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   Table of Contents - Current issue
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April-June 2021
Volume 19 | Issue 2
Page Nos. 67-128

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EDITORIAL  

COVID-19 vaccines: Hope on the horizon with doubts Highly accessed article p. 67
Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/cmi.cmi_14_21  
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ORIGINAL ARTICLES Top

Knowledge, attitude, and practice of university students toward COVID-19 in Sudan: An online-based cross-sectional study p. 70
Safaa Badi, Muhammad Abdou Abdulraheem, Anas Albagir Mustafa, Mazin Sayed Matar, Bashir Alsiddig Yousef
DOI:10.4103/cmi.cmi_155_20  
Background: On March 11, 2020, the WHO has declared that coronavirus disease 2019 (COVID-19) is a global pandemic infection. People's commitment to the recommended control measures is generally affected by their knowledge, attitudes, and practices (KAPs) concerning COVID-19; hence, this study aimed to assess the KAPs of university students in Sudan regarding COVID-19. Materials and Methods: This was an online descriptive cross-sectional study, performed between April and June 2020 among Sudanese students enrolled in 10 universities in Khartoum state. The study was conducted using an online questionnaire designed in Arabic. The sample size in this study was 657 students. Data were collected by a convenience sampling method and were analyzed using the Statistical Package for the Social Sciences. Results: More than 60% of the participants were females, around two-thirds (68.1%) aged between 18 and 23 years. More than 81% of the participants live in urban areas; approximately two-fifth (59.5%) of them were medical students. About 59% of the participants have sufficient knowledge. Twenty-two percent of the participants reported a positive attitude, while 71% of them reported a fair attitude, and only 3.8% reported a negative attitude. Nearly 94% of them do not go out of home, and 95% do use disinfectants, solutions, and face masks to prevent contacting and spreading COVID-19. Knowledge was significantly associated with age, gender, study level, being medical or nonmedical students, attending online lectures or webinars about COVID-19, and educational level, while attitude was significantly associated with gender. Conclusion: More than half of the participants had sufficient knowledge, and the minority of them had a negative attitude toward COVID-19, while most of them had a good practice. Gender and attending online lectures or webinars about COVID-19 were the predictors for participant's knowledge.
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Clinical profile of patients with delirium who presented to the department of psychiatry of a tertiary care teaching hospital p. 78
Mathews Joseph Panicker, Anil Kakunje
DOI:10.4103/cmi.cmi_153_20  
Background: Delirium is characterized by decline in cognitive performance and is associated with various medical and psychiatric comorbidities. Each of these may be further associated with deranged clinical investigations. Objectives: To determine the clinical profile of delirium in patients referred to the department of psychiatry in a tertiary care hospital from October 2019 to October 2020. Methodology: This was a cross-sectional study which was conducted in a tertiary care teaching hospital among 48 in-patients who satisfied the criteria for delirium as per ICD-10, over a period of 1 year after obtaining clearance from the institutional ethics committee. A specialized pro forma was used to record demographic, medical, psychiatric, and other relevant clinical data. Results: The mean age of all participants was found to be 56.73 years ± 17.2 years. Among 48 patients with delirium, 45 had hepatic risk factors and 34 patients had multiple risk factors. Results of electrolytes between patients with and without encephalopathy were found to be statistically significant for sodium and chloride. Conclusions: Delirium continues to be a clinical diagnosis without any specific laboratory parameters and hence it becomes quite difficult to predict its onset and poses a threat for its management. Therefore, the awareness of such risk factors that increase the risk for developing delirium will lead to a better understanding of this complex syndrome which is crucial for its prevention and management.
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Study of obstructive sleep apnea parameters in patients of nasal polyposis using peripheral arterial tonometry p. 83
Rajat Basak, Devinder Rai, Manish Munjal
DOI:10.4103/cmi.cmi_2_21  
