Jawaharlal Institute Of Postgraduate Medical Education And Research Research Articles

Why are You Late? A Descriptive Study of Delay in Treatment Seeking among Patients of Carcinoma Breast Presenting to a Tertiary Care Hospital in South India

Objectives: The objectives of this study were as follows: Primary: To estimate the proportion of breast cancer patients with delay in presentation. Secondary: To assess the reasons for delay in presentation among patients with breast cancer. To identify the sociodemographic and clinical characteristics associated with delayed presentation among patients with breast cancer. Materials and Methods: We conducted a hospital-based descriptive study at a tertiary care hospital- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), from a period of January 2016 to June 2016. The participants were interviewed at the time of their hospital visit with a standardised questionnaire after obtaining informed consent. The patients were asked to recall the time interval between the first recognition of symptoms and the first medical consultation. A duration of >3 months was considered a patient delay. The patient reported the first symptom, and the symptoms at presentation were noted. Through clinical examination of the breasts, axilla and other systems was performed, and the positive clinical features were recorded. Results: A total of 126 women were included in the study. Out of 126 patients, 37 patients (29.4%) presented to healthcare personnel within 3 months of identifying their symptoms, and 89 patients (70.6%) presented later than 3 months. The mean duration of delay is 171.5 days, with a standard deviation of 229.45 and a median delay being 120 days. The most common cause for delay was due to the patient’s perception that the lump was harmless or temporary. The average time taken by the patients to present to JIPMER for definitive management of breast cancer after visiting a local physician was a median of 25 days and a mean of 48.77 days. The time taken for confirmation of diagnosis from the time of presentation to JIPMER was a median duration of 13 days and a mean duration of 16.58 days with a standard deviation of 12.31. About 90% of the patients had their diagnosis confirmed within 1 month. Conclusion: In our study, the proportion of delayed presentation among breast cancer patients was found to be 70.6%. Patients from rural areas and with lower educational status were found to have a higher incidence of delayed presentation. Lack of awareness of breast cancer symptoms and their misinterpretation as harmless, temporary and benign are the main reasons for delayed presentation. Patients who practised breast self-examination presented earlier. Further studies with a larger sample will help in identifying the other sociodemographic and clinical characteristics responsible for delayed presentation.

Healthcare Provider-Related Factors in the Diagnostic Delay of Cervical Cancer: A Cross-Sectional Study.

Background and objective Cervical cancer is the second most common malignancy among Indian women. In 2018, the World Health Organization (WHO) called for global action toward the elimination of cervical cancer through the triple-intervention strategy. One of its pillars is ensuring 70% screening coverage of eligible women with a high-performance test at least twice in their lifetime. Various factors contribute to the delayed diagnosis of cervical cancer, increasing the burden of the disease. In this study, we aimed to determine the healthcare provider (HCP)-related factors in the diagnostic delay of advanced cervical cancer. Methods This prospective cross-sectional study was conducted over two months in the cancer clinic of the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. We interviewed 384 women diagnosed with advanced cervical cancer [the International Federation of Gynecology and Obstetrics (FIGO) stage IB3-IVB] by using a questionnaire to capture data inputs regarding the various healthcare services they had received in the past 10 years along with details of HCPs. The collected data were analyzed using the software STATA version 17.0. Results Among 384 participants, 185 (48.1%) had interacted with an HCP in the past 10 years; 157 (40.8%) of them had visited a healthcare facility.Among these 185 women, only 22.16% had been advised to undergo screening, and only 15.18% had been tested despite several having access to primary health centers within 10 km of their residence. The lack of screening guidance by HCPs accounted for 78% of delayed diagnoses of cervical cancer. Conclusions Based on our findings, a deficiency in screening guidance in the asymptomatic period by healthcare providers across various levels of our healthcare system contributed significantly to the delayed diagnosis of cervical cancer.

Portal Vein Thrombosis in Patients With Cirrhosis of the Liver: Prevalence and Risk Factors.

Chronic liver disease very often culminates into cirrhosis and its associated complications. One of the serious complications is portal venous thrombosis, which can occur due to a variety of risk factors. One significant factor contributing to portal hypertension is portal vein thrombosis (PVT).In this study, we aimed to investigate the prevalence of PVT among patients with liver cirrhosis in a tertiary hospital and identify the factors associated with this complication. This was a cross-sectional observational study of 93 diagnosed liver cirrhosis patients treated at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in southern India between June 2020 and January 2021.A thorough evaluation of the clinical condition of the patients and associated comorbidities was done. The patients then underwent Doppler ultrasound/CECT/MRI to look for PVT and its extent. The collected data were analyzed using Statistical Product and Service Solutions (SPSS, version 24) (IBM SPSS Statistics for Windows, Armonk, NY). Comparison between two proportions was done using two two-tailed Z-test/Fisher's exact tests. Our study found a PVT prevalence of 17.2% in cirrhotic patients, with a higher prevalence of acute PVT than chronic PVT. Ascitic fluid infection, longer duration of cirrhosis, and increased cirrhosis severity were significantly associated with PVT development. We found no significant associations between PVT and gender, hypertension, smoking, diabetes, or the duration of alcohol intake. This study highlights the importance of early screening for PVT using Doppler USG in all patients diagnosed with cirrhosis. Additionally, anticoagulation therapy for acute PVT may be considered in patients without bleeding risks.

