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   Table of Contents - Current issue
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January-April 2022
Volume 15 | Issue 1
Page Nos. 1-104

Online since Monday, January 24, 2022

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EDITORIALS  

Omicron: The tsunami?? p. 1
Bhagyashri B Patil
DOI:10.4103/kleuhsj.kleuhsj_76_22  
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Transparency in peer review – is this an emerging trend? p. 4
Harpreet Kour, Punnya Angadi
DOI:10.4103/kleuhsj.kleuhsj_74_22  
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ORIGINAL ARTICLES Top

Assessment of hidden leprosy cases in North Karnataka by leprosy case detection campaign – A mixed-method study Highly accessed article p. 7
Ooviya Jayaseelan, Deepti M Kadeangadi, MS Shivaswamy
DOI:10.4103/kleuhsj.kleuhsj_41_21  
BACKGROUND: Leprosy, also known as Hansen's disease, is a chronic infectious disease, caused by Mycobacterium Leprae. India and Indonesia contributed 92% of the South-East Asia Region's caseload. AIM: The aim of this study is to identify leprosy cases in the general population by active surveillance. MATERIALS AND METHODS: As a part of the leprosy survey, the teams comprised healthcare workers and volunteers who performed house-to-house survey and examined all the household members to identify any suspects with hypopigmented and hypoanesthetic patches. The suspects were examined by the medical officer. Clinically suspected leprosy patients were then referred to the district hospital for laboratory confirmation. RESULTS: Of the 123 screened individuals, 62.5% of the suspects were aware of the presence of skin lesions (hypopigmented patch), 45.8% of them noticed the presence of patch or patches 3 months before this survey. Six of 123 were clinical suspects of leprosy, 83.3% were aware of the availability of treatment for leprosy in the primary health center. Only three among the six knew that leprosy is completely curable. All six had social stigma about leprosy. CONCLUSION: Despite many awareness campaigns on leprosy, social stigma on leprosy is still prevalent. Healthcare workers need to educate the general population about the modes of spread, availability of the treatment, and myths/false beliefs on leprosy.
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The psychological status of resident doctors during the COVID-19 pandemic and its association with resilience and social support: A cross-sectional study p. 12
Kathleen Anne Mathew, Kudrat Jain, Arya Jith
DOI:10.4103/kleuhsj.kleuhsj_191_21  
CONTEXT: The COVID-19 pandemic has affected the psychological status of frontline medical professionals who constantly work under stressful situations. The role of social support and resilience in safeguarding the mental health of resident doctors, is an area, which has not received due attention. AIMS: To assess the psychological status (depression, anxiety, and fear of COVID-19) and its association with resilience and perceived social support in resident doctors during COVID-19 pandemic. SETTINGS AND DESIGN: A cross-sectional descriptive study was conducted among the resident doctors in a tertiary hospital in Kochi, Kerala. MATERIALS AND METHODS: A web-based survey created using Google forms was sent via social media groups to the resident doctors of a teaching hospital in Kochi between August to September 2020. Two hundred completed responses were obtained. Study tools included a sociodemographic proforma, Patient Health Questionnaire-9, Generalized Anxiety Disorder scale-7, Fear of COVID-19 scale, Brief Resilience Scale, and Medical Outcomes Study Social Support Survey. STATISTICAL ANALYSIS USED: Psychological status (depression, anxiety, fear of COVID-19) was expressed using descriptive statistics; its association with sociodemographic variables using Chi-square test and its correlation with resilience and social support using Pearson correlation. RESULTS: Depression and anxiety were reported in 69% and 59.5% of the respondents, respectively. The mean fear of COVID-19 score was 24.06 (3.220). Resilience and overall social support index showed a significant negative correlation with depression and anxiety scores (P = 0.000). Emotional social support and affectionate social support showed a significant negative correlation with fear of COVID-19 (P = 0.040; P = 0.045, respectively). Conclusion: A large proportion of resident doctors were noted to have depression, anxiety, and fear of COVID-19. Individuals with higher levels of resilience and perceived social support had lesser levels of depression, anxiety, and fear of COVID-19.
