Acta Medica International

Romosozumab: A new anabolic arrow in quiver for management of osteoporosis Alok Singh, Dhyuti Gupta Acta Medica International 2020 7(2):57-62 The multifactorial disease of the elderly, characterized by accelerated bone loss and a high risk of fracture (even with trivial trauma), osteoporosis, is known to primarily affect postmenopausal women. Moreover, the precipitating factors for the same mainly are the hormonal and nutritional deficiency. Clinically, the most common fracture to be encountered is the vertebral compression fracture. Apart from exogenously supplementing calcium and Vitamin D, a diverse group of drugs (bisphosphonates, denosumab, teriparatide, strontium ranelate, raloxifene, and calcitonin) are available to manage the case of osteoporosis. The latest drug to be approved and included in this quiver is a sclerostin-targeting monoclonal antibody, romosozumab. This new drug appears to be promising in managing the postmenopausal patients of osteoporosis. Although the array of adverse effects is not well recognized, a black box warning has been issued for this drug in reference to contraindicated use in patients with comorbid myocardial infarction. The intent of the authors for this review is to discuss the pharmacological profile of romosozumab, with particular emphasis on supportive clinical trials as well as the adverse drug reactions associated with its use.

Laboratory findings in COVID-19 patients and biomarkers for early assessment of severity and mortality Asbah Shams, Madhu Sinha, Abhijit Das, Natasha Gulati, Rani Sahu, Man Mohan Mehndiratta, Chandra Shekhar Acta Medica International 2020 7(2):63-68 The novel coronavirus-19 (severe acute respiratory syndrome coronavirus-2) pandemic has crossed more than 4,006,257 cases with 278,892 deaths worldwide and 67,152 cases and 2206 deaths in India. The disease has a variable clinical course ranging from mild to severe disease. Although most of the patients are asymptomatic, some patients with comorbidities have a high propensity of clinical worsening and mortality and it is this chunk of patients that we need to recuperate. Studies have shown that a number of laboratory parameters, which are easily available and inexpensive, can adequately predict the disease severity at an early stage. In a resource-limited country like India, where costly investigations cannot be routinely carried out in the magnitude as big as that of this pandemic, it is imperative that patients be monitored with these simple and inexpensive parameters that are elucidated in this review. We carried out an electronic search on PubMed and Google Scholar with keywords “laboratory abnormalities in COVID-19,” “coagulopathy in COVID-19,” “sepsis in COVID-19,” “hematologic abnormalities in COVID-19,” “kidney injury in COVID-19,” “acute respiratory distress syndrome in COVID-19,” “cardiac injury in COVID-19,” “liver injury in COVID-19,” and “severity indicators in COVID-19” till present date (May 11, 2020). All studies that appeared in our search results were scrutinized and 40 studies were selected for the study.

Dissatisfaction and problems in marital life of spouses of patients with bipolar disorder: A cross-sectional study from a tertiary care hospital Bilal Ahmad Bhat, Rouf Ahmad Mir, Arshad Hussain, Iqra Rasheed Shah Acta Medica International 2020 7(2):69-75 Introduction: The objective was to understand the marital dissatisfaction/satisfaction and problems in different areas of marital life in spouses of patients with bipolar disorder (BD). Materials and Methods: In this cross sectional descriptive study on BD patients and their spouses, a semi structured questionnaire was used to collect sociodemographic details. Couple satisfaction index (CSI) was used to identify marital satisfaction or dissatisfaction, whereas problem areas questionnaire (PAQ) was used to identify areas in which spouses of BD patients were often dissatisfied or have disagreements about their partner's behavior. Results: A total of 170 BD patients, along with their spouses, were included in our study. Marital dissatisfaction was present in 104 (61.2%) and there was no significant relation with sociodemographic variables except for the number of children (P = 0.002). Mean scores on CSI and PAQ were 42.75 ± 17.32 and 28.91 ± 11.28, respectively, with a significant negative correlation between these (r =-0.712; P = 0.0001). Handling family finances; rearing children or parenting, career/job related decisions, demonstrations of affection, handling household tasks, spending recreation leisure time together, moodiness/temper/emotionality, and problems in sex relations were important areas in which partners of BD patients were facing a significant problem. Conclusions: Marital dissatisfaction was very common in spouses of BD patients and they faced a lot of problems in various areas of their lives. As clinicians, we need to evaluate and understand the issues related to the marital life of normal spouses of BD patients to provide emotional and practical support to them, individually as well as couples.

Awareness and attitude about heart transplantation among undergraduate nursing students: An institution-based survey in India Suresh K Sharma, Hemlata Sadhanu, Manisha Naithani, Anshuman Darbari, Jyoti Bharadwaj, Maneesh Sharma Acta Medica International 2020 7(2):76-80 Introduction: Heart transplantation is the currently available and established lifesaving therapy for the end stage heart failure. Considering the paucity of data about nurses' awareness and attitude about heart transplantation, this survey was undertaken. The aim of this study was to assess the awareness and attitude regarding heart transplantation among undergraduate nursing students. A questionnaire based cross sectional survey was conducted among undergraduate nursing students studying in an institute of national importance in India. Materials and Methods: A prevalidated questionnaire was administered among 147 randomly selected participants who were willing to participate in the study. Results: All the students (100%) were aware about organ donation, but majority (77.5%) informed that their source of information on this topic is by Internet/media. Around 18.4% of participants had already pledged permission for organ donation after death and 70.8% were willing to donate the organ after death. Conclusion: Results showed the gap existence and need of addressing this among undergraduate nursing students regarding organ donation and heart transplantation.

