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   Table of Contents - Current issue
January-June 2020
Volume 7 | Issue 1
Page Nos. 1-55

Online since Thursday, June 11, 2020

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A report on the requirements of rigorous research p. 1
Sanjeev Kumar Jain, Ummi Afifa, Sonika Sharma
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Tryptase: A novel prognostic biomarker in chronic myeloid leukemia p. 3
Anisha Mathew, Manisha Naithani, Uttam Kumar Nath
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of the Philadelphia chromosome. It is treated with tyrosine kinase inhibitor agents targeted against the breakpoint cluster region-Abelson murine leukemia 1 fusion transcript. Disease risk stratification at diagnosis of chronic-phase (CP) CML is done using Sokal, Hasford, and EUTOS scores which use basophilia as a major component. However, basophil counts can be both variable and inaccurate. The serum tryptase level is being studied as a novel biomarker which represents the total basophil compartment. Tryptase, deriving its name from trypsin-like activity commonly expressed by mast cells, and also by immature basophils of patients suffering from various myeloid and leukemic disorders, has a role in tumor proliferation. Patients with seemingly low-normal levels of basophils and raised tryptase levels progress further in disease despite treatment. There is a recent interest in the role of serum tryptase as a prognostic marker in CML-CP.
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A clinicopathological analysis of bone and soft tissue sarcoma in children and young adults: Time to adapt with the rapidly changing landscape? p. 7
Abhishek Basu, Debottam Barman, Shinjini Chakrabarty, Janmenjoy Mondal, Bhukya Swetha, Ansuman Bhattacharjee, Ipsita Chakraborty
Context: Primary bone and soft-tissue sarcomas (STSs) are rare tumors, comprising <1% of overall adult cancers. Despite its heterogeneous molecular profile, multimodality management of these tumors has led to the 5-year overall survival (OS) benefit, from approximately 50% in 1970 to the range of 75%–80% presently, in the adolescent age group. Various hospital-based registries have tried to address the scarcity of data of bone and STSs in Indian context in the last decade, but the number is not encouraging enough to gauge the pattern of care of the disease in children and young adults. Aims: To analyze the predictive and prognostic factors of clinical outcome in bone and STS in children and young adults. Settings and Design: This was a retrospective, single-institutional study from a prospectively maintained database. Subjects and Methods: We enrolled biopsy-proven patients (aged 3–35 years) of bone and STS, attended at our outpatient department during the period of January 2015 to December 2017 and traced till November 2019. Follow-up time was defined by the period from the date of registration to the date of last attendance or death. Statistical Analysis Used: Univariate log-rank analysis and unpaired t-test were used to assess the potential prognostic factors for progression-free survival and OS and further validated by multivariate Cox regression analyses. Results: Tumor size, stage at presentation, and treatment modality were the significant prognostic factors for both bone and STS. Children had better OS with 3-year OS (89.7% vs. 71.8%). Conclusions: We recommend multidisciplinary management with emphasis on early intervention in these tumors.
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Caregiver burden and quality of life in primary caregivers of schizophrenia patients: A cross-sectional study from a tertiary care hospital p. 13
Bilal Ahmad Bhat, Shabir Ahmad Dar, Rouf Ahmad Mir, Arshad Hussain
Background: With a shift in treatment and care of schizophrenia over the years, with more and more patients being treated on an outpatient basis and cared in community, caregivers experience distress in psychological and emotional health, have reduced social contact, have financial difficulties, have low life satisfaction, and have poor mental and physical health. Aims: The aim is to understand the quality of life (QoL) and the extent of burden perceived by caregivers while caregiving a family member with a diagnosis of schizophrenia. Materials and Methods: This was a cross-sectional study. A total of 75 schizophrenia patients and their caregivers were included in this study. Standardized instruments were administered to patients as well as to caregivers to collect data regarding symptomatology in patients and perceived burden and QoL in their caregivers. Results: The mean age of caregivers was 40.49 ± 12.65 years, and of patients was 37.45 ± 9.55. The mean score on the Schizophrenia Caregiver Quality of Life (S-CGQoL) questionnaire was 44.8 ± 8.67. 76% of caregivers had a score <50. QoL was significantly correlated with burden on caregivers (r = −0.478; P = 0.0001) and duration of illness of patients (r = 0.243; P = 0.014). The mean score on Zarit Burden Interview (ZBI) was 38.28% ±11.19. 64% of caregivers perceived mild-to-moderate burden. Caregivers burden was correlated with manifestation of negative symptoms in patients (r = 0.287; P = 0.013). Negative symptom scores significantly predicted the burden perceived by caregivers. Conclusion: Caregivers of schizophrenia patients experience a considerable level of burden which with significant correlations between negative symptoms in patients and scores on ZBI. Negative symptoms in patients were the only predictor of the burden on caregivers. Low QoL with a score of <50 on S-CGQoL was present in two-thirds of caregivers. QoL was related positively to the duration of illness and negatively to the burden on caregivers.
