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   Table of Contents - Current issue
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July-December 2020
Volume 5 | Issue 2
Page Nos. 97-240

Online since Friday, December 18, 2020

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MEDICAL EDUCATION TEACHING NOTE  

“PhysioLego:” Learning concepts, building, and applying physiology knowledge Highly accessed article p. 97
Hwee-Ming Cheng, See-Ziau Hoe
DOI:10.4103/bjhs.bjhs_9_20  
When we talk about conceptual learning, we also think about certain principles in physiology that recur in various organ systems in the body. These global underlying themes are like the Lego building blocks when we look at the mechanics of physiological processes. One main?” PhysioLego” concept of building brick is the relationship between membrane selective permeability and effective osmotic pressure. This is expressed in laboratory class demonstration by saying that the tonicity of a solution is dependent on not just the osmotic concentration but also importantly on the membrane penetrability of the solute in solution. The “PhysioLego” osmotic bricks and its construction to build an integrated understanding of physiology and pathophysiology will be described in this article.
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REVIEW ARTICLES Top

The International Yoga Day, political discourse, and soft power game in India Highly accessed article p. 102
Janmejaya Samal
DOI:10.4103/bjhs.bjhs_15_20  
The International Day of Yoga is being celebrated every year on 21st June since 2015, throughout the globe. The United Nations (UN) General Assembly on December 11, 2014, declared that 21st June would be celebrated as the International Day of Yoga or World Yoga Day following lobbying by the Prime Minister of India, Mr Narendra Modi. One hundred and seventy countries around the globe supported the resolution which even did not require vote. Mr Narendra Modi, in his address to the UN in September 2014, stated that it is not about the exercises rather the way of discovering oneself. Furthermore, he stated that it is the longest day of the Northern Hemisphere and has special significance in many parts of the world. It is the day of summer solstice. It is now being celebrated beyond religion, region, and culture, however, it has been politicized since its first day of observation. It is neither an innocent event nor dissociated from politics and soft power game in India. Despite all these, many believe that it would live up to its lofty ideals and that these become its eternal legacy.
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Evidence that does not lie - Implementation of raped victims and treatment algorithm within the oral surgery department: From ashes to truth p. 106
Shubha Ranjan Dutta, Purnima Singh, Deepak Passi, Jwala Nepal, Kusal Kumar Das
DOI:10.4103/bjhs.bjhs_28_20  
Odontologists play a primary duty in the identification of individuals or missing persons in a scenario of a mass disaster, violent crime, child abuse, and elder abuse. When it comes to the identification of the victim or the suspect, their dental traits could turn out to a compelling proof and can help in slimming down the result of the investigating welfare work. Typically, it becomes necessary to use some least known and fewer widespread techniques in identification procedure such as lip prints, rugae patterns, and willing odontometrics can provide relatively valid conclusions referring to a person's identification. This review elucidates the importance of cheiloscopy, palatoscopy, and canine odontometry in a person's identification in relation to sex prediction and discrimination. This review article provides the newest information about the recent major advances and discoveries related to the classical and modern developed methods of dental identification that would enhance the knowledge and awareness among the professionals examining the youth victims of sex trafficking in urban and rural communities or identification of the rape or sexual abuse victims and the convicts, particularly in the Indian subcontinent when the rate of raped or sexually abused victims has risen. Various search engines such as Medline, PubMed, PsycINFO, EMBASE, and Web of Science were explored for scientific articles (original clinical research findings, case reports, and review articles) in the present subject area. A manual search strategy was adopted to obtain relevant literature on human trafficking, sexual violence, dental identification, and forensic odontology. There were no fixed inclusion and exclusion criteria before and after the literature search. Thus, the articles and items reviewed in this article were picked based on their relevance to the present topic, and an attempt was made to understand the application of various available methods of dental identification all over the world and its applicability to the forensic odontologists in the Indian subcontinent. The dental professionals who operate on the potential victims of human trafficking in secondary care units usually lack data and confidence. Coaching is required significantly for the dental employees who are involved in the identification of the victims and answering their demands, along with creating safe referrals.
