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   Table of Contents - Current issue
Coverpage
July-September 2022
Volume 19 | Issue 3
Page Nos. 133-193

Online since Friday, August 5, 2022

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GUEST EDITORIAL  

Hemming heart with newer needles: I hope the thread last forever p. 133
Sarita Rao
DOI:10.4103/am.am_91_22  
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EDITORIAL Top

Innovations in cardiovascular sciences – A roadmap toward new standardization in cardiovascular treatment p. 135
NN Khanna
DOI:10.4103/am.am_107_22  
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ORIGINAL ARTICLES Top

Comparison between clinical, magnetic resonance imaging, and arthroscopic findings in meniscal and cruciate ligament injuries: A cross-sectional study p. 137
VM Predeep Kumar, Raju Karuppal
DOI:10.4103/am.am_74_22  
Introduction: Complete evaluation of knee injury includes detailed clinical examination, radiological evaluation, and arthroscopy. Objective: The objective of this study was to compare the effectiveness of clinical, magnetic resonance imaging (MRI), and arthroscopic findings in meniscal and cruciate ligament injuries. Patients and Methods: A cross-sectional study of 40 post knee injury symptomatic patients aged 20–40 years. Clinical and MR imaging findings were compared with arthroscopic findings (considering arthroscopy as the gold standard diagnostic test). The specificity, sensitivity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared. Results: The specificity, sensitivity, PPV, NPV, accuracy of clinical examination, and MRI were similar for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries. The diagnostic accuracy of clinical examination and MRI were 82.5% and 90%, respectively, and 95% and 92.5% for medial meniscal and lateral meniscal injuries, respectively, and 97.5% and 100% for ACL and PCL injuries, respectively. Conclusion: The diagnostic accuracy of clinical examination is similar to MRI for ligament injuries and marginally lower for meniscal injuries. MRI is useful to clarify clinical diagnosis in clinical cases of meniscal and cruciate ligament injuries that are doubtful.
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Coverage of maternal & child health services by the beneficiaries residing in an Urban Poor Locality, Bengaluru p. 142
Ashwath N Doddabele Hanumanthaiah, Hulugappa Lakshmi, Manchegowda Ramya, Huluvadi Shivalingaiah Anwith
DOI:10.4103/am.am_77_22  
Introduction: Under the National Population Policy-2000, National Health Policy-2002, 10th Five-Year Plan, and Reproductive and Child Health-2 Programme, the maternal and child health (MCH) services of the urban poor have been recognized as an important thrust area for the country's development. Objective: The objective is to assess the MCH services coverage and utilization provided by the government. Methods: A cross-sectional study was conducted during October 2015–November 2016 in the eight urban poor localities falling under the urban field practice area of the medical college in Bengaluru. Using the probability proportional to population size, a total of 2540 beneficiaries meeting the inclusion and exclusion criteria were included in the study. Data were collected using pretested semistructured pro forma by interview method and analyzed using appropriate inferential and descriptive statistics. Results: Around 83.3% of subjects had registered their pregnancy within 12 weeks. Majority (83.1%) of women delivered in the government hospital and 7.2% had complications following delivery. Around 56.8% of women had practiced one of the family planning methods (couple protection rate of 56.8%). Most of the women 67% had utilized MCH services in the past 6 months and 74.5% utilized services from the government health facility. The utilization of MCH services was mainly by subjects of the Muslim religion, nuclear families, literates, and unemployed and on applying Z-test this difference was statistically significant. Conclusion: Coverage of MCH services was not satisfactory. There is a statistically significant difference in the utilization based on religion, type of family, literacy, and employment.
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Health status of perimenopausal and postmenopausal women at Mangalore, Karnataka, India p. 147
CV Divya, Vasantkumar V Bhanushali, E Vinu, KS Premlal
DOI:10.4103/am.am_65_22  
Objectives: Women spend approximately one-third of their lives postmenopausal due to increased life expectancy. In this study, the daily activities of the study participants were associated with menopausal symptoms. Methodology: The women aged between 40 and 60 years residing in Mangalore town were selected as subjects for the current community-based cross-sectional study. The study participants were either going through natural menopause or had attained natural menopause. The data include sociodemographic profile, marital history, obstetric history, history of contraceptive use, history of chronic diseases, habits, physical activity, menstrual history, and menopausal symptoms. In addition, the individual effect of these variables on daily activities was noted among the participants. The investigator also examined the patients and measured the relevant anthropometric measurements along with the record. Results: The total number of study participants in the current research was 364. The most prevalent menopausal symptoms are night sweats (72.8%), irritability (94.2%), vaginal dryness (76.7%), decreased libido (94.8%), and fatigue (88.7%). The common comorbidities were anemia (49.5%), dental caries (23.4%), and hypertension (23.1%). There is a significant association between age at menopause (P < 0.05) and factors such as religion, socioeconomic status, age at menarche, length of menstrual cycles, number of bleeding days per cycle, history of oral contraceptive pill use, parity, age at first childbirth, and occupation (beedi workers). The women's daily activities (P < 0.05) in this age group were affected by the most familiar menopausal symptoms, including fatigue and irritability.
