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   Table of Contents - Current issue
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July-August 2022
Volume 15 | Issue 4
Page Nos. 453-615

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EDITORIAL  

Paradigm shifts in public health: Lessons from the Covid-19 pandemic p. 453
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_418_22  
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GUEST EDITORIALS Top

Impact of the COVID-19 pandemic on occupational health of Indian laborers and migrant workers p. 455
MZ M. Nomani
DOI:10.4103/mjdrdypu.mjdrdypu_422_22  
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Monkeypox: Revisit of the old threat and emerging imported cases p. 457
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_440_22  
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Strengths and challenges of flipped classroom: A blended learning approach p. 460
Mausumi Basu
DOI:10.4103/mjdrdypu.mjdrdypu_111_21  
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COMMENTARIES Top

Mucormycosis: An addendum to India's COVID-19 woes p. 462
Shreyasi Roy
DOI:10.4103/mjdrdypu.mjdrdypu_641_21  
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Science in the times of COVID-19 p. 466
Basavraj S Nagoba, Rayate Abhijit
DOI:10.4103/mjdrdypu.mjdrdypu_96_21  
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BRIEF COMMUNICATION Top

Changes in the emergency department dynamics during COVID-19 pandemic p. 468
Gina Maryann Chandy, Darpanarayan Hazra, Priscilla Rupali, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/mjdrdypu.mjdrdypu_188_21  
In the past 20 years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and 2003, H1N1 influenza in 2009, and Middle East Respiratory Coronavirus in 2012 have been recorded. The COVID-19 pandemic caused by SARS-CoV-2 has infected millions across the globe and has been a unique public health challenge with its increased rates of contagion and transmission. This outbreak was likely to have started from a zoonotic transmission event associated with a large sea-food market that also traded live wild animals. An exponential increase in the number of nonzoonotic cases in late December 2019, pointed toward the risk of human-to-human transmission. This led to a faster spread of infection and made the outbreak difficult to contain. The situation was unique in the busy Emergency Department (ED) of our institution, where regular emergency care could not be halted but had to be modified to accommodate COVID-19 confirmed and suspect patients. The ED needed to develop standard operating protocols to isolate and manage these patients, without putting other patients and health-care workers at risk of infection. This is a story of evolving practices in the ED of a leading tertiary care center of South India.
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RESIDENTS CORNER Top

Why and how to attend a medical conference p. 472
M Vishnu Sharma
DOI:10.4103/mjdrdypu.mjdrdypu_371_20  
It is important to attend medical conferences for professional development. Proper planning and focus during the conference is essential for a good outcome. In this article, we briefly discuss how to plan and make the best use of attending a medical conference.
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REVIEW ARTICLES Top

Effectiveness of Pelvic Proprioceptive Neuromuscular Facilitation on Trunk Stability and Gait Parameter in Stroke Patients: A Systemic Review Highly accessed article p. 475
Smit R Shah, Heta Doshi, Chaitali Shah
DOI:10.4103/mjdrdypu.mjdrdypu_406_20  
Background and Purpose: Neurological deficits after stroke are impaired motor functions including balance and gait. Such gait deviations are associated with decreased gait velocity followed by a change in the timing and distance with each step cover. The pelvic proprioceptive neuromuscular facilitation (PNF) facilitates the trunk and lower extremity motion and also provides the stability of trunk. The aim of this review is to systematically evaluate the effectiveness of Pelvic PNF on gait and trunk stability in stroke patients. Methods and Analysis: This systematic review was conducted according to the Preferred Reporting Items for Qualitative Systematic Reviews guidelines. The electronic databases were searched for a quality assessment from the start of databases with all studies of review interest being “Pelvic PNF” exercise, and the outcome of interest was related to trunk function and gait parameters. The characteristics of each study are outlined in Population, Intervention, Comparison and Outcome, and the findings using the Critical Appraisal Skills program for Randomized Controlled Trials were used to assess methodological quality. Results: The reviews in these studies were interest-related “Pelvic PNF.” The results of these reviews of all studies suggest that Pelvic PNF significantly improves trunk stability as well as gait parameters which proves this technique to be most applicable in stoke patients. Conclusion: This review had looked at the Pelvic PNF exercises to physiotherapy care for treatment of hemiparetic patients and demonstrated significant improvement in trunk stability and gait parameters such as cadence, gait velocity, and stride length.
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Authorship for interdisciplinary research: Who should be the first author? p. 483
Pradnya Kakodkar, Ramesh Bhonde
DOI:10.4103/mjdrdypu.mjdrdypu_613_20  
Background: Authorship disputes are not rare when it is interdisciplinary research involving multiple researchers from different disciplines. Aim: The aim of this artilce is to recommend authorship guidelines for interdisciplinary research through a review of literature. Materials and Methods: Literature was searched using the search terms “Interdisciplinary research” and “authorship” in Medline since 2000–2020 and using Google. The literature was read and compiled. Based on the available literature suggestions and the present-day journal guidelines, recommendations are proposed. Results: Twelve unique and relevant articles were selected. They were read thoroughly, and four suggestions for determining authorship in interdisciplinary research are hereby proposed: (1) according to the International Committee of Medical Journal Editors; (2) group authorship; (3) contributor role taxonomy with 1000-point system; and (4) co-first authorship. Conclusion: Interdisciplinary team to harmoniously prepare the author list using the proposed suggestions and sort it at the initial planning stages before undertaking the work to avoid displeasure at the end.
