Background: Thyroid hormone is a key substance in normal homeostasis, having variable influence on cell metabolism on different organs. Hypothyroidism is common, potentially serious, often clinically overlooked, readily diagnosed by laboratory testing, and eminently treatable. Aim: This study was conducted with the aim of finding the effect of regular physical exercise of medium-intensity on thyroid function in patients already undergoing treatment for hypothyroidism. Materials and Methods: A total of 20 ambulatory treated hypothyroid patients were included in the study. Serum samples were collected and evaluated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH) both before and after 3 months of daily 1 h physical exercise, from those patients doing exercise and from those who did not do any physical exercise. T-test was used to find a significant difference between the two groups. Results: Serum TSH was found to be significantly decreased in patients of regular exercise group postinterventionally (P < 0.001) when compared with nonexercise group (P = 0.43). Serum T3 and T4 were also found to be significantly raised in regular exercise group postinterventionally (P = 0.007 and P < 0.001 respectively) but not in nonexercise group (P = 0.92 and P = 0.73 respectively). On inter group comparison significant decrease in TSH was found in regular exercise group (P = 0.002) and significant increase was found in levels of T3 (P = 0.002) and T4 (P = 0.001) in regular exercise group. Mean weight was also found to be decreased in regular exercise group postinterventionally. Conclusion: Every hypothyroid patient should do regular physical exercise along with thyroxine replacement to improve thyroid function.

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Florence Nightingale, who was called as “the lady with the lamp,” by the sick and injured at Crimean war, has laid down strong foundational principles in nursing. Her multitasked role contributed significantly toward the development of nursing profession into structured institution. As an administrator, educator, researcher Nightingale's contributions moved nursing from disrespectable profession into replacing more of autonomy and evidence-based practice.

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Pleural effusion as a consequence of acute pancreatitis is transient, usually left-sided; straw colored and accounts for 1% of all the cases. Rarely, it may be right-sided and hemorrhagic causing difficulty in establishing the diagnosis, especially if the chest symptoms are disproportionately more than the abdominal symptoms. We present a case of a young alcoholic male patient with a history of inadequately treated tuberculosis in the past, who presented with massive right pleural effusion, ascites, and right hydrocele and was overtly symptomatic for 1 week before hospital admission. Evaluation of pleural fluid revealed hemorrhagic, lymphocyte predominant exudate with low Adenosine Deaminase (ADA) and high amylase level. Ascitic fluid too showed similar characteristics. His serum amylase level was also elevated which prompted us to make a clinical diagnosis of pancreatic pleural effusion with ascites. Further radiological investigations confirmed the diagnosis of acute pancreatitis. Early pleural fluid amylase testing will certainly avoid a delay in the timely diagnosis.

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Personality is the way we think, feel, perceive, and react to the external world, which has been thought of by different workers since ancient times. The number of theories itself reflects that personality is not an homogenous entity and the development of personality is biopsychosocial as viewed by psychiatrists and psychologists of different times.

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The currently available clinical antidepressants can be classified into 13 different classes based on their mechanisms of action. These basic pharmacological concepts thoroughly elucidate and unravel the therapeutic actions and side effects of the wide range of antidepressants currently available. The two classical mechanisms are exhibited by tricyclic antidepressants (TCAs) and by monoamine oxidase inhibitors (MAOIs). Regarding the 11 relatively nonclassical antidepressants, the most widely prescribed agents are the selective serotonin reuptake inhibitors (SSRIs). The mechanisms of action for the other classes of antidepressants that exhibit additional actions on serotonergic neurotransmission are dual serotonin-norepinephrine reuptake inhibition (SNRI), serotonin receptors antagonism with serotonin reuptake inhibition (SARI), serotonin 5-HT_1Aautoreceptor partial agonism with serotonin reuptake inhibition (SPARI), serotonin-norepinephrine reuptake inhibition and serotonin receptors antagonism antidepressant with potent antipsychotic D2 receptor blockade/antagonism (SNRISA with potent antipsychotic D2 receptor blockade/antagonism), norepinephrine reuptake inhibition with serotonin receptors antagonism (NRISA), noradrenergic α₂-receptor antagonism with specific serotonergic receptors-2 and-3 antagonism (NASSA), and atypical antipsychotics that exhibit weak D₂receptor antagonism with potently strong 5-HT_2Areceptor blockade. Furthermore, the two classes that exhibit selective norepinephrine reuptake inhibition (NRI) and dual norepinephrine-dopamine reuptake inhibition (NDRI) define separate novel classes of antidepressants that have a direct action on the noradrenergic neurotransmission system but have no direct action on the serotonergic neurotransmission system, while the last remaining one class of N-methyl-D-aspartate-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist also represents a separate novel class of antidepressants with a direct action on the excitatory glutamatergic neurotransmission system but no direct action on the serotonergic, noradrenergic, or dopaminergic neurotransmission systems. Lastly, this review remarkably advocates for the incorporation of the atypical antipsychotics and NMDA-glutamatergic ionoceptor antagonist/inverse agonist/partial agonist as new member classes of the antidepressant agents because of their clinically significant roles in the management of depression disorders.