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ORIGINAL ARTICLES Top

A systematic review on the effect of high.intensity training on heart rate variability in sports professionals and healthy young adults p. 114
Shweta Shenoy, Prachi Khandekar
DOI:10.4103/bjhs.bjhs_6_20  
BACKGROUND: Exercise plays an essential role in managing cardiovascular disorders, and high-intensity training (HIT) exercise is a potential, time-effective alternative to traditional aerobic exercise. OBJECTIVES: The objective of this study was to evaluate the effect of HIT program on the time and frequency domains of heart rate variability (HRV) in sports professionals and healthy young adults (18–30 years of age) through a systematic review. METHODS: Physiotherapy Evidence Database (PEDro), PubMed, ScienceDirect, Taylor and Francis Online, and Google Scholar were searched for relevant studies. PEDro scale was used to assess internal validity, exclude risk bias, and assess the methodological quality of studies. RESULTS: A total of 4430 search results were obtained by searching for specific keywords, out of which, only 7 studies met the inclusion criteria after removing all the duplicate articles. Our results showed that HIT programs have significant effect on HRV (root mean square of successive difference [RMSSD], mean difference [MD] =13.35, 95% confidence interval [CI] =1.73, 24.97), high-frequency (HF, MD = 381.7, 95% CI = 321.54, 441.86) power, and low- to high-frequency power (MD = -0.10, CI = -0.73, 0.53) ratio in young adult athletes and healthy young adults. No significant difference was found in other HRV variables. CONCLUSION: HIT is an effective exercise program that can cause improvement in parasympathetic and sympathetic cardiac modulation depending on the duration of the HIT program. HIT program can be given for 2–4 weeks to improve HRV in young adults.
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Concept of cumulative dose in Ayurveda with special reference to metallic Bhasma p. 127
Pravin Jawanjal, Bishwajyoti Patgiri, SS Savrikar
DOI:10.4103/bjhs.bjhs_20_20  
BACKGROUND: Metals and minerals are an integral part of Ayurvedic therapeutics. Many cases of metal toxicity caused by the administration of Ayurvedic drugs are being reported every now and then. It has been observed that in most of these reported cases, the Ayurvedic drugs were used in inappropriate dose and duration. In view of this observation, an attempt has been made in this article to bring forth the appropriate therapeutic and cumulative dose of metallic Bhasmas as described by Ayurvedic classics. The concept of the cumulative dose appears to be the most ignored part by Ayurvedic practitioners. AIMS AND OBJECTIVES: To search and find out the references of cumulative dose with special reference to metallic Bhasma and to explore the concept of cumulative dose in Ayurveda. METHODS: Ancient Ayurvedic classics and other available translations in various languages, published books, and other topic-related material available online were viewed and compiled references to elaborate on the concept of cumulative dose with special reference to metallic Bhasma. STATISTICAL ANALYSIS: The cumulative frequency method is used to determine the cumulative dose. RESULTS: Total 2 references found out of the one reference in Ayurved Prakasha and one in Sharangadhara Samhita with the commentary of adhamallas dipika. DISCUSSION: According to Sharangadhara Samhita, with the commentary of Adhamallas Dipika therapeutics dose of metallic Bhasma for Swarna 2 Yava (62.5 mg), whereas 1 Yava according to Ayurveda prakasha but the cumulative dose is same. CONCLUSION: As per Sharangadhara Samhita, with the commentary of Adhamallas metallic Bhasma can be used for 16 days and as per Ayurveda Prakasha 32 days. It needs to be determined in accordance with the status of Agni, Dosha, Desha, Kaala, Prakruti, and other factors.
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Shelf-life evalution of Agastyharitaki Avaleha and its granule: A preliminary study p. 132
Vasundhara Jaluthriya, Pravin Jawanjal, Prem Kumar Goud, BJ Patgiri, P Bedarkar
DOI:10.4103/bjhs.bjhs_56_19  
BACKGROUND: Shelf life is the indication of best before use duration, the importance of quality of package and storage condition is also emphasized in classics. Nowadays, due to the development and adaptation of packaging and storage technology by Ayurvedic industries, a need arise to restudy and re-establish the newer ones criteria. AIM AND OBJECTIVES: The aim and objectives of the study were to evaluate the shelf life of Agastyaharitaki Avaleha (AHA) and its granule prepared with Khanda Sharkara through accelerated stability study. SUBJECTS AND METHODS: Physicochemical parameters were measured at 40°C ± 2°C temperature and 75% ± 5% relative humidity. The analysis was repeated at intervals of 1, 3, and 6 months, and average 10% degradation of both the test drug samples was calculated and extrapolated to find the shelf life. RESULTS: Agastyaharitaki granule (AHG) prepared with Khanda Sharkara showed more extractive values and sugar contents and found to have a longer shelf life (5.28 years) than AHA?(1.57 years). AHG is comparatively more stable than AHA.
