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   Table of Contents - Current issue
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January-March 2018
Volume 5 | Issue 1
Page Nos. 1-88

Online since Friday, January 12, 2018

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REVIEW ARTICLE  

A review on child and maternal health status of Bangladesh Highly accessed article p. 1
A. H. M. Mahmudur Rahman
DOI:10.4103/cjhr.cjhr_65_17  
Child and maternal nutritional and health status is a very much concerning issue of Bangladesh. To summarize the specific conditions of Bangladeshi child and maternal health and related issues. This is a descriptive review and overall analysis and description of the literature was done regarding child and maternal health of the general population living in Bangladesh. The evidence reflected that infant, child, and maternal mortality in Bangladesh have declined gradually at least over the past years. It is found that infant mortality 2 times, child mortality 6 times, and under five mortality rates 3 times declined comparatively than the last two decades but it is noted that maternal assassination circumstance has not declined. Knowledge on child and maternal health carries an important role in education. Health knowledge index significantly improve child and maternal health although differentially. It is obvious that poverty is one of the root causes that have led to a high child and maternal mortalities and morbidities faced by the people of Bangladesh. The requirement for socio economic relief for those living in rural Bangladesh remains one of the core issues. Recently, Bangladesh is successfully declining the total number of childhood and nutrition related mortalities despites various complexities, but maternal health status is not improving at the same pace. Nongovernment and government funded organizations and policymakers should come forward for running some effective programs to conquer the situation completely in Bangladesh.
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ORIGINAL ARTICLES Top

Neonatal morbidity and mortality in a Rural Tertiary Hospital in Nigeria p. 8
Umma Idris Abdullahi
DOI:10.4103/cjhr.cjhr_64_17  
Background: Nigeria is one of the greatest contributors to the neonatal morbidity and maternity worldwide. Objective: This study was undertaken to determine the morbidity and mortality pattern of the neonatal admission including the outcome. Materials and Methods: This was a 1-year (March 2015 to February 2016) retrospective study of all the consecutive neonatal admissions in the special care baby unit (SCBU) of Federal Medical Centre Birnin Kudu, Jigawa State, Nigeria. The data obtained were entered into a predesigned pro forma and analyzed appropriately. Results: A total of 205 neonates were admitted to SCBU during the study period with the ratio of the males to females admitted was 2.1:1. The major causes of morbidity were neonatal sepsis (32.2%), birth asphyxia (29.3%), and prematurity (18.5%). In this study, overall mortality rate was 7.16% with birth asphyxia accounting for 13 (40.6%) of the total deaths (χ2 = 1.50, P = 0.68). One hundred and fifty-nine (77%) were discharged, 12 (6%) were discharged against medical advice, while 2 (1%) were referred. Conclusion: Neonatal sepsis, birth asphyxia, and prematurity are the major causes of neonatal morbidity and mortality in this locality.
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Association between psychological distress and unmet information needs among female cancer patients in two selected teaching hospitals in South-West Nigeria p. 11
Foluso O Ojewole, Amarachi Marie Madu, Chinomso Ugochukwu Nwozichi
DOI:10.4103/cjhr.cjhr_62_17  
Background: Cancer-related information is a major need among cancer patients. Existing data indicate that cancer patients who are anxious or depressed have poorer treatment outcomes. Aim: The aim of this study is to assess the association between psychological distress and unmet information needs among female cancer patients in two teaching hospitals in Southwest Nigeria. Materials and Methods: Using a descriptive-correlational design, 244 females in the oncology units of two selected Nigerian teaching hospitals were purposively selected to complete a modified psychological distress scale and a self-developed information need questionnaire. Data were analyzed using descriptive and inferential statistics P value set at 0.05. Results: Majority (76%) of the patients were psychologically distressed, 71.3% of the participants wanted specific information on their cancer disease. There is a correlation between cancer patients' level of psychological distress and their unmet information needs (P = 0.027; r = −0.142) and a correlation between cancer patients' information needs and duration of their illness (P = 0.034; r = −0.135). Conclusion: Cancer patients experience psychological distress to some extent. Furthermore, they are interested in finding out information about their cancer disease. Every unmet information needs impact on the psychological distress experienced by patients. It is, therefore, recommended that nurses and other healthcare professionals should endeavor to assess the specific information needs to provide required information and ease their psychological distress.