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Review and practical recommendations for peripheral nerve block during Coronavirus Disease-2019 pandemic p. 487
Sangeeta Khanna, GV Krishna Prasad
DOI:10.4103/mjdrdypu.mjdrdypu_401_20  
Coronavirus disease-2019 (COVID-19) was announced as a global pandemic by the World Health Organization on March 11, 2020 due to its rapid spread and multinational involvement. Operating room preparedness in these times should encompass increased vigilance, protective measures, and alternative procedures in an effort to mitigate the spread from a proven or suspected case. Specifically, by reducing aerosol-generating procedures as in general anesthesia, anesthesiologists can decrease exposure to patient's respiratory secretions and transmission of virus to the health-care professional and other patients. The Interoperability Standards Advisory in its advisory has also recommended regional anesthesia over general anesthesia as one of the steps that can reduce aerosol spread. Further, to restrict airway manipulation, peripheral nerve blocks (PNB) should be considered whenever possible in suspected or confirmed cases of COVID-19 undergoing surgery. PNB has the advantage of maintenance of respiratory functions, prevention of aerosolization, and so preventing viral transmission. This article explores the practical information and suggested measures for conducting PNB in COVID-19 patients with suggestions toward resource planning, clinical environment modification, equipment preparation, supply of drugs, choosing of correct personal protective equipment, safe PNB procedures, anesthesia monitoring, and postanesthetic care. By addressing these issues, infection control during anesthesia can be achieved and which is essential in the present era with emerging infection and novel pathogens such as coronavirus 2 causing the severe acute respiratory syndrome. Thus, framing a structured protocol for PNB among these patients is essential for the best perioperative outcome.
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ORIGINAL ARTICLES Top

A clinical study of resections in oral cavity carcinomas p. 494
Amit Parasnis, Virendra S Athavale, Prachi Athavale, Benod Kumar, Omkar Gutta
DOI:10.4103/mjdrdypu.mjdrdypu_603_20  
Background and Aims: Oral carcinoma is one of most common cancers reported globally of which most arise in developing countries such as India. In our study, the presentation of disease in oral cavity, types of resection with closure and clinical with histopathological correlation has been described. Methods: Prospective study done in Dr. D. Y. Patil Medical College, Hospital and Research Center, Pimpri, Pune, under General Surgery Department. Carcinomas of the oral cavity operated from July 2012 to September 2014 were included. Diagnosis was confirmed by biopsy/fine-needle aspiration cytology. Patients were subjected to appropriate surgeries, which were performed by the same surgeon and the histopathological specimens had been evaluated by the same pathologist. Results: Of the 50 patients in our study, age of the patients varied from 32 years to 91 years with highest number of patients were found in the age group of 41–50 years, with 32 (64%) patients were male accounting for male preponderance. Composite resections for the primary were done in 72% and wide local excisions in 28%. A total of 5 radical neck dissection, 40 MRND 10 Supraomohyoid neck dissection were performed according to the stage of the neck and their reconstruction. Conclusion: Oral cavity carcinomas are one of the most commonly occurring malignancies in India and most of them are detected in the low socioeconomic strata of the society. Although the distribution of primary site was varied, it was possible to achieve some uniformity in the treatment of these patients on the background of diversity in clinical presentation.
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E-cadherin as a Prognostic Biomarker in Oral Squamous Cell Carcinoma: A Pilot Study at Tertiary Care Hospital p. 501
HR Khan, Bharat Umakant Patil, Nitin M Gangane
DOI:10.4103/mjdrdypu.mjdrdypu_240_21  
Introduction: In a recent survey of cancer mortality in India, oral cavity cancer was listed as the leading cause of mortality in men, causing 29% of cancer-related deaths. Objective: The aim is to investigate the expression of E-cadherin to elucidate its role in determining the biological activity of the disease as a reliable and potential marker. Materials and Methods: E-cadherin immune-reactivity was evaluated in ten randomly selected fields in consecutive 50 cases diagnosed with oral squamous cell carcinoma (OSCC) and in each case, its mean was taken for the evaluation of E-cadherin expressing cells. The distribution and intensity of immunostaining E cadherin were also semi-quantitatively evaluated. Results: The most prevalent age group involved was the fifth decade and alveolus was the main site. The most common histological subtype was found to be well-differentiated squamous cell carcinoma and stage IV was the most common subtype in our study. The P value was significant for association between differentiation of tumor, staining location, and expression of E-cadherin (P value-0.002). E cadherin expression was compared with mortality; we found five out of seven death cases showing strong E cadherin expression, however, this was not statistically significant. Conclusions: Clinical and histopathological characteristics of malignancy, such as metastasis, recurrence, low survival, and poor tumor differentiation, have been associated with low expression of E-cadherin in OSCC.
