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   Table of Contents - Current issue
January-March 2021
Volume 10 | Issue 1
Page Nos. 1-64

Online since Thursday, March 4, 2021

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The Journal of Clinical and Scientific Research: The first decade! p. 1
B Vengamma, P VLN Srinivasa Rao
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Nasal carriage of antibiotic-resistant staphylococci among undergraduate medical students, with special reference to methicillin-resistant Staphylococcus aureus Highly accessed article p. 2

Background: Staphylococcus aureus and other staphylococci are the commensals of the human body, the anterior nares being an important niche for colonisation. The medical students constitute an important component of the hospital population. Studies of staphylococcal carriage among the medical students are almost non-existent from India. This study was conducted with the primary aim of finding out the nasal carriage of antibiotic-resistant staphylococci among the medical students in our institution. Methods: A total of 162 medical students equally divided between the preclinical and clinical batches were the study participants. A nasal swab was collected from the participants and cultured. Suspected colonies were identified as S. aureus and antimicrobial susceptibility done by standard methods. The students were also asked to fill up a questionnaire to identify any risk factor associated with staphylococcal carriage. Results: The overall colonisation rate was 48.8% for S. aureus with 45.7% in the non-exposed pre-clinical students' group to 51.8% in the exposed clinical students' group which was not significant. The carriage rate for methicillin-resistant S. aureus was 6.3% among the S. aureus isolates. A survey of the risk factors revealed no significant association of hostel stay, family size, previous hospital admission, skin or soft-tissue infection with increased carriage rate. However, a history of previous antibiotic therapy had a significant association with nasal carriage. Conclusions: High rates of colonisation with S. aureus calls for further detailed multicentric studies with application of moecular methods from India.
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Comparison of estimated glomerular filtration rate equations in elderly with chronic kidney disease p. 9

Background: Chronic kidney disease (CKD) a growing epidemic in India with limited studies addressing the problem of ideal equation for estimated glomerular filtration rate (eGFR) among elderly Indian patients. Currently, eGFR is calculated employing the CKD Epidemiology Collaboration (CKD-EPI) equations of which the combination of creatinine and cystatin-c (eGFR cr-cys) is recommended as more accurate. However, preferred equations and filtration markers in elderly individuals are debated. Methods: The present prospective observational study conducted from 2012 to 2014 at our tertiary care centre, aimed at identifying the best filtration marker and eGFR equation for elderly CKD patients. One hundred and seven elderly CKD patients were studied. Comparison of eGFR equations derived from modification of diet in renal disease (MDRD) and CKD-EPI, based on creatinine and cystatin-c was done. Results: Median creatinine was 2.4, and median cystatin-c was 1.9. On comparing the correlation between all four equations by spearman correlation coefficient, difference was noted. eGFR by EPI-creatinine and cystatin-c correlated with all other three equations with correlation coefficient of 0.84 for both MDRD, EPI-creatinine and 0.82 for EPI-cystatin-c equations, respectively. Conclusions: Of the four equations for eGFR, EPI-cystatin-c and creatinine equation showed better correlation with all other equations, hence might be the better equation for confirmation and classification of the elderly CKD patients.
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Prevalence of sexually transmitted diseases in an urban slum area p. 15

Background: The early diagnosis and treatment of sexually transmitted diseases (STDs) helps in reducing the incidence of human immunodeficiency virus. High prevalence of STDs and sexually transmitted infections has been reported from various parts of India. Methods: A community-based cross-sectional study was carried out in an urban slum area in 140 females age 16 years and above to study the prevalence of STDs. For the diagnosis of STDs, the syndromic approach was used. Results: Majority of them (34.2%) were in the age group of 21–29 years. Among presenting complaints, low backache was the most common (48.5%) followed by dysmenorrhea (28.5%) of women. Lower abdominal pain was evident in 16.5%; it was highest in the age group of 21–29 years (20.8%). Vaginal discharge was present in 22.8%, it was highest in the age group of 21–29 years (46.9%). Genital ulcer was seen in 4 (2.9%) cases. Association between STDs and marital status, education, occupation was not found to be statistically significant. Conclusions: Our observations suggest that symptoms of STDs were high in the population, studied. However, no association could be established between presence of STDs and socio-demographic variables.
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General health check-up of employees aged ≥40 years at a tertiary care hospital for their health status and to diagnose their health problems p. 19

