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   Table of Contents - Current issue
Coverpage
January-April 2023
Volume 16 | Issue 1
Page Nos. 1-179

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EDITORIALS  

Need for microlevel reforms to promote research studies by medical college faculties and students Highly accessed article p. 1
Gajanan D Velhal
DOI:10.4103/kleuhsj.kleuhsj_61_23  
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Influence of social media in research: Boon or bane Highly accessed article p. 4
Punnya V Angadi, Harpreet Kour
DOI:10.4103/kleuhsj.kleuhsj_82_23  
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Human monkeypox pandemic in 2022 Highly accessed article p. 7
Rathinasamy Muthusami, Kandhasamy Saritha
DOI:10.4103/kleuhsj.kleuhsj_526_22  
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REVIEW ARTICLES Top

A brief overview of various vaccines against nCOVID19, including safety, efficacy, reported cases, clinical trials, and progress Highly accessed article p. 13
Sumel Ashique, Shubneesh Kumar, Himanshu Kumar, Jayita Roy, Soumen Pal, Swagata Pal
DOI:10.4103/kleuhsj.kleuhsj_505_22  
Even if many countries are against it since vaccinations are not readily available, industrialized countries continue to make some vaccines designated under the World Health Organization's emergency use listing mandatory for entry into their countries. The first half of 2021 has seen the introduction of SARS-CoV-2 vaccinations in several countries, after the exceptional speed of vaccine development and testing in 2020. Using keywords in online databases such as Pubmed, Scopus, Web of Science, Cochrane, and Embase, this systematic search was carried out. The findings were collected into a report. We were unable to do an adequate human study because we included so many different kinds of vaccinations. A look at current vaccination-controlled trials and actual facts on immunization success is also presented. The efficacy of new vaccines is continually being tested in ongoing vaccine trials. Increasing the alternatives for global vaccine production to manufacture sufficient vaccine shots for international usage and to enhance the statistics for the potential utility of various vaccination platforms in forthcoming pandemics are also a result of this.
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Value of interdisciplinary approach in the management of type 2 diabetes mellitus, periodontitis, and tooth loss: Narrative review p. 30
Sunila Bukanakere Sangappa, Harsha Mysore Babu, Sona Elizabeth Chacko, Ashwini Jithendra, M Srinath Kenkere
DOI:10.4103/kleuhsj.kleuhsj_527_22  
The effects of diabetes mellitus (DM) Type 2 and periodontitis have been studied for several years. In this review, the bidirectional effects on both these chronic inflammatory diseases have been evaluated. Both the diseases are known to exacerbate the pathophysiology of each other and reduce the quality of life of individuals suffering from these conditions with added risk factors. Increased blood sugar levels act adversely on dental plaque and the immune system causing inflammation leading to periodontitis and bone loss which in turn affects insulin sensitivity. Identifying and treating one of these conditions will help in reducing the severity of the other. Literature search was performed from electronic databases through PubMed and Scopus of articles published since 1996–April 2022. We included the research studies toward studies relating to the importance of collaborative approach in the management of periodontal conditions in subjects with Type 2 DM as a major criterion among population globally. This article shows the significance of why dentists and physicians should collaborate with each other for managing the periodontal and diabetic conditions of the patients. Both the diseases can be immensely improved if the providers are knowledgeable about the concept and a team approach is utilized.
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ORIGINAL ARTICLES Top

Echocardiographic assessment of the right ventricular function in acute myocardial infarction p. 37
SB Lohitashwa, Srinidhi Hegde, Kiran Varghese, MA Srilakshmi, Sreekantha Sudaraghavan
DOI:10.4103/kleuhsj.kleuhsj_337_21  
Background: Assessment of the right chamber function has not given much importance; this could be due to complex structure, asymmetric shape, and difficulty in visualization, and resulted in poor understanding of the impact of the right ventricular (RV) function on prognosis. Echocardiography commonly used and most readily available investigation modality for the assessment of the right ventricular function. AIMS AND OBJECTIVES: The aim of this study was to evaluate the relation between RV function and left ventricle (LV) dysfunction and Killip class in acute myocardial infarction (AMI) exclusive of RV infarction. MATERIAL AND METHODS: A total of 21 consecutive patients admitted to the coronary care unit with AMI were included and echocardiography was performed within 24 h of admission to assess RV and LV functions. RV function was quantified with a tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), RV longitudinal strain, RV myocardial performance index (RVMPI), and compared with the LV ejection fraction and Killip class. Results: Statistical analysis revealed that the majority of patients were male (90.5%) and only 9.5% of patients were female with a mean age of 50.9 years. Anterior wall MI was more common (58%) than inferior wall MI (42%). The study findings revealed that the RV longitudinal strain had a significant negative correlation (r2 = 0.803, P = 0.001) with Killip class and LV ejection fraction, whereas TAPSE, RVMPI, and RVFAC were poorly correlated with RV dysfunction. Conclusion: From the study findings, we concluded that echocardiographic assessment of RV functions demonstrated that larger infarcts correlated with RV dysfunction. RV involvement was more pronounced in anterior MI than inferior MI. Hence, the earliest recognition of RV dysfunction is warranted. Keywords: Acute myocardial infarction, echocardiograph, right ventricular function.
