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   Table of Contents - Current issue
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September-December 2020
Volume 47 | Issue 3
Page Nos. 139-198

Online since Thursday, January 21, 2021

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EDITORIAL  

Significance of tissue banking in biomedical research Highly accessed article p. 139
Shridhar C Ghagane, Rajendra B Nerli
DOI:10.4103/jss.JSS_126_20  
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REVIEW ARTICLE Top

Health-care databases and its role in transformation of medicine p. 141
Lakshmi Venkata Simhachalam Kutikuppala, S V Venu Gopal Raju, Sadhana Jonna, Tarun Kumar Suvvari, Navya Reddy Veeramreddy
DOI:10.4103/jss.JSS_67_20  
Health-care database is a collection of health-care data organized for storage, accessibility, and retrieval. Health-care database serves to replace the paper documents, filing cabinets of old, and file folders, which will be more convenient and immediate. At present, health-care system is in a transition from a patient care perspective toward information-based medicine requiring data from various sources such as laboratory tests, genetic tests, medical images, family histories, and patient medical records, which need to be easily stored, integrated, and analyzed. The most commonly used database in health care is the online transaction processing (OLTP) database among different types of databases available. OLTP database is the one that is a single computer application runs on, and the main strength of it is quick and real-time transaction processing. Electronic health record is a prime example of the OLTP, and practitioners enter routine clinical and laboratory data into them during usual practice as a record of the patient's care. Data can be stored externally in a secure place and can be backed up to prevent data loss with these health-care databases. The back-end data can therefore become more accurate and standardized because of the front-end software providing tip text and enforce data. Furthermore, the health-care database allows the rapid processing of classical transactions such as laboratory results and payment claims as the data are computerized.
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ORIGINAL ARTICLES Top

Viral load and genotype of recent hepatitis E virus outbreak in Chittagong, Bangladesh Highly accessed article p. 144
Rajat Sanker Roy Biswas, Syduzzaman Sydu, Shaikh Md Hasan Mamun, Sanjoy Kanti Biswas, Nahid Sultana, Austin Sequeira, Jean Bishop
DOI:10.4103/jss.JSS_42_19  
Introduction: There is an outbreak of hepatitis E virus (HEV) infection in Chittagong, Bangladesh in the year 2018. Due to unavailability of data of HEV infections in this region, objectives of the present study are to find the viral load and genotype the HEV infections. Methods: It was an observational study done in a tertiary care hospital during one year. A total of 125 Ig-M HEV positive cases were recruited tested by ELISA. After collection blood samples those were sent to Sliea Gen L.L.C, Texas, USA for detection of viral load and genotype maintaining proper procedure. Ethical clearance was taken from the hospital authority and informed written consent was taken from all patients and funding was provided by Sliea Gen L.L.C. USA. Results: Among the total 125 study patients, male was 90(72') and female was 35(29') where 7(5.6') were pregnant. Among them most 45(36.0') were at age group 30-40 years. Mean ± SD of age was 33.78 ± 14.29 years. All (100') cases were Ig-M Anti HEV positive and 9(7.2') cases were also positive for HBsAg, 1(0.8') cases were Anti HCV positive and none was Anti HAV positive. Regarding viral load Log 4-6 were found in 55(44.0') cases and >Log 6 were found in 23(18.4') cases and again 30(24.0') cases had 1000-10,000 IU/ml, 25(20.0') cases had 1,0,000-1,00,000 IU/ml and 23(18.4') cases had 1.00,000- 10,00,000 IU/ml viral load. Genotype 1F was found in 68(54.4') cases as the only genotype and no other genotype was found in the sample. Conclusion: So, in this region Chittagong, Bangladesh genotype 1F is the main genotype found and also they showed variable viral load.
