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   Table of Contents - Current issue
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April-June 2020
Volume 9 | Issue 2
Page Nos. 67-149

Online since Saturday, July 18, 2020

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REVIEW ARTICLES  

Corona virus outbreak and Radiology Department: Workplace preparedness, evidence based measures to limit transmission, and how radiologist can help reduce the spread Highly accessed article p. 67
Amol M Lahoti, Kavita Makasare
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_57_20  
As we are facing a country wide lockdown in view of international pandemic of Corona Virus-2019 (COVID-19) and deal with never seen before circumstances all over the world, healthcare personnel are often first one to get affected in view of direct exposure because of limited availability of knowledge and personal protection equipment (PPE). Planning and preparedness are essential to respond effectively to outbreaks and epidemic. Radiologists have greater risk of acquiring and transmitting infection due to its close contact with patients during ultrasound (USG) and other procedures related to invasive patient care the service needs to offer. High density, limited space, and working in air conditioned set up are needed for computed tomography, MRI, ultrasonography, X-ray machines; this makes it essential to set specific guidelines to limit transmission and utilize resources in the best possible way so as to minimize the transmission, and at the same time, implementation of a well-prepared plan as per the radiology department is required to prevent further transmission of the virus to department staff members and patients. A multitiered, updated scientific approach suited to us needs to be devised, followed, and monitored at the administrative and departmental level, taking into account the Radiology team that includes doctors, technicians, assistants, and patient contact-operating points. Here, is a systematic scientific review of infection control measures that cover the different dynamics of utmost patient care and staff protocols without hampering the patient treatment for the radiology department set up. We review precautions and safety measures for radiology department personnel to manage patients. It is not clear to what extent the COVID-19 epidemic would establish itself and how long it is going to continue in India. As case diagnosis may take anywhere from a minimum of 14 days to a few months to be visible, we need to enhance surveillance and prepare the community in a proportionate way. Radiology department and the overall health care system should be prepared, educated to continue the servicing emergency scans procedures and important elective procedures following the strict aseptic precautions so health care workers and patients safety are maintained. Each one of us should understand the disease dynamics, routes, and source of transmission and should take utmost precautions to prevent transmission to colleagues and patients by properly using PPE, as early detection and limiting exposure of healthcare workers, employees, and patients is of utmost importance.
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Microbial biofilms—Development, behaviour and therapeutic significance in oral health p. 74
S Nithya, Susmita Saxena, Jitin Kharbanda
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_5_20  
Background: Biofilms are communities of microorganisms that are found attached to a surface. They develop on both biotic and abiotic surfaces and could act as a source of infection. The formation of biofilm involves the population of bacteria in an extracellular matrix exhibiting a cooperative group behavior. It is a dynamic process that involves adhesion, growth mobility, and extracellular matrix production with both cells and the environment contributing to the formation of this matrix material. The biofilm exhibits unique properties of protecting itself from host defenses and desiccation, persistence in the flowing system, heterogeneity, spatial organization, and resistance to antimicrobial agents through its ability to influence gene expression and phenotype. Quorum sensing, a means of a cell to cell communication is closely interconnected to the development of biofilm formation and inhibition. Dental plaque is the most common and well known oral biofilm. The preponderance of biofilm-associated diseases and its resistance in eradication has potentiated the need for further research in this field. Purpose: The purpose of this review is to create an awareness of the dentist on biofilms, its mode of formation, and the effect of biofilms on oral health. A comprehensive search of all literature on biofilms pertaining to oral health using literary search engines like PubMed and PubMed central has been taken into account in reviewing the pathogenesis and significance of biofilms in this article.
