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   Table of Contents - Current issue
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January-June 2022
Volume 7 | Issue 1
Page Nos. 1-169

Online since Monday, June 27, 2022

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REVIEW ARTICLES  

Dental implants and its use in children: A narrative review Highly accessed article p. 1
Dipti Chawla, Aman Deep, Sumit Chhatwalia
DOI:10.4103/bjhs.bjhs_25_21  
Among the various congenital dental abnormalities in children, loss of tooth due to trauma and hypodontia are few that are most prevalent. A wide range of treatment modalities are available for these abnormalities, however, removable prosthesis is the most common treatment option to be used, but a pitfall of this method is that it may increase the residual alveolar bone resorption and other problems related to periodontal support of the remaining teeth. Dental implants, another treatment modality, are generally advocated in adults or young patients that are beyond their craniofacial growth potential. This comprehensive review will discuss the use of dental implants in normal growing patients and some special scenarios including orthodontic consideration and mini-implant use in pediatric population. This review sorted the literature in main themes of influence of growth on the usage of dental implants in children; use of dental implants in children suffering from ectodermal dysplasia; use of dental implants in traumatic dental injuries sustained in children; and for orthodontics intervention during childhood. The literature was searched using databases such as PubMed, Scopus, MEDLINE, and Google. The titles and abstracts were screened, and full text was retrieved for publications that studied the use of dental implants in children in any form of intervention. The results indicated that scientific studies have documented high functional and esthetic results in cases of prosthetic treatments on implants, min-implants in children. However, the use of implants in children is high restricted to anterior mandibular region, with most clinicians opting for growth completion before implant placements. The establishment of the mastication, speech function, and normal appearance is highly crucial for growth of the jaws and facial bones. However, isolated use of mini-implants in growing children has definitely broaden the idea of the use of implant modification in children, yet to achieve maturation.
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Effect of yogic practices on thyroid hormones: A review Highly accessed article p. 7
Shuchi Mohan, Rameswar Pal
DOI:10.4103/bjhs.bjhs_23_21  
The beneficial effect of Yoga on the parameters of thyroid hormone has been evaluated through the various clinical trials. Since its review has not been recorded earlier, this study has been performed to investigate the effectiveness of Yogic practices on thyroid hormones, more specifically T3, T4, and TSH. Searches were performed through February–June, 2020 using the PUBMED and GOOGLE. The keyword used for search was Yoga and thyroid or thyroid disorder. Only experimental studies were selected which were reported in English, printed in prevailed publications, and inspecting the effectiveness of the regular practice on thyroid hormones in these studies. A total of 41 studies were selected through various searches, among which 11 met criteria for the final review. Hypothyroid patients showed decrease in thyroid-stimulating hormone (TSH), hyperthyroid patients showed decrease in tetraidothyronine (T4), polar tri-idothyronine (T3) syndrome population also showed positive effect of Yoga. Perimenopausal women showed not so significant change in these parameters. Healthy middle-aged individuals showed increase in TSH in the male population and near significant increase in this hormone was shown in the female population, also there was decrease in basal T3 and T4 in both male and female. All these changes were in normal range. Other two studies on healthy individuals did not show any significant change in T3, T4 or TSH. 1 study was done on hypothyroid patients using hand mudra only, showed significant changes in level of these parameters. In conclusion, it may stated that yogic practice may regularize thyroid hormone functioning and improve total health.
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Tinnitus: A morbid clinical entity in COVID-19 patient Highly accessed article p. 14
Santosh Kumar Swain
DOI:10.4103/bjhs.bjhs_87_21  
Coronavirus disease-2019 (COVID-19) is a highly infectious respiratory disease caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which result in plethora of health implications. The COVID-19 epidemic has impacted the lives of millions of people worldwide, wreaking havoc on health-care delivery, economic activity, and social connection. Although the majority of COVID-19 patients have respiratory symptoms, some experience neurological manifestations. The impact of the SARS-CoV-2 infection on the cochlea is a novel presentation which is not explored to date. Because of the risk of COVID-19 infection spreading from person to person, the majority of countries implemented social distancing and suggested people for home isolation. Social distancing and stay home protocol inducing stress and depression because of social isolation. Tinnitus has been documented in COVID-19 infection. However, tinnitus is not properly investigated in COVID-19 patients. Viral infections usually cause intracochlear damage and result in auditory dysfunction. Presently, there is little evidence for the direct relation of novel coronavirus and tinnitus. Tinnitus and hearing loss are important inner ear manifestations are reported in different literature which is considered morbid clinical entity in the present COVID-19 pandemic. This review article discusses details of this epidemiology, etiopathology, assessment, and management of tinnitus among patients with SARS-CoV-2 infection.
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A review on the efficacy of fish oil and its components in alleviating the symptoms of primary dysmenorrhea p. 19
Shreyasi Roy
DOI:10.4103/bjhs.bjhs_128_21  
Periods are part of normal sexual health for women during their reproductive years. In addition to various social and religious stigmas during those “bad stains” days, period cramps (also called dysmenorrhea) accompany us to make the situation worse. Studies have showered numerous data regarding various pharmacological interventions (PIs) and non-pharmacological interventions (non-PIs). Non-PIs have been preferred mostly in cases where PIs are contraindicated. Fish oil supplements or omega-3 supplements are one of the safest non-PIs. The present study attempted to conduct a review of the existing literature to illustrate the aptness and potentiality of fish oil in easing period cramps.
