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   2018| May-August  | Volume 11 | Issue 2  
    Online since May 18, 2018

 
 
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ORIGINAL ARTICLES
Substantiating accuracy of Goodsall's rule in fistula-in-ano (Bhagandar) with anatomical consideration
Pradeep Shahajirao Shindhe, Ramesh Shivappa Killedar
May-August 2018, 11(2):151-154
DOI:10.4103/kleuhsj.kleuhsj_271_17  
BACKGROUND: The exact identification of the internal opening in the surgical treatment of anorectal fistulae is of basic importance for effective management, and the same concept was existed long back which was described by Acharya Sushruta in the context of Bhagandar (Arvachina and Parachina).In the current practice, the rule of Goodsall enables identification of the internal opening whether anterior or posterior with relation to its external opening. OBJECTIVES: The objective of this study is to substantiate the accuracy of Goodsall's rule and to establish rationality of the rule with anatomical consideration MATERIALS AND METHODS: A total of 53 operated (kshara sutra ligation) cases of fistula-in-ano during 2014–2015 were retrospectively assessed for locations of the primary (Arvachina) and secondary (Parachina) openings from the case sheets. The normal distribution test was used for the data analysis. RESULTS: Totally 46 anal fistula patients followed the Goodsall's rule while 7 patients were not as per rule, and all of them were falling in anterior external opening group. CONCLUSION: Posterior external opening fistulas were as per Goodsall's rule and anterior opening >3.25 cm or far had a straight or radial fistulous tract, which are against the Goodsall's rule.
  3,073 139 -
EDITORIALS
Is patient modesty being honored or outraged in clinical practice? High time to introspect
Syed Esam Mahmood
May-August 2018, 11(2):105-107
DOI:10.4103/kleuhsj.kleuhsj_50_18  
  2,786 186 -
ORIGINAL ARTICLES
Effect of uphill, level, and downhill walking on cardiovascular parameters among young adults
Samir Adhikari, Parwati P Patil
May-August 2018, 11(2):121-124
DOI:10.4103/kleuhsj.kleuhsj_79_17  
BACKGROUND: Uphill walking and downhill walking are the different forms of walking which causes cardiovascular changes in the body. By changing the gradient of the treadmill, we can change the severity of exercise by keeping the speed constant. AIM: This study aims to evaluate the cardiovascular changes during uphill, level, and downhill walking in young adults. STUDY DESIGN: This was an experimental study MATERIALS AND METHODS: Twenty participants (15 males and 5 females) having normal body mass index were made to walk on the treadmill at different gradients of −15%, 0%, and +15% at a preferential speed for a constant duration of 15 min. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and rate pressure product (RPP) were recorded before and after walking. STATISTICAL ANALYSIS: Statistical analysis was done by ANOVA test using SPPSS, version 20 (IBM, Bangaluru, Karnataka ,India), where P < 0.05 was taken as statistically significant. RESULTS: There was a significant increase in HR (105.8 ± 20.06), SBP (133.3 ± 13.54), and RPP (14146 ± 3025) during uphill walking as compared to downhill and level walking. There were no significant changes in cardiovascular parameters when level walking and downhill walking were compared. DBP did not show any significant changes at any gradient of walking. CONCLUSION: Cardiovascular response increases during uphill walking, but level walking and downhill walking show no difference in cardiovascular response. These findings can be used to prescribe the exercises for young adults.
  1,519 112 -
Retrospective analysis of all patients undergoing blood transfusion in obstetrics at a Tertiary Care Hospital, Belgaum: A cross-sectional study
Deshpande Madhushree, Mrityunjay C Metgud, Kamal Patil
May-August 2018, 11(2):116-120
DOI:10.4103/kleuhsj.kleuhsj_233_17  
OBJECTIVES: This study was conducted to know the various indications of blood transfusion (blood and blood products) in obstetrics and to know transfusion reactions if any. METHODOLOGY: This study was done from September 2014 to September 2015 in the Department of Obstetrics and Gynaecology, KLE Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi. All women who received blood and blood product transfusion for any obstetric cause during this period were analyzed to know the indications for transfusion and to know transfusion reactions. RESULTS: A total of 204 women received blood and blood products transfusion in this study. The indications for blood and blood product transfusion observed in our study were anemia, obstetric hemorrhage, hemolysis, elevation of liver enzymes and low platelets, thrombocytopenia, disseminated intravascular coagulopathy, ruptured ectopic, ruptured uterus, and others (incomplete abortion, complete abortion, hydatidiform mole, and persistent trophoblastic disease). Anemia in pregnancy was the most common indication and was observed in 121 cases (58.45%) followed by Obstetric hemorrhage, which was seen in 40 cases (19.32%). The incidence of transfusion reactions was 4.41% in our study. CONCLUSION: A proper knowledge for blood and blood product transfusion is needed to make it available for people who are actually in need and also to decrease the economic burden. The appropriateness of utilization of blood and blood products lies with the physicians' compliance with blood transfusion guidelines. Anemia followed by obstetric hemorrhage still persists to be a major cause for blood and blood product transfusion. Measures to prevent anemia should be implemented. Obstetric hemorrhage is an emergency situation and cannot always be avoided or prevented. The development of various strategies to avoid transfusion reactions is needed.
