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   Table of Contents - Current issue
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July-December 2020
Volume 7 | Issue 2
Page Nos. 57-169

Online since Tuesday, December 22, 2020

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REVIEW ARTICLES  

Romosozumab: A new anabolic arrow in quiver for management of osteoporosis Highly accessed article p. 57
Alok Singh, Dhyuti Gupta
DOI:10.4103/ami.ami_68_20  
The multifactorial disease of the elderly, characterized by accelerated bone loss and a high risk of fracture (even with trivial trauma), osteoporosis, is known to primarily affect postmenopausal women. Moreover, the precipitating factors for the same mainly are the hormonal and nutritional deficiency. Clinically, the most common fracture to be encountered is the vertebral compression fracture. Apart from exogenously supplementing calcium and Vitamin D, a diverse group of drugs (bisphosphonates, denosumab, teriparatide, strontium ranelate, raloxifene, and calcitonin) are available to manage the case of osteoporosis. The latest drug to be approved and included in this quiver is a sclerostin-targeting monoclonal antibody, romosozumab. This new drug appears to be promising in managing the postmenopausal patients of osteoporosis. Although the array of adverse effects is not well recognized, a black box warning has been issued for this drug in reference to contraindicated use in patients with comorbid myocardial infarction. The intent of the authors for this review is to discuss the pharmacological profile of romosozumab, with particular emphasis on supportive clinical trials as well as the adverse drug reactions associated with its use.
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Laboratory findings in COVID-19 patients and biomarkers for early assessment of severity and mortality p. 63
Asbah Shams, Madhu Sinha, Abhijit Das, Natasha Gulati, Rani Sahu, Man Mohan Mehndiratta, Chandra Shekhar
DOI:10.4103/ami.ami_69_20  
The novel coronavirus-19 (severe acute respiratory syndrome coronavirus-2) pandemic has crossed more than 4,006,257 cases with 278,892 deaths worldwide and 67,152 cases and 2206 deaths in India. The disease has a variable clinical course ranging from mild to severe disease. Although most of the patients are asymptomatic, some patients with comorbidities have a high propensity of clinical worsening and mortality and it is this chunk of patients that we need to recuperate. Studies have shown that a number of laboratory parameters, which are easily available and inexpensive, can adequately predict the disease severity at an early stage. In a resource-limited country like India, where costly investigations cannot be routinely carried out in the magnitude as big as that of this pandemic, it is imperative that patients be monitored with these simple and inexpensive parameters that are elucidated in this review. We carried out an electronic search on PubMed and Google Scholar with keywords “laboratory abnormalities in COVID-19,” “coagulopathy in COVID-19,” “sepsis in COVID-19,” “hematologic abnormalities in COVID-19,” “kidney injury in COVID-19,” “acute respiratory distress syndrome in COVID-19,” “cardiac injury in COVID-19,” “liver injury in COVID-19,” and “severity indicators in COVID-19” till present date (May 11, 2020). All studies that appeared in our search results were scrutinized and 40 studies were selected for the study.
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ORIGINAL ARTICLES Top

Dissatisfaction and problems in marital life of spouses of patients with bipolar disorder: A cross-sectional study from a tertiary care hospital p. 69
Bilal Ahmad Bhat, Rouf Ahmad Mir, Arshad Hussain, Iqra Rasheed Shah
DOI:10.4103/ami.ami_153_20  
Introduction: The objective was to understand the marital dissatisfaction/satisfaction and problems in different areas of marital life in spouses of patients with bipolar disorder (BD). Materials and Methods: In this cross sectional descriptive study on BD patients and their spouses, a semi structured questionnaire was used to collect sociodemographic details. Couple satisfaction index (CSI) was used to identify marital satisfaction or dissatisfaction, whereas problem areas questionnaire (PAQ) was used to identify areas in which spouses of BD patients were often dissatisfied or have disagreements about their partner's behavior. Results: A total of 170 BD patients, along with their spouses, were included in our study. Marital dissatisfaction was present in 104 (61.2%) and there was no significant relation with sociodemographic variables except for the number of children (P = 0.002). Mean scores on CSI and PAQ were 42.75 ± 17.32 and 28.91 ± 11.28, respectively, with a significant negative correlation between these (r =-0.712; P = 0.0001). Handling family finances; rearing children or parenting, career/job related decisions, demonstrations of affection, handling household tasks, spending recreation leisure time together, moodiness/temper/emotionality, and problems in sex relations were important areas in which partners of BD patients were facing a significant problem. Conclusions: Marital dissatisfaction was very common in spouses of BD patients and they faced a lot of problems in various areas of their lives. As clinicians, we need to evaluate and understand the issues related to the marital life of normal spouses of BD patients to provide emotional and practical support to them, individually as well as couples.
