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   Table of Contents - Current issue
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May-August 2022
Volume 49 | Issue 2
Page Nos. 89-218

Online since Tuesday, August 23, 2022

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EDITORIAL  

Has treatment for all cancers arrived? p. 89
Rajendra B Nerli, Shadab Rangrez
DOI:10.4103/jss.jss_144_22  
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REVIEW ARTICLES Top

Incidence of adverse drug reactions among elderly patients: A systematic review and meta-analysis Highly accessed article p. 91
Rajesh Hadia, Dhaval Joshi, Dipika Bhil, Rajesh Maheshwari
DOI:10.4103/jss.jss_50_22  
Background: Several studies suggest that adverse drug reactions (ADRs) are commonly seen among hospitalized elderly and found common causes of hospital admission leading to substantial morbidity and mortality among elderly. However, no meta-analysis was conducted till date to estimate the overall incidence of ADRs among elderly. Objectives: To estimate the overall incidence of ADRs in elderly patients, incidence of ADRs in elderly in different health-care settings, incidence of serious ADRs in elderly patients, and the continent-wise incidence of ADRs in elderly patients. Design: Meta-analysis and systematic review. Methodology: Studies were identified through searching different databases such as MEDLINE, Cochrane Database of Systematic Reviews, Google Scholar, Clinical Key, and Scopus (published from 1980 to October, 2015) and by hand searching the reputed journals on geriatrics and gerontology and references of the included articles. Original peer-reviewed research articles published in English, defined ADRs according to the WHO's or similar definition and assessed the incidence of ADRs in elderly or having sufficient raw data to determine the incidence were included. Disease- or treatment-specific studies were excluded. Before meta-analysis, the studies were evaluated for heterogeneity using Chi-square and I2 statistics. The overall incidence of ADRs among the elderly with 95% confidence interval (CI) was determined using a random-effects model (DerSimonian and Laird method). Subgroup analyses were performed based on study settings and continent where the studies conducted. All the analyses were carried out using Review Manager (RevMan, version: 5.3) software. Results: Of the 5747 articles retrieved, only 56 and 54 articles were included for systematic review and meta-analysis, respectively. The overall incidence (95% CI) of ADRs among elderly population was 12.94%. The health-care setting-wise overall incidences of ADRs in the elderly were 17.53%, 19.54%, and 6.92% in inpatients, outpatients, and patients hospitalized due to ADRs, respectively. The continent-wise overall incidences of ADRs in elderly were 12.15%, 22.94%, 12.34%, and 18.76% in Asia, Australia, Europe, and USA, respectively. Electrolyte disorders and skin rashes were the common manifestations of the drugs. Cardiovascular drugs and NSAIDs were the most common causative drugs for the ADRs among elderly. Polypharmacy was the major risk factor for ADRs in elderly population, irrespective of the type of health-care settings and continents. Conclusions: The incidence of ADRs in the elderly was higher and is a significant health-care burden in the elderly. Appropriate prescribing, proper compliance, and monitoring for ADRs are needed to decrease the incidence of ADRs in elderly patients.
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Role of Aloe vera in the management of oral submucous fibrosis p. 103
Palak H Shah, Rashmi Venkatesh
DOI:10.4103/jss.jss_49_22  
Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity commonly prevalent in India and other southeastern countries where consumption of areca nut is predominated. As it has significant morbidity and mortality, early diagnosis and prompt treatment are essential. At present, none of the treatment modalities offers a complete cure for the diseases. Thus, in the search of newer treatment modalities, various Ayurvedic medicines have been studied in recent years. The present review aims to summarize the role of Aloe vera for the treatment of OSMF.
