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   2021| January-March  | Volume 10 | Issue 1  
    Online since February 2, 2021

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COVID-19: The enigma of asymptomatic carriers and silent transmission

January-March 2021, 10(1):11-16
The presence of asymptomatic carriers is well known in the COVID-19. These carriers play a significant role in the disease transmission. Little is known about its magnitude, types, detection, and management. This narrative review highlights all these aspects of asymptomatic COVID-19 carriers. Much is still unknown about asymptomatic carriers in COVID-19 and its contribution in the silent spread of infection. A literature of three electronic databases with prespecified search terms was done to include the status quo data on asymptomatic carriers in COVID-19 infection. This narrative review will be useful for epidemiologists, clinicians, policymakers as well as the public in general.
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A recent approach of telescopic prosthetic fitment for rehabilitation of a congenital limb deficient child with longitudinal fibular deficiency using Jaipur limb technology: A case study

January-March 2021, 10(1):78-82
Rehabilitation of children with congenital lower limb deficiencies is a very confronting task. An 8-year-old boy presented with left lower limb deficiency since birth and inability to perform the activity of daily living as per expectation with his old ortho-prosthesis. The current case study explores a recent telescopic prosthetic design with relatively less engagement over deficient limb but capable to restore maximum function in an economic way.
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A woman with oculocutaneous manifestation of neurofibromatosis type 1: A rare case report

January-March 2021, 10(1):83-86
Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder involving multiple systems and affects approximately 1 out of 3000 persons. Ocular manifestations are very rare with Lisch nodules, plexiform neurofibroma, and optic pathway gliomas. The proper diagnosis of NF-1 is a crucial task for a clinician due to the various clinical manifestations including vision and life-threatening malignancies in few patients, which may arise in the different phases of life. Here, we present the case of a 45-year-old woman with NF-1 presenting with rare ocular features along with systemic manifestation of the disease.
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An unusual variation - Unilateral Gantzer's muscle

January-March 2021, 10(1):87-89
The accessory head of flexor pollicis longus (FPL) muscle, also known as the Gantzer's muscle, was first described in 1813. The accessory head of FPL muscle significantly varies between studies in its origin, innervation, and relationships to the anterior interosseous nerve and the median nerve. In a 50-year-old male cadaver, we found an additional muscle belly arising from medial epicondyle and joining with the tendon of FPL muscle. The total length of the accessory muscle was 8 cm and was innervated by the ulnar nerve, which is not mentioned in any of the articles in the literature. It is called as Gantzer's muscle as it is taking origin from medial epicondyle. Due to the significant variations in the origin, insertion, innervation, and relationship to the anterior introsseous nerve, median nerve, ulnar nerve, and ulnar vessels of the accessory head of FPL, dependable anatomical knowledge is essential for diagnosis and treatment of nerve entrapment syndromes and avoiding injury during the surgical procedures.
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ABO and Rh blood groups distribution in Aleppo Province, Syria
Ahmad Alhamid, Aos Alhamid, Albaraa Abdulsalam, Ezzeldin Nashed, Samer Haj Kaddour
January-March 2021, 10(1):90-90
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Can yoga play a role in improving health-related status of patients with obstructive sleep apnea?
A Mooventhan, L Nivethitha
January-March 2021, 10(1):91-92
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Women's mental health and domestic violence in India during COVID-19 pandemic
Bhavika Mansharamani, M Kishor
January-March 2021, 10(1):92-94
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Focused-pulsed electromagnetic field treatment reverses lipopolysaccharide-induced alterations in gene expression profile in human gastrointestinal epithelial cells