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Uric acid level and its correlation with glycemic control in diabetics with normal renal function p. 507
Muzamil Latief, Obeid Shafi, Zhahid Hassan, Summyia Farooq, Farhat Abbas
DOI:10.4103/mjdrdypu.mjdrdypu_585_20  
Introduction: Limited studies have evaluated the relationship between uric acid and diabetes mellitus (DM), with different studies reporting varying findings. We aimed to investigate the association between levels of uric acid and glycemic control in type 2 DM (T2DM) in our patient cohort. Materials and Methods: We analyzed 200 consecutive patients in the age group of 30–70 years suffering from T2DM with normal renal functions (glomerular filtration rate >60 ml/min/1.73 m2), after excluding patients taking medications for lowering uric acid levels or diuretics. Fasting blood glucose (FBG), random blood glucose (RBG), glycated hemoglobin (HbA1c), and serum uric acid levels were measured in all the patients. Results: The mean age of the study population was 55.25 ± 12.05 years. There was no statistically significant difference in mean age, FBG, RBG, serum uric acid, and HbA1c levels or between males and females in our study cohort. There was a statistically significant negative correlation (P < 0.05) between uric acid levels and HbA1c (r = −0.189) and FBG (r = −0.114). Conclusion: We report an inverse correlation between uric acid levels and glycemic control in diabetic patients with normal renal function, irrespective of gender.
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Effects of mobile phone texting on postural control and gait parameters in college students p. 511
Neha Kulkarni, Pooja Patel, Reema Joshi, Preeti Gazbare
DOI:10.4103/mjdrdypu.mjdrdypu_36_21  
Background: Mobile phone has become a part of everyday life. Mobile phone texting is one of the major causes of road traffic accidents, falls and injuries in young adults. Dual-task activities while using mobile phone increases the risk of falls. Objectives: To find out the changes in postural control and gait parameters while using mobile phone in young college students. Materials and Methods: A total of 100 college students of age 18–25 years participated in the study. NeuroCom Balance Master was used and the subjects were tested with and without phone. The participants had to maintain balance on firm surface and foam surfaces with and without phone. For walking, participants had to walk without phone followed by walking with phone. Outcome measures used were Modified Clinical test for Sensory Interaction on balance and Walk Across for balance and gait respectively. Results: The study showed statistically significant changes in postural control on firm and foam surfaces. Furthermore, the gait parameters such as step length, speed and step length symmetry were altered significantly, except step width while using the mobile phone. Conclusion: Subjects showed increased postural sway, step length and step length symmetry while the step width and speed decreased on using the mobile phone.
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Standardization of Purisha Pariksha with special reference to Jala Nimajjan Vidhi p. 516
Rajesh Uikey, Anukul Chandra Kar
DOI:10.4103/mjdrdypu.mjdrdypu_354_19  
Backgroud: Jala-Nimajjan Purisha Pariksha is an ancient method that has been described in all most all the Samhitas, which was done to assess the presence of Ama (undigested substance) in the stool. Ama is an important factor which is considered generally as the root cause of all the diseases. So, this technique was considered as an important tool to ascertain the presence of Ama in the stool. This is a simple method in which stool mass is dropped on water and observation is being made whether stool floats or sinks. If stool sinks, then it is associated with Ama or otherwise if it floats, then it is Nirama (digested substance). Aim: The aim of the study was to standardize the procedure of Jal-Nimajjan Purisha Pariksha. Materials and Methods: The present study is broadly divided into two parts: Part-I a pilot study for standardization of Jala-Nimajjan Purisha Pariksha in terms of physical parameters And Part-II: study on features of Jala-Nimajjan Purisha Pariksha in apparently healthy volunteers along with routine and microscopic examination of stool. Thirty apparently healthy volunteers were selected from BHU campus. Results: This study showed a significant result in correlation with textual descriptions of Ayurveda regarding Agni and Purisha Pariksha. Statistically, Chi-square test was applied to obtained data and analyzed by SPSS software version 6. Conclusion: This method is more important because it can detect the Ama before its manifestation of symptoms in the whole body. Whenever there is abnormality of Agni in the body, it has a direct effect on digestion. If Agni does not work properly, then Ama is produced in the intestine. Stool is the first excretory substance produced as a result of digestion. If any changes occur in the bowel, it will be seen first in stool and can be detected by Jala-Nimajjan Purisha Pariksha.
