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   Table of Contents - Current issue
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January-June 2021
Volume 8 | Issue 1
Page Nos. 1-78

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ORIGINAL ARTICLES  

A cross-sectional study on physical activity, sedentary behavior, and sleep among under-five children in slum areas of burdwan municipality, West Bengal p. 1
Prosun Goswami, Amitava Chakraborty, Dilip Kumar Das, Soumalya Ray
DOI:10.4103/amit.amit_58_21  
Introduction: Less time in physical activity, increase in sedentary time, and screen time have various negative health consequences and are a matter of concern for childhood health now-a-days. The study was to find out the prevalence of adequate physical activity and sleep, the status of sedentary behaviour and screen time among under-five children residing in the slum areas of Burdwan Municipality and their association with selected demographic and socioeconomic characteristics of study participants. Materials and Methods: This cross-sectional study was done among 180 under-five children residing in slums of Burdwan Municipality in Purba Bardhaman District of West Bengal, India, during January to March 2020. A predesigned, pretested schedule was used to collect necessary information on physical activity, sedentary, and sleep behavior of under-five children following the recent guideline by the World Health Organization. Ethical approval was obtained from the Institutional Ethics Committee of Burdwan Medical College and Hospital. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), software version 20. Results: Overall 69.4%, 70%, and 63.3% of the children were physically active, restrained themselves in enjoying their sedentary life and screen viewing within recommended timeframe, respectively. 84.4% children had adequate sleep time with nap. Logistic regression revealed that the absence of siblings was associated with inadequate physical activity (adjusted odds ratios [AOR] =3.82 [1.88, 7.77]) and more than recommended sedentary lifestyle (AOR = 5.01 [2.45, 10.26]) while more than recommended screen viewing was associated with age (AOR = 4.84 [2.34, 10.00]) and house condition (AOR = 6.54 [2.32, 18.42]). Conclusions: This study put emphasis on the requirement of focussed intervention on increasing physical activity and reduction in screen-based engagement among under-five.
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The relationship between motivational persistence and achievement goal orientations of vocational school of health services students p. 7
ibrahim Uysal, Aysen Melek Aytug Kosan, Emine Sevinc Postaci, Murat Tekin
DOI:10.4103/amit.amit_51_21  
Introduction: One of the factors determining the quality of health service delivery is well-trained and qualified health personnel. In addition to receiving a quality education to train qualified health personnel, the importance of the learner being ready and motivated to learn is obvious. The purpose of this study is to examine the relationship between motivational persistence and achievement goal orientations of Vocational School of Health Services students. Materials and Methods: In this research, which is structured in relational comparison type besides its descriptive feature, we studied with 278 students studying at Health Services Vocational School. The data were obtained with "Motivational Persistency" and "Achievement Goal Orientation" scales. In the analysis of the data, correlation and path analysis were used as well as descriptive statistics. Results: When achievement goal orientation and motivational persistency are examined with all subdimensions, the motivation to follow long-term goals was positively significant with the learning approach. The motivation to follow the current goals was positively significant with the motivation to learning approach achievement and to follow long-term goals while was negative with motivation to approach the performance. The motivation to repeat unattainable goals has been found to be positively significant with the motivation to learn approach, learn avoidance achievement orientations and long-term goals, and to follow existing goals. Conclusion: The results of the research showed that students' achievement learning approach and motivational persistency were prone to iteration subdimensions of unattainable goals. Although the study parallels with the literature, it is important to provide a better understanding of how the achievement goal orientation of the students of the Vocational School of Health Services affects the processes of motivational persistency.
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Health-Care Personnel's Perspective on COVID-19 Vaccination – A Cross-Sectional Study p. 16
Neethu George, Abdul Malik Shagirunisha Rizvana, Nawin Jai Vignesh Kumar, Rock Britto
DOI:10.4103/amit.amit_47_21  
Introduction: The COVID pandemic was a modern world disaster which had physical, psychological, and economical impact among the people. This made the governing agencies and others to rollout vaccine in a prompt basis. The objectives were to assess the attitude of health-care personnel toward COVID-19 vaccination using online survey and to assess the willingness of COVID-19 vaccination and factors affecting it among health-care personnel. Materials and Methods: We conducted a cross-sectional study using web-based platforms among 471 health-care personnel's within a period of a month (December 2020–January 2021). The study was conducted after obtaining institution ethic committee approval and informed consent. The questionnaire contains sociodemographic detail, COVID profile section, and questions which reveal the beliefs and attitude toward vaccination particularly COVID-19. The data collected was entered in Microsoft Excel and analyzed using SPSS version 16 software. Results: Among the participants, 56 (11.9%) were diagnosed with COVID-19 and 119 (25.3%) were not willing to take vaccine. Participants who were hesitant about the role of vaccine in immunity, afraid of side effects, doubtful about effectiveness and protection and who doubt about the production involving cost and supply have showed unwillingness to vaccination (P < 0.05). Conclusion: A quarter of the present study population showed unwillingness to take COVID vaccine, and evidence of uncertainty about the vaccine safety and production was exposed in the study. The results should be looked upon gravely as the issues appeared here can be maximized when the vaccine rollout happens in public.