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Repeatability of arterial pulse-based diagnosis (Naadi pariksha) by test–retest method: An observation study p. 41
Usharani S Sanu, BS Prasad, Rudramma R Hiremath, Sunil S Vernekar
DOI:10.4103/kleuhsj.kleuhsj_398_21  
INTRODUCTION: Naadi pariksha is a historical diagnostic skill of physicians to examine the state of dosha (dosha avasta) in patients. Although this is a commonly used examination, there is still a need for standardization in the collection of data and reliability of the diagnostic technique. Considerable researchers have been conducted on the pulse classification based on its characters but this study was conducted to analyze the repeatability of arterial pulse-based diagnosis (Naadi pariksha) by test–retest method in a single group. AIM: The study aims to test and retest the repeatability of the arterial pulse-based diagnosis. The naadi parameters such as pulse wavelength and pulse character were tested for repeatability in the gap period of 9–18 min in a controlled environment. MATERIALS AND METHODS: This was an observational study conducted in Belagavi. An Ayurveda physician examined the pulse of 30 healthy volunteers twice, within an interval of 9–18 min. A random sampling of volunteers was adopted (to avoid bias), and the data were recorded graphically as per the study protocol. This study was conducted for 6 days with five participants per day for examination. The Naadi pariksha was done to examine the pulse wavelength and pulse character. The data obtained from the test and retest of Naadi pariksha were statistically analyzed using paired t-test to study the difference between both the test–retest methods. RESULTS: All the data collected from the naadi examination were statistically analyzed using IBM SPSS Statistics 26. The mean difference in pulse wavelength was 0.004 mm (standard deviation [SD]: 0.2067 mm, degree of freedom (df): 29, and t: 0.106). There was no statistically significant difference between the two variables: test and retest pulse wavelength (P > 0.05). The mean difference in pulse character was 0.333 mm (SD: 1.64177 mm, df: 29, and t value: 1.112). There was no statistically significant difference between the two variables: test and retest pulse wavelength (P > 0.05). CONCLUSION: The reliability and repeatability of pulse-based diagnosis depend on the adaptation of standardized techniques in arterial pulse data collection along with the training, maintaining the controlled environment, and experience of a physician in naadi pariksha. Quantification of the physiological signals has become more important to create evidence and research documentation. The results of this study suggest that an identical report may be obtained on repetition of the test within 9–18 min. This demonstrates the repeatability of arterial pulse-based diagnosis (naadi pariksha).
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Evaluation and comparison of antibacterial effects of a licorice gel and chlorhexidine gel on Porphyromonas gingivalis, Aggregatibacter actinomycetamcomitans, and Tannerella forsythia – An in vitro study p. 48
Alpana Andrews, Neelamma Shetti
DOI:10.4103/kleuhsj.kleuhsj_13_22  
INTRODUCTION: Periodontitis is known to cause inflammation and progressive breakdown of tooth-supporting structures. The treatment for periodontitis includes scaling and root planing that effectively removes the disease causing plaque and antimicrobial agents such as chlorhexidine (CHX) used as an adjunct to maintain the healthy state of tissues. However, these antimicrobial agents have unpleasant side effects that have led researchers toward discovering, isolating, and developing natural herbal plant extracts as effective antimicrobial agents. Hence, the purpose of the study was to assess and compare the antimicrobial activity of the one such herbal plant extract Glycyrrhiza glabra (licorice) gel and CHX gel on periopathogens. MATERIALS AND METHODS: The hydroalcoholic root extract of G. glabra (licorice) was prepared through maceration, evaporation, and lyophilization to obtain dried crude extract. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of the G. glabra extract against Porphyromonas gingivalis, Aggregatibacter Actinomycetemcomitans, and Tannerella forsythia were determined using broth dilution method and streaking on blood agar plates. The gel was then prepared accordingly using Carbopol 940. The antibacterial activity of the prepared G. glabra gel was tested and compared to CHX gel using the agar well diffusion assay. RESULTS: The MIC of G. glabra extract was found to be 15 mg against A. actinomycetamcomitans and T. forsythia and 7.5 mg against P. gingivalis. The MBC of the G. glabra extract was 30 mg for all three organisms. The antibacterial effects of the prepared licorice gel were assessed using agar well diffusion assay, and it showed that 100 μl of prepared licorice gel had a greater effect on A. actinomycetamcomitans and T. forsythia but not P. gingivalis. CONCLUSION: Licorice extract showed inhibitory activity against P. gingivalis, A. actinomycetamcomitans, and T. forsythia.
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Comparative evaluation of antifungal efficacy and potency of soft liners incorporated with powder extracts of Lawsonia inermis and Withania somnifera on the growth of Candida albicans – An in vitro study p. 54
Rahul Suresh Jaiswal, Hema Kanathila, Ritiha C Uppin
DOI:10.4103/kleuhsj.kleuhsj_36_22  
CONTEXT: Denture relining materials are soft and resilient materials used in the treatment of patients with denture soreness. Studies have concluded that rugged surface of the liners allows the sticking of the Candida albicans and later gives rise to a condition called denture-induced stomatitis. AIMS: The aim of this study is to evaluate and compare the antifungal efficacy and potency of denture soft liners incorporated with powder extract of Lawsonia inermis and Withania somnifera on the growth of C. albicans. MATERIALS AND METHODS: A total of 105 samples were taken in this in vitro study and was divided into three groups: To check for the antifungal activity with 35 samples each. L. inermis and W. somnifera powder extract were incorporated in soft liner at 1%, 3%, 5%, and 7% concentration and the antifungal efficacy against C. albicans was tested by calculating the diameter of inhibition zone for 1, 7, and 14 days. Statistical analysis used: Subgroup analysis was carried out using one-way analysis of variance (ANOVA) test. Pair-wise comparisons were carried out through Tukey's multiple post hoc procedures. RESULTS: When comparison of four subgroups (1%, 3%, 5%, and 7%) was done with the mean zone of antifungal efficacy at 1st day, 7th day, and 14th day time points in both the groups by one-way ANOVA, statistically significant results were obtained with P of 0.0001. CONCLUSIONS: L. inermis and W. somnifera natural herb extracts have shown to have antifungal activity against C. albicans and can be used as an alternative for the synthetic antifungal drugs.