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ORIGINAL ARTICLES Top

Efficacy of moderate-intensity physical activity in lowering non- high-density lipoprotein cholesterol in stage 2 essential hypertensive patients p. 80
Barkha Gupta, Sonali Sharma, Sudhir Bhandari, Sapna Jangir
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_47_20  
Background: Hypertension and non–high-density lipoprotein cholesterol (non-HDL-c) measure is a useful evaluation tool to assess heart disease risk. Increasing physical activity (PA) is considered to reduce blood pressure (BP) and non-HDL-c in patients with hypertension. Objective: This study assesses the influence of moderate and regular PA on non-HDL cholesterol in essential hypertension. Subjects and methods: We studied 100 patients of either gender, aged 40–69 years of stage 2 essential hypertension in this interventional study. Patients were enrolled for 12 weeks of PA intervention (10,000 footsteps per day) and were followed at 15 days interval in the first month and after that 1-month duration. Lipid profile was estimated at baseline and at the final assessment visit (after 12 weeks). Results: The data included in this study confirm the beneficial effects of regular PA on non-HDL-c levels (P < 0.000001). It was found that after 12 weeks of intervention program, the cholesterol, triglycerides; low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), and non-HDL-c were lowered from 276.53 to 194.19, 191.17 to 110.58, 196.07 to 120.72, 38.23 to 22.12, and 234.32 to 142.84, respectively. It was also noted that high-density lipoprotein cholesterol (HDL) was increased from 42.21 to 51.35 following the interventional program. All the results were highly significant (P < 0.000001). Conclusions: A non-pharmacological activity like PA is beneficial for better management of hypertension to avoid cardiovascular co-morbidities. Twelve weeks of physical exercise program (walking of 10,000 footsteps/day) decreases the risk associated with BP elevation by improving non-HDL-c in hypertensive patients.
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Role of color Doppler ultrasound and MDCT angiography in the evaluation of peripheral arterial disease p. 86
Kirankumar Kondeti, B Vijayalakshmi Devi, AY Lakshmi, Abha Chandra
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_48_20  
Background and Objective: The main objective is to study the correlation between color Doppler ultrasound and multidetector computed tomography (MDCT) angiography in evaluating peripheral arterial disease. Settings and Design: Prospective observational study. Materials and Methods: The study was conducted in the Department of Radio Diagnosis, SVIMS, over a period of 18 months from March 2018 to July 2019. All of the 80 consecutive patients who were referred to the Department of Radio Diagnosis with clinical suspicion of peripheral arterial disease (PAD) were studied. Color Doppler ultrasound followed by MDCT angiography were done in all of the patients. Results: Out of the total 1680 vessel segments in 80 patients, color Doppler sonography (CDS) was able to detect 545 (32.4%) positive segments, in comparison to the CTA which was able to detect 732 (43.5%) bilaterally, with 11.1% of cases detected more on MDCT angiography predominantly grade-2, 3, 4, except for grade-1. On overall except for wall thickness, MDCT angiography was better in detecting wall calcification, occlusion, and thrombus on comparison with CDS. Conclusion: CDS and MDCT angiography showed good agreement for grade-0, 1 PAD when compared to grade-2, 3, 4. CDS with an advantage of no risk of radiation, contrast related complications should be considered as a preliminary screening test in all patients with clinical suspicion of PAD. MDCT angiography should be considered for grade-2, 3, 4 stenosis assessments for selecting an appropriate treatment.
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CYP2C9 polymorphisms are associated with phenytoin toxicity in South-Indian epileptic patients p. 92
Rakesh Reddy Reddigari, SV Naveen Prasad, Vengamma Bhuma, P VGK Sarma, Appa Rao Anumolu
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_72_20  
Background and Aims: The contribution of CYP2C9 in phenytoin metabolism is generally modest, but it increases with increasing serum phenytoin concentration. In the current study, we sought to study the association of CYP2C9*2 and CYP2C9*3 polymorphism with clinical and biochemical phenytoin toxicity in epileptic patients presenting to a tertiary care hospital in South-India. Methods: In total, 50 patients on phenytoin therapy and clinically diagnosed with phenytoin toxicity in neurology outpatient department/casualty/intensive care unit and medicine wards were considered as cases. A total of 50 patients on phenytoin therapy without any evidence of toxicity were considered as controls. CYP2C9*2 (exon-3) and CYP2C9*3 (exon-7) gene polymorphisms were studied using the allele specific PCR method. Results: Out of 100 patients, CYP2C9*2 polymorphism was seen in 8 (8%) patients in which 6 (12%) were cases and 2 (4%) were controls. CYP2C9*3 polymorphism was seen in 23 (23%) patients out of which 17 (34%) were cases and 6 (12%) were controls. Mean serum phenytoin level in cases was 24.23 ± 1.3 μg/ml, whereas in controls, it was 17.10 ± 0.6 μg/ml and the difference was statistically significant with P value <0.0001. Mean serum phenytoin level among patients with CYP2C9 polymorphism was 25.21 ± 4.72 μg/ml, whereas among patients without polymorphism, it was 17.51 ± 3.51 μg/ml (p < 0.0001). Conclusion: Our findings conclude that the presence of CYP2C9*2 and CYP2C9*3 polymorphisms are associated with increased serum phenytoin levels and increased risk of clinical toxicity with phenytoin.