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Predisposing factors of mycotic infections in COVID-19 patients p. 106
Satyam Singh, Sourya Acharya, Samarth Shukla, Komal Muneshwar
DOI:10.4103/jss.jss_31_22  
The coronavirus disease 2019 pandemic (COVID-19) has led to considerable hike in hospitalizations for pneumonia with multiorgan disease requiring immediate hospital care, maintenance of oxygen saturation level, and severe cases requiring mechanical ventilation. This opens the window of opportunity to microscopic organisms such as different species of fungus including Candida, Aspergillus, Rhizopus, and Cryptococcus adding other fungi causing opportunistic invasive fungal infections (OIFIs), and other bacteria to cause concurrent infections in COVID-19-diseased patients which on occasion not promptly diagnosed and are mostly diagnosed after death, which get chance due to invasive procedures such as intubation and immunosuppressant drugs which mostly consists of corticosteroids, patient with diabetes mellitus or any other chronic disease causing immunosuppression, patient having a history of chronic obstructive airway disease, development of antibiotic resistance, and vulnerability of pulmonary tissues regarding developing colony for mycotic infections. In this review, we talk over the character of mycotic concurrent infections in aggravation of COVID-19 disease severity and focus on arising trends associated with fungal infections in coronavirus-diseased (COVID-19 diseased) cases. In addition, this review impart the view on the risky component for concurrent mycotic infections in COVID-19 diseased patients who are hospitalized and focuses the possible task of extended immunemodulatory treatments in managing concurrent mycotic infections, comprising COVID-19-associated pulmonary aspergillosis, COVID-19-associated Candidiasis, and mucormycosis. This article restates the demand for prompt detection regarding presumed COVID-19-related systematic mycosis in the health-care settings which could empower fast OIFI diagnosis, treatment, and lowers the mortality rate.
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Omicron: A variant of public health concern p. 114
Manish Taywade, Debkumar Pal, Ranjana Kalra, Shampa Maji
DOI:10.4103/jss.jss_1_22  
With the detection of Omicron, a new variant of severe acute respiratory syndrome coronavirus-2 in South Africa, a question arises regarding its implication in public health. The infectivity, ability of getting detected by available testing method and effectiveness of existing vaccine against this strain are not known properly. This Omicron variant can impact public health similarly or more than the Delta variant. The research is going on in many countries to get conclusion regarding the impact of the Omicron variant in public health.
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Integrating patient safety in the existing undergraduate medical curriculum p. 117
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_102_21  
The field of medicine has made significant advancements owing to multiple scientific innovations, and the outcome is quite evident in terms of improvement in the health outcomes. The aim of the current review is to understand the magnitude of the problem, scope of patient safety in undergraduate medical education, and components of the same. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website. Overall, 20 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include patient safety and medical education in the title alone only. If we really aim to minimize the errors on our part and thereby improve the patient safety, the ideal approach will be to train the undergraduate medical students about different aspects of patient safety during their training period. We must understand that mere knowledge about patient safety (Knows level in Miller's Pyramid) will not serve the desired purpose. Rather, the better approach will be to target knows how and even does level in Miller's Pyramid, as ensuring patient safety is predominantly a skill. To conclude, patient safety curriculum is an important component of the medical undergraduate training. The need of the hour is to acknowledge the importance of patient safety, plan for its integration within the existing curriculum, and implement the same with the help of faculty members.
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ORIGINAL ARTICLES Top

Association of D-dimer and lipid biomarkers with preeclampsia and their role in prediction from a rural tertiary care setting p. 121
K Jhansi, JM Harsoda
DOI:10.4103/jss.jss_52_22  
Background: Preeclampsia affects 5%–7% of all pregnancies globally and is the leading cause of maternal and fetal death and morbidity. The mechanisms responsible for the pathogenesis of preeclampsia are unclear. Preeclampsia is characterized as hypertension with or without proteinuria after the 20th week of pregnancy and is associated with endothelial dysfunction, systemic vasoconstriction, inflammation, oxidative stress, and intrauterine growth restriction, and multiorgan dysfunction. Materials and Methods: A total of 120 women were divided into two groups: 60 women without PE (control group) and 60 women with PE in a prospective observational case–control study conducted in a rural tertiary care setting in India. This study was done from January 2019 to December 2019, after approval from the local ethical committee. Women with singleton pregnancy either primiparous or multiparous, aged between18 and 40 years were included in both case and control groups. Results: The participants in this study ranged in age from 18 to 38 years old, with an average age of 26.38 ± 4.38 years. The average age of the women in the case group was 26.42 + 3.92 years, while the average age of the women in the control group was 27.38 ± 4.52 years. Most of the patients were between the ages of 31 and 40 (51.67%) years. The mean gestational age in the case group was 26.60 ± 2.19 weeks, while it was 26.73 ± 2.39 weeks in the control group. Conclusion: Early screening of pregnant women for high D-dimer levels and lipid profile can play a significant role in reducing the morbidity and mortality of both mother and fetus.
