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   Table of Contents - Current issue
Coverpage
January-April 2019
Volume 12 | Issue 1
Page Nos. 1-98

Online since Friday, January 18, 2019

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EDITORIAL  

Trauma center is the need of the hour p. 1
RB Nerli, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_313_18  
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REVIEW ARTICLES Top

Do noise stress impact to addiction? p. 3
Sundareswaran Lognathan, Arbind Kumar Choudhary, Kuppusamy Mahesh Kumar
DOI:10.4103/kleuhsj.kleuhsj_170_18  
Numerous studies have illustrated the impact of stress on addiction, its development, relapse vulnerability, and the dopamine mechanism. However, various studies on noise exposures as a stressor had been done, which could alter the hypothalamic–pituitary–adrenal (HPA) axis. Noise exposure harmful effect and changes in the individual's health was at least consideration and were less noticed. This review elucidates the facts and consequences of noise exposure toward mesolimbic dopamine circuitry perceptible in addiction. Further, this review generates greater attention and awareness among people toward noise exposure influence on addiction and its relation with dopamine. The noise stress may act as a synergistic influence or augments effect on dopamine level in the synapse of an addicted or initial stage of addicted individual through the corticosterone through HPA axis. The combined effects of multiple stressors (physical, chemical, biological, social and mental etc.) have greater impact than simply the individual stressors. The elevated corticosterone level in noise exposure in turn inhibits the transporter involved in dopamine uptake and further enhance the dopamine level within the synapse of reward circuit may enhance the vulnerability of relapse in addiction. The significance of noise exposure as a stress and other mild stressors influence effect on addiction and psychiatric disorders need to be focused. Strict law-making measures need to be enforced to control and prevent the individual and combined effect of noise stress with other stressors on health.
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Predatory journals: A threat to evidence-based science p. 12
Mamta Choudhary, Nancy Kurien
DOI:10.4103/kleuhsj.kleuhsj_146_18  
One of the latest threats emerged to the integrity of academic publishing is predatory journals. These journals have paved the way for low-quality articles by exploiting gold open-access publishing, threatening standards of evidence-based science. These journals lack the authentication of legitimate scholarly journals such as peer review, editing, editorial boards, editorial offices, and other editorial standards, imposing a number of new ethical issues in publishing research papers. Some of these claim to assess submissions within 72 h and digitally publish them on acceptance and receipt of the fee, showing their only motivation of procurement of evaluation and publication fees. While many of the predatory publications can be easily recognized as such by most in their respective professions, some present them as highly sophisticated and operate websites that mirror prominent mainstream journals. Even experienced professionals sometimes fail to recognize these dubious journals and join the editorial boards of these journals or submit articles, posing a big threat to publication standards and ethics. It is the utmost need of authors, i.e., scientific authors have ample opportunities for publicizing their research. However, they have to selectively target journals and publish in compliance with the established norms of publishing ethics.
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An empirical understanding on the concept of Sattvavajaya Chikitsa (Ayurveda Psychotherapy) and a mini-review of its research update p. 15
Govardhan Belaguli, HP Savitha
DOI:10.4103/kleuhsj.kleuhsj_175_18  
Sattvavajaya Chikitsa (SC) (Ayurveda Psychotherapy) is one among the brainchild concepts of Acharya Charaka (father of Indian medicine). In Ayurveda, SC is considered to be having the psychospiritual approach with a nonpharmacological treatment modality which solely deals on the mind and its related attributes. SC has 5 methodology, 2 principles, 3 dimensions, 3 psychotherapeutic domains, and 5 techniques. This psychotherapy helps in controlling Manas (mind) away from Ahita Artha (distractible, unwholesome objects/thoughts/perceptions). Withdrawal of the bothered mind from unwholesome objects is the prime focus of SC. Mainly focusing on the intelligence, consciousness, memory, and spiritual aspects of the affected individuals, SC aims at stimulating consciousness, altering, and discriminating the maladaptive thoughts/actions. Thus, it helps in managing psychiatric, psychological, and psychosomatic ailments. The present review article throws light on the detailed descriptions of basic doctrines of SC concept and also offers a brief note on its contemporary relevance, recent insights, and applied clinical facets. The paper reports the researches, reviews, and studies on SC encompassing nonpharmacological nootropic efficacy.
