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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 7 | Issue 2
Page Nos. 33-80

Online since Thursday, January 2, 2020

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EDITORIAL  

Evidence-based health care: Let's embrace the good p. 33
Arti P Muley, JD Lakhani
DOI:10.4103/JIHS.JIHS_46_19  
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ORIGINAL ARTICLES Top

Influence of petroleum product exposure on serum micronutrient concentrations in automobile mechanics p. 35
Ayobola A Iyanda
DOI:10.4103/JIHS.JIHS_8_19  
Background Aim of the Study: Occupation-related pathological presentations have been recognized in automobile mechanics, several of which are oxidative stress-induced. Altered micronutrient levels can help in predicting the possibility of oxidative stress-related diseases. It is for this reason that micronutrient levels are being assessed in auto mechanics. Materials and Methods: Questionnaire was administered to obtain information on workers' safety assessment, lifestyle choices, and work experience. Estimation of micronutrient levels was carried out on sera of 80 adult males, 40 of whom were auto mechanics and the other 40 constituted the control group. Essential trace elements (Zn, Cu, Se, Mn, Co, Fe, Mo, and Cr) and vitamins (Vitamins A, B6, C, D, and E, thiamine, riboflavin, niacin, and folic acid) were determined using atomic absorption spectrometry and high-performance liquid chromatography, respectively. Student's t-test was utilized to establish a significant difference between test and control groups. P ≤ 0.05 was considered statistically significant. Results: Micronutrients with antioxidant attributes such as Zn, Cu, Mn, Se, Vitamin E, and ascorbic acid were significantly reduced compared with controls. Data obtained from an administered questionnaire showed that there were no conscious efforts or program to ensure the safety of the mechanics. Conclusions: Auto mechanics are prone to altered serum micronutrient levels.
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Time management among undergraduate medical students: A study from a tertiary health-care teaching institution in Puducherry p. 39
Bijaya Nanda Naik, Surendar Rangasamy, HN Vrushabhendra
DOI:10.4103/JIHS.JIHS_36_19  
Background: Time is a nonrenewable resource and effective time management is the key to better academic performance. Objective: To assess the time management skills of undergraduate medical students of a tertiary care health instituMethodology: This cross-sectional study was conducted among 243 undergraduate medical students of a tertiary healthcare institution in Puducherry. The time management skill was assessed using a time management questionnaire (TMQ) which has 18 items in 5-point Likert scales. A score of ≥58 on TMQ was considered as good time management skill. Results: The mean (standard deviation) of the TMQ score was 52.7 (9.8) overall, and 18.2 (5.8), 19.4, (3.5) and 15.1 (3.4), respectively in short-range planning, time attitude, and long-range planning domains. More than two-third of the students were found to have poor to average time management skills. Students with high readiness for self-directed learning were found to have significantly higher TMQ score [55.7(9.9) Vs 50.1 (8.9), P=0.000]. Conclusion: Majority of the students possess poor to average time management skills. Further study relating time management with academic performance may be conducted and counseling/workshops should be organized for students to improve their time management skills.
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Analysis of creatinine clearance in patients on antimicrobial and analgesic therapy p. 44
S Priestly Vivekkumar, Arvinth Arthanareeswaran, E Sathya Suganya, Anirudha Sathya Narayanan
DOI:10.4103/JIHS.JIHS_3_19  
Background: Nephrotoxicity has become increasingly common due to indiscriminate use of drugs. Analgesic nephropathy is a unique drug-induced kidney disease which is characterized by renal papillary necrosis and interstitial nephritis resulting from prolonged excessive consumption of combination antipyretic analgesics. This study was done to assess the renal work load in hospitalized patients taking analgesics and antimicrobial medication by creatinine clearance and to find their consequences. Aim and Objectives: (1) To determine the proportion of participants having altered creatinine clearance. (2) To compare the creatinine clearance among the hospitalised patients on treatment with antimicrobials and analgesics. Materials and Methods: It was a cross sectional