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   Table of Contents - Current issue
Coverpage
October-December 2020
Volume 10 | Issue 4
Page Nos. 171-239

Online since Tuesday, October 27, 2020

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REVIEW ARTICLES  

Emerging Pharmacotherapy for COVID-19 Treatment: An Integrative Review p. 171
Deepa Shaji Thomas, Divya K Yesodharan, Judie Arulappan
DOI:10.4103/ijnpnd.ijnpnd_52_20  
Background: COVID-19 has become the global pandemic incapacitating the health systems and demanding investigation of possible pharmacotherapeutic options against SARS CoV-2. Although social distancing, hand sanitizing and supportive care remain as the preventive and management measures of COVID-19, clinical efficacy of various therapeutic agents is being tried out simultaneously to reduce the mortality associated with the disease. Objective: To ascertain the potential drugs/treatment for COVID 19 from the published literature across the world from its origin until June 2020. Methods: A literature search was done in CINAHL, Pub Med, Google Scholar, Science Direct, Springer, Wiley, EEEE, and Medline computerized repositories for complete texts from December 2019 until June 2020. The search terms used were COVID-19, treatment, antimalarial, antibiotics, antiretroviral, antiviral, plasma, immunoglobulin, heparin and immunosuppressant. The inclusion criteria adopted in the study were original research articles with current treatment process and potential drugs used in COVID 19 patients, primary data, published in English and full article available for free download. Results: There is no absolute single pharmacotherapeutic measure identified till date to cure this disease. The studies reviewed reported that the clinical improvement of the disease could be due to the result of other supportive measures and the results are inconclusive as the disease is impacted by various coexisting medical conditions. More clinical trials at large scales are needed to tackle this crisis at the earliest. Conclusion: Inventing a new vaccine or drug against coronavirus may take years to fully develop. However, clinicians are trying to treat this disease with already prescribed drugs for other diseases like H1N1, malaria, HIV, and SARS. It is important to note that there may be emergence of new clinical characteristics, treatment trials and outcome of COVID-19 as the disease evolves.
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Migraine: Update and Future Perspectives p. 179
Anne S.T. Sahithi, T. Muthu, Radha Saraswathy
DOI:10.4103/ijnpnd.ijnpnd_26_20  
Migraine is a disease known as polyneuropathy, which is intolerable to the sufferer, family and community. Persistent headaches mark this condition in patients with migraine. The primary focus of this review article is to summarise the current findings of the migraine epidemiology, prevalence, neuroimaging tools, risk factors and prospects. Currently, a rise in migraine cases has been reported for persons of age between 25 and 55 years. A rapid increase in migraine cases was reported for people having lower socioeconomic status. Patients with migraine have shown an increase in the incidence of mental illness and co-morbidity. These patients are diagnosed using various neuroimaging tools such as (a) computerized tomography (CT), (b) magnetic resonance imaging (MRI), (c) functional (fMRI), (d) PET (Positron Emission Tomography), (e) SPECT (Single-Photon Emission Computed Tomography), (f) CEPs (Cortical Evoked Potentials), (g) MEG (Magnetoencephalography), and (h) Diffusion Tensor Imaging (DTI). In clinical practice, Headache Impact Test (HIT-6 ™) is used to measure the pain impact in patients with migraine. Precipitating factors such as (a) caffeine, (b) sleep apnea, (c) sleep deprivation, (d) stress, and (e) depression that cause migraine have been discussed in detail. The prospects for the future research have been discussed based on (a) Pain and psychological factors, (b) cognitive techniques, (c) new developments in treatment, and (d) neuromodulation. In this review, it is concluded with the possibility of reducing the progression of migraine disease through pathopsychological knowledge. Also, the progression can be reduced by implementing high research standards in clinical studies.
