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   Table of Contents - Current issue
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November-December 2021
Volume 14 | Issue 6
Page Nos. 599-735

Online since Tuesday, November 2, 2021

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EDITORIALS  

How to read, write, and review? Highly accessed article p. 599
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_688_21  
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Need for Indian medical services – Time to learn and unlearn p. 602
Harshal Tukaram Pandve, Swetha Rajeshwari
DOI:10.4103/mjdrdypu.mjdrdypu_426_20  
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CONTEMPORARY ISSUE Top

Coronavirus disease 2019 – Emerging and future challenges for oral health care professionals p. 604
Sadaksharam Jayachandran
DOI:10.4103/mjdrdypu.mjdrdypu_386_20  
The coronavirus disease 2019 (COVID-19) which originated as an epidemic in the province of Wuhan, China, has become a major public health challenge and the World Health Organization has announced the outbreaks of the COVID-19 as a public health emergency of international concern. The dental health care professional's role in the prevention of transmission of the coronavirus among the public is critical while carrying out major dental emergencies and procedures with proper personal protective measures. Due to the characteristics of dental settings, the risk of coronavirus crossinfection may be high and hence the dental professionals play a prime role in aiding the medical community by the organization of emergency dental and clinical support.
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REVIEW ARTICLE Top

Evaluation of different therapies in indian patients with chronic urticaria: A systematic review of randomized controlled trials in the last decade p. 609
Anant D Patil, Ganesh Bingewar
DOI:10.4103/mjdrdypu.mjdrdypu_243_20  
The objective of this study was to perform a systematic review of randomized controlled trials (RCTs) related to chronic urticaria in Indian patients evaluating different treatment options published in the last decade. A systematic literature search of PubMed/Medline was performed using keywords “Study(ti) OR trial(ti) AND urticaria(ti) AND “2009”(Date-Publication): “2020”(Date-Publication). All the selected articles were screened for author information and study design. Only RCTs from India were considered for the final analysis. Out of 205 articles retrieved, 11 RCTs were selected for the systematic review. Six RCTs evaluated the effects of antihistamines (loratadine, levocetirizine, rupatadine, and olopatadine) in Indian patients with chronic urticaria. The results show that these agents are effective and well tolerated in the treatment of chronic urticaria. Other therapies evaluated through RCTs included levocetirizine plus montelukast, add-on methotrexate, azathioprine, cyclosporine, narrowband ultraviolet B, psoralen plus ultraviolet A, and vitamin D. Levocetirizine 5 mg plus montelukast 10 mg combination was found to be as effective as levocetirizine 10 mg in patients not responding to levocetirizine 5 mg/day. A small trial did not prove the benefit of methotrexate add-on therapy with antihistamine. Azathioprine trials show that it can be a useful option in resource-limited settings. Second-generation antihistamines represent the most commonly investigated therapies through RCTs in India, and they represent a valuable option in the management of chronic urticaria.
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RESIDENTS CORNER Top

Why and how to attend a medical conference p. 614
Vishnu Sharma M
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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ORIGINAL ARTICLES Top