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Terminalia arjuna – A possible alternative to commercial mouthwashes, against periodontopathic bacteria: An in vitro study p. 98
Siva Sai P Dandu, Gujjula Sravanthi, Sameevulla Mohammed, Sundeep Narahari, Sailaja L Sistla, Ravindra Reddy Nagi Reddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_81_20  
Background and Aims: Periodontitis is irreversible plaque-mediated damage to gums and its supporting structures. Plaque is a niche of complex organisms forming biological associations for their attachment and sustenance, forming the basis for periodontal diseases. There is a vast diversity in oral microbiota, depending on the site. Dentition creates natural surfaces and barriers for the diversification of bacteria. For instance, periodontal bacteria differ between supra and subgingival tissues. The plaque mounted on the subgingival area chiefly houses gram-negative anaerobes such as Treponema denticola, Tannerella forsythia, and Porphyromonas gingivalis. The current study aims to compare and contrast the antimicrobial potential of Terminalia arjuna with commercially available mouth rinses against clinical isolates of periodontal bacteria based on the well-diffusion method. Materials and Methods: Preparation of Terminalia arjuna bark extract was done. For the detection of periodontal bacteria, Porphyromonas gingivalis, and Treponema denticola, polymerase chain reaction (PCR) was used. The well-diffusion method was used to test the antimicrobial activity. Results: The aqueous extract of Terminalia arjuna showed minimum zone of inhibition of 23.33 ± 0.577 for Porphyromonas gingivalis and 24.33 ± 0.577 for Treponema denticola while the commercially available mouthwashes M1, M2, M3showed 29.33 ± 0.577, 29.33 ± 0.577, 24.33 ± 0.577, respectively towards Porphyromonas gingivalis and 29.66 ± 0.577, 27.33 ± 0.577, 25.66 ± 0.577, respectively towards Treponema denticola The results depicted nearly equal efficacy of Terminalia arjuna aqueous extract similar to those of commercial mouthwashes against the test bacteria. Conclusion: Antibacterial tests of Terminalia arjuna bark extracts showed promising results even at low concentrations. Hence, it can be an alternative to commercially available mouthwashes, which suffer from having numerous drawbacks ranging from burning sensation while in use to yellowing of teeth surfaces. Herbal medicines are considered to be much safer than other synthetic formulations and possess wide acceptance by people. Hence, this study forms a basis for future studies in this area.
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Study of fungal rhinosinusitis p. 103
Padmavathi Devi Chaganti, Natta B Rao, Karri M Devi, B Janani, Pamidipalli V Vihar, Govada Neelima
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_98_20  
Background: Rhinosinusitis is a common disorder occurring in 20% of the population. Chronic sinus infection unresponsive to antibiotics should raise the suspicion of Fungal rhinosinusitis. Various types of fungi caused inflammation of sinus mucosa. Aims and Objectives: Thepresent studywas undertakento determine the etiology, clinical features, and diagnosis of Fungal Rhinosinusitis. Material and Methods: Twenty cases of rhinosinusitiswere studied in two years period in a tertiary care hospital. Specimens collected were processed with paraffin processing andstained with H and E stain. Special stains for Fungus were done in all cases. Results: Cases of Rhinosinusitis were mostly seen in the 5th decade with femalepreponderance. All the cases were non-invasive and Maxillary sinus was involved in majority of cases. Aspergillus was identified in majority of cases followed by Candida. Mucor mycosis was seen in diabetics. Conclusion: In the present study, all the cases of rhinosinusitis are non-invasive. A special stain for Fungus helps in identifying the type of organism.
