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  Most popular articles (Since August 31, 2018)

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Evaluation of interleukin-6 and its association with the severity of disease in COVID-19 patients
Sudhir Bhandari, Govind Rankawat, Ajeet Singh, Dileep Wadhwani, Bhoopendra Patel
July-September 2020, 11(3):132-136
Background: The present study was undertaken to determine the levels of interleukin-6 (IL-6) and evaluate its association with clinical presentation, severity, radiological imaging, management, and outcome in coronavirus disease (COVID-19) infection. Methods: The present study included 132 admitted COVID-19 patients, categorized into three groups. Group 1 had IL-6 within the normal reference range, Group 2 had IL-6 raised up to ten times the upper normal limit (UNL), and Group 3 had IL-6 level raised > ten times the UNL. The patient's data concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome were extracted from their medical records for subsequent evaluation, interpretation, and association among the groups. Results: COVID-19 patients with raised IL-6 levels exhibited frequent symptomatic presentations, severity, and critical illness, especially with extremely high IL-6 levels (P < 0.001). Radiological findings in terms of a digital chest radiograph and high-resolution computed tomography (CT) chest indicated severe lung involvement in patients with extremely high IL-6 levels (P < 0.05). The majority of patients with extremely raised IL-6 levels were associated with the classic COVID-19 CT images (P = 0.014). Patients with extremely raised IL-6 levels required intensive treatment as compared to normal IL-6 group in terms of tocilizumab therapy (P = 0.008), noninvasive ventilation (P < 0.001), and intensive care unit care (P = 0.009) associated with higher mortality (P = 0.046). Conclusion: Raised IL-6 levels in COVID-19 patients should be considered a risk factor for the severity of the disease, inflammatory storm, and rapid pulmonary invasion. There is an urgent need for establishing a treatment protocol in patients with extremely raised IL-6 levels.
  28,479 298 -
Assessment of the air quality and its impact on health and environment in India
Mradul Kumar Daga, Govind Mawari, Dipu Bharali, Himanshi Banker, Priya Mehar, Prachi Saluja, Diksha Kumar, Dikshant Kumar, Manish Kumar Jha, Prashant Gargava
July-September 2019, 10(3):117-125
Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM10 and PM2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.
  6,055 324 -
Sources and toxicological effects of lead on human health
Bikash Debnath, Waikhom Somraj Singh, Kuntal Manna
April-June 2019, 10(2):66-71
Lead toxicity is one of the most hazardous metal toxicities. It can enter the body through lead-based paint, dust, water, soil, tableware, and folk medicines. Children are especially prone to develop lead toxicity. Lead acts by inducing oxidative stress due to inefficient replenishment of glutathione. Lead can also cause hemolytic anemia due to disruption of the cellular membrane by lipid peroxidation. Lead toxicity also affects neurotransmitter levels and causes severe health issues related to organ damage, some even leading to death. The main aim of this review article is to summarize lead toxicity detection, its sources, and its mechanism including various toxicological effects on human health. It also focuses on the prevention and treatment of lead toxicity.
  5,084 492 8
Burden of antenatal depression and its risk factors in Indian settings: A systematic review
Priyanka Arora, Bani Tamber Aeri
April-June 2019, 10(2):55-60
According to the National Mental Health Survey-2016, one in every ten persons in India suffers from depression and anxiety, and 20% of these depressed Indians are pregnant women and new mothers. This systematic review was conducted to assess the burden of depression and risk factors associated with it among the Indian pregnant women. Electronic database (PubMed and Google Scholar) was used to identify any retrospective/prospective observational research studies published in English language which specifically examined antenatal depression (AD) among Indian women using a validated scale. A total of 995 citations were retrieved, out of which only eight studies were included. The prevalence of AD was found to be ranging from 9.18% to 65.0% in northern, western, and southern part of India. However, there is a lack of research on AD from the eastern part of country. The factors such as unplanned pregnancy, multigravidity, history of abortion, advancing pregnancy and age, lower/lower-middle socioeconomic status, poor education status of women, unemployment, bad relations with in-laws, male gender preference, and demand for dowry were significant predictors for AD. Therefore, it is necessary to provide the health-care professionals and women with the knowledge about these factors for early prediction of women at high risk of AD, which might help them to get timely intervention and reduce the burden of depression. Furthermore, the results from this review implicate that more research is needed in future in this field to further validate the findings of the present review.