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Congenital rubella syndrome and its postoperative visual outcome: A prospective longitudinal study in a tertiary care hospital in eastern India p. 20
Smiti Rani Srivastava, Jayeeta Mazumder, Mahesh Chattopadhyay
DOI:10.4103/kleuhsj.kleuhsj_186_21  
BACKGROUND: Congenital rubella syndrome is a threatening consequence of rubella infection in pregnancy characterized by the triad of cardiac, ocular & hearing defects. The morbidity and financial load associated with congenital rubella syndrome have an adverse effect on the quality of life. AIMS and OBJECTIVES: To evaluate the postoperative visual outcome of congenital rubella cataract and assessment of the immediate postoperative complications. MATERIALS AND METHODS: Institution-based longitudinal prospective observational study was carried out among 21 patients aged 1 month to 6 years of both sex groups with congenital rubella cataract. A single surgeon performed phacoaspiration and anterior vitrectomy. Intraocular lens implantation was done in children aged >2 years where the rest were kept aphakic. Best-corrected visual acuity and immediate postoperative complications were assessed in all cases preoperatively and at 1 week, 4 weeks, and 6 months postoperatively. STATISTICAL ANALYSIS USED: Data were entered into Excel and analyzed by SPSS (version 25.0; SPSS Inc., Chicago, IL, USA) and Graph-Pad Prism version 5. RESULTS: The study evaluated 28 eyes of 21 patients. The mean age of the study population was 21.1 ± 20.27 months with male predominance (1.625:1). Among 28 eyes only 10 eyes (35.71%) single-piece acrylic hydrophilic intraocular lenses were implanted and the rest 64.29% were kept aphakic. Immediate postoperative complications were noted such as anterior uveitis(9 eyes), corneal edema(3 eyes), striate keratitis(6 eyes) with more predilection towards aphakic patients & rest had no significant complications. At 6 months follow-up, significant improvement of best-corrected visual acuity (≥6/60) was noted in 52.38% of eyes which was about 5.12% pre-operatively ('P' value <0.01). CONCLUSION: Significant improvement in visual outcome was noted with early diagnosis and intervention with acceptable rate of immediate postoperative complications.
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Study to evaluate the role of surgical management in acute osteomyelities in children p. 26
Shrihari L Kulkarni, Sunil Mannual, Naveenkumar Patil, Manjunath Daragad
DOI:10.4103/kleuhsj.kleuhsj_352_21  
INTRODUCTION: Acute hematogenous osteomyelitis is predominantly seen in children, accounting for 1% of all hospital admissions. It is a limb-and life-threatening condition with variable presentation, requiring prompt diagnosis and immediate treatment. Sequential intravenous and oral antibiotics, immobilization, surgical drainage and symptomatic measures are main treatment modalities for management of this condition. The aim of this study is to evaluate the role of surgical management in acute osteomyelitis. MATERIALS AND METHODS: Twenty-five children with acute hematogenous osteomyelitis were included in this cross-sectional retrospective study. Clinical, laboratory, and radiological data were collected and examined. Follow-up records of patients were analyzsed to note the status of healing, complications, and functional outcome. Data were analyzed using SPSS version 20, paired t-test, and Chi-square test. The chosen level of significance was P < 0.05. RESULTS: Sixty percent of the patients were male with average age of 7 years. The median duration of symptoms was 10 days. Sixty percent of the patients had a history of trauma. Tibia was most commonly involved followed by femur. Staphylococcus aureus was the most common organism isolated from the culture. Twenty-one patients were managed surgically. Average follow-up period was 4.2 months. At 3 weeks' follow-up, majority of the patients had reduction in pain and swelling. Twenty-two patients had a complete recovery. Three patients developed chronic osteomyelitis, two of them developed deformity. It was observed that surgical treatment was significantly associated with better outcome as compared to conservative management for acute osteomyelitis (P = 0.011). CONCLUSION: Surgical intervention is of at most importance in patients with acute osteomyelitis in the presence of abscess. Prompt surgical decompression with sequential intravenous-oral antibiotics gives an excellent outcome in the management of acute osteomyelitis in children.
