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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 6 | Issue 4
Page Nos. 283-401

Online since Thursday, December 24, 2020

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EDITORIAL  

What's new in Academic International Medicine? The importance of nutrition in hospitalized COVID-19 patients p. 283
Anthony T Gerlach, Sheela Thomas, Cindy A Byrd
DOI:10.4103/2455-5568.304608  
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REVIEW ARTICLE Top

Pregnancy during COVID-19 pandemic – Maternal and neonatal outcomes: A concise review p. 287
Hira Khan, Hafsa Sabzposh, Sohiel Deshpande, Rahul Kashyap
DOI:10.4103/IJAM.IJAM_94_20  
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began as an epidemic in China and has spread rapidly in many other countries. Severe adverse pregnancy outcomes resulted from SARS and Middle-East respiratory syndrome. Although consequences of infection with SARS-COV-2 for pregnancies are uncertain at this time, the possibility of severe outcomes should be considered. The physiological maternal adaptations in pregnancy predisposed women to more severe pneumonia, resulting in higher maternal morbidity. There is a paucity of literature regarding the effect of SARS-CoV-2 infection during pregnancy, thus limiting both counseling and management of these patients. This literature review combines the studies from different geographical locations and focuses on whether SARS-CoV-2 infection is transmitted vertically from mothers to neonates and if there are adverse pregnancy and neonatal outcomes such as fetal distress, premature labor, and acute respiratory distress syndrome. We also reviewed the guidelines regarding breastfeeding during the SARS-CoV-2 pandemic. We have used PubMed utilizing search terms as COVID-19, pregnancy, SARS-CoV-2, coronavirus, and pregnancy outcomes. We found sixty studies that met our inclusion criteria, of which total ten studies were included in the review. Inclusion criteria are based on the studies which had pregnant women who were exposed to SARS-CoV-2 and had information on vertical transmission of SARS-CoV-2. Currently, there is no evidence that SARS-CoV-2 undergoes intrauterine or transplacental transmission from infected pregnant women to their fetuses. Based on the current course of SARS-CoV-2 and its rampant growth, it is reasonable to expect that an enormous number of possible asymptomatic pregnant women will present for care. It is suggested that SARS-CoV-2 infection is commonly asymptomatic and should be suspected in all pregnant patients in areas with predominant disease. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice.
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ORIGINAL ARTICLES Top