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Impact of one-dose package dispensing with patient counseling on medication adherence in geriatrics suffering from chronic disorders p. 18
Narayana Goruntla, Vijaya Jyothi Mallela, Devanna Nayakanti
DOI:10.4103/cjhr.cjhr_78_17  
Introduction: Medication nonadherence in elderly patients could result in a waste of medical expenses in a long-time span as well as deterioration of the patient's medical condition. Aim: The aim of this study is to evaluate the impact of one-dose package dispensing with patient counseling on medication adherence among elderly patients suffering from chronic disorders. Settings and Design: This is prospective, open-labeled, randomized trial carried out at dispensing pharmacy of the secondary care referral hospital, located in resource-limited settings of Anantapur District, Andhra Pradesh, India. Subjects and Methods: A total of 330 (aged ≥60 years) patients were randomly assigned to one of three study groups: Group A (n = 110), no change in dosing and packing; Group B (n = 110), one-dose package dispensing; Group C (n = 110), One-dose package dispensing with patient counseling. Medication adherence levels were measured using a pill count and visual analog scale (VAS) method at baseline and follow-up (after 1 month). Statistical Analysis: Descriptive statistics were used to represent the sociodemographic, clinical, and medication adherence profile of study participants. One-way ANOVA test is used to assess significant differences between three groups with a P < 0.05. Results and Discussion: Medication adherence levels measured by pill count and VAS method were significantly better in Group C (98.98 ± 1.34, 95.09 ± 5.02) one-dose package with patient counseling and Group B (92.93 ± 3.77, 90.09 ± 5.98) one-dose package dispensing than Group A (87.51 ± 6.23, 84.63 ± 6.86) conventional package (P = 0.0001, 0.004). Conclusion: Patients >60 years who are on multiple medications can benefit from one-dose package dispensing and appropriate counseling. This will improve medication adherence hence better outcomes.
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The association of lifestyle with the physical activity and diet of adolescents in Bhopal City, India p. 23
Binu Santha, Sudheer Hongal, Vrinda Saxena, Manish Jain, Vidhatri Tiwari, Aishwarya Singh
DOI:10.4103/cjhr.cjhr_74_17  
Purpose: To assess the association of lifestyle with physical activity and diet of adolescents in Bhopal City, Madhya Pradesh. Materials and Methods: A convenience sample of 310 college going adolescents within an age range of 17–23 years from an Arts Institute in Bhopal city were selected for the study. Self-reported questionnaire for adolescents to assess lifestyle factors (tobacco and alcohol consumption), regular physical activity, and dietary habits were used. Descriptive statistics and Spearman's correlation were applied wherever indicated. Results: Out of the total study population, 54% were males and 46% were females. Majority, i.e., 66% of the total study participants were optimal weight, 28% were underweight, and only a few, 5% were overweight. A significant association was observed between lifestyle habits (P < 0.05) and regular physical activity and dietary habits. Conclusion: Lifestyle factors have a strong association with regular physical activities and dietary practices among the adolescents. The unsatisfactory lifestyle habits of adolescents are a major public health concern. These maladapted habits track into later life as predictors of depleted health. Hence, it is mandatory that health professionals keep a check and provide regular health education among children and adolescents.
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Functioning and productivity of Jan Aushadhi stores in India: The owners' perspective p. 28
Prasanna R Deshpande, Mohd Kazim Sheriff, Atmaram P Pawar
DOI:10.4103/cjhr.cjhr_60_17  
Objective: Jan Aushadhi (People's Medicine) Stores (JAS) are still struggling to get well established in India. Although the Jan Aushadhi (JA) scheme was launched in 2008, the number of JAS has not increased much until now. Therefore, we aimed to determine the working and productivity of JAS in the country. Methodology: We conducted a web-based survey of current JAS owners using a validated questionnaire. The questionnaire was sent to the E-mail addresses as mentioned on JA website. We solicited the information about the aspects such as background information, working and productivity of the store, hurdles while running a JAS, and the opinions. Results: One hundred and sixty-nine individuals responded to the survey out of 1008 (response rate = 16.76%). One hundred and forty-three (84.62%) JAS owners have reported the net monthly profit to be Rs. <5000/-. They have also reported that there are certain hurdles while running the shop. Other important average values for certain parameters were follows: patients approaching a JAS/day – 47.43, net profit/month – Rs. 4230.85, and prescriptions filled/day – 27.06. Conclusion: Dealing with generic drugs is a multifaceted and complex issue in India. JAS were not as “economically productive” as to a regular “government”/community pharmacy in India. There are some flaws as far as the functioning JAS is considered. Although JA scheme was launched long back, it has not spread well in the country until now. Productive inputs are essential for better running of the scheme. The government should think of the hurdles and the suggestions as reported by the JAS owners.