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Quality of sleep among clinical medical students of Bayero university, Kano, Nigeria p. 524
Ibrahim Ahmadu, Nuhu Abubakar Garba, Muhammad Shakur Abubakar, Umma Abdulsalam Ibrahim, Mustapha Gudaji, Musa Usman Umar, Godpower Chinedu Michael, Peter David Igoche, Mustafa O Asani, Ibrahim Aliyu
DOI:10.4103/mjdrdypu.mjdrdypu_185_20  
Background: Sleep deprivation and disruptions are associated with both psychological and physiological disorders. Medical students have an increased risk for sleep deprivation. This study aimed to determine the quality of sleep among clinical medical students of Bayero University Kano (BUK). Materials and Methods: This is a cross-sectional study that was conducted between February and March 2019 among clinical students of BUK. The data were obtained using sociodemographic questionnaire as well as the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) self-administered questionnaires. Two hundred questionnaires were administered to the students in their 4th, 5th, and 6th academic year. SPSS version 20 was used for the statistical analysis of the data collected. Results: A total of 181 questionnaires were completed out of the 200 that were administered, making a response rate of 90.5%. There were 114 males (63%) and 67 females (37%), giving a male-to-female ratio of 1.7:1, which is in keeping with the gender distribution of the students. The mean age (± standard deviation) of the students was 23.8 ± 2.9 years. The overall poor sleep quality was found to be 53.0% based on the PSQI, whereas the overall excessive daytime sleepiness was found to be 38.3% using the ESS. Poor sleep quality was found to be 61.1%, 51.7%, and 42.9% among the students in the 4th, 5th, and 6th academic years, respectively (P = 0.14). Excessive daytime sleepiness was found to be 45.8%, 41.7%, and 22.9% among the students in the 4th, 5th, and 6th academic years, respectively (P = 0.03). Conclusion: The prevalence of poor sleep quality is high among the clinical students of BUK.
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Health profile and nutritional status of rural primary school children in Western Maharashtra. Is school absenteeism associated with undernutrition? p. 529
Basant Singh, Nikunj Kumar Kansara, Ankur Bansal, Prabhakar Teli, Arun Kumar Yadav
DOI:10.4103/mjdrdypu.mjdrdypu_620_20  
Background: Healthy adulthood thrives on the foundation of a healthy childhood. Earlier studies show different morbidity patterns and prevalence of under-nutrition in children studying in Government primary schools. The present study was undertaken to explore the morbidity pattern and nutritional status of children studying in a government primary school in the field practice area of Rural Health Training Centre of a medical college in Pune, Western Maharashtra. Methodology: A cross-sectional study was done in a Government Primary School during January–February 2019. A total of 134 school children studying in classes 1st to 7th underwent anthropometric measurements, medical examination, dental examination, and haemoglobin estimation to bring out the common morbidities present in children of school-going age. School records of the past 6 months of the academic year 2018–19 were used to know the prevalence of absenteeism among the subjects studied, and an attempt was made to find any association between absenteeism and under-nutrition among school children. Results: Out of 134 children, 26 (19.4%) were stunted, 51 (38.64%) were underweight, and 2 (1.49%) were found to be obese. Dental caries was found in 73 (54.48%) pupils, and it was the commonest morbidity found. Eighty-six (64.18%) of the examined school children were anemic. Thirty-five (26.12%) had ear problems, skin problems were found in 35 (26.12%), 6 (4.48%) had refractive errors, and 2 (1.49%) were having Tachycardia. An association was found between abesentism and underweight (P = 0.02). Conclusions: The present study found that under-nutrition is present among children studying in a rural Government school despite the mid-day meal programme being implemented in the school. Targeted interventions may be planned for undernourished children to improve their nutritional status, and more studies are required to assess their health needs and problems.
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Effect of suboccipital release technique in forward head posture: A comparative study p. 534
Amita Aggarwal, Ashwani Nair, Tushar J Palekar, Dhammapal Bhamare
DOI:10.4103/mjdrdypu.mjdrdypu_665_20  
Background: Forward head posture is a postural malalignment. It can lead to increased neck pain and decreased neck mobility. Objective: The purpose of this study was to find added effect of suboccipital release technique with conventional treatment on neck pain, disability, mobility, and craniovertebral angle (CVA) in forward head population. Materials and Methods: Fifty subjects with forward head posture and neck pain were randomly allocated in two groups. Experimental group (Group A) was given myofascial release to suboccipital group of muscles along with conventional treatment and control group (Group B) received conventional treatment. Subjects received treatment three times a week, for 2 weeks. By the end of session, pre- and post-comparison was done for neck pain, disability, range of motion, and CVA. Statistical Analysis: Data were analyzed with Winpepe software and Primer software using Wilcoxon signed-rank sum test, Paired t-test, and Mann–Whitney rank sum test. Results: Statistical significance was found between and within the group with respect to pain, disability, and cervical range of motion (P < 0.05). CVA had shown significant results only for within the group. Conclusion: This study concluded that suboccipital release technique along with conventional treatment significantly improve neck pain, disability, and range of motion in forward head posture.