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Atrial fibrillation (AF) is the most common observed arrhythmia in clinical practice. In the literature, AF events associated with drug induction are available. Cetirizine is a second-generation histamine antagonist used in the treatment of allergies, angioedema, and urticaria. We wish to present an atypical case who took cetirizine medication for relieving symptoms of upper tract respiratory system infection, experienced rapid ventricular response AF and treated successfully. To best of our knowledge, this is the first case of cetirizine-induced AF.

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Recent times have seen a shift in interest from a focus upon the deficits of individuals to a focus upon individual's strengths. Resilience is a positive psychology construct that has been investigated for decades, prior to this paradigm shift. This article reviews definitions of resilience over time. Although there is no single agreed definition; resilience is commonly described as the ability to bounce back. The risk of stress and negative life events in triggering mental illness has long been recognized. Similarly, the positive outcomes of some individuals to highly adverse situations have also been of interest for a long time. These positive responses or outcomes in the face of significant risk or adversity are generally known as resilience. This article provides a review of definitions of resilience and resilience related phenomena as well as a historical review of the focus of resilience research across the decades in order to inform future research and theorizing. The article concludes with recommendations to researchers to explicitly define their definition and conceptualization of the construct as well as the imperative to move towards a unified view of the construct of resilience. Further, it is clear that research on resilience has progressed and evolved over the decades however this does not denote that research in the area is complete. As such researchers should still seek to understand the complexities of resilience, how to build resilience in different populations, or in individuals experiencing similar adversities.

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Background: Stress is a fact of life that every human deals with on a daily basis. In the transitional nature of student life in professional courses like nursing, initial period of course is stressful and it adversely affects the emotional, physical, social, and academic functions. Even though the perception and response to stress and way of coping differs individually, it may produce questionable behavioral patterns in student nurses during the course of their study like feeling of loneliness, nervousness, sleeplessness, and worrying. Thus, the student nurse faces a lot of challenges and problems at the time of I Year. Objectives: The present study aimed to determine the level of stress and coping mechanisms adopted by I Year B.Sc. nursing students. Materials and Methods: A total of 60 I Year B.Sc. nursing students were selected by using non-probability convenient sampling technique. The tools used for data collection were perceived stress scale, structured coping scale, and socio- demographic proforma. Results: The studies revealed that majority of students (95.1%) were in the age group of 17-19 years. The results showed that only one student (1.7%) has severe stress, 46.7% has moderate stress, and remaining 51.6% has mild stress, and majority of the students (100) had average coping. There was no significant correlation (-1.167) between stress and coping mechanism of I Year B.Sc. nursing students. Conclusion: Majority of students had mild stress and average coping. The nurse administrator should plan and organize educational program for nursing students, in order to prepare them to cope up with any stressful situations. Hence, the researcher emphasizes the need for more research to improve the knowledge and by applying the research finding for future.

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Background of the study: The growing fetus depends entirely on its mother's healthy body for all needs. However, sometimes it can be a time of fear of suffering and death, in case women begin pregnancy with low or absent stores of iron because of previous pregnancy, poor iron intake, substance abuse; increased fetal demands of iron leads to iron deficiency anemia. Iron deficiency anemia is the most common form of malnutrition in the world and is the eighth leading cause of death in pregnant women in developing countries leading to the low birth weight, which is in turn an important risk factor for infant mortality. Objectives: To determine the knowledge of antenatal mothers regarding management of anemia during pregnancy. Materials and Methods: Non-experimental descriptive study was conducted to assess the knowledge of antenatal mothers from Yenepoya Medical College Hospital. A sample size consists of 50 antenatal mothers were selected through non-probability purposive sampling. The data was collected by using pretested structured knowledge questionnaire. Data was analyzed using SPSS version 16 and the results expressed as proportions. Results: The majority of the antenatal mothers (54%) had satisfactory knowledge, 38% had poor knowledge, and 8% had good knowledge regarding anemia during pregnancy. Conclusion: The overall knowledge in the study population was 29.9%. Hence, the researcher emphasizes the need for more research to improve the knowledge of antenatal mothers on anemia during pregnancy.

