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   Table of Contents - Current issue
Coverpage
September-December 2022
Volume 15 | Issue 3
Page Nos. 187-321

Online since Saturday, September 17, 2022

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EDITORIALS  

Engaging a self-directed learning session: Myths and facts Highly accessed article p. 187
Sheetal Harakuni
DOI:10.4103/kleuhsj.kleuhsj_529_22  
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Is the journal I am sending my research for publication indexed? Highly accessed article p. 190
Punnya V Angadi, Harpreet Kour
DOI:10.4103/kleuhsj.kleuhsj_531_22  
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REVIEW ARTICLES Top

Grading of prostate cancer: Evolution and changing concepts Highly accessed article p. 192
Vijayalaxmi M Dhorigol, Ranjit P Kangle
DOI:10.4103/kleuhsj.kleuhsj_90_22  
Grading system for prostatic cancer (PC) was first described in1966 by Dr. Donald Gleason. Over the years, histologic, clinical diagnosis and management of PCa have evolved, leading to revisions of the Gleason system first by the International Society of Urological Pathology (ISUP) in 2005 and more recently in 2014. Unlike the original Gleason score (GS) ranging from 2 to 10, the current system no longer assign Scores 2–5, the lowest score being 6. The new grading system of 2014 proposed Five Grade Groups based on revised GS which produces a smaller number of grades with the most significant prognostic differences and may contribute to a decrease in the overtreatment of low-grade PC detected by prostate-specific antigen screening. This review provides an update on the evolution and revision of the Gleason grading system, with a discussion on the deficiencies, benefits, and limitations of the revised and new grading system of ISUP 2005, 2014, and 2019.
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Bibliometric analysis of media reporting of suicide: A worldview p. 199
Sujita Kumar Kar, Kritika Chawla, Babli Kumari, Ankita Saroj, Amit Singh, Bandna Gupta, Adarsh Tripathi, Shashwat Saxena
DOI:10.4103/kleuhsj.kleuhsj_376_21  
Suicide is a global mental health challenge and suicides frequently get a wide media coverage. The media reporting of suicide and subsequent suicides are closely associated. Studies reveal country wise variations in the quality of media reporting. We aimed to do a bibliometric analysis of the published research on media reporting of suicide. All the published articles available on the PubMed database from the time of inception till August 2021 were included in the study. All the PubMed IDs of the articles were entered in Harvard Catalyst, a free online software, for bibliometric analysis, and data were extracted and verified. A total of 158 published articles were identified. The average number of authors per article was 5.108 and the average number of times an article cited was 9.639 (excluding self-citation). The h-index of the published articles was 19. The Crisis journal published the maximum number of articles (n = 24). The highest number of average citations was for systematic reviews. Maximum articles were published in 2020 (n = 27). Suicide reporting in the media is an important subject of suicide research. However, original studies on this subject are few. Large-scale studies will contribute to the development of an evidence base for future recommendations and guidelines on this important subject.
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Immunological characteristics of CoVID-19 and its implications p. 204
Amrita Ghosh, Ranabir Pal, Ray Elizabeth Dominic, Mugdha Mittal, Luis Rafael Moscote-Salazar, Bukkambudhi V Murlimanju, Rafael Cincu, Amit Agrawal
DOI:10.4103/kleuhsj.kleuhsj_126_22  
CoVID-19 is the most formidable unequaled global challenge invading 220 countries and territories in this millennium to uncountable saga of mortality, disability as humanity is witnessing devastation of socio-economy with more than 4 million deaths till date. The natural history of CoVID-19 from transmission through varied clinical features to overt complications is still under global research and research groups are on the run to trace its ramifications. This ranges from primary involvement of the pulmonary system to multisystem involvement through web of immunological pathways associated with susceptibility, clinical presentations, and severity of COVID-19. It has been hypothesized that the safe and effective mass vaccination program across the globe can ensure flattening of the pandemic curve to prepandemic normal life. This research group explored the basic and applied researches on molecular and immune mechanisms of SARS COV-2 virus. A sincere attempt has been made in futuristic research vision to find potential strengths, shortfalls, and efficacy of the plant-based immunotherapy, antibodies, and vaccine. Different research groups have hypothesized for the best possible use of these indigenous, stable, secure, efficacious natural products by searching their potential to accomplish emergency demands in this trying time. There is an urgent need to understand the inherent immunological predictors of the natural history of the disease spread over the spectrum from mild to severe forms of the disease and harp on these issues. In the wake of multiple waves with worse situations of evolving clinical features with the “variants of concern” and “variants of interest” and innovative interventions, this research group believes in optimum mix of microbial-derived biologicals with immune modifying drugs will broaden the preventive and curative spectrum.
