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   Table of Contents - Current issue
July-September 2021
Volume 10 | Issue 3
Page Nos. 189-251

Online since Wednesday, August 4, 2021

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Factors affecting accessibility of maternal health-care institutions in Meghalaya: A hospital-based study Highly accessed article p. 189
Bibiana G Momin, Pranti Dutta
BACKGROUND: The present study determines to understand the maternal health-care infrastructure in Meghalaya, a state of Northeast India. The state has large number of population of 2,964,007 (Census 2011), however, the state has only two public District Hospitals related to maternal health-care services – one in East Khasi Hills District and the other one in West Garo Hills District. Furthermore, according to the National Rural Health Mission (2015–2016), the maternal mortality ratio of Meghalaya is 211/100,000 live births which is higher than the national average. MATERIALS AND METHODS: A hospital-based mixed method study has carried out to identify the problems faced by the women during their maternity period and to assess the quality and availability of maternal care infrastructure in Meghalaya. To conduct the interview, the present study covered all 80 pregnant women who were admitted in the major two district maternal health-care hospitals of Meghalaya for maternity care (i.e., delivery and postdelivery period) during the period of hospital visit in October 2019. RESULTS: The study shows that majority of the admitted women came from different villages of different districts of Meghalaya as those remote areas have no adequate maternal health-care institutions nearby other than dispensary or subcenter. The study also revealed that women who came to get treatment in hospital during pregnancy had to face difficulties like to travel a long distance, use public transport, bad road conditions, and financial problems. CONCLUSION: To improve the health scenario of health-care system in the remote village areas, the Government should give more focus on infrastructure development in terms of availability of adequate facilities for handling any emergency cases of maternal care in remote areas of Meghalaya.
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Ocular morbidity pattern among patients attending Red Cross Eye Unit in Sunyani, Ghana Highly accessed article p. 197
Victor Opoku-Yamoah, Ebenezer Afrifa-Yamoah
BACKGROUND: Visual health information is particularly important in planning appropriate interventions to combat preventable causes of blindness and visual impairment. Nonetheless, there is limited information on ocular health conditions in Ghana. The study set out to determine the pattern of ocular morbidity at the Red Cross Eye Unit in the Bono Region of Ghana. SETTINGS AND DESIGN: The study was carried out at the Red Cross Eye Unit in the Bono Region of Ghana and used a hospital-based retrospective cross-sectional study design. MATERIALS AND METHODS: A review of patient's ocular health records throughout the year 2018 was performed. Patients were conveniently sampled, and socio-economic details and diagnosis were analyzed. STATISTICAL ANALYSIS USED: Analysis was carried out using Statistical Package for the Social Sciences (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). RESULTS: A total of 2400 patients records were reviewed, comprising of 1012 males (42.2%) and 1388 females (57.8%) with a male to female ratio of 1:1.4. Each patient sampled was diagnosed with an ocular condition and the modal age group was found to be 41–60 years. The most common cause of ocular morbidity among the patients was refractive error (32.4%). This was followed by acute conjunctivitis (29.7%) and cataract (12.3%). Refractive error and acute conjunctivitis were found to be significantly higher among females (P < 0.05). CONCLUSIONS: Refractive error, acute conjunctivitis, and cataract were common ocular morbidities found in this study. Interventions should target these ocular conditions to minimize the risk of preventable visual impairment and blindness in the Region.
