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   Table of Contents - Current issue
June 2021
Volume 10 | Issue 6
Page Nos. 2059-2432

Online since Friday, July 2, 2021

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Diagnostic tools for evaluating the effectiveness of COVID 19 vaccines: Challenges and solution Highly accessed article p. 2059
Dinesh Yadav
Evaluation of potential immunity due to SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) infection or vaccination is essential for health as well as social and economic recovery. Two vaccines (Covishield and Covaxin) produced in India have been authorized for emergency use in India. Which vaccine to prefer if the choices given to the recipients is a matter of general curiosity and public health interest. Different types of testing methodologies are being carried out in various laboratories around the world. There is no standardized measurement process and definitive set of values to know the protective immune response. A suitable antibody test which can be used as a tool to check whether the vaccine has triggered a sufficient immune response is required. The method needs to have the ability to measure the true quantity of antibody generated and it should be traceable to the international unit.
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Curriculum for Masters in General Practice – Bhutan p. 2061
Chhabi Lal Adhikari
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Is it time to consider shreds of epidemiological and environmental evidence associated with high transmission of COVID-19? p. 2120
Ravi Kant, Poonam Yadav, Surekha Kishore, Mukesh Bairwa, Mahendra Singh
Novel coronavirus named COVID-19 that emerged in late December from Wuhan affected almost the entire globe. Recent studies provided new insight into the high transmission of the disease. This review explores the current evidence of epidemiological and environmental factors associated with high transmission of COVID-19. Even transmission and symptoms found among cats, dogs, ferrets, and tiger suggested low species barrier of the virus. The airborne transmission was found even up to 4 m, and fecal transmission with virus particles and RNA in sewage and wastewater suggests rethinking containment strategies. However, temperature, humidity, and pollution were also associated with transmission and mortality trends of COVID-19. To better mitigate and contain the current pandemic, it is a need of hours to consider the recent shreds of evidence to prevent further spread and require detailed investigations of these evidences by extensive epidemiological and meteorological studies.
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Systematic review and meta-analysis of efficacy and safety of hydroxychloroquine and chloroquine in the treatment of COVID-19 p. 2126
Niti Mittal, Rakesh Mittal, MC Gupta, Jyoti Kaushal, Ankita Chugh, Daisy Khera, Surjit Singh
Repurposed drugs like hydroxycloroquine (HCQ) and chloroquine (CQ) are being tested for potential therapeutic role in COVID-19. We aimed to evaluate efficacy and safety of HCQ and CQ in COVID-19. Using PubMed, EMBASE, medRxiv, Google Scholar, clinicaltrials.gov, electronic search was carried out to identify relevant articles till June 2020 with re-evaluation in last week of November 2020. Observational and interventional clinical studies comparing efficacy of CQ or HCQ to standard management or other drug/s for SARS-CoV-2 infection patients were included. Cochrane review manager version 5.3 was used for synthesis of meta-analysis results. For randomized controlled trials, risk of bias was assessed using cochrane collaboration risk of bias assessment tool, version 2.0 (ROB-2). ROBINS-I was used for quality assessment of observational studies. Overall evidence quality generated by review was graded as per GRADE Recommendation. A total of 903 studies were screened. Nineteen studies were included in synthesis of meta-analysis with total of 4,693, 1,626, and 6,491 patients in HCQ/CQ, HCQ/CQ + AZ and control groups, respectively. HCQ/CQ treatment was associated with significantly increased rates of virological cure (OR = 2.08, 95%cI = 1.36–3.17; P = 0.0007) and radiological cure (OR = 3.89, 95%cI = 1.35 – 11.23; P = 0.01) compared to control. HCQ/CQ had no difference in unadjusted mortality rate (unadjusted OR = 0.98 95% cI = 0.70–1.37, P = 0.89, random effect model) and adjusted hazard ratio for mortality (adjusted HR = 1.05, 95%cI = 0.86--1.29; P = 0.64). However, a significant increase in odds of disease progression (OR = 1.77, 95%cI = 1.46–2.13; P < 0.00001) and QT prolongation (OR = 11.15, 95%cI = 3.95–31.44; P < 0.00001) was noted. The results with HCQ/CQ and azithromycin combination were similar to HCQ/CQ mono-therapy. In the light of contemporary evidence on effectiveness of HCQ/CQ, judicious and monitored use of HCQ/CQ for treatment of COVID-19 patients is recommended in low to middle income countries with emphasis on no mortality benefit. Registration number of Systematic review. Register in PROSPERO database: cRD42020187710
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Level of exercise and physical activity among pregnant women in Saudi Arabia: A systematic review p. 2140
Salwa A Almalki, Eman F Ibraheem, Turkiah Alotibi
The current study aimed to clarify the health benefits of physical activity on the mother and fetus in the Saudi women population. Besides, it is intended to provide recommendation based on the literature and results of studies from Saudi Arabia for exercise in pregnancy to improve the general health of women in Saudi Arabia. Prenatal physical exercise enhances physical and mental health of pregnant women. It can also reduce the risk of multiple pregnancy-related complications such as; lower back pain, fluid retention and risk of gestational diabetes. All these factors can affect fetal development and life later. Multiple studies showed that prenatal exercise could reduce the risk of fetal macrosomia with no effect on other perinatal or postnatal complications. The study followed the systematic literature review approach where it included multiple medical search Databases using PICOS eligibility criteria up to January 2019. The review was based on the following keywords: pregnancy, gestational, or prenatal) and (physical exercise, exercise, or physical activity. There are only two studies that dealt with physical exercises among Saudi women. The results indicated a relation between prenatal physical exercise on improving or decreasing risks on the mother and child during pregnancy.
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Role of immature platelet fraction (IPF) in sepsis patients: A systematic review p. 2148
Abubakar Tauseef, Maryam Zafar, Wafa Arshad, Joseph Thirumalareddy, Akshat Sood, Umar Farooque, Sunil Nair, Mohsin Mirza
Sepsis is extremely common amongst critically ill patients and requires early diagnosis. Hence, identifying a biomarker that could acknowledge sepsis at its prior stage is of vital significance. Immature platelets are a percentage of circulating platelets that contain RNA and is a newer parameter that is measured using automated hematology analyzers in diagnosing sepsis. This review article discusses 10 articles that reveal the role of immature platelet fraction in predicting the onset of sepsis and its relationship with mortality in sepsis. Literature search was done using PubMed, Scopus and Google Scholar and words like platelet indices and immature platelet fraction were typed in the search bar. The aim of this review article is to present a precise form of data that talk about immature platelet fraction (IPF) and its association with the severity and mortality of sepsis. Five out of 10 articles suggest that immature platelet fraction can predict the onset of sepsis and eight out of 10 articles suggest that increased IPF values are associated with high mortality.
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Impairment of olfactory and gustatory sensations in severe acute respiratory syndrome corona virus 2 (SARS-CoV-2 virus) disease p. 2153
Anurag Tiwari, Manisha B Patil, Jishnu Nath, Anuve H Phukan, Syed Aafaque, Sandeep Adika, C Meena Kumari, Sourya Kumar, Abhishek S Nayyar
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2 virus) disease had first appeared in December 2019 in Wuhan, China, and since then, it has emerged as a global threat to humanity. An early diagnosis and isolation are the most significant measures required to prevent its spread. Recent anecdotal evidence has suggested impairment of olfactory and gustatory sensations associated with corona virus disease (COVID-19). Angiotensin-converting enzyme-2 is an important aspect for the manifestations seen in this deadly viral disease. The associated olfactory and gustatory dysfunction can also lead to partial and/or complete loss of the ability to smell and taste in the early stages of disease onset. Evidence has also suggested that the presence of SARS-CoV-2 nucleic acid in human saliva makes it the carrier of the infectious viral disease and aids in its diagnosis. The present review focuses on the listed clinical manifestations in the form of olfactory and gustatory impairment in SARS-CoV-2 virus disease.
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Together let us confront it: An outbreak investigation of hepatitis B in Pathanamthitta district, Kerala p. 2159
Sangeetha Merrin Varghese, AL Sheeja, Abel K Samuel Johnson, Abey Sushan, CS Nandini, George M Chandy, PS Rakesh, Marina Rajan Joseph, Alice David, Geethu Mathew, Prince Alexander
Introduction: Hepatitis B is a potentially life-threatening liver infection caused by the Hepatitis B virus (HBV). The established routes of transmission are from mother to infant, sexual contact, and exposure to blood or body fluids. Though HBV is preventable by vaccine and robust infection control practices, outbreaks of HBV infection do occur in India. However, the state of Kerala with its health parameters, one among the best in the country, cannot afford to have continuing outbreaks. An unusual increase in the reported cases of Hepatitis B in a rural area of Pathanamthitta district of Kerala, called for an outbreak investigation. Aims: To describe the epidemiological features, to determine the risk factors associated with HBV transmission, and to suggest measures to prevent future transmission. Methods: A community-based case-control study (1:2) was undertaken. A total of 162 participants (54 cases and 108 age, gender, and neighborhood matched controls) took part in the study. Focus group discussions were conducted with subject experts to develop an interview schedule assessing 40 risk factors. It was further reviewed by the University of Sydney. Data was collected by trained Junior Health Inspectors and Junior Public Health Nurses of the Primary Health Centers. Data was analyzed using SPSS v. 20. Proportions were compared by Univariate analysis, sub-group analysis, and logistic regression. Population Attributable Risk (PAR) was also calculated. Results and Conclusion: More than 90% of the infections were IgM anti-HBc positive, suggesting a recent infection. Interventions during hospitalization [OR: 7.98 (95% CI – 2.17--29.4)], family history of Hepatitis B [OR. 4.14 (95%CI – 1.73--9.9)], and laboratory investigations [OR: 3.99 (1.72--9.31)] were found to be significant risk factors. PAR was highest for laboratory interventions (32%). Vaccinating household contacts and strict enforcement of infection control practices could substantially reduce the burden of this fatal disease.