Background: Obstructive sleep apnea (OSA) syndrome is characterized by partial or complete cessation of airflow and oxygen desaturation during sleep owing to upper airway collapse. This study assesses the OSA parameters in nasal polyposis patients before and after functional endoscopic sinus surgery (FESS) with the help of peripheral arterial tonometry (PAT) device. Methodology: This was a prospective study done in the months of April 2015 to June 2016. Patients with bilateral nasal polyps with Lund Mackay Scoring marking equal to and more than two of both sides. Thirty patients willing to undergo PAT sleep study before and after FESS were recruited. The sleep parameters thus obtained in the pre- and postoperative period were analyzed. Results: Out of 30 patients, 22 patients were male and eight patients were female. The mean age was 43.17 with standard deviation of 10.06 years. The mean body mass index was 29.12 with a standard deviation of 5.76. All patients underwent FESS. The PAT study was done before and after surgery. Snoring grading and Epworth Sleepiness Scale scoring improved in the majority of patients after surgery. The mean respiratory disturbance index (RDI) in the preoperative period was 32.7 which decreased to 11.34 in the postoperative period. The mean apnea hypopnea index (AHI) in the preoperative period was 22.85 which decreased to 6.34 in the postoperative period. The mean oxygen desaturation index (ODI) in the preoperative period was 16.8 which decreased to 4.4 after surgery. Significant correlation (P < 0.001) was found between pre- and postoperative RDI, AHI, ODI, and oxygen desaturation events. Conclusion: The OSA parameters before and after endoscopic sinus surgery in nasal polyposis patients got improved. The PAT device, which is the newest novel plethysmograph, proved to be a reliable device for the assessment of sleep apnea parameters in nasal polyposis in the pre- or postoperative period.
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Neonatal outcome of babies born to mothers with abnormal umbilical artery doppler p. 88
JP Padma, Lathika Nayar
DOI:10.4103/cmi.cmi_8_21  
Background: Umbilical artery Doppler reflects the status of placental circulation. Very few studies have reported the outcome of intrauterine growth restriction infants with abnormal Doppler flow pattern. Methodology: This prospective observational study was conducted between February 2014 and December 2014. Antenatal mothers with umbilical artery Doppler abnormality, admitted our labor room were recruited and neonates were followed up till postnatal day 28 or till the date of hospital discharge whichever is later. Results: During the study, 201 antenatal mothers with abnormal umbilical artery Doppler admitted to labor room were included in the study. More than half, 107 (53%) babies were preterm. Of the 184 live babies, 57 (28%) had respiratory distress of which 36 had transient tachypnea of the newborn, 12 had hyaline membrane disease and 8 had meconium aspiration syndrome. Absent or reversal of end-diastolic flow was more in those mothers with preeclampsia. The rate of intensive care unit admissions was significantly higher in absent or reversal of diastolic flow (AREDF) group when compared to forward end diastolic flow (FEDF) group. Preterm small for gestational age babies and perinatal asphyxia were significantly high in pregnancy-induced hypertension (PIH) group. Conclusions: Neonates with absent or reversal of diastolic flow in umbilical artery have significantly higher morbidity and mortality when compared to those with FEDF. Even within the abnormal Doppler group, PIH adversely affects the perinatal and neonatal outcome, indicating that PIH is an independent risk factor in predicting adverse perinatal and neonatal outcome.
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Knowledge, attitude, and practice of community pharmacists toward tablet splitting and crushing at omdurman locality: A cross-sectional study p. 94
Mohammed Ali Gafar, Bashir Alsiddig Yousef, Alnada Ibrahim, Zuheir Abdelrahman Osman
DOI:10.4103/cmi.cmi_143_20  
Background: The splitting or crushing of tablets has many advantages, such as dose flexibility, cost reduction, and ease of swallowing. Despite these benefits, there are many drawbacks to this practice. Pharmacists should be able to make decisions and counsel patients concerning these techniques. Our study aimed to evaluate their knowledge, attitude, and practice about tablet splitting and crushing. Methods: A descriptive cross-sectional survey was carried out among 150 community pharmacists using a validated self-administered questionnaire. A stratified random sampling technique was used to select the participants. The knowledge, attitude, and practice were evaluated. Associations between the variables were tested using the Chi-square method. Results: Out of 147 participants, 67.1% were females. The majority of subjects were between 20 and 30 years of age. About 48% of respondents scored a fair knowledge level and 23% of them were knowledgeable of the subject matter. Furthermore, 51% of pharmacists showed good attitudes, as they do not usually recommend the splitting and crushing of tablet dosage. Moreover, more than half of the participants used alternative formulations for patients who were unable to swallow. Nearly 65% of participants did not encourage tablet splitting to help patients to save money. Almost 80% of them declared that they never advised a patient to split or crush enteric-coated or sustained-release tablets. Moreover, a significant association was found between participants' knowledge and their professional experience. On the other hand, the participants' attitude was significantly associated with their age and training levels. Conclusion: The study showed variable knowledge levels among participants. Nearly 51% of the participating pharmacists showed good attitudes regarding the study subject. Experience, age, and training have a positive effect on the knowledge and attitude of participants.
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REVIEW ARTICLES Top