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Correlation between transverse abdominis muscle endurance and body mass index among college students p. 125
Gayatri H Patel, Sonali J Chitte, Camy Anilkumar Bhagat, Paras Abhesinh Bhura
DOI:10.4103/jss.jss_40_22  
Introduction: From among the core muscles (local and global), transversus abdominis muscle (TrA) is controlled independently as compared to the other trunk muscles. It creates a belt around the abdomen. “Abdominal draw-in” of the abdomen creates isolated activation of the TrA. Body mass index (BMI) is a measure of body fat based on height and weight. Low endurance of inner core muscles is one of the risk factors for mechanical low back pain. Studies say that high BMI is a risk factor for low back pain. This study aims to assess the TrA muscle endurance and BMI to determine the correlation between the two parameters. Purpose: The objective of the study is to find the correlation between BMI and transverse abdominis endurance among KPGU Physiotherapy College students. Materials and Methods: In this correlation study, 30 college students were selected by convenience sampling method on the basis of inclusion and exclusion criteria. BMI of all participants was calculated. Transverse abdominis muscle endurance was assessed using pressure biofeedback/sphygmomanometer. Results: Results showed a significant negative correlation between TrA endurance and BMI (Pearson's correlation test; r = −0.45 at P < 0.05). Conclusion: The study concluded that students with higher BMI have low TrA endurance.
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Morphometric scrutiny of the radial head: A foundation for prosthesis crafting p. 128
Shilpi Shrivastava, Shilpa M Bhimalli, Sheetal Vishwanath Pattanshetti
DOI:10.4103/jss.jss_37_22  
Background: Radius is one of the two constituent bones of the forearm. It is frequently fractured or dislocated due to trauma, pathology, etc. Prosthetic radial head may be indicated in the management of comminuted fractures of the radial head. Aims and Objectives: This study was undertaken with the aim to measure various dimensions of the head of the radius bone and to collate these dimensions between right-sided and left-sided bones. Materials and Methods: Three hundred bones, collected from the Department of Anatomy of Jawaharlal Nehru Medical College, Belagavi, Karnataka, were systematically investigated using digital Vernier caliper, normal ruler, and inelastic thread. The data recorded were then analyzed to obtain the results. Results: The mean length, diameter, and circumference of the head of the radius bones were 9.47 ± 1.49 mm, 19.92 ± 2.03 mm, and 6.42 ± 0.63 cm, respectively (irrespective of the side). For only one aspect, the length of the radial head, a statistically significant difference was obtained between the values of bones of both sides. Conclusion: Numerous studies have shown an extensively varied range of values for several parameters. Utmost care and precision are required by the orthopedic surgeons, prosthetists, etc. while treating patients or prosthesis making, to avoid untoward outcomes like soreness, etc. This study strives to underline this need for precision by highlighting the varied range of parameters in the regional population.
