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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 8 | Issue 2
Page Nos. 77-179

Online since Wednesday, January 11, 2023

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EDITORIAL  

Women empowerment and information and communication technology Highly accessed article p. 77
Tripta S Bhagat
DOI:10.4103/2773-1987.367580  
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GUEST EDITORIAL Top

Charaka Shapath: A way of life Highly accessed article p. 80
SK Jain
DOI:10.4103/2773-1987.367581  
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REVIEW ARTICLES Top

Cohabitation of tuberculosis and human papillomavirus-positive infections in the development of cervical cancer p. 82
Aayush Raj, Harshath Parves, Ashish Kumar, B Prabasheela, Sivanesan Dhandayuthapani
DOI:10.4103/sujhs.sujhs_40_22  
Tuberculosis (TB) has been implicated in the pathogenesis of malignancies and may interfere with their diagnosis. TB and cancer frequently coexist and the relative immunosuppression caused by cancer or its treatment may lead to the reactivation of latent TB infections, leading to increased morbidity and mortality. Human papillomavirus (HPV) infection causes cervical cancer, particularly HPV 16 and 18 strains account for 75% of these cases. Although it is difficult to determine the exact chronology of events using data from reported diagnoses of infections, it is possible to draw preliminary conclusions regarding the relationship between co-infections and HPV infection, HPV persistence, and the development of CIN3+. This review highlights the underappreciated overlap of the cohabitation of TB and HPV + ve infection in the cause of cervical cancer.
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Antioxidants and its role in endocrine disorders p. 86
Urvashi Midha, Juhi Aggarwal, Jyoti Batra, Eram Hussain Pasha, Luna Sinha
DOI:10.4103/sujhs.sujhs_38_22  
An excessive synthesis of ROS results in oxidative stress and results in deleterious process that damages cell structures i.e. lipids, proteins, and DNA. Oxidative stress plays a major role in various human disease states, including endocrine dysfunction. A number of diseases connected with free radicals have recently been reported in the medical field. The risk of diseases caused by oxidative stress is exacerbated by an unhealthy lifestyle, chemical exposure, pollution, cigarette smoking, drugs, illness, and stress, among other things. Antioxidants are molecules that can scavenge free radicals and aid in the reduction of oxidative stress-induced damage. Traditional herbal treatments and dietary items were the primary sources of antioxidants for ancient peoples, protecting them from free radical damage. In this article, we present a brief overview of the role of oxidative stress in a variety of common human endocrine disorders, such as diabetes and thyroid disease, as well as a discussion of the therapeutic potential of dietary antioxidant (Vitamin C & Vitamin A) techniques.
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Biochemical mechanism of ferroptosis-mediated cancer cell death in triple-negative breast cancer: An insight p. 90
Anitha Chidamabaram, Malarvili Thekkumalai, B Prabasheela, Tripta S Bhagat, Jyoti Batra, Sivanesan Dhandayuthapani
DOI:10.4103/sujhs.sujhs_37_22  
Ferroptosis is a form of programmed cell death (PCD), distinct from apoptosis, that was identified in 2012. The process is driven by the iron-dependent oxidative degeneration of lipids. Ferroptosis causes cell death through the accumulation of iron-dependent lipid reactive oxygen species. Free radicals cause degradation of lipid molecules by the removal of electrons through oxidation. The process is dependent on intracellular iron as the accumulation of iron acts as a catalyst for converting peroxides into free radicals. The oxidative degradation of lipids occurs when there is depletion of the antioxidant glutathione and a loss of activity of the lipid repair enzyme glutathione peroxidase 4. The lipid peroxidation then leads to cell membrane denaturation. The biochemical mechanism behind the unique iron-dependent programmed cell death with reference to the triple negative breast cancer have been reviewed in this article.
