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   Table of Contents - Current issue
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September-December 2020
Volume 34 | Issue 3
Page Nos. 121-178

Online since Thursday, April 29, 2021

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ORIGINAL ARTICLES  

Knowledge of mothers and caretakers on adverse events following immunization in an urban community of Imphal Highly accessed article p. 121
Vanlalduhsaki , Romola Pukh
DOI:10.4103/jms.jms_115_20  
Context: Immunization is a great success in public health and has prevented a number of diseases. Although there are some adverse effects from certain vaccines, the benefits of vaccination have resulted in significant decline in infant and childhood morbidity and mortality. Parental concerns about perceived vaccine safety issues have led increasing number of parents to refuse or delay vaccination for their children. Hence, the knowledge regarding immunization in prevention of infectious disease among mothers and caretakers of under-five children is important. Aims: We aimed to assess the knowledge of mothers/caretakers of children under 5 years of age about adverse effects following immunization. Settings and Design: It was a cross-sectional study conducted in the urban field practice area of the Department of Community Medicine, Regional Institute of Medical Sciences, Imphal. Subjects and Methods: House-to-house survey was carried out and data were collected using a semi-structured questionnaire among the mothers and caretakers of children under 5 years of age. A total of 400 participants were interviewed in the study. Statistical Analysis Used: Data were entered in IBM SPSS Statistics 21 (IBM Corp. 1995, 2012) and summarized using descriptive statistics such as percentages and proportions. Chi-square test was employed to test the association between knowledge on immunization and selected variables of interest. P < 0.05 was taken as statistically significant. Results: Out of the 400 respondents, only 23.5% had adequate knowledge regarding immunization, 19% had average knowledge, and 57.5% had poor knowledge. Mothers who were above 30 years had better knowledge than those younger (P < 0.001). The higher the education level, the better was the knowledge, and this was also significant (P < 0.001). Christians were found to have better knowledge than Hindus (P < 0.001), and working mothers had better knowledge than homemakers (P < 0.001). There was no association between type of family and knowledge. 40.3% of the respondents were aware of adverse events following immunization (AEFI), out of which 37.9% acquired it mainly from the accredited social health activists/auxiliary nurse midwives, and the most common adverse event identified was fever (87.6%). 72.2% of the respondents who had experienced an adverse event following immunization in their children reported that the event developed within 6 h. Conclusions: Nearly one-fourth (23.5%) of the participants had good knowledge about immunization and nearly half of them were aware of AEFI. The main source of immunization and AEFI was reported to be peripheral health workers. Knowledge of the participants was significantly associated with mothers' age, educational status, and religion and employment status.
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Spectrum of histopathological lesions of nose and paranasal sinuses: A 5-year study p. 128
Urmi Chakravarty Vartak, Aditi Girishrao Sarnaik, Shailesh Vartak, Farhat Pathan
DOI:10.4103/jms.jms_100_20  
Aims and Objectives: To study the spectrum of lesions of nose and paranasal sinuses over a period of 5 years in a tertiary care hospital. To find the incidence and age and sex distribution along with their clinical presentation and various histopathological patterns. Materials and Methods: The study included biopsies and resection specimens. The clinical details such as age and sex of the patient, clinical presentation, and radiological findings were retrieved from the records. The tissue specimens were processed after fixing in 10% formalin and stained with hematoxylin and eosin stains. Various special stains were performed as per the need such as Gomori methenamine silver stain and periodic acid–Schiff for fungus. The neoplastic lesions were classified as per the World Health Organization 2017 classification. Results: The incidence of nose and paranasal sinus lesions was 0.71% (310 cases). Nonneoplastic cases (156) constituted 50.32%, whereas neoplastic lesions (154) constituted 49.67%. Benign neoplasms (126) were 40.64% and malignant neoplasms (28) formed 9.03% of total neoplasms. A wide age ranging between the 1st and 9th decades was observed. Male predominance in neoplastic as well as nonneoplastic lesions was noted. Nasal obstruction (90.96%) was the most common symptom seen. Radiology was available in 30 cases and accurate diagnoses were made in 28 cases (93.33%). Among nonneoplastic lesions, inflammatory cases (128) formed the largest group (82.05%). Nasopharyngeal angiofibroma (NPA) was the dominant benign neoplasm (67.46%) exclusively seen in males of the second decade (76.47%). Among malignant lesions (9.03%), squamous cell carcinoma was the most common (28.57%) malignancy. Lesions with round cell morphology could not be typified on histopathology; hence, immunohistochemistry (IHC) was done for the exact diagnosis. Conclusion: This study elaborates wide spectrum of lesions encountered in nose and paranasal sinuses with their relative frequencies in the population. Nonneoplastic lesions are more common than neoplastic lesions. Histopathological examination is essential for the diagnosis as clinical and radiological features may be overlapping. Round cell tumors could not be typified on the basis of histopathology; hence, use of ancillary techniques such as IHC plays a vital role in diagnosis.