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A study on predictors of nomophobia among undergraduate medical students of a Tertiary Care Teaching Institute in Kolkata, West Bengal p. 133
Mausumi Basu, Vineeta Shukla, Sanghamitra Maulik, Prince Kerketta, Ratul Kumar Bysack
DOI:10.4103/jss.jss_36_22  
Background and Objectives: Undergraduate medical students are more prone to develop stress, anxiety, and depression; and COVID-19 is an additional source of pressure for them. The present study was conducted with the objectives to estimate the proportion of nomophobia among undergraduate medical students of a tertiary care teaching institute in Kolkata and to find the factors associated with it. Materials and Methods: An observational study, cross-sectional in design, was conducted at a tertiary care teaching institute in Kolkata among 395 undergraduate medical students for a period of 8 weeks. Nomophobia Questionnaire scale was used to measure nomophobia. Data were analyzed using the SPSS software version 25.0. Multivariable multinomial logistic regression was performed to find the predictors of moderate and severe nomophobia. Results: All the medical students had some degree of nomophobia. About 26.8% of them had severe nomophobia, 61.3% had moderate nomophobia, and 11.9% had mild nomophobia. Age up to 20 years and the presence of addiction had statistically significant higher odds of severe nomophobia. Age up to 20 years, the presence of addiction, and up to 6 h' time spent per day with smart phone had significantly higher odds of moderate nomophobia. Conclusion: There was a high proportion of nomophobia among young budding doctors. Those who have already got moderate nomophobia should use smart phones more wisely and judiciously and avoid downloading addictive applications.
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A study to assess the impact of gender and psychiatric distress on coping responses and the levels of anxiety, depression, and suicidal ideation in undergraduate medical students p. 140
Oindrila Paul, Arunima Chaudhuri, Ushri Banerjee, Kalyan Kumar Paul
DOI:10.4103/jss.jss_2_22  
Background: Medical education is one of the most stressful academic curricula across the globe, and response to stress can be manifested as physical response, emotional response, cognitive response, and behavioral response. Aims: The aim was to study the relationships between coping styles, level of anxiety, level of depression, and level of suicidal ideation in medical students with a special emphasis on gender differences. Materials and Methods: This cross-sectional study was conducted on 250 medical students of a medical college in West Bengal. Data were collected using online Google Forms. A pretested structured questionnaire contained five scales, namely General Health Questionnaire-28, Coping Response Inventory, State-Trait Anxiety Inventory, Beck Depression Inventory-II, and Adult Suicidal Ideation Questionnaire. Results: Out of 250 students, 63.6% were male. In the case of psychiatric distress, 57.5% of males and 42.5% of females reported no considerable psychiatric distress. Among those with considerable levels of psychiatric distress, majority (68.6%) were male. Most (88%) of the participants exhibited above-average levels of state anxiety and only 0.8% of them exhibited above-average levels of trait anxiety. Moderate-to-severe levels of depression were found in 39.2% of the participants and 27.6% of them reported frequent suicidal ideation. Majority of the participants utilized avoidance coping methods such as cognitive avoidance, acceptance or resignation, seeking alternative rewards, and emotional discharge (ED). ED was found to be the most frequently used coping response. Conclusions: Psychiatric distress has a significant impact on the levels of depression, anxiety, suicidal ideation, and coping responses in medical students. Gender had a significant role in the case of suicidal ideation and ED in medical students. Emotion-focused coping is more in use among medical students as compared to approach coping or problem-focused coping.
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Effects of muscle energy technique and proprioceptive neuromuscular facilitation stretch technique on hamstring muscle flexibility in recreational athletes p. 148
D Dinesh, S Sudhakar
DOI:10.4103/jss.jss_24_22  
Introduction: The most common muscle injury in sports is the hamstring muscle. It needs long rehabilitation and has a great possibility of recurrence as it has a great tendency to shorten. Stretching is the treatment used to improve muscular flexibility, thereby increasing range of motion, and the study prevents sports injuries and athletic performance. Aim of Study: The aim of this study is to compare the efficacy of muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) stretch technique on the flexibility of the hamstring among recreational athletes. Materials and Methods: Thirty healthy recreational athletes were divided into two groups MET and PNF for 4 weeks – 5 sessions/week. Outcome Measures: The Modified Back Saver's Sit and Reach Test was the outcome measure. Statistical Tool: The Student t-test was used for statistical analysis. Conclusion: There was a significant difference seen in the PNF stretch technique and hamstring flexibility with the use of the MET.