  4,316 468 6
Japanese encephalitis: Strategies for prevention and control in India
Ruchir Rustagi, Saurav Basu, Suneela Garg
January-March 2019, 10(1):12-17
Japanese Encephalitis (JE) is an important re-emerging vector-borne zoonotic disease of the 21st century which is the most important cause of morbidity and mortality due to pediatric viral encephalitis in Asian populations. India and China together report 95% of the disease burden where it is also an important cause of acute encephalitis syndrome. JE is a neglected tropical disease which disproportionately afflicts poor and economically disadvantaged populations in rural regions of low and middle-income countries which often lack well-equipped tertiary care centers for the management of JE cases presenting with central nervous system manifestations and related complications. JE has large animal reservoirs among pigs and water birds which renders JE elimination difficult. Hence, current strategy for JE prevention and control pursues a combined approach inclusive of expansion of JE vaccination coverage in endemic regions, vector control, and surveillance. Unfortunately, the lack of public health infrastructure, economic resources, and lack of political commitment has resulted in most endemic countries in the developing world failing to take adequate steps for achieving these recommended measures for JE control, especially with regard to developing surveillance capacities and reference laboratories for the diagnosis of JE. Moreover, the threat of JE has increased in recent years due to factors such as climate change and lack of economic development in several endemic zones even as the disease has begun affecting adult populations. Evidence from surveillance data in some countries also suggests that increase in vaccination coverage for JE does not necessarily correlate with decline in JE disease burden. Ultimately, JE is likely to persist as a major public health problem in the developing world and impede their economic development unless it receives adequate attention from the global health community.
  4,167 488 -
Listen, care, and going extra mile: Guiding principles for physicians and teachers in health-care profession
Vijay Rajput
January-March 2019, 10(1):1-5
In the medical field, emphasis has been on the development of trust between the physician and the patient, similar to that of a teacher and learner. This is because a solid foundation of trust benefits patients' overall care and students' learning. Trust is critical because it allows the patient to believe that the doctor is there to give them the best care possible. Trust improves the physician–patient relationship because the patient believes he or she is receiving high-quality care as a result. It is important for residents and physicians to be aware of their behavior in their interactions with patients and learners, even if the interaction is only for a few minutes. This awareness is key for the development of trust and long-lasting benefits for clinical care and medical education. Physicians and teachers should develop three crucial skills to develop trust early with their patients and learners: (1) listening, (2) caring, and (3) going the extra mile for patients and learners. These attributes, when applied to patient care and teaching, will travel far in a physician's career and be beneficial to their patients' overall health. This article will explore these three skills and examples of their applications, which medical professionals can use in their day-to-day practice in light of a time-restricting, multitasking, and technologically advanced world.
  3,560 207 -
Hepatitis B virus transmission and health-care workers: Prevention, management, and awareness toward the disease
Bineeta Kashyap, Urvashi Tiwari, Anupam Prakash
January-March 2019, 10(1):6-11
The risk of transmission of hepatitis B, a global communicable disease, has become a matter of concern in recent years. Health-care delivery has the potential to transmit hepatitis B virus (HBV) and hepatitis C virus to both health-care workers (HCWs) and patients. The risk of transmission is most clearly related to the frequency of exposure or the extent of direct contact with human blood and body fluids. Health care must be provided with the best practice of safety and standards of care. Adherence to recommended improved safety devices, standard precautions, and fundamental infection-control practices is a must to prevent transmission of blood-borne pathogens. Long-term treatment with the goal of clearance of HBV is often required. Safe and effective hepatitis B vaccines along with postexposure prophylaxis with hepatitis B vaccination alone or in combination with HBV immunoglobulin have been available, the impact of which has been reported in several countries in preventing HBV transmission among HCWs.