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Nitrobenzene, a pale yellow oily liquid with an odor of bitter almonds, is used in the synthesis of Aniline dyes, flavoring agent, and also in rubber industry. Recently it is also used as a plant growth nutrient. It causes methemoglobinemia with symptoms including headache, nausea, dizziness, fatigue, shortness of breath, cyanosis, and convulsions. Severe acute exposure to nitrobenzene can cause jaundice, renal failure, and coma, and it may be fatal. We report a case of Plant growth nutrient (nitrobenzene) poisoning with multiple complications like hemolytic anemia, renal failure, seizures, and pneumonia. Patient was managed with intravenous methylene blue along with other supportive therapy and survived. So, early aggressive management and a watch on complications might be helpful in saving patient's life from this poisoning.

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Low birth weight (LBW) is a significant public health concern at global level. LBW is the outcome of interplay of multiple maternal factors. Maternal age is an important variable leading to LBW and preterm births. The literature review was done with extensive search from Medline, the Educational Resources Information Center, and the Combined Health Information Database for publications that identified the studies related to maternal age and birth weight. With exception of few studies which concluded that age did not significantly affect birth weight of newborns, majority of research indicated that a very young maternal age is causally implicated with an increased risk of having LBW and preterm births. Little research has been conducted on births to older mothers, even though such births are becoming increasingly common in developed countries. Advancing maternal age is associated with a decreased potential for fetal growth, possibly reflecting biological aging of maternal tissues and systems or the cumulative effects of disease. Results of multivariate analysis showed a U-shaped relationship between maternal age and LBW among whites, with the youngest (younger than 15) and the oldest (aged 40 and older) mothers being at high risk than 25-29 years old; older teenagers were not at any significantly higher risk. For the black, the risk of LBW rose steeply with maternal age (mothers aged 15-19 years are significantly lower risk than those of 25-29 years for LBW infants).

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The huge burden of sickle cell disease (SCD) coupled with a correspondingly high morbidity and mortality, particularly in Sub-Saharan Africa, has made it really imperative to invest more in ways of reducing the prevalence of this disorder. The SCD genetic counseling and testing have been shown to educate individuals on SCD and also offer those at risk the opportunity of making informed decisions on marriage and pregnancy. We reviewed available data on genetic counseling and testing for SCD, using the PubMed, PubMed Central, Google Scholar, and African Index Medicus search engines, through a combination of words and phrases relevant to the subject and attempted to highlight how this can be better applied in a resource-poor setting such as Nigeria, with a huge disease burden. More advanced countries with significant population of patients with SCD and other hemoglobinopathies have evolved functional genetic and counseling protocols, with remarkable impacts on disease epidemiology; this feat however does not appear to be replicated in a number of African countries. This paper reviewed genetic counseling and testing for SCD in countries with high disease burden, with particular emphasis on Nigeria, which has a disease prevalence and carrier rate of 2-3% and 20-30%, respectively.

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Background: In health-care services, when bare upper arm blood pressure (BP) measurement is impractical, the forearm may be used as a surrogate for traditional upper arm BP. Objective: This exploratory study aimed to determine the significant difference and correlation between the upper versus forearm BP measurements among low-risk prenatal women. SMaterials and Methods: A total of 156 low-risk prenatal women in the third trimester of pregnancy attending antenatal clinics at Municipal Maternity Corporation Hospitals, Bengaluru, were recruited by purposive sampling. Upper and forearm noninvasive BP (NIBP) measurements obtained by mercury sphygmomanometer, thrice at an interval of 15 min were averaged. The main outcome measures were the significant difference and correlation between the upper arm and forearm BP measurements. Results: The mean systolic BP (SBP) (117.14 ± 3.041 mmHg) and diastolic BP (DBP) (69.31 ± 8.461 mmHg) in the forearm was significantly higher than the upper arm SBP (111.72 ± 5.53; P = 0.002) and DBP (61.46 ± 6.014 mmHg; P = 0.016). The mean difference in SBP between upper and forearm was 5.42 ± 2.016 mmHg and in DBP 7.85 ± 3.204 mmHg. Upper versus forearm BP measurements had revealed a significant positive linear correlation in SBP (r = 0.849; P = 0.013) and DBP (r = 0.816; P = 0.021) by Pearson product-moment correlation coefficient. Clinically 94 (72.31%) had a significant BP measurements difference in forearm versus upper arm by approximately 6–10 mmHg. None of the maternal characteristics were independent predictors for the mean difference in SBP and DBP measurement. Conclusion: Forearm NIBP measurements are higher than the BP obtained at the upper arm location. This must be taken into consideration whenever the forearm is used as an alternative site for the upper arm BP.

