Indian Journal of Medical Sciences

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EISSN : 0019-5359
Published by: Scientific Scholar (10.25259)
Total articles ≅ 144
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, Jaishree Ganjiwale, Aparna Parikh, Nirali Trivedi, Satinder Kaur, Rachana Chennamaneni, Neha Choudhary, Roshni Pande, Sonal Dande, Priya Iyer
Indian Journal of Medical Sciences, Volume 73, pp 164-169; https://doi.org/10.25259/ijms_319_2021

Abstract:
Objectives: This study is about the challenges faced by the women doctors in India during the first wave of the COVID-19 pandemic. Material and Methods: We conducted an online survey in 2020 for women doctors who were professionally engaged in active patient management in India before the onset of the current pandemic. Results: A total of 260 valid responses were received. Only 28% (73/260) were able to provide at least 50% of professional services as compared to the pre COVID-19 lockdown period. Statistically significant differences related to emotional health (feelings), physical activity, changes in how family sees the lady professional, personal free time availability, and family bonding. Conclusion: COVID-19 has led to the following important concerns for professional women - academic productivity; work-life balance; missed opportunities for collaborating; mental health, the need for equity-minded academic leadership, and decision-making. Our study showed that majority were stressed during the COVID-19 lockdown – with the impact being highest among those giving more than 50% of their time to professional medical services outside their homes.
Indian Journal of Medical Sciences, Volume 73, pp 281-285; https://doi.org/10.25259/ijms_403_2021

Abstract:
Dr. Prathap Chandra Reddy is the Founder-Chairman of the Apollo Hospitals Group (AHG) and is considered a living legend and architect of modern private health care in India. In 1983, Dr. Reddy started the first professionally run private hospital – Apollo Hospitals in Madras (now Chennai). Since then, the AHG has expanded to over 73 hospitals across the country. The state-of-the-art facilities have made advanced health-care services accessible and affordable to all in need. AHG has a presence in primary care, secondary care, tertiary care, quarterly care, health IT, tele-health (tele-consults, tele-pathology, tele-cardiology, and tele-radiology), eICU pharmacy retailing, project consultancy, research, and academics. He catalyzed a “reverse brain drain” by inspiring hundreds of Non-Resident Indian Doctors to come back to India, by creating opportunities and providing them with a world class medical ecosystem. Dr. Reddy’s contributions are widely recognized by patients, doctors, the health-care fraternity across the world, the community at large, and by the Government of India.
Sangeeta Shukla, Manisha Gupta, , Rishi Shukla
Indian Journal of Medical Sciences, Volume 73, pp 170-173; https://doi.org/10.25259/ijms_234_2021

Abstract:
India is passing through a significant impact of Wuhan origin coronavirus disease 2019 (COVID-19) pandemic in the second wave. Mucormycosis is emerging as a larger problem for our patients as compared to the first wave. Several plausible explanations have been put forth –but none has been proven as yet. We herein report eight cases of COVID-19-associated rhino-orbital mucormycosis diagnosed and managed at our center. We observed a higher risk among middle-aged men, with known or covert diabetes who received high-dose steroids and/or prolonged oxygen for COVID-19 management.
Sandeep S. Sawakare, Sandeep P. Tandon, C. S. Pramesh, Sudeep Gupta, Manju Sengar, Sarbani Gosh Laskar, Sindhu S. Nair, Gauravi A. Mishra, Nishu S. Goel, Shradha Patkar, et al.
Indian Journal of Medical Sciences pp 1-5; https://doi.org/10.25259/ijms_194_2021

Abstract:
Objectives: Continuation of health-care facilities for non-COVID illness during the SARS-CoV-2 pandemic is mired with apprehension of infection to health care workers (HCWs). The lack of facilities can result in dire outcomes for patients of NCDs such as cancer. The Objective of this paper is to assess the risk of running a healthcare facility during the pandemic. Material and Methods: A retrospective analysis was carried out at a tertiary cancer hospital to understand the quantum of risk to HCWs while providing care to patients of cancer and to SARS-CoV-2 patients, within the same set-up with optimal segregation. Data were collected for 6 weeks during which attendance, exposure, and infection status of doctors and nurses were recorded along with comorbidities. Results: Of 1041 doctors and nurses who attended duties during the study period, 299 worked in dedicated COVID care areas while 742 worked in routine cancer care areas. The proportion of HCWs that developed symptoms or were tested positive for COVID-19 was 3.7% and 3.9%, respectively, with no statistically significant difference between the two. The proportion for the same was found to be 1.2% among the 645 staffs who were on leave. No correlation could be established between pre-existing comorbidities and risk of acquiring infection. Conclusion: Providing COVID care and routine specialty care within the same hospital premises do not put the HCWs at a drastically increased risk of acquiring infection subject to clear demarcation of work areas, screening at gates by trained personnel, regulation of number of hospital visitors, and optimal use of PPEs.
Richie Gupta, Rajat Gupta
Indian Journal of Medical Sciences pp 1-8; https://doi.org/10.25259/ijms_494_2020

