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   Table of Contents - Current issue
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March-April 2021
Volume 14 | Issue 2
Page Nos. 115-245

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EDITORIAL  

Science in the time of corona: That uneasy feeling Highly accessed article p. 115
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_17_21  
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COMMENTARY Top

The publication “pandemic”: Another new normal? Highly accessed article p. 117
Riniki Sarma, Nishkarsh Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_82_21  
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GUEST EDITORIAL Top

COVID-19: The quagmire of policies and responses p. 119
DS Faujdar, Arun Kumar Yadav
DOI:10.4103/mjdrdypu.mjdrdypu_701_20  
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PROTOCOL Top

Sero-surveillance of SARS-CoV2 infection among health-care workers: A protocol p. 123
Subhadeep Ghosh, Atul Kotwal, Kapil Pandya, Arun Kumar Yadav
DOI:10.4103/mjdrdypu.mjdrdypu_529_20  
Introduction: The objectives of the present survey are to estimate the seroprevalence and sero-conversion of SARS CoV2 among the health-care workers (HCWs) in health-care establishments and to analyze the various characteristics (risk factors) associated with SARS CoV-2 infection with the overall aim to generate evidence for planning and preventive measures in the Armed Forces. Methodology: Eight hospitals have been chosen based on the hospital admission rates of COVID-19 patients and local epidemiological situation of COVID-19 prevalent in the region. A total of 3800 HCWs would be enrolled in the cross-sectional survey. For longitudinal study, 1000 personnel would be followed up at 3 and 6 months. Population proportion to size would be used for enrolment at various stages. A validation study is inbuilt in the study. From each site, a nodal officer would be designated for facilitating. Real-time data monitoring and quality checks would be done. Sero-surveillance would be done using ELISA-based immunoglobulin antibody. Results: The present study would provide the estimates of seroprevalence and rate of seroconversion among the HCWs. The factors associated with seroprevalence and seroconversion would be delineated. Discussion: The protocol lays down the plan of action to implement the multi-centric serosurveillance project. The survey will provide an assessment of seroprevalence of COVID-19 infection among the health-care workers of hospitals of central ministry from the various parts of the country and its trend over a period of time.
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REVIEW ARTICLE Top

Adaptation of anesthesia practices owing to coronavirus disease-2019 pandemic p. 128
Raunaq Chakraborty, Anju Gupta, Anjum Goth, Prashant Sirohiya, Nishkarsh Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_312_20  
For coronavirus disease-2019 (COVID-19), substantial proportion of secondary transmission may occur before illness onset. During the epidemic of severe acute respiratory syndrome, it was evident that particularly those involved in airway-related procedures such as endotracheal intubation was highly susceptible. In this situation, we anesthesiologist need to rapidly keep updating ourselves with the available literature and adopt and evolve new practices in our regime. In this article, we have tried to suggest evidence-based practices for the perioperative management and operation theater workflow in the existing scenario of the coronavirus pandemic.
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ORIGINAL ARTICLES Top

Clinical and demographic profile of pediatric COVID-19 in a tertiary care teaching Hospital p. 134
Suryakant Sayanna Mundlod, Deepali Abhijit Ambike, Sabahat Ahmed, Abhijeet Byale
DOI:10.4103/mjdrdypu.mjdrdypu_606_20  
Background: Coronavirus disease 2019 (COVID-19) is a disease that emerged from the global epicenter Wuhan, China in December 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Globally, there was an explosion of the outbreak of SARS-COV-2 infections, triggering a major health concern all over the world. By June 2020, the World Health Organization confirmed a total of approximately 9 million COVID-19 cases that included 477634 deaths (5.2%) in 216 countries. Materials and Methods: All COVID suspect children admitted in the pediatric ward were screened for SARS-CoV-2 by reverse transcription-polymerase chain reaction. Presenting between May 1, 2020 and August 31, 2020 and their demographic and clinical parameters were analyzed. Results: In the present study, out of 158 confirmed COVID-19 positive pediatric cases, history of high-risk contact was seen in 21 cases, history of international travel in 6 cases, history of residing in containment areas in 17 cases and co-existing disease was found in 3 cases. Fever was seen in 49 cases, cough in 21 cases, sore throat in 3 cases, shortness of breath in 6 cases, headache in 1 case, rhinorrhea in 7 cases, nausea/vomiting in 7 cases, abdominal pain in 4 cases, and diarrhea in 6 cases. Conclusion: The study highlighted that children are less vulnerable and at a lower risk of developing COVID-19 and when they contract the COVID-19 infection, they have a milder or asymptomatic disease than adults with few or minimum complications.