  1,259 199 -
Pattern of drug resistance in hospital-acquired pneumonia in a tertiary care hospital: Cross-sectional study
Ramitha Ravi Malgere, Bhagyashri B Patil
May-August 2018, 11(2):111-115
DOI:10.4103/kleuhsj.kleuhsj_279_17  
INTRODUCTION: Hospital-acquired pneumonia (HAP) is associated with the highest mortality rate of 35%–50% globally and is the second or the third most frequent nosocomial infections. AIMS AND OBJECTIVES: The aims of the study were to know the pattern of drug resistance in HAP, study the clinical profile, and treatment outcome in HAP. MATERIALS AND METHODS: A cross-sectional study was performed from January 2016 to December 2016. A total of 100 patients who developed HAP were enrolled in the study. Totally 88 patients had positive bacterial culture growth and 12 patients had no growth or fungal growth. Hence, 88 patients were screened for further analysis. RESULTS: A total of 88 patients developed HAP and ventilator-associated pneumonia (VAP) with bacterial growth. The mean age of the patients was 54 ± 7 years. The most common organisms isolated are Acinetobacter (13.6%), Enterobacter species (12.5%), Klebsiella (26.1%), Pseudomonas (18.2%), and Staphylococcus species (22.7%). In early onset (27.2%) and late onset of HAP (23.9%), chronic obstructive pulmonary disease was the most common predisposing disease (41.7%, 47.7%). In early onset (14.8%) and late onset of VAP (34%), cerebrovascular accidents (23.3%) and neurological diseases (26.7%) were the most common diseases. Acinetobacter species were resistant to most of the commonly used antibiotics with sensitive to only Carbapenems. All the strains of Staphylococcal species were sensitive to vancomycin and linezolid (100%). The mortality was highest with Klebsiella (27.9%) and Pseudomonas (23.2%) infections, neurological diseases (72.8%), and in the late onset of VAP (34%). CONCLUSION: The study demonstrated that the resistance to commonly used antibiotics is on rise to various organisms. Hence, an antibiogram setup needs to be revised for every 6 months.
  1,249 207 -
Anaerobic bacteriological profile of leukorrhea in reproductive age group women
GS Spurthi, Sharada C Metgud, Metgud Shridevi
May-August 2018, 11(2):160-164
DOI:10.4103/kleuhsj.kleuhsj_186_17  
INTRODUCTION: Leukorrhea is one of the most common complaints of women in their reproductive age group attending the OBG OPD and Bacterial Vaginosis (BV) is its most common cause. AIM: of the study was to isolate and identify the anaerobic bacteria causing leukorrhea. MATERIALS AND METHODS: This was a cross sectional study conducted in a medical college and tertiary care hospital, on 250 married women in their reproductive age group attending the OBG OPD with complaints of leukorrhea. High vaginal swabs were collected from these women and BV was diagnosed using Amsel's clinical composite criteria. Anaerobic bacteria were isolated from the samples using standard operative procedure. RESULTS: Out of 250 women, 220 (88%) had a thin, grey, homogenous discharge and 30 (12%) had thick, white non offensive discharge, indicating vaginal candidiasis. Out of the 220 women, 123 (55.9%) were diagnosed to have BV by Amsel's criteria and 42 (19%) of them were culture positive for anaerobic bacteria. Porphyromonas spp. (55%) was the most common bacteria isolated, followed by Peptostreptococcus spp. (17%) and Bacteroides spp. (14%). CONCLUSION: Anaerobic bacteria are important pathogens in the causation of bacterial vaginosis along with other aerobic organisms.
