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2023 | January-December | Volume 9 | Issue 1-4

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Naveen Reddy, Kirtilaxmi Benachinmardi, Sangeetha Sampath, Lakshminarayan Sura Anjina

Can Glycemic Parameters Predict Causative Pathogen in Diabetic Foot Ulcer?

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:3] [Pages No:1 - 3]

Keywords: Bacterial culture growth, Diabetes, Diabetic foot infection, Fasting blood glucose, Hemoglobin A1c

   DOI: 10.5005/jp-journals-10045-00225  |  Open Access | 


Introduction: About 15% of diabetic patients get affected with a complex and heterogeneous disorder with diabetic foot syndrome (DFS) once in a lifetime. Objectives: To record the pattern of pathogenic infectious agents across various levels of fasting blood glucose (FBS) levels and hemoglobin A1c (HbA1c) in type 2 diabetic foot ulcer patients to determine the better predictor among culture growth and FBS levels. Materials and methods: This is a cross-sectional study at a tertiary healthcare center for the duration of 2 months. Pus from the diabetic foot infection was sent to the microbiology laboratory and processed immediately. Microorganism identification and antibiotic susceptibility testing were carried out as per the standard procedures. At the same time, FBS by spectrophotometric method and HbA1c values [Bio-Rad DIO HbA1c analyzer, by high-performance liquid chromatography (HPLC) method] of all the patients involved in the study were recorded. Results: Maximum patients (81%) had FBS of >126 mg/dL and 58% had HbA1c of ≥10. Gram-negative bacilli (GNB) were 80% and gram-positive cocci (GPC) were 20%. With FBS of <100 mg/dL, culture revealed 50% of Klebsiella spp and 50% of Proteus spp. In FBS of 100–126 mg/dL, P. aeruginosa (50%) was common. In ≥126 mg/dL, along with GNB, GPC was also detected. Conclusion: Fasting blood glucose (FBS) and HbA1c values can be of great help in predicting the organism associated with diabetic foot infections and starting the bacteria-targeted antibiotic therapy to reduce further complications.



Ashwini Hungund, Deepa Reddy, Rishi S Prasad

Comparative Study of Effects of Low-dose Midazolam and Low-dose Dexmedetomidine on Hemodynamic Variables and Surgical Conditions in Hypertensive Patients Undergoing Cataract Surgery under Regional Anesthesia: A Prospective Comparative Study

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:5] [Pages No:4 - 8]

Keywords: Cataract, Dexmedetomidine, Hypertension

   DOI: 10.5005/jp-journals-10045-00226  |  Open Access | 


Background and aims: Midazolam and dexmedetomidine have been routinely used for intravenous sedation in ophthalmic surgeries. Dexmedetomidine is an alpha-2 agonist that provides sedation and analgesia without respiratory depression. It has also been shown to reduce intraocular pressure (IOP) in ophthalmic surgeries done under regional anesthesia. Midazolam has been used alone or in combination with opioids or propofol with variable results. This study aimed to compare the efficacy of single low-doses of midazolam and dexmedetomidine for reducing blood pressure (BP) in patients undergoing ophthalmic surgeries under local anesthesia. Methods: In a prospective blinded study, 50 patients undergoing cataract surgery under local anesthesia whose on table BP was >150/90 mm Hg were randomly divided to receive either dexmedetomidine 0.4 μg/kg or midazolam 20 μg/kg single dose. Reduction in BP, heart rate (HR), sedation level, decrease in IOP, and any delay in discharge were assessed. Results: There was a significant drop in HR after 10 minutes in the dexmedetomidine group compared to the midazolam group (p < 0.05). Systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were comparable in both groups. But eight patients in the midazolam group required a second dose of the study drug for the control of BP, which was clinically significant. Also, patients who received dexmedetomidine had a significant fall in IOP compared to those who received midazolam (p < 0.00001). The sedation score was 2 in all patients and there was no delay in discharge from the recovery room. Conclusion: Small single dose of dexmedetomidine of 0.4 μg/kg in patients undergoing short duration cataract surgery under regional anesthesia, provides adequate control of BP without causing undue sedation, respiratory depression, and without any delay in discharge compared to 20 μg/kg midazolam.