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Impact of structured training of basic surgical skills in controlled environment for first.year postgraduate students of surgical specialties p. 140
K Tejaswini Vallabha, Girish K Kullolli, Vikram Sindgikar, Basavaraj S Narasanagi, Deepak Chavan, Hemant Kumar, Dayanand Biradar, Ramakant Baloorkar
DOI:10.4103/bjhs.bjhs_3_20  
BACKGROUND: Appropriate training and obtaining adequate competency in basic surgical skills is very essential for a fresh postgraduate in surgical specialties to deliver effectively various responsibilities. Due to absence of any methodology to assess these skills before entry into the surgical residency program, anxiety and low confidence regarding the skills, there is delay in allotting graded responsibilities by the faculty and seniors. Hence a short structured training program to address these skills was planned and implemented. MATERIALS AND METHODS: One hundred and forty two trainees underwent this course in last five years. The training included very basic surgical skills demonstrated and hands on training in controlled environment of clinical skills laboratory. Secondary outcome was assessed for available forty three trainees. RESULTS: The immediate feedback suggested that the training was necessary, very useful and perception wise the trainees felt their competencies improved significantly from 60 -80%. They also opined that these facilities should be allowed to use regularly and all of them opined that they wish to be assessed after three months to assess internalization of skills obtained. Retention test was conducted for 43 available postgraduates in the form of OSCE .Their scores revealed good improvement in the skills by 60-80% suggesting the utility of the training and improvement in the competencies. CONCLUSION: Training of various basic surgical skills in a controlled environment improves competencies of fresh postgraduates, improves their confidence and reduces time for allotting graded responsibilities
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Adherence to iron/folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka Sub City, Addis Ababa, Ethiopia p. 145
Birhanu Tadesse Urgessa, Ziyad Ahmed Abdo
DOI:10.4103/bjhs.bjhs_48_20  
CONTEXT: Iron-folic acid deficiency is the leading nutritional deficiency globally, affecting the lives of >2 billion people, accounting over 30% of the world's population. Provision of iron-folic acid supplement to all pregnant women, is among the very critical interventions to reduce the burden of anemia. Even though the service is free in Ethiopia, the prevalence of anemia is slowly increased in the country. AIM: The aim is to assess adherence to iron-folic acid supplementation and associated factors among pregnant women attending governmental health center in Yeka sub city, Addis Ababa, Ethiopia, from November 1 to 30, 2019. METHODOLOGY: An institutional-based quantitative cross-sectional study was used to conduct the study. Systematic sampling system was used to select 408 study populations. Data were collected through interview using structured questionnaire. Bivariate and multivariable logistic regressions were employed to identify the predictor variables. Statistical significance was considered at P < 0.05 with adjusted odds ratio (AOR) calculated at 95% confidence interval (CI). RESULTS: A total of 408 pregnant women attending anti-natal care (ANC) were participated in this study, with response rate of 100%. The overall adherence rate was found to be 71.3%. Women whose family income >1500 Ethiopian Birr (ETB) (AOR [95% of CI]) = 3.77 (0.58–24.38)], having secondary or higher educational level (AOR [95% of CI]) = 1.48 (0.90–2.43), having history abortion (AOR [95% of CI] = 6.99 (1.11–44.19), starting ANC visit in first trimester (AOR [95% of CI] = 3.0 (0.24–37.18) were significantly associated with iron-folic acid supplementation. CONCLUSION: According to this study, adherence to iron-folic acid supplementation was relatively high. Empowering women in economy and education are very important. Proper counseling and health promotion about iron-folic acid supplementation, promoting the benefits of early and frequent ANC visit are very important to increase adhere to iron-folic acid supplementation.
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Truncal growth pattern of Yogasana-practising children and adolescents p. 154
Debjani Mandal, Uday Sankar Ray, Pratiti Ghosh
DOI:10.4103/bjhs.bjhs_13_20  
BACKGROUND: Truncal growth forms a robust skeletal frame which determines athletic execution. At present, yogasana practice is in high demand. AIM: Thus, the evaluation of effect of yogasana on growth pattern during childhood and adolescence (aged 4–15 years) is required. MATERIALS AND METHODS: A cross-sectional study was conducted on Bengalee children of similar socioeconomic status. Anthropometric measurements, namely height (stature), biacromial breadth, and bicristal breadth were analyzed from 864 yogasana-practitioners (YPs) and 738 untrained control participants (CPs), subgrouped into yogasana-practising boys (YBs), yogasana-practising girls (YGs), control boys (CBs), and control girls (CGs). Unpaired t-test was performed to assess the level of significance between the anthropometric parameters of different groups. Correlation of breadth ratio and stature with biacromial and bicristal breadth was determined by Pearson's correlation coefficient. RESULTS: YP had significantly greater biacromial breadth (P < 0.05) and bicristal breadth (P < 0.05) than CP. The mean biacromial breadth decreased, especially in YG. The shoulder and pelvis size were significantly different between YB and CB but not so among females. Growth in breadth ratio was also strongly correlated with bicristal breadth growth. CONCLUSION: Medium-sized shoulder and pelvis in YB and medium-sized shoulder relative to narrow-sized pelvis in YG nullifies the effect of yogasana training on specific bodily growth of YP. Hence, in contrast with high-demand sports, yogasana practice is not reflected on truncal growth.
