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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 18 | Issue 2
Page Nos. 71-150

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EDITORIAL  

The havoc caused by the second wave of COVID-19 in India p. 71
Raju Vaishya
DOI:10.4103/am.am_36_21  
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ORIGINAL ARTICLES Top

Awareness of hand hygiene among physicians at Benghazi Medical Center during COVID-19 pandemic. A cross sectional study p. 73
Khaled D Alsaeiti, Sanad M A. Benali, Mohamed A Hamedh, Salem A Ibkhatra
DOI:10.4103/am.am_119_20  
Introduction: Hands of the physicians play a significant role in the transmission of nosocomial infections; the aim of the current study is to describe the physician's knowledge regarding hand hygiene (HH) and their compliance to that during their daily round. Materials and Methods: A cross-sectional descriptive study was conducted among physicians working at Benghazi Medical Center during May 2020. We used WHO's HH questionnaire for healthcare workers. The maximum score obtainable for knowledge was 25. The practice of HH was assessed by a self-designed questionnaire. Results: A total of 250 out of 276 giving a response rate of 90.5%. Physicians with work experience of 5 years or less constituted the highest involved group (68%). Based on the WHO HH questionnaire a moderate level of knowledge prevailed (45.2%) followed by a good (36%) and poor (18.8%) level of knowledge respectively, and as expected the highest level of good knowledge was found among those with more than 10 years of work experience. Regarding HH practice, most of the studied group prefer to use alcohol-based hand rub routinely 112/250, the same findings regarding Frequency of performing HH in the daily round. Strangely 182 (72.8%) say that HH is effective in controlling COVID-19 while only 134 (53.6%) say that protects physicians against COVID-19, though in their knowledge, most of our physicians prefer to perform quick HH method. Conclusion: HH is an important tool for the prevention of the COVID19 pandemic. The overall knowledge and practice of HH were moderate to good among study subjects and few numbers of physicians had attended formal training about HH in the last 3 years. These findings indicate that our physicians require increased emphasis on HH
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Association of menstrual patterns with perceived stress score in college-going female students of a South Indian Town p. 76
Panneerselvam Periasamy, V Suganthi, Ponmurugan Karuppiah, Sasikala Gunasekaran, A Chandrabose, KC Subha, P Thamizhvanan
DOI:10.4103/am.am_29_21  
Background: A natural phenomenon involving the discharge of blood through the vagina from the uterus, occurring at more or less monthly at regular intervals during the reproductive life of females is called menstruation. A normal menstruation occurs for the first time in the adolescent period between 11 and 14 years of age generally, with a period length of around 7 days, with a normal cycle length ranging between 21 and 45 days with an average blood loss of 20–80 ml. Materials and Methods: This was a cross-sectional study of 3-month duration (February 2019 to June 2019), in which 291 students from the various courses including medical, nursing, physiotherapy, and art and science students of a tertiary care hospital participated. Results: Two hundred and ninety-one students were included in the study, among which the age of the students was between 18 and 23 years of age with the majority of students between 20 and 21 years (43.99%). Most of them belong to rural backgrounds (40.55%) and majority of them are day scholars (86.25%). Discussion: This study was pointed to find a relation between stressful life events and menstrual patterns among college-going students of different courses of undergraduate college. Previous studies till now have reported a higher percentage of distress among postgraduates (32.8%) and resident doctors of hospitals (36.4%). Conclusion: Despite high levels of stress in undergraduate students, other factors can also play a significant role in maintaining their menstrual cycle.
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Isolation and characterization of microbial population associated with industrial waste effluent and their antibiotic sensitive pattern p. 80
Aakash Shukla, Mahesh Chandra Sahu
DOI:10.4103/am.am_23_21  
Background: Both organic and inorganic chemicals are deposited in industrial effluents, which contain radioactive, metals, antibiotics, and carcinogenic substances. These effluents are directly or indirectly affecting the daily life of human. Through food chains, it migrates to human health and cased different diseases with different drug-resistant strains. Materials and Methods: Fifty-five industrial waste effluent samples were collected from waste effluent sites serially diluted and documented CFU from individual effluents and subcultured for isolated colony on nutrient agar plate, and then, grown bacteria were identified with culture morphology and biochemical tests. Disc-diffusion method was used for antibiotic sensitivity pattern of isolated bacteria. Results: From 55 industrial waste samples, total 13 different types of bacterial strains were found from industrial waste effluent. Among all isolated bacteria, Pseudomonas sp., Staphylococcus epidermidis, Pseudomonas aeruginosa, Bacillus sp., Acinetobacter