Abstract:
A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to a persistent distress, which is known as gender incongruence (GI) (previously gender dysphoria). These persons are known as trans genders. A subset of these individuals feels that they are trapped in the wrong sexed body and need to bring their physical sex into alignment with their gender. The “gender” is already imprinted into the brain at birth, and hence cannot be changed, but the physical sex of a person can be, through gender affirmation surgeries (GAS). There has been relative paucity of data from India regarding medical and surgical affirmative management of trans-persons, and hence, the authors present their experience in GAS together with current demography, hypothesis regarding etiology and management, as carried out in India. Authors have been providing comprehensive affirmative management to trans persons, through their multi-specialty gender identity clinic (GIC) sited in a tertiary care hospital. Over past 27 years, the senior author has performed over 3,000 GAS. The authors have noticed a 20- fold rise in presentation of these cases (from six cases per year in 1993 to now around 150 cases in the year 2019), an observation, which is similar to the experience of large volume GICs worldwide, as well as many recent publications. There has been a steep rise in the number of persons with GI worldwide, and those reporting at GICs. In the face of this rising number, authors present their experience, together with current demographics and management. Authors have also contributed to the first version of Indian Standards of Care for persons with GI and people with differences in sexual development/orientation Indian standards of care 1in November 2020.
Sunita Arora, Anju Huria, Poonam Goel, Jasbinder Kaur, Sunita Dubey
Indian Journal of Medical Sciences pp 1-5; https://doi.org/10.25259/ijms_446_2020

Abstract:
Objectives: Intrahepatic cholestasis of pregnancy (IHCP) is the most common reversible form of hepatic disease in pregnancy. The risk of sudden intrauterine infant death is major threat as none of the fetal monitoring proved effective for its prevention. This study was conducted to know the prevalence of IHCP along with fetal and maternal outcome in North Indian population. Material and Methods: This case–control study was conducted over a period of 6 months. One hundred pregnant patients were recruited in each group. Patients with IHCP were included in case group whereas apparently healthy pregnant women with singleton pregnancy were included in control group. Bile acids were done only once at the time of initial visit whereas liver enzymes were done at initial visit and subsequently weekly for total 3 times. All cases of IHCP were started on ursodeoxycholic acid (UDCA) with a dose of 10–15 mg/kg/day throughout pregnancy and three doses of 10 mg Vitamin K by intramuscular route were also given. Fetal and maternal outcomes were compared between both the groups. Total numbers of deliveries in that time period were also noted to find out the prevalence of disease. The tests of two or more proportions were done using Fisher’s exact test and Chi-square test. P < 0.05 was considered statistically significant. Results: The prevalence of IHCP was 4.08% in our population, however, women from urban area had higher incidence of cholestasis than rural population. History of recurrent disease was found in 30% of women. Out of 100, 96% presented with itching and only 57–58% had raised liver enzymes levels. In 89% of patients (89/100), bile acids levels were >14 μmol/l. During follow-up, SGOT and SGPT levels were significantly improved over 2-week interval while on treatment with UDCA; however, levels were still on higher side. There was no correlation found between cholestasis of pregnancy with preterm labor and meconium-stained liquor in the present study. Comparable results were found in terms of respiratory distress syndrome and NICU admission, whereas significant high incidence of neonatal jaundice found in the control group. Conclusion: Itching over whole body was the predominant presenting complaints of cholestasis of pregnancy. Diagnosis should be supported by bile acids in women with normal liver enzymes to decrease the cost of investigations. Early termination of pregnancy between 36 and 37 weeks can be considered in women with bile acids >40 μmol/L and in non-compliant patients on UDCA treatment.
Nagendra Mishra, Henil Upadhyay, Charmy Parikh
Indian Journal of Medical Sciences pp 1-4; https://doi.org/10.25259/ijms_47_2021

