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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 12 | Issue 2
Page Nos. 99-185

Online since Tuesday, June 4, 2019

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EDITORIALS  

Pediatric renal transplants Highly accessed article p. 99
RB Nerli, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_99_19  
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Burnout among healthcare professionals: Is it a cause for concern? Highly accessed article p. 101
Punnya V Angadi
DOI:10.4103/kleuhsj.kleuhsj_102_19  
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REVIEW ARTICLE Top

Maternal mental health and its influence on infant growth and development: A systematic review of observational studies in South and East Asia p. 103
Shubhashree Venkatesh, J Vindhya, Anita Nath
DOI:10.4103/kleuhsj.kleuhsj_9_19  
Maternal mental stress during pregnancy is an important public health concern. There is strong evidence from the Western world to support the presence of a significant association between maternal stress in pregnancy and adverse outcomes in the offspring. There are fewer studies from the South and East regions of Asia. The search was conducted according to the PRISMA criteria. Databases which included NCBI PubMed, Scopus, and Embase were used to search for relevant studies according to the eligibility criteria. Most of the studies have shown a significant relation between stress, depression, and anxiety during various stages of pregnancy with delayed mental, motor, and behavioral development of the child. Although studies from the region show a significant relation between various stress factors during pregnancy and child development, more such studies are needed, especially those using potential biomarkers as indicators of pregnancy-related stress.
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ORIGINAL ARTICLES Top

