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   Table of Contents - Current issue
January-June 2020
Volume 5 | Issue 1
Page Nos. 1-96

Online since Wednesday, July 8, 2020

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COVID-19: The role of tertiary care teaching hospitals in India p. 1
MS Biradar
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Topical antibacterials: Current concepts and advances p. 3
Sowmyashree Krishna, Spandana Prakash Hegde, Manjunath Mala Shenoy
Skin and mucosa act as a barrier against the entry of microbial agents, but loss of integrity of the skin weakens the host defense mechanisms and antimicrobials appear to play a role. Antibiotics have come a long way from penicillin which was accidentally discovered by Alexander Fleming when experimenting on influenza virus to the latest unnamed molecules. Recent topical antibiotics include retapamulin, nadifloxacin, dapsone, ozenoxacin, REP8839, and BAL19403. This article summarizes the current scientific information on newer topical antibiotics available along with overview of other old antibiotics, their indications in various fields, advantages of topical over oral antibiotics, available formulations, side effects, and precautions to be followed so as to minimize the emergence of drug resistance. Indiscriminate use of topical antibiotics is an important contributor for the development of bacterial resistance and should be curbed and they should be judiciously used. There is no ideal topical antibiotic, and clinicians must be watchful to identify the various patterns of antibiotic resistance.
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Mechanism of diabetic nephropathy and traditional drugs for management Highly accessed article p. 8
Shabnam Ansari
Diabetic nephropathy (DN) is a microvascular complication of diabetes mellitus which affects the kidneys. Recent reports of increasing prevalence of diabetes around the globe suggested that that the prevalence of DN will be doubled by 2025. There is an extremely high risk of progression of DN to end-stage renal disease and cardiovascular morbidity and mortality. Control of sugar levels, blood pressure control via renin–angiotensin–aldosterone system inhibition, and regular monitoring of renal functions have remained the principle of the management for DN for a long time. As conventional drugs cannot fulfill all the clinical needs due to accessibility, clinical efficacy, and safety issues, the need for novel inexpensive traditional drugs from Unani medicine to improve DN treatment and reduce the risk of complications has become urgent. Several herbal and mineral drugs have been mentioned in the old Unani books for the treatment of similar conditions stipulating DN. Through this article, an uttermost effort has been put to rememorize the mechanism of development of DN and available Unani drugs so that effect and mechanism of these drugs could be evidenced in the treatment of DN in future.
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A study on serum lipid parameters in individuals with major depressive disorder in comparison to normal controls p. 15
Bilal Ahmad Bhat, Shabir Ahmad Dar, Arshad Hussain
BACKGROUND: Evidence seems to suggest that dysfunction in many biological functions is associated with major depressive disorder (MDD). Literature suggests a possible link between different lipid parameters and depression. AIMS: The aim was to study lipid parameters in persons diagnosed with MDD and to find a correlation between these lipid parameters and depression. SETTINGS AND DESIGN: This was a case–control study conducted in outpatient services of the psychiatry department. MATERIALS AND METHODS: A total of 100 subjects were included in this study. Fifty drug-naïve depression cases as assessed clinically and with Hamilton Rating Scale for depression were included in the study group, while the control group comprised 50 normal controls. Lipid parameters were obtained from fasting blood samples in both the groups. STATISTICAL ANALYSIS: Data analysis was performed using SPSS 16. Continuous variables and categorical variables were summarized, respectively, as mean and standard deviation and frequency and percentage. RESULTS: The mean serum total cholesterol (TC) and mean serum low-density lipoprotein cholesterol (LDL-C) in the study group were significantly low in comparison to the control group. There was a significant negative correlation with serum TC (r = −0.710; P = 0.0001), mean serum LDL-C (r = −0.608; P = 0.0001), and triglycerides (TGs) (r = −0.289; P = 0.042). CONCLUSIONS: Drug-naïve Individuals with MDD had significantly low TC and LDL-C in comparison to normal individuals. A significantly negative correlation was there between the severity of depression and TC, LDL-C, and TG.
