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   Table of Contents - Current issue
May-August 2020
Volume 1 | Issue 1
Page Nos. 1-66

Online since Monday, July 20, 2020

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The Journal of Medical Evidence from the All India Institute of Medical Sciences, Rishikesh p. 1
Ravi Kant, Ajeet Singh Bhadoria, Samiran Nundy
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COVID-19 in India's towns and villages p. 2
Prasan Kumar Panda, UB Mishra
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Clinical spectrum of carcinoma of the gallbladder in the Indian states of Uttarakhand and Western Uttar Pradesh: A retrospective study from a tertiary care hospital of Northern India p. 4
Navin Kumar, Deepak Rajput, Amit Gupta, Varun Popuri, Tanuj Singla, Ashikesh Kundal, Jyoti Sharma, Bhargav Gajula
Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the study was to identify the hotspot regions and relationship of gallstones to GBC in two northern states of India. Materials and Methods: It was a retrospective, observational, hospital-based cohort study. The data of patients with locally advanced (LA) or metastatic GBC from January 2019 to December 2019 were evaluated for geographical distribution of cases, and their clinical spectrum was compared with the presence or absence of associated cholelithiasis. Statistical analysis was performed using R Statistical software version 3.6.2. Results: Forty-two patients were enrolled in our study. A high burden of GBC was observed from Western Uttar Pradesh (District Bijnor 12(29%) and Muzaffarnagar 7(17%)) and Uttarakhand (District Haridwar 7(17%), whereas the remaining 16(38%) patients were residents of other districts of Uttarakhand (UK) and Western Uttar Pradesh (UP). In our study, only 17(40.5%) patients had associated cholelithiasis. Metastatic disease at presentation was seen in nearly 59% of patients with cholelithiasis and 52% of patients without cholelithiasis. Jaundice was the most common presentation in 12(70.6%) patients, followed by pain in 9(nearly 53%) patients with GBC associated with gallstones. Whereas in patients with GBC without gallstones, loss of appetite and loss of weight was the most common presentation in 16(64%) followed by jaundice in 13(52%). Conclusion: Most cases with LA or metastatic GBC in the present study were not associated with cholelithiasis. Clinical spectrum of either LA or metastatic GBC is similar, irrespective of presence or absence of gallstones.
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Scrub typhus in the Himalayan ranges and sub-Himalayan plains: Recognising an expanding clinical syndrome p. 8
Augustine Jose, Apoorva Chaudhary, Prasan Kumar Panda, Deepjyoti Kalita
Background: Scrub typhus, a rickettsial zoonosis, is endemic in the Indian sub-continent but is rare in the Himalayan region due to natural geographic barriers to both organism and vector. Aims: To study the clinical profile of scrub typhus cases admitted in a tertiary care center. Patients and Methods: We did a retrospective observational study of the positive cases from July 2018 to June 2019 in a tertiary care center. All possible risk factors, demographic details, clinical presentations, laboratory parameters, treatment, and outcomes were analyzed. Results: A total of 80 cases were analyzed. The maximum number of cases was observed in September. Major symptoms noted were fever, abdominal pain, headache, cough, breathlessness, and myalgia. Atypical presentations including capillary syndrome and demyelinating polyneuropathy were observed. The eschar detection rate was low. Among organ involvement, hematology system (70%) was most commonly involved followed by liver, kidney, brain, lungs, and heart respectively. The case fatality rate was 6.82%. Himalayan and non-Himalayan cohorts (n = 32 vs 48 respectively) did not show any statistically significant differences in clinical profile, although one could observe that Himalayan cohorts had higher incidences of leukopenia, splenomegaly, and myocarditis, while fever for >7days at admission, hepatomegaly, acute respiratory distress syndrome, major organ involvement resulting admission in high dependency unit (HDU), and mortality were higher in non-Himalayan cohorts. Conclusion: The current study reveals few atypical presentations and complications differing from the classical scrub typhus. Raised ALP is noticed in majority of cases which can be established as a diagnostic marker in acute undifferentiated febrile illnesses in further study. The presence of leukocytosis has high predictive association with major organ involvement and complications.
