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   Table of Contents - Current issue
March-April 2021
Volume 34 | Issue 2
Page Nos. 65-128

Online since Tuesday, September 28, 2021

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What Can COVID Teach Us about Research Integrity? p. 65
Margaret Winker
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Clinicopathological characteristics, prognostic factors and treatment outcomes of seminomatous germ cell tumours from a tertiary cancer centre in eastern India Highly accessed article p. 68
Deepak Dabkara, Sandip Ganguly, Joydeep Ghosh, Satyadip Mukherjee, Sujoy Gupta, Indranil Mallick, Sumit Mukherjee, Divya Midha, Meheli Chatterjee, Archisman Basu, Ammara Hasan, Bivas Biswas
Background. Seminomatous germ cell tumour (SGCT) is a rare but curable malignancy of young adults. The literature on management and outcome of SGCT is scarce from India. We report the demography and treatment outcome of SGCT at our centre. Methods. We did a retrospective analysis of patients with SGCT treated from March 2011 to December 2018. Patients were staged appropriately with imaging, and pre- and postoperative tumour markers. High inguinal orchiectomy was performed in all with a testicular primary and received subsequent stage-adjusted adjuvant treatment. Patients were monitored for metabolic syndrome during follow-up after completion of treatment. Results. We treated 85 patients with a median age of 37 (range 20–68) years. The primary site of the tumour was the testis in 80 (94%) and mediastinum in 5 (6%) patients. Cryptorchidism was present in 20 (25%) patients and testicular violation was present in 11 (14%) patients. Stage of the disease was I in 61, II in 13 and III in 6 patients. Adjuvant treatment in stage I disease was single-agent carbo-platin (area under the curve ×7) in 38 (62%), surveillance in 20 (33%) and radiotherapy in 3 (5%) patients. Five patients in the surveillance group relapsed. The 7-year mean (SD) relapse-free survival and overall survival were 83.1% (8%) and 98.7% (1.3%), respectively. Thirty-one patients (n = 52, 60%) had features of metabolic syndrome. Conclusions. SGCTs have a high cure rate. Long-term follow-up is essential for monitoring toxic effects. Early diagnosis, avoidance of testicular violation and multidisciplinary management are the key features for better long-term outcome in SGCT.
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Functional independence measure (WeeFIM) reference values in Indian children aged 3–7 years: A cross-sectional study p. 73
Krima P Chokshi, Jaya Shanker Tedla, Amitesh Narayan, Sailakshmi Ganesan, Ravi Shankar Reddy
Background. We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3–7 years in India using this cross-sectional study. Methods. We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results. There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions. We have provided reference values for WeeFIM in children of India aged 3–7 years (35–84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.
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Substance use and its associated factors among school students p. 79
Parvesh Batra, Anju Dhawan, RM Pandey, Manju Mehta, Rajesh Sagar, Anita Chopra
Background. There is lack of comprehensive data on substance use and associated factors among school students in Delhi, India. Methods. We used a cluster sampling method based on sections of classes in schools to conduct this study in two government-run schools in Delhi. All enrolled students from 8th, 9th and 11th grades participated (n = 405). The WHO Student Drug Use questionnaire was administered in a single session for a class section for assessing substance use. Results. The participation rate was 90.6%. The rates of past 12 months’ use of tobacco, alcohol, cannabis and inhalants were 22%, 12.1%, 12.1% and 8.6%, respectively, while rates for ‘sedatives and tranquillizers’ were 4.9%, opium 2.7% and other opioids 1.2%. Lifetime use of heroin was reported by two students and use in the past 12 months by one student. Multiple substance use was high. Higher age was associated with the use of alcohol and cannabis. According to logistic regression model results, use by a family member significantly increased the probability of using tobacco (adjusted odds ratio [AOR] 11.3; 95% confidence interval (CI) 3.4–37.8) and alcohol (AOR 3.75; 95% CI 5.1–1059.3). Similarly, use by peers significantly increased the probability of tobacco (AOR 7.7; 95% CI 2.0–29.8) and cannabis use (AOR 5.7; 95% CI 1.5–21.5). Having poor harm perception significantly increased the chances of inhalant use by students (AOR 5.5; 95% CI 1.5–20.1). Conclusion. The study results bring to attention the prevalent and important problem of substance use among schoolchildren. We recommend that (i) intervention strategies for school settings are important and need to factor in the use of illicit substances (cannabis); (ii) psychosocial intervention by trained school counsellors in school settings is the mainstay for intervention for cannabis and inhalants; and (iii) heroin users should be referred to healthcare facilities for detoxification.