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Awareness and attitude about heart transplantation among undergraduate nursing students: An institution-based survey in India p. 76
Suresh K Sharma, Hemlata Sadhanu, Manisha Naithani, Anshuman Darbari, Jyoti Bharadwaj, Maneesh Sharma
DOI:10.4103/ami.ami_152_20  
Introduction: Heart transplantation is the currently available and established lifesaving therapy for the end stage heart failure. Considering the paucity of data about nurses' awareness and attitude about heart transplantation, this survey was undertaken. The aim of this study was to assess the awareness and attitude regarding heart transplantation among undergraduate nursing students. A questionnaire based cross sectional survey was conducted among undergraduate nursing students studying in an institute of national importance in India. Materials and Methods: A prevalidated questionnaire was administered among 147 randomly selected participants who were willing to participate in the study. Results: All the students (100%) were aware about organ donation, but majority (77.5%) informed that their source of information on this topic is by Internet/media. Around 18.4% of participants had already pledged permission for organ donation after death and 70.8% were willing to donate the organ after death. Conclusion: Results showed the gap existence and need of addressing this among undergraduate nursing students regarding organ donation and heart transplantation.
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Selfitis, narcissism, and emotional intelligence: Eliciting the interrelation among medical students in Kolkata, West Bengal Highly accessed article p. 81
Soumalya Ray, Tanmay Kanti Panja, Dipta Kanti Mukhopadhyay
DOI:10.4103/ami.ami_149_20  
Introduction: Selfitis, the obsessive behavior to take and share one's own photographs, is a popular activity among young adults. It is growing with the availability of cheap data and free social network services. Scientific literature considers it as an effort to emphasize self-importance in the context of inadequate social support. The aim was to assess the burden of selfitis among medical students and to identify factors associated with it. This cross-sectional study was conducted among 166 students of a medical college in Kolkata, from December 2019 to March 2020. Materials and Methods: The level of selfitis was assessed using the Selfitis Behavior Scale (SBS). Narcissism was evaluated using Narcissistic Personality Inventory-16 and emotional intelligence (EI) was assessed using the mind tool EI questionnaire. Quantitative data were expressed as mean (±standard deviation) or median (±interquartile range) and qualitative data were expressed in frequency and percentage. Binary logistic regression was done with the level of selfitis as a dependent variable and narcissistic trait, EI, and other sociodemographic, individual characteristics as the independent variable. Results: Around one-third (35.5%) of the respondents had borderline selfitis according to SBS. None of the respondents had acute or chronic selfitis. Perceived presence of recreational activity (adjusted odds ratio [AOR] - 15.71), availability of pocket money (AOR - 69.42), family support (AOR - 6.30), and narcissistic trait (AOR - 3.94) were positively associated with borderline selfitis. Conclusions: Around one-third had borderline selfitis. Narcissism and lack of perceived family support were found to be associated with it.