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Comparative photoelastic stress analysis between all-on-four implant-supported cobalt-chromium framework and carbon fiber reinforced framework with varying cantilever lengths - An in vitro study p. 60
Rutvi Shah, Anandkumar Patil, Akhil Deshpande, Swapnil Shankargouda
DOI:10.4103/kleuhsj.kleuhsj_57_22  
CONTEXT: In implant prosthodontics, metal frameworks are used to rigidly spilt the implants together to provide rigidity and stiffness to the prosthesis. However, due to the limitations associated with the metal framework fabrication, the recent advances have made it possible to fabricate metal-free implant-supported prostheses using fiber-reinforced composite frameworks. AIM: This study aimed to evaluate and compare photoelastic stresses between all-on-four implant-supported cobalt-chromium (Co-Cr) framework and the carbon fiber-reinforced composite (CFRC) framework at varying cantilever lengths. MATERIALS AND METHODS: Two photoelastic models of an edentulous mandible were fabricated according to the all-on-four concept. Following this, frameworks with a bilateral cantilever extension of 20 mm, one with CFRC and the other with Co-Cr, were fabricated and were subjected to a progressive load of 120–180 N with an interval of 20 N. The principal stresses (σ) were calculated using the mean maximum fringe order. STATISTICAL ANALYSIS: The quantitative analysis was performed using the Kruskal–Wallis test and Mann–Whitney U-test, P ≤ 0.05. RESULTS: The CFRC framework showed mean principal stress values significantly lower than the Co-Cr framework under all loading conditions; however, deformation of the framework was observed at the cantilever lengths of 15 mm and 20 mm. CONCLUSION: The study and its findings have indicated that the CFRC framework appears suitable for the fabrication of a framework for an “All-on-four” prosthesis. Within the confines of this study, the use of 10 mm as an arbitrary cantilever length recommendation for the CFRC framework and 15 mm for the Co-Cr framework seems reasonable.
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Evaluation of efficacy of 0.1% of chlorine dioxide mouthwash against oral malodor – A pilot study p. 67
Prajakta Brahmankar, Shweta Shivayogi Hugar, Vinayak R Kumbhojkar, Neelamma Shetti
DOI:10.4103/kleuhsj.kleuhsj_73_22  
BACKGROUND: Oral malodor, also known as halitosis or bad breath can be defined as an offensive odor that emerges from the oral cavity and can be easily detected by others. The etiology of halitosis is multifactorial and can include several intra- and extraoral factors such as gingivitis, periodontitis, chronic sinusitis, nasal inflammation, diabetes mellitus, lung carcinoma, liver insufficiency, cirrhosis, uremia, trimethylaminuria, and postnasal drip. Chlorine dioxide associated with chlorite anion results in the oxidative consumption of amino acids such as cysteine and methionine, which are precursors of volatile sulfur compounds (VSC). Thus, it can reduce the concentrations of VSCs which help in the reduction of oral malodor. Due to the lesser availability of literature to prove the effectiveness of this chlorine dioxide formula, this study is conducted to evaluate the inhibiting effect of commercially available chlorine dioxide-containing mouthwash – FRESHCLOR to combat oral malodor in patients. MATERIALS AND METHODS: The study was conducted among the patients reporting at the outpatient department of periodontics who visited with the chief complaint of bad breath and bleeding gums at KAHER'S VK Institute of Dental Sciences, Belagavi. Patients were selected according to inclusion criteria and divided into test and control groups. Post scaling Freshclor mouthwash was distributed to all test group participants. The organoleptic ratings for halitosis, gingival index (given by Loe H and Silness J, 1963), and plaque index (given by Loe H and Silness J, 1964) were recorded at baseline and 2 weeks for the group. RESULTS: There was a statistically significant reduction in halitosis with a reduction of gingival and plaque indices at 2 weeks from baseline in the test group. CONCLUSION: With the results, it can be concluded that chlorine dioxide-containing mouthwash – freshclor is effective in reducing halitosis.
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Knowledge, attitude, and practices of rational use of medicines among the postgraduate residents of a tertiary care teaching hospital in North Karnataka: A facility-based cross-sectional study p. 71
Nishtha Malhotra, MS Shivaswamy
DOI:10.4103/kleuhsj.kleuhsj_80_22  
BACKGROUND: The overuse, underuse, or misuse of medicines by the postgraduate residents results in wastage of scarce resources and widespread health hazards. “Rational use of medicines” (RUMs) would bring health care within the reach of the poor by reducing costs. This study was conducted to assess the knowledge, attitude, and practices of RUMs among the postgraduate residents of a tertiary care teaching hospital. MATERIALS AND METHODS: A facility-based cross-sectional study was conducted for a period of 6 months (November 2019–April 2020). With the help of universal sampling, a self-developed, prevalidated, semi-structured questionnaire was distributed to 200 residents, to obtain information about the knowledge, attitude, and practice of RUM. Written informed consent was obtained from the participants after explaining to them about the study. RESULTS: About 92.5% of the participants were aware of the term “RUM” and 84% were aware of the term “Essential Medicines.” Sixty-one percent of the residents had good knowledge about RUM, and 51% had good practice of RUM. Logistic regression analysis showed statistically significant results that postgraduate students of the nonsurgical departments were more likely to have good knowledge and practice RUM than postgraduates of the surgical departments. Juniors (1st Year postgraduate residents) among the postgraduates also seemed to have an increased likelihood of practicing RUM. CONCLUSIONS: The knowledge gap and lack of good practice of RUM observed among the postgraduates can be reduced by imparting education regarding RUM more efficiently in the medical colleges, to inculcate it into daily clinical practice.
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Clinical and histopathological correlation of unilateral nasal mass – A retrospective observational study p. 79
Raghunath Shanbag, JS Arunkumar, Shraddha Pai, Santosh S Garag, GY Pooja, Umesh R Dixit
DOI:10.4103/kleuhsj.kleuhsj_96_22  
INTRODUCTION: Nasal obstruction and nasal discharge are the most common symptoms in otorhinolaryngology practice; they may be unilateral or bilateral. Unilateral persistent nasal obstruction may indicate the presence of sinonasal lesion that could be inflammatory or neoplastic. Biopsy and histopathological examination of the nasal mass will give the definitive diagnosis, which was correlated with the clinical diagnosis. MATERIALS AND METHODS: This study was conducted retrospectively in a tertiary health care center after collecting the data of patients who underwent biopsy or surgical excision of unilateral nasal mass during 6 years period from January 2015 to December 2020. A total of 208 patients who met the inclusion criteria were included in the present study. These cases were subjected to a detailed history, clinical examination, nasal endoscopy, computed tomography scan, biopsy or excision biopsy, and histopathological examination. The data collected from these cases were compiled, analyzed, and conclusions were drawn. RESULTS: Of these 208 patients, majority (127; 61.1%) had non-neoplastic lesions while 81 (38.9%) had neoplastic lesions based on clinical diagnosis. Among patients with neoplastic lesions, 50 (61.7%) were benign and 31 (38.3%) were malignant. CONCLUSION: Antrochoanal polyp is the most common type of unilateral nasal mass, followed by inflammatory polyp among nonneoplastic lesions and hemangioma and inverted papilloma among neoplastic lesions in this study. Majority of the patients were in the age group of 11‒20 years. Nasal obstruction and rhinorrhea were the most common symptoms in majority of patients.