Cytotoxic activity of endophytes isolated from Allamanda blanchetii A. DC p. 112
Harsha D Pednekar, Harsha V Hegde, Pramod J Hurakadale, Jyoti D Wagawade, Kishore G Bhat, Chetana Bogar
DOI:10.4103/kleuhsj.kleuhsj_7_19  
AIM: To evaluate the cytotoxic potential of endophytic fungi isolated from A. blanchetii. MATERIALS AND METHODS: Endophytic fungi were isolated from A. blanchetii using surface sterilization methods, grown in different types of media to ascertain their suitability for growth. Mass culture was prepared using suitable media and extracts using several solvents were prepared and dried. These extracts were later evaluated using MTT assay for their cytotoxic potential. RESULTS: Hydroalcoholic extract of Phomopsis species exhibited better cytotoxicity (80 μg/ml) when compared ethyl acetate extract of the same 160 μg/ml. Similarly, ethyl acetate extract of Phomopsis species, ethyl acetate extract of Alternaria aff. raphani J. W. Groves and Skolko also demonstrated cytotoxicity of 160 μg/ml in MTT assay against MCF 7 cell line. CONCLUSION: Both the species of Phomopsis and Alternaria have shown significant cytotoxicity in MTT assay.
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Impact of refractive error correction on mental and visual development in children with global developmental delay p. 117
KS Smitha, VD Patil, Mahesh D Kamate, Madhav Prabhu, Umesh Harakuni, OP Rakshitha
DOI:10.4103/kleuhsj.kleuhsj_315_18  
PURPOSE: The purpose of the present study is to evaluate visual acuity and refractive status in children with global developmental delay (GDD) and to study the effect of early correction of refractive errors on vision and developmental quotient (DQ). METHODS: In this case series data with pre–post design, 100 consecutive children from 1 to 5 years of age diagnosed with GDD attending the child development clinic and referred to ophthalmology were evaluated for ocular complaints, status of visual acuity, and type of refractive error. Glasses were prescribed on the basis of cycloplegic retinoscopy. Etiological diagnosis and DQ were documented. Follow-up was done after 6 months for visual acuity, DQ, and qualitative questionnaire administered for the caretaker. Statistical analysis was done using the Chi-square test. RESULTS: Fifty-six children were <2.5 years of age and 44 children were >2.5 years. Severe GDD prevalence was more in children <2.5 years (43%) and mild GDD in >2.5 (50%). Of 47 who showed improvement in vision, 39 (71%) showed improvement in social behavior also, which was statistically significant. In children <2.5 years, more improvement in DQ was seen in the moderate intellectual disability group after refractive error correction. However, in the children of 2.5 years and above, more improvement was seen in the severe group. Overall, improvement in DQ in children from 1 to 5 years was statistically significant at 14%. CONCLUSION: Harmful effects of sensory visual deprivation on the development and functioning can be dampened by a simple and cost-effective approach of spectacles therapy which makes a spectacular effect in the case of children with GDD.
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Quantification of mast cells in reactive oral lesions – A clue to the morphologic diversity p. 123
Saurabh Shekar, Punnya V Angadi
DOI:10.4103/kleuhsj.kleuhsj_3_19  
OBJECTIVE: Inflammatory fibrous hyperplasia (IFH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF), and peripheral giant cell granuloma (PGCG) are common oral soft-tissue reactive lesions that correspond to excessive connective tissue proliferation as a reaction to trauma or irritational factors local to the oral cavity. These lesions have specific differences in their histopathologic appearances and behavior in spite of having common etiologic factors. Mast cells (MCs) are immune-regulatory cells that have an important role to play in oral inflammation and have also been associated with tissue remodeling and fibrosis in various disorders. METHODOLOGY: MCs were stained with toluidine blue in cases of IFH (20), PG (20), PGCG (20), and POF (20) along with normal gingiva tissue as control (5) for quantification and comparison among them. RESULTS: The mast cell count was low in normal mucosa but a progressive increase was seen from PGCG to IFH to POF with maximum mast cells were evident in PG. There was a significant difference noted in the MC counts between the normal mucosa and the oral reactive lesions (P < 0.05). However, the difference in the MC count did not reach statistical significance among the reactive lesions (P = 0.400). CONCLUSION: MCs emerged as significant players in the pathogenesis and histopathologic diversity of oral reactive lesions by their effects on fibroblasts and endothelial cells.