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Nutritional status of Hill Korwa preschool children of Jashpur:A particularly vulnerable tribal group of Chhattisgarh Highly accessed article p. 20
Subal Das, Manisha Ghritlahre, Aafreen Siddiqui, Khangembam Somibabu Meitei
INTRODUCTION: Malnutrition is considered as one of the major public health problems in developing counties like India. AIMS: To understand the nutritional status of preschool children of Hill Korwa Tribe of Jashpur district, Chhattisgarh, India. MATERIALS AND METHODS: A crosssectional study was carried out among the preschool children of Hill Korwa Tribe, Jashpur district Chhattisgarh, India. In total, 106 children between 2-6 years of age including 60 boys and 45 girls were screened for their nutritional status and hygienic practices. Data of age and hygienic practice (lavatory use and drinking water) were collected from their parents/care takers and also from aanganwadi workers. The statistical analysis was done using statistical package with Statistical Package for Social Sciences (SPSS) Statistics version 23. Verbal approval from their parents was obtained before the beginning of data collection. RESULTS: The age-sex combined overall prevalence of undernutrition of the studied population is 54.7%. Comparatively girls are more undernourished (62.2%) than boys (49.2%). Negative significant sex difference (t = -2.967, sig = 0.010) in mean BMI at the age of 2 years has been observed. The highest prevalence of undernutrition was found among those children who are practicing open defecation (63.4%) than those children who were using toilets (36.9%). Significant age difference in the prevalence of nutritional status has been observed among girls (χ2 = 32.162, df = 8, P = 0.000). CONCLUSION: The present study reveals a high prevalence of undernutrition among Hill Korwa children aged between 2-6 years. Proper nutritional and awareness program on hygienic practices can have a significant impact in reduction of undernutrition among them. Target oriented and community specific program based on, survey report of health and nutritional status should be designed.
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Study the influence of yogic asana on body composition and cardiopulmonary functions of adolescent girls p. 26
Indranil Manna
INTRODUCTION: Inadequate physical activity leads to obesity, diabetes, and cardiopulmonary dysfunctions. Adolescent girls undergo certain changes during this phase of life. Yoga exercises can help to develop their body composition and physiological status and thus maintain good health. AIM: The present investigation aimed to see the influence of yogic asana on subcutaneous adipose tissue and cardiopulmonary functions of adolescent girls. MATERIALS AND METHODS: A total of 87 girls (age: 12–14 years) were screened, of whom 27 were excluded from the study after medical examinations and the remaining 60 volunteers were grouped randomly into (i) yoga group (n = 30) and (ii) control group (n = 30). The yoga group followed a yoga training of 60 min/day, 6 days/week for 12 weeks with no yoga training in the control group. RESULTS: The 12 weeks of yogic training showed an increase (P < 0.05) in forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), maximum ventilatory volume (MVV), and breath-holding time (BHT), with reduction (P < 0.05) in subcutaneous adipose tissue (body fat), systolic blood pressure (SBP), resting heart rate (RHR), and respiratory rate (RR) among the yoga group participants. On the other hand, the yoga group exhibited a higher (P < 0.05) level of FVC, FEV1, PEFR, MVV, and BHT and lower (P < 0.05) subcutaneous adipose tissue, SBP, diastolic blood pressure, and RR when compared to the control group after 12 weeks of study. CONCLUSIONS: Regular practice of yogic asana helps to lower subcutaneous adipose tissue and enhance the cardiopulmonary fitness of adolescent girls, which may reduce the expanses toward medication and increase the productivity.
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Compliance to hand hygiene and its associated factors among health care provider in general hospital in Addis Ababa, Ethiopia p. 32
Ziyad Ahmed Abdo, Meaza Gezu Shentema, Mulugeta Tamire Awono, Yohannes Lakew Tefera
INTRODUCTION: Globally, a significant proportion of healthcare providers and patients acquire nosocomial infections through contaminated hand. Failure to perform appropriate hand hygiene is considered to be the leading cause of healthcare-acquired infection worldwide. OBJECTIVES: To describe compliance to hand hygiene and its associated factors among healthcare provider in general hospital in Addis Ababa, Ethiopia. METHODOLOGY: An institutional based cross-sectional study was conducted among healthcare providers working in general hospitals in Addis Ababa. Multistage sampling system was used to select 708 participants. Data were collected using a self-administered structured questionnaire. Data were entered into Epi data version 3.1, and then exported to SPSS version 22 for data management and analysis. Multivariable logistic regression was performed to identify factors associated with healthcare providers hand hygiene practice. RESULTS: A total of 651 healthcare providers were participated in this study, with a response rate of 91.9%. The overall good hand hygiene practice of healthcare providers were 50.4%. Educational status: master and above holders (adjusted odds ratio [AOR] [95% of confidence interval (CI)]) = 0.46 (0.26, 0.84) and first-degree holders (AOR [95% of CI]) = 0.43 (0.23, 0.82), attitude (AOR [95% of CI] = 1.61 (1.09, 2.38), knowing functionality of infection prevention committee (AOR [95% CI]) = 1.57 (1.03, 2.38), functionality of hand washing sink (AOR [95% of CI]) = 2.26 (1.07, 4.79), availability of running water (AOR [95% of CI]) = 1.86 (1.011, 3.432), and availability of hand hygiene guide (AOR [95% of CI]) = 1.66 (1.13, 2.43) were significantly associated with hand hygiene practice. CONCLUSIONS: According to this study, good hand hygiene practice is low. This indicates that patients and healthcare providers are at high risk of acquiring nosocomial infection. Hence, government and management of the hospital must give emphasis on patient safety.