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A community-based study to assess the perceptions and barriers in utilization of no-scalpel vasectomy among married men in a rural area of South India p. 139
Prateek Saurabh Shrivastava, Saurabh RamBihariLal Shrivastava
DOI:10.4103/jms.jms_126_20  
Background: India is the second most populous country in the world after China. In 1992, the government introduced an innovative technique “no-scalpel vasectomy” (NSV), a simpler, safer, and cheaper method aimed at increasing male participation in family planning. Despite the many advantages over female sterilization techniques, NSV still accounts for <1% of all the family planning methods used in India. Hence, this study was conducted among married men in a rural area to assess their knowledge and perceptions regarding NSV and identify various barriers in utilization of NSV. Materials and Methods: A community-based cross-sectional descriptive study was carried out for 6 months in the rural field practice area of a tertiary care hospital in Chengalpet district among a total of 170 married men in the age group of 21–60 years. Systematic random sampling was used to identify the study participants, and all the eligible participants were interviewed using a pretested semi-structured schedule. Data entry was done in Microsoft Excel, and analysis was done using the Statistical Package for the Social Sciences, version 23. Results: Good knowledge level about NSV was found in only 21 (12.4%) participants. Among the 170 study participants, only 2 (1.2%) had undergone vasectomy. The most common barriers to utilization of NSV were found to be availability of alternative methods of contraception by 136 (80%) participants followed by misconceptions about the procedure of NSV in 134 (78.8%) participants. Conclusion: The study highlights the urgent need to overcome the misconceptions and sociocultural concerns not only regarding NSV but also about the importance of male involvement in family welfare by targeted interventions in order to boost the acceptance of this simpler terminal contraception method.
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Medical students' practice, attitudes, and motives toward physical activity: A cross-sectional study p. 144
Vanlalduhsaki , Jalina Laishram, Brogen Singh Akoijam
DOI:10.4103/jms.jms_1_21  
Background: Medical students have substantial knowledge of the benefits of regular physical activity. A person's motives for physical activity are important in determining whether the person will be physically active. Objectives: The purpose of this study was to explore the attitude and motivation to be physically active among undergraduate medical students. Materials and Methods: This was a cross-sectional study conducted in a tertiary care medical institute in Manipur between July 18, 2016, and August 16, 2016. Self-administered questionnaire was used for data collection. Data collected were analyzed in IBM SPSS version 21. The results were summarized in frequencies and proportions for categorical variables and in means and standard deviations for continuous variables. Chi-square test, ANOVA, and Student's t-test were employed and P < 0.05 was considered statistically significant. Results: Out of 361 participants, 180 (49.9%) were females. The mean age of the participants was 22.55 ± 2.08 years (range: 18–34 years). Body mass index of majority of the participants (59%) fell within the normal range. About 62.3% of the students were currently engaged in physical activity. Attitude of the students toward physical activity was favorable and the total mean attitude score was 3.82. Intrinsic motivation was identified as the most important motive for being physically active. Conclusions: The participants displayed a favorable attitude toward physical activity with no difference in attitude compared to male and female students. Those who were active identified intrinsic motivation as the most important motive for being physically active.
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Study of resected specimens of ectopic pregnancy: A-5 year experience in Regional Institute of Medical Sciences Hospital, Imphal p. 149
Rachel Shimray, Paramita Rudra Pal, Sharmila Laishram, Gayatri Pukhrambam
DOI:10.4103/jms.jms_4_21  
Background: Ectopic pregnancy remains the leading cause of maternal death in early pregnancy. It is assuming greater importance because of its increasing incidence and its impact on woman's fertility. Objectives: To study the histomorphological changes of ectopic pregnancy and its correlation with relevant parameters such as age, site, parity, and gestational age. Materials and Methods: This study was conducted in the Department of Pathology, Regional Institute of Medical Sciences, Imphal, for a period of 5 years (January 2015–December 2019). All the specimens with a clinical diagnosis of ectopic pregnancy were included in the study. Histomorphological changes and other relevant parameters such as age, site, parity, and gestational age were analyzed. Results: A total of 160 ectopic pregnancies were diagnosed during the study period. A total number of pregnant women attending antenatal outpatient department during the study period was found to be 121,1941 giving an overall rate of occurrence of 0.13% or 1.31/1000 pregnancies. The most common site of involvement was fallopian tube (95%), mostly on the right side (64.37%). The most common age group was 30–39 years (mean age 30.8 years). Nearly 91.25% of cases were multiparous presenting mostly in their first trimester. Predominant-associated histopathological findings were chronic salpingitis (43.12%), acute salpingitis (20.62%), and salpingitis isthmica nodosa (7.5%). One case was found to be associated with paratubal cyst. Conclusion: Histopathological examination of resected ectopic pregnancy specimens can give an insight into the etiopathogenesis of ectopic pregnancy, thereby helping in early treatment and preventing recurrence.