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Profile of internet addiction, anxiety, and depression in patients of mixed anxiety and depressive disorders p. 137
Rishab Verma, Darpan Kaur, Rakesh Ghildiyal
DOI:10.4103/mjdrdypu.mjdrdypu_369_20  
Background: The Internet plays a very valuable role in knowledge, learning, and skills enhancement. There is scarce literature regarding the profile of internet addiction (IA) in patients of mixed anxiety and depressive disorders among developing countries. Aims: The aim of this study was to assess the profile of IA, anxiety, and depression in patients of mixed anxiety and depressive disorders. Methodology: This study was conducted at the Department of Psychiatry, MGM Medical College and Hospital, Navi Mumbai, India. Inclusion criteria comprised adult patients who were diagnosed with ICD 10 diagnostic criteria for mixed anxiety and depressive disorder, having access to the internet, and willing to participate in the study. Patients not having access to the internet and not willing to participate were excluded from the study. The patients were assessed using the IA test (IAT), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). Informed consent and Institutional Ethics Committee Clearance was obtained. Data were analyzed biostatistically. Results: Our sample size of n = 60 comprised 60% (n = 36) males and 40% (n = 24) females. The mean age of the sample was 32.6 years. Majority of patients came from the semi-urban area. The mean HAM-D score of the sample was 18.96 and the mean score HAM-A score was 20.2. The mean score of IAT was 34.7. Conclusions: We conclude that the IA is prevalent in patients with mixed anxiety and depressive disorders and clinical rating scales can provide additional symptom profiles for anxiety and depression.
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Parenting style and personality correlates of internet addiction: A cross-sectional study p. 143
Sunil Shivam, Bhushan Chaudhari, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/mjdrdypu.mjdrdypu_329_19  
Aim: The aim of this study was to assess the prevalence of Internet addiction (IA) and its correlation with personality traits and perceived parenting styles in college-going students. Materials and Methods: The current cross-sectional study was done at a medical college in a semi-urban area near Pune. A total of 623 university students were included in the study with their consent. They completed a questionnaire assessing sociodemographic background and Internet usage pattern, Young's IA scale to assess IA, the Big Five Inventory for assessing personality traits, and Short-Form Egna Minnenav Barndoms Uppfostran (My Memories of Upbringing) scale for measuring perceived parenting styles. Results: The prevalence of IA in medical students was 56.81% (mild IA: 49.59%, moderate IA: 7.22%). Neuroticism showed a significant positive correlation with IA, whereas extroversion, openness to experience, agreeableness, and conscientiousness showed a significant negative correlation. In perceived parenting styles, rejection and overprotection had a significant positive relation and emotional warmth had a significant negative relation with IA. Conclusion: Neuroticism, rejection, and overprotection by parents were positively associated with IA. Personality traits of extroversion, openness to experience, agreeableness, conscientiousness, and emotional warmth by parents were negatively associated with IA.
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Study of dry eye parameters in diabetics in a tertiary care hospital p. 155
Sakshi Patil, Sunita Bishnoi, Ajit Joshi
DOI:10.4103/mjdrdypu.mjdrdypu_67_20  
Aim: This study aims to study the frequency and severity of dry eye in diabetic patients and their correlation with duration of diabetes. Materials and Methods: This cross-sectional prospective study was conducted on all patients with diabetes mellitus presenting to ophthalmology department of a tertiary care hospital between November 1, 2019, and December 31, 2019. The study population included diabetic patients who were above the age of 40 years. Detailed ocular history including diabetic history was recorded and comprehensive ocular clinical examination to assess the dry eye status was done. Schirmer's I test and Tear film Break-Up Time (TBUT) tests were performed and results were recorded. Results: In this study, 100 eyes of 50 diabetic patients were subjected to dry eye tests. Varying degree of dryness was seen in 34 patients (68%). Schirmer's test was abnormal (<10 mm) in 24 patients (48%) and TBUT test was abnormal (<10 s) in 34 patients (68%). Majority of patients (60%) were asymptomatic. Statistically significant association was seen between the duration of diabetes with Schirmer's I test and TBUT test (P = 0.00). Conclusion: Dry eyes are a frequent association seen in patients with diabetes. Simple noninvasive tests for dry eyes such as Schirmer's test and TBUT test should be considered as an integral part of routine examination in diabetics as these may be asymptomatic.