Audifax Kpeno, Pratap K Sahu, Nihar R Panda

Stress among Female Primary School Teachers in Kodie and Buohu Circuits of Afigya Kwabre District in Ghana

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:8] [Pages No:9 - 16]

Keywords: Coping strategies, Female teachers, Manifestation, Primary school, Stress, Symptoms

   DOI: 10.5005/jp-journals-10045-00233  |  Open Access | 


Background: This study aimed to assess the level of stress experienced by female teachers in the Buohu and Kodie circuits of the Afigya Kwabre district in Ghana, identify the sources and symptoms of stress, and examine the stress coping strategies employed by these teachers. Materials and methods: The research approach was a quantitative descriptive survey, and a sample size of 86 female teachers was used. A questionnaire survey was conducted to collect data from the female school teachers who had given their acceptance to participate in the study. The face-to-face interaction was solely for the purpose of delivering and collecting the questionnaire and not for interviews or obtaining qualitative data. Data were presented as mean values and analysis was conducted using Statistical Package for the Social Sciences (SPSS), using independent sample t-tests. All procedures were approved by the Institutional Review Board of the University of [edited out for blind review]. Results: The results showed that 60.8% of respondents experienced moderate levels of stress and the top stressors were inadequate teaching and learning materials (TLMs), pupil misbehavior, workload, and lack of recognition. The most prominent symptoms of stress among female teachers were depression, restlessness, weakness, short-term tiredness, and sleeplessness. The study also found that social support is essential in reducing stress levels among these teachers. Conclusion: The study highlights the need to address the sources of stress among female teachers in Ghana and the importance of social support as a coping mechanism. Overall, this study provides valuable insights into stress management strategies that can be employed to support the well-being of female primary school teachers in Ghana.



Kalpana Basany, Meera Rajgopal, Mahathi Nadella, Kiranmai Sannithi

Cross-sectional and Prospective Study of Aerobic Vaginitis and Its Outcomes in Pregnant Women Attending a Rural Teaching Hospital, Telangana

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:5] [Pages No:17 - 21]

Keywords: Aerobic vaginitis scoring, Follow-up, Pregnancy outcomes, Vaginitis

   DOI: 10.5005/jp-journals-10045-00234  |  Open Access | 


Aims and background: Aerobic vaginitis (AV) is an alteration in vaginal bacterial flora. AV has drawn attention because of its threat to women's reproductive health and pregnancy. If AV is not diagnosed early and treated correctly, it can diffuse in the genital apparatus and during pregnancy can cause abnormal outcomes like preterm birth, premature rupture of membrane (PROM) chorioamnionitis, etc. Little is known about the treatment's success in reducing adverse pregnancy outcomes in mothers with AV infection. The study aims to report the prevalence of AV in pregnant women and to provide evidence of the threat of AV on pregnancy outcomes. Materials and methods: Vaginal swab specimens were obtained from females attending the obstetric outpatient department (OPD) from June 2021 to May 2022. Swab samples were immediately sent to the laboratory for Gram stain, AV scoring, and culture and sensitivity. All participants were followed up to evaluate pregnancy outcomes. Results: A total of 197 pregnant women enrolled in the study, 21 (10.7%) women were having AV. The majority of the isolates belong to the Staphylococcus species (47.9%, 11/23) followed by Escherichia coli (E. coli) (26.1%, 6/23). Antibiotic resistance has shown to be minimal. Conclusion: Screening of all pregnant women for infections like AV contributes to the improvement of pregnancy outcomes. Clinical significance: Knowing the incidence of the infection and its outcomes improves the standard of care among pregnant women.



S Yeshaswini, Shahafas Ali Kongath, Vidhya Malyam, Vishnu Vardhan Gopalakrishnan

Comparative Study of Impact of Vaccination on Adherence to COVID-appropriate Behavior, Psychiatric Comorbidities and Quality of Life amongst Postvaccinated Individuals in Urban and Rural Bengaluru

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:4] [Pages No:22 - 25]

Keywords: Coronavirus protocols, Coronavirus vaccination, Psychiatric comorbidities, Quality of life