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Obesity and heart rate variability: A cross-sectional study in obese young adults p. 34
BA Soumya, Renu Lohitashwa, Vidya M Nadiger
DOI:10.4103/kleuhsj.kleuhsj_228_21  
CONTEXT: Obesity is one of the important causative factors for multiple co-morbid conditions that can lead to metabolic and cardiac disorders. Many research studies indicate the association of obesity and sudden cardiac deaths. AIMS: This study was aimed to evaluate the cardiac autonomic nervous system activity, given by the changes in heart rate variability (HRV) in healthy obese young adults. SETTINGS AND DESIGN: This cross-sectional study included thirty obese young adult males of 18–25 years and 30 age-matched healthy adult males. Power spectral analysis of HRV was used to determine the autonomic imbalance. SUBJECTS AND METHODS: HRV was performed using HRV software (Lab Chart 7). Numerical data of absolute values of low frequency (LF) and high frequency (HF) (in ms2), normalized units of LF and HF (in nu) and LF/HF ratio were expressed as mean ± standard deviation and analyzed. RESULTS: On statistical analysis, it was found that HF in normalized units was significantly low in obese young adults compared to age-matched controls. LF (nu) and LF/HF ratio were higher in obese subjects compared to controls, though they were not statistically significant. Although there was negative correlation between HRV parameters and body mass index in obese individuals, it was not significant. CONCLUSIONS: These results suggest that obese young adults present with changes in the autonomic nervous system, characterized by decrease in parasympathetic activity.
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Impact of a particular diet on the nutritional status and glycemic response of noninsulin-dependent diabetes mellitus patients – An analytical study p. 38
Yellesh Pothula, S. S. B. Sharma, A Krishnaiah, Purna Singh Addanki
DOI:10.4103/kleuhsj.kleuhsj_222_21  
BACKGROUND: Diabetes mellitus is a heterogeneous primary disorder of carbohydrate metabolism with multiple etiological factors that generally involve absolute or relative insulin deficiency or insulin resistance or both. All causes of diabetes ultimately lead to hyperglycemia, which is the hall mark of this disease syndrome. Nutrition and diet play a critical role in the course of disease, in the controlling hyperglycemia in addition to drugs in diabetes mellitus patients. OBJECTIVES: To assess nutritional status of noninsulin-dependent diabetes mellitus (NIDDM) patients and glycemic response to the given type of food as compared to normal individuals. MATERIALS AND METHODS: Out of 40 cases of NIDDM patients, 15 normal subjects belonging to the same age and socioeconomic group were selected for the study on glycemic response to dextrose load and given test food (idly). In another six of NIDDM subjects, glycemic response to test food chapati was studied. In 13 cases of diabetes with hypertension, 12 cases of diabetes without hypertension, and 16 cases of normal subjects, a wide range of biochemical parameters like lipid profile, free fatty acid (FFA) levels, serum, and erythrocyte copper and malondialdehyde levels were estimated among them. DISCUSSION: The results of the study showed that in NIDDM patients, body mass index is significantly lower than the normal, showing that obesity is not a predisposing condition in these subjects. The glycemic response to food (idly) is much higher than the response observed in normal subjects. The extent of suppression and FFA levels in the serum that was brought out by the food for glucose is lower than that observed in normal subjects. CONCLUSION: High lipid profile values and low copper levels can favor the generation of lipid-derived free radicals, which further predispose to the vascular changes and hypertensive states observed in the NIDDM patients.