A study of perceived stress, burnout, and job satisfaction of doctors and nonmedical staff in a medical college of West Bengal during COVID-19 pandemic Highly accessed article p. 617
Arunima Chaudhuri, Suhrita Paul, Tanushree Mondal, Ayan Goswami
DOI:10.4103/mjdrdypu.mjdrdypu_414_20  
Background: The COVID-19 crisis has placed additional pressure on doctors and the health-care system in general, and the research shows that extra pressure brings a greater risk of psychological distress. Aims: To study perceived stress levels, burnout, and job satisfaction of doctors and non-medical staff in a medical college of West Bengal during COVID-19 pandemic. Materials and Methods: This cross-sectional, observational study was carried out on 105 doctors (Group A) and 64 non-medical staff (Group B) in Burdwan Medical College after taking institutional ethical clearance and informed consent of the subjects. An online semistructured questionnaire was developed, with a consent form attached to it. The specific instruments which were included in the survey were job satisfaction scale, perceived stress scale (PSS), and abbreviated Maslach Burnout Inventory. Results: PSS of Group A was 18.68 ± 4.248 and of Group B was 18.625 ± 4.082; P value: 0.931. There was no significant difference in the perceived stress score between the two groups, but perceived stress scores in both groups were significantly higher than average score. Average score is considered as 13. 44% in Group A had PSS 20 or above and 42% in Group B had PSS 20 or above; P = 0.775 and Chi-square 0.0816. Job satisfaction score in Group A was 36.97 ± 6.32 and Group B was 37.81 ± 4.99; P value: 0.346. In Group A, 22.12% had scores between 42 and 50 (indicates very high job satisfaction); 26.92% had scores between 39 and 41 (high job satisfaction); 36.54% had scores between 32 and 38 (average job satisfaction); 7.69% had scores between 27 and 31 (low job satisfaction); and 7.69% had scores between 10 and 26 (very low job satisfaction). In Group B, 31.25% had scores between 42 and 50 (indicates very high job satisfaction); 18.75% had scores between 39 and 41 (high job satisfaction); 37.5% had scores between 32 and 38 (average job satisfaction); and 12.5% had scores between 27 and 31 (low job satisfaction). PSS was negatively correlated with job satisfaction score in both groups with more negative correlation in Group A as compared to Group B (Group A – r value: −0.21069; Group B – r value: −0.08197); satisfaction with medicine scores was 12.96 ± 3.34; depersonalization scores: 5 ± 2.3; personal accomplishment scores: 12.096 ± 3.457; and emotional exhaustion scores: 6.66 ± 3.42. Conclusions: Doctors as well as non-medical staff perceived high stress during the COVID-19 pandemic, but they were mostly satisfied with their jobs and burnout scores were not alarming.
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Hand hygiene in housekeeping staffs: An assessment of their perceptions and practices in a tertiary care hospital of Kolkata p. 623
Sinjita Dutta, Ankita Mishra, Mausumi Basu
DOI:10.4103/mjdrdypu.mjdrdypu_415_20  
Background: Hand hygiene is the single most important measure for preventing infection. However, this is often insufficiently recognized by the housekeeping staffs, who are not involved in direct patient care but have frequent contact with the patient's environment. This could lead to increase in transmission of nosocomial infections. Objectives: The objectives of this study were to analyze the knowledge, attitude, and practice regarding hand hygiene among housekeeping staffs of a tertiary care hospital in Kolkata. Materials and Methods: A descriptive type of observational study with cross-sectional design was conducted on 260 housekeeping staffs of a tertiary care hospital in Kolkata in 2019 using a predesigned, pretested, and structured schedule. The statistical analysis was done using Microsoft Office Excel 2007 (Microsoft Corp., Redmond, WA, USA) and Statistical Package for the Social Sciences (SPSS) version 25.0. Results: 83.5% and 60.4% of the study population had satisfactory attitude and practice regarding hand hygiene, respectively, but only 37.3% had a satisfactory knowledge. Working in pediatrics and OBG departments had statistically significant odds of satisfactory knowledge (P < 0.05). Female gender and working in surgical/medical departments showed statistically significant odds (P < 0.05) of having positive attitude. Experience of ≤5 years in this work and receiving training had a positive association with good practice of hand hygiene. Conclusion: The overall low scores on the knowledge items indicate that these staffs require continuous in-house training on hand hygiene throughout their employment.
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Staging laparoscopy for assessing inoperability in gastrointestinal malignancies: Is it useful? p. 631
Manish K Sondhi, Samir K Gupta, Alok J Bhalla, Shrirang Vasant Kulkarni
DOI:10.4103/mjdrdypu.mjdrdypu_23_21  
Background: Despite the availability of modern cross-sectional diagnostic staging modalities, preoperative assessment of operability in intra-abdominal malignancy is often inadequate, especially in patients being considered for potential curative resection, resulting in many unnecessary laparotomies. Staging laparoscopy (SL) is usually undertaken in tertiary care centers, but the same has not been widely studied in India. The aim of the present study was to find out the possibility of diagnosing inoperability on SL and to study whether SL can prevent unnecessary laparotomy in cases of clinically diagnosed potentially resectable abdominal malignancies. Methods: This prospective diagnostics study was conducted in consecutive patients with gastrointestinal malignancies. All eligible patients were subjected to a thorough SL to look for inoperability before a therapeutic laparotomy. Statistical analysis of SL as a diagnostic modality was performed and the results were noted. Results: A total of 88 such patients were studied. The SL demonstrated inoperability in 24 out of the 88 (27.3%) patients. However, it failed to predict inoperability in 11 (12.5%) patients, yielding a sensitivity of 68.57% and specificity of 100%. The positive predictive value (PPV) of SL was 100%, whereas the negative predictive value (NPV) was 82.81% with efficacy of 87.5%. Conclusions: The specificity, PPV, NPV, and accuracy of SL to rule out inoperability in clinically diagnosed potentially resectable intra-abdominal gastrointestinal malignancies are noteworthy. The sensitivity of SL for the same purpose, though relatively low, may be augmented with practices such as liberal use of frozen section biopsy and intraoperative ultrasound. However, SL still fails to demonstrate unresectability due to locoregional advancement and aortocaval lymph node mets.
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Thyroid profile in idiopathic childhood steroid-sensitive nephrotic syndrome p. 637
Madhumita Nandi, Biswanath Basu, Amlan Tarai, Tanmoy Sar
DOI:10.4103/mjdrdypu.mjdrdypu_189_20  