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ORIGINAL ARTICLES Top

Assessment of implementation of the national programme for the prevention and control of cancer, diabetes, cardiovascular diseases, and stroke at subcenters of Belagavi taluka: A cross-sectional study p. 21
Vinayak H Kashyap, MS Shivaswamy
DOI:10.4103/kleuhsj.kleuhsj_232_18  
CONTEXT: Mortality due to noncommunicable diseases (NCDs) has increased worldwide and, according to the World Health Organization report in 2012, 68% of mortality was due to NCDs. In India, deaths due to NCDs in 2008 were 5.3 million. A rapid health transition is being experienced in India with a rising burden of NCDs. The first point of contact of patients with health services is primary health-care (PHC) facilities, which are the most appropriate places for patient screening and early detection. The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) was launched in 2010 in India and in Belagavi district on September 29, 2015. Periodic evaluation helps to understand the problems a program is facing in managing and implementing so that appropriate modifications can be suggested. AIMS: To assess the implementation of NPCDCS at subcenters of Belagavi taluka. SETTINGS AND DESIGN: A cross-sectional study was conducted in Belagavi taluka of Belagavi district, Karnataka, from January 1, 2017, to December 31, 2017. SUBJECTS AND METHODS: The list of PHC centers and subcenters was obtained from the District Health Office, Belagavi. Simple random sampling method was used, and three subcenters from each of the 12 PHCs in Belagavi taluka were selected, accounting to 36 subcenters. Permission from the medical officer at the PHC was obtained, the concerned auxiliary nurse midwives (ANMs) of the selected subcenters in Belagavi taluka were contacted, written informed consent was obtained from all the participants, and the data were collected using a pretested, predesigned structured questionnaire based on personal interview by the investigator. STATISTICAL ANALYSIS USED: Rates, ratios, and percentages were calculated. RESULTS: The selected 36 subcenters in Belagavi taluka covered a population of 248,753, with a mean subcenter population of 6909. Nearly 63% of the subcenters were conducting the NCD camps weekly, with average number of NCD camps conducted per subcenter being 30/year, and the population screened for NCDs across all 36 subcenters was 64,096 accounting to 25.77% coverage. The prevalence of diabetes was found to be 4.87%, and the prevalence of hypertension was found to be 4.99% and, among the screened population, 69% of the ANMs had received training regarding NPCDCS and all the necessary equipment were adequate except for referral cards. CONCLUSIONS: NCD screening camps were being conducted at all subcenters and only 69% of ANMs had received training for NPCDCS and the necessary equipment and Information, Education and Communication materials were available at all selected subcenters for conduction of NCD camps.
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Excessive gestational weight retention and weight gain in postpartum: Perception of women p. 28
Thilagavathy Ganapathy
DOI:10.4103/kleuhsj.kleuhsj_150_18  
CONTEXT: Childbearing women are the second victims for significant gestational weight retention and weight gain during reproductive years. There may be unique reasons to weight management in this period. AIM: To explore what women perceive as reasons for their excessive gestational weight retention and weight gain in the postpartum period. METHODS: By purposive sampling, n = 200 low-risk postnatal women less than a year of postpartum were recruited and their perceived reasons for excessive gestational weight retention and weight gain in the postpartum period were assessed. RESULTS: Participants perceived lowered physical activity, sedentary lifestyle behavior, lack of knowledge, misconceptions that breastfeeding automatically leads to weight loss, and high caloric intake as the reasons for gestational weight retention and gain in the postpartum period. Misconceptions that weight gain is predetermined by genetic factors, lack of support, and use of eating for physical and psychological comfort were also claimed as reasons for weight gain in the postpartum period. CONCLUSION: Reproductive health professionals should devise preventive measures to raise awareness on risks associated with unhealthy gestational weight retention and weight gain among average, overweight, and obese women in the postpartum period.
