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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 13 | Issue 2
Page Nos. 61-174

Online since Tuesday, June 23, 2020

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EDITORIAL  

Safety of health-care workers during COVID-19 times p. 61
RB Nerli, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_119_20  
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REVIEW ARTICLES Top

Acute kidney injury in patients with COVID-19 Highly accessed article p. 64
RB Nerli, Manas Sharma, Shridhar C Ghagane, Pulkit Gupta, Shashank D Patil, M Shubhashree, Murigendra B Hiremath
DOI:10.4103/kleuhsj.kleuhsj_116_20  
INTRODUCTION: An outbreak of a coronavirus disease 2019 (COVID-19) was noted in December 2019, affecting Wuhan city, Hubei Province, in China. It soon spread to other areas across the world. It is well known that the diffuse alveolar damage and acute respiratory failure caused by the coronavirus remain the main features; however, the involvement of other organs is also noted. In this review, we have attempted to determine the prevalence of acute kidney injury (AKI) in patients with COVID-19. MATERIALS AND METHODS: We conducted a literature search for relevant research papers published till April 25, 2020, using the electronic Google Scholar and PubMed database with the following terms: COVID-19, acute kidney injury, renal failure, and outcome. RESULTS: We found 16 articles related to AKI and COVID-19 in the English language from the Google Scholar database and PubMed database. Of these, six articles from China were directly related to the AKI in patients with COVID-19. Forty-nine percent (49.7%) of the admitted patients had comorbidities. Thirty patients (2%) out of 1430 patients had chronic kidney disease before admission. A total of 139 patients (9.36%) developed AKI during hospital admission. A total of 51 patients (52%) with AKI died during the course of treatment. CONCLUSIONS: The occurrence of AKI in patients hospitalized with COVID-19 was around 9%. Coexisting chronic kidney disease and other comorbidities were risk factors for the development of AKI. AKI was associated with a higher mortality in these patients.
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Molecular description of fibroblast growth factor and mechanisms by which fibroblast growth factor-21 mediating biological actions and acting as a biologic biomarker of cardiovascular diseases p. 68
Leta Shiferaw Melaku, Negeri Debela
DOI:10.4103/kleuhsj.kleuhsj_92_20  
Fibroblast growth factor (FGF) family members are mostly secreted as signaling proteins with diverse functions in development and metabolism. FGFs can be classified as intracellular, paracrine, and endocrine FGFs by their action mechanisms. FGF-21 is a novel member of endocrine FGF subfamily with pleotropic actions. Recent findings indicate that FGF-21 can act as a cardiomyokine; that is, it is produced by cardiac cells and acts in an autocrine manner on the heart itself. The heart is sensitive to the effects of FGF-21, both systemic and locally generated, owing to the expression in cardiomyocytes of β-Klotho, the key coreceptor known to confer specific responsiveness to FGF-21 action. It has been shown to exert cardioprotective effects in against cardiac hypertrophy, myocardial infarction, cardiac inflammation, cardiac ischemia-reperfusion injury, diabetic cardiomyopathy, and oxidative stress. It also promotes energy supply to the heart through fatty acid β-oxidation. Intracellular mechanisms involving peroxisome proliferator-activated receptor α and sirtunin 1 mediate transcriptional regulation of the FGF-21 gene in response to exogenous stimuli. This review explores the molecular mechanism by which FGF-21 provides cardioprotection.
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Should the AYUSH doctors be underutilized at subhealth centers under Ayushman Bharat while they prove effective at higher facilities under National Health Mission? p. 86
Janmejaya Samal
DOI:10.4103/kleuhsj.kleuhsj_32_20  
AYUSH systems of medicine are the six different indigenous systems of medicine prevalent and practiced in India. Postindependence, these individualized and healer-based systems got government patronization and legal support and converted into medical systems and evolved with time to the present form. From being the department of Indian Systems of Medicine in March 1995 to the Department of AYUSH in 2003 and most recently the ministry of AYUSH in 2014, these systems of medicine have evolved continuously with the growing need of time. With the initiation of National Rural Health Mission in 2005 under the scheme of mainstreaming of AYUSH and revitalization of local health traditions, these systems were promoted at each level and the practitioners came out of their silo and became part of the mainstream health-care delivery system serving both rural and semi-urban communities in the country. However, with the recent AYUSHMAN BHARAT program, these practitioners, especially the Bachelor of Ayurvedic Medicine and Surgery graduates, were offered to serve at the subcenter level as the Mid-Level Health Provider which in a way demotes the cadre. This opinion discusses about this dichotomy situation with AYUSH workforce and government's “easy and soft target” attitude in utilizing AYUSH workforce.
