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   Table of Contents - Current issue
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May-August 2021
Volume 14 | Issue 2
Page Nos. 169-293

Online since Monday, May 31, 2021

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EDITORIAL  

Challenges and management of type-1 diabetes in COVID-19 pandemic Highly accessed article p. 169
Sujata Jali
DOI:10.4103/kleuhsj.kleuhsj_135_21  
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REVIEW ARTICLES Top

Sudden onset of olfactory and gustatory dysfunction - An early predictor to isolate the patient in COVID-19 pandemic Highly accessed article p. 173
Santosh Kumar Swain
DOI:10.4103/kleuhsj.kleuhsj_288_20  
Coronavirus disease-19 (COVID-19) is a new pandemic caused by severe acute respiratory syndrome coronavirus 2. The prevalent symptoms in COVID-19 include fever, cough, sore throat, rhinorrhea, myalgia, headache, dyspnea, and diarrhea. At the initial period of the COVID-19 pandemic, the clinical presentations such as olfactory and gustatory dysfunctions were considered as atypical. At present, olfactory and gustatory dysfunctions are not uncommon symptoms among COVID-19 infections in the COVID-19 pandemic. Initially, these two symptoms were underestimated and not recognized among scientific community. At present, many otolaryngologists over the world documented that COVID-19 patients presented with olfactory and gustatory dysfunctions even without the presence of nasal obstruction or rhinorrhea. The exact etiopathology for olfactory and gustatory dysfunctions is still not known. Future clinical and basic science studies may help to understand the mechanism for olfactory and gustatory dysfunctions in this pandemic. The objective of this review article is to discuss details of the olfactory and gustatory dysfunctions in COVID-19 patients. This article will surely increase awareness among the clinicians and people who are dealing with COVID-19 patients and their early diagnosis.
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Scope and need of curriculum mapping in accomplishing learning outcomes in the field of medical education p. 178
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_388_20  
Curriculum refers to the complete range of student experiences to which they will be exposed in the educational process. For any curriculum, communicability and transparency have been regarded as the crucial aspects. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of six articles were selected based upon the suitability with the current review objectives and analyzed. Curriculum mapping has been identified as the method to ensure communicability and transparency, but it also plays an important role in bridging the gaps between the declared, taught, and tested curriculum. The mapping helps establish a relationship between various components of the curriculum and is the key strategy to ascertain the accomplishment of learning objectives or outcomes formulated for any curriculum. In conclusion, the process of curriculum mapping in the field of medical education has been acknowledged as an effective strategy to facilitate evaluation, rapid improvement, and evolution of the curriculum and thus improve the educational outcomes.
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Effectiveness of meditation programs in empirically reducing stress and amplifying cognitive function, thus boosting individual health status: A narrative overview p. 181
Rohan Arora, Reshu Gupta
DOI:10.4103/kleuhsj.kleuhsj_108_20  
Meditation is increasingly being used to promote general health, to treat stress and stress-related conditions, and is also beginning to find its feet in cognitive therapeutics. This article intends to evaluate its impacts on stress and cognitive function, aiming to augment the understanding of the mechanisms and subsequent implications for individual health. A multistep approach was used for the purpose of selection of articles, which was based on shortlisting of titles, then abstracts and further full texts. Subject to selection criteria, keywords “Meditation,” “stress,” “cognition,” “reducing,” “health,” and “effectiveness” were used to search online databases and conduct hand searches. The results indicated a stress-lowering effect by neural, endocrine, and humoral changes, evidenced by multiple parameters such as heart rate variability, blood pressure, galvanic skin response, salivary cortisol, and cytokines, and a psychological improvement in emotional regulation and perseverative cognition, with clinical implications in daily life and clinical settings such as hypertension, cancer stress, chronic pain, posttraumatic stress disorder, glaucoma, and anxiety disorders. The positive effect on cognition occurs through mechanisms such as altered regional blood flow, brain remodeling, functionally altered connections, and reduced emotional vulnerability. Increased secondary organization of thoughts is noted with implications in student settings, work output, neurodegenerative disorders, learning disorders, and attention deficit disorders. Meditation thus potentially offers a modality which could boost all aspects of health in a cost-effective, low time-consuming manner to a wide spectrum of individuals. While the evidence thus far is constructive, further studies with larger samples, stronger study designs, and offering more conclusive evidence are required.