  3,302 419 2
Assessment of patient's knowledge, attitude, and practice regarding pulmonary tuberculosis in a tertiary care hospital
Viplav Narayan Deogaonkar, Saatchi Kuwelker, Smrati Bajpai
January-March 2019, 10(1):18-21
Background: Tuberculosis (TB) is one of the most common respiratory illnesses in India, to the extent that about 1/4th of the population afflicted by TB in the world, is found in India. The knowledge of the patient about the disease, his attitude toward it, and compliance to treatment are key factors in management of the disease. Objectives: The objective of this study is to assess the knowledge, attitude, and practices of the patients with regard to pulmonary TB. Methodology: A cross-sectional observational study was conducted among patients suspected of or diagnosed with pulmonary TB in a Tertiary Care hospital using a prestructured questionnaire. Results: A total of 100 patients participated in the study. Out of these, 74% had never suffered from TB in the past. Cough was identified as a symptom of TB by 75% participants. About 15% participants said they used no precautions while coughing. Conclusion: The study reveals that there are quite a few misconceptions regarding causes, transmission, and prevention of TB. There is still a long way to go to educate the population regarding such a common illness.
  3,312 372 -
Internet: A double-edged sword? – A cross-sectional study
Meera George, Malik Shanawaz Ahmed, Neethu George, Sony Simon
July-September 2019, 10(3):126-130
Introduction: The Internet has become a must-present factor in our day-to-day life. As like any other substance like plastic, the Internet also demonstrates threats which affect health and thereby life also. Objectives: To find the prevalence and impact of internet addiction on health and lifestyle of medical students in a private medical college in Kerala. Methodology: This cross-sectional study was conducted among medical students for a period of 1 month. A questionnaire was used to document the sociodemographic details, internet addiction by young's Internet Addiction Test, and questions regarding impact of the Internet on life. Results: In the present study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. Internet addiction was significantly associated with male gender, mobile/tablet usage, eye strain, time to initiate sleep, frequency of sleep trouble, hours spent on the Internet, money spent, presence of backache, and appetite change with internet addiction. Conclusion: The study finding of presence of internet addiction has to be considered seriously along with tobacco and alcohol consumption. Awareness has to be made relating to the right use, right amount, and right time of using the Internet.
  2,862 212 -
Implementation of antimicrobial stewardship activities in India
Arzoo Sahni, Arti Bahl, Rashi Martolia, Sudhir Kumar Jain, Sujeet Kumar Singh
January-March 2020, 11(1):5-9
Introduction: The ease of availability of antimicrobials and their excessive use is a growing issue which has significantly contributed to antimicrobial resistance (AMR). This is a matter of public health concern as the burden of AMR is far outpacing the research and development work done to develop new antimicrobials. India, being one of the top consumers of antimicrobials, now faces this threat which can only be curtailed through the implementation of antimicrobial stewardship program (AMSP). To address this issue, this systematic review attempts to study the implementation activities of AMSP in the country by the means of literature review. Methods: A comprehensive research using web-based search engines was performed employing a combination of search string: AMSP, ASP, implementation, impact, antibiotic stewardship, antimicrobial surveillance, infection control, and resistance control. The search yielded thirty papers between the time period of 2008 and 2019. 17 papers fulfilling the inclusion-exclusion criteria were taken up for review, employing PRISMA framework. Results: Results from different studies conducted on implementation of AMSP and its components were consolidated and analyzed to track the extent of AMSP activities. Moreover, by studying AMSP practices, gaps in implementation activities were identified by highlighting the AMSP components that were not fully utilized in the country. Conclusion: The results show that implementation of AMSP in India is still in its nascent stage as all the stewardship components are yet to be fully applied in the country. There seems to be a lot of scope in improving the implementation activities by building and strengthening of components such as use of information technology in monitoring and surveillance, use of antibiotic cycling and sensitizing staff, and broadening the role of different staff members to develop an effective program in the nation which meets the goals of National Action Plan-AMR.
