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   Table of Contents - Current issue
Coverpage
October-December 2021
Volume 12 | Issue 4
Page Nos. 183-248

Online since Sunday, October 31, 2021

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REVIEW ARTICLES  

Methods of dietary sodium estimation p. 183
P Aparna, Harshal Ramesh Salve, Anand Krishnan, Ramakrishnan Lakshmy, Sanjeev Kumar Gupta, Baridalyne Nongkynrih
DOI:10.4103/injms.injms_97_21  
Excessive dietary sodium intake is found to be associated with high blood pressure and its consequences such as cardiovascular disease and stroke. Daily sodium intake is found to vary from place to place as it is dependent on geography, ethnicity, socioeconomic factors, etc. In this review, we summarize the various methods of assessment of daily sodium intake such as dietary estimation methods using 24-h dietary recall, food frequency questionnaire and diet record, and biochemical methods using 24-h urine sodium or spot urine sodium estimation. Daily sodium intake estimated with spot urine sodium is dependent on the equation used to convert spot urine sodium to 24-h urine sodium. To identify the appropriate equation, validation studies need to be conducted. Population level sodium intake and it's monitoring is important for reduction of noncommunicable diseases.
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COVID-19 vaccines: A ray of hope p. 188
Neha Chand, Rajani Mathur, Shridhar Dwivedi
DOI:10.4103/injms.injms_86_21  
Coronavirus-induced disease (COVID-19) has emerged as a dreaded pandemic which is a threat to the entire world. It all began in Wuhan, China, in December 2019 and rapidly spread over the world. It is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which is an enveloped virus single-stranded, positive-sensed ribonucleic acid virus that enters the host cell lungs via endocytosis or membrane fusion utilizing the ACE-2 receptor. The virus particles release and replicate into new progenies, which cause cytokine storm in some cases by releasing pro-inflammatory mediators into the lungs. It dominantly manifests as SARS-CoV-2 and eventually involves all systems of human body. As of July 15, 2021, approximately 189 million COVID-19-infected cases have been reported worldwide, with over 4 million individuals dying as a result. In India, so far there are approximately 31 million infected cases and 4 lakhs human lives have been lost. Various antivirals, antibiotics, corticosteroids, and other adjuvant therapies were being experimentally employed for COVID-19 prophylaxis and treatment. Many pharmaceutical companies have worked on COVID-19 vaccinations to stop the virus progression and transmission. In several countries, including India, the United States, and Russia, the COVID-19 vaccine has already been approved for human use. India has been able to produce two vaccines, namely Covaxin and Covishield, and launches a massive vaccination drive for people above 18 years adults. Till now, approximately 304 million subjects have been partially vaccinated and 73 million subjects are fully vaccinated. Various other COVID-19 vaccines are in Phase 3 of clinical development. Vaccines against COVID are a major tool against the progression and prevention of COVID-19.
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ORIGINAL ARTICLES Top

A prospective study for the assessment of frailty in elderly chronic kidney disease patients p. 194
Narinder Pal Singh, Mohd Qasim Khan, Pankaj Nand Choudhary, Anish Kumar Gupta, Shaurya Kaul
DOI:10.4103/injms.injms_35_21  
Background: Frailty is a common clinical syndrome in the elderly that may be associated with increased risk of health complications and decreased physical functioning. Early screening of individuals who are at high risk of frailty is required to allow timely intervention for the prevention and reversal of frailty. There is a paucity of information on frailty among the Indian elderly population and especially among the elderly chronic kidney disease (CKD) population. Hence, the aim of the present study was to find out the occurrence of frailty in elderly patients with CKD. Methods: The present prospective cross-sectional study was conducted from an outpatient clinic of a tertiary care hospital. We enrolled 200 participants aged 60 years or above, dividing them into two groups as case (included those with CKD stage 3 and above who were not on dialysis with or without any coexisting comorbidities) and control groups (included those non-CKD patients with or without any coexisting comorbidities). Exclusion criteria were patients with prior history of stroke with neurological complications, dementia or cognitive deficit, severe Parkinson's disease, and nonambulatory. Assessment of frailty was done using the short physical performance battery test (SPPBT) and handgrip strength (HGS). Assessment of HGS was done using a JAMAR hand dynamometer. The data were analyzed using SPSS V 20.0. Results: Majority of the participants were male in the case group (58%), while they were almost equal in the control group (51%). Most of the participants belonged to the age groups of 60–70 years with a mean age of 68.8 ± 5.90 years and 67.99 ± 5.93 years in case and control groups, respectively. In the case group, more than half of the patients had CKD stage 4 (57%), followed by CKD stage 5 (36%). There was no significant difference in diabetes mellitus (P = 0.41), hypertension (P = 0.63), malignancy (P = 1.0), CLD (P = 0.097), and thyroid disorder (P = 0.85) among the groups. Using SPPBT, frailty was found to be significantly higher in CKD patients in comparison to control (78% vs. 62%, P = 0.014). Using the HGS criteria, frailty was detected almost similar in both the groups (CKD vs. non-CKD; 77% vs. 78%, P = 0.866). Frailty was found to be high (78.5%) in CKD patients who had estimated glomerular filtration rate of <30 ml/min. Moreover, frailty was significantly higher in those with diabetes with CKD than diabetic alone (P = 0.009). Conclusion: Frailty was found to be high in elderly patients with CKD as compared to the non-CKD population. This indicates a need for continuous assessment of frailty and timely tailored intervention for prevention and reversal of frailty in the elderly CKD population.
