Journal of Postgraduate Medicine, Education and Research

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2022 | October-December | Volume 56 | Issue 4

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EDITORIAL

Sonu Goel

Why All Doctors Require Leadership Trainings?

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:3] [Pages No:151 - 153]

   DOI: 10.5005/jp-journals-10028-1614  |  Open Access |  How to cite  | 

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RESEARCH ARTICLE

Swapnajeet Sahoo, Nitasha Sharma, Jyoti Kathwal, Aseem Mehra, Ritu Nehra, Sandeep Grover

Beliefs Related to COVID-19 Infection among the Nursing Students during the Early Part of the COVID-19 Pandemic

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:6] [Pages No:154 - 159]

Keywords: Beliefs, COVID-19, Nurses

   DOI: 10.5005/jp-journals-10028-1589  |  Open Access |  How to cite  | 

Abstract

Background: The COVID-19 pandemic has led to several misconceptions and controversies related to the transmission, treatment, prevention, and management of COVID-19 infection. Nursing personnel and students form a major group of frontline warriors, and they can play an important role in dispelling misconceptions. Hence, it is essential to understand their knowledge and beliefs related to various aspects of COVID-19 infection. Aim: To evaluate the beliefs held by the nursing students on various aspects of COVID-19. Materials and methods: An online cross-sectional survey was conducted through the Survey Monkey® platform using WhatsApp®, among the nursing students of two institutes in North India. Results: A total of 332 nursing students participated in the survey and the response rate to the survey was 57.2%. The mean age of the participants was 21.38 [standard deviation (SD)— 2.43] years, the majority being females (87.3%) and were pursuing graduation nursing courses (n = 318; 95.8%). Incorrect beliefs related to various preventive aspects, modes of spread of infection, and treatments were present in a significant proportion of the participants. When the prevalence of various misconceptions (number of participants with at least one incorrect response related) was evaluated, the same ranged from 42.8 to 93.7% in different areas. Conclusion: This survey highlights the widespread prevalence of misconceptions about various aspects of COVID-19 among nursing students, which needs to be addressed by proper education and awareness.

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RESEARCH ARTICLE

Deeksha Bhalla, Tulika Singh, Veenu Singla, Shruti Kumar

Breast Density Assessment with High-resolution Ultrasonography: A Reliability Study

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:5] [Pages No:160 - 164]

Keywords: BI-RADS, Breast density, Breast neoplasms, Mammography, Mass screening, Ultrasonography

   DOI: 10.5005/jp-journals-10028-1587  |  Open Access |  How to cite  | 

Abstract

Objective: To determine the accuracy of ultrasonic (US) assessment of breast density vs mammography, and its interobserver reliability. Methods: One hundred consecutive adult women were scanned using a high-frequency ultrasound transducer in the upper outer quadrant of a single breast. Breast density was recorded as one of four categories: < 25%, 25–50%, 50–75%, and > 75% by two radiologists. Digital mammography was performed on the same day and density was assigned to one of four breast imaging-reporting and data system (BI-RADS) categories by a third radiologist. Cohen's Kappa was used to compute inter-rater reliability for US assessment and intermodality agreement among mammographic and US density. Results: The most frequent mammographic density group was ACR B (43%). US density category B had the highest frequency of readings (49% and 51% readings of radiologists 1 and 2, respectively). Excellent interobserver agreement was seen for the measurements of US density; k = 0.968 [95% confidence interval (CI): 0.925–1]. Substantial intermodality agreement was seen for both radiologists 1 and 2; k = 0.675 (95% CI: 0.552–0.798) and 0.673 (95% CI: 0.551–0.796) respectively (p < 0.001). The US overestimated breast density in 14.5%, while underestimation was seen in 6.5% of cases. Conclusion: The US provides accurate and reproducible estimates of breast density. This enables personalized screening, particularly in young women and high-density breasts.

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RESEARCH ARTICLE

Sukhpal Kaur, Geetanjli Kalyan, Sushma K Saini, Bandna Kumari, Mukta Thakur, Madhur Kalyan, Manjeet Singh, Karobi Das, Ajay Singh, Shiv L Soni

Beliefs, Concerns, and Issues toward COVID-19 Vaccination amongst the Adult Population: A North Indian Study

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:6] [Pages No:165 - 170]

Keywords: Coronavirus disease 2019, Expression of concern, Safety, Vaccination, Vaccine efficacy