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Chemical cautery versus anterior inferior turbinectomy: Which is the better modality of treatment in nasal allergy? p. 160
KS Gangadhara Somayaji, Tom Koshy Jones, S Saimanohar
DOI:10.4103/bjhs.bjhs_49_20  
INTRODUCTION: Nasal allergy is one of the most common forms of allergy seen in practice. Although medical treatment is the most commonly accepted modality of treatment, surgery also has a role. This study was aimed at the assessment of nasal symptoms and mucociliary clearance in patients with nasal allergy, before and following chemical cautery with trichloroacetic acid (TCA) in one group and anterior–inferior turbinectomy in another group and to study advantages and disadvantages of each procedure. MATERIALS AND METHODS: This was a prospective, randomized, single-blind, controlled clinical trial conducted at a tertiary care hospital on a sample of fifty patients with a history of allergic rhinitis without a satisfactory response to medical line of treatment. Preoperative nasal airflow was assessed both subjectively and objectively using the nasal symptom score and the mucociliary clearance, respectively. One group was subjected to undergo anterior–inferior turbinectomy and the other group chemical cautery with 50% TCA. Postoperative nasal airflow was also assessed by similar methods after a duration of 1 month. RESULTS: All the patients had significant relief from their symptoms at the end of 1 month postprocedure, irrespective of the procedure done. However, patients who underwent anterior–inferior turbinectomy had more symptomatic relief compared to the other group. DISCUSSION: Debulking the inferior turbinate either with surgery or with cautery relives the nasal obstruction in patients with allergic rhinitis. The other symptoms of nasal allergy are also found to be less severe in these cases. CONCLUSION: Surgical line of treatment can be used as an effective intervention to satisfactorily alleviate patient's allergic symptoms. Anterior–inferior turbinectomy is preferred for the longer symptom-free life of the patients.
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Assessment of the Nutritional Status of Female Adolescents across Rural and Urban Areas of Belagavi – A School-based Comparative Study p. 165
Mayuri Hiremath, Harpreet Kour, Mubashir Angolkar
DOI:10.4103/bjhs.bjhs_81_19  
BACKGROUND: The present-day adolescent females will constitute to be important pillars of India in the near future. Adolescence is a phase for a high requirement of macro and micronutrients. OBJECTIVE: The objective of the study was to assess and compare the nutritional status among the female adolescent population of the rural and urban areas of Belagavi. MATERIALS AND METHODS: A school-based comparative study was carried out at five rural and five urban schools of Belagavi. A total of 110 female adolescents of age 10–16 years were randomly enrolled for the study. The study was conducted from March 2018 to December 2018. Variables included were age, height, weight, body mass index, waist circumference, hip circumference, waist–hip ratio, and dietary intake patterns by a 24-h dietary recall method. Data were analyzed using SPSS version 20.0 statistical software. RESULTS: In the urban population, nearly half of the study population, i.e., 26 (47.27%) subjects, were underweight, whereas in the rural population, 39 (70.90%) were underweight. The mean energy intake was 2194.32 ± 140.79 Kcal and 1993.49 ± 146.14 Kcal in the urban and rural populations, respectively. CONCLUSION: Most of the female adolescents from the rural areas were underweight and had less calorie consumption as compared to their counterparts from urban areas.