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COMMENTARY Top

Dry eye disease in patients with diabetes mellitus: An overview p. 160
Samanthila Waduthantri
DOI:10.4103/mjdrdypu.mjdrdypu_425_20  
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ORIGINAL ARTICLES Top

A Follow-up Study to Evaluate Lipids as Cost-Effective Markers in HIV-Infected Patients on Antiretroviral Therapy p. 162
Amrita Parmar, Tapan Kumar Saha, Babu Lal Somani, Pratibha Misra
DOI:10.4103/mjdrdypu.mjdrdypu_60_20  
Background: Human immunodeficiency virus (HIV) infection per se and antiretroviral therapy (ART) both are associated with dyslipidemias, one of the important risk factors in the development of premature atherosclerosis and coronary artery disease. Certain classes of highly active antiretroviral therapy (HAART), especially protease inhibitors, are more frequently associated with dyslipidemia. The objectives of this study were to evaluate and compare lipid profile – total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride in HIV patients before and after starting ART and also to correlate lipid profile and CD4 counts in HIV infection, thus evaluating the feasibility of using lipid profile to monitor the progression of infection in HIV-infected patients as an adjunct to CD4 counts in resource-limited settings. Methods: Paired samples of 100 newly diagnosed HIV patients were taken before and after treatment with HAART. CD4 cell counts and lipid parameters measured and compared using paired 't'-test. Each of the lipid parameter correlated with CD4 cell count. Results: Significant increase was seen in the levels of TC and HDL-C (P < 0.05) with treatment. CD4 cell count also showed a significant increase (P < 0.05) with therapy. HDL-C levels correlated significantly with CD4 cell counts in pretreatment group (r = 0.23, P = 0.020, 95% C.I.). Conclusion: Combination of zidovudine, lamivudine, and nevirapine is associated with significant increase in HDL-C. HDL-C levels are a good indicator of disease severity in HIV-infected patients before starting the therapy.
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A clinicopathologic study of placentae of low birth weight and normal birth weight babies born at a tertiary care center in western India p. 166
Manish Sharma, Jasvinder Kaur Bhatia, Ajay Malik
DOI:10.4103/mjdrdypu.mjdrdypu_179_20  
Context: Low birth weight (LBW) of newborn is associated with various clinical parameters as well as with placental pathology. Aims: This study aims to assess and compare the clinical parameters and placental pathology in LBW infants with normal infants. Subjects and Methods: Thirty-four placentae of full-term babies weighing <2.5 kg were taken as cases and 34 placentae of newborns weighing more than 2.5 kg were taken as controls. Clinical data parity, maternal age, weight, height, body mass index (BMI), mode of delivery, and period of gestation were collected. Gross examination, placental parameters: attachment of cord, placental dimensions, placental weight, infarction, and hematoma were noted. Sections were studied for accelerated villous maturation (syncytial knots), developmental villous capillary lesion (chorangiosis), acute infectious inflammatory lesions (chorioamnionitis), chronic infectious inflammatory lesions (stromal fibrosis), and other placental processes (massive perivillous fibrin deposition [ MPVFD], fibrinoid necrosis, atherosis, and calcification). Statistical Analysis: Chi-square test and logistic regression were performed on dichotomous variables with SPSS 20 to find association. Quantitative variables were analyzed by Unpaired T-test and Mann–Whitney's test for significance. P < 0.05 was taken as statistically significant. Results: The mean maternal age (26.7 years) was higher (P = 0.039) than controls (24.8 years); mean maternal weight (P = 0.14)], BMI (P = 0.029), and period of gestation (P = 0.0) were lower in cases than in controls. Cases and controls showed significant difference in eccentric attachment of umbilical cord (61.76% vs. 32.35%, [P = 0.015*]). On microscopy cases showed significant MPFD (P = 0.015*). A significantly higher stromal fibrosis (P = 0.028), atherosis (P = 0.024), ST knots (P = 0.012), and chorangiosis (58.82% vs. 26.47% [P = 0.007]) were noted in cases. Conclusions: We conclude that all placentas should be examined thoroughly to look for associated characteristic histomorphologic and gross findings which reflect hypoxia and decreased maternal fetal nutrient transfer.
