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   Table of Contents - Current issue
Coverpage
September-December 2022
Volume 3 | Issue 3
Page Nos. 45-78

Online since Monday, December 19, 2022

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EDITORIAL  

District medical colleges in India – Addressing the rural health-care needs p. 45
Raman Kumar
DOI:10.4103/jssrp.jssrp_27_22  
The shortfall of human resources in health has resulted in skewing the distribution of health workers such that vulnerable populations in rural, tribal, and hilly areas continue to be extremely underserved. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. The situation of human resources in health remains inadequate. To address the regional disparities in medical education and availability of human resources in health, the policy of establishing one medical college at each district in India was initiated. Impressive progress has been made during the past few years with respect to opening new medical colleges in the area of need across geographical coverage.
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REVIEW ARTICLE Top

Global health emergency of monkeypox after COVID-19: A narrative review p. 47
Prachi Jain, Manu Rathee, Akanksha Gopal Shetye, S Rajesh Divakar, Sandeep Singh, Sarthak Singh Tomar
DOI:10.4103/jssrp.jssrp_11_22  
Global hit by coronavirus is followed by another public health emergency known as monkeypox (MPX) that is a rare disease and yet has presented with sudden and wide geographic distribution. The guidelines have been released by the concerned authorities for prevention and management; however, strict measures need to be enforced so that these guidelines can be followed. Surveillance, intervention, close monitoring of the situation, and collaborative international efforts as per the guidelines can optimally aid in achieving the goal of curbing the infection spread. This article presents the current situation update of MPX infection globally and discusses the symptoms, management, and preventive measures to be followed for MPX infection.
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ORIGINAL ARTICLES Top

Prevalence of otorhinolaryngological manifestations of COVID-19 infection during third wave and comparison from seasonal flu and allergic rhinitis in a tertiary care hospital p. 53
Aditya Singhal, Pooja Agrawal, Vijender Kumar Agrawal
DOI:10.4103/jssrp.jssrp_12_22  
Background: Ever since the cluster of COVID-19 cases seen in Wuhan, China, the animal-origin virus has created havoc. These changes in clinical manifestations have been tracked in different waves, in different countries, also the virus behaving differently according to race and culture. To assess the prevalence of symptoms of COVID-19 infection during the third wave and compare it with seasonal flu and allergic rhinitis. Materials and Methods: A cross-sectional, comparative study was conducted at a tertiary hospital in Bareilly. A close-ended questionnaire was prepared to assess the otorhinolaryngological symptoms of COVID-19, seasonal flu, and allergic rhinitis. ENT findings were further confirmed by a suitable test. Results: A total of 145 tested positive for COVID-19 infection, 121 patients were diagnosed with seasonal flu, and 124 patients were diagnosed as cases of allergic rhinitis. Fever was the most common symptom in seasonal flu (100%) and COVID (93.8%) patients. Rhinorrhea (100%), lacrimation (100%), and sneezing (100%) were common symptoms in the allergic rhinitis group. A Chi-square test with Bonferroni correction showed a significant difference in the prevalence of symptoms in all three groups (P < 0.0001). Vaccination also contributed to less severity of COVID-19 disease. Conclusion: Involvement of otorhinolaryngology is considered a biomarker in all three groups with less frequent pulmonary features. It becomes necessary to correctly differentiate COVID-19 from the other two diseases for the proper treatment of patients.
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Impact of chronic kidney disease on functionality level among patients p. 59
C Vasantha Kalyani, Priyanka Malhotra, Kusum K Rohilla
DOI:10.4103/jssrp.jssrp_10_22  
Background: In recent years, there has been a greater focus on the rise of noncommunicable diseases, i.e., chronic kidney diseases (CKD) and their impact in low- and middle-income nations. Due to raised number of noncommunicable cases, functionality level of patients are affected so much. The present study aimed as exploring chronic kidney disease impact on level of functionality of patients. Materials and Methods: The current study used a purposive sampling strategy to survey 399 CKD patients who were visiting the dialysis unit of the All India Institute of Medical Sciences (AIIMS), Rishikesh, India. Results: The mean age of study patients was 50.4 years. Majority of patients were female (58%), married (80%), and belongs to urban community (84%). Majority of patients belonged to lower middle class (49%) socioeconomic status and were overweight (64%). Patient's functionality on Chronic Illness Scale showed that 55% patient's had a low impact of chronic illness on their life. Overall chronic kidney patients showed a medium (59%) functionality level on the Chronic Illness Scale. Conclusion: Chronic diseases have a negative impact on a patient's quality of life. As the patient advanced through the stages of CKD, his quality of life decreased. During the course of the disease, physical domains are severely impacted, which has an impact on mental quality of life as well.
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CASE REPORTS Top

