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   Table of Contents - Current issue
January-June 2020
Volume 7 | Issue 1
Page Nos. 1-38

Online since Tuesday, August 18, 2020

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Promoting research for undergraduates of medicine in India – A critical necessity p. 1
N Ananthakrishnan
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Human papillomavirus vaccination: An important tool in cervical cancer elimination p. 3
Veena Pampapati, Arpitha Anantharaju
The World Health Organization (WHO) has called for global elimination of cervical cancer, which essentially means achieving age-standardized incidence rates of <4/100,000 women worldwide, so that it ceases to be a public health issue. Vaccination against the human papillomavirus (HPV), screening for cervical cancer, and the treatment of precancerous lesions are effective tools for achieving this goal. HPV vaccination is recommended as a primary prevention measure in young girls before their sexual debut, and screening for cervical cancer is recommended for sexually active women. Three types of HPV vaccines are available-bivalent, quadrivalent, and 9-valent vaccines. Standard dosing recommended is the 3-dose regimen, whereas, in young girls between 9 and 15 years, 2-dose schedule is found to be as immunogenic as the 3-dose schedule. Countries like Australia have implemented vaccination using the quadrivalent HPV vaccine, and a large impact on HPV-related disease has been noted in Australia. Screening for cervical cancer can be done by cervical cytology, visual inspection after application of acetic acid (VIA), or HPV DNA testing. Low-cost screening techniques like VIA are useful in our country for large scale screening. Challenges in achieving elimination of cervical cancer are manifold and include vaccine manufacture and delivery, vaccine hesitancy, setting up of cervical screening and effective treatment of precursors, and, most importantly, availability of resources to fund screening and vaccination to a huge population. In developing countries like ours, the WHO goal can be achieved only by the commitment of state and central governments and nongovernment organizations.
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A prospective cohort study on closed-circuit television monitoring and direct observation for hand hygiene compliance in a pediatric intensive care unit p. 9
Lohiya Sham Balkisanji, Ponnarmeni Satheesh, Ramachandran Rameshkumar, Puneet Jain, Venkatachalam Jayaseelan, Subramanian Mahadevan
Background: Intensive care patients are at risk for healthcare-associated infections (HCAIs), and hand hygiene (HH) compliance in health-care workers (HCWs) is reportedly low. This study aimed to compare closed-circuit television (CCTV) monitoring to direct observation on the HH compliance and its impact on HCAIs. Methods: In a prospective cohort study, HCWs were observed for HH compliance and HCAIs were studied. The study period was August 1, 2014–December 31, 2014 (direct observation period), and March 1, 2015–July 31, 2015 (CCTV monitoring period), with 2 months washout period. A HH education module (running a video daily, reinforcement of HH everyday evening, 2-weekly classes about HH importance, and posters reinforcing the importance of HH on the prominent sites of pediatric intensive care unit) was implemented in both periods. Each day was divided into blocks of 6-h. One hour from each block was randomly selected stratified by day and night shifts. HH compliance was observed according to the World Health Organization, “My Five Moments of HH.” Results: A total of 751 patients (direct observation period n = 369, CCTV monitoring period n = 382) were admitted. The HH compliance rate was higher in the CCTV monitoring period (56.6%, n = 5953 / 10519) as compared to that of the direct observation period (36.1%, n = 2178 / 6028) (relative risk = 1.57, 95% confidence interval: 1.51 - 1.63, P ≤ 0.001). Ventilator-associated pneumonia (4.7 vs. 12 / 1000 ventilation-day) and central line-associated bloodstream infection (1.9 vs. 6.6 / 1000 central line-day) were lower in the CCTV monitoring period. There was no difference in mortality between the study periods (18.3%, n = 70 / 382 vs. 21.1%, n = 78 / 369, relative risk = 0.87, 95% confidence interval: 0.65–1.16, P = 0.333). Conclusion: CCTV monitoring was associated with improved HH compliance, which was associated with lower HCAIs.
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Prevalence and patterns of psychological and physical violence among nurses in a public tertiary health facility in Enugu, southeast Nigeria p. 15
Sussan Uzoamaka Arinze-Onyia, Olanike Rebecca Agwu-Umahi, Awoere Tamunosiki Chinawa, Anne Chigedu Ndu, Tochi Joy Okwor, Kassy Wilson Chukukasi, Ifeoma Juliet Ogugua, Emmanuel Nwabueze Aguwa, Adaeze Okeke Theodore
Background: Workplace violence (WPV) is a significant and persistent occupational health hazard and constitutes a major concern for employers and employees. While there is increasing evidence on the prevalence of WPV in the health-care settings, nurses have been shown to be disproportionately affected. Although widely researched globally, there is scarcity of data on this phenomenon in Nigeria. This study aimed to determine the prevalence of physical and psychological violence among nurses in a tertiary health institution. Subjects and Methods: A descriptive cross-sectional study using a questionnaire adapted from WPV in the Health Sector Country Case Study Questionnaire. This study was carried out among nurses at the University of Nigeria Teaching Hospital Enugu, Southeast Nigeria. Proportionate sampling method was used to select 301 respondents. Results: Majority (219, 72.2%) of the participants were aged above 35 years, were female (283, 94%) and were married (249, 82.7%). About half (152, 50.5%) of the respondents had spent 10 years or more in practice. Verbal abuse was the most prevalent form of psychological violence experienced (129, 42.9%) followed by bullying/mobbing (21, 7.0%) while sexual abuse was reported by a few (7, 2.3%). Physical violence, on the other hand, was experienced by 46 (15.3%). Majority of the physical violence was carried out with a weapon (39, 84.8%) and in most of the cases the attacker was patient's relative (35, 76%). Patients' relatives were mostly responsible for the verbal abuse (78, 60.5%) and bullying (10, 47.6%) while sexual assault was mostly carried out by a coworker (4, 57.1%). Conclusion: Psychological violence was commonly experienced by nurses in Enugu and physical violence was often carried out with a weapon. Policies should put in place to ensure safety of nurses.