Corticosteroids and invasive fungal infections in hospitalized COVID-19 patients – A single-center cross-sectional study

Background: During the coronavirus disease 2019 (COVID-19) epidemic, an increase in the incidence of fungal infections was observed. However, the real magnitude of these fungal infections and their risk factors among COVID-19 patients in the Indian population is unknown. Aim: To study the frequency, and spectrum of invasive fungal infections (IFI) among hospitalized COVID-19 patients, and the risk factors associated with invasive fungal infections. Methods: We performed a retrospective, cross-sectional study; including all adult patients, admitted to Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), a tertiary care hospital in Southern India between April 2020 and August 2021, with COVID-19. Based on clinical-radiological features, patients with fungal infections were grouped into three diagnostic categories. Demographics, clinical, and laboratory features of patients with fungal infections were analyzed to identify the risk factors. Results: About 10% (449 out of 4650) of the admitted patients with recent COVID-19, had some form of IFI. Among the patients with IFI, 80% (366 out of 449) were hospitalized for active COVID-19, whereas almost all the patients admitted with post-COVID complications had IFI. Of the 449 patients with IFI, 377 had mold infections and 88 had invasive candidiasis. Mucormycosis was the most common mold infection. Diabetes and diabetic ketoacidosis were strong independent predictors of IFI. We also found an association between end-stage renal disease, central venous catheterization, antibiotic usage, prior stroke, and corticosteroid therapy with IFI. Conclusions: The frequency of fungal infections among hospitalized COVID-19 patients was high. Special precautions in COVID-19 patients with diabetes mellitus, corticosteroid therapy, and prior antibiotic usage may help to reduce invasive fungal infections.

Robotic-Assisted Splenectomy by a Modified Lateral Approach: Technique and Outcomes.

Introduction The utilization of robot-assisted technique for splenectomy has recently gained popularity especially in patients undergoing splenectomy for hematological indications owing to its magnification of and easy manipulation of internal abdominal organs. Moreover, robotic splenectomy emerged as an essential teaching module before approaching more complex robotic procedures. Methods A total of 43 elective splenectomies were performed for hematological indications in Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) between January 2018 to July 2023 of which 14 patients underwent robotic splenectomy. All patients underwent lateral approach of robotic splenectomy with a modification of avoiding the lesser sac dissection. Prospectively maintained data were retrospectively analyzed and results were recorded in terms of intra-operative time taken, blood loss, need for blood and blood product transfusion and postoperative morbidity and mortality. Results The indications for patients who underwent robotic splenectomy include idiopathic thrombocytopenic purpura in eight patients, autoimmune hemolytic anemia in three patients, Evans syndrome in one patient and hereditary spherocytosis in two patients. The median splenic diameter was 14.8cm and the median platelet count before the operation was 10,800 cells/cubic millimeter (7000-3,20,000). The mean operative time was 92 minutes and blood loss was 40ml. The median duration of hospital stay was 2.4 days. All 14 patients had therapeutic success and there was no procedure-related mortality or morbidity. Conclusion Robotic splenectomy using the modified lateral approach can safely be performed with comparable operative time, blood loss and overall morbidity. However further studies are mandatory to confirm the advantage of this modified technique of lateral approach of robotic splenectomy.

Clinical profile of influenza virus-related hospitalizations in children aged 1-59 months: A five-year retrospective study from south India.

Influenza is a seasonal acute respiratory tract infection with different strains in circulation at different time periods with varying spectrum of clinical presentation. To study the clinical presentation, morbidity, and mortality patterns associated with different strains of influenza virus, to identify the predominant strains related to hospitalization, and to identify the seasonal trend in hospitalization and risk factors for mortality in children aged 1-59 months hospitalized with influenza. The records of children hospitalized with influenza were analyzed retrospectively (June 2013 to June 2018). Anonymized data from the Medical Records Department of our Institute, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), were used for the study and waiver of consent was obtained from the Institute Ethics Committee for Human Studies(JIPMER), which also approved the study. The data from the medical records were extracted as per the proforma and entered into Microsoft excel and summary statistics was obtained. Categorical data were expressed as proportion and analyzed using chi square test. Association was tested using odds ratio. Of the 693 children tested for influenza during the study period, 91 were found to be positive for influenza infection and out of which 68 (74.7%) were hospitalized. Infection was seen during both the summer and winter months. The predominant strain being A (H1N1) pdm09 (63.2%). The other strains found were A (H3N2) and Influenza B. The predominant diagnosis was pneumonia. The need for mechanical ventilation was more common with influenza B infection (p = 0.035). No significant risk factors for mortality could be found in our study. An absence of seasonal predilection for the disease was noted with influenza A (H1N1) pdm09 being the predominant strain with influenza B seen as an emerging strain and an important contributor towards morbidity.

