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   Table of Contents - Current issue
Coverpage
May-August 2021
Volume 35 | Issue 2
Page Nos. 47-86

Online since Saturday, November 27, 2021

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EDITORIAL  

Outbreak of respiratory syncytial virus infection during COVID-19 strict control: An implication in pediatrics p. 47
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jms.jms_52_21  
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REVIEW ARTICLE Top

Insights into the relationship between COVID-19 and diabetes mellitus: Public health perspective p. 48
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jms.jms_2_21  
The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of almost everyone across the globe. The present review has been carried out to explore and understand the relationship between COVID-19 infection and diabetes mellitus from the public health perspective. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 25 research articles were selected based on the suitability with the current review objectives. Keywords used in the search include COVID-19 and Diabetes mellitus in the title alone only. Considering the risk of poor prognosis of infection among diabetics, it has been envisaged that such people should strictly adhere to the preventive measures. Self-care plays a crucial role in the management of diabetes, and the significance of the same has immensely increased during the ongoing COVID-19 pandemic. As the people with diabetes constitute a high-risk group, it is the need of the hour to increase awareness among these people about COVID-19 infection. To conclude, the COVID-19 pandemic is far from over and the people living with diabetes are at significant risk to land up into complications, if they acquire the infection.This call for the need to intensify the preventive strategies and strengthen the health care delivery system for ensuring better management of diabetes among COVID-19 cases.
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ORIGINAL ARTICLES Top

