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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 33 | Issue 2
Page Nos. 71-116

Online since Tuesday, February 11, 2020

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ORIGINAL ARTICLES  

Study of evolving trends in the clinicopathological profile of breast cancer patients attending a tertiary cancer center Highly accessed article p. 71
Deep Sikha Das, Indibor Singh Yengkhom, Vimal Sekar, Sunita Akoijam, Ambika Devi Adhikarimayum, James Lalzuitluanga Chongthu
DOI:10.4103/jms.jms_82_18  
Background: Breast cancer is by far the most frequent cancer in the women of Northeast India, with the possibility of 1 in 83 females developing breast cancer in their lifetime. Manipur presents a similar picture with breast cancer comprising 15.3% of female cancers. With westernization of lifestyle, there has been an increase in the prevalence of risk factors. The present study tries to evaluate the changing trends in the demographic, clinical, and pathological profile of the breast cancer patients presenting to a tertiary cancer center in Northeast India within a time frame of 10 years' gap. Materials and Methods: In this descriptive, retrospective study, the records of histologically confirmed cases of breast cancer managed at the institute a decade apart were analyzed with respect to the various risk factors, stage, histological features, and receptor status. Changes in the trends were recorded. Results: The mean age at presentation was found to be younger in 2015–2017 compared to 2002–2004 (P < 0.05). More premenopausal women were diagnosed with breast cancer in 2015–2017 as compared to 2002–2004 (P < 0.005). When age at first childbirth was compared, there was significantly advanced age in 2015–2017. Body mass index was significantly higher in 2015–2017 group. When change in receptor status was evaluated, there was a decrease in cases of estrogen receptor/progesterone receptor positivity and increase in triple-negative cases in 2015–2017, which was statistically significant (P < 0.05). Conclusion: Within an interval of a decade, there has been a significant change in the clinicopathological profile of the breast cancer patients presenting to the institute. More aggressive patterns of disease have become more common with early age of presentation and aggressive biological behavior of receptor-negative tumors. Thus, we need to have a relook at the strategy to manage breast cancer in the coming future.
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Association between the lower extremity biomechanical factors with osteoarthritis of knee p. 76
Sanket Parekh, Jigar Mehta, Nirav Vaghela, Deepak Ganjiwale
DOI:10.4103/jms.jms_59_18  
Introduction: Osteoarthritis (OA) of the knee joint is one of the causes of pain and physical disability. Our aim is to prevent the OA of the knee joint. Hence, to prevent and to treat, the OA knee pain needs to find an association between various biomechanical factors of the lower limb and OA knee pain. Therefore, to assess the association between the lower extremity biomechanical factors with osteoarthritis of knee pain. Materials and Methods: Our study was a cross-sectional study, in that we have taken fifty participants who already diagnosed OA. The various biomechanical factors of the lower limb were measured along with outcome scales such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for the OA knee and Numeric Rating Scale (NRS) for the knee pain from each participant. Results: There was a significant correlation found between femoral anteversion and navicular drop with WOMAC scale with a P = 0.001 and 0.03, respectively. The significant correlation between femoral anteversion, hamstring muscle length, Q angle (dynamic), and tibial torsion with NRS pain scale with P = 0.07, 0.06, 0.07, and 0.06, respectively. Conclusion: The study concluded that body mass index, femoral anteversion, hamstring's length, navicular drop, tibial torsion, and Q angle (dynamic) are various biomechanical factors which might be responsible for the incidence of the OA knee along with functional limitation and OA knee pain.
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Subject preference for specialization and factors influencing it among medical graduates of Regional Institute Of Medical Sciences, Imphal p. 81
Jalina Laishram, RK S Agui, Sanjana Laishram, Brogen Singh Akoijam
DOI:10.4103/jms.jms_51_19  
