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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 19 | Issue 2
Page Nos. 73-130

Online since Monday, May 16, 2022

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EDITORIAL  

Training tomorrow's global digital health leaders p. 73
Amit Kaushal, P Murali Doraiswamy
DOI:10.4103/am.am_32_22  
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ORIGINAL ARTICLES Top

The characteristics of excess body weight in the school-going students of Qatar p. 75
Mohammaed Hamad Al-Thani, Shamseldin Ali Hassan Khalifa, Hammad Akram, Benjamin Vinodson, Muhammad Asif Ijaz
DOI:10.4103/am.am_114_21  
Background: Overweight and obesity among students have become a global public health concern. If no effective and timely measures are taken, the percentage is expected to rise. The ministry of public health growth monitoring program aims to gather accurate information about the health status of children and adolescents in the state of Qatar. The results help categorize the participants based on the body mass index (BMI) score as overweight and obese. Materials and Methods: The data were collected during the academic year 2016–17, from 332 school campuses and included 186,986 students. Weight in Kilograms and height in meters was calculated to compute BMI. Using the BMI results, patient's data was segregated based on the World Health Organization procedures for BMI-z-Score. The data were then further analyzed by age, sex, nationality, and on a municipality level. Results: Among 186,986 eligible students, about 42.3% were categorized as overweight and obese, with an approximately equal proportion of students being overweight (20.9%) or obese (21.4%). At 47.1%, Qatari male students had the highest prevalence of overweight and obesity, followed by Qatari females (43.8%), non-Qatari males (43.2%), and non-Qatari females (38.4%). On the basis of gender and nationality, Qatari and non-Qatari male students were predominantly more obese, whereas a higher proportion of female students from both nationalities were overweight. Conclusions: The 2016–2017 growth monitoring project results are somewhat similar to the previous growth monitoring findings. This school-based study provides evidence for relatively high levels of overweight, obesity in the state of Qatar compared to the global average.
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Psychological wellness of health-care professionals during the coronavirus disease-2019 pandemic p. 81
Lakshmi Ranganathan, Nagarajan Ramakrishnan
DOI:10.4103/am.am_150_21  
Background: The outbreak of the coronavirus disease-2019 (COVID-19) has been a major health crisis and is associated with psychological distress, specifically in health-care workers (HCW). Our study aimed to assess psychological wellness and sleep disturbances among HCW during the COVID pandemic and also to determine if the symptoms differed in those who were involved in caring for COVID patients in comparison with those who were not. Methods: This observational, cross-sectional survey was conducted during April–May 2020 at two facilities of a tertiary care hospital in Chennai, India, that provided care for COVID-19 patients. HCWs working in the critical care units and designated COVID units were included. A survey questionnaire comprising three components ‒ demographics, psychological wellness, and sleep ‒ was administered by email to participants. Results: The survey was sent to 230 HCW, and 190 completed it (response rate – 82.6%); the mean age was 29.7 ± 9.7 years; males/females–70 [36.8%]/120 [63.2%]). The overall mean depression score was 16.6 ± 4.4, indicating moderately severe depression. The overall mean anxiety score was 10.1 ± 3.4, indicating moderate anxiety. About 35.3% of the participants got <6 h of sleep, 56.3% reported inadequate sleep, and 52.6% reported disturbed sleep‒wake cycle. “Risk of getting infected” was the most important impacting factor (57.9%), followed by “disturbed work-life balance” (40.5%) and “uncertainty of outcomes” (24.2%). There were no differences in the depression, anxiety scores, or sleep quotients between the COVID treating and nontreating groups. Conclusion: Health-care professionals report high rates of symptoms of depression, anxiety, and sleep disturbances during the COVID-19 pandemic, irrespective of their involvement in caring for infected patients.
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Imaging spectrum of mucormycosis in COVID-19 patients using computed tomography and magnetic resonance imaging p. 89
Rakhi Chhikara, Manish Kumar, Rohit Kaushik, Simran Gupta, Lalit Kumar, Nitesh Mohan
DOI:10.4103/am.am_18_22  
Introduction: COVID-19 is an ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2. Imaging plays an essential role in the diagnosis and management of symptomatic patients. Mucormycosis has gained popularity recently as a complication in COVID-19-affected patients. Various types of mucormycosis are rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, disseminated, and uncommon forms. Aim and Objective: We aimed to evaluate various radiological features of different types of mucormycosis infection in COVID-19 patients. Materials and Methods: We studied thirty COVID-19 patients retrospectively who were referred to our hospital over a period of 6 months (January to June 2021). Computed tomography (CT) and magnetic resonance imaging (MRI) were used for imaging evaluation of the patients. Imaging diagnosis was confirmed on histopathology in 21 patients. Results: We identified thirty cases of mucormycosis in COVID-19 patients in our tertiary center. Out of total cases, 18 were of pulmonary form, 9 of rhino-orbital form, and 3 of rhinocerebral form. Bird's nest pattern of cavitation was the most common feature in pulmonary form of mucormycosis. Acute unilateral rhinosinusitis with the presence of T2 hypointensities within periantral and intraorbital fat stranding was found to be the most specific imaging appearance in rhino-orbital form of mucormycosis. Rhinocerebral form showed contiguous spread of the disease from the sinuses to the meninges and brain parenchyma. Conclusion: Imaging plays a decisive role for early identification of the mucormycosis infection in COVID-19 patients and determination of the disease extent. CT and MRI help in accurate diagnosis of the disease and follow-up in postoperative patients.
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Effect of COVID-19 on the management of tuberculosis at a rural hospital setting of India p. 96
M Suthandhira, N Dheepa, AR Susethira, P Kousikha, KD Kanagaraj
DOI:10.4103/am.am_142_21  
Background: Preserving and maintaining the continuity of tuberculosis (TB) essential services, expediting the surveillance of populations who are vulnerable to the disease, and carrying out high-quality epidemiologic research are required and very essential for reducing the TB burden in this era of COVID-19 pandemic. Hence, this study aimed toward assessing the effect of COVID-19 on the management of TB at a rural hospital setting of India. Methods: A retrospective observational cohort study is undertaken at a tertiary care hospital setting of India. The data from the TB center of a tertiary care hospital were gathered, where two cohorts are made based on a time frame, and the patients were evaluated over that selected time frame. Results: A total of 472 patients presented to the TB care clinic during the 2019 study period (Cohort A), whereas only 78 patients presented to the clinic in the 2020 study period. The diagnosis of TB was made based on the sputum examination and chest X-ray, where 104/472 (22%) were positive to TB in Cohort A and 42/78 (54%) were TB positive in Cohort B. Discussion: The fraction of TB patients who were obscured from the follow-up was prominently higher during the 2020 period when related to that of 2019 (17% vs. 9.6%; P = 0.01). There were 7 deaths that occurred during 2020 (17%), compared to only 3 deaths (2.8%) in the 2019 period (P = 0.04). Conclusion: Strengthening the governmental policies toward rapid adoption of TB control measures in times of newer challenges like COVID-19 must be an immediate priority in mitigating the disease burden.
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Association between C-Reactive protein at time of presentation and severity of COVID-19 pneumonitis and can C-Reactive protein improve referral system from periphery? p. 99
Mahesh G Solu, Vitan Kautukkumar Patel, Sumer S Ramawat, Chandrakesh R Yadav, Naveen C Kendole, Meet K Thakkar, Raj N Shah, Prachi D Bhanvadia
DOI:10.4103/am.am_126_21  
Introduction: The world has been under one vicious COVID-19 wave after the other for nearly 2 years, and the battle is still on. We know that the majority of serious infections have significant high-resolution computed tomography (HRCT) changes; a predictor for them would be a vital tool in this battle! Aims and Objectives: The study aimed to assess the correlation between C-reactive protein (CRP) at the time of presentation and HRCT score in patients with severe COVID-19 infection. Methods: In this prospective, single-center study of 121 patients with severe COVID-19 infection in a tertiary COVID-19 care center. Patients were assessed for the relationship between CRP levels and chest radiography in COVID-19 patients. Results: In patients who survived in severe COVID-19 infection, CRP on admission had a significant correlation with HRCT score with P = 0.019, and in patients who did not survive, CRP on admission had a significant correlation with HRCT score with P = 0.005. CRP at day 5 was also significantly correlated to HRCT score with P = 0.035 in survivors and P = 0.001 in patients who did not survive. Conclusion: In centers where HRCT chest is not available or financial resources are a major concern, we suggest early CRP, repeated after 3–5 days, could be a very useful prognostic factor for significant lung involvement during the course of illness. This, in turn, could be a very useful tool in determining a need for admission, referral to higher centers, or more intensive therapy early on.
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REVIEW ARTICLE Top