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Amount of screen time and occurrence of autistic-like symptoms in toddlers in a tertiary care hospital p. 538
Vishnu Priya Dikkala, PS Murthy, Raja Vikram Prasad, Venugopal Sharma, Suprakash Chaudhury
DOI:10.4103/mjdrdypu.mjdrdypu_720_20  
Background: Currently due to the easy accessibility of virtual gadgets connected through the internet, there is a constant negative impact from on-screen media exposure, which is seen increasing among toddlers. Aim: This study aims to evaluate the impact of screen exposure on toddlers. Materials and Methods: A convenient sample of 80 toddlers aged between 9 and 36 months were enrolled for the study, conducted for 3 months after obtaining written informed assent from parent/primary caregiver. Prior I. E. C. clearance is obtained for the study. A sample of 80 toddlers who were exposed to screen and attended to constantly by a parent/primary caregiver were included in the study. All were assessed by a pretested questionnaire regarding screen media use and Modified Checklist for Autism in Toddlers Revised. Results: About 52.5% toddlers were male and 47.5% were female. Around 36.5% toddlers screen-viewed for only about 1–2 h/day. 53% of the toddlers with more than 4 h of screen time per day were at high risk for developing Autism. Thus, a statistically significant correlation (P = 0.001) was established between the duration of screen use and the score of the Modified Checklist for Autism in Toddlers-Revised scale, with increased screen time showing greater autistic-traits. Conclusion: Toddlers with high screen media use developed autistic-like traits that may even progress to Autism. Hence, it is advisable to educate the parents/primary caregiver regarding the hazardous effects of early exposure to screen use.
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Hamartomas of Body: A Revisited Entity - An Experience of a Tertiary Care Hospital p. 544
Debahuti Mohapatra, Rupanita Biswal, Tapan Biswal
DOI:10.4103/mjdrdypu.mjdrdypu_512_20  
Introduction/Background: Hamartoma is a mass of disorganized tissue indigenous to the particular site. Although traditionally considered as developmental malformations, many hamartomas have clonal chromosomal aberration that is acquired through somatic mutation, thus now considered to be neoplastic. They arise virtually in all organs, either sporadically or in association with autosomal dominant syndrome. Materials and Methods: A retrospective study was carried out in a tertiary care health institute for 3-year period (January 2013 to December 2016), which included all visceral hamartomas from head to toe. Detailed clinicoradiological and pathological examination was done along with ancillary tests for definite diagnosis. Observation: The study included nine cases, categorized site wise as head and neck (one case of cystic lymphangioma), cardiothoracic (one case of chondroid hamartoma), gastrointestinal tract (GIT) (one case of Brunner's gland hamartoma), hepatic (one case of cystic lymphangioma), and genitourinary tract (four cases of angiomyolipoma [AML] and one case of myelolipoma). The age ranged from 1 year to 70 years showing a male predilection. The tumors were variable sized ranging from 0.5 to 20 cm in dimension either solitary or multiple. Some large tumors clinically masqueraded as malignant tumors and presented with complications. The postsurgical course and prognosis of all patients were uneventful. Conclusion: Hamartomas are usually not associated with significant morbidity but for the size and location of the tumor. Despite slow-growing and self-limiting behavior, some predispose to malignancy especially in the epithelioid AML and familial GIT hamartoma or may be seen associated with malignancy in syndromic forms.
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Head and neck trauma: Profile and factors associated with severe head injury p. 549
Kundavaram Paul Prabhakar Abhilash, Sisha Liz Abraham, Darpanarayan Hazra, Ankita Chowdary Nekkanti
DOI:10.4103/mjdrdypu.mjdrdypu_3_21  
Background: Head and neck trauma is an increasing cause of morbidity and mortality in India. The mode of trauma has varies with geographical progress and it is important to understand the factors associated with severe head injury among this cohort. Methods: This was a retrospective observational study of all adult trauma patients with head and neck trauma presenting to our emergency department (ED). Details of the incident, injuries and outcome were analyzed. Results: During the 3-month study, the ED attended to 16,169 patients with 2022 being trauma victims. Among them, 51.4 3% (n = 835) adults who sustained head, face or neck trauma and hence were included in the final analysis. Overall, RTA s were the predominant mode of injury (81.2% (n = 678), followed by fall on level ground (6.5%; n = 54), fall from height (5.1%; n = 43) and assault (3.7%; n = 31). A history of consuming alcohol prior to the incident was obtained in 16.2% (135) of the patients. Head, face, and neck injuries were seen in 74.9% (n = 626), 64.1% (n = 536), and 4.9% (n = 41) of patients respectively. Bivariate analysis showed male sex (90.3% vs. 76.8%; unadjusted odds ratio [OR]: 2.81, 95% confidence intervals [CI]: 1.19–6.64; P = 0.018) and pedestrian injuries (19.4% vs. 8.5%; unadjusted OR: 2.57, 95% CI: 1.30–5.07; P = 0.006) to have a statistically significant association with sustaining severe head injury. Conclusion: Head and neck trauma comprises a significant proportion of patients with trauma with RTA and falls being the most common causes. Among patients with head and neck trauma, males and pedestrians have an increased odds of sustaining severe head injury (Glasgow Coma Scale ≤8).
