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   Table of Contents - Current issue
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July-September 2020
Volume 9 | Issue 3
Page Nos. 203-300

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REVIEW ARTICLES  

Prevalence of behavioral risk factor in the United States of America adult population: A concise review of the findings from the behavioral risk factor surveillance system, 2001–2017 Highly accessed article p. 203
Chidiebere Emmanuel Okechukwu
DOI:10.4103/ijhas.IJHAS_116_19  
Adult citizens of the United States of America (US) have lesser life expectancy compared to inhabitants of the rest of the developed countries. The objective of this review was to evaluate the prevalence of behavioral risk factors, which are physical inactivity, weight gain, prevalence of smoking, hypertension, hypercholesterolemia, poor diet and heavy alcohol consumption, in all the US states including Washington DC and all the territories from 2001 to 2009, and 2011–2017 using data obtained from the behavioral risk factor surveillance system (BRFSS) database. Studies that investigated on lifestyle behaviors and behavioral risk factor among US citizens obtainable up to August 2019 were evaluated. PubMed database was used. The MeSH system was used to extract relevant research studies from PubMed. Data from the survey of behavioral risk factors for all the US States, including Washington DC and all territories was obtained from The BRFSS database. The findings from the Surveys on US adult's physical activity, entails participation in aerobic and muscle strengthening exercises to meet recommendations shows that from 2013 to 2017 a significant proportion of the US adult population did not meet up with physical activity guidelines for US adults. However, the results of the surveys on the consumption of fruits and vegetables among US adults at least 5 or more times/day from 2002 to 2009 shows that a significant proportion of the US adult population eats fruits and vegetables <5 servings/day which is below the advocated amounts of fruits and vegetables.
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Dermatophytoses: A short definition, pathogenesis, and treatment Highly accessed article p. 210
Ali Abdul Hussein S Al-Janabi, Falah Hasan Obayes Al-Khikani
DOI:10.4103/ijhas.IJHAS_123_19  
Dermatophytosis is an important type of fungal skin infection caused by dermatophytes. There is actually no part of the world that can be cleared from infection with dermatophytosis. The skin, hair, and nail of all types of mammalian, including humans, are under the risk to develop dermatophytosis. The disease is mainly caused by different species of dermatophytes within the cutaneous layer of the skin. Several topical and systemic antifungal drugs are used for the treatment of dermatophytosis. This review focuses on the general features of dermatophytic treatment, epidemiology, and the risk of contact with infected animals. Animal model as a promising branch for evaluation of new drugs is also discussed to give clear vision in the management of this worldwide predominant disease.
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ORIGINAL ARTICLES Top

Macroscopic, microscopic, and preliminary analytical evaluation and quality assessment of the root of Samarakhadyam (Byttneria herbacea Roxb.): An extrapharmacopoeial drug of Ayurveda p. 215
Tarun Sharma, Rabinarayan Acharya, CR Harisha, VJ Shukla
DOI:10.4103/ijhas.IJHAS_94_19  
BACKGROUND: Byttneria herbacea Roxb., an extrapharmacopoeial plant of Ayurveda, locally known as Samarakhai by tribal people of Odisha, belongs to the family Sterculiaceae. The roots of B. herbacea is traditionally claimed to be used in the management of wounds, fractures, swellings, gynecological disorders, diarrhea, cuts, ulcers, and others. Although the plant is used traditionally, for its pharmacognostical characteristics, no proper scientific evaluation has been reported. AIMS: To establish and standardize the root of the plant for its microscopical and physicochemical characteristics along with different qualitative tests and to assess heavy metals, aflatoxins, and insecticide and pesticide residue. MATERIALS AND METHODS: After proper authentication, the roots were exposed to macroscopy, microscopy and physicochemical, qualitative and high-performance thin-layer chromatography study as per the Ayurvedic Pharmacopoeia of India. Heavy metal analysis, aflatoxin analysis, and insecticide and pesticide residue analysis of the root were carried out following the standard methods. RESULTS: Microscopic study, through transverse section of root shows outer multilayered elongated compactly arranged cork cells, multiseriate medullary rays embedded with brown content, starch grains and prismatic crystals, centrally located vascular bundle consist of xylem and phloem. Physicochemical parameters showed that water-soluble extractive value (11.995%) was more than that of methanol-soluble extractive (5.936%). Chromatography study exhibited 8 peaks at 254 nm and 4 peaks at 366 nm. Heavy metals and aflatoxins B2, G1, and G2 were found in the prescribed limit, whereas aflatoxin B1 was above the limit of quantification. Insecticide and pesticide residues were not detected in the sample. CONCLUSION: Typical microscopical characteristics are multiseriate medullary rays, tannin contents, and prismatic crystals. Heavy metals and aflatoxins B2, G1, and G2 were found below the limit of quantification. The findings of the study may be helpful to identify, standardize, and for quality assessment of root of B. herbacea.