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Impact of antenatal care on pregnancy outcomes: A cross-sectional study in a rural community in Malaysia p. 172
Tahmina Afrose Keya, Kevin Fernandez, Kailash C Kharkwal, Nasrin Habib
DOI:10.4103/mjdrdypu.mjdrdypu_14_20  
Background: Malaysia has a high standard of health-care system, including antenatal care (ANC) services. Objective: This cross-sectional study was carried out to assess the impact of regular ANC visits on outcome in a rural community in Malaysia from September to November, 2019, in village Kampung Merbok in Kedah, Malaysia. Method and Materials: A pretested semi-structured questionnaire was used as a tool for data collection among the women who gave birth in public or private health-care centers. Association between the various components of ANC and pregnancy outcome was examined using multivariate logistic regression analysis, and Chi-square test/Fisher's exact test was used to interpret the association between the ANC visits and the outcome variables. Result: Among the respondents, 39 (78%) had more than four ANC visits. Fourteen (28%) respondents had adverse pregnancy outcome. All nonattendees had adverse outcome. Only 6 (12%) women (95% confidence interval: 3.22, 20.78) had a history of cesarean section. This study found statistically significant association between maternal ANC visits and maternal and neonatal outcome variables (P < 0.05). Pearson's correlation test also revealed the strong relationship between ANC and the outcome variables (P < 0.0001). Conclusion: In this study, mothers having regular ANC visits experienced better pregnancy outcome compared to those nonattendees. Nevertheless, it is necessary to adhere to a minimum level of four ANC visits for all pregnant women. More health promotion programs are required focusing on improving women's awareness of the necessity of ANC throughout their pregnancy.
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Effectiveness of instructed tooth brushing on plaque and oral hygiene among the visually impaired children from a residential blind school in Pune – An interventional study p. 180
Deepika S Dagar, Pradnya V Kakodkar, Sahana H Shetiya
DOI:10.4103/mjdrdypu.mjdrdypu_9_20  
Aim: The study was undertaken to evaluate the effect of instructed tooth brushing on plaque and oral hygiene among the visually impaired children from a residential blind school in Pune. Materials and Methods: An interventional study was conducted for 30 days at a residential Blind School for boys. Twenty-four blind children were recruited for the study. Baseline data were recorded using the modified patient hygiene performance (PHP) index and oral hygiene index-simplified (OHIS). Oral prophylaxis was undertaken. Oral health instruction pamphlet in Braille script was given to them. Supervised tooth brushing twice daily as per the musical audio instructions was performed for 30 days. Postintervention, the indices scores were recorded again. Paired t-test was used for comparison of pre and postintervention scores. Results: The modified PHP score pre and postintervention were 4.19 ± 0.54 and 1.81 ± 0.87, respectively, and the difference was statistically significant. The OHIS scores pre and postintervention were 3.31 ± 0.88 and 1.04 ± 0.54 and were also statistically significant. Conclusion: The present study revealed that the instructed tooth brushing program, along with oral prophylaxis and oral hygiene instructions in Braille for the visually impaired children for maintaining their oral hygiene is an effective method.
