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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 13 | Issue 4
Page Nos. 209-266

Online since Friday, November 18, 2022

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EDITORIAL  

Is the fight against COVID-19 falling prey to vaccine hesitancy? p. 209
Anupam Prakash, Ramesh Aggarwal
DOI:10.4103/injms.injms_131_22  
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REVIEW ARTICLE Top

Naltrexone beyond psychiatric domain p. 211
Ashutosh Garg, Khyati Thapliyal, Vivek Pal Singh
DOI:10.4103/injms.injms_35_22  
Naltrexone, an opioid receptor (OR) antagonist, at its standard doses, is a United States Federal Drug Administration-approved drug for opioid and alcohol use disorders. However, with the discovery of nonneuropsychiatric effects of OR signaling with low-dose naltrexone, it has found novel applications in inflammatory, malignant, insulin sensitivity-related, and chronic pain conditions. Lower doses also ameliorate its adverse effects. Its off-label use in the abovementioned situations has proven to be cost-effective against costly immunomodulating and antineoplastic drugs. Its lower cost and miniscule margin of interest have precluded in-depth analysis by the pharmaceutical industry. So far, only animal studies, cell culture studies, and case reports have been conducted, some of which exhibit promising benefits. There is a dearth of much-needed quality trials.
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ORIGINAL ARTICLES Top

