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   2021| September-December  | Volume 35 | Issue 3  
    Online since June 15, 2022

 
 
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ORIGINAL ARTICLES
Correlation between antral follicle count and anti-Mullerian hormone in infertile Indian women
Shivi Jain, Ram Chandra Shukla, Madhu Jain, Usha Singh, Tej Bali Singh
September-December 2021, 35(3):87-91
DOI:10.4103/jms.jms_126_21  
Background: Antral follicle count (AFC) and anti-Mullerian hormone (AMH) have been used as indicators of ovarian reserve in infertile women. There still exists a debate about the association between the two parameters. Objective: The objective of the study was to find out the relationship between AFC and AMH in infertile women. Methods: This was a prospective, hospital-based, cross-sectional study, in which 1083 infertile women (aged 20–40 years) with primary infertility were included. They were divided into four age groups, i.e., Group I (20–24 years), Group II (25–29 years), Group III (30–34 years), and Group IV (35–40 years). AMH and AFC were measured on 3rd day of menstrual cycle. Pearson correlation and linear regression analysis were done to find out the relationship between age, AFC, and AMH. Statistical analysis was done using IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA). A P < 0.05 was considered statistically significant. Results: There was modest negative correlation of AFC with age (r = −0.476, P < 0.001). AMH showed strong negative correlation with age (r = −0.844, P < 0.001) and modest positive correlation with AFC (r = 0.400, P < 0.001). For separate age groups also, statistically significant correlations (P < 0.05–P < 0.001) were noted between age, AFC, and AMH. Age explained 22.7% variation in AFC and 71.2% variation in AMH. Conclusion: There was a significant correlation between AMH and AFC in infertile women. AFC showed a continuous decline with increasing age. However, AMH increased with age till third decade of life and showed negative correlation with AFC. Thereafter, AMH started decreasing with age and showed positive correlation with AFC.
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Health-related quality of life of the geriatric population living in rural areas of West Tripura district of India: A cross-sectional study
Arpita Debnath, Himadri Bhattacharjya, Partha Sarathi Pal
September-December 2021, 35(3):92-97
DOI:10.4103/jms.jms_121_21  
Background: Growing life expectancy is challenging the quality of health care for elderly. Information regarding health-related quality of life (QOL) may help policy makers to design need-based health programs for this population. Objectives: The objective of the study was to estimate health-related QOL of the geriatric population living in rural areas of West Tripura district and to compare it between ethnic and nonethnic populations in respect to important domains. Materials and Methods: This community-based cross-sectional study was conducted during February 1, 2019–March 31, 2020 among 225 geriatric subjects of rural West Tripura district chosen by multistage sampling. The World Health Organization's QOL–BREF scale was used for data collection. Results: Among the study population, 46.2% had overall good health-related QOL. About 52.9% had good QOL in the environment, and 37.3% had good QOL in social relationship domains. Marginally higher proportion of the subjects from ethnic origin had better QOL than the nonethnic, but it was not significant. A higher proportion of the Muslim subjects had better QOL than the rest, but it was also not significant. Bivariate analysis showed significant associations of QOL with age, sex, literacy, financial condition, socioeconomic status, and type of family. Multivariate analysis identified male sex, younger age, and living with spouse as significant predictors of good QOL. Conclusion: Overall health-related QOL of the geriatric people living in rural areas of West Tripura district is poor, but younger male subjects of ethnic origin and living with spouse may enjoy relatively better QOL.
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E-test antifungal susceptibility profile of Candida spp. associated with vulvovaginal candidiasis in patients of Manipur
Sudipta Naorem, Ajit Kumar Singh Yanglem, Randhir Babu Singh Yendrembam, Ranjit Singh Laiphrakpam, Ranjana Devi Khuraijam
September-December 2021, 35(3):98-102
DOI:10.4103/jms.jms_117_21  
Background and Objectives: Vulvovaginal candidiasis (VVC) is one of the most common vaginal infections during fertile period of women. An increase in the prevalence of non-albicans Candida which are resistant to commonly used antifungals has been documented. Therefore, studying the antifungal susceptibility pattern of the causative agents is of great significance in successfully treating the ailment and understanding the local data. Materials and Methods: Forty-six Candida spp. isolated from VVC patients were subjected to antifungal minimum inhibitory concentration testing for itraconazole, fluconazole, and voriconazole using E-test method. Results: Candida albicans and Candida glabrata showed 87.8% and 60% sensitivity, respectively, to itraconazole. Twenty percent of Candida parapsilosis and 40% of C. glabrata were resistant to fluconazole. Voriconazole showed higher sensitivity with 0.013 μg/ml as the minimum concentration to inhibit all Candida spp. C. glabrata noted higher minimum inhibitory concentrations against itraconazole, fluconazole, and voriconazole. Interpretation and Conclusion: Voriconazole is the drug of choice in case of fluconazole treatment failure among VVC.