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ORIGINAL ARTICLES Top

Evaluation of knowledge and perceptions among medical undergraduate students toward novel coronavirus (COVID-19) in Southern Haryana, India: A cross-sectional study Highly accessed article p. 91
Abhishek Singh, Ram Kumar Panika, Avinash Surana, Vikas Gupta, Pooja Goyal, Mitasha Singh
DOI:10.4103/kleuhsj.kleuhsj_120_20  
BACKGROUND: The year 2019–2020 has seen a worldwide pandemic resulting from corona virus disease 2019 (COVID-19), which can result in illnesses ranging from the common cold to severe acute respiratory syndrome. Hence, this global health crisis of COVID-19 pandemic offers a unique opportunity to investigate the level of knowledge and perceptions among undergraduate medical students. METHODS: This prospective, web-based, cross-sectional study was conducted among 392 undergraduate medical students after obtaining informed consent during April 2020 using a 28-items structured questionnaire with close ended responses based on World Health Organization course materials and was distributed using Google forms. All the tests were performed at a significance level of 5%. RESULTS: More than three-fourth (82.1%) of the participants reported that they heard about COVID-19 through news media, while only less than half of the participants (44.9%) reported government official websites as information source. Overall, the study participants' knowledge regarding COVID-19 was satisfactory. Majority of the participants (94.9%) were aware of the source of COVID-19 origin as bats. Nearly half of the participants (51.9%) strongly agreed that COVID-19 is a fatal disease. CONCLUSION: Most medical students had minimal awareness regarding the source of reliable information, with satisfactory knowledge levels, and discrepancies in the perceptions of COVID-19, thus, with adequate training and counseling undergraduate medical students via structured teaching program, most medical students can act as a potential reservoir to fill the gaps in health-care services in the hour of need.
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Audio-visual training intervention improves knowledge, skill, confidence, and performance of barefoot nurses for screening noncommunicable disease p. 98
Shankarling Mallappa Timmapur, Biswamitra Sahu, TN Sathyanarayana, Achala Gopalkrishna Pai
DOI:10.4103/kleuhsj.kleuhsj_47_20  
CONTEXT: In India, the primary health system is inadequate to screen noncommunicable diseases (NCDs) at a population level due to sub-centers being short-staffed and underequipped. Training barefoot nurses (BFNs) to screen NCD is an important strategy of task shifting. Again, there is paucity of studies exploring the effectiveness of training program using technology for training BFNs in the screening of NCDs. AIMS: The aim of the study was to assess the effectiveness of audio-visual-based training to improve knowledge, skill, confidence, and performance (number screened and completeness of data entry) of BFNs to strengthen NCD screening. SETTINGS AND DESIGN: This study was conducted at Doddaballapura taluk of Bengaluru rural district, India. A mixed-method research design was employed to assess the effectiveness of an audio-visual module for training BFNs. SUBJECTS AND METHODS: Descriptive analysis was conducted to test the effectiveness of intervention in pre- and post-intervention period. A focus group discussion was conducted to explore the facilitators and barriers to the intervention. STATISTICAL ANALYSIS USED: Statistical analysis was performed using mean knowledge score (MKS) and two-tailed t-test. Descriptive analysis was done using simple percentages. RESULTS: The MKS of BFN improved across all the six components by 15% after the introduction of the video intervention. This improvement in MKS was statistically significant. The qualitative analysis testifies the improvement in skillsets, namely, finger pricking, swab placement, blood specimen collection, and waste disposal. In addition, the BFNs experience heightened confidence in conducting these procedures. The performance of BFNs has improved the number of screening and data entry into mobile apps. CONCLUSIONS: The findings from this study suggest that audio-visual-based training of BFNs improves their knowledge, skill, confidence, and performance during the screening of NCDs. This evidence has relevance for the Indian public health system, which is struggling due to short-staffing, and is a value addition for training BFNs.