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Spatial clustering and impact of household characteristics on under-five mortality in India: A secondary data analysis p. 15
Jatin Chaudary, S Akshay, D Shivaram Reddy, Anusha Sharma, Nishu Jha, Pawna Kaushal, Akshay Malik
Background: Under-five mortality rate (U5MR) is one among the best social indicators that identifies social development and well-being. Various risk factors are seen contributing to its increase. Aim: The present correlational study aims to identify the spatial clustering of U5MR in different states and union territories (UTs) of India and determines its association with household characteristics. Patients and Methods: The present study incorporates primary data for 29 states and 2 UTs (Delhi and Chandigarh) of India from the National Family and Health Survey-4 (2015–2016) for secondary data analysis. The data include the outcome variable which was the U5MR and predictor variables such as households with electricity; improved source of drinking water; toilet facility; solid fuels being used for cooking; anyone smoking and living in a pucca house. Primary data were analysed using GeoDa software, employing Univariate Local Indicators of Spatial Association, Spearman's correlation coefficient, ordinary least square (OLS) and spatial error model (SEM). Results: The study showed significant spatial clustering of high U5MR in six states and one UT, namely Rajasthan, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Bihar, Jharkhand and Delhi and clustering of lower U5MR in southern states of Tamil Nadu and Karnataka. The Spearman's correlation showed a significant positive association of U5MR with households using solid fuel for cooking and negative association with households using electricity, with toilet facility and Living in a pucca house. The OLS and SEM spatial regression models model showed an association between households with toilet facility and in which anyone smokes at home with under-five mortality. Conclusions: U5MR shows a significant clustering geographically. This mortality indicator is influenced by the external environment such as household characteristics.
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COVID-19: Gut and liver p. 21
Deepanshu Paliwal, Swati Rajput, Satyavati Rana
Currently, the world is facing a pandemic induced by novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed as coronavirus disease 2019 (COVID-19). Patients typically present with myalgia, fever and respiratory symptoms, but studies have stated the existence of gastrointestinal (GI) symptoms, liver injury and existence of SARS-CoV-2 RNA in the faecal specimen of these individuals. GI symptoms were also common during the previous outbreak of coronavirus family, i.e., severe acute respiratory syndrome and Middle East respiratory syndrome in 2003 and 2012, respectively. Literature reports multiple studies with varied proportions of GI symptoms such as abdominal pain, nausea, vomiting and diarrhoea. Hepatic injury was assessed with abnormal serum levels of aspartate aminotransferase, alanine aminotransferase and total bilirubin. SARS-CoV-2 may enter host cells by the presence of angiotensin-converting enzyme-2 receptor which is present in enterocytes (in small intestine), cholangiocytes (in bile duct) and hepatocytes (in liver) suggesting replication of virus in intestine and liver. This might be the cause of dysregulation of liver and GI functions. Another possible mechanism of dysregulation of the intestinal and hepatic systems might include inflammatory cytokine storm or antibiotic-induced toxicity. This article discusses a possible faecal-oral transmission due to viral shedding in the stool. This review article also emphasises on GI and hepatic aspects of COVID-19 which might become a defining tool in our fight against it.
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Nuclear Medicine from the past to the present: A brief story of its development, key impact areas in current times and its potential for the future p. 26
Vandana Kumar Dhingra, Mohit Dhingra, Sandip Basu
In this review, we briefly outline the journey and development of Nuclear Medicine in the Western world in contrast with its development in India and highlight the key areas where this modality has an impact today and likely to develop in the near future. A special mention of the recent developments in clinical Nuclear Medicine including Positron Emission Tomography-Computed Tomography (PET-CT) which form the backbone of personalised medicine is made.
