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   Table of Contents - Current issue
July-December 2021
Volume 7 | Issue 2
Page Nos. 71-148

Online since Friday, December 24, 2021

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Too little too late? Or a small step in the right direction? - Cancer screening in India Highly accessed article p. 71
Sonu H Subba
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Neuropsychiatric aspect of social isolation following a lockdown: A perspective p. 74
Shreshth Khanna, Ayush Jain, Bhupinder Singh Kalra
Coronavirus disease 2019 pandemic spreads through inhalation of aerosols or droplets. Therefore, the use of face masks, alcohol-based sanitizers, and most importantly practicing quarantine/ isolation and social distancing are the main modalities for its prevention and control. Although isolation is essential, various psychological effects have been implicated with its practice in most of the age groups. Longstanding isolation and negligible interpersonal interactions can have changes in psychological processes and neurological and morphological changes in the brain. Morphological changes as seen through the neuroimaging studies include reduced volume of the structures involved in the synthesis of various nerve growth factors leading to impaired neurogenesis and subsequently psychological changes which can manifest as mood alterations such as anxiety, depression, feeling demoralized, obsessive thinking, and altered sleep–wake cycles besides others especially, in the vulnerable age groups such as children and the elderly. Although quarantine remains the cornerstone to contain the spread of the pandemic, its psychological impact run simultaneously, which should be, understood, and addressed to ameliorate its long-term impact.
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Whether COVID-19 has waterborne transmission too? p. 79
Chandra Mohan Kumar, Bhabesh Kant Chowdhry, Shweta Singh
SARS CoV-2 and COVID-19 have hogged the headlines for almost 18 months and over the last 2 months, it has occupied the mind space of entire India. Its second wave has not only sent shock waves across the nation but has created ripples across oceans too. There has been intense debate over how it went spiralling up in such a manner that India is is reporting large number of cases daily as well as deaths. One of most hotly debated topics is “Whether it is being transmitted through contaminated water too?” There is enough evidence that the virus sheds in feces and that the virus sheds in feces, sewage, sewer lines, waste water, and sewage treatment plants as well as effluents of plants. The important factor is that about two-third of sewer is not treated. On top of that, countries such as India do not have universal access to safe drinking water and practice of open defecation is still prevalent. In such a scenario, likelihood of waterborne transmission cannot be ruled out.
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Novel infectious causes of acute pancreatitis: A comprehensive review p. 83
Saurabh Gaba, Monica Gupta, Ruchi Gaba, Sarabmeet Singh Lehl
Acute pancreatitis can result from a variety of infections. The causative pathogens have been well established to be certain viruses and parasites. However, certain infections fail to find mention in standard literature and have been overlooked due to the trivial number of cases of pancreatitis that result from them. Among these are influenza, leptospirosis, acute viral hepatitis, and certain tropical infections such as dengue, chikungunya, scrub typhus, malaria, and typhoid. In this narrative review, we have conducted a literature search on PubMed and EMBASE databases for cases of pancreatitis occurring in these diseases and compiled the data. Most of these infections are prevalent in the developing world, and consequently, more cases are reported from these regions. The pathogenesis, predictors of outcome, and the response to antimicrobial therapy have not been studied extensively. The actual incidence is probably higher than what is reported, and this subject deserves more attention.
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Prevalence and determinants of spacing contraceptive use among rural married women of Jammu, India p. 92
Priyanka Khuda, Nand Lal Gupta, Nishikanth Palaka, Gurjeet Kaur
Introduction: Promotion of family planning, especially the use of contraceptive methods is essential to secure the well-being and development of society. Despite rise in the temporary contraceptive usage over the years, the implementation of the spacing method has been indicated lower in rural as compared to the urban areas of India. This study aims to find out the prevalence and determinants of current use of spacing contraceptives among married rural women of Jammu district, Jammu and Kashmir. Material and Methods: A community-based, cross-sectional study was conducted from January to June 2018 among married rural women. The survey was conducted house to house, and data were collected with the help of a questionnaire and BG Prasad Scale. Multi-stage sampling procedure was adopted to select the participants. Bivariate and multivariable logistic regression model was fitted to identify the factors associated with the current use of spacing contraceptive methods. Results: The current use of spacing contraceptive among married women was found to be 16.4%. The male condom was the most used method (55.7%) as well as most preferred contraceptive (46.8%). Lack of knowledge was reported as the main reason for not using contraceptive method. The current use of spacing contraceptive method was significantly higher among the upper socioeconomic status (adjusted odds ratio (AOR) 2.37(1.06–5.29), women with higher education (AOR ) 5.04 (0.68–37.18), living in nuclear family (AOR 1.90; CI: 1.01–3.60), with 2 or more surviving children (AOR ) 2.45 (1.27–4.73), and living near health center (AOR) 1.69 (0.91–3.14). Conclusion: Effective targeted programs along with conduction of more field researches that give scientific information should be implemented to achieve the desired goal of contraceptive usage in the rural area among married couples.