   DOI: 10.5005/jp-journals-10028-1606  |  Open Access |  How to cite  | 

Abstract

Background: A great apprehension persists regarding the coronavirus disease (COVID-19) vaccination amongst the public, and there is a need to explore the same to intervene accordingly. Objective: To explore the beliefs, concerns, and issues toward COVID-19 vaccination amongst the general public in the Northern region of India. Materials and methods: Using a convenient sampling technique, adults were enrolled in the study. Online survey pro forma comprising information profile, beliefs, concerns, and issues related to the COVID-19 vaccine was developed and validated. The ethical clearance was taken from the Institutional Ethics Committee. The participants were provided with an online link on WhatsApp to fill out the survey pro forma with the consent form affixed to it. The self-reported data was analyzed by using Statistical Package for the Social Sciences (SPSS) version 20. Results: Around 60% of subjects had faith in science and vaccine. When asked about the final state of mind about vaccinating themselves and their family members, more than one-third of the participants (43.7) could not decide. Nearly 42% were willing to get vaccinated, whereas 15% denied taking the vaccine. Factors associated with the decision to take the vaccination were sex (male), place of stay (rural area), socioeconomic status (upper), and religion (Hindu). Conclusion: Participants of the study had major concerns regarding the safety of the vaccination, probable severe complications related to it, and apprehension about the affordability of treatment in private hospitals in case of possible adverse reactions to the vaccine. Hence, it is recommended to pay special emphasis to information and education regarding the safety and efficacy of the vaccine.

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RESEARCH ARTICLE

Navneet Singla, Mukesh Kumar, Kokkula Praneeth, Ashish Aggarwal

A Brief Report on the Prevalence of Vitamin D3 Deficiency in Children with Brain Tumors

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:3] [Pages No:171 - 173]

Keywords: Brain tumors, Deficiency, Vitamin D

   DOI: 10.5005/jp-journals-10028-1600  |  Open Access |  How to cite  | 

Abstract

Introduction: For both benign and malignant brain tumors, the outcome continues to remain dismal despite the progress made in the last half a century. The picture is gloomier in the pediatric age-group. As for any disease with limited survival and high morbidity, it is imperative to study the disease etiology to have meaningful interventions. Apart from genetics that cannot be modified, environmental and dietary factors play a role in oncogenesis, and these are potentially modifiable. A lesser-studied aspect is the role of micronutrients in the causation of brain tumors, especially in early childhood. We analyzed the association of vitamin D3 (Vit D3) in children with brain tumors. Methods and materials: A prospective study of 50 children diagnosed with brain tumors in early childhood (<5 years old) was carried out. Vit D3 levels were measured in the blood samples of these patients and their mothers. A correlation was established between levels of Vit D3 and brain tumors. Results: Around 26 children (52%) with pediatric brain tumors (PBTs) had Vit D3 deficiency. Of the 50 patients whose mothers were also analyzed, 22 (44%) mothers had Vit D3 deficiency. Interestingly, out of 26 children with Vit D3 deficiency, 17 were those whose mothers were also having hypovitaminosis D3. If the mother is deficient in Vit D3, the odds ratio for a child to be deficient in Vit D3 is 7.2 Conclusion: Large majority of children with brain tumors and their mothers were found to have a deficiency of Vit D3. Further large studies are required before any meaningful prevention strategy can be formulated.

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RESEARCH ARTICLE

Ananta Rao Kancharapu, Pritam Singha Roy, Radha Kanta Ratho, Subhabrata Sarkar, Amita Trehan, Deepak Bansal

One-third of Children with Febrile Neutropenia and Upper Respiratory Tract Infection Have an Identifiable Viral Isolate in Nasopharyngeal Aspirate: A Prospective Observational Study

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:5] [Pages No:174 - 178]

Keywords: Acute lymphoblastic leukemia, Immunocompromised, Leukemia, Polymerase chain reaction, Treatment, Virus