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Design, synthesis, and biological evaluation of novel diclofenac analogs as promising anti-inflammatory agents p. 35
Manjula K Chikkamath, Girish A Hampannavar, Mahesh B Palkar
DOI:10.4103/kleuhsj.kleuhsj_151_18  
INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used as analgesics and antipyretics in the treatment of pain, fever, and rheumatoid arthritis. Major side effect with treatment of NSAIDs is gastric irritation. 1,3,4-thiadiazole is an imperative scaffold since several of these derivatives are known to be associated with multiple biological activities such as anti-inflammatory, antibacterial, anti-cancer, anti-tubercular, and immunosuppressive. Literature survey reveals that certain compounds bearing this nucleus possess significant anti-inflammatory activity with reduced ulcerogenic effect. MATERIALS AND METHODS: In the present research work, we have synthesized thirteen 2-(2-[2,6-dichlorophenylamino] phenyl) acetohydrazide derivatives (4a–4m) and four 2,6-dichloro-N-(2-[6-phenylimidazo[2,1-b][1,3,4]thiadiazol-yl] methyl] phenyl) benzenamine derivatives (6a–6d) derived from diclofenac. All these newly synthesized compounds were screened for in vivo acute anti-inflammatory activity by carrageenan-induced rat paw edema method at a dose of 10 mg/kg bw. RESULTS AND DISCUSSION: Structures of these novel compounds were characterized based on their physicochemical and spectral analysis. Perusal of the activity data strongly suggests that compound 4d was most promising with significant anti-inflammatory activity, while moderate to good activity was observed for compounds 4a, 4c, g, 4i, and 4l. Among the imidazo (2,1-b) 1,3,4-thiadiazole series (6a–6d), compound 6b exhibited excellent anti-inflammatory activity, while compounds 6a, 6c and 6d displayed reasonably to good anti-inflammatory activity as compared to standard drug diclofenac. CONCLUSION: Among the series of synthesized compounds, two derivatives (4d and 6b) have displayed the most encouraging results and could be further exploited for developing newer anti-inflammatory agents with better efficacy and safety, which necessitates further investigations.
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Evaluation of effect of kalyanaka kshara in vibandha with special reference to constipation: An open clinical trial p. 44
Shubham Brajesh Gupta, Pradeep S Shindhe, RR Hiremath
DOI:10.4103/kleuhsj.kleuhsj_77_18  
INTRODUCTION: Constipation (vibandha) is a common clinical problem and symptoms of many diseases. It is not described as a separate disease in the classical text. Westerned life style, mental stress and diets are play major role in occurring in constipation (vibnadha). The diagnostic and evaluation of vibandha includes an proper history and investigation to exclude any other abnormalities and disease. OBJECTIVE: The objective of this study was to evaluate the effect of kalyanaka kshara in vibandha. MATERIALS AND METHODS: A clinical trial was conducted on a group of 30 patients diagnosed with the help of rome III criteria and Bristol stool scale with constipation (vibandha). Patients were selected openly irrespective of their religion, race, occupation, sex etc. They were internal administered kalyanaka kshara, a herbal formulation, at a dose of 500 mg Bid a day for ten days for internal administration with ghee and monitored at 3rd, 5th, 7th, 10th and 15th days for any adverse effect and effect of drug. Symptoms of constipation like straining, lumpy and hard stool, stisfction after daefecation, nature of stool etc. were observed over the treatment. RESULTS: Analysis of result showed improvement in vibandha (constipation). CONCLUSION: Finally study concluded that kalyanaka kshara is effective in the treatment of vibandha.
