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   Table of Contents - Current issue
May-June 2022
Volume 12 | Issue 3
Page Nos. 97-142

Online since Thursday, June 30, 2022

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Understanding suicide: A biopsychosocial framework Highly accessed article p. 97
Soumya Tandon
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Profile and in-hospital outcomes of deliberate self-harmed patients in a tertiary care centre Highly accessed article p. 100
Juby John, KP Rashmi, R Jayachandran
Objective: Suicide is an unrecognised and underestimated epidemic of high complexity and accounts for premature loss of at least 1 million lives worldwide, leaving behind irreparable loss and backlash to family, friends and society. This study was carried out with the aim of analysing the clinical presentation, modes of deliberate self-harm (DSH), demographic and biochemical features with outcomes of patients presenting with DSH and admitted through the emergency unit of the medicine department to a tertiary care teaching hospital in South India. Materials and Methods: The clinical presentation, demographic details, psychiatric evaluation and blood investigations of patients admitted with a history of DSH during the study (2020–2021) were analysed, with special emphasis on serum cholesterol, C-reactive protein (CRP) and thyroid-stimulating hormone (TSH). Results: In this study, of the 508 patients studied, the most common mode of self-harm was poisoning by drug overdose (32.28%) followed by plant toxin poisoning and rodenticide ingestion-finding different from other studies of South India during this COVID pandemic. Values of TSH, serum cholesterol, CRP and haematogram were normal in majority of patients. All the patients underwent psychiatry evaluation in which substance abuse, adjustment disorders and personality disorders were the most common diagnosis reached. Conclusions: Clinical profile and methods of DSH have marked regional variation necessitating the need to create a regional database. Serum cholesterol, CRP and TSH are subject to genotypic and regional variations and thus are not reliable as biomarkers of suicidal ideation.
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Pharmacovigilance study of spontaneous adverse drug reaction in a tertiary care centre p. 106
Wazid Ali, Smita Manjavkar, Imran Kazmi, Shamim Ullah Khan
Background: Adverse drug reactions (ADRs) are a rapidly growing universal problem that has a significant impact on users worldwide. They are the cause of significant disability and mortality and are expected to be associated with an economic burden on the health-care system. Aims: To promote patient safety from pharmaceutical products. Materials and Methods: A prospective, observational evaluation of the ADRs collected during spontaneous pharmacovigilance reporting over a period of 18 months in various hospital departments. During the study period, 214 individual case safety reports (ICSR) were reported. Results: The 214 reports that were identified, a slightly higher percentage of ADRs in females 105 (50.93%) was observed as compared to males 109 (49.07%), 73 (34.1%) serious and 141 (65.9%) non serious ADRs. In serious ADRs, the male patients were 35 (33.3%) and females were 38 (34.9%) including 6 (2.8%) deaths. The largest number of reports was associated with antimicrobials 41% followed by non-steroidal anti-inflammatory drugs − 21.1%, antidiabetic − 10.9%. The most commonly implicated organ system was skin − 46.62% followed by gastrointestinal reactions − 18.05%, blood and metabolic disorder − 11.65%, central nervous system − 6.77%, liver − 6.02% and cardiovascular system (3.38%). The outcomes were recorded as recovering (45.8%), recovered (26.2%), continuing (19.2%) and unknown (6.1%) at the time of processing ICSR through vigiflow database. The causality of more than half of ADRs were recorded as possible (59.8%) followed by probable (24.8%), certain (15%) and unlikely (0.5%). Conclusion: Limited ADR is permissible in normal clinical trials setting; hence, spontaneous adverse reaction reporting systems need to be developed, which may improve rational drug prescribing habits to obtain maximum benefits meanwhile minimizing the risk of health from undesirable effects of drugs.
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To study the role of magnesium and Gamma- glutamyl transferases in alcoholic liver disease p. 114
Kapila Gaikwad, Sohan Selkar, Sanjay Agrawal
Aim: To study the role of magnesium and gamma- glutamyl transferases in alcoholic liver disease. Objectives: (1) To estimate serum magnesium and serum glutamyl-transferases (GGT) in alcoholic liver disease. (2) To estimate liver enzymes Alanine Transaminases (ALT), Aspartate Transaminases (AST), Alkaline Phosphatase (ALP), and Total protein and Albumin in alcoholic liver disease. (3) To correlate serum magnesium with all liver enzymes. (4) To correlate serum GGT with all liver enzymes. Materials and Methods: All liver enzymes, serum magnesium, serum GGT, total protein and albumin were estimated in 50 alcoholic liver disease patients and 50 normal subjects on Trivitron Dirui autoanalyzer. Results: Significant difference was found between mean values of cases and controls in Mg, GGT, AST, ALT, Alkaline phosphatase, and Albumin (P<0.05). Positive correlation was found between Mg with GGT, ALT, Total proteins and Albumin. This indicates that the higher(lower) values of Mg are associated with higher(lower) values of GGT, ALT, Total proteins, and Albumin. But the result were not statistically significant.(P >0.05). Conclusion: Chronic alcoholic liver disease significantly elevates Gamma-glutamyl transferase. Hypomagnesemia is also seen in alcoholic liver disease. Gamma-glutamyltransferase has a significant relation with magnesium levels in alcoholic liver disease.