Combined Cyclin D2 and Protein Convertase 2 Genes in Differentiating Various Follicularpatterned Lesions and Neoplasms of the Thyroid: A Cross-sectional Study

Introduction: A pretherapeutic distinction between benign and malignant thyroid nodules is critical for the clinical management of patients presenting with thyroid nodules. However, certain follicular-patterned lesions, such as adenomatous nodules, follicular neoplasms comprising Follicular Adenoma (FA) and Follicular Carcinoma (FC), as well as the Follicular Variant of Papillary Thyroid Carcinoma (FVPTC), can pose a significant dilemma during pre-therapeutic Fine Needle Aspiration Cytology (FNAC) evaluation. The present (pilot) study explores the possible utility of messenger Ribonucleic Acid (mRNA) and the protein expression of the two relatively less-explored genes, Cyclin D2 (CCND2) and Protein Convertase 2 (PCSK2), in distinguishing various follicular-patterned thyroid lesions and neoplasms by testing these molecular markers initially on histopathological sections. Aim: To assess the RNA and protein expressions of CCND2 and PCSK2 genes in differentiating follicular-patterned thyroid neoplasms. Materials and Methods: This was a cross-sectional analytical study conducted over 6 years, from August 2014 to August 2020, at the Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Real-Time quantitative Polymerase Chain Reaction (RT-qPCR) along with Immunohistochemistry (IHC) was performed on a total of 75 tissue samples from follicularpatterned thyroid lesions and neoplasms, including 19 Follicular Hyperplasias (FHs), 10 Nodular Goitres (NGs), 17 FAs, 8 FCs, and 12 FVPTCs, along with nine Conventional Papillary Thyroid Carcinomas (CPTCs). After confirming the RNA and protein expression levels in each of these lesions, Immunoreactive Scoring (IRS) was performed to assess their IHC expression. The Kruskal-Wallis and Analysis of Variance (ANOVA) tests were used to analyse the mRNA expression data, and Pearson analysis was conducted to correlate the IHC data between the study groups. A p-value of <0.05 was considered statistically significant. Results: Among the 75 thyroid lesions studied, both NG and FA showed a relatively higher cyclinD2 mRNA expression, with fold changes of 1.21 and 1.46, respectively. This was also reflected in IHC, with moderate nuclear expression observed in these cases. The PCSK2 mRNA expression was similar to that of CCND2, with the only difference noted between FH and FA. On IHC, eight out of 75 cases had positive PCSK2 expression, including five FHs, two FVPTCs, and one FA, while the remaining 67 cases were negative. Conclusion: The CCND2 and PCSK2 genes assessed in the present study, regarding their mRNA and protein expressions, were not found to be of any practical value in distinguishing benign and malignant follicular lesions or neoplasms of the thyroid.

ASSESS THE KNOWLEDGE AND ATTITUDE ON PREVENTION OF DENGUE AMONG THE PATIENTS ATTENDANTS

Objectives: Dengue infection is increasingly recognized as one of the worlds emerging infection disease. Lack of knowledge and unfavourable attitude regarding preventive measure of dengue among public is leading to outbreak of dengue in many parts of India. The aim of the study was to assess the level of knowledge and attitude on prevention of dengue among the patients attendants in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Settings and Design: Descriptive cross-sectional study design. The study setting was Medical Record Department, JIPMER where patients came for the registration for the purpose of seeking treatment. Methods: The sample size was 176. The sampling technique used for the study was consecutive sampling who were satisfied with inclusion technique. The data collected with the help of questionnaire by face to face interview method. Statistical analysis used: All the categorical data were presented on frequencies, percentages, mean standard deviation, chi-square and correlation coefficient used to find the correlation of knowledge and attitude on dengue fever. Results: The study finding reported that 117(66.5%) of the participants had moderately adequate knowledge and 93 (52.8) moderately favorable attitude on prevention of dengue fever, at the same time adequate knowledge and most favorable attitude was not satisfactory level. Conclusions: It shows that public needs more educational intervention to improve their health practice against dengue by the health care provider.

Effect of Music on Pain, Anxiety and Physiological Parameters among Postoperative Sternotomy Patients: A Randomized Controlled Trial.

