Where are such teachers? A legend, an icon, and a role model! Shridhar Dwivedi Indian Journal of Medical Specialities 2019 10(4):179-183

Clinicodemographic profiling of zika outbreak in Jaipur, Rajasthan Raman Sharma, Madhulata Agarwal, Mayank Gupta, Ruchi Singh, Sunil Kumar Mahavar, Rajni Sharma, Deepa Meena Indian Journal of Medical Specialities 2019 10(4):184-189 Background: The 2018 postmonsoon outbreak of Zika virus infection, in a localized pocket of city of Jaipur, Rajasthan, so far the largest in India, alarmed the health authorities to optimize surveillance and measures. Hence, a community-based study to analyze the clinicodemographic profile was conducted to gain better understanding of its squeal. This study aimed to analyze the clinicodemographic profile of this new entrant viral infection. Methods: The study was designed as a community-based observational study. 1,488,870 people in vicinity of the index case were surveyed clinically from October to November 2018. A total of 1925 febrile individuals including pregnant ones in various trimesters of their pregnancy were screened for Zika infection by reverse-transcriptase-polymerase-chain-reaction (RT-PCR). Among these, 153 were RT-PCR positive and 111 cases consenting for the study were included and data collected were analyzed using SPSS 16 software. Results: The mean age of the study population was 27.51 years (95% confidence interval = 24.78–30.25), 53% of the patients were females. Out of 59 Zika-positive females, 27 (46%) were pregnant; 12 (44.4%) were in first trimester and 9 (33%) and 6 (22.2%) in second and third trimester, respectively. The incubation period ranged from 2 to 10 days, the most common symptom being low grade fever in 82%, followed by myalgia in 64.9% and arthralgia in rheumatoid distribution in 55.9%. On examination, a widely distributed blanching maculopapular rash was seen in 28.8%; nonpurulent conjunctivitis differentiating it from dengue was seen in 16.2%. Conclusions: Although Zika, a commonly prevalent virus in dengue endemic belts, yet unknown to our territory, usually causes a mild febrile illness, it can be a cause of intense apprehension to many if infection occurs in the first trimester of pregnancy. Formulating guidelines to tackle Zika pregnancy is a daunting task and needs collaboration across the globe to carry out future research and to get the knowhow.

Prevalence of obesity in Iranian children: Systematic review and meta-analysis Moloud Fakhri, Diana Sarokhani, Mandana Sarokhani, Ali Hasanpour Dehkordi, Leila Jouybari Indian Journal of Medical Specialities 2019 10(4):190-200 Background of the Study: Childhood obesity, in addition to the likelihood of its continuation in adulthood, is associated with an increase in mortality and various diseases. Purpose of the Study: This meta-analytic study aimed at determining the prevalence of obesity among Iranian children. Methodology: Two researchers independently searched national and international databases using MeSH, Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. The heterogeneity between studies was evaluated using the I2 index. Data were analyzed using STATA software. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Among 93 studies with a sample size of 3,845,768, the prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%), and the prevalence of overweight was 12% (girls 17% and boys 15%). The incidence rate of obesity in children was 13% based on US centers for disease control and prevention (CDC) 2000 reference, 11% on international obesity task force (IOTF) reference, 9% on World Health Organization reference, 9% on Iranian reference, 5% on CDC reference, and 3% on national center for health statistics (NCHS) reference. Meta-regression diagram also showed that the prevalence of obesity in children was not dependent on sample size. However, the prevalence of obesity declined during the years 1999–2016, which was statistically significant. Conclusion: The prevalence of obesity in Iranian children was less than of their overweight. On the other hand, the prevalence of childhood obesity in girls was lower than that of boys, and the prevalence of child overweight among girls was higher than that of boys.

Factors affecting quality of sleep in hospitalized patients: A cross-sectional survey in a tertiary care hospital Ovine Loyster D souza, Irene T. R. Alvares, Manjeshwar Shrinath Baliga Indian Journal of Medical Specialities 2019 10(4):201-206 Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.

Seroprevalence of hepatitis B infection among pregnant women in Southern Odisha Neha Samal, Sanghamitra Padhi, Laxmi Burman Indian Journal of Medical Specialities 2019 10(4):207-209 Background: Hepatitis B virus (HBV) infection continues to be a life- threatening health problem throughout world, infecting more than two billion people. While blood transfusion and unsafe therapeutic injection continue to be major risk factors, the role of vertical transmission remains under- estimated. Hence, this study was done to find out the prevalence of HBV infection and associated risk factors among healthy pregnant ladies in Southern Odisha. The present study was a prospective, observational study conducted, in the department of Microbiology, with collaboration of department of Obstetrics and Gynecology of MKCG Medical college from 1st March 2017 to 28th Feb 2018. Methodology: After collection of three to four millilitre of venous blood from the clients, sera was separated by centrifugation. They were then tested for Hepatitis B surface antigen (HBsAg) by Enzyme linked Immunsorbent assay (ELISA). Serological status of the subjects and correlation with their socio-economic characteristic was noted using a preset proforma. Babies born to HBsAg positive ladies were administered Hepatitis B vaccine and immunoglobulin. Results: Total 3,230 in non-duplicating serum samples were screened among which 150 (4.64%) were tested positive for HBsAg. Ladies with multiple sexual partners (57. 14%) followed by intravenous drug users (7.88%) were mostly positive for HBsAg. Conclusion: Exposure to risky social behavioural pattern, lack of awareness could be suggested as possible means of acquiring the infection. Immunization is the most effective and only way of preventing development of chronic carrier state. Hence all neonates were administered with hepatitis B vaccine and 0.5 ml of hepatitis B immunoglobulin within 12 hours of birth.