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Social impact of tracheostomy: Our experiences at a tertiary care teaching hospital of Eastern India p. 148
Santosh Kumar Swain, Satyabrata Acharya, Somadatta Das
DOI:10.4103/jss.JSS_61_20  
Background: Tracheostomy is a common surgical procedure performed in upper airway obstruction or in critically ill patients requiring prolonged ventilation. Although tracheostomy is a life-saving surgery, it is associated with higher rates of morbidity along with social stigma if stays for longer period. Although there are several studies for indications, complications, and different techniques for tracheostomy, but majority do not provide any insight into social impact of tracheostomy. Objective: The objective of this study is to assess the social impact of tracheostomy at a tertiary care teaching hospital. Materials and Methods: This is a retrospective observational study. The study was carried out from December 2017 to January 2020.There were 34 tracheostomy patients participated in this study. The observed complications in tracheostomy patients such as surgical/medical and social issues were documented. We conducted structured interviews with care givers of patients with tracheostomy. Results: Medical or surgical complications included excess mucus production (61.76'), infections at the stoma site (23.52'), blockage (17.64'), granulations around the stoma (11.76'), and maggots at the stoma (2.94'). The social impacts on tracheostomy patients included family reluctance to accept the patient with tracheostomy tube, unable to communicate and problems in social integration. Conclusion: Tracheostomy has several ranges of effects on quality of life of care givers and patients with tracheostomy. The management of social stigma associated with permanent tracheostomy is more challenging than any other complications due to tracheostomy procedure itself. It can be solved with proper counseling with family members those involved with patients.
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Human herpesvirus-8 latent nuclear antigen-1 expression in kaposi's sarcoma cases as seen in Nnewi, Anambra State: (A 10-year retrospective study) p. 153
Felix Emeka Menkiti, Cornelius Ozobia Ukah, Kayode A Adelusola, Ifeoma Florence Ezejiofor
DOI:10.4103/jss.JSS_46_19  
Background: Human herpesvirus-8 (HHV-8) is a recognized major causative agent of Kaposi sarcoma (KS). Latent nuclear antigen-1 (LNA-1) is constitutively expressed in all HHV-8-infected cells. The index study emphasizes the role of immunohistochemistry in the diagnosis of KS in Nnewi, Anambra State, Nigeria. After thorough searches in Google Scholar and PubMed, we discovered that our study is the first to employ HHV-8 LNA-1 immunohistochemistry in the diagnosis of KS in Nigeria and other parts of Africa. Materials and Methods: It is a 10-year retrospective analysis of all histopathologically diagnosed KS cases from the archives of both Nnamdi Azikiwe University Teaching Hospital and Pathocon Specialist Clinic and Research Institute Nnewi. Pathology report forms of all KS cases and their blocks were retrieved and recut, and the recut slides were reviewed to confirm the cases. Of the 69 cases of KS retrieved, only 58 that met the inclusion criteria were analyzed using HHV-8 LNA-1 immunohistochemical stains. Results: Of these 58 cases, 20.7' were KS mimickers misdiagnosed as KS while 79.3' were true KS. Confirmed or HHV-8 LNA-1-positive KS cases accounted for 1.3' of all solid malignancies and 15.7' of all sarcomas, with majority presenting as cutaneous lesions mainly involving the lower limb (52.2') and predominantly (69.6') in nodular stage. Conclusion: HHV-8 LNA-1 is an important immunohistochemical marker in confirming diagnosis of KS.
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Prevalence of depression, anxiety, and stress among medical students in a developing country during the COVID-19 pandemic: A pilot study p. 158
Arunima Chaudhuri, Tanushree Mondal, Ayan Goswami
DOI:10.4103/jss.JSS_59_20  
Background: COVID-19 pandemic has the potential to significantly affect the mental health of Medical professionals as well as Medical students, as they stand in the frontline during this hour of crisis. Aims: The aim is to assess mental health of undergraduate medical students and particularly in relation to the prevalence of anxiety, depression and stress in a Medical College of Eastern India. Materials and Methods: This cross-sectional pilot study was conducted in a Medical College of Eastern India after taking Institutional clearance and informed consent of the subjects. Three hundred and nine-two subjects participated in the present study. A link was created with the help of a Google form with depression, anxiety and stress scale-21 and demographic variables. The students were also asked to give a feedback on the online teaching program provided by the college. Statistical Analysis: Data were tabulated into excel sheet and analysis was done. Results: Among the 392 subjects who participated in the study 278 (70.92') subjects had normal stress scores, i.e., between 0 and 14; 114 (28.97') had stress score 15 or more; 6 (1.5') had stress scores 34+ (extremely severe stress), 14 (3.5') had stress scores between 26 and 33 (severe stress), 29 (7.39') had stress scores between 19 and 25 (moderate stress), 65 (16.58') had scores between 15 and 18 (mild stress). Two hundred and sixty-three (67.091') had normal anxiety scores between 0 and 7; 129 (32.9') had anxiety scores 8 or more. 15 (3.82') had anxiety score 20+ (extremely severe anxiety); 11 (2.81') had anxiety scores between 15 and 19 (severe anxiety); 64 (16.33') had anxiety scores between 10 and 14 (moderate anxiety); 39 (9.85') had anxiety scores between 8 and 9 (mild anxiety). Two hundred and sixteen (55.11') had normal depression scores between 0 and 9; 176 (44.89') had depression scores 10 or more. 24 (6.1') had depression score 28+ (extremely severe anxiety); 23 (5.86') had depression scores between 21 and 27 (severe depression); 70 (17.85') had depression scores between 14 and 20 (moderate depression); 59 (15.05') had depression scores between 10 and 13 (mild depression). Depression and stress scores were positively correlated with r = 0.765; depression and anxiety scores were positively correlated with r = 0.63; stress and anxiety scores were positively correlated with r = 0.73.77.4' of the students felt that during the lockdown period online support, regular assessment, feedback provided by the college were satisfactory. Conclusions: High scores of depression, stress and anxiety were observed among Medical students in this pilot cross sectional study. Longitudinal follow-up is necessary to study the impact of the present crisis on medical students.
