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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 9 | Issue 1
Page Nos. 1-45

Online since Tuesday, August 17, 2021

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EDITORIAL  

Role of oral microbiome in the SARS-COV-2 pandemic p. 1
Deepa Jatti Patil
DOI:10.4103/jihs.jihs_16_21  
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ORIGINAL ARTICLES Top

Ventilator-associated pneumonia: Outcome in pediatric intensive care unit of a tertiary care center p. 4
Arti Dhingra, Sonia Bhatt, Rajesh Kashyap
DOI:10.4103/JIHS.JIHS_22_20  
Background: The profile and pattern of ventilator-associated pneumonia (VAP) varies among different settings, depending on the definition, the type of hospital or intensive care unit (ICU), the population studied, and the level of antibiotic exposure. Aim: We aimed to study the profile and pattern of VAP among mechanically ventilated children admitted to a pediatric ICU. Methods: Critically ill children aged 1 month to 12 years of age, who received mechanical ventilation and developed VAP, were included in the study. The VAP was diagnosed using the Clinical Pulmonary Infection Score. The Pediatric Index of Mortality 3 (PIM-3) was also calculated. Categorization of diagnosis was done based on PIM-3 guidelines. The mean length of stay duration of mechanical ventilation was also noted down. Results: The incidence of VAP in the present study was 37.78%. PIM-3 was 2.24. The mean length of stay in cases of early VAP was 8.14 days, whereas it was 20.3 days in late VAP. Two important conditions that led to the development of VAP were respiratory conditions (33.33%) and neurological conditions (27.45%). Liver injury and renal injury were noted in 14 (27.5%) and 10 (19.6%) patients. Significant differences were observed in the mean length of stay and in cases of reintubation. The three most common organisms seen were methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter, and Klebsiella along with Pseudomonas, whereas among nonsurvivors, they were Candida, Citrobacter, Enterococcus spp., methicillin-resistant coagulase-negative staphylococci, and Streptococcus. Conclusion: VAP is a common entity among ventilated children. Cases of late VAP face a longer length of stay on mechanical ventilation. Parenteral nutrition and the presence of nasogastric tubing were significantly associated with late-onset VAP as compared to early VAP. Three most common organisms seen were MRSA, Acinetobacter, and Klebsiella along with Pseudomonas.
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Compliance to gluten-free diet may regenerate probiotic microbiota: First report p. 8
Moni Kumari, Malika Arora, Navdeep Kaur, Ranjit Singh, Parveen Bansal
DOI:10.4103/jihs.jihs_34_20  
Background: The human intestinal microbiota is very rich in probiotics which includes various species and strains of Lactobacillus, Bifidobacteria, etc. In certain diseased conditions, friendly microbiota may get disturbed or completely eradicated. To make up the loss of such beneficial species, one has to either replenish it from external source or remove the reasons responsible for killing of the microbiota. Similarly, the intestinal microflora also gets disturbed in celiac disease (CD), an autoimmune disorder caused due to the immune-toxic gluten peptides or due to delivery of variety of antibiotics that may act as dysbiotic agents. Aim: The present study was aimed to investigate the replenishment of microbiota after sticking to gluten free diet in celiac disease patient. Materials and Methods: In this study, ten patients each of four groups were included and their faecal samples were collected. Bacterial colonies were isolated from the sample and the colonies were examined by biochemical and morphological profiling. Results: The biochemical and morphological profile of microbiota in faecal samples demonstrated clear-cut regeneration of probiotic species in patients complying with gluten-free diet (GFD). This is the first report on regeneration of microbiota in relation to dietary compliance in CD patients. Conclusion: The results of study may play a great role in detecting the patient compliance to GFD and may serve as a non-invasive prognostic tool replacing biopsy especially for paediatric population.
