Indian Journal Of Clinical Practice <div class="row"> <div class="col-md-12"> <p>Indian Journal of Clinical Practice is the flagship peer-reviewed journal of IJCP Group<br />A multispecialty journal, it provides clinicians with evidence-based updated information about a diverse range of common medical topics, including those frequently encountered by the Indian physician, to make informed clinical decisions.<br /><br />Indian Journal of Clinical Practice is a peer-reviewed journal that publishes original research, clinical reviews, case reports, expert viewpoints, clinical practice guidelines, Medilaw, Medifinance, Spiritual Update, Lighter reading including latest news and updates in medicine from around the globe.<br /><br />Indian Journal of Clinical Practice has been published regularly every month since it was first launched in June 1990 as a monthly medical journal.<br /><br />The journal is available in print and is also available online. The ISSN (print version) number is 0971-0876; RNI number is 50798/1990.<br /><br />Indian Journal of Clinical Practice is indexed with Indian Citation Index and IndMed (</p> <p>IJCP Group was founded in 1990 by Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal and was the pioneer of medical journalism in India. It was started with the basic objective of updating the knowledge of the medical professionals, which is the need of the hour. We began with a single monthly journal called ‘The Indian Journal of Clinical Practice’ launched in 1990 by Late Dr Shankar Dayal Sharma, the then Vice President of India. Since then we have now grown into various multispecialty journals, customized books and publications, events, consulting, branding, Continuing Medical Education (CME) activities, doctor meetings, Key Opinion Leader (KOL) interactions, etc.</p> </div> </div> <div class="row"> <div class="col-md-12"><strong><span id="ctl00_ContentPlaceHolder1_Label2">Aim &amp; Mission</span></strong></div> </div> <div class="row"> <div class="col-md-12"> <p><br /><strong>Our Aim</strong><br />To help medical professionals both within India and abroad to stay updated with the latest advances in medicine and help improve patient outcomes and to provide a platform for doctors to share information<br /><br /><strong>Our Mission</strong><br />To be the leader in the field of medical communications and to make Indian medical literature vastly read within India and abroad.<br /><br /><strong>Our Vision</strong><br />To benchmark the kaleidoscope of medical information<br /><br /><strong>Our Guiding Principles</strong><br />Content is King, commitment, excellence, quality, timeline efficiency, creativity, innovation</p> </div> </div> IJCP Group en-US Indian Journal Of Clinical Practice 0971-0876 Efficacy of Modified Bleach Concentration Method for Demonstration of Acid-fast Bacilli in Fine Needle Aspiration of Lymph Nodes with Clinical Suspicion of Tuberculosis <p>Background: Tuberculous lymphadenitis is the most common form of extrapulmonary tuberculosis. Fine-needle aspiration <br>cytology of lymph node for its diagnosis is simple and safe. Conventional Ziehl-Neelsen (ZN) method for acid-fast bacilli <br>plays a key role in the diagnosis; however, it has variable sensitivity due to low bacterial load. We evaluated the role of <br>bleach concentration method before performing ZN method for the detection of mycobacterium in clinically suspected cases <br>of tuberculous lymphadenitis. Method: A total of 103 samples of fine-needle aspirates were collected from clinically suspected <br>cases of tuberculous lymphadenitis as part of routine diagnosis. All the samples were processed for cytology, conventional <br>ZN staining, bleach concentration followed by ZN staining. Results: As per cytomorphological diagnosis of aspirates, 50.50% <br>cases were categorized as reactive hyperplasia, 43.68% cases as tubercular lymphadenopathy and 5.82% cases of suppurative <br>lymphadenitis. The detection rates of conventional ZN method and bleach concentrated ZN method were 28.15% and 33%, <br>respectively. The bleach method has 100% sensitivity and specificity while conventional ZN method showed 85.29% and <br>100%, respectively. Conclusion: Bleach concentrated method can be done before conventional ZN staining for detection of <br>tubercle bacilli, as it has a higher case detection rate than that of the conventional ZN method.