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   2020| November-December  | Volume 33 | Issue 6  
    Online since July 11, 2021

 
 
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ORIGINAL ARTICLES
Intravenous ferric carboxymaltose rapidly increases haemoglobin and serum ferritin among pregnant females with moderate-to-severe anaemia: A single-arm, open-label trial
Shashi Kant, Partha Haldar, Sumit Malhotra, Ravneet Kaur, Ramashankar Rath, Olivia Marie Jacob
November-December 2020, 33(6):324-328
DOI:10.4103/0970-258X.321145  PMID:34341207
Background. Infusion of ferric carboxymaltose (FCM) can correct iron deficiency anaemia in the second or third trimester of pregnancy. However, large-scale public health use of FCM is constrained by two issues. First, there is limited evidence on the efficacy and safety profile of FCM in the Indian context. Second, logistic challenges in administering FCM at a subdistrict healthcare setting have not been assessed. We aimed to measure the mean increase in haemoglobin (Hb) level 2 weeks after infusion of FCM to pregnant females with moderate-to-severe anaemia attending a subdistrict hospital in India. Methods. During June–December 2016, we did a single-arm, open-label trial among pregnant females with a gestation of 16–32 weeks, Hb 5.0–9.9 g/dl. FCM was infused (per Ganzoni formula) in a single session up to a maximum of 1000 mg of iron. Hb and s-ferritin levels were measured at recruitment, 2 weeks post-infusion and at delivery. Adverse events were noted. Results. Seventy-seven pregnant females were enrolled with mean (SD) age 23.2 (3.1) years, gestation 27.6 (3.8) weeks and Hb 8.4 (0.9) g/dl. At 2 weeks post-infusion (n=63), the mean Hb level increased by 1.9 g/dl (95% confidence interval [CI] 1.6–2.3) and at delivery (n = 64) by 2.9 g/dl (95% CI 2.4–3.4). The median (interquartile range) (in ng/ml) for serum ferritin at baseline (n = 68), 2 weeks post-FCM infusion (n = 61) and at delivery (n = 39) was 6.3 (5.1–11.7), 275.4 (186.4–330.3) and 61.3 (42.5–132.0), respectively. No major adverse effects were reported. Conclusion. Infusion of FCM rapidly corrected anaemia, sustained its effect till delivery and replenished body iron reserves. FCM is safe and effective in treating anaemia in pregnant females in the second and third trimester at the subdistrict healthcare setting in India.
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EDITORIAL
Public Health is Key to Pandemic Preparedness
K Srinath Reddy, Himanshu Negandhi
November-December 2020, 33(6):321-323
DOI:10.4103/0970-258X.321142  PMID:34341206
  997 90 -
MEDICINE AND SOCIETY
Innovations to automate manual ventilation during Covid-19 pandemic and beyond
Joseph L Mathew
November-December 2020, 33(6):366-371
DOI:10.4103/0970-258X.315902  PMID:34341217
Manual ventilation by compressing self-inflating bags is a life-saving option for respiratory support in many resource-limited settings. Previous efforts to automate manual ventilation using mechatronic systems were unsuccessful. The Covid-19 pandemic stimulated re-exploration of automating manual ventilation as an economically viable alternative to address the anticipated shortage of mechanical ventilators. Many devices have been developed and displayed in the lay press and social media platforms. However, most are unsuitable for clinical use for a variety of reasons. These include failure to understand the clinical needs, complex ventilatory requirements in Covid-19 patients, lack of technical specifications to guide innovators, technical challenges in delivering ventilation parameters in a physiological manner, absence of guidelines for bench testing of innovative devices and lack of clinical validation in patients. The insights gained during the design, development, laboratory testing and clinical validation of a novel device designated the ‘Artificial Breathing Capability Device’ are shared here to assist innovators in developing clinically usable devices. A detailed set of clinical requirements from such devices, technical specifications to meet these requirements and framework for bench testing are presented. In addition, regulatory and certification issues, as well as concerns related to the protection of intellectual property, are highlighted. These insights are designed to foster an innovation ecosystem whereby clinically useful automated manual ventilation devices can be developed and deployed to meet the needs associated with the Covid-19 pandemic and beyond.