The use of calorically dense enteral formulas in adult home enteral nutrition population in a tertiary care center: A retrospective analysis p. 294
Ramya Narasimhan, Janki M Patel, Saketh R Velapati, Osman Mohamed Elfadil, Ryan T Hurt, Manpreet S Mundi
DOI:10.4103/IJAM.IJAM_92_20  
Introduction: The prevalence of home enteral nutrition (HEN) has increased dramatically as studies showing clinical benefit have emerged. During this time, the practice of HEN has evolved as well including the availability of diverse formulas ranging in macronutrient distribution and concentration. Despite this availability, there continues to be a paucity of data regarding the efficacy of 2.0 kcal/ml density formulas in the HEN population. Materials and Methods: A retrospective review of HEN database was conducted for the use of concentrated formula (2.0 kcal/ml). Baseline variables as well as efficacy of formula were assessed. Results: In the time period evaluated, 32 HEN patients with a mean age of 58 ± 13.4 years met inclusion criteria. A total of 25 (78.1%) patients were male, the most common indication for HEN was dysphagia (53.1%), and the most common diagnosis was head-and-neck cancer (65.7%). The vast majority (87.4%) received concentrated formula through percutaneous gastrostomy (PEG) and were able to receive 93.1% ±19.7% of their goal calories needs as well as 98.5% ±21.7% of their goal protein needs. A total of 9 (28%) patients were initially started on concentrated formula, whereas 23 (72%) were switched from their initial formula with most common indication being the need for additional calories. Twenty-nine patients (90.6%) were able to utilize the formula as their primary source of nutrition with 22 patients (69%) reported no adverse effects. Conclusions: Our study found that the use of concentrated formula was well tolerated in a diverse cohort of patients, meeting their calorie and protein needs. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning, Systems-based practice.
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Clinical profile and risk factors of recurrent urinary tract infection in patients with type 2 diabetes p. 301
Tauseef Nabi
DOI:10.4103/IJAM.IJAM_83_20  
Introduction: Type 2 diabetes (T2D) patients are at increased risk of recurrent urinary tract infection (UTI). The identification of the risk factors can help pinpoint modifiable factors amenable to a disease prevention strategy for recurrent UTI. This study is aimed to find the prevalence, clinical, biochemical profile, and risk factors of recurrent UTI in T2D patients and the effect on glycemic control and renal parameters on follow-up. Materials and Methods: This was a prospective hospital-based study done on admitted T2D UTI patients. Various clinical, biochemical parameters, and urine examination and culture were monitored. Patients were followed for 6 months concerning the number of UTIs, glycemic control, and renal parameters. Results: The prevalence of recurrent UTI was 39.6%. Recurrent UTI was common in females 61 (44.8%) compared to males 6 (18.2%). Poor renal function, uncontrolled diabetes, renal calculi, and cystopathy increase the risk of recurrent UTI in T2D females. Whereas in males, poor glycemia and lower estimated glomerular filtration rate (eGFR) increase the risk of recurrent UTI. The recurrent UTI patients had significantly higher glycosylated hemoglobin (HbA1c) at follow-up than at baseline, but renal parameters did not improve despite intensive treatment. Conclusion: Recurrent UTI is the consequences of uncontrolled glycemia, which in turn perpetuates UTI risk. A significant number of T2D patients develop recurrent UTI on follow-up, especially females. Recurrent UTI causes short and long-term hyperglycemia, and renal function continues to remain altered despite intensive treatment. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, and Systems-based practice.
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Complete clinicopathological profile and etiological spectrum of pancytopenia in adult patients attending a tertiary care referral center in Eastern India p. 309
Srishtidhar Mangal, Sankha Subhra Sinha
DOI:10.4103/IJAM.IJAM_55_20  
Introduction: Pancytopenia is a common hematological condition manifesting as a simultaneous decrease in formed elements of blood-red blood cell, white blood cell, and platelets. It happens in many illnesses, ranging from simple drug-induced bone marrow hypoplasia, megaloblastic anemia to fatal bone marrow aplasias and leukemias. Identifying the correct etiology and clinicopathological spectrum of pancytopenia helps in implementing timely and appropriate treatment. Hence, this study was undertaken for profiling pancytopenia and we chose to focus on adult patient only. Materials and Methods: The present study was an observational, cross-sectional study conducted at a tertiary care referral center in Kolkata which included 91 cases of pancytopenia over a period of 2 years. Cases were of both sexes and age >20 years who were not on any kind of drug therapy. Cases were evaluated clinically and with complete set of relevant pathological parameters. Results: In our study, the most common etiology was aplastic anemia (24.2%), followed by myelodysplastic syndrome (17.6%) and acute leukemia (14.3%). The most common age range being 21–30 years and most common symptom being progressive pallor. Anisocytosis, reticulocytosis, hypercellular marrow, and no marrow fibrosis were the most common hematological pictures. Severe pancytopenia was seen in aplastic anemia and acute leukemia. Conclusion: The present study concludes that detailed clinical history and complete hematological investigations including bone marrow studies in patients presenting with symptoms of pancytopenia are essential in understanding the disease process and to delineate the causes of pancytopenia. We found aplastic anemia to be the most common etiology in our study, consistent with the studies of Kumar et al. and Niazi et al. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, Medical knowledge, and Professionalism
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CASE REPORTS Top

