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   Table of Contents - Current issue
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January-April 2020
Volume 34 | Issue 1
Page Nos. 1-53

Online since Monday, November 16, 2020

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REVIEW ARTICLE  

SARS-CoV-2 variant: Its clinical importance and molecular epidemiology p. 1
Viroj Wiwanitkit
DOI:10.4103/jms.jms_76_20  
Coronavirus disease 2019 (COVID-19) is a newly emerging disease. COVID-19 pandemic becomes a global problem in 2020. The disease causes more than 22 infected persons worldwide. Since this respiratory infection is a new coronavirus infection, the knowledge of its clinical epidemiology is very important for proper management. The diagnosis of the infection is usually based on molecular diagnosis. The molecular study of the pathogenic virus, SARS-CoV-2, might detect a mutated virus. The COVID-19 with mutated virus is an interesting emerging problem in medicine. There are some new reported on SARS-CoV-2 variants that are associated with altered clinical feature. In this short review article, the author summarizes and discusses the data on SARS-CoV-2 variant. The clinical importance and molecular epidemiology of SARS-CoV-2 variant are focused on the present article.
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ORIGINAL ARTICLES Top

Different sources of information and their effects on contraceptives usage among female undergraduates in a Nigerian university p. 5
Ishaq Funsho Abdul, Aleakhu Imohagene, Lukman Omokanye, Kike T Adesina, Moses S Oguntoye, Gbenga O Popoola
DOI:10.4103/jms.jms_24_18  
Aim: The aim is to determine whether there is a significant and or predictable effect of information sources on contraceptives and contraceptives usage among female undergraduates at the University of Ilorin, Ilorin, Nigeria. Design: The study design involves cross-sectional structured questionnaire-based. Setting: The university campus. Participants: One hundred and fifty-one females from 100 to 500 levels and studying varying courses were selected from the bursary list of students using a multistage random sampling method. Main Outcome Measures: Do sources of information have a significant and predictable relationship with contraceptives usage? Results: Most of the students were 20–24 years old (53.0%) with a mean age of 20.28 ± 2.20 years. Christianity was the most practiced religion (55.0%), while Yoruba, the predominant tribe (73.6%). Out of the 91.4% aware of contraceptives, only 51.0% had ever used contraception. The condom was the most typical (90.9%) contraceptive used. Teachers were the most reported source of information on contraception (20.1%) but were not statistically significant, followed closely by peers (15.9%), with only 14.95% coming from hospital sources. However, at the multivariate level, radio was four times a significant predictor of use of contraception among the students (odds ratio [OR] = 4.288. 95% confidence interval [CI] [1.106–16.633]) while television was two times a predictor (OR = 1.987. 95% CI [0.776–5.091]). Conclusion: Television and radio were found to have a significant and predictable impact on contraceptives usage, so promotion of contraceptive use should engage the media more when targeting university students. The university's local radio becomes highly recommended, and the upcoming university local television station in sexual health and contraception information dissemination for students. Implication Statement: The promotion of sexual and reproductive health, especially contraception, to prevent sexually transmitted diseases and unwanted pregnancy on the campus of higher institutions are incredibly important. This study is contributing to understanding the ways and means of going about this demanding and evolving task.
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A population-based study on the burden of tobacco-related cancers in Kamrup urban district cancer registry of Assam, India p. 11
Jagannath Dev Sharma, Debanjana Barman, Arpita Sharma, Manoj Kalita, Amal Chandra Kataki, Ranjan Lahon, Chinmoy Misra
DOI:10.4103/jms.jms_72_19  
Background: Tobacco use remains a serious and persistent national problem and is the leading preventable cause of cancer worldwide. At least 1.3 billion people worldwide use tobacco in some form and are responsible for causing mortality of approximately 6 million people annually from cancer and other diseases. Materials and Methods: Data collection is active with participation of different sources including major hospitals, diagnostic centers, state referral board, and birth and death registration centers within registry area as cancer is not notifiable in India. Results: In males, a total of 4794 cancer cases were registered in Kamrup urban district during the period from 2010 to 2014, out of which 2386 cases were tobacco-related cancers (TRCs), and in females out of 3767 cases, 944 were TRCs. In the North Eastern Region, head-and-neck cancer is common, and high use of tobacco is a risk factor in this region. The age-standardized rate (age-adjusted rate) per 100,000 population of TRCs in males is 99.9 and in females is 48.0. Conclusion: Knowledge of the incidence and pattern of TRCs is of paramount importance in planning and implementing measures for primary prevention of tobacco use which is a major step in cancer control.
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Development and validation of a new tool (TerHosQual) for assessing service quality in a tertiary care hospital p. 17
Shalini Natarajappa, MD Ravi, Byalakere Rudraiah Chandrashekar, P Nagesh
DOI:10.4103/jms.jms_44_20  
