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   Table of Contents - Current issue
Coverpage
January-April 2021
Volume 48 | Issue 1
Page Nos. 1-53

Online since Wednesday, May 5, 2021

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EDITORIAL  

Scope of liquid biopsy in urological malignancies p. 1
Shreya Chandra, Rajendra B Nerli
DOI:10.4103/jss.jss_23_21  
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REVIEW ARTICLES Top

Implementing foundation course for medical undergraduates in India Highly accessed article p. 3
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_11_21  
The delivery of medical education to the undergraduate medical students and producing a competent medical graduate is a complex task, especially considering the wide range of domains, in which a medical student has to be trained. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of four studies similar to the current study objectives were identified initially and all were selected based on the suitability with the current review objectives. In an effort to make the newly joined students get familiar with the campus environment and the general structure of the academic program, a month-long foundation course has been proposed. The regulatory body emphasized the need to evaluate the foundation course at institutional level so that it can be improved based on the received feedback for the upcoming batches of students. To conclude, the introduction of foundation course as a part of the competency-based medical education for undergraduate students is a welcome step. The foundation course has the potential to offer multiple benefits to the students, and thus it is the need of the hour that a thorough planning goes in the background, and all the available resources and logistics are utilized well for the effective implementation of the course.
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Obesity and its impact on the different aspects of the COVID-19 infection: Public health perspective p. 7
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_21_21  
The coronavirus disease-2019 (COVID-19) pandemic continues to impact the lives of everyone and has influenced the functioning of all the sectors. In general, obesity tends to alter most of the physiological processes in the human body, including the immune system. Thus, it is important to get insights about the effect of obesity on the course of infection, so that morbidity and mortality can be minimized. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website, and a total of 16 articles were selected based on the suitability with the current review objectives. Keywords used in the search include COVID-19 and obesity. It has been reported that obesity plays an important role in different aspects of the infection (viz., increased risk to acquire the infection or more chances to transmit the infection), management, and the worst clinical outcome. To conclude, obesity has to be acknowledged as one of the risk factors for compromising the pulmonary functions and thus should be considered as a high-risk group. In fact, as obesity is an independent risk factor to warrant hospitalization of the COVID-19 patients, it is essential that the medical team anticipates the challenges and manages the obese patients proactively and improves their clinical outcomes.
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Training medical students to develop the skills for establishing clinical diagnosis p. 10
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_123_20  
In the field of medicine, it is extremely important to establish a correct and timely diagnosis to ensure delivery of appropriate quality assured care, maintain patient safety, and minimize hospital-induced errors. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 6 articles were selected based on the suitability with the current review objectives and analyzed. There are no doubts that the process of making a precise clinical diagnosis is a complex one and is error prone. Amid these facts, it is a real challenge for the medical teachers to teach and train the medical students with an aim to accomplish the core competency of reaching a correct clinical diagnosis in authentic settings. One of the approaches adopted by the teachers is to provide learning opportunities to the students so that they can develop critical thinking and clinical reasoning skills. In conclusion, medical teachers have to adopt a systematic approach for teaching students the skill of establishing a clinical diagnosis in authentic settings. It is essential that the training should start from the early years and should be implemented in such a way that students get a number of learning opportunities in real settings to be more useful.
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ORIGINAL ARTICLES Top

