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2020 | July-December | Volume 3 | Issue 2

EDITORIAL

Bindu T Nair

Online Teaching During COVID-19 Pandemic: The Perspectives of a Medical Teacher

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:2] [Pages No:31 - 32]

PDF  |  DOI: 10.5005/jp-journals-10070-0064  |  Open Access |  How to cite  | 

Original Article

Surendra V Pimparkar, Ashwani Sethi, Avinash Das, Himanshu Joshi

Role of Tissue Glue in Overlay Tympanoplasty vs Conventional Overlay Method

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:5] [Pages No:33 - 37]

Keywords: Fibrin glue, Overlay, TISSEL, Tissue glue, Tympanoplasty

PDF  |  DOI: 10.5005/jp-journals-10070-0058  |  Open Access |  How to cite  | 

Abstract

Purpose: The purpose of this research is to study the role of tissue glue (TISSEL) in overlay tympanoplasty when compared with the conventional overlay method. Study design: A prospective randomized comparative study was carried out at the ENT department of Base Hospital, Delhi, in which 60 patients with dry central perforation underwent overlay tympanoplasty. Out of these, 30 underwent conventional overlay tympanoplasty (control) and in the rest of the 30, overlay tympanoplasty was done with the use of tissue glue (cases). Results: Graft take-up rate in control is 90% and in cases 96.7% (p > 0.05). Hearing improvement within 20 dB of A–B gap (at 03 months) in control is 86.70 and 96.70% in cases (p > 0.05). Early hearing improvement (at 6 weeks) in cases was better when compared with the control (p < 0.05). The complication rate in cases is 10% with residual perforation in 01 patient, while that in control is 16.66% with residual perforation in 03 patients (p > 0.05). Conclusion: Graft take-up rate in hearing improvement was found to be better in overlay tympanoplasty with the use of tissue glue when compared with the conventional method with no statistically significant difference. The only significant advantage with the TISSEL group was found to be an early hearing improvement at 6 weeks. Tissue glue (TISSEL) was found to be safe and effective.

Original Article

Sachin Chourasia, Shivani Dhaka, Ravi Rautji, KV Radhakrishna

Epidemiological Profile of In-Hospital Deaths in a Tertiary Health Care Centre: A 3-Year Retrospective Study in Western Maharashtra

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:5] [Pages No:38 - 42]

Keywords: Cause of death, Death certificate, Global burden of disease, Hospital mortality, Retrospective study

PDF  |  DOI: 10.5005/jp-journals-10070-0054  |  Open Access |  How to cite  | 

Abstract

Aim: The knowledge of specific contributors to mortality is crucial for the improvement of health of the community. Globally, medical certificate of cause of death is used for gathering epidemiological statistics. Our study examines the mortality pattern with sociodemographic characteristics of in-hospital deaths, which occurred at a tertiary health care center in Maharashtra. Materials and methods: This study is a descriptive retrospective study in which 1,000 medical certification of cause of death forms (n = 1000) filled at a tertiary care hospital between Aug 2016 and Aug 2019 were analyzed. Results: Total 64.5% of cases were males and 35.5% were females. About 42% were elderly (60–80 years). About 23% of the deaths were due to “diseases of the circulatory system.” The highest number of cases died within the first 10 days of admission. The “diseases of circulatory system” was the commonest group causing deaths in “brief” hospital stay (<10 days), “diseases of digestive system” in “short” (10 days–1 month), “neoplasia” in “long” (1–3 months), and “diseases of nervous system” in “prolong” hospital stay (>3 months). Conclusion: The mortality rate among males was more than twice of females and maximum deaths were observed in the geriatric age group. The chief causes of mortality overall and among both males and females individually were the diseases of the circulatory system among which, the cerebrovascular diseases accounted for highest number of cases. Overall demographic data were comparable to observations from various national and international studies. Clinical significance: Cause-specific mortality statistics are routinely required by policy makers, researchers, and other professionals for decision-making for resource allocation, monitoring of health indicators, and identifying priorities for health initiatives. Availability of data remains limited and inadequate in many countries. Studies on in-hospital deaths are needed to identify mortality indicators in different regions and channel public health initiatives in the right direction.

