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   2020| October-December  | Volume 11 | Issue 4  
    Online since December 2, 2020

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Effectiveness of physiotherapy management in knee osteoarthritis: A systematic review
Sharick Shamsi, Abdullah Al-Shehri, Khaled Othman Al Amoudi, Shabana Khan
October-December 2020, 11(4):185-191
Background: Osteoarthritis is a major cause of musculoskeletal disability. Nonpharmacological and nonsurgical treatment is preferred for the management of knee osteoarthritis (OA). However, evidences are lacking regarding the effectiveness of multimodal physiotherapy program including, combination of various physical modalities (TENS, IR, US etc.) with therapeutic exercises, for the management of knee OA. Objectives: To determine recent research evidences for the effectiveness of combination of physical therapy interventions for treatment of knee OA patients. Methods: This systematic review mainly includes randomized controlled trails. Searching done by Google scholar, Pub med and PEDro from 2010 to 2019. We used terms like-knee pain, OA, TENS, exercise, and physiotherapy management. Results: Present outcomes shows that physiotherapy treatment is effective technique in reducing pain in patients with Knee OA without adverse effects. After implementing the inclusion and exclusion criteria, 100 articles were retrieved using the key words, but only 10 articles were selected for the study. Conclusion: Electrotherapy modalities in conjunction with exercise therapy program designed for treating knee OA patients proved to be more superior to exercise alone at improving quadriceps muscle activation by reducing pain and increasing function during exercise.
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Stress-related disorders in health-care workers in COVID-19 pandemic: A cross-sectional study from India
Surabhi Mathur, Divya Sharma, Ram Kumar Solanki, Manish Kumar Goyal
October-December 2020, 11(4):180-184
Background: The coronavirus disease-2019 (COVID-19) outbreak, first detected in Wuhan, China, has turned into a rapidly spreading pandemic ailing the human race throughout the world. Health-care workers (HCWs) are under immense physical and psychological pressure, adversely affecting their efficiency and decision making. Aim: We hereby intend to study the impact of COVID-19 pandemic in HCWs in reference with a variety of factors. Materials and Methods: A nationwide cross-sectional online study using semi-structured pro forma along with the Adjustment Disorder New Module and the Depression, Anxiety, and Stress Scale-21 was conducted among 200 respondents. Results and Discussion: Of the 200 respondents, 174 (87%) were doctors and 26 nursing staff, with a mean age of 42.1 ± 12.2 years, 62% were male, and 63% were working in the government sector. A significant number of respondents were found to be suffering from acute stress (9.5%), depression (17%), and anxiety (19.5%) which they attributed to the negative professional and personal influence of this ongoing pandemic scenario. HCWs on the front lines of this pandemic are facing compounding stressors and need robust psychiatric help to adequately take care of this need.
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Burnout of resident doctors in a teaching hospital in Jordan
Raed Nael Mohammad Al-Taher, Mohamad E Mahseeri, Rawan Abd AlMohsen Mohammad Al Habashneh, Moaath Alsmadi, Amal Ibrahim Abd Al Qader Abu Harb, Nadwa Basem Basheer Bustami, Awni D Shahait, Lana Alghanem, Fadi Alhalasa, Farah Moh'd Bassam Mutlaq Al Muhtaseb, Murad Mohammad Subhi Qirem, Shahd Maher Abdel Rahman Yaghi
October-December 2020, 11(4):192-196
Background: Burnout syndrome in the medical field recently gained much attention, becoming an essential factor in specialty selection and job satisfaction. In this study, we focus on evaluating the emotional distress among residents of various specialties at a tertiary hospital and associated factors. Methods: This is a cross-sectional study which was done using a sociodemographic questionnaire among residents of various specialties. The collected answers were assessed using Student's t-test and Chi-square test for continuous variables and categorical ones respectively. Results: A total of 250 out of 382 registered residents took the survey with a response rate of 65%, 48% were female, 67.1% single, mean age 27.5 ± 2.2, and mean weekly duty work was 71.8 ± 22.6. 53.6% of residents reported a high grade of emotional exhaustion. Furthermore, 82.4% of the residents exceeded the 24-shift length, reaching a maximum of 56 h straight in-house duty. Male residents reported a higher rate of feeling pressured to work, while female residents reported that they would learn more effectively and commit fewer errors if they slept more. Conclusion: This is the first Jordanian study to measure elements leading to resident emotional distress and its effect on personal achievement. The prompt recognition of risk factors is essential for the achievement of prophylactic actions against resident emotional distress, which can be minimized by a well-defined regulation for residency working hours.