Locking plate fixation for unstable proximal humerus fracture: A prospective study p. 51
Prem Regis, Victor Moirangthem
DOI:10.4103/jms.jms_119_20  
Background: Unstable fractures of the proximal humerus represent a surgical challenge despite the wide range of treatment options available. The proximal humerus locking plate is a good surgical option in the management of unstable proximal humerus fractures. Aim: The purpose of this study is to determine whether locking plate fixation in the treatment of displaced and unstable proximal humerus fractures leads to a good functional outcome. Settings and Design: Medical school hospital, observational study. Subjects and Methods: Thirty-two patients with unstable proximal humerus fractures treated with proximal humerus locking plate between November 2017 and March 2019 were included in the study. The fractures were classified based on the Neer's classification into two-, three-, and four-part fractures. The minimum follow-up was 1 year. The Constant–Murley scoring system was used for functional assessment. Constant scores for two-, three-, and four-part fractures were determined and compared with respect to the age, gender, handedness, and occupation of the study participants. Statistical Analysis Used: Chi-square test was applied for discrete variables and one-way ANOVA was used to compare between the three fracture types. P ≤ 0.05 was taken as significant. Results: Fourteen patients had two-part fractures, 13 patients had three-part fractures, and 3 patients had four-part fractures. The mean follow-up period was 17.5 months (range: 12–24 months). About 65.6% (n = 21) patients had good result, 31.3% (n = 10) had fair, and 3.1% (n = 1) had poor result. Constant scores for 2-part (84.14 ± 2.98) and 3-part fractures (82.15 ± 3.78) were significantly superior to those of 4-part fractures (72.80 ± 3.63) (P = 0.000 and 0.000, respectively). Difference between 2-part and 3-part fractures was not significant (P = 0.142). There was no significant difference in the functional outcome between patients who were employed and unemployed, right and left handed. Complications include stiffness in 6.3% (n = 2) and infection in 3.1% (n = 1) of cases. Conclusion: Proximal humerus locking plate gives stable fixation for 2-part and 3-part fractures. However, in case of Neer's 4 part-fractures, the functional outcome is relatively poor.
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Clinicomycological study of Candida isolates in a tertiary care hospital: A pilot study p. 58
Shibani Mishra, Anitha Subramanian, Anupma Jyoti Kindo
DOI:10.4103/jms.jms_28_21  
Background: Candida infection is on the rise with an increasing number of nonalbicans species. Therefore, the need to speciate Candida rapidly and accurately is of the utmost importance. The purpose of this study was to speciate Candida using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), to analyze the correlation of the isolates with the clinical condition, and to study the outcome of the patient. Materials and Methods: PCR-RFLP using universal primers ITS1 and ITS4 was done to speciate all isolates of Candida; patient details were collected to analyze the clinical condition and the outcome of the patient. Results: The most common species of Candida isolated was Candida tropicalis 14 (56%) followed by Candida albicans 5 (20%), Candida auris 3 (14%), Candida parapsilosis 1 (4%), Candida orthopsilosis 1 (4%), and Candida kefyr 1 (4%). Majority of the samples that were collected were urine samples 15 (60%). The average duration of hospital stay was found to be 13.8 days. A number of underlying risk factors were present such as patients with diabetes, sepsis, malignancy, covid19 infection, surgical patients, preterm patients, elderly patients, and patients on long-term steroids. Conclusion: Candidemia is on the rise nowadays with nonalbicans species responsible for the majority of the infections. Since the outcome of the patient depends on rapid diagnosis and prompt initiation of antifungal agents PCR-RFLP proves to be a rapid and reliable test to identify most of the prevailing species of Candida.
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A cross-sectional study of online medical education in the COVID-19 era p. 63
Akhilesh Kumar, Gurmeet Singh, Anand Pandey, Jiledar Rawat
DOI:10.4103/jms.jms_68_21  
Introduction: COVID-19 infection forced many alterations in our daily life, and continuation of classes by online mode is one of them. The effect of online classes on medical students has not been evaluated in our setup. This study was conducted to assess the medical student's perspective on the usefulness of online teaching. Materials and Methods: A cross-sectional study of undergraduate medical students was conducted through an online link-based Google Form from November 28 to December 3, 2020. Anonymous responses were collected and evaluated. The values are presented in numbers and tables. Results: A total of 329 datasets were received. Of these, 318 were included, and the remaining 11 were excluded. The smartphone was the most common gadget used for attending online classes (261, 83.7%). In 164 (57.2%) students, the routine lifestyle was grossly affected. The student complained of visual (183, 58.7%) and concentration (168, 53.8%) discomfort. Two hundred and seven (65.7%) students did not found online classes to be as efficient as traditional offline classes; however, 191 (61.2%) students stated that they might be interested in listening to lectures on interesting topics by experts from other reputed institutes. Conclusion: In the current circumstances, online classes are considered a stopgap measure for the continuation of teaching, but physical classes are preferred in this field. More time may be needed to overcome the problems faced due to the online system.
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Demographic profile of the patients with lumbar disc herniation presented in a tertiary care center, Manipur p. 67
Jungindro Singh Ningthoujam, Ajit Singh Naorem, Shugeta Devi Ningthoukhongjam
DOI:10.4103/jms.jms_106_21  
Background: Lumbar intervertebral disc herniation presents with a wide variety of demographic profiles among the patients of various regions. Depending on the regional factors such as environmental, socioeconomic and genetic factors, the demography may vary. Objectives: This study aimed to observe the demographic profile of patients with lumbar disc herniation and to find the association and correlation among the different variables. Materials and Methods: It is a cross-sectional study. Descriptive analysis was performed for parameters such as age, weight, height, and body mass index (BMI). Chi-square test was performed to see the association of different variables. A Spearman's regression analysis was performed to see any correlation between the quantitative variables. Results were evaluated with a confidence interval of 95% and significance level at P < 0.05. Results: We had 348 patients with a mean age of 52.49 (±13.34) years, out of which 194 (55.7%) were female. Visual analog scale score ≥7 was found in 194 (55.7%) patients. Of the patients, 228 (65.5%) were overweight and 40 (11.5%) were obese with a mean BMI of 26.99 (±2.61). In the physical activity, 159 (45.7%) fall in heavy group, 135 (38.8%) moderate, and 54 (15.5%) in light activity groups. L4L5 (183, 52.6%) and L5S1 (133, 38.2%) were the most common site of prolapsed. Grade 6 disc degeneration was the most common (101, 29.0%) followed by Grade 7 (96, 27.6%) and Grade 5 (77, 22.1%). 2ab was the most common pattern of prolapsed with 22.4%. Conclusion: Disc herniation is more common among females and in the middle age group. Overweight or obese people are at more risk of disc degeneration. L4L5 and L5S1 are the most common level of prolapse. Grades 6 and 7 of disc degeneration are more symptomatic and are associated with advancing age. Posterolateral disc herniation is the most common type and people engaged with heavy physical activities are at higher risk of disc degeneration.
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A prospective comparative study of pull-out suture technique versus modified Kessler technique in flexor tendon repair for Zone I and distal Zone II injuries p. 72
Manisana Singh Pebam, Akoijam Ibohal Singh, Saugat Das, Laishram Oken Singh, Nehar Sinam, Sanjib Nepram Singh
DOI:10.4103/jms.jms_109_21  
Background: Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in hand are dependent on a sound surgical repair allowing early active mobilization. Aims and Objectives: The purpose of the study was to compare the clinical and functional outcomes of Zone I and distal Zone II flexor tendon repair using pull-out suture technique with two-strand modified Kessler method. Materials and Methods: This hospital-based prospective study was conducted in a tertiary hospital setup in Manipur for 2 years' duration from November 2018 to November 2020. The study was conducted on 26 patients with a total of 30 injured digits, which were then divided into two equal groups of cases and control. Group A included study cases and were treated with pull-out suture technique. Group B included 15 control cases and were treated with modified Kessler technique. Comparison was done between the two different techniques based on patient variables and outcome measured with total active motion (TAM) evaluation system of the American Society for Surgery of Hands. Statistical Analysis: Data collected were entered into the SPSS version 16. Descriptive analysis of baseline characteristics of both study and control groups was done. The final analysis was done using the Chi-square test and SPSS version 16. P < 0.05 was taken as significant. Results: In our comparative study, at the 3-month follow-up range of motion was measured and TAM was calculated. Among case group, 2 (13%) belonged to good and 13 (87%) belonged to fair category, whereas among control group, 2 (13%) belonged to good and 1 poor category, and 12 (80%) belonged to fair category. About 50%–75% of functional recovery by 3 months was obtained in 80% of the cases and 73% of the control group. Conclusion: The pull-out suture technique is a good option for the management of Zone I and distal Zone II flexor tendon injuries.
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CASE REPORTS Top