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A cross-sectional study: Prevalence of alcohol consumption, factors associated, and its effects among undergraduate college students p. 152
Jitndra Kumar Saini, Hansaram Suthar
DOI:10.4103/jss.jss_15_22  
Background: Alcoholism is gradually tearing down college students worldwide. This is turning out to be a major social predicament. Alcohol misuse was reported as a strong predictor of students' mental health. Objectives: This study aimed to assess the prevalence of alcohol consumption, factors associated with it, and its effects among undergraduate students. Materials and Methods: A cross-sectional survey was applied on 180 undergraduates at Shekhawati PG College, Rajasthan, India, using stratified random sampling. Structured questionnaire and rating scale were used to collect the data. Results: The finding showed 25.55% prevalence of alcohol consumption with majority of being males (63.04%). Maximum number (47.8%) of the students started alcohol consumption at 18–19 years of age, with reasons being social gathering or marriage party (69.56%), peer pressure and curiosity about the effects of alcohol (13.04%), and drinking habit of the parents (6.52%). Majority of the student (65.21%) drink outside the home and at night time (91.30%). Maximum urge (86.95%) was felt for pleasure (93.47%) on special occasions or party functions. Early onset of consumption made students (28.26%) addicted. Maximum students (78.3%) showed mild effects of alcohol consumption, whereas 21.7% experienced moderate effects of alcohol consumption. Conclusions: The study showed that the most common age to start consuming alcohol was between 18 and 19 years, and common reasons to start included “social activities” and “peer pressure” for majority and for a few “curiosity” and “family influence.” It becomes incumbent on the government, health-care practitioners, and other stakeholders to promote responsible drinking and discourage premature drinking.
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Elder abuse in rural Belagavi: A community-based cross-sectional study p. 173
Nishtha Malhotra, MS Shivaswamy
DOI:10.4103/jss.jss_156_21  
Background: Elder abuse is defined by the WHO as: “a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person.” Elder abuse has always been considered a western problem and its existence in India has never been acknowledged seriously. The present study aimed to find the prevalence of elder abuse and assess the sociodemographic determinants for the same. Materials and Methods: A cross-sectional, questionnaire-based study was conducted among 400 in elderly population of age ≥60 years, residing for at least 1 year in rural field practice areas of primary health-care Vantamuri in Belagavi taluka and district, Karnataka state, India, by systematic random sampling from January 1, to December 30, 2020. A set of pretested standardized questionnaires consisting of three parts, including “Modified Geriatric Mistreatment Scale” to assess the elder abuse prevalence, were used. Statistical analysis was done by using rates, proportions, and percentages, and the association was tested with Chi-square test and binary logistic regression. Results: Among the 400 elderly participants, the overall prevalence of elder abuse was found to be 68 (17%). Among all these cases, maximum number of them were facing psychological abuse (59, 52%), followed by economic exploitation (24, 21%), neglect (23, 20%), and physical abuse (8, 7%). None of the participants had experienced sexual abuse. Statistically significant association was present between the occurrence of abuse and sociodemographic characteristics such as age ≥70 years, illiteracy, elderly living with family/spouse, and living in a house owned by spouse/others or a rented place. Conclusion: The prevalence of elder abuse was found to be low (17%) as compared to what was expected (35%). Elder abuse exists in India in various forms, and it is imperative to form new policies and strategies by the government, police, health administration, and NGOs to prevent abuse of elderly population in rural India.