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Serum leptin and adiponectin in metabolic syndrome: A brief review p. 95
Juhi Aggarwal, Urvashi Midha, Jyoti Batra
DOI:10.4103/sujhs.sujhs_36_22  
Metabolic syndrome in modern times is a global health issue in the world including India. Its prevalence in the population is following a crescendo pattern. By knowing metabolic syndrome not only we are able to diagnose it in an early and proper manner but can also promote the prevention program. Leptin is a hormone which is mainly synthesized in the white adipose tissue. Leptin level in blood is directly proportional to total adipose tissue mass. In the present study, the association of serum leptin and adiponectin with the components of metabolic syndrome was evaluated. Patients with metabolic syndrome had higher levels of leptin and low levels of adiponectin than Non-Metabolic syndrome (MS) Subjects. We have also found that as compared to the females, the male had a higher possibility of metabolic syndrome.
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Importance of cardiac magnetic resonance imaging in cardiomyopathies in present scenario p. 99
Ashok Kumar Sharma
DOI:10.4103/sujhs.sujhs_33_22  
Cardiomyopathy includes a heterogeneous group of diseases and conditions that are caused by mechanical and/or electrical dysfunction and shows inappropriate hypertrophy or dilatation which may be due to various causes, mostly genetic, can be confined only to heart or may be a part of systemic disorders. It includes hypertrophic, dilated, arrhythmogenic right ventricular cardiomyopathy, restrictive, and unclassified type. Cardiac magnetic resonance imaging (C-MRI) is currently the gold standard examination due to its high temporal and spatial resolution. In late gadolinium enhancement (LGE) studies, the gadolinium contrast which is administered, it has a slower washout rate in abnormal areas of increased extracellular space and fibrosis. The normal myocardium gets nulled and the abnormal areas are seen as bright areas on LGE. According to the Global Burden of Diseases, injuries, and risk factors study 2016, cardiomyopathy contributed to 0.12% of total deaths, 0.11% of total disability-adjusted life years in India. The main objective of the article is to review the role of MRI in cardiomyopathies (CMPs), especially after post-COVID-19 pandemic with the purpose whether this can be one shop modality with reference to echocardiography. With the advancement in MRI technology and availability of state of art cardiac coils and cardiac software C-MRI has emerged as modality of choice in diagnosis as well as in follow-up cases of CMPs diseases as it is nonoperator dependent as well as radiation-free modality.
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Triple-negative breast cancer in young aged Indian women - An overview p. 108
Sivanesan Dhandayuthapani, Tripta S Bhagat
DOI:10.4103/sujhs.sujhs_32_22  
The incidence of breast cancer has overtaken cervical cancer over the past decade and becoming the most common type of cancer among Indian women. Morbidity and mortality associated with the type of cancer are disproportionately higher in Indian women. Despite efforts being made to increase awareness about the causes, a large population of Indian women are already present with advanced stages of the disease. Reproductive factors are among the most well-established risk factors for breast cancer. However, their associations with different breast cancer subtypes defined by joint estrogen receptor/progesterone receptor/human epidermal growth factor status remain unclear. Triple-negative breast cancers (TNBCs) are known for early age at presentation, large tumor sizes, and overall poor prognosis. However, Indian studies are scarce with limited follow-up data. Hence, the present study is aimed at characterizing nonmetastatic TNBC patients in our population and comparing their outcomes with the non-TNBC subset. TNBCs are a subset of tumors with poorly understood tumor biology and behavior. Despite being labeled as having aggressive tumor biology and behavior, not many differences are seen in their clinical outcomes when they present as locally advanced cases.
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Genitourinary cancer: A perspective review p. 111
Atul Khajuria, Shilpa Sujit Kushte
DOI:10.4103/sujhs.sujhs_42_22  
Genitourinary (GU) malignancy comprises nearly half of the cancers diagnosed in men, and the incidence of this group of cancers increases with age. The key to successful management is to define appropriate goals (cure vs. palliation) based on the history and extent of disease, physiology and life expectancy of the patients, and cost–benefit ratio of treatment options. Recently, a number of genomic and molecular studies have provided an insight into the oncogenesis and progression of GU cancers, particularly bladder, prostate, and kidney cancers. These comprehensive innovative analyses have led to new molecular classification based on the genomic expression profiles and the discovery of potential diagnostic and therapeutic molecular targets.