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Molecular subtypes of breast carcinoma and its relation with clinicopathological features: A single-center initial experience
Zothangsung Joute, Maharshi Debnath, Gayatri Devi Pukhrambam, Sushma Khuraijam, Babina Sarangthem
September-December 2021, 35(3):103-107
DOI:10.4103/jms.jms_5_22  
Molecular subtypes of breast carcinoma and its relation with clinicopathological features: A single centre initial experience. Background: Breast carcinoma is the most common malignancy in female in the world. They are a group of heterogenous diseases with diverse clinical, morphological and gene expression profile. Molecular subtyping of histological types of breast carcinomas based on the expression receptors estrogen receptors (ER), progesterone receptors (PR), HER2 neu and Ki67 act as a surrogate marker for gene expression profiling. This helps in specific prognostic and predictive targeted therapy. Objective: Identification of various molecular subtypes and correlate with the clinicopathological parameters. Methods: This cross sectional study comprising of thirty four cases is conducted at Department of Pathology, Regional Institute of Medical Sciences, Imphal during a period of three years from August 2016 to July 2019. The histomorphological diagnosis and clinical parameters are correlated with immunohistochemical findings for ER, PR, Her2 Neu and Ki 67. Statistical analysis done by chi square test. Results: The commonest histological type is invasive carcinoma of no special type (88.2%). After molecular sub typing, Luminal B type (LUMB) is the most common type (38.2%). LUMA type found to be associated with smaller tumor size, grade 1-2 and seen mainly in 6rd and 7th decade of life. LUMB and Her-2 Neu enriched, triple negative type commonly associated with larger tumor size, grade 2-3 and seen in 4th to 6th decade of life. Conclusion: Some differences in clinicopathological profile of the molecular subtypes from other studies seen. A larger multicentric study with genetic analysis will help in understanding the disease pattern in our area helping in targeted and personalized treatment.
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Assessment of online teaching–learning during coronavirus disease-19 pandemic: Medical students' perspective
Prateek Saurabh Shrivastava, Saurabh R Shrivastava
September-December 2021, 35(3):108-112
DOI:10.4103/jms.jms_104_21  
Background: During the corona virus disease 19 (COVID-19) pandemic, most of the medical schools across the world has started to transfer the curriculum from face-to-face to online delivery using various virtual platforms for undergraduate teaching without any uniformity. It is imperative to understand the students' outlook about the current online teaching in order to make it more effective. This study was planned to gain an insight into the medical students' perspective toward online teaching–learning program and the challenges faced by them toward the same. Materials and Methods: It was a cross-sectional descriptive study conducted for 3 months at a medical college in Chengalpet district, Tamil Nadu, among 351 medical students across all professional years. The Google form platform was used to administer a semi-structured questionnaire to all the participants to obtain information related to various parameters of online teaching-learning. The statistical analysis was done using frequency and percentages. Results: A total of 351 students participated in this study, including 134 males and 217 females. Almost 318 (90.6%) perceived that online classes were able to cover academic portion amidst COVID-19 pandemic. The most common challenges found were network related issues, lack of practical sessions, including dissection and lack of exposure to clinical cases cited by 181 (90%), 77 (38.3%) and 72 (35.8%) participants, respectively. Conclusions: The study reveals the perspectives of medical students on online teaching–learning sessions and identifies important challenges pertaining to it. However, the positive overall experience by the students provides confidence to the medical education fraternity in the entire process of online teaching and learning amidst the COVID-19 pandemic.