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Qualitative, quantitative, and antioxidant analysis of phytochemicals present in Cinnamomum zeylanicum species p. 105
T Sivapriya, Sheila John
DOI:10.4103/kleuhsj.kleuhsj_8_20  
BACKGROUND: Many species of cinnamon are grown throughout the world. The bark of cinnamon has been used as a traditional medicine from ancient times. Scientific proof regarding the presence of active compounds responsible for its medicinal property in Cinnamomum zeylanicum is much needed. AIM: The present study was carried out to evaluate the phytochemical properties and anti-oxidant properties of C. zeylanicum bark. MATERIALS AND METHODS: After preliminary qualitative screening, the aqueous extract of C. zeylanicum was quantitatively assessed for total phenol, flavonoid, tannin, saponin, and coumarin. The antioxidant property was evaluated by ferric reducing antioxidant power (FRAP) assay. RESULTS AND DISCUSSION: C. zeylanicum species was found to possess different amounts of phytochemicals. Among the five components, total polyphenol content was highest in the extract. The total phenol content was around 436 mg/g, followed by saponin which was found to be around 71.25 mg, the tannin content was 43.80 mg, and the amount of flavonoid was 41.92 mg. The coumarin content was 57.70 mg. Estimation of the antioxidant potential by FRAP method indicated the maximum ferric reducing antioxidant power to be 1.377 at 1000 μg. CONCLUSION: Thus, the investigation proved the presence of several active constituents and the antioxidant potential of C. zeylanicum so that it can be used as regular food for preventing and curing diseases.
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Knowledge, attitude, and practice toward dengue fever among residents in Raichur p. 112
Ashok G Mahendraker, Amal Balakrishnakurup Kovattu, Shiv Kumar
DOI:10.4103/kleuhsj.kleuhsj_28_20  
INTRODUCTION: Dengue, which is caused by any one of the four-related viruses transmitted by mosquitoes, is a leading cause of illness and death in the tropics and subtropics. OBJECTIVE: This study was designed with the objective of assessing knowledge, attitude, and practice (KAP) toward dengue fever. MATERIALS AND METHODS: The survey questionnaire on the KAP of dengue among the residents of Raichur was completed by 100 respondents. RESULTS: The average score percentage of knowledge of respondents (84.4%) regarding dengue falls into good response level under the scoring system (59%–77.35%) and that of practice of respondents (22.5%) falls into poor response level under the scoring system (0%–37.5%). Almost all the respondents (96%) had a positive attitude to bring family members who got the symptoms of dengue to see a doctor for immediate treatment-positive correlation was found between KAP of the respondents. CONCLUSION: The study concluded that the poor practice toward dengue despite good knowledge and attitude level may be due to ignorance. This points out the need for further evaluative studies to assess the reason for poor practice and also to develop strategies to improve the same.
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Preparation and development of polyherbal formulation of medicinal plants for antiarthritic activity p. 120
Supriya S Chimagave, Sunil S Jalalpure, Bhaskar K Kurangi
DOI:10.4103/kleuhsj.kleuhsj_163_19  
AIM AND OBJECTIVES: The main objective of the present research was to prepare and develop polyherbal formulation of medicinal plants such as seed coat and kernel of Terminalia chebula and Terminalia bellirica and dried fruits of Emblica officinalisand evaluate the antiarthritic activity using animal models. MATERIALS AND METHODS: Using seed coat and kernel of T. chebula and T. bellirica and dried fruits of E. officinalis, Polyherbal formulation was prepared. Further antiarthritic activity of the prepared formulation was tested in female Wistar rats, using Freund's complete adjuvant as an inducing agent. RESULTS: The antiarthritic activity of polyherbal formulation against Freund's complete adjuvant-induced paw edema shows that all the three doses 250, 500, and 750 mg/kg p.o have significant effects and markedly reduced the swelling of paw. CONCLUSION: Polyherbal formulation exerts a significant protective effect against Freund's complete adjuvant-induced paw edema in rats.
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Pharmacist-led intervention on adverse events following immunization at a tertiary care hospital: A randomized controlled study p. 127
Nagel Baptist Menezes, Shashikala Wali, Madiwalayya Shivakantayya Ganachari
DOI:10.4103/kleuhsj.kleuhsj_111_19  
CONTEXT: An adverse event following immunization (AEFI) is defined as “any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine.” Pharmacists who do not administer vaccines also have a role in promoting the importance of immunization in other ways, which include: (1) history and screening of patients, (2) patient counseling, (3) documentation, (4) formulary management, (5) administrative measures, and (6) public education and awareness. AIMS: This study aimed to assess AEFI and record and report AEFIs. SUBJECTS AND METHODS: Forty-seven individuals were screened and randomized into two groups. One group received the conventional therapy, whereas the second group received pharmacist intervention. A comparison of the two groups gives an idea of how the objectives were fulfilled. STATISTICAL ANALYSIS USED: Chi-square test and McNemar test were used for statistical analysis. RESULTS: From the 47 individuals screened, 40 were selected and divided into two groups of 20 each: intervention and control groups. Of the two groups, 67.5% and 32.5% were male and female, respectively. A wide range of vaccines were administered, of which oral polio vaccine was the most administered, and typhoid, haemophilus influenzae type b, rotavirus, and Tdap were the least administered. Fever was the most commonly recorded AEFI, and loss of appetite was the least recorded. CONCLUSION: The reporting rate of AEFI increases with the intervention of a clinical pharmacist.