Background: Deciding what to do after MBBS is a tough decision for a medical graduate. It is perceived that postgraduate specialization is essential, and there is tough competition for postgraduate seats in the country. In Manipur, apart from a few assumptions based on individual and personal experiences, there are no significant data available regarding the perspective of medical graduates toward postgraduation (PG). Objectives: The objectives of this study are to determine the specialty preferences of medical graduates working as interns and house officers in the Regional Institute of Medical Sciences, Imphal, Manipur, India, and to determine the factors influencing them. Materials and Methods: This was a cross-sectional study. The data were collected using a self-administered questionnaire. Descriptive statistics such as mean, median, standard deviation, and percentages were used. The Chi-square test and Fisher's exact test were used to determine the association. Data analysis was performed using the SPSS IBM version 21. Results: Overall response rate was 93.6%. Of 147 respondents, 110 were interns and 37 were house officers. The mean age of the participants was 24.56 ± 1.97 years. More than half of the participants were female. Medicine and pediatrics were the two subjects preferred by most medical graduates. Females had more intention to do PG. Conclusion: Majority of the participants were inclined toward pursuing PG in the clinical subjects. Interest in the subject and love for patients were the two major reasons for subject preference.
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Fecal–oral-transmitted hepatitis A and E prevalence in Eastern India: A 3-year retrospective study p. 86
Gitanjali Sarangi, Muktikesh Dash, Dharitri Mahapatra, Bimoch Projna Paty, Dibya Prasna Mohanty, Nirupama Chayani
DOI:10.4103/jms.jms_67_17  
Background: Enterically transmitted hepatitis A virus (HAV) and hepatitis E virus (HEV) are responsible for sporadic and epidemic forms of acute hepatitis globally. Objectives: This retrospective 3-year study was conducted to determine the prevalence of HAV, HEV, and coinfection and its seasonal variations, age- and residence-specific epidemiological characteristics in a tertiary care hospital, Eastern India. Materials and Methods: Serum samples from clinically suspected acute viral hepatitis cases were collected at peripheral levels and sent to the Department of Microbiology maintaining precautions. These were processed for the detection of HAV- and HEV-specific Immunoglobulin M antibodies carried out by enzyme-linked immunosorbent assays method. Data were analyzed using GraphPad QuickCalcs statistical software Inc, USA. Results: The seroprevalence of HAV (54.3%) was higher than HEV (43.5%), and the coinfection rate was low (2.2%). The HAV infection was most commonly seen in pediatric and adolescent age group (≤18 years) whereas HEV infection in adults (P < 0.0001). The HAV outbreaks were commonly occurred in rural areas in comparison to HEV in urban areas (P < 0.0001). Both HAV and HEV cases were reported throughout the year. Conclusion: The enteric viral hepatitis cases are highly prevalent, and outbreaks have occurred throughout the year in coastal plains of Eastern India. There is a need for screening of HAV and HEV, especially among pregnant women and improving levels of personal hygiene. The data generated from this study will help the local authorities to plan for future vaccination strategies, improvement in sanitation program, and safe water supply to the needy population.
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Audit of informed consent document for major surgical procedures at a tertiary care hospital p. 91
Dhara Goswami, Swapnil Sudhirkumar Agarwal, Smruti B Vaishnav, Lavlesh Kumar, Krishnadutt Harishankar Chavali
DOI:10.4103/jms.jms_69_18  
Background: Consent is being regarded as the cornerstone of a doctor patient relationship. No patient can be forced, directly or indirectly, to accept treatment which it may refuse, even if it is painless, beneficial to him and without any risk including the fact that refusal may have life threatening consequences. Lack of an informed consent is an area that can win legal suits for the patient even when the claim for any negligence is weak. Aim: To review the informed consent documents in cases of major surgical procedures conforming the accepted principles of informed consent and to prepare a checklist for help in future audit of informed consent documents. Methods: Authors compiled a list of desirable and essential content areas in informed consent document based on commonly accepted professional standards. Informed consent forms of planned major surgical procedures for department of surgery, obstetrics and gynecology and orthopedics were included. 100 informed consent forms, selected randomly by computer at medical records department, for each department were studied for 23 attributes. Descriptive statistics and exploratory data analysis techniques were used to analyze the data. Result: The consent documents lacked a third of essential elements in totality for all the departments [08/ 23] while few partially. Conclusion: There is ample room for training of treating registered medical practitioner on how an informed consent should be documented so as to be safe ethically as well as legally. Consent is never a defense in an allegation of medical negligence.
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CASE REPORTS Top