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Impact of COVID 19 lockdown on the study of medical students: A cross sectional survey p. 86
Jolly Agarwal, Sonam Maheshwari, Anurag Agrawal, MK Pant, Yatika Chaudhary, Manisha Naithani
DOI:10.4103/ami.ami_148_20  
Introduction: During the pandemic of COVID 19, the traditional teaching of MBBS students has been shifted to online teaching. We conduct an online survey to know and record the impact of COVID 19 lockdown on the study of medical students of GDMC, Dehradun. The present study aimed to investigate the MBBS student's perception of online teaching. The results of this study may provide further inputs which might be of help to the students and faculty for further informed decisions. Materials and Methods: A cross sectional online survey during July 1–7, 2020 was applied to 334 medical students to evaluate the perception of online teaching among medical students. A questionnaire was prepared in Google form and divided into two sections. The first part covered demographics information of the respondent and the second part assessed with behavior and attitude toward online teaching. Results: The mean assessment, behavior, and attitude scores have significantly differed across age groups and previous experience. The medical students who had no exposure to online teaching their assessment score is higher than who had little exposure also found to be significant. The participants were agreed with the teaching way of the course (59.3%) and with the content of the course (56.9%). Majority of participants (58.4%) also agree that there are barriers in online learning. Most of the students agree (62.3%) and strongly agree (61%) that the course allowed them to take responsibility for their learning. Conclusions: We can conclude that the online learning program is a good alternative to classroom teaching in this era of the COVID 19 pandemic. This study can provide the basic architecture for making further strategy of course content.
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Prevalence of temporomandibular disorders in individuals seeking treatment at dental hospital: A cross-sectional study p. 90
Varsha Kanjani, Neel Gupta, Akash Bhatt, Mehak Tariq, Ajaz Ahmed, Kanchan Malawat
DOI:10.4103/ami.ami_146_20  
Introduction: Temporomandibular disorders (TMDs) being the most prevalent orofacial condition, is one of the major reason for patients to seek conservative intervention at dental hospital. The multifactorial etiology of TMDs along with the wide spectrum of associated signs and symptoms, mainly orofacial pain, restricted mouth opening, and deviation, has made the condition difficult to diagnose. The aim of the present study is to determine the signs and symptoms associated with temporomandibular disorders according to Research Diagnostic criteria for Temporomandibular disorders (RDC/TMD). Materials and Methods: The present cross-sectional study was conducted at dental hospital, Rajasthan among 1450 individuals. The 209 individuals, above 18 years of age who met the inclusion criteria were enrolled in the study. Along with signs and symptoms of TMDs (VAS score for orofacial pain, clicking sound, crepitus, reduced mouth opening (less than 40 mm), joint deviation and tenderness, etc.) the structured questionnaire according to RDC/ TMD were also assessed. The data was analyzed using Statistical Package for the Social Sciences version 21 software. Results: In the present study population, the prevalence of TMDs was 14.41% only. Most of the patients were in 2nd decade (33.01%) with female predilection (69.85%). The VAS score for patients complaining of orofacial pain (58.85%) was 6.32±1.12 with reduced mouth opening in 42.58%. According to RDC/TMD, the most common finding observed was TM joint deviation (63.15 %), followed by clicking sound (56.93%), crepitus (46.41%), MPDS (12.91%), internal derangements (10.52%) and osteoarthritis (6.22%). Conclusion: The prevalence of TMDs was more prevalent in younger generation, especially with female predilection. The most common signs and symptoms seen in the present study were orofacial pain, followed by reduced mouth opening, TMJ deviation and clicking sound.
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Cord blood lactate levels as marker for perinatal hypoxia and predictor for hypoxic ischemic encephalopathy p. 93
Ashish Kumar Simalti, Vandana Negi, Anil Kumar, Suman Kumar Pramanik
DOI:10.4103/ami.ami_144_20  
Introduction: This study was conducted to find if cord blood lactate correlates well with Apgar score and umbilical cord blood pH and subsequent development of hypoxic ischemic encephalopathy (HIE). Materials and Methods: It was a cross sectional, observational study which was conducted at a tertiary care referral center of North India from June 2018 to June 2019. Monitoring of cord blood lactate levels along with Apgar and cord blood pH was done for correlation of cord blood lactate with Apgar, cord blood pH, and subsequently development of HIE. Results: During the study period, 115 term neonates got enrolled based on inclusion criteria. Out of these, 83 babies had some degree of HIE based on Sarnat staging. Among these 83 neonates with encephalopathy, 36 had Stage III HIE while, 28 and 19 babies had Stage II and Stage I encephalopathy, respectively. Lactate levels correlated negatively with Apgar score and umbilical cord blood pH and higher levels of lactate correlated well with lower Apgar and cord blood pH. The mean lactate level was significantly higher in cases with HIE (5.18 mmol/L) as compared to cases without HIE (2.91 mmol/L). Conclusion: Our study shows that cord blood lactate can be used as a predictor for perinatal hypoxia. With the availability of cheaper handheld lactate monitors, lactate monitoring may become more practical option and need to be explored.