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Efficacy of sustained natural apophyseal glides in the management of mechanical neck pain: A randomized clinical trial p. 199
Sharick Shamsi, Faisal M Alyazedi, Samiha Mohamed Abdelkader, Shabana Khan, Ali Akhtar
DOI:10.4103/injms.injms_30_21  
Background: Neck pain is the second largest cause of disability worldwide. The chronic neck pain prevalence is 14% which is somewhat higher in females as compared to males. In India, the reported prevalence is 6%. Therapeutically, neck pain is managed by physiotherapists using rest, stretching and strengthening exercises, educating patient, and intense proprioception and positional exercises. Aim: We aimed to determine the evidences for the efficacy of sustained natural apophyseal glides (SNAG s) in the management of mechanical neck pain. Methods: One hundred patients (age group: 25–45 years) who were diagnosed with neck pain, with onset >1–3 months (chronic), were randomly assigned to Group A receiving conventional physiotherapy plus SNAGs and Group B receiving conventional physiotherapy plus ultrasound (US). Treatment was given for three times a week for the period of 2 weeks, once a day for 6 sessions. Before treatment and after 2 weeks of treatment, pain, range of motion (ROM), and neck disability were assessed on Visual Analog Scale (VAS), goniometer, and Neck Disability Index (NDI), respectively. This study was conducted in Raj Nursing and Paramedical College, Gorakhpur, ClinicalTrials.gov registration number: NCT04617288. Results: Patients in Group A that received conventional physiotherapy plus SNAGs showed greater improvement in pain and ROM compared with the conventional physiotherapy plus US group on the 2nd week compared with pretreatment (P < 0.050). Conclusion: The result of the study suggests that both the SNAG and US groups improve the symptoms of neck pain. The US group improved the pain symptoms but was too small to reach satisfactory outcome for patients. Based on these results, conventional physiotherapy plus SNAGs should be the treatment of choice for neck pain rather than conventional physiotherapy plus US.
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Absence of fourth slip of flexor digitorum brevis in Nepalese population p. 207
Ajaya Jang Kunwar, Krishna Deo Sharma, Dhiraj Maskey
DOI:10.4103/injms.injms_42_21  
Background: Flexor digitorum brevis (FDB), the most superficial muscle among the muscles of the sole, comprises four tendons running to the lateral four digits. Each tendon splits into two, providing the gap for the flexor digitorum longus to pass through and are inserted into the second to fifth middle phalanges. Several variations of FDB have been reported earlier around the world but only one study showing the absence of fourth tendon has been reported so far in Nepal that too has conflicting outcome compared to the present study. Aims and Objectives: The purpose of this study was to document the absence of the fourth tendon of FDB to the little toe in the Nepalese community, as well as to highlight the fact that there are variances within the Nepalese setting. Materials and Methods: The present study involved an examination of 30 cadavers [male], enabling us in a total of 60 intact feet collected over a 2-year period. Results: Out of 60 feet in toto, we found only two (3.33%) of those lacked the fourth tendon of Flexor Digitorum Brevis to the little toe, which was notably lesser than previously reported 100% absence in Nepalese population. Conclusion: The disparity in such data could be attributable to the Nepalese community's diversity, which could indicate the presence of ethnic significance. The probable difference due to ethnic diversity in the Nepalese population should be taken into account for the medical procedure
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Number of relationships between abnormal values in oral glucose tolerance test and adverse pregnancy outcome p. 211
Burak Bayraktar, Meriç Balikoglu, Miyase Gizem Bayraktar, Ahkam Göksel Kanmaz
DOI:10.4103/injms.injms_29_21  