observational study in which 1200 patients were enrolled, divided into 2 groups, with Group A: Comprising of those under antibiotic treatment; with Group B: Comprising of those under analgesic treatment. Creatinine clearance was calculated by Modification of Diet in Renal Disease (MDRD) equation and CKD-EPI equation. Observation and Results: On analyzing the drugs causing renal impairment out of 1200 participants, it was found that among analgesics diclofenac (52%) and among antibiotics, aminoglycosides (61%), were more commonly resulting in renal dysfunction. Conclusion: According to the present study, it is clear that precaution has to be taken before initiating antimicrobials and analgesic therapy, as they are often nephrotoxic.
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Dimensions of emotional intelligence of doctors in a tertiary care centre in kerala p. 48
Safa Puliyakkadi, Swathi Chalil, Ruth Abraham, JP Dipin, Ashwin Raj, Sona Dayan
DOI:10.4103/JIHS.JIHS_32_19  
Background: Emotional intelligence (EI) has been defined as “the ability to monitor one's own and other people's emotions, to discriminate between different emotions and label them appropriately, and to use emotional information to guide thinking and behaviour.” This study was taken up to evaluate EI of doctors which plays a pivotal role in doctor–patient relationship.Objectives: The aim of the study was to study the dimensions of EI of doctors in a tertiary care center in Kerala and to find the association between the EI and its dimensions with the sociodemographic variables. Materials and Methods: The cross-sectional study was conducted among doctors in Government Medical College, Thrissur district. The Schutte Self-report Emotional Intelligence Test Scale was used among 70 participants. The total score of the scale ranges from 33 to 165. Selected sociodemographic profile of the participants and the four dimensions of EI were studied. Results: The total EI score obtained was 116.08 ± 14.76, with 95% confidence interval (112.62, 119.53). Nine (12.9%) had good EI, 51 (72.9%) had average EI, while 10 (14.3%) had poor EI. The senior faculty had a higher total EI score as compared to junior residents and interns (P = 0.04). This was the same in the dimension of managing own emotion (P = 0.01). Doctors from the nonclinical department had higher total EI score compared to doctors from the clinical department (P = 0.01). Conclusion: Although the mean total EI score is in bagreeable limits, 10 (14.3%) of the doctors had poor EI, which warrants immediate attention.
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Evidence-based education system: Self-reflection and a case study from an undergraduate medical student of Sumandeep Vidyapeeth p. 52
Harsh S Dave, Som J Lakhani, Jay Rajeshkumar Patwa, Niraj Pandit
DOI:10.4103/JIHS.JIHS_23_19  
Prologue: Evidence-based medicine is a medical technological advancement which promulgates decision-making for the care of individual patient which is scientific, proven, evidence-based, recent, and rational. This is possible because of the advancement in information generation and dissemination technology. Aim and Objective: The aim of the study was to generate evidence; this learning experience is presented. This research article is a case study and self-reflection of my experiences which has evolved in the stepwise fashion of my learning experience through a system of Evidence-based Education System (EBES). Methodology: Qualitative as well as quantitative assessment of EBES is done by sharing my experience, as a medical student of the past 4 years at Sumandeep Vidyapeeth deemed to be University. A detail examination of the system, the role of the teacher/facilitator, and its components are studied and presented. Results: It was a difficult concept for a novice; however, overtime, I started solving jigsaw puzzle inform of grasping medical concepts better. My concept of textbook and class room learning was metamorphosed in additional learning in the form of problem-based learning and raising a query for better understanding. I started understanding classroom lectures better when certain terms were used by the medical teacher such as “RCT,” “PICO analysis,” “Meta-analysis,” “Level of evidence,” “Class of recommendation,” and “Cochrane review”. Conclusion: EBES is a novel system which encompasses a vista of principles of evidences in the whole teaching–learning process which is interwoven in the curriculum in a manner which has benefited me and also will benefit other medical students.
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CASE REPORTS Top