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Ocular manifestations in SARS COVID admitted patients: A hospital-based study p. 46
Nagbhushan Chougule, Mitali Vijay Mangoli, Avaneet Kumar, V Bindushree Reddy, Arvind L Tenagi
DOI:10.4103/kleuhsj.kleuhsj_168_21  
CONTEXT: Ongoing COVID-19 Pandemic. AIMS: The aim of this study is to assess the ocular manifestations of coronavirus disease (COVID-19) admitted in KLES Dr. Prabhakar Kore Hospital and MRC, KAHER, Belagavi, Karnataka, India. SETTINGS AND DESIGN: This is a cross-sectional study. SUBJECTS AND METHODS: It was a cross-sectional study, which included 100 patients who tested positive for COVID-19 (reverse transcriptase-polymerase chain reaction) and were admitted from August 2020 to September 2020 in KLES Dr. Prabhakar Kore and MRC Hospital, KAHER, Belagavi, Karnataka, India. Approval from the ethical committee was obtained, and informed consent was taken from all the patients included in this study. STATISTICAL ANALYSIS USED: Statistical analysis was performed using statistical software R and Microsoft Excel. Categorical variables were given in the form of frequency (%). RESULTS: A variety of ocular symptoms which included conjunctival congestion and dry eyes were noted. Of the 100 patients assessed, 43 patients had new-onset ocular symptoms. In these 43 patients, the history of onset of ocular complaints and the day of onset of COVID symptoms was analyzed, and it was found that 35 patients (81.39%) complained of their ocular symptoms at the same time as they started experiencing the symptoms of COVID. CONCLUSIONS: Severe acute respiratory syndrome coronavirus-2 is thought to be transmitted from person to person mainly through respiratory droplets or close contact. The ocular surface is exposed to the outside environment, which may be a potential gateway for pathogens such as viruses to invade the human body. Furthermore, eye rubbing is another high-risk factor for virus transmission, which has been confirmed in adenovirus-induced conjunctivitis. It is important for all health-care workers to be updated about these symptoms in this regard.
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Influence of intraoperative lignocaine infusion on analgesia, stress response, and recovery profile in laparoscopic cholecystectomy: A randomized control study p. 50
Reena R Kadni, G Prasanna Kumar, Chakravarthy Joel, Varghese K Zachariah, Priya Pushpavathi, Anil Kumar Narasimha
DOI:10.4103/kleuhsj.kleuhsj_148_21  
INTRODUCTION: Laparoscopic cholecystectomies are performed as daycare procedures. Postoperative pain associated with it may need multimodal opioid-free approaches to fast track the recovery. Intraoperative intravenous lignocaine infusion was employed in this study to observe it effect on analgesia, hemodynamic stress response, and recovery profile in patients undergoing laparoscopic cholecystectomies. METHODOLOGY AND RESULTS: This was a randomized placebo-controlled study with enrollment of 64 participants. The “L” group received preservative-free intravenous lignocaine 2% at 1.5 mg/kg bolus followed by continuous infusion at a rate of 1.5 mg/kg/h till skin closure. The “C” group received equal amounts of normal saline. No significant statistical difference was observed between the two groups with time to first analgesic, total analgesic consumption, and visual analog scale scores. No significant difference was seen with sedation, time to achieve modified Aldrete score, and time to return of bowel activity. Only significant difference in heart rate was observed in lignocaine group after intubation with no effects on mean arterial pressure. CONCLUSION: Lignocaine infusion did not prove any added benefits in terms of postoperative analgesia, opioid requirements, and functional recovery after laparoscopic cholecystectomy. Hemodynamic stress response were better maintained in lignocaine group. Bolus dose of lignocaine may prove beneficial and equipotent as fentanyl.
