Marine Medical Society

Can pre-exposure prophylaxis be a game changer to prevent new HIV infections? A discussion with an armed forces perspective Sougat Ray, Sunil Goyal, Shabeena Tawar, Vijay Bhaskar, Vinny Wilson Journal of Marine Medical Society 2019 21(1):1-3

Artemisinin resistance: Cause for worry? Anurag Khera, Reema Mukherjee Journal of Marine Medical Society 2019 21(1):4-8 Background: Artemisinin resistance is being reported from certain regions of the world. Globally, the scientific community is engaged in tracing the epidemiology of this resistance while also working on possible interventions to curb the spread. Aim: We reviewed the epidemiology of antimalarial drug resistance, especially artemisinin resistance both globally and in India, and report the possible ways forward. Literature Search: Resistance to all antimalarial drugs developed initially in South East Asia and thereafter spread globally. Artemisinin-based combination treatment (ACT) was formally recommended by the World Health Organisation (WHO) in 2005 to achieve an enhanced barrier to drug resistance. However in 2008, resistance to artemisinin was first reported from Western Cambodia/Thailand. Subsequently, P falciparum chromosome 13 ('kelch' motif or K13) (Pfk 13) was implicated with slow in vivo parasite clearance. As of 2019, artemisinin resistance has been confirmed in six countries of the Greater Mekong Sub-region. The North east states of India have been the portal for entry of anti-malarial drug resistance over the past decades. Though in vitro testing have not shown evidence of decreased artemisinin sensitivity, however, Pfk13 mutations have been reported from India, thus sounding a note of caution and indicating the need for continued genetic, clinical and public health surveillance. Conclusion: Though clinical cure in falciparum malaria infection continues to be elicited through use of ACT even in the countries reporting artemisinin resistance, however a comprehensive framework for combating the resistance has already been put into action by the WHO.

Review of advances in management of pulmonary hypertension Manjit Sharad Tendolkar, Rahul Tyagi, R Ananthakrishnan, Ajay Handa Journal of Marine Medical Society 2019 21(1):9-14 Pulmonary hypertension (PH) is characterized by an increased pulmonary artery pressure with subsequent increase in morbidity and mortality. Epidemiologically, one of the common causes of PH among serving soldier is chronic thromboembolic PH. There have been recent reports of PH among divers. There has been a lot of advancement in the management of PH in recent times. We review the management of this condition with special emphasis on recent advances.

Accuracy of magnetic resonance imaging of the shoulder in evaluation of anterior shoulder instability Yogesh Sharma, Mohammed Schezan Iqbal, Ajay Deep Sud, Pankaj Sharma, Mohit Thapa Magar Journal of Marine Medical Society 2019 21(1):15-18 Background: Shoulder arthroscopy is currently considered the gold standard in diagnosing shoulder pathologies. Although magnetic resonance imaging (MRI) has an established accuracy in determining labral injuries following glenohumeral instability, the opinions of surgeons and radiologists regarding MRIs are still inconsistent till date. The aim of this study was to carry out a diagnostic evaluation of MRI vis-a-vis shoulder arthroscopy for the assessment of Bankart and Hill-Sachs lesions in subjects of anterior shoulder instability. Subjects and Methods: This was a diagnostic evaluation study, estimating the accuracy of MRI in diagnosing lesions encountered in shoulder dislocations vis-a-vis shoulder arthroscopy. Ninety participants of anterior shoulder dislocation were evaluated preoperatively with a shoulder MRI. The study participants were later subjected to a diagnostic shoulder arthroscopy and managed operatively on a case-to-case basis. Results: The sensitivity and specificity of MRI to diagnose a Bankart lesion were 90.78% and 85%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 97% and 63% for the same. The sensitivity and specificity of MRI to diagnose a Hill–Sachs lesion were 92.68% and 85.71%, respectively. The PPV and NPV were 84.44% and 93.33% for the same. The diagnostic accuracy for MRI detection of Bankart lesion was 91% and of Hill–Sachs lesion was 88.89%. Conclusions: MRI is a very sensitive and specific tool in the detection of lesions commonly associated with shoulder instability, namely Bankart and Hill–Sachs lesions.