   DOI: 10.5005/jp-journals-10045-00227  |  Open Access | 


Introduction: Coronavirus 2019 (COVID-19), pandemic has increased mental illnesses. Vaccination was the preferred method of protection and there is sparse knowledge regarding the impact of vaccination on mental health status. Awareness, availability, and accessibility to healthcare vary between urban and rural settings. Aim: This study compared the adherence to COVID-appropriate behavior, psychiatric illnesses, and quality of life (QOL) among post-vaccinated individuals in urban and rural populations. Materials and methods: A comparative cross-sectional study was done on 606 vaccinated individuals of both urban and rural Bengaluru. Data was collected through a self-structured questionnaire which incorporated a sociodemographic profile, depression anxiety, and stress scale (DASS-21), and QOL and was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Results: In both urban and rural population, majority followed COVID-appropriate behaviors. It was found that anxiety was significantly high in the rural, whereas QOL was low in both urban and rural areas. Individuals with high scores on depression, anxiety, and stress (DAS) were found to have a negative correlation with QOL. Conclusion: In addition to vaccination, adhering to COVID-appropriate behavior is necessary to eradicate the disease. Appropriate mental health care should be provided even in the rural setting to address COVID-related anxiety and depression.



Audifax Kpeno, Pratap K Sahu, Surjeet Sahoo

Deliberate Self-harm among Adolescents: Risk Factors, Diagnosis, and Preventive Measures

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:7] [Pages No:26 - 32]

Keywords: Preventive, Remedial solutions, Self-harm, Youth

   DOI: 10.5005/jp-journals-10045-00232  |  Open Access | 


Introduction: Deliberate self-harm (DSH) is a problem that affects a lot of kids and teenagers, with various factors contributing to it. Aim: This review is aimed to determine the most effective preventive and remedial solutions for youth who engage in DSH and have diverse personality traits. Materials and methods: Literature was reviewed, identifying commonalities among articles and reporting on the most effective preventive measures, diagnoses, and risk factors for DSH. Findings: The review highlights the need for standardized definitions and assessment methods, research on the long-term outcomes of interventions, and information on the cost-effectiveness and scalability of solutions for self-harm among youth, particularly in resource-limited settings. The risk factors for adolescent DSH include substance use, peer/academic pressure, bullying, and exposure to violence. Signs of self-harm may include unexplained injuries, scars, and social isolation. Conclusion: The study recommends using various diagnostic tools and a multi-method approach to identify and assess self-harm behaviors among adolescents. The write-up emphasizes the need for preventive measures to address self-harm behaviors among youth, including implementing psychoeducational programs, addressing family conflicts, and educating young people about the harmful effects of stigmatization against mental health services. Encouraging positive parent–child relationships and implementing preventive measures, such as school-based programs and psychoeducation, can help prevent self-harming behaviors. Clinical significance: The findings of this review can help clinicians and researchers better understand the risk factors for adolescent self-harm and the need for effective preventive and remedial interventions.



Jaish George, Nasreen Begum, Dinesh Raghav

Use of Bisphosphonates in Osteogenesis Imperfecta Leading to Iron Deficiency Anemia and Heart Failure: A Case Report

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:3] [Pages No:33 - 35]

Keywords: Anemia, Alendronate, Bisphosphonates, Case report, Genetic mutation

   DOI: 10.5005/jp-journals-10045-00224  |  Open Access | 


Background: Osteogenesis imperfecta (OI) is a group of disorders in which there is a defect in the quantitative and qualitative production of collagen synthesis due to genetic mutations. Case description: We report a case of a 37-year-old dwarf male with OI who presented with severe anemia and cardiac failure. He was on alendronate sodium 70 mg weekly once for the past 2 years. She was treated with transfusions of packed red blood cells, Lasix (loop diuretic), and iron therapy. Conclusion: There is no curative treatment for OI, but bisphosphonate therapy improves the quality of life of the patients. Bisphosphonates reduce bone resorption and thereby fractures. Judicial use should be considered in view of adverse side effects.



Dennis Henry, Vishal Methre, Yumjom Padu

Fixed Drug Eruption to Levocetirizine: A Case Report

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:2] [Pages No:36 - 37]

Keywords: Antihistamines, Case report, Fixed drug eruption, Levocetirizine

   DOI: 10.5005/jp-journals-10045-00235  |  Open Access | 


Fixed drug eruption (FDE) is a delayed-type hypersensitive reaction. It presents as skin lesions that recur at the same sites upon repeated exposures to an offending agent. It represents the most common cutaneous adverse drug reaction pattern in Indian patients. Corticosteroids and antihistamines are the major workhorses for the treatment of these adverse reactions after withdrawal of the offending drugs. In a few rare cases, the antihistamines given for treatment can also cause the patient to have FDE. Here, we present the case of a patient who got FDE due to levocetirizine.



