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   Table of Contents - Current issue
September-December 2019
Volume 33 | Issue 3
Page Nos. 117-162

Online since Wednesday, October 21, 2020

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Doctors and the law p. 117
Gayathri Chandrasekhar, Uma Warrier
India today is booming in medical tourism. Health-care needs and the related workforce are growing rapidly. During this growth, there are a lot of challenges that the health-care workforce is facing – the most prominent among them is violence on doctors. This article focuses on the protection of doctors – at the individual, community, and at the legal level. The methodology is based on qualitative content analysis of articles related to doctors' violence across print and online data available from medical/public health journals, newspapers, and online posts. This review article informs and highlights the measures, best practices, and laws that doctors can look at for protecting themselves when faced with violence at work. The article necessitates the critical aspect of self-protection and also shares some recommendations to enhance the protection of doctors at their workplace.
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Prevalence and characteristics of asthma-chronic obstructive pulmonary disease overlap among asthma and chronic obstructive pulmonary disease patients in a tertiary care center in Northeast India p. 122
Lalfakzuala Renthlei, Asoka Wangkheimayum, Silpa Kshetrimayum, Prameshwari Ningthoujam, Noklangkumla Sangtam, Sujas Datta
Introduction: There is an increasing awareness of a subgroup of patients with chronic airway obstruction which shares several features of asthma as well as chronic obstructive pulmonary disease (COPD) known as asthma-COPD overlap (ACO). There are limited studies on the characteristics of this subgroup while the disease tends to be more severe in them compared to those with asthma or COPD alone. The aim of this study is to determine the prevalence and clinical and sociodemographic profile of ACO. Materials and Methods: This is a single-center, cross-sectional study over a 2-year period from September 2016 to October 2018. Patients above 40 years of age attending our center for the treatment of asthma or COPD in the study period were enrolled. Using the stepwise syndromic approach stated in the recent Global Initiative for Asthma guidelines, they were classified into the groups: asthma, COPD, or ACO. Results: Of the 164 patients enrolled, 37 (22.6%) were found to have ACO. Among patients with ACO, 21 (56.8%) were female (P = 0.016). The prevalence was highest in the age group of 51–60 years, and 31 (83.8%) were smokers/ex-smokers. Majority (43.5%) had normal body mass index. The mean forced expiratory volume in 1 (FEV1) (pre- and postbronchodilation) was lower for patients with ACO (1.4 ± 0.482 and 1.6 ± 0.391) compared to asthma/COPD alone (1.7 ± 0.663 and 1.8 ± 0.682) but was not clinically significant. The postbronchodilation FEV1/forced vital capacity was significantly lower for ACO (69.4 ± 13.2) compared to asthma/COPD alone (72.9 ± 12.7). Twenty-five (67.5%) patients had reversibility. Conclusion: Using the syndromic approach, the prevalence of ACO was found to be 22.6%. Significantly more females and smokers/ex-smokers present with ACO. Patients with ACO have worse lung function than those with asthma/COPD alone.
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Knowledge, attitude, and practice on hepatitis B and C among adult residents in an urban community in Imphal West, Manipur p. 128
Jalina Laishram, H Sanayaima Devi, Shantibala Konjengbam, Vijaya Elangbam
Background: Viral hepatitis is a serious public health problem. The number of hepatitis B virus (HBV) carriers in India accounts for 10%–15% of the entire pool of HBV carriers of the world. Hepatitis C is an emerging infection in India whose long-term implications will be felt in the decades to come. Objectives: The objective of the study is to determine the knowledge, attitude, and practice of hepatitis B and C among adult residents in an urban community in Imphal West and to assess the association between knowledge and selected variables of interest like age, sex, etc. Materials and Methods: This was a cross-sectional study. Data were collected using a structured interview schedule. Descriptive statistics such as mean, median, standard deviation, and percentages were used. Chi-square test was used to determine association. Data analysis was done using SPSS IBM version 16. Results: Majority of the respondents (94.6%) had ever heard of hepatitis B, but only half of the total respondents had ever heard of hepatitis C. 55.1% of respondents had inadequate knowledge. Adequate knowledge was significantly associated with older (>50 years) age, male sex, higher education level, being employed, and being vaccinated against hepatitis B. Attitudes toward the disease and toward those who are infected were mostly positive. The level of vaccination against hepatitis B was found to be low. Conclusion: The study showed the need to improve public awareness of both hepatitis B and C to contribute to the improvement of screening and vaccination process.
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Controlled ovarian stimulation protocols in assisted conception: Agonist versus antagonist in normal responders p. 134
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Kabir Adekunle Durowade, Abubakar Panti, Ganiyu Adekunle Salaudeen
Background: Controlled ovarian stimulation protocols are an important variable for the success of assisted reproduction treatment. The choice of any particular method is influenced by the physicians' experience, patients' preference, and availability of the stimulation drugs. Aims and Objectives: This study aimed at comparing the reproductive outcomes of agonist and antagonist stimulation protocols in assisted conception. Materials and Methods: This is a cross-sectional comparative study of 94 eligible patients that underwent assisted reproduction program at the Assisted Reproduction Technology unit of a tertiary institution. The patients were treated with agonist or antagonist protocol according to the clinician's and patient's preference. Gonadotrophin-releasing hormone (GnRH) agonist and antagonists were administered to 47 patients each, respectively. Results: There were significant differences between agonist and antagonist in the duration of follicle stimulating hormone (FSH), cycle cancellation rate and risk for ovarian hyper stimulation syndrome (OHSS) (P < 0.05). The overall clinical pregnancy rate was 36.2%. The clinical pregnancy and live birth rates in the GnRH antagonist group were higher although it was not statistically significant (P > 0.05). Conclusion: GnRH antagonist protocol gives a shorter stimulation period and reduced number of FSH used, thereby less costly. It also offers less cycle cancellation rate and OHSS risk than the GnRH agonist group, although there was no statistically significant difference in the clinical pregnancy, live birth rate, and miscarriage rate between the two protocols. These results may be helpful for clinical practice. Further controlled randomized prospective studies with larger sample sizes are recommended.