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Utility of C4D deposits in native renal diseases and relation with disease progression p. 50
Sucheta Yadav, Atin Singhai, Suresh Babu, Vijay Kumar Singh, Anupam Wakhlu, Satyendra Sonkar, Bhupendra Pal Singh, Chanchal Rana
DOI:10.4103/kleuhsj.kleuhsj_156_18  
INTRODUCTION: C4D is a well-known biomarker of complement cascade. The utility of C4D in identification of antibody-mediated rejection has been known since its incorporation in Banff classification in 2003. Recently, many researchers have turned their attention to C4D deposition in native renal diseases. The present study was done at our tertiary care center to adjudge the significance of C4D deposits in native renal diseases across Indian cohort of patients. MATERIALS AND METHODS: A retrospective study was done on fifty cases of native renal diseases and followed up at 6 months. C4D immunohistochemical analysis was performed on formalin-fixed paraffin-embedded renal tissue sections with antibody against C4D (polyclonal rabbit immunoglobulin G antihuman C4D antibody). RESULTS: All cases of membranous nephropathy, immunoglobulin A nephropathy, and hypertensive nephropathy showed glomerular C4D positivity ranging from 2+ to 3+. Nearly 50%, 50%, 43%, and 40% cases of diabetic nephropathy, membranoproliferative glomerulonephritis, lupus nephritis, and postinfectious glomerulonephritis, respectively, demonstrated positive glomerular C4D deposits. Increased intensity expression of glomerular C4D deposits was in significant concordance with presenting 24 h urinary protein level at the time of biopsy and in follow-up trends; C4D positive cases were noted to have slowed recovery process as evidenced by delay in returning to normal range proteinuria. Higher histological grades in respective native diseases' classification correlated with increased glomerular C4D intensity expression. C4D positivity in other renal compartments did not yield any significant results. CONCLUSION: C4D positivity can be explored as a diagnostic and prognostic tool in native renal diseases as well, apart from transplant biopsies' evaluation
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Clinical pharmacist assessment in monitoring and resolving the adverse drug reaction in bipolar disorder patients: A prospective, observational study at tertiary care teaching hospital p. 56
Parihar Ashish Singh, S Ganachari Madiwalayya, V Tekkalaki Bheemsain
DOI:10.4103/kleuhsj.kleuhsj_149_18  
BACKGROUND: Adverse drug reaction (ADR) is a noxious, unintended effect of the drug which may occur due to pharmacotherapy of the disease. Bipolar disorder is a chronic mental illness represented by mania, depression and cyclic episode. The treatment of Bipolar disorder is lifelong. Hence, there are increased chances of ADRs. METHODOLOGY: An observational, prospective study was performed on 286 patients, to identify, monitor, and resolve the ADR with bipolar disorder patients. The patients aged 18–65 years of either gender or diagnosed with bipolar disorder were enrolled in the study. Patient-related data had been collected from the patient record; probability of ADR was measured by Naranjo scale and severity by Hartwig scale. Descriptive statistics had been used for study data interpretation. RESULTS: A total of 286 patients were enrolled in the study, of which 27 patients suspected with ADR. Among all the ADR, nonallergic side effect suffered ADR were 88.1%. Of which, the most common ADR were hand tremor and hypothyroidism, which were associated with lithium (81.4%) followed by valproate (11.1%). On causality assessment, 44.4% cases were probable and possible. In most cases, severity of ADR was founded at Level III with 74.7% and Level II with 25.9%. The rate of acceptance of pharmacist intervention by a psychiatrist has been found to be 74.7%. The major cause of ADR was a drug/dose selection (74.07%). CONCLUSION: ADRs occur most frequently in bipolar disorder. The incidence of drug-related noxious effect can be minimized by the prior identification, monitoring, and reporting. Thus, the clinical pharmacist can play a key role in pharmacovigilance of ADR.
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Correlates of suicide and temporal variations in subjects with suicide attempt p. 62
Bandna Gupta, Prashant Choudhary, Adarsh Tripathi, Anil Nischal, Manu Agarwal
DOI:10.4103/kleuhsj.kleuhsj_310_18  
BACKGROUND: Suicide Attempt is a self-inflicted, potentially injurious behavior with a nonfatal outcome for which there was evidence of intent to die. Life changes could act as a stressor causing enhanced susceptibility for suicidal risk. Suicide is a complex public health problem due to interactive social, cultural, biological and psychological risk factors. AIM: To study suicide intent and it's association stressful life events in subjects with suicide attempt. MATERIAL AND METHODS: The study was cross-sectional, non-interventional study which included 102 patients. Semi-structured Performa including socio-demographic and clinical history details, Presumptive Stressful Life Events Scale (PSLES) [Singh et al., 1984] was used for assessment of psycho-social and adverse life events and Beck suicide Intent Scale was used for assessment of suicide intent. Data obtained was analyzed using appropriate statistical tool. RESULTS: Statistically significantly higher suicide intent was present in males (P = 0.001), age group 31-45 years (P = 0.043), Earning group (P = 0.008), family income <10000 per month (P = 0.028), family history of suicide attempt (P = 0.028), past suicide attempt (P < 0.001) and subjects having psychiatric illness (P < 0.001). On applying Pearson's correlation , strong correlation was found between stressful life events score and suicide intent score (r = 0.705, P <0.001). CONCLUSION: Male gender in age group 31-45 years had higher suicide intent The earning group had higher suicide intent as compared to non earning group. Higher suicide intent was present in subjects having positive family history of suicide and history of prior suicide attempt. Study reported strong co-relation between Stressful life events and suicide intent score. Stressful life event score was significantly higher in subjects having psychiatric illness and past history of suicide attempt.
