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   Table of Contents - Current issue
Coverpage
September-December 2019
Volume 12 | Issue 3
Page Nos. 187-269

Online since Tuesday, October 15, 2019

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EDITORIAL  

Patient safety Highly accessed article p. 187
RB Nerli, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_178_19  
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REVIEW ARTICLES Top

Gene therapy for childhood neuromuscular and neurodegenerative disorders: An update Highly accessed article p. 189
Prateek Kumar Panda
DOI:10.4103/kleuhsj.kleuhsj_81_19  
The central nervous system is a rather complex site for gene therapy as it contains neurons, astrocytes, and oligodendrocytes, and they have discrete and intricate interconnections between them, establishing a delicate balance. However, with significant advances in scientific technology and development of new viral vectors, now, gene therapy has a greater promise for pediatric neurological disorders, especially for certain neurodegenerative diseases, which still remains to be invincible by other pharmacological modalities. Adeno-associated virus (AAV) vector is the predominant vector used for gene therapy currently. Gene editing therapy using antisense oligonucleotides has been successfully implemented in neuromuscular diseases such as dystrophinopathy and spinal muscular atrophy (SMA). Recently, an AAV-mediated gene therapy is approved by the Food and Drug Administration for SMA, and it is considered to be the most expensive drug in the world. Gene therapy for dystrophinopathy has also been safely tried in two clinical studies, although its efficacy is yet to be demonstrated. In Xlinked adrenoleukodystrophy, late infantile metachromatic leukodystrophy, late infantile neuronal ceroid lipofuscinosis and Canavan disease results of human trials are very much promising. Ongoing clinical trials in several lysosomal storage disorders such as mucopolysaccharidosis type III, Fabry disease, and Pompeii disease are currently active. In mouse models, several other neurodevelopmental disorders have also been tested successfully for gene therapy.
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Pediatric airway diseases p. 196
Santosh Kumar Swain, Jasashree Choudhury
DOI:10.4103/kleuhsj.kleuhsj_12_19  
The diseases of the pediatric airway is often challenging to the clinician. It needs a dedicated team of clinicians for evaluation and treatment. Obstructing lesions of the pediatric airway due to congenital or acquired causes often create fatal situations. Majority of the pediatric airway lesions are due to prolonged intubation or tracheostomy and prematurity. Management of the pediatric airway lesions often complicated with additional congenital malformations or severe comorbidities. It is often important for the pediatrician to understand the different pediatric airway lesions and its issues relevant to the airway management of the pediatric patients. This review article will give an overview of commonly encountered airway problems in children and its management.
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Bio-medical waste disposal in India: From paper to practice, what has been effected p. 202
S Ramesh Kumar, N Venkata Abinaya, Alaga Venkatesan, Mohan Natrajan
DOI:10.4103/kleuhsj.kleuhsj_112_19  
Bio-medical waste (BMW) disposal is a very important but challenging task. Health-care waste contains potentially harmful microorganisms, which can infect hospital patients, health workers, and the general public. Exposure to hazardous health-care waste can result in disease or injury. The Government of India has been laying down rules, namely, Bio-Medical Waste (Management and Handling) Rules, in 1998, The draft of Bio-Medical Waste (Management and Handling Rules 2011,), and recently Bio-Medical Waste Management Rules, 2016. Evidence from different parts of India show that the knowledge on BMW disposal among health-care personnel is low, and the practice of the same is not satisfactory. Strict implementation of the rules laid down is necessary and is the need of the hour.