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Total knee replacement at Southwestern Saudi Arabia: A single-center experience p. 2166
Mohammed Lafi Al-Otaibi
Background: Knee replacement enables the surgical management of end-stage knee joint osteoarthritis. In Saudi Arabia, there has been a recent increase in total joint replacement surgery. However, there is insufficient literature regarding patient outcomes in this region. Here, we assessed characteristics of patients who underwent total knee arthroplasty and their improvements on knee society score, timed up and go test, and 2-min. walk test. Methods: Patients who underwent primary total knee replacement at our tertiary care private hospital in Abha from January 2013 to January 2020 were included. The same orthopedic surgery performed primary cemented cruciate-substituting knee replacement. Knee function was evaluated using the knee society scoring system, timed up and go test, and 2-min. walk test. Results: Out of 420 patients, 350 were females (83.33%) and 70 males (16.67%). The mean age was 69.50 ± 7.48 years (range, 48–90). Most patients had osteoarthritis (84.5%), either degenerative or secondary because of trauma. Knee society functional and knee scores were poor preoperatively (mean, 38.21 ± 9.65; SD, 36.89 ± 8.23) but improved postoperatively (mean, 81.42 ± 12.74; SD, 85.49 ± 11.69; P < 0.001). The timed up and go test significantly changed from 28.51 ± 3.29 s to 18.18 ± 3.17 s (P < 0.001) and 2-min. walk test from 51.83 ± 6.48 m to 85.72 ± 8.92 m (P < 0.001). Conclusion: Despite knee replacement's late acceptance in Saudi Arabia, there have been increased cases in recent years and excellent improvements in knee function. The resulting knee society functional and knee scores, timed up and go tests, and 2-min. walk tests were better or similar to results seen by other researchers worldwide.
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Oral health status and treatment need in geriatric patients with different degrees of cognitive impairment and dementia: A cross-sectional study p. 2171
Santosh Kumar, Prakash C Jha, Bhupender S Negi, Nazia Haidry, Pranay Kulkarni, Saakshi Gulati, Jayalakshmi Muttu
Background: Health can be defined as more than an absence or lack of disease. It is generally related to personal, physical, social, along with spiritual wellness. However, the importance of good health is comparable with a progressive physical and cognitive limitations due to aging and hence, its clear definition is not possible. Hence, most of the important aims or goals in aging are unrelated to finding a cure but rather toward achieving an optimal function. Thus, a healthy aging process that encompasses physical, mental, psychological, and spiritual well-being is always much desired. Aim and Objectives: The aim and objective of this study is to assess the oral health status and degree of cognitive impairment along with dementia, if present. Materials and Methods: This is a prospective and cross-sectional analysis comprising of 300 study participants of which 150 are males while 150 are females. Cognitive ability is assessed using the Standardized Mini-Mental State Examination (SMMSE) scoring test. A score value lesser than or equal to 23 is considered as low, whereas a score of 24 and above represents normal cognitive abilities. Subjects with low score are selected for the study. Oral health status is assessed by examining a) total numbers of teeth present; b) presence or absence of denture use; and c) capacity for masticatory or chewing ability (recorded as yes or no). Demographic variables parameters include age, gender, and presence of smoking habit. Clinical parameters or variables are analyzed by employing the independent t-test and Chi-square test. Pearson's correlation analysis is used to test a correlation between impairment of cognitive capacity, oral health status, masticatory capability, and use of dentures, if present. Two-tailed t-test is used to derive a P value for significance. Results: The total numbers of teeth present are significantly correlated with a lower SMMSE score (R = + 0.56; P = 0.03) while a significant association is noted between ability for mastication and lower SMMSE score (P = 0.05). Conclusion: This study concluded that loss of cognition or dementia is closely related to a poor oral health status.
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Involvement of male spouse in care during pregnancy in rural areas of district Varanasi p. 2177
Reema Singh, Alok Kumar, Sangeeta Kansal
Background: Lack of male spouse involvement can affect the delays in the decision to take health care facilities, these are the main contributing factor for increasing maternal mortality and child death ratio. Men involvement in reproductive and sexual health including child health is important in reducing teenage pregnancy, maternal mortality, infant mortality, risky abortions, and total fertility rate. This study aimed to assess the awareness and practices of male spouse in maternal care services in rural areas. Methods: This is a community-based and cross-sectional study which was undertaken in randomly selected four villages of Kashi Vidyapeeth block, Varanasi. Total enumeration of women from the selected villages delivered within last 3 years was done and their husbands were interviewed by using a pre-designed, pretested interview schedule. Data on socioeconomic and demographic characteristics, awareness of various aspects and antenatal and postnatal care were collected and analyzed with SPSS 20 trial version. Results: Out of the total 130 interviewed male spouse (respondents), only 9.8% knows about minimum four antenatal visits. 26.9% were aware about the health related problems during pregnancy and only 7.7% were aware about the danger signs. Janani Suraksha Yojna was known to 11.5% only. 22.4% respondents accompanied their wife for antenatal registration and36.2% for T. T vaccination but 70.2% were present in the hospital during delivery. Logistic regression analysis shows that education of respondents is a key determinant of their involvement during pregnancy. Conclusions: This study identified overall low awareness of male spouse about antenatal visits and involvement during antenatal care. Therefore, there is a strong need to re-strategize the involvement of male spouse in reproductive health including antenatal period.
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Diagnostic accuracy of screening tools for chronic obstructive pulmonary disease in primary health care: Rapid evidence synthesis p. 2184
Jyoti Tyagi, Sandeep Moola, Soumyadeep Bhaumik
Background: Chronic obstructive pulmonary disease (COPD) contributed significantly to burden of diseases in India, with missed , incorrect, and delayed diagnosis in primary care. We conducted a rapid evidence synthesis, to summarize the evidence on accuracy of the screening tests for COPD in primary health care on request form State Health Resource Centre, Chhattisgarh. Methods: Considering the rapid nature of decision making, our approach was to first search for existing systematic reviews. We identified one existing systematic review on the topic with the search conducted until 2014. We updated the review by searching in two major databases screened, title/abstracts, and full texts of studies as per eligibility criteria and extracted relevant data. A narrative synthesis was conducted. Results: We retrieved 7,007 and included five new studies, to add to 10 studies of the existing systematic review. Overall, 13 studies assessed diagnostic accuracy of screening questionnaires [e.g., COPD Diagnostic Questionnaire (CDQ)], five assessed handheld flow meters (COPD6 and PICO-6), and four assessed the combination of both the tests. The CDQ questionnaire using a score threshold ≥16.5 or >17 demonstrated comparatively a higher sensitivity both in pooled result for ever-smokers [87.5% (95% CI 83.1--90.9%)] and among the adults >35 years [73.8--93% (95% CI 69--98%)] when compared to a different score threshold of CDQ and other questionnaires. Handheld flow meters reported a pooled high sensitivity of 79.9% (95% CI 74.2--84.7%) in ever-smokers and 87.9% in adults with age >35 years. Conclusions: The need for better diagnosis of COPD in primary healthcare can be addressed by using of COPD Diagnostic Questionnaire alone or in combination with hand-held flow meters. There is scope for more implementation research on the domain.
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Profile of donors and corneal tissue obtained through hospital cornea retrieval programme in a recently established eye bank of a tertiary care teaching hospital of eastern India p. 2195
Sony Sinha, Ranjeet K Sinha, Prateek Nishant
Context: There is a global need for quality eye banking practices and sensitization of primary care physicians toward corneal donation. Aims: To evaluate performance of a recently established eye bank (EB) and quality of corneas obtained, and identify areas of improvement during procurement and utilization of donor corneas. Settings and Design: This retrospective observational study is based on records of corneas collected through hospital cornea retrieval programme (HRCP) in the EB of a tertiary care institution during the first 2 years of its establishment. Methods and Material: Data on demographic characteristics of donors, death-preservation interval, specular microscopy parameters of corneas, indications for utilization, and reasons for non-utilization of corneas were collected. Statistical Analysis Used: Means, standard deviation, range, frequencies, and proportions were analyzed. Spearman's correlation coefficient and Kruskal–Wallis test were applied taking P < 0.05 as significant. Results: The EB retrieved 54 corneas from 27 donors with mean age 42.3 ± 24.2 years. All tissues were preserved in Cornisol®. Majority (50%) of transplantable tissues had an endothelial cell density (ECD) between 2,000 and 2,500 cells/mm2. ECD decreased significantly with increasing age (Spearman's ρ -0.747, P < 0.001; Kruskal–Wallis P < 0.001). Overall utilization rate of tissues was 87.04% (47/54), and utilizable corneas (50/54, 92.6%) were mainly used for optical purposes (34/50, 68%). Conclusions: Successful HCRP of the recently established EB has shown considerable promise in terms of quality and utilisation of corneas. There is need for active involvement of primary care physicians in contributing to increasing voluntary eye donation through awareness, advocacy, and social mobilization.
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Empowering adolescents as peer-educators for early prevention of non-communicable diseases: Through existing ‘POSBINDU’ program in Indonesia p. 2202
Mora Claramita, Novi Fitriyani, Nur Afrainin Syah, Oryzati Hilman, Fitriana Murriya Ekawati, Noor Afif Mahmudah, Rilani Riskiyana
Background: Human lifestyles, including sedentary activities, obesity, and smoking, are associated with a high risk of non-communicable diseases that are a leading cause of death globally. Accordingly, health promotion should be done as early as possible in the adolescent period. Aims: This study explores the efficacy of a peer-educator program in promoting the healthy habits of adolescents, via an existing Indonesian community initiative program called 'POSBINDU' (Integrated counseling Post), led by the general practitioners. Methods: Twenty-week 'experiential learning' approach with mixed-method was designed to: 1) Train 10 GP trainers, 2) Recruit and observe the 10 group-1 and 50 group-2 peer-educators in a high school; 3) Develop modules on health lifestyles by the GPS and peer-educators, and 4) Implement the POSBINDU program at the high school. Results: Both GPs and students' perceptions significantly increased before to after the intervention (p > 0.05). The participants also expressed they experienced increased comprehension of NCDs and the importance of healthy habits. Conclusions: The existing POSBINDU community's initiative program can potentially be improved by appropriate interventions to empower school students towards better healthy habits to prevent the early progression of NCDs.