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Fine-needle aspiration of thyroid and diagnostic accuracy p. 223
Preeti Singh, Monika Rathi, Vijay Jaiswal, Nidhi Verma, Priya Gupta, Veer Karuna, Snehlata Verma
DOI:10.4103/ijhas.IJHAS_131_17  
BACKGROUND: Fine-needle aspiration cytology (FNAC) is widely considered as the gold standard in the assessment of thyroid lesions. The aim of this study is to determine the diagnostic accuracy of FNAC of thyroid lesions performed at our institution and correlate it with histopathological findings and also to compare our findings with that of studies from other regions of the world. MATERIALS AND METHODS: The present study is a 1-year prospective study of FNAC of thyroid lesions performed in the pathology department of our institution during January 2014–December 2014. The FNAC findings were correlated with the histopathological diagnosis, wherever available. The records of 236 patients who had undergone FNAC during the study period were followed by histopathological evaluation wherever possible. The cytological results were classified as inadequate, benign, suspicious, and malignant. The histopathology diagnosis was classified as nonneoplastic (benign) and neoplastic (malignant). RESULTS: The results of the FNA histological diagnosis showed that 6 (2.5%) of the patients had FNA, which were inadequate for cytological assessment, 222 (93.6%) patients had benign lesions, 4 (2.2%) had lesions that were suspicious for malignancy, and 4 (2.2%) had malignant neoplasm. CONCLUSIONS: The correlation of FNAC findings with the histopathological diagnosis showed that our FNAC diagnostic accuracy rate was 97.55% with a sensitivity of 85.75% and specificity of 100%. The results of our study are comparable with the previous studies done and showed that FNAC is a sensitive, specific, and accurate initial diagnostic test for preoperative evaluation of patients with thyroid swelling. It is recommended as the first-line investigation.
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Antimicrobial activity of Cinnamomum zeylanicum aqueous extract against bacteria and fungi responsible for urinary tract infection Highly accessed article p. 229
Sivapriya Thiyagarajan, Sheila John
DOI:10.4103/ijhas.IJHAS_3_20  
BACKGROUND: In this modern age of multidrug-resistant pathogens, Cinnamomum zeylanicum has a promising antimicrobial activity against urinary pathogens. The study was conducted to determine the antimicrobial activity of cinnamon against the bacterial family Enterobacteriaceae strains and Fungi strains and compare it with standard antibiotics. MATERIALS AND METHODS: Standard agar well technique was executed to obtain the zone of inhibition (ZOI). Mueller–Hinton agar was prepared and left to cool at 45°C. The agar medium was poured into the Petri plates, and the medium was preseeded with cultures using a sterile cotton swab dipped in the inoculum. Wells of 6 mm were dug and the dug wells were then filled with 50, 100, and 150 μl of aqueous extract of Cinnamon zeylanicum and incubated at 37°C for 24 h. ZOI was determined and compared with standard antibiotics. RESULTS: Urinary pathogen, Staphylococcus aureus (ZOI-24 mm), was extremely sensitive to C. zeylanicum aqueous extract at 150 μl concentration, followed by Salmonella typhi (ZOI-22 mm) and Escherichia coli (ZOI-20 mm). Enterobacter spp. was also sensitive and demonstrated ZOI of 14 mm at 150 μl concentration. CONCLUSION: The ZOI for pathogens with various concentrations of C. zeylanicum was comparatively significant and demonstrated its potential use as an antimicrobial agent with an efficacy that can be compared to that of the already recognized and widely used antibiotics, namely, cephalexin and amikacin.