  1,160 117 -
Comparative evaluation of the dimensional accuracy of cast partial denture frameworks fabricated by conventional technique and light-cure wax technique: An in vitro study
Rijuta Virmani, Anandkumar G Patil, Raghunath Patil, Prashant A Karni
May-August 2018, 11(2):155-159
DOI:10.4103/kleuhsj.kleuhsj_245_17  
BACKGROUND: Removable partial dentures are an economical way of replacing lost structures, especially in cases where FPD or implants are not possible. Metal alloys by the conventional lost-wax technique are the most common way of fabricating such dentures which can be done by using either conventional casting wax or light-cure wax. PURPOSE: The objective of this study is to evaluate and compare the dimensional accuracy of cast partial denture frameworks fabricated using conventional casting wax and light-cure wax. MATERIALS AND METHODS: This in vitro studied was carried out in the Department of Prosthodontics and Crown and Bridges, and Department of Oral Pathology and Microbiology, KAHE's KLE VK Institute of Dental Sciences, Belagavi. A total of 30 samples were included in the study divided into two groups as follows: Group 1: cast partial denture frameworks fabricated using conventional casting wax and Group 2: cast partial denture frameworks fabricated using light-cure wax. A partially edentulous Kennedy's Class III Mod 1 metal die was created, which was then duplicated using a silicone duplicating material to form a master mold. 15 refractory (phosphate bonded investment) and 15 stone (Type III gypsum) casts were poured according to the manufacturer's instructions onto which conventional casting wax and light-cure wax was adapted, respectively, followed by subsequent investing and casting using cobalt–chromium alloy. The final frameworks were finished and polished and checked for dimensional accuracy by assessing the dimensional fit and the linear dimensional change. The dimensional fit was evaluated by measuring the gap between the palatal major connector and the palatal portion of the metal die at five different points: at midline, at 5 mm, and at 10 mm on either side of the midline, by interposing pattern resin between the two and checking thickness under a stereomicroscope. The linear dimensional change was assessed by calculating the difference of the distance between two specific points on the die and the frameworks. The data were subjected to independent t-test (P < 0.05). RESULTS: The dimensional fit of the Group 1 frameworks using conventional casting wax was 748.25 μm and Group 2 using light-cure wax was 794.02 μm. The result was statistically insignificant. The linear dimensional changes observed for Group 1 and Group 2 were 0.78 mm and 0.63 mm, respectively. The result was statistically insignificant. CONCLUSION: There was no significant difference between the dimensional accuracies of the cast partial denture frameworks fabricated using conventional casting wax and light-cure wax. Hence, the light-cure wax fabrication method can be considered as an alternative for the cast partial denture framework fabrication, as it is simple and much less time-consuming.
  1,092 167 -
REVIEW ARTICLE
The downsides of industry-funded development of new therapeutics
Mir Shoeb Ulla Adil, Ruqiya Sultana
May-August 2018, 11(2):108-110
DOI:10.4103/kleuhsj.kleuhsj_164_17  
Clinical trials are a series of studies that help evaluate the safety and efficacy of a newly discovered drug. Although government funds around 80% of basic research to discover new drugs, it does not sponsor clinical trials at a competent level. Most of the trials are financially supported by pharmaceutical companies which arecertainly a worthwhile contribution to drug discovery, but it also influences the outcome of a clinical trial by ensuring acceptable government policies. Studies revealed that industries often practice selective reporting where unfavorable results are concealed, and positive outcomes are over-published, thereby misleading policies and future research. These downsides can be countered by utilizing funds that are totally devoid of industrial interference. It was reported that medical practitioners widely accept results from government-funded research studies and degrade the integrity of industry-funded clinical trials. Government-funded clinical trials virtually result in flawless conclusions which are extensively accepted and employed in conducting future research. Unlike industry-funded research work, government-funded trials emphasize on the need of the hour and deliver a quality result which is witnessed by the emergence of 93 Nobel Prize winners through the National Institutes of Health funded research work. A survey study revealed that 68% of respondents endorsed for doubling government funds for drug development. Utilizing standard methodologies from health economics such as cost-effective analysis and health technology assessment and public–private collaborations can be a solution for several developing and underdeveloped countries which cannot afford to sponsor drug research on its own.
