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   Table of Contents - Current issue
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October-December 2019
Volume 8 | Issue 4
Page Nos. 219-295

Online since Tuesday, October 15, 2019

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REVIEW ARTICLES  

A review article: Brain damage and neuroplastic responses Highly accessed article p. 219
Debela Tolessa Yadate, Adugna Chala Wari, Kelil Haji Bedane, Gizaw Mamo Gebayehu
DOI:10.4103/ijhas.IJHAS_87_18  
Globally, brain damage is becoming a major problem which can be caused by trauma, cerebrovascular disorders, brain tumors, and infectious diseases. Traumatic brain injury and cerebrovascular disorders are considered highly prevalent and given attention in this review. Their pathology is almost identical and includes oxidative damage, excitotoxicity, and several inflammatory events that lead to neurological damage and finally to death. Both traumatic brain damage and stroke induce hypoxia and glucose deprivation in brain tissue which lead to excessive accumulation of calcium and sodium ions within brain cells and release of glutamate into the extracellular compartment. All of these progress to the production of reactive oxygen species leading to oxidative damage, excitotoxicity, and inflammatory damage which can also activate cell death signaling molecules and finally to neural death. Brain regeneration (neuroplasticity) is potential future therapies in the treatment of brain damage. Neuroplasticity is the capacity of the nervous system to restore brain structure and functions. This could be due to the regrowth of axons whose peripheral projections were damaged, restoration of damaged nerve cells and production of new nerve cells which replace the lost one. This issue is especially important because most of the current drugs are not effective or are limited to symptomatic management. Oxidative damage inhibitors, glutamate inhibitors, anti-inflammatory inhibitors, anti-cell death signaling molecules, and agents promoting neural cell regeneration are among the current targeted strategies for the treatment of brain damage. Therefore, this review summarized the major cause of brain injury and mechanisms involved in the process of neuroplastic response.
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Polycystic ovary syndrome: An updated review Highly accessed article p. 229
Muthusamy Ranga Priya, A Nanthini, KP Bini
DOI:10.4103/ijhas.IJHAS_9_19  
Polycystic ovary syndrome (PCOS) is one of the most common metabolic and reproductive disorders among the reproductive age women. PCOS presents with the symptoms of androgen excess, menstrual dysfunction, hirsutism, acne, and obesity, which significantly impacts their quality of life. It not only a reproductive problem but also as a severe metabolic disease that carries crucial health risks as age increases. PCOS has an increased risk of multiple morbidities, including insulin resistance, type II diabetes mellitus, obesity, cardiovascular disease, cancer, infertility, and psychological disorders. This review summarizes that the literature has so far provided from guidelines to diagnosis of PCOS and also this review gives a general overview about the morbidities associated with PCOS, specifically with its more severe classic form. Finally, the review will stress on the various aspects of treatment currently used in the management of this condition.
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ORIGINAL ARTICLES Top

Can N acetyl cysteine - Taurine provide additional reduction in microalbuminuria in type 2 diabetic patients already on optimum doses of Angiotensin converting enzyme inhibitors? p. 236
M Premanath, M Mahesh, M Suresh Babu, M Bhanukumar, D Devananda
DOI:10.4103/ijhas.IJHAS_27_19  
BACKGROUND: Usage of either angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) with or without dual channel calcium blockers (DCCB) is the standard recommendation for prevention of progression of micro to macro albuminuria and diabetic nephropathy (DN); however, these agents have their limitations. Animal studies with taurine and N-acetyl cysteine (NAC) have demonstrated additional reduction of microalbuminuria (MA). OBJECTIVES: To know whether the combination of NAC and taurine would additionally reduce MA and transforming growth factor β (TGF β) expression in T2 diabetics who are already on optimal doses of either ACEI or ARB and/or DCCB, and to know the effect of this combination on glycated hemoglobin (HbA1c), blood pressure (BP), lipid parameters, and estimated glomerular filtration rate (e-GFR). MATERIALS AND METHODS: Eighty diabetics, having MA, who were already on optimum doses of ARB or ACEI and or DCCB were recruited. Fifty were allocated to the test group and 30 were in the control group. All were examined with their height, weight, body mass index, waist circumference, and BP was measured initially and at the end of 3 months. The test group was administered NAC + taurine tablets, one tablet daily for 3 months and placebo was given to the control group. HbA1c, lipid profile, serum creatinine, MA, TGF β and e-GFR were estimated before and on completion of the study. ANOVA and Pearson's correlation were employed for statistical analysis. RESULTS: Forty-one in the test group and 21 in the placebo group completed the study. The test group did show reduction in MA and TGF β. MA reduced from 161.75 ± 120.38 mcg to 138.42 ± 153.60 mcg. TGF β decreased from 15.69 ± 9.16 to 12.68 ± 8.02 and both were not statistically significant. There was no change in serum creatinine and e-GFR. The drug did not have any significant effect on lipids, HbA1c, and BP. CONCLUSIONS: The combination of NAC + taurine provides additional reduction in MA and TGF β in those on ARB or ACEI with or without DCCB. The drug may thus be beneficial to those who have reached maximum reduction of MA with the other molecules. TGF β reduction is also a bonus which may postpone nephropathy. Further studies with larger recruits and increased doses may show statistically significant results.