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Treatment outcome of percutaneous nephrolithotomy: The initial experience from a tertiary care Center p. 97
Ifrah Ahmad, Irshad Ahmad, Arif Hamid, Erum Khateeb
DOI:10.4103/ami.ami_134_20  
Introduction: The purpose of the study was to assess the operative characteristics and treatment outcome of percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi at our hospital. Materials and Methods: Patients with significant size symptomatic renal calculi not manageable by conservative management and those with calculi resistant to extracorporeal shock wave lithotripsy (ESWL) were included in the study. Patients excluded from the study were those with significant coagulopathy, active upper urinary tract infection, and renal calculi in ectopic kidneys. Results: Our study group had a mean age of 42.46 ± 11.29 years. Nearly 60% of stones in our study were of size 21–30 mm in the longest diameter with mean stone diameter of 24.56 ± 7.809 mm. Mean hemoglobin drop following the procedure was 1.35 ± 0.843 g/dl. Mean operative time was 93.56 ± 9.90 min. We had an overall success rate of 83.5% in our study. Fourteen failure cases were managed by ESWL (ten cases), second look PCNL (three cases), and by open surgery (one case). Conclusion: Although we find a higher frequency of minor complications such as transient mild hematuria (37.6%), mild puncture site pain (55.3%), or low-grade fever (24.7%), no major or long-term side effects were observed in our series.
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Infectious granulomatous dermatitis: Clinicohistopathological study with some unusual clinical presentation p. 102
Praneeta Jaswant Singh, Ambrish Kumar
DOI:10.4103/ami.ami_130_20  
Introduction: Granulomatous dermatitis has a varied differential diagnosis ranging from infectious etiology to immune mediated diseases. In tropical countries like India, infectious etiology forms an important cause of granulomatous dermatitis with tuberculosis (TB) and leprosy being the major contributing factors. The present study was carried out with the aim to determine the frequency of various etiological agents causing infectious granulomatous dermatitis in our hospital setup and to see clinicohistopathological correlation in these cases. Materials and Methods: This is a hospital based retrospective study conducted in the department of pathology over a period of 1 year. All the skin biopsy cases diagnosed as infectious granulomatous dermatitis were retrieved from the histopathology record section for analysis and were categorized based on the causative etiological agents. Special stains were applied wherever necessary in addition to routine hematoxylin and eosin stain. Results: A total of 40 cases of infectious granulomatous dermatitis were included in the present study. Most common diagnosis was leprosy (57.5%), followed by TB (30.0%), actinomycosis (5.0%), dermatophytosis (2.5%), histoplasmosis (2.5%), and cysticercosis (2.5%). Gender wise distribution showed male predominance with 57.5% of cases and age wise distribution showed a peak in the age group of 41–60 years (32.5%). Clinicohistopathological correlation was found in 87.50% of the cases. The unusual clinical presentations were seen in cases of cysticercosis, actinomycosis, and histoplasmosis. Conclusion: Histopathological examination of the skin biopsies is an important diagnostic tool providing definitive diagnosis as well as clinicohistopathological correlation in cases of infectious granulomatous dermatitis.