  1,089 168 -
EDITORIALS
Bed wetting
RB Nerli
May-August 2018, 11(2):103-104
DOI:10.4103/kleuhsj.kleuhsj_140_18  
  975 188 -
ORIGINAL ARTICLES
Comparison of effectiveness of silver zeolite as an antimicrobial agent in acrylic and silicone soft liners in complete denture patients: An in vivo study
Bishakha Singh, Mahantesh Bembalagi, Jyoti M Nagmoti, Raghunath Patil, Abhijit Patil
May-August 2018, 11(2):170-174
DOI:10.4103/kleuhsj.kleuhsj_243_17  
BACKGROUND: Soft liners (SLs) are easily colonized and infected by Candida species and bacteria, leading to denture-induced stomatitis. Hence, it is essential that the SLs be taken care of. To serve such a purpose, antimicrobial zeolites have been incorporated. Limited in vitro evidence suggests that silver zeolite (SZ) is a potentially effective antimicrobial agent. Hence, this study aims to analyze and compare the antimicrobial effectiveness of SZ when added to two different types of SLs in vivo for 28 days in complete denture patients. MATERIALS AND METHODS: This study was undertaken to determine the efficacy of SZ as an antimicrobial agent when incorporated in acrylic soft liners (ASLs) and silicone soft liners (SSLs). A total of 32 edentulous patients were selected and were divided into two groups. Group 1 consisted of 16 patients, wherein SSL was used, and Group 2 consisted of 16 patients with ASL. The reduction of colony-forming units (CFUs) was seen in both the groups after an interval of 28 days. RESULTS: There was a greater reduction noted when SZ was incorporated in SSLs after 28 days. Group 1 showed a mean reduction of CFU from 4.60 to 1.98, whereas Group 2 showed a mean reduction from 4.73 to 3.39. Thus, SZ was effective in both the SLs. CONCLUSION: SZ showed a significant reduction in CFU in both the SLs. Hence, this in vivo study concluded that incorporation of SZ is effective as an antimicrobial agent when added to SLs.
  1,029 122 1
To evaluate the effect of probiotics on the prevalence of oral Candida organisms in denture wearers: An in vivo study
Deepali Jagadeesh Rane, Ramesh Nayakar, Sheetal Harakuni, Raghunath Patil
May-August 2018, 11(2):136-145
DOI:10.4103/kleuhsj.kleuhsj_240_17  
STATEMENT OF PROBLEM: Candida species are the major human fungal pathogens that cause both mucosal and deep-tissue infections. Fungal infections have been successfully treated by systemic antifungal agents for a very long time. The toxicity of available antifungals and resistance to these drugs are a concern; thus, the use of probiotics has emerged as an alternative therapeutic technique for treating Candida infections. PURPOSE: The purpose of this study was to evaluate the effect of probiotics on the prevalence of oral Candida organisms in denture wearers with different age groups. MATERIALS AND METHODS: Sixty completely edentulous denture wearers were divided into three groups: 50–59 years (Group A), 60–69 years (Group B), and 70 years and above (Group C). The sample collected from the denture surface and palatal mucosa pre- and postprobiotic usage were subjected to CHROMagar followed by Germ tube test and then Corn meal agar for identification and counting the number of Candida colonies. The attributed scores were tabulated and submitted for statistical analysis using Kruskal–Wallis ANOVA test, Mann–Whitney U-test, Wilcoxon matched pairs test, and paired t-test. RESULTS: Reduction in the number of Candida colonies was statistically significant in Group A and Group B on the denture surface as compared to that of Group C. However, there was no significant difference observed in all the three groups in the number of Candida colonies on the palatal mucosa. CONCLUSION: The study shows that multispecies probiotic product may represent as an alternative treatment for reduction of Candida infections in the oral cavity of elderly denture wearers.