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Multiple renal arteries in kidney transplantation p. 211
Rajendra B Nerli, K Shankar, Shridhar C Ghagane, Neeraj S Dixit
DOI:10.4103/kleuhsj.kleuhsj_318_18  
Kidney transplantation has become the preferred renal replacement therapy for patients suffering from end-stage renal disease. Today, the results of kidney transplantation have improved enormously due to advances in organ harvesting, organ preservation, surgical techniques, and last but not least immunosuppressive regimens. Renal transplantation is more cost-effective than hemodialysis and provides better quality of life. The success story of transplantation has led to significant demand for organs, which is not met by the current supply of donors be it living or deceased. Besides augmentation of the number of living kidney donation, the lack of organs is partially compensated by extended donor criteria including multiple renal arteries. This article reviews the techniques and pitfalls of arterial reconstruction during renal transplantation.
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ORIGINAL ARTICLES Top

Age-appropriate feeding practices of mothers and nutritional status of infants in an urban community in Kano State, North West Nigeria p. 215
Umma Abdulsalam Ibrahim, Amole Taiwo Gboluwaga, Zubairu Iliyasu, Mahmud Gambo Jahun
DOI:10.4103/kleuhsj.kleuhsj_47_19  
BACKGROUND: Age-appropriate infant feeding practice, a major determinant of child growth, development, and survival, remains suboptimal in many developing countries. OBJECTIVES: This study determined the mother's nutritional knowledge, infant feeding practices, nutritional status of their infant, and factors associated with infant feeding practice in an urban community in Kano State. MATERIALS AND METHODS: A cross-sectional study was conducted in selected communities in Kano Municipal, one of the urban local government areas in Kano State. Using mixed method of data collection, a semi-structured questionnaire was administered to 440 mothers and their infants, and three focus group discussions (FGDs) with ten participants in each group were conducted for mothers of infants. Anthropometric indices were used to determine the children's nutritional status. Data were analyzed using the Statistical Package for the Social Sciences statistical software (version 21), while thematic analysis was used to summarize data from the FGDs. RESULTS: Majority of the mothers (87.5%) had adequate knowledge of infant feeding practices. Few (16.8%) of the mothers breastfed exclusively, and many (82.5%) of the mothers introduced complementary foods to their infants before 6 months of age. The prevalence of wasting and stunting among infants was 38.9% and 36.4%, respectively. Educational status and antenatal care were associated with good infant feeding practices. CONCLUSION: Although majority of the caregivers had adequate knowledge of infant feeding, it was not translated to good practice, and thus, nutritional status was poor. Mothers with secondary /tertiary level of education were two times more likely to have good infant feeding practice while mothers that had ANC are four times more likely to have good infant feeding practices Efforts should be made to improve girl child education and develop sustainable strategies to improve feeding practices and nutritional status of children.
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Derivation of a new formula for the estimation of low-density lipoprotein cholesterol p. 223
Ravish Huchegowda, Rajani Kumawat, Binita Goswami, Pramod Lali, Srinivas H Gowda
DOI:10.4103/kleuhsj.kleuhsj_86_19  
BACKGROUND: Low-density lipoprotein cholesterol (LDLc) is a well-known surrogate marker to assess the cardiovascular health and risk of atherosclerosis. Due to the feasibility of calculating the LDLc from the estimated values of other subfractions of cholesterol, it has been commonly applied in resource-limited settings. However, calculated LDLc presents with a significant bias, probably due to the lack of relevance of equation in the local population. MATERIALS AND METHODS: A total of 200 samples were assessed for serum lipid profile by automated method. Parallelly, based on the values of subfractions of cholesterol obtained, an equation was derived using polynomial multiregression analysis. We also tested the ability other published equations to accurately predict the LDLc value. RESULTS: We found the best fit equation as LDLcal= (0.88 × total cholesterol) − (0.02 × triglycerides) − (0.03 × high-density lipoprotein) − 37.48. The equation performed better than most other published equations, including Friedewald's equation. It was also noted that Chen's equation had the best prediction and Ahmidi's equation performed the poorest. CONCLUSION: This study highlights a significant need for improved formulas to estimate serum LDLc based on other cholesterol parameters.