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Emergency medical response services in the union territory of Dadra and Nagar Haveli, India p. 202
Vikram Khan, Ankush A Sanghai, Dolatsinh B Zala, VK Das
BACKGROUND: Emergency medical response services (EMRS) are an integral part of today's health system. Prehospital care and transport of a patient to the health facility is the main function of EMRS. It is very difficult to evaluate the efficacy of this system. The evaluation of the efficacy of the EARS based on various parameters is the main aspect of the study. In this observational study, the epidemiology of emergency, utilization of services, quality and cost matrixes of services were analyzed. MATERIALS AND METHODS: The study was conducted in Union Territory of Dadra and Nagar Haveli, India from January 1, to December 31, 2017. The secondary data were collected from the Emergency Response Centre. Various parameters such as epidemiology of medical emergencies, extent pattern of utilization of EMRS, quality of services, and cost parameters were recorded. RESULTS: Total 28716 medical emergencies were handled by EMRS in the year 2017. Among them acute abdominal pain was recorded as the most common emergency, followed by pregnancy-related emergencies and fever. Most of the users belonged to the rural/tribal area and females utilized the facility more than males. The average response time for providing the services in the rural and urban area was recorded as 8:42 min and 13:25 min, respectively. Various parameters of service utilization, cost-effectiveness, and quality were noted. CONCLUSIONS: The planning and support from all levels (at the national, provincial and community) are important aspect to provide quality and cost-effective services. The data of EMRS may help to develop quality benchmark for the EMRS.
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Factors driving the “preferred place for delivery” among tribal women in Southern India p. 211
Kavita Yadav, MR Narayana Murthy, Manohar Prasad, Praveen Kulkarni
BACKGROUND: Mother and child health is an important issue for the tribal community and a lot of it depends on the prenatal, natal and postnatal care of the mother and child. Institutional deliveries are known to have a positive impact on their health and it is important to understand the factors that lead to the choice of place of delivery. MATERIALS AND METHODS: A community-based study was conducted in the tribal area of H D Kote taluk Mysore. Of 16 Primary Health Centers, five centers which cover nearly 50% of the population were chosen for the study. All the mothers who resided in those areas and delivered from January 2013 to December 2013 were chosen for study, which came to 215. Those who had migrated to areas outside our study area and those who were not found in home during data collection home visit were left out. Hence, the final sample size came to be 165. Chi-square test and Fisher's exact test and logistic regression analysis were applied to test the significance of association of factors with place of delivery. RESULTS: In the present study, 20.6% mothers had delivered at home, 12.7% in government hospital, and 66.7% in private hospital. Past delivery experience, early registration of pregnancies, and higher number of pregnancies were the factor found to be significantly associated with institutional deliveries. CONCLUSION: Mothers who utilize the antenatal care services and who have had experience of delivery in a hospital/higher number of deliveries are more likely to choose hospital for their delivery.
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A new functional indoor ramp walk test among stable perioperative valve replacement patients – An observational crossover study p. 216
Manivel Arumugam, Mahesh Ramaraj, Baskaran Chandrasekaran, Murugesan Periyanarkunam Ramaiya, Pitchaimani Govindharaj
BACKGROUND : Postcardiac valve replacement patients face difficulty in their day-to-day functional activities, especially during climbing stairs and walking uphill or on a ramp in society. Assessing the uphill walking capacity, there is a dearth of functional stress test over routinely used six-min walk test (6MWT). Therefore, a new three-min steep ramp walk test (3MRWT) was constructed to meet the demands similar to an uphill walk and may provide more functional stress than routinely used 6MWT. MATERIALS AND METHODS: Observational crossover study was conducted with 30 stable postoperative either mitral or aortic or double valve replacement patients, who were as inpatients in the Department of Cardiothoracic and Vascular Surgery, Multispecialty Medical College Hospital, Coimbatore, India. The participants were assigned to walk 3MRWT and 6MWT simultaneously on the 5th postoperative day. RESULTS: The results revealed that the mean distance covered in 6MRWT was 273.4 ± 45.06 m, and in 3MWT, it was 149.7 ± 37.8 m. A highly positive correlation was observed between 3MRWT and 6MWT distance covered by the patients with valve replacement (r = 0.834). CONCLUSION: The study shows that 3MRWT is valid over routinely available 6MWT and may provide higher functional stress in a shorter duration than later in valvular replacement patients in assessing the maximal functional capacity during discharge.