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ORIGINAL ARTICLES
Right ventricular dysfunction in rheumatic heart valve disease: A clinicopathological evaluation
Shantanu Pande, Surendra K Agarwal, Prabhat Tewari, Vinita Agrawal, Nilesh Srivastav, Shashank Tripathi, Neetu Soni, Sunil Kumar
November-December 2020, 33(6):329-334
DOI:10.4103/0970-258X.321133  PMID:34341208
Background. Dysfunction of the right ventricle (RV) in rheumatic heart disease (RHD) is a poor prognostic factor. We planned to observe the clinicopathological changes in the RV of patients with RHD. Methods. We defined RV dysfunction by a myocardial performance index value of >0.4 on transthoracic echo-cardiography and included patients with isolated severe mitral stenosis in sinus rhythm with normal left ventricular (LV) function from April 2014 to April 2016. The patients were divided into two groups based on the absence (group I, n=21) and presence (group II, n=22) of RV dysfunction. RV muscle biopsy was evaluated for the presence of apoptosis, fibrosis and fat deposition apart from other clinical and echocardiography parameters. Results. Patients in both the groups had a similar demographic profile and LV dimensions and function. The age of the patients in the two groups was the only clinical parameter that was significantly different; older patients were in group II. A higher value for RV systolic pressure (RVSP) and the grade of tricuspid regurgitation was seen in group II. Though there was no significant difference in the presence of fibrosis and intensity of apoptosis in the RV biopsy samples, the deposition of fat in the interstitial spaces was decreased in group II. Age at presentation had no significant difference or correlation with the deposition of fibrosis or fat in the RV myocardial biopsy. Conclusions. Patients with RV dysfunction were older in age and their RVSP was raised at operation, suggesting that earlier intervention may help in preserving RV function.
  599 92 -
Male infertility in India: Demographics, aetiology and outcomes of standard clinical practice
Rohit Kaushal, Nishant Gurnani, Manoj Kumar, Rima Dada, Rajeev Kumar
November-December 2020, 33(6):340-343
DOI:10.4103/0970-258X.321136  PMID:34341210
Background. Although the outcomes of assisted reproductive technologies (ART) and corrective surgery for male infertility are reported in the literature, these are based on studies specifically designed to assess the outcomes of individual interventions and do not reflect the real-life (intent-to-treat) outcomes of managing infertility. There are sparse data on the actual utilization of treatment and pregnancy outcomes in these patients. We aimed to evaluate the demographics, aetiology, treatment utilization and outcomes of treatment of male infertility in a tertiary care centre. Methods. We prospectively enrolled 447 infertile males for evaluation over 30 months beginning October 2015. All patients were evaluated and investigated as per the study protocol to identify the cause of infertility. The patients were advised interventions based on the diagnosis and were followed up to assess delivery of treatment and outcomes of interventions in terms of pregnancy rates. Results. Of the 447 enrolled patients, 426 (mean age 31 years) completed the initial diagnostic evaluation. About 83% had primary infertility, 40% had oligo/astheno/ teratozoospermia, 40% had azoospermia, and 21.1% had obstructive azoospermia. Genetic abnormalities were detected in 9.3% of the 162 patients screened. ART was advised for 71.8% of patients, but only 18% of patients actually received the treatment though they had a high success rate (38%). In contrast, surgery was recommended to only 35 (8.2%) patients, but only 18 (58%) received the recommended treatment with a pregnancy rate of 33.3%. Overall, only 24.4% of patients received the advised treatment with a pregnancy rate of 36.8%. Conclusions. ART was the most common intervention recommended, but less than one-fourth of couples received the recommended treatment. Surgery is indicated in a small number of patients, but is delivered to a larger proportion than those advised ART with both modalities having similar pregnancy outcomes.
  480 72 -
An assessment of compliance with the provisions of Cigarettes and Other Tobacco Products Act 2003: Is Shimla a smoke-free city?