Background: Evaluating service quality (SQ) is an important consideration in the era of ever-increasing inflow of patients through medical tourism. This not only influences the satisfaction of customers but also their purchase intentions. Objective: The objective was to develop and validate a new tool (TerHosQual) for assessing SQ in a tertiary care hospital in Mysore, India. Materials and Methods: Initial tool consisting of 72 items was drafted by synthesizing literature review and inputs from subject experts. The items were segregated into 13 dimensions in consultation with three internal experts. Content validation was done by 12 subject experts. Based on their inputs, 21 items were deleted from the initial tool (8 items for lack of relevance, 6 items for lack of appropriateness, 3 items for lack of clarity of words, and 4 items for redundancy). Response process validity of the final tool consisting of 51 items under 13 dimensions was done using cognitive interview (retrospective verbal probing method). Test–retest reliability assessment was done on ten prospective participants to assess the reliability of the tool before pilot testing the tool on 30 participants. Results: It was found that the Cronbach's alpha if item deleted did not show significant improvement for any of 51 items in the tool as well as for 13 dimensions. The Cronbach's alpha coefficient for 51 items in the tool was 0.95 and for 13 dimensions, it was 0.87, indicating a high degree of reliability of the items in the tool under these dimensions. Conclusion: The pilot study demonstrated the feasibility of using this new tool in a tertiary care hospital while indicating the reliability of the tool. However, the tool needs to be further evaluated using a larger sample size and factor analysis to validate these results of the pilot study.
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A study of relationship between maternal serum vitamin D levels during pregnancy and risk of preterm births p. 25
Gurpreet Kaur Dhillon, Suneeta Singh, Harpreet Singh Dhillon, Shibu Sasidharan
DOI:10.4103/jms.jms_50_20  
Background: Preterm birth is the leading cause of death among neonates and children under 5 years of age with long-term adverse sequelae in the survivors. Vitamin D is being increasingly researched for its protective effect against the risk for preterm births due to its role in immunomodulatory and anti-inflammatory processes. An observational study was undertaken to study the relationship between maternal serum Vitamin D levels during peripartum period and the risk for preterm birth. Materials and Methods: This study employed a cross sectional design in a tertiary care center on 569 patients to study the relationship between maternal serum Vitamin D levels and risk of preterm births. Results: A total of 569 samples of maternal and neonatal serum were analyzed for serum 25-hydroxyvitamin D (25[OH]D) levels. Four hundred and sixty-four (81.54%) mothers had Vitamin D sufficient (VDS) levels ≥30 ng/ml and 105 (18.45%) had Vitamin D deficient (VDD) levels <30 ng/ml. Out of the total 569 deliveries, 501 (88.04%) occurred at term (≥37 weeks' period of gestation) and 68 (11.95%) were preterm (<37 weeks' period of gestation). The incidence of preterm births was 10.77% in the VDS group as compared to 17.14% in the VDD group (P = 0.038). The mean cord blood 25(OH) D level of preterm neonates was 12.68 ng/ml (standard deviation [SD] 3.85, range 7.9–22) and term neonates was 13.63 ng/ml (SD 3.76, range 8.2–27) (P = 0.035). Conclusion: The rate of preterm delivery was 1.59 times higher in mothers with Vitamin D deficiency. Furthermore, the mean cord blood Vitamin D levels were higher in term newborns.
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Knowledge, attitude, and practices about biomedical waste management as per 2016 rules among resident doctors and nursing staff in a tertiary care specialty hospital: A cross-sectional study p. 31
Pranjal Dey, Basudeb Das
DOI:10.4103/jms.jms_73_20  
Background: During the health-care delivery process, healthcare establishments generate hazardous bio-medical wastes (BMWs) which need for appropriate handling and management to prevent environmental and public health hazard. Different healthcare professionals should have adequate knowledge, attitudes, and practices with respect to BMW management. Honorable Supreme Court of India had led down the guidelines on BMW (Management and Handling) Rules in 1998, which was amended in 2016 by the Environment ministry. Objective: To assess knowledge, attitude, and practices regarding BMW management among the resident doctors and nursing staff in a tertiary care specialty teaching hospital as per new BMW Management Rules, 2016. Study Design: This was an institution based cross-sectional study. Methods: Predesigned, pretested, structured questionnaires were administered on fifty resident doctors and fifty nursing staff of the hospital with their prior consent. Data were analyzed using SPSS-25. Chi-square test and independent-sample t-test were applied for the analysis. Results: Both groups had adequate and comparable knowledge about BMW management. The nursing group had significantly more favorable attitude and adequate practice in comparison to resident doctors (P = 0.0001). There was lack of adequate training in both the groups significantly more in resident doctors. Regarding practices, resident doctors had more inadequate practice regarding handling, segregation, disposal, reporting, and record maintenance of BMW than nursing staff. Conclusion: Nursing staff have a better attitude and good practice than the resident doctors about BMW management. There should be a regular training program regarding BMW management for both the cadres of health-care workers.
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A study of factors affecting visual outcome in small incision cataract surgery p. 36
Renu Magdum, Iqra Mushtaq, Aishwarya Koul
DOI:10.4103/jms.jms_77_20  
