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   Table of Contents - Current issue
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May-August 2021
Volume 48 | Issue 2
Page Nos. 55-117

Online since Wednesday, August 18, 2021

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EDITORIAL  

Mucormycosis (Black Fungus) in COVID-19 times p. 55
Shridhar C Ghagane, Rajendra B Nerli
DOI:10.4103/jss.jss_70_21  
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REVIEW ARTICLES Top

Encouraging reflection among medical undergraduate and postgraduate students for advancement of learning and development of skills p. 57
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_7_21  
The field of medical education is quite complex and there are lots of unsaid expectations of a medical student to eventually transform into a competent medical professional. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 13 articles were selected based on the suitability with the current review objectives. Apart from the various teaching–learning methods adopted by the teachers in the delivery of information, it is a must that in order to accomplish deep learning, we have to encourage medical students to reflect upon all the learning and clinical interactions. As a matter of fact, most of the regulatory and professional bodies have strongly advocated for the inclusion of reflection in different phases of both undergraduation and postgraduation medical education. In conclusion, the strategy of reflection should be looked upon as a method for advancement in knowledge, shaping the learning in the future, and to improve the competence level to deal with complex and emotionally or ethically challenging situations. It is the need of the hour that all the medical institutions should develop a detailed plan to encourage students to reflect upon and improve their learning.
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Practice of handwashing: An effective tool to control COVID-19 pandemic p. 60
Santosh Kumar Swain
DOI:10.4103/jss.jss_110_20  
Coronavirus disease 2019 (COVID-19) is a dreaded disease affecting the whole world with no proven pharmaceutical intervention and also no proven vaccine available till now. It is caused by a novel virus called as severe acute respiratory syndrome coronavirus 2. This virus is highly contagious and spread through the droplets of the infected persons by coughing, sneezing, or even touching the infected surface. In such situation, prevention is an important option to control this COVID-19 infection. The role of the handwashing for preventing the communicable diseases has been known for more than century. Handwashing is an inexpensive and widely available protective measure for both personal and pandemic prevention of the viral respiratory tract infections. However, it remains a neglected public health measure in pandemic. Educating for hand hygiene is remarkably beneficial for prevention of the COVID-19 infections. Alcohol-based sanitizers with moisturizers have least irritancy and sensitizing potential in comparison to the soaps and synthetic detergents.
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Ensuring successful implementation of portfolios in medical institutions: Potential challenges and solutions p. 65
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_25_21  
The portfolio refers to a collection of documents supporting learning over a period of time and essentially includes reflection on learning. The present review was carried out to explore the practices required for the successful implementation of portfolios in a medical college set-up. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of nine articles were selected based upon the suitability with the current review objectives and analyzed. To ensure that the tool of portfolio facilitates learning, it is essential that the intended objectives should be made clear to both the medical student and the assessor. The successful introduction and implementation of a portfolio in a medical college are determined by a number of factors, and any medical institution planning to introduce portfolio within their settings should give due consideration to them. In conclusion, portfolio is an effective tool for documentation of learning in the period of medical training. However, to ensure that portfolios are successfully implemented, it is a must that the administrators remain dedicated toward it and encourage both teachers and students to actively participate in the same.
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ORIGINAL ARTICLES Top