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Traditional homemade probiotic drink “Kanji” versus marketed probiotic drink: Critical representation of hidden therapeutic potentials p. 13
Gagandeep Singh, Malika Arora, Mukesh Maithani, Moni Kumari, Parveen Bansal
DOI:10.4103/jihs.jihs_31_20  
Background: The traditional homemade Kanji (commonly known as Kanjika) is an Indian fermented drink, which is prepared from black carrots and has indigenous probiotic species. It is being used since long back due to its high nutritional/therapeutic value and availability of anthocyanin pigment. However, the use of traditional food drinks is decreasing and these are being replaced by marketed probiotic drinks. At present, probiotics are regulated as per their intended use, and there are certain confusions and challenges in regulatory guidelines. Hence, ensuring safe, swift, and successful usage of probiotics is the urgent need of the hour. Aims and objective: The present study was aimed to investigate homemade Kanji and a marketed formulation for its analytical/ biological studies in order to compare their therapeutic potency. Materials and Methods: A marketed probiotic drink was procured from the local market and Kanji was prepared at home using a traditional method. Results: The preliminary evaluation of kanji over marketed probiotic drink has shown that the homemade drink Kanji is having better probiotic, antioxidant, and antimicrobial profile in comparison to the marketed products. Conclusion: The results concluded that the traditional homemade drinks are more effective and safe beverages even as per today's lifestyle.
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Knowledge, attitude and practices for HBV and HCV (Hepatitis B virus and Hepatitis C virus) among the students of a central university in South Delhi (India) and strategies for prevention of disease p. 19
Anjum Ara, Deep Inder, Pawan Kumar, Kafil Akhtar
DOI:10.4103/jihs.jihs_2_21  
Hepatitis B and C are one of the major blood-borne viral infections in India and across the globe. There is an urgent need to address this public health problem at the community level. Aims and Objectives: This study aimed to assess knowledge, attitude, and practice (KAP) about hepatitis B virus (HBV) and hepatitis C virus (HCV) among the students of a central university, thus identifying and bridging the gaps in KAP by formulating strategies at the community level. Materials and Methods: A cross-sectional study was done among 127 participants between November 2019 and December 2019. Data for KAP were collected using self-structured questionnaire after obtaining written informed consent. The data included demography, basic knowledge, modes of transmission, attitude, practices, and preventive measures to control HBV and HCV. Descriptive data were analyzed using SPSS-18 software. Results: Overall awareness level was 60% among university students. Knowledge about transmission via blood/blood related products (71%), reuse of needle or syringes (66%), ear/nose piercing/tattooing (33%), prevention through vaccination (76.4%) was found. Overall negative attitude toward the infected patient was 82% and avoidance behavior was 29%. In practice, 55% of participants had completed all doses of vaccination. Eighty-five percent participants agreed to visit a doctor following any symptoms and 70% found proactive in containment and educating the masses. Conclusion: The lacunae in KAP can be bridged by active participation, training, and education of the students of university by focused strategies based on communication and behavior change and positive motivation using public platforms and social media by university authorities from time to time.
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REVIEW ARTICLE Top