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Perceptions of medical students regarding medical profession: Is there a change during graduation course? p. 100
Priyanka , Manish Kumar Goel, Sanjeev Kumar Rasania
Introduction: Medical students enter this profession with a set of perceptions toward the practice of medicine. The study of these factors becomes important as it may provide an insight into the perceptions of doctors toward medical profession to maintain a high standard of professionalism among medical practitioners. Material & Methods: This study was conducted by the department of community medicine of a premier medical institute of Delhi and involved the analysis of 457 feedback forms filled by medical students about their perceptions regarding medical profession at the time of entry and at the end of graduation. The responses were read several times and categorized into similar thematic areas. Results: At the time of choosing profession, 74.8% mentioned the reasons as, its respectable status in the society, 71.8% mentioned their interest to serve people, 26.9% the possibility of huge financial earning, and 21.2% the ease of getting employment. At the end of graduation, 312 (68.3%) considered ease of getting a job and 251 (54.9%) high paying capacity. The proportion of participants mentioning the profession to be prestigious and respectful (50.1%) and intention to serve people (51.2%) considerably declined. Regarding the reasons for change, majority (74.6%) mentioned stress, 66.7% felt it less rewarding, and 54.2% mentioned difficulty to maintain work-life balance. Conclusion: There was a change in students' perceptions at the end of graduation as compared to the time of entry. Their focus shifted from being in a respectful profession and serving community to getting jobs and earning money.
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Integrated approach for survival and development during first 1000 day of life: Assessing Health Systems Readiness in three Aspirational Districts of Jharkhand (India) p. 105
Jaya Swarup Mohanty, Anil Kumar Prabhanjan, Prasant Kumar Saboth, Harish Kumar, Enisha Sarin, Akay Minz, Shailesh Kumar Chourasia, Sachin Gupta
Introduction: With increased evidence of the association between early child-rearing practices and children's health, growth, and development, the government of India has introduced several policies and strategies, of which the home-based care for young child (HBYC) is the most recent. An assessment was conducted in three aspirational districts in Jharkhand to see system preparedness for implementation of the program. Material & Methods: Eight district key health personnel from 3 districts were interviewed on health systems readiness components. A total of 100 Sahiyas (Accredited Social Health Activists) and 100 mothers were selected across 8 villages in 2 blocks in each of the 3 districts of Lohardaga, Simdega, and West Singhbhum, and interviewed with a structured questionnaire on knowledge and practices. In addition, 24 auxiliary nurse midwifes, Sahiya Sathis, and Anganwadi workers were interviewed. Data collection teams underwent an orientation. Results: Most nodal persons were recruited; however, orientation to HBYC and awareness of key components such as incentives, supervision mechanism, and monitoring indicators was lacking. Supply of prophylactics and equipment was inadequate. Knowledge of community health workers was inadequate for many child care indicators except Oral Rehydration Salt (ORS) preparation (96%) and initiation of complementary feeding (97%). Knowledge of danger signs requiring referrals was particularly low (30%). Mothers' knowledge and practices were low on all the indicators. Conclusion: The HBYC program can build its success on the present health system functioning by tailoring trainings to focus on gaps in knowledge, addressing specific gaps in supplies, improving supervision, and integration efforts
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Smart phone usage pattern and associated insomnia among undergraduate students of a Medical College in Chengalpattu district, Tamil Nadu: A cross-sectional study p. 113
Geetha Mani, Karthikeyan Elavarasan, Prasan Norman, Thirunaaukarasu Dhandapani
Introduction: With increased integration of technology into medical education, smart phones have become an indispensable tool. Excess exposure to smart phones and its inadvertent use result in adverse health consequences, both physical and psychological. This study was planned to assess smart phone usage pattern and prevalence of smart phone addiction among undergraduate medical students and to identify association between smart phone usage and insomnia. Material and Methods: A descriptive, cross-sectional study was conducted among undergraduate students of a medical college in Chengalpattu, Tamil Nadu, during January and February 2020. A total of 221 students from first, second, and third year MBBS participated. A Google Form with informed consent, smart phone usage practices, Smartphone Addiction Scale-Short Version (SAS-SV), and Athens Insomnia Scale (AIS) was used as study tool. Data were summarized as percentages, mean, and standard deviation and appropriate statistical tests of significance applied using SPSS software. Results: Approximately half the students (49.3%) used smart phones for up to 3 h daily. Online videos (37.5%) and social media (34.9%) were the most common applications used; 39.4% skipped night-time sleep to use smart phone. The prevalence of smart phone addiction and insomnia was 23.5% and 30%, respectively. Gender, duration of use, time spent in online chats, and Internet search were significantly associated with insomnia; 51.9% of those with smart phone addiction reported insomnia (P < 0.05). Conclusion: The prevalence of smart phone addiction and associated insomnia are high among medical students. With evolving need for technology in medical education, it is imperative that students are sensitized to rational use of smart phones.