Abstract:
Actinomycosis is a rare chronic granulomatous suppurative infection caused by Gram-positive bacteria. The occurrence of primary vesical actinomycosis is extremely rare and only a few cases have been reported. Pre-operative diagnosis of vesical actinomycosis is challenging as the clinical and radiological features usually point towards bladder malignancy. Therefore, in most cases, definitive diagnosis is usually made after histopathological examination of the involved tissue. A 60-year-old male presented with complaints of hematuria, burning micturition, irritative, and obstructive urinary symptoms for 15 days. USG revealed a large soft-tissue mass having a polypoidal intraluminal and extraluminal component and involving the right posterolateral urinary bladder wall. CT scan showed a large irregular soft-tissue mass with multiple cystic lesions involving the right lateral wall of the urinary bladder. Transurethral resection of bladder mass biopsy was performed and the histopathological examination showed bacterial colonies of Actinomyces with changes of cystitis cystica. The patient was treated with amoxicillin and potassium clavulanate for 3 months. Actinomycosis should be kept as a rare differential diagnosis in cases presenting as bladder mass. The diagnosis is most commonly made by histopathology and may need a repeat biopsy to arrive at the correct diagnosis. The patient should be treated by penicillin group of antibiotics for 2–3 months and followed up for years to detect any recurrence.
Raju Vaishya, Anupam Sibal, P. Shiva Kumar
Indian Journal of Medical Sciences, Volume 73, pp 159-163; https://doi.org/10.25259/ijms_211_2021

Abstract:
Objectives: The COVID-19 pandemic has severely impacted health-care delivery globally, especially for non-COVID diseases. These cases received suboptimal attention and care during the pandemic. In this observational cohort study, we have studied the impact of the COVID-19 pandemic on various aspects of medical and surgical practices. Material and Methods: This observational, cross-sectional cohort study was performed on the data of a 710 bedded, multispecialty, and tertiary care corporate hospital of the national capital of India. The data of the pandemic period (April 1, 2020–March 31, 2021) were divided into three main groups and were then compared with the patient data of the preceding non-pandemic year (April 1, 2019–March 31, 2020) of more than six hundred thousand cases. Results: From the data of 677,237 cases in these 2 years, we found a significant effect of COVID-19 pandemic on most spheres of clinical practice (P < 0.05), including outpatient attendance and surgical work. The specialties providing critical and emergency care were less affected. Although the total hospital admissions reduced by 34.07%, these were not statistically significant (P = 0.506), as the number of COVID-19 admissions took place during this time and compensated for the drop. Conclusion: The COVID-19 pandemic has significantly impacted health-care delivery to non-COVID cases across all the major medical and surgical specialties. Still, major urgent surgical and interventional work for cases was undertaken with due precautions, without waiting for the ongoing pandemic to end, as the delay in their treatment could have been catastrophic.
Sridhar Amalakanti, Samdhani Syed
Indian Journal of Medical Sciences, Volume 73, pp 221-225; https://doi.org/10.25259/ijms_285_2020

Abstract:
Objectives: Human immunodeficiency virus (HIV) infection and neurological illness cause heavy financial burden to the patients. The economic costs of each of the disease have been reported in many studies, but the toll of both together on the patients has not been studied clearly. As neurological illnesses are seen in up to one-third of HIV patients, the combined costs need to be understood. Even with free public health services, there are out of pocket expenditures on the patients. Material and Methods: In the tertiary Government General Hospital, Guntur in India, we studied the out-of-pocket costs of time and money borne by 50 HIV-seropositive individuals hospitalized for a neurological illness during April and May 2019. We obtained data from the patients and caregivers by face-to-face oral questionnaires. Results: The median duration of HIV infection was 2.5 (IQR 0.4–7.8) years. A high proportion of our patients (20/50) was diagnosed with tuberculous meningitis. The total median time lost by each HIV-seropositive patient due to neurological illness (private consultation, travel, and hospital stay) was 27.5 (8.7–134.3) days. The total median financial burden due to neurological disease requiring hospitalization (travel, food and medicine, wages lost, private consultation expense, and loans incurred) on each patient was ₹19,150 (855–59881). Conclusion: HIV patients with neurological illness are burdened by heavy costs of time and money. They are forced into debt and lose substantial wages, most of it due to private consultation.
Anuradha Patel, Sushma Bhatnagar, Brajesh Ratre
Indian Journal of Medical Sciences, Volume 73, pp 275-280; https://doi.org/10.25259/ijms_457_2020

Abstract:
Palliative care is emerging as a recognized and needed branch all over the country. Integration of palliative care with oncology enhances patient’s quality of life, decreases suffering and depression, ensures good end of life care, better patient’s satisfaction, and decreases cost by avoiding unnecessary chemotherapy or ventilator support. The aim of this narrative analysis is to provide a truly integrated supportive model of palliative care practiced at DR BRA IRCH, AIIMS, Delhi, a tertiary cancer care center in India. It consists of inpatient and outpatient services with round the clock consultation teams. Integration of palliative care with other oncology has helped us in providing holistic and comprehensive care to the patients. We aim that this model might help in creating patient centric comprehensive care model in various other cancer centers with limited resources.
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