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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 8 | Issue 3
Page Nos. 151-217

Online since Monday, August 5, 2019

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EDITORIAL  

Role of psychiatry teachers training in national mental health services in India, reflection and roadways for future p. 151
M Kishor, Mohan Isaac, MV Ashok
DOI:10.4103/ijhas.IJHAS_33_19  
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ORIGINAL ARTICLES Top

Treatment of snakebite with snakestone – A preliminary observational study p. 155
Dushad Ram, Christy Jancy
DOI:10.4103/ijhas.IJHAS_45_19  
BACKGROUND: Snakestone (blackstone) is known to be useful in the treatment of snakebites in different parts of the world for centuries. So far, no empirical study examined its usefulness in snakebite. This study was conducted to know the efficacy of snakestone in snakebite. METHODS: This was a clinic based cross-sectional observational study. Fifty-six consecutive individuals with different snakebites who underwent snakestone treatment were recruited and assessed with demographic clinical pro forma and clinical assessment was done for recovery from snakebite. STATISTICAL ANALYSIS USED: Descriptive and inferential statistics (Kruskal–Wallis test) were used. RESULTS: The mean score on age was 34 years, 8 h since the bite, and 278 stones were used. Number of stone used for treatment varied significantly based on postbite symptom (P < 0.05), type of snake (P < 0.05), and body part bitten (P < 0.05). All participants recovered from snakebite, and treatment was uneventful. CONCLUSIONS: Snakestone treatment may be effective in snakebite. Further study is needed to replicate the finding.
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Internet addiction and its associated factors: Study among the students of a public health school of Kolkata p. 159
Anand Kishore, Tania Pan, Narendra Nath Naskar
DOI:10.4103/ijhas.IJHAS_43_18  
INTRODUCTION: The Internet has brought a wealth of information and has turned to be an important tool for education, entertainment, and communication. However, aspects such as ease of access and social networking have led to addictive behavior. MATERIALS AND METHODS: An institution-based study was conducted among 147 students of a public health school in Kolkata from October to November 2017. A self-administered questionnaire was used to collect the data on demographic characteristics and the pattern of Internet use, and the assessment of Internet addiction (IA) was done using the validated Young's IA Test. Data entry and analysis was done using SPSS version 16.0. All those who scored more than 30 were considered as IA. RESULTS: Of 147 students, 44.2% were found to have some degree of IA. Mean age (standard deviation) of the students was 27.9 (5.9) years and 74.8% of the respondents were females. Most students (92.5%) accessed the Internet from their mobile phones and 33.3% have reported to have permanently online login status. Majority (82.3%) have reported social networking as a reason for Internet use. It was found that students with factors such as age group of 27–33 years, male sex, single status, residing away from home, low physical activity, permanently online status, social networking, and accessing the Internet for entertainment were more addicted to the use of Internet. CONCLUSION: The findings suggest a need for students to indulge in outdoor activities. Interacting with people socially rather than being active on social networking sites and involvement in other recreational activities will help alleviate their dependence on the Internet.
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Association of serological parameters and platelet counts in dengue fever: A hospital-based study p. 164
Sneha Mohan, Renu Dutta, Amit Kumar Singh
DOI:10.4103/ijhas.IJHAS_88_18  
BACKGROUND: Dengue fever (DF) is an acute febrile arboviral disease affecting the tropical and subtropical regions of the world. It is known that early and specific diagnosis of dengue hemorrhagic fever (DHF) or dengue shock syndrome (DSS), followed by supportive therapy, reduces morbidity and mortality. Serum levels of secreted NS1 positively correlate with viral titers and have been a useful tool in dengue infection (DI) diagnosis. NS1 detection is reported to be sensitive as well as highly specific. Apart from the dengue-specific parameters, platelet count is the only accessory laboratory test available in the peripheral areas that can support the diagnosis of DHF or DSS. In this study, we tried to correlate the platelet counts and immunochromatography (ICT)-based dengue serology tests. METHODS: A total of 525 serum samples from clinically suspected DF were collected. The samples were tested immediately for NS1, immunoglobulin M (IgM), and IgG by ICT-based tests. Platelet counts of all the cases positive for any of the dengue parameters were noted. The statistical analysis was performed using Z-test. RESULTS: One hundred and nine specimens were tested positive for either one or more of the three markers (NS1, IgM, and IgG). Platelet count <1,00,000/ml was noticed in 65 cases (%) of 109 dengue-positive cases. Of 79 cases who were positive for NS1 antigen only, thrombocytopenia was observed in 44 cases, whereas thrombocytopenia was observed in six of six cases positive for NS1 + IgM. The association of thrombocytopenia in NS1 + IgM-positive cases was statistically significant (Z = 2.125, P = 0.0331). CONCLUSION: In the present study, association of thrombocytopenia in dengue parameter-positive cases was found to be highly significant. ICT is the only excellent tool as it is easy, rapid, and easily available in areas with poor resources. Apart from dengue-specific parameters, platelet count is the only accessory laboratory test available in the peripheral areas that can support the diagnosis of DI.
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Anxiety, depression, and suicidal ideations among patients with dermatological problems p. 168
Masarat Z Jabeen, Shaily Mina, Ram Chander
DOI:10.4103/ijhas.IJHAS_153_17  
BACKGROUND: High comorbidity is seen in psychiatric illness and dermatological problems ranging between 21% and 43%, which could be due to cosmetic impact/body image perception/disfigurement due to disease per se; majority of the cases go undetected due to overshadowing of mental illness by physical ailment, stigma, or improper assessment. The present research attempted to evaluate the comorbidity of anxiety, depression, and suicidal ideations among dermatological conditions METHODS: A population-based cross-sectional study with consecutive sampling was conducted in the outpatient department of a dermatology clinic. The Primary Care Evaluation of Mental Disorders (Patient Health Questionnaire-9 and Generalized Anxiety Disorder- 7) was used to assess the presence of psychiatric symptoms in these patients. RESULTS: A total of 1076 patients were included in the study, with age ranging between 10 and 82 years. Females had significantly more depression, anxiety, and suicidal ideation among individuals suffering from dermatitis. Males had significantly more anxiety among individuals suffering from lichen simplex chronicus. Females had significantly more depression and suicidal ideation among individuals suffering from hair disorders. Overall, 22% of individuals had suicidal ideation, of which 4.2% had active suicidal ideations. CONCLUSION: Significant active suicidal ideations were observed among individual dermatological conditions. Female reported having more depressive symptoms with no gender difference in anxiety disorder.