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Assessment of knowledge, attitude, awareness, and opinion of patients on routine dental services during COVID-19 pandemic: A cross-sectional study p. 180
Shaila V Kothiwale, Alpana Andrews, Komal Mehta, Shweta Shivayogi Hugar
DOI:10.4103/jss.jss_145_21  
Background: The novel severe acute respiratory syndrome-coronavirus-2 virus has undoubtedly disrupted the life of every individual and created a global health and economic crisis. Health-care systems, including dental clinics, were affected and patients with dental pain suffered since they were unable to seek dental care at the right time. It has since become relevant to examine and understand the outlook and views of patients toward seeking routine dental services and their acceptance of alternative methods of dental practice through the COVID-19 pandemic. Hence, this cross-sectional questionnaire study was conducted to assess the knowledge, attitude, and opinion of patients visiting a dentist for routine dental services during the COVID-19 pandemic Methodology: A cross-sectional questionnaire-based survey was conducted among 200 patients who visited the dental college for their treatment. Their responses were recorded and descriptive analysis, Chi-square test, and multiple logistic regression analysis were carried out to evaluate their responses. Results: The participants were aware of the transmission of COVID-19 (91%), 64% believed it was safe to visit a dentist and 99.5% believed it necessary to take proper precautions before visiting the dentist. Participants (84%) preferred having dental consultations over phone/email/video calls compared to regular in-person consultations during the pandemic. Conclusion: Teledentistry has the potential to emerge as an effective mode of managing patients with dental needs to reduce the burden on dental clinics and hospitals. It can ensure the accessibility to dental care even in the remotest area by allowing patients to connect with dentists through appropriate digital and social media.
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Automated complete blood count profile as a probable indicator of dengue fever severity in children p. 186
Arijit Majumdar, Abhisek Kumar, Soumali Biswas
DOI:10.4103/jss.jss_135_21  
Background: Dengue is now endemic in more than 100 tropical and subtropical countries. Ninety percent of dengue hemorrhagic fever occurs in children <15 years of age. Leukopenia and thrombocytopenia near the end of the febrile phase are the common findings in dengue fever. Aims and Objectives: (1) To see any significant correlations between various hematological parameters with severity of dengue and (2) to see the shift in the values (increase/decrease) of platelet indices in dengue patients. Materials and Methods: One hundred and twenty patients admitted either with laboratory report of seropositive dengue or with dengue-like symptoms and who were found to be dengue positive after admission were included in the study. Complete hemogram including platelet indices was evaluated by an automated cell counter. Clinical examinations were performed in detail with special reference to the presence of warning signs such as vomiting, lethargy, pain abdomen, bleeding, and ascites. Results: Total leukocyte count, platelet distribution width, and mean platelet volume were not significantly different in patients with warning signs from those without it. The level of mean hematocrit was significantly higher and the mean plateletcrit was significantly lower in dengue with warning signs. Conclusions: Simultaneous measurement of complete blood count and platelet indices can provide us a valid instrument for the measurement of dengue disease severity and an insight into the potential etiology that resulted in change in platelet indices.
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Awareness, attitude, and practice about basic life support among dental students p. 190
Savita Bansal, Jigyasa Gupta, Juhi Singhla, Kadambari Harit, Kajasai Ragesvari, Manya Jain
DOI:10.4103/jss.jss_125_21  
Introduction: A medical emergency can be described as a sudden onset of serious illness or injury requiring immediate medical attention otherwise it can put a patient's health in serious jeopardy, often referred to as a situation risking “life or limb.” It is thus imperative that dental students are competent enough to administer basic life support (BLS) to manage emergencies which can occur anywhere and anytime. Materials and Methods: A cross-sectional survey was conducted to assess the knowledge, attitude, and perception among dental students of Manav Rachna Dental College, Faridabad, about BLS. A total of 177 students participated in the study. The respondents were provided with a prevalidated, self-administered questionnaire which comprised 23 closed-ended questions about knowledge, three questions about attitude, and five questions about practice of BLS. The questionnaire was administered in an online mode using Google Forms. Results: The results showed that majority of students lacked adequate knowledge about BLS protocol. The average score of 177 respondents was 7.8/23 points which is significantly low. Discussion: Life-threatening medical emergencies can occur at any time. There have been reports of Cardiopulmonary Arrest (CPA) and deaths in dental clinics. Therefore, it is crucial for dental practitioners to have adequate knowledge about BLS or CAB consisting of (C) circulation, (B) breathing, and (A) airway opening. Conclusion: The dental students lack adequate knowledge to perform BLS procedures with ease and confidence. However, they had a positive attitude toward it.
