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   Table of Contents - Current issue
January-June 2020
Volume 8 | Issue 1
Page Nos. 1-53

Online since Tuesday, June 30, 2020

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Bioethics: Challenges in COVID-19 pandemic Highly accessed article p. 1
AK Seth
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5-Fluorouracil-Induced hepatic perturbation: Protective potential of selenium p. 3
Elias Adikwu, Nelson Clemente Ebinyo, Anerobi Fredrick Odira
Background: Hepatotoxicity is a serious adverse effect that has characterized the therapeutic use of 5-fluorouracil (5-FU). Selenium (Se) has shown potential therapeutic benefits in animal models of some diseases. Aim: This study assessed the ability of Se to protect against hepatotoxicity induced by 5-FU in albino rats. Materials and Methods: Adult male albino rats (n = 40) were grouped and used. Group A (Control) was treated with normal saline (0.2 mL) intraperitoneally (i. p.) daily for 5 days. Group B (B1–B3) was treated with Se (0.125, 0.25, and 0.50 mg/kg i. p.) daily for 5 days, respectively. Group C was treated with 5-FU (20 mg/kg i. p.) daily for 5 days. Group D (D1–D3) was supplemented with Se (0.125, 0.25, and 0.50 mg/kg i. p) before treatment with 5-FU (20 mg/kg i. p.) daily for 5 days, respectively. After treatment, the rats were anesthetized; blood samples were collected for serum biochemical assessments. Liver was evaluated for biochemical parameters and histology. Results: Liver and serum aminotransferases, gamma-glutamyl transferase, lactate dehydrogenase, alkaline phosphatase, total bilirubin, and conjugated bilirubin levels were significantly (P < 0.001) increased in 5-FU-treated rats when compared to control. Liver glutathione peroxidase, superoxide dismutase, catalase, and glutathione levels were significantly (P < 0.001) decreased, whereas malondialdehyde levels were significantly (P < 0.001) increased in 5-FU-treated rats when compared to control. Hepatocyte necrosis occurred in 5-FU-treated rats. Nonetheless, 5-FU-induced alterations were significantly abrogated in a dose-dependent fashion in rats supplemented with Se 0.125 mg/kg (P < 0.05), 0.25 mg/kg (P < 0.01), and 0.50 mg/kg (P < 0.001) when compared to 5-FU-treated rats. Conclusion: Se may be effective against hepatotoxicity caused by 5-FU.
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The effect of vitamin C on toxic metals, antioxidant minerals, oxidative stress, and lipid profile of automobile workers p. 9
Chikaodili Nwando Obi-Ezeani, Chudi Emmanuel Dioka, Samuel Chukwuemeka Meludu, Ifeoma Joy Onuora
Context: Automobile workers (AMWs) are exposed to lots of toxic chemicals with associated adverse health consequences. The adverse health effects are mainly attributed to oxidative stress, however, antioxidant vitamins may aid in ameliorating these adverse effects. Aim: The aim of this study was to examine the effect of Vitamin C supplementation on toxic metals, antioxidant minerals, oxidative stress, and lipid profile of AMWs. Settings and Design: Twenty-nine AMWs and 30 controls aged 19–55 years were recruited for this study. Subsequently, 27 AMWs received 500 mg Vitamin C tablets daily for 2 months. Subjects and Methods: Five milliliters of fasting blood samples was collected before intervention and at 1- and 2-month intervals for biochemical analyses. Blood lead (Pb), cadmium (Cd), selenium (Se), and zinc (Zn) were analyzed using atomic absorption spectrophotometer, malondialdehyde (MDA) and total antioxidant capacity (TAC) were measured spectrophotometrically, total cholesterol (TC), high-density lipoprotein (HDL), and triglyceride (TG) were measured enzymatically, whereas MDA/TAC, low-density lipoprotein (LDL), very LDL (VLDL), and non-HDL (nHDL) were calculated. Statistical Analysis: Data were analyzed, and statistical significance was set at P < 0.05. Results: The mean levels of Pb, Cd, MDA, MDA/TAC ratio, TC, LDL, VLDL, TG, and nHDL were significantly higher, whereas Se and Zn were significantly lower in AMWs compared to controls (P < 0.05). After 2 months of supplementation, Pb and TG levels decreased significantly, whereas Se, Zn, and HDL levels increased significantly compared to their values at 1 month and baseline (P < 0.05). MDA, MDA/TAC, TC, LDL, VLDL, and nHDL decreased progressively, whereas TAC level increased progressively from baseline to 2 months of Vitamin C intake (P < 0.05). Conclusion: Vitamin C reduced blood lead and oxidative stress, improved antioxidant defense, and may modulate dyslipidemia and adverse cardiovascular outcomes in AMWs.