Study of thyroid profile and prolactin levels in female infertility patients: An institutional analysis p. 13
Sonia Kundu, Sudhamani S Rao, Kritika Singh, Rajiv Rao
DOI:10.4103/jss.JSS_79_20  
Introduction: Thyroid as an endocrine organ along with prolactin hormone plays a significant role in the fecundity of the couple. Disorders in these hormones may cause menstrual abnormalities and anovulation, leading to infertility. Its dysfunction is not uncommon and is often reversible or preventable with early detection and treatment. This study was undertaken to study the occurrence of thyroid hormone dysfunction and hyperprolactinemia in infertile women. Materials and Methods: In this study, we studied the thyroid profile and prolactin levels in 100 infertile women who visited the obstetrics and gynecology department or in vitro fertilization center of a tertiary care hospital. The frequency of hypo- and hyperthyroidism along with hyperprolactinemia was studied, and the association between thyroid dysfunction and levels of serum prolactin was analyzed. Results: The majority of the infertile women were euthyroid. Thyroid dysfunction was noted in 27% of infertile women, with 17% showing hyperthyroidism and 10% showing hypothyroidism. Hyperprolactinemia was observed in 9% of infertile females. Hypothyroidism was found to be positively associated with hyperprolactinemia. Conclusion: Blood examination for thyroid hormone and prolactin should be kept in consideration as important routine workup in female infertility patients so that patients can be appropriately managed.
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Empowerment status of school-going adolescents in Anekal Taluk of Bengaluru District p. 17
Jacob Davies Kalliath, Nancy Angeline Gnanaselvam, Nihal Xavier Pinto, Michael Chirayath, Naveen Ramesh
DOI:10.4103/jss.JSS_39_20  
Context: Empowerment is a multidimensional social process that enables vulnerable population to participate in and control the various determinants of health. This study was done to assess the empowerment status and factors associated with it among school-going adolescents in Anekal Taluk, Bangalore Urban District. Materials and Methods: It was a cross-sectional study. The sample included government school-going adolescents between 14-18 years of age. Study tools used were self-designed expert validated questionnaire on adolescent empowerment. Data were entered on EpiData and analyzed by SPSS version 16.0. Results: Among the 351 study participants, 196 (56%) were females and 188 (58%) were in 10th and 11th standards. In health domain, 186 (53%) of the students were aware about at least two nutritious foods and 317 (90.3%) of the students knew to cook food on their own; 271 (77.2%) of the students knew how to start a bank account and 307 (87.5%) knew what to do in a hospital when they are sick; 328 (93.6%) of students believe that minimum age for marriage for females was between 18-20 years and 329 (93.7%) knew at least one method of family planning; 282 (80.3%) of the students knew at least one vocational skill; 21 (6%) knew about child protection laws and 203 (58%) believe that decisions regarding important life events should be taken by both parents in conjunction with children. Conclusions: Adolescents lacked empowerment in terms of knowledge regarding reproductive health and nutrition. Years of schooling was found to be associated with better empowerment.
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Fetomaternal outcome in epilepsy in pregnancy in a tertiary care hospital p. 21
Rabiya Khursheed, Shaheera Ajaz, Beenish Jeelani, Saima Wani, Abida Ahmed
DOI:10.4103/jss.JSS_82_20  
Introduction: Epilepsy is one of the most common neurological disorders in obstetrics. Pregnancy with epilepsy is associated with increased risk of complications such as preeclampsia, antepartum hemorrhage, stillbirths, neonatal deaths, intrauterine growth restriction (IUGR), and preterm delivery. Aims and Objectives: To study the fetomaternal outcome of pregnancies complicated by epilepsy. Materials and Methods: This was a single center retrospective study conducted over a period of 27 months from March 2017 to June 2019. Maternal variables studied included baseline parameters such as age, parity, and mode of delivery. Other variables studied included duration of epilepsy, seizure during pregnancy, antiepileptic drug usage in pregnancy, and maternal complications. Fetal outcome variables analyzed were number of live birth, stillbirth, birth weight, Apgar score, congenital anomalies, and perinatal complications. Results: Out of 40 patients with epilepsy in pregnancy, 28 were on antiepileptic drugs (AEDs) during the current pregnancy. The cesarean section rate was 65% in these patients which were higher than in patients without epilepsy. Fourteen patients (35%) delivered vaginally out of which ten were induced. There were six patients who had convulsions four had convulsions in the antepartum period and two had convulsions in the postpartum period. Maternal outcome included gestational hypertension in 6 (15%), postpartum hemorrhage in 1 (2.5%), premature rupture of membranes in 2 (5%), hypothyroidism in 2 (5%), and no maternal death. Prematurity was observed in 10%, low birth weight in 22.5%, and IUGR in 15%. All the neonates received 1 mg of Vitamin K at birth liveborn infants were delivered in 36. Conclusion: There was no maternal mortality in our study. The good maternal outcome is because of early booking, regular antenatal visits and regular intake of folic acid, and appropriate number and dose of AEDs. Epilepsy in pregnancy is a high-risk factor which needs thorough evaluation and care from preconception to delivery. These women need delivery at a tertiary care center for the optimum outcome for the perinatal complications.
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A cross-sectional study to evaluate hand preferences from performance measures namely work done, nerve conduction velocity, and bimanual coordination among phase I medical students p. 25
Jaysheela Bagi, Harpreet Kour
DOI:10.4103/jss.JSS_5_20  
Background and Objective of the Study: Most of the individuals classify themselves as right or left handed but it is not entirely clear whether handedness should be determined based on preference inventories, hand performance tasks, or a combination of both. The strength and significance of the relationship between hand preference and performance asymmetries have always been contested. Materials and Methods: This cross-sectional study has evaluated different performance measures to predict hand preference among a total of 150 1st year medical students. The performance measures included work done by ergography, nerve conduction velocity test, and bimanual coordination test. Results: A statistically significant correlation was found between hand performance and preference measures (P < 0.05 was considered as significant). Conclusion: This study helps to understand the degree of hand dominance on various performance tasks. In particular to medical profession, this study may help in the modifications of the instruments and training given to medical students in improving their bimanual dexterity.
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Incidence, risk factors, and microbiology of central venous catheterization-associated bloodstream infections at a surgical tertiary intensive care unit p. 28
Abhishek Shrivastava, Shalendra Singh, Priya Taank, Kaminder Bir Kaur, KC Pradip, Vikas Marwah, Munish Sood
DOI:10.4103/jss.JSS_68_20  
Background: Central venous catheters (CVCs) can act as a portal for bloodstream infections, which increases the morbidity and mortality in intensive care units (ICUs). Objective: The primary aim of this study was to find out the incidence, to ascertain risk factors of bloodstream infections related to CVC, and to know the microbiological profile of organisms causing catheter-related bloodstream infection (CRBSI) in an ICU of a tertiary level hospital. Methodology: All patients who had CVC insertion in the operation theater before the procedure and were later transferred to ICU, and those patients who were directly admitted to the ICU and had CVC inserted were included in the study. On suspicion of an insertion-site infection, site swabs were sent for microbiological analysis. If catheter tip colonization/infection or CRBSI was suspected, the CVC was removed, and the tip of the catheter along with two sets of blood (peripheral and central) was sent for culture analysis. A semi-quantitative culture analysis was done to confirm CRBSI. Results: On review of data, 150 patients with cumulative 1056 catheter surveillance days revealed an incidence of 24.66% for CVC-related infections, which included exit site infections (5.33%), catheter tip infections (13.33%), and CRBSI (6%). The rate of CRBSI associated with CVCs placed in the surgical ICU was 35.3 per 1000 catheter surveillance days. Staphylococcus aureus was the most common organism causing CRBSI and CONS (coagulase-negative staphylococcus) was the most common organism causing catheter tip and exit site infections.
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To study the association between daytime sleepiness and cognition as tested by stroop test in Indian medical students p. 33
Shilpa Khullar, Mitasha Singh, Suman Das, Kamya
DOI:10.4103/jss.jss_89_20  
Context: Human populations have undergone a steady constant decline in sleep hours attributable to changes in environmental and social circumstances. Excessive daytime sleepiness has been associated with a decreased capacity to perform daily activities and cognitive decline all over the world particularly among students. Aim: The aim of our study was to see the association between excessive daytime sleepiness and cognitive function in Indian medical students. Settings and Design: It was a cross-sectional study conducted in a Government Medical College located in the Delhi/NCR region. Materials and Methods: The study included 60 healthy young volunteers in the 18–30 years age group of both sexes. The students were assessed for daytime sleepiness using the Epworth Sleepiness Scale (ESS). Color–Word Stroop Test was used to assess cognition in both the groups. Statistical Analysis: Data were expressed as mean ± standard deviation and analyzed using SPSS Software Version 21. Results: The average score of the ESS scale of the participants was 7.33 ± 2.20. In the Stroop Test, the reaction time of congruent trial and incongruent trial was 24.81 ± 7.76 and 31.15 ± 8.03 s, respectively. No significant correlation was seen between the ESS score and parameters of the “Stroop Test.” Conclusion: The reaction time of the incongruent trial was significantly higher as compared to the congruent trial (P < 0.05) in the Stroop Task. No significant correlation was seen between the ESS score and Stroop Test results.
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CASE REPORTS Top