Introduction: Music is a non-invasive, inexpensive and non-pharmacological nursing intervention that has no side effects and can be effective when provided alongside the routine care in cardiothoracic and vascular surgery (CTVS) ward and intensive care unit (ICU). The objective of the study was to assess the effect of music on pain, anxiety and physiological parameters among the post-operative sternotomy patients from CTVS ward and ICU in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. Methods: A randomized controlled trial research design was used to conduct the study among 70 post-operative sternotomy patients. The pain score, and anxiety level were recorded using Numerical Pain Rating Scale (NPRS) and post-operative anxiety scale, with the physiological parameters recorded for both groups before the music intervention, after the first post-operative day, and after the intervention on seventh post-operative day. Data were analyzed by SPSS software version 23. Results: There was a marked reduction in the mean score of pain, anxiety, systolic and diastolic blood pressure (SBP & DBP), heart rate and respiratory rate in the study group as compared to the control group. There was a significant difference between the mean score of pain, anxiety, SBP, DBP, heart rate, respiratory rate and oxygen saturation in both groups after the intervention. Conclusion: Music was found to be effective on pain, anxiety, diastolic blood pressure, heart rate and oxygen saturation among post-operative sternotomy patients. Thus, it is essential to include music as a tool in post-operative care.

Anti-proliferative and Anti-migratory Activities of Diphyllin on Human Colorectal Cancer Cells

Published on:June 2022 Journal of Young Pharmacists, 2022; 14(2):198-202 Original Article | doi:10.5530/jyp.2022.14.37 Authors: Sagar Puli, Ramasamy Raveendran* Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantari Nagar, Puducherry, INDIA. Abstract: Background: Colorectal cancer (CRC) is the third leading cause of death, probably because of its invasive and metastatic potential. Agents that can mitigate the growth and prevent migration may benefit CRC. Diphyllin and its analogues belong to glycosylated compounds previously reported for their in vitro cytotoxicity against many viruses, candida, and human malignant cells. This study aims to evaluate the anti-proliferative and antimigratory activities of diphyllin on human CRC cells. Methods: The MTT assay was performed to determine the 50% inhibitory concentrations (IC50) in HT-29, SW-480, and HCT-15 CRC cells. The acridine orange and ethidium bromide (AO/EB) dual staining was used to ascertain the type of cell death. HT-29 cells were subjected to short-term 5-fluorouracil+oxaliplatin (5-FU+Ox) to eliminate the most sensitive cells. The remaining surviving cells were further treated with diphyllin alone or combined with 5-FU. The combination effect of diphyllin with 5-FU in 5-FU+Ox surviving HT-29 cells was determined by flow cytometry-based Annexin V apoptosis assay. The wound-healing assay was used to detect the anti-migratory activity of diphyllin on 5-FU+Ox surviving HT-29 CRC cells. Results: The IC50 values of diphyllin were found to be 2.9±0.38, 1.3±0.28, and 3.9±0.65 μg/mL against HT-29, SW-480, and HCT-15, respectively. Microscopic examination manifested apoptotic changes like chromatin condensation, nuclear fragmentation, and formation of apoptotic bodies in diphyllin treated CRC cells. Flow cytometry analysis revealed that diphyllin enhances the apoptosis in 5-FU+Ox surviving HT-29 cells. Wound-healing assay displayed the inhibitory activity of diphyllin in 5-FU+Ox surviving HT-29 cells. Conclusion: Diphyllin shows anti-proliferative activity by inducing apoptosis in HT-29, SW-480, HCT-15 cells and 5-FU+Ox surviving HT-29 cells and impairs their migration. Key words: Anticancer, Apoptosis, Cytotoxicity, Flow cytometry, Woundhealing.

Covid-19 and Psychology: A Scientometric Assessment of India’s Publications during 2020-21

International Journal of Medicine and Public Health,2022,12,1,1-7.DOI:10.5530/ijmedph.2022.1.1Published:January 2022Type:Review ArticleCovid-19 and Psychology: A Scientometric Assessment of India’s Publications during 2020-21Sandeep Grover, BM Gupta, Madhu Bansal, and K.K. Mueen Ahmed Sandeep Grover1,*, BM Gupta2, Madhu Bansal3, K.K. Mueen Ahmed4 1Post Graduate Institute of Medical Education and Research, Chandigarh, INDIA. 2Formerly with CSIR-NISTADS, New Delhi 110012, INDIA. 3Panjab University, Department of Mathematics, Chandigarh, INDIA. 4Phcog.Net #17, Cox Town, Bengaluru, Karnataka, INDIA. Abstract:Objectives: The present study examines the publication output of authors from India on the topic of “Covid-19 and Psychology” using bibliometric methods. Methods: The publications as listed in Scopus database were identified by using “Covid-19” and its synonyms keywords in “Keyword” and “Title” tags. The results obtained were further restricted to subject “Psychology” under subject tag and country to India. Results: 372 publications emerged in the last 2 years on the topic of “Covid-19 and Psychology”, accounting to 4.63% share of global output. About 9.95% and 25.81% share of Indian publications received external funding support and involved international collaboration, respectively. The author’s from 277 organizations and 416 authors participated unevenly in the research in this area. The highest number of publications emerged from National Institute of Mental Health and Allied Sciences (NIMHANS), Bangaluru, followed by Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, All India Institute of Medical Sciences (AIIMS), New Delhi and All India Institute of Medical Sciences (AIIMS), Bhubaneswar. Authors from Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry had highest impact in terms of citations per paper and relative citation index, followed by authors from King George’s Medical University (KGMU), Lucknow, and Manipal Academy of Higher Education (MAHE), Manipal. The journals that published the highest number of publications were Asian Journal of Psychiatry (158 papers), Indian Journal of Psychological Medicine (44 papers), and Frontier in Psychology (18 papers). The most commonly investigated topics in terms of frequency of appearances of keywords were mental health (93), followed by anxiety (80), mental disease (68), depression (64), mental stress (34), and social isolation. Conclusion: Over the last 2 years a large number of publications have emerged in the area of COVID-19 and psychology from India. Keywords: Covid-19, Psychology, India, Bibliometrics, Scientometrics. Keywords:Bibliometrics, COVID-19, India, Psychology, Scientometrics.View:PDF (579.03 KB)