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Knowledge and practice of cardiopulmonary resuscitation among clinical students of a medical school in Kano, Nigeria p. 242
Ibrahim Aliyu, Godpower Chinedu Michael, Bukar Alhaji Grema, Zainab F Ibrahim
DOI:10.4103/ijhas.IJHAS_79_18  
INTRODUCTION: Among common determinants of survival include the ability to effectively execute the basic life support drill during resuscitation. Therefore, this study seeks to determine the knowledge of cardiopulmonary resuscitation (CPR) among medical trainees who are in their clinical years in our tertiary hospital with the aim of identifying knowledge gaps if any. MATERIALS AND METHODS: The study was cross-sectional and was conducted over 12 weeks from April to June 2017. A pretested self-administered questionnaire which was developed in English language was distributed to the subjects. RESULTS: There were 118 male (67.4%) and 57 female (32.6%). Furthermore, 95.4% of the respondents were unaware of circulation, airway and breathing sequence (CAB) in adult resuscitation; and 82.3% were aware of ABC steps in pediatric resuscitation; 52% of the respondents were wrong in adult chest compression to ventilation ratio; similarly, 46.3% were incorrect on pediatric chest compression: ventilation ratio. One hundred and forty-six (83.4%) of the respondents had seen a defibrillator; however, only 3 (2.1%) had ever used it. The knowledge score of the respondents ranged from 0.0 to 55.0; while the mean was 19.4 ± 11.8. One hundred and seventy (97.1%) of the respondents scored <50%. The knowledge score was generally poor for all the classes through this observation was not statistically significant (Fisher's exact test = 1.926, P = 0.449); similarly, the timing of CPR training had no relationship with their knowledge score however this finding was not statistically significant (Fisher's exact test = 3.262,P= 1.00). CONCLUSION: There was poor knowledge of CPR among respondents despite reporting been trained.
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The role of physical therapists' knowledge, attitudes, and practices in health promotion in Arsi zone, Southeast Ethiopia p. 247
Guta Bulcha, Leta Melakud
DOI:10.4103/ijhas.IJHAS_60_18  
BACKGROUND: Physical activity is a first-line therapy and protects against many chronic health conditions. Primary health-care practitioners are ideally positioned to promote physical activity. Physical therapy interventions should be aimed at promotion and maintenance of health, quality of life, and fitness. There is, however, a shortage of such research evidence in Ethiopia. OBJECTIVE: We aimed to estimate the level of knowledge, attitude, and practice (KAP) of physical therapists toward health promotion in Arsi zone of Oromia, Southeast Ethiopia. MATERIALS AND METHODS: This community-based, cross-sectional study was conducted in April 2018 among 45 physical therapists. Data were collected using pretested, structured, and self-administered questionnaires. Participants were selected by quota sampling technique. The questionnaire was drafted specifically to test the KAP. The data were double entered and analyzed by SPSS program version 20.0. Descriptive statistics were used. The KAP were estimated using proportion. RESULTS: In the present study, the response rate was 90.0%. Ages of the respondents ranged between 24 and 87 years. Nearly 57.8% of the participants got initial physical therapy knowledge from either of their parents, 53.3% of the respondents heard about health promotion from families and friends, and 57.8% of them received health promotion at their workplace. The overall percentage of all the respondents' KAP in health promotion was 60.1%. CONCLUSIONS: The respondents' have good KAP toward health promotion. However, there is still room for improvement. In addition, there is a lack of proper guidelines in determining the impact of physical therapy.