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Incorporating One Health competencies into the medical curriculum: Need of the hour p. 211
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_406_22  
The manner in which a doctor approach patient care significantly depends on the way in which they were trained during their undergraduation period. The purpose of the current review is to explore the necessity to incorporate One Health competencies in the medical curriculum and devise a framework for the same. An extensive search of all materials related to the topic was carried out on the PubMed search engine and a total of 14 articles were selected based on their suitability with the current review objectives. Keywords used in the search include One Health and medical education in the title alone only. The analysis of the major outbreaks of infectious diseases in the last couple of decades has shown an association with environmental changes. The presence of all these factors has compelled the international welfare agencies and public health authorities to adopt a One Health approach in medical curriculum to integrate humans, animals, and the ecosystem for the containment of these infectious diseases. To ensure that the current crop of medical students who will be joining the health workforce on completion of their training should be trained in different aspects of one health during their undergraduation period. In conclusion, the training of medical students on the One Health approach is an essential aspect of medical training considering the trends of outbreaks of infectious disease outbreaks. It is high time to acknowledge the need and prepare medical students to work as effective members of the interprofessional team and accordingly incorporate One Health competencies into the medical curriculum.
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ORIGINAL ARTICLES Top

Vitamin D status of children at a tertiary care hospital of Agartala, North-east India: A cross-sectional study p. 214
Elvia Jamatia, Sankar Roy, Arpita Das, Portia Dewan, Tapan Debnath
DOI:10.4103/kleuhsj.kleuhsj_135_22  
CONTEXT: High prevalence of Vitamin D deficiency (VDD) has been reported in the pediatric population from the different parts of the country. However, there is a lacuna of data on the Vitamin D status of children from the north-eastern part of the country. AIMS: The aim of this study is to assess the serum Vitamin D level and also to find out the prevalence of VDD among children and adolescents in Agartala, a major city in North-east India. SETTINGS AND DESIGN: Cross-sectional descriptive study. MATERIALS AND METHODS: The serum 25 (OH) D levels of 258 children from age 1 to below 18 years, attending the outpatient clinics of the hospital were analyzed from June 2020 to June 2021. STATISTICAL ANALYSIS USED: Data being nonparametric was presented as median and inter quartile range. The group differences were computed by the Mann–Whitney U-test. P < 0.05 was considered statistically significant. RESULTS: Sixty percentage of the study population had insufficient levels of Vitamin D, with girls having significantly lower levels of serum Vitamin D. Only 27% of adolescents had optimum level of serum Vitamin D. CONCLUSION: A high prevalence of Vitamin D insufficiency and VDD was found among the children living in the urban and sub urban areas of Agartala city in North-east India.
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The coexistence of concha bullosa and nasal septum deviation in adult Nigerians p. 219
Beryl Shitandi Ominde, Patrick Sunday Igbigbi
DOI:10.4103/kleuhsj.kleuhsj_379_21  
BACKGROUND: Concha bullosa (CB) with an associated nasal septum deviation (NSD) compromises the paranasal sinus drainage through the osteomeatal complex hence predisposing to sinus disease. This study aimed at elucidating the concomitant existence of CB and NSD in adult Nigerians. MATERIALS AND METHODS: Following institutional ethical approval, brain computed tomography images of 336 patients (199 males and 137 females) aged ≥ 20 years were analyzed for CB and NSD in the Radiology Department of a Teaching Hospital. Using the Statistical Package for the Social Sciences software version 23, the prevalence of these variants was expressed in percentages, and their association was probed using the Chi-square test. The angle of septum deviation was summarized in means and standard deviations. The differences in deviation angle in the presence of either ipsilateral or contralateral CB were assessed using the independent t-test. P < 0.05 was considered statistically significant. RESULTS: The prevalence of coexisting CB and NSD was 77, 22.9%. There was a significant preponderance of NSD away from a unilateral or dominant CB (54, 84.4%) (P = 0.022). This deviation occurred at a significantly higher angle (11.82° ± 2.21°) than deviation toward a CB (9.86° ± 2.63°) (P = 0.036). CONCLUSION: The awareness of the association between CB and NSD in our population emphasizes on mandatory preoperative radiological evaluation to aid in planning for safe endoscopic surgeries through the nose.