Effect of SARS-CoV-2 vaccination on severity and outcome of COVID-19 among health-care workers of a tertiary care hospital in India p. 216
Rajni Gaind, Neeraj Kumar Gupta, Ravindra Nath, Nilushree Srivastava, Tanushree Gahlot, Pranav Ish, Nitesh Gupta
DOI:10.4103/injms.injms_56_22  
Introduction: SARS-CoV-2 vaccines decrease the risk of infection. However, data on the utility of vaccines in decreasing the severity of COVID-19 need to be evaluated. This study was carried out with the primary objective to assess the severity and clinical outcome of COVID-19 infections among unvaccinated and vaccinated health-care workers (HCWs). Methods: This was a hospital-based retrospective cohort study including all HCWs who developed microbiologically confirmed COVID-19 over 6 months from January 31, 2021, to July 31, 2021 (during the second wave of COVID-19 in India). Data were recorded through a questionnaire which included demographic details, primary location of work, history of vaccination with dates, comorbidities, severity of COVID-19, and outcome. HCWs who tested positive for SARS-CoV-2 before any dose of the COVID-19 vaccine were included in the “unvaccinated” group. Whereas HCWs who developed SARS-CoV-2 after a single or both doses of vaccine were included in the vaccinated group. The outcome and mortality among the vaccinated and unvaccinated groups were evaluated and compared. Results: The study included 500 HCWs who developed a microbiologically confirmed CVOID-19 infection. It was a predominantly middle-aged population with 247 unvaccinated and 253 vaccinated at the time of developing COVID-19. Only one-fourth of the population (26%) was working in the COVID-19 area and the source of COVID-19 to most was either a COVID-19 patient (39%) or a colleague (38%). Around 13% of the population had comorbidities with cardiovascular disease and diabetes being the most common. The majority of the patients were mild (71%) and most were treated at home in isolation (91%). Only 4% of the study population required intensive care. Among the vaccinated group, COVID-19 infection was predominantly mild and this difference was statistically significant as compared to the nonvaccinated. No difference was found in mortality among the two groups; however, the overall mortality was only 1%. Conclusions: SARS-CoV-2 vaccines reduce the severity of COVID-19 besides preventing infections and its spread. This can help in effective care of COVID-19 in home isolation without overburdening the health-care services. More studies including clinical parameters and microbiological components are required to understand the true extent of this protection of vaccines from severe forms of COVID-19.
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NOTCH and tumor necrosis factor-alpha converting enzyme levels could be used in COVID-19 for risk stratification p. 221
Dilay Karabulut, Gülçin Şahingöz Erdal, Cennet Yildiz, Gülsüm Oya Hergünsel, Umut Karabulut, Elif Binboğa, Nilgun Isiksacan
DOI:10.4103/injms.injms_52_22  
Background: Novel coronavirus disease-2019 (COVID-19) has become a public emergency that is characterized by a dysregulated immune response and hypercoagulable state. The purpose of the present study was to evaluate NOTCH and tumor necrosis factor-alpha converting enzyme (TACE) levels in COVID-19-infected patients and assess their predictive value on the severity of the disease. Methods: A total of 116 severe-critical COVID-19 patients who were interned intensive care were included in the study. The severity of the disease was evaluated according to the WHO classification system. Patients were divided into two groups according to their cTroponin T (cTnT) levels. Patients who had cTnT levels at least five times the upper limit of normal constituted Group 1 (n = 58); patients who had normal cTnT levels constituted Group 2 (n = 58). Besides, 62 age- and sex-matched healthy controls, who applied to cardiology outward clinic were taken as a control group (Group 3). All patients underwent echocardiographic examination. NOTCH and TACE levels were assessed using enzyme-linked immunosorbent assay. Results: The average age of the patients was 59.96 ± 15.46 years, 92 (51.7%) were female and 86 (48.3%) were male. The mean length of hospital stay was 16.35 ± 10.97 days. NOTCH levels were significantly higher in Group 1 patients compared to Group 2 and control group of patients P = 0.001). NOTCH levels of Group 2 were significantly higher compared to the control group (P = 0.002). Similarly, the TACE levels of Group 1 were significantly higher than that of Group 2 and the control group (P = 0.001). Mortality and length of hospital stay were significantly higher in Group 1 patients compared to Group 2 patients (P = 0.002 and P = 0.004, respectively). TACE levels of deceased patients were significantly higher than that of live patients (P = 0.004). There was a positive relationship between the length of hospital stay and NOTCH levels in Group 1 patients (r = 0.527, P = 0.003). TACE and NOTCH levels were positively correlated with troponin levels (r = 0.627 and r = 0.671, respectively P < 0.001 for both). NOTCH value of 0.34 nmol/L and TACE value of 6.53 μg/mL predicted inhospital mortality with a sensitivity of 90.30% and 63.6% and specificity of 91.5% and 78.6%, respectively. Conclusion: Measurement of NOTCH and TACE levels during severe acute respiratory syndrome coronavirus infection could be helpful for risk stratification.
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Clinical spectrum and outcome of guillain-barré syndrome with plasmapheresis p. 226
Safia Bano, Zomer Sardar, Muhammad Ahmar, Sumayyah Liaquat, Bilal Shafiq, Ahsan Numan
DOI:10.4103/injms.injms_50_22  