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Piecewise hazard model for under-five child mortality p. 40
Rakesh Kumar Saroj
OBJECTIVE: The application of piecewise hazard model in mortality data becomes more useful over classical survival methods. This method is used to find the number of location of cut points and estimate the hazard model. The piecewise hazard model is fitted on National family health survey (NFHS IV) from different variables like socio demographic, biological and proximate co-factors. The aim of the study to describe the piece-wise constant hazard model and find the important factors in under-five child mortality data. METHODS: For the research used the National Family Health Survey-IV data of Uttar Pradesh. The Cox regression analysis is used for finding the important of factors through preliminary analysis. After that, apply the piecewise constant hazard model in those important factors. RESULTS: The piecewise model shows that six month time interval is very crucial for children till completing the five year of the age. The important factors are women's age in years, total children ever born, present breastfeeding, smoking, size of child, delivery by caesarean section, ANC visits, and birth orders in the under-five child mortality. CONCLUSION: Piecewise hazard model is found very important for the under-five child mortality, through the various times cut point. The Piecewise hazard model can be useful for clinicians, researchers and public health experts. Time is very important factor for reducing the child mortality.
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Influence of phytomelatonin on immune cell function in male golden hamsters p. 46
Dipanshu Kumar Vishwas
BACKGROUND: An assortment of plant animal groups incorporates phytomelatonin, shows the similar pattern as in animals recommending its capacity can be closely resemble animals as in plants. AIMS AND OBJECTIVES: An in vivo research work needed to explore the impact of dietary phytomelatonin, i.e., the cabbage and carrot, on immune cell functions in a male rodent golden hamster (Mesocricetus auratus). MATERIALS AND METHODS: In this study, we examined the general immune response (spleen weight, total leukocyte count, and % lymphocyte), delayed type hypersensitivity (DTH) response, the blastogenic response of peripheral blood mononuclear cell (PBMC), splenocytes, and bone marrow mononuclear cell proliferation in terms of granulocyte macrophage colony forming unit (GM CFU) count, as an indicator of bone marrow macrophages. RESULTS: An increased circulatory melatonin level due to melatonin supplemented diet enhanced the total leukocyte count, % lymphocyte count, a proliferation of splenocytes, PBMCs, GM CFU count, % DTH response, and serum cytokine (interleukin 2 and interferon γ) production. CONCLUSION: A correlation study recommended that incited serum melatonin is emphatically corresponded with the improvement of the safe status of hamsters. In this way, our information infers that dietary melatonin may impact resistance on account of its high selectivity and sensitivity. Thus, it could be suggested that the dietary phytomelatonin might be one of the strong restorative procedures to enhance the immune responses for better well being of a person at its any age of life.
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A cross-sectional study of students' perception of educational environment and its determinants using the Dundee Ready Education Environment Measure scale p. 53
Yugantara Ramesh Kadam, Sanjay Raguel Quraishi, Vivek Baliram Waghachavare, Randhir Vishnupant Dhobale, Anupriya Suresh Mane, Alka Dilip Gore
INTRODUCTION: Educational environment is important for students' learning. Continuous quality improvement and innovation are very essential in a medical college. The Dundee Ready Education Environment Measure (DREEM) is a reliable and validated instrument that identifies specific problem areas within an institution for different components of the same student body. Problems can be taken care of, if we identify them. OBJECTIVES: The objectives of this study were as follows: (1) to assess perceptions of the educational environment of students and (2) to identify gender-, age-, and semester-wise differences in the perceptions. MATERIALS AND METHODS: Study design: Institution-based cross-sectional study. Study place: Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli. Study duration: 6 months. Study subjects: Medical students of all semesters. Exclusion criteria: attendance < 60% and not willing to participate. Study Tool: DREEM Scale. Sample size: All students. STATISTICAL ANALYSIS: Mean score, Standard Deviation (SD), and Z-test. RESULTS: There were total 440 students (203 boys and 237 girls) of total four semesters. Age ranged from 17 years to 28 years (mean 20.34 ± SD 1.59). Majority of the students were from the fourth semester (147). The mean DREEM score was 118.13 ± SD 21.43, which indicates that educational environment is “more positive than negative.” A significant association was found between students' academic self-perceptions (SASP) and students' perception of atmosphere (SPA) score and semester. CONCLUSION: Students' perception of overall educational environment was as of more positive. Subscale scores and item analysis show the areas of weaknesses such as authoritarian teachers and teachers get angry in class which needs improvement. The global score was independent of age, sex, and semester. The score of SASP and SPA was significantly high in second-semester students.