Background: Nephrotic syndrome (NS), the most common glomerular disease of childhood, characterized by massive proteinuria which may have a negative impact on the circulating thyroid hormone status necessitating thyroid hormone supplementation in these children. Aim: The aim was to determine the thyroid status in steroid-sensitive NS during the time of relapse and remission. Materials and Methods: In this single-center prospective observational study, we documented thyroid hormone profile (thyroid-stimulating hormone [TSH], thyroxine, and triiodothyronine) in fifty children at presentation (first attack or relapse) and again 4 weeks after remission. Baseline characteristics were noted in the prestructured proforma. Results: Out of the total fifty children analyzed, 29 were male and 21 females. Although both T3 and T4 levels were within the normal range in all participants during attack/relapse and in remission, there was a statistically significant difference in absolute levels of both T3 and T4 at relapse and remission (P = 0.001). There was a significant rise of TSH levels during attack/relapse which normalized to normal values after 4 weeks of remission (13.08 ± 7.9 vs. 2.43 ± 1.00 mIU/L, P = 0.0001). None required thyroid hormone replacement therapy. Conclusion: The rise of TSH level during relapse is mostly transient and usually does not require thyroid hormone supplementation.
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Efficacy of flipped classroom teaching on the cognitive domain in second-year physiotherapy students p. 642
Pranjal Grover, Shweta Phadke
DOI:10.4103/mjdrdypu.mjdrdypu_290_20  
Introduction: Flipped learning is an instructional strategy and a type of blended learning that reverses the traditional learning environment by delivering instructional content, often online, outside the classroom. It moves activities, including those that may have conventionally been considered homework, into the classroom. With the availability of resources but restrictions on time, flipped learning can replace or be an adjunct to conventional classroom teaching as per the need. Objectives: (1) Comparison of the MCQ test scores pre- and postflipped learning classroom. (2) Analyze the feedback of the students on flipped learning through structured questionnaire. Materials and Methods: This study included 36 second-year students from TMV's Lokmanya Medical College of Physiotherapy. After approval from the Institutional Ethical Committee, written consent was obtained from the participants. The study material was mailed to all the participants. Flipped classroom instructional strategy was employed with videos of “Gait-Kinetics and Kinematics” that were uploaded. Two classroom lectures were conducted for in-depth exploration and problem-solving done. Pre- and postMCQ test administered and feedback was taken. Results: A significant improvement was seen in the MCQ test score post two flipped learning sessions (P < 0.001). The feedback questionnaire analysis established that flipped classroom technique is an effective teaching method. Conclusion: Flipped classroom teaching is an effective teaching method in bringing about a change in the cognitive domain of second-year physiotherapy students.
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Effectiveness of structured teaching versus child-to-child teaching program on knowledge regarding worm infestation to middle school children in Puducherry p. 646
S Jemima, P Sumathy
DOI:10.4103/mjdrdypu.mjdrdypu_279_20  
Background: Worm infestations are one of the most widely prevalent neglected tropical diseases (NTDs) which are inextricably linked to poor sanitation and hygiene. Aims: This study aims to assess the effectiveness of structured teaching plan and child-to-child teaching in raising awareness about helminthiasis. Methods: Thirty-seven standard children each from two government secondary schools in Puducherry were selected by simple random sampling. Data on knowledge regarding worm infestation and selected demographic variables were collected using a structured questionnaire. Two groups with 30 subjects each were created, where Group 1 was taught according to a structured teaching plan, and a child-to-child teaching approach was adopted for Group 2. The effectiveness of interventions was adjudged using a paired t-test. The association between the level of knowledge and select demographic variables was examined using a Chi-square test. Results: A vast majority of subjects in Group 1 and Group 2 had inadequate and moderately adequate knowledge of helminthiasis, respectively, prior to intervention. However, the mean test scores of Group 1 increased by 20.6 following intervention with a structured teaching plan. An incremental mean difference of 19.16 was witnessed in Group 2. The child-to-child teaching program was found to be equally effective as a structured teaching plan. A statistically significant association was found between the level of knowledge and demographic variables such as age and place of defecation (P < 0.05). Conclusion: Peer learning was found to be a novel and reliable method of expanding the knowledge of middle school children on prevention of hookworm infestation, thereby encouraging healthy behaviors.
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Use of flipped classroom for the teaching of postgraduate students: An experience p. 652
Anand Nair, Arun Kumar Yadav
DOI:10.4103/mjdrdypu.mjdrdypu_456_20  
Background: Flipped classroom uses a face-to-face approach and delivery of content to the students on an online platform. It combines principles of self-directed learning and active participation. There are not many studies that analyzed the benefits of this approach in India. Methods: A flipped classroom session was planned for postgraduate students of community medicine. The faculty conducted discussion on topic and content. The content was selected and sent to students. Students were divided into three groups. A small group teaching session was held after 1 week. Improvement was objectively measured using a pre-posttest. Feedback from the students was taken on Likert's scale and open-ended questionnaire. Results: All students (n = 10) agreed with topic selection and quality of content. All were satisfied with the approach and admitted to being interested in attending another session. Eighty percent agreed that teacher-student interaction was better as compared to a regular classroom. Average pre-test multiple-choice question score was 60% and posttest score 87.7% (p < 0.001). Conclusion: Flipped classroom is a useful tool to improve the learning experience of students. However, sessions should be well planned with discussion and consensus among stakeholders. Further research is required for evaluating the benefits of this method on larger scales.
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Influence of electronic media on speech and language delay in children p. 656
Shradha Salunkhe, Rasika Bharaswadkar, Manojkumar Patil, Sharad Agarkhedkar, Vineeta Pande, Shailaja Mane
DOI:10.4103/mjdrdypu.mjdrdypu_636_20  