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Comparison of preemptive analgesia with bupivacaine versus bupivacaine-dexmedetomidine in femoral block for fracture femur p. 233
Aparna Bagle, Shreyank P Solanki, Tanya Gulia, Shivangi Gaur, Chaitanya Gaidhani, Spoorti Pujari
DOI:10.4103/ijhas.IJHAS_4_20  
BACKGROUND: Patients with fracture femur experience very severe pain and anxiety. These patients require adequate analgesia to allow radiological, orthopedic, and other procedures. An ideal analgesic technique should provide pain relief without altering consciousness. Femoral nerve block (FNB) has been proved very effective in providing satisfactory analgesia in fracture femur patients. Dexmedetomidine has analgesic property when used as an adjuvant in regional anesthesia. MATERIALS AND METHODS: This prospective, double-blind randomized comparative study was conducted on sixty American Society of Anesthesiologists I and II patients scheduled for elective fracture femur surgeries. They were divided into equal groups of thirty patients. FNB was given 15 min prior to spinal anesthesia. Group B received injection 0.25% bupivacaine 20 ml + 0.5 ml normal saline in FNB, while Group D received injection 0.25% bupivacaine 20 ml + injection. Dexmedetomidine 1 μg/kg, making a total volume of 0.5 ml. Hemodynamic variables, Visual Analog Score (VAS) score, and duration of analgesia were recorded from baseline till the end of surgery and 2 h postoperatively. Statistical analysis was done using SPSS version 20.0 (IBM software product, USA). RESULTS: Duration of analgesia for Group B was 5.37 ± 0.56 h and for Group D was 6.63 ± 0.86 h. Duration of analgesia was prolonged in Group D. Fall in VAS was significantly higher in Group D after 10 min of femoral block compared to Group B. Although changes in heart rate, systolic blood pressure, and mean arterial pressure were statistically significant in both the groups, patients were hemodynamically stable. CONCLUSION: Addition of dexmedetomidine in a dose of 1 μg/kg to bupivacaine 0.25% in FNB effectively reduces pain associated with positioning for spinal anaesthesia and prolong the duration of analgesia and without significant hemodynamic alteration.
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Tumor histopathological response to neoadjuvant chemotherapy in bone sarcomas: A single-institutional experience p. 240
Sujata Jetley, Zeeba S Jairajpuri, Safia Rana, Nazia M Walvir, Shaan Khetrapal, Sabina Khan, Mohd Jaseem Hassan, Javed Jameel
DOI:10.4103/ijhas.IJHAS_119_19  
BACKGROUND : The histological response to chemotherapy is regarded as an independent prognostic variable in bone tumours. The surgical pathologist, thus has an important role in the management of primary malignant bone tumors like osteosarcomas and Ewing's sarcoma subsequent to neoadjuvant chemotherapy. AIMS AND OBJECTIVES: We report a short series of fifteen cases of osteosarcoma and three cases of Ewing's sarcoma in which the histological response of the tumor after giving neoadjuvant chemotherapy to the patient of bone tumours was assessed and graded. MATERIAL AND METHODS: Bone tumours was assessed and graded by Huvos grading. The correlation of this histopathologic tumor response with clinical outcome is a well-established routine investigation in patients with bone sarcomas and the grading of the tumor response is based on definable histopathologic criteria. RESULT: Fifteen out of eighteen cases in this study showed a response to neoadjuvant chemotherapy, which was categorized as Huvos Grade 1 (%50%) and Huvos Grade 2 (50% to 90%). One case of osteosarcoma showed a Grade 4 response with a total absence of tumor cells in all the sections. One case of osteosarcoma and Ewing's sarcoma each were categorized as Grade 3, showing tumor foci. CONCLUSION: It was concluded that necrosis of tumor area when greater than 90%, is regarded as a powerful positive prognostic indicator for survival in patients of high grade bone sarcomas.