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Selenium as a therapeutic adjuvant for isoniazid/rifampicin-induced hepatotoxicity p. 60
Elias Adikwu, Ebinyo Clemente Nelson, Peter Fiyebo
BACKGROUND: Isoniazid-rifampicin (INH-RIF) is used for the treatment of tuberculosis, but its hepatotoxicity is a serious health predicament. Selenium (Se) is a trace element with potential to safeguard cells from damage. AIM AND OBJECTIVE: This study assessed the potential of Se to prevent INH/RIF-induced hepatotoxicity in albino rats. MATERIALS AND METHODS: Forty-five adult male albino rats were randomly assigned to four groups. Group 1A (Placebo control) and Group 1B (Solvent control) were orally treated with normal saline (0.2mL) and corn oil (0.2mL) daily for 21 days, respectively. Group 2 (2A–2C) was orally treated with Se (0.1, 0.2, and 0.4 mg/kg) daily for 21 days. Group 3 was orally treated with INH-RIF (50/100 mg/kg) daily for 21 days. Group 4 (4A–4C) was orally pretreated with Se (0.1, 0.2, and 0.4 mg/kg) before oral treatment with INH-RIF (50/100 mg/kg) daily for 21 days, respectively. After treatment, the rats were weighed and anesthetized. Blood samples were collected and analyzed for serum liver function markers. Liver samples were weighed and analyzed for histology and biochemical indices. RESULTS: INH-RIF caused significant (P < 0.001) decreases in body weight, superoxide dismutase, glutathione, catalase, and glutathione peroxidase levels with significant (P < 0.001) increases in liver weight, malondialdehyde, alkaline phosphatase, aminotransferases, lactate dehydrogenase, gamma-glutamyl transferase, total bilirubin, and conjugated bilirubin levels, when compared to control. INH-RIF caused liver ischemic necrosis and vascular congestion. Hepatotoxicity induced by INH-RIF was abrogated in a dose-dependent fashion by pretreatment with Se 0.1 mg/kg (P < 0.05), 0.2 mg/kg (P < 0.01), and 0.4 mg/kg (P < 0.001) when compared to INH-RIF. CONCLUSION: Se may serve as an adjuvant treatment for hepatotoxicity caused by INH-RIF.
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Menstrual marks: An evaluative study to assess knowledge and practices among urban and rural adolescent young females of Kanpur, India p. 68
Rohan Sachdev, Kriti Garg, Garima Singh
CONTEXT: Menstruation is a unique phenomenon for females. The beginning of menstruation is one of the most significant processes occurring among young females during the adolescent age. AIMS: To assess and compare the real knowledge and practice regarding menstrual marks among adolescent urban and rural young females about menstruation. SETTINGS AND DESIGN: Urban and rural adolescent school young females were selected as participants. SUBJECTS AND METHODS: A school-based, cross-sectional questionnaire study was conducted from June to July 2019 among the adolescent school-going young females of Kanpur who were selected from two urban and five rural schools. All young females aged between 9 and 17 years who have attained menarche were selected and the sample size came out to be 530. STATISTICAL ANALYSIS USED: Collected data were analyzed using IBM SPSS Statistics-version 21. Descriptive statistics included the calculation of percentages. Categorical data were compared using the Chi-square test. All values were considered statistically significant for a value of P < 0.05. RESULTS: 51.8% of rural young females participated in the study. Young females aged 12–14 years were the main participants, and 67.2% of rural and 80.3% of urban young females were aware of menstruation before menarche. Both group young females knew sanitary napkins which were statically significant (P < 0.001). Urban young females were found to be more aware of the menstruation cycle. CONCLUSIONS: Hygienic exercise and knowledge during menstruation were disappointing in the rural area. Rural young females should be more educated about the traditional beliefs and misconceptions regarding menstruation.