  2,585 387 1
Factors affecting quality of sleep in hospitalized patients: A cross-sectional survey in a tertiary care hospital
Ovine Loyster D souza, Irene T. R. Alvares, Manjeshwar Shrinath Baliga
October-December 2019, 10(4):201-206
Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.
  2,638 313 1
Adoption and validation of the adolescent stress questionnaire for Indian high school students
Ovine Loyster D Souza, Sucharitha Suresh, Manjeshwar Shrinath Baliga
October-December 2019, 10(4):210-218
Introduction: Adolescent stress questionnaire (ASQ) – a 58-item inventory covering broad range of adolescent distress was developed and validated for Australian adolescents. The present study reports a modification of the ASQ for the Indian context. Methodology: Initially, a focus groups study was carried out with 8 adolescents and 8 experts to understand the relevance of the subject and domain contents of ASQ using the original ASQ. Later content validation was done by the experts in the field for the modified ASQ. The modified version was administered to (n = 20) adolescents for pilot testing. In the next stage, the scale was given to 153 adolescents and readministered to the same samples after 1 week. Statistical analysis was done to ascertain the internal consistency, component factor, and test–retest reliability as per the standard analysis. Results: During stage one, 38 questions were retained which were more relevant to Indian context. The internal consistency of 6 subscales was ≥8 and measuring 0.89 for overall questionnaire. The test–retest reliability measured 0.96 for the overall scale (P < 0.0001) for each domain. During the confirmatory factor analysis, above half (20 of 38) of the items confirmed high correlations with their component scale, with factor loadings P < 0.5. Conclusion: The modified ASQ had acceptable internal consistency and test–retest reliability. Further testing with adolescent students living in other parts is recommended to provide a more complete assessment of the questionnaire.
  2,674 216 -
Where are such teachers? A legend, an icon, and a role model!
Shridhar Dwivedi
October-December 2019, 10(4):179-183
  2,544 192 -
The knowledge, attitude, and practices relating to tuberculosis among drug-resistant tuberculosis patients
Kevisetuo Anthony Dzeyie, Saurav Basu, Tanzin Dikid
April-June 2019, 10(2):76-78
Introduction: A tuberculosis patient infects several healthy people prior to the diagnosis and initiation of treatment. Indiscriminate spitting in the community has been identified as a challenge to the prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. Methodology: We conducted a descriptive cross-sectional study at a tertiary care hospital to evaluate knowledge, attitude, and practices relating to tuberculosis by interviewing patients of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis using a semi-structured questionnaire. We evaluated knowledge of tuberculosis on etiology, mode of spread, treatment factors, attitudes on the importance the respondent attributed to the factor and practices on adherence to treatment, and hygiene for the prevention of spread including safe sputum disposal. Results: We enrolled 250 patients (165 males) with a mean age of 29 ± 11 (mean ± standard deviation) years. On knowledge of tuberculosis, most of the patients had correct knowledge regarding tuberculosis symptoms (241, 96%), mode of spread (235, 94%), and correct duration of treatments 246 (98%) for drug sensitive tuberculosis. On attitude, all the patients consider adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing and 239 (96%) on safe disposal of sputum as important. However, only 45 (18%) reported practicing correct sputum disposal and 66 (26%) patients reported disposing of their sputum in the open. Conclusion: This study suggests that despite good knowledge and attitude, there is a lack in practice of safe disposal of sputum by tuberculosis patients. Efforts toward sensitization regarding safe disposal of sputum need to be strengthened.