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Exploring potential of Kushmanda Avaleha in respiratory illness – A comprehensive review Highly accessed article p. 27
Sheetal Sharma, Shreshtha Kaushik, Pramod Yadav, Galib Ruknuddin, Pradeep K Prajapati
DOI:10.4103/bjhs.bjhs_84_21  
Respiratory ailments represent over 10% of all disability-adjusted life-years, a statistic that reflects the measure of active and productive life lost owing to a condition. A large number of Confections (Avaleha) have been recommended in various authoritative treatises by ancient seers for different respiratory disorders. Kushmanda Avaleha is one such multi-ingredient Ayurvedic formulation, which is advocated for the first time in Ashtanga Sangraha for Cough, Hiccups, Fever, Dyspnea, etc. Its chief constituent is Benincasa hispida Thumb. It has also been included in the Essential drug list published by the Ministry of AYUSH. Thus, this article is emphasized on compiling and exploring various classical references as well as reported current literature in various scientific journals and online databases about the therapeutic potential of Kushmanda Avaleha as well as its ingredients with special reference to respiratory illness. All the information has been placed here in comprehensive manner. Moreover, a number of studies have also been conducted and published which established the efficacy of its all ingredients in diverse respiratory pathologies through manifold mechanisms such as Bronchodilator, Anti-tussive, Mucolytic, etc. Therefore, on meticulous appraisal, it can be inferred that Kushmanda Avaleha is a complete care and an effective medication for various respiratory disorders.
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ORIGINAL ARTICLES Top

Effect of intense military exercise on physical proficiency and hormonal responses of soldiers: A pilot study p. 35
Angad Yadav, Kavita Arya, Archana Malhari, Roshani Meena, Tirthankar Chatterjee, Debojyoti Bhattacharyya, Som Nath Singh, Madhusudan Pal
DOI:10.4103/bjhs.bjhs_14_21  
BACKGROUND: Military training activities are typically challenging and push the soldiers toward their maximum limits of capabilities to improve proficiency in real time situations. In terms of injury prevention, unit performance, and overall morale, the individual's physical capabilities must be in concert to the job demands. Hormones play an important role in regulating various physiological processes including fuel utilization by exercising muscles. AIMS AND OBJECTIVES: This study was undertaken to quantify the hormonal demand of an intense military training event. MATERIALS AND METHODS: The study was conducted at a military training center on 25 male healthy soldiers who had completed 11 week training. Venous blood samples were drawn before and immediately after the event. RESULTS: In hormonal responses, the levels of epinephrine (P < 0.001), norepinephrine (P < 0.01), cortisol (P < 0.001), serotonin (P < 0.01), and aldosterone (P < 0.001) were significantly increased while testosterone (P < 0.001) was found significantly decreased after event. The present study demonstrated that the physical proficiency training activity was highly energy demanding due to significantly increased sympathoadrenergic responses and induced a high level of acute stress due to significant reduction of testosterone. In addition to this, the significantly increased serotonergic responses indicated that the level of fatigue was high during activity. CONCLUSION: The findings of the present study may be helpful in screening of individuals before inducting into such intense military training activity to minimize the risk of injuries.
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Work-related musculoskeletal disorders in tyre factory workers – An observational study p. 41
Anand Heggannavar, Snusha Naik
DOI:10.4103/bjhs.bjhs_58_21  
CONTEXT: Work-related musculoskeletal disorders (WRMSDs) are considered major public health problems and the leading cause of occupational injury. Activities such as prolonged standing, repetitive task, awkward sitting posture, heavy lifting, pulling, and pushing may result in functional impairment and pain due to poor working conditions and absence of work injury prevention programs. AIM: This study aimed to determine the prevalence of WRMSDs in factory workers. SETTINGS AND DESIGN: An observational study was carried out in a tyre factory in India. SUBJECTS AND METHODS: Two hundred and fifty-two (n = 252) male workers aged 21–59 years with at least 1 year of job tenure were included in this observational study. The assessment was done using the Nordic Musculoskeletal Questionnaire and Rapid Entire Body Assessment (REBA) tool. STATISTICAL ANALYSIS USED: Data analysis was done using Chi-square test to calculate the prevalence of musculoskeletal disorders. RESULTS: The most commonly affected body regions of factory workers in 12 months were neck and lower back with P = 0.001and P = 0.146, and problems faced in the past 7 days were more common in the lower back and neck with P = 0.004 and 0.001, respectively. This study reported the highest prevalence in the neck (62.7%) and lower back (54.8%). The REBA tool revealed a majority of the workers emerged under the category of high risk. CONCLUSIONS: The study concluded that neck and lower back regions were found to be more commonly affected, and a majority of workers emerged into high-risk category.
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COVID-19 pandemic and nursing students: Stress, depression, and coping behaviors – An exploratory study p. 45
K Kavitha, Basheerahamed J Sikandar, Rachel Joseph
DOI:10.4103/bjhs.bjhs_83_21  
BACKGROUND: The COVID-19 pandemic has created a confused state of day-to-day affairs among people of all walks of life. The sudden changes in the routine classes and lack of available resources for continuing academic activities are the major sources of stress and other mental health issues among nursing students. AIM: To determine nursing students' stressful experiences, the presence of clinical depression due to the pandemic, and coping behaviors adopted by them. METHODOLOGY: Nonexperimental, exploratory, cross-sectional research design was used. A total of six institutions have been selected for the study. Three hundred and sixty-seven participants who fulfilled the eligibility criteria were selected by the nonprobability convenient sampling method. The tool consisted of 4 parts: (a) pro forma to elicit sociodemographic variables, (b) Impact of Event Scale-Revised (IES-R) to assess the level of stress, (c) Center for Epidemiologic Studies Depression (CES-D) to screen for features of depression, and (d) bipolar scale to measure the coping behaviors. The data were collected through an online survey. RESULTS: Out of 367 nursing students, 318 (86.64%) were in the group of 18–22 years, and a majority (74.38%) were female. A majority of participants (30.79%) had high symptoms of posttraumatic stress disorder. A significant relationship between nursing students' stress scores with coping activities such as watching the news (B = 0.735, P < 0.05), anxiety (B = 1.326, P < 0.001), health (B = −2.891, P < 0.05), exercise (B = −1.656, P < 0.05), and faith (B = 1.150, P < 0.05). CONCLUSION: To promote the mental health and overall well-being of nursing students, proper guidance and counseling by the teachers and mentors are needed.