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ORIGINAL ARTICLES Top

Detection of COVID-19 using rapid point-of-care chromatographic immunoassay-based test p. 116
Shubhendu Singh, Dakshina Bisht, Ashutosh Rawat, Jagriti Bansal, Ritu Jain
DOI:10.4103/sujhs.sujhs_39_22  
Introduction: Coronavirus disease 2019 (COVID-19) has so far affected over 41 million people globally. The limited supply of real-time reverse transcription-polymerase chain reaction (rRT-PCR) kits and reagents has made meeting the rising demand for incompetent. Therefore, numerous easy-to-use rapid antigen tests (RATs) based on lateral flow technology have been developed and are the need of the hour. This has a risen a crucial need for point-of-care devices for on-site detection. The objective of this study was to detect SARS-CoV-2 in suspected persons by rapid point-of-care (POC) chromatography immunoassay-based test. Aim: The present study was conducted during the initial pandemic where all suspected cases were subjected to rapid POC chromatography immunoassay-based test and evaluated the outbreaks of COVID-19. Materials and Methods: A cross-sectional study was conducted among 239 patients suspected of COVID-19. Nasal samples were collected for the rapid diagnostic test. The rapid chromatographic immunoassay test was performed immediately in all the patients. Results: Of the 239 sample that were tested by Rapid antigen detection test, 89 (37.2%) were positive and 150 (62.7%) were found negative. Maximum number of patients that were positive from 60-74 years of which male were 23 (25.8%) and female were 13 (14.6%) and minimum number of cases were from above 75 years in which male were 5 (5.6%) and female 2 (2.2%). Conclusion: The RAT showed an admirable specificity to rule in COVID-19 patients within the first 5 days of illness and had a reasonable sensitivity. Therefore, patients showing positive results need to immediately get treatment and those with negative tests should be reconfirmed by rRT-PCR as it is considered the gold standard for COVID-19 testing.
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Perceived fear and anxiety as an after effect among coronavirus disease-2019 patients and their treating doctors p. 121
Rani Srivastava, Ashok Kumar, Brijesh Saran, Tripta Bhagat, Shivani Bansal, Anita Tyagi, Yashaswini Srivastava
DOI:10.4103/sujhs.sujhs_28_22  
Introduction: Coronavirus disease-2019 (COVID-19) represented a human tragedy among the general population and has been an unprecedented challenge for patients, treating doctors, and the entire world. This fact has created continuous fear, anxiety, and many more psychological discomforts such as impairment in healthy happy life, drug abuse, increased religiosity, and hopelessness, and it is also being noticed that women and women-treating doctors are found to be more prone to catch psychological disturbances. Objective: Considering all the above challenges, this study was intended to test the general health, level of fear, anxiety, and general well-being of COVID afflicted individuals and their treating doctors. Methodology: Here, the general well-being, level of anxiety, stress, and fear of COVID-19 patients and their treating doctors are examined. This study has been counducted online for COVID-19 patients (with Telephonic calls) and direct interview of treating doctors. The patient's details were taken from hospital records to contact them online. On the other side, the faculty of their treating doctors who have been physically involved in this project were examined for psychological testing. This study has been conducted in the Department of Clinical Psychology in collaboration with Medicine, Santosh Medical College, Hospitals, Ghaziabad, UP. Results and Discussion: Out of 1325 total cases, only 34% of cases took interest to provide us feedback after recovery. Approximately the similar proportion of cases, i.e., 35% did not respond but rather gave silly rationales as if they did not want to be recognized. One of the smartest groups of such population was who were proved to be highly fake as they furnished all fake identities even during their admission. It was very shocking. COVID patients did not reveal any serious psychopathology. Now if we compare the psychological profile of treating doctors (faculty and PG), their overall health has shown remarkable concerns means their mental health is affected. Conclusion: Therefore, this study concludes that the knowledge and perception about this pandemic and factors associated with anxiety/depression among frontline physicians are needed to be taken care of because it is marked among the doctors of Santosh Hospital.