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Comparison of gait biomechanics in patients with and without knee osteoarthritis during different phases of gait cycle p. 169
Amrinder Singh, Ravneet Kaur, Shweta Shenoy, Jaspal Singh Sandhu
DOI:10.4103/bjhs.bjhs_19_20  
OBJECTIVE: The aim of this study was to investigate the differences in temporal and spatial parameters in patients with and without knee osteoarthritis (OA) during different phases of gait cycle. MATERIALS AND METHODS: In this study, two groups were taken, OA group and healthy group. OA group consisted of 25 females suffering from knee OA (mean age 60.04 ± 5.74 years; mean height 150.44 ± 5.88 cm; mean weight 63.76 ± 7.28 kg), and healthy group consisted of 25 females (mean age 50.56 ± 7.03 years; mean height 155.16 ± 4.08 cm; mean weight 61.77 ± 12.03 kg). Both OA and healthy groups were assessed for temporal and spatial gait parameters by Zebris FDM Treadmill analysis system. RESULTS: Mann–Whitney U-test was used to compare the results of the study groups. Significant differences were found in the following variables – left stance phase (%), right stance phase (%), right load response (%), right mid stance (%), right preswing (%), left swing phase (%), right swing phase(%), double stance (%), right and left foot rotation (degrees), and cadence (steps/min). CONCLUSION: The spatial and temporal differences between patients with knee OA and healthy elderly females suggest that patients with knee OA adopt different strategies to reduce impact on knees. Gait dysfunction can be evaluated by assessing the various gait parameters, and treatment progression can be done in patients with knee OA. The assessment of gait by Zebris FDM Treadmill analysis system is a simple way which is done objectively.
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Comparative study of occurrence of recurrent aphthous stomatitis during exam stress and relaxed phase in dental college students of Krishna Institute of Medical Sciences p. 173
Mugdha Vijay Karambelkar, SR Ashwinirani, Abhijeet Sande, KA Kamala
DOI:10.4103/bjhs.bjhs_5_20  
INTRODUCTION: Recurrent aphthous stomatitis (RAS) is a common disease characterized by the development of painful recurring, solitary, or multiple ulcerations. RAS is classified according to different clinical variants as (1) minor (Miculiz's aphthae), (2) major (periadenitis mucosa necrotica), and (3) herpetiform ulcerations. AIM: The aim was to compare the occurrence of RAS during exam stress and relaxed phase in dental college students. METHODOLOGY: Selection criteria: (1) Inclusion criteria: All dental students who are willing to participate and exam-going students of year. (2) Exclusive criteria: Students who are not willing to participate in study during exam time. A total of 100 dental students were included in this study. History record and clinical examination was carried out in the Department of Oral Medicine and Radiology. The students were examined twice-during exam period (1 week prior to the exam) and in nonexam period. The data collection was done using a set of questionnaires. Statistical analysis was done using Microsoft Office Excel. RESULTS: In the present study, the occurrence of RAS was 50%. Majority of the students were in 20–21years age group. Out of fifty students, forty were females (80%) and ten (20%) were males. Stress was the most common factor which accounted for 68%. The most common site of occurrence was labial mucosa. In the present study, as students were under stress of exams once in 6 months, the appearance of RAS was found more (52%), followed by 3 months (38%) and very few students suffer once in a month (10%). In majority of students (82% of cases), RAS healed within a week. CONCLUSION: Based on the results of our study, the occurrence of RAS in dental college students was high 50%. On comparison of phases, the occurrence of RAS was high during exam period, which shows association with stress.
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Perceptions, Attitudes, and Barriers to scientific publications among medical college staff members – A cross-sectional study p. 178
Vijaya Shankargouda Dandannavar, Jyoti Nagamoti, Ashwini Narasannavar, Nirmala Anand
DOI:10.4103/bjhs.bjhs_14_20  
BACKGROUND: In the medical profession to improve health care, there is a need to conduct valid and reliable research work and that doctors, nurses, and other care workers play an important role in health care. Attitude and perceptions have a significant impact on staff performance, which, in turn, decides the performance of the organization. There is a need for the provision of the requirements of researches, which would bolster their enthusiasm and improve the attitude and research productivity AIM: The aim of this study is to find out the publishing practices, perceptions, attitudes, and barriers regarding scientific publications among pre and para clinical faculties. MATERIALS AND METHODS: Institutional Ethical committee (IEC) was obtained, and a prevalidated structure questionnaire which had four sections pertaining to sociodemographic status, perception, attitudes, and barriers was used to collect the required data from 57 faculty members, willing to participate in the study, and the questionnaire was administered after taking voluntary informed consent from them RESULTS: About 31.60% of participants manuscript were rejected, and among them, the reasons for rejections were no new knowledge, not of journal interest, similar studies were published earlier published, inappropriate title, study was simple and plain and such studies were not published, sample size inadequate, no correct reasons given by the reviewers, inappropriate methodology, not well scripted, not as per the scope of the journal, lots of pending articles, and inappropriate statistic's used. Fifty-six percent of the total faculty were primed about the Basics of the Research Methodology and that 53% of participant's felt that research Methodology and training for the research in the medical field will be useful and would improve the standard of research productivity. More than 50% of the study participants were of the opinion the Post graduates should learn more about and conduct research in a scientific way. Twenty-five percent of the study participants were of the opinion that getting involved in research will over burden them. Majority of the study participants felt that motivation to take up research by receiving timely incentives for publication's would persuade them to take up research. Thirty-six percent of the Participants felt that the reasons for the nonindulgence in research were personal and 21% were inclusive regarding the availability of resource's for conducting the research. CONCLUSION: Major barrier to publications was financial aspects and the unavailable resources though it was considered important for the promotions and future prospects. Majority of the medical faculty were of the opinion that Research methodology and training in the medical field will improve the standard of teaching. In order to increase the no of the faculty publications the barriers both at the individual and institutional levels can be overcome by giving suitable incentives to the faculty members and encourage them to publish by providing all the resources needed and free excess to the information as well.