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Transrectal ultrasonography and biopsy of the prostate p. 188
RB Nerli, Manas Sharma, Shridhar C Ghagane
DOI:10.4103/kleuhsj.kleuhsj_5_19  
When compared to other solid organ malignancies, the diagnosis of prostate cancer is not reliant on imaging findings alone. Men found to have abnormal digital rectal examination findings, raised serum prostate-specific antigen levels, or both are subjected to prostate biopsy to arrive at a diagnosis. Since its introduction in the 1970s, Transrectal ultrasonography (TRUS) plays a vital role in the diagnostic pathway to guide prostatic biopsy. However, many men are subjected to unnecessary biopsies, leading to a diagnosis of clinically-indolent cancer or occasionally missing a focus of clinically significant disease. Currently, TRUS-guided prostate biopsy performed under local anesthesia is in widespread use for the diagnosis of prostate cancer. The peripheral zone of the prostate showing a hypoechoic lesion is the most common finding consistent with prostate cancer. In this review, we aim to highlight the ultrasonographic anatomy of prostate, the technique, and associated complications along with a brief note on the recent advances in imaging technology for the diagnosis of prostate cancer.
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Dietary aldose reductase inhibitors and prevention of diabetic complications p. 194
Ameena Anjum, Janamolla Sreeja, Yarlagadda Swapna, Rajesh Bolleddu, Sama Venkatesh
DOI:10.4103/kleuhsj.kleuhsj_105_19  
Prolonged exposure to hyperglycemia can lead to the development of complications such as cataracts, retinopathy, neuropathy, and nephropathy. Several mechanisms are supposed to be involved in this process such as increased aldose reductase (AR)-related polyol pathway, increased formation of advanced glycation end products, and excessive oxidation stress in the body. AR is the principal enzyme of the polyol pathway in the development of secondary complications of diabetes, and its inhibition provides a significant strategy to prevent these complications. Synthetic aldose reductase inhibitors (ARIs) have been developed, but they suffer drawbacks and safety issues demanding research on natural sources for potential ARIs. Many dietary substances and phytochemicals were reported as being good source of ARIs including Spinacia oleracea, Ocimum sanctum, Foeniculum vulgare, Momordica charantia, Cinamomum zeylencium, and Cuminum cyminum. This review was undertaken to provide an insight into the use of dietary ARIs for prevention, delay, or management of the secondary complications and to serve as a guide for further research for their optimum and effective use and also to create awareness among the diabetics.
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ORIGINAL ARTICLES Top

Prevalence and risk factors of diabetic retinopathy in rural population of Belgaum district p. 200
Arvind L Tenagi, Lisa Sunny, Vivek Wani, Mahesh I Magdum, KS Smitha, BK Bhagyajyothi
DOI:10.4103/kleuhsj.kleuhsj_204_19  
BACKGROUND: Rural population is highly underprivileged in terms of access to tertiary eye care facilities. AIMS: The aim of the study was to determine the prevalence of diabetic retinopathy (DR) and associated risk factors among known diabetics in the rural population of Belgaum district. SETTINGS AND DESIGN: A cross-sectional population-based study was carried out from January 2018 to December 2018. METHODOLOGY: Three hundred and forty patients underwent a detailed ocular examination. Clinical grading was based on early treatment of DR study guidelines. Random blood sugar, blood pressure, height, weight, hemoglobin, serum creatinine, and glycated hemoglobin (HbA1c) were measured. STATISTICAL ANALYSIS: Chi-square and analysis of variance tests were used to assess risk factors. RESULTS: The prevalence of DR was found to be 23.82%. Of this, 19.11% had nonproliferative DR (PDR) and 3.53% had PDR. Nearly 1.18% had clinically significant macular edema. A statistically significant association was found between DR and duration of diabetes, HbA1c, smoking, and family history of diabetes. CONCLUSION: The significant prevalence of DR as per this study signifies the need for regular structured screening camps and the availability of basic vitreoretinal facilities at the primary level.