January-March 2021, 10(1):55-69
BACKGROUND: Although the therapeutic effects of pulsed electromagnetic field (PEMF) treatment are well documented, underlying mechanisms of PEMF in treating pathological conditions are incompletely understood. METHODS: We utilized a human gastrointestinal epithelial cell system to investigate the influence of a low-frequency electromagnetic field generated from a focused PEMF (f-PEMF) device on the expression of human genes. We simulated an inflammatory condition by stimulating the cells with lipopolysaccharide (LPS). A set of LPS-activated cells were then subjected to 100-Hz f-PEMF for 30 seconds to observe the therapeutic effect of f-PEMF. We determined the therapeutic effect by analyzing the reversal of LPS-induced alterations in gene expression using RNA-seq analysis. The results were compared to the changes between untreated controls versus LPS treated cells, defining the homeostatic alteration of changes in gene expression profile caused by LPS stimulation alone. We further compared LPS treated versus LPS + f-PEMF treated cells to examine the effect of f-PEMF in the reversal of the LPS-induced alterations in gene expression patterns. RESULTS: A total of 38,162 genes (of 60,448 tested) were constitutively expressed in the untreated control cells. Stimulation with LPS altered the expression profile through de novo-induction of >1950 genes that were originally unexpressed and silencing 2486 constitutively expressed genes. LPS treatment also altered expression levels in a large panel of genes. Exposing LPS-treated cells to 100 Hz of f-PEMF for 30 seconds (s) showed reversals of LPS treatment-induced altered gene expression. In this paper, we emphasize the f-PEMF regulation of genes associated with inflammatory processes. CONCLUSION: Our data indicates for possibility of developing new nonchemical alternative therapeutic approaches for treatment of inflammation and pain.
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Knowledge, attitude, practice, and cost assessment of over the counter drugs in female athletes in Pune city, India

January-March 2021, 10(1):70-77
BACKGROUND: Over-the-counter (OTC) medications are accessible medications convenient for consumers available in community pharmacies and other retail outlets without a prescription. When it comes to the use of OTC medications in sports, the primary use is to treat pain and inflammation. Athletes may also take medicines to treat specific medical conditions or common illnesses such as cold, congestion, cough, allergies, and skin infections. METHODS: It was a prospective, observational, multi-centered study conducted among female athletes at various sites in Pune. The study was conducted for duration of 6 months. A questionnaire was developed and distributed. Chi-square and Pearson correlation coefficient tests were used for the assessment of P value. P < 0.05 was considered to be statistically significant. RESULTS: In this study, a total of 324 questionnaires were distributed, of which 300 participants returned with completed questionnaires, i.e., with a response rate of 92.59%. Majority, i.e., 49.34% of participants, belonged to the age group of 21–25 years. The average KAPC score was found to be 11.93 (for knowledge), 8.42 (for attitude), 10 (for practice), and 2.41 (for cost) out of 20, 17, 23, and 3, respectively. The overall assessment of the KAPC score was found to be good, i.e., “58.24%.” The P values calculated were only significant for weight versus attitude (0.000984) and weight versus practice (0.000431). CONCLUSION: The athletes had good knowledge and good cost management approach however; they showed poor attitude and poor practice regarding OTC medications.
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Electrolytes imbalance and their clinical outcomes in the intensive care unit: A prospective, observational study

January-March 2021, 10(1):17-22
BACKGROUND: Various researchers have concluded in their work focusing on the essentiality of electrolyte imbalance admitting even under good medication conditions the prognosis of the patients with poor electrolyte imbalance was found challenging. METHODS: This is a current prospective study. The medical information of the patients was obtained from the medical history chart and the reasonable study outcomes were justified. RESULTS: The educational levels and lack of interest of the participants were identified to be negligible which also impacts the good maintenance of the electrolyte balance in the patients. CONCLUSION: Electrolyte imbalance causes notable changes in the physiology of the body. A high quality of life ensures the proper maintenance of the electrolyte balance may prove to be essential.
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Safety and efficacy of linezolid treatment in comparison with vancomycin for methicillin-resistant Staphylococcus aureus nosocomial infection: A prospective study in Mysore City, South India