Assessment of personal hygiene and morbidity pattern among primary schoolchildren in a rural coal-field area of West Bengal, India p. 68
Baisakhi Maji, Sumana Samanta
DOI:10.4103/jss.jss_105_20  
Background: Foundations of lifelong responsibility for maintenance of good health are laid down in childhood. School is the best place where information regarding hygiene, environment, and sanitation, as well as social customs, should be conveyed. Materials and Methods: Community-based cross-sectional study was conducted in August–September 2017 at the rural coal-field area of Raniganj in Paschim Burdwan district of West Bengal, India. One government undertaken Bengali medium primary school was selected by SRS among 45 primary schools in Raniganj block area. After complete enumeration, the sample size became 106. Data were collected by interview of parents and children as well as observation of personal hygiene among children. A predesigned, pretested, and structured interviewer-administered questionnaire was used. The questionnaire consisted of sociodemographic information, illness during last 15 days, assessment of nutritional status according to the WHO grades of malnutrition based on BMI, and different indicators of personal hygiene. Data were entered into Microsoft (MS) Excel spread-sheet and analysis was done with the help of statistical software SPSS 20.0 version. Results: About 29% of students suffered from common health morbidities in preceding 15 days. Children who suffered from morbidity had less hygiene score than who had no morbidity and this difference was statistically significant. Hygiene score was significantly associated with WHO grade of malnutrition. Binary logistic regression showed that mother's education, hygiene score, and class were significantly related to the presence of morbidity. Conclusion: Majority of the childhood illnesses are preventable by promotion of hygienic practices among schoolchildren through proper health education of their parents and teachers.
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Assessment of knowledge, attitude, and practices regarding oral and dental hygiene among dental outpatients in Central India: A cross-sectional study p. 73
Rakesh Kumar Mahore, Vikas Gupta, Ram Kumar Panika
DOI:10.4103/jss.jss_101_20  
Background: Orodental diseases present a major public health problem. About 90% of schoolchildren worldwide and most adults have experienced caries, with the disease. Little is known about oral and dental health attitudes and behaviors and practices among people from developing countries and especially, in this part of our country. Aims: The present study was carried out with an aim to assess the knowledge attitude and practices in oral and dental hygiene in patients attending the dentistry outpatient department. Materials and Methods: This hospital-based cross-sectional study was conducted during 2019 among 426 patients visiting the outpatient department of dentistry. A pretested, predesigned, standardized questionnaire was used to collect data. Ethical approval was obtained from the Institutional Ethical Committee prior to the conduct of the study. Collected data were entered into the MS Excel spreadsheet and analysis was carried out using IBM SPSS Statistics for Windows at a 5% level of significance. Results: Only 18.3% of participants were aware that a minimum of two times per day brushing of teeth is essential and nearly one-third of subjects (32.4%) disagreed with the fact that dental problems can lead to other health problems/systemic illness. More than half of subjects (52.1%) were using self-medication (pain killer/clove/clove oil/) as a primary approach to dental problems and was significantly associated with age and gender education (P < 0.05). Conclusions: In the present study, more than half of the study subjects visited dentist only when they had dental problems. Public awareness programs should be run involving health workers, nurses, medical, and paramedical students.
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Development of Bengali version of a questionnaire assessing impact of hyperuricemia on quality of life p. 79
Sangita Saha, Rajat Chattopadhyay, Satadal Das, Paulami Sarkar, Chintamani Nayak, Koushik Bhar, Pankhuri Misra, Abhijit Chattopadhyay, Priyanka Ghosh, Subhasish Ganguly, Shyamal Mukherjee, Munmun Koley, Subhranil Saha
DOI:10.4103/jss.jss_114_20  
Context: Hyperuricemia and gout has been found to be associated with reduced health-related quality of life (HRQoL); however, there is no available Bengali questionnaire assessing the same. Aims: We aimed to develop the Bengali version of a questionnaire and examine its cross-cultural adaptability considering linguistic equivalence. Settings and Design: A multicentric, mixed methods, cross-sectional study was conducted through consecutive sampling at the outpatients of three homeopathic hospitals in West Bengal. Subjects and Methods: The Bengali version of the questionnaire was produced by standardized forward–backward translations. Psychometric analysis was run to examine its factor structure, validity, and reliability. Statistical Analysis Used: Reliability was examined using internal consistency (n = 210). Construct validity was examined by exploratory factor analysis (n = 105) using principal component analysis (PCA; varimax rotation). Subsequently, confirmatory factor analysis (CFA; n = 105) was performed to verify the model fit. Results: The internal consistency (Cronbach's α =0.880; 95% confidence interval 0.855–0.902), test–retest reliability and concurrent validity of the questionnaire– all were within acceptable limits. The (Kaiser–Meyer–Olkin = 0.832) and Bartlett's test of sphericity (Chi-square: 1644.344 at df = 210, P < 0.001) both suggested adequacy of the sample. In factor analysis using varimax, all the items loaded above the prespecified value of 0.4 and identified 6 components, explaining 77% of the variation. One item revealed a negative variance; hence the whole component of 2 items was removed from further evaluation. The goodness-of-fit of the 5-components model in CFA was also acceptable (Comparative fit index = 0.702, tucker Lewis index = 0.641, Root Mean Square Error of Approximation = 0.156, and Standardized Root Mean Square Residual = 0.123). Conclusions: The developed Bengali version of the questionnaire consisting of 19 items and framed within 5 components, appeared to be a valid and reliable instrument measuring HRQoL in patients suffering from hyperuricemia.
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Information-seeking behavior on Coronavirus Disease-19 Vaccine on the internet: A global and Indian search trend analysis p. 93
Shaikat Mondal, Himel Mondal, Ritushri Samantaray
DOI:10.4103/jss.jss_18_21  
Background: A significant portion of the global population seeks health-related information on the Internet. The world is searching for an effective vaccine to control the coronavirus disease-19. Knowing the information-seeking behavior of the population helps in designing an awareness program. Aim: This study aimed to explore the information-seeking behavior of the global and Indian population by analyzing Internet search trends. Materials and Methods: This cross-sectional study was conducted from April to November 2020. We used fully anonymous data available in the public domain (https://trends.google.com/trends). The phrase “COVID vaccine” was searched with “schedule,” “when,” “cost,” “where,” and “side effect” to compare the trends. The global and Indian data were categorized month-wise and statistically tested by the Chi-square test. Results: Global Internet users seek information on “when” the COVID vaccine would be available followed by “where” to get the vaccine. The “schedule,” “cost,” and “side effect” come later. Indian search trend is similar for “when” and “where.” However, the third query was the “cost” followed by “schedule” and “side effect.” Conclusion: The Internet search trend showed that people around the world want to know when they would get a vaccine and where to get it. The least search volume was about the side effects of the vaccine. Primary care physicians, government, and nongovernment stakeholders may use this finding for optimum dissemination of information both online and offline.
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Expressivity of ABO antigens and increased predisposition for periodontal disease: A cross-sectional analysis p. 98
J Suresh Babu, C Swarnalatha, Tayf Naif Radhi Alshammari, Farahnaz Muddebihal, Manisha B Patil, Deepak R Kolte, Mohammad Saafaq Alshammari, Fatma Ayyad Alshammari, Abhishek Singh Nayyar
DOI:10.4103/jss.jss_44_21  
Context and Aim: Association between certain systemic diseases and ABO antigens is a well-known fact. The purpose of this study was to determine whether there is any association between periodontal disease and ABO blood group antigens. Materials and Methods: A cross-sectional study was carried out on 200 subjects who were randomly selected from individuals referred for periodontal treatment. The study subjects were segregated into healthy gingiva/mild gingivitis (Group I), moderate/severe gingivitis (Group II), and varying grades of periodontitis groups (Group III), based on Loe and Silness index and clinical attachment loss as the criteria. The study groups were, further, categorized and graded using Ramfjord's periodontal disease index. Blood samples were collected to identify ABO blood groups. Statistical Analysis Used: Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 17.0 (SPSS Inc., Chicago, IL, USA), while Chi-square test was used for statistical analysis. A P < 0.05 was considered statistically significant. Results: The findings of the present study suggested that patients with blood group antigens O and B were more predisposed to develop periodontitis with at least one side with attachment loss of more than 3 mm and with periodontal pocket depth of more than 4 mm (P < 0.001). Conclusion: There is a correlation existing between periodontal disease and ABO blood group antigens as far as this region was concerned. This association could be explained by the various blood group antigens acting as receptors for infectious agents associated with periodontal disease. This broad correlation between periodontal disease and ABO blood group antigens pointed toward susceptibility of the subjects with certain blood groups to periodontal disease.
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CASE REPORTS Top