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Personal protective equipment usage and its disposal by the residents of Dhaka city during the COVID-19 pandemic: A mixed-method enquiry p. 206
Shuvashis Saha, Md Shah Newaz, Shajib Hazari, Mohammad Kabir Uddin, Samiul Iqbal, Kh Salekuzzaman
DOI:10.4103/kleuhsj.kleuhsj_413_20  
CONTEXT: COVID-19 has caused unprecedented hazard not only to the health and economy but also to the environment worldwide. In the absence of an effective vaccine to the mass people, practice of preventive measures against coronavirus can only save the health and economy of a poor nation like Bangladesh. On one hand, poor practice of protective behavior against the novel coronavirus has been reported among the general population and on the other hand, sudden rise of personal protective equipments (PPEs) use are causing massive damage to the environment of the cities like Dhaka. AIMS: This study aims to understand the perception and practice of use and disposal of PPEs against COVID-19 by the residents of Dhaka city. MATERIALS AND METHODS: A cross-sectional study was designed with a mixed-method approach with an online survey and key informant interviews of the residents of Dhaka city. RESULTS: About 44% of respondents were regular mask users and 3% used gloves regularly while staying out of home. Confusion, discomfort, hot weather, and unaffordability were commonly reasoned for not regular use. About 40% of the respondents disposed their used masks or gloves to open places in the streets at some point of their life during the pandemic. Lack of proper disposal facilities in the city was evident throughout the study. CONCLUSIONS: A proper health education program along with government initiatives enhancing disposal facilities around the city can improve the situation.
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“Mothers knowledge and attitude on feeding of banked human milk among infants” with view to develop an information booklet” p. 211
Hussainbi A Tahasildar, Gavishiddhayya B Salimath
DOI:10.4103/kleuhsj.kleuhsj_123_20  
INTRODUCTION: Donor breastfeeding is the best natural feeding. Especially in high-risk and preterm infants, donor breast milk is the best source of nutrition. The benefits of breastfeeding for the neonates are already known; when mother breast milk is not flowing due to some medical conditions, then the alternative best source donor breast milk. OBJECTIVES: The objective of the study was to assess the knowledge and attitude of mothers on feeding of banked human milk among infants and also to find out associations with sociodemographic variables. METHODOLOGY: The study was conducted at KLE'S Dr. Prabhakar Kore Hospital among 100 postnatal mothers with a convenient sampling method. A self-structured questionnaire was prepared on knowledge and attitude among mothers of infants regarding feeding of banked human milk. RESULTS: The results revealed that 9 (9%) mothers had high knowledge, 42 (42%) mothers had medium knowledge, and 49% of them had low knowledge, and 66% of the mothers had medium attitude, 21% mothers had low levels of attitude, and 13% of mothers had a high attitude toward feeding of banked human milk among infants. CONCLUSION: Our study assessed different levels of knowledge and attitude and created awareness on donating and accepting of breast milk from milk banks among the mothers of infants toward feeding of banked among infants.
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The other corona warriors: A KAP study on COVID-19 among janitors and housekeeping staff from a tertiary care hospital in Eastern India Highly accessed article p. 218
Vineeta Shukla, Ripan Saha, Ankita Mishra, Meghna Mukherjee, Mausumi Basu, Raghunath Misra
DOI:10.4103/kleuhsj.kleuhsj_389_20  
BACKGROUND: Janitors and housekeeping staff are an integral part of our health-care system and are also in the frontline to fight this pandemic. COVID-19 infection is a new disease which currently has no specific treatment and vaccine, but this disease is preventable if there is a high level of awareness. This is especially important for housekeepers as they are unable to get adequate protection unlike doctors and nurses. They also receive less importance and appreciation than other frontline workers. OBJECTIVES: To assess the knowledge, attitude, and practice (KAP) of janitors and housekeeping staff of a tertiary care hospital on COVID-19 and to find out the factors associated with KAP. MATERIALS AND METHODS: An observational study was carried out among 214 janitors and housekeeping staff of a tertiary care hospital in Kolkata. The data were analyzed using SPSS software version 20.0. Each response was scored, and subjects having a total score above the median score of KAP scores were said to have adequate knowledge, positive attitude, and satisfactory practice, respectively. Multivariate logistic regression was done to check the association between KAP of the study population with their sociodemographic profile. RESULTS: About 53.3% of the study population had adequate knowledge, 56.1% had positive attitude, while 62.6% had satisfactory practice (≥median score). Age, posting in medicine & allied departments and surgery and allied departments were found to have statistically significant odds of inadequate knowledge. Odds of having negative attitude was found to be statistically significant in those working as security and kitchen staff and residing within the institution premises. Odds of having unsatisfactory practice was found to be statistically significant in the age group of 34 years and above and those following Islam religion. CONCLUSION: The janitors and housekeeping staff had adequate knowledge on COVID-19, and their attitude was mainly positive with satisfactory practice. However, the proportion of adequate knowledge, positive attitude, and satisfactory practice could have been higher. As the global threat of COVID-19 continues to increase, greater efforts through campaigns that target frontline workers and the wider population are urgently needed.