  2,396 248 1
Prevalence of obesity in Iranian children: Systematic review and meta-analysis
Moloud Fakhri, Diana Sarokhani, Mandana Sarokhani, Ali Hasanpour Dehkordi, Leila Jouybari
October-December 2019, 10(4):190-200
Background of the Study: Childhood obesity, in addition to the likelihood of its continuation in adulthood, is associated with an increase in mortality and various diseases. Purpose of the Study: This meta-analytic study aimed at determining the prevalence of obesity among Iranian children. Methodology: Two researchers independently searched national and international databases using MeSH, Scopus, PubMed, Science Direct, Web of Science, Springer, Magiran, Iranmedex, SID, Medlib, and the Google Scholar search engine. The heterogeneity between studies was evaluated using the I2 index. Data were analyzed using STATA software. This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Among 93 studies with a sample size of 3,845,768, the prevalence of obesity in Iranian children was 7% (girls 8% and boys 10%), and the prevalence of overweight was 12% (girls 17% and boys 15%). The incidence rate of obesity in children was 13% based on US centers for disease control and prevention (CDC) 2000 reference, 11% on international obesity task force (IOTF) reference, 9% on World Health Organization reference, 9% on Iranian reference, 5% on CDC reference, and 3% on national center for health statistics (NCHS) reference. Meta-regression diagram also showed that the prevalence of obesity in children was not dependent on sample size. However, the prevalence of obesity declined during the years 1999–2016, which was statistically significant. Conclusion: The prevalence of obesity in Iranian children was less than of their overweight. On the other hand, the prevalence of childhood obesity in girls was lower than that of boys, and the prevalence of child overweight among girls was higher than that of boys.
  2,415 219 -
Substance abuse and depression among auto-rickshaw drivers: A study from the national capital region of Delhi, India
Shaurya Kaul, Anish Kumar Gupta, Taposh Sarkar, Syed Khursheed Ahsan, Narinder Pal Singh
July-September 2019, 10(3):143-148
Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers.
  2,399 186 -
Effect of hypothyroidism on cognitive status: Evidence from stroop task
Shilpi Goyal, Abhinav Dixit, Neelam Vaney, SV Madhu
January-March 2020, 11(1):34-39
Background: Very less work has been done in the past to assess cognition in hypothyroid patients using classical color-word Stroop task. The Stroop color-word task is a well-recognized tool which estimates cognitive inhibition. Stroop task is based on the fact that reading words and identifying color of written words are two different information and they process with a common response channel but with different speeds. The aim of this study was to assess the cognitive inhibition process in drug-naïve hypothyroid patients and their comparison with the same patients after the attainment of euthyroid status and also with euthyroid controls using classical color-word Stroop task. Materials and Methods: Thirty drug-naïve newly diagnosed hypothyroid patients were study cases who underwent Stroop task once before initiating treatment and then after the attainment of euthyroid state. We performed the same test in euthyroid controls twice at an interval of 3 months for comparison purpose. Correlation analysis was also done for hypothyroidism and cognition. Results: The reaction time of Stroop task was decreased in all the three conditions of each block, i.e., neutral, incongruent, and congruent conditions after the attainment of euthyroid state, and the finding confirms posttreatment modulation of the attention processes in hypothyroid patients. Reaction time of Stroop task in hypothyroid patients was positively correlated with the serum thyroid-stimulating hormone levels. Processing of color identification was suppressed than reading words in hypothyroid patients as evidenced by increased reaction time of Stroop task. This increase in reaction time can be reversed by earlier identification of drug-naïve hypothyroid cases so that they can get timely treatment to restore their cognitive status. Conclusions: Stroop task scores are reduced in overt hypothyroid patients, but improve after thyroid replacement therapy.