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Introduction of module on informed consent training for interns during compulsory surgery rotation p. 19
Rajneesh Kumar, Tania Moudgil, Rajiv Arora, Ankita Attri, Sahil Singh
Background: The use of consent in patient care is a critical skill it is as essential as any other basic standard on which surgical exercise relies. In the present study, an effort was made to formulate a module for training interns on this skill. Materials and Methods: After taking permission from IEC, 140 interns were enrolled for the study. After needs assessment, a module for training the interns for taking informed consent in all scenarios was prepared and validated. Interns were assessed using directly observed procedural skill (DOPS). Feedback was taken from interns and faculty on training through this module at the end of their posting. Results: A total of 140 interns undertook 3 DOPS each and all the interns performed: nonsatisfactory in DOPS 1 (below 4 in each subcompetency), satisfactorily in DOPS 2 (4–6 in each subcompetency), and satisfactorily in DOPS 3 (6–8). Comparison of DOPS 1, 2, and 3 done was done using repeated measure ANOVA and P value was highly statistically significant (P = 0.000). Comparison of progression of scores showed statistically significant P value (P = 0.000). Conclusion: DOPSs is an effective and feasible assessment tool for assessing interns for taking informed consent.
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An online survey on practice and opinion on preoperative viral serology testing among anesthesiologists, surgeons, and public health professionals p. 31
Tuhin Mistry, Habib Md Reazaul Karim
Background and Objectives: Currently, there is no recommendation or guideline on routine preoperative viral serology testing. This online questionnaire-based survey was conducted to explore the current practice and opinion across the country (India). Methodology: After obtaining permission from the investigators' affiliated institute, a set of 12 questions with multiple choices was sent to the anesthesiologists, surgeons, and public health professionals using the Google Form. The participants anonymously completed this online-based questionnaire. The responses were downloaded in the Excel format and further expressed in absolute number and percentage scale. Interprofessional comparisons were made using Fisher's exact test (INSTAT software from GraphPad Prism Software Inc., La Jolla, CA, USA), and P < 0.05 was considered statistically significant. Results: A total of 1157 e-mails were sent, of which 216 bounced; 22.8% of the remaining responded, the majority (76.3%) were anesthesiologists. One-hundred and eighty-seven (89.9%) responders opined for routine preoperative viral testing: 182 (87.5%) were practicing, while 142 out of the 206 (68.9%) of the responders' hospitals had a protocol in place. Compared to the opinions of public health administrators/community physicians, no statistically significant difference (all P > 0.05) was found between the anesthesiologists and the surgeons. Even the anesthesiologists, as well as the surgeons, had similar opinions and practices (all P > 0.05) except the anesthesiologists who were having statistically significantly higher knowledge about the inability to detect case by serology testing during the window period (P = 0.02). Conclusion: Preoperative viral (hepatitis B virus surface antigen, anti-hepatitis C virus, and human immunodeficiency virus I and II) testing is very rampant as routine, and nine out of ten practitioners opine for the mandatory routine practice in India.