Dennis Henry, Leena Raveendra, Gauri Patel

Platelet-rich Fibrin Matrix for Nonhealing Ulcers: A Case Report

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:3] [Pages No:38 - 40]

Keywords: Case report, Cost-effective, Platelet-rich fibrin matrix, Ulcer

   DOI: 10.5005/jp-journals-10045-00236  |  Open Access | 


A nonhealing ulcer is defined as an ulcer that does not heal even after 13 weeks of constant treatment. The treatment of this condition causes the patient a great economic and mental burden. Even with the widely available treatment modalities, the treating doctor faces the challenge to give significant results at a low-cost. Here, we report three cases and explore platelet-rich fibrin matrix (PRFM), a low-cost yet effective modality treatment cornerstone for nonhealing ulcers.



Manoj Kumar Nagarajan, Rajiv R Sanji, Srirangaprasad Krishnaswamy

Internal Jugular Vein Thrombosis Following Cortical Mastoidectomy in Coronavirus 2019 Era

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:3] [Pages No:41 - 43]

Keywords: Coronavirus disease 2019, Chronic suppurative otitis media, Intracranial complication of chronic suppurative otitis media, Internal jugular vein thrombosis, Sigmoid sinus thrombosis

   DOI: 10.5005/jp-journals-10045-00228  |  Open Access | 


Introduction: Forward-lying sigmoid sinus and injury during cortical mastoidectomy are complications every otologist bears in mind while operating. Pseudomonas infection of the middle ear cleft is difficult to eradicate. Following coronavirus disease 2019 (COVID-19), there is a hypercoagulable state which surgeons have to take into account while caring for affected individuals. Here is a case with all three problems, necessitating prolonged treatment. Case description: We report the clinical course and management of a teenage child who developed unilateral near-complete thrombosis of the internal jugular vein (IJV), jugular bulb, and partial thrombosis of distal sigmoid sinus—with a short segment thrombus—following myringoplasty and attempted cortical mastoidectomy. She developed a severe throbbing headache postoperatively (post-op). Imaging showed hypoplastic transverse and sigmoid sinus on the opposite side, aberrant anterior, and laterally placed sigmoid sinus on the operated side. Although the child had no history of upper respiratory tract infection/COVID-19 infection preoperatively, post-op measured COVID-19 antibody levels were elevated. The patient was treated with intravenous and oral anticoagulants, and antibiotics, leading to a complete resolution of symptoms. Conclusion: In the COVID-19 era, seemingly common problems may be amplified and more difficult to manage. In this report, we illustrate a problem which may be faced by the otologist—to raise awareness and improve clinical care.



Debarchana Sarkar, P Mirudhubashini Swarup, Pooja Shashidharan

Uncontrolled Diabetes Mellitus Presenting as Isolated Abducens Nerve Palsy

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:3] [Pages No:44 - 46]

Keywords: Hypertension, Isolated abducens nerve palsy, Type 2 diabetes mellitus

   DOI: 10.5005/jp-journals-10045-00229  |  Open Access | 


Background: This case report demonstrates the acute onset of diplopia due to isolated abducens nerve palsy secondary to uncontrolled diabetes, presenting as ophthalmoplegia. Case description: A 55-year-old female with a history of type 2 diabetes mellitus (DM) and hypertension presented with sudden onset binocular horizontal diplopia in the past 15 days, which was greater at a distance and worsened on looking toward the right. Ophthalmological examination was unremarkable except for right eye abduction limitation on lateral gaze. Blood investigations revealed glycated hemoglobin (HbA1c)—11.8, fasting blood sugar (FBS)—271, postprandial blood sugar (PPBS)–385, and the rest of the reports were unremarkable. Fundoscopic examination of eyes was normal. Magnetic resonance imaging (MRI) brain and orbit were also normal. A diagnosis of isolated sixth nerve palsy (ISNP) secondary to uncontrolled diabetes was made. Subsequently, the patient was put on oral hypoglycemia agents, insulin, aspirin, and dark goggles with alternate eye occlusion therapy. Over the course of 4 days of hospital stay, the patient noticed a 20% improvement in her symptoms. Conclusion: It is important to consider sixth nerve palsy in poorly controlled diabetic patients presenting with diplopia with normal neurological findings.