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HIV/acquired immune deficiency syndrome stigma, perceived social support, and medical adherence among HIV/acquired immune deficiency syndrome children: A mediation analysis p. 86
Varsha Singh, Anupriya , Swaran Lata
DOI:10.4103/kleuhsj.kleuhsj_128_22  
Introduction: The present study brings forward the relationship among HIV/acquired immune deficiency syndrome (AIDS) stigma, perceived social support (PSS), and medical adherence found among HIV/AIDS children. Methodology: A sample of 90 HIV/AIDS-affected children aged 10–18 years from motilal nehru hospital, Allahabad, Uttar Pradesh, India, was selected for the study. Participants were assessed HIV/AIDS stigma, pss, and medical adherence. The tools of descriptive statistics, correlational and regression analysis, and mediation analysis were performed to accomplish the desired objective of the study. Results: Correlational analysis makes it evident that HIV/AIDS stigma is prominently negatively correlated to PSS (r (88) = −0.670, P < 0.01) and medical adherence (r (88) = −0.770, P < 0.01). Taking into consideration hierarchical regression analysis, it was found that the PSS significantly contributed to 33.2% variance in HIV/AIDS stigma and hiv/aids stigma contributed to 55.7% variance in the process of medical adherence. The achieved results of the mediation analyses validate the mediating role of HIV/AIDS stigma in the association between pss and medical adherence (β = 0.20, Confidence interval = 0.003 to 0.057, P = 0.031). Conclusion: These findings contribute to empirical evidence about psychological predictors and the observable consequences of hiv/aids-related stigma.
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Prevalence of near-miss events and its impact among medical students using bikes and cars in Chennai: A cross-sectional study p. 92
Janakiram Marimuthu, S Pravinraj
DOI:10.4103/kleuhsj.kleuhsj_134_22  
CONTEXT: The WHO's Global Status Report on road safety 2015 indicates that worldwide the total number of road traffic deaths has plateaued at 1.25 million per year, with the highest road traffic fatality rates in low-income countries. Urgent action is needed to achieve the determined target for road safety, reflected in the newly adopted 2030 Agenda for Sustainable Development (goals 3 and 11), and halving the global number of deaths and injuries from road traffic crashes by 2020. AIM: This present study aims to estimate the prevalence of near-miss events among medical students using bikes and cars in Chennai. MATERIALS AND METHODS: A total of 300 undergraduate and postgraduate medical students who were studying at the Government Medical College of Chennai were included in this cross-sectional study. A predesigned semi structured validated questionnaire was used to collect the data from the participants and was analysis was done. STATISTICAL ANALYSIS USED: In this study, the data analyzed were qualitative data. Chi-square test was used to test the significance. Analysis was done using SPSS version 17. RESULTS: More than half of the students (61.7%) participated in the study belonged to the age group 17–21 years and were pursuing 2nd year of MBBS. The prevalence of near-miss among medical students was found to be 56.3%. This study revealed that many students had been involved in the near-miss events due to violations of traffic rules and regulations. Most of the students showed corrective behavior after previous near-miss experiences to avoid road traffic accidents.
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A study of dermatophytosis in patients attending dermatology outdoor patient department at a tertiary care center p. 98
Vaibhavi Vijay Nanoty, Priyanka Kishanbhai Patel, Rajesh Mahadeo Trimukhe, Milind Ramchandra Ubale, Debapriya Das Choudhury, Pradnya R Joshi
DOI:10.4103/kleuhsj.kleuhsj_152_22  
BACKGROUND AND PURPOSE: Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. The dermatophytes are included in three fungal genera: Epidermophyton, Microsporum, and Trichophyton. The infections caused by dermatophytes are known as ringworm or tinea infections. Although there are increasing numbers of antifungals available for the treatment of dermatophytes, some cases and relapses have been unresponsive to treatment. The aim and objectives of the present study are to identify the dermatophyte species causing superficial fungal infections and study their susceptibility to antifungals. MATERIALS AND METHODS: A total of 60 clinically diagnosed cases of dermatophytosis of patients attending the dermatology outdoor patient department were studied. The samples of these patients were collected and processed for microscopic examination and fungal culture. The causative dermatophytes were isolated and identified. Antifungal susceptibility testing of dermatophytes was done by Epsilometer strip minimum inhibitory concentration method against antifungal agents – fluconazole, itraconazole, and terbinafine. RESULTS: The most common clinical presentation in patients found was tinea corporis. Maximum dermatophyte isolates obtained on culture were Trichophyton rubrum. On antifungal susceptibility testing, terbinafine showed good results compared to azoles. CONCLUSION: Antifungal susceptibility testing of dermatophytes could be performed to study response and assist clinicians in choosing an effective therapy for patients.