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The race to find COVID-19 Vaccine: So near, yet so far!
Sonali Sachdeva, Udita Gupta, Anupam Prakash, Shubha Laxmi Margekar, Ritika Sud
October-December 2020, 11(4):175-179
In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the first case was reported in Wuhan, China in December 2019. The pace at which the virus is being transmitted across the globe and the sudden increase in numbers of cases is much faster than severe acute respiratory syndrome and Middle East respiratory syndrome. With the rising number of cases, coronavirus disease 2019 (COVID-19) not only has an adverse effect on health, it has a deep seated impact on the economic and social front. Hence, the development of an effective vaccination strategy seems to be the only light at the end of the tunnel. The ongoing pandemic mandates the speedy evaluation of multiple approaches in order to elicit protective immunity and to curtail unwanted immune-potentiation which plays an important role in the pathogenesis of this virus. Being developed by more than 90 institutions in the world, a vaccine which is both effective and safe becomes all the more essential in the current time. Various types of vaccine strategies are being tested under different phases of clinical trials. The present paper hopes to provide an overview of the current work going on in this direction, with an aim to further fuel effects for an early and effective COVID-19 vaccine platform.
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Comparative analysis of rheumatoid factor levels by immune turbidimetry and latex agglutination assays among anti-cyclic citrullinated peptide-positive rheumatoid arthritis patients
Bineeta Kashyap, Rituparna Saha, Krishna Sarkar, Narendra Pal Singh
October-December 2020, 11(4):207-211
Background: Rheumatoid arthritis (RA) is one of the most common contributors to the burden of chronic and debilitating polyarthritis. Materials and Methods: Over a period of 3 months, 264 symptomatic patients were tested for the presence of anti-cyclic citrullinated peptide (CCP) antibodies, and the first 50 patients with RA whose serum samples tested positive for anti-CCP (>10 AU/ml) were included in the study. Immune turbidimetric assay was employed to determine the titers of rheumatoid factor (RF) in patients of RA who have tested positive for anti-CCP and its performance was compared with latex agglutination testing modality. Results: Majority (82%) of the study population were female with a male-to-female ratio of 1:4.6. Latex agglutination test for RF using RHELAX-RF test kit yielded RF values ≥10 IU/ml in 31 (62%) patients, while the Immunoturbidimetric test: SPECTRUM RF Test Kit imparted RF titers ranging between 2.4 and 53.76 IU/ml, with a median RF titer of 22.22 IU/ml. The percentage agreement between the latex agglutination and immune turbidimetry assay for analyzing RF was 88%, with a strong positive correlation between latex agglutination and immune turbidimetry assay for RF (Spearman coefficient: r = 0.8097). Conclusion: Since the updated American College of Rheumatology/European League Against Rheumatism classification of RA underscores the precise titers of RF and anti-CCP in scoring RA, absolute titers of RF conferred by the immunoturbidimetry could be a welcome relief to slash inter-observer variations and hand out titers to better classify and treat patients of RA.
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Unlocking the mental health crisis in health-care providers during COVID-19 pandemic
Jasmine Parihar, Kirat Grewal
October-December 2020, 11(4):173-174
  3,075 257 1
Scrub and spleen: Scrub typhus with a splenic infarct
Cynthia Amrutha Sukumar, Arya R Poduval, Nandakrishna Bhat, Sudha Vidyasagar
October-December 2020, 11(4):223-225
Scrub typhus is a mite-borne infection endemic in India. Among the spectrum of complications associated with this tropical illness are manifestations such as encephalitis, acute respiratory distress syndrome, myocarditis, hepatomegaly, splenomegaly, and pancreatitis. Although splenomegaly is a known association among the gastrointestinal complications, splenic infarcts are sparsely reported in the literature. This case is about a woman with scrub typhus who presented with unexplained pain abdomen which was diagnosed as a splenic infarct.