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Relationship between dentofacial morphology and mandibular movement from rest position to maximum intercuspation in Class II division 1 malocclusion patients p. 255
Pornpan Jariyavithayakul, Chairat Charoemratrote
DOI:10.4103/ijhas.IJHAS_21_19  
BACKGROUND: The objective of this study was to determine the relationship between dentofacial morphology and mandibular movement from rest position to maximum intercuspation in Class II division 1 malocclusion patients. MATERIALS AND METHODS: The sample comprised of 45 patients who were 10–14 years old and had Class II division 1 malocclusions. Eighteen cephalometric variables were evaluated to determine the dentofacial morphology using lateral cephalograms. Mandibular movements were recorded from mandibular rest position to maximum intercuspation using mandibular kinesiography. Spearman's correlation coefficient was used to analyze the relationships between mandibular movement and other dentofacial variables. RESULTS: Mandibular movement in the anteroposterior dimension was significantly negatively correlated with the curve of Spee (COS) (r = −0.45) and freeway space (r = −0.44) and positively correlated with the sella-nasion-mandibular plane (SN-MP) angle (r = 0.47) and the Frankfort-mandibular plane angle (FMA) angle (r = 0.44). Two types of mandibular movement in the anteroposterior dimension were observed. Twenty-six of 45 patients (57.8%) exhibited posterior mandibular movement from rest position to maximum intercuspation (backward group) and 19 subjects (42.2%) presented anterior movement (forward group). COS and freeway space were greater in the backward group. The SN-MP and FMA angles were higher in the forward group. CONCLUSIONS: COS, freeway space, and mandibular plane angle may relate to mandibular movement from rest position to maximum intercuspation in Class II division 1 malocclusion. Patients with deep COS combined with a large freeway space and smaller mandibular plane angle tend to present posterior mandibular movement from rest position to maximum intercuspation.
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Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey p. 263
Jyoti Abhay Parle, Sarah Chougle
DOI:10.4103/ijhas.IJHAS_49_18  
BACKGROUND: Currently, the Government of India is providing comprehensive integrated health care to the rural people under the umbrella of National Rural Health Mission. A village level community health worker “Accredited Social Health Activist (ASHA)” acts as an interface between the community and the public health system. A time-to-time assessment of the knowledge of ASHAs is essential as the success of government's health programs in rural areas depends on them, and hence, this research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. SETTINGS AND DESIGN: A cross-sectional study was done at Panvel Taluka in Raigad District of Maharashtra. The study participants were Trained ASHA workers. MATERIALS AND METHODS: A cross-sectional study was conducted in rural field practice area of the department of preventive and community physiotherapy. The study participants were trained ASHA workers. All 100 ASHA workers were included as per the eligibility criteria. After obtaining prior consent, all ASHAs were interviewed using a self-designed, semi-structured questionnaire. STATISTICAL ANALYSIS USED: Data were analyzed in Excel and valid result and conclusion were drawn. RESULTS: Majority of ASHA workers had correct knowledge about problems faced by women during breastfeeding (91%), breastfeeding positions (97%), and delivery positions (96%). They were lacking in knowledge about pelvic floor problems such as uterine prolapse and urinary incontinence. This research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare. CONCLUSION: Despite the training given to ASHA workers, they are hardly aware about preventive measures for women's health and child development.
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Exploring effectiveness of mass drug administration program against lymphatic filariasis in Raichur district, Karnataka p. 268
Praveen Kulkarni, Jenee Dowerah, Jose Jom Thomas, MR Naryana Murthy, K Ravikumar
DOI:10.4103/ijhas.IJHAS_46_19  
BACKGROUND: Lymphatic filariasis is one of the oldest and most debilitating neglected tropical diseases known to humankind. In India, around 630 million people are at risk of lymphatic filariasis. Mass drug administration (MDA) program against lymphatic filariasis is a strategy adopted by the Government of India to eliminate this scourge by breaking the chain of transmission of disease. AIMS: The objective of the study was to assess the effectiveness of MDA program. SETTINGS AND DESIGN: This cross-sectional study was conducted across four clusters (three rural and one urban) spread over three endemic talukas of Raichur district, Karnataka, in October 2018. MATERIALS AND METHODS: Multistage random sampling was used to select the clusters. Sixty houses in each of the selected clusters were surveyed. Information on coverage, compliance, directly observed treatment, reasons for non-consumption, source of information on MDA and adverse drug reactions were collected using pretested structured pro-forma by interview technique. STATISTICAL ANALYSIS USED: Descriptive statistical measures such as percentages, mean, and standard deviation were applied. Inferential statistical tests such as Chi-square test and Z-test were applied. RESULTS: Among the 240 households visited, a total of 1222 persons were identified as beneficiaries for MDA program. Among the beneficiaries, 617 (50.5%) were male and 605 (49.5%) were female. About 25.12% of the beneficiaries were under 15 years of age. Only 1147 (93.9%) of the total eligible beneficiaries had received diethylcarbamazine and albendazole tablets as part of the MDA program. The compliance rate was 87.2%. The coverage and compliance rates were significantly higher in rural areas compared to urban area. CONCLUSIONS: Raichur district has attained a higher level of coverage and compliance for MDA, but the difference in these indicators between rural and urban areas is a disturbing phenomenon, which has to be addressed through intensive behavior change communication strategy.