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Standard manufacturing procedure of Bhallataka Kshara (Herbo-mineral prepation) p. 51
Pravin Jawanjal, Bishwajyoti Patgiri, SS Savrikar
DOI:10.4103/bjhs.bjhs_12_21  
INTRODUCTION: Bhallataka (Semecarpus anacardium Linn.) Kshara is mentioned in Charaka Samhita Grahani Chikista Adhyaya. It is indicated in Hridaroga (heart diseases), Pandu (anemia), Grahani dosha (bowl disorder), and Gulma (abdominal distention). MATERIALS AND METHODS: Bhallataka Kshara is prepared by Putapaka (incineration) method. RESULTS AND DISCUSSION: The method of preparation needs a strong heat (Prakhar agni), and hence, a temperature of 650°C was maintained. CONCLUSION: There is a 69.37% of loss in terms of yield in the preparation of Bhallataka Kshara in the electrical muffle furnace mentioned at 650°C.
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Prevalence of thyroid disorders in type 2 diabetic patients – A 1-year cross-sectional study p. 56
Rikita Ramesh Mudhol, Shivakumar Veeranna Turamari, Rekha Ramesh Mudhol, B Srinivas
DOI:10.4103/bjhs.bjhs_28_21  
BACKGROUND: Diabetes is one of the commonest health problem and has become a major health challenge worldwide. There is evidence from the literature suggesting that the intricate bond between Thyroid disorder and diabetes mellitus deceivingly contributes to micro and macro-vascular complications. OBJECTIVE: This study is being undertaken to determine an association between prevalence of thyroid disorders in Type 2 diabetic patients. MATERIAL AND METHODS: A hospital based prospective cross sectional study was carried out in the department of Medicine, at a tertiary care hospital in Belgaum. The study included 100 Type 2 diabetic patients who were interviewed for demographic details, duration of diabetes and history of other comorbid conditions. The patients were subjected to clinical examination and were investigated for fasting blood sugars, post prandial blood sugars, glycosylated haemoglobin (HbA1C), free triiodothyronine (T3), free thyroxine (T4) and thyroid-stimulating hormone (TSH). Data was analysed using SPSS statistical software version 20.0. RESULTS: The prevalence of thyroid disorder in type 2 diabetic patients was 35%. Of them 16% had subclinical hypothyroidism. The males outnumbered the females in the study and 22% of the males had thyroid disorder (P = 0.8390).Subjects in the age group of 61 to 70 years, prevalence was higher as compared to other groups (P = 0.0569).There was an increased risk of thyroid dysfunction in long standing type 2 diabetics (P = 0.0240).The prevalence was higher in patients with poor glycemic control, though the findings were not statistically significant (P = 0.1021). CONCLUSION: Thyroid Dysfunction is widely prevalent in patients with type 2 diabetes in our study. Hence it is prudent to screen routinely for Thyroid dysfunction in type 2 Diabetic patients, which will help in improving the quality of life and reduce the mortality rate.
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Efficacy of autologous fibrin glue versus sutures in reducing astigmatism following pterygium surgery: A 1-year randomized controlled study p. 62
Sheetal Vishwanath Girimallanavar, Rekha Mudhol, Vijayalaxmi S Kori
DOI:10.4103/bjhs.bjhs_60_21  
AIM: To evaluate the astigmatic changes before and after pterygium surgery and to study the effect of autologous fibrin glue over sutures in terms of efficacy in reducing corneal astigmatism. SETTINGS AND DESIGN: Randomized controlled trial. SUBJECTS AND METHODS: Forty-four patients with primary pterygia were taken up and divided as follows: Conjunctival autograft with autologous fibrin glue as Group 1 (n = 22) and autograft with 8-0 vicryl sutures as Group 2 (n = 22). All patients were preoperatively assessed for visual acuity, anterior, posterior segments, and Keratometric values using Bausch-Lomb keratometer on postoperative day 1, 7, 1 month, and 3 months. STATISTICAL ANALYSIS: Mann–Whitney test was performed to compare the median keratometric astigmatic changes preoperatively and postoperatively between the groups. P < 0.05 was considered statistically significant. RESULTS: 50.5 was the mean age and 14.81 standard deviation (SD) in Group 1 and 48.86 was the mean and 13.23 SD in Group 2. Group 1 had 40.9% males and 59.1% females, Group 2 had 54.5% males and 45.5% females. The preoperative keratometric values significantly decreased postoperatively in both groups and the median postoperative keratometric value was significantly reduced in Group 1 (0.5) as compared to Group 2 (1.25). Pterygium excision using autologous blood was more effective in reducing corneal astigmatism. CONCLUSION: Pterygium excision surgery reduces corneal astigmatism and thus improves visual acuity. Autologous blood is better option to attach the conjunctival autograft than sutures in reducing astigmatism.