Selfitis, narcissism, and emotional intelligence: Eliciting the interrelation among medical students in Kolkata, West Bengal Soumalya Ray, Tanmay Kanti Panja, Dipta Kanti Mukhopadhyay Acta Medica International 2020 7(2):81-85 Introduction: Selfitis, the obsessive behavior to take and share one's own photographs, is a popular activity among young adults. It is growing with the availability of cheap data and free social network services. Scientific literature considers it as an effort to emphasize self-importance in the context of inadequate social support. The aim was to assess the burden of selfitis among medical students and to identify factors associated with it. This cross-sectional study was conducted among 166 students of a medical college in Kolkata, from December 2019 to March 2020. Materials and Methods: The level of selfitis was assessed using the Selfitis Behavior Scale (SBS). Narcissism was evaluated using Narcissistic Personality Inventory-16 and emotional intelligence (EI) was assessed using the mind tool EI questionnaire. Quantitative data were expressed as mean (±standard deviation) or median (±interquartile range) and qualitative data were expressed in frequency and percentage. Binary logistic regression was done with the level of selfitis as a dependent variable and narcissistic trait, EI, and other sociodemographic, individual characteristics as the independent variable. Results: Around one-third (35.5%) of the respondents had borderline selfitis according to SBS. None of the respondents had acute or chronic selfitis. Perceived presence of recreational activity (adjusted odds ratio [AOR] - 15.71), availability of pocket money (AOR - 69.42), family support (AOR - 6.30), and narcissistic trait (AOR - 3.94) were positively associated with borderline selfitis. Conclusions: Around one-third had borderline selfitis. Narcissism and lack of perceived family support were found to be associated with it.

Impact of COVID 19 lockdown on the study of medical students: A cross sectional survey Jolly Agarwal, Sonam Maheshwari, Anurag Agrawal, MK Pant, Yatika Chaudhary, Manisha Naithani Acta Medica International 2020 7(2):86-89 Introduction: During the pandemic of COVID 19, the traditional teaching of MBBS students has been shifted to online teaching. We conduct an online survey to know and record the impact of COVID 19 lockdown on the study of medical students of GDMC, Dehradun. The present study aimed to investigate the MBBS student's perception of online teaching. The results of this study may provide further inputs which might be of help to the students and faculty for further informed decisions. Materials and Methods: A cross sectional online survey during July 1–7, 2020 was applied to 334 medical students to evaluate the perception of online teaching among medical students. A questionnaire was prepared in Google form and divided into two sections. The first part covered demographics information of the respondent and the second part assessed with behavior and attitude toward online teaching. Results: The mean assessment, behavior, and attitude scores have significantly differed across age groups and previous experience. The medical students who had no exposure to online teaching their assessment score is higher than who had little exposure also found to be significant. The participants were agreed with the teaching way of the course (59.3%) and with the content of the course (56.9%). Majority of participants (58.4%) also agree that there are barriers in online learning. Most of the students agree (62.3%) and strongly agree (61%) that the course allowed them to take responsibility for their learning. Conclusions: We can conclude that the online learning program is a good alternative to classroom teaching in this era of the COVID 19 pandemic. This study can provide the basic architecture for making further strategy of course content.

Prevalence of temporomandibular disorders in individuals seeking treatment at dental hospital: A cross-sectional study Varsha Kanjani, Neel Gupta, Akash Bhatt, Mehak Tariq, Ajaz Ahmed, Kanchan Malawat Acta Medica International 2020 7(2):90-92 Introduction: Temporomandibular disorders (TMDs) being the most prevalent orofacial condition, is one of the major reason for patients to seek conservative intervention at dental hospital. The multifactorial etiology of TMDs along with the wide spectrum of associated signs and symptoms, mainly orofacial pain, restricted mouth opening, and deviation, has made the condition difficult to diagnose. The aim of the present study is to determine the signs and symptoms associated with temporomandibular disorders according to Research Diagnostic criteria for Temporomandibular disorders (RDC/TMD). Materials and Methods: The present cross-sectional study was conducted at dental hospital, Rajasthan among 1450 individuals. The 209 individuals, above 18 years of age who met the inclusion criteria were enrolled in the study. Along with signs and symptoms of TMDs (VAS score for orofacial pain, clicking sound, crepitus, reduced mouth opening (less than 40 mm), joint deviation and tenderness, etc.) the structured questionnaire according to RDC/ TMD were also assessed. The data was analyzed using Statistical Package for the Social Sciences version 21 software. Results: In the present study population, the prevalence of TMDs was 14.41% only. Most of the patients were in 2nd decade (33.01%) with female predilection (69.85%). The VAS score for patients complaining of orofacial pain (58.85%) was 6.32±1.12 with reduced mouth opening in 42.58%. According to RDC/TMD, the most common finding observed was TM joint deviation (63.15 %), followed by clicking sound (56.93%), crepitus (46.41%), MPDS (12.91%), internal derangements (10.52%) and osteoarthritis (6.22%). Conclusion: The prevalence of TMDs was more prevalent in younger generation, especially with female predilection. The most common signs and symptoms seen in the present study were orofacial pain, followed by reduced mouth opening, TMJ deviation and clicking sound.