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Prevalence of musculoskeletal disorders and eye strain among the radiologists in Belagavi p. 185
Anand Heggannavar, Ashwin Patil, Fleur Lewis, Charlene Luis, Radhika Malu
DOI:10.4103/bjhs.bjhs_16_20  
BACKGROUND: Radiologists face unique occupational health hazards among which musculoskeletal injuries, chronic eye strain, and others are yet to receive adequate attention. Mental strain due to demanding turnaround times and work pressures may lead to burnout. These combine to decrease overall work satisfaction and productivity. AIMS: The aim of this study was to determine the prevalence of musculoskeletal disorders (MSDs) and eye strain among the radiologists in Belagavi. SUBJECTS AND METHODS: This was an observational study where a self-administered questionnaire inclusive of the Nordic Musculoskeletal and Eye Strain Survey Questionnaire was provided to 47 radiologists. This questionnaire was given to most of the radiology centers in Belagavi specifically to radiographers who had at least more than 2 years of experience and daily work duration of more than 7 h. STATISTICAL ANALYSIS USED: The statistical analysis was carried out using Statistical Package of the Social Science s Version 20.0. RESULTS: The prevalence of neck pain among candidates was 74.4% followed upper back pain with rate of 65.9% and lower back pain with rate of 63.8%. The prevalence of shoulder pain was 57.4%. Wrist/hand pain was 55.3% while 29.7% complained of elbow pain. Twenty radiologists state that their symptoms have aggravated after introduction of picture archiving and communication system. CONCLUSIONS: There was a prevalence of MSDs and eye strain seen among radiologists.
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Electromyographic activity of vastus lateralis muscle of dominant thigh (right) in relation to performance levels during the leg/knee extension exercise performance with 30 repetition maximum load p. 194
Dhananjoy Shaw, Deepak Singh, Manvinder Kaur, Umesh Kr Ahlawat, Dinesh Bhatia
DOI:10.4103/bjhs.bjhs_22_20  
CONTEXT: Leg/knee exercise has been extensively used to study the electromyographic (EMG) activity of the quadriceps muscle group. However, conducted studies have several limitations related to methodology. AIMS: To assess the effect of performance level on the EMG activity of the vastus lateralis (VL) muscle of the dominant thigh (right) during the performance of leg/knee extension exercise with 30 repetition maximum load. Thigh dominance was based on the result of leg dynamometer. SETTING AND DESIGN: The study was a cross-sectional study, and data collection was conducted in Indira Gandhi Institute of Physical Education and Sports Sciences, University of Delhi, India. MATERIALS AND METHODS: Healthy intercollegiate-level male sportspersons (n = 19, age = 19.84 ± 2.1 years, height = 171.38 ± 8.48 cm, and weight = 70.42 ± 13.8 kg) were randomly selected as the subjects. Leg extension exercise was performed on Cybex VR1 leg curl exercise device and EMG data were acquired using a 4-Channel Wireless EMG BIOPAC Inc. MP150 system. A criterion called relative impulse (RI) was developed. Based on the magnitude of RI of the subject, nine subjects were enlisted and were equally divided into high-performance (HP), mid-performance (MP), and low-performance (LP) groups. The raw EMG signals were quantified, and time-domain (root mean square [RMS] and integrated EMG [IEMG]) and frequency-domain variables (Median Frequency [MDF] and Mean Frequency [MNF]) were derived with the help of? MATLAB. STATISTICAL ANALYSIS USED: One-way analysis of variance and least significant differences (at P < 0.05) for post hoc analysis were used to determine the significant influence of performance level. RESULTS: All three groups (HP, MP, and LP) displayed a declining pattern in the EMG activity of the VL in the selected variables, except MP group in the MDF, MNF, and RMS. Significant effect of performance level was observed between LP and HP groups and between MP and HP groups in MDF and MNF (P < 0.05). CONCLUSION: The findings are useful for understanding muscular fatigue as they focus on its electrophysiological aspect.