Types of research articles and research misconduct: Book review p. 24
Nipin Kalal, Nimarta Rana, Missam Merchant
DOI:10.4103/jihs.jihs_6_21  
The field of research involves persistence and hard work to conduct research and understand the results. It is a matter of concern for several initial career researchers that how to publish article. It is significant to have a comprehensive idea about the different kinds of articles that can be publish in different journals. This comprehensive book review provides ideas about types of research articles and research misconducts.
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CASE REPORTS Top

Acute myocardial infarction and HIV infection: A case-based review p. 30
Rohit Dhanraj Chordiya, Jitendra Dewjibhai Lakhani, Cinosh Mathew
DOI:10.4103/jihs.jihs_33_20  
Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a life-threatening condition. Cardiovascular (CV) complications are not uncommon and are one of the leading causes of death in patients suffering from this infection. This case report is of a patient, tested HIV positive who presented to the hospital with myocardial infarction (MI). The objective of this case review is to highlight CV complication such as MI in HIV/AIDS who did not have common cardiac risk factors such as diabetes mellitus, hypertension, or obesity. Acute MI may be presenting feature of HIV infection and may need timely intervention by combined specialist care.
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Space management with gerber space regainer p. 33
Vaishnavi Umeshbhai Shah, Bhavna Haresh Dave, Susmita Shrenik Shah, Paridhi Samir Shah
DOI:10.4103/jihs.jihs_8_21  
Mesial migration of primary 2nd molar and 1st permanent molar occurs due to early exfoliation of primary first molar. Early exfoliation of deciduous teeth may lead to destruction in the integrity of normal occlusion. Early orthodontic procedures are often used to facilitate favorable developmental modifications in the developing occlusion. There are different space regaining methods described in literature. This case report presents a space regaining accomplished with distal movement of tooth by Gerber Space Regainer.
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Resin infiltration technique: A case report and literature review p. 36
Deepika N Chari, Bhavna H Dave, Paridhi S Shah
DOI:10.4103/jihs.jihs_9_21  
An incomplete/defective formation of organic enamel matrix of teeth leads to enamel hypoplasia. Such spots are prone to caries and provoke plaque accumulation. This can involve color alternation which can be of major esthetic concern. Although complete color making might not be achieved, resin Infiltration CONcept (ICON) has few benefits over other methods of being noninvasive, does not require anesthesia, and the procedure can be performed in a single sitting. This paper along with a case has a brief literature review of ICON (resin infiltration technique).
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High-dose methotrexate: Treatment experience in patient with B-cell philadelphia-positive acute lymphoblastic leukemia p. 39
Avinash Khadela, Bhavin Vyas, Shrikant Joshi
DOI:10.4103/jihs.jihs_13_21  
High-dose methotrexate (HDMTX) is gaining importance in the management of acute lymphoblastic leukemia (ALL). Its efficacy and toxicity depends on dose strength, route of administration, and infusion time. HDMTX toxicities can be controlled by continuous monitoring of urine pH and adequate supportive care (hyper-hydration, alkalinizing agents, and leucovorin rescue). A patient suffering from B cell Ph + ALL was kept on Berlin-Frankfurt-Münster-90 protocol and administered methotrexate 8 g/cycle by intravenous infusion with normal saline over 6 h. He developed leucopenia and severe anemia after receiving the first cycle of chemotherapy, which was treated with subcutaneous filgrastim 300 mcg OD for 5 days and 1 pint red blood cell. After the third cycle, patient developed mucositis and treated with leucovorin and local anesthetics; and continued the chemotherapy. In conclusion, the patient was continuously monitored for urine pH and tolerated the HDMTX well when provided adequate supportive care.
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SHORT COMMUNICATION Top

Scope of long-case examination as an assessment tool among medical students and the way forward p. 42
Saurabh R Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jihs.jihs_35_20  
Assessment in medical education remains the key driving force for learning and ensures gradual progression by means of bridging the lacuna among medical students. Bedside teaching and assessing the same with the help of either long-case or short-case examinations is a well-known and frequently employed practice in clinical training. Although long-case examinations have been in use for multiple decades, we have to accept the drawbacks of these assessments that include allocation of marks on the basis of unstructured questions, the presence of inter-case variability, and non-adherence to the blueprint which, in turn, results in a haphazard selection of cases for examination. Further, the possibility of a strict or lenient examiner and the simultaneous presence of factors like patients (cooperative or non-cooperative patients or nature of illness in the patient) or students (liked or not liked by the teacher – the issue of being biased) complicates the entire process of assessment. Despite the presence of these constraints, long-case examinations generally have high face validity and give the opportunity for the student to evaluate the concerns of patients from all dimensions. In conclusion, long-case examinations remain an effective tool to assess the skills of medical students. However, we should aim to minimize its limitations and then use it for the benefit of medical students, and thus, direct observation and use of a standardized checklist have been advocated.
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LETTER TO EDITOR Top

Taxane group of chemotherapeutic agent and acute coronary syndrome p. 44
Roop Kaur Gill, Deepali Lodha, Jitendra D Lakhani, Vivek Vaswani
DOI:10.4103/jihs.jihs_10_21  
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