Context: Guillain-Barré syndrome (GBS) is an acute inflammatory neuropathy and has several electrophysiological subtypes and clinical variants. Treatment is mainly supportive and immunotherapy is given to shorten the disease course. Aims: The aim of this study was to define the outcome of GBS with plasmapheresis and to determine its clinical spectrum. Materials and Methods: The prospective study was done at Mayo Hospital, Lahore, for 1 year from November 2020 to November 2021. The diagnosis of GBS was made on Brighton criteria for GBS. The outcome of therapy was assessed at 3 and 6 months, using the Medical Research Council Scale and Hughes Functional Grading Scale (HFGS). Results: A total of 50 patients were enrolled in the study. Twenty-seven (54%) were males and 23 (46%) were females. Seventeen (34%) had acute motor axonal neuropathy, 16 (32%) had acute motor and sensory axonal neuropathy, 15 (30%) had acute inflammatory demyelinating polyradiculoneuropathy, and 2 (4%) had Miller-Fisher syndrome. Plasmapheresis was done in all patients. HFGS score was assessed at discharge, at 3 months, and after 6 months of illness onset. The improvement in mean HFGS score was 2.79 ± 0.41 at 3 months and 1.94 ± 0.25 at 6 months of symptoms onset from the mean score of 3.46 ± 0.93 at the time of discharge from the hospital. Conclusion: Excellent outcome was observed after plasmapheresis. Majority of participants were able to walk without support at the 6-month follow-up. Plasmapheresis should be initiated early in the management of GBS where intravenous immunoglobulins are costly.
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Use of reference management software among Allopathy, Ayurveda, and Homeopathy practices p. 231
Ellora Barman, Bhupen Barman, Arvind Nune, Arvind Nongpiur
DOI:10.4103/injms.injms_95_22  
Background: Reference management software (RMS) enable researchers to organize and manage large number of references that are typically identified during the publication of research articles. Aims and Objectives: The purpose of our study was to determine the extent to which faculties from allopathy, homeopathy, and Ayurveda use RMS for their academic pursuits and to identify which methods are used most frequently. Methods: The survey was circulated among the faculties of three different disciplines of the health-care system to collect respondent demographic details and questionnaire responses. Data distribution and variable type were used to perform descriptive analysis. Results: The data from 114/150 respondents were analyzed. Of the 114 faculties who responded to our survey, 72 (63%) reported using RMS to publish their articles. Knowledge of how to use RMS software is common in allopathic faculties (40%), followed by homeopathy (14%) and Ayurveda (9%). Zotero (41%) is the most popular RMS software among users, followed by Mendeley (31%) and Endnote (12%). Conclusion: Despite being underreported, RMS software is frequently used for the needs of authors from various disciplines in the health-care system.
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Evaluation of haller's cells prevalence in a sample of Polish population assessed using panoramic radiographs p. 236
Angelika Manaj, Aleksandra Osiak, Magdalena Piskórz, Karolina Futyma-Gąbka, Ingrid Różyło-Kalinowska
DOI:10.4103/injms.injms_68_22  
Introduction: Haller's cells are air structures with variable presence in individuals. They are situated in the anterior part of the ethmoid bone on the inferior and medial walls of the orbits. Their presence can be symptomatic and they may also be an impediment in surgical procedures. A panoramic radiograph commonly used in dental diagnostics allows visualization of their presence. The aim of the study is characteristics and estimation of Haller's cell prevalence in a sample of the Polish population based on panoramic radiographs. Materials and Methods: The study consisted of 467 panoramic radiographs including patients of both genders (303 females and 164 males), aged 17–23 years with a mean of 20.2 years. All radiographs have been evaluated for Haller's cells' presence, shape, number, and location with gender predilection. Results: Haller's cells were found in 72 cases, which comprised 15.4% of the studied group, with a slightly higher prevalence in females (17.82% in females and 10.97% in males). The most predominant shape was oval. Unilateral distribution of the cells outnumbered bilateral variants. One to three Haller's cells were found on one side, in the own material. Conclusions: Panoramic radiograph revealed a relatively low prevalence of Haller's cells in a sample of the Polish population. It is possible to assess the shape and determine the exact number of these cells. Based on the panoramic examination, we can state that they are located more often unilaterally with a slightly higher prevalence in females.
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Health-related quality of life and its association with depression in type ii diabetes mellitus patients: A cross-sectional study from Delhi p. 241
Kanika Singh, Anita Shankar Acharya, Sanjeev Kumar Rasania, Jyoti Khandekar, Rodney Preetham Vaz
DOI:10.4103/injms.injms_47_22  
Background: Diabetes mellitus is noncommunicable disease that in most cases affects the whole life after diagnosis with long-standing effects and debilitating complications. It is also one of the top five causes of mortality and contributes significantly to morbidity. Besides limitations and complications to physical health, it also significantly affects the mental health and affects the quality of life (QOL) among the patients. The current study aimed at finding the QOL among the patients living with diabetes. Methodology: A cross-sectional study was conducted among diabetic patients attending a diabetic clinic at a district hospital in East Delhi between December 2016 and March 2018. A total of 250 study subjects were included in the study. The Physical Health Questionnaire (PHQ 9) and the World Health Organization QOL-BREF questionnaire were used along with a pretested, semi-structured questionnaire for data collection. Data analysis was done on SPSS 23. Results: The prevalence of depression was found to be 17.6% as per the PHQ-9. Health-related QOL was highest for social domain (63.81 ± 12.74) and lowest among the psychological domain (40.83 ± 8.93) followed by environment (46.92 ± 8.34). The score of all the domains was lowest among depressed group as compared to nondepressed study subjects. Conclusion: Mental health can be adversely affected in the case of patients with diabetes which in turn can affect the QOL of the cohort. Hence, it is important to focus on mental well-being of the diabetics and timely intervention.
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CASE REPORTS Top