Background: An electronic media in the form of television, mobile phones, computers, and tablets has become an integral part of many households and has both positive and negative influences on the child. The duration spent by children on electronic media has drastically increased leading to decreased vocabulary, attention span, and overall decrease in child–parent interaction leading to speech and language delay. Aims: We aimed to study the duration of electronic media usage and influence on the speech and language delay in children between 6 months and 6 years. Materials and Methods: This is a cross-sectional study conducted after institutional ethics committee approval and written informed consent. The duration of use of media and its effect on speech and language delay was assessed using the Language Evaluation Scale Trivandrum and hyperactivity by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Statistical analysis was done using MedCalc. Results: Four hundred and twenty-five children were enrolled. 3–6-year-old children from joint and extended families and from upper-middle and upper socioeconomic status used more media. Attention deficit hyperactivity disorder (ADHD) was seen in 9.4% of children using media. Speech and language delay was seen among 28.4% of children who used media for more than 3 h. Conclusions: The prolonged duration of electronic media for more than 3 h is associated with speech and language delay in children. Mobile media provides more interaction than passive television viewing, and the risk of speech delay is more in prolonged television viewing. Hyperactivity (ADHD) is seen more in children using electronic media.
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Keeping in pace with new biomedical waste management rules: Assessing the knowledge, attitude, and practices of health-care workers of a tertiary care hospital in North India p. 662
Gurpreet Singh Bhalla, Kuntal Bandyopadhyay, Chetna Pandey, Navneet Anand, Shilpi Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_335_20  
Background: Due to changes in biomedical waste management rules in 2016 and further amendments frequently thereafter, there is a need to constantly update oneself on this subject, especially the health-care workers (HCWs). Methods: A descriptive cross-sectional survey was conducted among the HCWs in a tertiary care hospital. A total of 500 pretested questionnaire were distributed with 427 feedbacks received. Data were analyzed using SPSS version 20 and Epi Info software. Results: A total of 427 participants responded with an overall response rate of 85.4%, which included 57 doctors (faculty), 124 resident doctors, 116 nurses, 110 paramedical staff, and 20 housekeeping staff. The mean age of the overall study group was found to be 30.06 ± 8.30 years with 242 male (56.67%) and 185 (42.33%) female participants in the study. The overall percentage of satisfactory response (≥60%) for the domains of knowledge, attitudes, and practices shows a declining trend as per occupation with best response among the faculty and worst among the supporting staff with a significant association (P < 0.001) for previous training and higher correct response among the participants. Conclusions: Overall awareness of this subject is unsatisfactory across various levels of health-care facilities, especially among the grassroot level workers. Thus, widespread publicity, continuous training programs, and audits are must for awareness and uniformity in practices through all echelons.
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Completeness of informed consent documents in synopsis of postgraduate medical students of a medical college of Western Maharashtra p. 668
Laxmikant Choudhary, Promod Chandra Awasthi, K Rahul Ray, Renuka Kunte, Arun Kumar Yadav
DOI:10.4103/mjdrdypu.mjdrdypu_292_20  
Introduction: Research is a key requirement and is an integral part of postgraduate (PG) studies. In biomedical and health research involving human participants, obtaining voluntary informed consent is a must requirement for researchers' respect for individual autonomy as well as safeguard of participants against abuses and exploitations. The Indian Council of Medical Research (ICMR) has come out with the Revised National Ethical Guidelines for Biomedical and Health Research Involving Human Participants – 2017 giving essential and additional elements of an informed consent document (ICD). Materials and Methods: The study was a descriptive study done over a period of 12 weeks. A sample of 155 PG students were selected, who had submitted their synopsis in medical research unit of a medical college of Western Maharashtra. ICDs were scrutinized and evaluated with a checklist given by the ICMR guidelines 2017 and analyzed using SPSS version 20. Results: Of 155 students, 131 (91.6%) were males as compared to 24 (15.48%) females, and 43 (27.7%) belonged to clinical specialty as compared to 112 (78.3%) from para and nonclinical. Of 155 students, 143 (92.3%) had attached informed consent forms (ICFs) as compared to 12 (7.7%) who had not attached in their synopsis. In ICFs among 143 students, 59 (41.1%) students used English and local language (Marathi) and 84 (58.7%) used only English language. Conclusion: PG students have appropriately prepared ICFs; however, there are some discrepancies in some of the elements. There is a requirement of sensitizing PG students through regular training programs to reduce discrepancies in ICDs.
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Etiology of primary amenorrhea: Experience from a tertiary care hospital in Western India p. 674
Rajesh Kumar Mishra, Uttara Aiyer Kohli, Atul Seth, Sumeet Ranjan Tripathy
DOI:10.4103/mjdrdypu.mjdrdypu_395_20  
Objectives: The etiology of primary amenorrhea is varied and can involve different organ systems. Gonadal dysgenesis and Mullerian agenesis are two most common disorders contributing to it. However, there is no consensus about the prevalence of different etiologies among studies reported from different parts of the world. The present study was carried out to evaluate different etiological factors responsible for primary amenorrhea in Western India. Materials and Methods: This was a prospective observational study carried out at a tertiary care hospital in Maharashtra. Thirty cases of primary amenorrhea were evaluated over a period of 2 years and data were analyzed regarding etiology and various management options. Results: Fourteen out of 30 cases had Mullerian agenesis and gonadal dysgenesis was reported in five cases. No case of genital tuberculosis was reported in our study. Most cases of Mullerian agenesis were managed with vaginoplasty, whereas cases of gonadal dysgenesis were managed with cyclical hormonal therapy. Conclusion: Mullerian agenesis was the most common etiology of primary amenorrhea followed by gonadal dysgenesis in our study. Diagnosis of patients of amenorrhea should be meticulous and their management depends on the underlying etiology.
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ORIGINAL RESEARCH ARTICLES Top