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Comparative study of hemostasis file in newly diagnosed leukemia patients and healthy persons at the Hematology and Blood Transfusion Department, National Hospital, Abuja p. 68
Nuhu Andrew Yashim, Dorcas Yetunde Obazee, Olumide Faith Ajani, Paul Olaiya Abiodun, Love Adeiye Ajani, Felix Olaniyi Sanni
DOI:10.4103/bjhs.bjhs_35_21  
BACKGROUND: Hemostasis is a complicated and multifaceted condition that often leads to the stoppage of bleeding from injuries. At presentation, blood coagulation irregularities are common in patients with acute leukemia. AIM AND OBJECTIVE: This study aimed to compare hemostasis profiles of newly diagnosed leukemia patients with healthy persons. METHODOLOGY: This is a cross-sectional study carried out at the Hematology and Blood Transfusion Department of the National Hospital Abuja, Nigeria, from June 2018 and May 2020 among 30 newly diagnosed leukemia patients and 30 healthy persons. Complete blood counts, platelets, hemoglobin, total white blood count, packed cell volume prothrombin time (PT), activated partial thromboplastin time (APTT), erythrocyte sedimentation rate (ESR), and fibrinogen were assayed on patients' venous blood using the standard methods. Data analysis was done using software IBM-SPSS version 25. Associations between the variables were determined using Student's t-test taking a P < 0.05 as significant. RESULTS: The mean and median age of the leukemia patients was 45.8 ± 10.73 and 41 years, respectively. The mean value of PT (21.2 ± 0.9 seconds) and APTT (39.0 ± 1.4 seconds) was raised significantly (P < 0.001) in leukemia patients than in control (4.8 ± 0.3 s) and (13.9 ± 0.3 s). The mean value of ESR among leukemia patient was 41.7 ± 4.6 mm/h, while it was 29.6 ± 0.4 mm/h in control (P < 0.001). Mean value of fibrinogen reduced significantly 181.9 ± 3.70 mg/dl in leukemia patients as compared to control 261.6 ± 5.21 mg/dl (P < 0.001). CONCLUSION: This study found significant differences in hematological and hemostasis profiles levels between leukemia and healthy persons, which shows the presence of inflammation.
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Magnitude of underweight and its associated factors among children aged 6–59 months visiting health center in Nefas Silk Lafto Sub City, Addis Ababa, Ethiopia p. 73
Firehiwot Girma, Tsegaye Demessie, Ziyad Ahmed Abdo
DOI:10.4103/bjhs.bjhs_3_21  
INTRODUCTION: Millions of children in low-income countries suffer from malnutrition, which continues to be the most important public health problem in developing countries. Although the proportion of underweight has declined in Addis Ababa, it remains a leading cause of illness and death in children <5 years. Therefore, this study aims to close the knowledge gap by assessing the prevalence and factors related to underweight among children aged 6–59 months who visit the health centers in Nefas Silk Lafto Sub City, Addis Ababa, Ethiopia. MATERIALS AND METHODS: An institutional-based, quantitative cross-sectional design was used to conduct the study. Systematic sampling system was applied to select 422 study participants. The data were collected via interview using a structured questionnaire. Weight of children was taken according to the recommended standard procedures. WHO Anthro software was used to convert anthropometric measurements into Z-scores. Bivariate and multivariable logistic regressions were employed to identify the predictor variables. Statistical significance was considered at P < 0.05 with adjusted odds ratio (AOR) calculated at 95% confidence interval (CI). RESULTS: The overall underweight prevalence among under-five children was 9.9% with 95% CI (7.2–12.8). Participants from low household income (AOR = 1.6; 95% CI 1.4–1.97), children having a history of diarrhea (AOR = 14.7; 95% CI: 3.7–23.3), children who were frequently ill (AOR = 12.7; CI = 1.02–15.1), children who were not frequently breastfed (AOR = 9.3; CI = 1.6–12.9), children who were given prelacteal foods at birth (AOR = 11.7; CI = 2.2–13.9), and children from family which used public toilet (AOR = 5.4; CI = 1.05–6.5) were more likely to be underweight than their respective counterparts. CONCLUSIONS AND RECOMMENDATION: Prevalence of underweight was 9.9% is even better than the nation. Strengthening behavior change activities, enable mothers to avoid giving prelacteal foods and increase the frequency of breastfeeding should be in place to prevent diarrhea and promoting environmental cleanness are recommended.
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Impact of vegetarian and nonvegetarian dietary habits and age on body composition and bone mineral density of office workers p. 82
Vishwendra Vikram Singh, Angad Yadav, Amit Bansal, Vijay Kumar Singh, Saroj Kumar Verma, Shiva Saxena, Vandana Kirar, Mrinalini Singh, Bhuvnesh Kumar, Som Nath Singh
DOI:10.4103/bjhs.bjhs_8_21  
INTRODUCTION: Measurement of bone mineral density (BMD) is important for skeletal health. Several factors such as age, gender, dietary habits, exposure to sunlight, lifestyle, and bodyweight influence BMD directly or indirectly. People living in metropolitan cities are at risk of low BMD due to low Vitamin D status and less physical activity. This study aimed to evaluate BMD status of office workers and also establish a correlation between body composition and BMD with different age groups and dietary habits. MATERIALS AND METHODS: The present study was carried out on 175 participants with 124 males and 51 females. Body composition was determined using bioelectrical impedance and BMD measurements were made using peripheral dual-energy X-ray absorptiometry. RESULTS: A strong and positive correlation was observed between body composition and BMD. Fat-free mass (FFM) has a more significant correlation than fat Mass with BMD. Handgrip strength was significantly higher in the right forearm (RF) of nonvegetarians. When compared with the Indian reference range, 20% of males and 23.5% of females had low BMD at the measurement site, ultradistal forearm. Both male and female participants below 30 years of age had higher BMD compared to participants above 30 years of age. CONCLUSION: It was observed that there were no statistically significant differences in BMD of vegetarians and nonvegetarians. It was also seen that the bone density decreases while the age increases. It may be due to inadequate nutrition, poor lifestyle, physical inactivity, and many more. Bone health is a major public concern and should be taken seriously where osteoporosis and fracture risks are considered.