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Hepatoprotective effects of hexane root extract of Alchornea laxiflora in sodium arsenate toxicity in wistar albino rats p. 38
Esosa Samuel Uhunmwangho, Nurudeen Olajide Rasaq, Iyanuoluwa Olubukola Osikoya
DOI:10.4103/cjhr.cjhr_33_17  
Background: Medicinal plants are have been used in the treatment of myriad disease conditions, Alchornea laxiflora is one of such medicinal plant. Aim: To investigate the hepatoprotective effect of hexane root extract of Alchornea laxiflora against sodium arsenate induced liver damage in wistar male rats. Setting and Design: Extraction and administration of bioactive extract. Materials and Methods: Extraction of air-dried ground root of Alchornea laxiflora was done by extracting 500 g with 500 cm of 95% hexane for 72 hrs.The animals (120-150 g) were pre-treated with the extract at varying doses (0.1, 0.5, 1.0, 10, 50 and 100 mg/kg body weight) for seven days orally prior to the intra-peritoneal administration of the toxicant (sodium arsenate) at a dose of 2 mg/kg body weight at the eight day. Hepatoprotective activity of the extracts was evaluated by studying the Cytochrome b5content, Glutathione-S-transferase and 4- Nitroanisole-o-demethylase activities in the liver, Plasma levels of Alanine aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP) and the levels of Total protein, Albumin, Globulin and Glutathione of the various groups. Statistical Analysis: The data were analysed with Microsoft excels (for windows 2007) and Student t-test and ANOVA. Result and Conclusion: The results suggest that pre-treatment of rats with hexane root extract of Alchornea laxiflora for seven days reduced the elevated levels of liver enzymes, reduced the levels of induced liver metabolizing enzymes and the levels of Total protein, Albumin, Globulin and Glutathione that was increased by the toxicity of sodium arsenate in rats and as such possess hepatoprotective effect against sodium arsenate.
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MISSION HOSPITAL SECTION Top

Approach to chronic low back pain in a Rural Mission Hospital: An audit report p. 43
Tapan Kumar Paraseth, Manjulata Gajendran, Deeptiman James
DOI:10.4103/cjhr.cjhr_40_17  
Background: Challenging psychological and ergonomic burden demands a streamlined approach to Chronic low back pain (LBP) in rural population. Methodology: All patients with chronic LBP managed in the outpatient physiotherapy and occupational therapy clinic at the rural mission hospital from July 2015 to June 2016 were included in a retrospective chart audit. Patients' demographic data and diagnosis were statistically analyzed with t-test. Results: One hundred and fifty five patients were included in the study. 65 patients (42%) had mechanical LBP, 46 patients (30%) had chronic LBP with lumbar radiculopathy, 22 patients (14%) had discogenic chronic LBP, 15 patients (10%) had chronic LBP due to osteoporosis, 5 patients (3%) had chronic infective spondylitis and 2 patients (1%) had post-traumatic chronic LBP. 25 patients (16%) were less than 30 years old, 106 patients (68%) were between 30 and 60 years and 24 patients (16%) were older than 60 years. Higher incidence of mechanical chronic LBP was noted in younger group (t [129] = 1.36, P = 0.17) and higher incidence of chronic LBP with lumbar radiculopathy (t [129] =1.181, P = 0.239) was noted in middle aged patients, respectively. Gender prevalence of osteoporosis was statistically significant (t [153] =2.188, P = 0.03). Conclusion: Chronic LBP constituted 23% of all patients managed at the PT/OT outpatient clinic and mechanical chronic LBP was the most common diagnosis. Highest incidence of chronic LBP was noted in the middle aged 'working class' group of patients. Higher proportion of osteoporosis was detected among the female patients.
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CASE REPORTS Top

Nonsurgical healing of a large periapical lesion associated with a two-rooted maxillary lateral incisor p. 48
Kapil Krishan Dua, Preet Kanwal Kaur Atwal
DOI:10.4103/cjhr.cjhr_73_17  
Maxillary lateral incisors are teeth which have shown a high incidence of anatomic variation. Correct diagnosis along with proper treatment plan ensures a successful treatment outcome in these teeth. This paper reports a nonsurgical healing of a two-rooted maxillary lateral incisor with a large periapical lesion.