Original Article

Sridhara Reddy, Gurunadh Satyanarayana Velamakanni, Shailesh Mogra

Prevalence Study of Ocular Morbidity among Primary School Children in Delhi Area

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:3] [Pages No:43 - 45]

Keywords: Ocular morbidity, Refractive error, School children, Squint

PDF  |  DOI: 10.5005/jp-journals-10070-0048  |  Open Access |  How to cite  | 

Abstract

Aim: To estimate the prevalence of ocular morbidity among primary school children in Delhi area. Materials and methods: This was a descriptive cross-sectional study. The study was conducted among primary school children of age group 5–12 years in Delhi area. A total of 1,100 school-going children were evaluated. After questionnaire administration, visual acuity, examination of anterior and posterior segment structures of the eyes of the children were carried out. For the statistical analysis, children were divided into three groups: group I (5–7 years), group II (8–10 years), and group III (<12 years) based on age. Results: A total of 1,100 school children (625 boys and 475 girls) participated in the study. A total of 282 (25.6%) children had visual impairment and 315 (28.6%) children had ocular morbidities. The common ocular morbidities identified were refractive error 25.6%, color vision defective 0.9%, convergence defect 1.8%, and squint 0.2%. The older age group (8–10 years) had a higher prevalence of refractive error, especially myopia, compared to the younger age group (5–7 years) and group (<12 years) (p < 0.001). Conclusion: A high prevalence of ocular morbidity among school children of age group 8–10 years was observed. Refractive errors were the most common ocular disorders. This study emphasized that a simple school visual screening program is effective for the early detection of ocular problems.

Original Article

Hunsehalli Revanasiddappa Narendra, Aparna Nerurkar, Shibu Sasidharan

Observational Analysis of Changes in Endotracheal Tube Cuff Pressure During Laparoscopic Surgery

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:46 - 49]

Keywords: Cuff pressure, Endotracheal tube, Laparascopic surgery, N2O, Pneumo-peritoneum

PDF  |  DOI: 10.5005/jp-journals-10070-0052  |  Open Access |  How to cite  | 

Abstract

Background: Laparoscopic surgery is performed under general anesthesia with mechanical ventilation, and a high-volume, low-pressure endotracheal tube (ETT) with a sealing cuff pressure about 20–30 cm of H2O is commonly used for a proper seal and avoidance of overinflation. Nitrous oxide (N2O) is an inhalational anesthetic that is used with oxygen in the ratio 50:50 for the maintenance of anesthesia if there is no facility of medical air. However, N2O increases the intracuff pressure of the tracheal tube due to diffusion of N2O in to cuff during general anesthesia. The present research was done to study the cuff pressure changes during laparoscopic surgeries with N2O anesthesia and to assess its variation during the various stages of surgery and also its correlation with position of the patient. Materials and methods: A study was done in a tertiary-level hospital over a period of 1 year in 70 patients undergoing laparoscopic surgery. Endotracheal tube was inflated with incremental doses of 0.5 mL of air to a point where no leak on auscultation on the suprasternal area was noted. Cuff pressure measurement using cuff pressure monitor (Hand pressure gauge) was done at the time of first inflation of cuff up to 20–30 cm of H2O and airway pressure, along with total amount of air inflated was noted as “zero” reading. Thereafter, cuff pressure was measured at regular interval of 5 minutes. Cuff pressures and airway pressures were taken just prior to insufflation, 2 minutes after abdominal insufflation, thereafter every 15 minutes throughout surgery, and 2 minutes after desufflation and prior to extubation. Results: Out of 70 patients, maximum patients were of the age-group of 20–50 years (78.5%). There was no statistically significant difference between the groups. Cuff pressure at the induction was kept in range of 20–30 cm of H2O. In this study, mean tracheal cuff pressure at baseline was 21.10 + 6.16 (p value of 0.207) and prior to insufflation was 21 + 7.13 (p value of 0.733). The cuff pressures at 2 minutes post insufflation (P2), P15, P30, P45, and P60 were 31.40 ± 12.54 cm of H2O, 25.79 ± 8.68 cm of H2O, 24.61 ± 7.37 cm of H2O, 23.83 ± 9.43 cm of H2O, and 24.63 ± 4.77 cm of H2O, respectively. p value was strongly significant showing a positive correlation between pneumo-peritoneum and cuff pressures. We could see the cuff pressure continuously increasing in successive readings. Post desufflation and prior to extubation, there was a fall in cuff pressure with mean cuff pressure being 17.24 + 5.32 cm of H2O and 15.27 + 4.00 cm of H2O, respectively, which also suggests that cuff pressures increased with pneumoperitoneum. Conclusion: Use of N2O increases the cuff pressure (31.4 + 12.54 cm of H2O), especially immediately post-insufflation (35.54 + 12.06 cm of H2O), more so in head low position (36.28 + 12.13 cm of H2O). Mean airway pressure (Ppeak) also increased with pneumoperitoneum (22.60 + 4.38 cm of H2O). The regular monitoring of endotracheal tube cuff pressure should be a part of regular safe practice of anesthesia, and use of handy device like hand pressure gauge should be implemented in regular practice where N2O is used.