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Role of laboratory biomarkers in assessing the severity of COVID-19 disease. A cross-sectional study p. 2209
Deba J Nizami, Vidya Raman, L Paulose, Komal S Hazari, Ayaz K Mallick
Background: Corona virus disease 2019 (Covid-19) has high infectivity and mortality rate. Covid-19 patients can suddenly deteriorate and develop life threatening complications. Hence, there is a need to identify laboratory biomarkers in order to categorize high risk patients. The main purpose of the study is to investigate the role and correlation of laboratory parameters such as total leucocyte count (TLC), absolute lymphocyte count, platelet count, C-Reactive Proteins (CRP), serum ferritin, serum lactate dehydrogenase (LDH), serum procalcitonin and D-dimer in severe and non-severe Covid-19 patients. Methodology: This retrospective cross-sectional study was conducted at Latifa Women and Child Hospital in the UAE after obtaining ethical committee clearance. Based on the symptoms and the criteria by National Institute of Health, USA, 109 patients were divided into three groups: Non-severe with 75, severe with 18 and critical with 16 patients. Laboratory data of these patients were assessed through the electronic medical records (SALAMA). Statistical analysis was done using Statistical Packages for Social Sciences (SPSS) version 25.0 (SPSS/PC; SPSS-25.0, Chicago, USA). Laboratory test profiles were expressed as mean (SD). Independent 't' test and ANOVA were used to study the significance of means. P value less than 0.05 was considered significant. Result: Males were more severely affected than females. Severe and critically ill Covid-19 patients had a significantly higher TLC, serum LDH, ferritin and CRP and lower absolute lymphocyte count. PCT and D-dimer were significantly elevated in critical group. Conclusion: Along with clinical presentation and radiological findings, biochemical parameter may also be considered as important predictors for assessing severity in covid-19 patients.
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Impact and perception about distant online medical education (tele-education) on the educational environment during the COVID-19 pandemic: Experiences of medical undergraduate students from India p. 2216
Karthik Vishwanathan, Geetika Madan Patel, Devanshu Jayeshbhai Patel
Introduction: The impact of online medical education using videoconferencing platforms on the education environment during the present COVID-19 pandemic is not known. The objectives were to evaluate the impact of online teaching using videoconferencing platforms on the education environment, satisfaction, and perception of the medical undergraduate students to online teaching. Methods: This prospective observational survey undertaken at a medical college included voluntarily participating medical undergraduate students from first (2nd semester), second (4th semester), and third year MBBS (6th and 8th semesters). The education environment was evaluated using the validated Dundee Ready Education Environment Measure (DREEM). The perception of the students was evaluated using questionnaire with five point Likert scale response. Results: The response rate in our survey was 77.5% (465 out of 600 students). The mean DREEM score of medical undergraduate students was 132.3 ± 19.8. Domains of DREEM evaluated were students' perception of learning (30.1 ± 6.3), students' perception of teachers (29.7 ± 4.6), students' academic self-perception (21.3 ± 4.9), students' perception of atmosphere (32.5 ± 6.2), and students' social self-perception (18.7 ± 3.5). Two hundred and fifty five students (54.8%) were extremely satisfied and quite satisfied with the online teaching–learning modalities. Two hundred and fifty eight students (55.5%) rated online learning methods to be very useful and quite useful during the lockdown period. Conclusion: The educational environment at our medical college was positive and students had a positive perception and attitude toward the role of the videoconferencing platforms for learning (telemedicine) during the COVID-19 pandemic lockdown.
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Serum vitamin B12 status of patients with type 2 diabetes mellitus on metformin: A single-center cross-sectional study from Bangladesh p. 2225
Muhammad Shah Alam, A B M Kamrul-Hasan, Syeda Tanzina Kalam
Background: Metformin use is a known cause of B12 deficiency in patients with type 2 DM (T2DM). Diabetic peripheral neuropathy (DPN) often has clinically indistinguishable clinical features of B12 deficiency-induced peripheral neuropathy (PN). Objective: The present study aims to assess serum vitamin B12 levels in patients with T2DM on metformin. Subjects and Methods: This cross-sectional study was conducted at a specialized endocrine outpatient clinic in Cumilla, Bangladesh, over six months from January 2020 to June 2020. Non-pregnant adults (≥18 years age) receiving metformin for T2DM for at least six months were evaluated for PN and assessed for serum B12 levels. Results: Among 90 subjects evaluated, 28 (31.1%) had B12 deficiency and 6 (6.7%) had borderline B12 deficiency; 56 (62.2%) had normal B12 levels. Study subjects with subnormal B12 used metformin for a longer duration [8.5 (7.0-14.0) vs. 5.0 (2.25-10.0) years, median (IQR), P = 0.006], gram-years of metformin use was higher in them [12.0 (7.9-14.0) vs. 5.75 (2.0-13.6) years, median (IQR), P = 0.005] and they had a higher mean corpuscular volume [85.9±7.2 vs. 82.4±6.4 fL, mean±SD, P = 0.020] compared to those having normal B12 levels. Serum B12 levels had a strong negative correlation with duration of metformin use and gram-years of metformin use. B12 status did not influence the presence and severity of PN. Conclusions: A considerable number of patients with T2DM have subnormal B12 levels. Periodic screening for serum vitamin B12 level may be of clinical benefit in such patients.
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A study of risk factors and complications in elderly hypertensive subjects p. 2230
TY Sri Hari, TY Sree Sudha, Anjaly Mary Varghese, K S B S Krishna Sasanka, Pugazhenthan Thangaraju
Background: Hypertension among the elderly is a major, highly prevalent yet treatable cardiovascular disease. Aims & objectives: Study aims to highlight the risk factors for hypertension in the elderly in an urban setup for the benefit of improving quality of life and also reduce the incidence of the cardiovascular related complications. Methodology: This is a Cross-sectional observational study. Included 125 study subjects based on selection criteria. The selected patients were subjected to a preformed and pretested schedule of questions pertaining to the risk factors. Results: Among the known hypertensive patients above 60 years of age, 125 subjects were included in the study. Smoking (62%), alcohol consumption (21%), family history of hypertension (26%), family history of diabetes (70%) were statistically significant risk factors observed for the development of hypertension. Conclusion: Sedentary lifestyle (physically less active) and anthropometric measures like overweight and obesity, abnormal waist circumference, and abnormal waist hip ratio were all identified as remarkable risk for hypertension. Myocardial infarction (20%), stroke (14%), and heart failure (12%) were the chart buster complications of hypertension in the vulnerable geriatric population.
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Tobacco smoking and depressive symptoms among male medical students in Al-Baha University p. 2235
Hawthan A Alzahrani, Mohammed S Alghamdi, Abdullah A Alzahrani, Abdulaziz A Alzahrani
Background: Smoking is a psychosocial problem regarding its causes mainly. In primary health care units, depression is the most common problem that affects the whole body and arises with physical, emotional, and cognitive symptoms. This study aimed to determine the prevalence rate of tobacco smoking and depressive symptoms among male medical students of Albaha university. Also, to investigate the association between tobacco smoking and depressive symptoms among male medical students of Albaha university. Method: A cross-sectional study was conducted on All the male medical students in the all-academic year levels of Al-Baha medical college using a self-administrated questionnaire. Results: Two hundred and eight medical students completed the study. About half of the participants (49.5%) weren't smokers. More than two-thirds (69.5%) started smoking in the first academic year. Our statistical analysis results reported; a significant correlation regarding the marital status (P-value = 0.000). The abnormality was significantly higher among current smokers (P-value = 0.013) and markedly lower among nonsmokers (P-value = 0.004). Regarding types of smoking, cigarette smokers were seriously depressed (P-value = 0.000). Conclusion: There is a relationship between smoking and depressive state among medical students. Researches must be conducted to explain this relation of depression symptoms with tobacco and not to increase the prevalence of smoking by helping students quit smoking.
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Prevalence, risk factors and quality of life of Lower Urinary Tract Symptoms (LUTS) among men attending Primary Care slum clinics in Bangalore: A cross-sectional study p. 2241
Priyesh Kant, Leeberk Raja Inbaraj, Nirupama Navamani Franklyn, Gift Norman
Background: Men, more than 50 years of age, have a higher incidence of lower urinary tract symptoms (LUTS), and this increases with the advancing age. The prevalence of LUTS varies in different geographical areas across the world, and studies have reported that LUTS in men may significantly affect the quality of life (QoL) and influence their health-seeking behavior. Early detection of LUTS is essential as it is related to several complications. This study aimed to estimate the prevalence of LUTS and factors associated with LUTS and health-seeking behavior. Methods: We interviewed 201 men (>50 years) attending two urban primary care clinics in Bangalore using the IPSS questionnaire and calculated the prevalence of LUTS. Factors associated with LUTS and health seeking-behavior were tested using the Chi-square test. A P-value less than 0.05 was considered as significant. Results: The prevalence of LUTS was 85%. LUTS was significantly associated with those having diabetes and those consuming more than two cups of tea per day. The most common symptom was nocturia (85.4%) and a weak stream (35.0%). Moderate and severe LUTS were significantly associated with poor QoL score (P < 0.0001). Only 9.3% of the men sought medical help in spite of their symptoms, and the most common reason for seeking health care was the disturbance they had due to the urinary symptoms (81.3%). Conclusions: Family physicians should be aware that a significant proportion of the men in the age group of 50 years suffer from LUTS, and eliciting the same is essential during the process of consultation.
