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   Table of Contents - Current issue
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January-March 2021
Volume 19 | Issue 1
Page Nos. 1-65

Online since Wednesday, January 13, 2021

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EDITORIAL  

COVID-19 pandemic: Quo Vadimus? Highly accessed article p. 1
Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/cmi.cmi_140_20  
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ORIGINAL ARTICLES Top

Rapid assessment of Rashtriya Bal Swasthya Karyakram program implementation and beneficiary feedback at two district early intervention centers in Chhattisgarh State in India p. 3
Shruti Atul Prabhu, Nikhil Keshav Shukla, Mandala Sai Roshni
DOI:10.4103/cmi.cmi_110_20  
Background: The Government of India launched the child health screening and early Intervention programme called Rashtriya Bal Swasthya Karyakram in 2014 to screen children from 0 to 18 years for the early detection of 4 D's (Defects, Diseases, Deficiency, and Developmental Delays including disabilities). Under this program, district early intervention centers (DEICs) are set up as nodal centers at the district level to manage the cases of 4Ds. There are few studies published evaluating the functioning of DEICs or reflecting the feedback from beneficiaries. Aims: The aim of this study is to assess the functioning and infrastructure of DEIC and beneficiary feedback. Methods: One good performing district (Raigarh) and one poor performing district (Raipur) were selected for rapid assessment. Observational check list according to norms was used for assessment of facilities, staffing pattern, and semi-structured questionnaire used for beneficiary feedback. Data were entered in Microsoft excel for the analysis. Results: DEIC Raipur was deficient in staff and infrastructure. Among all the referred cases, only 38.9% and 31.5% reached DEIC Raipur and Raigarh, respectively. DEIC Raigarh deserves special mention. It has special Orthotics unit, “Sensory garden,” and Disability Rehabilitation Center. Beneficiaries face many difficulties at DEIC despite having necessary referral forms. 73.4% parents said loss of daily wages was a deterrent to go to DEIC repeatedly for follow-up. Conclusion: There was a deficiency of staff and infrastructure in DEIC Raipur. DEIC Raigarh had a well-equipped rehabilitation center. It should be developed as “Model DEIC” for Chhattisgarh and explore the possibility of telemedicine to provide services to neighboring underserved districts. Beneficiary feedback was below satisfaction.
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Evidence generation for postprandial Insulin administration for better management of diabetes in noncritically iII patients p. 8
Divya Lalwani, Arti Muley, Harshal Mahida
DOI:10.4103/cmi.cmi_107_20  
Introduction: Previously, premeal sliding scale insulin regimen was used to control sugar levels in hospitalized type-2 diabetes patients. However, the now recommended basal-bolus regimen also failed to show any substantial advantage over the traditional sliding scale regimen in the latest Cochrane review. Methodology: In this retrospective cohort study, data were collected from two groups of patients who received basal with premeal bolus regimen and those who received modified sliding scale regimen (basal with both pre- and lower dose postprandial insulin by sliding scale). The data collected were analyzed to compare the mean reduction in blood glucose level, number of hypoglycemic episodes, and mean hospital stay among the two groups. Results: A total of forty patients were included in the study. Twenty received basal with both pre- and postprandial insulin correction by sliding scale and other twenty received basal insulin with postmeal bolus correction regimen. The mean hospital stay in sliding scale with postprandial insulin correction was 3.9 ± 2.2 days, and in other group, it was 6.1 ± 4.47 days. Two out of twenty patients in the sliding scale with postprandial insulin group, whereas six out of twenty patients in the other group had hypoglycemic events. Conclusion: Basal with both pre- and postmeal (low dose) insulin by sliding scale might be an answer to the concerns of faster attainment of euglycemia in hospitalized type-2 diabetes patients with minimal risk of hypoglycemia. We plan a prospective study with a larger sample size to substantiate the evidence.
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Human papilloma virus testing in oral squamous cell carcinoma in Southern India: A case–control study p. 12
Jennifer Prince Kingsley, Pranay Gaikwad, Priya Abraham, John Chandrakumar Muthusami
DOI:10.4103/cmi.cmi_102_20  
Background: Oral cancer is a major public health burden in India ranking third among cancers; about 90% of all oral cancers are oral squamous cell carcinomas (OSCCs). Human papillomavirus (HPV) is a well-established oncogenic agent in the causation of cervical squamous cell carcinoma (SCC) and an important risk factor for oropharyngeal SCC, but the link between HPV and OSCC is inconsistent. Knowledge of HPV profile in the OSCC has positive implications for treatment and prevention strategies. Methods: A case–control study was conducted to determine the prevalence of HPV status in 40 newly diagnosed OSCC cases (24 males; 16 females). Age- and gender-matched controls were recruited from the outpatient clinic of a large teaching hospital in Southern India. A questionnaire was used to ascertain the risk factors for OSCC. Using a cytobrush, epithelial cells were obtained from oral cancer lesions or normal mucosa in cases and controls, respectively. The HPV detection and genotyping were done using a real-time polymerase chain reaction technique. Results: Chewing tobacco was strongly associated with OSCC (odds ratio: 3.6; 95% confidence interval: 1.4–9.7), adjusted for potential confounding factors including smoking and alcohol consumption. All the OSCC cases and controls tested negative for HPV DNA. Conclusions: There is an inconsistency in the prevalence of HPV infection in OSCC in India. The prevalence of HPV in OSCC was nil, so the testing for HPV may be unnecessary. The inconsistency of the positivity of HPV in OSCC may be due to a wide palette of geographic and sociocultural differences that exist in the subcontinent. Further studies are, therefore, needed to evaluate the prevalence of HPV in OSCC in the subcontinent and plan optimal therapeutic strategies.
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Are rotational night shifts taking its toll on health-care professionals? A pilot study p. 19
AY Nirupama, D Vinoth Gnana Chellaiyan, G Ravivarman
DOI:10.4103/cmi.cmi_122_20  
Background: It has always been suggested that sleep deprivation has a deleterious effect on the ability of health workers who are involved in multitude of life-saving tasks, which often require more attention and concentration. The Centers for Disease Control and Prevention and the national health portal (Government of India) have now recognized sleep deprivation as a public health epidemic. Materials and Methods: A cross-sectional study was done including health-care professionals working night shifts on rotation at a tertiary level health-care facility, using a semi-structured questionnaire to test the status of their sleep deprivation, cognitive ability, and quality of life as a pilot study. Stratified random sampling was used to select the study participants and health-care professionals with other factors which may interfere with sleep deprivation testing were excluded. Data were analyzed using IBM-SPSS, and required statistical tests were applied (Pearson Chi-square, Fisher exact, Spearman correlation, and Wilcoxon signed-rank test). Results: About 95.12% of participants reported < 6 h of sleep post night shifts, of which 51.2% were found to show signs of sleep deprivation. Of this 51.2%, 28.57% were also found to have lower cognitive function scores, and statistically significant lower cognitive scores were observed during night shifts than during day shifts. The median value of the Montreal cognitive assessment (MOCA) score during the night shift was 27 (interquartile range [IQR] = 4) and the median value of MOCA score during the day shift was 29 (IQR = 1). A poor QOL was observed in 17.07% of the study participants, and it was found to have a significant positive correlation with hours of sleep obtained. Conclusion: The results from the present study points towards a significantly high burden of sleep deprivation among health-care professionals working rotational shifts (51.2%). This warrants a need for further evaluation on larger populations and adoption of comprehensive measures including preventive and promotive aspects like sleep counselling and yoga/meditation for management.
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Evaluation of counseling services provided by community pharmacists and patients' satisfaction toward their services: A cross-sectional survey from Sudan Highly accessed article p. 24
Mazin Sayed Matar, Abdallah Majthoub Eljanzoury, Sulieman Ibraheem Musa, Mohammed Alsiddig Abdulwahaab, Anas Albagir Mustafa, Bashir Alsiddig Yousef, Safaa Badi
DOI:10.4103/cmi.cmi_138_20  
Background: Patient counseling is an integral part of the pharmacy services provided in community pharmacies, and it can be used as a tool to determine the quality of health care. This study aimed to evaluate the community pharmacists' counseling services and determine patients' satisfaction toward these services. Methodology: This study was a descriptive, community-based cross-sectional study in the Sudanese population from March 2020 to June 2020. One thousand nine participants responded to the questionnaire. A convenience sampling method was used to collect the data. Data were collected using an online predesigned standardized questionnaire and then analyzed using the Statistical Package for the Social Sciences. Results: It was found that most of the participants (78.4%) were from urban areas. The majority of the participants (84.8%) completed their education until the university level, and 82% of the respondents were aged between 18 and 29 years. Females were 57.1%, and 50.5% of the participants work in the medical field. About 60% (59.9%) of them have never been asked if they had an allergy to certain drugs when they visited the pharmacy and 81.6% did not receive any information about what to do if they missed a dose, whereas 71.6% have never been told about the possible side effects of the drugs they are prescribed. The average score of satisfaction among the participants was 18.24 ± 3.953. It was found that 32.1% and 11.8% of the people involved in the study were satisfied and very satisfied with the pharmacist's counseling services, respectively. Chi-square test revealed that opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field. Conclusion: More than two-thirds of the participants reported positive feedback toward the community pharmacists and their services. Patient satisfaction was significantly associated with gender, residence, and working in the medical field. Opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field.
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REVIEW ARTICLES Top