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Risk of cardiovascular changes in hypothyroidism in North-west Punjab population p. 185
Gagandeep Jagota, Rajinderjit Singh Ahi, Rakendra Singh, Saranpal Singh
DOI:10.4103/mjdrdypu.mjdrdypu_314_19  
Background: This study was done with an objective to study the cardiovascular involvement associated with newly detected overt and subclinical hypothyroidism. Methods: A total number of 150 newly detected hypothyroid patients, diagnosed by the clinical evaluation, confirmed by thyroid hormone assay, were subjected to electrocardiograph and echocardiography. It was a cross-sectional study design based on the random sampling method, which was conducted for 2 years in the Central Laboratory of Adesh Institute of Medical Sciences and Research and Center for Interdisciplinary Biomedical Research, Adesh University. Results: Of 150 patients studied, 62 were overt hypothyroid and 88 were subclinical hypothyroid. Forty-one were male and 109 were female. Hypothyroidism was newly diagnosed more in females and maximum in the age group of 41–70 years (69.9%). Of 150 patients, 63.3% had symptoms <2-month duration. Cardiovascular symptoms were present in 68.0% of patients. Bradycardia was observed in 44.0% of patients. Stage 1 hypertension was noticed in 30.7% (systolic high blood pressure). Low-voltage complexes in electrocardiogram (ECG) were present in 34.0% study group. Pericardial effusion was present in 32.7% of patients. Diastolic dysfunction was noticed in 20.0% study group. Altered lipid profile was present in 74.0% (total cholesterol) and 65.3% (total triglycerides). Conclusions: Hypothyroidism is common in female, maximum between the age group of 17 and 47 years. Majority of the patients have cardiovascular changes such as ECG abnormalities, pericardial effusion, diastolic hypertension, and diastolic dysfunction. Systematic study was done to know the early effects of hypothyroidism on cardiovascular system. The identification of patients with hypothyroidism is an important individual as well as public health issue. Hence, early detection and initiation of hormone replacement therapy can minimize the associated cardiovascular changes.
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Assessment of safety of retropupillary iris-claw intraocular lens as a viable option in surgical aphakia p. 190
Minal Doulatramani, Renu Magdum, Rupali Maheshgauri, Radhika Paranjpe
DOI:10.4103/mjdrdypu.mjdrdypu_269_19  
Background: Aphakia is the most dreaded and inadvertent complication of cataract surgery. Visual rehabilitation with wide variety of surgical options is a challenge for the ophthalmologist. Our study evaluates the safety and efficacy of the retropupillary implantation of the iris-fixated intraocular lens (IOL) in a 2-month follow-up period. Aims: This study aims to assess the visual outcome, identify complications, and assess the long-term stability of eyes undergoing retropupillary iris-claw lens implantation for aphakia. Settings and Design: This was a prospective interventional study (single-group, before–after study). Materials and Methods: Sixty eyes with surgical aphakia fulfilling the inclusion criteria were considered. Preoperatively, evaluation of visual acuity, slit-lamp examination, fundus examination, intraocular pressure, corneal endothelial cell count, macular thickness, and edema was done. Anterior vitrectomy was done, and retropupillary iris-claw lens was implanted. Postoperative best-corrected visual acuity (BCVA), IOP, corneal endothelial cell density, macular edema, and IOL stability were evaluated. Statistical Analysis: The computer software statistical package for the social sciences, version 20.0 (SPSS) was used, and a 0.05 level of significance was considered. Results: The major cause of aphakia was posterior capsular rupture (55%). Postoperative BCVA on day 60 was 6/6–6/18 in 83.33% of cases. Three patients had disenclavation of the haptic which required retucking of IOL. No patient had corneal decompensation, cystoid macular edema, or IOP rise. Conclusion: Our results demonstrate that retropupillary technique of iris-claw implantation is a safe and effective method for visual rehabilitation in aphakic patients. This surgical procedure has an advantage of posterior chamber implantation with a low intraoperative and postoperative complication profile.
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Epidemiology of newborn transport in India - The reality check p. 196
Tanushree Mondal, Moksuda Khatun, SK Md Habibulla, Somosri Ray, Avijit Hazra, D Ivan M, Rakesh Mondal
DOI:10.4103/mjdrdypu.mjdrdypu_336_19  
Background: Transporting sick neonates from the periphery to a tertiary care unit is a challenge and transport-related factors can have a bearing on their survival. These factors influence ultimate survival in resource poor settings. Objectives: The objective is to evaluate the transport characteristics for sick newborns from peripheral centers to tertiary care referral hospital. Methods: A prospective study was done with sick newborns transported to our tertiary care teaching hospital over a period of 1 year. The transport logistics were recorded in detail and analyzed. The analyses were repeated for preterm and term babies separately. Results: There were 36.32% preterm babies in the study cohort of 961 newborns. The descriptive profile of the newborns enrolled in the study has been presented along with descriptive summary of the newborn transport logistics. Approximately 23% of babies were born to teen age mothers. Some prereferral counseling was done for only about 20% babies and <1% had vitals monitored during transport. Prereferral stabilization was scarce and around 41% babies had labored breathing or gasping at admission. As many as, 47% babies had no prereferral intervention and 31% had no referral notes; in only 3.3% instances, there was clear prior intimation to the referral unit. Conclusion: Sick newborn transport logistics are to be improved for reducing neonatal mortality in resource poor settings.