Vamsee Vuduta, Nischitha Anil, Sai Rakesh Vadlamudi, Vijay M Bengalorkar

A Case of Posterior Reversible Encephalopathy Syndrome in Postpartum Female with Status Epilepticus

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:4] [Pages No:47 - 50]

Keywords: Autoimmune diseases, Magnetic resonance imaging, Posterior reversible encephalopathy syndrome, Postpartum

   DOI: 10.5005/jp-journals-10045-00230  |  Open Access | 


Posterior reversible encephalopathy syndrome (PRES) is a rare condition in which some parts of the brain are affected by tissue edema. The highly elevated blood pressure (BP) by itself may result in PRES. We also find underlying disease conditions with high BP presenting as PRES. The features of PRES are headache, altered vision, and seizures. Patients with this disorder may develop neurological symptoms like confusion or paresis of the upper and lower limbs or, at times, both. The causes of PRES have severely elevated BP, infections, preeclampsia, certain drugs, or autoimmune diseases. Imaging studies help in the diagnosis of PRES. Magnetic resonance imaging (MRI) brain scan may show gyral hyperintensity in the posterior aspect of the bilateral parietal lobes without diffusion restriction. Treatment of PRES includes treatment of the etiology and the underlying complications. Here we present a case of PRES in a postpartum female patient of day 10.



Yajnadatta Sarangi, Nalinikanta Ghosh, Somanath Malage, Anu Behari

Mature Cystic Teratoma of the Adult Male Pelvis: A Rare Case Report and Review of Literature

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:4] [Pages No:51 - 54]

Keywords: Case report, Germ layers, Mature cystic teratoma, Sacrococcygeal teratoma

   DOI: 10.5005/jp-journals-10045-00238  |  Open Access | 


Mature cystic teratomas (MCTs) are rare tumors of embryonic origin composed of tissue from at least two of the germ layers. These tumors are common in females with a female-to-male ratio of 4:1. Most of the sacrococcygeal teratoma (SCT) in adults present as intrapelvic masses, in contrast to neonates, where >90% present as extra pelvic masses. These are extremely rare in the adult male pelvis; only nine cases have been reported in the literature, and they are usually asymptomatic. They may also present with urinary retention, pain, altered bowel habits, and rarely as prostatic abscess and chronic discharging sinus. Management is usually challenging because of difficult anatomical location and the risk of nerve and pelvic floor muscle injury leading to fecal and urinary incontinence. Here, we describe the clinical presentation, evaluation, and treatment of a case of MCT involving presacral space in an adult male with a review of the literature.



Rangalakshmi Srinivasan, Sowmya MJ Iyengar, Swathi Natesh

Medical Conferences and Continuing Medical Education Programs: Meet, Eat, and Learn—The Untold Story

[Year:2023] [Month:January-December] [Volume:9] [Number:1-4] [Pages:5] [Pages No:55 - 59]

Keywords: Conferences, Continuing medical education, Questionnaires, Surveys

   DOI: 10.5005/jp-journals-10045-00237  |  Open Access | 


Introduction: Medical conferences and continuing medical education (CME) programs are extremely useful for any medical professional. Most of the surveys conducted in conferences are feedback surveys and focus mostly on the quality of the provided information and the need for improvement of the same. However, the other side of the story remains unsaid, such as the reasons for conference attendance and participant preferences. The coronavirus disease 2019 (COVID-19) pandemic has caused the disruption of conferences and CMEs. Objective: We aimed to analyze the compliance issues faced by participants during conferences and the choice between online and offline conferences. Materials and methods: This survey was a paper-based questionnaire with 17 questions. After the Institutional Ethical Committee clearance, the survey was conducted at state and national anesthesiology and critical care conferences held in India from November 2019 to October 2020, followed by an e-mail with two more questions on COVID-19. Descriptive statistics was used to analyze the data. Results: In our study, 67.5% of participants felt conferences gave them a learning platform, 69.3% of participants wanted a 3-day conference, and 55.6% preferred it on weekends. About 63.39% of participants were interested in attending conferences with colleagues. Attendees faced several deterrents—35.92% felt work pressure, and 20.55% narrated that permission from the institutional authorities was a deterrent. Due to the COVID-19 pandemic, 72.5% of participants preferred webinars; out of them, 44.9% of participants opted for offline conferences when the pandemic gets controlled and conditions are favorable. Conclusion: Practitioners prefer offline CMEs and conferences that are lively and effective, with good topics delivered by experts along with fun-filled hands-on sessions and entertainment.


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