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A study on contraceptive prevalence rate and factors influencing it in a rural area of Coimbatore, South India p. 2246
Jenit A Osborn, Sriram Rm, S Karthikeyan, SL Ravishankar
Introduction: India is the first country to implement National Family Program in 1952. Acceptance of contraceptive methods is influenced by various factors at the individual, family, and community level with their roots in the socioeconomic and cultural milieu of Indian society. This study was carried to find the contraceptive prevalence rate among eligible couples as well as to find the factors influencing it in a rural area of Coimbatore. Methodology: The study was carried out using the data extracted from the family health survey conducted by trained field staff for the purpose of furnishing details regarding people residing in the field practice area of Rural Health Training Centre (RHTC), Vedapatti located in Coimbatore district after obtaining Institutional Human Ethical clearance. All eligible couples were included for the study. Contraceptive prevalence is expressed in percentage with 95% Confidence interval. Univariate analysis (Chi-square test) was done to find the association between contraceptive acceptance and independent variables. Strength of association is determined by odds ratio with 95% Confidence Interval (cI). P < 0.05 was considered statistically significant. Results: Contraceptive Prevalence Rate among eligible couples was found to be 75% (95% cI: 73.6–76.4). Most commonly used method among the study participants was tubectomy (81.6%), followed by condoms (11.4%), intrauterine devices (6.3%), and oral contraceptive pills (0.7%). Higher age of the women, religion, educational status of the women, socioeconomic status, working status of the women, number of living children, age at the time of marriage, and age at the time of first child birth were found to have statistical significant association with higher usage of contraception. Conclusion: The contraceptive prevalence rate was found to be higher in this study population and multiple factors were influencing the contraception usage among the eligible couples.
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Perception of safety from workplace violence affects job satisfaction among doctors practicing modern medicine in India: A nationwide survey p. 2252
Farhad Ahamed, Amandeep Kaur, Paramita Sengupta, Tandra Ghosh
Background: Doctors are often been judged negatively as a consequence of high expectation and demand from their job and face violence at workplace. Continuous worry of facing aggression at workplace may seriously affect job satisfaction and intention to job turnover. However, the association between workplace safety and job satisfaction had not been studied earlier in India. Methods: A cross-sectional survey was conducted among doctors from November 2019 to April 2020 using a pre-tested, semi-structured, anonymous “Google forms” based questionnaire among doctors working in private and/or public healthcare settings across India. Perception of safety was assessed by scoring in a scale. Cronbach's coefficient of the scale was calculated to be 0.88. Job satisfaction was assessed using the 5-item Brayfield and Rothe measure of job satisfaction. Cronbach's coefficient of the scale was 0.76. The data was coded and analyzed with the help of STATA-12. Results: 617 doctors practicing modern medicine participated in this study from all over India. 262 (42.5%) doctors were found to be satisfied at their job. Perception of safety at workplace was found to have 2.5 times greater influence on job satisfaction of doctors. 23.2% of the doctors expressed job turnover intention which was positively correlated with job satisfaction and perception of safety. Conclusion: Perception of safety from workplace violence was found to have significant effect on job satisfaction and turnover intention than actual violence. Appropriate strategy may be undertaken to address this apprehension at workplace.
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Sociodemographic and psychosocial correlates of substance abuse among street children: A cross-sectional survey in the streets of Kolkata, West Bengal p. 2259
Gandhari Basu, Saumyadeep Biswas, Pravin Pisudde, Reshmi Mondal
Context: India is now witnessing steady increase of substance abuse in younger age group. Street life is a major reason in addition to curiosity, unawareness of harm, migration, peer pressure. Aims: To assess the prevalence, pattern and related factors of substance use and stress among the street living children. Settings and Design: This street-based observational, cross sectional survey included 150 street children living in vicinity of railway stations, business activity centre and major religious places of Kolkata. Methods and Material: A descriptive research was done in 150 street children, aged 6 to 18 years and stayed in the street for at least six months. Respondents and care givers were interviewed with pre designed proforma to obtain information on socio demographic attributes, pattern of substance abuse, psycho social issues, self rated health. Weight and height were recorded by calibrated standardized instrument. Statistical analysis used: Collected data were analyzed with SPSS 22.0(licensed). Chi-square test or Fisher's exact test was done for normally distributed, skewed and categorical variables respectively. The significance level was set at 5%. Results: Two-thirds of participants used substance. Illiteracy was significantly more in females. Perceived positive benefit was commonest reason while feeling happiness and diminished pain was the most common expectation behind substance abuse. Peer group had the biggest influence (92.0%) on their life. Substance abuse was significantly more in males, adolescents, employed, without family attachment, adult as influencer and in those who lived on street without family. Conclusions: Higher prevalence of substance abuse among males, adolescents with adult influencer, employed and without family attachment highlighted the urgent need of intervention to see a better future.
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A descriptive study of the clinical and etiological profile of balanoposthitis p. 2265
N Jegadish, SD Fernandes, Murali Narasimhan, R Ramachandran
Background: Balanoposthitis is defined as an inflammatory condition of glans penis and prepuce. There are wide variety of etiologies including both infectious and noninfectious conditions. This study attempts to throw light on information regarding clinical and microbiological aspects of balanoposthitis. Objectives: To study various clinical patterns, etiologies, and predisposing factors of balanoposthitis. Methodology: A descriptive study was undertaken on 106 cases who presented to sexually transmitted disease (STD) clinic with balanoposthitis between November 2017 and April 2019. A detailed history, physical examination, and investigations like KOH mount, leishman staining, gram staining, dark field microscopy, cultures, and other investigations were done wherever indicated. The data collected was tabulated and analyzed. Results: In our study, infectious etiology was the most common and was found in 77.36% cases. About 13.41% of cases with infectious balanoposthitis had multiple etiological agents. Noninfectious etiology was found in 22.64% cases. The most common infectious cause of balanoposthitis was candida, noted in 59.76% cases, followed by herpes simplex virus (19.51%), human papilloma virus (13.41%), and scabies (8.54%). Among noninfectious etiologies, adverse drug reaction (4.72% of total cases) was the most common, followed by lichen planus (3.77%) and psoriasis (3.77%). There was significantly higher incidence of phimosis in diabetic patients with candidal balanoposthitis. Conclusion: Identifying the etiology facilitates early treatment and hence reduces the infectivity and transmission of disease and also the disease complications like phimosis. In addition, multiple infectious etiologies should always be kept in mind while evaluating STDs.
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Assessment of frailty and outcome of an ethnogeriatric population in periurban slums of Delhi, India – An interventional strategy in a primary health care setting p. 2272
Meely Panda, Farzana Islam, Sushovan Roy, Rambha Pathak, Varun Kashyap
Introduction: The burden of frailty and aging will have a profound impact on the economy along with the deteriorating clinical condition of the olds. Aim: This study aim was to assess frailty of an ethnogeriatric cohort and associate it with domains of quality of life in Delhi along with a follow-up outcome assessment. Method: Edmonton frail scale on an ethnogeriatric cohort of 200 individuals in periurban slums of Delhi was used and associated with quality of life, calculated by the WHO-BREF –QOL questionnaire. An interventional strategy for healthy aging was adopted, and a follow-up outcome assessment was done to look out for mortality or morbidity. Result: There were 37% frail with a mean score of 60 and 25% prefrails beyond 60 years with a significant increase in frailty with age. Females, single, working, and illiterate elderly were frailer as compared to their counterparts. Social domain followed by psychological domain of the QOL had least scores in the frail elderly. Olds, away from their place of origin were 25 times more likely to be frail and had lesser family integration, assessed by regression analysis. Nearly 6% died, with 21% of hospital readmissions after a 6-month follow-up. Discussion: An earlier start of assessment would give us more time to react and respond and be pro-active for healthy aging besides taking into consideration the diverse ethnography in our country. Conclusion: Cross-cultural variations need the physicians to address the health care disparities and language barriers so as to make interventions more convenient.
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The adverse effects of Ketamine on Procedural Sedation and Analgesia (PSA) in the Emergency Department p. 2279
TS Dilip, Gina Maryann Chandy, Darpanarayan Hazra, Jagadesha Selvan, Priya Ganesan
Background: Procedural sedation and analgesia (PSA) in the emergency department (ED) is mainly used for wound irrigation, reduction of fractures, and wound closure. Ketamine is one of the most commonly used drugs for PSA in the ED. The study was conducted in the ED of a large tertiary care hospital in southern India to evaluate the adverse effects of Ketamine on PSA. Materials and Methods: This is a prospective observational study performed in the ED for 6 months (October 2019–March 2020) in 151 patients who required Ketamine for PSA. Titrated doses of Ketamine was administered in all patients; hemodynamic variables and adverse events were recorded at timed intervals. Results: During the study period, a total of 151 patients in the ED required PSA. The mean age of the study Cohort was 37 ± 15 years, and males accounted for 83%. All individuals obtained adequate sedation and pain relief. It was found that the incidence of adverse reactions to Ketamine was higher in young people (18- to 40-year-old), which was 63%. The most common adverse reaction in the study population was 39 cases of hypertension (44.8%), followed by vomiting in 25 cases (28.7%) and delusion in 6 cases (4%). There was no significant adverse effect in any patients which necessitated admission. Conclusion: Ketamine is a drug with good analgesic, sedative properties and has been shown to have a good safety profile with minimal adverse events for use as PSA in ED. Side effects were most common in the younger adult age group and hypertension was the most common side effect.