Successful Isolation of Burkholderia pseudomallei from Soil by Extended Incubation of Ashdown’s Agar: A Cross-sectional Study

Introduction: Melioidosis is an infectious disease of humans and animals caused by an environmental saprophyte Burkholderia pseudomallei. Although the organism is associated with soil and water, environmental isolation is rarely successful which could be due to the existence of viable but non-culturable forms. Aim: To isolate B. pseudomallei from the soil to detect the environmental presence of this organism in and around Puducherry, India. Materials and Methods: A descriptive cross-sectional study was carried out from July 2018 to January 2021 at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. A total of 473 soil samples were collected from areas surrounding the residence and workplaces of seven culture-proven melioidosis cases, from Puducherry and three districts of Tamil Nadu (Cuddalore, Nagapattinam and Villupuram) during the dry and wet seasons. Soil samples were enriched in Ashdown’s broth and cultured on Ashdown’s agar. The plates were incubated at 37°C and examined daily for seven days with a further extended period of incubation till the tenth day for samples that did not show growth. Suspected isolates were subjected to Vitek 2 system for biochemical identification. Confirmation of the isolates was carried out by antigen detection and Polymerase Chain Reaction (PCR). Results: From 473 soil samples processed, bacteria with colony morphology similar to B. pseudomallei were isolated in 56 (11.83%) samples. Only one isolate, which was detected on the tenth day of incubation was confirmed as B. pseudomallei using antigen detection and PCR. This sample was collected during the wet season (December 2020) from Endur, in the Villupuram district of Tamil Nadu, India. Conclusion: The study findings highlight the importance of extended incubation of culture plates at 37°C for up to ten days to improve the chances of isolation from the soil.

Effect of Incisional Negative Pressure Wound Therapy Following Incisional Hernia RepairA Randomised Controlled Trial

Introduction: Incisional hernia is one of the common complications following abdominal surgery in patients undergoing laparotomy. Various surgical procedures are performed by creating a potential space and placing a foreign body (mesh), which may render the wound susceptible for many postoperative complications. It is clinically important to evaluate the efficacy of Incisional Negative Pressure Wound Therapy (INPWT) in reducing wound complications. Aim: To compare the efficacy of INPWT dressing with traditional gauze dressing in reducing postoperative complications following meshplasty in incisional hernia repair. Materials and Methods: This was a hospital-based randomised controlled trial, conducted in the Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, from October 2013 to July 2015. 64 consenting patients with incisional hernias undergoing meshplasty were included in this study. After being randomised into the two study groups, they had their postoperative wounds dressed with either INPWT (Group A) for five days, or traditional gauze (Group B) based dressings. Operative parameters like duration of surgery, type of dissection and type of skin sutures used were studied and analysed. Also, postoperative outcomes like Surgical Site Infection (SSI), seroma, duration of drain, hospital stay were analysed using Chi-square or Fisher’s-exact test. Results: Out of total 64 patients, there was a statistically significant reduction in the volume of drain (p=0.004) and duration of wound drainage (p=0.029) with the use of INPWT. There was also a reduction in the incidence of SSI (6.7% vs 17.6%) and seroma (6.7% vs 11.8%) and the duration of postoperative hospital stay (6.03±1.99 days vs 7.09±2.31 days) in the INPWT group, which were however not statistically significant. Age, comorbidities, Body Mass Index (BMI), duration of surgery, type of dissection and type of skin sutures were not found to have any effect on the parameters assessed. Conclusion: Incisional negative pressure wound therapy in postoperative wounds, following meshplasty for incisional hernia significantly reduces the volume and duration of wound drainage. It also reduces the incidence of SSI, seroma and the duration of hospital stay

Utility of Urinary Nephrin in Patients With and Without Diabetic Nephropathy and Its Correlation With Albuminuria.