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To study the effect of yoga asana and pranayama on pulmonary function test in chronic obstructive pulmonary disease (copd) patients p. 126
Rajkumar Prasad, Rinku Garg, Sanjay Sahay
DOI:10.4103/sujhs.sujhs_26_22  
Background: Pranayama is an integral part of yoga training. Pranayama is a regulated breathing practice that improves airway responsiveness. Yoga asana and pranayama have been shown to reduce resting respiratory rate and enhance vital capacity, maximum voluntary ventilation, breath-holding time, maximal inspiratory pressure, and expiratory pressure. Aim: This study aims to study the effect of yoga, asana, and pranayama on pulmonary function disease (chronic obstructive pulmonary disease [COPD]) patients. Materials and Methods: This was a prospective observational study which was conducted in the Department of Physiology in association with the Department of Respiratory Medicine Santosh Medical College and Hospital, Ghaziabad, Uttar Pradesh, with a sample size of 55 participants on stable patients diagnosed (COPD) with aged between 40 and 65 years of either sex. Written informed consent and approval from the institutional ethics committee were taken before starting the study. The paired t-test was used to compare the mean and standard deviation of the quantitative variables. When the P < 0.05, the results are statistically significant. To conduct statistical analysis, SPSS 20.0 was used. Results: We observed a statistically significant increase in forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FVC/FEV1 ratio, and peak expiratory flow rate after 8 and 12 weeks of yoga training compared to the first visit (0 week) baseline before yoga training. Conclusion: The results of our study showed that the regular practice of yoga, asana, and pranayama for 45 min a day minimum of 3 days a week for 12 weeks showed improvement in pulmonary function tests of COPD patients. It was also concluded that yoga and asana along with pharmacological treatment for COPD patients showed improved breathing patterns and pulmonary function parameters. It was observed that yoga, asana, and pranayama had improved physical condition by reducing weight and body mass index which enhances pulmonary function.
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Comparison of pulmonary function test and body mass index in medical and paramedical students p. 130
Namrata Lahoty, Garg Rinku
DOI:10.4103/sujhs.sujhs_25_22  
Context: Obesity has become a serious public health issue in emerging nations, notably in India. Obesity alters the mechanics of the respiratory system, as well as exercise tolerance, gas exchanges, respiratory pattern modulation, and respiratory muscle strength and endurance, among other things. Aims: The aim was to compare the pulmonary function test parameters in normal weight, overweight, and obese young people among the medical students. Settings and Design: Obesity and overweight have become a global problem. They are the key health issues in both industrialized and developing nations today. As a result of obesity, which was defined as an excess of fat tissue in the body, a several systemic illnesses and a higher mortality rate might occur. Many bodily systems may be affected by obesity, resulting in higher rates of illness and death in the community. Subjects and Methods: The present study was carried out at Santosh Medical College in the Department of Physiology and was a cross-sectional study. Based on the body mass index (BMI), three student groups were taken as normal, overweight, and obese, which was followed by pulmonary tests conducted using spirometry, and the observations were noted and were compared among the three groups. Statistical Analysis Used: In this study, descriptive and inferential statistical analyses was performed. Continuous measurement data was shown as mean ± standard deviation (SD), whereas categorical measurement results was presented as a number (%). The significance is determined at a 5% level of significance. Assumptions: (1) Independent variables should have a normal distribution, (2) Samples selected from the population should be random, and sample cases should be independent. Conclusions: This type of study is completely novel to this geographic location as a comparison is made between two different strata (medical and paramedical students) of both genders, and it aimed to determine whether there is a difference in pulmonary function between obese, overweight, and normal weight people, especially in this section of the country. As a result, the current study in both the groups found that: (1) Forced vital capacity in overweight people was much lower than in people of normal weight and much lower in obese compared to overweight, (2) Forced expiratory volume in the 1 s in overweight people was much lower than in people of normal weight and much lower in obese compared to overweight, (3) Forced expiratory flow 25–75 in overweight people was much lower than in people of normal weight and much lower in obese compared to overweight, (4) Peak expiratory flow rate in overweight people was much lower than in people of normal weight and much lower in obese compared to overweight. As a result, all of the indices of the lung function evaluated in this study indicated a statistically significant inverse relationship with a rise in BMI. This suggests that a rise in the body mass index changes lung functioning, potentially leading to long-term consequences and being linked to early mortality and morbidity.