</p> PARWINDER KAUR SILKY MAHAJAN KANWAL MASIH Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 708 712 Lighter Side of Medicine <p>lighter reading</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 795 795 Determination and Persistence <p>INSPIRATIONAL Story</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 793 793 Importance of Silence <p>Spiritual Update</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 792 792 News and Views <p>Around the globe</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 786 791 Medtalks with Dr KK Aggarwal CMAAO Coronavirus Facts and Myth Buster <p>Medical Voice for Policy change</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 779 785 Professional Indemnity Insurance for Medical Professionals <p>Medicolegal</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 775 778 Information Technology and Healthcare Education: Scope and Opportunities <p>Brief communicatio&nbsp;</p> SANCHIT TIWARI PK KAR BV MURLIMANJU AMIT AGRAWAL Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 773 774 efenamic Acid as Steroid-sparing Antiinflammatory Drug During Viral Phase of COVID-19: 5 Case Reports <p>The diverse disease manifestations in coronavirus disease 2019 (COVID-19) patients are an enigma since some cases display <br>little to no symptoms, whereas others develop severe fever and pneumonia, leading to acute respiratory distress syndrome <br>and eventually death. Given the excessive inflammatory activity, there is a need to target a regulator of cellular inflammation <br>while leaving the antiviral pathways intact. Corticosteroids are used as potent anti-inflammatory agents; however, it may <br>also be linked with attenuation of viral clearance leading to nonuniform benefits across the disease spectrum. Mefenamic acid <br>can be used as a steroid-sparing, long-term drug in the management of COVID-19 and post-COVID inflammation. In this <br>article, the management of 5 mild-to-moderate COVID-19 cases using steroid-sparing anti-inflammatory agents is described.</p> KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 759 763 Multiple Causes Leading to Massive Splenomegaly in an Elderly Female <p>Splenomegaly is defined as enlargement of the spleen measured by size or weight. The spleen is an essential site for <br>hematopoiesis and immunosurveillance. Splenomegaly may be diagnosed clinically or radiographically using ultrasound, <br>CT imaging or MRI. Splenomegaly may be a transient condition or may be due to serious underlying acute or chronic <br>condition. A combination of clinical examination, serology and imaging may diagnose splenomegaly and the underlying <br>cause. Derangement in the complete blood (cell) counts and morphology including WBC, RBC and platelets will vary based <br>on underlying disease. Abnormalities in liver function tests, lipase, rheumatologic panels and disease-specific infectious <br>testing help in ascertaining the cause of splenomegaly. We present here a rare case of massive splenomegaly which had <br>multiple causes within the same patient contributing to a massive spleen and a diagnostic enigma.</p> MUHAMMAD UWAIS ASHRAF SHEHZAD FAIZUL HAQUE MOHD. JAVED Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 766 769 Uterine Didelphys with Pregnancy and Obstructed Labor: Intrapartum Course Complicated by a Rare Uterine Anomaly <p>Mullerian duct anomalies (MDAs) are congenital anatomic abnormalities of the female genital tract that arise from nondevelopment or non-fusion of the mullerian ducts or failed resorption of the uterine septum, with a reported incidence of <br>0.1-10.0%. MDAs are clinically important because they are associated with an increased incidence of impaired fertility, menstrual <br>disorders and obstetric complications. We hereby report a case of a primigravida with full-term pregnancy with obstructed <br>labor referred from a primary health center. During the course of examination, she was found to have congenital abnormality of <br>uterus and vagina. She underwent an emergency cesarean section with good perinatal outcome. Women with uterus didelphys <br>belong to a high-risk group, although pregnancy outcome is comparatively good.</p> SHASHIDHAR B HEMALATHA M SHETTI Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 770 772 A Study to Evaluate the Efficacy and Safety of a Herbal Preparation for Burn Wounds <p>Background: Burn is a common medico-surgical problem all over the world, most devastating of all wounds, and imposes <br>a serious burden on physical, mental and socioeconomic conditions of the victim. Rapid and effective treatment of burnt <br>skin is vital to hasten wound closure and healing. The process of burn wound healing is divided into four consecutive and <br>overlapping phases: hemostasis, inflammation, proliferation and remodelling. Local treatment of burn wounds includes <br>cleansing, debridement and burn wound dressing, typically incorporating topical antimicrobial agents; however, there is <br>no consensus on which agent or dressing is optimal for burn wound coverage to prevent or control infection or to enhance <br>wound healing. Various silver preparations (monocrystalline and slow release) are the mainstay of many approaches but <br>antimicrobial peptides, topical photodynamic therapy, chitosan preparations, new iodine delivery formulations, phage <br>therapy and natural products, such as honey and essential oils, have all been tested. The continuous increase in antibiotic <br>resistance, besides the high susceptibility of burn wounds to infection, and the difficulty of systemically administered <br>antibiotics to reach the damaged tissue, have all made the development of new topical antimicrobials for burn infections a <br>potential area of innovation for researchers. Use of medicinal plants for dressing wounds has been described by traditional <br>medicine. Objectives: The purpose of this study was to evaluate the efficacy and safety of a herbal preparation in patients <br>with burns in a prospective, noncomparative, open-label and single-center study design. The study population comprised <br>of patients aged 18 years and above suffering from superficial and deep burns involving up to 30% total body surface area. <br>Methods: After written informed consent and evaluation of inclusion/exclusion criteria, subjects were treated for 14 days. <br>Efficacy assessments included wound epithelialization, wound microbiology, blood leukocyte counts and safety assessments <br>included pain score and adverse events. Results: Over a period of 5 months, 26 patients, mainly between 20 and 30 years, <br>and with female predominance, were enrolled in the study. At the end of treatment, almost 74% of the subjects showed more <br>than 50% skin epithelialization. Approximately, 82.6% of patients had fall in blood leukocyte count. Wound colonization <br>showed Klebsiella and Pseudomonas in a decreasing trend from 39.1% on Day 7 to 8.7% on Day 14, remarkably less than <br>historical controls. All patients experienced burning pain after spraying the product which lasted for almost 15 minutes and <br>demonstrated decreasing intensity from Day 1 to 14. No local adverse events were found in the patients, with high patient <br>satisfaction. Conclusion: The herbal preparation was a very effective and safe treatment option in patients with superficial <br>and deep partial-thickness burns involving up to 30% total body surface area. It prevented wound infection and significantly <br>improved wound epithelialization</p> MADHURI GORE DIPESH WAGHMARE Copyright (c) 2024 Indian Journal Of Clinical Practice 2020-01-08 2020-01-08 31 8 726 730 Study of Pseudomonas aeruginosa Growth in Hospitalized Patients <p>Pseudomonas aeruginosa is a leading cause of nosocomial infections, ranking second among the Gram-negative pathogens. <br>Hence, this study was required to enhance the knowledge about this particular organism. A total of 100 isolates of P. aeruginosa<br>isolated from various clinical specimens like urine, pus, blood, body fluids, sputum, collected from patients, irrespective <br>of age and sex, were identified by standard microbiological procedures. A total of 100 culture positive samples were taken <br>and it was found that P. aeruginosa was predominantly present in urine samples of males aged between 21 and 30 years.</p> SUMIT KHATRI SONIA BHARTY SANJAY BHARTI KSHITIZ CHOURASIYA Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 732 735 Effectiveness of Home-based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease <p>Pulmonary rehabilitation (PR) is an effective intervention for chronic obstructive pulmonary disease (COPD). However, <br>uptake of PR is low due to patient frailty, transportation issues and access. Home-based rehabilitation has been introduced <br>in recent years to palliate the lack of feasibility for many patients to attend traditional center-based PR programs. Hence, <br>this study was conducted to evaluate COPD patients in home-based PR. A total of 56 patients were evaluated for 6 months’ <br>period in 4 different occasions. It was concluded that home-based PR was effective as improvement occurred in all parameters.</p> SUMIT KHATRI BRAHMA PRAKASH KRISHNA GOPAL SINGH MRITYUNJAYA SINGH Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 736 740 Correlation Between Nasal Mucociliary Clearance and Peak Expiratory Flow Rate During Various Phases of Menstrual Cycle <p>Nasal mucociliary clearance (NMC) time and peak expiratory flow rate (PEFR) were tested in 30 Indian healthy female <br>volunteer medical students, 18-24 years of age, having regular menstrual cycles. NMC time was assessed by Andersen’s <br>saccharin technique. The mean values of NMC of two menstrual cycles were 10.81 ± 2.143, 8.233 ± 1.942 and 11.12 ± 2.118 in <br>menstrual, proliferative and luteal phase, respectively. On comparing proliferative phase with menstrual and luteal phases, <br>NMC time difference was highly significant (p &lt; 0.001) and when luteal and menstrual phases were compared, results were <br>not significant (p &gt; 0.05). NMC time was significantly less in proliferative phase when compared with other two phases of <br>menstrual cycles. Thus, various