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Population-level interest and trends in meditation and yoga during lockdown imposed due to coronavirus disease 2019 pandemic In India: Evidence from Google Trends p. 119
Abhinav Sinha, Shishirendu Ghosal, Navdeep Tyagi, Navroj Singh, Karan Prakash Singh
Introduction: Yoga and meditation have a potential to give mental peace and calm. The present coronavirus disease 2019 (COVID-19) has forced countries to impose lockdown due to its infectious nature, thus restricting people in their homes posing psychosocial impact which can be reduced through yoga. Google Trends (GT) is a proxy indicator for population-level interests, which is used instead of traditional survey methods during pandemic. The objective of this study was to monitor population-level interest and trends in yoga and meditation during lockdown imposed due to COVID-19 in India through GT. Material & Methods: GT is an open-access, web-based tool which provides unfiltered sample of active search requests made to Google. Various keywords related to yoga and meditation were used to retrieve web-based search volume from January 30, 2020, to June 7, 2020, for India. These data were correlated with number of cases and deaths reported due to COVID-19 as an increase in cases and death might lead to stress among masses. Results: The search trends and daily number of confirmed cases were fairly correlated (r = 0.647, P = 0.000). The relative search volume for the search trends was also fairly correlated (r = 0.665, P = 0.000) with number of daily deaths due to COVID-19. States such as Uttarakhand and Goa had a higher share of search whereas Meghalaya and West Bengal searched the least. Conclusion: GT showed an increase in population-level interest in yoga and meditation during COVID-19 lockdown which is a positive indicator for population. This indicates the need for continuity of trend so as to make it a routine habit even after the situation becomes normal.
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Prevalence and gender differences in risk factors for noncommunicable diseases in an urban village of Delhi, India: A community-based cross-sectional study p. 125
Anita Khokhar, Poornima Tiwari, Geeta Pardeshi, Shalini Smanla, Priyanka Sharma, Mohammad Rashid, Prateek Goyal
Introduction: About 60% of all deaths in India occur due to noncommunicable diseases (NCDs) and their complications. Early screening for the risk factors can result in a significant reduction in morbidity & mortality. The study was conducted to assess the risk factors for common NCD in an urban village of Delhi, India. Material & Methods: A house-to-house survey was conducted in the study area and risk assessment was done for apparently healthy individuals ≥30 years of age using Community-Based Assessment Checklist by the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke. Participants with a total risk score of more than four were categorized as being at risk of development of NCDs. Descriptive analysis was performed and Chi-square was used to find out gender-related differences in risk factor scores. Results: A total of 478 adults participated in the study with a mean age of 40.3 ± 9.7 years and 54.6% were females. Majority (93.1%) of study participants had at least one risk factor. Approximately 17.2% of study participants had a total risk score of more than 4. There was a high prevalence of modifiable risk factors with more males being tobacco (P < 0.001) and alcohol users (P < 0.001) and more females being inactive (P = 0.007) and having abdominal obesity (P < 0.001). Conclusion: One in six study participants with age ≥30 years was found to be at high risk of having NCDs. This calls for heightened screening activities in this age group along with gender-specific approaches to address the risk factors.