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Prevalence of modifiable risk factors associated with diabetes in indian adolescents and young adults: A pilot study p. 108
V Venugopal, Judu V Ilavarasu, A Mooventhan
DOI:10.4103/ami.ami_124_20  
Introduction: This was a cross sectional study to understand the prevalence of modifiable risk factors of diabetes among adolescents and young adults in India. Materials and Methods: The pilot study was carried out using a questionnaire based survey. A literature review was performed to explore the common risk factors associated with type 2 diabetes mellitus and a self administered questionnaire was developed and validated. The snowball sampling method was applied and the questionnaire was sent through E mails, social networking sites, and applications. Results: A total of 317 young adults and adolescents, aged between 16 and 25 years, across eight different states of India completed the survey. Among the various risk factors, 64.04% had normal healthy sleeping hours of 6–8 h, and 71.61% happy with the sleep quality. Only 23.08% skipped breakfast more than three times a week and 40.69% reported to consume whole grains every day. About 68.46% had little or no stress. The major concern was the low of physical activity (>150 min/week) and inadequate fruit intake (>1 serving a day) among 75.1% and 81.07% of respondents, respectively. Conclusion: Low physical activity and inadequate fruit intake are the important risk factors prevalent in the given age group.
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Managerial challenges in establishing a structured cardiopulmonary resuscitation program in a small health-care setup p. 113
Jyotsna Agarwal, Jayanta K Das
DOI:10.4103/ami.ami_120_20  
Introduction: Effective cardiopulmonary resuscitation (CPR) program is required in all health care organizations (HCOs). The focus is primarily on technical aspect of CPR training and managerial challenges encountered in establishment of CPR program are not discussed in detail previously. The aim was to study the managerial challenges in establishing a structured CPR program in a small HCO. A prospective, observational study conducted over a period of 3 months. All staff of the HCO was trained in basic life support. Materials and Methods: A CPR committee was constituted which formulated the CPR policy, CPR rapid response teams (CPR RRT), and training protocols and recorded observations during the study period. Statistical Analysis Used: Mean, percentage, and gain score were used for statistical analysis. Results: The major challenges encountered were unorganized work, lack of resources, old building structure with difficult to access areas, lack of knowledge upgradation, and nonmotivated staff. The clinical staff, involved in regular CPRs, although had basic CPR knowledge, they required continual refresher training. The nonclinical staff showed much larger improvement in scores post training. Conclusions: Flexible functional CPR policy with multidisciplinary CPR RRTs, low dose high frequency training, customized crash kits, interdepartmental liasoning, and mock drills were found useful in making “CPR a reflex manoeuvre” and effective implementation of CPR program. Concepts and principles implemented from organizational behavior, leadership, and motivation such as “Herzbergs Motivational hygiene theory” were useful. Continual training of staff is required for consistent delivery of high quality CPR and even nonmedical staff can be trained to provide high quality Basic Life Support (BLS) similar to clinical staff.
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Effect of social and clinical conditions on blood pressure variation in angolans hospitalized with malaria p. 121
Euclides Nenga Manuel Sacomboio, João Andrade Bande, Santo Sebastião Doqui Zua
DOI:10.4103/ami.ami_84_20  
Introduction: Malaria is the leading cause of death in Angola, followed by road accidents, and represents about 20% of hospitalizations in health facilities and about 35% of the demand for curative care. The objective of this study was to assess the effect of social and clinical conditions on the variation of blood pressure in hospitalized Angolans with malaria. Materials and Methods: The study was conducted as a cross sectional and quantitative approach. Results: Of the 333 patients followed, 28% of the patients were normotensive, 50% with moderate hypertension (HTN.1) and 20% with severe hypertension, in the first 48 hours of hospitalization. These data changed after 4 days, where in the last 48 hours before the end of the study, 33% of patients were normotensive, 56% were moderate hypertensive (HTN.2) and 11% were severe hypertensive and the average age of the patients was 27 years old (standard deviation = 9) and the female/male ratio was 153/180, mostly from urban areas in Luanda (76%) and moderate and severe hypertension was more frequent in students, unemployed and business people (72% ). In the first 48 hours, the number of patients with low parasitemia was 42%, with moderate and high parasitemia was 58%. In the last 48 hours before the end of the study, patients with moderate and high parasitemia accounted for only 11% and patients with low parasitemia accounted for 89%, where patients treated with artemether were 90% of the study population and showed significant changes in pressure levels when compared with patients treated with artesunate (10%), the mortality rate was 6%, a large group of them remained hospitalized (63%) and 31% were discharged. Conclusion: In general, many patients with malaria had high blood pressure during hospital admission, and throughout the hospitalization period, in some cases, there was a significant reduction depending on social conditions, parasitemics, and medical and medication treatment.
