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   2021| July-December  | Volume 8 | Issue 2  
    Online since December 30, 2021

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Applications of artificial intelligence in epilepsy
Pradeep Pankajakshan Nair, Rajeswari Aghoram, Madhuri Laxman Khilari
July-December 2021, 8(2):41-48
Epilepsy is a common neurological condition characterized by a predilection for recurrent seizures. It affects 3.0–11.9 persons per 1000 in India. The advent of machine learning and artificial intelligence (AI) has allowed us to harness computing power to evaluate enormous amounts of data to provide more definitive answers to many vexing questions in epilepsy such as the nature of a paroxysmal event, prediction of seizure, response to therapy, etc. In this article, we present an overview of AI and machine learning approaches to the diagnosis and management of epilepsy. We performed a MEDLINE search with both keywords (AI, epilepsy, Epilepsy, Machine learning, seizure) and MeSH terms (AI, Seizures) combined with Boolean operators. We present a narrative summary of the results. We initially discuss basic concepts regarding AI and its divisions, followed by a discussion of the role of AI in epilepsy from published studies particularly in the areas of diagnosis and classification of epilepsy; seizure detection and prediction; epileptogenesis; and management of epilepsy. Despite the growing popularity of AI in epilepsy, it should be remembered that these approaches are not without drawbacks. All machine learning approaches are data expensive and require a large computational capacity. This also has a bearing on the time taken for the development of these algorithms. AI is here to stay and influence all aspects of care for people with epilepsy (PWE) and it is necessary to equip ourselves to interface with these smart systems. This balance will help provide the best possible care to PWE.
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Analysis of cesarean section using Robson's ten group classification system in a tertiary care center from Southern India: A cross-sectional study
Kanmani Murugesan, Sasirekha Rengaraj
July-December 2021, 8(2):75-82
Background: The rising cesarean section (CS) rate is a global concern and World Health Organization in 2015 has proposed the use of Robson-10 group classification system as a standard for assessing and monitoring CS both within and across the healthcare facilities. Objective: The objective is to analyze the CSs performed in a teaching hospital using Robson 10-group classification system. Methodology: The present cross-sectional study was done over a period of 1 year from May 2017 to April 2018. All eligible women delivered in JIPMER, a tertiary care referral center during the study period were classified as per Robson Ten-Group classification system. Caesarean delivery rates were reported. The relative and absolute contribution to CS rates in each groups were calculated. Epi data V.3.1 was used for data analysis. Results: Among 16,863 women delivered during the study, the CS rate was 21.4%. The three common indications for CS overall were fetal distress, nonprogress of labor, and cephalopelvic disproportion. Group 1 (nulliparous, singleton, term cephalic, spontaneous labor) was the largest size followed by group 2 (nulliparous, singleton, term cephalic, induced labor) with 25% and 16.9%, respectively. The maximum contribution of CS was by group 5 (multiparous women, singleton, term cephalic, previous uterine scar) followed by group 2 with 34.9% and 18.9%, respectively. Conclusion: Robson group 5, 2, and 1 were the major contributions to CS in our hospital. Further studies are needed to study the appropriateness of indications for CS especially in groups 2 and 1 as they are the future group 5.
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New beginnings and new challenges
Vikram Kate, Vikas Menon
July-December 2021, 8(2):39-40
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Detection of rare blood group Ax phenotype in blood donor
Rakesh Kumar, P. M. Bala Bhasker, Romesh Jain, Avineesh Chandra
July-December 2021, 8(2):87-89
Background: Karl Landsteiner discovered ABO blood group system in early 20th century, but still, uncertainty remains in immune-hematology while detection of ABO subgroups or weaker variants. The presence of weak subgroups in blood donor samples gives rises to discrepancy in forward (cell) and reverse (serum) grouping. Methods and Materials: We here report a case of the 'A' weak Rh 'D' Positive, Probably Ax Phenotype in a blood donor who came for replacement donation at our blood bank. The blood group discrepancy was resolved by using serological testing, Adsorption elution technique and saliva secretor study. Results: Blood grouping by the tube technique showed no reaction was shown with anti-B, a faint reaction with anti-A, 1+ agglutination with Anti-AB, and a significant reaction (4+) with anti-D and anti-H. The patient's serum showed the presence of anti-B antibody as well as anti-A1. Result for eluate showed microscopic agglutination (1+) with group A cells and a negative reaction with group B cells and saliva secretor study showed having only H substance. Conclusion: This report highlights the importance of cell and serum grouping in solving blood group discrepancy in blood donors. This rare phenotype in a donor is first of its kind reported from India.
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Effectiveness of structured feedback after formative tests on first year MBBS students' performance in summative examination
Vijayetha P Patil, Vidya S Patil
July-December 2021, 8(2):70-74
Background: Feedback gives an opportunity to students to analyze their work, performance, correct themselves and improves learning. The outcome also depends on the way it is delivered, and hence, we analyzed the effect of constructive feedback on students' performance and their perceptions. Objectives: The objective of this study is to evaluate the effect of a structured constructive feedback on the performance of low achieving students and to analyze their perceptions on feedback. Methodology: Students of the 1st year MBBS scoring <50% marks in Biochemistry test were included and divided into two groups randomly: Group A received feedback intervention and Group B was the control group. Structured constructive feedback based on Pendleton's rules was given to students in Group A after each formative assessment. Their logbook writing was also assessed. Performance score was compared between groups using student t-test. Students' perceptions on effect of feedback on their learning and performance were evaluated using a validated questionnaire. Results: We found significant improvement in the performance of Group A in the immediate assessment test following feedback (t = 2.09, P = 0.04), but subsequent tests did not show any difference between the groups. Logbook performance was better in Group A than Group B (t = 2.51, P = 0.02). Greater number of students in Group A passed the summative examinations as compared to Group B. Students reported good perceptions on the feedback sessions and wanted it frequently. Conclusions: Feedback helped the students to identify their areas of lacunae and measures to overcome them in their studies. Students who received feedback showed improved learning attitude. They were satisfied with the feedback sessions and valued it.