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Knowledge and perceptions of mothers of under-five children attending a tertiary care hospital about childhood diarrhea: A cross-sectional study p. 127
Dipak Kumar Dhar, Nilratan Majumder
DOI:10.4103/kleuhsj.kleuhsj_43_19  
CONTEXT: Diarrhea is a major cause of morbidity and mortality among young children. The incidence of diarrhea has remained almost unchanged over the years, highlighting the scope of prevention. A mother is the primary caregiver of a child. Her perceptions and knowledge of a disease determine her care-seeking behavior and health of the child by extension. AIM: The aim of the present study was to assess the level of knowledge of mothers about different aspects of childhood diarrhea. SETTINGS AND DESIGN: A hospital-based, descriptive cross-sectional study was carried out in the Department of Paediatrics, Agartala Government Medical College and G. B. Pant Hospital, Agartala, Tripura, over a period of 2 months. MATERIALS AND METHODS: The sample size for the study was 700. Convenience sampling technique was used to interview 700 mothers of under-five children, using a predesigned structured interview format. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 13. Descriptive statistics and Chi-square test were used for analysis. P < 0.05 was considered as statistically significant. RESULTS: Majority of the mothers had a correct perception of the symptoms and causes of diarrhea. Most of them also knew about the importance of handwashing and had also heard about oral rehydration solution (ORS). However, their awareness about the warning signs indicating severe dehydration and the role of ORS in diarrhea was very poor. Educational level was found to be significantly associated with the knowledge. CONCLUSIONS: To bring down the mortality rate, mothers have to be made aware of the warning signs and the role of ORS because adequate knowledge is a critical component of the decision-making process.
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Prevalence of Vitamin D deficiency in patients with acute exacerbations of bronchial asthma: A one-year hospital-based cross-sectional study p. 132
Srinija Kummaraganti, Gajanan S Gaude
DOI:10.4103/kleuhsj.kleuhsj_222_18  
BACKGROUND AND OBJECTIVES: Bronchial asthma is one of the most common chronic diseases. In India, bronchial asthma has 66% frequency of reported exacerbations. Vitamin D has action on pro-inflammatory mediators and smooth muscle function and proliferation, which has a direct relevance for lung function in asthma. This study was done to investigate the prevalence of Vitamin D deficiency in patients presenting with asthma exacerbations and to assess the correlation between decreased levels and various indicators of severity of exacerbations. MATERIALS AND METHODS: A total of 118 participants of whom 93 patients had acute exacerbations of bronchial asthma were included in this study. Vitamin D levels were analyzed among different subgroups based on asthma control, severity, and severity of exacerbations. Vitamin D levels were correlated to forced expiratory volume in 1 s (FEV1)% predicted, body mass index (BMI), steroid use, and number of exacerbations in the previous 1 year. RESULTS: Prevalence of Vitamin D deficiency was 88.2%. Mean Vitamin D (± standard deviation [SD]) level was 12.50 ± 6.41 ng/ml, which was lower than that of patients in remissions (30.61 ± 4.00 ng/ml). Mean FEV1% predicted (±SD) was 54.06% ±15.39%. Patients with severe asthma and uncontrolled asthma had the lowest Vitamin D levels compared to the other subgroups (P < 0.0001). Vitamin D levels were lower in patients with severe exacerbation (8.61 ± 4.16 ng/ml) as compared to mild-moderate exacerbation (17.44 ± 5.25 ng/ml). Vitamin D levels were positively correlated with FEV1% predicted (r = 0.66) and were negatively correlated with BMI (r = −0.89), steroid usage (r = −0.85), and the number of exacerbations in the previous 1 year (r = −0.83). All were statistically significant (P < 0.05). CONCLUSION: Vitamin D deficiency is highly prevalent in patients during exacerbations of bronchial asthma. It is also associated with lower lung functions and increased number of exacerbations. Thus, improving Vitamin D status might be effective in the prevention and treatment of bronchial asthma and exacerbations.
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REVIEW ARTICLE Top