sp., Staphylococcus aureus, Micrococcus sp., Citrobacter sp., Shigella sp., and Escherichia coli. Moreover, also 2 Aspergillus sp. and 2 unidentified fungus were revealed from this study. Antibiotic sensitivity pattern revealed that all the organisms show 100% resistant to amoxiclav, 71% resistant to ampicillin, 43% resistant to oxacillin antibiotics, 23% resistant to streptomycin, and 15% resistant to both gentamycin and tetracycline antibiotics. Furthermore, we revealed 31% methicillin-resistant Staphylococcus aureus from industrial waste, whereas rest 69% revealed methicillin-susceptible Staphylococcus aureus strain. All the Gram-positive strains are shown highly resistant against beta-lactam group antibiotics. Conclusion: Our findings raise potential public health concerns for industrial waste effluent. Workers and individuals exposed to reclaimed wastewater. Because of increasing use of reclaimed wastewater, further study is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater.
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A retrospective analysis of the prosthetic joint infections of the hip and knee at a tertiary care center of India p. 85
Suresh Babu, Raju Vaishya, Hena Butta, Raman Sardana, Leena Mehndiratta, Yashpal Gulati, Yatinder Kharbanda, Havind Tandon
DOI:10.4103/am.am_9_21  
Introduction: An increase in the number of primary total joint arthroplasties has correspondingly led to an increase in revisions as a result of various complications. The prosthetic joint infection (PJI) is a major complication with concordantly increased morbidity and costs. Through this study, we aimed to determine the bacteriological profiles of PJI diagnosed at our institute and analyze them in the context of patient profiles, joints affected, and the center where the index procedure was done. Materials and Methods: A retrospective study of the revision surgeries for PJI in hip and knee arthroplasties during the period between 2014 and 2019 was conducted. An analysis of 43 patient profiles, with 29 of those being knees and the rest 14 being hips was done, concerning the clinical picture, microbiological profile, and co-morbidities. Results: PJI constituted 31.03% of the revision cases. The knee joint was involved in 67.44% (n = 29) and the hip joint in 32.56% (n = 14). Early infection was seen in 2 (4.65%) and late infections in the remaining 41 (95.34%). 51.66% (n = 22) were culture-positive PJI, whereas 48.34% (n = 21) were culture-negative (CN) PJI. Preoperative C-reactive protein was elevated in 46.51% of the patients (48.27% knees and 42.87% hips). The erythrocyte sedimentation rate was preoperatively elevated by 65.12%. Of the comorbidities PJI was associated with, diabetes mellitus in 30.23%, hypertension in 39.53%, hypothyroidism in 16.28%, skin disorders in 4.65% (psoriasis and eczema), and immunosuppression in 4.65% cases. Conclusions: Microbial growth on routine culture is not mandatorily positive in several clinically suspected PJI. Hence, a stringent protocol requires to be followed in the use of antibiotics, the collection and transportation of samples, and in the selection of media for cultures in the cases of PJI. Notwithstanding the limitations of this study, we conclude that bacterial infections do not follow any predictable patterns, and constant vigilance with a low threshold to suspect and investigate PJI is needed in the management of PJI. We propose based on our study findings that no antibiotics should be used only after a bacteriological diagnosis and antibiotic sensitivity is obtained, else it results in a high rate of CN PJIs.
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Need for appropriate hospital attire in orthopedic patients p. 93
Yashpal Gulati, Prince Raina, YS Suresh Babu
DOI:10.4103/am.am_10_21  
Introduction: Literature review shows multiple studies on the role of physician attire on patient perceptions. These studies came up with the conclusion that specific dress design might improve the patient-physician bonding. A less likely studied factor in literature was the design of patient attire. The present study aims to design and assess the efficacy of ORTHO dress in orthopedic specialty patients. Patients and Methods: The study population includes 136 patients (62 males and 74 females) presenting to the in-patient department and admitted under orthopedic specialty over 6 months from September 2018 to February 2019 with upper and lower limb illness. The picture-based survey of patient’s preferences regarding choice of attire was conducted on the 3rd day of hospital stay. Results: The mean age of patients was 42.26 ± 10.24 years. The age distribution involves 78 cases (57.35%) were between 15 and 60 years and 58 cases (42.64%) were more than 60 years of age The results show that 124 patients (91.17%) preferred ORTHO dress when dress choice was given when compared with usual hospital dress. Chi-square analysis was used as a test of significance. P < 0.05 was considered statistically significant. Conclusion: Patient attire is the least studied parameter in the medical literature. The influence of specific specialty on patient’s attire is never studied. The ORTHO dress being newly designed and used in orthopedic patients involving upper and lower limb illness plays important role in patient management and has a role in providing better nursing and postoperative rehabilitative care.
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REVIEW ARTICLES Top