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Acceptance and Knowledge of COVID-19 Vaccine among Health-Care Professionals in Western Uttar Pradesh, India p. 24
Shilpa Patrick, Preeti Singh, Ruchi Choudhary, Prithpal Singh Matreja
DOI:10.4103/amit.amit_45_21  
Introduction: Knowledge and acceptance of COVID-19 vaccine among health-care professionals (HCPs) are an important aspect in the success of the vaccination drive in India, as HCPs are the first group to receive the vaccine. Various factors affecting the attitude of getting COVID-19 vaccine and to better address those factors will help in widespread acceptance among the general public. Materials and Methods: This was a cross-sectional study which was conducted among HCPs by circulating Google form. The form was distributed among the medical students and physicians through social networking sites such as E-mail and WhatsApp. The questionnaire consisted of 18 questions focusing on the assessment of knowledge and acceptance about COVID-19 vaccine. It was a self-administered and pilot-validated questionnaire. Results: Out of total participants, 473 (78%) were willing to take vaccination and were in the opinion that getting vaccination is a good idea. Eighty-eight percent of the participants were worried about the effectiveness of the COVID-19 vaccine. Fifty-five percent of the participants were anxious regarding getting vaccine and its efficacy. Conclusion: Knowledge and acceptance were moderate, but overall attitude of getting vaccination was positive. Majority of the HCPs are still anxious about the long-term efficacy; therefore, appropriate steps need to be taken to address the factors contributing to the low acceptance of the COVID-19 vaccine.
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Pre-COVID conventional offline teaching v/s intra-COVID online teaching: A descriptive map of preference patterns among first year M.B.B.S students p. 28
Rashmi Bhardwaj, Shital Hathila, Himanshu R Joshi, VH Vaniya
DOI:10.4103/amit.amit_34_21  
Introduction: Medical education today is equipped with an armamentarium of newer online-based methods of correspondence courses, computerized virtual patient simulation, many open online courses in medical sciences, and tele-learning. The sudden, unplanned change from conventional teaching to online teaching during COVID-19 poses unique challenges and opportunities for teachers and learners, both. Many themes and principles have emerged for good online teaching learning and assessment practices (GOTLAP). Materials and Methods: The present study, involving 392 MBBS first year students from two universities, was conducted with an aim of comparing students' perception regarding online and offline teaching methodology, and online v/s offline method of assessment and to recommend the principles of GOTLAP. Data collected were analyzed by Strength, Weakness, Opportunity, and Threat (SWOT) analysis to provide a focused measure on how students perceive the program of online teaching and assessment. Results: In the present study, majority of the students (approximately 49.6%) have shown preference for offline teaching methodology, 22.9% has shown similar preference for both methods, while 27.5% has shown preference for the offline teaching method. SWOT analysis applied on qualitative data is a useful tool for assessing our present status in online learning and laying a ground work for formulating GOTLAP and a plan of future strategy. Conclusions: The GOTLAP principles can effectively pave way for the incorporation of blended learning (currently underutilized) in undergraduate medical education.