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Role of sonourethrography in the evaluation of anterior urethral stricture: A 1-year hospital-based observational study p. 132
Bibi Ayesha I. Pathan, SI Neeli, DB Udoshi
DOI:10.4103/kleuhsj.kleuhsj_5_20  
CONTEXT: Urethral stricture is a pathology involving the anterior urethra. The parameters to the surgical approach are precise measurement of stricture length and spongiofibrosis. Retrograde urethrography (RGU) is considered as the gold standard investigation. Its limitations are poor definition of stricture length and the detection of spongiofibrosis. Sonourethrography (SUG) detects stricture and accurately measures length and spongiofibrosis. AIM: The aim of this study is to compare the efficacy of SUG in the evaluation of anterior urethral strictures. SETTINGS AND DESIGN: The study design involves hospital-based 1-year observational study. SUBJECTS AND METHODS: One-year prospective observational study was conducted in the Department of Radio-Diagnosis at the KLE'S Dr. Prabhakar Kore Hospital and MRC, Belagavi. Thirty patients underwent RGU and SUG. Sensitivity, specificity, positive, and negative predictive values of SUG were calculated. Unpaired t-test was used to determine the length of the anterior urethral stricture. The values were compared with RGU and intra-operative results. The percentage of patients detected to have spongiofibrosis was computed. STATISTICAL ANALYSIS USED: Mean, standard deviation, and unpaired t-test were used for statistical analysis. RESULTS: The sensitivity and specificity of sonourethrogram as compared to retrograde urethrogram was found to be 92% and 100%, respectively, with positive and negative predictive values of 100% and 71.43%, respectively. Intra-operative stricture length correlated better with SUG with the determination of spongiofibrosis being an advantage. CONCLUSION: RGU is the best imaging modality, but SUG also provides similar results with benefits such as precise measurement of stricture length and degree of spongiofibrosis.
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Jaffe's kinetic method comparison between isotope dilution mass spectrometry standardized versus nonstandardized method p. 137
Girish Konasagara Shanthaveeranna, Anitha Devanath
DOI:10.4103/kleuhsj.kleuhsj_39_20  
INTRODUCTION: Serum creatinine is estimated by several methods in different laboratories, having varying degrees of bias and imprecision, leading to different values across the laboratories with the same sample. To reduce the interlaboratory variations in creatinine assay, creatinine standardization program was established by the National Kidney Disease Education Program Laboratory Working Group and recommended that creatinine calibration should be done with material traceable to an Isotope dilution mass spectrometry (IDMS) reference measurement procedure. AIMS AND OBJECTIVE: To compare the serum creatinine estimated by CRE (calibration nonstandardized IDMS with correction factor) and CRE2 (standardized to IDMS) method. MATERIALS AND METHODS: The study was conducted in a tertiary care hospital as a part of validation of CRE2 method. Two hundred samples were selected from individuals aged between 18 and 60 years with normal serum urea, creatinine, and electrolytes based on the CRE2 method. Further, the sample is estimated for serum creatinine by CRE method on the same instrument with a correction factor (Siemens Dimension RXL with LM). Descriptive statistics and Bland–Altman analysis were used to describe the population and check for agreement between the methods. RESULTS AND CONCLUSION: The average serum creatinine by CRE and CRE2 method was 0.803 mg/dl and 0.809 mg/dl, respectively. Bland–Altman plot shows a good agreement between the methods for serum creatinine with a mean bias of − 0.01 mg/dL for serum creatinine values ranging from 0.4 to 1.4 mg/dL.