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A study of performance of first MBBS students in internal assessment conducted online during the COVID-19 pandemic Highly accessed article p. 555
Arunima Chaudhuri, Tanushree Mondal, Suhrita Paul, Ayan Goswami
DOI:10.4103/mjdrdypu.mjdrdypu_506_20  
Background: The COVID-19 pandemic has greatly impacted the progress of medical education. As the crisis continues, it is important to develop valid and reliable methods of assessment. Aims: To assess the impact of the competency-based medical education (CBME) implemented online in the department of physiology during this pandemic on the results of internal assessments conducted online. Materials and Methods: This pilot study was conducted on two hundred First-year MBBS students at Burdwan Medical College after taking Institutional clearance in 6 months. Two internal assessments had to be conducted online in 6 months. We divided our internal assessment sessions which were conducted at three monthly intervals into 4 compartments: multiple-choice questions, short answer type questions, orals, and spots. We conducted two surveys to assess the stress levels of the students and two feedback surveys to assess our teaching program. Statistical analysis: T-test and Chi-square test was used to analyze the data. Results: Assessments scores of students in the first session were 59.68 ± 10.91; assessment scores of students in the second session were 73.21 ± 8.66; P < 0.001 ** (highly significant). Perceived stress score (PSS) in the first survey was 21.36 ± 3.84 and PSS in the second survey was 20.77 ± 4.13; P = 0.144. Thirty students failed in the first session while 1 in the second session, χ2 = 32.1; P < 0.0001**. At the end of 3 months, 11.4% had difficulty in studying physiology, while at the end of 6 months, 8.5% had difficulty in studying physiology with online support. Conclusions: The first MBBS students were able to cope up better with the online mode of teaching with the passage of time and regular feedback provided to them. The results of the present study demonstrate that the department of physiology could implement CBME online and conduct internal assessments also.
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Gastric ultrasonography in assessment and quantification of gastric contents in fasting diabetic and nondiabetic patients p. 561
Delma D Cunha, Padubidri S Balakrishna Achar, T Gurumurthy, Manasa Acharya
DOI:10.4103/mjdrdypu.mjdrdypu_75_21  
Context: Gastric ultrasound is an emerging point-of-care diagnostic tool to examine stomach contents and determine pulmonary aspiration risk at the bedside. This is helpful in guiding airway and/or anesthetic management in the acute care setting, when nil per oral (NPO) status is doubtful or unknown or patient has conditions or comorbidities that affect gastric emptying. Aims: The objectives of the study were to evaluate and quantify the gastric contents and grade the fullness of the stomach in fasting patients. Settings and Design: This was an observational, analytical study conducted on patients who presented for elective surgeries who were fasted for 8 hours for solids and 6 hours for clear liquids. Materials and Methods: Adult patients aged between 18 and 70 years of American Society of Anesthesiology physical status 1–3 were included in the study. Gastric ultrasonography was performed and gastric volume was calculated. Data were entered in Microsoft Excel 2007 and analyzed using SPSS version 22.0. Results: Our study included a total of eighty subjects. The mean age in the diabetic group was 49.3 ± 16.4 years and in the nondiabetic group 49.4 ± 16.8 years. Despite fasting status, 75% of the subjects were found to have Grade 1 (up to 100 ml) gastric contents on ultrasonography. The data were found to be statistically significant with P < 0.05. There was no significant correlation of age and ultrasonography findings. However, body mass index of the patient was found to have a strong correlation with gastric content and its volume (P < 0.0001). Conclusion: In the current practice, NPO status, especially for emergency cases, is elicited via history which is unreliable, and in individuals at higher risk for delayed gastric emptying, this may pose a greater threat for aspiration. Using gastric ultrasonography as a screening tool prior to planning the anesthetic induction and technique can help avoid unnecessary perioperative complications.
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Influence of socio-economic status on lifestyle preferences contributing to childhood obesity: A cross-sectional study Highly accessed article p. 565
Poonam Ashish Gupte, Shital Ashok Giramkar, Supriya Sudhakar Bhalerao
DOI:10.4103/mjdrdypu.mjdrdypu_485_20  
Background: Socioeconomic status (SES) is the major determinant for lifestyle preferences in individuals, contributing to development of metabolic diseases like obesity. Aims: This study was undertaken to study the influence of SES on lifestyle preferences, namely dietary habits, food beliefs, physical activity, and their contribution to childhood obesity in school children of Pune city. Settings and Design: School-based, cross-sectional, observational study. Materials and Methods: Following approval from the Institutional Ethics Committee, the study was conducted in schools representing high, medium, and low SES in Pune. Children of either sex, aged 9–14 years were recruited after obtaining parental consent and verbal assent of children. Anthropometry and body composition along with dietary choices, food beliefs, and physical activity was recorded using predesigned questionnaires. Statistical Analysis: Parametric data are expressed as mean ± standard deviation, whereas nonparametric data are expressed as median (range). Distribution of children into different weight categories and data regarding unhealthy food consumption frequency and food beliefs is expressed in percentages. Results: Of 424 total recruited children, obesity prevalence was the highest in high SES school children (10.49%) while overweight prevalence was high in middle SES school children (18.11%). Middle SES school had maximum children with high waist circumference and body fat percentage along with high frequency of unhealthy food consumption. Surprisingly, activity profile from middle SES school was significantly better as compared to other schools. Conclusion: Children from middle SES school with maximum prevalence of overweight displayed poor dietary choices, average food beliefs, and habits pressing the need for aggressive strategies for obesity prevention.
