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   Table of Contents - Current issue
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May-August 2020
Volume 47 | Issue 2
Page Nos. 59-137

Online since Friday, September 11, 2020

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EDITORIAL  

Corona virus disease-2019 infection: Prevention and control Highly accessed article p. 59
Gajanan S Gaude
DOI:10.4103/jss.JSS_51_20  
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REVIEW ARTICLE Top

Otorhinolaryngological manifestations in COVID-19 infections: An early indicator for isolating the positive cases p. 63
Santosh Kumar Swain, Satyabrata Acharya, Nibi Sahajan
DOI:10.4103/jss.JSS_57_20  
COVID-19 is an infectious respiratory disease caused by a novel virus severe acute respiratory syndrome corona virus 2. Clinical manifestations of COVID-19 range from asymptomatic or flue such as symptoms to severe dyspnea or breathlessness. The combination of the symptoms such as anosmia, persistent cough, fever, fatigue, diarrhea, abdominal pain, and lack of appetite are commonly found in CVOID-19 patients. The symptomatology due to otorhinolaryngological manifestations is often by respiratory tract infections and predominantly found for consultation at otorhinolaryngology clinic. Otorhinolaryngological manifestations are usually associated with aerosol producing symptoms and so highly contagious in very short period. It is need to identify the patient with symptoms and rightly pinpoint to infect individuals. This review article focuses on the otorhinolaryngological manifestations and its implications in early transmission of the COVID-19 along with the preventions. This article will surely increase awareness among the frontliner clinicians and help them to protect themselves along with early suspicion of cases before spreading the diseases to community.
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ORIGINAL ARTICLES Top

Evaluation of the relationship between serum level of Vitamin D and decayed, missing, and filled teeth (DMFT) in young women in Semnan, Iran (2018–2019) p. 69
Maryam Jalili Sadrabad, Shabnam Sohanian
DOI:10.4103/jss.JSS_14_20  
Introduction: Previous studies have shown that Vitamin D has an effect on calcium absorption, mineralization, and dentin formation and also on the maturation and formation of developing teeth, but the aim of this study was to evaluate the relationship between serum level of Vitamin D and Decayed, Missing, and Filled Teeth (DMFT) in adult patients with developed teeth. Materials and Methods: In this descriptive, cross-sectional study, 200 women with the age range of 15–40 years who referred to the Semnan Dental School in 2018–2019 and satisfied the inclusion and exclusion criteria were selected randomly. Then, DMFT, Plaque Index (PI) and SI index, age, the history and recent Vitamin D deficiency, and the history of xerostomia in patients were studied and statistically analyzed. Results: Only 4 (2%) of the women had a DMFT index score of 10 and 78 (39%) had a score of 3 and 4, respectively. Most patients were aged 30 years and younger (64.5%) and most of them (90.5%) had no previous history of Vitamin D deficiency and only eight patients (4%) had xerostomia. More than half of the individuals (54%) had some degree of recent Vitamin D deficiency. More than half of the women had PI grade 3 (54%) and 82 individuals (41%) had high blood sugar levels. According to Spearman's results, there was a moderate and negative correlation between DMFT and Vitamin D levels. Conclusion: Therefore, the lower the level of Vitamin D, the higher the DMFT index by excluding other caries-causing factors. Consequently, it is recommended that this is considered in high-risk groups in order to prevent oral health problems.
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Vertigo in children: Our experiences at a tertiary care teaching hospital of eastern India p. 74
Santosh Kumar Swain, Sampada Munjal, Nibi Shajahan
DOI:10.4103/jss.JSS_20_20  
Objective: The aim of this study is to evaluate the vertigo among pediatric age presenting to the vertigo clinic at the department of otorhinolaryngology of a tertiary care teaching hospital. Materials and Methods: Patient records of 108 children under the age of 18 years with vertigo as the chief complaint examined at vertigo clinic, the department of otorhinolaryngology of tertiary care teaching hospital between January 2015 and March 2020. All the data were retrospectively reviewed. The clinical presentations, laboratory tests including audiological and vestibular tests were analyzed. Results: This study consisted 108 children with 66 girls (61.11%) and 42 boys (38.88%) between the age of 4 and 18 years (mean age, 12.4 years). The most common etiology for pediatric vertigo in this study was vestibular migraine (VM) followed by benign paroxysmal vertigo of children and vestibular neuritis. The duration of vertigo attacks occurred in seconds in 29 children (26.85%), min in 45 children (41.66%), hours in 27 children (25%), and more than 24 h in 7 children (6.48%). Conclusion: VM was found to be a more common diagnosis in pediatric vertigo, although several peripheral vestibular causes were diagnosed. Proper evaluation of vertigo in children should be done with thorough neuro-otologic examination. Other multidisciplinary team members should be there during evaluation of vertigo in children to avoid unnecessary delay in diagnosis and treatment.