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Setting up preanesthesia evaluation clinic – An experience of planning and establishment at a private medical college and hospital p. 246
Sathish Raju Nilakantam, CL Gurudatt, M Dayananda
DOI:10.4103/ijhas.IJHAS_22_20  
BACKGROUND: Preanesthesia evaluation (PAE) (also called preanesthetic assessment or preanesthesia checkup) is a detailed medical checkup and laboratory investigations performed by the anesthesiologist before a surgical procedure, to assess the patient's physical condition and any other medical illnesses or diseases the patient might be suffering from. Dedicated outpatient PAE clinics are fairly latest phenomenon, and information is thin from developing world. The role of PAE clinic is to evaluate all patients for surgical procedures requiring general or regional anesthesia before hospital admission, whether for day-care surgical procedures or for inpatient surgical procedures. Optimal use of PAE clinic avoids unnecessary postponements, suboptimal utilization of operation theater, and personnel and parental time. AIMS: The aim of this study was to describe the methods, challenges, and opportunities that we came across in setting up a PAE clinic in a university-based tertiary care teaching hospital attached to a medical college at Mysuru in South India. MATERIALS AND METHODS: The PAE clinic was planned to set up in the outpatient department area of this medical college cum tertiary care hospital, manned by a multimodal team. RESULTS: With the utilization of available resources, the establishment of daily PAE clinic was possible in this university-based tertiary care teaching hospital. CONCLUSION: PAE is a clinical base and framework for perioperative patient management. This article describes a scalable model that can be replicated in similar resource-constrained hospitals/health-care organizations.
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Impact of swachh bharat summer internship by medical students at a village in Trichy, Tamil Nadu p. 251
Kumarasamy Hemalatha, Prabha Thangaraj
DOI:10.4103/ijhas.IJHAS_124_19  
BACKGROUND: Inadequate sanitation and hygiene is one of the important public health issues in rural communities of India. Swachh Bharat Gramin was initiated by the Government of India to accelerate sanitation services in rural areas. Recently, Swachh Bharat Summer Internship (SBSI) program was introduced to involve students of higher educational institution to contribute 100 h of service for cleanliness activities and mass awareness creation in villages. The objective of this study was to assess the impact of SBSI activities by medical students at a selected village in Trichy district. MATERIALS AND METHODS: Under SBSI program, a community-based educational intervention study was done in a rural area of Trichy district from May to July 2018. The intervention was provided by a team of medical students to about 1600 individuals residing in the village. Among them, 100 individuals were included in pre- and posttest survey to assess the impact of intervention. The activities include Information, Education, and Communication, community mobilization, and participation to prevent open-air defecation (OAD), promote handwashing, and proper solid waste management. The Chi-square test was used to compare baseline and postintervention results. RESULTS: In baseline survey, 45% have ever heard about Swachh Bharat Mission (SBM), 58% were practicing OAD, and 55% were unaware about waste segregation at household level. Awareness on SBM, waste segregation at household, and practice of handwashing improved in postinterventional survey (P < 0.05). Among the study population, 62% were motivated by our activities to change their behavior toward better sanitation. CONCLUSION: The internship program improved the knowledge and behavior on sanitation at the rural community, and it also provided a learning opportunity for medical students.
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Influence of food pouching habit during television and multimedia device viewing on dental caries: A cross-sectional study p. 258
Abhishek Das, Payel Agarwala, Sudipta Kar, Gautam Kumar Kundu
DOI:10.4103/ijhas.IJHAS_98_19  
BACKGROUND: Television and multimedia device viewing has been implicated as a possible risk factor for dental caries. AIMS: The aim was to find out the correlation of dental caries with increased duration of food chewing habits during screen viewing. MATERIALS AND METHODS: Closed-ended, validated questionnaires were asked from parents of children, followed by an oral examination and calculation of the dmft values of children. Settings and Design: A cross-sectional study was carried out in various schools of Kolkata, where 3–6-year-old 419 participants were selected by a simple random sampling method. Statistical Analysis Used: The statistical software IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data. RESULTS: Children who watch screens during mealtime and snack time, obtained dmft score was 5.91 ± 4.224 compared to those who do not watch screens, the dmft score was 2.47 ± 2.551. The dmft score among the children who watch various screens for <30 min (N = 242), 30–60 min (N = 143), and >60 min (N = 34) were 3.38 ± 3.228, 6.49 ± 4.182, and 9.53 ± 3.768, respectively. The P value was <0.001 in all of the comparisons (statistically highly significant result). CONCLUSIONS: This study shows that prolonged eating time during screen usage is detrimental for oral health and the cause of increased dmft.