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Fetal accessory renal arteries and other renal anomalies p. 572
Dinit K Tom, Purushottam Rao Manvikar, Maitreyee Madhav Mutalik
DOI:10.4103/mjdrdypu.mjdrdypu_65_21  
Background: Human kidneys develop from intermediate mesoderm, in three successive stages; pronephros, mesonephros and metanephros. The definitive kidney, which is derived from metanephros occupy sacral region initially, which ascent later, reaching the adult position by 9th week. It receives blood supply from different sources during its development and ascent. Accessory renal arteries are widely studied in adults while the same in fetuses is an understudied topic. Aims and Objectives: The present study was carried out to find out the percentage of accessory renal arteries in fetuses and associated positional congenital anomalies with it. Materials and Methods: Fifty fetuses of gestational ages ranged from 14 to 40 weeks were collected from the department of Obstetrics and Gynecology, with prior permission from Head of the department and Dean. Results: The study showed a higher percentage of accessory renal arteries in fetuses (30%) and in 2 out of 50 fetuses dissected (4%), accessory renal arteries were found to be associated with positional anomalies. One was a case of bilateral ectopic kidney whereas the other was a horseshoe kidney (HSK). Lobulation were seen in most of the kidneys and 3 cases of bilateral accessory renal arteries without any obvious anomalies were noted. Conclusion: As the advancement in prenatal diagnostic techniques, screening for accessory renal arteries in fetuses can provide a clue for associated congenital renal anomalies. Knowledge on vascular variation in fetuses will help pediatric surgeons in planning abdominal surgeries in new born and children of early ages, where vascular anatomy may be different than in adults.
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CASE REPORTS Top

Postavulsion complete loss of both lids with corneal injury and orbital floor fracture: A surgical challenge p. 579
Sheerin Shah, Devika Rakesh, Sahil Goel, Rajinder K Mittal, Ramneesh Garg, Karan Singh
DOI:10.4103/mjdrdypu.mjdrdypu_22_21  
Total upper and lower eyelid reconstruction remains a challenging task for plastic and reconstructive surgeons. Repair of full-thickness defects >50% of the horizontal length of the lids can be particularly complex. Here, we discuss a case of a 52-year-old male who presented to the emergency with avulsion of the right upper and lower eyelids associated with corneal injury and orbital floor fracture. Among all the possible choices of locoregional flap available, we chose the paramedian forehead flap for anterior lamella reconstruction of both upper and lower lids, and the posterior lamella was reconstructed with buccal mucosal graft while orbital floor reconstruction was carried out with prosthesis. This reconstructive modality resulted in satisfactory function and esthetic outcome.
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An unusual cause of recurrence of cholesteatoma in a child p. 583
Prasanna Kumar Saravanam, Aishwarya Gajendran
DOI:10.4103/mjdrdypu.mjdrdypu_452_20  
Predicting the extent of cholesteatoma preoperatively in pediatric patients is a daunting task for the operating surgeons. Several times the operating surgeons come across unexpected findings that define the course of surgery inspite of appropriate preoperative workup. Bone wax is usually made of bee wax admixed and which is made pliable with paraffin or petroleum jelly. It is commonly used to achieve hemostasis during the course of ear surgeries in unexpected bleeding. In this case, we report a rare event in revision mastoid surgery where a large chunk of bone wax that was used in the previous surgery by another surgeon that had migrated into the external auditory canal and was a constant source of pain and discharge in the ear. Diagnostic difficulties and management of the same have been discussed.
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Idiopathic hypertrophic pachymeningitis as a rare cause of spinal cord compression p. 587
Dhaval Dave, Furqan Mohd Akram Khan, Shalesh Rohatgi, Satish Nirhale, Prajwal Rao, Pravin Naphade
DOI:10.4103/mjdrdypu.mjdrdypu_9_21  
Idiopathic hypertrophic pachymeningitis (IHP) is a rare inflammatory disease characterized by inflammation and hypertrophy of the dura mater. Spinal form of IHP is extremely rare. We report an idiopathic hypertrophic spinal pachymeningitis case, a 67-year-old female who presented with neck and upper back pain with progressive paraparesis and sensory level. Her magnetic resonance imaging cervico-dorsal spine showed abnormal epidural hypointensity on T2-weighted images from C5 to T4 with significant cord compression and intramedullary cord signal changes at T2 and T3 levels. The lesional biopsy was done suggestive of chronic inflammatory changes. She was treated with steroids and was able to walk unaided.
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Challenges associated with the management of giant mandibular ameloblastoma in a resource-poor environment p. 591
Ezekiel Taiwo Adebayo, Afolake Shakirat Salami, Emmanuel Adetolu Adelusi, Lilian Ejije Ahaji
DOI:10.4103/mjdrdypu.mjdrdypu_714_20  
Ameloblastoma, the most common odontogenic tumor in sub-Saharan Africa, has initial clinical features of painless, slow growth that sometimes results in giant sized, neglected, or gigantic lesions, often called giant ameloblastoma. The definition of giant ameloblastoma is controversial, their full characteristics, especially tumor growth rate, are yet to be fully elucidated, but their large sizes make management quite challenging. This case report presents giant mandibular ameloblastoma that developed over 10 years in a 30-year-old male. The lesion extended from one ramus to the other, measuring 48 cm × 38 cm × 17 cm. The treatment was segmental resection of the lesion after preoperative tracheostomy. Reconstruction was by retaining jaw form using the titanium reconstruction plate due to inability to perform free-bone grafts in this environment. There is need for universal health insurance in Nigeria to improve financial access to health-care services. Improved technical skill of surgeons and other clinical staff will also assist to optimize the treatment outcomes for patients with giant-sized lesions.