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Real-world effectiveness of generic antihypertensive drugs of pradhan mantri bhartiya janaushadhi kendra p. 195
Chandani Sheikh, Nikita Donage, Bhavana Donga, Stephen Benny, Kiran Majjigeri, Sowmya Spoorthi, Ramesh Bhandari, MS Ganachari
DOI:10.4103/jss.jss_11_22  
Background: The Government of India started the Janaushadhi Scheme in 2008 to control individuals' expenditure by providing low-cost generic medicines for health benefits. Hence, this study aims to study the real-world effectiveness of Jan Aushadhi generic antihypertensive medicines at a Pradhan Mantri Bhartiya Janaushadhi Kendra and also to assess knowledge and attitude toward generic drugs. Methods: This study was done in Pradhan Mantri Bhartiya Janaushadhi Kendra. Participants who were hypertensive and on at least one antihypertensive drug from Pradhan Mantri Bhartiya Janaushadhi Kendra were enrolled in the study. All the participants received three blood pressure (BP) measurements, i.e., two manual readings and an average of two taken. One digital reading is followed by questionnaires, which help assess patients' knowledge and attitude using Pradhan Mantri Bhartiya Janaushadhi Kendra medicines. All the participants were evaluated for baseline, 1st-month, 2nd-month, and 3rd-month follow-up visits. The baseline, 1st-month, 2nd-month, and 3rd-month data were compared using paired t-test and Cochran's q-test. Results: The important findings were a considerable reduction in BP compared to the baseline, 1st-month, 2nd-month, and 3rd-month follow-up. Approximately half of the patients (53.36%) know the difference between generic and brand medicines. A significant proportion of the participants believe that taking Janaushadhi medication reduces the cost. Hence, considerable improvement was evidenced in all outcome measures. Conclusion: A significant reduction in systolic and diastolic BP was achieved for all the hypertension stages, providing the authentication that most hypertensive patients may benefit from low-cost generic Jan Aushadhi medicines.
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CASE REPORTS Top

Severe eczematous dermatitis with hyperimmunoglobulin E syndrome p. 201
Raavi Ramapure, Nidhi Pugalia, Samyak Ganjre, Adarshlata Singh, Bhushan Madke
DOI:10.4103/jss.jss_53_22  
Primary immunodeficiency syndrome represents a heterogeneous group of inherited disorders caused by mutations in genes encoding functional proteins of the immune cells and characterized by an increased risk of infections, autoimmunity, autoinflammation, malignancy, and allergic disorders. Hereby, we report an 8-year-old-male child with complaints of severe itchy lesions over the body since infancy. Thorough investigations showed he had primary immunodeficiency with underlying hyperimmunoglobulin E syndrome.
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Afatinib-induced acneiform eruptions p. 204
Twinkle Singh Thakur, Shreya Agrawal, Bhushan Madke, Sugat Jawade, Gauri Padmawar, Khushboo Verma
DOI:10.4103/jss.jss_41_22  
Epidermal growth factor receptor (EGFR) inhibitors are being increasingly used in the treatment of non-small cell carcinoma of the lung. Cutaneous toxicity of various EGFR inhibitors is being increasingly noticed by dermatologists. We hereby report a case of papulopustular eruption in a male patient who had received oral afatinib for well-differentiated squamous cell carcinoma of the lower lip. The offending drug was continued and the papulopustular eruption was treated with oral doxycycline and local care.