Response of proinflammatory cytokine, tumor necrosis factor-alpha to moderate physical activity in nondiabetic hypertensives and type 2 diabetic hypertensives p. 679
Barkha Gupta, Sonali Sharma, Sudhir Bhandari, Sonal Bhardwaj, Asrar Ahmed
DOI:10.4103/mjdrdypu.mjdrdypu_85_21  
Introduction: Hypertension is a multifactorial disease and is a major risk factor for cardiovascular disease, particularly in patients of diabetes mellitus. Management of hypertension is one of the critical components of comprehensive clinical management of diabetics. Aim: The aim of this study is to evaluate the effect of physical activity on systemic inflammation in patients with hypertension and type 2 diabetes mellitus in patients with hypertension. Methods: A total of 100 participants of either gender aged 40–69 years of Stage 2 essential hypertension were included in the study and assigned to 12 weeks of moderate physical activity (walking 10,000 steps/day). These study participants were further divided into two groups: type 2 diabetic (n =66) and nondiabetic (n = 34) hypertensives. Anthropometric parameters were noted and biochemical variables estimated at baseline and postintervention and evaluated statistically. Results: Twelve weeks of walking resulted in improved levels of inflammatory cytokine tumor necrosis factor-alpha (TNF-α). Systolic and diastolic blood pressure (BP) were reduced from 168.98 ± 3.76 to 154.29 ± 7.48 mmHg and from 103.38 ± 2.46 to 89.08 ± 3.62 mmHg, respectively. Body weight and body mass index were reduced from 69.8 ± 7.09 to 68.3 ± 6.53 kg and 23.21 ± 3.35 to 22.70 ± 3.16 kg/m2, respectively. A significant decrease in glycated hemoglobin (Group 1: 8.36% ± 1.83% vs. 7.74% ± 1.82%; Group 2: 5.56% ± 0.4% vs. 5.09% ± 0.19%) was found. A significant reduction in TNF-α levels in hypertensives with diabetes and a significant (P < 0.0001) decrease in nondiabetic hypertensive participants (Group 1: 1.38 ± 0.701 vs. 1.068 ± 0.657 pg/ml; Group 2: 1.341 ± 0.749 vs. 0.894 ± 0.601 pg/ml, respectively; pre vs. post P < 0.0001) were observed, respectively. Conclusion: Regular moderate physical activity induces anti-inflammatory state in hypertensives by reducing levels of proinflammatory marker TNF-α. It also resulted in good glycemic control and improvement in BP and has health beneficial effects.
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Does infertility affect the quality of life of infertile women? A study in a gynecology outpatient department of a tertiary care hospital of Kolkata p. 685
Deepta Dutta, Aparajita Dasgupta, Soumit Roy, Chandra Shekhar Taklikar, Debdatta Ghosh, Bobby Paul
DOI:10.4103/mjdrdypu.mjdrdypu_8_20  
Background: Infertility, which is an inability to conceive after a prolonged time period, is a neglected domain of reproductive health. Infertility affects couples physically and psychologically and leads to discrimination and stigma in society, especially to women. Various sociodemographic, physiological, and environmental attributes and access to health care may interplay with the quality of life (QoL) of the women afflicted with infertility. Objectives: The aim of this study was to assess the QoL and its predictors among women diagnosed with infertility. Materials and Methods: A cross-sectional study was conducted among 247 women diagnosed with infertility and receiving treatment for at least 6 months at a gynecology outpatient department in a tertiary care hospital of Kolkata. Results: The mean (±standard deviation) score of total ferti-QoL was 65.76 (±11.15). Differential mean scores were observed in domains of ferti-QoL such as emotional (58.49 ± 12.75), body/mind (47.67 ± 16.14), relational (78.36 ± 15.51), social (60.71 ± 12.43), core (61.31 ± 12.71), environment (80.09 ± 10.77), tolerability (70.95 ± 11.97), and treatment (76.44 ± 10.36). Nearly half of them also reported abuse in terms of verbal (50.6%) and physical (6.9%). On multivariable analysis, unsatisfactory QoL was significantly associated with age above 32 years (adjusted odds ratio [AOR] = 2.76, confidence interval [CI] = 1.07–7.12), increasing duration of infertility (AOR = 1.46, CI = 1.17–1.82), and presence of chronic diseases (AOR = 2.21, CI = 1.01–4.83). Conclusion: There is, till date, no provision of management for women suffering from infertility in the Reproductive and Child Health Programme. The problem of infertility must be considered as a public health problem, and all policymakers, health administrators, and other stakeholders should come forward with exemplary guidelines specially targeted for providing relief to these affected women in every stratum of the health-care system.
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CASE SERIES Top