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Lifestyle behavior of patients with noncommunicable diseases during COVID-19 pandemic: An observational study p. 227
Renu Bala, Amit Srivastava
DOI:10.4103/kleuhsj.kleuhsj_38_21  
CONTEXT: Coronavirus disease (COVID-19) poses an unprecedented challenge and adversely affects the lifestyle of people with noncommunicable diseases (NCDs) due to enforced restrictions by the governments. AIMS: The study aimed to assess the physical activity and prophylactic behavior, along with change in sleep, alcohol intake, and tobacco consumption during the enforced lockdown. MATERIALS AND METHODS: The study was conducted in August 2020 and recruited NCD patients visiting the institute's outpatient department. Questions were formed on prophylactic behavior, changes in sleep, and alcohol and tobacco consumption along with a validated scale of International Physical Activity Questionnaire (IPAQ) Short Form. RESULTS: The study recruited 413 patients with a mean age of 54.34 years. The median IPAQ score was 536 metabolic equivalent task-minutes/week, with 41.96% of the patients demonstrating low physical activity. A statistically significant difference between the IPAQ scores was found among different NCD groups (P = 0.009). There was a statistically significant decrease in number of hours of sleep during the pandemic as compared to before the pandemic (P = 0.000). Furthermore, there was a significant change in tobacco consumption (P = 0.000) and alcohol consumption (P = 0.000) during the pandemic. The patients followed preventive practices to a larger extent. CONCLUSION: The study highlighted that the NCD patients should follow an optimal physical activity schedule, take proper sleep, and continue following prophylactic behavior.
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Study of “three delay model” of maternal morbidity and mortality in two tertiary care hospitals of Belagavi p. 234
Jyoti Singh, Chandra S Metgud
DOI:10.4103/kleuhsj.kleuhsj_280_20  
INTRODUCTION: Every year millions of women around the world suffer from pregnancy, childbirth, and postpartum complication. Approximately 810 women die every day worldwide from preventable causes related to pregnancy and delivery. The concept of severe acute maternal morbidity or near miss was aptly developed for the present health-care system. The World Health Organization (WHO) has defined “near-miss” as a woman, who is close to death, survives a complication that occurred during pregnancy, delivery, or up to 42 days after the termination of her pregnancy. The important causes of maternal mortality and morbidity have been summarized as the three delays. These delays have been identified to understand the gap in access to adequate obstetric management. Delays in access to quality care have been identified as one of the important determinants of preventable maternal death. The present study was planned to assess the “three delay model” leading to the occurrence of severe maternal outcome (SMO) in two tertiary care hospitals of Belagavi, Karnataka, as proposed by the WHO near-miss approach. OBJECTIVE: This study aimed to study the “three delay model” leading to maternal morbidity and mortality in two tertiary care hospitals of Belagavi. MATERIALS AND METHODS: A cross-sectional study was conducted in two major tertiary care hospitals of Belagavi, namely KLE Dr Prabhakar Kore Charitable Hospital and Belagavi Institute of Medical Sciences Hospital for a duration of 1 year among antepartum, intrapartum, and postpartum mothers experiencing SMO. A sample of 200 was calculated based on the prevalence of previous maternal near-miss (MNM) incidence ratio. To assess the MNM cases, “Modified Facility Based MNM Review Form” was used. RESULTS: Out of 200 MNM cases, 145 (72.5%) subjects belonged to the age group of 21–30 years and 17 (8.5%) of the women were aged ≥31 years. The mean ± standard deviation age of the study participant was 25.0 ± 4.45 years. Based on the obstetric profile of the study subject, it was noted that 139 (69.5%) participants had presented to the study hospitals as unbooked cases and 93 (46.5%) were primigravida. Majority (160, 80.0%) of the MNM women had presented as referred cases. The MNM incidence ratio in the present study was recorded as 12.05/1000 live births with a MNM: maternal death ratio of 3.3:1. All types of delays were noted among the study participant in our study. Type I delay that consisted of lack of awareness and resources was seen in 134 (67.0%) MNM cases, followed by 130 (65.0%) experiencing Type II delay comprising logistics delay between home and health-care facility and in between the health facilities along with lack of communication network and the third type of delay being observed at the referring health facility in all the referred study participant. Assessment of association between maternal outcome and the “3 delay model” by use of logistic regression analysis suggested that women who faced any kind of delay (I, II, and III) during their pregnancy were more likely to end up with poor maternal outcomes. CONCLUSION AND RECOMMENDATION: The present study aimed to assess the delays that lead to poor maternal outcomes. The current study revealed the deficiencies that need to be tackled and taken care of on an urgent basis. Hence, there must be a multidisciplinary approach to manage the high-risk maternal cases for timely intervention and management and reduce the burden of maternal morbidity and mortality on a global scale.