A rare case of horseshoe kidney with unilateral chronic pyelonephritis in a cadaver p. 102
R Balasubramanian, Sheetal Vishwanath Pattanshetti, Ranjit Kangle, Manasi Gosavi, Karthik Srevatsa, Rajendra D Virupaxi, Vishwanath M Pattanshetti
DOI:10.4103/jss.jss_59_21  
Horseshoe kidney is one of the most common congenital urologic anomalies, with an incidence of 1 in 400 live births. The presence of this type of fusion anomaly of kidneys with resultant progression to renal pathology sometimes may remain obscured or dormant, due to the person being asymptomatic for years, only to be incidentally encountered during an autopsy, or during a cadaveric dissection. Similarly, during routine cadaveric dissection, we came across with a list of variations along with congenital anomalous horseshoe kidney. In this case report, we discuss about anatomical variation and pathological findings of horseshoe kidney.
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Management of Gilbert's syndrome with low-dose, diluted hyperbaricity of spinal bupivacaine: A rare-rare combo p. 107
Reena Ravindra Kadni, Laji Abraham Samuel, S Archana, A Sravanthi
DOI:10.4103/jss.jss_6_21  
Gilbert's syndrome (GS) is an inherited unconjugated hyperbilirubinemia state. Regional anesthesia is recommended over general anesthesia in the management of these patients for surgeries. We describe anesthesia management of a young patient with GS for a below umbilical surgery, with modified spinal anesthesia by diluting the hyperbaricity and reducing the concentration in prone position. Selective sensory blockade with stable hemodynamics, faster recovery, and minimal stress response proved to be beneficial. When feasible, this modified spinal anesthesia can be opted for the management of short duration surgeries in patients with GS.
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Supine percutaneous nephrolithotomy in a patient with a history of previous spinal surgeries p. 110
Rajendra B Nerli, Shashank D Patil, Shoubhik Chandra
DOI:10.4103/jss.jss_49_21  
Patients with abnormal body habitus because of spinal deformities and patients having undergone previous spinal surgeries present a challenge during surgical, anesthesiologic, and technical procedures. In these patients, management of urolithiasis may be difficult because of anatomic variations and respiratory dysfunction, stone size, spinal deformities, or risk of spinal injuries. Percutaneous nephrolithotomy (PCNL) as monotherapy has advantages in removing large stones and achieving excellent results with minimal morbidity. PCNL in supine position has several advantages attached to it, which include improvement in anesthetic management, decreased intrarenal pressures, decreased radiation exposure and improved ergonomics of fluoroscopy, improvements in patient positioning, and shorter operative time. We report a case of supine PCNL in a patient who was operated previously on the cervical and lumbar spine.
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SHORT COMMUNICATIONS Top