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Reflected images processing and the diseases of the brain p. 174
Sadanandavalli Retnaswami Chandra, Sumanth Shivaram, Thomas Gregor Isaac
DOI:10.4103/ijhas.IJHAS_27_18  
OBJECTIVES: The objective of the study reflected image processing defects in patients with dementia. PATIENTS AND METHODS: Patients with memory complaint with Hindi Mental Status Examination (HMSE) score of 20 seen in the last 5 years were evaluated for mirror agnosia and mirror-image agnosia. Visual acuity was checked and corrected. A 45 cm × 45 cm plain mirror was used. It was kept at 30-cm distance from the patient. Their ability to recognize the mirror was confirmed. They were asked to identify reflected objects, ornaments, dress, self-image, image of caregiver, and two each of famous, smiling, crying, and novel faces. RESULTS: A total number of patients with memory complaint were 512 and vascular dementia were 211. Others = 301 patients who had features suggestive of apraxia and agnosias = 69. Among the 69 patients, 65.2% were male and 34.8% female, mean age was 62.5. Disease wise distribution is frontotemporal dementia: 24.64%. Vascular dementia: 21.84%. Alzheimer's disease (AD): 20.29%. Unclassified: 14.49%. Mixed: 14.49%. diffuse Lewy body disease: 2.89%. Cortico basal degeneration syndrome (CBGD): 1.45%. The pattern of reflected image processing abnormality is mirror agnosia: 9 patients. Mirror-image agnosia: 11 patients. CONCLUSIONS: Patients with AD showed wide variety of apraxias and mirror agnosia. Those with mirror-image agnosia did not show apraxias. In both groups, females were dominated. There is a clear delineation of features in patients with mirror agnosia and mirror-image agnosia. Mirror-image and mirror agnosia in degenerative dementias are not reported in the literature.
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Adaptive radiotherapy in non-small cell lung cancers: Is there a dosimetric benefit of volumetric modulated arc radiotherapy over three-dimensional conformal radiotherapy? p. 180
Anshuma Bansal, Rajit Rattan, Rakesh Kapoor, Reena Kumari
DOI:10.4103/ijhas.IJHAS_14_19  
AIM: The study aimed to evaluate the change in gross tumor volume (GTV) in pretreatment and mid-treatment planning computed tomography (CT) scans, to find its dosimetric impact on normal tissue sparing when doing adaptive radiotherapy in lung cancers, and to do dosimetric comparison between volumetric modulated arc radiotherapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) plans. MATERIALS AND METHODS: Fifteen patients with advanced non-small cell lung cancer, planned for radical radiotherapy, underwent planning CT scans at baseline and after 40 Gy. Target volumes were delineated on both scans, and both 3DCRT and VMAT plans were made. Phase I delivered 40 Gy to initial planning target volume (PTV). Two Phase II plans for 20 Gy to PTV boost were developed on initial and mid-treatment scans. Plan sums were made. Volumetric and dosimetric changes in target volumes and normal structures were analyzed. RESULTS: There was a significant reduction in primary GTV (31.26%; P = 0.001) and PTV (28.07%; P = 0.001) in mid-treatment CT scan. VMAT plans were superior to 3DCRT plans in terms of lesser V20 and V5 doses to the ipsilateral lung (V20: 33.03% vs. 58.89%; P = 0.00 and V5: 63.62% vs. 77.20%; P = 0.001), lesser V5 doses to the contralateral lung (V5: 19.12% vs. 32.16%; P = 0.03), and lesser mean doses to the heart (12.61 Gy vs. 15.06 Gy; P = 0.02); however, PTV coverage was similar in both the plans. Among the two Phase II VMAT plans, those made on mid-treatment CT scans were superior in terms of V5 doses to the contralateral lung (5.23% vs. 7.99%; P = 0.001), mean dose to bilateral combined lung (3.57 Gy vs. 5.10 Gy; P = 0.03), and Dmax spinal cord (7.90 Gy vs. 11.36 Gy; P = 0.05). CONCLUSION: The study demonstrates the superiority of VMAT plans over 3DCRT plans and emphasizes the need for adaptive radiotherapy planning with VMAT in lung cancers for minimizing normal tissue toxicity without compromising local control.
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Molecular characterization of rotavirus genotype-A in children with acute diarrhea attending a tertiary hospital in Ilorin, Nigeria p. 187
Dele Ohinoyi Amadu, Idris Nasir Abdullahi, Anthony Uchenna Emeribe, Peter Omale Musa, Lawal Olayemi, Thairu Yunusa, Chisom Emmanuel Okechukwu, Matthew Oluwafemi Salami
DOI:10.4103/ijhas.IJHAS_94_18  
BACKGROUND: Despite indications that severe rotavirus diarrhea in children under <5 years of age is a major public health problem, only limited specific data on rotavirus burden are available in Sub-Saharan Africa. This study aimed to carry out molecular characterization of circulating rotavirus strains causing acute diarrhea among under-five children attending University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. MATERIALS AND METHODS: Ninety-three under-five children who are hospitalized with severe diarrhea were enrolled and their stool samples were collected for the detection and subsequent characterization for G and P rotavirus serotypes. RESULTS: Of a total of 93 samples comprising 54 (58.1%) males and 39 (41.9%) females, 25 (26.9%) samples were positive for rotavirus by ELISA. Genotyping by RT-PCR was done on 25 samples. The most prevalent type-able VP7 G types were G9 (28%), G1 (24%), followed by G12 (20%), G2 (12%), and G10 (4%); on the other hand, the most prevalent type-able VP4 P types are P8 (48%), P4 (24%), and P6 (16%). The most common G-P combination was G9P (4) (20%) followed by G12P (8) and G1P (4) (16%, respectively); then GNTP (8) and G1P (6) (8%, respectively); and G9P (8), G12P (4), G10P (6), G2P (8), and G2P (6) (4%, respectively). The rotaviruses isolated from these children were from those <24 months of age (100%). There is statistical relationship between the prevalence of rotavirus infection with age (P = 0.033) but not with gender (P = 0.765). CONCLUSION: This study highlights the rotavirus disease burden and diversity of rotavirus strains circulating in UITH. Continued sentinel surveillance will provide useful information to policy-makers with regard to rotavirus vaccine introduction.
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MEDICAL EDUCATION Top