The business of telehealth p. 103
Krishnan Ganapathy
DOI:10.4103/am.am_33_22  
The author has been actively involved in the successful management of a number of small and mega telehealth projects. This communication summarizes the importance of management science in addressing operational, technical, and clinical challenges in virtually reaching the unreached. These are seldom discussed. Publications dealing with organizational, regulatory, and cultural issues vis a vis its deployment in initiating, sustaining, and making viable telehealth activities have been reviewed. The WHO framework for the implementation of telemedicine services gives some guidelines. This article reflects personal experience, from discussions with the author's street-smart team. The latter's approach fitted in with the dicta of management gurus. A detailed need assessment study was the first step. Risks in program implementation, challenges in providing teleconsultants, and the necessity for training, retraining, learning, relearning, and unlearning are emphasized. Identifying champions in the community and team and making the project self-sustaining is critical. Future-ready access to cost-effective, need-based, appropriate technology including a robust telecommunication network is vital. Patient perspectives of telemedicine quality must be considered. Measurable, reproducible, objective parameters to quantify success need to be defined. Barriers need to be foreseen and addressed. Legal, regulatory, and security issues have to be complied with. Cultural transformation is necessary for the acceptance of technology-enabled remote virtual health care. Urban teleconsultants need to be sensitized for community interaction while deploying cutting-edge technology. Identifying opportunities to initiate telehealth activities, implementation challenges, and adoption of pandemic-associated specific strategies are discussed.
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CASE REPORTS Top