Laparoscopic removal of congenital seminal vesicle cyst in a preadolescent male: A unique case report p. 38
G Ajay Kumar, MN Reddy, B S R. Prasad Babu, A Lava Kumar, A Sindhuri
DOI:10.4103/jss.JSS_29_20  
Zinner syndrome refers to the triad of ipsilateral renal agenesis, seminal vesicle cysts, and ejaculatory duct obstruction. Ipsilateral renal agenesis may be associated with seminal vesicle cysts in 70% of cases, but a remnant ureteral bud has been shown to coexist in only 27% of these cases. While some patients may remain asymptomatic and are discovered incidentally, others present with symptoms related to seminal vesicle cysts or ejaculatory duct obstruction, voiding, or ejaculatory difficulty, or pain. Symptomatic cases are very rare in the preadolescent age group. The uniqueness of our case report is that the patient is a 16-year-old male with suprapubic discomfort who was diagnosed with left seminal vesicle cyst (Zinner syndrome) and was successfully managed by laparoscopic resection. To our knowledge, none of the case reports were published in such age group.
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Mania with malignant catatonia due to nonpara neoplastic Anti-N-methyl-D-aspartate-Receptor encephalitis in a 29-year-old female – A rare entity p. 41
Sunny Garg, Alka Chauhan
DOI:10.4103/jss.jss_107_20  
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a rare neurological autoimmune encephalitis. Its symptoms may mimic psychosis as this disease is neurological disorder in psychiatric costume. Disparity in clinical symptoms and nonsupportive laboratory investigations except the cerebrospinal fluid (CSF) analysis delays the diagnosis. We presented a case of 29-year-old female with psychiatric symptoms such as suspiciousness, decreased sleep, and boastfulness. Within few days, the patient developed neurological symptoms like seizures, disorientation, while the patient was on antipsychotic and benzodiazepines. Her symptoms worsened and the patient entered into the catatonic phase of the illness along with autonomic instability. We reached a positive diagnosis of Anti-NMDA encephalitis through CSF analysis. The patient recovered completely with the help of immunotherapy and intensive cognitive rehabilitation. This case emphasizes the need of a multidisciplinary approach in the management, early detection, and adequate treatment of this challenging illness for the better outcome of the patient.
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SHORT COMMUNICATIONS Top