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Academic loss-related anxiety among college students during COVID-19 pandemic p. 239
Sagar Rai, Zareen Akhtar, Kaushal Kishor Singh, Madan Lal Brahma Bhatt, Sudhir Kumar Verma, Sujita Kumar Kar
DOI:10.4103/kleuhsj.kleuhsj_398_20  
BACKGROUND: The global outbreak of SARS-CoV2, initially affecting few individuals in Wuhan city of China, is now devastating millions of lives. Among all, students face substantial challenges, mainly in academic losses due to the imposed lockdown that may be detrimental to their mental well-being. Our study aimed to identify the anxiety levels among university students undergoing training in various disciplines. METHODS: It was a cross-sectional study. General Anxiety Disorder-7 scale within a semi-structured questionnaire was used to assess students' anxiety levels about their academic loss. RESULTS: A total of 507 students from India participated in the survey. Eventually, the prevalence of students experiencing anxiety was significantly high, and approximately 25% of the students reported moderate to severe anxiety levels. This emphasizes the need for psychological support to the students through various means to develop innovative solutions to handle the crisis. CONCLUSION: Moreover, the lowest prevalence of anxiety among healthcare sciences students leads us to conclude that this population is well prepared mentally and hence should be the first choice of the future resort if the need arises to aid the current healthcare workforce.
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Correlation between cigarette smoking and raised intraocular pressure in males p. 245
Sushmita Mukherji, Soumen Karmakar, Sibaji Dasgupta
DOI:10.4103/kleuhsj.kleuhsj_290_20  
OBJECTIVE: Smoking is one of the most important risk factors both in systemic as well as ocular diseases. Its role in pathogenesis of ocular hypertension and open-angle glaucoma has been proposed, but there remains a controversy in the study results. Our aim is to find any association between cigarette smoking and raised intraocular pressure (IOP). METHODS: This was a cross-sectional study. A total of 60 male subjects were selected according to inclusion and exclusion criteria. Thirty-one were selected using simple random sampling, had raised IOP, among which 17 were smokers. Two-nine matched subjects had normal IOP, with 11 smokers among them. Smoking parameters were classified using Smoking Index as well as pack-years. The correlation between different smoking parameters and IOP was studied and analyzed. RESULTS: There was a positive association between IOP and smoking overall (P value 0.021). In addition, there was a significant correlation between IOP and pack-years (P value 0.036), as well as IOP and duration of smoking (P = 0.044). However, there was no significant association of daily number of cigarettes smoked with IOP, as well as between mild, moderate, and heavy smokers in terms of intraocular pressure. CONCLUSION: Smoking is found to be an important risk factor in pathogenesis of ocular hypertension, as well as glaucoma. Lifestyle modification in terms of prohibition of smoking may reduce the overall incidence and progression of glaucoma worldwide.
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Mobile application-assisted observation of hand hygiene practices among nurses in a tertiary care center: A cross-sectional study p. 249
A Malini, B Bhuvaneshwari
DOI:10.4103/kleuhsj.kleuhsj_17_21  
BACKGROUND: Improper hand hygiene (HH) practices are responsible for nearly 40% of health care-associated infections (HCAIs). Good HH measures are the most cost-effective means of reducing its incidence. Health-care workers (HCWs) play an important role in reducing HCAI by adhering to HH and intensive care unit protocols. OBJECTIVES: The objectives of the study are to assess the knowledge regarding HH among nurses using a questionnaire and to assess compliance to the WHO's “My five moments of hand hygiene” among nurses using a mobile application (App). MATERIALS AND METHODS: This was an observational cross-sectional study in a tertiary care center conducted among 100 nurses willing to participate. Their knowledge on hand hygiene was assessed using the WHO questionnaire, and compliance to the WHO's “My five moments of hand hygiene” was assessed by direct observation and documentation using a mobile App (Speedy Audit™, freely downloadable, developed by Handy Metrics Corporation). The data on compliance were entered into the mobile App which saves it as a MS Excel sheet. The knowledge and compliance rate were then calculated using proportions. RESULTS: Of 100 nurses who participated in the study, 72% had good knowledge about HH practices. Overall compliance to “My five moments of hand hygiene” was 73.6%, with 100% compliance for “after body fluid exposure” and “after touching a patient” and 50% for “after contact with patient surroundings.” CONCLUSIONS: Our study has shown that nurses not only have good knowledge about HH practices but have also implemented it. Periodic awareness programs on HH and the provision of adequate hand washing facilities can facilitate better practices.