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Intraoral biosensors: A promising diagnostic tool p. 118
Shefali Dogra, Pankaj Dhawan, Shivam Singh Tomar, Ashish Kakar, Era Kakar
The article encompasses a research on intraoral biosensors, which was conducted using keywords such as “Intraoral biosensors,” “health care monitoring devices,” “biomarkers”, “cloud servers,” “Internet of dental things (IoDT)” and “wireless sensors” in the databases of PubMed/Medline and Google Scholar between 1990 and 2020. Biomedical devices such as intraoral biosensors that are involved in continuous healthcare monitoring have garnered the attention of several researchers across the world. These devices function as an interconnecting link between the human systems and the outer environment. Recently, chair-side monitoring and early diagnostic tests are highly valuable for periodic monitoring and treatment planning for patients. These devices use biological reactions to detect and measure a particular chemical compound substance and then send an electronic signal. The chief advantages of these ubiquitous devices are high sensitivity and fast response. Intraoral biosensors integrate various materials and devices on one unique chip, hence functioning as the latest analytical and diagnostic tool of dentistry. This review highlights the basic concepts, principles and role of intraoral biosensors in the diagnosis of caries, periodontitis, oral cancer and dental fluorosis.
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SARS-CoV-2 infection evolving into aplastic anaemia: An unusual presentation of COVID-19 in the paediatric age group p. 125
Akanksha Bhatia, Vijay Kumar, Ankita Yadav
Aplastic anaemia can develop due to various viral infections. However, SARS-CoV-2 infection evolving into aplastic anaemia is rarely seen. Here, we present a case of a 6-year-old boy who presented with epistaxis and rashes all over the body after recovery from COVID-19. Peripheral blood smear examination revealed pancytopenia with neutropenia and also reticulocytopenia. Bone marrow biopsy showed a hypoplastic marrow (cellularity of 10%), leading to a diagnosis of aplastic anaemia.
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A case of PUO in diabetes mellitus p. 128
PK Agarwal, Shipra Gulati, Ambuj Garg, Sunila Jain
Histoplasma capsulatum, a thermal dimorphic fungus, is the agent of histoplasmosis. It is a common cause of endemic mycosis. We report the case of a 64-year-old female, a known case of diabetes mellitus, hypertension, beta-thalassemia trait who presented with persistent fever, decreased appetite and weight loss for a period of 1 month and found to have anaemia and hepatosplenomegaly. She was diagnosed with histoplasmosis on liver biopsy. She was started on amphotericin 'B' liposomal for 14 days. She showed marked improvement symptomatically and later put on tablet itraconazole 200 mg twice a day for 1 year and was advised for follow-up.
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Synchronous primary malignancies and pre-cancers affecting entire hysterectomy specimen: A report of an unfortunate case p. 131
Shreekant Bharti, Iffat Jamal, Pritanjali Singh
Synchronous tumours of the female genital tract are rare, accounting for approximately 1%–2% of all gynaecological malignancies involving simultaneous independent primary malignancies. Synchronous tumours in the ovary and endometrium are the most common combination. We report on a 58-year-old postmenopausal woman who presented with bleeding per vaginum for 1.5 months with no prior menstrual complaints. On per vaginal examination, a mass was felt in the pelvis. Ultrasonography revealed a mass of 8 cm × 9 cm in size filling the entire uterine cavity. Contrast enhanced computed tomography showed a multilobate mass in the pelvis, replacing the whole uterus and cervix, with heterogeneous enhancement and internal necrosis. Bilateral ovaries were not visualised separately. The radiological impression suggested an endometrial carcinoma. Wertheim's hysterectomy was subsequently performed. On microscopic examination, the uterine mass revealed a malignant mixed Müllerian tumour (carcinosarcoma) of the endometrium, along with a high-grade serous carcinoma of the left ovary and left fallopian tube. The right fallopian tube showed adenocarcinoma in situ. The patient had an unusual past history of multiple system comorbidities, a few of which were continuing and for which she was receiving medical treatment.
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Do checklist-based box system interventions improve post-natal care service utilisation? p. 135
Manish Taywade, Debkumar Pal, Dinesh Prasad Sahu
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Challenges in Medical Education - Let's talk about solutions p. 137
Harish Gupta
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Effects of COVID-19 pandemic on medical equipment's/devices supply chain p. 140
Abid Haleem, Mohd Javaid, Shahbaz Khan
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