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Evaluation of functional disability in cervical radiculopathy patients p. 103
Shreya Singh, Prachi Khandekar Sathe, Abhinav Sathe, D Vijay Kumar
DOI:10.4103/kleuhsj.kleuhsj_163_22  
AIM: The main aim of this study was to evaluate functional disability in patients with cervical radiculopathy. Our second aim was to compare neck disability between males and females. METHODS: The study included 35 participants of both sexes, in which 21 were female and 14 male. We have used three scales for the evaluation of neck disability: (1) Cervical radiculopathy Impact Scale (CRIS), (2) Neck Pain and Disability (NPAD) Scale, and (3) Copenhagen Neck Functional Disability (CNFD) Scale. RESULTS: The mean scores of CRIS were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The NPAD Scale scores were 14.35 ± 15.59 in males and 33.22 ± 17.58 in females. The mean scores of the CNFD Scale were 7.92 ± 5.56 in males and 13.50 ± 5.61 in females. All three scales showed a significant difference between the scores of the two genders, indicating more disability in female patients as compared with the male patients. CONCLUSION: Our results showed 26.22% and 25.88% disability as per CRIS and Neck Pain and Disability Scale, respectively. We found mild-to-moderate disability in our subjects according to the CNFD Scale. The study concluded that females have more disability in cervical radiculopathy as compared to males.
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Estimation of serum uric acid in patients of acute myocardial infarction p. 111
Devendra Nath Mishra, Rajesh Kumar Singh, Hari Prasad, Anuj Dwivedi
DOI:10.4103/kleuhsj.kleuhsj_171_22  
BACKGROUND: Acute myocardial infarction (AMI), often known as a heart attack, is a medical emergency that is the top cause of mortality for both men and women worldwide. Recent evidence suggests that it is caused by the sudden blockage of a coronary artery by a blood clot, also known as coronary thrombosis. Due to the regional impending of blood supply, heart muscles become damaged. Uric acid has been shown in large cohort studies to be an important independent risk factor for cardiovascular mortality. As serum uric acid (SUA) is an early predictor hence study will help to devise a better remedy for AMI. AIM: This study aims to study the levels of SUA in patients with AMI as compared to the control. OBJECTIVE: The primary goal of this study is to examine SUA levels in patients with AMI and to correlate uric acid levels with associated mortality in AMI. The secondary goal is to predict AMI early diagnosis, better management and treatment, and prognosis. METHODS: The current study was conducted at the department of biochemistry and the central investigation laboratory at our institute, in partnership with the department of medicine, intense cardiac care units, medical intensive care units, and emergency and private hospitals. A total of 100 patients were investigated. There were 50 instances of AMI and 50 age-matched healthy controls. The Microlab 300 analyzers (semi-autoanalyzer) were used to assess SUA concentrations, and the comparisons between the two groups were examined using an unpaired t-test. A P < 0.05 was deemed statistically significant. RESULTS: There was a substantial rise in the mean level of SUA in cases on the 0, 3rd, and 7th days were 8.503 + 2.976 mg/dl, 5.472 + 2.683 mg/dl, and 4.992 + 1.707 mg/dl day, respectively, which were higher than controls group (3.976 + 0.947 mg/dl). Comparison between control and AMI SUA on 0 and 3rd days was found to be more significant than the 7th day. There was a substantial rise in blood uric acid levels in cases when compared to healthy controls (P < 0.005). CONCLUSION: Thus, the study shows that blood uric acid levels play a significant role in the diagnosis and therapy of AMI.
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Adverse drug reactions to first-line antituberculosis drugs at four DOTS centers in Goa, India p. 115
Rupchandra Navelkar, Ian Antao Pereira, Frederick Satiro Vaz
DOI:10.4103/kleuhsj.kleuhsj_184_22  
BACKGROUND: Major adverse drug reactions (ADRs) can cause significant morbidity and can compromise the treatment regimen. This can result in substantial additional cost due to added outpatient visits to the health facility or laboratory investigations or hospitalization in serious instances. Treatment is often prolonged with additional challenge of compliance. Hence, there is a need to monitor and manage these ADRs timely for better patient care and outcome. This study was carried out with the objective of studying the pattern of ADRs due to first-line antitubercular drugs and to carry out the causality and severity assessment of the reported ADRs. METHODOLOGY: A prospective observational study was conducted at four DOTS centers. All tuberculosis (TB) patients registered and receiving treatment under DOTS were enrolled for the study and were followed up at regular intervals till the end of their treatment. Patients' demographic, personal, disease, investigation, and ADRs details were entered in a predesigned patient recording form. Causality assessment of all ADRs were done using Naranjo algorithm. Severity assessment was done using modified Hartwig and Siegel scale. The study was approved by the institutional ethics committee of the institute. Statistical analysis was conducted using IBM SPSS Statistics for Windows. RESULTS: Of 186 patients, 23 patients (12.26%) developed one or more ADRs. The average number of ADRs per person was 1.43. Majority of the ADRs were reported in the 20–40 years of age group and ADRs were more likely to be among females compared to males. There was no association between type of TB, site of TB, regimen of anti-TB drugs, treatment outcomes, and ADRs. Around 84.85% and 15.15% of ADRs were classified as of mild and moderate severity, respectively, as per modified Hartwig and Siegel scale, while, as per Naranjo algorithm, 72.73% of the ADRs were classified as probable and 27.27% of ADRs as possible. No ADRs were classified as definite. CONCLUSION: Thorough understanding of the various ADRs and their management will help in the effective treatment of TB as well as designing effective counseling methods, which will help in adherence to treatment and also to have better compliance.
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Maternal and fetal outcomes among pregnant women with cardiac disease attending a tertiary care hospital: A prospective observational study p. 119
Hema Sharanagouda Patil, Jyothi Kotireddy, Abhijeet B Shitole, Sharanagouda S Patil
DOI:10.4103/kleuhsj.kleuhsj_393_22  
BACKGROUND: Pregnancy in women with cardiac disease is associated with an increased risk for adverse maternal and neonatal outcomes and the present study evaluated maternal and fetal outcomes of pregnancies complicated by cardiac disease. MATERIALS AND METHODS: An observational prospective study was conducted among 105 pregnant women with cardiac disease attending a tertiary care hospital from February 1, 2017, to January 31, 2018, and followed 30 days postpartum. Data on maternal and gestational age, nature of the underlying cardiac lesion, comorbidities, cardiac intervention, and medication were recorded. Up until 28 weeks, the patients were checked every 2 weeks by an obstetrician and a cardiologist, then weekly until birth. Age groups, cardiac lesion, and maternal and fetal outcomes were presented as frequency, and proportion was analyzed using coGuide software, V.1.0 was used for statistical analysis BDSS, Bangalore, Karnataka, India. RESULTS: Out of 101 subjects, 98 (97.03%) were aged 18–35 years, 75 (74.3%) participants had K/C/O cardiac disease, and in 24 (23.8%) subjects, rheumatic heart disease with isolated mitral stenosis was the predominant cardiac problem. Twenty-two (21%) subjects had undergone surgical correction before to pregnancy, and 6 (8%) patients had cardiac complications, among which 1 (2.9%) had pulmonary edema. Maternal death was noted in 4 patients (3.6%). The incidence of cases with small for gestational age was noted in 36 (35.6%) patients, fresh stillbirth in 1 (2.9%), macerated stillbirth in 1 (2.9%), and neonatal death was noted in 1 (2.9%) patients. Twenty-six (25.7%) participants were diagnosed for the first time with cardiac disease. CONCLUSIONS: Heart disease is linked to an increased risk of severe maternal and perinatal outcomes, such as maternal and fetal death and morbidity, among pregnant women.