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Risk factors associated with complicated alcohol withdrawal syndrome
Navdeep Banyal, Harpreet Singh Dhillon, Shibu Sasidharan
September-December 2021, 35(3):113-117
DOI:10.4103/jms.jms_92_21  
Background: Alcohol withdrawal syndrome (AWS) is a frequent presentation in patients with alcohol dependence syndrome. Complicated alcohol withdrawal state (i.e., delirium and/or convulsions) is the most severe form with significant morbidity and mortality if left untreated. Therefore, it is imperative to identify the risk factors associated with complicated AWS for early diagnosis and swift management. Materials and Methods: This study utilized a cross sectional design in a tertiary care center on 60 patients to identify the risk factors associated with complicated alcohol withdrawal. The data collected were subsequently subjected to statistical analysis with appropriate tests (Pearson Chi-square test, t-test). Results: Out of the 60 patients, 30 developed complicated AWS. Amongst the demographic variables, patients with education <10th standard, unemployment and history of delirium tremens were found to be significant predictors of complicated AWS. Patients with complicated AWS consumed higher mean ± standard deviation (19.33 ± 1.77 vs. 11.87 ± 1.17) units of alcohol per day (P < 0.001). The duration of alcohol withdrawal lasted for 7.13 ± 4.17 days in complicated AWS compared to 5.23 ± 2.70 days in uncomplicated (P = 0.041). Tacycardia (P = 0.001), respiratory rate (P = 0.001), low platelet count (P < 0.001) and higher Erythrocyte sedimentaion rate (P < 0.001) were also found to be significant predictors of complicated AWS. Serum gamma-glutamyl transferase GGT values were higher in complicated AWS but the difference was not statistically significant. Conclusion: This study found lower education, unemployment, history of delirium tremens, higher units of alcohol consumed per day, tacycardia, higher respiratory rate, lower platelet count and higher erythrocyte sedimentaion rate as significant predictors of complicated AWS.
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CASE REPORTS
COVID-19-associated Guillain‒Barre syndrome: Is it parainfectious or postinfectious?
Abujam Indrajit Singh, Rothangpui , M Ratankumar Singh, Rajendra Thangjam, Ch Shivaranjan
September-December 2021, 35(3):118-121
DOI:10.4103/jms.jms_6_22  
COVID -19 since its inception from the month of December 2019 has been associated with myriads of systemic complication apart from the respiratory failure, with Guillain-Barre syndrome (GBS) being one of the prominent neurological complication. More than 220 patients with GBS have been reported thus far. We wish to share 3 cases of GBS associated with COVID 19 admitted in our institute. GBS is one of the most common causes of acute, acquired weakness and is often provoked by a preceding infection, which triggers an immune response, cross-reacts with shared epitopes on peripheral nerve (molecular mimicry). Interestingly one of the cases developed limb weakness concurrently with the respiratory symptoms, probably during the viremic phase; the other 2 cases few weeks after recovering from COVID 19. So, is there a specific association with covid 19 and GBS? If associated, is it Para infectious or Post infectious? Further studies are needed to unravel its association with COVID 19.
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LETTER TO EDITOR
Characteristics of COVID-19 vaccine-associated hypermetabolic lymphadenopathy, a new problem in cancer screening by 18F-fludeoxyglucose positron emission tomography-computed tomography: A preliminary summary
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
September-December 2021, 35(3):126-126
DOI:10.4103/jms.jms_83_21  
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CASE REPORTS
An unusual presentation of angiomatoid fibrous histiocytoma as a perineo-scrotal swelling
A Mohamad Safwan, Sandeep Bhaskaran Babu, Rachel Abraham, Annes Thivya
September-December 2021, 35(3):122-125
DOI:10.4103/jms.jms_85_21  
Angiomatoid fibrous histiocytoma (AFH) is one of the spindle cell neoplasms having fibroblast and myofibroblast origin. The perineoscrotal region is an uncommon site for such tumors and never reported in the literature. We present a 31-year-old gentleman presented with a painless, rapidly growing scrotal swelling for 2 months duration. Guided core needle biopsy demonstrated spindle cell neoplasm; regional magnetic resonance imaging (MRI) revealed a large mass extending from the perineum to inter-testicular space within the scrotal sac. After staging evaluation, he underwent en bloc resection of the tumor. Histopathology showed features of AFH which is supported by immunohistostains positivity to smooth muscle actin, clusters differentiation (CD) 68, CD99, and desmin. Despite any adjuvant treatment, he remained disease-free on follow-up MRI for 4 years. AFH can also have an unusual origin from perineoscrotum, and it grows rapidly and has a good prognosis.
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