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Impact of irritable bowel syndrome and body mass index on mental health - A prospective cross sectional study p. 14
Arvind Bamanikar, Shivam Sharma, Bhumika Vaishnav
Introduction: Irritable bowel syndrome (IBS) is one of the most common causes of chronic diarrhea. Chronic diarrhea has substantial effect on the physical and mental health (MH) of the patient. Aims: The aim of this study was to evaluate the association between IBS with chronic diarrhea and body mass index (BMI) and effect of severity of symptoms, body weight on MH of patients with IBS. Study Design: A prospective cross-sectional study was performed on patients having diarrhea predominant IBS during September 2017–August 2019. Methods: Ninety-seven patients suffering from IBS-D as diagnosed on the basis of Rome criteria IV had were studied. The severity of symptoms in IBS-D where evaluated according to the IBS-score of symptom-severity. MH was assessed by Patient Health Questionnaire-9 questionnaire. Statistical Analysis: SPSS statistical software was used to analyze the data. ANOVA was used to analyze demographic data. Pearson correlation coefficients were used to analyze linear correlation between demographics, BMI, and MH. Multiple regression test was used in MH analysis with respect to predictive role of BMI. Impact of confounding factors was tested with respect to the gender, age, family status, educational status, severity of the symptoms, and BMI. Results considered statistically significant if P < 0.05. Results: The mean BMI was 23.9 + 5.2 kg/m2. The BMI distribution showed that 59.2% of the IBS patients were of normal weight; 29.8% had BMI more than 25 kg/m2 and 11% had BMI subnormal (P < 0.01). MH was negatively associated with both overweight and severe symptoms of IBS-D; after adjusting for age, gender, marital status, and education. Conclusion: IBS-D patients were significantly overweight or obese which was associated with severe symptoms and impaired MH.
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A Cross-sectional study on screening for knee osteoarthritis and associated factors in a rural area of India p. 19
Lakshmi Venkata Simhachalam Kutikuppala, K Vani Madhavi, MV Sathvika
Background: Osteoarthritis (OA) is a degenerative disease that worsens over time after fourth decade of life. It accounts for the decrease in activities of daily living in the elderly population. Hence, early diagnosis and treatment are essential to increase the quality of life. Objectives: The objective is to identify the high risk people for OA in a rural area and to find out the significant factors associated to OA among the rural population. Materials and Methods: Cross-sectional study among rural population with a convenient sample size of 100 in which 50 were male and 50 were female. Institutional ethics committee approval was taken. Informed written consent was obtained from the participants. Data collection procedure employed was Western Ontario and McMaster Universities (WOMAC) OA index. Statistical analysis was done by Epi-info statistical software package version 3.5.4 for data analysis. Results: According to WOMAC Index 38% of the subjects belonged to high risk and 62% belonged to low risk. Age group, gender, and family history were significantly associated with these scores. Conclusion: In a resource poor setting, questionnaire-based tool to detect high risk individuals for OA at an early stage is useful in reducing the morbidity.