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Occupational safety and health hazards among cashew processing workers of Cuddalore district: A cross-sectional study p. 254
Janana Priya, Lavanya Ayyasamy, Sri Madhu Priya Mahendiran, Adhithyaa Selvarathinam
DOI:10.4103/kleuhsj.kleuhsj_6_21  
BACKGROUND: Occupational health and safety is a major concern of all time despite consequent advancement in all forms of industries. As stated in multiple research papers from various parts of the nation, more than 90% of workers involved in cashew processing were females who are socially and economically backward.This paper aims to find the existing occupational health hazards of workers in the cashew processing unit and the level of safety measures adopted. In addition, the health outcome in relation to certain improvisations made in the process was also analyzed. MATERIALS AND METHODS: Full-time workers from the cashew processing unit were selected as the study population through convenience sampling technique. This study was conducted on 200 workers from May 2019 to October 2019. For data collection, a semi-structured questionnaire was used to collect information on demography, working environment, and personal protective equipment (PPE) utilization; a Modified Nordic questionnaire for muskuloskeletal disorder and rapid upper limb assessment scale for ergonomic assessment. Descriptive analysis followed by Chi-square test was done to find the association between the nature of the job and hazards. RESULTS: Muscular skeletal pain in the various regions holds a major part of all health hazards faced by the workers (low back pain [n = 72, 36%] and wrist/hand pain [n = 65, 32.5%]). The proportion of low back pain is highly noticed among shelling workers (79.2%) and wrist/hand pain among peeling (41.5%), roasting (21.5%), and grading (20%), respectively (P ≤ 0.001). The change from squatting shelling to machine shelling has reduced low back pain to some extent, but the overall hazard risk remains unchanged. The majority of workers were not provided with proper PPE, hand washing facilities, and medical facilities within the unit. CONCLUSION: Prolonged work time due to piece-rate system and poor PPE utilization exacerbate hazards. In order to provide a healthy and safe workplace, it is important to identify, monitor, and reduce the risk associated with workplace hazards.
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Emerging crisis of multidrug-resistant enterococci from a rural tertiary care hospital of North India p. 260
Jyoti Sangwan, Kirti Lohan, Pratibha Mane, Mukesh Kumar
DOI:10.4103/kleuhsj.kleuhsj_392_20  
INTRODUCTION: Enterococci are emerging as a major pathogen causing a variety of hospital-acquired nosocomial infections and community-acquired infections contributing significantly to patient's morbidity and mortality. The emergence of multidrug-resistant enterococci worsens the problem as multidrug resistance leaves fewer therapeutic options for clinicians in treating life-threatening infections. MATERIALS AND METHODS: This was an observational study carried out from March 2019 to February 2020. Antimicrobial susceptibility testing of enterococci was done by Kirby–Bauer disc diffusion method, and results were interpreted as per the Clinical and Laboratory Standards Institute guidelines 2019. RESULTS: Multidrug-resistant enterococci were reported to be 62.7%. A variable antimicrobial susceptibility pattern was seen with different antibiotics. Majority of isolates were resistant to β-lactam (96.6%), and high-level aminoglycoside resistance was seen in 39% of isolates. Glycopeptide resistance was observed in teicoplanin (14.6%). No vancomycin and linezolid resistance was noted. CONCLUSION: The prevalence of multidrug-resistant enterococci was reported to be 63%; the resistance was more common in Enterococcus faecium as compared to Enterococcus faecalis. This study highlights the emergence of multidrug-resistant enterococci, especially to high-level aminoglycoside and glycopeptide which poses a serious therapeutic challenge.