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Normative assessment of renal dimensions from computed tomography p. 222
Damodar Rokka, Sharma Paudel, Prakash Kayastha, Saroj Chhetry, Sudil Paudyal, Sundar Suwal
BACKGROUND: The values measured by ultrasound for normal renal dimensions in adults are well established, but not much is known about the normal renal size of Nepalese subjects from computed tomography (CT). This study aimed to establish normal CT values for kidney dimensions from patients undergoing contrast-enhanced CT (CECT) abdomen examination. MATERIALS AND METHODS: This was a cross-sectional study carried out in patients undergoing CECT scan with different clinical history excluding abnormalities with the urinary system. The study consisted of the measurement of 212 bilateral kidneys in 106 adults. The kidney length (KL) from pole to pole, kidney width (KW), and cortical widths (CW) at the upper, middle, and lower pole were measured. For measuring length, axes were adjusted for each kidney in double oblique sagittal planes, for the width of kidney and cortex in double oblique coronal planes using a 3D-software available in the scanner (Neosoft). Analyses for normal distribution, t-tests, and correlation were performed using SPSS version 20 (IBM, USA). RESULTS: KL was 95.52 ± 8.91 mm for the right kidney (RK), and 98.22 ± 8.85 mm for the left kidney (LK). CW at the upper, middle, and lower poles on RK was 5.33 ± 0.97 mm, 5.29 ± 0.97, and 5.03 ± 0.88 mm, whereas on the LK was 5.30 ± 0.94 mm, 5.19 ± 0.97, 5.03 ± 0.96 mm, respectively. The KW was 49.15 ± 5.76 mm and 49.11 ± 5.52 mm on RK and LK, respectively. The most significant independent factors for KL and KW were age, body surface area (BSA), gender, height, and weight and were found to be statistically significant (P< 0.05 each). CONCLUSIONS: We established the normal references of various renal measurements which provide the radiologists and the referring clinicians an insight about the normal range of different renal parameters. Since there are several influencing factors on kidney size, the assessment should be made individually. The major influencing factors found are BSA, height, gender, age, and weight.
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Risk communication in COVID-19 pandemic: A note for health-care workers p. 227
Abdel-Hady El-Gilany, Nesrine Saad Farrag
The concept of risk communication (RC) in the era of COVID-19 pandemic needs to be highlighted. Basic definitions, steps, principles, cycles, benefits, barriers, and harms of RC were briefly outlined. This brief review is intended to be a quick guide for health-care workers and risk communicators. It will be useful for busy health-care workers in providing information and counseling regarding COVID-19.
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Fetal medicine as a part of early clinical exposure p. 231
Lalitha Natarajan, Darshana Srinivasan, Dhakchenya C Sekar, Punithavathi Krishnamoorthi, Pananghat A Kumar
CONTEXT: Clinical relevance of basic sciences is not well appreciated by the preclinical students. In an effort to remedy this, Medical Council of India has introduced the program of early clinical exposure. Although broad guidelines are provided, institutions have been bestowed with the responsibility of conducting this important program depending on the available resources and local logistics. AIMS: The aim of the study is to create an awareness of correlation of fetal medicine with the participants taught during preclinical year, particularly embryology. SETTINGS AND DESIGN: Preclinical students were posted in the Division of Fetal Medicine in the Department of Obstetrics and Gynecology, as observers. The program enabled the students to appreciate the procedures performed in the clinics and to interact with the consultants and health-care staff during their posting. They interacted with the patients as well. SUBJECTS AND METHODS: Preclinical students observed the clinical procedures performed in the clinics. Tests were conducted before and after the intervention, and their results were compared to evaluate the effectiveness of the program. Open-ended feedback was also taken to assess the impact of this program on the students. STATISTICAL ANALYSIS USED: Fisher's exact test was used to evaluate the test scores. RESULTS: Test scores revealed that this program improved the general awareness about the scope of fetal medicine and its direct relevance to the fetal developmental events; they learn in embryology. Feedback comments reiterated this fact. CONCLUSIONS: Posting of preclinical students in fetal medicine during ECE program has observed the desired effect of them realizing the clinical significance of subjects; they are learning during their preclinical year of study. It has also impressed upon them the scope of fetal medicine as a subject.