Cord blood lactate levels as marker for perinatal hypoxia and predictor for hypoxic ischemic encephalopathy Ashish Kumar Simalti, Vandana Negi, Anil Kumar, Suman Kumar Pramanik Acta Medica International 2020 7(2):93-96 Introduction: This study was conducted to find if cord blood lactate correlates well with Apgar score and umbilical cord blood pH and subsequent development of hypoxic ischemic encephalopathy (HIE). Materials and Methods: It was a cross sectional, observational study which was conducted at a tertiary care referral center of North India from June 2018 to June 2019. Monitoring of cord blood lactate levels along with Apgar and cord blood pH was done for correlation of cord blood lactate with Apgar, cord blood pH, and subsequently development of HIE. Results: During the study period, 115 term neonates got enrolled based on inclusion criteria. Out of these, 83 babies had some degree of HIE based on Sarnat staging. Among these 83 neonates with encephalopathy, 36 had Stage III HIE while, 28 and 19 babies had Stage II and Stage I encephalopathy, respectively. Lactate levels correlated negatively with Apgar score and umbilical cord blood pH and higher levels of lactate correlated well with lower Apgar and cord blood pH. The mean lactate level was significantly higher in cases with HIE (5.18 mmol/L) as compared to cases without HIE (2.91 mmol/L). Conclusion: Our study shows that cord blood lactate can be used as a predictor for perinatal hypoxia. With the availability of cheaper handheld lactate monitors, lactate monitoring may become more practical option and need to be explored.

Treatment outcome of percutaneous nephrolithotomy: The initial experience from a tertiary care Center Ifrah Ahmad, Irshad Ahmad, Arif Hamid, Erum Khateeb Acta Medica International 2020 7(2):97-101 Introduction: The purpose of the study was to assess the operative characteristics and treatment outcome of percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi at our hospital. Materials and Methods: Patients with significant size symptomatic renal calculi not manageable by conservative management and those with calculi resistant to extracorporeal shock wave lithotripsy (ESWL) were included in the study. Patients excluded from the study were those with significant coagulopathy, active upper urinary tract infection, and renal calculi in ectopic kidneys. Results: Our study group had a mean age of 42.46 ± 11.29 years. Nearly 60% of stones in our study were of size 21–30 mm in the longest diameter with mean stone diameter of 24.56 ± 7.809 mm. Mean hemoglobin drop following the procedure was 1.35 ± 0.843 g/dl. Mean operative time was 93.56 ± 9.90 min. We had an overall success rate of 83.5% in our study. Fourteen failure cases were managed by ESWL (ten cases), second look PCNL (three cases), and by open surgery (one case). Conclusion: Although we find a higher frequency of minor complications such as transient mild hematuria (37.6%), mild puncture site pain (55.3%), or low-grade fever (24.7%), no major or long-term side effects were observed in our series.

Infectious granulomatous dermatitis: Clinicohistopathological study with some unusual clinical presentation Praneeta Jaswant Singh, Ambrish Kumar Acta Medica International 2020 7(2):102-107 Introduction: Granulomatous dermatitis has a varied differential diagnosis ranging from infectious etiology to immune mediated diseases. In tropical countries like India, infectious etiology forms an important cause of granulomatous dermatitis with tuberculosis (TB) and leprosy being the major contributing factors. The present study was carried out with the aim to determine the frequency of various etiological agents causing infectious granulomatous dermatitis in our hospital setup and to see clinicohistopathological correlation in these cases. Materials and Methods: This is a hospital based retrospective study conducted in the department of pathology over a period of 1 year. All the skin biopsy cases diagnosed as infectious granulomatous dermatitis were retrieved from the histopathology record section for analysis and were categorized based on the causative etiological agents. Special stains were applied wherever necessary in addition to routine hematoxylin and eosin stain. Results: A total of 40 cases of infectious granulomatous dermatitis were included in the present study. Most common diagnosis was leprosy (57.5%), followed by TB (30.0%), actinomycosis (5.0%), dermatophytosis (2.5%), histoplasmosis (2.5%), and cysticercosis (2.5%). Gender wise distribution showed male predominance with 57.5% of cases and age wise distribution showed a peak in the age group of 41–60 years (32.5%). Clinicohistopathological correlation was found in 87.50% of the cases. The unusual clinical presentations were seen in cases of cysticercosis, actinomycosis, and histoplasmosis. Conclusion: Histopathological examination of the skin biopsies is an important diagnostic tool providing definitive diagnosis as well as clinicohistopathological correlation in cases of infectious granulomatous dermatitis.

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