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Cytomorphological study of lymph node lesions at a tertiary care center p. 132
Summi Ganguli, Mayurika Subodh Kumar Tyagi, Malay Bajpai, Swati Singh, Prem Kumar Garg, Abhishek Pathre
DOI:10.4103/sujhs.sujhs_22_22  
Introduction: Lymphadenopathy is one of the most common clinical presentations of patients attending the outpatient department. The degree and pattern of morphological changes depend on inciting stimulus and the intensity of the response. Fine-needle aspiration cytology (FNAC) is an important procedure in establishing the diagnosis of various lymph node lesions. It is a widely accepted, accurate, sensitive, and specific test used in an outpatient setting. Methodology: An observational study was carried out at the department of pathology of a tertiary care hospital in North India from July 2019 to February 2020. A total of 100 lymphadenopathy cases were taken. Smears were stained with Giemsa and categorized according to the cytomorphological pattern. Ziehl - Neelsen (ZN) stain was done in clinically suspicious cases of tuberculosis (TB). Data regarding brief history, site, age, and cytomorphologic features were collected and analyzed. Results: Out of 100 cases of lymph node aspirations, 70 cases showed features of tubercular lymphadenitis followed by reactive lymphadenitis, 29 cases while 1 malignancy. TB was prevalent in all age groups. Conclusion: Lymph node FNAC is a simple, cost-effective investigation with great importance in view of high prevalence of TB in our country, where an atypical presentation of TB can be screened. Purulent aspirate smears which do not show typical features of TB can be dismissed as acute suppurative lymphadenitis in the absence of ZN staining. Acid-fast bacillus positivity in such cases confirms the diagnosis and helps in better patient management.
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Prevalence of anemia among pregnant women attending NIMS Hospital, Jaipur, Rajasthan, in Western India p. 137
Atul Khajuria, W Imnasenla, Raju Sehrawat, Ashish Gupta, Shyam B Sundar, Mahendra Kumar Verma, Surekha Patil
DOI:10.4103/sujhs.sujhs_34_22  
Background: Anemia is the most common hematological disease in pregnancy. Anemia is described as having a hemoglobin (Hb) concentration in the peripheral blood of 10 g/dl or less, in accordance to the most current WHO standard. Iron deficiency is the most frequent reason of anemia at some point of pregnancy. Folic acid deficiency is a much less frequent cause. In some communities, up to 80% of pregnant women are anemic. Women from low socioeconomic groups and young adults are the most vulnerable. Anemia is identified using measuring Hb concentrations and examining a peripheral blood smear for red blood cell changes. Iron and folate supplementation is advocated in the course of being pregnant to keep away from complications. Objective: The objective of this study was to investigate the prevalence of anemia among pregnant women in NIMS Hospital, Jaipur. Subjects and Methods: Blood was collected and investigations are done on Elite 580. Results: This presence study enlightens the number of pregnant anemic patients according to education level, class, diet, and age. Sociopersonal status of pregnant women, the number of anemic was higher in illiterate than literate and according to the socioeconomic condition of anemic pregnant women, the number is much higher in poverty than in higher classes, whereas the number is much lesser in nonvegetarian than vegetarian and is higher in age between 21 and 30 years of age than below or above it. Conclusion: Most of the pregnant women attending NIMS Hospital, Jaipur, were found to be anemic. Therefore, appropriate interventions by the competent authority are recommended to tackle this condition among pregnant women.