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Moisture, carbohydrate, protein, fat, calcium, and zinc content in finger, foxtail, pearl, and proso millets p. 228
KN Shankaramurthy, Manjunath S Somannavar
DOI:10.4103/kleuhsj.kleuhsj_32_19  
BACKGROUND: Millets are a group of variable small seeded grass, widely grown around the world as cereals crop. The finger millet had more moisture and calcium content. Whereas, fat content was least when compared to three other different millets. Foxtail millets had more protein content, pearl millets had more zinc and proso millets had more carbohydrate and fat content. AIM: To determine the proximate constituent and micronutrient content of finger millet, foxtail millet, pearl millet and proso millet. OBJECTIVES: To analyse the moisture, carbohydrate, fat, and protein content of finger millet, foxtail millet, pearl millet, proso millet by standard methods of AOAC. To analyse the calcium and zinc content of finger millet, foxtail millet, pearl millet, proso millet by atomic absorption spectrophotometer. MATERIALS AND METHODS: Proximate analysis of samples (moisture content, carbohydrate, protein, fat, calcium and zinc) was performed by standard methods of Association of Official Analytical Chemist (AOAC). RESULTS AND CONCLUSION: The mean values of finger millet for moisture content (12.86 ± 0.95) had highest and fat content (1.58 ± 0.36) was least. In foxtail millet protein content (12.94 ± 0.87) was highest and in pearl millet zinc content (3.29 ± 0.47) was highest. In proso millet fat content (12.80 ± 0.30) and carbohydrate content 75.06 ± 7.3) was highest when compared to the other millet. Calcium (344.45 ± 2.62) had highest in finger millet whereas pearl millet zinc content (3.29 ± 0.47) was highest when compared to the other millets. Hence, the study results can be useful for informing the people to select the different millets depending upon the nutritional needs.
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Comparative evaluation of retention and antibacterial efficacy of Compomer and Glass Hybrid Bulk Fill restorative material as a conservative adhesive restoration in children with mixed dentition: An in vivo study p. 233
Madhura V Mundada, Shivayogi M Hugar, Seema Hallikerimath, Chandrashekhar M Badkar, Rucha Davalbhakta, Sanjana P Soneta
DOI:10.4103/kleuhsj.kleuhsj_244_18  
AIM: The aim of the study is to compare and evaluate the retention and antibacterial efficacy of Compomer and Glass Hybrid Bulk Fill restorative material as a conservative adhesive restoration in children with mixed dentition. MATERIALS AND METHODS: Sixty children of age 6–12 years with mixed dentition were selected and divided into Group I – Compomer and Group II – Glass Hybrid Bulk Fill. After thorough oral prophylaxis and baseline collection of saliva, restorative treatment was carried out using the two materials. Retention of the material and salivary Streptococcus mutans count (CFU/ml of saliva) was estimated at 1 month and 3 months after restorative procedure. RESULTS: The retention rate with Glass Hybrid Bulk Fill group and Compomer group was 100%. Statistical significant reduction in salivary S. mutans colony count was seen with both the groups at both different time intervals. Maximum reduction was noted in Glass Hybrid Bulk Fill group at 3-month intervals, and gradual reduction was seen with Compomer group. CONCLUSION: Both the materials, Glass Hybrid Bulk Fill restorative material and Compomer, showed good retention. Moreover, both the materials have shown good antimicrobial activity after 3-month follow-up.