Ocular manifestations of myeloma with coexistent autosomal dominant polycystic kidney disease in a young female p. 97
Vivek S Guleria, Mukesh Dhillon, Bhupesh Guleria, Velu Nair
DOI:10.4103/jms.jms_140_13  
Multiple myeloma is a clonal B-cell disease of proliferating plasma cells that rarely involves the eye. On the contrary, renal involvement is frequently seen in myeloma. At the time of diagnosis, about 30%–40% of patients with myeloma have evidence of renal impairment. There are multifactorial causes of renal impairment in multiple myeloma; however, coexistent autosomal dominant polycystic kidney disease (ADPKD) in a patient with myeloma has not been reported. We report a case of a 34-year-old female who presented with severe anemia, cataract right eye, bilateral corneal opacities, and multiple cysts in kidney and liver. She was eventually diagnosed as a case of multiple myeloma associated with ADPKD.
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Pemphigus vegetans: A rare variant of pemphigus vulgaris p. 101
Banyameen Iqbal, Akshi Raj, Saijal Gupta
DOI:10.4103/jms.jms_20_19  
Pemphigus vegetans (PV) is a rare clinical variant of pemphigus vulgaris and comprises up to 1%–2% of all pemphigus cases. It is characterized by vegetative plaques in the inguinal folds, flexural areas, oral mucosa, trunk, and thighs. It is accompanied by the presence of autoantibodies against desmoglein-3. We are presenting a case of a 36-year-old man with oral ulcers and multiple pustules in the flexural areas, inguinal region, and thighs. Systemic examination was uneventful. Skin biopsy was taken from the lesion over the thigh and subjected to light microscopy and immunofluorescence examinations. Based on clinical findings, histopathological characteristics, and direct immunofluorescence, a final diagnosis of PV was made.
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Takayasu's arteritis: Anesthetic implications and management of a patient for cesarean section using combined spinal-epidural technique p. 104
Adrish Banik, K S H Sandeep, N Ratan Singh
DOI:10.4103/jms.jms_32_19  
Takayasu's arteritis (TA) or pulseless disease is a rare, idiopathic, chronic granulomatous vasculitis that affects mainly aorta and its major branches. We report herewith the anesthetic management of a parturient who suffered from TA scheduled for elective cesarean section by using combined spinal-epidural technique, which offers the combined advantage of both spinal and epidural anesthesia and postoperative analgesia. Anesthesia for patients with TA is complicated by severe uncontrolled hypertension, end-organ dysfunction, stenosis of major branches of aorta, and difficulties in monitoring hemodynamic parameters. Our patient was a full-term, 29-year-old female weighing 60 kg, of height 154 cm, gravida 1, and para 0 scheduled for elective lower segment cesarean section. The intraoperative period was uneventful with minimal rise in blood pressure (BP) which was managed accordingly with antihypertensive medications. The patient was stable in the postoperative period with minor rise in BP from baseline and was shifted to ward after being monitored in the intensive care unit for 24 h.
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Isolated tubercular granuloma at orbital apex p. 108
Santosh Kumar Swain, Suprava Das, Mahesh Chandra Sahu
DOI:10.4103/jms.jms_10_19  
Isolated tubercular granuloma at the orbital apex is an extremely rare clinical entity which may lead to difficulties in the diagnosis because of the similarities in the presentation to that of a neoplasm. We are presenting a case of 19-year-old male with isolated tubercular lesion at orbital apex. The diagnosis was confirmed by endoscopic biopsy and treated with antitubercular therapy. The diagnosis of isolated tubercular lesion at the orbital apex mainly depends on the clinician having a high index of suspicion. Although it is extremely rare, tuberculosis can be kept in mind and considered as a differential diagnosis of patients presenting with a solitary tumor at orbital apex to avoid unnecessary surgery.
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LETTERS TO EDITOR Top

Implementation and evaluation of a module to sensitize faculty and postgraduate students on competency-based medical education p. 112
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jms.jms_66_17  
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Penicillium marneffei pneumonia: A summary of Thai cases in 10-Year period (2009–2018) under universal coverage for antiretroviral therapy p. 114
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/jms.jms_12_19  
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Cost–utility analysis of toxoplasmosis serological screening: Comparison between application in pregnant and HIV-infected patients p. 116
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jms.jms_48_18  
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