Fluid resuscitation in adult burns p. 103
Ashish Kumar Gupta, Ebenezer Asirvatham, Komala Abhishek Reddy, Shashank Lamba
DOI:10.4103/cmi.cmi_137_20  
Fluid replacement is an integral part of adult burn care, especially in patients with more than 20% total body surface area involvement. The fluid loss in burns has to be adequately replaced to maintain satisfactory tissue perfusion and prevent shock. Over these years, many different formulas and a variety of fluids have been used to resuscitate these patients. This article reviews the current trends and different approaches in fluid management.
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Amitriptyline in irritable bowel syndrome: A clinical review p. 110
Mani Rajagopalan, Ashray Rajagopalan, Ashwin Rajagopalan
DOI:10.4103/cmi.cmi_13_21  
Irritable bowel syndrome is the most common functional gastrointestinal disorder in the primary care setting. Symptoms tend to be long lasting and patients have been reported to have a higher prevalence of psychological distress. Antidepressants have been shown to be effective in its management and we review trials involving amitriptyline. Possible mechanisms of action are discussed.
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OPINIONS Top

Inculcating research skills among medical students during their training p. 115
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/cmi.cmi_146_20  
Research is the backbone of medicine, and the advancement in the field of research plays a crucial role in improving the quality of care offered to the general population. In general, the process of development of research skills by medical students can be either accomplished by integrating research within the curriculum or by means of encouragement of specific activities or course distributed throughout the course depending on a clearly defined plan. Like any other competency, it is a must that there has to be a framework for the assessment of research skills to ascertain the competency of medical students. In conclusion, it is the need of the hour that medical students should be given an adequate number of learning opportunities to develop research skills during their undergraduation period. However, for this to happen, research-related competencies should be included within the curriculum and a specific comprehensive framework targeting research-related attributes should be developed.
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Shrinking and psychological disappearance of the penis: A salient psychocultural issue in Nigeria p. 117
Chidiebere Emmanuel Okechukwu
DOI:10.4103/cmi.cmi_10_21  
Koro syndrome is a psychiatric disorder characterized, by severe anxiety, with grievances of a shrinking penis in men and fear of its retraction into the abdomen and consequent death. Koro is also identified as genital retraction syndrome or shrinking penis syndrome, and it was recognized in the diagnostic and statistical manual of mental disorders, fourth edition in the section of culture-bound syndromes. There are numerous reported cases of penis loss in Nigeria, the suspicion associated with penile retraction usually transforms into a severe panic attack concerning fear of loss of potency and virility in men. Psychosocial factors, cultural belief, religious doctrine, strong confidence in the mystical powers of voodoo, and present mental condition of an individual often act as stimulus in the reported cases of male genital retraction and mysterious penis theft in West Africa. Moreover, in Nigeria, it is often believed that individual genitals were stolen for ritual and occultic purposes. Patients with Koro can be treated using psychotherapy with reference to the underlying symptoms and mental disorder.
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CASE REPORTS Top

Diabetic gustatory sweating p. 119
S Sheetal, S Amith Kumar
DOI:10.4103/cmi.cmi_141_20  
Gustatory sweating refers to facial sweating after ingestion of food or drink. Gustatory sweating may develop as a symptom of autonomic dysfunction in patients with diabetes. It is reported in long-standing diabetes mellitus with associated complications such as neuropathy and nephropathy. We hereby report the case of a man, with long-standing diabetes, with associated neuropathy, who developed this symptom during an episode of tight control in glycemic status.
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Advanced primary abdominal pregnancy – A case series based on single-center experience from a rural secondary level hospital in Northeast India p. 122
V Carolin Solomi, Vijay Anand Ismavel, Ann Miriam
DOI:10.4103/cmi.cmi_154_20  
Five patients with advanced primary abdominal pregnancy presented to our center between 2010 and 2020. The clinical profile, presentation, and management of these patients are described with a discussion on this rare but important condition. Of the five, four women survived. There was preoperative fetal demise in four of them, and one patient had a healthy live term baby. Advanced primary abdominal pregnancy, although very rare, is a life-threatening variation of ectopic gestation. Correct diagnosis is often a serious obstetric dilemma and the condition is associated with a 90-fold increase in maternal mortality rate and fetal survival is exceedingly rare. The clinical symptoms by which patients present are similar to other ectopic pregnancies like tubal ectopics. However, in our subset of patients, all were in their third trimester and four out of five presented in shock. Hence, a high degree of clinical suspicion for abdominal pregnancy is required to clinch a correct diagnosis. Often, the diagnosis of abdominal pregnancy is made only during laparotomy. Preoperative ultrasound has 50% accuracy in diagnosing this condition. Magnetic resonance imaging is considered gold standard for the diagnosis of abdominal pregnancies. Medical management with methotrexate is opted when the site of abdominal pregnancy is in the liver and spleen where life-threatening hemorrhage is expected. Surgical management is considered in patients with severe intraperitoneal hemorrhage and in second- and third-trimester abdominal pregnancies. Early diagnosis and proper surgical management irrespective of the stage of gestation is important for achieving good outcome.
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Anterior abdominal wall abscess: A rare presentation of advanced carcinoma of the stomach p. 126
Royson Jerome Dsouza, Vasanth Mark Samuel, Cecil Thankachan Thomas, Pranay Gaikwad
DOI:10.4103/cmi.cmi_1_21  
Surgeons often encounter patients with advanced carcinoma of the stomach that necessitate urgent operative interventions. The presentations include perforation-peritonitis, bleeding, and gastric outlet obstruction. Carcinoma of the stomach is known to invade surrounding organs such as the transverse colon, pancreas, spleen, liver, and rarely, the anterior abdominal wall. In this case report, we describe an elderly diabetic male patient who presented with a large anterior abdominal wall abscess. The contrast-enhanced computed tomography scan of the abdomen showed a communication from the pylorus of the stomach to the abscess cavity. He underwent drainage of the abscess, and the wound was transiently managed with a vacuum-assisted closure. On gastroscopy, a fistulous opening was noted in the pylorus with surrounding erythema. The biopsy from the lesion was reported as a poorly differentiated adenocarcinoma with signet-ring cells. Anterior abdominal wall abscess is a rare presentation of carcinoma stomach and when identified, the primary aim of the treatment should be the sepsis control and wound healing followed by definitive management.
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