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Knowledge, attitude and practices towards COVID-19 among Indian residents during the pandemic: A cross-sectional online survey p. 107
A S Veeramani Kartheek, K Himavathy Gara, Dharma Rao Vanamali
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_75_20  
Background and Aims: Infection prevention and control measures were enforced to contain COVID-19 pandemic. Public adherence to these measures profoundly influences transmission dynamics. The study aimed to evaluate knowledge, attitude and practices (KAP) towards COVID-19 among Indian residents. Methods: An online semi-structured questionnaire was developed using Google Forms. Total 751 respondents were recruited for the survey based on snowball sampling technique. Survey constituted sequential questions on socio-demographic variables and KAP with a total score of 22. Mean knowledge score was compared among different groups. Regression analyses were used to determine association between various factors and KAP. Results: Participation was almost equal in both genders with mean age of 27.3 ± 9.5 years. The accuracy rate for responses was 74%. 87.2%, 84.42% and 90.5% participants agreed for adequate control, win against COVID-19 and lockdown being an effective containment method respectively. Though 97.6% respondents agreed about frequent hand washing, only 77.87% confirmed about washing hands ≥20 secs. The adherence to social distancing and lockdown restrictions was confirmed by 97.3% and 97.3%, respectively. 13.18% respondents agreed for Hydroxychloroquine purchase. Higher knowledge score was positively associated with Healthcare workers, upper socio-economic class and adherence to appropriate preventive practices. Conclusion: Knowledge score had significant association with optimism and adherence. Accuracy rate of 74% reflected inadequate awareness. Around 75% followed hand hygiene guidelines and few (5%) didn't follow lockdown restrictions suggesting gap between information and implementation. For effective containment of the pandemic and adequate protection of our health care system, existing barriers need to be addressed by promoting behavioural changes.
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Comparison of efficacy of intrathecal dexmedetomidine and magnesium sulfate as an adjuvant to 0.5% hyperbaric bupivacaine in patients undergoing infraumbilical surgeries under spinal anesthesia p. 116
Kavita Jain, Surendra K Sethi, Rahul Jain
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_70_20  
Background: Adjuvants in spinal anesthesia extends not only the duration of surgical anesthesia but also provides postoperative analgesia. This study aimed at comparing efficacy of intrathecal dexmedetomidine and magnesium sulfate as an adjuvant to 0.5% hyperbaric bupivacaine in various infraumbilical surgeries. Materials and Methods: 120 patients belonging to American Society of Anesthesiologists (ASA) physical status I or II aged 18 to 65 years of either sex were enrolled and randomly allocated into two groups. Group D (n = 60) received intrathecal bupivacaine (hyperbaric) 0.5%, 12.5 mg (2.5 ml)+dexmedetomidine 5 μg (0.5 ml) while Group M (n = 60) received bupivacaine (hyperbaric) 0.5%, 12.5 mg (2.5 ml) + magnesium sulfate 75 mg (0.5 ml) = 3 ml. Onset of sensory and motor block, time to reach peak level of sensory block, time to two segment regression, duration of sensory and motor block, duration of analgesia, sedation score, hemodynamic changes, and side effects were noted. Results: Onset of sensory and motor block were significantly faster in Group D (2.78 ± 0.34 min and 3.73 ± 0.43 min) compared to Group M (6.47 ± 0.43 min and 7.72 ± 0.48 min); (P < 0.05) Group D (131.70 ± 5.74 min) showed significantly prolonged time to two segment regression compared to Group M (102.78 ± 6.54 min); (P < 0.001). Duration of sensory and motor block were significantly prolonged in Group D (339.75 ± 23.57 min and 314.38 ± 14.93 min) when compared to Group M (248.18 ± 12.89 min and 228.81 ± 11.01 min); (P < 0.05). Duration of analgesia was significantly prolonged in Group D (348.26 ± 22.35 min) than Group M (268.01 ± 11.31 min); (P < 0.001). The patients remained hemodynamically stable in both groups without undue sedation and minimal side effects; (P > 0.05). Conclusion: Dexmedetomidine (5 μg) leads to faster onset as well as prolonged duration of both sensory and motor block, prolonged duration of postoperative analgesia in comparison to magnesium sulfate (75 mg).