January-March 2021, 10(1):23-30
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative agent of nosocomial infection in health-care setups causing morbidity and mortality. Treatment with vancomycin remains the standard protocol for the antibiotic treatment. However, the emergence of vancomycin-resistant strains has prompted the use of alternate drug therapies. Linezolid is the best alternative to combat this resistant strain. In the present study, we aim to evaluate the clinical evidence of linezolid treatment in MRSA-infected patients within Mysore city. METHODS: This prospective study assessed the efficacy of linezolid and vancomycin for the treatment of MRSA infections. Fifty patients who fit into the inclusion criteria were considered from four tertiary hospitals. Five milliliters venous blood (only once), pus, urine, sputum, and aspirates were collected from MRSA patients and evaluated by culture studies for its susceptibility to various antibiotics. RESULTS: Results of this study demonstrate that linezolid treatment as oral and intravenous preparations is as effective as vancomycin with 100% efficiency and fewer adverse effects (79 in 40 patients vs. 64 in 16 patients) for the treatment of MRSA nosocomial infection. The observed adverse effects includes local pain (P = 0.312) and thrombophlebitis (P = 0.005) with vancomycin; and anemia (P = 0.348) and thrombocytopenia (P = 0.313) with the use of linezolid. The findings were consistent with the existing knowledge database. CONCLUSION: The results from the study indicate that linezolid offers the same benefit as vancomycin with far fewer drawbacks.
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A study to evaluate ventilatory derangements of 1st year medical students on exposure to formaldehyde by assessing forced expiratory volume in 1 s/forced vital capacity ratio

January-March 2021, 10(1):31-35
BACKGROUND: A doctor experiences various occupational hazards. One of them is exposure to formaldehyde during gross anatomy dissection classes. Since it vaporizes at room temperature, the respiratory system is easily affected. The present study was undertaken to assess the ventilatory derangements that occur on this exposure. METHODS: The spirometric parameter, forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio, was recorded in 80 medical students using spirometer RMS Helios 401. Percent-predicated values were used for analysis. The baseline values were recorded at the beginning of the academic calendar and followed up at the end of the 1st, 6th, and 10th months. RESULTS: The overall mean FEV1/FVC ratio declined over the study period though not markedly but was statistically significant (P = 0.004). Restrictive and mixed patterns were predominantly seen, but the number decreased with time. CONCLUSIONS: Formaldehyde causes detrimental effects on the ventilatory dynamics.
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Knowledge, attitude, and practice of community pharmacists toward dispensing drugs available in different delivery systems at Khartoum locality

January-March 2021, 10(1):36-42
BACKGROUND: Many Food and Drug Administration-approved drugs are available in different delivery systems, such as immediate-release, delayed-release, and extended-release systems. Community pharmacists are supposed to have good knowledge about the differences between those formulations and adopt a systemic dispensing of drugs with the different delivery systems. Thus, this study aimed to assess the knowledge, attitude, and practice of community pharmacists toward dispensing drugs with varying systems of delivery. METHODS: A cross-sectional study was conducted among community pharmacists (n = 172) using a validated self-administered questionnaire. A simple random sampling method was applied to select the participants. The overall knowledge, attitude, and practice scores were calculated, and then, the associations between these scores and demographic characteristics were measured by Chi-square test and analyzed by the Statistical Package for Social Sciences (SPSS). RESULTS: Out of 172 pharmacists, 67.4% of them were female, whereas pharmacists with bachelor represented 68%. Regarding the knowledge of the respondents, 19.8%, 44.2%, and 36% of them have high, moderate, and low levels of knowledge, respectively. Furthermore, 76.7% of the respondents showed a negative attitude, whereas 23.3% of the total respondents have a positive attitude. In addition, 52% of the pharmacists exhibited good practice performance, whereas 48% had a bad practice toward dispensing available drugs with multiple formulations. Moreover, there are positive correlations between knowledge, attitude, and practice of pharmacists in dispensing drugs available with different delivery systems. CONCLUSION: 44.2% of the community pharmacists have a moderate level of knowledge, 76.7% had a negative attitude, and 52% had a good practice toward dispensing drugs with different delivery systems.
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Coronavirus disease-2019 pandemic: Masks use/misuse at tertiary health-care center in northern India