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Factors associated with case fatality in COVID-19 p. 79
Aastha Poddar, Abhishek Gogate, Anusha S Kumbar, Kurt Cordeiro Sydney Francis, Jayaprakash Appajigol, Shivalingappa B Javali
DOI:10.4103/jss.JSS_45_20  
Introduction: The ability of the novel coronavirus SARS-CoV-2 to selectively target high-income countries, has puzzled many epidemiologists. Several possible protective factors such as Bacillus Calmette–Guérin (BCG) vaccine coverage, higher environmental temperature, higher proportion of the younger population, prevalence of hypertension (HTN), diabetes, and smoking have been suggested. This study aims at understanding the influence of each of these factors on case fatality rate due to COVID-19. Methods: We selected two or more countries in each geographical region, which were severely affected by SARS-CoV-2 infections. Case fatality rate for each country was calculated obtaining data on the number of cases and deaths in each country. The details of coverage of BCG vaccination, prevalence of HTN and diabetes, age structure of the population, and average maximum and minimum temperatures during February and March months of 2020, and prevalence of smoking for each country were taken from the World Health Organization and other standard databases till May 9, 2020. Statistical analysis was done using Karl Pearson's correlation and multiple linear regression model. Results: Case fatality rate was negatively correlated with BCG coverage of the country, percentage of population below 14 years age and average maximum temperatures. Conclusions: Environmental temperature, wider BCG coverage, and higher proportion of the younger population in middle- and low-income countries might have played a protective role against COVID-19.
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Protocols for moderate-intensity and vigorous-intensity exercise for undergraduate practical teaching p. 85
Himel Mondal, Shaikat Mondal, Debasish Das
DOI:10.4103/jss.JSS_25_20  
Background: In academic teaching, we need exercise protocols with moderate and vigorous intensity for observing cardiorespiratory changes in different grades of exercise. Aim: We aimed to formulate exercise protocols with moderate- and vigorous-intensity for apparently healthy adult subjects for undergraduate practical teaching to be used in the observation of cardiorespiratory changes in different grades of exercise. Methods: We hypothesized that 50 m brisk walking (to and fro, four times in a clinical physiology classroom) is moderate-intensity exercise and spot jogging with full effort and verbal encouragement for 1 min is vigorous-intensity exercise. We measured heart rate (HR) immediately after moderate-intensity and vigorous-intensity exercise and compared it with the standards where attainment of 50%–70% of maximum achievable HR (HRmax) is moderate-intensity exercise and 71%–85% of HRmaxis vigorous-intensity exercise. Results: Data of 85 participants (male = 59, female = 26) with mean age 19.56 ± 1.13 years were analyzed. The percentage of HRmaxachieved in the moderate-intensity exercise was 58.19 ± 7.55, and vigorous-intensity exercise was 78.19 ± 8.48. About 85.88% of participants were within 50%–70% of HRmaxin the moderate-intensity exercise and 72.94% of participants were within 71%–85% of HRmaxin the vigorous-intensity exercise. Conclusion: A brisk walking for a distance of 50 m can be considered as moderate-intensity and a spot jogging with full effort for 1 min can be considered as a vigorous-intensity exercise for observing cardiovascular changes in different grades of exercise. These protocols can be used for physiology practical teaching in a small practice room without using any instrument in resource-limited settings.