IntroductionNephrin is a podocyte-specific protein that may serve as a urinary biomarker in patients with diabetic nephropathy. The objectives of the study were to determine urinary nephrin levels in patients with and without type 2 diabetic nephropathy and to assess the correlation between urinary nephrin and albuminuria.MethodsThis was a cross-sectional comparative study that was carried out at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry over 18 months. Diabetic study subjects were divided into three groups-normoalbuminuria, microalbuminuria, and macroalbuminuria. Urinary albumin was detected by the dipstick method in a spot urine sample for all study subjects. In subjects with trace or no albuminuria, nephelometry was used to quantify urinary albumin levels. Urinary nephrin was estimated by the ELISA technique for all study subjects.ResultsSubjects in the microalbuminuria group had higher urinary nephrin levels than those in the normoalbuminuria and macroalbuminuria groups. There was a weak positive correlation between urinary albumin and nephrin levels among the study subjects (p < 0.001).ConclusionUrinary nephrin levels are increased in patients with diabetic nephropathy. There was a weak positive correlation between urinary albumin and nephrin levels among these patients.

Effect of Structured Educational Program on Practices of Radiation Safety Measures Among Health Care Providers in Urology Operation Theater

IntroductionEndourologists are at increased risk of exposure to radiations. Many studies are available that have studied awareness in doctors in general, but very few studies available regarding any intervention to improve the knowledge of radiation safety measures. We have made an attempt to study the role of an educational intervention to improve the knowledge of our Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) urology operation theater health care providers (HCPs).Materials and methodsOur study was an Interventional study (prospective clinical trial), conducted in the Department of Urology, JIPMER from January 2017 to March 2018. All, that is, 40 operation theater HCPs were given a questionnaire as baseline. The baseline response was compared to the response after the Structured Education Program (SEP) by using the same questionnaire. The knowledge of participants before SEP was compared with the knowledge after SEP using the chi-square test. All statistical analysis was carried out at a 5% level of significance and p-value < 0.05 was considered as significant.ResultIn our study after SEP, participants use of lead apron has increased from 72.5% to 92.5%, indicating improvement. There is an increase in the use of thyroid shield from 22.5% to 95%. In our study after SEP, knowledge about background radiations improved in participants from 25% to 87.5%. Knowledge about Radiation dose of chest X-ray improved from 22.5% to 52.5%. Knowledge about ALARA (As Low As Reasonably Achievable) improved from 47.5% to 95% after SEP. Knowledge that MRI and USG do not have ionizing radiation improved from 62.5% to 97.5%, and from 75% to 92.5% for MRI and USG, respectively, after SEP. Regarding organ sensitivity, 100% HCPs had given correct answers after SEP as compared to 80 before SEP.ConclusionOur study shows that SEP at regular intervals has made significant improvements in daily practice in operation theater HCPs. SEP has increased the use of radiation protective gears among HCP. Hence we recommend SEP at regular intervals for urology operation theater HCPs for a healthy and safe working environment.

Changing face of dermatology – A paradigm shift

Over the last three and half-decade of my life, I have seen the changes in dermatology and marked paradigm shift towards procedural dermatology and cosmetic dermatology. Dermatosurgery clinics started in 1996, and lasers were procured in 2009, setting the tone for laser and cosmetic dermatology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. Cosmetic dermatology (aesthetic medicine/medical aesthetics) has now been recognized as a sub-specialty of dermatology. Dermatologists have supremacy over other aesthetic practitioners as they also treat visible as well as stigmatizing skin disorders. In the last two decades in India, more and more women are taking up dermatology to pursue aesthetic practice. Women in dermatology have started their association, the Women’s Dermatologic Society, and their journal, International Journal of Women’s Dermatology (IJWD). Skin lightening products are overwhelmingly used by women and are one of the world’s largest markets. Nowadays, aesthetic surgical procedures are done with a motive to earn profits. Cosmetology has gained tremendous interest in the world, especially in the United States of America. Much of its recognition is due to scientific research in the development of imaging techniques, drug therapy, and other nonsurgical methods lessening downtime for the patients. The focus in dermatology is shifting gradually from diseased skin to desired skin which people prefer. Hence, the journal CosmoDerma, gives cosmetology its due place. Moreover, there is an increase in the anti-ageing population in this world who don’t want their face wrinkles and aging skin changes. In the absence of world wars in recent times and the increasing longevity of man, the cosmetic industry/aesthetic industry is surging ahead despite the COVID 19 pandemic. Accreditation system to regulate the practice of cosmetology practice needed to be put in place in all countries. Many of these cosmetology practitioners are inadequately equipped to perform cosmetology procedures. There is a need for structured training and accreditation for cosmetic dermatology, aesthetic surgery, dermatosurgery, use of lasers, and hair transplantation.