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Knowledge & Awareness regarding colorectal cancer among health and allied students of King Saud Bin Abdulaziz University for Health Sciences, Jeddah p. 2284
Syed Sameer Aga, Muhammad Anwar Khan, Enad Fahd Alsulimani, Mahmoud Ali Fallatah, Abdulrahman Suliman Alquzi, Rakan Ahmed Alzahrani, Mohammad Tarek Binyamin
Background: Colorectal cancer (CRC) is one of the pivotal public health issues in Saudi Arabia currently. There is a need to examine the knowledge and awareness of the health professions' students who are going to be the caretakers of the public in years to come. Objectives: The aim of this study was to investigate the knowledge and awareness of CRC in health and allied students of our Health Sciences University in Saudi Arabia. Materials and Methods: An online predesigned and validated and self-administered Survey/Questionnaire was dispensed to all health and allied students. Descriptive statistics was performed using SPSS. Data were analyzed by demographic distributions to determine if students of these groups displayed any differential awareness and knowledge for CRC. Results: A total of 372 of students answered the online questionnaire with a mean age of 20 + 7.3 (SD) years. There was almost an equal distribution of male (47.8%) and female (52.2%) students and majority of them were single (97.3%). In this study, we found that the students were not having any knowledge of the epidemiology of CRC in Saudi Arabia. The knowledge about the various risk factors of CRC was also very dismal; only a minority of them (34.4%) was able to identify 5 out of 12 CRC risk factors correctly. However, 59.7% of students had no idea about the test/examination methods that are used in screening and detection of CRC, but majority (76.1%) of them were aware that people should get screened for CRC. Conclusions: A very low level of awareness and knowledge about CRC was observed in this study among all health and allied students. We strongly recommend that there is a dire need of proactive aggressive preventive medicine campaigns, educational programs, and curricular modifications for the students to prepare them for the challenges posed by increasing burden of cancer in the kingdom.
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An epidemiological study on quality of life among elderly in an urban area of Thirumazhisai, Tamilnadu p. 2293
Gomathy Parsuraman, Pooja Vijayakumar, VM Anantha Eashwar, Ruma Dutta, Yogesh Mohan, Timsi Jain, Dinesh Kumar, Nisha Chandru, Krithiga Sivakumar
Introduction: One of the most important indicators of health and well being of the elderly is the quality of life they live in. Owing to the rise in elderly population due to the demographic transition, there is growing need to address the health concerns of this population. Aims: The study was undertaken to find out the Quality of Life among the elderly and the associated factors. Methodology: This is a descriptive cross sectional study done in urban area of Thiruvallur district Tamil Nadu. To arrive at the required sample of 199, elderly people above 60 years were selected by probability proportionate to size sampling. Semi-structured pre-tested questionnaire was used for data collection regarding sociodemographic details and related factors. Katz scale was used to assess activities of daily living and Quality of life (QOL) was assessed using WHO quality of life BREF (WHOQOL BREF) questionnaire. Results: Moderate score in QOL was obtained in all the 4 domains with highest in Psychological and environmental domains. Nearly 99% of had full activity in Katz scale. All the three QOL domains were found to have statistical significant association with age and education. Gender and marital status were found to be associated with psychological domain, and employment/pensioner status with physical domain. Conclusion: Measures like Health education have to be targeted for the elderly in ways to improve their physical and psychological wellbeing which can imporove the quality of life they live in. Primary care and family physicians have to be made aware and empowered to identify the various domains of QOL in elderly and to identify in which domain the person needs to take care the most.
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How informed is the informed consent? p. 2299
H Vikas, Ananth Kini, Nishant Sharma, Naveen R Gowda, Anant Gupta
Background: Informed consent is a cornerstone of the ethics of modern medical care. In an ideal world, informed consent is a process of education – a conversation between a surgeon and a patient or family that allows the patient or family to make the best possible decision regarding care. Objective: The study was conducted with objectives of assessing information given to the patient before taking consent for surgery and determining the compliance to various contents of the consent forms. Material and Methods: This was a prospective study over a period of 12 weeks in wards of various surgical departments of a 1000+ bedded tertiary care hospital. Patient interviews were conducted to assess their level of information and the consent forms were reviewed to assess the compliance. Observations: The overall level of information r4egarding various aspects among the participants was 75.14%. The level of information varied statistically with age, literacy level, annual income and the type of surgery. All the patients (100%) stated that they were informed about the current clinical condition/ problem, while only 34% were informed about risk and 26% about the alternative options. All the forms (100%) had a statement regarding the explanation of procedure to the patient/ guardian and none of the forms (0%) contained names of all practitioners performing the procedure. Conclusion: There is need to create awareness among doctors and also to educate patients regarding the importance of informed consent.
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A study to assess the knowledge and awareness among young doctors about emergency contraception p. 2304
Subrat Panda, Rituparna Das, Ananya Das, Nalini Sharma, Anusuya Sharma
Background: Emergency contraception (EC) is the contraception on demand which can prevent millions of unintended pregnancies. The knowledge and awareness of young doctors towards EC who may be the first contact physician of the society has not been well studied. This study aims to assess the knowledge and awareness of young doctors in a teaching institute in northeast India.Methodology: This study was carried out among 200 young doctors and included 100 interns and 100 postgraduate trainees (PGT) and senior resident doctors (SRD) from January 2020 to March 2020 to compare their knowledge and awareness about EC. A predesigned self-administered 22 items questionnaire was used to collect data. Observation: In our study, majority of the doctors in both groups were aware of levonorgestrel 1.5 mg tablet as EC (93% and 95%) and more interns than PG SRD were aware of its easy availability (86%, 35%, P value < 0.0001), government supply (77%, 30%, P value < 0.0001), and that copper intrauterine contraceptive device (IUCD) can be used as EC up to 120 h (89%, 60%, P value < 0.0001). Most doctors were unaware of ulipristal acetate. Most PGT SRDs believe that EC promotes irresponsible behavior, sexually transmitted diseases, and promiscuity but most intern did not agree to it (P value < 0.0001 for each). More than 65% doctors in both groups were aware of the mechanism of action of EC. PGT SRD were more aware of the effectiveness of EC (62%, 80%, P value 0.0078). More interns were aware that EC affects the next period (53%, 25%, P value < 0.0001). Conclusion: Interns were more aware about contraception than PGT and SRD, especially about government supply of EC, about IUCD, and behavioral aspect like promoting irresponsible behavior, sexually transmitted disease, and promiscuity.
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Computer vision syndrome among Saudi population: An evaluation of prevalence and risk factors p. 2313
Alaa N Turkistani, Arwa Al-Romaih, Majd M Alrayes, Abdulrazaq Al Ojan, Wisam Al-Issawi
Introduction: In the recent era of technological evolution, electronic devices have become an essential part of our lives, not merely in professional work settings, but also in daily leisure activities. Although these devices have simplified our lives, they are associated with a wide variety of health complaints. Thus, the so-called computer vision syndrome (CVS) has become a growing public health problem and has gained significant attention as it plays an important role in the quality of life of each individual, which in turn has put an increased burden on the health care system. Eye symptoms are among the most reported, yet extraocular symptoms were frequently described as adding an extra load. Method: An electronic survey was distributed randomly through social media platforms among the general population in Saudi Arabia, between the period from July to December 2017, irrespective of their sociodemographic factors, aiming to determine the prevalence of CVS and to verify the most common associated risk factors. Results: In total, 690 participants were involved in our study, with a mean age of 33.8 years. Of these, 77.6% suffer from CVS, with eye-burning being the most common ocular symptoms (71%), as well as itching (67.5%), blurred vision (65%), tearing (62.3%), and other eye symptoms being reported. Neck/shoulder pain was found to be the most prevalent extra ocular symptom (85.2%); also back pain and headache are frequently expressed (78% and 70% respectively). A significant positive correlation was observed between CVS symptoms and time spent using the devices (P-value: 0.002). Conclusion: As technology advances, electronic devices have become a common tool that is used for different purposes on daily basis. We found in our study that the so-called computer vision syndrome is a growing public health problem. Thus, community education about the impact of such a lifestyle for proper handling of electronic devices must be addressed to avoid such health complaints.
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Prevalence of common Mental Disorders among pregnant women-Evidence from population-based study in rural Haryana, India p. 2319
Shreya Jha, Harshal Ramesh Salve, Kiran Goswami, Rajesh Sagar, Shashi Kant
Background: Mental disorders during pregnancy is one of the major public health problem because of its effect on both mother and child. Objectives: The objective of the study was to assess the burden of common mental disorders (CMDs) among pregnant women in rural Haryana, North India. Methods: A community-based cross-sectional study was conducted in 28 villages of rural Haryana in 2016. Pregnant women in the study area with period of gestation 25–34 weeks were enrolled and assessed for presence of CMDs in two phases. Primary Care Evaluation of Mental Disorders—Patient Health Questionnaire was used for screening and Mini International Neuropsychiatric Interview (MINI) for diagnosis of CMDs. Results: A total of 457 pregnant women were included in the study. Mean age of pregnant women was 23.9 years (SD- 3.9). Prevalence of CMDs was 15.3% (95% CI, 12.0–18.6). Of these, major depression was 2.8% (95% CI, 1.4– 4.4), and Generalized Anxiety Disorder was 15.1% (95% CI, 11.8–18.4) as per MINI. On multivariate analysis, no statistically significant association was found between CMDs during pregnancy with any obstetric, sociodemographic determinants, and child health outcomes. Conclusion: High prevalence of CMDs, especially anxiety, observed among pregnant women in rural area necessitates the need for integration of screening of CMDs during routine antenatal care in India.