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Spectrum of unusual ectopic pregnancies on imaging: Case series p. 152
Madhuri Pundlikrao Udgire, Varun Vasant Nimje, Shubham Baburao Bodhankar, Tushar Suresh Yadav, Rushabh Chordiya
DOI:10.4103/am.am_56_22  
Background: Ectopic pregnancy is a life-threatening condition commonly encountered in the emergency department and possesses high morbidity and mortality association in women of childbearing age. However, there are some unusual ectopic pregnancies that are rare. Objective: The purpose of this case series is to illustrate and familiarize clinicians with imaging findings along with risk factors and management strategies of less commonly encountered unusual ectopic gestations. Materials and Methods: Patients referred to the department of radiodiagnosis and imaging with unusual ectopic pregnancy were included. A 1–7 MHz convex transducer was used for transabdominal examinations, and a 3–12 MHz endovaginal ultrasound probe was used for transvaginal examinations. Conclusion: Incidence of gestations with ectopic implantations is rising, and knowledge of the imaging appearance of uncommon ectopic gestations is important for clinicians in correct diagnosis and timely treatment initiation.
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A single-center cross-sectional study on the clinical profile of pancytopenia and a novel scoring system for megaloblastic anemia p. 157
Sanjaykumar Somsingbhai Rathwa, Darshankumar Manubhai Raval, Shashwat Mallik, Shahin Khan
DOI:10.4103/am.am_58_22  
Background: Our study tries to identify the main culprits causing pancytopenia and its typical clinical presentation, along with the clinical and hematological profile of megaloblastic anemia (MGA)-induced pancytopenia, in a tertiary care hospital in western India. Methods: This observational cross-sectional study was carried out on 50 patients diagnosed with pancytopenia in our hospital over 1 year (January 2019–January 2020). A scoring system is also described to distinguish cobalamin deficiency from other etiologies of pancytopenia. Results: MGA due to cobalamin deficiency was the leading cause of pancytopenia. The most frequently seen sign was whiteness, while the most typical symptoms were lethargy, malaise, and generalized weakness. Patients between 20 and 50 years of age were most often affected, with a male predominance being noticed. While blood counts revealed life-threatening anemia in most patients, the leukopenia and thrombocytopenia were not as severe. Conclusion: It was concluded that MGA due to dietary deficiency of Vitamin B12 is the most common etiology for pancytopenia in western India. Our scoring system could be used as an alternative to serum cobalamin tests to diagnose cobalamin deficiency, subject to confirmation in larger populations.
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Cross-sectional study on awareness and usage of Government COVID-19 mobile health applications among adult smartphone users of Assam p. 163
Madhur Borah, Chandana Deka
DOI:10.4103/am.am_70_22  
Background: As the COVID pandemic became an emergency situation in India, government COVID-19 mobile health (mHealth) apps through smartphones and mobile internet reached citizens across the country and catered to their health needs. Data available from Assam and North Eastern states of India regarding the COVID-19 mHealth apps Arogya Setu app and CoWIN portal, their awareness, usage, and its effectiveness among the general population were very less. Therefore, this study was done with the objectives to find out the awareness and usage of Government COVID-19 mHealth apps among the adult smartphone users of Assam. Methodology: The study was conducted through an online survey method using the Google forms. A total of 310 adult smartphone users from eight different districts of Assam were selected by the convenient sampling method. Data processing and statistical analysis was done using the MS Excel platform. Five-point Likert scale was used for the measurement of respondents' opinions. Results: The awareness level was found to be more than 90%. On user experience of the government mHealth apps, 70% of the respondents agreed that these apps were easy to use and navigate. The satisfaction level of the respondents regarding the apps was found to be high and 80% of study participants trusted the apps. Conclusion: Our study observed that awareness and usage of the government COVID-19 health applications were high among the study participants.
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REVIEW ARTICLE Top