Perspective of ophthalmologists providing direct care to COVID-19 positive patients at JIPMER, Puducherry

Dear Editor: Over the past 4 months, coronavirus disease-2019 (COVID-19) cases have been rising exponentially in India.[1] The preparations to tackle the situation had necessitated the recruitment of clinicians from various specialities including ophthalmologists for providing direct care to patients with COVID positive at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry. As ophthalmologists, we were initially a little perturbed and uncertain about our role in dispensing duties at the COVID-19 designated hospital of our institute. However, a 1-day workshop on various aspects of evaluation, care, and management of COVID; video-based demonstrations, hands-on training on personal protective equipment (PPE) kit donning and doffing; and post-workshop certification test had eased out most of the initial anxiety, and instilled a sense of self-confidence in us. Since then, we have been performing regular duties as frontline health care workers (HCWs) in the management of COVID positive patients under the supervision of the specialists from the core branches of Medicine and Anaesthesiology. Various responsibilities and duties for Ophthalmologists in the COVID hospital include the screening of patients with symptoms of influenza-like illness (ILI) or severe acute respiratory infection (SARI), eliciting a detailed history of travel and contact as per ICMR guidelines,[2] oropharyngeal and nasal swab collection, transport to lab in viral transport medium (VTM); segregation of patients for admission into intensive care units (ICU), suspect or positive wards; daily monitoring of vitals and treatment charts of the patients; regular counseling of the patients; coordination with the Department of Community Medicine for contact tracing, advice on home quarantine post-discharge and ensuring strict adherence to the quarantine guidelines.[3] We also need to perform fundus evaluation of COVID positive patients admitted with other systemic co-morbidities like cerebral venous thrombosis (CVT), and head injury to rule out papilledema. Universal precautions are being followed by us at all instances of potential exposure. We, infact, cannot afford to let our guard down at any point of time. Entry into the COVID wards is allowed only after proper donning of PPE kit performed under the observation of another HCW. Doffing is also done following all steps of the guidelines in a sequential manner. However, as the routine protocols for PPE donning/doffing do not account for handling of ophthalmic instruments, we had to make small modifications to conduct safe fundus evaluation using indirect ophthalmoscope (IO). We use three layers of gloves instead of two, use goggles instead of face shield after PPE donning to minimize fogging, and cover the IO and its wirings with plastic cling film. After performing the examination, the first layer of gloves are removed and 20 D lens is cleaned with soap and water, disinfection of the IO is performed with 95% isopropyl alcohol as per VRSI guidelines.[4] Routine sequence of PPE kit doffing is then performed in sequence with the remaining two layers of gloves. There is no scope for allowing any PPE breach while performing our role as frontline HCWs. In case any breach is noted, we are advised to doff immediately, report to the institute HCW helpline and do exposure risk assessment. Few instances of PPE breach that we noted in our fellow HCWs were mostly related to improper fitting of n95 masks. To conclude, these new responsibilities do come with some degree of stress owing to the exponentially increasing new case load; fear of potential exposure; deprivation from surgical training for the residents; depleted academics and clinical training; and prolonged social distancing. To mitigate this stress, regular counseling of the residents, involvement in virtual classrooms, and wet lab practice is being advocated and followed at our institute. Our stint and experience at COVID hospital, however, provides us with a unique opportunity to actively participate in the fight against the COVID pandemic, apart from performing our routine duties as Ophthalmologists. The pandemic is here to stay and therefore, our role as frontline warriors at COVID hospital will continue. In times to come, Ophthalmologists and other non-core branch specialists in other institutes as well will have to play a major role in fighting the pandemic apart from managing their respective speciality cases. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prophylactic Tracheostomy for Inhalational Burns.

BACKGROUNDVarious studies have reported different conclusions over the safety and benefits of early tracheostomy in burns. Our study aimed to assess the role of prophylactic tracheostomy in treatment and improvement of outcomes in inhalational burns in India.METHODSIn a retrospective descriptive analysis of burns admitted over 1 year in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Tertiary Burns Center in India, patients with thermal burns of TBSA less than 60% and those with indirect evidence of airway burns were enrolled and divided into two groups who underwent prophylactic tracheostomy vs. patients for whom prophylactic tracheostomy was not done. Mortality was the final point and primary variable measurement.RESULTSTotally, 10 patients with inhalational burns were admitted. Out of the 4 patients for whom prophylactic tracheostomy was undertaken, three patients survived, while one died. Out of the 6 patients for which prophylactic tracheostomy were not performed, 4 patients died; while 2 survived. The average percentage of burns TBSA in the prophylactic tracheostomy group was 34%. Average age of patients in the prophylactic tracheostomy group was 31.3 years. The average percentage burns TBSA in the group, where prophylactic tracheostomy was not carried out was 42%. Average age of patients in the prophylactic tracheostomy group was 36.2 years.CONCLUSIONOur study is a pilot study to investigate the possibility and a way to improve outcomes in patients with inhalational injuries. Larger trials may be needed to facilitate or disprove the same.