Introduction: In spite of the changing patterns of blindness seen globally, cataract remains the most common cause of blindness worldwide. Modern cataract surgery aims to achieve a better unaided visual acuity (VA) with rapid postsurgical recovery and minimal complications. Small incision cataract surgery (SICS) is the most common cataract surgery done all over the world due to its nondependence on expensive machines and easier learning curve. VA following surgery is one of the key indicators for evaluating the quality of surgery. Materials and Methods: This descriptive observational study was conducted in the ophthalmology department of a tertiary care hospital. It included 50 eyes of patients with uncomplicated senile cataract who underwent SICS. Patients were first evaluated for cataract using visual assessment, slit-lamp examination, ophthalmoscopy, and B-scan in case of mature cataracts. Results: Age of patients varied from 39 to 72 years. The hardness of the nucleus varied from Grade 1 to Grade 4 by lens opacities classification system III classification. The types of cataract operated were cortical cataract with posterior subcapsular cataract (n = 36) and nuclear cataract (n = 16). Thirty-eight eyes out of 50 eyes (68%) had unaided VA of 6/18–6/60, whereas only 24% of eyes had vision better than 6/18 on POD 1. Unaided visual outcome on POD 7 showed 60% cases with VA better than 6/18. In two cases, vision remained below 6/60. Intraocular lens power was determined using the SRK II formula. In majority of cases (48%), the incision size was between 6.5 and 7 mm. The contour of the external incision was straight in 72% cases and frown shape in 14% cases. Most eyes showed improvement of vision between 1st and 7th postoperative day. However, in one eye, vision remained below 6/60. Conclusions: Sight restoring cataract surgery is undoubtedly one of society's most cost-effective medical commonly done surgeries not only in India but also all over the world. All grades of nuclear sclerosis can be dealt with by this technique. A surgeon can further improve his/her postoperative results by giving due attention to the site, size, and contour of his/her incisions and taking care to protect the corneal endothelium while doing intraocular maneuvers and nucleus removal.
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A study of factors affecting visual outcome in small incision cataract surgery p. 36
Renu Magdum, Iqra Mushtaq, Aishwarya Koul
DOI:10.4103/jms.jms_77_20  
Introduction: In spite of the changing patterns of blindness seen globally, cataract remains the most common cause of blindness worldwide. Modern cataract surgery aims to achieve a better unaided visual acuity (VA) with rapid postsurgical recovery and minimal complications. Small incision cataract surgery (SICS) is the most common cataract surgery done all over the world due to its nondependence on expensive machines and easier learning curve. VA following surgery is one of the key indicators for evaluating the quality of surgery. Materials and Methods: This descriptive observational study was conducted in the ophthalmology department of a tertiary care hospital. It included 50 eyes of patients with uncomplicated senile cataract who underwent SICS. Patients were first evaluated for cataract using visual assessment, slit-lamp examination, ophthalmoscopy, and B-scan in case of mature cataracts. Results: Age of patients varied from 39 to 72 years. The hardness of the nucleus varied from Grade 1 to Grade 4 by lens opacities classification system III classification. The types of cataract operated were cortical cataract with posterior subcapsular cataract (n = 36) and nuclear cataract (n = 16). Thirty-eight eyes out of 50 eyes (68%) had unaided VA of 6/18–6/60, whereas only 24% of eyes had vision better than 6/18 on POD 1. Unaided visual outcome on POD 7 showed 60% cases with VA better than 6/18. In two cases, vision remained below 6/60. Intraocular lens power was determined using the SRK II formula. In majority of cases (48%), the incision size was between 6.5 and 7 mm. The contour of the external incision was straight in 72% cases and frown shape in 14% cases. Most eyes showed improvement of vision between 1st and 7th postoperative day. However, in one eye, vision remained below 6/60. Conclusions: Sight restoring cataract surgery is undoubtedly one of society's most cost-effective medical commonly done surgeries not only in India but also all over the world. All grades of nuclear sclerosis can be dealt with by this technique. A surgeon can further improve his/her postoperative results by giving due attention to the site, size, and contour of his/her incisions and taking care to protect the corneal endothelium while doing intraocular maneuvers and nucleus removal.
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Clinicopathological and immunohistochemical study of male breast carcinoma: Experience from a tertiary care teaching hospital of South India p. 41
Panduranga Chikkannaiah, Srinivasamurthy Venkataramanappa, Vinutha Lakshman, Nidhi Nair
DOI:10.4103/jms.jms_75_20  
Introduction: Male breast carcinoma (MBC) accounts for 1% of all breast carcinomas. Compare to female counter part, they present with advance stage and high lymph node positivity and carries a poor prognosis. Invasive ductal carcinoma (IDC) no special type was the most common histopathological type. They express high hormonal receptor positivity. Few epidemiological studies of MBC are available in the northern part of India, but studies in the Southern India are spares. Hence, this study was undertaken to document the clinicopathological parameters and IHC profile associated with MBC in this region of India. Materials and Methods: This is a retrospective study for a period of 10 years. Each case was assessed for clinical presentation, laterality, quadrant of the breast involved, fine-needle aspiration cytology diagnosis, mammography, type of surgery, size of tumor, histopathological diagnosis, lymph node status, metastasis, SBR grading, and TNM staging. Immunohistochemical expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (Her 2) Neu, and Ki 67 was graded as per the standard protocol. Results: During the study period, 16 MBC were observed, constituting 1.5%. The median age is 59 years; painless lump is the most common presentation. IDC no special type is the most common variant. The left breast was commonly affected (81.25%). None of them had a family history of breast carcinoma; central subareola region is the most common anatomical site involved. 62.5% were in Grade 2 and 28.5% showed ipsilateral axillary lymph node involvement. High hormonal receptor positivity was noted in 100% cases, whereas 12.5% showed Her 2 amplifications. Conclusion: Our study also conclude that the pathology of MBC is as most of the cases are presenting with Stage 2 and less lymph node involvement which may carry a better prognosis; however, more studies on the large sample are required to document the same.
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CASE REPORT Top