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Emotional intelligence among schoolteachers in rural Karnataka – A cross-sectional study p. 89
Deepika Nagaraj, Naveen Ramesh
DOI:10.4103/jss.JSS_22_20  
Introduction: Teachers are fundamental in the educational process and play an essential role in molding the next generation. Schoolteachers handle children coming from various backgrounds, and hence, it necessitates that they develop the kind of emotional intelligence (EI) which is required to deal with these complexities. Aims: The aim of the study was to assess the EI among the schoolteachers and its association with sociodemographic factors. Methodology: This was an exploratory descriptive cross-sectional study. One hundred and two teachers who met the inclusion criteria of having work experience of more than a year in the selected three schools were included in the study. The EI was assessed using the leadership toolkit EI questionnaire. The data were entered in Microsoft Excel and were analyzed using the Statistical Package for the Social Sciences (SPSS) (SPSS version 16). Results: Among the 102 teachers, 35 (34.3%) teachers were in the age group of 21–33 years, 72 (70.6%) teachers were female, 61 (59.8%) teachers had work experience of more than 5 years, and 68 (66.7%) were permanent employees. Female teachers had better EI compared to males, and this was statistically significant with P < 0.05. Conclusions: More than half of the teachers had “strength” with regard to self-awareness, motivating oneself, empathy, and social skills except managing emotions. Female teachers had significantly higher EI scores compared to males. There was no statistical significance between age, marital status, years of experience, duration of work in the present school, nature of employment, and EI.
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Nepalese women's cultural beliefs and practices regarding postpartum period p. 93
Prayag Raj Joshi, Ram Krishna Maharjan, Chandara Kala Dawadi
DOI:10.4103/jss.JSS_31_20  
Introduction: This study is carried out to assess the postnatal traditional beliefs and practices among women of Bajhang district. Postpartum is an hour after the delivery of the placenta and the following 6 weeks. Methodology: An Explanatory Sequential Mixed Method was carried out in Jayaprithvi municipality, Bajhang district. A self administrative questionnaire was the data collection tool, and all women (124 women) having children below 2 years of age and residing in those areas were selected using the census sampling method from randomly selected wards for the quantitative survey. For the qualitative part, 21 young women, who had delivered at least one live baby, were selected purposively. The focus group discussion (FGD) was used as the data collection tool. Results: The findings show that postnatal practices are being influenced by several cultural beliefs and practices transmitted from generation to generation. Most of the practices were harmful to health; however, some traditional practices were beneficial to the mother and baby. Discussion: It is essential for planning and implementing health education programs for these women to be aware of beneficial and harmless practices and try to use scientific knowledge as a mean of eradication of the harmful ones. In the same way. Conclusion: Socio cultural practices need to be promoted, and some certain traditional medicines that have been used in society since ancient times should be identified and uplifted to improve the maternal and neonatal survival rates in Nepal, For this, maternity care providers must partner with local women and provide locally based primary maternity care. It can be recommended that future research should emphasize the in-depth study of cultural beliefs and practices and associated spiritual belief.
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Principal components analysis of educational resources usage among undergraduate medical students during the COVID-19 pandemic in Southern Haryana, India p. 99
Avinash Surana, Ram Kumar Panika, Vikas Gupta, Abhishek Singh
DOI:10.4103/jss.JSS_41_20  
Background: The year 2019–2020 has seen worldwide pandemic resulting from COVID-19 which posed the closure of teaching institutions including medical colleges and have put the students in dilemma. Aim: The present study was conducted with the aim to evaluate the accessible and preferable educational resources among medical students during this pandemic phase. Materials and Methods: This web-based cross-sectional study was conducted among 392 undergraduate medical students after obtaining informed consent during April 2020 using a 24-item structured questionnaire with close-ended responses. Existence of clustering within the student's preferred educational resources was investigated using principal components analysis (PCA). Results: The mean age of the study participants was 20.71 ± 1.65 with 51.3% males and 48.7% females. The major response regarding educational resources were online lectures, online teaching videos reading textbook, and written notes. Wilcoxon signed-rank test revealed that preference for online lectures, online teaching videos, interactive online materials, and medical apps were found to be statistically significant for learning when compared to revision (P < 0.05). The clustering was observed along the online and offline differentiation of resources.Conclusion: This novel study has made an attempt to find out the common educational resources used during COVID-19 pandemic and also analysis using PCA was done to find the clustering of educational resources for new learning or revision of skills and knowledge. Given the increasing number of individuals for online educational resources, it is important to develop a body of evidence supporting teaching excellence and providing information about effective teaching tools in online education.