Exudative retinal detachment: An unusual ocular manifestation of syphilis p. 246
Belfaiza Soukaina, Abdellaoui Taoufiq, Fiqhi Issam, Mouzari Yassine, Reda Karim, Oubaaz Abdel Bar
DOI:10.4103/injms.injms_62_22  
Ocular syphilis is a disease known as a great simulator.It can affect the structures of the eye. It often manifests by an anterior uveitis. Posterior segment involvement is very rare and it is exceptionally complicated by exudative retinal detachment. We report the case of a patient with bilateral bullous retinal detachment in the context of ocular syphilis with a good evolution after treatment by penicillin G and corticotherapy.
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Large cell neuroendocrine carcinoma of the lung in posttuberculosis cavity p. 249
Mansoor C Abdulla
DOI:10.4103/injms.injms_23_22  
A 73-year-old male was admitted with hemoptysis for 2 months. He was diagnosed to have sputum-positive pulmonary tuberculosis 4 years back and was treated with antitubercular drugs for 6 months. Contrast-enhanced computed tomography (CT) of the thorax at that time revealed a cavitary lesion with surrounding consolidation in the right lower lobe of the lung. Contrast-enhanced CT of the chest during present admission showed a mass lesion in the lower lobe of the right lung, which was diagnosed as large cell neuroendocrine carcinoma of the lung on histopathological examination. We describe a patient who developed large cell neuroendocrine carcinoma of the lung in a posttuberculosis cavity which, to our knowledge, is the first such report.
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A paraneoplastic optic neuropathy revealing a pulmonary epidermal carcinoma p. 251
Yassine Mouzari, Issam Fiqhi, Belfaiza Soukaina, Taoufiq Abdellaoui, Mohammed Allaoui, Karim Reda, Abdel Bar Oubaaz
DOI:10.4103/injms.injms_42_22  
Paraneoplastic optic neuropathy is a relatively rare ocular manifestation. We report the case of a patient with bilateral papilledema revealing a pulmonary squamous cell carcinoma. Paraneoplastic neuropathy is linked to an immune reaction by the presence of autoantibodies against collapsin responsive mediator protein 5 . Diagnosis is based on the determination of these autoantibodies and the search for occult cancer by PET scan.Treatment is often based on corticosteroid therapy and sometimes immunosuppressive treatment is necessary in the case of corticosteroid unresponsiveness.
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Hemophagocytic lymphohistiocytosis after ChAdOx1 nCoV-19 coronavirus vaccination in a patient with no known comorbidities p. 254
Nitin Rai, Saumitra Misra, Shashank Prajapati, Shubhajeet Roy, Geeta Yadav
DOI:10.4103/injms.injms_80_22  
Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory condition where there is marked cytopenia and large-scale activation of macrophages and CD8+ cytotoxic T cells. HLH may be of two types – primary HLH caused by genetic abnormalities and secondary HLH due to infections, malignancies, autoimmune disorders, rheumatologic disorders, and metabolic dysfunctions. We describe a case of HLH following the first dose of the ChAdOx1 nCoV-19 Corona Virus vaccine. In this patient, there was no clear precipitant of HLH. The most probable explanation could be intense immune activation by vaccine constituents producing aberrant activation of inflammatory cytokines. There were no signs of infection or malignancy. Since our patient was clinically stable, his symptoms had resolved and HLH parameters had improved, no HLH-specific therapy was given.
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LETTERS TO EDITOR Top

Accessory spleen torsion simulating acute appendicitis p. 258
Yurisiel Montero Verdecia, Fernando Karel Fonseca Sosa, Yurisel Sánchez Pompa, Miriela Lisbet León Fonseca
DOI:10.4103/injms.injms_24_22  
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The posterior fossa intracranial pressure monitoring in neurocritical care: It is time to evaluate objectively in forbidden territories p. 260
Tariq Janjua, Luis Rafael Moscote-Salazar, William A Florez-Perdomo
DOI:10.4103/injms.injms_72_22  
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Acute hemorrhagic leukoencephalitis in COVID-19 infection p. 261
Mansoor C Abdulla
DOI:10.4103/injms.injms_71_22  
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Cutaneous leukocytoclastic vasculitis after ChAdOx1 nCoV-19 vaccine p. 263
Mansoor C Abdulla
DOI:10.4103/injms.injms_87_22  
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Cerebral edema: Role of insulin and insulin signaling pathways in the brain p. 265
Tariq Janjua, Luis Rafael Moscote-Salazar
DOI:10.4103/injms.injms_73_22  
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