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Metabolic complications of childhood obesity p. 2325
Jeyaraj Munusamy, Jaivinder Yadav, Rakesh Kumar, Anil Bhalla, Devi Dayal
Context: Childhood obesity is a global health problem. A percentage of 2.3 of Indian boys and 2.5 of Indian girls are obese. Childhood obesity is associated with many morbidities like diabetes mellitus, coronary artery disease, musculoskeletal problems, and increased mortality. Aims: The aim of this study is to estimate burden of metabolic complications of obesity in child and parents of obese children and compare it with normal-weight children. Settings and Design: The study was done at a tertiary health center in northern India. It was a cross-sectional study. Methods and Material: We enrolled 60 obese children and age- and sex-matched 26 controls, based on Indian Academy of Pediatrics (IAP) 2015 body mass index (BMI) charts. Anthropometric parameters and metabolic complications in family were compared between cases and controls. Clinical markers of metabolic derangements and laboratory metabolic profile were assessed for obese children. Statistical Analysis Used: Descriptive statistics was used to describe frequencies. Chi-square test and Mann–Whitney test and Spearman correlation were used for comparison. Results: The prevalence of obesity and obesity-related complications was high in families of obese children. Ten percent of obese children had impaired fasting glucose and 30% had Haemoglobin A1c (HbA1c) in prediabetes category. Forty percent of obese children had dyslipidemia, 45% had transaminitis, and 46.7 were vitamin D deficient. A percentage of 41.7 of obese children had fatty liver on ultrasound. Conclusions: The family health and child weight are linked through home environment and genetics. The metabolic complications of obesity prediabetes, dyslipidemia, fatty liver, and lower vitamin D level are common in childhood obesity. Regular screening and interventions of metabolic complications are essential for saving child's future health.
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What necessitates obstetric transfers? Experience from a secondary care hospital in India p. 2331
Asha Elizabeth Mathew, Anne George Cherian, Tobey Ann Marcus, Sam Marconi, Venkata Raghava Mohan, Jasmine Helan Prasad
Background: India attributes to about 15% of the maternal mortality globally. Many a time poor maternal and neonatal outcomes occur unanticipated during intrapartum and postpartum period. An efficient referral system identifies the indications necessitating prompt referrals besides ensuring patient friendliness and continuity of care. Methodology: The descriptive, retrospective study was done in a secondary care hospital of a teaching institution in South India, run by primary care physicians, obstetricians and pediatricians. It describes the referrals from labour room in a year, identifying the referral rate, indications, maternal and neonatal outcomes. Results: The referral rate was found to be 3 per cent. The most common indication for the referrals was hypertensive disorders of pregnancy (54.5 percent). Among the women referred, there were no maternal deaths and majority had uncomplicated postpartum period. Eleven women developed postpartum hemorrhage. Neonatal outcome reflected a good trend as 83 per cent had an uneventful hospital stay. There were eight early neonatal deaths. Conclusion: The hospital could reduce the referral load to its tertiary care due to adequate training of primary care post graduates in basic obstetrics and anaesthesia skills, establishing standardized referral protocol and monitoring with regular clinical audits. Patient experience could be improved with inter referral unit communication and linking the health information system.
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Medical students' awareness of Personal Digital Assistant Devices' impact on their health p. 2336
Waleed Altwaijri, Raghad Mansour Almunyif, Ghayda Hatem Alotaibi, Lama Abdullah Alowais, Saba Wasim, Mesnad Alyabsi
Aims: 1. To evaluate medical students' awareness of personal digital assistant devices impacts on their overall health. 2. To estimate medical students' hours on digital devices. 3. To determine the most common effect of personal digital assistant devices on medical student health. Settings and Method: This descriptive cross-sectional study was conducted at the college of medicine of a in Riyadh, Saudi Arabia. The participants were medical students, and a questionnaire consists of 3 sections was used. A sample of 289 medical students participated in the study. Kruskal–Wallis test was used to analyze the relationship between the knowledge score and the year of study. Statistical Analysis used and Results: The research included medical students whose ages ranged from 19 to 25 years with a median (IQR) of 22.00 (21.00–23.00). Approximately, 56% of the participants were males, and the majority of the students were from year 3. The average hours spent daily while using PDA for studying was 5 hours with SD 2.7. 167 (58%) of the students reported that studying using PDAs has affected their life. The most experienced effects reported was dry eyes and vision problems 53 (54%). Conclusions: The current study revealed that the majority of medical students have adequate knowledge of PDAs' effects on their health despite their continuous use. More attention should be paid to reduce the effects on their health by raising campaigns to increase the awareness of all the students and the community.
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Strategies for COVID-19 control among migrant labourers in a developing country setting: Pathanamthitta model from Kerala p. 2342
Nooh P Bava, S Sreekumar, Geethu Mathew, Abey Sushan, AL Sheeja, P Parvathy
Background: The ongoing pandemic of Covid-19 is a public health emergency with serious implications world-wide including India.Vulnerable population like migrants are often left out of epidemic preparedness planning and reaching out these marginalized population is a challenge. Objective: To describe different strategies implemented for control and prevention of Covid-19 among migrants in Pathanamthitta. Results: Strategies for Covid-19 control among migrant labourers were planned and implemented with intersectoral coordination and community participation. Line listing and risk stratification, mobilisation of community volunteers, contactless active symptomatic surveillance using technology, IEC activities for awareness generation in multiple languages, sample collection, testing and distribution of personal protective equipment's were initially implemented. Setting up of a call centre facility assisted with M health technology exclusively for addressing concerns of migrants was first and one of its kind in the country. In addition to that special measures were taken to improve adherence and wellbeing of migrants which included addressing medical needs of migrants including psychological needs, ensuring food security, migrant hostels for the providing shelter, basic health care, isolation facilities and arranging transportation facilities for more than 10,000 stranded migrants. The success of these strategies was evident from the fact that not even a single migrant labourer was tested positive in the district during this period Conclusion: Pathanamthitta district being in a resource constraint setting showed a very effective model by implementing technology assisted strategies tailored to the needs of population.The success of these highly effective and replicable strategy underlines the need to incorporate principles of primary health care in crisis management.
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Epidemiological characteristics of children with coronavirus at a joint commission-accredited hospital in the United Arab Emirates p. 2348
Latifa Al Mansoori, Salwa Al Kaabi, Satish Chandrasekhar Nair, Manal Al Katheeri, Ghassan Ghatasheh, Huda Al Dhanhani, Aysha Al Kaabi
Objectives: Our aim was to identify the epidemiological characteristics and transmission patterns of coronavirus (COVID-19) among pediatric patients in the multicultural and multiethnic city of Al Ain in the United Arab Emirates (UAE). Method: A retrospective study was conducted by abstracting data from the electronic medical records of pediatric patients with COVID-19 from two major public hospitals in Al Ain. The data of patients from birth through 16 years of the cases with COVID-19 confirmed by reverse transcription-polymerase chain reaction were obtained. In addition to the epidemiological characteristics, transmission patterns, comorbidities, index cases, travel history, and coinfection with other viruses were analyzed. Cohen's kappa was used to assess interrater reliability and descriptive data. Chi-square test was used to assess significant differences between the variables and was conducted using Statistical Product and Service Solutions software. Results: We identified 298 (150 males, 148 females) laboratory-confirmed cases. The patients' median age was 7 years. Of these, 50% had parents who also tested positive. Most patients (86.9%) were healthy without any known medical problems. The coinfection rate was ~2%. Conclusion: The epidemiological characteristics of children with COVID-19 in Al Ain are similar to those observed internationally. Children of all ages appeared to be susceptible to COVID-19 and no significant sex or ethnicity differences were detected. Furthermore, this study provides strong evidence of human-to-human transmission.
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Voluntary blood donation among female health care university students in Saudi Arabia, knowledge and status p. 2353
Shaddin A Alaskar, Jumanah A Alsadhan, Rawan M Alanazi, Lama S Alnashi, Razan K Almutairi, Yusra S Chachar, Moussab Damlaj
Context: Blood donation is an essential lifesaving procedure. There is a continuous effort to supply the high demand in hospitals. Aims: To assess the current status, knowledge, and attitudes of female health care students in King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) regarding blood donation. Settings and Design: A cross-sectional study was done with students in the female campus of KSAU-HS in Riyadh. Methods and Material: The sample was categorized based on the college and year of study. A self-administered questionnaire was distributed during the first semester of the 2018–2019 academic year to an estimated 20%–25% of students per batch. Statistical analysis used: Statistical Package for Social Sciences version 22 (SPSS Inc., Chicago, IL). Results: A total of 302 students completed the questionnaire with a median age of 21 years and a range of 18–30 years. Only 14.6% of the sample previously donated blood, with half of this group donating more than once. Just less than half (48.7%, n = 147) have been exposed previously to a university campaign related to blood donation. The majority (74.5%, n = 225) knew their blood type, small proportions (16.6%, n = 50) and (10.9%, n = 33) reported knowing family members or friends requiring blood products. More than half (57.6%) of the students admitted not having sufficient knowledge regarding blood donation, and the majority (75.1%) were not aware of the quantity of blood collected during a donation. Two-thirds, 31.4% and 32.1% agree and strongly agree, respectively, that blood donation is a duty that every individual should perform. Just more than half (53%) of the students strongly agreed that they are motivated to donate blood on moral or religious grounds. Conclusion: The proportion of prior blood donation in the sample was low. This is due, in part, to inadequate knowledge about the donation process. Given that many students felt motivated to donate, it is possible that raising awareness through educational interventions could increase donations in female health care students.
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Prevalence and clinical presentation of sinusitis in pediatric age group in Aseer, Saudi Arabia p. 2358
Ali M S Alshehri, Ohood A Assiri, Afnan M S Alqarni, Muhammed A Y Alkhairi, Mohammed A A Alzahrani, Sarah H A Alshehri, Nada A A Alshehri, Ahmed Y Abouelyazid
Background: Paediatric rhinosinusitis is mostly different than that in adults. More frequently, children presented with cough, bad breath, crankiness, low energy, and swelling around the eyes, besides a thick yellow-green nasal or post-nasal discharge. About 5- 13% of childhood viral upper respiratory tract infections may advance to acute rhinosinusitis, with some of them developing a chronic condition. Aim: To assess prevalence and clinical presentation of sinusitis in the paediatric age group in Aseer, Saudi Arabia. Methodology: A retrospective record-based study was conducted in Abha Maternity and Children Hospital in Abha city, Saudi Arabia between January 2015 and January 2018. All medical records during the study period for children whose from to 15 years old attended the hospital and diagnosed as having sinusitis were included. Results: The study included 100 children with complete files whose ages ranged from less than 1 year to up to 13 years old with a mean age of 5.3 4.2 years. Nearly 51% of the children aged 4 years or less and male were 53 (53%). Past history for chronic rhinosinusitis (CRS) was positive among 30 children. Regarding clinical presentations of rhinosinusitis (RS) as reported by the children caregivers, fever was the most reported complaint (50%) followed by red eye (44%), ringing nose (42%), cough (41%) and headache (36%). Mucous culture was positive among 58 cases. The most isolated pathogens were streptococcus pneumoniae (45.6%), Haemophilis influenza (24.6%). Conclusions: In conclusion, the study revealed that CRS is a common disease in children at different ages, especially, maxillary and frontal sinuses. In most of the cases, medical treatment is highly appreciated; though, surgical intervention may be needed in a small percentage.