Measures that matter in head-and-neck cancer: Review of health-related quality of life p. 32
Sobin V Jacob, Sharief K Sidhique, Annie Jacob, Jenifer Jeba, Santam Chakraborty, Balu Krishna Sasidharan
DOI:10.4103/cmi.cmi_130_20  
In head-and-neck cancer (HNC), it is imperious to assess changes in health-related quality of life (HRQoL) for a comprehensive evaluation of patient needs and treatment outcomes. Currently, there is limited literature about HRQoL measures used in the Indian context. This lack of information may make it difficult for clinicians to understand their patients' overall well-being and hamper their ability to contrive the appropriate treatment plans. Several questionnaires are currently available and used to assess HRQoL in HNC. The objective of this review is to briefly reflect upon the available questionnaires in HNC, their availability in Indian regional languages and conceivable improvement in the design of the questionnaires, and their clinical use. This will allow the head-and-neck clinical team to compare and contrast the available questionnaires and make an informed choice about the most appropriate measure based on their study design or clinical workflow.
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Indocyanine green beyond quantitative liver function tests – An adjuvant in pediatric imaging: A review of its uses and a protocol for administration in pediatric surgical practice p. 42
Tarun John K. Jacob, Gordon Thomas
DOI:10.4103/cmi.cmi_133_20  
Indocyanine green (ICG) is a nontoxic, inert, anionic water-soluble tricarbocyanine dye with ability to fluorescence when light of the near infrared spectrum is focused onto it with a customized camera. ICG has been known as a diagnostic agent for decades. As with many diagnostic modalities in the medicine, the use of ICG has slowly expanded to find varied and novel applications in the clinical practice. Its use as an imaging modality in pediatric surgery is only increasingly being recognized. The uses of ICG range from bile duct identification, biliary atresia surgery, bowel ischemia delineation, tumor detection, parathyroid identification, and lymph leak detection to name a few. Its safety profile, property to bind to plasma proteins, and be excreted exclusively in the bile make it ideal for intraoperative pediatric surgical imaging. Data on ICG use in children are limited to a handful of case reports and few case cohorts globally. A broad literature search on the history of ICG use, pharmacology, licensing applications, and clinical reports specifically for pediatric populations was carried out. This review was done with intent to analyze the safety profile and compile the various indications of ICG use in children. The dye finds ever expanding clinical uses in our large tertiary referral unit for children in NSW, Australia, and it was our intent to create a protocol that allows for its safe use in routine clinical practice. This protocol created will benefit not only our patients, but is one that can be adopted for other pediatric surgical services worldwide.
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CASE REPORTS Top