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Scrub typhus in winters: A report of two cases from a tertiary care center in sub-himalayan region of the indian subcontinent p. 51
Tanya Jain, Vibhu Parcha, Sujeet Raina, Rajesh Sharma
DOI:10.4103/cjhr.cjhr_94_17  
In India, the geographic variation has been observed while reporting an outbreak of scrub typhus. Our country exhibits seasonality in scrub typhus outbreaks that coincides with the monsoon and postmonsoon period of June–October in Northern regions while it is autumn and early winter from September to January in Southern India. The occurrence of scrub typhus in winter months has not been reported from the sub-Himalayan region of the Indian subcontinent. We report two cases of scrub typhus diagnosed in December and February in a tertiary care center of Himachal Pradesh, India.
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Cerebral venous thrombosis in inflammatory bowel disease p. 54
Sunil Mathew, Reddy Ravikanth
DOI:10.4103/cjhr.cjhr_53_17  
Patients with inflammatory bowel disease (IBD) have a higher risk of venous thrombosis compared with the general population. The most common sites of venous thrombosis in IBD patients are the deep veins of the legs, pulmonary system, and portal and mesenteric veins. However, cerebral venous thrombosis (CVT) is rarely associated with IBD. In patients with IBD complicated by CVT, favorable outcomes are possible with early diagnosis and appropriate treatment. However, when patients are not treated, the mortality rate can be as high as 50%. Here, we present a 32-year-old man with the complaints of headache and seizures earlier diagnosed with ulcerative colitis. A diagnosis of CVT was made based on imaging findings. Thromboembolism is an extraintestinal complication of IBD, more frequently venous thrombosis and pulmonary thromboembolism.
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Suspected hepatotoxicity and thrombocytopenia: Sodium valproate and carbamazepine p. 57
Siddhi Umarje, Arundhati Diwan, Asawari Raut
DOI:10.4103/cjhr.cjhr_87_17  
A young male was admitted in a tertiary care hospital with the complaints of excessive nausea, loose stools and fever with chills since few days. He was found to have thrombocytopenia, elevated liver enzymes, and suspected renal impairment. The patient was a known case of epilepsy, mood disorder and mental retardation. Since 6 months he was on sodium valproate, carbamazepine and trihexiphenidyl/risperidone fixed dose combination. Suspecting adverse drug reactions (thrombocytopenia, elevated liver enzymes), carbamazepine and sodium valproate were withdrawn. The patient was treated symptomatically with anti-pyretics and parentral fluids. On follow-up visit, the liver enzymes and platelet count were normal. The patient was maintained on levetiracetam and trihexiphenidyl/risperidone and the caretakers were counseled for the drugs therapy and monitoring parameters.
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Regaining esthetics with unconventional complete denture: Clinical case series p. 60
Angleena Y Daniel, Surbhi Mehdiratta, Harit Talwar, Smitha Daniel
DOI:10.4103/cjhr.cjhr_46_17  
Prosthodontic rehabilitation of edentulous patients can be the most satisfying if treatment can restore patient's function with superior esthetics. Conventional complete denture fabrication in patients with labially inclined premaxilla and maxillary labial undercuts is complicated due to the need for surgical correction. Failure to undergo surgical intervention results in complete dentures with compromised esthetics which could have long-term undesirable psychological bearing on edentulous patients. This article describes nonsurgical treatment modalities for proclined premaxilla in completely edentulous patients to achieve comprehensive rehabilitation with highest regard to esthetics.
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A rare case of severe Hunter's Syndrome p. 63
Sharon Vincent, Joe Mathew Cherian, Abi M Thomas, Rajesh Kumar
DOI:10.4103/cjhr.cjhr_79_17  
Hunter's Syndrome or mucopolysaccharidosis Type II is a rare metabolic disorder caused by the deficiency of lysosomal enzyme iduronate-2-sulfatase. It results in progressive accumulation of deramatan and heparan sulfates in tissues leading to a wide clinical spectrum of systemic manifestations. This is a case report of a 6-year-old boy with classical features of Hunter's Syndrome who presented with a chief complaint of multiple decayed teeth. The purpose of this case report is to highlight the role of a pediatric dentist in the management of such special children with advanced dental care.