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Epidemiological profile among young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care center in Goa p. 125
Shubham Kumar, Bhargav Pandurang Sawant Dessai
DOI:10.4103/kleuhsj.kleuhsj_413_22  
INTRODUCTION: The incidence of myocardial infarction (MI) is increasing among the young population in India. Change in lifestyle is the main reason for such an increase in prevalence. Although MI in young is less severe than in old patients, it causes a significant morbidity to the individual. Young MI has the potential of being a major public health problem in our country and its complications can cause major morbidity and mortality. Hence, it is necessary to understand the prevalence of risk factors in order to improve our strategies for the prevention and management of young MI. AIM: To study profile of young patients (≤45 years) suffering from acute myocardial infarction in a tertiary care centre in Goa. MATERIALS AND METHODS: A retrospective record-based study was conducted on patients aged ≤45 years who suffered from ST-elevation MI and were admitted in Goa Medical College, Bambolim, from January 1, 2019, to December 31, 2021. Data on anthropometric measurements, demographic characteristics, clinical profile, hospital stay, complications, and other details were extracted from these records. RESULTS: Among the 176 patients, 73 (42%) patients consumed alcohol, 116 (66%) were current smokers, 48 (28%) were diagnosed with hypertension (HTN), 92 (48%) were diagnosed with dyslipidemia, and 34 (20%) were diagnosed with diabetes. Among the patients, 36 (21%) had a history of coronary artery disease and 56 (32%) had a history of HTN. Fifty-three (30%) had a history of diabetes mellitus (DM) in the family; among them, 27 had diabetes and 10 were prediabetic. Fifty-six (31%) participants were admitted for >7 days following MI. Forty-eight (27%) had complications post-MI. Trend analysis showed a significant association of complications and increased hospital stay with type 2 DM (T2DM), HTN, smoking, and dyslipidemia (P < 0.05). Most of the patients 91% of T2DM, 90% of hypertensives, and 83% of patients suffering from dyslipidemia were diagnosed after they were admitted with MI. CONCLUSION: As we already know that the incidence of ischemic heart disease (IHD) is already rising in the general population, there is also an alarming rising trend of IHD in young people too. This study provides the prevalence of assorted risk factors in young MI. The rising trend of complications with an increase in risk factors studied in our group makes early diagnosis imperative for better management and prevention of complications. Increased burden of IHD in young people will lead to decreased quality of life, increased morbidity, and mortality and also have an increased economic burden for the society. This underscores the importance of building capacity of the primary health-care system for early detection of diabetes, HTN, and dyslipidemia and making people aware of unwarranted effects of smoking and alcohol consumption. Proper management and prevention of the above said risk factors would go a long way in preventing young MI as described in this study.
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Does a ban on liquor sales benefit alcohol dependence patients? A study on usage and procurement of alcohol during the COVID-19 lockdown p. 130
Naren Albert Rajendran, Kailash Sureshkumar, Shabeeba Z Kailash, Sivabackiya Chitravelu, Niha R Rumaisa
DOI:10.4103/kleuhsj.kleuhsj_489_22  
BACKGROUND: Restricting the availability of alcohol in “dry states” and during the COVID-19 lockdown reveal illegal trading and consumption of illicit liquor leading to deaths and use of alternate harmful substances. The current study aims to fill the gaps in the literature to study alcohol usage and its procurement during its complete ban of sale. MATERIALS AND METHODS: A cross-sectional study of purposively sampled alcohol-dependent patients (n = 62) was conducted in an OPD setting, comparing two time periods: before and during total lockdown 2020. After reinforcing confidentiality and privacy, data were collected and analyzed. RESULTS: Alcohol usage during the lockdown was positively related to severity of alcohol dependence syndrome (r = 0.67, P = 0.00), quantity of alcohol consumed (r = 0.59, P = 0.00), and its cost of procurement (r = 0.43, P = 0.00) before lockdown. During the lockdown, the proportion of consuming alcohol more than or equal to 90 units weekly significantly decreased (Pearson Chi-square = 4.12, P = 0.04) and their predicting factors are rural residential location, moderate-income bracket, low socioeconomic class, and severe alcohol dependence. Furthermore, a significant increase in the proportion of procuring alcohol from the black market or used illicit liquor was observed (Fisher's exact test P = 0.00) with higher odds being associated with illegal procurement before lockdown (odds ratio = 22.00; 95% confidence interval = 3.93–123.28; P = 0.00). Increased use of alternate substances such as nicotine (37.1%) and cannabis (9.7%) during the lockdown was also observed. CONCLUSION: Although alcohol consumed did not significantly differ, illegal sources and money spent on procurement increased during the lockdown. Thus, a legal ban of liquor sales did not benefit alcohol dependence patients, and such restriction availability strategies may benefit from health awareness, treatment, and psychosocial support.