Ankit Chaudhary, Anita Thakur, Tripti Chauhan, Anjali Mahajan, Vijay Barwal, Anmol Gupta, Shaina Chamotra
November-December 2020, 33(6):335-339
DOI:10.4103/0970-258X.321141  PMID:34341209
Background. Tobacco consumption in any form is a major contributor to non-communicable diseases, and it is the leading preventable cause of death worldwide. Secondhand smoke is also harmful. To halt the smoking epidemic and protect people from second-hand smoke, the Government of India enacted the Cigarettes and Other Tobacco Products Act (COTPA) in 2003. Methods. We ascertained compliance with the provisions of COTPA 2003 at 183 public places and 41 transport facilities of Shimla city from August 2017 to July 2018. Results. Only 48% of public places had good compliance with the provisions of COTPA 2003. On average, a public place was found to be compliant with 7 of 10 key indicators of Section 4. Educational institutes and government offices had a higher rate of compliance compared to other places. Active smoking and signages signalling ban on smoking were observed in 17% and 95.6% of public places, respectively. Smoking aids (e.g. ashtrays) were observed at <10% of places. A designated smoking area was not seen at any public place. Conclusion. Overall compliance of the Act was low with less than half the places having satisfactory compliance with Section 4. There is a need to raise awareness about the negative effects of smoking on health and environment and ensure strict adherence to the provisions of COTPA 2003.
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REVIEW ARTICLE
Facility preparedness for an obstetric unit during the Covid-19 pandemic
K Aparna Sharma, Vatsla Dadhwal, Anubhuti Rana, Seema Singhal, Sunesh Kumar, Neerja Bhatla
November-December 2020, 33(6):349-357
DOI:10.4103/0970-258X.321135  PMID:34341213
Covid-19 infection has placed health systems under unprecedented strain and foresight for preparedness is the key factor to avert disaster. Every facility that provides obstetric service needs a certain level of preparedness to be able to handle at least Covid-suspect pregnant women awaiting test reports, who need to be managed as Covid-positive patients till reports are available. Thus, these facilities need to have triage areas and Covid-suspect labour rooms. Healthcare facilities can have designated areas for Covid-positive patients or have referral linkages with designated Covid-positive hospitals. Preparation includes structural reorganization with setting up a Covid-suspect and Covid-positive facility in adequate space, as well as extensive training of staff about infection control practices and rational use of personal protective equipment (PPE). A systematic approach involving five essential steps of making standard operating procedures, infrastructural reorganization for a triage area and a Covid-suspect labour ward, procurement of PPE, managing the personnel and instituting appropriate infection control practices can ensure uninterrupted services to patients without compromising the safety of healthcare providers.
  447 83 -
HOW TO DO IT
Sample size calculation with simple math for clinical researchers
Kameshwar Prasad
November-December 2020, 33(6):372-374
DOI:10.4103/0970-258X.321139  PMID:34341218
Clinicians often need a quick and rough idea of the sample size to assess the feasibility of their clinical research question, but developing countries often lack access to online calculators or its language. I describe a formula that clinicians, residents or any health researcher can remember and use to calculate sample size with mental arithmetic or with the use of a simple pocket calculator. This article covers controlled clinical trials. The formula for two equal-sized groups is simple: n = (16p [100–p])/d2 per group for dichotomous outcomes, where p is average of the two proportions with events, and d is the difference between the two proportions. For continuous scale outcomes, the formula is n=16s2/d2 per group where s is the standard deviation of the outcome data and d is the difference to be detected. The formula needs to be modified for unequal-sized groups. This simple formula may be helpful to clinicians, residents and clinical researchers to calculate sample size for their research questions. The feasibility of many research questions can be easily checked with the calculated sample size.
  404 72 -
CLINICAL CASE REPORTS
Chronic myeloid leukaemia after chemoradiotherapy for solid malignancies
Mehmet Baysal, Gülcin Ulutas, Ali Gokyer, Elif Umit, Emine Ikbal Atli, Onur Kirkizlar, Hakan Gürkan, Ahmet Muzaffer Demir
November-December 2020, 33(6):347-348
DOI:10.4103/0970-258X.321138  PMID:34341212
Haematological malignancies associated with chemoradiotherapy (CRT) are often acute myeloid leukaemias and myelodysplastic syndromes. Chronic myeloid leukaemia (CML) has been reported rarely in these situations. Cytogenetics of CRT-associated CML is not different from de novo CML, and there are not enough data about its prognosis. We report two patients who had CRT because of lung cancer and squamous cell carcinoma of head and neck, who subsequently developed CML.