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Pediatric tracheostomy: A 10-year experience at a tertiary care teaching hospital in Eastern India p. 224
Santosh Kumar Swain, Ishwar Chandra Behera
DOI:10.4103/kleuhsj.kleuhsj_130_22  
BACKGROUND: Tracheostomy in pediatric patients is considered a surgery of significant morbidity and mortality. However, the airway management with tracheostomy in the pediatric age group has changed over time with respect to indication and outcome. OBJECTIVE: The objective of this study is to evaluate the indications and complications of pediatric tracheostomies. MATERIALS AND METHODS: This is a prospective study done on pediatric tracheostomies at a tertiary care teaching hospital. The study period was from September 2011 to October 2021. The data on age, gender, indications, and complications over 10 years were analyzed. In this study, pediatric tracheostomy was classified into prolonged intubation, obstruction in the upper airway, anomalies in the craniofacial region, neurological disorders, and vocal fold paralysis. If a child required ventilator assistance, they were placed in the prolonged intubation group. RESULTS: There were 162 pediatric tracheostomies performed during the study time. Of 162 children, 98 (60.49%) were male and 64 (39.50%) were female, with a male-to-female ratio of 1.5:1. Of 162 children, 112 (69.13%) underwent tracheostomy for prolonged ventilation and 50 (30.86%) underwent tracheostomy for upper airway obstruction. Intraoperative complications were seen in 9 (5.55%) cases of pediatric tracheostomy. There were 28 (17.28%) pediatric patients with a tracheostomy who presented with postoperative complications. CONCLUSION: Standardization of the pediatric tracheostomy, the timing of the procedure, and appropriate indications of pediatric tracheostomy are helpful to minimize morbidity and mortality in pediatric patients.
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Misconceptions about diabetes mellitus among diabetes patients: A cross-sectional study p. 230
Suyesha Nalavadey, Sulakshana Shridhar Baliga
DOI:10.4103/kleuhsj.kleuhsj_383_21  
BACKGROUND: Diabetes mellitus is a lifestyle-related painless disease. India has the highest diabetes burden in the world and is called as the “Diabetic Capital of the world.” Even though the disease is so rampant, there are ample misconceptions about diabetes and this has become a hurdle in effective management and control of the disease. MATERIALS AND METHODS: A cross-sectional study was conducted at the urban health center among 200 diabetics. Patients were asked about their belief in misconceptions regarding diet, exercise, treatment-seeking behavior, and self-care of diabetes. RESULTS: From a total of 200 participants, 112 (56%) were females. Majority 183 (91.5%) were self-monitoring their blood glucose. More than half of the participants were on oral hypoglycemic drugs. In this study factors such as low educational status, participants staying in joint family, low socioeconomic class, participants on oral hypoglycemic drugs, participants on both oral hypoglycemic drugs and insulin, participants on herbal treatment had more prevailing misconceptions regarding diabetes. CONCLUSION: There were many prevailing misconceptions among the diabetic patients, especially related to diet, treatment, and self-care. Regular health education programs regarding misconceptions can change the attitude of diabetic patients and improve their compliance toward treatment.
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A survey study on self-reported practice and work environment among anesthetist trainees in Nigeria p. 235
Olusola K Idowu, Babatunde B Osinaike
DOI:10.4103/kleuhsj.kleuhsj_393_20  
CONTEXT: The safe practice of anesthesia encompasses professionalism, equipment, monitoring, medications, and conduct of anesthesia. Therefore, standard training is sine qua non to guarantee good surgical outcomes in a specialty associated with delicate and high-risk cases. AIMS: The aims are to survey the work practices among anesthetist trainees from different centers across Nigeria. SETTINGS AND DESIGN: A descriptive cross-sectional survey study conducted at the Department of Anaesthesia, University College Hospital, Ibadan, Nigeria. SUBJECTS AND METHODS: Anesthetist trainees were administered structured questionnaires following informed consent. STATISTICAL ANALYSIS USED: The Statistical Package for the Social Sciences (IBM SPSS version 23.0®) was used to analyze the obtained data. Results were presented using a frequency and percentage table, with a bar graph. RESULTS: Out of the 76 respondents, there were 57 (75.0%) male and 19 (25.0%) female trainees who were mostly >30 years (90.8%). Mean residency duration was 1.4 ± 0.6 years, with many within 1–2 years of postgraduate training (67.1%). Many were junior registrars 71 (93.4%) and mostly (64.5%) work for >8 h. On clinical work practices, all the respondents reported that they always discuss the risks, purpose, and benefits of anesthesia (100.0%), 77.6% always discuss patient management with superior, 57.9% always provide postanesthetic care, and 88.2% always obtain informed consent. Only 6 out of the 13 anesthetic techniques listed had ≥50% positive responses with confirmation of their abilities to perform these techniques. CONCLUSIONS: Most of the anesthetist trainees reported considerable abilities concerning clinical work practices in anesthesia. However, we observed significant limitations in the provisioning of some anesthetic techniques among many junior registrar trainees and this was not unexpected considering their current level of training.