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A cross-sectional study to investigate the association between excessive smartphone use and sleep disturbances among adolescents, studying at KLE Society's Raja Lakhamagouda Science Institute, Belagavi, Karnataka, India, with a view to develop an information booklet p. 237
Sabiyah Youssouf, Sumitra L Aribenchi, Gavi Salimath
DOI:10.4103/kleuhsj.kleuhsj_76_19  
BACKGROUND: We are in the second decade of the 21st century and technology has enveloped us in such a way that it is the technological gadgets that help us to open our eyes in the morning (i.e., alarm on a smartphone or an alarm clock), and it is the same technological devices that accompany us to our bed and remain there till we close our eyes at the night. The most important and multifunctional gift that the technology has provided us is the “Smartphone,” that has impacted our lives negatively. Smartphone addiction is a new kind of health disorder that is increasing the risk of severe health problems including sleep disturbances among adolescents. OBJECTIVE OF THE STUDY: The aim of the present study was to find out the association between excessive smartphone use and sleep disturbances among adolescents. MATERIALS AND METHODS: A cross-sectional study was conducted on 150 adolescents, who were selected by nonprobability purposive sampling technique. Standardized Smartphone Addiction Scale Short-Version and Pittsburgh's Sleep Quality Index were used to assess the smartphone addiction and sleep disturbances among the participants, respectively. The correlation between smartphone addiction and sleep disturbances was found by Karl Pearson's correlation coefficient. RESULTS: The results of the study showed that majority of the participants (99 [66%]) had high smartphone addiction and minority of them (51 [34%]) had low smartphone addiction. Out of 150 participants, 80 (53.33%) showed high sleep disturbances, whereas 70 (46.67%) showed low sleep disturbances. The study findings showed a significant positive correlation (r = 0.8921) between excessive smartphone use and sleep disturbances among adolescents. CONCLUSION: The study concluded that excessive smartphone use affects both the sleep quality and sleep quantity of adolescents; moreover increased smartphone addiction leads to increased sleep disturbances among them.
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CASE REPORTS Top

Milker's nodule p. 242
Snehal Balvant Lunge, Bhavana Doshi, BS Manjunathswamy, Shashikala Mudgal
DOI:10.4103/kleuhsj.kleuhsj_11_19  
Milker's nodule is caused by a cylindrical parapoxvirus that is most commonly endemic in cattle. It affects those in close contact with animals harboring the virus. We report a 30-year-old female, milkmaid who presented with painful raised lesions over the right hand of 8-day duration. No lymphadenopathy was noted. Skin biopsy revealed epidermal hyperkeratosis, parakeratosis, and acanthosis with dense inflammatory infiltrate in the papillary dermis. The patient was treated with a course of antibiotics for the secondary infection, as there was no specific treatment for the same.
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Management of hemiplegia (pakshaghat) through Ayurveda p. 245
Prajapati Abhay, Mishra Swarnima, VG Huddar
DOI:10.4103/kleuhsj.kleuhsj_38_19  
Globally the incidence of non-communicable diseases is on the rise, drawing attention for its prevention and treatment. Hemiplegia is one amongst them, causing physical and mental instabilities. its prevalence is about 9 cases per 1000 in global population A male patient aged 38 years attending kayachikitsa OPD of AIIA, already diagnosed case of right sided hemiplegia. he took the treatment for 6 weeks. He didn't get satisfactory results so he came at AIIA. In this case there was involvement of kapha dosha along with dominancy of vaata dosha this condition is known as maarga avaranajanya. In this case because the patient taken the treatment timely and got complete relief after the total treatment duration of 68 days. the results was challenging in this case of pakshaghat after oral medication along with panchkarma treatment.
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Hyperreactio luteinalis: A clinical dilemma p. 248
Seema R Balasubramaniam, Vishrabdha R Pawar
DOI:10.4103/kleuhsj.kleuhsj_182_18  
Hyperreactio luteinalis (HL) is a pregnancy-associated benign condition with bilateral, rarely unilateral, ovarian enlargement caused by the presence of multiple cystic follicles secondary to β-human chorionic gonadotropin stimulation. Here, we report the case of a 24-year-old second gravida with a singleton pregnancy, with pregnancy-induced hypertension, who presented to the casualty with the chief complaints of headache and dizziness. The patient was later referred to the department of obstetrics and gynecology for further evaluation. On ultrasonography, a single live intrauterine pregnancy of 21-week gestation and bilateral enlarged cystic ovaries were revealed. With a clinical suspicion of ovarian tumor, bilateral oophorectomy was done, and the specimens were sent for histopathological study. On microscopy, the sections showed ovaries with numerous theca lutein cysts with hyperplasia and luteinization of the theca cells. Thus, surgical treatment is required for most of these patients. HL does not require any specific treatment except observation, unless complications occur.