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A study on adiponectin, uric acid, and C-reactive protein in prediabetic and diabetic subjects p. 89
Rachna Sharma, Pallavi Anand, Shrawan Kumar
DOI:10.4103/bjhs.bjhs_34_21  
BACKGROUND: Diabetes and prediabetes are always on the rise over the past decade, but little is known about the development of type 2 diabetes mellitus dysfunction in young adults. The study was conducted in prediabetic and diabetic patients in order to belong to an anti-inflammatory hormone adiponectin and pro-inflammatory marker uric acid (UA) in these patients and also to determine the role of these markers in future cardiovascular disease (CVD) risk. MATERIALS AND METHODS: This case–control study was conducted at Rama Medical College and Hospital, Kanpur. Out of 400 participants recruited, 140 subjects were control, 140 were prediabetics, and the remaining 120 were controlled. The detailed history of the patients regarding age, gender, height, weight, and family history regarding obesity and other chronic illnesses was taken. Patients with medical complications or diseases and conditions that may affect levels of inflammatory markers were excluded from the study. The data analysis was done using SPSS 16 and the results were presented as mean ± standard deviation where P < 0.05 has been considered as statistically significant. RESULTS: The adiponectin level was found significantly decreased and C-reactive protein and UA levels were increased in both study groups (prediabetes and diabetes) while comparison was done with control group. Similarly, basic parameters including waist/hip ratio, body mass index, glycated hemoglobin, and fasting blood glucose were increased. CONCLUSION: The study showed that prediabetes and diabetes are diseases of inflammatory origin with a high level of pro-inflammatory molecules. These medications are not only potent risk factors for prediabetes and diabetes but also mediate significant future CVD risk in these patients.
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Factors affecting outcome in neonates with esophageal atresia with or without tracheesophageal fistula p. 94
Nandkishor Dhanvantrao Shinde, Kishor Mankar, MR Adarsh Gowda, Meirajuddin Tousif
DOI:10.4103/bjhs.bjhs_68_21  
BACKGROUND: Esophageal atresia (EA) with or without tracheesophageal fistula (TEF) is a common congenital anomaly requiring urgent surgical intervention after birth. Due to improvement in antenatal diagnosis and postnatal management in neonates with EA, there are better overall survival rates in the developed countries. However, the outcome is still poor in developing countries where multiple factors contribute to higher morbidity and mortality. AIM: To evaluate various factors affecting the perioperative management and their outcome in neonates with EA with or without TEF. MATERIALS AND METHODS: This descriptive observational study was conducted for 4 years. Neonates who underwent surgery for EA with or without TEF at our institute were included. Age of the neonate at presentation, gender, birth weight, period of gestation, antenatal diagnosis records, clinical presentation, associated congenital anomalies, surgical interventions, gap between upper and lower esophageal ends, postoperative complications, and outcome was recorded. RESULTS: Total, 44 neonates underwent surgery for esophageal atresia with or without TEF in our institute. Male-to-female ratio was 2.4:1. The mean birth weight of neonates was 2500 ± 900 g. The mean gestation age was 35 ± 5 weeks. Sepsis was the leading cause of postoperative morbidity seen in 45.5%, followed by anastomotic leak in 22.7%. Postoperative mortality was 59% with the survival rate of 41%. CONCLUSION: Sepsis, hypothermia, delayed diagnosis, delayed referral, aspiration pneumonitis, anastomotic leaks were the preventable factors affecting the outcome.
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Oxidative stress in sickle cell anemia can be a prognostic marker for disease severity: A case − control study in the western region population of Maharashtra p. 99
Neha N Satam, Vinayak W Patil, Thankamani Marar, Deepa Garg
DOI:10.4103/bjhs.bjhs_55_21  
CONTEXT: Sickle cell anemia (SCA) or sickle cell disease (SCD) is an inherited blood disorder characterized primarily by chronic anemia and periodic episodes of pain. There are reports that increase in oxidative stress may play a significant role in the pathophysiology of SCA. AIM: The present study aims to investigate enzymatic and nonenzymatic antioxidant status in SCA patients to understand the incidence of increased oxidative stress in the populace of tribal Palghar region of Western Maharashtra. SUBJECTS AND METHODS: Patients with SCA (n = 250) and age- and sex-matched healthy persons (n = 250) as controls from the primary health center of Palghar were included in this study. Informed written consent was obtained from all the participants. RESULTS: Activities of enzymatic antioxidants such as glutathione peroxidase, glutathione-S-trasferase, catalase, and level of nonenzymatic antioxidants such as glutathione, Vitamin E and C decreased significantly in SCA participants when compared to controls. The level of lipid peroxides and activity of superoxide dismutase increased significantly above normal in SCA participants. SCA is characterized by the increased generation of reactive-oxygen species resulting in oxidative damage of various cell types, including erythrocytes and this chronically elevated oxidative stress in SCD might play a significant role in the increased autoxidation of Sickle hemoglobin (HbS), increased intravascular hemolysis, ischemia-reperfusion injury, and chronic inflammatory complications. CONCLUSION: The present study indicates that oxidative stress can be considered one of the prognostic markers to evaluate the clinical severity of the SCA participants.