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Alteration in ankle kinematics during uneven surface ambulation in stroke survivors: An exploratory observational study p. 262
Muhammed Rashid, Jerin Mathew, Kavitha Raja
DOI:10.4103/ijhas.IJHAS_20_20  
BACKGROUND: Impaired walking ability is a common disability in stroke survivors and is a known risk factor of fall. Navigation of uneven terrain is essential for rural residents of regions in much of the developing world even for basic activities of daily living. AIMS: This is a preliminary exploratory study to evaluate kinematic gait parameters of the ankle joint in stroke survivors in comparison to typical adults. MATERIALS AND METHODS: Seven chronic adult stroke survivors and seven age-matched typical adults were recruited for the study. Measurement of ankle and subtalar joint kinematics at different events of the gait cycle was recorded and analyzed using a motion analyzing software, Kinovea 0.8.15. Settings and Design: This is a prospective pilot study. Statistical Analysis Used: Descriptive statistics. RESULTS: During different events of the gait cycle, a large difference in range of motion in ankle and subtalar joints was noticed between stroke survivors and typical participants on pebbles and sand. CONCLUSIONS: The impact of gait deviations on joint kinetics is a future direction that will inform rehabilitation professionals on strategies to prevent joint loading, leading to dysfunction. Early intervention strategies to improve joint kinematics on different surfaces can potentially reduce the risk of fall, making the patient safe to ambulate on uneven terrains.
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Morbidity status and quality of life among elderly population in rural Bengaluru p. 267
Pradeep Tarikere Satyanarayana, Jatin Krishna Reddy
DOI:10.4103/ijhas.IJHAS_14_20  
BACKGROUND: Elderly people may suffer from the multiple health disorders and are vulnerable for many physical and mental disturbances. Quality of life (QOL) in elderly population can be affected by many health factors. AIMS: The aim of the study is to identify the morbidity pattern and to assess the QOL among elderly. MATERIALS AND METHODS: The sample size calculated was rounded off to 230. Elderly participants aged above 60 years were interviewed after taking informed written consent. A pretested semi-structured questionnaire was used to assess sociodemographic profile morbidity pattern and to assess QOL, the questionnaire is called WHO Quality of Life -Old (WHO QOL-OLD) questionnaire was used for the data collection. Settings and Design: This was a community-based cross-sectional study done in rural health training center of MVJ Medical College and Research Hospital, Hoskote, Bengaluru. Statistical Analysis Used: Descriptive statistics such as percentage were used, and independent t-test was used to compare the between various groups. RESULTS: Among 231 study participants, 122 (52.8%) belonged to 60–65 years' age group, 126 (54.5%) were female, 130 (56.3%) were illiterate, and 119 (51.6%) were completely dependent financially on family members. The mean score and transformed facet score (TFS) of facet VI (Intimacy) were the highest, and the lowest mean score and lowest TFS were observed in facet IV (social participation). CONCLUSIONS: Among elderly, QOL is hampered because of senescence, chronic diseases, social displacement, and financial or physical dependence. Promotion of QOL among elderly at primary health-care level needs to be planned by the policy makers.