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The effect of malaria-induced serum tumor necrosis factor-alpha on epiphyseal bone formation of rats p. 39
Ato Ampomah Brown, Leonard Derkyi-Kwarteng, Chrissie Stansie Abaidoo
Aim: Malaria infection has long been associated with stunted growth in children and by extension bone formation. There is, however, a paucity of information on the specific factors or substances that are responsible for this observation. The objective of this study was, therefore, to find out whether malaria-induced tumor necrosis factor-alpha (TNF-α) influenced in any way the formation of the epiphyseal bone layer of Sprague Dawley rats. Materials and Methods: Thirty-two Sprague Dawley rats aged 4 weeks were used in this study, and the animals were randomly allocated to four groups (Group A–D), with each group having 8 animals. Animals in Group A were given oral artemether/lumefantrine combination drug only, animals in Group B were inoculated with Plasmodium berghei (NK65) only, those in Group C were inoculated with P. berghei (NK65) and treated with oral artemether/lumefantrine, while animals in Group D were neither inoculated with the malaria parasite nor given artemether/lumefantrine therapy. Blood was drawn from the animals at predetermined intervals to measure serum TNF-α levels. Results: Recurrent bouts of murine malaria caused serum TNF-α levels to be significantly elevated even after the infected animals were successfully treated. The elevated serum TNF-α levels were found to correlate with the amount of bone tissue deposited at the distal femoral epiphysis. Conclusion: Malaria-induced TNF-α most likely delays bone tissue formation and may be a major contributing factor in the development of stunted growth in children.
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Role of diffusion tensor imaging scores in patients with spinal trauma p. 44
Ankur Malhotra, Mohini Chaudhary, Arjit Agarwal, Shruti Chandak, Deepak Singla
Background: Many patients of spinal trauma who have an apparently normal conventional magnetic resonance imaging (MRI) scan ultimately progress to neurological degradation in the long run. Diffusion tensor imaging (DTI) can play a vital role in such patients and can be used to assess the true extent of injury. Aims: The aims are to study the utility of DTI in detecting abnormalities in patients with spinal cord trauma and to obtain DTI scores. Materials and Methods: The study comprised 30 individuals including 20 cases and 10 apparently healthy controls who underwent conventional MRI, followed by DTI of involved spine. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained by planning three regions of interest in the spinal cord at, above, and below the level of trauma. Results: Signal changes in the cord on conventional MRI were seen in 8 cases and were absent in 12. A significant difference was observed in mean FA values at the level of injury in cases without any change in signal intensity in the cord on conventional MRI (0.391 ± 0.12) as compared to controls (0.65 ± 0.165) as well as in mean ADC values in cases (1.534 ± 0.511) and controls (1.132 ± 0.616). Conclusions: DTI is an invaluable modality in assessment of the spinal cord following traumatic injury because it can detect subtle disruption of white matter leading to significant difference in the FA and ADC values.
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Rhombencephalitis secondary to toxoplasma gondii infection: Case report and literature review p. 51
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara, Juliana Oliveira Freitas Silveira
Immunocompetent (IC) individuals with primary toxoplasmosis are usually asymptomatic. However, in some IC, toxoplasmosis can present with brainstem encephalitis. We report an adult female patient with headache associated with worsening coordination. Physical examination showed bilateral, symmetrical, and nontender cervical lymphadenopathy. Toxoplasmosis immunoglobulin G (IgG) and IgM were high, and the IgG antibody avidity pattern was low. The cerebrospinal fluid analysis was requested that revealed a positive polymerase chain reaction results for toxoplasmosis. A brain magnetic resonance imaging (MRI) showed a T1-hypointense left pontine lesion. Pyrimethamine and sulfadiazine were started. After 1 month, the patient had full recovery. Four months after, the individual was admitted due to progressive abnormal eye movements and tremor. Her neurological examinations showed ocular myoclonus and Holmes tremor. A second brain MRI showed hypertrophy of the ipsilateral inferior olivary nucleus. In the follow-up, her symptoms decreased mildly. The tremor was managed with clonazepam and levodopa. Furthermore, immune suppression investigation was negative.
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Retraction: Oxidative stress and biomarker of tumor necrosis factor alpha, malondialdehyde, and ferric reducing antioxidant power in hypertension p. 55

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