A rare presentation of nasal tuberculosis p. 47
Santosh Kumar Swain, Ishwar Chandra Behera
DOI:10.4103/jms.jms_26_19  
Tuberculosis is a chronic granulomatous disease common in developing countries resulting in significant morbidity and mortality. It has varied clinical presentations, and it varies from common pulmonary tuberculosis to the rare lone like tuberculosis of the nose involving the columella like in this case. Primary nasal tuberculosis is an extremely rare clinical entity even in developing countries where tuberculosis is common. Early diagnosis and treatment will definitely reduce the morbidity of the disease. It becomes more difficult to diagnose if presenting with nonspecific symptoms which are not associated with classical nasal tuberculosis. Here, we report the diagnosis and treatment of a rare case of primary nasal tuberculosis in the columella region.
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SHORT COMMUNICATION Top

Call for global leaders to improve their preparedness and response amidst changing dynamics of the coronavirus disease 2019 outbreak p. 50
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jms.jms_15_20  
The Corona Virus Disease-2019 (COVID-19) outbreak continues to increase in terms of reported cases, attributed deaths and global distribution since the detection of the first case in the Wuhan city of China. The important finding is that China has been successful in minimizing the incidence as well as attributed deaths, but an opposite trend has been observed in rest of the world. As cases have been reported even in those nations which are having a weak healthcare delivery system, we have to ensure that we are ready with a concerted, well-coordinated and a holistic response plan. The need of the hour is to recognize that no one is immune to infection and thus we have to do our part, as an individual, as a community and as a nation as well to protect people from this novel infection. In conclusion, the COVID-19 outbreak is a global public health emergency with a very high risk of transmission. It is extremely essential to improve our level of preparedness and mount a strong and well-coordinated response plan to contain the infection across the globe.
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LETTERS TO EDITOR Top

COVID-19, detection in a country and treatment in another country – Issue on international referral p. 52
Viroj Wiwanitkit
DOI:10.4103/jms.jms_47_20  
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Distancing of importation: Observation on imported COVID patients p. 53
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/jms.jms_58_20  
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