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Effectiveness of additional Mulligan taping over conventional therapy in young female gymnasts with lateral ankle sprain p. 271
Gauri Sudhakar Kulkarni, Aarya Desai
DOI:10.4103/ijhas.IJHAS_84_18  
BACKGROUND: Researchers found that ankle sprains accounted for sports-related injuries in twenty high school sports. Mulligan taping which is well known for ankle sprain and can be easily sustained by subjects. The study was conducted to determine the effect of Mulligan taping on the incidence and severity of ankle injury in women's gymnastics. MATERIALS AND METHODS: Study design: Experimental study. Sample size: Sixty. Study setting: Gymnastics sports complexes in and around the city area. Sample distribution: Alternate allocation method. Study sampling: Purposive sampling. Inclusion criteria: Gymnasts diagnosed/ Prediagnosed with lateral ankle sprain (LAS)grade 2(sub acute) more than 2 weeks, vault and rhythmic gymnastics player of10–20 years of female practicing gymnastics more than 2 months and reporting minimum two episodes of giving away. Exclusion criteria: Recent surgeries on lower limbs, male gymnasts, recent fracture of the ankle and chronic ankle sprains. Procedure: Total sixty gymnasts' satisfying the inclusion–exclusion criteria and were divided into two equal groups by alternate allocation method i.e. Group A who underwent additional Mulligan taping with glides and Group B who underwent only conventional therapy. Post treatment data was collected and statistically analysed. Outcome measures: Visual Analog Scale (VAS) and Foot and Ankle Ability Measure (FAAM). RESULTS: In Group A, t-value pre- and posttreatment for FAAM score was 48.346, which shows a significant change at P < 0.05. t-value of VAS score pre- and post-treatment was 66.880 at P < 0.05. In Group B, t-value pre- and post-treatment for FAAM score was 35.134 at P < 0.05. CONCLUSION: Additional Mulligan taping has shown significant effects over conventional therapy in young female gymnasts with LAS.
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Research fair: A three pronged innovative effort for fruitful publications out of post graduate dissertations p. 277
MN Suma, Basavanagowdappa Hathur, Praveen Kulkarni, GV Manjunath
DOI:10.4103/ijhas.IJHAS_161_20  
BACKGROUND: Medicine and research have almost become synonymous due to the emergence of evidence-based medicine. To keep up with the advancements in medical science, postgraduate students should learn the art and science of research. Postgraduate dissertations should take no longer a formality to acquire the degree but can be the best opportunity for disseminating their works as effective research publications. MATERIALS AND METHODS: We adapted research fair intervention to encourage the postgraduate students to publish their dissertation work. Students were asked to convert their dissertation into poster, which was adjudged by the experts from within and outside the institution. Best dissertation award competition was held to encourage them to showcase their work. The manuscript writing workshop was conducted to orient them on preparing a research article by making them work for the small group with the expert mentor. RESULTS: Among 100 students who participated in the research fair, 88 completed the feedback survey. The majority of the participants, 71.6% and 59.1%, mentioned that poster presentation and the feedback by the judges were very useful. About 54.5% of the participants mentioned that the manuscript writing workshop was very useful. Out of 100 manuscripts drafted during research fair, 78 (78.0%) have been submitted to various national and international journals. Out of these 21 articles are accepted for publication, 12 are published and 45 are in the review process. The overall success rate of the intervention was 42.3%. CONCLUSIONS: The research fair intervention was successful in encouraging feedback from the participants and the higher rate of submission for publication.
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CASE REPORTS Top

Volumetric-modulated arc radiotherapy for pituitary macroadenoma p. 284
Anshuma Bansal, Jaspinder Kaur, Gurpreet Singh, Neeru Bedi, Ripanpreet Kaur, Raja Paramjeet Singh, Vinod Dangwal, Harjot Bagga
DOI:10.4103/ijhas.IJHAS_33_20  
This case report highlights the management of nonfunctional pituitary macroadenoma with volumetric-modulated arc radiotherapy, compared to three-dimensional conformal radiotherapy.
