SBV Journal of Basic, Clinical and Applied Health Science

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2020 | January-March | Volume 3 | Issue 1

EDITORIAL

Balachandra V Adkoli, Subhash C Parija

Development of Medical Professionalism: Curriculum Matters

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:3] [Pages No:1 - 3]

PDF  |  DOI: 10.5005/jp-journals-10082-02243  |  Open Access |  How to cite  | 

Abstract

This article is second in the series of articles dedicated for the development of professionalism in medical education and practice. In the previous article, we defined the contours of medical professionalism, an area of greatest concern to the medical profession and the society alike. We also listed the attributes of a medical professional related to the four domains of functioning—patient care, teaching, research, and administration. In this article, we underline the importance of early sensitization and training of medical students, along with faculty development. We highlight the issues and challenges in designing a curriculum, including teaching and assessment of professionalism. We propose that the new competency-based curriculum recommended by the Medical Council of India is a good beginning, although much needs to be done to develop a comprehensive strategy for robust training and assessment of professionalism.

REVIEW ARTICLE

Natasha C Saldanha, Sivaprakash Balasundaram, Sukanto Sarkar

Metabolic Syndrome and Mental Disorders: A Literature Review

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:6] [Pages No:4 - 9]

PDF  |  DOI: 10.5005/jp-journals-10082-02259  |  Open Access |  How to cite  | 

Abstract

Background: People with mental disorders have higher mortality rates in comparison with the general population. The occurrence of metabolic syndrome is greater in people with mental disorders than in the general population. A review of the research literature was carried out with regard to metabolic syndrome, its prevalence in the general population, and among those with psychiatric disorders. Materials and methods: Literature search was conducted with the ensuing search terms, keywords, and phrases—“metabolic syndrome,” “severe mental illness,” “mental disorder,” “schizophrenia,” “bipolar disorder,” “substance use,” “prevalence,” “alcohol dependence,” and “physical activity.” The search was executed in databases such as PubMed, ProQuest, and Google Scholar. Review results: Considerable debate exists regarding the causes for the high prevalence of metabolic disturbances in patients with mental disorders; however, gaps remain in relevant aspects, inspiring further studies in specific smaller groups of psychiatric patients to evaluate the impact of each variable on the risk for developing metabolic syndrome. From this review, we surmise that there are several factors that influence the amplified prevalence of metabolic syndrome among patients with mental disorders. Rather than a sole causative factor, there are multiple factors associated with metabolic syndrome, such as sociodemographic variables, clinical variables, and level of physical activity. Conclusion: The research literature supports the requisite for timely identification of metabolic syndrome in people with mental disorders and initiation of suitable interventions. Clinical significance: It is of paramount significance that guidelines pertinent to the Indian context are developed for the monitoring and screening of psychiatric patients for metabolic syndrome and physical health in general.

REVIEW ARTICLE

Umamageswari Arunachalam, Adithan Chandrasekaran

Genetic Polymorphism in Alcohol-dependent Genes: A Review

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:6] [Pages No:10 - 15]

PDF  |  DOI: 10.5005/jp-journals-10082-02260  |  Open Access |  How to cite  | 

Abstract

Alcohol dependence (AD) is a complex multifactorial disorder that poses a serious medical and sociological problem. Neurobiology of drug abuse helps us understand the genetic, cellular, and molecular mechanisms that influence transition from occasional, controlled use to loss of control in drug-seeking behavior. Elements of impulsivity and compulsivity yield a composite three-stage addiction cycle mediated by discrete neurocircuits involving the basal ganglia, extended amygdala, and prefrontal cortex. Genetic polymorphisms of the genes encoding alcohol metabolism enzymes and neurotransmitter signaling molecules in dopamine (DA) and opioid systems substantially contribute to individual variations of susceptibility to AD. The primary enzymes involved in alcohol metabolism are alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). Genetic variants of these genes result in acetaldehyde accumulation and hence have a protective effect on the risk of alcoholism. Yet another mutant variant of microsomal enzyme cytochrome P 450 2E1 c2/c2 that is found to be associated with higher transcriptional activity might play a role in the development of AD. Though functional variant 118G allele in exon1 of the μ-opioid receptor (OPRM1) gene has been associated with the development of AD, few clinical studies do not unequivocally support the association. Dopamine is an important neurotransmitter involved in reward mechanism, and the most studied genetic variant of DA D2 receptor (DRD2) gene has been found to be associated with increased AD risk.