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A comparative study of psychopathology and functioning in patients of obsessive–compulsive disorder with good and poor insight from a tertiary care center in North India p. 140
Chandan Prasad, Bandna Gupta, Anil Nischal, Manu Agarwal, Shweta Singh
DOI:10.4103/kleuhsj.kleuhsj_297_19  
BACKGROUND: Degree of insight in Obsessive Compulsive Disorder (OCD) varies with different symptom dimensions of OCD and not much of studies are done in this area. There is need to study insight in more detail in patients of OCD along with psychopathology and functioning. AIMS: To study and compare Psychopathology and Functioning in Patients of Obsessive Compulsive Disorder with Good and Poor Insight. METHOD: This is a cross sectional study and 94 patients fulfilling diagnostic criteria for OCD on the basis of the ICD10-DCR were assessed on Yale- Brown obsessive compulsive scale (Y-BOCS), Dimensional Yale- Brown obsessive compulsive scale (DY-BOCS), Brown Assessment of Belief Scale (BABS) and Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS: A total of 94 patients of OCD were assessed and 76 (81 %) patient had good insight (BABS < 12) where as 18 (19%) had poor insight (BABS ≥ 12). Duration of illness (P = 0.007) and duration of untreated illness (P = 0.006) was significantly longer in poor insight group. Compulsions subscale score (P = 0.003), mean total score (P = 0.014) and SOFAS mean score (0.001) was significantly higher in poor insight. Mean score of clinical severity in dimension of aggression, sexual and religious obsession was significantly higher (P = 0.001) in good insight group. CONCLUSION: Majority of patient with predominant symptoms as aggression, sexual and religious obsessions belonged to good insight group. Patients with poor insight had higher severity of illness, longer duration of illness and duration of untreated illness.
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Comparative evaluation of antibacterial efficacy of green coffee bean extract mouthwash and chlorhexidine mouthwash against Streptococcus mutans and Lactobacilli spp. – An in vitro study p. 147
A Gowtham, Chandrashekhar M Badakar, Shivayogi M Hugar, Niraj S Gokhale, Rucha N Davalbhakta, Riddhi Joshi
DOI:10.4103/kleuhsj.kleuhsj_239_19  
INTRODUCTION: Dental caries can occur in an individual irrespective of age, which makes preventing the incidence of dental caries vital. The prevention of dental caries includes various types of oral hygiene measures. One such modality is the use of mouthwash. As chlorhexidine mouthwash causes several adverse effects, there is a need for herbal alternative. Green coffee bean extract is one such herbal alternative. AIM: The aim of this study is to compare and evaluate the antibacterial efficacy of green coffee bean extract mouthwash and chlorhexidine mouthwash against Streptococcus mutans and Lactobacilli spp. MATERIALS AND METHODS: The ethanolic extract of green coffee bean was obtained by treating it with cellulase and 30% ethanol. Minimum inhibitory concentration and minimum bactericidal concentration were obtained by the broth dilution method and culture plating method, respectively. Based on these values, 3% green coffee bean extract mouthwash was prepared, and the antibacterial efficacy against S. mutans and Lactobacilli spp. was tested using the direct contact test. The obtained data were analyzed using the Mann–Whitney U-test and Wilcoxon matched-pair test. RESULTS: Intergroup comparison using Mann–Whitney U-test showed that green coffee bean extract mouthwash is equally effective against S. mutans and Lactobacilli spp. as compared to chlorhexidine mouthwash. Wilcoxon matched-pairs test showed that the efficacy of green coffee bean extract mouthwash reduced over a period of 10, 30, and 60 min time intervals. CONCLUSION: Therefore, green coffee bean extract can be used as an alternative to chlorhexidine as mouthwash.
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Ocular manifestations in patients with diabetes with end-stage renal disease p. 155
Nagbhushan Chougule, Umesh Harakuni, Rolika Bansal, Lisa Sunny
DOI:10.4103/kleuhsj.kleuhsj_88_19  
PURPOSE: Diabetic nephropathy is the most common cause of kidney failure and end-stage kidney disease. The present study was undertaken to find ocular changes and complications associated with diabetic end-stage kidney disease. MATERIALS AND METHODS: A 1-year cross-sectional study was conducted in the department of ophthalmology at a tertiary care hospital in South India between January 2008 and December 2008 on 50 patients with diabetes mellitus undergoing renal hemodialysis. Patients were subjected to general physical examination, systemic examination, and ocular examination. Best-corrected visual acuity, intraocular pressure, and detailed examination of anterior and posterior segments were assessed. RESULTS: Male (74%) preponderance was observed, and 50% of the patients had age more than 60 years. Thirty-two (32%) of the patients had duration of renal dialysis <6 months. Twenty-six (26%) eyes had duration of vision loss within a year with duration of diabetes up to 4 years. Blurring of vision was the most important symptom noticed among the patients. Patients with decreased vision <6/24 were about 47%. Fifty-three percent of the patients had vision of 6/6–6/18. Eighty percent of the eyes had diabetic retinopathy in one or the other form. Overall ocular changes seen in patients were diabetic retinopathy (48%), hypertensive retinopathy (12%), and cataract (9%). Proliferative diabetic retinopathy was the most common (50%) cause of visual impairment. CONCLUSION: Patients with diabetic end-stage kidney diseases are at high risk of ocular morbidities. Timely screening and treatment may help to reduce the ocular morbidities in this group.