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The aspartate aminotransferase to platelet ratio index for assessing hepatic fibrosis in human immunodeficiency virus-hepatitis C virus coinfected patients: A local experience p. 154
Moirangthem Ratankumar Singh, Pukhrambam Vedanti Devi, Md Sadam Hussain, Gayatri Devi Pukhrambam
DOI:10.4103/jms.jms_17_21  
Background: HCV infection is widespread among HIV infected populations because of their increased life expectancy with the advent of HAART. Hepatic fibrosis is one of the most robust prognostic factors used to predict HCV disease progression and clinical outcomes. This study's objective was to evaluate hepatic fibrosis using APRI in HIV-HCV co-infected individuals compared to HIV monoinfected. Methods: A total of 120 HIV infected patients (mean age 41.7±10.0 years) was enrolled in a study conducted in JNIMS, Manipur from August 2017 to August 2019. Liver fibrosis was assessed by the APRI which signifies the presence and absence of significant fibrosis if APRI > 1.5 and APRI < 0.5 respectively. Correlation between hepatic fibrosis and immunological status was established. Statistical analysis was done using SPSS version 21. Results: HIV-HCV co-infected patients had a higher abnormal mean AST level (114.18±150.19 IU/L) than HIV monoinfected (65.03±47.71 IU/L). The mean platelet count in HIV-HCV co-infected patients (106±38×103 cells/mm3) was lower than that of HIV monoinfected (207±80×103 cells/mm3). The mean APRI score in HIV-HCV co-infected patients (3.05±3.89) was higher than that in HIV monoinfected (1.02±1.38) indicating the presence of significant hepatic fibrosis in the co-infected group (p<.001). Conclusion: A high AST level combined with thrombocytopenia (APRI score>1.5) is an indicator of hepatic fibrosis in HIV-HCV co-infected individuals. Our study demonstrates that HIV-HCV co-infected patients and HIV related advanced immunosuppression is associated with higher APRI. Because of its simple, non-invasive and less costly nature, APRI may be utilised for assessing hepatic fibrosis in resource-limited settings.
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A comparative clinical study of collagen and paraffin gauze dressing on skin donor site p. 162
Saugat Das, Akoijam Ibohal Singh, Laishram Oken Singh, Nehar Sinam, Sanjib Nepram Singh
DOI:10.4103/jms.jms_25_21  
Background: Split skin grafting (SSG) is a commonly performed plastic surgical procedure. It is done to cover wounds, defects from excision of cutaneous lesions, donor sites of fascio-cutaneous flaps. The harvest of a split thickness skin graft causes a partial thickness injury. Complete re-epithelialization occurs in 10-14 days, although the rate may be affected by the local wound environment. However, tissue desiccation and infection can convert a partial thickness injury to a full thickness loss. Aims and Objectives: The purpose of the study was to determine the best method of dressing the donor site split-thickness graft between conventional paraffin gauze dressing and collagen-based dressings with respect to the rate of healing, pain, secretion, infection, and cost. Settings and Design A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 60 patients who underwent split skin graft procedure. Materials and Methods: The selected sample will be divided into two groups. The donor site dressing was done in two different ways. One was dressed with collagen sheet and the other with paraffin gauze dressing. The two groups were compared on the basis of post-operative pain, complication, and healing. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value <0.05 was taken as significant. Results: A total of 60 patients were included in this study as per the estimated sample size. The Case group i.e., the patients for whom the STSG donor site were dressed by Collagen dressing and the Control group i.e., the patients for whom paraffin gauze dressings were used. Patients with collagen dressings are found to have only minimal to moderate pain in the entire postoperative period. In these patient's analgesic requirement is reduced, and early mobilization can be done. This is the major advantage of using collagen as a donor site dressing. We found that collagen slightly increases epithelization, which will reduce the chance of infection saving time and resources for the hospital staff and minimizing discomfort for the patient. Conclusion: In this study it was found that dressing the donor site for split-thickness graft with collagen-based dressings gave better results with respect to the rate of healing and post-operative pain scores than conventional paraffin gauze dressing.