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Major neurological disorders in tribal areas of Himachal Pradesh: A community-based survey p. 57
Ashok Bhardwaj, Sunil Raina, Sanjay Kumar, Mitasha Singh, Dinesh Kumar, Piyush Sharma
DOI:10.4103/kleuhsj.kleuhsj_195_21  
BACKGROUND: Neurological disorders are being recognized as a part of epidemiological transition worldwide. The much-needed database on neurological diseases in India is lacking. OBJECTIVE: The objective of this study was to estimate the prevalence of major neurological disorders in tribal population of Himachal Pradesh. METHODOLOGY: A community-based survey was conducted in two tribal districts and two tribal blocks of one district of Himachal Pradesh, India. A cluster-randomized sampling technique was used to study a population of 10,000 between 2017 and 2018. Forty clusters were identified in three districts. The study was conducted in two phases in individuals above 7 years of age. The individuals screened positive in stage 1 (using the National Institute of Mental Health and Neurosciences protocol for assessing neurological disorders) were examined by clinical team in stage 2 and classified. RESULTS: A total of 8255 individuals reported for phase two of the study (response rate of 82.55%). The crude prevalence of neurological disorders in the tribal population was 3.04% after clinical assessment in stage 2. Migraine (1.9%) was the most common disorder followed by stroke (0.47%). CONCLUSION: The prevalence of neurological disorders in tribal populations is comparable to the general population. This is an indicator of lifestyle diseases entering into the indigenous population and demands neurological health care tailored in primary health care.
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A study on the perceived impact of indoor air pollution in a slum area of Kolkata, West Bengal p. 63
Sinjita Dutta, Vineeta Shukla, Mausumi Basu, Meghna Mukherjee, Ankita Mishra, Ripan Saha
DOI:10.4103/kleuhsj.kleuhsj_172_21  
BACKGROUND: Indoor air pollution is one of the most serious environmental health concerns in today's times. OBJECTIVES: The objective is to find out the sources and health effects of indoor air pollution as well as assess the housing conditions among residents of a slum area in Kolkata. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among 220 households in a slum area of Kolkata. Data were collected using a predesigned, pretested, structured schedule by face-to-face interview and observation technique and analyzed using SPSS version 25.0. RESULTS: About 56.8% of the study population complained of having at least one symptom of indoor air pollution. Factors associated with three or more symptoms were female gender, lower-middle socioeconomic class, absence of dampness, exposure to tobacco smoke, use of mosquito repellent, and presence of kitchen in the living room. CONCLUSION: The slum population should be educated about the major associated factors of indoor air pollution found in our study.
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Role of structured exercise therapy on cognitive markers and stress parameters in young patients with Type 2 diabetes mellitus p. 70
Harpreet Kour, VA Kothiwale, Shivaprasad S Goudar
DOI:10.4103/kleuhsj.kleuhsj_287_21  
BACKGROUND AND AIMS: Diabetes mellitus (DM) patients face cognitive impairments owing to neuronal dysfunction following constant oxidative stress. The influence of exercise therapy in the management of DM is widely recognized among the elderly. However, its role among young adults in India is not explored. This study aimed to assess the effect of structured exercise on cognitive markers and stress parameters in young DM patients. MATERIALS AND METHODS: This interventional study with a pre- and post-model was conducted among 48 newly diagnosed type 2 DM patients who were asymptomatic for cognitive dysfunctions. Glucose profile was recorded by commercially available kits. Cognitive function markers and stress parameters, namely, Tau Protein was estimated in plasma samples using enzyme-linked immunoassay Kit, nitric oxide (NO) by colorimetric method, Catalase and malondialdehyde (MDA) assay by the spectrophotometric method. Patients were trained for the structured exercise therapy as per the protocol and evaluated at the end of 6 months. The change in the quantitative parameters before and after the intervention was assessed by paired t-test. P < 0.05 was considered statistically significant. RESULTS: The mean of Tau protein, catalase NO, and MDA showed significant statistical difference (P < 0.001) when compared from baseline to postintervention. However, the mean of fasting blood glucose (P = 0.8705), postprandial blood glucose (P = 0.8121), and glycated hemoglobin (P = 0.8121) reported insignificant values from baseline to postintervention. CONCLUSIONS: Integrated approach of structured exercise therapy has improved the cognitive functions and decreased oxidative stress.