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A clinico-hematological evaluation of pancytopenia at Government Medical College and Hospital, Latur: A 2-year observational study p. 202
Rahul Suryakant Abhange, Rahul Pundalik Jadhav
DOI:10.4103/mjdrdypu.mjdrdypu_333_19  
Context: Pancytopenia is defined by reduction of all the three formed elements of blood below the normal reference. Hematological investigation forms the bedrock in the management of patients with pancytopenia and therefore needs detailed study. The aim of this study was to identify the underlying etiologies of pancytopenia cases presenting at our institute with clinico-hematological evaluation. Materials and Methods: In this 2-year prospective study, 105 patients aged ≥15 years admitted in hospital with a hematological diagnosis of pancytopenia followed by bone marrow aspiration and/or biopsy after receiving an informed consent were studied. The criteria applied for pancytopenia were hemoglobin level: <13.5 g/dL for males and <11.5 g/dL for females; total leukocyte count: <4 × 109/L; and platelet count: <150 × 109/L. Pregnant women and patients aged <15 years along with those who did not give consent for bone marrow aspiration or biopsy were excluded. A detailed clinical examination was carried out in all cases. Results: In the present study, megaloblastic anemia (67.62%) was the most common cause of pancytopenia, followed by aplastic anemia (15.25%), leukemia (3.81%), malaria (3.81%), hypersplenism (3.81%), liver cirrhosis (1.90%), myelofibrosis (1.90%), multiple myeloma (1%), and enteric fever (1%). Conclusions: The severity of pancytopenia and the underlying pathology determine the management and prognosis. Thus, comprehensive clinical and hematological evaluation of pancytopenia cases will help in identification of the correct cause and in implementing the appropriate therapy.
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Determination of a safe time and safe protocol for oral hydration in pediatric patients following general anesthesia p. 207
Sushama Raghunath Tandale, Sunita M Khedkar, Kalpana V Kelkar, Shriaunsh Abhade, Subhadra Sinha
DOI:10.4103/mjdrdypu.mjdrdypu_330_19  
Background: The study was aimed to evaluate the safe time and safe protocol for postoperative resumption of oral hydration in pediatric patients undergoing elective nonabdominal surgery under general anesthesia. Methodology: One hundred and sixty patients (of age 6 months to 12 years) were assigned into two groups. The assessment of level of consciousness, protection of the airway (coughing and swallowing), absence of nausea and vomiting, and normal saturation were used as the safety criteria for start of postoperative oral hydration in both groups. Clear fluids in dose of 0.5–1 ml/kg were offered to them after completing 4th and 1st h of recovery in standard and experimental group, respectively. Next hour onward clear fluids was given as per the need of patients. Safety profile, safety protocol, and parental/patient satisfaction with early and delayed oral hydration were recorded. Data analysis was done using SPSS (Statistical package for social sciences) version 20:0 and P < 0.05 was considered statistically significant. Results: Statistical insignificant difference was found with age, sex, weight, and the American Society of Anesthesiologists status, duration of surgery, type of surgery, type of anesthesia, fasting time, time from last intake of liquid and solid preoperatively in both the groups. None of the patients enrolled in the study experienced desaturation, moderate sedation, regurgitation, or pulmonary aspiration of gastric content. The incidence of postoperative nausea and vomiting was 7.5% and 3.75% in the standard and experimental group, respectively. Mean total volume of oral hydrating solution was 140.82 ml and 123.56 ml in standard and experimental group, respectively. Statistically significant difference (P < 0.001) was observed in parental/pediatric patient satisfaction score among two groups. Significantly shorter time to oral hydration in experimental group (71.44 min) than standard group (244.44 min) was as expected. Conclusion: Early postoperative oral hydration with clear liquid is safe and highly satisfying for parents and patients following elective nonabdominal surgery.