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Comparative analysis of plyometrics and core training on performance indices of Indian handball players p. 104
Amrinder Singh, Deepesh Patel, Shweta Shenoy, Jaspal Singh Sandhu
DOI:10.4103/bjhs.bjhs_132_20  
BACKGROUND: Handball is a strenuous contact sport placing emphasis on running, jumping, throwing, hitting, blocking, and pushing. Various technical and tactical skills are required for this dynamic sport, namely speed, agility, balance, power, strength, and coordination. Hence, the aim of the present study was to assess the changes in the physical fitness components with 8 weeks of plyometric training and core training given to the handball players and to compare the effect of both training methods on the handball players. METHODS: Sixty players were randomly selected to participate in the study. The players were divided into three groups, namely Group A (plyometric), Group B (core), and Group C (control) (n = 20 each). The speed was assessed with 40 m dash sprint, agility by Illinois agility test, and lower limb power by isokinetic dynamometer (BIODEX). The experimental group underwent their respective trainings, and the control underwent conventional training. The posttraining results were recorded after 8 weeks of training. RESULTS: There was a significant difference within the groups, but there was no significant difference between the three groups. CONCLUSION: Both training methods were equally beneficial for the improvement in sprinting speed, Illinois agility test, and lower limb power.
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Association of cleft lip and palate with predisposing factors p. 110
SR Ashwinirani, Girish Suragimath
DOI:10.4103/bjhs.bjhs_122_21  
BACKGROUND: The cleft lip (CL) and palate are common orofacial congenital abnormalities observed in Indian population. Various predisposing factors contribute to this condition. PURPOSE: The purpose is to assess the most common type of CL and palate and to study predisposing factors associated with its development. MATERIAL AND METHODS: This cross-sectional prospective study was carried in 80 patients with CL and palate. A detailed history was recorded in predesigned pro forma. The occurrence of different types of CL and palate with predisposing factors were assessed. RESULTS: Out of 80 patients, 18.8% of patients had only CL, 46.2% had unilateral CL with palate (UCLP), and 35% had a bilateral CL with palate (BCLP). CL and palate were observed more in males. The left side of the lip was more affected than the right side. Low socioeconomic status patients had more incidences. Advanced maternal age, more than 35 years, was the most common predisposing factor 62.5%. Consanguineous marriage of parents was the second-most predisposing factor observed in 40% of cases. Breastfeeding habit was observed in 73.3% of CL patients, 25% in UCLP patients, and 17.2% in BCLP patients. CONCLUSIONS: Males were more commonly affected by CL and palate with the left side predominance. Advanced maternal age above 35 years was the most predisposing factor followed by consanguineous marriage of the parents.
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Acute myeloid leukemia: Comparing French–American–British classification with immunophenotype and cytogenetics p. 115
Mekhala Rao, Girish Kamat, Deepak Goni, Girish Balikai
DOI:10.4103/bjhs.bjhs_138_21  
BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous disease as it affects multiple lineages of hematopoietic cells. AIMS AND OBJECTIVES: This study aims to (1) evaluate the immunophenotypic findings of AML patients, (2) correlate the morphological subtypes of AML according to French–American–British classification with immunophenotypic findings, and (3) correlate the immunophenotypic findings in AML patients with findings in cytogenetic studies. MATERIALS AND METHODS: The present study was a cross sectional study. Seventy three patients with a final diagnosis of AML, whose immunophenotyping and/or cytogenetic study results were available, were included in the study. RESULTS: Twenty one (31.81%) out of 66 patients with AML aberrantly expressed lymphoid antigens. The lymphoid antigens expressed were CD7, CD19, TdT, and CD5 which were found in 13 (19.69%), 9 (13.6%), 2 (3%), and 1 (1.51%) patient, respectively. Two out of three patients with t(8;21)(q22;q22) had CD19 aberrant expression. This association was found to be statistically significant with the Fisher exact test, with a statistic value of 0.0277 (P < 0.05). Co expression of two lymphoid antigens such as CD7 and CD19 was associated with monosomy 7 and was found to be statistically significant with a Fisher exact test, with a statistic value of 0.0217 (P < 0.05). In our study, t(8;21) (q22;q22) was found in AML M2 and AML M1. Many of the patients in our study were diagnosed as acute leukemia by morphological evaluation and were not diagnosed as AML. However, immunophenotyping and cytogenetics helped in getting final diagnosis of such patients. CONCLUSION: In conclusion, this study highlights the importance of morphological, immunophenotypic, and cytogenetic evaluations in the diagnosis of AML.
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Long term effects of mobile phone use on sleep quality, stress score and depression score in female medical students p. 121
Anuya Anand Joshi, Kanchan Chandrashekhar Wingkar, Anand Govind Joshi, SV Kakade
DOI:10.4103/bjhs.bjhs_120_20  
BACKGROUND: Extensive us of mobile phones (MP) has led to exposure to a dangerous level of electromagnetic fields (EMF). Adolescents are at an age where good quality sleep, mental and physical wellbeing is of utmost importance. Recent studies have shown that the EMF radiation from MP and similar devices can cause symptoms such as fatigue, trouble sleeping, depression, moodiness , anxiety etc. However there is no conclusive data available so far on this issue. So present research work was conducted to assess quality of sleep, stress score and depression score in female medical students those they were using mobile phones for longer durations. MATERIALS AND METHODS: For present study 240 female medical students (age group 18 to 23 years) were studied. Depending upon mobile use students were divided into following groups. Group A) 1 to 50000 minutes. Group B) 50001 to 100000 minutes. Group C) 100001 to 150000 minutes. Group D) 150001 and Above. Minutes. Following tests were studied in all the students. 1) Pittsburgh Sleep Quality test score 2)Three Minute Depression Test score 3) Stress score . Values of various scores were compared within the groups. RESULTS: For depression score Significant difference (P value<.05 ) was observed between group A (4.029 ± 2.91) and Group C (6.65 ±4.64). No significant differences were observed for stress and sleep scores. CONCLUSION: Long term MP use is associated with mild type of depression. However further research on large sample size, exact measure of EMF exposure and more duration of EMF exposure is required to reach to conclusion.