Organizing pneumonia as a presentation of connective tissue disorders p. 691
Mahavir S Bagrecha, Sachinkumar S Dole, Tushar R Sahasrabudhe, MS Barthwal
DOI:10.4103/mjdrdypu.mjdrdypu_408_21  
Organizing pneumonia (OP) is a clinical, radiological, and histological entity that is classified under the group of interstitial lung diseases. The diagnosis of OP is based on a characteristic histological pattern in the presence of certain clinical and radiological features. We present four cases of OP who presented with respiratory complaints of several weeks duration. Skin lesions typical of underlying connective tissue disorders were observed in three patients, and these were confirmed on biopsy. The diagnosis of OP was confirmed with the computed tomography scan thorax of all cases and additionally on histopathology of pulmonary lesions in two cases. All of these patients responded well to steroids, but one patient died due to respiratory failure.
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CASE REPORTS Top

A rare case of isolated congenital foot drop in a new-born infant p. 695
Narmadha Morvil, Suresh Chandran, Ashwani Bhatia, Krishna Revanna Gopagondanahalli
DOI:10.4103/mjdrdypu.mjdrdypu_239_20  
We report a case of congenital foot drop in a term neonate born through cesarean section for breech presentation. The antenatal history was unremarkable; the baby was born well and no significant anomalies were noted at birth except for right congenital foot drop. The rest of the neurological examination was unremarkable with normal head and spine ultrasound scans. The postnatal period was otherwise unremarkable with normal feeding and examination. Baby was discharged home in stable condition with regular physiotherapy on follow-up. The foot drop completely resolved by 3 months of age with physiotherapy alone. Baby is currently doing well with normal growth and development.
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Ultrasound -Guided stellate ganglion block: A miracle for patients of systemic lupus erythematosus with vasculitis p. 698
Yashwant Nankar, Aparna Bagle, Archana Nankar, Shilpa Deshmukh
DOI:10.4103/mjdrdypu.mjdrdypu_597_20  
In patients of systemic lupus erythematosus (SLE) with vasculitis, along with medical management, stellate ganglion block (SGB) is also recommended frequently to improve the vascularity of the upper limb and in some instances prevent the gangrene of fingers. In this article, we described the management of a SLE patient presented with progressive gangrene of the finger. Ultrasound-guided SGB was successfully given in this patient to relieve pain and improve vascularity, which also helped in healing of ischemic ulcer on digits.
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Chromoblastomycosis: Masquerading as squamous cell carcinoma p. 703
Puneet Baveja, Gurpreet Kaur Walia, Gourang Paliwal, Tankala Rajkamal
DOI:10.4103/mjdrdypu.mjdrdypu_570_20  
Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue caused by one of several dematiaceous (naturally pigmented) fungi. Predominantly, an infection of the humid tropical and subtropical regions, chromoblastomycosis does occur in India, and its diagnosis is usually delayed due to the low level of clinical suspicion. Here, we present the case of a 65-year-old male who presented with gradually progressive raised lesions over the right thigh of 8 years' duration with a history of sustaining injury through horse tail. Dermatological examination revealed a well-defined, erythematous, verrucous plaque on the lower third of the right thigh and knee with ill-defined advancing margins. Histopathological examination of skin biopsy and potassium hydroxide preparation of material scraped from the surface of lesions showed characteristic “sclerotic bodies” of chromoblastomycosis, and the patient was started on anti-fungal drugs to which he responded very well with regression of most of his lesion.
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Primary breast T-cell lymphoma p. 706
Fariba Binesh, Mohammad Forat Yazdi, Pegah Kamal, Sara Mirhosseini, Seyed Hossein Shahcheraghi
DOI:10.4103/mjdrdypu.mjdrdypu_374_20  
Primary breast lymphoma is an uncommon neoplasm. The vast majority of breast lymphomas are B-cell type; only in a few cases, the tumor cells show a T-phenotype. Because the imaging findings are nonspecific, the diagnosis is made by histology. A 42-year-old woman presented with chief complaints of exertional dyspnea, dry cough, postnasal discharge, and right breast mass during the last month. The patient underwent an excisional biopsy, and a diagnosis of T-cell lymphoma was made. The patient received chemotherapy. After the end of chemotherapy, radiotherapy was done. Primary breast T-cell lymphoma presents as a nonspecific mass on mammography, and as a result, it can be confuse with breast carcinoma. Proper diagnosis and subsequent appropriate treatment lead to excellent prognosis. Chemotherapy is the treatment of choice. Radical surgery should be avoided.
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Primary cutaneous alveolar rhabdomyosarcoma, an uncommon entity p. 709
Fariba Binesh, Mohammad Ebrahimzadeh Ardakani, Pegah Kamal, Fatemah Pourhosseini, Sara Mirhosseini, Seyed Hossein Shahcheraghi
DOI:10.4103/mjdrdypu.mjdrdypu_337_20  
Although secondary rhabdomyosarcoma (RMS) of the skin is not uncommon, the primary type is rare. RMS arising on subcutaneous tissue in an adult is sorely uncommon. It usually affects the skin of the face. Among the four histologic subtypes, the alveolar variant is the least frequently presented variant. Here, the authors introduce a patient with primary cutaneous alveolar RMS of the scalp. The tumor manifested as an immense plaque-like lesion confined to the scalp. The diagnosis was made by histological and immunohistochemical features of the biopsied specimen. Immunohistochemistry stains revealed that the tumor cells were positive for Desmin and negative for HMB45 and CD34. Surgery combined with adjuvant chemotherapy seems to be the best treatment. If complete resection of the lesion is not possible, radiotherapy is recommended. This case demonstrates that primary cutaneous RMS should be considered in the assessment of peculiar malignant tumors of the skin, and proper ancillary studies will be helpful.
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A case of aripiprazole-Induced neuroleptic malignant syndrome p. 712
Santosh Ramdurg, Shivakumar P Chaukimath, BK Manovijay
DOI:10.4103/mjdrdypu.mjdrdypu_101_20  
Neuroleptic malignant syndrome (NMS) is a serious medical emergency with significant fatality rates if not recognized and treated early. High-potency first-generation antipsychotics are reported to have more incidence of NMS. Aripiprazole-induced NMS is very rare, and here we report the case of a 38-year-old woman with bipolar illness disorder. The disorder started after escalating the dose and resolved after stopping the medicine.
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Behcet's diseases' coexistence with idiopathic thrombocytopenic purpura p. 714
Saloni Abhijit Desai, Uddhao S Zambare, Chitra S Nayak
DOI:10.4103/mjdrdypu.mjdrdypu_191_20  
Behcet's disease (BD) is a chronic multisystem disorder characterized by a triad of oral ulcers, genital ulcers, and uveitis. Association between BD and other autoimmune disorders is not well documented. BD with idiopathic thrombocytopenic purpura has rarely been reported. Here, we present the case of a 16-year-old female presenting with recurrent oral and genital ulcers with a low platelet count diagnosed as BD with idiopathic thrombocytopenic purpura based on clinical and laboratory findings. The patient showed an excellent response to systemic corticosteroids.
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COMMENTARIES Top