Knowledge and practices about protein supplement use amongst students of a medical college Kuntal Bandyopadhyay, Sougat Ray, Shruti Vashisht, Gurpreet Singh Bhalla, Manbeer Singh Sarao Journal of Marine Medical Society 2019 21(1):19-23 Background: Nutrition and sports go hand in hand. With the availability of a wide range of protein supplements in the market and a risk taking mindset of the young generation to achieve fast and presentable results to their appearance or performance, a thorough knowledge and the selection of the right product becomes important. Materials and Methods: A descriptive cross-sectional study was conducted in a medical college in an urban locality over a period of 06 months. Participants were selected from a medical college by simple random sampling method and a total of 385 selected participants were distributed pre-tested questionnaires. Data was collected and the results were tabulated using appropriate statistics. Results: Amongst 385 participants (276 male & 109 females), 80 (20.8%) participants used supplements regularly. The mean age and BMI of protein supplement consumers was found to be 20.8 ± 1.4 years & 21.61 ± 1.9 Kg/m2. The association of use of supplements was found to be highly significant amongst those playing more than one sport (p<0.001), playing daily (p<0.001) and working out in gym (p<0.001). While the most common reason participants cited for consumption of supplements was to augment their diet and build muscles (46.3%), the commonest source of their information was found to be internet (65.8%). Conclusion: There still exists a huge gap in the knowledge and practices on the use of supplements amongst the college students which needs to be bridged and thus, by highlighting gaps in nutritional knowledge, sport nutrition professionals may begin to address these gaps by educating sportsperson with a view toward minimizing injury and enhancing sport performance.

Dexmeditomedine as an adjuvant reduces the minimum effective anesthetic volume of ropivacaine required for supraclavicular brachial plexus nerve block Parli Raghavan Ravi, MN Vijai Journal of Marine Medical Society 2019 21(1):24-30 Background: Dexmeditomidine has been used as an adjuvant with local anaesthetic amides for supraclavicular brachial plexus block for improving the quality and duration of analgesia. We conducted this study to find out that whether as an adjuvant it reduces the minimum effective anaesthetic concentration (MEAC) and minimum effective anaesthetic volume (MEAV). Materials and Methods: 90 patients undergoing upper limb surgery were randomized into three groups and given ultrasound guided supraclavicular block. Group A received 30 ml of 0.5% Ropivacaine, Group B received 20 ml of 0.5% ropivacaine with 50μgm dexmeditomidine and Group C received 15 ml of 0.5% ropivacaine with 50μgm of dexmeditomidine. The onset of sensory and motor block, the duration of sensory and motor block, quality of analgesia, haemodynamic and sedative parameters were recorded. SPSS software was used for statistical analysis. Results: The onset of sensory block in Group B(9.47±3.54mins) and Group C (12.45±3.86) was faster in comparison to Group A(17.64±5.36) which was statistically significant. The duration of the block was also more in Group B and C in comparison to Group A. The requirement of rescue analgesia was also less in Group B and C. There were no statistically significant changes in the haemodynamic parameters and sedation scores. Although the patients of Group C received lesser volume and dose of ropivacaine than Group B, there was no statistically significant delay in onset or duration of sensory and motor block neither any change in the quality of analgesia. Conclusion: We concluded that 15 ml of ropivacaine with 50μgm of dexmeditomidine is adequate for good quality of analgesia with no compromise on onset of analgesia and duration of block..

An epidemiological study of varicella outbreak in a military training establishment Dattatraya Ramkrishna Sinalkar, Rahul K Ray, SM Sudumbrekar Journal of Marine Medical Society 2019 21(1):31-35 Context: Though incidence of the Varicella has decreased in recent years due to introduction of vaccine; outbreaks continue to occur in closed environments such as those of militaries. The present study describes one such outbreak in a military training establishment. Setting and Design: This cross sectional study was conducted at a Secondary level hospital. Aims: To describe the distribution and characteristics of Varicella infections and to make suitable recommendations for prevention and control. Materials and Methods: All admitted cases of Varicella from a military training establishment during the outbreak were included in the study. Epidemiological data was collected by face to face interview. Statistical Analysis Used: Statistical analysis was performed using Epinfo software version 3.5.3. Results: Total 332 recruits were admitted in the local military hospital in said outbreak. Eight administrative staffs of recruiting center and two medical staffs attending the patient at hospital were also affected. The age of the patients ranged from 18 to 34 years with a mean of 20.3 ± 3.5 years. None of the cases admitted had developed any complication and their hospital stay remained uneventful. Maximum cases (59%) were presented with rash as a first clinical manifestation and 94.3 % of them had history of contact with a case of Varicella. None of them gave a history of vaccination. Conclusions: Though policy to offer vaccination against Varicella to all recruits on entry level exists, it should be implemented on ground to ensure unnecessary interruption in training activities.