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Determination of ovarian reserve in different age groups of infertile women p. 164
Saima Wani, Shaheera Ajaz, Lubna Rashid, Javid Ahmed, Rabiya Khurshid, Aabida Ahmed
DOI:10.4103/jss.JSS_44_20  
Background: Infertility is a major global issue, and the childbearing potential can be estimated by determining the ovarian reserve. Ovarian reserve is described as a quantity of the ovarian follicles and quality of oocytes. Aims and Objectives: The objective of our study was to identify the correlations between follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), and antral follicle count (AFC) in different age groups of infertile women and to distinguish the most reliable marker for ovarian reserve with the objective of selecting a strategy for initial stages of infertility management. Materials and Methods: In this prospective study, 101 infertile women were assessed. The study participants were divided into three age groups: 20–29 years, 30–39 years, and >40 years. FSH, LH, AMH, and AFC were done on day 2–3 of menstrual cycle. Results: A total of 101 infertile women were assessed in our study. The mean age of the participants was 33.3 ± 4.37 years and the mean infertility period was 3.36 ± 2.26 years. The mean body mass index was 23.75 ± 2.97 kg/m2. The mean FSH level was 8.18 ± 5.54 and the mean AMH was 1.98 ± 1.0. The mean AFC was 9.29 ± 5.09. There was a statistically significantly elevated negative correlation between age and AMH level (rs = -0.667, P < 0.0001) and AFC (rs = -0.64, P < 0.0001). We observed a statistically significantly positive correlation between age and FSH (rs = 0.569, P < 0.0001). The correlation analysis performed in separate groups showed that AMH and AFC showed a statistically significant positive correlation for Group I (r = 0.953, P < 0.0001), Group II (r = 0.966, P < 0.0001), and Group III (r = 0.865, P < 0.001). A statistically significant negative correlation between FSH/LH and AMH was detected only in Group II (r = -0.661, P < 0.0001) and Group III (r = -0.735, P < 0.003). A statistically significant correlation existed between FSH and AFC in Group II (r = -0.657, P < 0.000), Group III (r = -0.664, P < 0.01), as well as between age and FSH only in Group III (r = 0.551, P < 0.04). Conclusion: AMH is more reliable marker of ovarian reserve compared to FSH/LH as the correlation between AMH and AFC is strongly positive. AMH can detect decrease in ovarian reserve much earlier than FSH/LH. The use of AMH combined with AFC definitely improves the evaluation of ovarian reserve in all age groups of infertile women.