Developing an educational research questionnaire to enhance the generalizability of survey findings p. 99
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/am.am_7_21  
In general, most of the researchers in the field of medicine carry out research work in their area of specialty and not give much attention toward educational research. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of five articles were selected based on the suitability with the objectives of the current review. It won't be wrong to document that the majority of the educational research is carried out in the form of an educational survey using questionnaire as the data collection tool. However, the reality is that more often than not the questionnaires are poorly designed and does not adopt a rigorous approach to its construction. This calls for the need to adopt a standard approach while designing the questionnaire so that all the study participants identically interpret the questions and give their responses correctly. In conclusion, it is essential for the researchers to use a validated and reliable tool for conducting an educational survey. This can be ensured by strictly adhering to the proposed steps as it significantly improves the quality of the questionnaire used in medical education and thereby enhance the probability of collection of comprehensive data.
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Optimal diagnostic strategy for coronavirus disease 2019 detection in liver transplant recipients: Critical review of available evidence p. 101
Michael T Olson, Tania Triantafyllou, Saurabh Singhal
DOI:10.4103/am.am_20_21  
Liver transplant recipients may face an unusually high risk for coronavirus disease 2019 (COVID-19). Observations of heightened risk, rapid progression of severe complications, greater infectivity, and potential for atypical disease presentations in transplant recipients underscore the critical importance of establishing an early diagnosis. Existing diagnostic approaches are marred by unreasonably high false-negative rates. Given the concerns for false-negative results, we performed a narrative review in effort to compile evidence for and against an optimal diagnostic algorithm for detecting COVID-19 in liver transplant recipients. In this algorithm, patients are triaged according to risk of severe acute respiratory syndrome coronavirus 2 infection. Initial testing is performed with reverse transcriptase-polymerase chain reaction, followed by chest computed tomography after 4 days. Repeat tests are performed as per the risk category, patient status, and urgency of transplant. Liver transplant centers should validate the algorithm presented herein, which is based on existing evidence and designed to maximize patient and provider safety, while assuring accuracy in diagnosis.
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The COVID-19 vaccine: A race nearing the finish line p. 111
Tarun Kumar Suvvari, Siddhi Hegde, Shreya Sreeram, LV Simhachalam Kutikuppala
DOI:10.4103/am.am_18_21  
The impact of the coronavirus disease-2019 (COVID-19) pandemic on global health and the economy is so extensive that it has driven several countries to go on a quest for a vaccine. The evaluation of future generation vaccine platforms is the need of the hour. In the majority of nations, innovative technology is being used to hasten the vaccine development process. The evolution of a safe and effective vaccine takes time. The journey from its genesis to making the final product available to the public is a tedious course of action. Vaccines generally function by mimicking the infectious agent, which can be a bacterium, virus, or other microorganisms that cause disease. The characteristic feature of the COVID-19 vaccine development is the use of a wide array of technology platforms, including the virus-like particle, peptide, nucleic acid (DNA and RNA), viral vector (replicating and nonreplicating), live attenuated virus, an inactivated virus, and recombinant protein in the process of vaccine preparation. Despite the hurried nature of their current development, all COVID-19 vaccines being developed will receive regulatory approval only if they meet the rigorous safety and efficacy standards. Effective and productive global co-ordination and co-operation between the vaccine developing agencies, regulating authorities, policymakers, governments, funding organizations, and public health bodies are essential to ensure the large-scale manufacturing and equitable distribution of promising end-stage vaccine candidates. Besides various concerns on the safety and efficacy of various COVID-19 vaccines, the vaccination drive had successfully started in most developed and developing countries in the global race to vaccinate the people.
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Telegenomics: Relevance in India p. 122
Krishnan Ganapathy
DOI:10.4103/am.am_26_21  
Telegenomics, the application of telemedicine for genetic counseling (GC), has considerable growth potential in the India of today. Increasing awareness of preventive medicine, gradual acceptance of telehealth, and widespread availability of reliable good connectivity make remote GC eminently doable. This India-centric review summarises the necessity and importance of telegenetic counseling. In addition to the review of relevant appropriate current literature in this ultra-niche area, the author brings a holistic view, based on his 22 years of personal experience in the field of Telehealth in India. The communication highlights that whatever can be accomplished in a direct face-to-face consultation can be achieved in a virtual session. Following an overview of medical genetics in India and a global survey of GC, the components of and clinical indications for GC are highlighted. Advantages of telegenomics and training facilities in GC are discussed. The necessity to be future-ready in a changing world of “new normal” contactless medicine is stressed.
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Resistance of heavy metal and antibiotics at industrial effluents and agriculture stagnant water p. 127
Twinkal M Patel, Mahesh Chandra Sahu
DOI:10.4103/am.am_16_21  
Industries are developed day by day. It is required for the development of the country, but industrial pollution is the major problem worldwide. Industrial effluents contain organic, inorganic, radioactive, metals, antibiotics, and carcinogenic substances. Effluents directly or indirectly contact with drinking water and agricultural water and affect human health. Due to metal and antibiotic polluted environment, bacteria developed special resistant mechanism against heavy metal and antibiotic. In future, these bacteria easily survive in high dose and affect humans and agricultural land.
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Facilitating learning among medical students amid the ongoing coronavirus disease 2019 pandemic p. 132
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/am.am_133_20  
The ongoing coronavirus disease 2019 (COVID-19) pandemic has accounted for significant implications on all the public health institutions, and the same stands true for medical colleges. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 12 articles were selected based on the suitability with the current review objectives. Owing to the fact that the disease spreads predominantly by close contact and airborne mode, it was decided to close the medical colleges for students. Although such immediate actions prevented any major outbreak among medical students, owing to the uncertainty about how the pandemic will unfold, the pandemic accounted for a major impact on the effective delivery of medical education. The initiation of online mode of teaching–learning was not easy for all the medical colleges, and there were lots of issues pertaining to the resource constraints and the administrative support. In conclusion, the COVID-19 pandemic has disrupted the delivery of medical education to a remarkable extent. Although there have been challenges to deal with, then there have been multiple opportunities as well to ensure that the teaching continues and the students remain engaged.
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CASE REPORTS Top