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Assessment of quality of life and its determinants among the elderly residing in a rural area of Faridabad: A cross-sectional survey p. 130
Ekta Gupta, Shweta Goswami, Vaishali Aggarwal, Mitasha Singh, Rashmi Agarwalla
Introduction: Population aging as a result of demographic transition has brought into focus issues pertaining to health status of elderly. We aimed to assess different domains of quality of life (QoL) and its determinants among the elderly population of a rural area of Faridabad. Material & Methods: A community-based cross-sectional study was carried out among 300 elderly people aged 60 years and above from October 2018 to January 2019 in village Pali of Faridabad, Haryana. The World Health Organization QOL-BREF scale was used for the assessment of QoL. Results: The study included 44% males with a mean age of 67.1 ± 7 years. The mean QOL score was highest in psychological domain (63.26 ± 18.48), followed by environmental domain (62.64 ± 16.23), physical domain (60.58 ± 19.24), and lowest in social domain (59.33 ± 17.81). Conclusion: Physical domain of QoL was significantly better in nondiseased elderly, while social domain was not significantly affected by morbidities or health-seeking behavior. Overall, QoL was fair to good. Determinants of good QoL included social as well as economic characteristics such as higher education, sex, and the absence of chronic disorders.
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Strengthening home-based postnatal care of rural area of two districts of Haryana using mobile phone technology: A pilot study p. 135
Bharti Sharma, Ankit Raina, Vijay Kumar, Premananda N. Mohanty, Minakshi Sharma, Amit Gupta
Introduction: Home-based postnatal care (HBPNC) plays an important role in improving the survival of mothers and newborns by complementing facility-based care. In India, HBPNC was initiated in 2011 under National Rural Health Mission, but the coverage and quality of postnatal care still remain a challenge. In the present study, we describe the methodology used in strengthening the existing HBPNC by utilizing mobile phone technology. Material & Methods: The study was conducted in the rural population of two districts of Haryana in collaboration with the National Health Mission Haryana and Survival for Women and Children (SWACH) foundation. The Accredited Social Health Activists (ASHAs) in the study area were provided a mobile phone and training related to the use of mobile technology, their roles, responsibility, and the information to be shared through phone and its purpose. Results: Along with providing home-based post-partum care, a total of 120,654 births (from May 2015 to August 2019) with detailed outcomes of pregnancy have been reported to SWACH. Population-based birth defect surveillance, stillbirth surveillance, and investigation of neonatal deaths are being done successfully using the same platform. Deaths are also being investigated by verbal autopsy. Age- and stage-specific participatory learning groups for action have been created on mobile phones for pregnant women, postnatal mothers to provide support, and interactive education to improve the maternal, newborn, and child health. Conclusion: It is feasible to strengthen the existing HBPNC with mobile phone technology to improve maternal and child health further. Vital events can be captured on an ongoing basis through ASHA as a key informant.
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Germ cell tumor of anterior mediastinum: A rare case in young adult p. 140
Saurav Kumar, Raghvendra Gumashta
A 30-year-old diabetic male, urban resident, nonsmoker with Karnofsky performance score 80 was diagnosed with germ cell tumor of 13 cm × 9 cm with Stage I at right anterosuperior mediastinum after short duration of cough and hemoptysis. He did not have any difficulty in breathing or weight loss. The effort tolerance of the patient was up to four floors. The case received VIP-based chemotherapy with etoposide, ifosfamide, and cisplatin at a center of excellence. Thereafter, the surgical excision of the solid mass may be the optional line of treatment.
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Changes in undergraduate medical education practices during COVID-19 pandemic p. 144
Mukund Sable, Saurav Sarkar, Vinaykumar Hallur, Priyadarshini Mishra
Introduction: The countrywide lockdown in response to COVID-19 pandemic necessitated a shift from conventional teaching to online teaching. This study aimed to find the issues and challenges faced by medical teachers on the virtual platforms of teaching during lockdown. Material and Methods: A cross-sectional survey was conducted among the medical teachers of a tertiary care hospital between august to october 2020. A google form with study questionnaire was circulated among participants. Results: Online live lectures were major mode of online teaching. 36.5% of teachers felt that they were successful and only 19.2% felt, they were unsuccessful in engaging most of the students. Discrepancies between efforts and outcome (20.54%), absence of definite guidelines (20.54%), unwanted disturbances (19.17%), lack of technical expertise (19.17%), absence of uniform format (10.95%), and lack of knowledge (6.84%) were the challenges faced. A change in the content of slides (52.8%), increased use of videos, charts, and figures (41.5%), changes in lesson plan (32.1%), including assessments after each class (28.3%) and division of content into sub-topics for better understanding and easy upload (22.6%) were the modifications made by faculty for online teaching. Around half of the faculty members disagreed that teaching can be conducted online postlockdown. Conclusion: The pandemic is a situation that should encourage all medical educators to be trained and adapt to online teaching methodologies.
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