Dynamic health information system: Need of the hour to keep up with the momentum of ever-changing natural history of disease p. 112
Mitasha Singh, Shweta Goswami
DOI:10.4103/jss.jss_33_21  
The ongoing pandemic of Covid 19 is different from previous ones in the sense that the data science combined with statistical analysis has countless applications in epidemiology of the disease. The final product of data analysis is usually of interest to the readers. However, through this article we bring forth the process of the data collection, movement and management at the ground level. The data generators and collectors are usually the health workers who were also the care givers during the pandemic. The duplication of record maintenance and data flow at multiple places by the burnt-out workers deteriorates the quality of data. Integrated database is the need of hour for quality health management system.
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Using script concordance tests for assessing clinical reasoning skills of medical students p. 116
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_24_21  
The clinical reasoning competency has been identified as one of the core competencies, which is expected to be attained by an undergraduate medical student. It is difficult to assess the clinical reasoning skills in a standardized manner using the available existing tests. To address these gaps and to ensure standardization of the assessments, a script concordance test (SCT) has been designed and implemented in the field of medical education to assess different domains. The test is designed in such a way that it indicates the manner in which a doctor in authentic settings organizes their knowledge and attempts to solve the problem using clinical reasoning skills. In conclusion, the SCT in the field of medical education can be employed to assess clinical reasoning skills and the ability of the student to interpret the given findings under the clouds of uncertainty. Moreover, owing to the relative ease to create, administer, and score and because of better psychometric indices, each of the medical colleges should explore its possibility and implement it within their settings as a tool for teaching and assessment.
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