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Goldenhar syndrome: Report of two cases with review of literature p. 67
Ananya Madiyal, Subhas G Babu, Vidya Ajila, Medhini Madi, Supriya Bhat
DOI:10.4103/cjhr.cjhr_55_17  
Goldenhar syndrome consists of a varied group of malformations that can involve multiple systems of the body. It is believed to be a variant of hemifacial microsomia with ocular and vertebral involvement. Characteristic findings, such as hypoplasia of one half of the face, epibulbar dermoids, ear tags, and spinal cord defects, warrant the name occulo-auriculo-vertebral dysplasia. The syndrome occurs due to imbalance in cells during the blastogenesis period of embryo formation. It is found to involve the derivatives of first and second branchial arches. The condition is apparent at birth, but the phenotype can vary greatly in its severity depending on the activation and expression of the defective gene. Reported here are detailed clinical and radiographic features of two sporadic cases of Goldenhar syndrome in young males. This work mainly highlights the various theories of etiopathogenesis as well as step-wise management protocol for patients diagnosed with the syndrome.
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Denture-induced esophageal perforation: Role of esophagogastroduodenoscopy and fully covered self-expandable metallic stent p. 72
Rajesh Sharma, Vishal Bodh, Deepika Bodh, Brij Sharma, Disha Sharma, Shaweta
DOI:10.4103/cjhr.cjhr_63_17  
Acute esophageal perforations are potentially life-threatening events that carry high morbidity and mortality rates. There has been a paradigm shift in the standard treatment of acute esophageal perforations from surgery to esophageal stents over the last two decades. We report a case of a 62-year-old male, managed successfully with fully covered esophageal stent for foreign body (denture)-induced acute esophageal perforation. The report also highlights the failure of routine radiological investigation to detect and localize denture (as dentures are made of radiolucent material).
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Isolated brain metastasis from prostate cancer: A case report p. 75
Abhijit Singh, Amit Tuli, Kim Jacob Mammen
DOI:10.4103/cjhr.cjhr_27_17  
Brain metastases arising from prostate cancer are exceedingly rare and generally occur late in the course of the disease. Most patients have widespread metastatic disease before developing brain metastases from prostate cancer. We report the case of an 80-year-old male with adenocarcinoma of the prostate presenting with isolated symptomatic brain metastasis.
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Symptomatic isolated metastasis from an asymptomatic primary tumor p. 77
Sukhdev Pandey, Amit Tuli, Kim Jacob Mammen
DOI:10.4103/cjhr.cjhr_32_17  
Renal cell carcinoma (RCC) is the second most common among all genitourinary malignancies. With the advent of radiological imaging, the presenting triad of fever, hematuria, and abdominal mass is rarely seen. Osseous metastasis of RCC is the second most frequent location after lung metastases. They rarely present as a symptomatic-isolated lesion with an asymptomatic primary tumor. We have identified an unusual facet of the metastatic pattern of this tumor in its unusual propensity to metastasize to the scapula. Scapular metastasis when present, is frequently large, and is generally not part of a picture of disseminated disease. We present a case of symptomatic metastasis with asymptomatic primary (RCC).
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Rehabilitation of maxillofacialtrauma patient with dental implants: A case report p. 80
Nitasha Gandhi, Sumir Gandhi, Nirmal Kurian, Surbhi Mehdiratta
DOI:10.4103/cjhr.cjhr_35_17  
Motor vehicle accidents are among the main etiologic factors of maxillofacial injuries. Immediate and comprehensive treatment involving multiple disciplines is needed to successfully restore the damaged hard and soft tissues and reinstate the function and esthetics. This clinical report describes the oral rehabilitation of a young patient with mid-face and mandibular fractures and extensive loss of the dentoalveolar segments in the anterior mandible as a result of a road traffic accident. The patient underwent open reduction and rigid fixation of the fractures followed by implant placement and screw retained hybrid prosthesis fabrication for replacement of missing hard and soft tissues.
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IMAGES Top

Herpes zoster ophthalmicus p. 84
Satvinder Singh Bakshi
DOI:10.4103/cjhr.cjhr_80_17  
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Extracranial meningioma presenting as infratemporal fossa mass p. 86
Reddy Ravikanth, Sunil Mathew, Vijay Kishan, Robert Patrick Selvam
DOI:10.4103/cjhr.cjhr_96_17  
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A potato nose! p. 88
Satvinder Singh Bakshi
DOI:10.4103/cjhr.cjhr_81_17  
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