Multifocal sarcomatoid urothelial carcinoma of the renal pelvicalyceal system and ureter: A diagnostic dilemma p. 76
Anita Nangia, Shivali Sehgal
DOI:10.4103/jms.jms_103_20  
Sarcomatoid urothelial carcinomas (SUCs) are characterized by intimately mixed malignant epithelial and malignant mesenchymal components. We present a case of a multifocal SUC in the left pelvicalyceal system of the kidney and the left ureter. SUC although rare should be included in the differential diagnosis of multifocal tumors of the renal pelvis and ureter. Immunohistochemistry is essential to confirm the diagnosis and rule out other differentials including pure sarcoma, sarcomatoid variant of renal cell carcinoma, and pseudosarcomatous mesenchymal proliferation.
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Crossed testicular ectopia: A report of two cases p. 80
Puja Ganguly, Pankaj Halder, Partha Chakraborty, Kartik Chandra Mandal
DOI:10.4103/jms.jms_40_21  
The term “crossed testicular ectopia” (CTE) means the deviation from the normal path of descent resulting in unilaterality of both testes. The condition is mostly detected incidentally during repair of inguinal hernia or laparoscopic evaluation of impalpable undescended testis. Preoperative identification of this anomaly is feasible during the clinicoradiological evaluation of the genito-urinary abnormalities. Orchiopexy (transeptal/extraperitoneal transposition/laparoscopy-assisted) is the mode of surgical management. We present here two cases of CTE where laparoscopy-assisted trans-inguinal orchiopexy was done.
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Successful treatment of bilateral renal artery stenosis in a patient presenting with acute kidney injury p. 83
Guliver Potsangbam, Gautam Thangjam, Gurumayum Suman Kumar Sharma, Nongdrembi Rajkumari, Sumidra Laishram
DOI:10.4103/jms.jms_69_21  
A common causes of secondary hypertension is renal artery stenosis (RAS), of which the vast majority are caused by atherosclerosis. Since angiotensin II receptor blockers (ARBs) are one of the most commonly used antihypertensives, their use may precipitate acute kidney injury in patients who have an underlying bilateral renal artery stenosis. In this case report, a female patient with bilateral severe ostial stenosis of the renal arteries developed acute kidney injury (AKI) requiring renal replacement therapy. Post angioplasty and stenting of the bilateral renal arteries, the patient made a complete renal recovery.
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LETTER TO EDITOR Top

COVID-19, tele-education, and medical students p. 86
Rujittika Mungmunpuntipatip, Viroj Wiwanitkit
DOI:10.4103/jms.jms_63_21  
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