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Fungal rhinosinusitis by Geotrichum candidum p. 287
Kirtilaxmi K Benachinmardi, S Sangeetha, Shivaprakash M Rudramurthy
DOI:10.4103/ijhas.IJHAS_117_19  
Rhinosinusitis is an inflammatory infection of the sinuses caused by infectious agents such as bacteria and fungus. Fungal rhino-sinusitis by Geotrichum candidum is rare. A 45-year-old woman presented with complaints of serous nasal discharge from the left nostril for 3 months associated with dental pain in both upper and lower jaws. The patient was recently diagnosed of diabetes mellitus and hypertension. Pus from nasal douching was sent for fungal culture and sensitivity. KOH preparation revealed occasional hyphae. Fungal culture grew white, cottony aerial mycelia. On microscopy, rectangular arthroconidia varying in length between 4 and 10 μm were seen. The isolate was confirmed as G. candidum based on internal transcribed spacer regions of fungal ribosomal DNA. She was started on oral itraconazole for 14 days. Repeated isolation of same etiological agent in culture and confirmation with molecular techniques is essential for accurate diagnosis and appropriate management of fungal infections.
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Acute hand ischemia after radial artery catheterization in a young patient p. 290
Shalendra Singh, Sri Krishna Venigalla, Munish Sood, Priya Taank, Deepak Dwivedi
DOI:10.4103/ijhas.IJHAS_8_20  
Cannulation of the radial artery is frequently required for the continuous beat-to-beat monitoring of blood pressure and frequent aspiration of blood samples for performing arterial gas analysis. Acute hand ischemia after radial artery cannulation is an uncommon complication encountered in the young population. An unusual occurrence of this relatively uncommon ischemia is described herewith in a young male.
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Hypersensitivity reaction to iron sucrose in a postpartum woman p. 292
Shiv Kumar, G Madhuri, D Rita
DOI:10.4103/ijhas.IJHAS_15_20  
Anemia is one of the most common nutritional deficiency disorders and global issues affecting pregnant women. It is associated with high maternal morbidity and mortality. It is the most common disorder affecting approximately 25% of the world's population. Although oral iron therapy has beneficial effects, intravenous iron is preferred to treat moderate-to-severe anemia for much more rapid resolution of iron-deficiency anemia with minimal adverse reactions. Iron sucrose has a favorable safety profile, and it can act as an alternative to other forms of parenteral iron preparations in correction of iron store depletion. This report highlights the adverse reaction to iron sucrose in a postpartum woman with moderate iron-deficiency anemia.
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The economic burden of attempted suicide p. 294
Nidal Ammanullaha, Vedavathi Gowda, Vinod Patel, M Kishor
DOI:10.4103/ijhas.IJHAS_12_20  
Suicide is major concern in India, 1,34,516 people committed suicide in 2018 according to National Crime Records Bureau. There are many causes for Suicide and one of the treatable causes is Depression. Burden of non -communicable diseases are rising in India, particularly chronic diseases & injuries that includes suicides. Although economic impact of suicide is reported, there is scarcity of economic cost of suicide attempt in Indian context. Here we report a case report to estimate the economic cost of attempt on life, managed at tertiary care hospital.
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SHORT COMMUNICATION Top

Need of a concerted and sustained approach in the fight against corona virus disease-2019 pandemic p. 296
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijhas.IJHAS_51_20  
The Corona Virus Disease-2019 (COVID-19) pandemic has produced extensive impact not only on the health sector, but also on the individuals, households, communities, and nations at large. The experience with the disease in the different parts of the world has given us the message that in order to minimize the spread of the infection, we should improve our capacities to correctly diagnose all cases, including mild and moderate cases, and ensure their isolation and provision of appropriate treatment. However, it is quite obvious that it cannot be done by the health sector in solitude, and will essentially necessitate the assistance from all the involved stakeholders, including the members of the community for developing a resilient health care delivery system. In conclusion, the COVID-19 pandemic has affected the human life and the source of their livelihoods in a significant manner. Thus, the need of the hour is to implement a multi-sectoral approach promptly, which is unprecedented in nature and ensure provision of equitable care to all the sections of the community.
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PERSPECTIVE Top

E-learning: A key to sustain learning during COVID-19 pandemic p. 298
Trupti Bodhare
DOI:10.4103/ijhas.IJHAS_104_20  
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