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Exploring perceptions and experiences of community people toward chhaupadi culture in Nepal: Social-ecological approach p. 168
Prayag Raj Joshi, Ram Krishna Maharjan
DOI:10.4103/jss.JSS_54_20  
The Chhaupadi culture contributes to the huge proportion of mother and infant mortality in Nepal. Despite a large provision in eliminating this culture in the last almost decades, the culture remains constant. The Chhaupadi Pratha after childbirth is still in practice, especially in Far-western province. Several quantitative studies described the Chhaupadi culture and some qualitative studies have also carried out on exploring the perceptions of community people regarding Chhaupadi culture, but most of the studies had taken this practice as only for monthly menstruation. To fill this gap, I aimed at exploring the perceptions of community people and their experiences related to Chhaupadi Pratha in Kailali district. A prospective qualitative study was conducted among thirty mothers and five other key informants from Godawari municipality. Data were collected through in-depth interviews, key informant interviews, and focus group discussions. Data analysis was guided by the Kenneth McLeroy's social-ecological model (SEM) including five levels of factors which influenced the maternal and child health (MCH) care practices of mothers. While mothers showed little decision-making autonomy, interpersonal factors played an important role in their use of modern health services. Besides, community and social factors as well as organizational and health system factors also shaped mothers' MCH care practices. To improve the MCH care practices of mothers, all the five levels of SEM should be taken into account while developing health programs targeting mothers.
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Correlation between ocular sun exposure and pterygium: A hospital-based study p. 176
Iqra Mushtaq, Renu Maghdum, Deepaswi Bhavsar, Banyameen Iqbal
DOI:10.4103/jss.JSS_34_20  
Background: The term “pterygium” comes from the Greek word “Pterygos,” which means “wing.” The major predisposing factors are the hot and dry climate and long periods of ultraviolet light exposure. Epidemiological studies have revealed that the prevalence of pterygium is inversely related to latitude, and that it is greater among outdoor workers than indoor workers. Although sun exposure has been accepted as a risk factor for pterygium, there is no objective diagnostic tool to measure the total amount of sun exposure of an individual. Materials and Methods: This is a prospective study carried out for a period of 1 year on 100 eyes with pterygium. Demographic variables including age, sex, residence, education, income, smoking, alcohol drinking, exercise, and especially sun exposure were collected from interviewing the patients as per the pro forma. Their occupation was categorized according to the fields of profession. A detailed eye examination which included slit-lamp examination, visual acuity, refractive status, and size of the pterygium was recorded. The size of the pterygium was measured in millimeters from its apex to the limbus using the slit-lamp beam. Pterygium was graded, depending on the extent of the corneal involvement, and all the patients were divided into five grades (Grades I to V). Results: Out of 100 pterygia, 89' were located nasally, whereas only 11' were temporal. Nearly 84' of the total pterygia were found in unilateral eyes, whereas only 16' were seen in bilateral eyes. The male-to-female ratio was 1.8' (65 males: 35 females). Nearly 35' of the pterygia were seen in middle-aged males (41–60 years), followed by 20' in 21–40 years' age group. Grade III pterygium was seen in 15' of male patients in 41–60 years' age group, whereas only 8' were seen in the same age group in females. Maximum number of patients having pterygium 10' (Group B) and 15' (Group C) showed a maximum duration of daylight exposure of 8 and 10 h, respectively. Conclusion: This study shows that outdoor work and sunlight exposure are positively associated with the development of pterygium. Besides sun exposure, other factors which favor pterygium formation such as dusty environment, smoking, and genetics should also be taken into consideration, and further research should be done to ascertain their role in pterygium formation. Public education should focus on encouraging people to take appropriate protective measures, such as wearing sunglasses and brimmed hats when outdoors, and to avoid unnecessary sunlight exposure.
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Significance of human epidermal growth factor receptor 2 neu immunostain in head and neck squamous cell carcinoma p. 180
Ponkhi Doley, Srinivasamurthy Venkataramanappa, Panduranga Chikkannaiah
DOI:10.4103/jss.JSS_60_20  
Introduction: Squamous cell carcinoma is the most common head and neck cancer. In spite of advances in the diagnosis and treatment, a prognosis still remains poor. Head-and Neck squamous cell carcinoma (HNSCC) is found to express human epidermal growth factor receptor 2 (Her 2) neu marker. Materials and Methods: The present study was conducted for a period of 1 year from January to December 2017. All the cases which have been pathologically diagnosed as HNSCC were included in the study. Results: During the study period, a total of 50 cases were observed. Male: female ratio was 1.7:1. In our study, buccal mucosa was the most common site (26'). Well-differentiated morphology was more common (36'), and 34' cases were positive for Her 2 Neu expression. Conclusion: Her 2 neu expression may not be a reliable molecular prognostic marker for HNSCC.