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Perioperative management of a case of peripartum cardiomyopathy for elective cesarean section p. 235
Shalendra Singh, Nitesh Kumar, George Cherian Ambooken, Shibu Sasidharan, Priya Taank
Peripartum cardiomyopathy (PPCM) during pregnancy is relatively rare. The anesthesia management of any heart pathology during peripartum requires the most stringent and meticulous care at every step. We report a 27-year-old woman, a diagnosed case of PPCM with previous lower segment cesarean section (LSCS) admitted for elective LSCS
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A “CHAR” Ming syndrome: Heart, bone, and eye p. 238
Anusha Mruthyunjayaswamy, Smitha Bhat
Heart diseases are common congenital anomalies, with a prevalence of 8–12 per 1000 live births. Several genetic syndromes are associated with specific cardiac anomalies and Char was the first to describe a syndrome associated with patent ductus arteriosus (PDA) and various features, including a short philtrum, duck bill lips, ptosis, low set ears, and short fifth digits in both hands and feet. Here, we report a case of a 20-year-old male who presented with the triad of char syndrome, that is, a PDA with a shunt reversal, facial dysmorphism, and skeletal abnormalities. Additionally, he had congenital deafness and both eyes iris coloboma, a rare association which has never been reported so far. Char syndrome is rare; only a few cases have been reported worldwide, and almost none from our region.
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Impact of physical activity levels on length of hospital stay in patients with severe COVID ARDS p. 242
Hetal Manoj Mistry, Akhila Natesan
SARS-CoV2 is a lethal virus that primarily affects the respiratory system causing severe pneumonia leading to ARDS. This case series describes the cases of two middle-aged men suffering from severe coronavirus disease-19 ARDS presenting to hospital with similar clinical signs who were given similar treatments. Pre infection activity levels of both patients were assessed using Global Physical Activity Questionnaire and length of hospital stay was observed for both patients. Patient with sedentary lifestyle prior to infection had a longer length of hospital stay of 25 days whereas the second patient who had an active lifestyle had a shorter length of hospital stay of 11 days. Based on our observations, we conclude that pre infection physical activity levels positively influences the severity of disease and helps to reduce length of hospital stay. With lockdown being declared in many parts of the world on account of the second wave of infection, it is important to encourage people to adopt a healthy lifestyle while adhering to the norms of lockdown.
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Fetal monitoring in neurosurgery: An essential paradigm? p. 245
Saurav Singh, Amiya Kumar Barik, Sanjay Agarwal
Neurosurgical procedures during pregnancy are not uncommon, and anesthetic management of these patients are complicated by the physiologic changes of pregnancy, effects of anesthetic agents on fetus, and a need for vigilance to prevent a possibility of fetal demise. The value of intraoperative fetal heart rate (FHR) monitoring though controversial, is immense, and with various modalities available to choose from, necessary interventions could be made before fetal viability is jeopardized. We report the utility of intraoperative FHR monitoring using ultrasonography in case of a 32-year-old, 28 weeks, pregnant female, G4P(1)A2, posted for bifrontal craniotomy and excision of meningioma with subfalcine herniation.
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COVID-19 and health policy reformation in Nigeria p. 248
Abdullahi Tunde Aborode, Kenneth Bitrus David, Jegede Oluwatoyin Imisioluwa, Ajagbe Abayomi Oyeyemi, Abdulhammed Opeyemi Babatunde
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COVID-19-positive health-care workers in an oncology setup: Considerations for return to work p. 249
Vivek G Bhat, Preeti D Chavan, Prashant C Bhat, Navin S Khattry
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