A neuro-immunological cocktail p. 316
K Nikitha, Sachin Sureshbabu, Remesh Bhasi, LK Sreevidya
DOI:10.4103/IJAM.IJAM_32_20  
This report describes the story of a young female, diagnosed with the rare combination dermatomyositis and myasthenia gravis (MG). The patient presented with progressive muscle weakness without typical skin manifestations of dermatomyositis, except for an early mechanic's hand. In addition, the patient had fatiguability and mild ptosis which raised the suspicion of MG which was later confirmed by the presence of anti-acetyl choline receptor antibodies and clinical response to pyridostigmine. On evaluation, she was found to be seropositive for Mi-2Beta antibody, which is a myositis-specific antigen for classical steroid responsive dermatomyositis. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice based learning and improvement.
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Chylothorax in a young child after a palliative cardiac surgery p. 320
Amar M Taksande, Gnanvelu Injeti, Maithali Joshi, Rewat Meshram
DOI:10.4103/IJAM.IJAM_90_20  
Chylothorax is an unusual complication in children. It is diagnosed by demonstrating high triglyceride content in the pleural fluid and a low cholesterol concentration in relation to the serum cholesterol. While undergoing cardiothoracic surgery, damage to the thoracic duct may take place which is one of the leading causes of chylothorax. Here, we present a case of chylothorax in a 10-year-old boy who was operated for cyanotic congenital heart disease. He was managed for resolution of chylothorax with various measures such as dietary management, intercostal drainage tube, drugs, and respiratory exercises. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Patient care and Procedural skills.
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A case of subvalvular aortic stenosis with pancytopenia: A nightmare for cardiac surgeons p. 324
Sharma Dhruva, Dixit Sunil, Sharma Anil, Mittal Saurabh
DOI:10.4103/IJAM.IJAM_67_20  
An 18-year-old boy presented with difficulty in breathing since birth. He had ejection systolic murmur heard loudest in the right second intercostal space radiating to the right carotids. On blood examination, he had severe pancytopenia. Electrocardiogram revealed left ventricular hypertrophy with a prominent Q-wave. On ultrasonography, it was revealed that the patient had splenomegaly with multiple collaterals. Echocardiography showed a tricuspid aortic valve with three cusps with a subaortic membrane. Concomitant splenectomy and subaortic membrane excision on cardiopulmonary bypass under general anesthesia was done. His platelet counts recovered soon after splenectomy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge, and Systems-based practice.
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EXPERT COMMENTARY Top

The mental health burden of social distancing during the coronavirus disease 2019 pandemic p. 328
Samia Mazumder, Ijeoma Nnodim Opara
DOI:10.4103/IJAM.IJAM_76_20  
The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching economic and mental health impacts on a global scale. Symptoms of anxiety, depression, and overall distress may have been exacerbated by the mental health tolls of the pandemic. It is also important to consider the impact of gender, socioeconomic status and whether one is a frontline worker involved in the treatment of critically ill patients. In order to fully recover from the pandemic, we must be able to identify and treat any mental health disorders that may emerge from the effects of social distancing. Improving access to mental health screening and treatment opportunities through platforms that utilize telehealth may be a part of the solution. In addition, providing institutional support for health-care workers, promoting a safe work environment, and encouraging a robust conversation about mental health will aid in mitigating the negative impacts of social distancing during the COVID-19 pandemic. The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning, Systems-based practice
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CONFERENCE ABSTRACTS AND REPORTS Top

Growth through adversity: The impact of COVID-19 pandemic on the american college of academic international medicine p. 332
Christina Bloem, Annelies De Wulf, Sagar Galwankar, Manish Garg, Donald Jeanmonod, Ron Maio, Gregory Peck, Ziad Sifri, Vicente H. Gracias, Prabath W. B Nanayakkara, Rebecca Jeanmonod, Sona Garg, Harry L Anderson III, Ijeoma Nnodim Opara, Andrew Miller, Michael S Firstenberg, Pia Daniel, Salvatore Di Somma, Thomas J Papadimos, Stanislaw P Stawicki
DOI:10.4103/IJAM.IJAM_162_20  
The COVID-19 pandemic has been especially challenging to the academic international medical (AIM) community. The impact on the field of clinical medicine has been the most pronounced, particularly in the way that education is provided and academic medicine is pursued by clinicians. With the goal of providing top quality, highly relevant content for our membership, the American College of Academic International Medicine (ACAIM) teamed up with our sister organizations, the World Academic Congress of Emergency Medicine (WACEM), the Global Research on Acute conditions Team (GREAT, Rome, Italy and Basel, Switzerland), and EMA-INDIA (Indirapuram, India). The goal of this truly global coalition was to jointly host weekly web meetings that focus on topics relevant to participating stakeholder communities, with additional focus on the ongoing COVID-19 pandemic. Summary of these efforts and outcomes is provided in this article. The following core competencies are addressed in this article: Interpersonal and communication skills; Professionalism; Practice-based learning and improvement
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The women in medicine summit: An evolution of empowerment in Chicago, Illinois, October 9 and 10, 2020: Event highlights, scientific abstracts, and dancing with markers Highly accessed article p. 337
Katayoun Madani, Tricia Pendergrast, Vidya Sundareshan, Shikha Jain
DOI:10.4103/2455-5568.273937  
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LETTER TO EDITOR Top

Innovative strategies to strengthen medical education-related activities in medical colleges of India p. 399
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_2_19  
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