COVID-19-associated rhino-mucormycosis and pulmonary aspergillosis infection p. 63
Jitender Singh, Tarika Sharma
DOI:10.4103/jssrp.jssrp_6_22  
In the current pandemic, the incidence of fungal infections-associated COVID-19 is surging. Diabetes mellitus, overzealous steroid, and antibiotic use for COVID-19 management may cause or exacerbate the fungal disease. In paranasal sinus (PNS), ethmoids followed by the maxillary sinus are commonly involved with the risk of intra-orbital or/and intracranial involvement is quite common. In lungs, COVID-19 infection has higher mortality rate, if there is an associated fungal infection. Aspergillus fumigates is the most common fungus that cause lung infection and present as discrete lesion different from COVID-19 manifestation. Two cases of COVID-associated fungal infections, i.e., rhino-mucormycosis and pulmonary aspergillosis are described here. In the first case, computed tomography (CT) of PNS was done for the complaints of mild right-sided facial swelling and mild restriction of the eye globe on day 27 of illness. CT showed hyperdense content involving the right-sided nasal sinus with the remodeling of bones with erosion and thinning of the inferior and medial orbital wall with the extension of soft tissue into the extraorbital space. The patient was treated with Amphotericin B and posaconazole oral suspension as the first-line antifungal monotherapy. In the second case, on complaints of cough with expectoration on the 20th day of illness, X-ray chest and CT chest were done which confirmed a thick-walled cavity in the right lung and other post COVID features. The tracheal aspirate culture was suggestive of Aspergillus fumigatus and Aspergillus antigen galactomannan was found positive in the fluid. The patient was treated for the same with antifungal therapy. Hence it is important to pay attention to the high probability of fungal infections in COVID-19 patients. The association of coronavirus with mucormycosis of the PNSs and aspergillosis of the lung must be given outmost consideration. Noncontrast CT of the PNSs is usually the first investigation of choice for PNS involvement, and CT chest help in the diagnosis of pulmonary fungal infection. Uncontrolled diabetes and use of steroids are two of the main factors for aggravating factors. Both early surgical intervention and anti-fungal treatment should be sought for the management.
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Ethibond suture with underlying infection – A knotty complication p. 67
Ganesh Singh Dharmshaktu, Naveen Agarwal, Ishwar Singh Dharmshaktu
DOI:10.4103/jssrp.jssrp_7_22  
The surgical site infection is a therapeutic challenge and requires additional interventions, prolonged treatment, and increased health-care expenditure. Superficial infections are easier to treat with debridement, regular dressing, and an appropriate antibiotic regimen. Retained and buried sutures are an occasional source of infection and are reported in the literature. Braided nonabsorbable sutures like Ethibond may be the uncommon reason for adjacent area infection that may present later as nonhealing draining sinuses. We report one such encounter in which an adult patient with chronic nonhealing sinuses over the proximal tibia region underwent debridement to unearth embedded sutures used in previous surgery, the removal of which led to gradual recovery and healing of wounds.
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Management of pilonidal sinus using homoeopathic medicine in combination with Kshar Solution: A case report of a novel approach p. 70
Ashish Kumar Dixit, Danish Javed, Nibha Giri
DOI:10.4103/jssrp.jssrp_9_22  
Pilonidal sinus (PNS) occurs beneath the skin in the gluteal cleft just above the anus. It continues to pose a number of therapeutic challenges and its treatment is mostly surgical. A 33-year-old male shopkeeper consulted the homeopathy outpatient department of AYUSH with complaints of mild pain and bloody pus (serosanguinous) from the sinus tract and intermittent mild fever, for the past 2 years. The patient was apprehensive about the surgery and did not want it. We devised a therapy strategy for the patient. Depilation of the tract followed by the adding of a Kshar solution to spontaneously cauterize the scar tissue was performed. Finally, the homeopathic drug Silicea 200 was given for 3 months period, and the case was followed for more than 9 months. The case exhibited a marked reduction in probing of the tract (1.7–0 cm), Visual Analog Scale (VAS) for pain (3-0), and discharge (+++ to NIL) after 3 months of treatment. The Outcome in Relation to Impact on Daily Living scale score was +4, indicating that he is back to normal in terms of both the main complaint and overall well-being. At the final visit, the Modified Naranjo Criteria for Homeopathy score was +8 on a scale of −6 to +13. Homeopathy in combination with the Kshar solution can be an effective alternative approach to the management of PNS. As a result, controlled clinical trials are warranted.
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Fetal malformation anencephaly with placenta accreta spectrum (increta): Two different tales in a pregnancy – A rare case report p. 74
Indu Lata, Ruchi Gupta, Amrit Gupta, Pallavi Prasad
DOI:10.4103/jssrp.jssrp_13_22  
Placenta accreta spectrum (PAS) disorders (accreta, increta, and percreta) are rare but are potentially life-threatening obstetric conditions of high maternal and fetal or neonatal morbidity and mortality. In the patient at risk for accreta, obstetrical ultrasonography should be performed and it can be complemented with magnetic resonance imaging. In suspected cases, a multidisciplinary team with clinical expertise should be involved. Anencephaly is a major lethal fetal anomaly of severe central nervous system malformation and the most common type of neural tube defect (NTD). Although the etiology of anencephaly remains unclear, various maternal-related environmental and genetic risk factors have been reported. Termination of pregnancy is offered for all prenatally diagnosed cases. We are presenting management of the rare case of a pregnant woman having placenta increta with fetal NTD malformation in the form of anencephaly.
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LETTER TO EDITOR Top

Learning curve for laparoscopic surgery: Bypass to open procedures? p. 77
Danish Javed, Sana Anwar
DOI:10.4103/jssrp.jssrp_8_22  
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