phases of menstrual cycle do have effect on nasal mucosa. This may be related to change <br>in hormonal levels in different phases of menstrual cycle. PEFR and NMC time were measured during menstrual (2nd-4th <br>day), proliferative (9th-12th day) and luteal phase (19th-21st day) of menstrual cycles. PEFR was measured by Wright’s peak <br>flow meter in standing position during various phases of two menstrual cycles. The mean of PEFR of two menstrual cycles <br>was considered. On comparison of luteal and menstrual phases, the PEFR difference was found highly significant (p &lt; 0.001). <br>Similarly on comparing proliferative and luteal phases, the PEFR difference was found highly significant (p &lt; 0.001). But on <br>comparing menstrual and proliferative phases, the PEFR difference was not found significant (p &gt; 0.05). When NMC and PEFR <br>were correlated by Pearson’s equation in all the three phases of menstrual cycle 1, then the correlation coefficient was found <br>not significant in menstrual (r = 0.330, p &gt; 0.05), proliferative (r = 0.2499, p &gt; 0.05) and in luteal phase (r = 0.3433, p &gt; 0.05), <br>which showed that any increase or decrease in one parameter (NMC) is not significantly affecting other parameter (PEFR) <br>in any phase of menstrual cycle. Similar results were found in menstrual cycle 2 and even when mean of both cycles was <br>considered. The correlation coefficient of cycle 2 was r = 0.3361, p &gt; 0.05 in menstrual, r = 0.3375, p &gt; 0.05 in proliferative and <br>r = 0.3514, p &gt; 0.05 in luteal phase, which was not significant. The correlation coefficient of NMC and PEFR of both cycles <br>was r = 0.343, p &gt; 0.05 in menstrual, r = 0.2903, p &gt; 0.05 in proliferative and r = 0.3570, p &gt; 0.05 in luteal phase, which was <br>also not significant.</p> JYOTI YADAV SNEH LATA GARG Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 742 749 A Demographic and Etiological Study of Dyspepsia Patients Presenting to a Rural Hospital in South-West Rajasthan <p>Introduction: Dyspepsia is one of the most common complaints of patients coming to a hospital causing great economic <br>and social burden over a society. A proper understanding of its causes in a specific region can greatly help in reducing <br>the cost of healthcare and in increasing productivity. Material and methods: A total of 128 patients were included in the <br>study. Proper history-taking, physical examination and relevant investigations including upper gastrointestinal endoscopy <br>(UGIE) + rapid urease test (RUT) and ultrasound abdomen were done to evaluate the causes of dyspepsia. Rome III diagnostic <br>criteria-based questionnaire was used to find out functional dyspepsia. Results: Amongst the various causes of dyspepsia, <br>gastroduodenitis was the most common cause of dyspepsia (89%), out of which 77.2% were Helicobacter pylori positive, and <br>as many as 22.8% were H. pylori negative. On the other hand, of all the patients who were H. pylori positive (total 91 patients, <br>i.e., 71.1%), 96.7% (88 out of 91) patients had gastroduodenitis and/or peptic ulcer disease. Functional dyspepsia was found <br>only in 8.6% patients. Majority of patients (60.2%) consumed drinking water from reverse osmosis supply. UGIE could lead <br>to a definitive diagnosis in as many as 91.5% cases. Conclusion: In the South-West Rajasthan region, H. pylori infection has a <br>strong correlation with gastroduodenitis and peptic ulcer disease although all gastroduodenitis patients may not be H. pylori<br>positive. Functional dyspepsia is not a very common entity in this region. In our study, reverse osmosis water seems to <br>provide no protection from dyspepsia.</p> DHARSANDIA SAGARKUMAR KANTILAL SOMENDRA MOHAN SHARMA ANIL KUMAR CHAWLA NABAJYOTI UPADHYAYA Copyright (c) 2024 Indian Journal Of Clinical Practice 2020-01-08 2020-01-08 31 8 752 756 Patient-Ventilator Asynchrony: Etiology and Solutions <p>Patient-ventilator asynchrony is one of the most cited reasons for giving sedation during mechanical ventilation. Various <br>studies show that 40-50% of increase in sedative dosing is done to curb asynchrony. The acute respiratory distress syndrome <br>(ARDS) network protocol for lung protective ventilation directs the clinician to adjust the ventilator settings or give sedation <br>when there are more than three breaths stacking (double triggers) per minute. This review article discusses the etiology <br>behind patient-ventilator asynchrony and the proposed solutions.</p> VITRAG H SHAH ARIJIT SAMANTA SUMIT RAY Copyright (c) 2024 Indian Journal Of Clinical Practice 2020-01-08 2020-01-08 31 8 714 724 CMAAO Coronavirus Facts and Myth Buster: Long COVID – NICE Guideline <p>From the desk of THE group editor-in-chief</p> Dr KK Aggarwal Copyright (c) 2024 Indian Journal Of Clinical Practice 2021-01-08 2021-01-08 31 8 705 707