Behcet's disease: A rarity p. 717
S Jayachandran
DOI:10.4103/mjdrdypu.mjdrdypu_385_20  
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Strengthening rehabilitation component in the management of COVID-19 cases p. 719
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjdrdypu.mjdrdypu_304_20  
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Knowledge, attitude, and practice of public personnel and COVID-19 containment p. 721
Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_346_20  
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An overview of achalasia cardia in children p. 722
Rajendra K Ghritlaharey
DOI:10.4103/mjdrdypu.mjdrdypu_400_20  
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COVID-19: The curious case of the dog that did not bark p. 724
Vadisha Srinivas Bhat
DOI:10.4103/mjdrdypu.mjdrdypu_277_20  
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VIEWPOINT Top

Coronavirus disease 2019 pandemic: Implications for schools and strategies to prevent school-based transmission p. 726
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjdrdypu.mjdrdypu_89_20  
The ongoing coronavirus disease-2019 (COVID-19) outbreak has finally been declared as a pandemic not only because of the caseload and the geographical distribution, but also because of the expectation that the prevailing trends suggest that the number of cases, attributed deaths and also the number of affected nations is expected to increase further. Amidst all these alarming developments, it becomes an important priority for the health professionals and stakeholders to ensure that school children and educational facilities are protected adequately. There is a need to ensure that measures are taken in school settings to prevent the entry and spread of the causative virus through those individuals who might have been exposed to it. In conclusion, the current trends suggest that the COVID-19 pandemic is there to stay and affect a greater number of individuals and nations. Amidst all these health concerns, it becomes our responsibility to not only safeguard the health status of school-going students, but also ensure that their learning is not affected and thus a balanced and an evidence-based approach is the need of the hour.
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COMMENTARIES Top