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Desflurane versus sevoflurane in laparoscopic cholecystectomy: A comparison of recovery profile and home discharge in Indian patients p. 213
Divya Gahlot, Sharmila Ahuja, Neha Yadav, Sujata Choudhary
DOI:10.4103/mjdrdypu.mjdrdypu_343_19  
Context: Laparoscopic cholecystectomy is one of the most commonly performed minimal access surgeries nationwide, safely done as a day care procedure. Anesthetic techniques facilitating early recovery and home discharge have become the need of the hour. Aims: To compare early, intermediate, late recovery characteristics and time to home readiness following use of sevoflurane or desflurane as maintenance anesthesia in laparoscopic cholecystectomy in Indian subpopulation. In addition, postoperative complications such as coughing and shivering and total antiemetic and analgesic requirements postoperatively were also noted. Settings and Design: This was a prospective randomized study, and randomization was done by computerized random number table into two groups (30 patients in each group). Group S received sevoflurane and Group D received desflurane as maintenance agent. Subjects and Methods: Sixty patients of age group 18–60 years belonging to the American Society of Anesthesiologists Grade I and II undergoing laparoscopic cholecystectomy were recruited. A standard anesthesia induction was done and airway was secured with a ProSeal laryngeal mask airway of appropriate size. The patients subsequently received either sevoflurane 1%–2% or desflurane 3%–6% with 60% N2 O in O2 as per group assigned. Inhalational agent was discontinued at the time of endoscope removal. Early, intermediate, and late recovery parameters were noted. Statistical Analysis: The tests of significance used were parametric test (unpaired t-test) and ANOVA. The outcome measures were compared statistically using unpaired t-test and ANOVA, and P < 0.05 was considered statistically significant. Results: Early recovery parameters were achieved faster in patients receiving desflurane as compared to sevoflurane with no difference in time to achieve intermediate recovery and home readiness. Conclusion: Despite a faster early recovery with desflurane, no additional benefit in terms of home discharge and patient satisfaction was found, thus making use of either of the agents suitable for laparoscopic cholecystectomy on a day care basis.
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A Comparison of the effect of resistance training on upper extremity motor function, motor recovery, and quality of life in sub-acute stroke participants p. 219
Prabin Bastola, Priyanka Singh, Deepak Pinto
DOI:10.4103/mjdrdypu.mjdrdypu_227_19  
Background and Objectives: Previous literature could not find sufficient evidence to support the use of resistance training (RT) protocol and its effect on stroke. Most of the studies were small and of moderate quality. Recommended in previous study that well-design randomized controlled trials with structured protocol are needed to determine the optimal exercise prescription. Hence, the objective of this study was to design a structured protocol of RT for sub-acute ischemic stroke subjects with moderate upper limb impairments. The primary aim of this study was to find the effect of RT on upper extremity (UE) motor recovery, motor function, and secondary aim was to find the effect of RT on health-related quality of life in stroke participants. Materials and Methods: There was total number of 40 participants, out of which 20 were in RT group and 20 were in conventional therapy (CT) group. Both the RT group and CT group received the same usual care rehabilitation programs for 30 min, and additionally, had each of their own therapies for 50 min per session, 5 days a week for 8 weeks. The action reach arm test (ARAT), manual muscle testing (MMT), Fugl-Meyer assessment (FMA), and stroke-specific quality of life (SS-QOL) were used as an outcome measure to assess gross manual dexterity, motor recovery of UE, and quality of life at preintervention and postintervention. Results: At baseline, participants of both group showed no significant differences regarding ARAT, MMT, FMA, and SS-QOL scores but after 8 weeks of intervention, participants of both group showed statistically significant improvements in all the variables measured (P < 0·05). Moreover, participants of the RT group had greater improvement in all variables compared to CT group. Conclusion: The present study confirms that structured protocol used for RT is an effective treatment technique to improve UE motor recovery, motor function, and quality of life in stroke participants compare to CT. It is cost-effective, easy, and safe method for rehabilitation and most important can be easily administered at home by the participants.