Papillary thyroid carcinoma with skeletal metastasis: Late presentation of thyroid cold nodule p. 46
AR Vishnu, Julie Hephzibah, David Mathew, Saumya Sara Sunny
DOI:10.4103/cmi.cmi_98_20  
A 60-year-old female presented with complaints of swelling in front of the neck; on evaluation with thyroid uptake, study showed the presence of cold nodule in the right lobe of thyroid. Fine-needle aspiration of the nodule showed benign disease and started on antithyroid medications. The patient was lost to follow-up for 10 years, after which she presented with swelling in the same region of the cold nodule. Due to the continued increase in the size of the swelling, she underwent a fine-needle aspiration biopsy and ultrasound with findings consistent with carcinoma, for which she underwent total thyroidectomy, followed by radiation therapy. On further evaluation for residual thyroid using iodine, whole-body scan showed residual disease with disseminated osseous and lymph node metastases, which was treated twice with 100 mCi of I131, resulting in. A cold nodule on thyroid scan can be benign or malignant and should be kept on regular follow-up and if left untreated may present with disseminated aggressive disease.
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Verrucous hemangioma: A rare and distinct entity p. 50
Farhan Asif Siddiqui, Jawad Al-Khalaf, Yusef Al-Marzooq, Kimy Khan
DOI:10.4103/cmi.cmi_123_20  
Verrucous hemangioma (VH) is an uncommon congenital vascular lesion that presents at birth or in early childhood. The clinical and histopathological resemblance to angiokeratoma and infantile hemangioma raises the question of it being a variant or a separate distinct entity. The authors take this opportunity of reporting a case of VH, occurring in a 14-year-old female for its rarity and the possibility of recurrence, if not diagnosed correctly and treated by wide excision followed by skin grafting.
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Nifedipine-induced gingival enlargement: A case report with review p. 54
Renita Lorina Castelino, Sajad Ahmad Buch, Anusha Rangare Laxmana
DOI:10.4103/cmi.cmi_136_20  
Calcium-channel blockers (CCBs) are widely used for the treatment of various cardiac conditions. Although CCBs have gained mass acceptance and popularity among the medical fraternity, their effect on the oral cavity is often under-reported and rarely debated. This group of medication causes gingival enlargement in some patients, affecting normal practice of oral hygiene, masticatory functions, besides causing esthetic concerns. A severe case of gingival enlargement is presented in a 53-year-old female patient with a history of nifedipine use.
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MEDICAL EDUCATION Top

Formulating a curriculum on research methodology for medical undergraduates using kern's model p. 58
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/cmi.cmi_103_20  
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Scope of feedforward in medical education and the role of teachers p. 60
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/cmi.cmi_139_20  
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LETTERS TO THE EDITOR Top

Does maternal overnutrition during pregnancy cause obesity in offspring? p. 62
Chidiebere Emmanuel Okechukwu
DOI:10.4103/cmi.cmi_108_20  
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Does heavy alcohol consumption contribute to abdominal obesity in men? p. 64
Chidiebere Emmanuel Okechukwu
DOI:10.4103/cmi.cmi_131_20  
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