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Job stress and its associated factors among working women in Pokhara Metropolitan, Nepal Highly accessed article p. 105
Jenny Ojha, Tulsi Ram Bhandari, Renu Karki
DOI:10.4103/jss.JSS_50_20  
Background: Stress is a relationship between the person and the environment which has become one of the most serious health issues worldwide. Globally, the reported prevalence of stress shows 28% of men and 53% of women go through work-family stress. The prevalence is even more in Asian countries. In India, 87% of women are stressed for time to manage work and family. Methods: A cross-sectional analytical study was conducted among the working women of Pokhara Metropolitan. A stratified random sampling technique was used in the study. The total number of samples was divided into each category of the organization as per the percentage available. A self-administered structured questionnaire was given to all 183 women from the selected public as well as a private organization. Descriptive statistics were reported for demographic, socioeconomic, and various environmental as well as the nature of job-related factors of the respondents. A Chi-square test was used to find out the association between the variables. Results: This study revealed that the prevalence of job stress was 47.5% by Effort Reward Imbalance Questionnaire at mean score 40.08 (standard deviation ± 4.97). The age range of the participants was between 20 and 40 years, with a median age of 29 years. The majority of working women (61.2%) were from the age group of 20–30 years. The various factors found to be associated with job stress were participant's age, family type, health-care benefit at the office, and provision of health-care benefits. Conclusions: The findings of the study reveal that the overall prevalence of job stress was found to be 47.5%. Emphasis should be given to health-care benefits at the office of women as well as for the provision of proper family support and care during their job.
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Perceived changes in knowledge and skills of nursing personnel after the completion of training in safe injection practices: A study from the tertiary care hospital of Haryana, India p. 110
Vikas Gupta, Suraj Chawla, Neeraj Gour, Pawan Kumar Goel
DOI:10.4103/jss.JSS_35_20  
Background: Unsafe injection is an important cause of transmitting blood-borne infections such as hepatitis B virus, human immunodeficiency virus, and hepatitis C virus. In a country-like India, health system usually suffers from the paucity of workforce and nursing personnel are the most susceptible to unsafe injection and needle stick injury. Aim: The present study was carried out with the aim to assess the knowledge and skills among nursing personnel regarding safe injection practices and to measure the change following training session. Materials and Methods: This was a hospital-based cross-sectional study, included all 230 nursing personnel those who were currently working in the hospital. A pretested, predesigned, standardized questionnaire was used. Everyday activity of the study was divided into three parts. First part of activity included pretest second part of activity consisted of 3–4 h training session and third part was posttest. The collected data were tabulated and analyzed using the SPSS Statistics for Windows, version 22.0. Results: Nearly 52.9% of the participants were aware of diseases transmitted through unsafe injection and 45.5% of participants were aware about appropriate sharp waste disposal. Only 20.6% of participants wore gloves before injection administration, and 56.1% used needle destroyer for disposing off the needles. Conclusion: Periodic reinforcement of the nursing personnel with hands on training sessions is the need of the hour to protect them from needle stick injuries and prevent the spread of blood borne pathogens in public at large.
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Assessment of community-based intervention programs on the knowledge and risk perception of allied workers on HIV/AIDS p. 116
Ali Johnson Onoja, Felix Olaniyi Sanni, Paul Olaiya Abiodun, John Shaibu, Daniel Oguche, Imam Adamu, Sheila Onoja
DOI:10.4103/jss.JSS_46_20  
Background: Adequate knowledge of HIV is an important tool in preventing and control of the virus. Workers in rural communities may not have assessed to adequate education and counseling on preventing themselves from acquiring the disease unless there is an intervention. This study sought to assess the impact of 3-year community-based intervention programs on the knowledge and risk perception of allied workers about HIV/AIDS in Bonny Kingdom. Methodology: This is a quantitative study that employed a structured questionnaire among a representative sample of allied workers aged 15–49 years. The data obtained included the sociodemographic characteristics such as age, sex, education, occupation, and marital status and information related to HIV/AIDS. Data were analyzed using SPSS version 25.0. Results: This study comprised baseline and postintervention surveys with 419 and 587 respondents, respectively. The overall knowledge of HIV in both the surveys was 77.3% and 86.4%. Baseline respondents showed a poor knowledge of mother-to-child transmission of HIV (28.2%) and injection route of the disease (37.7%) as compared to 66.9% and 73.4% among the intervention group. About 64.0% of the baseline respondents were at significantly higher risk of acquiring HIV as compared to 18.1% among postintervention group (P < 0.001). Thirty-two (7.6%) had multiple sexual partners at baseline, while 21 (3.6%) had in postintervention. The proportion of respondents who had transactional sex or sex with sex workers was 13.4% in baseline and 2.4% in the postintervention survey. Conclusion: This study has found a significant improvement in the knowledge about HIV and reduction in risky sexual behavior among the allied workers in an African rural community; it is advocated that this program be extended to other rural communities on a regular basis.