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Value of self-assessment as a learning tool in dental education and practice: A descriptive study p. 265
Sunila Bukanakere Sangappa, Radha Madhavi
DOI:10.4103/kleuhsj.kleuhsj_37_21  
BACKGROUND: Self-assessment (SA) skills are integral to lifelong learning process as they are a mode to share educational responsibility. Therefore, the purpose of this study was to explore the dental undergraduate student's perception, practice of SA, and its impact over their academic and clinical performance. MATERIALS AND METHODS: This cross-sectional study was carried out among 444 dental students regarding practice of SA in their academic and clinical practice across all the years for a period of 3 months. Data were collected by a pilot-tested self-administered structured questionnaire adopting convenient sampling and analyzed using SPSS Version 22 Software. RESULTS: Mean score for the value of SA skill as a learning tool was lower (60.21 ± 4.83) among 3rd-year dental students and highest (65.26 ± 4.69) among interns with an overall mean score of 62.59 ± 5.27, and the results of one-way ANOVA revealed that the year-wise mean score difference was statistically significant. The post hoc test revealed that the mean score for value of SA skills was significantly different between 1st-year and 3rd-year students. Although undergraduate students valued the need of SA skills for lifelong learning process, there is paucity toward their ability to accurately perform SA. CONCLUSION: In the context of how SA is perceived by dental undergraduates, our study suggests that the acceptability of SA is seldom explored. The focused responses of the participants of this study underline the importance and need of training and practicing SA skills in dental undergraduate curriculum.
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Prevalence and pattern of obstructive sleep apnea in chronic obstructive pulmonary disease patients from northern India p. 274
Rakesh Tank, Priyanka Tank, Abhishek Singh
DOI:10.4103/kleuhsj.kleuhsj_25_21  
BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation, hyperinflation, and ventilation-perfusion mismatch. It is now considered as a systemic disease. The prevalence of obstructive sleep apnea (OSA) in COPD is variable with a paucity of literature from Indian subcontinent. AIM: This study was conducted to observe the regional prevalence and pattern of OSA in patients of COPD. MATERIALS AND METHODS: The present prospective study was carried out in the Department of Internal Medicine, Pt. B.D. Sharma, PGIMS, Rohtak, for a period of 20 months, i.e. during July 2012 to February 2014. Patients seeking care at the Department of Internal Medicine and diagnosed with COPD formed the study population. COPD patients stable for at least 6 weeks were included in this study. Mild COPD patients, ischemic heart disease patients, any comorbid state, known case of OSA, and patients having COPD with acute exacerbation were excluded. The prescreening tools for the identification of OSA are Berlin sleep questionnaire and the Epworth sleepiness scale (ESS). Polysomnography was done using Somnologica studio 3.3.2 Embla N7000 sleep unit system. RESULTS: OSA with apnea–hypopnea index (AHI) ≥5/h was present in 10 out of 40 participants (25.0%). Berlin scores were found to be 0.10 ± 0.03 and 0.70 ± 0.04 in nonsleep-disordered breathing (SDB) and SDB participants, respectively. ESS scores were observed to be 2.60 ± 0.82 and 7.90 ± 2.51 between non-SDB and SDB participants, respectively. The difference in AHI between patients with non-SDB and SDB was statistically highly significant (1.36 ± 0.37, 13.41 ± 3.40; P < 0.001). Variation in numbers of apnea in rapid eye movement (REM) (1.20 ± 0.68, 9.9 ± 1.87) and non-REM (4.47 ± 1.48, 50.50 ± 8.70) between two groups of participants was found to be statistically significant (P < 0.05) and highly significant (P < 0.001), respectively. Average O2 saturation and O2 desaturation events were also varied significantly between two groups of patients. CONCLUSIONS: The prevalence of OSA in COPD patients was found to be in the higher range. Sleep was significantly distorted in all its aspects in patients of COPD. ESS was found efficient in screening the patients of COPD for coexistent OSA. Berlin's questionnaire can be used to evaluate patients of overlap syndrome.
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CASE REPORTS Top

Photokeratitis following exposure to germicidal ultraviolet lamps during the COVID pandemic p. 279
Suprava Das, Pradeep Kumar Panigrahi, Deergha Pareek
DOI:10.4103/kleuhsj.kleuhsj_31_21  
Twelve patients presented with symptoms of pain, redness, watering, and photophobia following exposure to germicidal ultraviolet (UV) lamp. Anterior segment examination showed varying degrees of ciliary congestion and superficial corneal punctate epithelial erosions in all patients. Diagnosis of post-UV photokeratitis was made. Patients were treated with topical antibiotics and artificial lubricating drops. All patients were symptom free 1 week following presentation. The use of standard protective gear and closely following manufacturer guidelines can prevent such complications.