Research and development priorities in the Coronavirus Disease 2019 Pandemic p. 46
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_70_20  
The number of cases reported in the ongoing coronavirus disease-2019 (COVID-19) pandemic continues to rise across the world. The primary reason due to which the disease is able to produce so much disastrous impact is its novel nature, as the virus was detected for the first time and even now there are many epidemiological, clinical and virological characteristics which are not known about the disease. All the available facts clearly suggest the need that we have to strengthen the research and development sector immensely, otherwise the disease will continue to claim lives of thousands of more people and will eventually break the health system of each and every nation and negatively impact the economy of the nations as well. In conclusion, research and development is a primary focus of interest for all the stakeholders involved in the fight against COVID-19 pandemic. The need of the hour is to expedite the entire process and utilize the research findings in ensuring better prevention and effective treatment of the cases of the disease.
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Coronavirus Disease 2019 Pandemic: Strengthening water, sanitation, and hygiene facilities for interrupting the chain of transmission p. 48
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_71_20  
The coronavirus disease-2019 (COVID-19) pandemic has stretched the health system beyond their capacity & capability. The initial evidence has suggested that the infection is transmitted from one person to another through close contacts and droplets and thus the role of infection prevention strategies is extremely important. It has been advocated that frequent and proper maintenance of hand hygiene can prove to be the most effective strategy to prevent infection acquisition. However, in order to maintain hand hygiene, it is ideal to have access to safe water, sanitation and hygienic (WASH) facilities, as this will significantly reduce the risk of the transmission of infection between humans. Thus, all steps should be taken to ensure that improved WASH facilities and waste management provisions are available at home, education institutions, workplaces, community and health care establishment. In conclusion, the provision of standard WASH facilities in all the settings is critical to strengthen hand hygiene practices and thereby plays a significant role in reducing the risk of acquisition of infection and thus the caseload of COVID-19.
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Implementation of a student support system in medical institutions p. 50
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_109_20  
The training period in the delivery of medical education has to be utilized for the comprehensive development of the student. Acknowledging the presence of multiple problems in the life of a medical student is inevitable to plan and implement a student support system within each of the medical institutions. In fact, specific standards have been laid down by the national and international regulatory bodies to minimize stress, resolve problems, and holistically address all the issues which can together influence the academic performance of a student. The need of the hour is to adopt a student-centered approach that enables the students to understand their thoughts and feelings better and this can be streamlined with the help of a mentor or teacher in a confidential and nonjudgmental manner. In conclusion, the life of a medical student is full of ups and downs, and thus, there is an indispensable need to develop a student support system, which ensures the comprehensive development of them. Moreover, the success of such a system will be determined by the institutional culture, wherein all the stakeholders work together for the betterment of the students.
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Introducing electives in the undergraduate medical training period: Points to ponder p. 52
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_113_20  
The period of undergraduate medical training is fully packed owing to the extensive amount of information and skills that needs to be passed on to the medical students. This calls for the need to incorporate an elective within the curriculum that gives an opportunity to the students to not only opt for their preferences but also to suit their career likings. While designing an elective course, it is a must that the organizers should state the specific learning objectives, the duration of the course with scheduling and timetabling of the sessions, the course organizer, resource materials, and prerequisites for joining the elective. Moreover, due consideration has to be given toward carrying out the evaluation of the elective course. In conclusion, electives represent an important aspect of the medical training and prepare the students for their future career by increasing vocational opportunities. The need of the hour is that all the medical institutions should sensitize the faculty members and initiate a series of elective courses for the benefit of students.
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