Cardiovascular manifestations in COVID-19 patients p. 168
Jyotsna Maddury, Mani Krishna, Achukatla Kumar
DOI:10.4103/am.am_24_22  
Most important medical challenge during the past 2 years is the COVID-19 pandemic due to SARS-CoV-2 virus. COVID-19 morbidity is increased in the presence of CAD risk factors. Effect of CAD risk factors and COVID-19 infection are bidirectional. Preexisting conditions, such as cardiovascular disease (CVD), hypertension, diabetes, and obesity, increase the severity as well as mortality rate of COVID. COVID-19 disease induces multiple cardiovascular manifestations, such as myocarditis, acute myocardial injury, acute myocardial infarction (MI), stress-induced cardiomyopathy, cardiogenic shock, arrhythmias, and, subsequently, heart failure (HF) and cardiac arrest. Increase of troponin suggests a hyperinflammatory state or may be due to acute myocarditis. Elevated troponin without other laboratory markers elevation suggests aggressive COVID-19 disease than myocardial injury. Stress or takotsubo cardiomyopathy occurred primarily in women with COVID-19 and these women have more severe HF. The patients with COVID-19 positive more frequently have multivessel thrombosis, stent thrombosis, and a higher thrombus when compared to COVID-19-negative STEMIs. Because of higher thrombus burden more usage of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors and thrombus aspiration and higher heparin doses to achieve therapeutic activated clotting times were also noted. Patients with pulmonary embolism had significantly higher hs-cTnT and NT pro-BNP levels than those without pulmonary embolism. In COVID-19, arrhythmias noticed are atrioventricular/ventricular block, sinus tachycardia, sinus bradycardia, atrial arrhythmias, and ventricular arrhythmias. Consideration for potential drug interactions should be taken when treating CVD patients with COVID-19.
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CASE REPORTS Top