Original Article

Cassinadane A Vayarvel, Vengatapathy Kuzhandai Velu, Shaik A Hussain, Ramesh Ramasamy

Association of Insulin Resistance with Vitamin B12 Status in Type 2 Diabetes Mellitus Patients on Metformin Therapy

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:3] [Pages No:16 - 18]

Keywords: Diabetes mellitus, Insulin resistant, Metformin, Vitamin B12

PDF  |  DOI: 10.5005/jp-journals-10082-02233  |  Open Access |  How to cite  | 

Abstract

Introduction: Association of insulin resistance with obesity and metabolic syndrome is an established fact. Vitamin B12 deficiency resulting from metformin therapy in type 2 diabetes mellitus (T2DM) patients was documented in the literature. In our study, we tried to explore the association of insulin resistance with vitamin B12 deficiency in T2DM patients on metformin therapy. Materials and methods: A total of 120 T2DM patients on metformin for at least 6 months with minimum dose of 1,000 mg/day between age group 35 years and 55 years were included. They were divided into group I (with B12 deficiency) and group II (with normal B12 levels). Patients who were on multivitamin supplementation or B12 therapy, nutritional deficiency of vitamin B12, or with any coexisting cause of B12 deficiency like alcoholism, liver, thyroid, and cardiac diseases were excluded from the study. Following biochemical parameters were estimated: fasting plasma glucose, fasting plasma insulin, and vitamin B12. Homocysteine and HOMO-IR were calculated. The statistical analysis, such as Student\'s t-test and Pearson correlation test, was performed. Results: B12 deficiency (group I) showed significant increase in insulin resistance. A negative correlation was observed between vitamin B12 and HOMA IR. Homocysteine showed positive correlation with HOMA IR. Conclusion: There is a negative correlation between the levels of vitamin B12 and insulin resistance and a positive correlation between homocysteine and insulin resistance in T2DM patients on metformin therapy.

Original Article

Shanmuga Priya, Nasreen Begum

Correlation of Lipid Profile with Duration of Diabetes and HbA1c Levels in Type 2 Diabetes Mellitus Patients: A Descriptive Cross-sectional Study

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:4] [Pages No:19 - 22]

PDF  |  DOI: 10.5005/jp-journals-10082-02234  |  Open Access |  How to cite  | 

Abstract

Background: HbA1c predicts the risk for the development of complications in patients with diabetes mellitus. The serum lipid profile of diabetic patients should be measured periodically to take suitable action based on age and type of disease. There exists a positive relationship between the HbA1c level and cardiovascular disease in nondiabetic cases even within the standard range of HbA1c. Numerous studies have been done to find the correlation between the blood glucose levels and parameters of the serum lipid profile. Aims: This study aims to estimate the serum lipid profile and HbA1c levels in type 2 diabetes mellitus (T2DM) and determine the associated factors including the duration of diabetes mellitus among type 2 diabetes mellitus of a tertiary care hospital in Tamil Nadu, India. Materials and methods: The cross-sectional study was done on 124 inpatients and outpatients in a tertiary care hospital, Tamil Nadu, India. Data were collected from the eligible patients on basic clinical details and blood investigations in the fasting state were assessed for FLP-total cholesterol, HDL, LDL, VLDL, TGL, HbA1c, CBC, urine routine, renal function test, and thyroid function test. Results: Eighty patients (64.5%) were having bad glycemic control based on HbA1c >7.5% and the remaining were having good glycemic control. Correlation of the lipid profile with duration of diabetes and HbA1c levels showed a significant positive correlation with total cholesterol, LDL, VLDL, and triglycerides. Correlation of other numerical variables such as age, HbA1c, and hemoglobin with duration of diabetes shows a significant positive correlation of age with HbA1c. Conclusion: Significant positive correlation of HbA1c with lipid profiles in our study suggests that HbA1c can also be used as a predictor of dyslipidemia in addition to a glycemic control parameter for prevention of complication.

Original Article

S Ganesan, Selvarajan Sandhiya, DK Subrahmanyam

Frequency of ADRs and their Economic Impact in a Tertiary Care Public Sector Hospital in South India

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:9] [Pages No:23 - 31]

PDF  |  DOI: 10.5005/jp-journals-10082-02235  |  Open Access |  How to cite  | 

Abstract

Background: Adverse drug reactions (ADRs) are significant causes of morbidity and mortality worldwide and also increase the healthcare cost due to hospital admission and extended hospital stay. Many countries spend 15–20% of the hospital budgets to treat drug-related problem. In India, the frequency of ADRs to individual drugs and their economic burdens are rarely evaluated. Aim: The aim of this article was to study the frequency and pattern of occurrence of ADRs and their economic impact in a hospitalized patient. Materials and methods: The prospective, observational study was carried out in four wards of the general medicine department. The WHO\'s definition of an ADR and intensive monitoring method was adopted. The direct cost imposed by ADRs was calculated using the available resources and indirect cost according to the human capital approach. The frequency and pattern of ADRs were evaluated. Results: A total of 3012 patients were intensively monitored and among them 317 patients were identified with ADRs. Among 317 patients, 8.8% of the patients developed ADRs during the hospital stay, 1.7% patients were admitted to hospital due to ADRs, death due to ADRs was 0.32%, and the overall incidence of ADR was 10.5%. The higher frequency of the ADRs was observed with methotrexate (33.33%), followed by dapsone (23.8%) and antitubercular drugs (ATT) (22.58%). The average cost per patient in the management of ADRs was ₹3367. Conclusion: Early detection and prevention of ADRs reduce the morbidity, mortality, and healthcare expenditures. The outcome of this study may be used to predict and prevent ADRs, which results in the effective healthcare budget of the hospital.