  1,006 112 1
Effect of school-based intervention program for children with obesity: A randomized control trial
Deepa C Metgud, Apeksha A Hungund, Archana A Kulkarni
May-August 2018, 11(2):146-150
DOI:10.4103/kleuhsj.kleuhsj_68_17  
INTRODUCTION: Obesity in childhood is a major health issue that is seen in both developed and developing countries. Childhood obesity is associated with high risk of adulthood obesity and a series of health problems such as insulin resistance, hypertension, hyperlipidemia, type II diabetes mellitus, sleep apnea, and psychosocial problems. With the social development and changes in lifestyles, currently children and adolescents are lacking physical activity. METHODOLOGY: This study was a randomized control trial. One thousand one hundred and sixty-five students were screened aged 6–12 years. Among the screened children, 32 obese children were recruited in the study and randomly allocated into Groups A (n = 16) and B (n = 16). Group A received structured school-based physical activity intervention and Group B received physical activity of child's choice of 45 min for 6 days/week for 4 weeks in addition to health education. RESULTS: The mean age difference of the participants between the Groups A and B was 0.12 ± 0.08 years. There were significant changes in weight, body mass index (BMI), and skinfold thickness scores. The mean difference in weight, BMI, and skinfold thickness between the group was 0.43 ± 1.17, 1.1 ± 0.46, and 6.61 ± 3.29, respectively. CONCLUSION: The present study concluded that both the types of school-based physical activity interventions are equally effective in reducing weight, BMI, and skinfold thickness scores. However, structured physical activity showed a better reduction in mean weight at the end of 2 weeks of intervention and nonstructured physical activity showed a better reduction in mean weight at 4 weeks of intervention.
  916 121 -
Comparison of stress distribution on bone and mini-implants during en-masse retraction of maxillary anterior teeth in labial and lingual orthodontics: A three-dimensional finite element analysis
Ankita Anil Ringane, Rohan Hattarki
May-August 2018, 11(2):130-135
DOI:10.4103/kleuhsj.kleuhsj_248_17  
INTRODUCTION: In fixed orthodontic treatment, space closure is one of the most challenging aspects. The common method of en-masse retraction in sliding mechanics is the use of the elastomeric chain and power arm. Recently, titanium mini-implants are used as absolute sources of orthodontic anchorage. Lingual and labial bracket placement influences the pattern of tooth movement, but the stress that occurs around the teeth, the mini-implants, and the surrounding bone can be accurately mapped using a three-dimensional (3D) finite element method. AIM: The aim of this study was to evaluate the stress distribution on bone and mini-implants during en-masse retraction of maxillary anterior teeth in labial and lingual orthodontics with the help of finite element analysis. MATERIALS AND METHODS: Following the standard protocol for 3D finite element models, two models were created for en-masse retraction of the six anterior teeth: one model using the labial technique with the mini-implant placed at a height of 5 mm from the alveolar crest bucally and the second model using the lingual technique with the mini-implant placed at a height of 5 mm from the gingival margin palatally, and 200 g of retraction forces was given using a elastomeric chain. RESULTS AND CONCLUSIONS: The Von Mises stresses in the bone and mini-implant were significantly higher in the lingual technique as compared to the labial technique. The variations in stress patterns in the bone and the mini-implant in the labial and lingual technique could be the result of difference in the inter-bracket distance, point of force application, and its location to the center of resistance of the dentition.
  926 103 1
Prevalence of sensorineural hearing loss among type-II diabetes mellitus patients attending KLES Dr. Prabhakar Kore Hospital and MRC: A cross-sectional study
Aniruddh Tiwari, Ramesh S Mudhol
May-August 2018, 11(2):165-169
DOI:10.4103/kleuhsj.kleuhsj_187_17  
INTRODUCTION: Diabetes mellitus (DM) is an important healthcare concern in the modern world. This disease and its complications can affect virtually every system in the human body. A possible complication of DM is sensorineural hearing loss (SNHL). AIM: The current study aimed to evaluate the prevalence of SNHL among the patients of type-2 DM attending the hospital as well as to correlate the severity of hearing loss to the duration of diabetes and the glycosylated hemoglobin (HbA1c) levels. A total of 125 known cases of type-2 DM were included in the study. METHODOLOGY: For each patient, a detailed history was taken, thorough clinical ear, nose, and throat examination was done, hearing thresholds were evaluated by means of pure tone audiometry and HbA1c levels were measured. RESULTS: SNHL was seen in 76.8% of the patients. Robust correlation was seen between the severity of SNHL and the duration of DM (P < 0.0001, r coefficient 0.3668). Positive correlation was seen between SNHL and HbA1c levels (P = 0.0001, r coefficient 0.3517). CONCLUSION: This study confirms that there is a high prevalence of SNHL in type-2 DM.