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Population-based seropositivity for IgG antibodies against SARS-CoV-2 in Ahmedabad city p. 2363
Om Prakash, Bhavin Solanki, Jay Sheth, Divyang Oza, Mina Kadam, Sheetal Vyas, Aparajita Shukla, Jayshri Pethani, Hemant Tiwari
DOI:Original Article  
Context: Ahmedabad city with approximately 7 million population was one of the earliest cities to witness the high case load of COVID-19 pandemic in India. A population-based sero-survey was ideally suited in Ahmedabad to guide the public health response for managing COVID-19 pandemic. Objectives: To study the percentage sero-positivity for SARS-CoV-2 to understand the pandemic status and deriving conclusions for guiding the public health measures for managing the COVID-19 pandemic. Settings and Design: Population-based cross-sectional sero-surveillance. Methods and Material: Large scale sero-surveillance with population-based stratified sampling covering more than 10,000 samples from general population of Ahmedabad was carried out during second half of August 2020. The seropositivity was correlated and compared with various demographic factors and other parameters for valid and precise predictions on the immunity status of the population. Results: With 2,396 samples positive for IgG antibodies from a total of 10,310 samples, the seropositivity against COVID-19 in the general population of Ahmedabad is around 23.24%. The seropositivity has increasing trend with increasing age and is significantly higher among females (25.37%) than males (21.81%). The zone wise positivity ranged from 11.74% to 33.14%. This closely correlates with the cases recorded so far, higher for those zones with high current or past cases. Conclusions: Seropositivity of 23.24% in general population indicate the overall current level of protection. Since effective vaccine is not yet available, it is required to continue emphasis on the public health preventive measures for controlling and managing the COVID-19 pandemic.
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Assessment of the knowledge, preferences and concern regarding the prospective COVID-19 vaccine among adults residing in New Delhi, India – A cross-sectional study p. 2369
Farzana Islam, Rashmi Agarwalla, Meely Panda, Yasir Alvi, Vishal Singh, Arup Debroy, Arindam Ray, Amruta Vadnerkar, Shraddha Uttekar
Background: Understanding the perception and concerns of people about COVID-19 vaccine in developing and populous country like India will help in understanding demand for the vaccine and further tailoring out public health information and education activities. The study was carried out to assess the present state of knowledge people have about the probable vaccine for COVID-19, to know the preferences of respondents about this vaccine and to learn the expectations and apprehensions of people about features of this prospective COVID-19 vaccine residing in the capital city of India. Methods: This cross-sectional study was conducted amongst the residents of Delhi, India from July to October 2020. Both offline and online interview method was used to collect date from 513 participants representing various occupational strata. Data were collected on sociodemographic variable, vaccine acceptance and concerns regarding COVID-19 vaccine. Results: Among the study population, 79.5% said they will take the vaccine while 8.8% said they were not going to take the vaccine and remaining 11.7% had not yet decided about it. More than 50% were willing to pay for the vaccine and 72% felt vaccine should first be given to health workers and high-risk group. Conclusion: The following study has helped to understand the percentage of people who are hesitant to take the vaccine and also the concerns regarding the vaccine. Also since half of the population is willing to pay for the vaccine, a strategic approach considering the various economical classes of people could be applied in a developing country like India.
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Observational study on the response of tenofovir monotherapy versus tenofovir plus telbivudine dual therapy in patients with hepatitis B virus related acute on chronic liver failure p. 2376
Abul H Manik, Debraj Malakar, Sheikh M Noor-E-Alam, Mamun A Mahtab, Dulal C Das, Ayub A Mamun, Sakirul Khan, Mohammad Fazle Akbar, Zakiur Rahman, Salimur Rahman
Introduction: HBV is major health problem globally due to complications, including ACLF, cirrhosis and hepa¬tocellular carcinoma. ACLF due to exacerbation of CHB is associate with 30%-70% mortality. Reduction of HBV-DNA is therefore a target of therapy in ACLF-B. Methods: Patients with spontaneous reactivation of HBV [(ALT >5×ULN or >2× baseline) and HBV-DNA >20,000 IU/ml] were randomized to Tenofovir mono therapy (300 mg/day) or Tenofovir plus Telbivudine (600 mg/day) dual therapy with standard care. Clinical and biochemical parameters were evaluated at baseline, 1 week, 4 weeks and at 3 months. Virological evaluation was done at baseline and at 3 months. Primary end points were reduction of HBV-DNA and resolution of ascites, as applied. Secondary end point was reduction of liver related complications, therapy related adverse effects and survival at 3 months. Results: 27 patients were enrolled. 15 received mono therapy with Tenofovir and 12 received dual therapy (Tenofovir plus Telbivudine). Baseline parameters in 2 groups had no significant difference. In both groups there was significant improvement of S. bilirubin, ALT, INR, CTP score and MELD score. Only MELD score showed significant improvement in patient with dual therapy at 3 months in comparison to mono therapy. 11 patients on Tenofovir mono therapy (n=15) showed undetected HBV-DNA (91.7%) at 3 months and one patient had detectable HBV-DNA (<2,000 IU/ml). 10 patients on dual therapy (n=12) had undetectable HBV-DNA (100%). Ascites resolved in 3 patients in both groups. Patients receiving dual therapy showed significant improvement in AKI on follow up compared to those on Tenofovir mono therapy. Among 5 deaths, 3 received mono therapy with Tenofovir and 2 dual therapy. Predictors of mortality had high S. bilirubin, HBV-DNA, MELD score and CTP score. Conclusion: In spontaneous reactivation of HBV presenting as ACLF, combination of Telbivudine plus Tenofovir is safer with less nephrotoxicity and better outcomes.
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Role of tenofovir and telbivudine in treatment of hepatitis B related acute on chronic liver failure p. 2381
Debraj Malakar, Mamun A Mahtab, Abul H Manik, Sheikh M Noor E Alam, Dulal C Das, Ayub A Mamun, Md Sakirul Islam Khan, Zakiur Rahman, Salimur Rahman, Sheikh Mohammad Fazle Akbar
Introduction: ACLF is characterized by acute deterioration of liver function in patients with chronic liver disease. HBV is one of the most important causes of both acute insult and underlying chronic liver disease in ACLF. Reactivation of HBV is one of the common causes of ACLF in our region. ACLF requires multiple organ support and is associated with high short and medium term mortality. This is the reason why early, rapid reduction of HBV DNA is essential in treating ACLF-B. Methods: Consecutive patients of ACLF-B due to spontaneous reactivation of HBV (ALT> 5xULN or >2 x baseline and HBV DNA >20,000 IU/ml) were randomized into tenofovir group (300mg/day) and telbivudine group (600mg/day) along with standard medical treatment. Clinical and laboratory parameters were evaluated at baseline, day-7, day-14, day-30 and day-90. HBV DNA was evaluated at baseline and after three months of therapy. Primary end point was survival or death at three months. Secondary end point was improvement of liver function assessed by Child-Turcotte Pugh score and MELD score at three months. Results: 30 patients were enrolled in the study and 15 of them received tenofovir and 15 patients received telbivudine. Most of the baseline parameters showed no difference except serum AST and serum creatinine level that showed statistically significant difference between two groups. After antiviral therapy both groups showed significant clinical improvement along with CTP and MELD scores. However statistically significant improvement between tenofovir and telbivudine groups was only seen with MELD score. Survival rate was 80% in tenofovir group and 60% in telbivudine group, but this was not statistically significant. Low serum albumin at baseline was predictor of mortality. Conclusion: In patients of ACLF-B, antiviral therapy with both tenofovir and telbivudine improve liver function, but there is no statistically significant difference in survival between tenofovir and telbivudine.
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Prevalence, knowledge, and perception about the use of herbal medicines jazan - Saudi Arabia p. 2386
Amani Osman Abdelmola, Ahmed Bahri, Ismail Abuallut, Basmah A Refaei, Walaa K Hakami, Alhanouf K Abutaleb, Salwa M Mahzari, Mariam A Mashragi, Shahad A Es'haq, Khadijah F Aldarbi
Aim: This study aimed to assess the prevalence, knowledge and perception of Jazan province residents about traditional herbal medication. Materials and Methods: A cross-sectional study was done on 440 Saudi residents using an electronically distributed questionnaire. The questionnaire included 39 items divided into 4 parts. Data collected were about demographic characters, knowledge and perception about HM, and HM usage among participants. Results: Most of the participants used HM for therapeutic purposes (80.9%) and (29.5%) believed that mixing herbs together led to more effective results. The participants agreed to a very high degree that inherited culture plays an important role in HM use, however (84.5%) of them never used herbs. The participants used herbs mostly for treatment of diabetes mellitus representing (37%) and hypertension (20.5%). Age, marital status, and the job of participants had a statistically significant effect on participants' views about HM. While, gender, educational level, income, place of residence and chronic diseases had no statistically significant effect. Conclusion: The highest percentage of the participants used HM for therapeutic purposes. Increasing awareness of Saudi population about instructions and restrictions when using HM is greatly needed.