January-March 2021, 10(1):43-47
BACKGROUND: Coronavirus disease (COVID-19) can spread via a cough or respiratory droplets, contact with bodily fluids, or from contaminated surfaces. Aerosol-generating procedures, such as noninvasive ventilation, high-flow nasal cannula, bag-mask ventilation, and intubation are of particularly high risk. Standard precautions, including strict hand hygiene and appropriate use of mask are vital preventive measures. The objective of this study was to assess the adherence rate among the health-care workers (HCWs) to the judicial use of masks during the coronavirus pandemic (COVID-19) at a tertiary health-care center in northern India. METHODS: Institution-based descriptive cross-sectional study was done to evaluate the proper utilization of masks and hand hygiene practices at the tertiary level of healt care in India. Data were collected and analyzed using Epicollect 5 app and the WHO hand hygiene audit tool. RESULTS: Among the 252 total opportunities for performing hand hygiene, only 72 (28.6%) moments were utilized. One hundred and eighty one (39.87%) HCWs applied the mask inappropriately, i.e., other than the one indicated. Overall adherence to guidelines for mask use was found in 195 (34.7%) HCWs, whereas nonadherence was among 366 (65.2%) HCWs. CONCLUSION: Proper hand hygiene and judicious use of mask are crucial for preventing the transmission of infection. However, the utilization of masks is under or mis-utilized for most of the time. We suggest didactic training and educational interventions to be followed for capacity building and motivating the HCWs for infection prevention practices.
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Quality of life in caregivers of children with developmental delay – A case–control study

January-March 2021, 10(1):48-54
BACKGROUND: Caregivers role is crucial in lives of children with developmental delay. Most caregivers have little time for themselves leading to poor social life and quality of life (QOL). Social rehabilitative services among caregivers have improved health of children with developmental delay. We assessed the QOL of caregivers of children with developmental delay and compared with those of normal children. METHODS: Thirty children with developmental delay were selected as cases and thirty normal children as controls. Clinical profile of cases and sociodemographic details of all the participants was assessed. World Health Organization QOL-BREF was used to assess QOL of the caregivers in physical, psychological, social, and environment domains. RESULTS: Fifty percent of cases had severe developmental delay. QOL among caregivers of cases was poor in physical, psychological, social relationships, and environment domains. Mean QOL scores of caregivers of controls were significantly higher than mean QOL scores of caregivers of cases in all four domains. As severity of disability increased there was worsening of QOL observed in all four domains. CONCLUSIONS: QOL of caregivers of children with developmental delay is worse compared to that of controls, and it became worse with increase in the severity of the disability. Hence, there is a need for social support group among the caregivers along with medical rehabilitation.
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Vertigo during childhood: A disabling clinical entity

January-March 2021, 10(1):5-10
The etiology of the vertigo in pediatric age group is often multi-factorial, so clinician should approach a dizzy child with an open mind. Vertigo is not an uncommon symptom in children, though it often unrecognized in clinical practice. The vertigo in children may be acute nonrecurrent spontaneous vertigo, recurrent vertigo and nonvertiginous dizziness or disequilibrium or ataxia. The major causes for vertigo in the pediatric age group are benign paroxysmal vertigo of childhood, vestibular migraine and otitis media. Detailed patient history, routine physical examination, cochlear function tests, vestibular functions tests and imaging are helpful for getting the diagnosis in childhood vertigo. Moreover, the lack of the standard diagnostic protocol for pediatric vestibular examination represents another drawback for effective management of the pediatric vestibular impairment. This review article is a narrative discussion on prevalence, etiopathology, clinical manifestations and current management of the pediatric vertigo. This review article will make a baseline from where further prospective trials for pediatric vestibular disorders can be designed and help as a spur for further research in this clinical entity as there are not many studies in this clinical entity.
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Revisiting E-education platforms for nontechnical courses to aid online teaching during pandemic times in India: A review

January-March 2021, 10(1):1-4
The education system worldwide has been greatly impacted by COVID-19 pandemic 2019–2020, which has led to the temporary closure of both primary and higher education sectors, posing an uncertainty among the system and other concerned fraternities. Citing the potential disruption of learning activities, the UNESCO recommended the use of distance learning programs and open educational platforms that schools and teachers can use to reach learners remotely and limit the disruption of education. With the challenge of fighting the pandemic in one hand and preventing the hampering of education on the other hand, India has called to continue the educational process making an effective use of technology and other available options. The paper is aimed to review such e-platform and initiatives set up in the government portals itself long before any idea of the dawn of current pandemic which can offer a great bundle of resourcefulness for the faculties to monitor continuous learning experience in this pandemic time.
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