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Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India p. 141
Atul Khajuria, Rakesh Das
DOI:10.4103/sujhs.sujhs_41_22  
Background: Anaemia affected population includes male, females as well as children and is a common problem that has been seen in western India. Megaloblastic Anaemia is common in India but regarding its prevalence and causative factors data is insufficient. The most common cause of megaloblastic anaemia includes deficiency of folic acid and Vitamin B12. Due to vegetarian lifestyle of the people the deficiency of Vitamin B12 is more common rather than the other macronutrient. In today's time, only iron and folic acid is provided by Anaemia control or prophylaxis program. This issue needs focus and hence this study has been chosen. Objective: To focus on the incidences of Megaloblastic Anaemia in Western India and analyse the possible causative factors. Materials and Methods: Patients with a haemoglobin <10 g/dl and peripheral smear findings consistent with megaloblastic anaemia present in the hospital over a period of 2 months will be included in the study. Patient's diet, drug intake, present symptoms and other history will be taken into account. Recording of complete blood counts, peripheral film examination, reticulocyte count and cobalamin and folate assays will be done. Patients suffering from chronic disease like renal disease, cancer, tuberculosis, liver disease etc., Will be excluded from the study. All data will be collected and statistically evaluated. Results: In the current study, 500 patients who were admitted to the gynaecology, paediatric, and medical wards were all assessed. These patients were all eligible to participate. They were divided into three groups based on the mean corpuscular volume (MCV) value, serum assay, and peripheral smear results: Macrocytic, normocytic, and microcytic anaemia. A megaloblastic blood film or low serum indicators along with the normal MCV value were categorised as having macrocytic anaemia. A total of 100 patients had macrocytic anaemia identified. The distribution of sexes was: 70 (male), 30 (female). There were discovered to be 55% of patients with cobalamin deficit and 8% of patients with folate deficiency. Every patient were vegetarians, coming from a poor socioeconomic status. Conclusion: The diagnosis of Megaloblastic anaemia was done through complete blood counts, red cells and assays of two vitamins. Majority of patients having megaloblastic anaemia was due to deficiency of cobalamin. Poor diet in cobalamin or folate were the contributing factors in Megaloblastic anaemia. Prevention can be done through awareness camps and education programmes and also through proper diet. Vitamin B12 should be included in the diet of patients along with iron and folic acid.
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Determinants of patients' adherence to glaucoma topical therapy among Nigerian adults p. 145
Olamide Yetunde John-Sam, Abdulkabir Ayansiji Ayanniyi, Rilwan Chiroma Muhammad
DOI:10.4103/sujhs.sujhs_7_22  
Context: Glaucoma is a leading cause of irreversible blindness globally. Among its risk factors only raised intraocular pressure is modifiable with capacity to reduce the progression of glaucoma. Adherence to intraocular pressure lowering medications is a key factor in the medical management of glaucoma. Aims: The aim of this study was to determine adherence to glaucoma topical medications and its determinants among patients. Settings and Design: This was a comparative longitudinal hospital-based study. Subjects and Methods: Ninety-six primary open-angle glaucoma patients were randomly grouped into A and B and surveyed for topical medication adherence and its determinants. All participants were counseled on medication adherence, and given dosing time schedule. Participants in Group B/reliable household members were reminded through phone calls to use their medications. Adherence level, its determinants, effect of adherence on intraocular pressure (IOP), and central visual field defect progression were assessed at baseline, 90 days, and 180 days. Statistical Analysis Used: Data normality was tested using Shapiro–Wilk test. Results were presented in frequency tables, figures, and charts. Chi-square test, Fisher's exact test, and odds ratio were used to evaluate the associations between variables where applicable. Multivariate logistic regression was employed to determine factors predicting adherence. The level of statistical significance was set at P < 0.05. Results: At baseline, 35.4% of the participants were adherent to medications, with intervention at 90 days (81.2%, A, and 79.2%, B) and at 180 days (75.0%, A, and 83.3%, B) of the participants who adhered to medications. Predictors of adherence to medications were age below 40 years (adjusted odd ratio [AOR] = 5.10; 95% confidence interval [CI], 1.18–21.82; P = 0.029) and the presence of comorbidities (AOR = 5.41; 95% CI, 1.64–17.86; P = 0.009). There was no significant difference in the mean IOP between the two groups at baseline, 90 days, and 180 days. Conclusions: There was an improvement in medication adherence following counseling. Younger age and comorbidities were notable adherence determinants.