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Anxiolytic activity of Berberis aristata root extract in mice p. 73
Divya Goel
BACKGROUND: Anxiety is a common emotional response in humans and it is one of most common psychiatric illnesses. Interest in herbal drugs is growing nowadays for the optimum treatment of anxiety. The aim of the present study was to explore the anxiolytic effect of berberine chloride (BER). MATERIALS AND METHODS: Elevated plus maze model was used to know its anxiolytic effect and possible mechanism on acute administration in mice. Six groups of mice with six in each group were used. Group I served as control group; Group II received diazepam (0.5 mg/kg); and Groups III, IV, and V received BER in doses of 2.5, 5, and 10 mg/kg, respectively. Group VI received BER 5 mg/kg after flumazenil 5 mg/kg. RESULTS: As compared to control, berberine chloride solution at all three doses 2.5 mg/kg (P < 0.01), 5 mg/kg (P < 0.01), and 10 mg/kg (P < 0.01) increased the total entries into open arms entries as well as total time spent in open arms. CONCLUSION: Anxiolytics effect of berberine is comparable to diazepam, likely to be mediated by gamma-aminobutyric acid A – Cl channel complex as effects of berberine were blocked by prior administration of flumazenil. Further studies are needed to identify the phytoconstituents of the berberine which mediated the observed anxiolytic effects.
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Oral and perioral manifestations in Down's syndrome patients p. 77
SR Ashwinirani, Girish Suragimath
INTRODUCTION: Down syndrome (DS) is also known as trisomy 21, is a genetic disorder caused by defect in chromosome 21. It is the most commonly diagnosed congenital malformation/mental retardation syndrome. DS individuals have greater risk of many systemic conditions like epilepsy, diabetes, leukemia, hypothyroidism and upper respiratory tract infections. Advances in medical field have increased the mean survival rate of these individuals. The dentist should able to diagnose the oral manifestations in DS patients and improve the quality of life of these individuals. AIMS AND OBJECTIVES: The present study was designed to assess the oral and perioral features of DS patients and to compare age and gender wise distribution of these findings. MATERIALS AND METHODS: Total of 100 DS patients were included in the study from special school in western part of Maharashtra. The clinical examination was carried out to record perioral, intraoral hard and soft tissue features in a predesigned proforma. The frequency and percentage distribution of these features were compared between the gender and age groups. RESULTS: Out of 100 DS patients majority were males (63%). Fissured tongue was the most common (73%) intraoral feature present. Constricted palate was present in 59% of cases, Angles class III malocclusion was the most common occlusion abnormality present in these patients. CONCLUSION: Majority of patients affected with DS were males and fissured tongue was the most common soft tissue feature present in these individuals.
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Balanced scorecard for teaching faculty members working in a medical college p. 83
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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A case of arrhythmogenic right ventricular dysplasia/cardiomyopathy with pneumothorax and degloving injury of the right upper limb p. 85
Varun Suresh
Arrhythmogenic right ventricular dysplasia / cardiomyopathy (ARVD / C) is a rare genetic cardiomyopathy characterized by fibro-fatty replacement primarily of the right ventricular myocytes,and can present as any of 'concealed' disease, 'overt arrhythmia' followed by sudden cardiac death, isolated right heart failure or biventricular failure: mimicking dilated cardiomyopathy. We present the successful management of a 65 year old male patient with ARVD/C presenting to us with trauma and Cardiogenic shock for limb saving emergency surgery.
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Wilkie's syndrome - An unusual presentation in an elderly female p. 88
Lakshmi Venkata Simhachalam Kutikuppala, MV Sathvika, T Uma Maheswara Rao, Hemanth Kumar Chowdary
Wilkie's syndrome, also called as superior mesenteric artery syndrome (SMAS), is an extremely uncommon condition, which is evident in only 0.1%–0.3% of the population. This is a case of a 55-year-old female who presented to our hospital complaining of abdominal discomfort for 20 days, vomiting of two episodes per day for 20 days, constipation for 20 days, decreased appetite for 20 days, and significant weight loss. After further examination and investigations, it was diagnosed as SMAS and managed surgically through duodeno-jejunostomy followed by duodeno-jejunal and jejuno-jejunal anastomosis. She was later followed through conservative management and discharged from the hospital in a stable condition.
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Critical comment on “An exploratory study to assess the prevalence and risk factors of malnutrition among under-five children residing in selected rural areas of district Sirmaur, Himachal Pradesh” p. 91
Radha Saini
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Rare case of nephrocalcinosis in an adult female p. 93
Reddy Ravikanth, Pooja Majumdar
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Tribute to a doyen of physiology in South Asia: Prof. Arif Siddiqui, editorial adviser (medical education), BLDE University Journal of Health Sciences p. 95
Pallavi Kanthe, Lata Mullur, Sumangala M Patil, Kusal K Das
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