Objective: The aim of this study is to investigate the effect of detecting one or more positive values in 75 g oral glucose tolerance test (OGTT) performed between 24 and 28 gestational weeks on neonatal biometry (macrosomia, newborn weight, head circumference, and body length of newborn), obstetric results, and treatment requirement. Materials and Methods: Between January 2019 and December 2020 at the University of Health Sciences Tepecik Training and Research Hospital, pregnant women who underwent 75 g OGTT between 24 and 28 gestational weeks and had singleton pregnancy were included in the study. Multiple pregnancies, pregnancies with gestational age <37 and ≥42 weeks, pregestational diabetes mellitus, pregnancies with intrauterine growth retardation, those with chromosomal and/or congenital anomalies, those with thyroid disease, pregnant women whose information could not be reached, and/or whose information was deficient were excluded from the study. These pregnant women were classified into Group 1 with a positive single value, Group 2 with two positive values, and Group 3 with all positive values according to 75 g OGTT values. Results: Two hundred and eighty-three singleton-term and gestational diabetic pregnant women who met the inclusion criteria were included in the analysis. The age of pregnant women and their body mass index (pre-pregnancy and at during test) increased from Group 1 to Group 3, and the differences between all groups were significant (P < 0.001, P < 0.001 and P < 0.001, respectively). The number of pregnant women treated with insulin increased significantly from group 1 to group 3 (P<0.001). Birth weight and body length of new-borns were significantly higher in Group 3 as compared to Group 1 and Group 2 (P = 0.033 and P = 0.017, respectively). Macrosomia prevalence was the highest in Group 3 with 21.7% (P < 0.001). Conclusion: The number of positive values detected between 24 and 28 weeks of gestation in 75 g OGTT was associated with the birth weight, body length, and macrosomia of the newborn and also could be used as an early biomarker to mother's insulin requirement.
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Severity and prevalence of sperm DNA damage among infertile males at a tertiary hospital, north central, Nigeria p. 216
Waliu Olatunbosun Oladosu, Sikiru Abayomi Biliaminu, Musbau Ishola Abdulazeez, Saheed Olanrewaju Jimoh, Olabamiji Abiodun Ajose, Adekunle Bashiru Okesina
DOI:10.4103/injms.injms_23_21  
Context: Seminal fluid analysis (SFA) is the most important investigative tool for evaluation of male infertility. However, it is limited in detecting causes of sperm abnormalities while some individuals with normal SFA are still considered infertile. Evaluating sperm deoxyribonucleic acid (DNA) integrity as an ancillary investigative tool to SFA will enhance the investigation of infertility. Aims: The aim is to assess the prevalence and severity of sperm DNA damage based on semen level of 8-hydroxydeoxyguanosine (8-OHdG) in males with and without abnormal SFA. Settings and Design: This was a descriptive cross-sectional study of 120 males with at least one SFA parameter abnormalities as test controls and 120 normal controls. Subjects and Methods: Seminal 8-OHDG was assayed as a marker of sperm DNA damage using ELISA method. Statistical Analysis Used: Normally distributed data were expressed as mean ± standard deviation otherwise expressed as median and interquartile range. Results: The mean ages of subjects and controls were 35.84 ± 6.0 vs. 36.22 ± 7.56 years. The mean seminal 8-OHDG was significantly higher among subjects than among controls (15.21 ± 3.80 ng/ml vs. 12.45 ± 4.0 ng/ml, P = 0.015). The reference value of seminal 8-OHDG obtained in this study was 4.45–20.45 ng/ml and the prevalence of sperm DNA damage among subjects compared to controls was 10.8% versus 3.3%, P = 0.024. Severe DNA damage corresponding to sperm DNA fragmentation index of >30% was 3.3% in subjects and was not present in any male partner in the control group. Significant sperm DNA damage was also associated with reduced sperm count (P = 0.043), while its association with reduced sperm motility was not statistically significant in this study. Conclusions: The prevalence and severity of sperm DNA damage were more significant among males with, than those without, abnormal SFA parameters.