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Diagnostic accuracy of cardiac biomarkers in chronic kidney disease patients for detecting occurrence of acute coronary syndrome: A comparative study p. 130
Poonam Makhija, Rupinderjeet Kaur, Shaminder Kaur, Paramdeep Singh
DOI:10.4103/ami.ami_81_20  
Introduction: The diagnosis of coronary artery disease or acute coronary syndrome (ACS) is difficult in patients of chronic kidney disease (CKD). This study was planned to evaluate the role of cardiac biomarkers in diagnosis of ACS in such patients. To evaluate the role of biochemical cardiac markers in the diagnosis of ACS in patients with CKD and to study the relation of stage of kidney disease and biochemical cardiac biomarkers. Materials and Methods: Atotal of 350 patients in different stages of CKD were enrolled and subjected to measurement of blood levels of creatine kinase (CK) MB and Troponin I (Trop I). The data were analyzed by dividing subjects into groups based on positivity of biomarkers, presence of electrocardiogram (ECG) changes, and stage of CKD. Results: Sensitivity of CK MB and Trop I was 60.81% and 56.76% and specificity was 72.1% and 83.33%, respectively. Although both showed low positive predictive values, the negative predictive value of both CK MB and Trop I was good. Stage of CKD did not significantly affect the level or positivity of the biomarker in patients with ECG changes. Conclusions: CK MB and Trop I potentially rule out the probability of ACS in patients showing negative test results, which should always be interpreted in light of ECG changes in CKD patients.
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Clinical characteristics of takayasu arteritis: A retrospective study from a tertiary care hospital in North India p. 137
Arun Hegde, Vishal Mangal, Kavita Singh, Kovilapu Uday Bhanu, Anurag Jain, Vivek Vasdev
DOI:10.4103/ami.ami_78_20  
Introduction: Takayasu's arteritis (TA) is a granulomatous vasculitis of the large vessels, mainly involving the aorta and its branches. The disease has diverse manifestations across various ethnic populations. The epidemiological profile of TA has not been well established in India, with existing studies demonstrating varied clinical findings. Materials and Methods: In this retrospective, hospital record-based study, 30 TA patients, meeting 1990, American College of Rheumatology criteria for TA, were included. The study intended to characterize the demographic profile, clinical characteristics, laboratory parameters, imaging findings, and management profiles of TA, amongst patients presenting to the rheumatology outpatient department of a tertiary care hospital in India. Results: The mean age at presentation was 26.4 ± 11.4 years. The male to female ratio was 1:5. The mean duration from onset of symptoms to point of diagnosis was 8.7 ±5.7 years. Upper limb claudication was the most frequent symptom seen in 23/30 (76.7%) patients, followed by syncope in 12/30 patients (79%). The most common arteries involved were the subclavian artery, carotid artery and the renal arteries (counted together). Type 1 and Type V were the most common angiographic subtypes, each seen in ten (33.3%) patients. Methotrexate was the most frequently used conventional synthetic disease modifying anti-rheumatic drug (csDMARD) and was used in 27/30 (90%) patients. A total of five (16.7%) patients required biological DMARDs (bDMARD) in view of refractory disease, four patients received tocilizumab while one patient received infliximab. Conclusion: TA is a female predominant, large vessel vasculitis. The subclavian arteries, followed by the common carotid and the renal arteries, are the most common vessels involved. Tocilizumab is fast emerging as an effective bDMARD for disease control especially in csDMARD refractory cases.
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A study of COVID-19 with limited testing kits p. 143
Manav R Bhatnagar, Anubhav Bhatnagar, Supriti Bhatnagar
DOI:10.4103/ami.ami_76_20  
Introduction: In this paper, we consider a fundamental problem of testing faced by the health staff on testing COVID 19 patients. In general, the number of testing kits or testing capabilities is limited, and the number of COVID 19 patients is much larger than that. This paper tries to answer this fundamental question that how to perform COVID 19 testing to reduce the death rate. Materials and Methods: We consider that the survival rate of patients is dependent over two parameters: their age and severity of symptoms at a time. Based on these observations, we propose a survival rate function. Using the survival rates, the death rate for an individual is obtained. MATLAB was used for plotting the graphs. Results: It is shown by numerical results that by using the proposed mechanism, the average death rate can be significantly reduced. Conclusion: It is proposed to conduct the testing for those patients who lie in the high death rate regimen.