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Background and Objectives: The husk fibers of coconut (Cocos nucifera) are reported to be used by people of rural areas of South India for daily cleaning their teeth. As the beneficial effects of this plant material, with respect to antimicrobial properties against common cariogenic bacteria, are not scientifically proven, the present study was conducted. Materials and Methods: The husk of coconut was collected and aqueous extract was prepared and antimicrobial properties against common oral pathogens like Streptococcus mutans, Streptococcus salivarius, Streptococcus mitis, and Lactobacillus acidophilus were performed by agar well diffusion method. The values obtained were then subjected to statistical analysis using one way ANOVA and Tukey HSD. Results: Aqueous extract of coconut husk showed a concentration-dependent antimicrobial activity against different tested organisms with zone of inhibition ranging from 4.44 to 15.33 mms. However, the efficacy was less in comparison to chlorhexidine. Conclusion: Inhibitory action against cariogenic bacteria exhibited by aqueous extract of coconut husk indicate presence of highly effective active compounds in these extracts, which can be identified and incorporated into modern oral care systems for controlling dental caries.

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Emotional well-being is a state of positive mental health where the individual is able to handle his emotions and all life activities. He understands his emotions, learns, and copes with all the negative situations, achieves, and finds a positive emotional state which finally leads to success. Covid-19 is a disease caused by newly discovered novel corona virus. The outbreak came to light in December 2019 with the emergence of unexplained fever and pneumonia. In the next few months, the disease spread to various countries worldwide and turned into a pandemic. Governments around the world took drastic measures to control the pandemic and safeguard the citizens. Strict isolation, quarantine, and lockdowns were introduced. People were confined to their home for multiple days which led to intense mental stress. Day-to-day activities were disturbed, and people also suffered huge-economic losses. With the reduction in interpersonal contact and social activities, various psychological problems have emerged and suicides are being reported. Health-care personnel went through great stress and sleepless nights in taking care of the Covid-19 patients. In times of these stressful situations, the mental health awareness can play a crucial role. Simple behavior changes and mindfulness can make significant changes toward positive mental health. The maintenance of proper mental hygiene and regular support from mental health-care workers played a significant role in this regard. However, routine personal health care became less accessible to the general public during the pandemic. This has paved the way for the development of digital psychiatry. Thus, we bring out this review to provide an overview of the emotional well-being, mental health awareness of people during lockdown, prevention of suicide, and emergence of digital psychiatry during Covid-19 pandemic.

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India has nearly 120 million elderly people with various physical, psychosocial, economic, and spiritual problems. While the functionally and cognitively fit can access usual health-care facilities provided by the government, these people need active aging program to keep them independent. Health ministry has created geriatric centers and geriatric clinics in most of the states; however, these centers may not serve the functionally and cognitively impaired elderly. There is great need for mobile units, day-care centers and hospices, and need for training of personnel in home nursing. Routine care clinics cannot handle the burden of geriatric population to address their multimorbidity and several other age-related problems. There is a need for a rapid training of health-care professionals of various disciplines in geriatric care. Government must support nongovernmental organizations and other agencies which provide day care, home care, and palliative care so that these services become affordable to all the elderly.

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Metopic suture is a dense fibrous joint extending from the nasion to the bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. A rare case of persistent metopic suture in a 60-year-old male is documented, who committed suicide by alleged consumption of organophosphorous compound at District Govt. Wenlock Hospital, Mangalore, Karnataka, India. Metopic suture may mimic skull fracture and may mislead an inexperienced forensic expert. Neurosurgeon should also be aware of this anatomical variation while performing frontal craniotomy, as the persistent metopic suture may mimic vertical fracture of the skull. Hence, in this case report, the clinical and medico-legal implications of the persistent metopic sutures have been discussed.

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Context: Stress in medical education is common and process-oriented. It often exerts a negative effect on their academic performance, physical health, and psychological well being. Aims: This study aims at identification of such susceptible students in the early stage i.e. first year of medical education, and to provide them essential support in the form of an intervention program to lessen the negative consequences of stress. Materials and Methods: A cross-sectional survey was carried out among the First MBBS students of NKP Salve Institute of Medical Sciences and Research Center, Nagpur, India. A 41-item questionnaire was designed to assess the sources of stress and their severity. Likert's 5-point scale was used to quantify the extent of severity on each item. Coping strategies adopted by students were assessed by using a 22-item stress inventory, and a questionnaire based on 19 institutional stress-reducing factors was used to identify its role. Results: The survey resulted into an overall response rate of 87% (131 out of 150 students). Median stress level based on 41 items was evaluated for each student. About 29% (40 students) had median stress level greater than 3. Female students were more stressed (17.19%) than male students (14.93%). The study revealed that students generally adopt active coping strategies rather than avoidant strategies like alcohol and drug abuse. The study indicated that emotional support system is a major stress-relieving factor for students. Conclusion: Prevalence of perceived stress is high among medical students. It seems that academic-related problems are greater perceived stressors. Review of academics, exam schedules and patterns, better interaction with the faculty and proper guidance, intervention programs and counseling could certainly help a lot to reduce stress in medical students.