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Cross-sectional study on assessing quality of life of patients diagnosed with superficial dermatophytosis in South-West India p. 160
Bhavana Doshi, Vijaya Sajjan, BS Manjunathswamy, Anisha P Bindagi
DOI:10.4103/kleuhsj.kleuhsj_265_19  
BACKGROUND: Dermatophytosis is a common skin infection, having recurrent and persisting course because of topical steroid abuse, irregular treatment, and poor hygiene. The aim of this study was to assess the quality of life (QoL) of patients diagnosed with superficial dermatophytosis. MATERIALS AND METHODS: Patients (n = 100) diagnosed with superficial dermatophytosis were recruited in the study. A pretested, structured questionnaire was used for recording patient's details. The observing dermatologist simultaneously assessed the clinical severity of the disease. Data were collected by a single examiner and recorded in a case record pro forma. Clinically doubtful cases were included after examining samples with 10% KOH. Correlation analysis was performed between the Dermatology Life Quality Index (DLQI) score and the study variables. RESULTS: Out of 100 patients, 42 had DLQI scores with moderate effect (score 6–10). A total of 19 patients had a very large effect on QoL and four patients had DLQI scores bearing an extremely large effect on QoL. Both males and females had similar mean DLQI values. A moderate correlation was found between DLQI scores and the use of topical steroids (r = 0.0002), and a slight correlation was found between duration of the disease and DLQI scores (r = 0.006). CONCLUSION: A high prevalence of the disease was found in males, and prolonged disease duration with use of topical steroids was observed. A significant impact was found in the QoL of the patients. Hence, proper counseling and treatment, along with early detection, is needed.
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SHORT COMMUNICATIONS Top

Coronavirus disease 2019 outbreak effective containment: Need and scope of information network and risk communication p. 165
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_73_20  
Corona Virus Disease-2019 (COVID-19) outbreak continues to increase in terms of caseload and geographical distribution and the attributed deaths worldwide. Even though, the public health authorities should aim for the strengthening of all the domains, an extremely crucial element of the response plan has to be designing a risk communication system, which is in place for ensuring that correct information is delivered to the community in real-time. In order to respond to this concern, the World Health Organization has designed an information network for epidemics, which is an innovative tool and plays a defining role in ensuring the provision of trustworthy and customized information to the different sections of the community across the world. In conclusion, the ongoing COVID-19 outbreak is the biggest global public health priority and it is important to acknowledge that support from the community will be an important factor in enabling the effective containment of the outbreak. Thus, it is our responsibility to ensure that we establish a strong risk communication system and develop trust with the community by passing reliable and time-based information.
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Medical professionals: Need and role of professionalism p. 167
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_283_19  
In the field of health and patient care, no more doctors are acknowledged as healers and this has resulted predominantly because the current breed of doctors has fallen short in sustaining the high standards set by the earlier generation of doctors. If we introspect, it is us only who have to be blamed for the current trends and keeping all these facts into account, there is an urgent need to take steps to resurrect the images of doctors in the eyes of the community. It is a fact that present day students' enters the course without any priming and have limited knowledge about morals and values. The need of the hour is to adopt a combination of teaching-learning methods in a longitudinal manner to teach professional values to students in all the years of course. In conclusion, professionalism is a core competency for all the medical graduates and special attention and efforts should be taken to ensure that all students acquire the desired traits during the duration of their course and are ready and well-equipped to deal with the challenges of the medical field.
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LETTERS TO EDITOR Top

Why it is imperative to understand the psychosocial determinants of health while treating childhood asthma? p. 169
M Shuriya Prabha, V Dinesh Kumar
DOI:10.4103/kleuhsj.kleuhsj_37_20  
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The immunity boosting circus p. 171
Jessica Philip
DOI:10.4103/kleuhsj.kleuhsj_106_20  
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