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Arrack shops as probable hot spots of tuberculosis transmission in urban Puducherry, South India: An exploratory study p. 23
Saras Singh, Mahalakshmy Thulasingam, Dineshkumar Giriyappa, James Thottyplackel Devasia, Sonali Sarkar
Background: Alcohol use is common among male tuberculosis (TB) patients of Puducherry, particularly from lower socioeconomic strata who consume liquor from local arrack shops. These shops could be hot spots for the transmission of infection. Hence, this study aimed to explore whether arrack shops could be probable hot spots for the transmission of infection. Materials and Methods: An exploratory, descriptive study was conducted at three primary health-care centers in Puducherry, among male pulmonary TB patients using a pretested semistructured questionnaire. Home visits and visit to the arrack shop were made to assess for factors conducive to the transmission of TB. Results: Most of the patients belonged to lower socioeconomic status and consumed alcohol, mostly from arrack shops. The arrack shops had poor sanitation, were overcrowded, and multiple persons with TB visited the shop. Many had the behavior of spending more than an hour at the arrack shops. Conclusion: There is a possibility of TB transmission of at the arrack shops. Active case finding in the arrack shop may be beneficial.
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Comparison of skin closure technique with stapler and subcuticular suture in patients with inguinal hernia undergoing lichtenstein tension-free mesh repair – An open-label randomized controlled trial p. 27
Sathasivam Sureshkumar, Datta Souraja, Elangovan Archana, Sahla Sathar, Thulasingam Mahalakshmy, Chinnakali Palanivel, Vikram Kate
Background: Both subcuticular suturing and stapler closure are used for skin closure. However, the superiority of one over the other is yet to be established clearly. Aims: This study compares the efficacy of skin closure technique by stapler and subcuticular suture in patients undergoing Lichtenstein repair for inguinal hernia. Methods: Elective inguinal hernia repair patients were randomized to undergo skin closure using either subcuticular sutures or staplers. Skin closure time in minutes, postoperative wound site pain using the Visual Analog Scale, wound cosmesis and scar outcome using the Patient and Observer Scar Assessment Scale, and patient satisfaction using the Likert scale were assessed. Results: A total of 38 patients with inguinal hernia were included: 20 in subcuticular suture group and 18 in stapler group. The scar outcomes assessed by patients (3.05 ± 1.83 vs. 4.94 ± 2.54; P = 0.0013) and observers (2.83 ± 0.98 vs. 4.44 ± 1.67; P = 0.0105) were significantly better in the subcuticular group. The time taken for skin closure was significantly longer in the suture group (P < 0.001). There was no significant difference between the two groups in terms of postoperative wound pain (P = 0.65), patient satisfaction (P = 0.238), and outcome of wound healing (P = 0.900). Conclusion: The cosmetic outcome of skin closure with subcuticular suture was better. Time taken for skin closure using staplers was shorter compared to suturing. Postoperative wound pain, patient satisfaction, and wound healing were similar between the two groups.
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Nerve conduction study as a diagnostic tool in atypical presentation of accidental organophosphorus poisoning p. 32
Santosh L Wakode, Naina S Wakode, Samrat Bose
Poisoning with organophosphorus (OP) compounds is a worldwide phenomenon. However, atypical presentation of OP toxicity, particularly when there is a paucity of muscarinic manifestations, can be a diagnostic challenge. We report a patient with atypical symptoms where exposure to OP poison was not clearly determined. Motor nerve conduction studies done to rule out acute motor neuropathy revealed that a single supramaximal stimulus-evoked repetitive compound motor action potentials. As this finding is the earliest and most sensitive indicator of acetylcholine esterase inhibition, OP poisoning was suspected. Decreased plasma acetylcholinesterase levels confirmed the diagnosis. The patient recovered completely with treatment. Although the diagnostic hallmark of OP poisoning is a reduction in serum and red blood cell cholinesterase activity, clinicians should be alert to recognize evidence of neuromuscular transmission failure seen on nerve conduction study to diagnose atypical or concealed cases of OP poisoning.
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Coexistence of metaplastic carcinoma of the breast with tuberculous axillary lymphadenopathy: A rare occurrence p. 35
Raveendran Vishnu, Balakrishnan Gurushankari, Krishnaraj Balamourougan, Thirthar Palanivelu Elamurugan, Sathasivam Sureshkumar, Rajakannu Muthukumarassamy, Devi Prasad Mohapatra, Debdatta Basu, Vikram Kate
Metaplastic breast carcinoma (MBC) is a rare malignant neoplasm of the breast which is highly aggressive and is known for its early recurrence and poor prognosis. Concurrent detection of a MBC and tuberculosis of the axillary lymph node is a rarity. To the best of our knowledge, there is no such case report in the literature. A 35-year-old premenopausal woman was diagnosed as a case of left carcinoma breast with a left axillary lymph node. Core-needle biopsy of the breast was suggestive of squamous cell carcinoma. The patient underwent modified radical mastectomy with a latissimus dorsi myocutaneous flap. The postoperative biopsy of the breast and axilla revealed MBC and tuberculous lymphadenitis of the axillary lymph node. The patient received antitubercular therapy and radiotherapy, followed by chemotherapy and had no recurrence on follow-up. This case report emphasizes that metaplastic carcinoma breast can coexist with tuberculous axillary lymphadenopathy.
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