A gap analysis of critical thinking skills and attitude toward critical thinking among interns p. 193
Zayabalaradjane Zayapragassarazan, Thomas V Chacko
DOI:10.4103/ijhas.IJHAS_22_19  
BACKGROUND: Studies have called for reforms in medical education to create a better generation of doctors who can cope with the system-based problems; they would encounter in an interdisciplinary and collaborative environment and make better-reasoned decisions for quality patient care. To achieve this, critical thinking (CT) is at the very heart of development of new medical knowledge. Medical academics and practitioners have raised concerns about the low levels of CT and stress the need for fostering CT among medical practitioners. OBJECTIVE: The objective of this study was to identify and analyze the gap among the interns with respect to their CT skills and attitude toward CT. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted among the MBBS interns of an institution of national importance in India. The interns were administered with a short version of Watson-Glaser CT appraisal tool to assess their CT skills and with CT disposition self-rating form to assess their attitude toward CT, respectively. The data were analyzed to assess their level of CT skills and their attitude toward CT. RESULTS: Sixty-one percent of the interns responded to the survey, and only 26% of interns had high CT skills; the five dimensions of CT showed varied levels of skills among the interns. Fifty-one percent of interns showed positive attitude toward CT. CONCLUSION: The findings showed a gap among the interns in their CT skills and their attitude toward CT.
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CASE REPORTS Top