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A comparative study of magnetic resonance imaging and colonoscopy in evaluation of colorectal diseases p. 32
Vaibhav Khare, Rajul Rastogi, Amit Mishra, Neha , Abhishek Kumar Singh, Sunil Kumar, VK Singh, Vijai Pratap, Nitishkumar Yeshlawat
DOI:10.4103/amit.amit_21_21  
Introduction: Colorectal disease, especially carcinoma, is an important cause of morbidity and mortality in modern era. With rising incidence of colorectal diseases and due to limitations of conventional flexible fiber-optic colonoscopy (gold standard tool), imaging plays a significant role in evaluation of these patients. Recent technical advancements coupled with noninvasive and radiation-free nature has made magnetic resonance imaging (MRI) an acceptable screening tool in colorectal diseases. Hence, we planned this study to evaluate role of MRI in colorectal diseases in our tertiary care, medical college, hospital. Materials and Methods: Forty-four patients with signs and symptoms of colorectal disease were evaluated by 1.5 Testa MRI followed by conventional, flexible, fiber-optic colonoscopy on the same day after obtaining approval from the institutional ethics committee and after obtaining written informed consent using strict criteria. Bowel preparation was done using polyethylene glycol. Data from MRI and colonoscopy were recorded in predesigned pro forma and compared with the final diagnosis. Appropriate statistical methods and tools were used to evaluate the results. Results: Majority of the patients in the study were in the age group of 21–40 years with male predominance. Altered bowel habit followed by bleeding per rectum was the most common presentations. Both MRI and colonoscopy overdiagnosed the lesions as malignant with higher errors by MRI. MRI was very effective in the detection of growth, strictures, diverticulosis, mucosal thickening/edema, and extracolonic manifestation but failed in detecting small polyps and ulcers. MRI had high sensitivity and negative predictive value (NPV) of 100% with an accuracy of more than 70%. Conclusions: Although conventional colonoscopy is considered as a gold standard tool in the diagnosis of colorectal diseases, it has several limitations including its invasive nature and low yield as a screening tool. Hence, MRI with its noninvasive and radiation-free nature along with its high sensitivity and NPV for malignant lesions should be considered over colonoscopy as well as computed tomography in evaluation of colorectal diseases.
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Comparative evaluation of high-resolution ultrasonography and magnetic resonance imaging in painful wrist joint p. 38
Abhishek Kumar Singh, Rajul Rastogi, Neha , Vaibhav Khare, Vijai Pratap, Najmul Huda
DOI:10.4103/amit.amit_14_21  
Introduction: Wrist joint is a commonly used joint in day-to-day activities and hence is not only susceptible to various pathologies but is also the cause of significant morbidity in cases of painful wrist. Although magnetic resonance imaging (MRI) is the usual imaging investigation preferred for the evaluation of painful wrist joint, its inherent limitations in form of high cost, limited availability, higher scan time, and lack of comparison with contralateral side have prompted us to design a study comparing the role of high-resolution ultrasonography (HRUS) with MRI in such cases. Materials and Methods: Forty patients of painful wrist joint were evaluated with HRUS and MRI following approval of IEC and after informed consent. The two imaging modalities were compared not only in the detection of various findings related to painful wrist joint as joint effusion, synovitis, synovial hypertrophy, tenosynovitis, rice bodies, bone erosions, etc., but also in diagnosing the final group of disease. Appropriate statistical tests were then used to analyze the results. Results: Our study revealed that HRUS is similar to MRI in the detection of joint effusion, synovitis, synovial hypertrophy, tenosynovitis, rice bodies, etc., but is very poor in the detection of bony pathologies, especially marrow edema or chronic fractures. In our study, HRUS was equivalent to MRI in the final diagnosis in 67.5% cases, was inferior to MRI in 30% cases and was superior to MRI in 2.5%. Conclusions: Since HRUS has a high accuracy in detecting the pathologies in cases of painful wrist joint, it should be used as the first imaging modality. Patients with equivocal diagnosis or requiring surgical planning may, however, be subjected to MRI.
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Maternal and neonatal risk factors for neonatal jaundice and readmission – An Indian perspective p. 44
Navjot Kaur, Gurpreet Kaur Dhillon, Shibu Sasidharan, Harpreet Singh Dhillon
DOI:10.4103/amit.amit_62_21  
Introduction: Neonatal hyperbilirubinemia is a common neonatal ailment and is mostly benign except in few cases where it might progress to kernicterus. Neonatal jaundice is preventable and treatable if detected in time, and therefore, it is crucial to identify risk factors for developing severe hyperbilirubinemia. Materials and Methods: A prospective observational study was conducted with the aim to examine the risk factors for significant jaundice and also for readmission to the hospital. Results: A total of 1159 neonates were enrolled, of which 11.2% (n = 134) developed significant neonatal jaundice prior to discharge and 2.1% (n = 25) were readmitted with significant jaundice. The maternal risk factors for significant jaundice were primigravida with age range between 23 and 27 years, "O" blood group, conception by in vitro fertilization and embryo transfer (IVF-ET), antenatal oxytocin use, and lower segment cesarean section delivery. The neonatal risk factors for significant jaundice were late preterm male neonates born with birth weight between 2 and 2.5 kg and delayed cord clamping (DCC). The maternal risk factors for readmisssion jaundice were young primigravida with "O" blood group hailing from North India with antenatal use of oxytocin and gestational diabetes mellitus. The neonatal risk factors for readmission jaundice were low birth weight, DCC, twin pregnancies, neonates discharged between 48 and 72 h after birth. Conclusion: The statistically significant factors (P < 0.05) associated with an increased risk of developing significant hyperbilirubinemia requiring readmission included low birth weight, gestational age 35–36 weeks and 6 days, DCC, and IVF-ET conception.
