sectional study among people residing in four service area villages of a rural primary health centre in Puducherry, India. Probability sampling techniques were used to select participants. The Pittsburgh Sleep Quality Index was administered to detect sleep disorders among the participants. The data were entered and analysed using EpiData entry 3.1 and Stata 12 software, respectively. Association between various individual factors and sleep disorders was assessed using generalized linear models adjusting for clustering at the household level and expressed as prevalence ratio with 95% confidence interval (CI). Results. The mean (SD) age of the 501 participants was 38.3 (15.4) years. Poor quality of sleep was present in 36.3% (95% CI 32.2%–40.6%). In multivariate generalized linear model, age >60 years (adjusted prevalence rate ratio [aPRR] 1.68; 95% CI 1.11–2.53), female sex (aPRR 1.57; 95% CI 1.18–2.08), living in a broken family (aPRR 1.47; 95% CI 1.06–2.02) and having a television in their sleeping room (aPRR 1.40; 95% CI 1.40–1.79) were independently associated with poor quality of sleep. Conclusions. A high prevalence suggests that sleep disorders are a problem in the rural community too. Capacity building among the existing health workforce to identify and treat sleep disorders and health education activities focusing on sleep hygiene among the general public are needed to tackle sleep disorders in the community.
  465 83 -
EDITORIAL
‘Indian Dyslipidaemia’: A unique challenge
MK Garg, Surender Deora
May-June 2020, 33(3):129-131
DOI:10.4103/0970-258X.314003  PMID:33904414
  435 79 -
MEDICAL EDUCATION
Structured, functional histology practical modules: An answer to medical students’ histology nightmare and the way forward for relevant histology instruction in the Indian undergraduate medical curriculum?
Tripti Meriel Jacob, Visalakshi Jeyaseelan, Sunil Jonathan Holla, Ivan James Prithishkumar, Bina Isaac, Suganthy Rabi
May-June 2020, 33(3):166-171
DOI:10.4103/0970-258X.314019  PMID:33904422
Background. It is often a challenge to make histology instruction relevant and interesting. We assessed whether structured, worksheet-based histology practical modules with emphasis on functional histology and clinical application, would improve the learning experience and help students focus on relevant functional and clinical correlates. Methods. In eight practical sessions, 100 students worked as two groups, one group undergoing new intervention practical modules and another group undergoing the routine laboratory practical exercises as a control group. For every pair of laboratory practical exercises, the groups alternated. Spot tests administered in the following week assessed identification ability as well as application of knowledge. Feedback was collected in the form of written questionnaires from faculty and students, student focus group discussion and in-depth interviews. Analysis of test scores as well as feedback was done. Results. Test scores were better following the intervention method when comparing the overall score as well as its subcomponents of identification and analysis-type questions (p<0.001). The weaker performers in the class as well as high achievers showed better test scores with the intervention method (p<0.001). Feedback from faculty and students reflected better student experience with the intervention method. Suggestions were made to improve the approach further. Conclusion. Studying histology through structured modules, which emphasize functional and clinical correlates, appears to improve the identification and application ability of the student as well as the student experience.
  414 46 -
CLINICAL CASE REPORTS
Automated-red cell exchange for methaemoglobinaemia in a G6PD-deficient patient
Aseem K Tiwari, Geet Aggarwal, Vaibhav K Gupta, Dinesh Arora, Swati Mehta Pabbi, Ganesh Rawat
May-June 2020, 33(3):149-151
DOI:10.4103/0970-258X.314007  PMID:33904418
Methaemoglobinaemia in G6PD deficiency can be managed by oxidizing agents such as methylene blue and red cell exchange (RCE). We describe a G6PD-deficient patient who presented with oxidative stress with methaemoglobinaemia and was successfully managed with automated-RCE. At presentation, the patient had anaemia, was restless, was tired and had dyspnoea. Co-oximetry showed methaemoglo-binaemia of 10.1 U/g. Further testing revealed the patient had insufficient quantities of G6PD enzyme activity (0.1 U/g Hb). In view of methaemoglobinaemia, severe G6PD deficiency and signs of haemolysis, therapeutic RCE was planned. The patient underwent two automated-RCE procedures on consecutive days, bringing down his methaemoglobin levels from 12.5 to 0.1 U/g. In each procedure, 1.5 volumes of RCE at 100% balance rate was performed using 5 units of red blood cells. The patient responded well to RCE and other supportive treatment and was off medication and doing well at day 100 of follow-up.