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An unusual case of phytobezoar causing gastric outlet obstruction p. 282
Aditi Shivcharan Agrawal, Tuhina Mishra
DOI:10.4103/kleuhsj.kleuhsj_18_21  
A bezoar is defined as the accumulation of certain indigestible or poorly digestible substances in the gastrointestinal tract in the form of a mass, and when the bezoars consist of fruits and vegetables fibers, they are labeled as “phytobezoar.” Bezoars in the stomach are a rare condition and are often associated with episodes of gastric dysmotility and prior gastric surgery, though sometimes they can present without any significant history. Phytobezoars are difficult to diagnose due to its overlapping signs and episodic nature. however, in medical literature, the information about phytobezoars is insufficient due to the limited amount of documented cases, as well as the lack of research about this topic. in this case report, we present a rare case of gastric outlet obstruction with signs and symptoms overlapping with gastric carcinoma. On further investigation, the obstruction was found to be due to ingestion of unidentified type of vegetable fibers causing food impaction and phytobezoar formation for a 72-year-old patient with no former history of any type of surgeries.
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Sick sinus syndrome and hyperthyroidism: A rare phenomenon p. 284
Nitesh Kumar, Diwakar Verma, Kapil Gupta, Madhu Kiran, Prakarti Yadav, Shatrughan Pareek
DOI:10.4103/kleuhsj.kleuhsj_23_21  
Cardiovascular complications play a very crucial part in hyperthyroidism and increased mortality and morbidity risk. Besides tachyarrhythmia, impaired systolic ventricular dysfunction and diastolic dysfunction may cause thyrotoxic cardiomyopathy in a small percentage of the patients, as another high mortality complication. Bradycardia in hyperthyroidism is a rare phenomenon which is associated with the sinus node dysfunction, atrioventricular node dysfunction, and conduction disturbance, or due to the effect of the drugs, i.e. beta-blockers. A 70-year-old female patient was brought to the emergency department with the history of feeling dizziness, lightheadedness, and bradycardia. While waiting in emergency, she had an episode of syncope, followed by regain of consciousness after 20 min. The patient was shifted for pacemaker insertion. Furthermore, hyperthyroidism and sick sinus syndrome are rare phenomena; it is highlighted mainly among patients with Graves' disease.
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Rare clinical presentation of umbilical endometriosis p. 287
Aditi Shivcharan Agrawal, Tuhina Mishra
DOI:10.4103/kleuhsj.kleuhsj_20_21  
Primary umbilical endometriosis is a rare disorder accounting for 0.5%–1% of extragenital endometriosis. It is defined as the presence of ectopic endometrial tissue within the umbilicus. Although it mostly presents as a typical cyclic umbilical discharge coincidental with a palpable mass, the diagnosis is often delayed due to its low prevalence and abnormal presentation, as in this case. The possibility of subcutaneous endometriosis should not be ruled out when an umbilical mass is detected, even if there is no history of previous surgery. Other differential diagnoses of umbilical mass include paraumbilical hernia, surgical scar (laparoscopy), primary umbilical tumor, granuloma, Sister Mary Joseph's nodule, and urachal duct cyst. In our report, we present the case of a 40-year-old female who came with a painless mass in the umbilicus for the past 10 years.
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SHORT COMMUNICATION Top

Encouraging experiential learning throughout the period of medical training p. 290
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_402_20  
The learning which happens in the case of an adult learner, including the medical students occurs in a wide variety of ways and is influenced by multiple factors. Experiential learning, as the name suggests, refers to the learning process that occurs through experience, and can be better understood as the learning via reflection on doing. The basic concept of experiential learning is that it facilitates learning in terms of a direct experience of an individual student, which may occur within or beyond the classroom settings. An undergraduate medical student can get benefited from experiential learning right from the early stages of training, upon exposure to clinical settings, during the internship, and even in their period of residency. In conclusion, experiential learning is an innovative form of learning that advocates for the acquisition of knowledge, improvement in interpersonal or communication skills through experience. The best part is that it helps in the gradual progression of the student right from the early stages of their learning till the period of residency and even after.
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LETTER TO EDITOR Top

Severe acute respiratory syndrome coronavirus 2: Oncology-related perceptions p. 292
Atin Singhai, Parul Jain, Ranjan Solanki
DOI:10.4103/kleuhsj.kleuhsj_404_20  
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