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ORIGINAL ARTICLES Top

Appropriateness of Electroencephalographic Referrals in a Tertiary Care Psychiatric Hospital: Retrospective Study from Oman p. 188
Said Al-Kaabi, Salim Al-Huseini, Bader AL-Habsi, Naser Al Balushi, Mohammed Al-Ruzaiqi, Alia Al-Wahibi, Shadha Al-Ghammari, Nasser Al-Sibani, Samir Al-Adawi
DOI:10.4103/ijnpnd.ijnpnd_85_20  
Objective: To investigate whether electroencephalogram (EEG) requests at a psychiatric tertiary care center in urban Oman are being made according to guidelines for best practice. Methods: This study was carried out at a psychiatry tertiary care hospital in Muscat providing the most comprehensive psychiatric service in the country. Cases were examined retrospectively for11months from January to December 2018. Relevant information was recorded on a proforma prepared for this study. The request was judged as being appropriate or otherwise according to international best practice. Results: During the study period, 421 patients were referred to the EEG laboratory. Approximately 71% of them were males and 29% were females. Approximately 94% of EEG results were deemed as being normal. In terms of appropriateness of requesting EEG, only 5% of the requests were considered “appropriate” according to the guidelines. The factors associated with the appropriateness of requests included age, abnormality in EEG, and the reason given for the request. Conclusions: The majority of EEG referrals were not being made per guidelines. More studies are needed to uncover and examine the factors contributing to the overprescription of EEG among physicians in Oman. Educating the physicians on the judicious use of EEG is therefore warranted.
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Protective Effects of Flavonols From Crataegus Oxycantha Against Inflammatory Markers of Atherosclerosis: A Structure Based, Molecular Docking And Dynamics Studies p. 194
Arul Salomee Kamalabai Ravindran, Muthuswamy Anusuyadevi, Swaminathan K Jayachandran
DOI:10.4103/ijnpnd.ijnpnd_73_20  
Coronary atherosclerosis is a life-threatening chronic disease that occurs in the arteries of the heart. The disease builds-up by various processes in a series that are hyperlipidemia, endothelial dysfunction, inflammation, LDL deposition and modification to OxLDL, macrophage infiltration all together known as plaque deposition, followed by foam cell formation, leading to plaque rupture and finally thrombosis which results in a complete blockage of blood flow. Among all the above, inflammation is the key event in the pathogenesis of atherosclerosis. TNF-α and IL-6, the known inflammatory markers are reported to be the key initiators and developers of plaque. Therefore this study aimed to find out the best blockers for these inflammatory markers by in-silico molecular docking and dynamic studies, using Maestro (Schrödinger). The blockers used in this study are the active secondary metabolites from Crataegus oxycantha, a well-known cardioprotective plant with numerous medicinal properties. The overall in-silico outcomes reported that a secondary metabolite Epicatechin gallate can be one of the best agents to minimize inflammation by inhibiting these inflammatory markers. Therefore these results should be further taken for experimental studies to prove the efficacy of Epicatechin gallate as a drug that can minimize inflammation and reduce Myocardial infarction complications.
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Determinants of Compliance with Iron Supplementation Among Pregnant Women in a Tertiary Care Hospital in Oman p. 203
Esra M Alkhasawneh, Vidya Seshan, Judie Arulappan, Savithri Raman
DOI:10.4103/ijnpnd.ijnpnd_57_20  
Introduction: Anemia in pregnancy is one of the most common widespread public health problems in the world and it remains as emerging problem in the developing countries and is an important indicator for maternal mortality and morbidity in the Middle East. Objective: This study aimed to determine the level of compliance with iron supplementation and its determinants among pregnant women. Methods: The study adopted a descriptive cross-sectional research design. Noronha compliance questionnaire was used to determine the level of compliance to iron supplementation and its determinants. One hundred and sixty five Omani pregnant women of 20 weeks of gestation and above visiting antenatal outpatient department were the participants of the study. Descriptive and inferential statistics were used to analyze the data. Results: The results showed that 72.7% of the women were compliant and 27.3% of them were non-compliant to iron supplementation. A chi-square test showed that there was a significant relationship between side effect and non-compliance to iron supplementation X2 (1, N = 165) = 6.53, P < 0.05. Results of Logistic regression analysis showed that side effects of iron supplementation significantly predicted the non-compliance to iron supplementation b = −1.76, Wald X2 (165) = 8.36, P < 0.05. Conclusion: Increasing awareness among the pregnant women on the importance of iron supplementation during pregnancy is essential to expect desirable outcomes in both the mother and the newborn.