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Evaluating the validity of the National List of Essential Medicines 2015 for “anesthetic agents” in 2022: An observational cost analysis p. 137
H Shafeeq Ahmed
DOI:10.4103/kleuhsj.kleuhsj_464_22  
BACKGROUND AND AIMS: The concept of essential medicines (EMs) was introduced in 1977 by the World Health Organization. The most recent National List of EMs (NLEM) is the NLEM 2015, comprising 376 drugs. The following study was undertaken due to the lack of similar studies conducted on anesthetic agents and aims at evaluating “Section 1 – anesthetic agents” of NLEM 2015 and the relevance of EMs in India. MATERIALS AND METHODS: The study takes into account the drugs under Section 1 anesthetic agents. Data were collected from MedGuideIndia, a database of medicines marketed in India. Both cost ratio and percentage cost variations were calculated. RESULTS: Under Section 1 – anesthetic agents, atropine 1 ml injection (0.6 mg/1 ml) at 654.72% and lignocaine + adrenaline 30 ml injection has the lowest percentage cost variation at 6.26%. It was identified in the current study that the average percentage cost variation and cost ratio of all the 24 variations of the drugs is 164.51% and 2.64%, respectively. 1.3 – preoperative medication and sedation for short-term procedures have the highest price variation drug, atropine and 1.2 – local anesthetics have the lowest price variation drug, lignocaine + adrenaline. CONCLUSION: This study mainly discusses the large price variations comparing the lower versus the higher priced branded variants under Section 1 anesthetic agents. Appropriate physician education is required and newer pricing regulations require enforcement.
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Age at marriage and first birth interval: A systematic review and meta-analysis p. 142
Anushri Pradip Patil, Naresh K Tyagi, Jang Bahadur Prasad
DOI:10.4103/kleuhsj.kleuhsj_418_22  
BACKGROUND: Age at marriage is one of the proximate determinants of fertility. Women with early age at marriage experiences early motherhood, associated with high fertility, low education, and rural residence accompanied with poverty. In the present study, an attempt has been made to evaluate age at marriage and factors affecting it and its effect on first birth interval (FBI) using systematic review and meta-analysis. METHODOLOGY: Inclusion criteria were availability of full- and free-text articles, published in English language, and current married age of mother being 13 years and above. PubMed and Google search was used for systematic review for the study. Meta-analysis was carried out using Microsoft Excel 2013. RESULTS: Pooled-weighted average age at marriage was 19.96 years (with 4.26 standard error). The age at marriage in China was highest (21.56 years). Literacy and occupation of women had significant effect on age at marriage. Urbanization could not affect significantly on age at marriage. Furthermore, FBI has been modified by age at marriage.
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Primary total knee replacement without drain: A good and safe practice to inculcate p. 147
Sunil Kumar Thakur, Suresh Kumar Choudhary, Mukesh Kumar, Ravishekar N Hiremath, KP Jaidev, Rohini VK , Monika Sharma, Sisir Kumar Raut, Hardewa Ram
DOI:10.4103/kleuhsj.kleuhsj_383_22  
BACKGROUND: The use of drain in primary total knee replacement (TKR) started with the belief that it prevents hematoma formation and infection. The fear of infection made this practice an essential step that enjoyed a long journey. However, in recent years, majority of evidence-based studies have not only been failed to provide substantial benefits of the drain but also have proven this a counterproductive step. OBJECTIVE: The purpose of our study is to assess the outcome of performing primary TKR without the use of a drain. METHODOLOGY: After meeting inclusion and exclusion criteria, a prospective observational study was conducted on 186 patients (191 knees) who underwent primary cemented total knee arthroplasty without the use of drain from September 2018 to March 2020 and were followed up for one year. Surgery was performed under tourniquet, bleeders were electro cauterized, and injection tranexamic acid was used to control bleeding. A good preoperative screening for foci of infection, tight glycemic control for diabetics, part preparation, prophylactic antibiotics, and gentle handling of soft tissue was ensured to control infection. Deep vein thrombosis prophylaxis was instituted after risk stratification. Ambulation and physiotherapy were started as per protocol. The clinical parameters such as pain score and range of motion (ROM) were measured by a physiotherapist. Postoperative hemoglobin (Post Op Hb) and requirement of dressing change/reinforcement were monitored by the ward nurse. Aspiration of the knee if required was done by the treating surgeon. RESULTS: Post Op Hb drop was insignificant and none of the patients required blood transfusion. Tense arthrocoele, requiring rescue analgesia, were found in 5(2.6%) patients which responded well with knee aspiration. There was significant improvement (P < 00001) in pain score and the targeted ROM were achieved in 3 weeks' postoperative. Although ecchymosis was a common finding (20.4%), it did not require special attention. Blisters developed in six patients which were managed by antibiotic-impregnated paraffin dressing. Wound healing was not delayed in any patient. None of the patients acquired infection. CONCLUSION: Performing primary TKR without drain is a safe practice to exercise as it neither increases the risk of infection nor poses a significant threat of blood loss and blood transfusion. The presence of arthrocoele in postoperative period does not compromise short term clinical and functional outcomes. The incidence of developing tense hemarthrosis is very less and if aspirated, relieves patient's discomfort and aborts the surgeon's fear of infection. Moreover, not only the cost of drain and utilization of workforce is saved but the question of caring for the drain and its complications also ends.
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Influence of systematic training on morphophysiological and motor ability profiles of Indian young male kayakers p. 153
Tamoghni Manna, Snehunsu Adhikari, Alak Kumar Syamal
DOI:10.4103/kleuhsj.kleuhsj_585_22  
CONTEXT: Little information is there on the training effect on junior Indian kayakers. Hence, it is of great interest to explore the influence of systematic training on morphophysiological and motor ability profiles of Indian young male kayakers. AIMS: The aim of this study was to find out such a training intensity that would be suitable for junior athletes to reach the zenith of their success. SETTINGS AND DESIGN: This was carried out in the center of Jagatpur, Sports Authority of India on 11 male kayakers. The training program was divided into eight phases. MATERIALS AND METHODS: Body height, body weight, body mass index, standing broad jump, standing vertical jump, trunk flexibility, 6 m × 10 m shuttle run, bench pull test/4 min, bench press test/4 min, sit-ups/min, push-ups/min, medicine ball throw, maximal oxygen uptake, 60 m standing start for anaerobic speed endurance, 2.4 km run, and hemoglobin (g%) were measured by the standard procedures. STATISTICAL ANALYSIS USED: Training phase differences were determined by analysis of variance, then Schiff's Post hoc test was performed with confidence levels at P < 0.001, P < 0.01, and P < 0.05. RESULTS: Performing time of 60 m standing start (sec) and 6 m × 10 m shuttle run (sec) was significantly decreased at P < 0.05 and P < 0.01. Standing vertical jump performance (cm), sit up/min, and push-up/min were significantly increased at P < 0.001, P < 0.05, and P < 0.05, respectively. Bench press performance/4 min and hemoglobin content were significantly improved at P < 0.001. CONCLUSION: Improvement and betterment were noted in performances even in formally trained athletes. A modified training protocol may be adopted for further improvement.