  407 47 -
MEDICAL EDUCATION
Effectiveness and perceptions of MBBS students about process-oriented guided inquiry learning in biochemistry
Smita S Sonoli, Shrimanjunath Sankanagoudar
November-December 2020, 33(6):362-365
DOI:10.4103/0970-258X.321143  PMID:34341216
Background. On reviewing our teaching methods through students’ feedback, we realized they were dissatisfied with the present teaching methodology of lectures in terms of knowledge retention and problem-solving. This issue was addressed using student-centred and cooperative learning methodology, i.e. process-oriented guided inquiry learning (POGIL) where pre-designed questions guide students to enquire concepts, with reflection writing exercise helping students to strengthen their concepts. This study analysed the effectiveness and perceptions of POGIL sessions conducted after lectures. Methods. The study was approved by the institutional ethical committee. A total of 42 (7 groups; each group with 6 members of high, low and average achievers) consented and POGIL-sensitized MBBS phase I students were part of the study. One-hour POGIL sessions were conducted a week after lecturing with reading material. Pre-, post- and retention test multiple-choice questions (MCQs) were administered for assessment of effectiveness and a close-ended questionnaire for recording perception. Results. Post-test and retention test MCQ scores were statistically higher than pre-test scores both in all participants and low achievers (p<0.05). Around 60% of the students felt that the POGIL activities and working in teams helped them to understand concepts. Reflection analysis revealed the best and least understood concept and students came up with memory aids to remember complex metabolic regulation. Conclusion. POGIL might be a promising reinforcement strategy to lectures in biochemistry and preferred tool to address the issue of low achievers in the class.
  362 46 -
CLINICAL CASE REPORTS
Overlapping polyclonal lymphoproliferative disorders
Ramona Bonometti, Mattia Bellan, Daniele Sola, Antonello Gibbin, Francesco Gavelli, Filippo Patrucco, Paolo Spina, Alessandro Gualerzi, Serena Favretto, Luigi Mario Castello, Pier Paolo Sainaghi, Mario Pirisi
November-December 2020, 33(6):344-346
DOI:10.4103/0970-258X.321144  PMID:34341211
Multicentric Castleman disease (MCD) is a rare clinical entity characterized by a polyclonal lymphoid proliferation, leading to generalized lymphadenopathy, organomegaly and systemic symptoms. It has been reported in association with either other monoclonal or polyclonal lymphoid disorders, such as POEMS syndrome and immunoglobulin (Ig)G4-related disease. We present a patient showing a variant of MCD, sharing common features with POEMS syndrome and associated with the proliferation of IgG4-producing plasma cells.
  339 45 -
SELECTED SUMMARIES
Laparoscopic smoke and Covid-19: The debate continues
Srineil Vuthaluru, Aditya Baksi
November-December 2020, 33(6):358-359
DOI:10.4103/0970-258X.321140  PMID:34341214
  333 50 -
LETTER FROM CHENNAI
Uninformed Non-Consent
MK Mani
November-December 2020, 33(6):380-381
DOI:10.4103/0970-258X.321137  PMID:34341221
  334 43 -
SPEAKING FOR OURSELVES
Truth telling and fully disclosing to cancer patients in India: A pragmatic approach
Navika Nayar, Reena Nair, Mohandas K Mallath
November-December 2020, 33(6):375-378
DOI:10.4103/0970-258X.321134  PMID:34341219
  309 40 -
SELECTED SUMMARIES
Physician schedules and patient safety: Critical appraisal
Suvir Singh, Komalpreet Kaur
November-December 2020, 33(6):359-361
DOI:10.4103/0970-258X.321146  PMID:34341215
  304 38 -
OBITUARY
S. Padmavati
Upendra Kaul
November-December 2020, 33(6):379-379
DOI:10.4103/0970-258X.321132  PMID:34341220
  277 37 -
NEWS FROM HERE AND THERE
News from here and there

November-December 2020, 33(6):382-384
DOI:10.4103/0970-258X.321147  
  243 29 -