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Exercise among pregnant females in maternity and children hospital in Jeddah, Saudi Arabia, 2019: Prevalence and barriers p. 2394
Marwa A Aljehani, Liqaa F Alghamdi, Ohoud B Almehwari, Abdul-Hameed M Hassan
Objectives: To estimate the prevalence and explore factors of adequate physical activity among pregnant women in maternal care. Materials and Methods: A cross-sectional study conducted in healthy pregnant women visiting the antenatal clinics of the Maternity & Children's Hospital, Jeddah, Saudi Arabia. A structured questionnaire was administered face to face to collect the following: 1) sociodemographic and obstetrical data; 2) the Arabic version of the Pregnancy Physical Activity Questionnaire (PPAQ) developed by Lisa Chasan-Taber; and 3) barriers to exercise. The PPAQ enabled calculating average weekly energy expenditures in various activities, in metabolic equivalent (MET-h/week) and determining two levels of physical activity (active versus inactive). Results: Two hundred and five pregnant women were included: 49.3% were multiparous (gravida >2) and 55.6% declared exercising before pregnancy. The median overall energy expenditure was 108.0 MET-h/week, and household/caregiving activities accounted for the most important share (median = 45.7 MET-h/week), followed by transportation (12.6 MET-h/week). Of the total, 45.9% met the WHO criteria of adequate physical activity. There was no statistically significant difference between physically active and inactive participants across demographic factors. The most common barriers to being active were lack of energy, fatigue, or drowsiness (70.2%), lack of education by doctors (68.3%), and inconvenient weather (62.0%). Conclusion: Women in Saudi Arabia have decline in physical activity during pregnancy, and less than 50% maintain a level of exercise that enables beneficial effects on their overall health and pregnancy outcome. Health authorities and decision makers should consider implementing a national strategy and guidelines for the promotion of physical activity during pregnancy.
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COVID-19 seropositivity among non-medical frontline office staff from two cities in Rajasthan, India p. 2400
Vidhi Jain, Manoj Kumar Gupta, Malika Grover, Tejashree Nare, Saumya Srivastava, Pankaj Bhardwaj, Akhil Dhanesh Goel, Suman Saurabh, Sanjeeta Dara, Ashok Kumar, Praveen Sharma, Vijaya Lakshmi Nag, Sanjeev Misra
Aims: The indigenously developed Indian Council of Medical Research (ICMR)-NIV COVID Kavach IgG enzyme linked immunosorbent assay (ELISA) has been recommended for seroprevalence among vulnerable populations in India, which provided essential services throughout the lockdown. The staff working in the High Court was one such group. We compared anti-SARS-CoV-2 IgG seropositivity among the staff of Jodhpur and Jaipur High Courts, Rajasthan, India. Methods: Asymptomatic judiciary staff of Jodhpur and Jaipur benches of High Courts were enrolled after informed written consent. A questionnaire was filled and 3–5 ml venous blood was collected from participants. The ICMR-NIV COVID Kavach IgG ELISA and EUROIMMUN IgG ELISA were used for detection of Anti-SARS-CoV-2 IgG antibodies. Results: A total of 63 samples (41 from Jodhpur and 22 from Jaipur) were collected between 28th July to 4th August 2020. The overall anti-SARS-CoV-2 IgG seroprevalence was found to be 6.35%. Seropositivity was higher among the staff from Jaipur (13.64%) as compared to Jodhpur (2.44%). The Kavach ELISA results were in complete agreement with EUROIMMUN ELISA. The infection control measures were deemed effective. Conclusion: Seroprevalence among the staff of Jodhpur High Court was found to be lower than Jaipur, reflecting higher susceptibility to COVID-19 in the former. Many offices worldwide are closed till mid 2020 but need to come up with pre-emptive policies eventually. This study may help to anticipate the possible challenges when other government/private offices start functioning. The infection control practices of one workplace may help formulate guidelines for other offices.
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Paradigm Shift in Socio-Demographic Profile of Dengue Infection: A Hospital Based Cross-Sectional Study p. 2405
Ranjeeta Nayak, Manasi Panda, Sarmistha Padhy, Kumar G Mishra
Background: Dengue is the most rapidly spreading mosquito borne viral disease in the world with increasing geographical expansion to new countries and from urban to rural settings due to combination of urbanisation, population growth, increased international travel and trade and global warming. The epidemiology of dengue fever in India has been very complex with a seasonal pattern. The first outbreak in Odisha was in 2010 and is now spreading to different districts of the state. Materials and Methods: A hospital based cross-sectional study was carried out between 2017 to 2018 in the dengue ward of a teaching hospital in Berhampur, Ganjam district of Odisha. Results: The prevalence of admitted dengue patients was 4.32%. Majority of the patients were males (81.9%) and ≥15 years old (91.7%). About 68.5% were from rural areas and belonged to low socio-economic status (53.2%). Cases were reported mostly in peri-monsoon periods and 65.7% of them came directly to the hospital. Conclusion: The study highlights the need to curb the rural spread of the disease through activities in creating awareness among all section of people to promote control measures and early reporting of all fever cases, capacity building of rural doctors for early detection, treatment and early referral of high-risk patients and availability of ELISA based tests in sub-district hospitals along with Rapid Diagnostic Kits (RDKs). Emphasis for preventive and control measures to be increased during peri-monsoon periods and also to be instituted in offices, educational institutes and other indoor activity areas.
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Awareness, knowledge, and attitude toward venous thromboembolism among Aseer Population, Saudi Arabia p. 2411
Ali Al Bshabshe, Wesam Faried Mousa, Mohammed Sultan Alshehri, Mazen Mohammed Saeed Alshahrani, Omar Mohammed Alamri, Fayez Saeed Alshehri, Mohammed Ali AlFlan, Afnan Sultan Alshehri
Objectives: Calls to carry efforts to increase awareness about venous thromboembolism (VTE) as a preventable major healthcare problem with serious consequences has been upraised. This study was planned to get an overview of the awareness, knowledge, and attitude toward VTE among Aseer population, Saudi Arabia and the need for an education plan. Materials and Methods: Questionnaire composed of 35 questions based cross-sectional study was conducted online via Google documents to public in Aseer that included both genders aged more than 18 years who agreed to be involved in the study, to assess knowledge and attitude toward VTE. The collected data were presented as numbers, percentages, and were analyzed using Statistical Package for Social Sciences version 24. Results: The results of the data showed that awareness knowledge and attitude toward VTE were lacking and unsatisfactory. Conclusion: Diligence to spread knowledge and awareness of VTE among public in Aseer is required. Further surveys involving other populations are warranted.
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When the head is big, think this too: Megalencephalic leukoencephalopathy in a toddler with only a large head. A case report p. 2416
Shyam Chandrasekar, Joseph John, Amit K Satapathy, Samarendra Mahapatro
We present a one-year old, developmentally normal toddler from a non Agarwal community, who presented to us with only a large head. The examination findings were unremarkable except a large head circumference. Neuroimaging confirmed the diagnosis of megalencephalic leukoencephalopathy (MLC). Although developmental delay and seizures are common manifestations in MLC, we want to highlight the fact that many children like ours may have no neurological manifestations at all which makes it necessary to do neuroimaging to establish the diagnosis and offer genetic testing for confirmation of the same.
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IgA nephropathy superimposed on diabetic nephropathy: A case report with review of literature in eight Indian studies p. 2419
Bifica Sofia Lyngdoh, Pakesh Baishya, Jaya Mishra, Evarisalin Marbaniang, Biswajit Dey
Diabetes mellitus is one of the foremost diseases in the modern era and diabetic nephropathy contributes to a major percentage of end-stage kidney disease. Although diabetic nephropathy is difficult to revert back, detection of nondiabetic renal disease (NDRD) is important to detect as most of them are treatable. We describe a case of a 62-year-old female with long-standing diabetes mellitus presenting with massive proteinuria and clinical features of nephrotic syndrome. The kidney biopsy showed class III diabetic nephropathy along with focal proliferative glomerulonephritis with crescent formations. The immunofluorescence study showed strong mesangial IgA deposition with the predominance of lambda stain. This confirmed the diagnosis of diabetic nephropathy with superimposed IgA nephropathy. We reviewed eight Indian studies herewith to demonstrate NDRD spectrum in the Indian diabetic scenario.
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The requirement of hemodialysis in patients with acute gastroenteritis–induced acute kidney injury p. 2423
Supriyaa Bhakthavatchalam, Devasena Srinivasan, R Prithviraj
Acute gastroenteritis is an important cause of preventable acute kidney injury (AKI). Inadequate or delayed restoration of diarrheal losses results in a very high incidence of AKI. Diarrheal illness is a major reason for hospitalization, but data on consequent acute kidney injury are sparse. The objective of the study is to determine the incidence of AKI in infectious and noninfectious diarrheal illness requiring hospitalization and to identify correlates and outcomes of diarrhea-associated AKI. None of the patients had any organism isolated in stool, probably due to prompt initiation of antibiotics/inadequate culture growth. Three out of our 6 cases did not require hemodialysis (HD) and AKI resolved on conservative management alone (fluids, electrolyte management, and antibiotics). Three out of 6 cases had nonresolving AKI and were dependent on renal replacement therapy (RRT) even at 1 month after discharge as they remained oliguric. One recent paper has reported the recovery of renal function after a period of dialysis. Frequent electrolyte abnormalities, risk of (catheter-related/bloodstream) infections, and severity of the primary disease are the chief reasons for the persistently high morbidity. Although, there was no mortality in our study.
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Envisaging a trans-fat free India? - A myth or reality p. 2428
Sheikh Mohd Saleem, Om Prakash Bera, Sudip Bhattacharya
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Revision to the point system by the Dental Council of India p. 2430
Balaji Manohar
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Retraction: Survival in human rabies but left against medical advice and death followed – Community education is the need of the hour p. 2432

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