  2,420 161 -
Association of demographic and lifestyle factors with semen quality of men with fertility problems attending infertility center in North Karnataka
Makhadumsab M Toragall, Sanat K Satapathy, Girish G Kadadevaru, Murigendra B Hiremath
April-June 2019, 10(2):79-83
Background: Male factor is responsible for 50% of infertility cases. Universal deterioration in human sperm quality occurring in recent times is receiving a greater attention. The impact of numerous lifestyle factors including age, smoking, alcohol consumption, and exposure to occupational and environmental pollutants is unfavorable to male reproductive health. The present study intended to find out the association of demographic, occupational, and several lifestyle factors on semen quality of men diagnosed with infertility. Materials and Methods: The study enlisted 432 men diagnosed with fertility issue. Couples were administrated with a structured questionnaire to provide their demographic attributes and medical and reproductive health information. The collected data were statistically analyzed using SPSS software version 20.0. Results: The mean age of men was 34.44 ± 0.21 years at the time of consultation. Among seven semen abnormalities, asthenozoospermia was recorded the highest (30.09%). Most of the participants were having secondary education (32.26%), working as laborers (26.62%), and were having multiple addictions (27.77%). Decreased sperm count and motility was noticed among advanced age group and those with addictions. Different occupational statuses had substantial correlation with the sperm quality of participants. Conclusion: The incidence of male infertility and the potent lifestyle aspects studied have displayed an association with each other. However, influence of these aspects on impairment of male fertility can be overcome with modification toward healthier lifestyle.
  2,276 256 -
Assessment of economic Burden and quality of life in stable coronary artery disease patients
Lalit Kumar, Anupam Prakash, SK Gupta
January-March 2019, 10(1):26-29
Background: Coronary artery disease (CAD) is known to adversely impact the quality of life (QOL) of the patients and poses an economic burden to the family and society. However, the same has not been estimated in India. Objectives: To estimate the annual economic burden (direct and indirect cost) and QOL in stable CAD patients at a Government Tertiary Care Hospital of Delhi, India. Materials and Methods: A cross-sectional study was carried out in a Government Tertiary Care Hospital of Delhi using a convenient sample of 113 CAD patients. A prestructured pretested questionnaire was used to collect information on direct and indirect costs of therapy for CAD patients, and QOL assessment was done using SF-36 questionnaire. Results: The total average annual cost incurred by patients of stable CAD was Indian National Rupees 15691.45, of which 78.49% was attributable to direct cost (drugs, supplements, diagnostic tests, and transportation charges) while 21.5% to the indirect costs (wage loss of the patient and caretaker, during the days of hospitalization). Both the components of QOL, namely, physical component score (PCS) and mental component score (MCS) were reduced in the stable CAD patients. PCS was 35.53 and MCS was 39.16. Conclusion: CAD poses not only an economic burden on the patient, family, and the society but is also associated with impairment of QOL of the patient too.
  2,144 274 1
Effect of exercise training on dimensions of quality of life and fatigue in people with congestive heart failure class II and III: A randomized controlled trial
Ali Hasanpour-Dehkordi, Mitra Yadollahi, Shahriar Salehi Tali, Reza Ghanei Gheshlagh
January-March 2020, 11(1):15-20
Background: Improved living conditions and increased life expectancy have led to aging in societies. Increased incidence of chronic heart disease is one of the most important economic, social, and health challenges of the 21st century. Aim: This study aimed to examine the effect of exercise training on dimensions of quality of life and mental status in people with congestive heart failure Class II and III. Materials and Methods: This study was carried out on patients with chronic heart failure. For this purpose, 52 eligible patients were chosen and randomly divided into case and control groups. The participants in the case group were asked to follow an exercise program three sessions per week in the morning for 24 weeks. This exercise program comprised 5–10 min of warming, 20–30 min of exercise, and 5 min of cool-down. Data were collected by the SF-36 questionnaire and analyzed by the SPSS version 18. Results: The results revealed that there was a significant difference in the mean score of various dimensions of quality of life including NYHA functional Classes II (P = 0.032) and III (P = 0.027), fatigue, BP, and general health in Classes II (P < 0.001) and III (P = 0.021) between the two groups before and after the intervention. Conclusion: Given that exercise leads to improvement of physical functioning, role-physical, role-emotional, social functioning, mental status, general health, and lower levels of fatigue and body pain in patients with congestive heart failure, it is recommended that patients incorporate regular exercise into their daily routines.