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Mesenteric cystic lymphangioma – A rare entity with unusual presentation p. 595
Merin Jose, Shirish Chandanwale, Madhuri Singh, Akshi Raj, Charusheela Gore
DOI:10.4103/mjdrdypu.mjdrdypu_427_20  
Lymphangiomas are a rare benign proliferation of the lymphatic system. Intra-abdominal lymphangioma is rare and accounts for <5% of lymphangioma cases. Cystic mesenteric lymphangioma is extremely rare and accounts for <1% of abdominal lymphangiomas. Abdominal swelling, pain, vomiting, and constipation are common clinical presentations. We report a case of a 5-year-old boy with no significant medical history of illness who presented with acute abdomen. Preoperative accurate diagnosis by radiological modalities is very difficult. Surgical excision is the choice of treatment. Definitive diagnosis requires histopathological examination.
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Livedo reticularis in Graves' disease: Just a coincidence? p. 598
Saurabh Gaba, Mandeep Singla, Monica Gupta, Jyoti Aggarwal
DOI:10.4103/mjdrdypu.mjdrdypu_413_20  
A 37-year-old woman with well-controlled Graves' disease on carbimazole therapy presented with new-onset livedo reticularis (LR) on her legs which later regressed spontaneously. The history, examination, and investigations did not reveal any known cause for the lesion. Literature search has revealed only one report of LR in a patient of Graves' disease who had thyrotoxicosis and coexisting anticardiolipin antibodies. The patient in this report was euthyroid at the time of development of LR and did not have any antiphospholipid antibody. It is not clear whether this finding was incidental or there is a true association of LR with Graves' disease.
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Donath-landsteiner hemolytic anemia with erythrophagocytosis and platelet phagocytosis in peripheral smear: Rare findings p. 601
Majed Abdul Basit Momin, Anamika Aluri, PM Bala Bhaskar
DOI:10.4103/mjdrdypu.mjdrdypu_373_20  
The Donath-Landsteiner (DL) hemolytic anemia or paroxysmal cold hemoglobinuria (PCH) is a rare subtype of autoimmune hemolytic anemia (AIHA). We report here a case of a 22-year-old young female who presented with acute onset shortness of breath. Routine hematological investigation revealed erythrophagocytosis and platelet phagocytosis by monocytes in peripheral blood smear, which are rarely reported in AIHA, especially the DL. The unusual blood smear findings directed the pathologists to initiate workup for hemolytic anemia that yielded positive results in direct Coombs test C3d (Complement) and direct DL test. The findings confirmed the case as DL hemolytic anemia. To the best of our knowledge, this is the first report of both erythrophagocytosis and platelet phagocytosis in peripheral blood smear in PCH.
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Congenital mesoblastic nephroma beyond infancy p. 605
Priya Dhandore, Narendra Narayan Hombalkar, Mohd Hamid Shafique Ahmed Khan
DOI:10.4103/mjdrdypu.mjdrdypu_362_20  
Congenital mesoblastic nephroma (CMN) is a peculiar renal tumor with a unique clinical, therapeutic, and prognostic pattern. CMN is a benign renal tumor of the neonatal period and early infancy. Although a rarity, presentations beyond infancy are also reported. Rarely, this tumor presents beyond infancy. The case report tries to highlight the fact that this tumor though rare beyond infancy should also be included in the list of differentials of childhood renal masses. It also underlines the utility of preoperative biopsy and the role of nephron-sparing surgery while dealing with such a benign etiology (considering the excellent prognosis associated with the condition).
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LETTERS TO THE EDITOR Top

Ophthalmology training in India during COVID-19 pandemic: Perspective from a tertiary eye care hospital p. 609
Srinivasan Sanjay, Chaitra Jaydev, Sriharsha Nagaraj, Rohit Shetty
DOI:10.4103/mjdrdypu.mjdrdypu_446_20  
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Cutaneous aspergillosis presenting as surgical site infection p. 610
Vikas Pathania, Prerna Shankar, Kanwaljit Kaur, Deepak Vashisht, AW Kashif, Rohit Kothari
DOI:10.4103/mjdrdypu.mjdrdypu_451_20  
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New COVID-19 vaccine, thiomerosol, and reversible cerebral vasoconstriction p. 613
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_398_21  
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COVID-19, telehealth, and eye-ear-nose-throat care provider p. 614
Rujittika Mungmunpuntipatip, Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_516_20  
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Laws for COVID-19 containment and human rights consideration p. 615
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_11_21  
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