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Clinicomicrobial assessment of urinary tract infections in a tertiary care hospital p. 69
Mallikarjun S Karishetti, Hussain Basha Shaik
DOI:10.4103/kleuhsj.kleuhsj_296_17  
BACKGROUND AND OBJECTIVES: Urinary tract infections (UTIs) encompass a wide array of infections, accounting for a vast number of community as well as hospital-acquired infections. This study was undertaken to evaluate the changing clinical presentations and risk factors of UTIs and the etiological agents in complicated and uncomplicated UTIs. METHODOLOGY: This 1-year cross-sectional study was comprised of 500 patients with signs and symptoms of UTI and/or with UTI confirmed by urine culture in the admitted in the Department of Medicine and Nephrology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi. RESULTS: Most of the patients (59.00%) of the patients were males and the male-female ratio was 1.43:1. The most common age group was 51–60 years comprised of 25.40% of the patients and the mean age was 53.60 ± 17.55 years. Majority of the patients (76.80%) had complicated type of UTI. Most of the patients had fever with chills (65.60%), followed by pain abdomen (47.00%). Majority of the patients (88.20%) had community-acquired infection while 8.40% and 3.40% of the patients had catheter-related nosocomial infection and noncatheter nosocomial infection, respectively. Overall, Escherichia coli was the most common organism (56.40%) isolated and it was the most common organism isolated in patients with nosocomial catheter-related infections as well as noncatheter-related nosocomial infections. Furthermore, E. coli was the most common organism isolated in patients with complicated (57.03%) and uncomplicated UTI (55.17%). The most common risk factor was type 2 diabetes mellitus (T2DM) (40%) followed by chronic kidney disease (19.2%). CONCLUSION: The most common clinical presentations of UTI are fever with chills. T2DM is the important risk factors of UTI. E. coli is the predominant causative agent in all the UTIs.
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Recurrent vesicovaginal fistula: Our experience p. 75
RB Nerli, Abhijit Musale, Shridhar C Ghagane, Sushant Deole, Shivayogi E Neelagund, Murigendra B Hiremath, Neeraj S Dixit
DOI:10.4103/kleuhsj.kleuhsj_161_18  
INTRODUCTION: One of the major complications of vesicovaginal fistula (VVF) surgery is recurrent fistula formation. A repeat repair is undertaken after resolution of the inflammatory response to the initial procedure. We report our experience with recurrent VVF managed at our center. MATERIALS AND METHODS: We retrospectively reviewed the inpatient/outpatient case records of all women who underwent repair of recurrent VVF at our center. The age of the patient at initial presentation of VVF, cause of VVF, and site, size, position, and type of repair were noted. RESULTS: During the study period from January 2000 to December 2016, a total of nine women with a mean age of 38 years underwent repair for a recurrent VVF at our center. All patients were assessed in detail 12 months after the repair. All patients were continent and were voiding well. CONCLUSIONS: It is important to strictly adhere to the basic surgical principles so as to achieve a successful VVF repair. The bladder closure is much more important in achieving a successful repair than vaginal closure. Recurrent VVFs should always be treated with interposition of a tissue graft between the bladder and the vagina.