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Ofloxacin-induced fixed drug eruptions p. 22
Kushalkumar H Gohel, Kusum V Shah, Shivani Patel, Juliet Joy Joseph, Jilce Mathew
Fixed drug eruption (FDE) is a form of drug induced dermatosis condition. Drugs which most commonly induce FDE are antibiotics, anticonvulsants, antiviral agents and even nonsteroidal anti-inflammatory drugs. Here, we report a case of 50-year-old male with history of hepatosplenomegaly for which he was treated at a regional hospital and was prescribed with tablet ofloxacin (200 mg). The patient visited the pulmonary medicine department of our hospital for respiratory complaints and a dermatological reference was made for skin lesions. The findings concluded the case as a drug-induced FDE with pulmonary tuberculosis (TB). The offending drug (tablet ofloxacin) was withdrawn and suitable treatment was provided for FDE and pulmonary TB. One-month follow-up visit reported no fresh respiratory complaints and resolution of skin lesions. Based on this case report, it can be concluded that though FDE is not a common ADR of ofloxacin, caution must be addressed before prescribing it to the patient. For confirmed cases, it is essential to provide education and counseling to the patient and care giver to prevent its recurrence in future.
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Phonetic rehabilitation by speech therapy following lingual frenectomy p. 25
Priya Gopal Shetty, Ramya R Iyer
A patient named Miss. Ayesha Saiyad, 18-year-old female, reported to the Department of Public Health Dentistry after undergoing lingual frenectomy for ankyloglossia, in the Department of Periodontics. As she was tutoring school students, she wanted improved clarity of her speech. Through postfrenectomy speech therapy sessions, we aimed to rehabilitate the patient's phonetics and improve her confidence in performing her work. Speech therapy sessions included counseling, motivation for improved speech outcomes and exercises to improve the range of the tongue movements. In the first visit, after recording the chief complaint and speech assessment it was noted that the patient's speech was comprehensible. However, problems were observed during production of speech sounds such as/l/,/ll/,/th/,/tha/ and/r/. The patient was diagnosed with a phonetic articulation disorder. Subsequently, the patient was advised to undergo speech therapy sessions. The counseling session was carried out and tongue protrusion and elevation exercises were demonstrated with the aid of the mirror. The patient was advised to practice the same at home. The patient was recalled after 1 week. Counseling was given and tongue elevation exercise holding water in the tongue was taught to the patient. While exercise and rolling of tongue were taught to improve tongue mobility. There was an improvement in tongue protrusion by 2 mm postspeech therapy. The patient was able to touch the palate with her tongue with mouth open, postspeech therapy. There was improvement in production of speech sounds/l/,/ll/,/th/,/tha/ and/r/. The patient's speech significantly improved after speech therapy.
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“Quarantine”: An unparalleled and pragmatic weapon in the prevention of infectious diseases p. 29
Hetal Pandya, Pradeep Sareddy
In the 21st century, the risk for deadly infectious diseases with pandemic potential (e.g., severe acute respiratory syndrome [SARS]) is increasing worldwide with the current pandemic, COVID-19 infecting populations across almost all the countries in the world. In response to the emerging and reemerging infectious diseases as well as acts of biological terrorism, the centuries-old strategy of quarantine is becoming a powerful component of the public health. We made an extensive review of relevant articles from various search engines. During the 2003 pandemic of SARS, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. In a globalized world which is becoming ever more vulnerable to communicable diseases, a historical perspective can help to clarify the use and implications of a still-valid public health strategy. The historiographer and the experts of public health did not give much attention to isolating the movement and barter of goods or people on land or sea to contain a contagious disease. Yet, a historical perspective of quarantine can contribute to a better understanding of its effectiveness in enclosing current pandemic like COVID-19.
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Diagnostic modalities used for celiac disease: Advancements and future prospects p. 34
Moni Kumari, Malika Arora, Navdeep Kaur, Ranjit Singh, Parveen Bansal
Celiac disease (CD) is an autoimmune disorder that occurs generally in genetically predisposed individuals due to the ingestion of gluten and related proteins. Initially, the occurrence was reported only in few of the countries, specifically in predominant Caucasian populations, but nowadays, it is being reported from almost all parts of the world. The increased prevalence rate of CD worldwide is because of an increase in awareness and detection of the disease due to advancements in diagnostic modalities which were not available in earlier times. As per current scenario, the clinical demonstration of the disease vary greatly due to multiple and varying symptoms; hence, there is a great difficulty in designing of specific and sensitive diagnostic tests. All the available diagnostic tools are invasive in nature leading to increased patient compliance. Serological (antigliadin antibody, EMA, transglutaminase immunoglobulin A, and deamidated gliadin peptide) test results always need to be verified by biopsy test in order to confirm the disease. A step-by-step diagnostic approach should always be followed by the doctors as well as patients for proper diagnosis and management of the disease. Keeping the scarcity of patient-friendly, specific, and sensitive diagnostic tools in mind, the present manuscript has been compiled to highlight different diagnostic modalities to enable coeliac disease scientists to find out and develop novel diagnostic techniques for this disease. In addition, the article also highlights the advancements in the development of new techniques over advantages and disadvantages of existing techniques.