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Spectrum of immunophenotypic aberrancies in acute leukemia along with their correlation with adverse hematological parameters p. 76
Sana Ahuja, Avneesh Malviya
DOI:10.4103/kleuhsj.kleuhsj_170_21  
BACKGROUND: The identification of aberrant phenotypes in acute leukemia is crucial for treatment monitoring and minimal residual disease analysis. Flowcytometric immunophenotyping in acute leukemia is an important tool for the detection of these aberrancies. There is wide variation in the incidence of aberrant antigens in acute leukemia in different studies and its correlation with prognostic markers. AIMS AND OBJECTIVES: The aim and objective of this study is to assess the frequency of aberrant markers in acute leukemia and determine any association with hematological parameters. MATERIALS AND METHODS: A total of 150 newly diagnosed cases of acute leukemia during the period January 2018–December 2020 were included. The flowcytometric immunophenotyping of all the above cases was done using BD FACS Canto II. RESULTS: Out of the total 150 cases of acute leukemia, 56.7% expressed aberrant phenotype. The proportional frequency of aberrant antigen expression in B-acute lymphoid leukemia (ALL), T-ALL and acute myeloid leukemia (AML) was 56.6%, 50%, and 58.5%, respectively. CD13, CD13, and CD7 were the most common aberrancies in B-ALL, T-ALL, and AML, respectively. Aberrant myeloid phenotype in B-ALL was associated with lower mean total leukocyte count (TLC) and blast percentage in peripheral blood as compared to the B-ALL with conventional phenotypes. Aberrant lymphoid phenotype in AML was associated with a higher TLC and greater blast percentage in peripheral blood than the AML with conventional phenotypes. CONCLUSION: Aberrant lymphoid phenotype in AML is associated with unfavorable hematological features. However, aberrant myeloid phenotype in B-ALL is not associated with adverse features.
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Assessment of different risk factors associated with SARS-CoV-2 infection among young adults of a relatively vulnerable district of West Bengal, India: A retrospective study p. 81
Tanusri Biswas, Saswati Chattopadhyay, Arindam Dasgupta, Aroni Chatterjee, Debsopan Roy, Suhrita Paul
DOI:10.4103/kleuhsj.kleuhsj_252_21  
INTRODUCTION: The observed increased infectivity among young adults in the last few months has made it evident that the SARS-CoV-2 is not only capable of infecting younger adults but can also exhibit severe symptoms in them. The exact role of different risk factors in case of COVID infected young is still very much under debate. OBJECTIVE: In this study, we tried to identify different epidemiological and clinical risk factors which might be responsible for increasing the chance of infection among young adults with confirmed SARS-CoV-2 infection. MATERIALS AND METHODS: A total of 198 young adults from 18 to 29 years of age who were tested COVID-19 positive by the reverse transcription polymerase chain reaction at Burdwan Medical College and hospital during January 2021 to July 2021 were included in this retrospective observational study. RESULTS: The total population of individuals were divided into two different groups for statistical analysis, first group with 65 individuals (32.8%) who were admitted to the hospital and the second group with 133 (67.2%) patients who were not hospitalized and discharged after preliminary examination. 30.8% of the hospitalized patients required admission to intensive care unit (ICU), while 56.9% patients among those hospitalized required respiratory support and 29.2% required mechanical ventilation. DISCUSSION: Our study showed that diabetes and hypertension conjugated with obesity are quite common comorbidities associated with the hospitalized young adults. We have also pointed out that asymptomatic patients and those with mild symptoms presented a relatively stable clinical course, quite similar to that observed in other studies. Furthermore, our patients had a high rate of ICU admission per hospitalization which may be a reflection of a variety of social determinants that influence health outcomes. Conclusion: Our study by providing an exhaustive data set from the hospitalized and non-hospitalized SARS-CoV-2 infected young adult patients will surely provide a better understanding of the prevalence and effect of COVID among this vulnerable fraction of the population.