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Correlation of enzyme-linked immunoassay with line immunoassay for the detection of antinuclear antibody in autoimmune diseases p. 240
Ashna Bhasin, Abha Sharma, Poonam Sood Loomba, Bibhabati Mishra, Madhusmita Das
DOI:10.4103/kleuhsj.kleuhsj_354_21  
INTRODUCTION: For the diagnosis of autoimmune disorders, detection of antinuclear antibodies (ANAs) is a key step. Indirect immunofluorescence assays are regarded as a gold standard method. Enzyme-linked immunosorbent assay (ELISA) is easily automated and less technical skills are needed and so used for ANA screening. Further testing is done with line immunoassay (LIA) for specific diagnosis of autoimmune disease. However, there is a lack of data comparing ELISA with LIA for ANA detection in the Indian population. OBJECTIVE: The objective of this study is to find the correlation between ELISA and LIA for ANA detection. METHODOLOGY: Serum samples received for ANA screen were tested using commercial kits for ELISA and LIA according to manufacturer's instructions. RESULTS: Total of 108 samples were tested both by ELISA and LIA. The total numbers of samples positive by ELISA were 26 and positive by LIA were 54 of 108. Samples that were both ELISA and LIA positive were 22 and both ELISA and LIA negative were 50. There was a fair level of agreement between the two methods (kappa = 0.333) with 95% confidence interval of 0.259–0.699. There was no significant difference in the distribution of most of the antibody types detected by LIA among ELISA positive and negative groups. However, the correlation of antibody type U1-Sn ribonucleoprotein with ELISA was found to be statistically significant (P = 0.0319). CONCLUSION: Detection of ANA is an important screening test. This present study shows moderate correlation between ELISA and LIA and hence both methods can be used depending on the workload of laboratories for cost-effectiveness. ELISA may be the preferred method for high-throughput laboratories.
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Aerobic bacterial study of postoperative lower segment cesarean site wound infection p. 244
K Pooja, MB Nagmoti
DOI:10.4103/kleuhsj.kleuhsj_106_21  
INTRODUCTION: Cesarean section wound infection illustrates a significant load to the health system as it carries an increased risk of infection as compared to normal vaginal delivery. Hence, it is necessary to identify the agents responsible as well as their extent of susceptibility for commonly used antibiotics. MATERIALS AND METHODS: The study was carried out at the Department of Microbiology, Jawaharlal Nehru Medical College. The specimens were inoculated on the blood and MacConkey agar. The colonies were identified by their morphological characteristics and the biochemical tests, antibiotic susceptibility test was carried for the isolated aerobic bacterial isolates. RESULTS: In the present study, Staphylococcus aureus (13, 56.68%) was the most common pathogen isolated, followed by Klebsiella pneumoniae (5, 21.9%). Gram-positive isolates showed greater sensitivity to tetracycline 11 (73.33%), followed by doxycycline (11, 73.33%) and clindamycin (9, 60%). Gram-negative bacteria showed the highest sensitivity meropenem (7, 77.78%), imipenem (6, 66.66%), and piperacillin + tazobactam (6, 66.66%). CONCLUSION: Frequent antimicrobial audit and qualitative research could give an insight into the current antibiotic prescription practices and the factors governing the same.