Imaging in chronic posterior dislocation of the elbow: A rare entity p. 135
Reddy Ravikanth
DOI:10.4103/am.am_5_20  
The elbow is a complex joint, and traumatic dislocation of the elbow is the second most common major joint dislocation in adults more commonly occurring in athletes. Initial investigation of the suspected elbow dislocation includes radiographs in anteroposterior, lateral and oblique views. This case report describes chronic posterior dislocation in a 58-year-old woman and also describes the magnetic resonance imaging anatomy of the elbow joint. Timely intervention can alleviate symptoms and can prevent deformity and neurovascular sequelae.
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Migration of a broken kirschner wire to the popliteal fossa following tension band wiring of a patellar fracture p. 138
Abhishek Vaish, Aabid Husain Ansari, Amit Kumar Gupta, Raju Vaishya
DOI:10.4103/am.am_12_21  
Kirschner wires (K-wires) are commonly used in the orthopedic trauma practice and liable to breakage and migration. We report the case of a middle-aged man with the migration of K-wire to the popliteal fossa after 11 years of patella fracture fixation and describe the technique of removal of the migrated and retained K-wires. A regular radiographic follow-up should be done to identify the presence of hardware breakage or migration following the use of K-wires. Once the wire migration is identified, it should be removed on an urgent basis regardless of symptoms, to avoid any major or minor complications.
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Computed tomography diagnosis of posterior rectus sheath hernia causing intermittent small bowel obstruction p. 142
Aruna Raman Patil, Madhukar Medipally, Amit Bansal, Nilotpal Chakma
DOI:10.4103/am.am_17_21  
Hernias of the posterior rectus sheath are a rarer type of interparietal hernia with only few cases reported up to date. Majority are postsurgical and posttraumatic. Clinical diagnosis may be challenging and imaging is often utilized for diagnosis. Computed tomography (CT) is the preferred imaging technique as it maps out the type, extent, contents, and associated complications. We report a case of posterior rectus sheath hernia with small bowel obstruction diagnosed on CT and managed successfully using laparoscopic primary repair.
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LETTER TO EDITOR Top

Diagnosis of quadriamniotic quadruplet gestation following spontaneous conception: Sonological appearance p. 146
Reddy Ravikanth
DOI:10.4103/am.am_134_20  
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Harlequin syndrome secondary to thoracic spinal tuberculosis p. 148
Raghav Gopal Poduval
DOI:10.4103/am.am_6_21  
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IMAGES IN MEDICINE Top

“Contact Lens” cornea in peripheral ulcerative keratitis p. 149
Sunny Chi Lik Au, Simon Tak Chuen Ko
DOI:10.4103/am.am_1_20  
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