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Serum lipid profiles in patients with allergic rhinitis p. 273
Satvinder Singh Bakshi, Murugaiyan Sathish Babu
DOI:10.4103/ijhas.IJHAS_2_18  
INTRODUCTION: Inflammation is implicated in atherosclerotic cardiovascular disease. Allergy is a systemic inflammatory condition, and this may potentiate cardiovascular disease. One of the possible mechanisms for this effect can be dyslipidemia. We aim to study the association of allergic rhinitis (AR) with dyslipidemia. MATERIALS AND METHODS: A total of 260 patients, 134 with AR and 126 controls were included in the study. The venous samples after overnight fasting were analyzed biochemically for lipids. RESULTS: Serum total cholesterol (P = 0.0312), low-density lipoprotein (LDL) (P = 0.0324), very LDL (P = 0.0352), and triglyceride (P = 0.0417) levels were significantly higher in patients with AR as compared to the controls. However, the values of high-density lipids were not statistically significant (P = 0.0696). CONCLUSION: Patients with AR have abnormal lipid profiles, which may play a role in the future development of cardiovascular complications in these patients.
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Same-day sputum smear microscopy for the diagnosis of pulmonary tuberculosis – Light-emitting diode fluorescent staining with direct sputum versus Ziehl–Neelsen staining with concentration sputum p. 277
T Jaya Chandra
DOI:10.4103/ijhas.IJHAS_12_19  
OBJECTIVE: The objective of the study was to evaluate the utility of fluorescent staining (FS) technique with direct sputum for the diagnosis of pulmonary tuberculosis (TB). MATERIALS AND METHODS: Three sputum specimens (spot, second spot, and morning) were collected from the study participants. One smear was prepared from the direct sample and one using the N-acetyl-L-cysteine-sodium hydroxide concentration method. The direct smears were stained using FS, and Ziehl–Neelsen (ZN) staining was used to stain smears prepared after concentration method. Smear results were pooled and compared in two categories: standard spot-morning and same-day smears. The Chi-square test was used to evaluate the statistical difference in smear-positive cases. RESULTS: Among 2922 participants included in the study, smear positivity was, respectively, 10.5% and 10.2% for FS and ZN smears using spot-morning approach. Using the same-day approach, the smear positivity was, respectively, 10.4% and 9.9% for FS and ZN smears; statistically, the difference was not statistically significant (P > 0.05) between the staining techniques in both the approaches. CONCLUSION: More smear positivity is the advantage of using FS technique. Given this advantage, National TB Control Programs of high-TB-burden countries should consider installing light-emitting diode FS technique in peripheral settings also.
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CASE REPORTS Top

A rare case report: Ayurvedic management of vocal cord nodules p. 282
Rozina Ashrafali Khoja, Sarika M Makwana, DB Vaghela
DOI:10.4103/ijhas.IJHAS_31_19  
Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal abuse or misuse. An increased vocal load, for example, due to the patient's profession, demands high-volume speech for the formation of nodules. In the present case report, a 26-year-old female patient acquired this disease followed by common cold cough. Her problems were aggravating by high-volume speech and getting fatigability also. This patient was given Anutaila Nasya with Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola Kwatha(Kavala). The patient was advised for strict voice rest and steam inhalation for better result. After 1 month of treatment, the patient got relief from all her complaints and gained normal voice. On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this single case report shows that ayurvedic management of vocal cord nodules gives excellent result and improves patients' quality of voice.
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Cytological diagnosis of an intramuscular lipoma located on the tongue p. 285
Krishnendu Mondal, Rupali Mandal
DOI:10.4103/ijhas.IJHAS_99_18  
An intramuscular lipoma (IML) usually arises within the large muscles of extremities. Intraoral examples of this tumor are uncommon. On histopathology, these are characteristically recognized from the diffuse infiltration of muscle fascicles by sweeps of adipocytic proliferation. Classic cytomorphology of the neoplasm has also been described, but are mostly encountered from the extremities. This latest report here explores the utility of fine-needle aspiration cytology in the diagnosis of an IML from one of its unusual locales at the tongue.
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LETTERS TO EDITOR Top

Low bone mineral density and its risk factors in an urban adult population of South India p. 288
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/ijhas.IJHAS_8_19  
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Need to expand and explore self-care for improving the health indicators of the disadvantaged sections of community p. 289
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijhas.IJHAS_51_19  
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Flood relief interventions in Kerala: A factsheet and critical analysis based on experiences and observations p. 290
Jose Jom Thomas, B Prakash, Praveen Kulkarni, M R Narayana Murthy
DOI:10.4103/ijhas.IJHAS_101_18  
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Immediate postoperative hypoxia–fat embolism syndrome: An unknown sinister p. 293
Saurabh Sud, Deepak Dwivedi, Sadhan Sawhney, Shalendra Singh
DOI:10.4103/ijhas.IJHAS_15_19  
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