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A case of synchronous dual malignancy with the index malignancy in the lower alveolus and a second primary malignancy in the left breast p. 33
Satya Prakash Agarwal, Jayendra K Arya, Priyanka Gupta, Bina Ravi, Anjum Syed
Multiple primary malignancies are nowadays commonly detected due to better radiological techniques, greater awareness and an increase in number of elderly cancer survivors. We are reporting a rare case of patient having dual synchronous malignancy of carcinoma left lower alveolus and ductal carcinoma in left breast who presented to the department of surgical oncology and integrated breast care center. The patient is on regular follow-up, and currently, there was no evidence of recurrent or residual disease. No such case has ever been reported, and despite a thorough check on all, we are unable to find any previously reported case. Hence, to the best of our knowledge, this case is the first of its kind to have simultaneous presentation of synchronous dual malignancies involving left lower alveolar and left breast cancers.
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Symptomatic duplicated gall bladder – A rare presentation with a review of the literature p. 35
Amit Gupta, Bhargav Gajula, Jaydeep Jain, Jyoti Sharma, Udit Chauhan, Ravi Kant
Gallbladder duplication is a rare congenital anomaly. Knowledge of its various types is important since it can complicate cholecystectomy. Many varieties of gall bladder duplication and its classification are reported in the literature. Pre-operative diagnosis plays a crucial role in the planning of surgery and preventing possible injuries or re-operation if the accessory gallbladder has been overlooked during the initial surgery. Gallbladder duplication though rare requires special attention to pre-operative anatomy and its variation. The operative challenge is more than the usual laparoscopic cholecystectomy and should be done by fundus first approach by an experienced laparoscopic surgeon. We report a case of a 44-year-old -male who presented with biliary colic. His pre-operative imaging confirmed the diagnosis of the duplicated gall bladder, and he underwent successful laparoscopic cholecystectomy.
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COVID-19: No end to controversies p. 38
Mahendra Singh, Yogesh Bahurupi, Abhishek Sharma, Bhavna Jain, Surekha Kishore, Pradeep Aggarwal, Ajeet Singh Bhadoria
The pandemic of COVID-19 is a global public health emergency which has seriously affected India. Poor and marginalized sections of the society have been affected the most. This relatively new disease is still evolving in various parts of the world with lots of implications like global socioeconomic disruption. In this article we have attempted to enumerate and discuss the evidence, for and against, regarding some of the commonly reported controversies regarding our management strategies in India. We collected information from various databases published by the World Health Organization (WHO), Indian Council of Medical Research (ICMR) and Ministry of Health and Family Welfare. Newer clinical, epidemiological and laboratory guidelines to control the corona virus are constantly being generated and updated but there is less understanding of the urgent need for strengthening our public health infrastructure.
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Medical education in India p. 42
Ravi Kant, Vartika Saxena, Jayanti Pant
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Dr. Prem Kumari Mishra p. 45
Ravi Kant
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Saddle bag urethral diverticulum in an elderly female – 'Female prostate sign' p. 46
Sonal Saran, Sumit Kumar, Ankur Mittal
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Combating the COVID-19 pandemic: 'Lockdowns' help in working out the solution p. 48
Sabyasachi Behera, Smrutiranjan Nayak
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Combating the Coronavirus disease 2019 pandemic: 'Lockdowns' amplify the problem p. 51
Subhra Rajat Balabantaray, Archisman Mohapatra
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How to do it: Living donor liver transplantation p. 54
Puneet Dhar, Abhishek Agrawal, Sudhindran Surendran, Unnikrishnan Gopalakrishnan, Samiran Nundy
Use of living donor has expanded the pool of potential transplant recipients. We have outlined here the indications, contraindications, donor workup and surgical technique of modified right liver graft retrieval, recipient hepatectomy, benching and recipient implantation in brief.
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My ideal medical college p. 61
Pranjal Garg
An ideal medical college not only delivers medical education but also introduces new trends in medicine. There are numerous elements of an ideal medical college. In this article, a comprehensive list of some of the elements is given, which are often ignored by medical students and medical institutions. The list includes acceptance to change, medical research, technical advancements in medicine, communication skills, public health, some structural changes in medical education, teaching methods and assessment of students, burnout and mental health issues among students. However, this list is not exhaustive, and only continuous feedback can help a medical establishment to reach the epitome of idealism.
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The doctor I want to be p. 65
Oshin Puri
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