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Pediatric community-acquired pneumonia in Federal Medical Center, Birnin Kudu, Jigawa State: Prevalence and outcome p. 152
Umma Abdullahi Idris
DOI:10.4103/sujhs.sujhs_3_22  
Context: Pediatric pneumonia is an important cause of morbidity and mortality among children in many hospitals in Nigeria. The relative contribution of this disease among children admitted to our facility has not yet been documented. Aims: The aim was to determine the prevalence and outcome of pediatric community-acquired pneumonia (CAP). Settings and Design: This was a cross-sectional study conducted at the Department of Pediatrics of FMCBKD. Methods: One hundred and twenty-three children aged 2 months–14 years who were managed for CAP from January 2019 to December 2020 were studied. Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Sciences software version 16. Continuous data were represented as mean or median as appropriate, while categorical data were presented as percentages. The Chi-square and Student's t-tests were used to identify the significant differences for categorical and continuous variables, respectively. P < 0.05 was considered statistically significant. Results: The prevalence of pneumonia was 9.2%. Most of the children were aged 24 months and below with a male preponderance of 1.5:1. Bronchopneumonia was the most common form of clinical presentation, and 67 (71.3%) children presented with severe disease. The case fatality rate was 29.8% (28 deaths), and most of the deaths were among children <24 months of age, females, and those who presented with severe disease. Conclusions: CAP is prevalent and causes a significant mortality in children in Jigawa State. Strengthening preventive measures to control pneumonia and increasing public awareness of early presentation to a health facility will reduce mortality.
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A CLINICAL UPDATED REVIEW Top

Iron deficiency anemia in different trimesters of pregnancy and laboratory diagnosis with hematological parameters and serum ferritin concentration p. 156
Jinu Varghese, Atul Khajuria
DOI:10.4103/sujhs.sujhs_35_22  
This article aims to provide an overview of the iron deficiency anemia (IDA) in different trimesters of pregnancy and laboratory diagnosis with hematological parameters and serum ferritin concentration. It is a laboratory leadership and quality management-based time bound prospective study that explains about IDA in different trimesters of pregnancy, causes of IDA, response to treatment, preventing IDA during pregnancy, lab leadership, and quality management.
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CASE REPORTS Top

Covid – 19 infection and treatment: Still an unfolding clinical scenario p. 169
Basil N Okeahialam
DOI:10.4103/sujhs.sujhs_29_22  
COVID-19 infection was declared a pandemic by the World Health Organization due to its widespread nature and devastating effect on health, demography, and economics all over the world. The disease has evolved fast, changing treatment paradigms as its pathophysiology became clearer. Lately, a vaccine was introduced, and its effects and efficacy have come to be a thing of challenge as experience continues to be gained. In this case report, the author shares his experience of unfolding scenarios with treatment of the disease in his clinical environment.
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Multiple fractures of foot in landslide and physiotherapy: Case study p. 172
Rutuja Ravindra Avaghade, Sandeep Babasaheb Shinde
DOI:10.4103/sujhs.sujhs_1_21  
Here is the case report of a multiple foot fractures due to landslides. landslides are the gravitational downward and outward movements of soil. landslides develop in unstratified homogeneous soils or are induces by certain types of stratification. The causes are excessive load pressures at the head of the slope. Landslides are rare to happen. Calcaneal fractures are rare but debilitating injuries. The annual incidence of fracture was 11.5 per 100,000, and occurred 2.4 times more frequently in males than females. Presenting a case of 40-year-old male with left comminuted calcaneal fracture and crushed injury on the right ankle due to landslide. He was conscious when brought to the hospital, where immediate measures were taken. He was operated on for the same and was managed surgically by open reduction internal fixation with plating. He was referred to physiotherapy. He presented with pain and swelling. Further, he was assessed and followed physiotherapy treatment. The results suggested reduction in pain and edema after immediate physiotherapy approach. For the cases of crush injury or calcaneal fracture initial treatment, cryotherapy followed up by weight bearing is found to be effective for the reduction of pain.
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LETTERS TO EDITOR Top

Pain problem in monkeypox: A consideration p. 176
Rujittika Mungmunpuntipantip, Viroj Wiwanitkit
DOI:10.4103/sujhs.sujhs_31_22  
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Urological problem and monkeypox: A note p. 177
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DOI:10.4103/sujhs.sujhs_30_22  
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Quarantine for COVID-19: Management on mass immigration of deported illegal workers p. 179
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DOI:10.4103/sujhs.sujhs_44_22  
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