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Corona virus disease 2019 pandemic containment: Utilizing the opportunity of staying at home for better parenting p. 43
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
The pandemic of Corona Virus Disease-2019 (COVID-19) has affected almost all sections of the community and compelled them to bring about alterations in their daily routine. Moreover, owing to the available epidemiological trends which suggest that most of the affected nations have reported a rapid upsurge in their caseload, the national leaders have been forced to implement restrictions. However, the good thing about these restrictions is that they have brought down both parents and children in the home for a longer period of time. In other words, the outbreak has given time for the parents to use it constructively for their benefit and also enjoy their stay at home. In conclusion, the COVID-19 pandemic has indirectly created multiple opportunities, wherein parents can understand their children better and utilize the available time for creating awareness about the disease and inculcation of healthy habits among their children, which can significantly reduce the risk of disease transmission.
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Utilizing the foundation course period for sensitizing medical graduates about writing rational prescriptions p. 45
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
It won't be wrong to say that patients trust their doctors that they can cure them of their illnesses and will take steps to ensure their well-being, with majority of them not being aware about the impact of a pharmaceutical industry on medical practice. The attitude of a medical professional towards the pharmaceutical industry can form quite early in their medical training, keeping the fact that they are exposed to an informal curriculum from their teachers or even peers. The students have to be sensitized about all this throughout their medical under-graduation period and the best place to initiate this in the Foundation Course itself. Similar things can be dealt again as a part of the Early Clinical Exposure sessions, AETCOM sessions, during clinical postings and during the internship. In conclusion, in order to stop the practice of irrational prescriptions, the undergraduate students should be trained to deal with the pharmaceutical industries within their curriculum across the entire duration, so that they are empowered enough to not get unduly influenced by the industry.
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Making a case for the usefulness of the traditional curriculum in indian settings p. 47
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
In the field of delivery of medical education in India, the adoption of Competency Based Medical Education (CBME) has been regarded as one of the most important landmarks in the timeline of the profession. Even though, we have shifted altogether to CBME, it is not right to consider that there were no positive attributes which were linked with traditional curriculum. We have to accept that CBME is a resource-intensive program in comparison to the traditional curriculum and thus in order to ensure its successful implementation, we have to adopt the better components of traditional curriculum and improve the assessment process as a whole. In conclusion, the traditional curriculum in medical education has played a very crucial role in the making of a wide range of specialists and doctors for prolonged durations. Although, some important attributes of a medical professional were not given much attention, we have to accept the fact that it was very much required for the successful launch and implementation of Competency-Based Medical Education in the nation.
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Indispensable need to involve multiple stakeholders to ensure global food safety: World Health Organization p. 49
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
Feedback has been identified as an approach to provide information about students' performance in order to help and guide them in planning for the attainment of the learning goals and to improve their behavior and skills. However, it is important to understand that the mere provision of feedback won't meet the purpose of closing the feedback gap and it has to be supplemented with follow-up actions and evaluation of the entire process of feedback to measure the change in behavior. It is quite essential to understand that in order to ensure that the process of evaluation of feedback remains effective and meets the intended objectives, it has to be planned in a systematic manner and that too well in advance. In conclusion, evaluation of feedback has to be a continuous process and the criteria for the same has to be explicitly defined for better planning and corrective measures based on the obtained results.
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An unusual/varied presentation of two cases of tuberculous meningitis p. 51
Mahmood Dhahir Al-Mendalawi
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Best weapon to fight COVID-19-like pandemic – Its host factors of epidemiological triad p. 52
Niraj Pandit, Ajay George Akkara
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