Original Article

Nupur Hooja, Kritika Tulani, Smriti Bhargava, Premlata Mital

Association of Complications in Hypertensive Disease of Pregnancy with Body Mass Index

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:3] [Pages No:32 - 34]

PDF  |  DOI: 10.5005/jp-journals-10082-02232  |  Open Access |  How to cite  | 

Abstract

Introduction: About 12.3% of all maternal deaths occur due to hypertensive disease of pregnancy (HDP). Obesity as measured by the body mass index (BMI) is a major risk factor for development and progression of HDP. The objective of the study was to evaluate the association of the various maternal and neonatal complications with the BMI in women with HDP. Materials and methods: Primigravida women were recruited at their first visit and BMI noted. Examination and all relevant investigations were done at all visits. A total of 45 women who developed HDP were included in the study. Any maternal or neonatal complication was recorded. Results: Most maternal complications like abruptio placentae and pulmonary edema were more in those women with higher BMI. Fetal growth restriction and neonatal complications were also observed more in women with BMI >24.9 kg/m2. Conclusion: Maternal and neonatal complications are significantly more in overweight women. Close monitoring of the blood pressure from the earliest of these women should be done. Clinical significance: Primary preventive measures by weight reduction prior to pregnancy and close monitoring of overweight women will help prevent the maternal and neonatal complications and improve outcome.

CASE REPORT

Roshni Kakitha, Sreedevi Ambujam, Ben Easow George

Bacillary Angiomatosis in an HIV-positive Patient Following a Goat Bite

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:3] [Pages No:35 - 37]

PDF  |  DOI: 10.5005/jp-journals-10082-02238  |  Open Access |  How to cite  | 

Abstract

Bacillary angiomatosis (BA) is caused by Bartonella henselae or Bartonella quintana reported to be acquired from cats or by trauma. A 40-year-old widow presented with a single large painful tumor over the left index finger at the site of a goat bite. With the history of goat bite, rapid increase in size, a uniformly soft purplish lobulated tumor, which bled on touch, and histopathology demonstrating proliferation of capillary-sized vessels, in the background of HIV infection, the differential diagnosis was narrowed down to BA and giant pyogenic granuloma (PG). All clinical diagnoses cannot be evidence based all the time, especially in resource-poor settings. Therapeutic trials are well-known in dermatology and the positive result needs to be considered as evidence for diagnosis in those situations. The remarkable clinical response to oral doxycycline, we feel, could be considered diagnostic of Bartonella infection, and hence, we report this case. Key messages: All clinical diagnoses cannot be evidence based all the time, especially in resource-poor settings. Therapeutic trials are well-known in dermatology. The positive result needs to be considered as evidence for diagnosis sometimes. The remarkable response to oral doxycycline of this goat bite incited skin lesion in our HIV-positive patient, we feel, could be considered diagnostic of Bartonella infection.

CASE REPORT

Roshni Kakitha, Indradevi Radhakrishnan

Multiple Nevus Achromicus Lesions: A Rare Entity

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:2] [Pages No:38 - 39]

PDF  |  DOI: 10.5005/jp-journals-10082-02236  |  Open Access |  How to cite  | 

Abstract

Nevus achromicus is an uncommon birthmark characterized by a well-defined hypopigmented patch resembling a splash of paint. It is usually noted at birth or in early childhood. They do not progress and are mostly seen on the trunk. We report a 20-year-old young man with multiple nevus achromicus scattered over his trunk and limbs. Nevus achromicus is usually solitary, but sometimes it could be multiple wherein the distribution is segmental. Hence, this is a rare case of generalized multiple nevus achromicus and so worth reporting.

CASE REPORT

Rasikapriya Duraisamy, Banupriya Balasubramaniam, Jagadeesh Anbazhagan, Soundararajan Palanisamy

Re-emergence of an Old Threat: Is it Time to Revise Our National Immunization Schedule?

[Year:2020] [Month:January-March] [Volume:3] [Number:1] [Pages:2] [Pages No:40 - 41]

PDF  |  DOI: 10.5005/jp-journals-10082-02262  |  Open Access |  How to cite  | 

Abstract

Pertussis is a highly contagious, vaccine-preventable, respiratory illness caused by Bordella pertussis. In recent years, pertussis infections have reemerged worldwide.1 In resource-poor countries, pertussis-associated case fatality rate is 4% and highest in infancy.2 In 2015, the WHO reported 142,512 pertussis cases globally and 89,000 deaths.3 In the year 2017 in India, totally 23,779 cases were reported with 7 deaths.4

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