Sudipta Kar's cribbed thumb guard: An innovative inexpensive way to treat thumb sucking p. 197
Sudipta Kar, Ananya Pal
DOI:10.4103/ijhas.IJHAS_63_18  
Active thumb sucking often causes malocclusion and/or facial deformity. Thumb sucking is such a detrimental habit when found in children above 6 years of age causing open bite formation, speech distortion, maxillary prognathism, posterior crossbite, mandibular retrognathism, and midline diastema. On the other hand, abnormal tongue thrusting may also cause growth disturbances of the orofacial structures and malocclusion. The present article has discussed on the management of such detrimental habits with an innovative yet a simple approach never been used before.
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Efficacy of short-term naturopathy and yoga interventions on palmoplantar psoriasis p. 202
Y Rosy Ayda, N Manavalan
DOI:10.4103/ijhas.IJHAS_59_18  
Psoriasis is a chronic inflammatory disease, associated with a higher risk of cardiovascular, metabolic, and renal disease, and patients may experience significant impairment of health-related quality of life even with localized disease. According to a study conducted on 3065 patients, plantar lesions were seen in 91.9% of patients and palmar lesions in 55.6% of patients. Our patient is a 47-year-old married man, with a history of erythema, scaling, itching pain often associated with bleeding on the affected area of both palms and soles since 6 months. After obtaining informed consent, he was admitted to our inpatient Department of Government Yoga and Naturopathy Hospital. Since naturopathic interventions aimed to put right the lifestyle improvement, he underwent treatments such as neutral enema, mud therapy, diet therapy, acupuncture, and yoga therapy at our inpatient department (IPD). Considering the basic principle of naturopathy, i.e., accumulation of morbid matter, one of the main causes of disease has been taken into an account for planning the line of treatment. Pre-blood investigations include resting blood pressure, pulse rate, respiratory rate, fasting blood glucose level, and serum cholesterol level. The patient was asked to fill the Psoriatic Area and Severity Index (PASI) was used as a tool to measure the severity of the lesions and the area affected. Pre- and post-assessments were done using PASI. Immediately after 2 days of intervention, the pain and the itching in the affected area was subsided, and after 15 days of intervention, our patient was provided with exclusive juice diet with 6 servings per day. After 20 days of intervention, the PASI Scoring was reduced from 8.8 to 2. A 20-day naturopathic intervention has shown clinically significant change in the severity of psoriatic lesions in our case.
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A rare ca(u)se of dysphagia p. 206
Kandan Balamurugesan, Prem Davis, Rajangam Ponprabha
DOI:10.4103/ijhas.IJHAS_4_19  
Achalasia is a rare lower esophageal motility disorder, in which there is destruction of myenteric plexi leading to the loss of esophageal peristalsis and inadequate relaxation of the lower esophageal sphincter in response to swallowing. Although the etiology of achalasia cardia is unclear, it is likely to be caused by autoimmune etiology. It is characterized by dysphagia of solids and liquids, regurgitation, weight loss, chest pain, heartburn, and nocturnal cough. Achalasia can be diagnosed on the clinical history and confirmed by barium swallow, and esophageal manometry which is the gold standard technique for diagnosis. Even though achalasia cannot be cured permanently, pneumatic balloon dilatation and myotomy remain the definitive treatment of choice in spite of availabilities of pharmacological therapies. We report a case of 25-year-old male admitted with chronic dysphagia and weight loss, diagnosed to be having achalasia cardia and treated accordingly.
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LETTERS TO EDITOR Top

Why should Sci-Hub be supported? Highly accessed article p. 210
Prasanna R Deshpande
DOI:10.4103/ijhas.IJHAS_91_18  
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Enhancing prevention and control and preparedness activities for influenza: World Health Organization p. 213
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijhas.IJHAS_10_19  
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India requires a public health law for disaster resilience p. 214
Edmond Fernandes, Sanjay Zodpey
DOI:10.4103/ijhas.IJHAS_19_19  
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Substituting screen time and sedentary behavior with physical activity among young children p. 216
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijhas.IJHAS_30_19  
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