Epworth sleepiness score to predict sleep apnea in acute stroke: Do we need to delve deeper? Rahul Tyagi, Pulikottil Wilson Vinny, Vivek Hande, Vijay Budhwar Journal of Marine Medical Society 2019 21(1):36-40 Introduction: Globally, stroke is a leading cause of death and disability. Obstructive sleep apnea (OSA) is globally being recognized as an emerging public health problem and a risk factor for stroke. Epworth Sleepiness Score (ESS) is increasingly being used as a screening tool to determine the likelihood of OSA in a patient before polysomnography (PSG). However, ESS questionnaires in patients with acute stroke and their comparison with overnight PSG have not been studied. We conducted this study at a tertiary care respiratory center in Mumbai to determine the effectiveness of ESS in predicting the prevalence of sleep apnea in acute ischemic stroke. Materials and Methods: Twenty-eight patients of acute stroke were included in the study. These patients were subjected to ESS and technician attended overnight PSG. Apnea–Hypopnea Index, oxygen desaturation index, and minimum saturation were determined at the overnight PSG. Results: Majority of patients belonged to 61–80 years' age group (53.6%) and were predominantly male (89.3%). Only 5 patients (17.9%) showed an ESS of more than 8, whereas 23 patients (82.1%) showed evidence of OSA on PSG. Sensitivity of ESS in predicting OSA in patients with acute stroke was 17.3%, whereas specificity was 80%. Conclusion: The use of ESS in patients of acute stroke to screen for sleep-disordered breathing (SDB) should be avoided. A PSG may be considered in these patients as early diagnosis of SDB in these patients can help in improving recovery.

Study of the anthropometry and prevalence of overweight in school boys in an Urban Area Sukhmeet Minhas, Rajesh Kunwar, Harinder Sekhon, Pijush Jaiswal Journal of Marine Medical Society 2019 21(1):41-45 Context: Overweight and obesity has been found to increase among children over the last few decades. Not only are more children becoming overweight, but they are also becoming so at a relatively younger age. Aims: This study of anthropometry of boys in a school in an urban area calculates the prevalence of overweight and thereafter suggests appropriate measures for improvement in lifestyle. Besides, secondary objectives were to determine the association of overweight and obesity with demographic factors. Settings and Design: A school-based, descriptive, cross-sectional study, in an urban area. Subjects and Methods: A sample size of 1537 was calculated. Anthropometric measurements of the participants were recorded including height, body weight, mid-upper arm circumference, and waist and hip circumference. Status of overweight and obesity was determined using body mass index. A structured questionnaire was used to record the personal particulars and sociocultural factors. Statistical Analysis Used: Data were analyzed using the software Epi Info™ version 7, developed by the Division of Health Informatics and Surveillance of the Centers for Disease Control, Atlanta. Results: Most participants ranged in age from 6 to 15 years, while 17.2% were overweight and 3.7% were found to be obese. Conclusions: As the main causes of excess weight include individual behavior and dietary patterns, children must be exposed and habituated to a healthy lifestyle as a preventive measure.

Spinal cord injury in organizational setup - A hospital based descriptive study Gurpreet Singh, Rajat Prakash, Vijay K Bhatti, Ajoy Mahen Journal of Marine Medical Society 2019 21(1):46-50 Introduction: There is dearth of data on Spinal Cord Injury (SCI) from developing countries where ironically, special focus is required. Aims and Objectives: To study SCI in an organisational set up. Material and Methods: An observational, cross sectional study at a tertiary care rehabilitation centre was conducted. Patients who had injury during service were included. Questionnaire and case records were used to collect socio-demographic variables, cause, level, severity and duration of injury and clinical, functional and psychological status. Organisational support was estimated for pre-hospitalisation services, inpatient welfare measures and post-hospitalisation rehabilitative services. Results: A total of 157 patients participated. Median age at time of injury was 27 years with 89.2% injuries within 18 - 37 years of age. Trauma was underlying cause in 94.3%. Most common level of injury was thoracic (37.6%) and majority (66.9%) were paraplegic. RTA was most common (42.6%) traumatic cause and Tuberculosis among non-traumatic causes(66.6%). Scores suggestive of stress disorder were present in 13%. Pre-hospitalization health facilities were available to 79.6%. Majority (59.2%) had access to health facilities within two hours. Personal assistance was available to 88.5% and 66.9% undertook rehabilitation course. Conclusion: Health education with emphasis to trauma prevention in young is required. Social security measures need to be replicated by all organisations, both public and private in the country.

Alexandros Sfakianakis
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alsfakia@gmail.com