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Cytological evaluation of enlarged peripheral lymph nodes: An institutional experience from kumaon region of Uttarakhand p. 148
Mohd Bilal Ali, Ghazala Rizvi, Ankit Kaushik
DOI:10.4103/ami.ami_67_20  
Introduction: Peripheral lymphadenopathy is a common clinical entity. It is significant as the underlying cause could range from a simple infection to a malignant lesion which could be either primary or metastatic. Fine needle aspiration cytology (FNAC) is the first line of investigation usually done to diagnose enlarged lymph nodes. Materials and Methods: This retroprospective study was done in the Department of Pathology, Government Medical College, Haldwani, from January 2008 to December 2018. Relevant details of the patients were taken from the records. The cytological diagnosis and site were noted and divided into major diagnostic categories with respect to age group, sex, and site. Results: A total of 16,985 cases were studied. About 42% showed reactive morphology, 31.77% were tubercular, 23.65% metastatic lesions, 2.49% were hematological malignancies, and only 0.08% were parasitic. The cervical lymph node was the most common site aspirated and it was also the most common site for metastasis (60.45%). Among the metastatic lesions, squamous cell carcinoma accounted for maximum cases (69.10%). Conclusion: FNAC is a simple procedure for investigating enlarged peripheral lymph nodes. The underlying cause may vary depending on the sociodemographic profile of the patients. It is a safe and effective procedure for giving a quick and reliable diagnosis in peripheral lymphadenopathy, thereby avoiding unnecessary excision biopsy.
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Clinical and biochemical profile of patients with Iron deficiency anemia at a tertiary care hospital p. 153
Abhishek Kumar, Anju Bharti, Lalit Prashant Meena, Vijai Tilak
DOI:10.4103/ami.ami_65_20  
Introduction: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide, especially in adolescent girls, women of reproductive age group, and young children. The clinical presentation and the other biochemical parameters differ in a different age, sex, and geographical group. A study to evaluate the clinical and biochemical profile of patients with IDA at a tertiary care hospital. Materials and Methods: One hundred and two Cases of IDA were taken from the outpatient department (OPD) and ward. After taking consent, the workup was done. Complete history and physical examination were done, and patients were evaluated for signs and symptoms of IDA. Laboratory investigations such as complete blood count with differential count, reticulocyte count, peripheral blood smears, serum iron, total iron binding capacity, serum ferritin, lactic dehydrogenase, stool for occult blood and ova, cysts, liver and renal function were done in all the patients. Results: One hundred and two patients of IDA were enrolled from OPD and ward. The majority of the patients were from the 21 to 30 years age group (25.5%). 37.3% were male and 62.7% were female patients. The main presenting complaint was weakness and easy fatigability (91%). Among the associated comorbidities, the most common were hypertension (13.7%). The majority of the patients had severe pallor (54.9%). Icterus was found in 1.9%. Splenomegaly was found in 4.9%. General blood pictures showed 97.1% had microcytes, 96.1% had hypochromasia and 97.1% had Anisocytosis, which is characteristic of IDA. Conclusion: The majority of patients came to the hospital after developing clinical features due to severe anemia. Therefore, a population based study to evaluate the mild form of IDA or to evaluate a preanemic iron deficiency state can help in the early diagnosis of these patients before they develop severe form.