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Suicidal behavior during the COVID-19 pandemic: A finding of an Indo-Nigerian online survey p. 249
Krittika Sinha, Tosin Philip Oyetunji, Sudha Mishra, Huma Fatima, Aathira J Prakash, Nitika Singh, G Srinivasan, Sujita Kumar Kar
DOI:10.4103/kleuhsj.kleuhsj_219_21  
BACKGROUND: The COVID-19 pandemic has a significant impact on the mental health and is associated with high suicidal behavior. This study is an effort to scrutinize suicidal behavior among general population in two countries, namely India and Nigeria. METHODS: This was an online survey conducted on 536 adult participants (272 from India and 264 from Nigeria) over a period of six months. It was conducted using a snowball sampling method. The participation in the survey was entirely voluntary. Current suicidality was measured among the participants. Data were collected in two countries only. RESULTS: Feeling of hopelessness over the past one month was reported by more than one-fifth of Indian as well as Nigerian participants. The differences in suicidal behavior of Indian and Nigerian participants were not statistically significant. Intention to hurt self and passive death wishes in the Indian population was higher than Nigerian participants, which can be explained by significantly higher medical morbidity and past psychiatric illness history in the Indian participants. Suicide attempt was reported in 1.1% of Indian participants and 1.51% of Nigerian participants in the past one month. On the other hand, 5.88% of the Indian participants and 2.65% of the Nigerian participants had suicidal ideation in the past month. CONCLUSION: High suicidal behavior has been reported during the COVID-19 pandemic among the participants from India and Nigeria.
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Seroprevalence of severe acute respiratory syndrome coronavirus 2 immunoglobulin G antibodies among health-care workers prior and after 4–6 weeks of coronavirus disease vaccine administration at tertiary care center of southwest Bihar, India p. 256
Mukesh Kumar, Richa Singh, Abhishek Kamendu, Amit Kumar Singh, Jyoti Sangwan
DOI:10.4103/kleuhsj.kleuhsj_179_21  
AIM: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health emergency. To control the spread, a mass vaccination program is initiated. Antibody titer after vaccination can be a better marker to monitor immunological response. MATERIALS AND METHODS: The study was carried out at the Department of Microbiology, Narayan Medical College and Hospital, Jamuhar Sasaram, southwest Bihar, considering the sample size, type, and collection. First, antibody was tested before vaccination and second antibody value after 28 days of the first dose of COVID vaccine among the health-care workers and housekeeping staff. RESULTS: A total of 251 subjects were administered with vaccination (Covishield) to check the immunoglobulin g (IgG) responses. The concentration of the SARS-CoV-2 IgG antibody in female patients tended to be higher than in male patients. CONCLUSION: There is a difference in antibody positivity among males and females. Most of the participants had IgG positivity, because of their profession, vaccination boosted percentage positivity in both males and females. Females have more IgG levels compared to males. Hence, recommend that separate guidelines can be made between males and females for vaccination dosages.
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Sociopsychological and biochemical determinants of health and disease in executive health check-up p. 261
AB Kudachi, MB Nagmoti, SK Rajshree, RS Mudhol
DOI:10.4103/kleuhsj.kleuhsj_259_21  
BACKGROUND: Preventive health check-ups are known to be associated with significant reductions in morbidity, mortality, and economic costs related to various diseases, especially chronic lifestyle diseases that progress silently. OBJECTIVE: The objective is to evaluate the sociopsychological and biochemical issues of health and disease in executive health check-up as well as to employ them for encouraging people to utilize the available preventive health services. MATERIALS AND METHODS: This cross-sectional study enrolled 768 individuals aged >20 years, irrespective of their gender, reporting for an executive health check-up and evaluated their demographic profile, morbidity, type of family, diet and socioeconomic status, biochemical profiling, and sociopsychological features. The data were statistically analyzed using correlations among different variables by Karl Pearson's correlation coefficient method. P < 0.05 and 0.001 indicated statistical significance. RESULTS: The participants had a mean age of 48.24 ± 12.84 years and a Male and Female ratio of nearly 2:1. The demographic parameters showed a significant association with the different levels of biochemical parameters (P < 0.05/0.001). CONCLUSION: There exist significant correlations between sociopsychological, and biochemical determinants of health and disease in executive health check-up. These incite the need for utilizing preventive/precautionary health services and early detection of disease status is speculative. There is uncertainty among the public and health-care professionals in utilizing these preventive health-care services in a beneficial, judicious, as well as in cost-effective manner.