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Effect of a structured exercise program on pain and quality of life in adult females with cyclic mastalgia: An experimental study p. 79
Samruddhi Shashikant Barve, Arati Mahishale
DOI:10.4103/kleuhsj.kleuhsj_110_18  
INTRODUCTION: Cyclic Mastalgia is defined as breast pain before the onset of menstruation. It may be experienced unilaterally or bilaterally and is often associated with tenderness. Pain usually subsides spontaneously but it re-occurs with subsequent menstrual cycles. METHODOLOGY: A total sample of 29 females were recruited for the study based on the inclusion and exclusion criteria. The outcome measures used were Visual Analogue Scale, RAND SF-36 questionnaire and Pressure Algometer. Pre intervention scores were recorded and an exercise programme was administered to the subjects, 3 times per week for 4 weeks. Post intervention outcome measures were recorded. RESULTS: The results proved that pain, tenderness and Quality Of Life improved significantly after the intervention with P value of (0.0001). Components of QOL like Physical functioning, Physical health, Emotional problems, Emotional well being, Social functioning, General health, Enegy levels improved after intervention. Determining the long term effects of the exercise programme was not a objective of the present study but we found that most of our study participants did not have recurrence of the symptoms of cyclic mastalgia for more than 3 months after the intervention. CONCLUSION: The Experimental study demonstrated that Structured Exercise Programme was effective in reducing pain, tenderness and improving Quality Of Life in adult females with cyclic mastalgia.
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Effect of follow-up home-based oromotor stimulation on breastfeeding performance in preterm low-birth-weight infants: A randomized control trial p. 85
Pushkar Topkar, Deepa Metgud, Vishwanath Machakanur
DOI:10.4103/kleuhsj.kleuhsj_129_18  
BACKGROUND: In preterm neonates, feeding problems are recognized as a challenging issue. Immaturity of the oromotor system, inability to generate a suck-swallow-breath pattern, and poor motor development are few factors contributing to feeding difficulties. Oromotor stimulation is one of the various techniques used to enhance breastfeeding in infants which is frequently given in hospitals. However, the effect of oromotor stimulation is given as a home-based program has not been studied. OBJECTIVE: The objective of this study was to evaluate the effect of home-based oromotor stimulation on weight, sucking frequency, duration of transition from spoon-feeding to breastfeeding, and Latch breastfeeding assessment in preterm low-birth-weight infants. MATERIALS AND METHODS: A randomized control trial was done on 40 preterm low-birth-weight infants where they were divided equally into intervention and control groups. Weight, Latch scores, and sucking frequency were noted at baseline. Routine Newborn Intensive Care Unit (NICU) care was given to infants in the control group whereas oromotor stimulation was given for 21 days as a home-based program to the intervention group. The outcome measures were evaluated on the 7th and the 21st day. RESULTS: Oromotor stimulation improved the sucking frequency, Latch scores, and hastened the transition from spoon-feeding to breastfeeding as compared to the controlled group (P < 0.05). However, there was no statistically significant difference in the weight gain in the two groups (P > 0.05). CONCLUSION: The present study concludes that home-based oromotor stimulation program is effective in improving sucking frequency, Latch scores, and duration of transition from spoon-feeding to breastfeeding in preterm low-birth-weight infants, although no significant changes were seen in the rate of weight gain between the groups. Oromotor stimulation should be added along with routine NICU care for preterm low-birth-weight infants to improve the breastfeeding performance.
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The diagnostic value of the combination of clinical tests for the diagnosis of supraspinatus tendon tears p. 91
Sameer Haveri, RB Uppin, Kiran Patil
DOI:10.4103/kleuhsj.kleuhsj_168_18  
CONTEXT: A large number of special tests have been described to examine the shoulder. It is unknown which combination of clinical tests might be optimal for the diagnosis of rotator cuff tears. AIMS OF OUR STUDY: To estimate the diagnostic accuracy of history and clinical tests and to find out which combination of clinical tests is best in diagnosing supraspinatus tendon tears. SETTINGS AND DESIGN: Diagnostic test accuracy study. METHODOLOGY: One hundred and thirty-four patients with shoulder pain were evaluated with history-taking and clinical tests and magnetic resonance imaging of the shoulder. STATISTICAL ANALYSES: Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratios were calculated with a 2 × 2 table. RESULTS: The combination of Neer test, painful arc test, and full can test yielded 100% sensitivity and 100% specificity in diagnosing supraspinatus tears of any type. CONCLUSIONS: Our study shows that individual clinical tests have moderate diagnostic value for the diagnosis of supraspinatus tears. Diagnostic value improves significantly when clinical tests are combined together. Neer test, painful arc test, and full can test form the best combination in diagnosing supraspinatus tears of any type.
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LETTER TO EDITOR Top

Role of feedback and mentoring in programmatic assessment p. 97
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_162_18  
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