Original Article

Vishan DS Jamwal, Bhukya Subhash, Sandeep Karunakaran, Nikita Naredi, Shallu Jamwal, Manish S Ahuja

Retrospective Study on the Infertility Profile of Patients Reporting for In Vitro Fertilization and Embryo Transfer in a Tertiary Care Hospital in India

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:50 - 53]

Keywords: Embryo transfer, In vitro fertilization, Infertility

PDF  |  DOI: 10.5005/jp-journals-10070-0063  |  Open Access |  How to cite  | 

Abstract

Infertility remains one of the health problems in India like anywhere else in the world. Infertility affects about 15% of the population. After the advent of the first in vitro fertilization (IVF) in 1978, there remains a ray of hope for infertile couples to have their own biological child. Over the past decade, there has been a mushrooming of assisted reproductive technology (ART) clinics in all the major cities of India. The number of IVF cycles performed annually in these clinics has been steadily increasing. There is a lack of data on the number of IVF cycles performed annually as there is no central or nodal agency that collects analyzes and maintains the IVF database of these clinics. Our study has worked out the infertility profile of infertile married couples in a retrospective manner. Our study showed that blocked fallopian tubes remain the single most common cause of infertility in India.

Original Article

Ajay K Gupta

A Retrospective Descriptive Study of Adverse Drug Reaction Monitoring in Tertiary Care Hospital

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:5] [Pages No:54 - 58]

Keywords: Adverse drug reaction, Pharmacovigilance, Safety monitoring

PDF  |  DOI: 10.5005/jp-journals-10070-0061  |  Open Access |  How to cite  | 

Abstract

Introduction: An adverse drug reaction (ADR) is any undesirable effect of a drug to the patient beyond its anticipated therapeutic effects while used clinically. Aims and objective: To analyze the incidence of ADRs in a tertiary care hospital reported from April 2015 till December 2017. Materials and methods: Two hundred ADR forms were included in the study and analyzed. These were codified into various drug classes according to anatomical therapeutic chemical (ATC) classification based on WHO–ATC Index 2019 besides categorized into preventable or not modified Schumock and Thornton scale. Severity was assessed based on a scale by Hartwig et al. Also, the ADRs were classified based on MedDRA 13.01 to system organ class (SOC) and preferred terms (PT) falling under respective SOC. Results: Maximum ADRs were reported by dermatology. Most commonly, it involved gastrointestinal system (GIT) followed by skin. Antibiotics and anti-cancer drugs caused maximum ADRs. About two-thirds were classifiable as moderate to severe, whereas about one-third were preventable. About 10% of cases were such that left deep impact of sequelae or were not recovered and one case was fatal. Conclusion: Extreme vigilance by clinicians is of utmost crucial virtue in detecting, diagnosing, and reporting such ADR for continued drug safety monitoring.