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Flow cytometric pattern of acute promyelocytic leukemia with aberrant expression of CD79a p. 140
Thingujam Bipin Singh, Babina Thangjam, David Howdijam, Ritika Srivastava, Dipdeba Takhellambam
Background: Acute promyelocytic leukemia (APML) is a subtype of acute myeloid leukemia seen mostly in young patients with an aggressive disease course and a tendency towards life-threatening disseminated intravascular coagulation (DIC), requiring prompt diagnosis and specific early intervention. The molecular hallmark of APL is t(15;17)(q22;q21) PML-RARA, and serves as the molecular basis of the highly effective therapy with all-trans retinoic acid. Flow cytometric (FCM) immunophenotyping facilitates a rapid diagnosis and subtyping of acute leukaemia and is critical in the management of patients with APML. Objectives: We analyse and describe the flow cytometric pattern of 5 cases of APML and describe the aberrant expression of CD79a, a hitherto B-cell lineage marker. Methods: Six-colour FCM analysis of bone marrow aspirate was performed for all cases. Trephine biopsies of all the cases were analysed for expression of CD79a primary antibody, SP18 clone; Ventana, Tucson, USA. Karyotypic analysis was also done. Results: Classic APL has a well-recognized flow cytometric pattern with increased side scatter, lack of expression of HLA-DR, CD11a, CD11b, CD18, positive CD117, negative or weakly positive CD15 and CD65, negative CD34, often positive CD64, variable (heterogeneous) CD13 and bright CD33.Four of the five cases were observed to aberrantly express CD79a. Conclusion: APL cases can be rapidly identified by FCM using a routine screening panel. CD79a aberrant expression in AML, either on IHC or on FCM, is strongly suggestive of a diagnosis of APML.
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Sleep quality among nurses in a tertiary hospital in Manipur p. 146
Soubam Christina, Shantibala Konjengbam
Context: Sleep disorder is a common problem worldwide. Nurses are also at risk of poor sleep owing to their work nature. The sleep quality of nurses has serious implications on their health as well as patients' care. Aims: The aim of this study was to determine the prevalence of poor sleep quality among nurses working in a tertiary hospital and to identify the factors associated with it. Settings and Design: A cross-sectional study was conducted in a tertiary hospital in Imphal. Subjects and Methods: All the nurses who were regular employees and had worked in the hospital for more than a year were included. Data were collected with the help of a self-administered questionnaire. The Pittsburgh Sleep Quality Index was used to measure sleep quality, and anxiety and depression were measured with the help of the Hospital Anxiety and Depression Scale. Statistical Analysis Used: Chi-square test was used to test for significance among proportions and t-test for comparing means. Multiple logistic regression analysis was also done. Results: A total of 457 nurses completed the questionnaires. The mean age of the participants was 39.12 ± 8.591 years. The prevalence of poor sleep quality was 43%. Anxiety and depression were significantly associated with poor sleep quality. Conclusions: Four out of every ten nurses had poor sleep quality. The high prevalence of poor sleep quality among the nurses is a matter of concern and warrants further investigation.
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Prevalence and associated factors of low back pain among nurses in a tertiary care hospital p. 152
Naorem Bimol, Christina Soubam, Shantibala Konjengbam, Akoijam Joy Singh
Background: Low back pain (LBP) is a common cause of morbidity among health-care workers. Nurses are vulnerable to LBP. It is crucial therefore to identify the factors associated with LBP to develop preventive programs. Objective: The objective of this study was to determine the prevalence of LBP and identify the factors associated with it among nurses in a tertiary care teaching hospital. Methods: A cross-sectional study was conducted among nurses employed in a tertiary care teaching hospital in Imphal during June 2015 and December 2015. A stratified random sampling technique with probability proportionate to size was used to select the study participants. A structured questionnaire was used to collect data. Results: Two hundred and twenty-two nurses participated in the study. The 12-month prevalence of LBP was 155 (69.8%). LBP was found to be significantly associated with stress at work, lifting heavy objects, body mass index, comorbid condition, long hours of standing (>2 h), and less hours of walking (≤2 h) at the work place. Conclusion: The findings of this study suggest that LBP is a common problem among nurses. Training for high risk work activities, relaxation techniques to reduce stress at workplace are recommended.
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Hydrocele of the canal of Nuck: A rare clinical entity p. 159
Hiralal Adhikari, Sinam Rajendra Singh
Hydrocele of the canal of Nuck, also called the “female hydrocele,” is a rare developmental disorder in females. The processus vaginalis accompanies the round ligament through the inguinal canal into the labium majus. This evagination of the parietal peritoneum forms the canal of Nuck in females. The canal of Nuck normally loses its connection with the peritoneal cavity during the first year of life, but can result in a hernia or hydrocele when the connection of the canal of Nuck fails to close. Among the various reasons of swellings in the female inguinal region, canal of Nuck cysts are rare entities, with little said about in literature. We present the case of a 30-year-old female that presented with right-sided inguinal swelling which, after ultrasonographic confirmation of diagnosis, was treated surgically.
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Seroprevalence of anti-hepatitis C virus: Fluctuation and the possible problem for further implication on hepatitis C virus eradication plan, a comment from Thailand p. 162
Sora Yasri, Viroj Wiwanitkit
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