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CASE REPORTS Top

A rare case of tubercular collarstud abscess of anterior abdominal wall p. 226
R Shiva, Iqbal Ali, Mridula Eswarawaka
DOI:10.4103/mjdrdypu.mjdrdypu_355_20  
Tuberculosis (TB) is considered as a ubiquitous disease, as it can involve any organ or a part of the body. Commonly, it involves the lungs and the abdomen. Muscle involvement is rare. In most cases, it is secondary to tubercular costochondritis or TB of the spine. Autopsy studies have revealed the abdominal wall involvement in <1% of patients who died of TB. A high index of suspicion is necessary to diagnose tubercular lesions in unusual anatomical locations. Antitubercular therapy is the main form of treatment; however, some patients may require surgical intervention. We are hereby presenting a case of tubercular anterior abdominal wall abscess secondary to wet peritonitis in a 40-year-old apparently healthy male with no past history of TB. The objective is to alert the clinicians and radiologists to the possibility of TB when considering such cystic lesions of the anterior abdominal wall.
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Dual antiplatelet therapy challenges in emergent noncardiac surgeries p. 230
Rahil Singh, Anisha Singh, Sukhyanti Kerai
DOI:10.4103/mjdrdypu.mjdrdypu_252_20  
In today's era, patients with coronary stents are presenting for various surgeries while still being on dual antiplatelet therapy. This leads to balancing the risk between myocardial ischemia if therapy is discontinued and bleeding risk due to surgery. Hence, it arises the need to introduce guidelines for managing such patients coming for elective as well as emergency surgeries for easy implementation. Developments related to coronary stents and antiplatelet agents are continuously evolving. A comprehensive understanding of the pharmacology of newer antiplatelet agents, efficacies of newer coronary stents, risk of stent thrombosis, and role of platelet function tests must be determined. There is an urgent need for the development of guidelines to manage such patients.
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COMMENTARY Top

Chromoblastomycosis: A neglected tropical disease p. 234
Gitanjali Sarangi
DOI:10.4103/mjdrdypu.mjdrdypu_73_19  
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LETTERS TO THE EDITOR Top

Subcutaneous dirofilariasis p. 236
Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_442_20  
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Chasing the virus: Not only difficult but also impossible. Are we going to hit a dead end?: Reply p. 237
Jyoti Ajagunde, Chanda R Vyawahare, Rajashri Patil, Nikunja Kumar Das
DOI:10.4103/mjdrdypu.mjdrdypu_584_20  
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Mentoring medical teachers for improving the quality of teaching in India p. 239
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjdrdypu.mjdrdypu_266_19  
Once a medical postgraduate student is conferred with their degree, it is certified that they are specialists in their subject, but the same degree does not account for their expertise in being a medical teacher. Mentoring has been acknowledged as an effective approach and has the potential to benefit all the involved stakeholders, namely mentee, mentor and the institution. The basic purpose of mentoring is to extend support, guidance and advice to the faculty members to refine their teaching skills and grow professionally. In conclusion, mentoring program for faculty members aids them to be more confident and enhance their teaching skills and professional growth. From the institution's perspective, it is extremely useful as we are creating a pool of teachers who will be playing a defining role in shaping the career of budding doctors.
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Encouraging feedback-seeking behavior among medical students p. 241
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjdrdypu.mjdrdypu_349_19  
In the field of medical education, the role of feedback in imparting effective curriculum delivery and making of a lifelong and self-directed learner has been acknowledged for a long period of time. Feedback seeking behavior is an important area which the administrators and teachers should aim to strengthen as it is ideal to have students as active seekers of feedback rather than passive recipients of the same. Feedback-seeking creates a platform for the effective exchange of information and plays an important role in eliminating the uncertainty related to the course and the desired competencies. In conclusion, feedback in medical education is an effective tool to promote learning among medical students. However, the overall effectiveness and teaching-learning can be enhanced if we can succeed in creating an atmosphere where the students develop a feedback seeking behavior to monitor their own professional growth.
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COMMENTARY Top

Much ado about AYUSH notification p. 243
Yogendra Shrivastava
DOI:10.4103/mjdrdypu.mjdrdypu_710_20  
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