An outbreak of acute viral myositis with different outcomes: A case series p. 56
Divya Goel, Arvind Vyas, Naveen Seervi
DOI:10.4103/JIHS.JIHS_40_19  
Viral myositis is induced by direct muscle invasion, molecular mimicry, production of immune complexes, immune dysregulation, and various other mechanisms. The pathogenesis of this entity is still unclear. Here, we report a case series of viral myositis with varied clinical presentations who had different outcomes ranging from complete recovery to death. To report a variety of clinical and laboratory presentation of an outbreak of viral myositis. This was a case series of seven patients, describing clinical, electrophysiological, and laboratory tests and histopathology and treatment results. The study showed a benign course in 2, recurrence in 1, fulminant necrotizing myositis in 4, and coexisting Guillain–Barre syndrome in 2 with 1 patient culminating to death in the latter group. The variability in outcome of viral myositis suggests that there are some genetic factors which lead to fulminant necrotizing myositis in contrast to the patients experiencing a benign course of myositis.
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Postinfectious (Varicella Zoster) myositis and mixed polyneuropathy p. 61
Arti Muley, Palak Rajendra Doshi, Sunil Kumar, Sukhaswarup Kanojiya, Mrugal Vipul Doshi, Kinjal Patel
DOI:10.4103/JIHS.JIHS_29_19  
We present a case of a 21-year-old male with weakness of all four limbs after primary episode of chicken pox. Nerve conduction studies and magnetic resonance imaging dorsal spine with whole spine and brain screening confirmed polyneuropathy and myositis, respectively. He responded well to intravenous steroids, with complete reversal of symptoms. This case shows that primary varicella zoster infection is a sufficient stimulus to drive antibody generation and precipitate clinical complications.
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A case of bilateral internal carotid artery complete occlusion p. 65
Mrugal Doshi, Arti Muley, Sunil Kumar, Sukhaswarup Kanojiya
DOI:10.4103/JIHS.JIHS_28_19  
Complete bilateral intracranial internal carotid artery occlusion is a rare disease with grave prognosis. It may cause recurrent stroke and extensive disability. We discuss a case of 62-year-old man who presented with sudden onset right sided hemiplegia, and GCS 7/15. CT scan revealed acute ischemic infarct in left MCA territory with mass effect and compression over the left lateral and third ventricle. Cerebral angiography showed bilateral intracranial internal carotid artery and middle cerebral artery occlusion. We present the case in view of wide range of presentation which depends on collateral formation and lack of specific guidelines for management.
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An unusual/varied presentation of two cases of tuberculous meningitis p. 69
Meera Praful Shah, Jitendra D Lakhani, Kinjal Satish Patel, Vivek N Vaswani
DOI:10.4103/JIHS.JIHS_26_19  
Tuberculosis (TB) in India has varied presentation which may manifest as pulmonary as well as extrapulmonary disease leading to difficult diagnosis. Here is the presentation of two cases of tuberculous meningitis (TBM). The first case was of a 35-year-old female having cortical paraparesis along with IX and X cranial nerve palsy. Magnetic resonance imaging of the brain with contrast showed multiple ring-enhancing lesions suggestive of TBM. The second case was of a 17-year-old female with anemia, hyponatremia, and hypochloremia having disseminated TB in the lungs, abdomen, and meninges. TBM presentation maybe varied and may present with disseminated TB.
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Dental calculus – An evergrowing heap of periodontal pathogens p. 73
Kevin Saraiya, Prasad Nadig, Monali Shah, Deepak Dave
DOI:10.4103/JIHS.JIHS_21_19  
Dental calculus is defined as an adherent, calcified, or calcifying mass that forms on the surface of teeth and dental appliances. Calculus plays a key role in maintaining and accentuating periodontal disease by withholding the plaque in close contact with the tooth surface and gingival tissue, leading to various pathological changes, thereby creating areas where plaque removal is impossible. The distribution of calculus is very versatile and it differs from individual to individual, from tooth to tooth, and from surface to surface. At certain period of time, the maximum level of calculus formation occurs after which a reversal phenomenon takes place, in reversal phenomenon is the decline from maximal calculus accumulation. This case report describes a case of patient with extensive calculus deposits.
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LETTERS TO EDITOR Top

The use of explanatory model interview catalog in mental illness research p. 75
Chittaranjan Subudhi
DOI:10.4103/JIHS.JIHS_14_19  
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Exploring the role of health workforce in the attainment of the universal health coverage p. 77
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/JIHS.JIHS_31_19  
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Advocating essential nutrition actions for reduction in malnutrition: World health organization p. 78
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/JIHS.JIHS_39_19  
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REVIEWERS, 2019 Top

Reviewers, 2019 p. 80
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