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Comparison of imaging characteristics on computed tomography and magnetic resonance urography in urological conditions p. 50
Nitya Verma, Rajul Rastogi, Vijai Pratap, Arawat Pushkarna
DOI:10.4103/amit.amit_12_21  
Introduction: Urinary tract (UT) pathologies are common causes of morbidity presenting mainly as acute flank pain, obstructive uropathy, and hematuria with calculus being the commonest cause. Computed tomography (CT) (noncontrast, contrast enhanced and urography) of the kidney, ureter, and bladder region has been considered as the mainstay in evaluation of patients with UT symptoms. Limitations of radiation exposure and risks of contrast injection in CT have provided space for magnetic resonance urography (MRU) that has recently gain acceptance. However, MRU is limited by its availability and higher cost. Thus, with the aim of evaluating the scope of MRU in various UT pathologies, we planned a comparative study between CT scan and MRU. Materials and Methods: Thirty-five patients with UT symptoms (acute flank pain, obstructive uropathy, and hematuria) were evaluated with CT scan and MRU after obtaining approval from Institutional Ethics Committee and written informed consent from the participants of the study. CT scan was performed on 128-slice CT scanner while MRU was performed on 1.5T magnetic resonance scanner using the standard protocol. The data thus recorded in a single-blinded manner were analyzed using appropriate statistical methods and tools. Results: Compared with CT scan, MRU had a poor accuracy in detecting UT stones especially <6 mm and without secondary signs of obstruction. However, MRU performed very well in patients with obstructive uropathy and hematuria subgroup with no significant difference in accuracy from CT scan. Overall, MRU had a moderate sensitivity of 76.3%, high specificity of 96.9% and moderately high accuracy of 85.7%. Conclusions: Although MRU has lower sensitivity to small sized UT calculus but is very specific to secondary signs of obstruction as well as to causes of obstructive uropathy and hematuria. It can serve as an excellent alternative tool especially in patients with contraindication of contrast injection in CT scan as well as in children, during pregnancy and in conditions requiring repetitive examinations.
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Utility of fine-needle aspiration cytology in diagnosis of cutaneous and subcutaneous metastasis p. 57
Nidhi Nair, Panduranga Chikkannaiah, Srinivasamurthy Venkataramanappa, Ragunatha Shivanna
DOI:10.4103/amit.amit_8_21  
Introduction: Cutaneous metastasis (CM) is an uncommon clinical presentation and poses trouble in diagnosis. However, it is remarkable and can occur due to a known or an unknown primary tumor. Despite the fact that clinical assessment helps in the diagnosis, Fine-needle aspiration cytology (FNAC) is a modest, basic, and quick principle line of investigation for the finding of CM. Materials and Methods: It was a retrospective study conducted in the department of pathology at a tertiary care teaching hospital. The study was conducted from January 2010 to May 2020. All cases of CM that has been diagnosed by FNAC were included. Results: During the study period, a total of 37 cases of CM were observed, constituting 0.15% of all FNACs. The age of the patients ranged from 35 to 74 years, and the male: female ratio was 1.05:1. Primary tumor was known in all 37 cases. Among males, lung carcinoma was the more common whereas breast was the most common organ of primary among females. The most common lesion was a single nodule (27 cases), with predominant site being chest wall (32.5%), and the most common tumor at microscopy was metastatic adenocarcinoma. Conclusion: FNAC is a fast and safe procedure that can be utilized as a first line of investigation in diagnosing metastatic skin lesions. Basic assessment of cytomorphology alongside significant clinical subtleties could help in recognizing the site of an unknown primary.