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Management of a complicated ‘pacemaker pocket’ site infection p. 84
Karthik Raghuram, Krishna Kumar Mohanan Nair, Narayanan Namboodiri, Debasish Das, Ajitkumar Valaparambil
Pocket site infection after implantation of a pacemaker is a dreaded complication which requires removing the device and reimplanting it at a contralateral site. Difficulties arise when the patient is dependent on pacing and when there are issues with venous access at the contralateral site. We report a patient with pacemaker pocket site infection with congenital complete heart block managed with explantation of the device, semi-permanent pacing during antibiotic treatment, reimplantation of the device at the contralateral site and management of subtotal subclavian vein stenosis noted during reimplantation.
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Pancreatic tuberculosis: An unusual presentation p. 86
Shubha Laxmi Margekar, Ravi Kumar Meena, Sunil Kapoor, Rajinder Kumar Dhamija
Tuberculosis (TB) of pancreas is a rare presentation in both immune-competent and immune-suppressed patients. Its presenting clinical features are usually vague and non-specific, while radiological features mimic other common pancreatic conditions such as malignancy, so it is often misdiagnosed. It commonly involves the head and the uncinate process of the pancreas. We report a middle-aged immune-compromised man who presented with left-sided tubercular pleural effusion and later was diagnosed as pancreatitis by clinical presentation and TB of pancreas on computed tomography of the abdomen.
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Corynebacterium striatum: An emerging nosocomial skin and soft-tissue pathogen p. 88
Sonu Kumari Agrawal, Swati Khullar, Anurag Srivastava, Arti Kapil, Benu Dhawan
The genus Corynebacterium is composed of Gram-positive, aerobic, non-motile, non-spore-forming bacilli that are widely distributed throughout the environment. They are usually found as commensals on the skin and are often considered as mere contaminants when isolated from clinical samples. We describe a patient with skin and soft-tissue infections due to Corynebacterium striatum following exploratory laparotomy identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The clinical importance and pathogenic potential of Corynebacterium species, especially C. striatum, cannot be underestimated. This report is a reminder to physicians of the possible pathogenicity of non-diphtherial Corynebacteria.
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Short-duration adjuvant trastuzumab therapy in human epidermal growth factor receptor 2-positive breast cancers: Has its time come? p. 90
Ajay Gogia, Abhenil Mittal, Atul Sharma, Hari Krishna Raju Sagiraju
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Communication skills training through ‘role play’ in an acute critical care course p. 92
Akshay Kumar, Navdeep Sokhal, Richa Aggarwal, Keshav Goyal, Kapil Dev Soni, Rakesh Garg, Sanjeev Bhoi, Ashok Deorari, Ajay Sharma
Background. Effective patient–doctor communication is a key component of patient-centred care, which is one of the six pillars of quality healthcare delivery. Structured and effective communication skills training for healthcare providers is the need of hour in medical education. We assessed the efficacy of role play and simulation in developing communication skills. Methods. As a key component of an acute critical care course (ACCC), communication skills are taught using role play models and simulation. Live feedback is critical in learning during this course as per the principles of adult learning (andragogy). Quantitative and qualitative data were collected to assess the efficacy of ACCC. Results. The 19th ACCC was introduced to interns at the All India Institute of Medical Sciences, New Delhi in December 2018. The teaching methodology and objective-oriented structured training in ACCC were much appreciated for training in human factors with emphasis on communication. A positive response was obtained from the candidates 3 weeks after they completed the course to assess whether interns are able to make use of this training in their day-to-day clinical practice amounting to a reliable evidence level of Kirkpatrick's ‘return of investment’. Conclusion. The use of ‘role play’ to teach communication skills is effective and superior to lecture-based teaching. Further structured and interactive programmes in communication skills training will improve patient care, relatives’ satisfaction and the image of medical profession.