COVID-19, school closure, city lockdown, and infection control p. 728
Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_215_20  
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Pulmonary hypertension - Basics p. 729
M Vishnu Sharma
DOI:10.4103/mjdrdypu.mjdrdypu_322_20  
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Changing dynamics of chronic obstructive pulmonary disease in India p. 731
Ankit Bhatia, Sharad Joshi
DOI:10.4103/mjdrdypu.mjdrdypu_233_20  
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LETTER TO THE EDITOR Top

Chronic obstructive pulmonary disease mortality in India: Variations and associated factors p. 732
Manas Pratim Roy
DOI:10.4103/mjdrdypu.mjdrdypu_27_20  
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BRIEF COMMUNICATION Top

Alternative use of intravenous set: A simple and cost-effective technique to assess sensory blockade in spinal anesthesia p. 734
Gauri Raman Gangakhedkar, Yogalakshmi Palani
DOI:10.4103/mjdrdypu.mjdrdypu_333_20  
The use of pinprick for assessment of the level of sensory blockade after spinal anesthesia is a time-tested modality. In order to overcome the shortcomings of pinprick while keeping in mind the economic restraints in a government-aided tertiary care institute, we have devised an alternative technique using the available resources. This article aims to highlight this technique and promotes the use of the same in other institutions.
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