Prescribing patterns of Virechana Karma in terms of Shuddhi Lakshana p. 139
Shawan Barik, Buduru Sreenivasa Prasad
DOI:10.4103/kleuhsj.kleuhsj_69_18  
BACKGROUND: The widespread use of various drugs in a single procedure and the increasing recognition of Shuddhi achieved as per the classics to provide the best result have stimulated interest in the manner in which physicians prescribe drugs. The main sources of this information can be found at the institutional-level like hospitals. These sources reveal a varied prescribing patterns in terms of drugs used for Snehapana, drugs used for Sarvanga abhyanga, and also in terms of drug selection for Virechana karma. It also reveals the pattern in the selection of dose and the duration of the treatment vary greatly among physicians according to their place, practice, disease, and the condition of the patient. METHODS: Therefore, a prospective study was conducted from May 2016 to December 2017 at KAHER's Shri BMK Ayurveda Hospital and Research Centre, Belagavi, Karnataka, India. A total of 1138 individuals were screened among which 319 individuals were taken as per the inclusion criteria, in which 300 participants completed the study. RESULTS: The outcome was measured on the basis of SamyakShuddhi Lakshana (SSL) of Snehana and Virechana karma. The study revealed that 51.33% of the individuals achieved avaraShuddhi, 42.33% achieved MadhyamaShuddhi, and 6.34% achieved PravaraShuddhi. In mridu koshtha, a total of 160–200 ml of ghrita intake can attain 10–11 vegas, in Madhyama koshtha total of 295–1130 ml of ghrita intake can attain 13–18 vegas, and in krurukoshtha total of 90–520 ml of ghrita intake can attain up to 21 vegas over a period of 3 or 5 days. 92.67% times Trivritleha was observed as prescribed drug which also has 30 min onset of Virechanavega with proper snehaSamyakShuddhi. DISCUSSION AND CONCLUSION: The study is the precursor to improve prescribing patterns and quality of care and thus provides a population based approach to advance clinical pharmacology and improved health outcomes resulting from improved prescribing choices.
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ORIGINAL ARTICLES Top