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Sustainable health financing system for India: The economic perspective p. 95
Dayashankar Maurya, Mukul Asher
Health policy discussions in India have primarily centred around the low level of public health financing, ignoring that total health expenditure in India is at par with many other countries with similar economic development. India spends 3.7% of its gross domestic product (GDP) on healthcare, but the health outcomes are not commensurate with spending. We argue that simply increasing public health spending will not improve health outcomes unless inefficiencies in the existing health financing arrangements, public as well as private, are addressed. Using economic reasoning, we identify several allocative and technical inefficiencies in existing health financing arrangements. We argue that increasing resource allocation in the present pattern of financing may even worsen the situation. We give recommendations to correct inefficiencies in current health financing arrangements before more allocations are made to improve the performance of the health financing system.
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Decoding the black box of health policy implementation: A case of regulating private healthcare establishments in southern India p. 100
Meena Putturaj, Upendra Bhojani, Neethi V Rao, Bruno Marchal
Background. Implementation of healthcare regulatory policies, especially in low- and middle-income countries where the private health sector is predominant, is challenging. Karnataka, a southern state in India, enacted the Karnataka Private Medical Establishments Act (KPMEA) with an aim to ensure quality of care in the private healthcare establishments. After more than a decade the implementation of KPMEA is suboptimal. Methods. We used a case study design. The case was ‘implementation of KPMEA’. The case study site was Bengaluru Urban district in Karnataka. Data from key informant interviews, focus group discussions held at the state, district and subdistrict levels and key policy documents, minutes of the meetings, data from the State Department of Health and Family Welfare, district level KPMEA data and litigations at the High Court of Karnataka were analysed using a framework. Results. The policy (KPMEA) content is inadequate and requires clarity in certain provisions of the Act. There was a lack of coordination between the implementing agencies. Workforce shortages were evident. Factors that impede the enforcement of the Act include poor knowledge and lack of competency of the officials on the content and the implementation mechanics of the policy, insufficient policy oversight from the state on the districts, corruption, political interference and lack of support from the local public, especially during raids on illegal establishments. Conclusions. A regulatory policy such as KPMEA needs a clear, comprehensive content and directions for operationalization. However, improving the content of the policy is not easy as some aspects of the policy remain contentious with the private healthcare providers/ establishments. Addressing health governance issues at all levels is key to effective enforcement.
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The burden of snakebite envenomation demands a hospital-based registry in India p. 107
Polani Chandrasekar Rubeshkumar, Manickam Ponnaiah, Manoj Vasant Murhekar
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Living Will and Green Hair p. 108
Anil Chandra Anand
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Looking behind the ‘Winner winner chicken dinner’ p. 111
Archisman Mazumder
In today's world, video games have become an integral part of our lives, even for adults. While gaming disorder is now recognized as a disease, the literature is still not extensive regarding various aspects of the obsessive playing of video games. Taking the Player-Unknown's Battlegrounds as an example, this article provides a medical student's perspective on the effects of excessive playing of video games and some positive aspects of video games, which are less talked about.
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Dr Venki Ramakrishnan's lecture on the discovery of structure of ribosomes p. 114
Hardik Revanand Bendale, Chirag Arvind Jorvekar
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Letter from Chennai p. 115
MK Mani
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Principles of Medical Education p. 117
Anu Thukral
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Viswanathan Shanta p. 118
T Rajkumar
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Arun Chítale p. 119
Anita M Borges
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Mattox manoeuvre: A forgotten method p. 121
Jitendra Mistry, Sumit Kapadia, Deepali Mistry
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Virtual physical examination in video consultations: A valid inspection component of physical examination? p. 122
Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math
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History of medicine in the undergraduate medical curriculum in India p. 122
Shridhar Dwivedi
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Informed consent during Covid-19 p. 123
Shubhi Goel, Nitesh Tewari, Vijay Prakash Mathur
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Educational support required by new forensic pathology trainees: An exploratory qualitative study p. 124
Manabu Murakami, Hideki Hyodoh, Kotaro Matoba
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News from here and there p. 125

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Masala p. 127
Bhavin Jhankaria
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Erratum p. 128

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