  345 54 -
IMAGES IN MEDICINE
Hamman syndrome
J Sankar, Maneesh Uniyal, Kishore Kumar
May-June 2020, 33(3):180-180
DOI:10.4103/0970-258X.314008  PMID:33904425
  362 34 -
CLINICAL CASE REPORTS
A case of Philadelphia chromosome-positive acute myeloid leukaemia with missense mutation R132c (c.394 c>t) and single nucleotide polymorphism rs11554137(G105G) in isocitrate dehydrogenase 1 gene
Akanksha Agarwal, Mili Jain, Shikha Tewari, Madhumati Goel, Ashutosh Kumar
May-June 2020, 33(3):146-148
DOI:10.4103/0970-258X.314004  PMID:33904417
Acute myeloid leukaemia (AML) is a heterogeneous disease due to its variable clinical, morphological and genetic features. New chromosomal and molecular abnormalities are being studied to evaluate novel treatment options and prognostic implications. We report a patient with AML who was Philadelphia chromosome-positive along with IDH1R132 mutation and SNP rs11554137(IDH1105GGT). Due to limited reports regarding these aberrations in patients with AML, there is no consensus regarding their prognostic implications. To the best of our knowledge, the presence of Philadelphia chromosome, IDH1R132 and SNP rs11554137 in a single AML patient with good prognosis is a novel finding
  300 47 -
MEDICINE AND SOCIETY
Mental Health Legislation: The validity of divergent views
KS Jacob
May-June 2020, 33(3):172-174
DOI:10.4103/0970-258X.314009  PMID:33904423
  309 37 -
CLINICAL RESEARCH METHODS
Primer on Epidemiology 2: The elements of study validity and key issues in interpretation
Shivani Anil Patel, Roopa Shivashankar
May-June 2020, 33(3):160-165
DOI:10.4103/0970-258X.314011  PMID:33904421
  305 40 -
IMAGES IN MEDICINE
Internal jugular vein phlebectasia: Pulsatile mass in the neck
Amr Idris, Tahir Salmani
May-June 2020, 33(3):181-181
DOI:10.4103/0970-258X.314012  PMID:33904426
  287 26 -
CORRESPONDENCE
Immune status against diphtheria toxin in tea garden population surveyed in Dibrugarh district, Assam
Utpala Devi, Pranjal Jyoti Baruah, Soumita Dutta, Suman Kalyan Paine, Nabajyoti Gogoi, Prasanta Kumar Borah
May-June 2020, 33(3):187-188
DOI:10.4103/0970-258X.314014  PMID:33904429
  241 39 -
LETTER FROM LONDON
Letter from London
Anna Ruddock
May-June 2020, 33(3):182-182
DOI:10.4103/0970-258X.314016  PMID:33904427
  243 32 -
LETTER FROM MUMBAI
Letter from Mumbai
Sunil K Pandya
May-June 2020, 33(3):182-184
DOI:10.4103/0970-258X.314017  PMID:33904428
  226 30 -
BOOK REVIEW
Health File of Mahatma Gandhi: His experiments with dietetics and nature cure
Sunil K Pandya
May-June 2020, 33(3):185-186
DOI:10.4103/0970-258X.314015  
  169 37 -
NEWS FROM HERE AND THERE
News from here and there

May-June 2020, 33(3):189-190
DOI:10.4103/0970-258X.314018  
  170 36 -