Background: The present study was undertaken to screen the employees of a tertiary care hospital aged ≥40 years to know their health status and to diagnose their new health problems. Methods: This cross-sectional, descriptive study was conducted with 487 employees of our hospital aged ≥40 years from November 2019 to February 2020. Study procedures included haemogram, fasting plasma glucose, fasting lipid profile, thyroid profile, renal function test, electrocardiogram (ECG) and abdominal ultrasound for both the genders. For female employees, additionally, mammograms and pap smears were performed. Results: A total of 487 hospital employees were studied. 43.5% were overweight and 17.0% were obese. Of these, 2.8% had abnormal ECG findings. A total of 131 (26.9%) new medical problems were detected. Among these, anaemia (8.0%), hypertriglyceridaemia (5.1%), hypothyroidism (4.5%), hypertension (4.1%) and diabetes mellitus (2.7%) constituted the major diseases. Conclusions: This study has proved that the general health check-ups are important to diagnose minor to major health problems at early stages and to treat them properly to cure the problem or to prolong the advancement of the disease.
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A surveillance study of multidrug-resistant organisms among clinically significant Gram-negative bacteria in a tertiary care teaching hospital from South India p. 25

Background: Sparse published data are available from Andhra Pradesh the burden of multidrug-resistant (MDR) Gram-negative bacteria in clinical specimens. Methods: We studied the burden of MDR Gram-negative bacteria from among various clinical specimens in our tertiary care teaching institute. Results: A total of 6900 isolates were obtained of which 2960 organisms were MDR. Escherichia coli were the most frequently isolated Gram-negative species (37%), followed by Klebsiella spp. (13.4%). Pseudomonas aeruginosa, Acinetobacter spp. and Enterobacter spp. were the other commonly isolated Gram-negative organisms. High resistance rates were observed for all antimicrobials studied except for cefoperazone-sulbactam (62.6%), meropenem (70%), aminoglycosides (64%) and polymyxin B (98.6%). In spite of high resistant rates (>50%) for ciprofloxacin (80%), cephalosporins (74.4%) and cotrimoxazole (65.7%), the above-mentioned antimicrobials were clinically effective. Extended-spectrum β-lactamase production was one of the significant mechanisms of resistance in our study as β-lactam resistance was 74.4%. Conclusions: Our study documents a high proportion of resistant Gram-negative organism isolates. Clinicians should consider this while initiating antibiotic treatment.
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Clinical study of burden of type 2 diabetes mellitus in acute coronary syndromes and their complications p. 31

Background: Sparse published data are available regarding the burden of Type 2 diabetes mellitus (T2DM) in patients presenting with acute coronary syndrome (ACS) in a health-care setting managed by physicians. Methods: The present study was conducted to assess the burden of T2DM, amongst persons admitted with ACS, and study the complications during their hospital stay. Results: During November 2016 and May 2017, 167 persons with ACS were admitted in the intensive care unit of a 15-bedded hospital managed by physicians. Of these, 66 (39.5%) were found to have T2DM (57 were known to have T2DM, T2DM was freshly detected in 9). Of the 66 patients with T2DM and ACS, 44 (67%) had ST-elevation myocardial infarction (MI) (25 persons had anterior wall MI and 19 had inferior wall MI) and 22 (33%) had non-ST-elevation MI/unstable angina. Ten (15%) patients died during hospital stay (9 died due to cardiac arrest and one patient died on the way to another centre). Other complications included acute left ventricular failure (n = 4). Two of these recovered with treatment and two others were shifted to another centre. One patient had developed cardiogenic shock and recovered with treatment. One person with post-infarction angina was referred to another centre for angiogram. Conclusions: Early recognition of diabetes mellitus in patients presenting with ACS is essential to save life and prevent complications.
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Subacute sclerosing pan encephalitis: An update p. 35