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CASE REPORTS Top

Giant ureterocele management in an adult male: A rare case report p. 185
G Ajay Kumar, B S R Prasad Babu, A Lavakumar, A Sindhuri
DOI:10.4103/jss.JSS_28_20  
Ureterocele is dilatation of lower ureter at its entry into the urinary bladder. It is classified into the single or duplex system and acquired or congenital. Acquired type is rare and seen in adults. We report the case of a 23-year-old male presented with voiding lower urinary tract symptoms and intermittent flank pain. He had a history of frequent spontaneous stone passage with right colicky pain 2 years back. On ultrasonogram and magnetic resonance urogram, diagnosis was made as right renal hydronephrosis with hydroureter due to right side giant intravesical ureterocele. The patient was managed by endoscopic transurethral incision and excision of ureterocele. It is the first case ever reported in the literature, where in giant ureterocele was completely removed by total endoscopic approach.
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Amyloidosis of submandibular lymph node masquerading as a salivary gland tumor: A rare case report with review of literature p. 188
Snigdha Mukharji, KP Shruthi, Amit Date, S Sudhamani, Rajiv Rao
DOI:10.4103/jss.JSS_55_20  
Amyloidosis is a disease characterized by the extracellular deposition of fibrillary proteins causing organ dysfunction. Submandibular lymphadenopathy is a rare clinical presentation of amyloidosis. Majority of the patients progress to develop systemic diseases and usually have AL amyloidosis. Here, we report a case of a 40-year-old male, who presented with a left submandibular swelling for 3 years. The clinical diagnosis was malignant submandibular salivary gland tumor. Systemic examination was unremarkable. Histopathological examination of the excised swelling revealed effacement of lymph node architecture by an eosinophilic Schiff poor material. Positive Congo red stain with apple-green birefringence on polarization confirmed it as amyloidosis. Serum protein electrophoresis was negative for M Band. Immunohistochemistry revealed kappa light-chain restriction in the deposits, characterizing it as localized primary amyloidosis of the submandibular lymph nodes.
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Giant fibroid polyp mimicking uterine inversion p. 192
Subrata Das
DOI:10.4103/jss.JSS_77_20  
A multiparous postmenopausal woman presented with continuous bleeding per vagina along with a large cervical polyp, protruding through introitus simulating uterine inversion. She was stabilized by five-unit packed-cell blood transfusion. After initial diagnostic confirmation, she was treated by polypectomy. Further investigations revealed it to be a giant fibroid polyp of benign nature arising from cervix. She was amenorrheic on the next 12 months of follow-up.
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SHORT COMMUNICATIONS Top

Health system response to the coronavirus disease 2019 pandemic-induced violence against women p. 195
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_56_20  
The coronavirus disease-2019 (COVID-19) pandemic has affected all the sections of the community, while the situation pertaining to women and girls is complex, as they have been subjected to incidents of violence. Even though, the data on violence against women during the ongoing COVID-19 emergency is not adequate, nevertheless reports of rising incidence of domestic violence has been reported. The outbreak has resulted in a stressful condition with disruption in the daily routine and has even accounted for financial hardships. From the public health perspective, such a risk just cannot be ignored and we have to be prompt in addressing these needs during even emergencies. In general, the health care delivery system has a crucial role to ensure that victims of violence remain safe and accessible during the entire outbreak. In conclusion, the COVID-19 pandemic has accounted for a simultaneous rise in the incidence of violence against women and thus the health sector has to improve their preparedness to respond to the challenge and ensure that the rights of women are not violated.
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Ensuring delivery of sexual and reproductive health and rights amidst the ongoing coronavirus disease 2019 pandemic p. 197
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_58_20  
The ongoing coronavirus disease-2019 (COVID-19) pandemic is a public health emergency of global concern and has very high potential for the transmission across the world. As the whole world is fighting the battle against this novel viral infection, a series of capacity building and strengthening measures has been implemented across different settings to break the chain of transmission and reduce incidence of case as well as attributed deaths. However, from the perspective of women, some of the lifesaving reproductive health services have been compromised and there is a definite possibility of a rise in the incidence of gender-based violence. In the global mission to attain universal health coverage, there is an indispensable need to not ignore these essential obstetric care services, otherwise we will lose all the gains achieved so far. In conclusion, the COVID-19 pandemic is expected to interfere with the routine delivery of essential and emergency obstetric care. Thus, it is the need of the hour to take appropriate measures and improve the preparedness level to ensure that even during these times we sustain the delivery of quality assured sexual and reproductive health services.
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