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Comparison of pulmonary functions in petrol pump workers and residents of oil refinery
Satyanath Reddy Kodidala, Ali Mohamad Ahanger, Asha Gandhi
October-December 2020, 11(4):197-200
Background: Health of human beings depends on their environment. Petrol pump workers (PPWs) are exposed to petrol/diesel fumes containing toxic compounds, which may affect the capability of lungs. Similarly, residents living around the oil refinery are exposed to pollutants, which may have deleterious effects on pulmonary health. Objectives: The study aimed to assess pulmonary function tests (PFTs) in residents living near an oil refinery and PPWs and compared with the control group. Materials and Methods: The study group (age: 20–45 years) comprised PPWs in Mathura district generally exposed to petrol fumes as well as dust particles and residents living within 5 km of Mathura oil refinery. Control group comprised unexposed staff residing in the campus. PFT values were recorded and compared in the three groups. Results: Lowering of mean PFT values in residents and PPWs was observed. Forced vital capacity (FVC) (L), forced expiratory volume in 1 s (FEV1) (L), FEV1/FVC, and peak expiratory flow rate (L/s) were, respectively, 3.37, 2.93, 87.25, and 8.44 in control group (C); 3.09, 2.61, 85.2, and 7.94 in PPW and 3.0, 2.58, 86.0, and 7.94 in residents (R). Maximum ventilatory volume and forced expiratory flow rate 25–75% were also reduced in the latter groups. Conclusion: Acute exposure to a polluted environment results in an alteration of pulmonary functions.
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Study of microalbuminuria in acute ischemic stroke and its correlation with severity
Dhiraj Kumar Gaurav, Rupali Malik, Anita Rani, Abha Dua
October-December 2020, 11(4):212-216
Introduction: With the rising incidence of noncommunicable diseases such as stroke in low- and medium-income countries like India, it has become imperative to identify the potentially modifiable risk factors and focus on prevention. Microalbuminuria (MA) is now gaining recognition as an independent risk factor for ischemic stroke. It has also been studied as a prognostic marker for acute ischemic stroke. Thus, it was intended to study MA in acute ischemic stroke and its correlation with stroke severity. Methods: A single-center case–control study was done after enrolling seventy cases of ischemic stroke with age between 40 and 65 years, satisfying inclusion and exclusion criteria during a span of 2 years. Fifty patients in the age group of 40–65 years with no history of stroke and transient ischemic attack and fulfilling the exclusion criteria were taken as control. All cases were subjected to detailed history, systemic clinical examination, and biochemical and radiological investigations with assessment of National Institutes of Health Stroke Scale (NIHSS) for grading of severity of ischemic stroke with semi-quantitative measurement of MA (urinary albumin: creatinine ratio). Results: Hypertension (62.86%), diabetes mellitus (34.29%), and smoking (27.14%) were found to be the major risk factors for acute ischemic stroke. MA was present in 48.57% of cases, whereas in the control group, MA was present only in 18% of patients. Our study showed MA as an independent risk factor for acute ischemic stroke. On multivariate logistic regression analysis of risk factors of acute ischemic stroke, odd ratio for MA was 4.312 with P = 0.005. In our study, cases with mean NIHSS 17.71 and median NIHSS 18 were positive for MA, while cases with mean NIHSS 13.03 and median NIHSS 12 were negative for MA, that is, cases with higher mean and median NIHSS were positive for MA. This association of MA with NIHSS was statistically significant (P = 0.036). Conclusion: MA was found in approximately half of the patients studied with acute ischemic stroke, and there was a significant association between MA and higher NIHSS.
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Rare or rarely detected: Septic pulmonary embolism with tricuspid valve infective endocarditis after an unsafe abortion
Barun Kumar, Gaurav Chauhan, Shishir Soni, Anupam Singh
October-December 2020, 11(4):226-228
Septic pulmonary embolism (SPE) with isolated tricuspid valve infective endocarditis (TVIE) after an unsafe abortion is an uncommon condition. However, unsafe abortion is common among reproductive-age women, especially in underdeveloped and developing countries contributing significantly to increased maternal mortality. As infective endocarditis and SPE are likely to be missed in transthoracic echocardiography and chest X-ray, respectively, in its incipient stage, there is a possibility that many cases of SPE with TVIE following such a predisposing condition may remain undiagnosed. We report a case of 26-year-old female with recent unsafe abortion who was diagnosed to have SPE with TVIE. Her clinical course depicts the possibility of missing the diagnosis, especially if subtle findings are overlooked that are emphasized in this case report.