   DOI: 10.5005/jp-journals-10028-1599  |  Open Access |  How to cite  | 

Abstract

Background: Upper respiratory tract infections (URTI) are common during episodes of febrile neutropenia (FN) in children receiving chemotherapy. Identification of viral organisms in children with FN and URTI may aid in reducing the duration of antibiotics. Materials and methods: The prospective study was conducted over 1½ years (July 2012–December 2013). Nasopharyngeal aspirates (NPA) of children (age ≤14 years) with acute leukemia or non-Hodgkin lymphoma with FN and symptoms of URTI (rhinorrhea with/without cough) were obtained. Reverse transcription polymerase chain reaction (RT-PCR) was utilized to identify respiratory syncytial virus (RSV), human parainfluenza virus 3 (HPIV-3), and human metapneumovirus (HMPV). Real-time PCR was performed for the detection of influenza A and B. Results: A total of 57 patients with a mean age of 6 years (range: 0.5–14) were included. The majority (89.5%) had acute lymphoblastic leukemia (ALL). About 21 viral isolates were identified in 19 (33%) patients. Influenza A and B (62%) topped the list, followed by RSV and HPIV-3 (14% each) and HMPV (10%). Blood cultures returned sterile from all. All patients recovered uneventfully from the episode of FN. Age (p = 0.35), absolute neutrophil count (ANC) (p = 0.68), or phase of chemotherapy (p = 0.36) were not identified as risk factors for the identification of the viral etiology. A higher proportion of samples collected during winter/spring were PCR-positive as compared to summer/autumn (56.7% vs 14.8%; p = 0.036). Conclusion: One-third of children with FN and URTI had an identifiable viral etiology. Future trials may be conducted to explore if antibiotics can be stopped early in patients with low-risk FN and URTI with an identifiable viral etiology. Clinical significance: The study contributes to data for antibiotic stewardship for managing children with low-risk FN and URTI.

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REVIEW ARTICLE

Karthik Badrinath, Robert G Crowther, Gregory A Lovell

Neuromuscular Inhibition, Hamstring Strain Injury, and Rehabilitation: A Review

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:6] [Pages No:179 - 184]

Keywords: Hamstring, Inhibition, Muscle injury, Neuromuscular, Strain injury, Surface electromyography

   DOI: 10.5005/jp-journals-10028-1597  |  Open Access |  How to cite  | 

Abstract

Objective: The purpose of this review was to summarize the neuromuscular inhibition of the hamstring and lumbopelvic musculature following a hamstring strain injury (HSI) and its subsequent implications on the rehabilitation of the injury. Design: Narrative review. Results: A search of electronic databases and references within the articles found 18 articles suitable for review. A critical review of the literature revealed that despite returning to the sport, athletes demonstrated an impairment in the myoelectric activity in the hamstring muscle group, particularly the biceps femoris (BF). Additionally, altered activation patterns in the lumbopelvic musculature (gluteus medius and maximus, external and internal oblique, thoracic and lumbar erector trunci) of healthy athletes were also associated with increased HSI risk. Conclusion: Despite athletes completing evidence-based rehabilitation programs, there is persistent neuromuscular inhibition present in the hamstring and lumbopelvic musculature on return to sport. Clinicians should be aware of this phenomenon as a return of athletes to sport with neuromuscular inhibition may increase their risk of hamstring strain re-injury. Measures such as surface electromyography (EMG) may be a useful tool to detect neuromuscular changes following HSI and help guide clinicians in the return to play process following an HSI.

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CASE REPORT

Majda T Elfseyie, Fatimah A Mohammed

Bilateral Occurrence of Supernumerary Cusps on the First Permanent Molars of 6-year-old Libyan Child: Case Report

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:4] [Pages No:185 - 188]

Keywords: Accessory cusp, Dens evaginatus, First permanent molars, Supernumerary cusps, Tooth anomalies

   DOI: 10.5005/jp-journals-10028-1601  |  Open Access |  How to cite  | 

Abstract

Supernumerary cusps are morphological variations classified into three patterns: Carabelli's cusp, dens evaginatus (DE), and talon cusps. DE is a disturbance of tooth formation that appears as an accessory tuberculated cusp composed of enamel, dentin, and pulp tissue. The first permanent molars (FPMs) may show alteration in their shape or structure. However, the alteration could be observed as accessory cusps on the occlusal surface or accessory roots or hypomineralization as molar incisor hypomineralization. DE is a rare dental anomaly that can occur in primary or permanent dentitions. It is infrequently seen on anterior teeth or premolars. However, their occurrence on molars is rarer. This presented a rare case of bilateral double supernumerary cusps on the right and the left maxillary FPMs of a 6-year-old Libyan boy, while the mandibular FPMs appeared with normal cusps. The aims of this study were to report and discuss the diagnostic methods and the management of this anomaly. In addition, shed light on the importance of early diagnosis and follow-up observation. That could help in reducing the potential dental problems and to improve patients’ quality of life.

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CASE REPORT

Yuvraj Singh Cheema, Amanjot Kaur, Ankit Chhabra, Baldeep Kaur, Raveena Bedi

Dengue Fever Mimicking as Granulomatosis with Polyangiitis: An Unsolved Diagnostic Dilemma

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:3] [Pages No:189 - 191]

Keywords: Dengue, Granulomatosis with polyangiitis, Vasculitis

   DOI: 10.5005/jp-journals-10028-1578  |  Open Access |  How to cite  | 

Abstract

Hemorrhagic manifestations are well documented with dengue fever (DF) but thrombotic/thromboembolic events complicating acute dengue illness are only scarcely reported in the literature. Here we present a case of a DF complicated by multiple brain infarcts along with pulmonary hemorrhage. The simultaneous occurrence of hemorrhagic and embolic phenomena in presence of thrombocytopenia provoked us to rule out the differential diagnosis of an underlying vasculitic disorder which would then have altogether diverse management.