  896 107 -
CASE REPORTS
Fabricated or factitiously induced illness in a neonate: A case report and review of literature
Hafsat Umar Ibrahim, Abdussalam Mohammed, Musa Gambo Takai, Fatima Usman, Zubaida Ladan Farouk
May-August 2018, 11(2):178-182
DOI:10.4103/kleuhsj.kleuhsj_80_17  
Fabricated or factitiously induced illness (FII) is a form of child abuse in which a caregiver imposes an illness on a child for some attention or gains. These gains could be financial or psychological. It is also known as Munchausen Syndrome by Proxy. In our clinical setting, the patient load is usually high and documentation is not adequate. Most cases could go unnoticed or undiagnosed due to work pressure. The case highlights a neonate with multiple admissions due to induced, imposed, and exaggerated illnesses by a mother, to get financial and psychological attention from the husband. She was found to have severe depression and background borderline personality disorder after a psychiatric evaluation. A high index of suspicion and communication between health-care providers including documentation helps in early detection of these children with FII. The need to further investigate and rule out risk factors in caregivers and child cannot be overemphasized.
  886 87 -
ORIGINAL ARTICLES
Cutaneous manifestations in neonates: A 1-year cross-sectional study in a tertiary care hospital
Swathi Shivakumar, BS Manjunathswamy, Tanmaya Metgud, Bhavana Doshi
May-August 2018, 11(2):125-129
DOI:10.4103/kleuhsj.kleuhsj_221_17  
BACKGROUND: Skin lesions in neonatal period range from transient self-limiting conditions to serious dermatoses requiring specific therapies. They can cause significant psychological distress to parents. The awareness of the fact that most of these conditions are benign and transient is important so that parents can be reassured. Since studies on neonatal dermatoses are limited, this study has been planned to know the spectrum of cutaneous lesions in neonates, both physiological and pathological. MATERIALS AND METHODS: All neonates <28 days old, attending KLEs Dr. Prabhakar Kore Hospital and MRC, Belgaum, were recruited into the study. Newborns admitted in the Neonatal Intensive Care Unit were excluded from the study. A written informed consent was obtained from the mother. The study design was nonrandomized cross-sectional study. A sample size calculation was done using the Chi-square test. Analysis of data was performed by STATA 11.2. An Ethical Committee clearance was obtained before the start of the study. RESULTS: One hundred and four neonates were enrolled in the study, out of which 49 (47%) neonates were male and 55 (53%) were female. Fifty-one (49%) neonates were born through normal vaginal delivery and 53 (51%) by cesarean section. Three (2.88%) neonates were born preterm, 5 (4.81%) post-term, and 96 (92.31%) neonates were born at term. Ninty-nine (95%) had physiological changes and 5 (5%) had pathological changes. The most common physiological change observed was mongolian spot in 34 (33%) of neonates followed by erythema toxicum neonatorum in 27 (26%) neonates and physiological desquamation in 21 (20%). Other less common physiological skin changes observed were milia, miliaria, hypertrichosis lanuginosa, vernix caseosa, and sebaceous gland hyperplasia. Pathological skin changes were observed in only five neonates, out of which one had bullous impetigo, one had birth trauma, 1 had furunculosis, 1 had intertrigo, and 1 was a collodion baby. CONCLUSION: Skin changes in newborn are very common. However, majority are physiological and transient requiring no treatment.
  866 97 -
CASE REPORTS
Rare case of diabetes mellitus, sensorineural hearing loss, and refractory megaloblastic anemia: SLC19A2 mutation
Tanmaya Metgud, Sujata Jali, Mahesh Kamate, Abhilasha Sampagar, Nishant Mittal
May-August 2018, 11(2):175-177
DOI:10.4103/kleuhsj.kleuhsj_44_18  
Reporting a rare and treatable case of thiamine responsive Megaloblastic Anemia with Sensori-neural Hearing Loss with Diabetes Mellitus in a 6 year old child due to SLC19A2 mutation. Simple thiamine treatment is cost effective and can reverse this disorder except hearing loss.
  846 78 -
LETTERS TO EDITOR
Capecitabine-induced tongue hyperpigmentation
Chaturbhuj Ramanand Agrawal, Silky Kothiwal
May-August 2018, 11(2):186-187
DOI:10.4103/kleuhsj.kleuhsj_114_17  
  639 76 -
The rising incidence of severe acute malnutrition in the conflict-affected parts of Nigeria
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-August 2018, 11(2):184-185
DOI:10.4103/kleuhsj.kleuhsj_77_17  
  631 71 -
A need for research implementation in undergraduate curriculum
Anita Teli
May-August 2018, 11(2):183-183
DOI:10.4103/kleuhsj.kleuhsj_320_17  
  604 77 -