  2,359 154 1
Nitroimidazole-induced reversible neurotoxicity
Dinesh Chouksey, Amandeep Singh, Nitisha Goyal, Ajoy K Sodani
October-December 2020, 11(4):220-222
The nitroimidazole group of drugs is commonly used in India and worldwide for diarrhea and other indications. People are taking it over the counter for their subsequent problems without consultation, and this is harmful to them on chronic use. Similarly, many indications such as amoebic liver abscess need long-duration therapy of these drugs which may present with its toxic effects. We report two cases of metronidazole and ornidazole overuse presented as central and peripheral nervous system toxicity. The magnetic resonance imaging changes similar to nitroimidazole drug toxicity can be seen in many other diseases, and it needs to correlate with a good history for the diagnosis to avoid unnecessary workup burden to the patient.
  2,357 139 1
A comparative study of interventions in spinal extranodal Non-Hodgkin's lymphoma: A single-center case series from North India
Shankar Acharya, Manoj Kumar, Nitin Adsul, Prem Shahi, Rupinder Singh Chahal, KL Kalra
October-December 2020, 11(4):201-206
Introduction: Non-Hodgkin's lymphoma (NHL) is highly sensitive to chemotherapy and responds to adjuvant chemotherapy within days. Review of literature reveals very limited studies with low statistical significance that compare the surgical and nonsurgical outcomes of spinal NHL. This study aims to compare the surgical and nonsurgical outcomes of spinal extranodal lymphoma causing metastatic spinal cord compression (MSCC). Materials and Methods: We retrospectively analyzed the treatment records of 14 cases out of 32 cases with biopsy-proven diagnosis of NHL involving the spinal column from January 2014 to January 2020. Five (35%) cases were managed nonsurgically with chemotherapy and 9 (64%) patients were managed surgically with adjuvant chemotherapy. Variables taken for evaluation were Karnofsky Performance Status (KPS), Frankel Grade, Spinal Instability Neoplastic Score, Ann Arbor Staging System, and International Prognostic Index (IPI) score. Results: The mean age was 51.9 ± 9.6 years and the median follow-up was 32.5 months. The most study population belonged to Grade III and IV Ann Arbor classification. At final follow-up, 100% of patients in the nonsurgical group and 66% in the surgery group were able to carry out normal activities (KPS >70). All three reported deaths occurred in the intervention group (KPS ≤40) and all deaths occurred within the 6 months of surgery. Conclusion: Primary chemoradiotherapy is mainly indicated in patients of nonemergent mild-to-moderate (Frankel grade >C) neurological deficit patients. Combination therapy (chemotherapy + surgery) is indicated in patients with emergent severe neurological deficit (Frankel Grade A, B, and C), spinal instability, and patients not responding to systemic or adjuvant chemotherapy.
  2,254 158 1
Amyloidosis presenting as a solitary nasal mass
Suvir Singh
October-December 2020, 11(4):217-219
Amyloidosis is characterized by extracellular deposition of amyloid fibrils. Localized collection of amyloid material in the form of a mass is extremely rare. Mr. M presented with epistaxis and was found to have a friable mass in the right maxillary antrum. Excision was followed by the resolution of symptoms, and histopathology revealed subepithelial collection of amorphous pink material. It was positive for methyl violet and Congo red stain and showed apple-green birefringence. Staining for serum amyloid A and kappa/lambda light chains were negative. Workup for multiple myeloma, positron emission tomography scan for other masses, and screening for end-organ damage was also negative. He continues to be asymptomatic on observation 1-year after presentation. Amyloidosis presenting as a nasal mass has been described in less than five patients so far. Local excision appears to be the best treatment and is associated with a low risk of recurrence on long-term follow-up.
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Rapunzel syndrome
Juan Guillermo Bauzá López, Fernando Karel Fonseca Sosa, Anival Ernesto Ramos Socarrás, Delmis Esther Montero Verdecia
October-December 2020, 11(4):229-230
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