  2,007 274 -
Non-convulsive status epilepticus presenting as acute confusional state in a young adult
BD Sharma, Amit Kumar Batra
January-March 2019, 10(1):35-38
Nonconvulsive status epilepticus (NCSE) can occur in a variety of clinical conditions and is characterized by prolonged electrographic seizures without clinically discernible seizure activity. It may be one of the most frequently missed diagnoses in patients with altered neurologic function because it is often seen in patients with other serious illnesses. For accurate diagnosis of NCSE, an alteration in baseline cognition or behavior and a concurrent epileptiform seizure pattern on electroencephalography (EEG) must be present. This case of a young adult male presented to our emergency room with an acute onset of confusional state and behavioral changes with no clue for its etiology on initial clinical or after routine investigations including CT brain until EEG picked up continuous epileptic discharges. He responded dramatically to antiepileptic drugs without any recurrence during follow-up of 4 months. Many cases like this are being diagnosed with the use of continuous EEG monitoring (cEEG) in Neurological Intensive Care Units. The advent of cEEG is instrumental in the diagnosis as well as monitoring the response to treatment of this condition with antiepileptic drugs. Increased awareness and a high index of suspicion are needed for timely diagnosis of NCSE if a patient presents with acute onset of unexplainable cognitive or behavioral change of at least 30–60 min duration. Patients with NCSE need to be managed exactly as convulsive SE, using EEG as a guide rather than clinical observations as the determinant of response to treatment.
  2,107 157 -
Global trends of clinical presentation of COVID-19
Ragini Sharma, Mradul K Daga, Govind Mawari, Vijay Kumar Karra, Naresh Kumar, Manish Kumar Jha, Suresh Kumar
April-June 2020, 11(2):59-64
Emerging and reemerging diseases pose global challenges for public health. Pneumonia of unknown origin, given the name COVID-19, began in China in December 2019. On March 11, 2020, the WHO declared it to be a pandemic. Currently, the disease is booming rapidly and impacting the well-being of people and the economy of countries globally. Observational studies have somewhat highlighted clinical findings of the disease, but there are still no decisive data about its global trends. The purpose of this review is to bring to light the huge disparities in the clinical presentation of the disease among countries. The data for this review were obtained from studies pertaining to clinical, laboratory, and imaging features obtained from various journals. It was found that occurrence of the most frequently seen features ranged as – fever (98%–35%), cough (88%–25%), dyspnea (88%–4.8%), and sore throat (61%–8%). A definite reason for this is still obscure. This calls for more conclusive studies to investigate the possible causes of these trends. This might go a long way in increasing our understanding of the disease and improve its diagnosis and treatment.
  2,009 242 1
Cardiac manifestations in dengue
Parag Viren Papalkar, Rajesh R Sarode, Sourya Acharya, Sunil Kumar
January-March 2019, 10(1):30-34
Aim: To study the prevalence of cardiac manifestations in patients of dengue fever. Settings and Design: This cross-sectional study was done in a tertiary care hospital conducted for a period of 2 years from September 2016 to October 2018. Methods: Patients with complaints of fever and suspected to have dengue were subjected to dengue serology. Confirmed cases of dengue were then classified according to the World Health Organization criteria into dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome. The assessment of cardiac manifestations was done based on electrocardiogram (ECG), echocardiogram, and cardiac marker. The data was analyzed using statistical significance tests. Results: Out of 60 patients, 36 (60%) were male and 24 (40%) were female, and the male-to-female ratio was 1.5:1. The mean age of the patients was 38 ± 16.69 years. Patients of dengue fever, DHF, and dengue shock syndrome were 51, 7, and 2 respectively. The most common ECG abnormality was sinus bradycardia seen in 9 (15%) patients, followed by sinus tachycardia in 6 (10%) and ST-T changes in 5 (8.33%). Echocardiography was normal in 54 (90%) patients, systolic dysfunction was found in 4 (6.67%) patients, and pericardial effusion was found in 2 (3.33%) patients. Eight (13.33%) patients had abnormal creatine kinase-muscle/brain values. Conclusion: Cardiac manifestations are common in dengue fever, seen in one-third of the patients. Platelet counts < 100,000/mm3 and a higher hematocrit are more likely to be associated with cardiac manifestations.