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Transplantation in hepatocellular carcinoma - controversies and recommendations: A review of current literature
Ruchir Bhavsar, Sri Aurobindo Prasad Das, Naimish N Mehta
July-December 2021, 8(2):49-56
Hepatocellular carcinoma (HCC) is the principal cause of death in patients with cirrhosis and the third leading cause of cancer-related death. HCC is present in around 80% of cirrhotic livers. Tumor recurrence and chronic liver failure are causative factors for mortality in the long term. Early liver transplantation (LT) for HCC with a significant tumor mass was associated with a poor prognosis owing to tumor recurrence. The vast experience and effectiveness of transplantation for HCC have sparked debates over whether the Milan criteria are overly stringent. The idea of tumor “downstaging,” expanding the limitations of tumor size, choice of either living related donor or cadaver donor transplantation, along with posttransplant care and its importance in HCC, are presently at the heart of a heated dispute. The recommendations in this article have attempted to highlight some of the disputed issues surrounding LT in HCC and may help programs in managing such patients better.
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Nutritional profile of Kolagur tribal women in Yercaud, Tamil Nadu, India: An exploratory study
R Durga Priyadarshini, D Annette Beatrice
July-December 2021, 8(2):63-69
Background: Malnutrition is a long-standing global health issue to which the tribal population are highly vulnerable. Timely diagnosis and appropriate treatment is crucial. Aim: The aim of the study is to assess the nutritional status of tribal women in Kolagur, Yercaud, using anthropometric, biochemical, clinical, and dietary assessment parameters. Subjects and Methods: An exploratory study was carried out among women (n = 100) between 18 and 60 years of age from Kolagur, a tribal village in Yercaud taluk, Salem district, Tamil Nadu, India. Information on sociodemographic profile of participants was collected using a structured interview schedule. Anthropometric, biochemical, clinical, and dietary parameters were assessed using appropriate standard techniques/tools. Nutrient intake was computed using Diet Cal software and the statistical analysis was done using IBM SPSS statistics software version 25. Results: Majority of the participants were malnourished of which 25% were underweight, 20% were obese, and 17% were overweight. The mean waist-to-hip ratio (mean ± standard deviation: 0.87 ± 0.13) was marginally higher than the normal cutoff value for women. The prevalence of anemia was much lower where only 21% had mild anemia, 5% had moderate anemia, and 1% had severe anemia. About 21% were prediabetic and 9% were diabetic. Majority (51%) of the participants had altered blood pressure levels with 20% in hypertension Stage 2, 19% in prehypertensive stage, and 12% in hypertension Stage 1. The mean intake of nutrients such as energy, thiamine, ascorbic acid, and folate was significantly higher than the recommended dietary allowances (RDA), whereas the mean intake of fat, retinol, riboflavin, pyridoxine, calcium, and iron was significantly lesser than the RDA. Conclusions: The findings of this study highlight the urgent need for well-planned nutrition-oriented health policies at the community level to eradicate the double burden of malnutrition.
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Pattern of severe malaria with special reference to Plasmodium vivax in pediatric population of the most aspirational region of North India
Aditi Minhas, Pratibha Mane, Jyoti Sangwan, Arti Dhingra
July-December 2021, 8(2):57-62
Introduction: Malaria is one of the major life-threatening health problems in most of the tropical countries. Children are the most vulnerable group accounting for 67% of all malaria-associated deaths worldwide. Southern Haryana is typically endemic for malaria. Therefore, the present study was undertaken to describe the clinical presentation of complicated malaria and correlate clinical complications with malarial species. Materials and Methods: It was an observational cross-sectional study conducted in the Department of Microbiology along with Department of Pediatrics, Shaheed Hasan Khan Mewati Government Medical College, Nalhar, Nuh, Haryana. A total of 100 children with severe malaria admitted in the pediatric ward, confirmed by peripheral blood smear and rapid diagnostic test, were included. Results: Out of 100 cases admitted, majority were due to Plasmodium vivax (73%), followed by mixed (18%) and Plasmodium falciparum (9%) infection. Children below 5 years were more infected (57%). Male preponderance was seen (55%). Fever was the most common symptom observed (95%). Pallor was the most common sign observed (85%). Among severity parameters, the most common were severe anemia (41%), jaundice (17%), abnormal bleeding (17%), convulsions (15%), and acute respiratory distress syndrome (7%). The case fatality rate was 3%. Conclusion: P. vivax was previously known to cause benign malaria. The present study found that P. vivax mono-infection can cause severe malaria in children and should no longer be considered as benign malaria.
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Human dirofilariasis: An emerging zoonotic nematodal infection - A case series
Linta Jacob, Nevil Varghese, Arjun G Menon, Ariyamparambil R Vinayakumar
July-December 2021, 8(2):83-86
Dirofilariasis is an emerging parasitic infection caused by Dirofilaria spp., a parasite carried by domestic dogs, cats, and other wild animals. Humans become accidental dead end hosts when inoculated with microfilariae by blood sucking arthropods like mosquitoes. Subcutaneous dirofilariasis is an accidental human infection that presents as subcutaneous nodules in the body resulting from an inflammatory reaction in response to the infection. We report a case series of human dirofilariasis to highlight its increasing trend from a tertiary care hospital in Kerala, South India.
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Letter to editor: Why must faculty members in medical institutions engage in research?
Sanjay Cherukuri
July-December 2021, 8(2):90-90
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Thanks to Reviewers 2021

July-December 2021, 8(2):91-91
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