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A detailed study on morphological profile, hand grip strength, flexibility, and working postures in housemaids of Kolkata p. 200
Piyali Mukherjee, Anindita Singha Roy, Amit Bandyopadhyay, Somnath Gangopadhyay
DOI:10.4103/bjhs.bjhs_51_20  
BACKGROUND: House maids belonging to the unorganised sector jobs in the developing countries suffer from serious health consequences due to their awkward working posture. AIMS AND OBJECTIVES: The study was aimed to evaluate the morphological profile, hand grip strength, flexibility and working posture in housemaids of Kolkata. MATERIALS AND METHODS: 94 female house maids of Kolkata were recruited in the study and standard procedures were adopted to evaluate the parameters. RESULTS: Morphological and cardiovascular parameters were within the normal range but hand grip strength was lower than normal reference range. Significant differences in physical parameters, conicity index (CI), waist and hip circumferences, lean body mass (LBM), hand grip strength (HGS) was found in different age groups of house maids. Depending on significant correlation (r=0.89, P<0.001) between percentage of fat and BMI, a linear regression equation has been computed. CI score depicted the tendency of developing central obesity from 30 years onwards while it was evident in 51–60 years' age–group. These indicated their proneness to cardiovascular diseases. Evaluation of centre of gravity (COG) and assessment of working posture depicted erroneous working posture during utensils cleaning, sweeping and mopping. Such changes in COG during different activities revealed unstable and awkward working postures which require immediate attention and correction among the house maids. CONCLUSION: It is concluded that although the morphological parameters were within the normal range in housemaids of Kolkata but their working postures were erroneous and awkward with poor HGS and they are prone to develop cardiovascular diseases.
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Social perception and practices of households regarding mask use in public places during COVID-19 postquarantine period p. 209
Abhishek Singh, Ram Kumar Panika, Vikas Gupta, Pawan Kumar Goel, Rakesh Kumar Mahore, Mansi Singal
DOI:10.4103/bjhs.bjhs_70_20  
INTRODUCTION: Cases have been reported of people affected with COVID-19, facing discrimination on account of heightened fear and misinformation about infection. Hence, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of perceptions and practices ??regarding the use of mask in public places among ?households of quarantined individuals following COVID-19 postquarantine period. MATERIALS AND METHODS: The study included household members of COVID-19-affected patients following postquarantine period during the 1st week of July 2020. After obtaining informed consent from 123 participants, a structured questionnaire was used to collect the data. All the tests were performed at a significance level of 5%. RESULTS: More than one-third of the participants (34.1%) were not using mask/personal protective equipment (PPE) at all in public places. Around two-third of the participants were willing to wear mask/PPE in public places such as local markets/street (64.2%), bus/train/flight (73.2%), neighborhood/institution (60.2%), and malls/shopping complex (72.4%). Only half of the study participants (50.4%) had an overall good perception score for wearing mask/PPE. CONCLUSIONS: The present study made an attempt to find the perceptions and practices of household personnel of quarantined individuals during postquarantine period regarding mask/PPE use while they are in public place, and it was observed that perception and practices were not satisfactory in this regard. The major cause might be increased stigma and violence, which might have created hesitation among them for using mask in public places. The study findings might help local administration to enhance psychological and social support.
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CASE REPORTS Top

A rare case of calvarial tuberculosis p. 216
Binoy Damodar Thavara, Bijukrishnan Rajagopalawarrier
DOI:10.4103/bjhs.bjhs_61_19  
Calvarial tuberculosis (TB) is a rare entity forming 0.2%–1.3% of skeletal TB. The authors report a case of 45-year-old male presented with a history of fall under the influence of alcohol. Two cut lacerated wounds were noted in the right frontotemporal region. Computed tomography (CT) showed right frontal hematoma with brain edema. The patient underwent right frontal craniotomy and evacuation of the hematoma. Scalp wounds were healed. After 3 months, the patient presented with a pus discharging sinus from one of the previous cut lacerated wound. No growth was found in the pus culture. It was treated with dressing and antibiotics. Due to the persistence of the pus, CT scan was taken after 7 months, which showed osteomyelitis of right frontal bone. Right frontal osteomyelitic bone, along with overlying subgaleal tissue, was excised. Histopathological examination of the bone showed focal inflammatory cell infiltration. Overlying tissue on hematoxylin and eosin stain showed caseating epithelioid cell granuloma surrounded by lymphocytes and Langhans multinucleate giant cell suggestive of TB. The patient recovered after 1 year of treatment with antitubercular treatment. In country like India, TB can present in any atypical locations. Persistent pus discharge from the scalp following surgery or trauma should raise the suspicion of TB. Persistent pus discharge not responding to conventional therapy should be investigated for TB. All the excised osteomyelitic skull bone should be sent for histopathological examination.