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Bacterial meningitis as the first presentation of multiple myeloma p. 207
Sasmita Zutushi, Samarth Shukla, Sourya Acharya, Amol Bhawane, Preeti Mishra, Satyam Singh
DOI:10.4103/jss.jss_34_22  
Multiple myeloma (MM) is a monoclonal gammopathy. Patients with MM are vulnerable to infections, especially by encapsulated bacteria. These infections have been associated with severe morbidity and mortality in MM. A key underlying cause of the immune system's decline in MM is insufficient production of polyclonal immunoglobulin, which manifests as severe hypogammaglobulinemia. An acute bacterial infection is rarely the first sign of the disease. We present a case of a 65-year-old male who presented to us with fever and disorientation. Clinical examination revealed signs of meningeal irritation. Cerebrospinal fluid study confirmed bacterial meningitis. Associated features such as renal failure, high erythrocyte sedimentation rate, hyperglobulinemia, and anemia lead to suspicion of MM which was later confirmed by serum electrophoresis.
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Placenta increta manifesting as unusual cervical mass after first trimester dilatation and curettage, managed by laparoscopy p. 210
Mrityunjay Metgud, Sindhu Alimilla, Kamal Prakash Patil, Mahadevi Savanur, Rajashekhar Malli, Adarsh Sanikop, Rahul Kenawadekar
DOI:10.4103/jss.jss_22_22  
Placenta accreta spectrum, is characterized by abnormal placental adherence to the myometrium. Depending on the depth of trophoblastic growth, it is classified into placenta accreta, placenta increta, and placenta percreta. This condition is associated with life-threatening hemorrhage, resulting in high maternal and neonatal morbidity and mortality. Placenta accreta usually presents with vaginal bleeding during difficult placental removal in the third trimester. Placenta accreta spectrum is very rarely present in the first trimester. Severe forms may complicate first-trimester pregnancy losses, causing profuse postcurettage hemorrhage. A 28-year-old lady with one living issue by cesarean section who had undergone a dilatation and curettage (D&C) 2 months ago for missed abortion, came with the complaints of prolonged vaginal bleeding following the procedure. On pelvic examination, the uterus was bulky, partly firm on one side, and soft on the other. Ultrasound examination revealed it to be a bicornuate uterus with retained products in one of the horns. Magnetic resonance imagining was suggestive of lateral cervical fibroid. Diagnostic laparoscopy revealed it to be a left lateral cervical mass. Total laparoscopic hysterectomy was performed. On histopathological examination, specimen revealed necrotic placenta infiltrating the endocervix and isthmus. Placenta accreta is a rare problem and difficult to diagnose in the first trimester. It can occur when there are risk factors or if there are ultrasound markers of the first trimester suspicious of the adherent placenta. A diagnosis of placenta accreta spectrum needs to be considered when there is post-D&C prolonged or heavy vaginal bleeding.
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A case report – Synchronous endometrial and ovarian cancer p. 213
Mrityunjay Metgud, Tella Srivani, Kamal Prakash Patil, Mahadevi Savanur, Rajashekhar Malli, Adarsh Sanikop, Rohan Bhise
DOI:10.4103/jss.jss_14_22  
Synchronous malignancies of the female genital tract are a very rare entities. Synchronous endometrial and ovarian cancer (SEOC's) is defined as simultaneous presence of these two cancers at the time of diagnosis as opposed to the metachronous cancer where these two cancers are diagnosed at different chronologic time points. Clinical presentation of these women is indistinct, and due to the different management and the favorable prognosis of SEOC's, an extensive pathological evaluation is required to distinguish SEOC's from the metastatic disease. Synchronous and Metachronous malignant tumours are the two components of multiple primary malignant tumours (MPMT's). The distinction between the independent primary tumors and metastatic tumours is clinically significant and complicated. Synchronous endometrial and ovarian carcinoma is a rare entity. SEOC's are more frequently undiagnosed. Henceforth, the diagnostic dilemma of SEOC's versus metastatic disease is challenging and therefore separating the two groups is important as the prognosis is different.
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Overdiagnosis and underdiagnosis in traumatic brain injury: A reality in the management of neurotrauma p. 217
Sabrina Rahman, Tariq Janjua, Moshiur Rahman, Yelson Alejandro Picon-Jaimes, Ivan David Lozada-Martinez, Luis Rafael Moscote-Salazar
DOI:10.4103/jss.jss_45_22  
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