Adoption and validation of the adolescent stress questionnaire for Indian high school students Ovine Loyster D Souza, Sucharitha Suresh, Manjeshwar Shrinath Baliga Indian Journal of Medical Specialities 2019 10(4):210-218 Introduction: Adolescent stress questionnaire (ASQ) – a 58-item inventory covering broad range of adolescent distress was developed and validated for Australian adolescents. The present study reports a modification of the ASQ for the Indian context. Methodology: Initially, a focus groups study was carried out with 8 adolescents and 8 experts to understand the relevance of the subject and domain contents of ASQ using the original ASQ. Later content validation was done by the experts in the field for the modified ASQ. The modified version was administered to (n = 20) adolescents for pilot testing. In the next stage, the scale was given to 153 adolescents and readministered to the same samples after 1 week. Statistical analysis was done to ascertain the internal consistency, component factor, and test–retest reliability as per the standard analysis. Results: During stage one, 38 questions were retained which were more relevant to Indian context. The internal consistency of 6 subscales was ≥8 and measuring 0.89 for overall questionnaire. The test–retest reliability measured 0.96 for the overall scale (P < 0.0001) for each domain. During the confirmatory factor analysis, above half (20 of 38) of the items confirmed high correlations with their component scale, with factor loadings P < 0.5. Conclusion: The modified ASQ had acceptable internal consistency and test–retest reliability. Further testing with adolescent students living in other parts is recommended to provide a more complete assessment of the questionnaire.

Absent inferior venacava and anti phospholipid antibody syndrome: Compounding risk factor for deep vein thrombosis and recurrent pregnancy loss Aruna Nigam, Nidhi Gupta, Abhinav Jain, Arima Nigam Indian Journal of Medical Specialities 2019 10(4):219-221 The spectrum of congenital anomalies of the inferior vena cava (IVC) has been well described in the literature, but the absence of IVC is a rare occurrence. Most of these patients remain asymptomatic, and the age of presentation depends on the development of deep-venous thrombosis. A young female presented to us with irregular bleeding per vaginum and recurrent pregnancy loss. A thorough general examination of the female patient revealed dilated veins over the abdomen and lower limbs. Investigations of recurrent pregnancy loss led to the diagnosis of antiphospholipid antibody syndrome and computed tomography venography to find out the cause of dilated veins lead to the diagnosis of absent IVC. Both these factors, i.e., absent IVC and the presence of autoimmune antibodies, have compounded the risk factor of thrombosis and management challenging which is discussed.

Area postrema syndrome: A lesser known variant of neuromyelitis optica spectrum disorder Gaurav Kumar Mittal, Shilpa Sekhar, John Jacob Mathew, Jennifer Singhdev Indian Journal of Medical Specialities 2019 10(4):222-224 One of the most specific presentations of neuromyelitis optica spectrum disorders (NMOSDs) is area postrema syndrome (APS). Although NMOSDs are now being increasingly encountered, APS is rarely reported in literature. With the emergence of the ever-expanding spectrum of neuromyelitis optica (NMO) comes various challenges in the prompt recognition, confirmation, and swift initiation of the therapy. Although with the new consensus criteria of the International Panel of NMO Diagnosis 2015, the earlier challenges of diagnosis have been removed to a great extent, still there is a long road ahead in the widespread dissemination of the current knowledge of NMOSD among health-care professionals in India. We hereby report a case of APS in a young female with endeavor to increase the awareness of this peculiar kind of presentation from India.

Idiopathic hepatic granulomatosis: A challenging case of fever of unknown origin Ashutosh Garg, Vivek Pal Singh, Jai Khullar, Afreen Khan Indian Journal of Medical Specialities 2019 10(4):225-228 For any physician, fever of unknown origin (FUO) is an enigmatic problem, while being equally frustrating. It tests the limits of patience of both the physician and the patient. While the majority of such cases end up being of infective etiology, the rest are attributable to noninfectious inflammatory disorders (NIIDs) and neoplasms. Among the NIIDs, most turn out to be connective tissue disorders (CTDs). CTDs are commonly known to have granulomas on histopathology. However, hepatic granulomas are rarely encountered. We present a case of FUO in an elderly urban North Indian businessman who after thorough workup was diagnosed with idiopathic hepatic granulomatous disease. Response to disease-modifying therapy was rewarding.

Cortical blindness in posterior reversible encephalopathy syndrome in postpartum eclampsia Sonakshi Singhal, Amit Baheti, Kirti Singh, Sourya Acharya, Neema Acharya Indian Journal of Medical Specialities 2019 10(4):229-230