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Evaluation of Functional Quality of Indian Dosa Batter Prepared Using Different Processed Rice and Horse Gram p. 210
V. Snehal, S. Karthikeyan, G. Nagamaniammai
DOI:10.4103/ijnpnd.ijnpnd_80_20  
Context: In recent days, functionally developed foods seem to show a higher range of activity towards a given target and have sparked avid interest among the customers consuming such products. The increased importance given to such products has come with an increase in the need for adequate nutrition to maintain the balance between health, mental development, and productivity. Aim: To enhance the nutritional profile of dosa batter with an optimal study on raw source materials like raw rice, cooked rice, rice soaked overnight, and horse gram. Settings and Design: Base ingredient of dosa batter, i.e. cooked rice was replaced based on products suggested by several optimization studies on processed rice and horse gram. Protein quality can be enhanced using a combination of cereals over legumes. Methods and Materials: The physico-chemical properties and proximate composition of the dosa batter were calculated by standard methods. The final product was assesed based on its physical properties like pH, color, texture, and its proximate composition. Results: Textural studies of optimized dosa batter show 18.5% of variation when compare to controls. Microbial studies were carried out using dosa batter. The hardness of the control dosa batter was 46.24 g while that of other combinations lies between 41 g to 45 g. Overnight soaked rice sample formation batter possesses a good level of softness when compared to the control sample. The presence of lactic acid bacteria (LAB) in all the four forms of batter was revealed from microbial analysis like gram staining followed by the catalase test. The total aerobic bacterial count in all the four formulations tends to increase in 16 hours. Conclusions: The present study reveals the incorporation of horse gram & fenugreek in dosa batter formulation significantly rising it the nutritional profile. Optimization studies reveals the potential activity starch from varying source also contributing in rising up the nutritional facts in prepared dosa batter.
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Effect of Isolated and Combined Training of Aerobic and Yoga on Creatine Kinase Among Sports Women p. 218
Vasudevan Shelvam, Aljinroy
DOI:10.4103/ijnpnd.ijnpnd_77_20  
Aims: To find out the effect of isolated and combined training of aerobic and yoga on creatine kinase among sports women. Methods: Creatine kinase (CK) is a protein that is found almost exclusively in muscle tissue. When skeletal muscle damage or disruption of muscle fibre occurs as a result of acute exercise, CK gets leaked into the blood stream. Hence it is considered as the most common plasma marker of muscle damage. Sixty female students (age between 18 to 25 years) were selected as subjects from various departments of Annamalai University, India to participate in this study. They were divided into four equal groups, group I underwent aerobic training, group II underwent yogic training, group III underwent combined training and group IV acted as control (who did not participate in any special training apart from their routine activities). The subjects were tested on selected criterion variable such as creatine kinase prior to and immediately after the training period. Results: The study indicates that there is a significant difference among aerobic, yoga, combined training groups and control group. Conclusion: There is a significant difference among the experimental and control group on the activities of CK, which confirms that the skeletal damage or disruption of muscle fibre happening in subjects recruited in our study.