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Assessing self-care perception among caregivers of dementia patients in a rural medical college of Darjeeling District, West Bengal, India p. 158
Avik Kumar Layek, Nilanjana Ghosh, Indranil Chakrabarti, Nirmal Kumar Bera
DOI:10.4103/ami.ami_52_20  
Introduction: Dementia is a prevalent cause of morbidity and runs a downhill course. Patients progressively become completely dependent on their caregivers who are usually untrained family members. The resultant burden causes caregiver burnout making them vulnerable to diseases. The objective of this study is to assess perception and practice of self care among caregivers and assess any barriers faced. Materials and Methods: A cross sectional qualitative study with 18 eligible caregivers was conducted from September to December 2019 using the appropriate study tools and techniques. Content analysis was done. Results: Majority were aware that self care was required though only five people practiced it. Medical attention was sought by all. Barriers faced were workload and lack of knowhow. Need for comprehensive domiciliary care structured module with graded nonpharmacological interventions and capacity building was reiterated. Conclusion: Perception regarding self care was present, but practice lacking and barriers faced were mostly lack of training and time constraints. However, a larger study is recommended.
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Dynamics of disability indices and professional rehabilitation of diabetes patients p. 162
Inna S Borysova, Vitaliy M Berezovsky
DOI:10.4103/ami.ami_51_20  
Introduction: The article presents results of the study about dynamics of disability indicators due to diabetes mellitus and their peculiarities in Dnipropetrovsk region and in Ukraine and presents recommendations for the professional rehabilitation of such patients and persons with disabilities. Material and Methods: We conducted a retrospective analysis of the dynamics of DM disability according to the data of the Municipal Institution “Regional Clinical Center of Medical and Social Expertise of Dnipropetrovsk Regional Council” and in Ukraine for the period 2016–2019. We analyzed medico-social cases and referrals for medical and social expertise of patients who were examined by doctors of regional specialized medical and social commissions evaluating patients' disability. Results: It was determined that the most common reasons for referral of patients with medical expertise were: insufficient glycemic control with the formation of chronic foot ulcers, which led to disorders of the feet musculoskeletal functions - 37.6%; lower limb amputation at different levels - 21.8%; impaired vision - 40.6%. Indicators of disability due to diabetes in Dnipropetrovsk region was stable in 2014-2019, but raised the average level of disability in Ukraine and ranges from 1.5 - 1.7 per 10 thousand population in 2014 vs 1.4-1.5 per 10 thousand in 2019. Persons with 3rd group disability made the largest part among persons with primary disability due to diabetes in 2014-2019: specific gravity ranged from 57.0% in 2018 to 70.5% in 2014. The unfavorable tendency of disability indicators is characterized by an increase of persons who were initially recognized as having disability due to DM with 1st group disability by 2 times from 6.6% - in 2014 to 12.9 - in 2018. Conclusion: This can be explained by the increased number of DM complications and their severity. The indicator of total rehabilitation among of persons who were initially recognized as having disability due to DM in Dnipropetrovsk region in 2014-2019 does not exceed 3%.
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Histological changes of upper lip from its cutaneous to mucosa region among males p. 166
Swati Saxena, Arvind Kumar Pankaj, Sachin Panwar, Anita Rani, Jyoti Chopra, Archana Rani
DOI:10.4103/ami.ami_29_20  
Introduction: Morphometry of lip lining help in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following trauma or tumor excision following craniofacial cancers or cosmetic procedures. Materials and Methods: Ten human male cadavers were procured in Department of Anatomy the rectangle shaped skin specimen through upper lip which included skin, mucocutaneous junction and mucosa were stained with Haematoxylin and Eosin stain. Total of 30 slides were prepared. Results: Thickness of skin (epidermis +dermis) of lip ranged from 664.72 μm to 882.34 μm among males. Epidermal thickness increases on moving from cutaneous region to mucosa region of lip. Lowest contribution of stratum corneum in thickness of epidermis was observed in vermillion region while highest contribution was observed in skin region. It was found to be absent in mucosa region of lip. Rete pegs at dermoepidermal junction was found to be maximum in vermillion region and minimum in skin region .It's depth increased as we move from skin to mucosa region of lip. In cutaneous part of lip, rete pegs were shorter and blunt. In vermillion region, they were narrow, long and slender while they were longest with blunt end in mucosa region. Depth of dermis was found to be maximum in skin region while minimum in vermillion region. It ranged between 578 μm -825.10 μm. Conclusion: Care should be taken while using dermal fillers in lip augmentation surgeries especially in vermillion region due to its close proximity to musculature in core of lip.
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