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CASE REPORT

Raja Raghu, Gauba Krishan, Ashima Goyal, Aditi Kapur, Sanjeev K Singh, Manoj A Jaiswal

Conservative Management of Infraorbital Space Infection Secondary to Type III B Dens Invaginatus: A Case Report

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:5] [Pages No:192 - 196]

Keywords: Abscess, Case report, DI, Dens Invaginatus, Space infection, Tooth anomalies

   DOI: 10.5005/jp-journals-10028-1558  |  Open Access |  How to cite  | 

Abstract

Aim and objective: We aim to emphasize the conservative management of infraorbital abscess secondary to dens invaginatus type IIIB. Background: Dens invaginatus (DI) is a developmental anomaly related to the morphological characteristic of the teeth. It occurs due to the invagination of developing enamel organs in the dental papilla before the complete calcification of the tooth. Case description: We report a case of a 13-year-old child reported with swelling on the right side of the face. Radiographic examination revealed the altered tooth morphology and complex root canal anatomy with periapical abscess associated with the permanent right maxillary canine. Debridement and obturation were done by lateral compaction technique with no surgical intervention for the treatment of infraorbital space infection. Conclusion: The proper three-dimensional evaluation of DI helps in identifying the root canal morphology and aids in efficient treatment planning. The obturation with mineral trioxide aggregate is a suitable method for treating DI especially in the case of immature teeth. The accurate diagnosis and proper treatment can prevent an unnecessary surgical intervention and has shown a favorable prognosis in the long term. Clinical significance: Nonsurgical management of odontogenic infections should be the preferred line of treatment, wherever feasible, because of the invasive nature of its surgical alternative. This becomes even more relevant when the patient involved belongs to the pediatric age-group which would make a surgical treatment plan all the more challenging.

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LETTER TO THE EDITOR

Nidhi Singh, Rashi Sarna, Rajeev Chauhan, Aparna Depuru

Continuous End-tidal CO2 Monitoring during Awake Craniotomy: A Reliable Makeshift Modality

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:2] [Pages No:197 - 198]

   DOI: 10.5005/jp-journals-10028-1609  |  Open Access |  How to cite  | 

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STATISTICS CORNER

Kamal Kishore, Vidushi Jaswal

Statistics Corner: Wilcoxon–Mann–Whitney Test

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:3] [Pages No:199 - 201]

Keywords: Brunner–Munzel test, Data interpretation, Mann–Whitney test, Nonparametric test, Two unpaired groups, Wilcoxon rank sum test

   DOI: 10.5005/jp-journals-10028-1613  |  Open Access |  How to cite  | 

Abstract

Wilcoxon–Mann–Whitney (WMW) test is a nonparametric counterpart of the t-test for comparing two unpaired groups. Traditional teaching and many books recommend applying WMW when: (1) continuous outcome variables violate assumptions and (2) data are ordinal. Standard recommendations about the applicability of WMW are not correct. Many health researchers also believe that WMW compares medians between groups; the reporting measure, however, is contextual—it depends on factors such as distribution type, sample size, and heteroscedasticity. A researcher comparing outcomes from two groups found that continuous dependent variables (DVs) do not fulfill the normality and homogeneity of variance assumptions. An initial literature search indicates that nonparametric methods are better for analyzing data. There are, however, a few vital questions concerning analyzing data with WMW: • Does the test make any assumptions? • What it compares—median or mean rank? • What is the null and alternate hypothesis? • What to report and how to interpret results?

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CPC CLINICOPATHOLOGICAL CONFERENCE REPORT

Uma N Saikia, Suvradeep Mitra, Neeraj Singla, Nidhi Prabhakar, Sanjay Jain, Sunny Bhardwaj, Pankaj Pant

Delayed Onset of COVID-19 Acute Respiratory Distress Syndrome (ARDS) in an Immunocompetent Patient

[Year:2022] [Month:October-December] [Volume:56] [Number:4] [Pages:8] [Pages No:202 - 209]

Keywords: ARDS, COVID-19, Immunocompetent, Late-onset

   DOI: 10.5005/jp-journals-10028-1615  |  Open Access |  How to cite  | 

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