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Does psychological health of future doctors affects academic performance? unmasking the masked p. 87
Afshan Kausar, Shaikh Shaista Parveen
DOI:10.4103/kleuhsj.kleuhsj_226_21  
INTRODUCTION: Psychological health of a medical student remains affected throughout the course. Medical education is usually seems to be associated with substantial extent of psychological morbidity. Thus, objective of the study was to collect data regarding depression, anxiety, and stress in 1st-year undergraduate medical students and to correlate it with their academic performance. MATERIALS AND METHODS: Forty-two item Depression Anxiety Stress Scale questionnaire was administered to 1st-year medical students. First terminal marks scored by students were recorded. Data were statistically analyzed. RESULTS: The study confirmed that the amount of stress and depression was comparatively higher than anxiety. Incidence of stress was 53.007%, anxiety 36.05%, and depression 44.03%. Negative correlation was found between stress, anxiety, and depression with academic performance. CONCLUSION: There is a considerable amount of depression and stress in 1st-year medical students that had affected academic performance. To conclude, there is a need for early detection, counseling, and rehabilitation to minimize the academic loss and improve the quality of health care.
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Quarantine during COVID-19 pandemic: A cross-sectional study to investigate its compliance and psychological impact among health care professionals in Southern Haryana p. 92
Abhishek Singh, Vikas Gupta, Pawan Kumar Goel
DOI:10.4103/kleuhsj.kleuhsj_182_21  
BACKGROUND: COVID-19 has caused a pandemic during 2019–2020 that has resulted in illnesses ranging from the usual flu to serious respiratory problems, even leading to mortality. Recent literature has suggested that the health (psychological) impact of quarantine is wide-ranging, substantial, and can be long-lasting. OBJECTIVES: The purpose of this study was to assess the mental health status (psychological distress) of those who experienced quarantine and their compliance with quarantine during the outbreak of COVID-19 among health care professionals. MATERIALS AND METHODS: The study included 217 health care staff (doctors and nurses) working in COVID-19 outpatient and wards, sent on quarantine at home or state-run facilities. The psychological impact was assessed using the Kessler Psychological Distress Scale (K10). Categorical data were presented as percentages (%), and the Chi-square test was used to determine the association, with a P < 0.05 considered statistically significant. RESULTS: Out of 217 participants, only 206 gave their consent to be part of the study, and only 10.2% (21/206) of quarantined subjects were compliant with all protective measures. It has a significant association with the participant's understanding of all the rationale for quarantine and with the Kessler Psychological Distress Scale (P < 0.05). The mean score obtained on Kessler Psychological Distress Scale (K10) subjects was 18.91 ± 5.16, whereas 63 subjects out of 206 (30.6%) had a score of 20 or more. CONCLUSION: Given the developing situation with the coronavirus, policymakers urgently need evidence synthesis to produce guidance for the public. Thus, the outcomes of this study will definitely help authorities, administrators, and policymakers to put quarantine measures in a better way.
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SHORT COMMUNICATION Top

Mobile and medical education: Points to ponder p. 99
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_39_21  
The field of medicine is advancing with each day and therefore the process of producing a competent medical professional becomes a significant one. The findings of multiple studies have revealed that a significant proportion of medical students are using their phones for the purpose of acquisition of knowledge and information and that too whenever they need it. The mobile phones in the field of medical education can be broadly used in two ways, namely the use of internet and various application, and the use of those items that have been stored in phones for ready reference by the students. Furthermore, the use of the mobile phones has significantly increased during the ongoing pandemic and has helped the teachers and students to continue the process of learning and assessment during these difficult times. To conclude, mobile phones have attained an important status in the entire process of medical education delivery. It is up to all of us that we understand the ways in which we can use mobile technology in the best interest of the students and patient care.
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LETTERS TO THE EDITOR Top

Mental health problems of women working in the unorganized sector p. 101
Priyanka Saikia, Abhijit Pathak
DOI:10.4103/kleuhsj.kleuhsj_216_21  
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Unfolding pandemic of severe acute respiratory syndrome coronavirus 2 and its evolving lessons p. 103
Harish Gupta, Ajay Kumar Patwa, Medhavi Gautam, Satish Kumar
DOI:10.4103/kleuhsj.kleuhsj_155_21  
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