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Determination of malnutrition and nutritional risks in aged individuals between 65 and 84 years in Turkey p. 126
Ceyda Durmaz, Indrani Kalkan
DOI:10.4103/bjhs.bjhs_121_21  
BACKGROUND: Nutritional inadequacy, physical impairments, and degenerative diseases are the main causes of a general deterioration in health and quality of life in aged individuals. OBJECTIVE: The to determine malnutrition and nutritional risks in Turkish aged individuals by evaluating nutritional status and recording anthropometric measurements. MATERIALS AND METHODS: Eight hundred and eighty-seven Turkish aged individuals aged between 64 and 85 years participated in the study. Nutritional habits were interrogated by face to face interview method. Anthropometric measurements (body mass index [BMI], waist, hip, and upper-middle arm circumference), nutritional screening index (NSI), and mini nutritional assessment scale (MNA) were used to evaluate nutritional status and malnutrition risk among the participants. RESULTS: As per MNA, 29.8% of females, 22.1% of males were at malnutrition risk whereas 4.5% of females and 4.3% of males were malnourished. In NSI evaluations, 23.3% of females and 17.1% of males were at medium risk whereas, 12.6% of females and 6.5% of males were in high-risk category. A moderate positive correlation was found between the BMIs of the individuals and upper-middle arm circumferences (P < 0.05). Furthermore, a moderate positive correlation was found between MNA and NSI scores (P < 0.05). CONCLUSION: It is necessary to evaluate the nutritional and health status of elderly people at a regular basis. Further studies are required for suitable nutritional intervention or recommendations for the aged group.
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Skin damage due to personal protective equipment among health-care professionals in a dedicated COVID-19 hospital of tribal India p. 134
Avatarkishan Jaisinghani, Vikas Gupta, Neeraj Gour, Munish Kumar Sharma
DOI:10.4103/bjhs.bjhs_123_21  
BACKGROUND: Health-care professionals (HCPs) are at much greater risk of infection due to the exposure to the highly infectious bodily fluids and droplet nuclei and needed use of personal protective equipment (PPE) to reduce the transmission risk. The present study was conducted with an aim of estimating the prevalence of various types of skin injuries among HCPs due to PPE usage. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted after obtaining the institutional ethical approval in a dedicated COVID-19 hospital for a period of 4 months among 276 HCPs wearing grade 2 and 3 PPE kit. The survey questionnaire (Google Forms) was focused on collecting the subject's baseline data (age and gender), duty hours, and type of skin injury experienced due to PPE usage. Chi-square analysis was used to find the association of between dependent and independent variables, and an association was significant for P < 0.05. RESULTS: 51.5% of subjects wore the PPE kit for 5 or more days/week during duty hours and 64.5% of subjects daily wore the PPE kit for 2 or more hours. 81.7% of subjects have suffered from skin injury after PPE usage. The most common symptom/sign for the skin injury that occurred was indentation and pain on the back of the ears (61.5%). CONCLUSION: The frequent skin injuries due to PPE among the HCPs might make them anxious and reduce their morale at work place, so an effective preventive measure should be adopted.
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Comparative pharmaceutico analytical study of Haratala (orpiment) Shodhana (purification) using different Shodhana media p. 141
Krupali Shailesh Jani, Prashant Bedarkar, Vinay J Shukla, Biswajyoti Patgiri
DOI:10.4103/bjhs.bjhs_70_21  
INTRODUCTION: Haratala is Uprasa mentioned since vedic period. Chemically, it is Arsenic trisulfide and also classified under schedule E1 drug. There are methods and medias used for Shodhana of Haratala. In the present study for Shodhana of Haratala, three Shodhana media have been taken, i.e., Triphala Kwatha, Tila Tail, Kanji. AIM: The aim of the study is to standardize pharmaceutical procedure of Haratala Shodhana in different Shodhana media and developing its comparative analytical profile. MATERIALS AND METHODS: Haratala Shodhana is done in different Shodhana Media, i.e., Triphala Kwatha, Tila Taila and Kanji. Total three batches in each Shodhana media were carried out for standardization. RESULTS AND DISCUSSION: Three hour duration was required for 100 g of Shodhana of Haratala average 2l of liquid media used for Shodhana, analytically there was significant difference in all three samples of Haratala was found, Three media were taken, i.e., Triphala Kwatha, Tila Taila, Kanji and there analytical profile will be generated to find the probable variations in before and after Shodhana. CONCLUSION: All three media were used for Shodhana of Haratala because all liquid medias were easily available for Shodhana and all possess different therapeutic utilities. Although there is a significant difference seen analytically after Shodhana, In X-ray diffraction, maximum number of peaks were found in Triphala Kwatha Shodhit Haratala so this could be used as differentiating factor for better comparison between all three Shodhana media.