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An unusual case of Bell's palsy (Ardita vata) managed through Ayurveda p. 251
Swarnima Mishra, Abhay Kumar Prajapati, Vithal G Huddar
DOI:10.4103/kleuhsj.kleuhsj_40_19  
Ardita vata presenting with palsy of one side of the face is akin to Bell's palsy or acute idiopathic lower motor neuron facial palsy. This is characterized by sudden-onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. Bell's palsy is an idiopathic, presumed immune-mediated phenomenon, possibly with an infection as the inciting event. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. A 17-year-old boy diagnosed with Ardita vata due to chronic ear infection was treated with Karpasasthyadi taila Nasya and oral Ayurvedic medicines along with two sittings of the Panchakarma procedure. The total duration of the treatment was 4 months; however, significant results observed after 1 month of treatment shown almost complete recovery without any concurrent medications. The patient suffers from the same complaint 5 years ago in the right side of his face, and for that, he took 2 years of allopathic treatment and got complete relief. This case is evidence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell's palsy) and as a proposition for further research on a greater number of patients.
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A mishap of “odd characters” disposed as tormenting obsessional ruminations in the psyche of an adolescent boy: The etiological design and empirical consideration as per Ayurveda principles Vis-a-Vis the biopsychosocial model p. 257
Govardhan Belaguli, Suhas Kumar Shetty
DOI:10.4103/kleuhsj.kleuhsj_2_19  
The present case vignette is on etiology of obsessive–compulsive disorder (OCD) in an 18-year-old boy who had developed the symptoms of apprehension with obsessive thoughts (fear of odd numbers, being a victim of any bad events) since 3 years. His complaints were manifested since his parents met with a road traffic accident. His psyche had “believed” that, because of his absence at the time of the incident and due to odd characters (which were alleged as contributor subsequent to that accident), the “mishap had occurred.” His beliefs had manifested as with the influence of “these causes – a bad event will occur.” These obsessional ruminations and fear of odd numbers gradually made him surrender to the compulsions of increased ritual belief, offering prayers to God for hour's together and frequent handwash (to please the God – not to harm him/his family and as a distress-relieving act). His Y-BOC scale score was 34 (extreme). The present manuscript offers a thought on the probable etiological factors responsible for the impairment of his psyche and the management. Our thoughts were based on the principles of Ayurveda and the domains of biopsychosocial model. His personality, age, interpersonal relationship with his parents; misperceptions of his insight, odd characters as the prime causes of the mishap; unwholesome/improper regimen of food; and the emotions which were controlled at a stressful event (accident) had triggered and manifested his feeble mind into OCD. The outcome of the present case report offers the opinion as an empirical stimulation and understanding on the pathogenesis of OCD in an adolescent boy.
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MEDICAL EDUCATION Top

Competency-based medical education and its need in the delivery of medical education in India p. 262
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_10_19  
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Need of E-learning in medical education and strategies for its implementation in medical colleges in India p. 264
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_1_19  
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LETTERS TO EDITOR Top

Is metabolic syndrome truly prevailing among 1st-year medical students of a medical college in North Karnataka, India? p. 266
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/kleuhsj.kleuhsj_153_19  
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Authors' response p. 267
Anita Teli, Vanishree Jabannavar, Isabella Adorno, G Sai Gayatri, Fillipos Lampis, Parwati Patil
DOI:10.4103/kleuhsj.kleuhsj_171_19  
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Emphasizing the critical role of feedback in competency-based medical education p. 268
V Dinesh Kumar, S S. S. N. Rajasekhar
DOI:10.4103/kleuhsj.kleuhsj_157_19  
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