Pseudohypoparathyroidism: A Rare Cause of Status Epilepticus p. 110
Vinit Suri, Avinash Goswami, Shishir Pandey, Monika Goyal
DOI:10.4103/am.am_122_21  
Hypocalcemia can result in a variety of symptoms which include paresthesias, muscle spasms, cramps, tetany and circumoral numbness. Arrhythmias, heart failure and seizures constitute the serious symptoms arising from hypocalcemia. Seizures resulting from hypocalcemia are more common in the pediatric population. Although hypocalcemia can result from several causes, hypoparathyroidism and Vitamin D deficiency are most commonly encountered causes in clinical practice. Pseudohypoparathyroidism is a rare cause of hypocalcemia. We report a case of a young boy who presented to the emergency in status epilepticus with encephalopathy. ECG revealed prolonged QT interval which prompted further evaluation for a possible metabolic cause for this new onset status epilepticus. Routine laboratory investigations revealed hypocalcemia. A parathyroid pathology was suspected since phosphate level was elevated. Parathyroid hormone (PTH) levels were elevated suggesting PTH resistance pseudohypoparathyroidism which was diagnosed after exclusion of other causes of hypocalcemia and other acquired causes of PTH resistance. Patient was managed with intravenous calcium gluconate infusion, oral calcium supplementation, calcitriol and antiepileptic drugs.
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Disseminated histoplasmosis in a patient with rheumatoid arthritis and interstitial lung disease p. 113
Deepak Rosha, Ishan Gupta, Vijay Kiran Gandham, Piyush Goyal
DOI:10.4103/am.am_37_22  
Histoplasmosis is a rare systemic fungal ailment. The clinical presentation of this disease is nonspecific and most physicians lack awareness about this disease. There is a paucity of diagnostic tests, due to which fungal infections remain undiagnosed. The dissemination of this infection beyond the lungs can remain asymptomatic. Infection mostly heals on its own but in few cases, it manifests as a pulmonary disease, very similar to tuberculosis. Systemic spread occurs in patients with debilitating diseases and those who are immunocompromised. We report a rare case of disseminated histoplasmosis in a 54-year-old female suffering from rheumatoid arthritis with interstitial lung disease with lung and bone marrow involvement. Appropriate administration of antifungal agents led to remarkable improvement.
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Chikungunya presenting with pulmonary involvement – An unusual manifestation p. 115
Sanjay P Khare, Amey V Yeolkar
DOI:10.4103/am.am_19_22  
Chikungunya is caused by an arthropod-borne alphavirus transmitted by the mosquito vectors Aedes aegypti and Aedes albopictus.[1] It is being increasingly reported in India in general and Mumbai in particular. The name chikungunya is derived from an African language and means “that which bends up” or “A disease that makes one walk with a stooped gait” because of the incapacitating arthralgia by the disease. The usual presentation is with inflammatory arthritis/polyarthralgia. Systemic manifestations are rare. In this report, we present a case of chikungunya with pulmonary manifestations, which is very unusual. A 69-year-old male patient with laboratory-confirmed reverse transcription-polymerase chain reaction (RT-PCR) chikungunya fever had lung involvement with acute hypoxemia and electrolyte imbalance. Initially, the patient was suspected to have COVID-19 disease as there was a fever with respiratory involvement, and he had presented right in the middle of a COVID-19 pandemic. Bilateral basal crackles and low SpO2 pointed toward the same. However, TruNAAT-COVID (once), rapid antigen test-COVID (once), and RT-PCR for COVID-19 (twice) were negative. Moreover, his upper respiratory tract Multiplex PCR panel was also negative, thereby truncating the possibility of infection with usual/other viruses. Hence, all the clinical features, X-ray, and high-resolution computed tomography of the chest pointed toward pulmonary involvement because of chikungunya, making this a very unusual presentation.
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CLINICAL IMAGES Top

High-resolution ultrasonography in open spinal dysraphism: Spina bifida with lumbosacral myelomeningocele p. 118
Ravikanth Reddy
DOI:10.4103/am.am_93_21  
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Retracting fingers?: A sign of uncontrolled blood sugars! p. 120
Jaspreet Kaur, Daljinderjit Kaur, Amtoj Singh Lamba
DOI:10.4103/am.am_141_21  
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LETTERS TO THE EDITOR Top

Balo's concentric sclerosis and borderline forms of multiple sclerosis p. 122
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/am.am_148_21  
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Corticosteroids are high-potency drugs and should be used judiciously p. 124
Harish Gupta, Nitu Nigam, Sudhir Kumar Verma, Ajay Kumar Patwa
DOI:10.4103/am.am_105_21  
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Distinct differences were noticed during the 3rd COVID wave in India p. 126
Jay V Turakhiya, Abhishek Vaish
DOI:10.4103/am.am_30_22  
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Postgraduate medical education in India – Ideals versus reality Highly accessed article p. 128
Harish Gupta
DOI:10.4103/am.am_147_21  
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