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Home Based Food Supplemented With RUTF (Ready To Use Therapeutic Food) Versus Only Home Based Food for Post Discharge Rehabilitation Phase Weight Gain in Children with Severe Acute Malnutrition p. 223
Ghosha Nilesh Pandav, Qury M Nagadia, Priyanka R Solanki, Rashmi S Thanvi, Nidhi P Dhamecha, Nehal H Patel
DOI:10.4103/ijnpnd.ijnpnd_53_20  
Background: Weight gain in patients of Severe Acute Malnutrition(SAM) after discharge from child malnutrition treatment centre (CMTC) is generally not satisfactory(<5gm/kg/day) on Home-based food alone. Aim: To compare post discharge weight gain in SAM patients gradually shifted from Ready To Use Therapeutic Food to home based food with those started directly on home based food. Materials and Methods: Sixty four children with SAM were included in study. The case group was given RUTF to be consumed at home along with other home based food while for control group only home based food was advised. In both the groups patients were followed up regularly every fortnight for three visits. Their weight, Height, Mid upper arm circumference(MUAC) and Z score were monitored in each visit. The difference in weight gain in both the groups was analysed using unpaired t test. Results: Thirty two children each in both case and control group were included. Rate of weight gain in case group was 2.08gms/kg/day while in the control group was 1.6gms/kg/day. The difference was statistically not significant. But age wise subgroup analysis showed that in toddler group weight gain in case group was 2.37gms/kg/day while in control was 1.13gm/kg/day, which is statistically significant (P<0.05). Conclusion: Introduction of RUTF as supplement to home based food significantly improves post discharge weight gain in toddler age group.
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Coronavirus Disease 2019 (COVID-19) and Vitamin D Status: Is there any Opportunity for Intervention? p. 229
Rizaldy Taslim Pinzon, Winny Frida, Vincent Ongko Wijaya, Dessy Paramitha, Patrick Nalla Nunsio, Abraham Al Jody
DOI:10.4103/ijnpnd.ijnpnd_48_20  
Background and Aim: Coronavirus disease 2019 (COVID-19) is a newly emerging infectious disease that has affected every aspect of life in many countries. Previous studies suggested that the role of vitamin D in the immune system has certain significances in managing COVID-19 patients. This study aims to report the level of vitamin D in COVID-19 patients. Methods: We collected a series of confirmed cases from period of March through May 2020. The data collected including clinical symptoms, clinical signs, and laboratory examinations from 10 COVID-19 patients in Bethesda Hospital, Yogyakarta, Indonesia. This study used ELFA (enzyme-linked fluorescent assay) to measure vitamin D levels in serum or plasma. The collected data was analysed descriptively. Results: This study examined 10 patients with mean age of 49.6, ranging from 14 to 73 years old and most common age group was <60 years (60%). The gender ratio was equal between men and women (50:50). Most common symptoms were fatigue (60%) and fever (50%), whereas hypertension (40%) was the most common comorbidity. Most of patients (90%) had vitamin D deficiency (<20 ng/mL) and only 1 patient (10%) had insufficient vitamin D levels (<30 ng/mL). Conclusion: All of the COVID-19 patients in this study had suffered a decreased vitamin D levels, and more common in non-elderly patients. This is a novel findings of vitamin D deficiency in COVID-19 and has not been reported yet. Physicians should be aware in managing COVID-19 patients, especially the risk of vitamin D deficiency.
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CASE REPORT Top

Nursing Care of a Women with Myasthenia Gravis During Pregnancy − A Case Report p. 235
Sophia Cyril Vincent, Judie Arulappan, Harshita Prabhakaran, Wafaa S Al Hasani
DOI:10.4103/ijnpnd.ijnpnd_51_20  
Background: Myasthenia gravis may be of special concern during pregnancy. The major complications include the Myasthenia crisis and respiratory failure. However, it can lead to preterm labor, difficult delivery and baby may be born with myasthenia gravis. Purpose: The purpose of this paper is to enlighten the progress and nursing care of woman who survived with Myasthenia gravis during pregnancy. The authors also have described the outcome of both the mother and the newborn. Methods: Case analysis was done to evaluate the progress of pregnant woman with myasthenia gravis. The informed consent was obtained from the woman and permission was sought to publish the details without disclosing the personal information. Conclusion: The case presented here has significant clinical interest as it is a rare case. A multidisciplinary team approach is required to manage Myasthenia gravis during pregnancy.
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