Adipokine levels and their association with insulin resistance and fetal outcomes among the newborns of Indian gestational diabetic mothers.

Objectives:To investigate the cord blood levels of adipokine and to assess their association with the fetal insulin resistance and fetal outcomes in newborns of gestational diabetic women (GDM).Methods:This cross-sectional study was performed in 40 GDM women and 40 healthy pregnant women (HPW) in the Department of Obstetrics and Gynecology at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) hospital in Puducherry, India, during the period from May 2016 to December 2017. Cord blood samples were collected at delivery from GDM and HPW groups. Cord plasma biochemical parameters such as insulin, C-peptide, adiponectin, leptin, resistin, and visfatin concentrations were measured. Leptin/adiponectin ratio (L/A), homeostasis model assessment of insulin resistance (HOMA2-IR), insulin sensitivity (HOMA2-%S) and beta cell function (HOMA2-%B) were calculated. The pregnancy outcomes such as birth weight (BW), Ponderal index and Apgar scores of the baby were measured.Results:The BW and Ponderal index of the baby were found to be significantly higher in GDM newborns compared to HPW newborns. Cord plasma insulin, C-peptide, HOMA2 –IR, visfatin, leptin, and L/A ratio were significantly higher whereas adiponectin level was lower in GDM compared to HPW. A significant positive correlation was observed between L/A ratio and fetal HOMA2-IR.Conclusion:Altered adipokine levels with increased L/A ratio was observed among the new-borns of Indian gestational diabetic mothers. There was an association between increased L/A ratio, insulin resistance and increased Ponderal index among the new-borns.

Fluid balance and clinical outcomes in mechanically ventilated children in pediatric intensive care unit : A retrospective observational, analytical study

Background : Positive fluid balance is shown to have adverse outcomes in mechanically ventilated children with Acute Respiratory Distress Syndrome (ARDS). Our study attempts to provide an understanding of the threshold of fluid balance requiring intervention in the management of mechanically ventilated children. Methods : This retrospective study was conducted in the Division of Pediatric Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER). Medical records from January 2015 to December 2016 were screened. All medical records of children aged 1-month to 13 years admitted to PICU and mechanically ventilated for more than 24 hours with documented input-output balance for at least 48 hours from the start of mechanical ventilation were included. Patients divided into =10% Fluid overload (FO) group and > 10% FO group. Results : Study included 107 children with 84 in =10% FO group and 23 in >10% FO group. The baseline characteristics were similar in terms of age (median 11 months Vs 12 months), sex (M:F = 47:37 Vs 10:13), Pediatric Risk of Mortality (PRISM)- III score (15 Vs 16), inotrope score (20 in both) & vasoactive score (30 in both) and number of patients receiving furosemide [59 (70%) vs 16 (69 %)]. Disordered control of breathing was the most common indication for mechanical ventilation in both groups [37(44%) Vs 12(52%)]. The proportion of children having ARDS [28(35%) Vs 13(56%), p=0.06] and AKI [37(44%) Vs 15(65%), p=0.07] were higher in >10% FO group of which significant number required renal replacement therapy [15(17%) Vs 10(43%), p=0.01]. More children were found to have shock in >10% FO group [58(69%) vs 18(78%), p=0.38] and the proportion of septic shock was significantly higher [27(32%) vs 13(56%), p=0.03]. The >10% FO group had a higher mortality compared to =10% FO group [32(38%) vs 13(57%) RR=1.2, 95%CI 1.0-1.5, p=0.11]. The median (IQR) duration of invasive mechanical ventilation was 6 (4-11) days in =10% FO group and 5 (3-10) days in >10 % FO group (p=0.90). PICU stay was longer in =10% FO group [9 days (6-15) Vs 8 days (6-15) p=0.82]. Ventilator-free days were comparable (23.5 Vs 22.5) and organ dysfunction scores - Pediatric Logistic Organ Dysfunction (PELOD) [12 in both] & Sequential Organ Failure Assessment (SOFA) [8 in both] were similar. The >10% FO group had greater failed extubations (7% Vs 20%) (p=0.23) and higher respiratory morbidity (median Oxygen Saturation Indices 3.55 vs 5.4, p=0.14, Oxygenation Indices calculated for 49 and 12 children respectively were 3.5 Vs 5.15, p=0.59). Conclusion : There was no significant difference in mortality or respiratory morbidity in positive fluid overload >10 % compared to fluid overload =10%. Future prospective studies including a larger number of children are required to obtain more evidence regarding the association of fluid overload with adverse outcomes.