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CASE REPORTS Top

Rare presentation of localized gingival overgrowth with osseous defect – Case report p. 159
Ruchi Srivastava, Anju Gautam
DOI:10.4103/kleuhsj.kleuhsj_492_22  
Gingival overgrowth is one of the most undesirable consequences that often lead to impaired esthetics and masticatory functions, compromised oral hygiene maintenance often requiring surgical excision of the excessive tissue. Gingival overgrowth belongs to a common group of lesions designated as focal reactive overgrowths. These growths are reactive in nature. A definitive diagnosis will then enable an appropriate management strategy. Peripheral giant-cell granuloma (PGCG) is a reactive focal overgrowth, ordinarily presents as an epulis-like growth. This is of a reactive rather than neoplastic nature and its pathogenesis is uncertain. It is widely considered to originate from the cells of the periodontal ligament, occurring as a response to irritants such as dental calculus, plaque, microorganisms, dental appliances, and restorations. The purpose of this article is to report the clinical, histopathological features and treatment of a case with PGCG arising from mandibular posterior alveolus in a 34-year-old female. The overgrowth was well defined along with the bone defect, involving the buccal aspect of the mandibular gingiva. The tooth was endodontically treated, the lesion was completely excised, and the osseous defect was filled with regenerative material. The 12-month follow-up radiograph revealed successful healing with no more recurrence.
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Bilateral perisylvian syndrome management and drug-related problems p. 163
Nirupama Kulkarni, Sarwamangala S Nanjayyanamath, DS Usha, Sanatkumar B Nyamagoud
DOI:10.4103/kleuhsj.kleuhsj_513_22  
Perisylvian syndrome is a noncurable condition characterized by polymicrogyria in the perisylvian or perirolandic region. Perisylvian means the region or area of the brain that is responsible for language. The bilateral perisylvian syndrome is a congenital neurological condition marked by abnormal neuron distribution in the cortex. We report the case of a 21-year-old female patient with the complaints of recurrent generalized clonic–tonic seizures with intellectual development disorder, loss of consciousness (5–10 min), blurring of vision, poor academic performance, slurring of speech, and history of clubfoot. An intelligence quotient assessment was conducted, and the result showed borderline intelligence. She was diagnosed with a case of bilateral perisylvian syndrome with recurrent seizure disorder with intellectual development disorder and she was treated with anticonvulsant medications.
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Impact of low-calorie diet plans and structured strength training regimens on body recomposition: A four-month case report p. 166
Anu Sasidharan, Suja Gopalakrishnan, Sreelakshmi Mohandas
DOI:10.4103/kleuhsj.kleuhsj_517_22  
A normal body weight can be maintained by balancing skeletal muscle mass (SMM) and body fat mass (BFM). InBody™ 270 is an easy-to-use bioelectrical impedance device when it comes to monitoring body parameters such as SMM and BFM. Such body parameters when kept in balance can reduce lifestyle diseases. This case report is an attempt to elucidate the impact of different diet plans and exercise regimens on changing (recomposition) the body composition parameters (SMM, BFM, etc.). One of the authors performed the experiments and recorded the observations. The blueprint for the diet included strategies such as low-calorie plans and intermittent fasting. The exercise regimen had different combinations of whole-body strength training four times a week. Almost eight kg of BFM was lost. The body weight had been brought to normalcy, and at the same time, SMM was preserved due to dietary interventions and exercises.
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Fibrolipoma of the buccal mucosa: A rare case report p. 171
DR Keerthana, Punnya V Angadi
DOI:10.4103/kleuhsj.kleuhsj_580_22  
Fibrolipoma is a benign neoplasm categorized as a histopathological variant of classical lipoma. The occurrence of fibrolipoma in the oral cavity is extremely rare. When present, it manifests as a pedunculated or sessile, soft, smooth-surfaced nodular mass. Although it may vary, the majority of lesions are <5 cm in size. There may be association between functional and aesthetic limitations related to anatomical sites. Hence, it is crucial to properly examine lipomas histopathologically for better treatment modalities. Here is a case report of fibrolipoma occurring in buccal mucosa.
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SHORT COMMUNICATION Top

Exploring factors that affect learning process of high achievers and low achievers and the role of medical teachers p. 175
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/kleuhsj.kleuhsj_534_22  
The syllabus in the medical curriculum is extremely vast, and in order to attain the intended learning competencies, students have to take intensive efforts to continue or expedite the learning process. Learning in itself is a complex process, as a number of factors play their part to ensure that a medical student can understand and apply the concepts or even perform the skills/procedures. In general, factors affecting the learning process have been broadly categorized into intrinsic (viz. Learning style) and extrinsic (such as learning environment and support from teachers). It becomes extremely crucial that teachers should be aware of these differences to ensure that learning can be facilitated among both types of students. To conclude, a number of factors are responsible to impact the learning acquisition process among medical students. It is important that a teacher should be aware of these wide gamut of factors, so that they can play a defining role in neutralizing some of these factors and encourage students to continue to learn.
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LETTER TO THE EDITOR Top

Vitamin D status of children at a tertiary care hospital of Agartala, North-East India: A cross-sectional study p. 179
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/kleuhsj.kleuhsj_558_22  
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