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Reporting frequency of potentially malignant oral disorders and oral cancer: A 10-year retrospective data analysis in a teaching dental institution p. 124
Namburu J Ramya, Poosarla C Shekar, Baddam V. Ramana Reddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_6_20  
Introduction: Incidence of oral potentially malignant and malignant lesions is increasing, thereby escalating the burden of cancer on our nation. Oral cancer and preceding lesions are of utmost importance for the present scenario. Various risk factors predominantly, consumption of tobacco with other synergetic products affect the oral mucosa. Registry of these lesions at a hospital-level and national level shall bring awareness in the public sector. Categorization of cases would lead to pooling of the overall data for oral potentially malignant disorders (OPMDs) and oral cancer (OC). The present study aimed to report the frequency of patients affected with potentially malignant oral disorders and oral cancer and to articulate the data at a teaching dental institution. Materials and Methods: A retrospective study was conducted in the department of Oral Pathology from the archives between 2009 and 2019. Data were manually retrieved year-wise concerning age, sex, site involved, and histopathological findings. Cases were evaluated to segregate OPMDs and OC. Results: Overall, 3223 oral biopsies were reviewed and analyzed. Six-hundred eighty-three (21.16%) patients were segregated, out of which OPMDs were 205 (6.38%) and 478 (14.8%) were oral cancer. Oral leukoplakia 3.2% constituted the highest number of patients in OPMDs group, followed by oral lichen planus (1.6%) and oral submucous fibrosis (1.36%). The most frequent lesion in the oral cancer group was oral squamous cell carcinoma (12.9%) followed by verrucous carcinoma (1.86%). The average age range affects the most common lesions was fifth decade in case of oral leukoplakia and sixth decade in case oral squamous cell carcinoma. The most frequently involved site in the oral cavity was buccal mucosa. Conclusion: Studies evaluating the prevalence rate of the OPMDs and oral carcinoma of the oral cavity are beneficial for general dental practitioners in making early diagnosis and treatment. Awareness programs on preventive and diagnostic measures at public and health sectors shall help in understanding the latest scenario. This is possible only after the registry of the lesions at various programmed levels.
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Fine-needle aspiration of goiter (benign and non-neoplastic) with thyroid function abnormalities p. 132
Debarshi Saha, Akshay Krishnamurthy, Ashwani Kumar, Ruchi Sinha, Jyoti Kini
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_270_14  
Introduction: Thyroid nodule is the prime indication for FNA, which is also a cheap and effective investigation. The current study seeks an association between benign goiter and aberrant thyroid function tests (TFTs). Can thyroid FNA anticipate overt morbidity resulting from thyroid function abnormalities? Materials and Methods: FNA records of 173 patients were studied along with the TFT results. A slide review was undertaken where the FNA impression did not correspond to the TFT. Results: The female:male ratio was 149:24. Two (1.15%) had inadequate cellularity. Nearly 95/173 cases had abnormal TFTs. Multinodular goiter (126), Hashimoto's thyroiditis (43), and two and one cases of granulomatous and unclassified thyroiditis, respectively, constituted our diagnostic profile. Abnormalities in TFT did not correlate with age group, gender, or FNA diagnoses. However, hypothyroidism (clinical and subclinical) was significantly observed in Hashimoto's thyroiditis (HT) cases. Further, scant colloid and hurthle cell change were significantly correlated with HT. A histological correlation was obtained in 46 cases. Four neoplastic cases among which three papillary carcinomas arising in small focal areas within cysts were seen. Conclusions: The major observation in this study is the subset of euthyroid and subclinically hypothyroid cases (23/43, 53.48%) of Hashimoto's thyroiditis (P = 0.0021). If treated with thyroxine replacement, overt hypothyroidism, particularly in pregnant women who are at risk of developing antithyroid antibodies, may be prevented. Besides, the inadequacy rate (1.15%) in the current study is low. False negatives 3/46 (6.5%), though available on a meager and selected subset of the patient population is still within the range of published data.