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COVID 19 and immune phenomenon in children
Anu Maheshwari, Kaveri Pandit, Virendra Kumar, Deonath Mahto
April-June 2020, 11(2):65-69
The novel coronavirus, named as severe acute respiratory syndrome (SARS)-CoV-2 has emerged as a global emergency. In December 2019, from a local outbreak in Wuhan, China, it has rapidly progressed to a global pandemic causing high morbidity and mortality exhausting all health-care facilities. COVID-19 is like any other respiratory virus but has more propensity to infect the lower parts of the respiratory system, namely bronchioles and alveoli. The innate and adaptive immune response helps the body to fight the virus. Atypical presentations such as Kawasaki disease, chilblain like lesions and other cutaneous manifestations, systemic inflammatory response syndrome-like illness (Toxic shock syndrome), Guillain–Barre syndrome, and other immune-related disorders have also been reported in various countries. Rapidly increasing cases worldwide have aroused global concerns regarding the need to understand the immunopathogenesis of the virus and possible explanations for various atypical manifestations occurring in children. This review is aimed at providing a complete understanding of the probable immune response in children and might predict future therapeutic target points.
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Correlation between nephropathy and ophthalmic complications in cases of sickle cell anemia: An entangled association
Aditi Pareek, Aditya Khandekar, Sourya Acharya, Pravin Tidake, Samarth Shukla
April-June 2019, 10(2):72-75
Background: Sickle cell disease commonly presents with unpredictable episodes of vasocclusion and pre mature RBC destruction, which manifest as acute pain and tissue ischemia. In kidneys, endothelial dysfunction occurs in the nephron leading to microalbuminuria, vaso-occlusion, ischemia, infarction, and ultimately nephron loss. Proliferative and non-proliferative retinal changes can also occur, due to similar underlying pathophysiology of vasospasm. Aims and Objectives: To study the correlation between Sickle Cell Nephropathy and Ophthalmic Complications in cases of Sickle Cell disease. Materials and Methods: Thirty five adults aged 18 to 60 years, having Sickle Cell disease were selected as study participants. Complete blood analysis was carried out, with assessment of Urine Albumin: Creatinine ratio and ophthalmic findings, studied by direct and indirect ophthalmoscopy, and slit-lamp biomicroscopy. Results: Patients were divided into two categories: Category I comprising of 7 patients who were admitted to the Medicine ICU with Crisis, and Category II comprising of 28 clinically stable patients. 5 patients from Category I (71.4%), and 2 patients from Category II (7.1%), were found to have findings of peripheral retinopathy. Category I patients had received a mean of 6.17 ± 2.14 blood transfusions, Category II patients had received 2.89 ± 1.81 transfusions, difference being statistically significant. Mean Hb in Category I patients was 6.37 ± 0.35 gm/dl, compared to 7.95 ± 0.81 gm/dl in Category II patients. The mean Urine Albumin/ Creatinine ratio of patients having Ophthalmic manifestations was found to be 286.71 ± 74.75 mg/g, while the mean Urine Albumin/ Creatinine ratio of patients with no Ophthalmic manifestations was found to be 31.82 ± 4.48 mg/g, difference being statistically significant. Conclusion: Sickle Cell nephropathy and retinopathy appear to stem as manifestations of a common underlying mechanism of sickle vasculopathy, and thus can be studied as markers for each other.
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