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Background and Purpose: The modified functional reach test (MFRT) is the objective measure for dynamic sitting balance. It quantifies sitting balance in two directions: Forward and lateral reach. So, the purpose of the study was to 1) provide clinical reference value and 2) examine the factors that may influence the anthropometrics measures. Materials and Methods: A total of 200 apparently healthy subjects participated in this descriptive study. All subjects were divided in two groups: Younger (20-39 yr) and middle-aged (40-59 yr). After anthropometric measurement, all subjects performed test by reaching forward and lateral with a closed fist while sitting. MFRT was taken with 3 trials with 15 sec break in between. Results: The mean score of the forward and lateral reach of right and left in group 1 was higher compared to group 2. The normative value of forward reach in group 1 was 34.05 ± 9.03 cm; for lateral reach right and left, it was 18.2 ± 5.26 cm and 17.32 ± 5.21 cm, respectively. For group 2, normative values for forward reach, lateral right and left were 25.18 ± 5.71 cm, 14.02 ± 3.98 cm and 13.53 ± 4.25 cm, respectively. There was no significant correlation of forward and lateral reach measures with the anthropometric characteristics in both the groups, except trunk length and BMI in group 1, which was significantly correlated ( P < 0.001). Conclusion: This study provides clinical reference value for younger and middle age group subjects while anthropometrics do not affect performance except trunk length and BMI in younger age group.

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This article aims at giving a broad overview on competency-based education to those who are currently in the predominantly knowledge focused discipline-based curriculum and so are uninitiated to the competency-based educational paradigm. This is done by taking them through the curricular trends in medical education that have happened elsewhere in the world and providing them with a gist of what is competency-based medical education, how it is different from the earlier paradigms of instruction, the advantages that this paradigm of mastery learning presents to help the learner acquire competencies needed for doing the professional tasks and duties that are in alignment with health needs of the country, the framework and the broad steps involved in its implementation, the challenges that its implementation presents particularly with regard to benchmarking for assessment as revealed by the experiences in the Western world that resulted in a three-decade lag between intention to change and actual change and the way forward to overcome these challenges particularly through faculty capacity-building using longitudinal faculty development programs or series of faculty retreats to ensure that it can be successfully implemented and sustained to serve the purpose of producing job-ready professionals.

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B12 deficiency is extremely common in India as is Vitamin D, folic acid, or iron deficiency, all because malnutrition is extremely common, even among the rich. The reasons for these are too many and are related to diet, lifestyle, and social and cultural issues. Any one of its varied manifestations can occur in isolation and can be coexisting with other comorbidities. In addition, the symptoms are modified also by the underlying disorder causing its deficiency. In spite of being a common disorder, its recognition is delayed or missed because the manifestations are diverse in nature, affecting all the organs and systems, and is often subclinical. To add to the confusion, laboratory estimations are notoriously unreliable even from the best of centers and doctors tend to rely on laboratory estimate of B12 levels. In this scenario, the doctors in India have to sharpen clinical skill to make a clinical judgment and initiate therapy and advocate a diet plan to give benefit to the patient. The ways and means of picking up those with clinical or subclinical B12 deficiency and the reasons and solutions to the problem are discussed in this article.

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The nasoalveolar molding (NAM) technique is a new approach to presurgical infant orthopedics that reduces the severity of the initial cleft alveolar and nasal deformity. This technique facilitates the primary surgical repair of the nose and lip to heal under minimal tension, thereby reducing scar formation and improving the esthetic result. NAM technique is the nonsurgical, passive method of bringing the gum and lip together by redirecting the forces of natural growth. NAM has proved to be an effective adjunctive therapy for reducing hard and soft tissue cleft deformity before surgery. This paper reviews the basic principles of NAM therapy, various types of appliances used in this therapy, protocol followed, and a critical evaluation of the advantages and disadvantages of this technique. Universally authors have agreed the positive outcome of NAM for better esthetics after cleft lip and palate (CLP) repair, but the long-term effects of this therapy are yet to be substantiated. Despite a relative paucity of high-level evidence, NAM appears to be a promising technique that deserves further research.

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