Despite increasing immunisation rates, developing countries continue to report subacute sclerosing pan encephalitis (SSPE). The defective measles virus causng SSPE persists in brain cells because of hypermutated M protein and deranged host's immune responses. Patients usually present with cognitive decline and myoclonus. However, atypical presentations such as seizures and visual loss are also quite common, causing wrong or delayed diagnosis in a significant number of cases. Diagnosis is based on suggestive clinical features, electroencephalographic findings and elevated cerebrospinal fluid (CSF) antimeasles antibody titre. Newer methods of reporting antibody levels such as CSF/serum quotient (CSQrel) result in increased specificity, but individual values of serum and CSF antimeasles antibody titres should also be checked if CSQrel is negative or equivocal. In highly suspicious cases with negative CSF antimeasles antibody profile, repeat testing should be done. Combination therapy with interferon-alpha and isoprinosine is the most common starting regimen. Intraventricular administration of interferon-alpha is theoretically the most effective route but requires meticulous hygiene and complications are frequent. Hence, the proper route and frequency of interferon-alpha treatment should be chosen depending on efficacy, affordability, disease stage and parent's expectations. Though treatment has largely remained unsatisfactory, reported rates of improvement or stabilisation (34%–35%) are much better than that for spontaneous remission (5%–10%). Fusion inhibitors and adenovirus-delivered small interfering RNA are being studied as new therapies. However, increasing immunisation rates can be the only long-term answer to tackle the menace of measles and its complications.
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Chronic osteomyelitis of the femur caused by Burkholderia pseudomallei in a patient with type 2 diabetes mellitus p. 43

Melidiosis is a life-threatening infectious disease, and the causative organism is Burkholderia pseudomallei. It occurs as an environmental saprophyte in endemic regions of northern Australia and Southeast Asia. A 43-year-old male patient known to have type 2 diabetes mellitus, presented with fever, thigh swelling. He had received treatment with multiple antimicrobial agents, including antituberculosis drugs, but no improvement was observed. An incision and drainage of medullary canal was done and pus culture grew Burkholderia pseudomallei. He was managed with intravenous meropenem followed by oral cotrimoxazole. A high index of suspicion is required for early diagnosis. Burkholderia pseudomallei infection should be suspected in patients with diabetes mellitus, in patients presenting with an abscess not responding to antimicrobial treatment, especially in patients from endemic areas. The organism responds only to specific antibiotics; therefore correct and timely diagnosis becomes crucial for a better outcome.
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Delusion of pregnancy in a woman with mental retardation p. 47

A false, fixed and firm belief of being pregnant despite factual evidence to the contrary is a delusion of pregnancy. This can occur in both men and women and is associated with many psychiatric and biological disorders. It should be differentiated from pseudocyesis, pseudopregnancy, simulated pregnancy and Couvade syndrome. We report a case of delusion of pregnancy in a woman with mental retardation.
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Isolated leishmaniasis at lower lip p. 50

Leishmaniasis caused by Leishmania spp. is a vector-borne disease and transmitted by the Phlebotomus sand fly. Lip is an extremely rare site for this lesion. The lesion often begins as erythematous papules, and slowly enlarges and ulcerates. The diagnosis is usually based on clinical features and laboratory tests. Here, we reported a case of an isolated lesion of the leishmaniasis at the lower lip. The patient presented with an ulcerative lesion and initially not healed by conservative treatment such as antibiotics. Histopathological and smear examination confirmed the diagnosis. The isolated lesion of leishmaniasis at the lower lip is rare and often confusing, which challenges diagnosis. Clinicians should keep in mind about this isolated localised lesion as a differential diagnosis of chronic pathology of the lower lip so that delayed diagnosis and treatment can be avoided.
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A rare case of pulmonary tuberculosis-associated hypercalcaemia and pancreatitis Highly accessed article p. 54

Hypercalcaemia is commonly seen in the context of parathyroid dysfunction and malignancy. When severe, it can precipitate a life-threatening sequel. The diagnostic evaluation of hypercalcaemia is contributed by several competing aetiologies, multiple co-existing conditions and confounded by polypharmacy. A 60-year-old female was rushed to emergency with severe pain in the abdomen. Her serum calcium level was 3.92 mmol/l. Pancreatitis was confirmed by biochemical and radiological investigations. She was subsequently diagnosed to have smear-positive pulmonary tuberculosis (TB). She was successfully managed with intravenous fluids, diuresis and bisphosphonates and showed good response to anti-TB treatment. This case emphasizes considering pulmonary TB in the list of differential diagnosis for hypercalcaemia.
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The dilemma of intimacy and other social stigmas associated with HIV-AIDS and COVID-19 p. 58
Janmejaya Samal
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Coronavirus infection in India: From the desk of dental surgeon p. 62

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