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Effect of self-instructional module on knowledge regarding care of arteriovenous fistula among hemodialysis patients in selected hospitals, Guwahati, Assam p. 270
Khumukcham Monali Devi, Manashi Sengupta
DOI:10.4103/kleuhsj.kleuhsj_92_22  
BACKGROUND: Chronic kidney disease is a major public health problem. Arteriovenous fistulas (AV fistulas) are considered the gold standard for hemodialysis vascular access based on their superior patency, low complication rates, improved adequacy, lower cost to the healthcare system, and decreased risk of patient mortality. A failing AV fistula places the patient at risk for inadequate dialysis, which can lead to numerous complications and increased morbidity and mortality. Patient education support patients to live the best possible quality of life. It instills patient self-confidence to help them carry out behavior necessary to reach the desired goal. OBJECTIVE: The purpose of the study is to determine the effect of self-instructional module by comparing the pretest and posttest knowledge scores regarding care of AV fistula among hemodialysis patients. MATERIALS AND METHODS: With a quantitative approach, preexperimental one-group pretest-posttest design was adopted for the study. In this study, 64 hemodialysis patients with AV fistula were selected by using nonprobability convenient sampling technique. The tools used for the study were demographic variables, self-structured knowledge questionnaire and self-instructional module. RESULTS: The study revealed that the mean posttest knowledge score (12) was significantly higher than the mean pretest knowledge score (7.32) as evidenced by t = 5.65 (P = 0.05) and P = 0.0001, which shows that self-instructional module was effective on care of AV fistula. It also revealed that there was significant association between pretest knowledge score and selected demographic variables of educational status and previous exposure to information. CONCLUSION: A similar study can be taken on large scale for better generalization. On the basis of the findings, the researcher concluded that self-instructional module on care of AV fistula was effective among hemodialysis patients.
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Skin problems among nurses due to personal protective equipment: A cross-sectional study from COVID-19 hospital p. 275
Suraj Chawla, Shewtank Goel, Abhishek Singh, Vikas Gupta
DOI:10.4103/kleuhsj.kleuhsj_256_21  
BACKGROUND: Nursing staff are at much greater risk of infection due to the exposure to the highly infectious bodily fluids and droplet nuclei and needed the use of personal protective equipment (PPE) to reduce the transmission risk. AIM: The present study was conducted to estimate the prevalence of skin injury and its type due to PPE usage nursing staff. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted after obtaining the institutional ethical approval in dedicated COVID-19 hospital for a period of 4 months among 144 nursing staff wearing Grade 2 and 3 PPE kit. Study subjects were approached through social networking websites and survey questionnaire (Google Forms) according to relevant guides; research literature was used for collecting the details regarding baseline, duty, and skin injury characterization. Chi-square analysis was used to find the association between dependent and independent variables and an association was significant for P < 0.05. RESULTS: It was observed that 54.7% of nursing staff were working for 6 or more hours and 16.5% of subjects were wearing the PPE kit for 5 or more hours per day. 86.3% of subjects have suffered from skin injury after PPE usage. The most common symptoms/signs for the skin injury occurred were indentation and pain on back of ears (61.9%). CONCLUSION: The skin injuries of PPE among the nursing staff may result in reduced morale for overloaded work and made them anxious, so an effective preventive measure should be adopted.
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Procalcitonin levels in COVID-19 patients in a tertiary care center p. 282
Avinash H Rajanna, Satyanarayana Narayanashetty, Yesheswini N Naik, Vaibhav S Bellary, Chethan N
DOI:10.4103/kleuhsj.kleuhsj_81_22  
BACKGROUND: Procalcitonin (PCT) is a glycoprotein calcitonin prohormone released by the thyroid parafollicular cells. In case of a microbial infection, PCT synthesis can be stimulated by the elevation of proinflammatory cytokines, including interleukin-6, interleukin-1b, and tumor necrosis factor-α. These mediators are massively involved in the so-called cytokine storm, typical of the progression from the viremic to the hyperinflammatory stage of COVID-19 and characterized by the onset of respiratory symptoms and interstitial pulmonary infiltrates. Thus, PCT elevation may represent a direct consequence of the COVID-19 cytokine storm and could also be interpreted as a “viral sepsis” syndrome. AIM: (1) To estimate serum PCT levels in patients with COVID-19 infection. (2) To access PCT level as a predictor of mortality. MATERIALS AND METHODS: A cross-sectional study was conducted on a total of 200 patients in Bengaluru during the study period from March 2021 to July 2021. A case record form with follow-up chart was used to record the duration of disease, history of treatment, and complications. Patients underwent biochemical investigations and PCT level. RESULTS: The study includes 200 patients; the majority were above 50 years of age group. Out of 200 patients, 170 were discharged and 30 died. The mean PCT level was 4.44 ± 45.34 ng/ml. PCT in those who are discharged was 1.25 ± 8.81 ng/ml and compared to those who died was 28.06 ± 128.4 ng/ml. This difference was statistically significant (P = 0.00). CONCLUSION: PCT can be used as a prognostic biomarker in COVID-19 patients; initially elevated levels may be used as a prognostic indicator of severity, deteriorating clinical picture, and even mortality.