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CASE REPORTS Top

Chromoblastomycosis: A rare fungal infection from a nonendemic region—Southern Odisha p. 139
Akash Panigrahi, Sanghamitra Padhi, Indrani Mohanty
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_79_20  
Chromoblastomycosis, a slowly progressing localized fungal infection confined to the skin and subcutaneous tissue, is caused by dematiaceous fungi. Dermal lesions are pleomorphic and can range from small nodules to large papillary like eruptions. Herein, we report a case of chromoblastomycosis in a 26-year-old male caused by Fonsecaea pedrosoi. The patient was immunocompetent and had thorn injury 4 years back and developed a nonhealing ulcer on the medial aspect of his right leg, which was clinically suspected as tuberculous or carcinomatous lesion. Punch biopsy was done and sent in normal saline for the histopathological examination. Microscopically, sclerotic bodies, characteristic of chromoblastomycosis, were noticed on hematoxylin and eosin stained sections. Potassium hydroxide mount of the punch biopsy also revealed dematiaceous branching septate fungal hyphae. The fungal culture produced typical black colonies of Fonsecaea pedrosoi. The case is of interest because to the best of our knowledge it has so far not been reported from our region—southern part of Odisha.
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Umbilical myiasis in a human neonate – Treated with turpentine oil p. 143
Dinesh K Barolia, Aditya P Singh, Ramesh Tanger, Arun K Gupta
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_94_18  
Umbilical myiasis in a human neonate is rare. It occurs due to the unhygienic upbringing of the baby. Common sites of myiasis are exposed areas of the body such as extremities, scalp, and back. Herein, we report a case of umbilical myiasis, an extremely rare condition in a 12-day-old neonate.
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Responding to the challenge of shortage of personal protective equipment in the corona virus disease 2019 outbreak p. 146
Saurabh R Shrivastava, Prateek S Shrivastava
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_32_20  
The Corona Virus Disease-2019 (COVID-19) outbreak, which started from a single city in China in December 2019 has been detected in 53 more nations till 29 February 2020 and this is a significant cause of public health concern worldwide. The available estimates suggest that the use of appropriate personal protective equipment (PPE) in a rational basis is a key component in the prevention and mitigation of the disease. However, amidst loads of uncertainty about various aspects of the disease and the resulting fear and anxiety, the use of PPE has been irrational and thus the public health authorities have faced their shortage and are finding it difficult to ensure optimal availability. In order to deal with the global shortage of PPE, a three-pronged strategy has been proposed focusing on minimizing the need, promoting the rational and appropriate use, and coordinating the supply chain network across the world. In conclusion, the personal protective equipment has an important role in the infection prevention and control of the ongoing COVID-19 outbreak. It is the responsibility of the public health authorities to rationalize the use of PPE to ensure their optimal availability across the world.
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Strengthening the prevention and control services against HIV infection to attain universal health coverage p. 148
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_50_19  
HIV infection has been acknowledged as a global public health concern since its emergence and it is clearly evident by the fact that the infection has accounted for the lives of 32 million people so far. It is important to consider that owing to the support from multiple sectors and a well-coordinated response owing to the assistance from the welfare agencies, the coverage of the prevention and control services has shown a gradual rise. However, from the public health perspective, it is quite obvious that the reported gains should not be a marker for complacency for the health authorities, as the observed gains are quite heterogeneous and there are a wide range of challenges which need to be addressed. In conclusion, in the battle against HIV epidemic, the need of the hour is to strengthen the package of HIV services and involve all the concerned sectors to ensure coverage of every section of the society.
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