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Epidemiological determinants of depression and its associated coping mechanisms among college students confined during COVID-19 lockdown: A cross-sectional e-survey in India p. 62
Sunny Garg, Alka Chauhan, Dinesh Verma, Karishma Chaudhary, Sanjeet Singh, Kirti Bansal
DOI:10.4103/amit.amit_1_21  
Introduction: During COVID-19 pandemic lockdown, mental health of students was highly pregnable to the loss of social connectedness, disarray of normal pattern of activities as well as academic issues. Adopted coping mechanisms may have played a significant role in surmounting the challenges related to the pandemic. The main aim of the survey is to evaluate the prevalence of depression, its determinants, and association with coping mechanisms among college students during COVID-19 lockdown. Materials and Methods: College students were invited during lockdown to participate in a nationwide cross-sectional e-survey using Snowball sampling technique (dated October 6th–30th, 2020). A total sample size of 920 was calculated. A self-administered questionnaire regarding sociodemographic characteristics, COVID-19 related experiences along with two scales (Patient Health Questionnaire-9 [PHQ-9], and Carver Brief-Coping Orientation to the Problem Experienced -28) for assessment of depression and adopted coping mechanisms was applied to participants. Chi-square test, independent t-test, Pearson's correlation, and hierarchical multiple regression analysis were used to investigate the determinants of depression and its association with coping mechanisms in college students. Results: On analysis of 884 qualified participants, it was revealed that 402 (45.5%) participants have depressive symptoms ranging from moderate to severe level. The mean score of PHQ-9 was 9.82 ± 6.61. Nearly 85% students were lagging behind in studies. Around 5%–10% of students initiated/increased the consumption of substances. The main determinants of depression in this study were age group of 21–24 years, thought of lagging behind in studies and family members/friends/relatives diagnosed with COVID-19. Adaptive coping mechanisms (emotional support, religion, and humor) were significantly associated with lower depressive symptoms and maladaptive coping mechanisms (self-distraction, denial, behavioral disengagement, and venting) were significantly associated with higher depressive symptoms among students. Conclusions: This survey revealed multiple determinants of depression, mainly including academic worries among college students. The college staff should provide a well-structured pedagogical framework to encourage them and alleviate the unpleasant psychological effects of pandemic on students.
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General health status and functional independence of rural and urban elderly population of sub-himalayas region, India: Comparative study p. 71
Payal Paliwal, C Vasantha Kalyani, Maneesh Sharma, Kusum K Rohilla
DOI:10.4103/amit.amit_190_20  
Introduction: Preserving independence in tasks and continuing an active life are the most significant features in improving elderly's health care. The aim of the present study was to identify and compare elderly general health status and functional independence among rural and urban areas of the Sub-Himalayas region, India. Materials and Methods: The study was nonexperimental comparative design, in which multistage sampling techniques were used. 200 elderly participants were selected, i.e., 100 elderly from rural and urban areas, respectively. Results: Majority elderly of rural and urban areas belong to 61–70 years, male, Hindu, married, living with their children, receiving government pension, taking three times meals/day and have a previous history of medical illness. The general health status of the rural elderly is good (P = 0.000 [3.45, 5.16]) as compared to the urban elderly. Rural elderly were functional independent (P = 0.009 [0.37, 1.38]) than urban elderly. Conclusions: It is important to monitor the general health status and functional independence of the elderly. The status of daily living activity always has a great impact on the level of happiness, well-being, and quality of life of the elderly.
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Retrospective study of tissue transglutaminase antibody levels in celiac disease-suspected patients at tertiary care hospital in Uttarakhand p. 75
Swati Rajput, Rohit Gupta, Itish Patnaik, Yogesh Bahurupi, Prashant Kumar, Kiran Meena, Nowneet Kumar Bhat, Satyavati Rana
DOI:10.4103/amit.amit_186_20  
Introduction: Celiac disease (CD) is a chronic gastrointestinal disorder arising due to gluten sensitivity in susceptible individuals. In India, one person per 100 is suffering from this disease. CD has been reported more in high wheat-consuming areas like northern India. However, the incidence of CD in patients attending tertiary care hospital of Uttarakhand has not yet been reported. Therefore, this study was planned. Materials and Methods: A retrospective study with 603 patients was done at AIIMS Rishikesh in Biochemistry Department. These patients were screened for CD by tissue transglutaminase antibodies (ttgA) levels using enzyme-linked immunosorbent assay method. Percentage of levels of ttgA <4 U/ml (normal value) and >4U/ml in male, female adults, and children was calculated. Chi-square test was applied to compare results. Results: Out of 603 patients, 23 (3.81%) had abnormally raised ttgA levels (>4 U/ml). Percentage (15.18%) of ttgA levels in male children was significantly (P = 0.01) higher than 2.56% in female children. Mean + standard deviation (SD) of normal and abnormal ttgA levels in patients was 1.17 + 0.45 versus 66.81 + 34.80 U/ml, respectively. Mean + SD of abnormal ttgA levels in children and adults was 72.84 + 41.91 versus 32.38 + 24.75 U/ml, respectively. There was a statistically significant difference in abnormal ttgA levels among children and adults with children predominantly being higher (P = 0.0235). Conclusion: This study shows that levels of ttgA suggestive of CD in children are higher as compared to adults and more in males than females attending tertiary care hospital of Uttarakhand.
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