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Prevalence of deep vein thrombosis in congestive cardiac failure patients p. 287
Muzafar Naik, Tariq Bhat, Waiz Gowhar, Abdul Ahad Wani
DOI:10.4103/kleuhsj.kleuhsj_132_21  
BACKGROUND: Congestive cardiac failure (CCF) and deep vein thrombosis (DVT) may coexist in a patient. The prevalence of DVT has been reported up to 34.1% in CCF patients, and its presence may increase the morbidity and mortality of CCF patients. The presence of DVT may increase the morbidity and mortality of CCF patients. With this background in mind, we conducted a study to know the prevalence of DVT in CCF patients from our part of the world. MATERIALS AND METHODS: An analytical cross-sectional study was carried out over a period of 1 year from March 2015 to February 2016 on 50 patients admitted with CCF to our hospital. After obtaining information on underlying comorbid illness, duration of CCF symptoms, and preliminary investigations, the patients were subjected to venous Doppler ultrasound. RESULTS: A total of 50 patients admitted with the diagnosis of CCF were enrolled in this study. The mean age of patients was 63.28 ± 9.5 years. The mean body mass index of the patients was 24.48 ± 2.8 kg/m2. Five out of 50 patients were found to have deep vein thrombosis in our study. The duration of symptoms of more than 10 days before seeking medical consultation was statistically significant in patients of CCF with DVT. CONCLUSION: In our study, 10% of patients with CCF had DVT on venous Doppler ultrasound. A longer duration of CCF symptoms before seeking medical consultation was significantly associated with DVT in our patients.
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Trends and analysing the correlation of population density and percentage of population suffered from COVID-19 - A linear regression model p. 291
Kamlesh Garg, Aarushi Mathur, Surinder Kumar, Ruchika Nandha
DOI:10.4103/kleuhsj.kleuhsj_232_21  
BACKGROUND: Since the emergence in December 2019, coronavirus disease (COVID-19) has impacted several countries and made it a worldwide pandemic. It is assumed that chances of transmission of infection of COVID-19 are increased if the population of a particular area is dense as it is a highly contagious disease and measures like social distancing could not be followed. The objectives of this study were as follows: to compare the trend of confirmed, recovered, deceased cases and recovery and death rate of COVID-19 (severe acute respiratory syndrome coronavirus 2) infection in the top 5 worst-hit states of India with National Capital Territory of Delhi and to analyze the correlation of population density with percentage of population suffered. MATERIALS AND METHODS: This descriptive population study retrieved the data published by daily health bulletins of states and Press Information Bureau, Government of India. The correlational coefficient and linear regression analysis were used to analyze the relation between population density and percentage of population suffered from COVID-19. RESULTS: Maharashtra continued to be the upmost Indian state with the highest number of confirmed, recovered, deceased cases and death rate. Further, it is estimated that population density has a negligible to low positive correlation (correlation coefficient value: 0.30) with the percentage of population suffered from COVID-19 and there is no significant relationship with P > 0.05 between the above two parameters as obtained using linear regression model. CONCLUSION: The population density does not have a strong correlation with the percentage of population suffered from COVID-19 in India.
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CASE REPORTS Top

Rhinoscleroma – still a predominant entity managed by rubber tube recanalization p. 298
AS Harugop, S Puneeth Nayak, Yashita Singh, Rahul Gulaganji
DOI:10.4103/kleuhsj.kleuhsj_136_22  
Rhinoscleroma is a chronic granulomatous infection affecting the nasal cavity and nasopharynx primarily. It results in functional and esthetic sequelae in patients. A patient presented to us with chronic extensive vestibular stenosis with external deformity of the nose. The patient underwent multistaged diagnostic nasal endoscopy with biopsy and recanalization using a sterile rubber catheter which showed significant clinical improvement. This case demonstrates that medical advancements have enabled a quicker diagnosis of rhinoscleroma and recanalization still remains an essential entity in managing the sequelae of rhinoscleroma.