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Laryngopharyngeal reflux in a school-going child with unusual clinical presentation p. 219
Santosh Kumar Swain, Ishwar Chandra Behera, Jatindra Nath Mohanty
DOI:10.4103/bjhs.bjhs_42_19  
Laryngopharyngeal reflux (LPR) refers to laryngopharyngeal manifestations of acid reflux from the gastroesophageal part. LPR is diagnosed by assessing the clinical symptoms, videolaryngoscopic assessment of the larynx, and double-probe monitoring of the pH. Hoarseness of voice is an important symptom for the diagnosis of LPR in children and frequently the only presenting symptom. Ambulatory 24-h double-probe (esophageal and pharyngeal) pH monitoring is both specific and sensitive for the diagnosis of LPR. Early diagnosis and treatment often results in the improvement of hoarseness and prevent complications. Endoscopic examination of the larynx and hypopharynx is an important step for patient selection as selected laryngeal findings are related with diagnosis, treatment, and outcome. Treatment options are medications and lifestyle modifications. Here, we present vocal process granuloma and unusual presentations of prolonged LPR in a 12-year-old boy.
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An odd cause of the lower limb restriction: Emphysematous pyelonephritis p. 222
Vigneshwar Adhithiya, Kulasekaran Nadhamuni, AM Anand, Mohamed Rafi Kathar Hussain
DOI:10.4103/bjhs.bjhs_61_20  
Lower limb restriction is usually due to any pathology affecting the joints or neurological causes. Emphysematous pyelonephritis is caused by gas-producing anaerobes and is one of the life-threatening diseases. It can extend into various fascial planes can be seen causing multiple ranges of symptoms. A 49-year-old male patient came with complaints of difficulty in extending the left lower limb for the past 1 month with associated left loin pain radiating to the left lower limb. Plain CT KUB shows features suggestive of bilateral emphysematous pyelonephritis with left retro-renal multi-loculated collection with extension of infection into anterior abdominal wall fascia and inferiorly into the left pelvic muscles and left thigh. Emphysematous pyelonephritis presenting as necrotizing fasciitis is a rare phenomenon. Patients with uncontrolled diabetes can clinically present with both these entities. Necrotizing fasciitis of the thigh leading to restriction of movement in the lower limb can sometimes be the cardinal clinical and odd presentation of emphysematous pyelonephritis.
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COMMENTARY Top

A data-driven approach to COVID-19: Resources, policies, and best practices p. 226
Meghana Aruru, Raanan Gurewitsch, Sarmistha Das, Pramit Ghosh, Bandana Sen, Indranil Mukhopadhyay, Saumyadipta Pyne
DOI:10.4103/bjhs.bjhs_37_20  
The grand scale of the COVID-19 pandemic has impacted all aspects of human life. It has revealed worldwide many systemic deficiencies in understanding, preparedness, and control of the disease. To improve the situation, a data-driven approach can guide the use of resources, aid policies, and benefit from the best practices of data acquisition, sharing, and dissemination. Public health decision-making and action depend critically on the timely availability of reliable data. In this study, we described the data types and principles that are useful for better understanding of the pandemic. We focused on public policies such as lockdown and social distancing. We observed a possible impact of change in mobility on different urban populations in the US. Finally, we discussed the potential of objective policies such as limited and local lockdown to balance the dual goals of preventing contagion while also maintaining economic stability with careful consideration for vulnerable populations.
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LETTERS TO EDITOR Top

Time to resort to innovative methods for the prevention and better control of diabetes p. 232
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/bjhs.bjhs_27_19  
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Costly nerve block needles for ultrasound.guided peripheral blocks! Is there a viable choice? p. 234
Varun Suresh
DOI:10.4103/bjhs.bjhs_17_20  
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Sociodemographic and clinical profile of children with autism spectrum disorders: An observational study from a tertiary care hospital p. 236
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/bjhs.bjhs_2_20  
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Beyond circular reasoning: Fishing the uncertainty behind shaken baby syndrome – Conceptual case report p. 237
M Shuriya Prabha
DOI:10.4103/bjhs.bjhs_78_19  
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Giant idiopathic right atrial aneurysm in an adult: Sonological appearance of a rare feature p. 239
Reddy Ravikanth, Pooja Majumdar
DOI:10.4103/bjhs.bjhs_42_20  
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