A community-based cross-sectional study about knowledge, attitude, and practices of food safety measures among urban households p. 154
Shilpa Reddy Ganta, Deepti M Kadeangadi
DOI:10.4103/kleuhsj.kleuhsj_277_18  
OBJECTIVE: The objective of this study was to assess knowledge, attitude, and practices of food safety measures among urban households of Belagavi using the World Health Organization (WHO) “Five keys for food safety.” MATERIALS AND METHODOLOGY: A community-based cross-sectional study was conducted from January 1, 2017, to December 31, 2017 among 400 women aged above 18 years who were involved in food preparation at urban households in the field practice area of Ashok Nagar, Belagavi, Karnataka, India. Data were collected using pretested and predesigned questionnaire based on the WHO five keys for food safety. Households were selected based on systematic random sampling. Statistical analysis was done by percentages, mean and standard deviation, and ANOVA using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Cor. RESULTS: The mean age of the participants was 37.96 ± 14.9 years, and the mean scores of knowledge, attitude, and practice regarding food safety were 7.1 ± 1.47 out of total score of 11, 15.45 ± 1.65 out of total score of 18, and 30.18 ± 4.21 out of total score of 40, respectively. The mean knowledge score was found to be lower in the age group of >35 years (P < 0.05, F = 5.7415) and socioeconomic status Classes III, IV, and V (P < 0.05, F = 1.828), and these differences were found to be statistically significant. CONCLUSION: Knowledge and attitude scores regarding food safety were good, but food safety practice scores were lower. Among the WHO five keys for food safety, knowledge, attitude, and practices regarding “cook thoroughly” and “keep food at safe temperature” were observed to be lower.
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Comparative effect of foam roller and M2T blade on hamstring flexibility in elderly population: A randomized control trial p. 160
Tanvi Pathania, Anil R Muragod
DOI:10.4103/kleuhsj.kleuhsj_118_18  
The joints become stiffer and less flexible as we tend to age. Hamstring muscle is one of the common muscles found to be tight in an individual and is the potential cause for low back issues altering the lumbopelvic rhythm in them. Various studies have compared numerous techniques to see which technique is best for increasing joint range of motion. However, there is dearth of literature on use of foam roller and M2T blade on hamstring tightness in elderly. In this study, we have compared the effect of static stretching, foam roller, and M2T blade on hamstring tightness in elderly subjects. This is a randomized control trial included 45 subjects with hamstring flexibility with age of 65–75 years both males and females. The participants were randomly allocated into three groups. Group A received static stretching, Group B received foam roller, and Group C received M2T blade for 4 weeks three times a week. Pre- and post-intervention values of passive knee extension (PKE) and sit and reach test (SRT) were observed. The results showed within-group improvements in static stretching, foam roller, and M2T blade which was statistically significant (P < 0.001). However, between-group comparison showed significant difference between foam roller and M2T blade, with P = 0.000 and 0.044 for PKE and P = 0.000 and 0.004, respectively, for SRT. Comparison between groups revealed M2T group to be more effective than foam roller.
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The prevalence of hypocalcemia in children with dengue infection: A 1-year cross-sectional study p. 166
Anshika Rajendra Singh, DK Dnyanesh
DOI:10.4103/kleuhsj.kleuhsj_308_18  
INTRODUCTION: According to WHO, Dengue is fast emerging pandemic-prone viral disease affecting mainly urban poor areas in tropical and subtropical countries. One of the important electrolyte disturbance documented in critical phase of severe dengue is hypocalcaemia. Hypocalcaemia is seen in cases with severe dengue and has been claimed to be linked with the immune response and severity of infection. OBJECTIVES: To study the prevalence of hypocalcaemia in children suffering from dengue infection. To study the association between the degree of hypocalcaemia and the severity of the illness. SETTINGS AND DESIGN: This study was a one year cross sectional study, conducted in a tertiary care hospital. METHODS AND MATERIAL: 100 subjects aged 1 month to 18 years suffering from dengue fever were included in the study. iCa and other biochemical parameters were done for all the subjects within 24 hour of admission. The collected data was coded and analyzed using ANOVA and chi-square tests. RESULTS: The mean age was 9.65 yr. The subjects were classified as per 2009 WHO criteria. The prevalence of iCa was found to be 59.0%. 11.7% subjects with dengue without warning signs, 83.7% subjects of dengue with warning signs and 100% of the subjects of severe dengue had hypocalcaemia. CONCLUSIONS: This study proves the association of the hypocalcaemia with the severity of dengue infection in the paediatric population and potentiates the use of ionic calcium as a biochemical marker to detect severe dengue infection early.
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Estimation of prevalence of metabolic syndrome among 1st year medical students of a medical college in North Karnataka, India p. 174
Anita Teli, Vanishree Jabannavar, Isabella Adorno, G Sai Gayatri, Fillipos Lampis, Parwati Patil
DOI:10.4103/kleuhsj.kleuhsj_13_19  
BACKGROUND: Metabolic syndrome is a growing concern as it predisposes to cardiovascular comorbidities and type 2 diabetes mellitus. Medical students lead fairly sedentary lifestyle. Early detection of metabolic syndrome and follow-up would help in preventing complications. The objective of the study was to determine the prevalence of metabolic syndrome in healthy medical students of JN Medical College and to compare the prevalence among male and female students. METHODOLOGY: A cross-sectional observational study was conducted from January 2018 to July 2018 involving 120 students, of which 67 (55.83%) were female and 53 male (44.17%). The study was conducted using the criteria for metabolic syndrome defined by international diabetes federation. Data for height, weight, body mass index, waist circumference, fasting blood glucose, serum cholesterol, serum triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein were collected. Data were analyzed using SSPS version 20.0. Comparison of physiological parameters was done using independent t-test, and prevalence was estimated using Chi-square test. P < 0.05 was considered as statistically significant. RESULTS: Metabolic syndrome was observed in 10.83% of sample population comprising 11.94% female and 9.43% male population. The prevalence among females was found to be more than males but not statistically significant (P = 0.66). The prevalence of individual parameters for metabolic syndrome were abdominal obesity (59.17%), raised TG (2.50%), reduced HDL (38.33%), raised blood pressure (BP) (systolic BP [SBP] – 20.83% and diastolic BP – 28.33%), and raised blood glucose (5.83%). In terms of gender analysis, 46.27% females and 28.30% of male had lower HDL values (P = 0.04). SBP was higher in 37.74% male when compared to 7.46% female (P = 0.0001). CONCLUSION: The study concludes that the overall prevalence of metabolic syndrome was found to be 10.83%. The prevalence among female (11.94%) was more than male (9.43%) population but not found to be statistically significant. Early detection of metabolic syndrome would help bring about attitude and lifestyle changes to prevent the progression of disease and its complication.
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MEDICAL EDUCATION Top

Role of curriculum committee in the planning, implementation, and evaluation of integrated teaching in medical education in India p. 179
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_307_18  
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LETTERS TO EDITOR Top

Improvising the audacity of case report: Suggestions for developing guidelines while reporting anatomical variations p. 181
V Dinesh Kumar, R Rajprasath
DOI:10.4103/kleuhsj.kleuhsj_319_18  
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A rare variety of pulmonary blastoma: A case report and review of literature p. 182
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/kleuhsj.kleuhsj_309_18  
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Time for a serious research implementation of the hypotheses in ancient Ayurveda literatures: A call from a roller coaster ride p. 183
Govardhan Belaguli
DOI:10.4103/kleuhsj.kleuhsj_177_18  
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