REVIEW ARTICLE

Dr Novy Gupte, Sapna Pradhan

Pharmacovigilance: Perspectives in India

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:59 - 62]

Keywords: Adverse drug events, knowledge, attitudes, and practices, Adverse drug reactions, Pharmacogenomics, Pharmacovigilance, Pharmacovigilance program of India, Stakeholders

PDF  |  DOI: 10.5005/jp-journals-10070-0062  |  Open Access |  How to cite  | 

Abstract

Background: Adverse drug reactions are a significant burden on the health system across the world. Paradoxically, a considerable chunk of ADRs is missed or not reported on account of avoidable reasons, resulting in bottlenecks in carrying out the proper management. This problem is much more evident in India and other resource-limited communities than in the prosperous countries of the West. Aim and objective: To provide a state-of-the-art update on pharmacovigilance with special reference to perspectives in India and make appropriate recommendations for improving ADR reporting. Design: The contents are based on a review of English medical literature augmented with the author\'s first-hand experience in the field over the past more than a decade. Results: Well-organized pharmacovigilance started in India with the launching of the Pharmacovigilance Programme of India in 2010. Despite it making a perceptible improvement in ADR reporting, high underreporting of ADRs still prevails. The yet greater thrust on inculcating awareness comprising knowledge attitudes and practices among the healthcare professionals is likely to lead to further improvement in ADR reporting, resulting in augmentation of the safe use of drugs. Conclusion: Pharmacovigilance, a mandatory drug safety activity, needs to be propagated with yet greater vigor among healthcare professionals in India.

CASE REPORT

Akula Hymavathi, Sarat C Uppaluri, Ashima Sharma

Alternating Bundle Branch Block or Pyridostigmine-induced Mobitz Type II Block Masquerading as Acute Coronary Syndrome

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:63 - 66]

Keywords: Coronary syndrome, Infarction, Retrosternal

PDF  |  DOI: 10.5005/jp-journals-10070-0060  |  Open Access |  How to cite  | 

Abstract

Background: “ST-T changes in the ECG!!” These words are enough to get the emergency doctor to spring into action. These changes can be diffuse and/or non-specific but we should rule out all emergent and urgent causes before shifting the patient to the specialist. To err on the side of dangerous etiology is the dictum. Introduction: Out of all emergency department (ED) patients with undifferentiated chest pain, 7% will have ECG findings consistent with acute ischemia or infarction, and 6–10% of those in whom cardiac markers are ordered will have initially positive results. Of all patients with the possible acute coronary syndrome (ACS), 5–15% ultimately prove to have ACS.1 Shortness of breath with chest pain mostly has a cardiac origin in the presence of dynamic ECG changes. We had managed a patient with rapidly evolving ECG changes, chest pain, palpitations, and grade III–IV dyspnea. In the chaotic environment of a busy ED, the most probable diagnosis here will be ACS. Comorbid conditions like diabetes mellitus, hypertension, and prior coronary artery disease (CAD) are commonly enquired. However, other long-standing illnesses like myasthenia gravis (MG), as in our patient can be easily missed if a patient is not forthcoming with history. We experienced a similar confusion when in the cacophony of chest pain, dyspnea, and T wave inversions with bundle branch blocks, ACS protocol was initiated and a simple diagnosis was missed. The significance of the alternating bundle branch block (ABBB) will be presented to the readers.

CASE REPORT

Abdul Nasser, Faheem Raja

Local Anesthetic Systemic Toxicity following Peribulbar Block: A Case Report

[Year:2020] [Month:July-December] [Volume:3] [Number:2] [Pages:2] [Pages No:67 - 68]

Keywords: Lipid emulsion therapy, Local anesthetic, Local anesthetic systemic toxicity, Peribulbar block

PDF  |  DOI: 10.5005/jp-journals-10070-0059  |  Open Access |  How to cite  | 

Abstract

Cataract surgery is performed routinely under regional orbital blocks including retrobulbar and peribulbar blocks. Several complications have been reported while performing these blocks, the most significant of which is the local anesthetic systemic toxicity (LAST). The symptoms and signs present in a varied spectrum, but every such case requires early recognition and immediate resuscitation to avoid long-term morbidity and even death. Lipid emulsion therapy forms the mainstay of treatment. We present a case of a 49-year-old man who planned to undergo cataract surgery under the peribulbar block, who developed LAST and was successfully treated with 20% lipid emulsion without any adverse sequelae.

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