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Faculty perspectives on introduction of competency-based medical education curriculum p. 147
Savitri Sidddanagoudra, Ashwini R Doyizode, Shantala Shripad Herlekar
DOI:10.4103/bjhs.bjhs_116_21  
CONTEXT: Global adoption of competency-based medical education (CBME) is a paradigm shift in India. Faculties play a key role in implementation by identifying and solving the challenges in CBME. AIMS: Perspectives of the faculties were undertaken to known about CBME implementation. SETTINGS AND DESIGN: Qualitative study design. SUBJECTS AND METHODS: The study included 270 medical faculties who were trained in CBME from May to September 2019. A prevalidated, closed, quantitative questionnaire was administered to faculties. Likert's 3-point scale was used for rating. STATISTICAL ANALYSIS USED: Data were analyzed based on percentage. RESULTS: Ninety-seven percent of faculties perceived that CBME should be the current method of approach, 88% perceived the need of more resources, 61% were better prepared to face the challenges in implementation of CBME, 47% perceived that training in CBME reduced resistance to accept CBME, and 45% needed more clarification on self-directed learning (SDL), assessment, and certification of skills. CONCLUSIONS: Implementation requires more resources and more clarity about SDL, assessment, and certification skill.
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Functional outcome after arthroscopic debridement with microfracture and platelet rich-plasma injection in osteoarthritis of knee – A prospective study p. 151
Sandesh Agarawal, Prabhu Ethiraj, Arun Heddur Shanthappa, Sachin C Thagadur
DOI:10.4103/bjhs.bjhs_53_21  
Surgical treatment for knee osteoarthritis (OA) involves debridement, lavage, and microfracture to enhance chondral resurfacing by providing a suitable environment for tissue regeneration. Platelet-rich plasma (PRP) stimulates chondrocyte proliferation. Combining microfracture with PRP injections helps promote early clinical improvement, and this study aims to assess the functional outcomes when all three techniques are used simultaneously. This prospective, observational, hospital-based study was conducted at R. L. Jalappa Hospital and Research Centre, SDUMC, Tamaka, involving patients with OA of the knee from June 2020 to November 2020. Clinical data were collected and evaluated with pre -and post-procedure Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analogue scale (VAS) scores. In all, 74.29% of the patients had Kellgren-Lawrence grade III knee OA and 25.71% had grade II knee OA. The levels of pain and knee function were evaluated using WOMAC and VAS scores before and 1, 3, and 6 months after the procedure. It was observed that 68.57% had good VAS scores, while 31.43% had poor scores. The mean WOMAC scores showed a statistically significant improvement (P < 0.001) with a decrease in the preoperative WOMAC score from 67.11 ± 8.73 to 50.14 ± 9.99 at 1 month, 40.83 ± 7.8 at 3 months, and 31.66 ± 5.28 at 6 months. Intra-articular PRP injection after debridement and microfracture is beneficial for pain relief and functional improvement and prolongs the treatment efficacy of microfracture in patients with symptomatic knee OA.
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CASE REPORTS Top

A deep lobe parotid tumor tending the facial nerve and its branches p. 156
Nisha Muruganidhi, Mariappan Rajagopal, Santhanakrishnan Kaliavaradan, Poornima S Bhat
DOI:10.4103/bjhs.bjhs_20_21  
Benign tumors of major salivary glands commonly affect the parotid gland and it is rare when the tumor exclusively involves the deep lobe of the gland. The mainstay of treatment is surgical excision. Parotid surgeries carry a formidable risk of injury to the facial nerve. Hence, identification of extracranial part of facial nerve using many of its anatomical landmarks helps in preventing this daunting complication. There are instances where the facial nerve's morphometry is altered due to the location and extent of the tumor. A better knowledge of the anatomy and anticipation for these variations can result in a better outcome limiting the complications of the surgery.
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Disseminated tuberculosis in association with erythema nodosum leprosum p. 159
Aswathi Raj, Balachandra S Bhat, Spandana Prakash Hegde, Manjunath Mala Shenoy
DOI:10.4103/bjhs.bjhs_17_21  
Mycobacterial diseases are endemic in India but simultaneous occurrence of tuberculosis and leprosy is rarely reported. We report a case of disseminated tuberculosis in an immunocompromised host due long-standing unsupervised corticosteroid intake with erythema nodosum leprosum (type 2 lepra reaction). The patient presented with generalized erythematous papulonodular skin lesions with malaise and body ache for the past 2 years. Later, he developed fever and testicular pain for which he sought medical advice. The diagnosis was based on the various laboratory and imaging studies supported by demonstration of Mycobacterium tuberculosis and Mycobacterium leprae in sputum and skin smears, respectively. The patient developed hepatitis which led to management challenges, however, the institution of antitubercular and antileprosy therapy in titrating doses resulted in improvement of the patient's condition.
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Raktamokshana (wet cupping therapy) in the management of calcified supraspinatus tendinitis presenting as frozen shoulder: A rare case report p. 163
Manisha Mansukh Kapadiya, Vikash Jain, Tukaram Sambhaji Dudhamal
DOI:10.4103/bjhs.bjhs_37_21  
Calcified tendinitis is one of the most common causes of shoulder pain and is characterized by the evidence of presence of calcific deposition in the rotator cuff. It is seen commonly affecting the supraspinatus tendon; however, it can be present in asymptomatic individuals also. The calcification requires surgical removal after that the tendon reconstitute again itself some times it disappear spontaneously also. In this case report, a 54-year-old male patient presented with painful restricted movements of the right shoulder joint. X-ray right shoulder demonstrated 1.5-cm sized calcific deposition in the supraspinatus tendon and was treated with two sittings of wet cupping therapy (WCT). The patient was assessed by Visual Analog Scale score and active range of movement. This case report shows that the cases of calcified supraspinatus tendinitis may be successfully managed with Raktamokshana (WCT).
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LETTER TO EDITOR Top

Phyllodes tumor of the breast in a postmenopausal woman: Radio- pathological correlation of a rare entity p. 168
Ravikanth Reddy
DOI:10.4103/bjhs.bjhs_27_21  
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