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A clinical study of single intraneural platelet-rich plasma injection in peripheral nerve repair p. 167
Saugat Das, Akoijam Ibohal Singh, Nehar Sinam, Laishram Oken Singh, Nepram Sanjib Singh
DOI:10.4103/jms.jms_26_21  
Background: Peripheral nerve injuries cause great morbidity leaving many with long-term disabilities with high societal costs. Direct tension-free microsurgical repair and/or the transplantation of a nerve autograft to bridge the gap are the gold standard treatments. However, such treatments may not recreate the suitable cellular and molecular microenvironment and in some cases, the functional recovery of nerve injuries is incomplete. Aims and Objectives: The purpose of the study is to investigate if, and to what extent, PRP can improve the clinical condition after nerve repair. To study the effects and therapeutic potential of platelet rich plasma in traumatic nerve injury. Materials and Methods: A hospital based Non-Randomized control trial was conducted in a tertiary hospital setup in Manipur, India, for a period of 2 years. This study was done on 12 patients who underwent peripheral nerve repair. Materials and method The selected sample will be divided into two groups. Control group was treated with direct tension-free epineural microsurgical repair and the treatment group was treated with direct tension-free epineural microsurgical repair along with intraoperative infiltrating the nerve stumps perineurally and intraneurally with a single dose of autologous PRP injection. Comparison was done on the basis of subjective and objective outcomes between the groups over a period of 1 year. Statistical analysis Statistical analysis was done by using IBM SPSS Version 21 for windows. Descriptive statistics such as mean, proportion, percentage were used to present the result. Chi square test was used to see the association of proportions. Student's t- test and repeated ANOVA were used for the continuous variables. P-value <0.05 was taken as significant. Results: A total of 12 patients were included in the study, who were divided into 2 groups i.e., Case group and Control group, with 6 patients in each. The two groups were comparable with regards to patient characteristics, nerve injured and time interval to surgery. The patients in the case group, had significant improved outcome, when compare to control group, in terms of subjective (quickDASH) and objective tests (2-point discrimination, sensory recovery, motor strength and nerve conduction studies). Conclusion: In this study we found that intraoperative PRP injection can improve the clinical outcome after nerve repair in traumatic nerve injury.
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CASE REPORTS Top

Nevus sebaceous associated with basal cell carcinoma p. 172
Moirangthem Henary Singh, L Rashil Simon, Angelica Laiphrakpam, L Sushila Devi
DOI:10.4103/jms.jms_7_21  
Nevus sebaceous of Jadassohn is a congenital, uncommon hamartomatous lesion of the epidermis, dermis, and appendages with the predominance of sebaceous elements. This hamartoma has the capacity to develop benign as well as malignant neoplasms, but the malignant transformation is rare. Herein, we report a case of basal cell carcinoma in the background of nevus sebaceous in a 53-year-old female highlighting the importance of prophylactic excision of this lesion.
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A case series of hypokalemic thyrotoxic periodic paralysis presenting in the North Eastern region of India p. 175
Monica Moirangthem, Longjam Nilachandra Singh, Moirangthem Janet, C Sreejith, Tasso Opo, Akoijam Joy Singh
DOI:10.4103/jms.jms_33_21  
Hypokalemic periodic paralysis (HPP) with thyrotoxicosis is a rare but treatable cause of sudden onset paralysis. Its occurrence is more common in males particularly of Asian descent. Presentation is like those seen in HPP with an additional feature of a hyperthyroid state, where the symptoms of hyperthyroidism may often be mild and thus may be missed. We are reporting a series of 4 cases of HPP in two males and two females from the North eastern region of India who presented with sudden onset weakness of limbs. Although hyperthyroidism is not common in this region of the country, all of them had elevated thyroid hormone levels on further evaluation. This case series is to highlight the significance of thyroid function test in cases presenting with a history of periodic paralysis.
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LETTER TO EDITOR Top

Number of COVID-19 test and positive rate: Is there any relationship? p. 178
Rujittika Mungmungpuntipantip, Viroj Wiwanitkit
DOI:10.4103/jms.jms_99_20  
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