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Eosinophilic granuloma with metachronous actinomycosis – A case report with literature review p. 302
Kavya Soundararajan, Sudeendra Prabhu, Pallavi Sabarad, Riaz Abdulla
DOI:10.4103/kleuhsj.kleuhsj_153_22  
Eosinophilic granuloma (EG) is a type of histiocytosis X with uncertain etiology. The lesion manifests as single or multiple areas of bone destruction with mild-to-severe pain or may be asymptomatic in some cases. In this article, a case of EG with actinomycosis is reported which occurred in an 11-year-old male in the left buccal vestibule extending from 22 to 24. Histopathologically, it showed dense, cellular infiltrate in the connective tissue composed of abundant eosinophils intermixed with atypical cells. After 4 months, the same patient reported with a recurrence in the palatal region. Histopathologically, the section showed some colonies of actinomycosis along with the features of EG. EG with metachronous actinomycosis is very rare in the literature. This article reports a new case of EG with actinomycosis and reviews previously reported cases of actinomycosis associated with other lesions.
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A battery where it should not be p. 306
Anil S Harugop, Mansi A R. Venkatramanan, Lakshmi Goswami, S Puneeth Nayak
DOI:10.4103/kleuhsj.kleuhsj_123_22  
The shiny and attractive nature of objects such as button batteries or coins draws children toward them. It is vital to correctly identify such foreign bodies and promptly remove them without causing any fragmentation or damage as that may cause the electrolyte within the battery to leak and further corrode the mucosa. Here, we present the case of a 5-year-old girl referred from a community hospital with a foreign object in the nose and how it was managed in a timely and successful manner.
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Multidisciplinary approach in the management of large infected periapical cystic lesion in the mandibular anterior region with platelet-rich fibrin p. 309
Kiranmayi Thote, P V Ravindranath Reddy, P Aproova Venkata Teji, Shivayogi M Hugar
DOI:10.4103/kleuhsj.kleuhsj_315_22  
Periapical cysts are considered as the most prevalent odontogenic cystic lesions of the jaws. These cystic lesions are usually asymptomatic; however, once infected, they result in tumefaction of the affected region. Current noninvasive diagnostic methods such as computed tomography, magnetic resonance imaging, and cone-beam computed tomography help in accurate assessment of size and nature of these lesions, which determine proper treatment planning and prognosis of the affected tooth. Management of these cystic lesions depends upon their extent. Periapical localized cysts can be managed by nonsurgical root canal therapy, whereas large periapical cysts require multidisciplinary approach involving an endodontist and an oral surgeon. Accelerated healing of soft and hard tissues near these lesions can be done using tissue engineering scaffolds such as platelet-rich fibrin and platelet-rich plasma. This case report presents successful multidisciplinary management of a large infected periapical cyst which was associated with mandibular incisors.
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SHORT COMMUNICATION Top

Moving forward toward the goal of meningitis-free world by 2030: Potential strategies p. 314
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_125_22  
Meningitis is a life-threatening and incapacitating condition that has been associated with significant amounts of fear, predominantly because of the high case fatality rate. Meningitis is one of the vaccine-preventable diseases, nevertheless, we significantly lack in our efforts directed toward the containment of the infection when compared with other diseases for which vaccines are available. Acknowledging the magnitude of the disease, the ability of the infection to result in a fatal outcome, and the availability of potent and effective vaccines, the World Health Organization (WHO) has formulated a road map to contain meningitis infection. To conclude, meningitis is a global public health concern and has been associated with a wide range of detrimental sequels. The need of the hour is that we join our hands together and work in collaboration with the community toward the successful elimination of meningitis.
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LETTERS TO THE EDITOR Top

The burden of neurological disorders in India and globally p. 316
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/kleuhsj.kleuhsj_127_22  
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Urgent measures needed to assess the mental health situation of medical professionals p. 318
H Shafeeq Ahmed
DOI:10.4103/kleuhsj.kleuhsj_148_22  
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Complexities of immune- regulation in COVID- 19 p. 320
Harish Gupta
DOI:10.4103/kleuhsj.kleuhsj_95_22  
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