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Oral health complications in type 2 diabetes: A hospital-based observational study among beneficiaries of employees state insurance in Puducherry, India p. 222
Palash Kumar Sanyal, Pramod Srirammohan, Sirshendu Chaudhuri
DOI:10.4103/injms.injms_8_21  
Background: Oral health evaluation is one aspect of diabetes care, that is usually not practised in majority of health care settings in India. Aims: To-identify the various complications related to oral health among Type 2 diabetics in a secondary care hospital in South India; and to identify the various determinants associated with it. Methods: In this cross-sectional study among the employees state insurance beneficiaries, we conveniently sampled the Type 2 diabetes patients attending the outpatient department for routine diabetic care and evaluated for some preidentified oral health conditions. Results: We recruited 124 participants, 76 (61.3%) males. The average duration of diabetes was 6.5 years (inter-quartile range-3–7 years). Gingivitis (n = 97, 78.2%) was the most common complication. Other important complications include-loss of functionality (n = 88, 71%), calculous (n = 87, 70.2%), and gingival recession (n = 56, 45.2%). In multivariate logistics regression modeling, young diabetics (adjusted odds ratio [AOR] −6.2; 95% confidence interval [CI] −2.2,17.6) and male populations (AOR − 2.6; 95% CI − 1.1, 6.0) were at higher risk of developing multiple complications. Conclusions: Diabetic population frequently suffers with oral complications. Health care professionals can include the importance of dental health care in the routine health education session for diabetics. In addition, clinicians can recommend dental evaluation to the diabetics apart from other clinical biochemical evaluation.
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CASE REPORTS Top

Fungal ball obstructive uropathy in an elderly female with nil comorbidity: A case report and review of literature p. 228
Vijoy Kumar Jha, Debasish Mahapatra
DOI:10.4103/injms.injms_32_21  
Fungal balls in the upper urinary tract are a rare cause of obstructive uropathy. We describe a case of renal fungal ball in an immunocompetent lady with extreme of age and gender as risk factors. The patient presented with recurrent renal colic and complicated urinary tract infection. She had complete resolution of symptoms with spontaneous passage of fungal ball and systemic antifungal therapy.
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Bilateral breast hamartoma p. 232
Jayabal Pandiaraja
DOI:10.4103/injms.injms_74_21  
Breast hamartoma is a rare benign tumor of the breast, and it is classified based on the variable tissue components. It is more common during the lactating period and premenopausal period. Bilateral breast hamartoma is rarely reported in the literature. It might create diagnostic difficulty based on fine-needle aspiration cytology and core needle biopsy. Radiological investigation sometimes might have overlaying findings with malignant disease. It is always better to undergo an excision biopsy for the confirmation of the diagnosis.
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LETTERS TO THE EDITOR Top

Systemic hemodynamic atherothrombotic syndrome: The real agent to consider for 24-h management of hypertension and cardiovascular events p. 235
Oberto Carlos Aguas-Salazar, Mario Andres Villaveces-Buelvas, Julieth Cristina Martínez-Ocampo, Ivan David Lozada-Martinez
DOI:10.4103/injms.injms_94_21  
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On changing and challenging landscape of vaccination arena p. 237
Harish Gupta, Nitu Nigam, Satish Kumar, Amit Kumar
DOI:10.4103/injms.injms_104_21  
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COVID-19 and non culturable bacteria: A plausible association p. 239
Falah Hasan Obayes Al-Khikani, Muayad Mahdi Kadim
DOI:10.4103/injms.injms_98_21  
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Medical tourism - Our choices decide our destiny p. 241
Harish Gupta, Nitu Nigam, Ajay Kumar Patwa, Satish Kumar
DOI:10.4103/injms.injms_50_21  
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Pneumocystis pneumonia with an unusual clinical presentation p. 243
Neeraj Kumar Gupta, Ankita Aggarwal, Ashish Bansal, Nitesh Gupta, Rohit Kumar, Pranav Ish
DOI:10.4103/injms.injms_66_21  
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Acute cutaneous lupus erythematosus p. 245
KC Manish, Latika Gupta
DOI:10.4103/injms.injms_51_21  
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Does tai chi and brisk walking exercises improve cognitive function in older adults? p. 246
Chidiebere Emmanuel Okechukwu
DOI:10.4103/injms.injms_75_21  
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Quizzing as a tool for medical education: A student centric model to develop leadership skills p. 248
Chetna Dengri, Jayesh Chopra, Chestha Dengri, Amir Maroof Khan
DOI:10.4103/injms.injms_96_21  
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