Sinonasal mucormycosis with an unusual involvement of palate p. 177
Santosh Kumar Swain
DOI:10.4103/am.am_130_21  
Mucormycosis is caused by a fungal infection that belongs to the order of Mucorales and is one of the rapidly spreading infections of the human body. Rhizopus species are the most common etiological agent associated with mucormycosis. It is an emergency clinical condition and has a poor prognosis. The most common variant of the mucormycosis is rhinocerebral type which may spread to the orbit and brain. The identification of mucormycosis in the palatal region is often rare and late occurrence. A case of multiple ulcerations in the palatal region occurs due to sinonasal mucormycosis in a 55-year-old is reported. He was known case of diabetes mellitus and was diagnosed with coronavirus disease 2019 infection 1 year back but recovered with conservative treatment at home. Anterior rhinoscopy showed purulent discharge in both nostrils. He had no swelling in the face and neck. No tenderness was found in the head-and-neck region. He was successfully managed by surgical debridement combined with systemic liposomal amphotericin B for 6 weeks. The survival of patients is often dependent on early diagnosis and treatment.
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Management of calcium in coronaries: Not always as expected p. 180
F Aaysha Cader, Saidur Rahman Khan
DOI:10.4103/am.am_29_22  
Percutaneous revascularization of calcified coronary lesions is being performed with increasing frequency. Particularly, in elderly patients at high bleeding risk (HBR), these procedures are rife with technical challenges, which need to be balanced against the need to adhere to the KISS (keep it simple and swift) principle, minimizing procedural complexity and duration. We report the case of a 75-year-old male with HBR, presenting with angina, in whom intravascular imaging-guided multivessel percutaneous revascularization was performed in vessels with coronary artery calcium (CAC). Rotational atherectomy was done for concentric calcification in the left anterior descending artery. CAC in a tortuous right coronary artery was tackled with a balloon-based strategy, with the help of a guide extension catheter (GEC), which itself led to long stent damage during manipulation, necessitating bailout. This case demonstrates the judicious use of available armamentarium in resource-limited settings for tackling different presentations of CAC and the appropriate selection of calcium-modifying strategy guided by intravascular imaging. We also emphasize the importance of exercising caution when using equipment such as GEC and the need for swift and appropriate bailout mechanisms of these complications.
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Activated charcoal hemadsorption in Cerbera odollam poisoning p. 184
Dyna Jones, Meenakshi Kalyan, Chaitra Kolli, Hemant Kumar
DOI:10.4103/am.am_7_22  
Cerbera odollam belongs to the poisonous Apocynaceae family, which grows in coastal salt swamps, creeks and along river banks found in South India. The poisonous part of the plant is the kernel containing the toxin cerberin which is a cardiac glycoside that produces symptoms and signs similar to acute digoxin poisoning. The treatment is mainly symptomatic as well as administration of digoxin immune fab antibodies. Digoxin immune fab antibodies bind with cardiac glycosides to reduce their active concentration. However, there could be various barriers in developing countries in regard to the administration of DigiFab antibodies such as availability and affordability. Activated charcoal, a cheaper alternative, reduces gastrointestinal absorption and enterohepatic recirculation. Although its role in C. odollam poisoning remains unclear, there have been various trials where multidose activated charcoal has been beneficial in glycoside poisoning. We present a case report of a young female with an alleged history of consumption of an unknown plant compound, identified as C. odollam presenting with acute-onset vomiting, altered mental status and laboratory parameters showed hyperkalemia and thrombocytopenia. Electrocardiogram (ECG) showed sinus bradycardia followed by inverted tick mark sign. Serum digoxin levels were raised (4.2 ng/ml). The patient was stabilized with supportive measures and hemadsorption with 300 g of cellulose-coated activated charcoal, which led to the reversal of the ECG and laboratory parameters to normal, leading to the complete recovery of the patient.
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Sepsis-induced suicidal left ventricular in a patient with hypertrophic cardiomyopathy/hypertrophic obstructive cardiomyopathy p. 187
K Roshan Rao, Sarita Rao, Ankur Gupta
DOI:10.4103/am.am_66_22  
Hypertrophic cardiomyopathy is the most common heritable cardiomyopathy, manifesting as left ventricular hypertrophy. In this case, a 48-year-male patient presented with complaints of shortness of breath, uneasiness for 15 days, right lower limb pain, and one episode of fever for 2 days. He was initiated on antibiotics but gradually started developing hypotension and oliguria. After optimizing the medical therapy and as a life-saving measure, alcoholic septal ablation was done in this patient as a last resort. The patient was weaned off the ventilator after 72 h and discharged in a stable condition. He has continued follow-up for 8 months and is asymptomatic; the gradient has not recurred. The patient had both issues, and timely alcohol septal ablation helped save the patient by optimizing the hemodynamics. This is a rare situation of suicidal left ventricular induced by sepsis-induced vasodilation.
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CLINICAL IMAGES Top

Actinomycetoma of foot caused by Nocardia - A case report p. 190
Praveen Kasina, Sowmya Srirama, Eshwar Rajesh, Venkata Ramana Kandi, Tarun Kumar Suvvari
DOI:10.4103/am.am_31_22  
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External musculoskeletal markers of marfan syndrome p. 192
Thirunavukkarasu Arun Babu
DOI:10.4103/am.am_23_22  
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