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CASE REPORTS Top

Managing the airway of acid burn contracture of the neck in a 12-year-old girl p. 122
Santosh Kumar Swain, Nibi Shajahan
DOI:10.4103/jss.JSS_19_20  
Managing the airway of patient with postburn contracture at the neck is often challenging for otolaryngologists and anesthesiologists. It affects the oro-pharyngo-laryngeal airway axes because of anatomical and functional deformities because of the long-standing contracture in the face and neck region. We present a case of extensive neck postburn contractures distorting anatomy, whose airway was assessed and managed using a video fiberoptic bronchoscope (FOB) (Ambu® aScope™). Our experience of the utility of FOB mirrors the experience and literature in the management of difficult airway.
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Giant renal angiomyolipoma managed by selective renal angioembolization: A unique case report p. 126
G Ajay Kumar, P V Siva Prasad, A Ravi Kumar, A Sindhuri, B S R Prasad Babu
DOI:10.4103/jss.JSS_27_20  
Renal angiomyolipomas (RMLs) can occur sporadically as solitary tumors or can be associated with tuberous sclerosis and present as bilateral multifocal disease. Modern radiographic imaging with ultrasonography (USG) or computed tomography (CT) scan can often diagnose this lesion based on its characteristic fat content. Even though it is a benign lesion, angiomyolipomas (AMLs) can be associated with symptoms, abdominal lump, and in some cases hemorrhage. Most can be managed with nephron-sparing approaches that include observation, angiographic embolization, or partial nephrectomy. The uniqueness of our article is that we successfully treated giant RML by angiography with selective renal angioembolization (RAE).
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SHORT COMMUNICATION Top

Improving the COVID-19 outbreak readiness in areas with humanitarian emergencies and low-resource settings p. 130
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_43_20  
The Corona Virus Disease 2019 (COVID-19) pandemic has transformed the lives of everyone and compelled public health authorities to take immediate steps to minimize the spread of the transmission. In general, the severity of the COVID-19 outbreak is significantly higher amongst people either suffering from humanitarian crises or residing in low-resource settings. From the public health perspective, it is essential to maintain a balance between the implemented public health and social measures required for the containment of the pandemic and the impact which these interventions will have on income, access to basic services and food supply, especially for these vulnerable sections of societies. The need of the hour is to mobilize all the concerned sectors and local community to enable whole of society approach for the readiness and response against the disease. In conclusion, the impact of COVID-19 outbreak in humanitarian emergencies and in low-resource settings can turn out to be very severe. There is an immense need to strengthen the public health and social measures and supplement it with prevention and control measures in accordance with the local settings to not only reduce the caseload, but also maintain the livelihood of the vulnerable people.
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COVID-19 pandemic: Ensuring health system sustainability through strengthening immunization activities p. 132
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_42_20  
The ongoing Corona Virus Disease-2019 (COVID-19) pandemic has reminded all the stakeholders that infectious diseases cannot be restrained within geographical boundaries. The urgent need to have a vaccine for the novel viral infection justifies the role which immunization plays in safeguarding the human lives and economic growth of a nation. Amidst the implementation of outbreak readiness and response activities, it is important to realize that the delivery of the routine immunization programs becomes even more crucial than earlier times. In conclusion, as the fight against the COVID-19 infection intensifies in the different parts of the world, there is a simultaneous pressing need to protect all age-groups from vaccine-preventable diseases through immunization, which will in turn play a crucial role in the sustainability of the health care systems.
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Scope of international traffic restrictions in the containment of the coronavirus disease 2019 pandemic: World Health Organization p. 134
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_52_20  
The Corona Virus Disease-2019 (COVID-19) pandemic has been declared as a Public Health Emergency of International Concern and its overall risk of transmission at global level has also been increased to very high based on the recent trends of the disease. It is the need of the hour to strengthen international traffic regulations, if we really want to limit the onward spread of the infection to other nations. The recent recommendations released by the World Health Organization does not support travel or trade restrictions in nations which are reporting cases. Acknowledging all these facts and understanding about the disease as it continues to evolve, the best approach for the containment of the infection is to increase the awareness level of travellers about the preventive measures and to obtain the health declaration from travellers at the time of arrival. In conclusion, for the containment of COVID-19 outbreak and for minimizing the risk of further transmission, strengthening of the international traffic regulations will play a critical role.
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Emphasizing the role of youth in the battle against COVID-19 pandemic p. 136
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_40_20  
The ongoing Corona Virus Disease-2019 (COVID-19) pandemic has impacted the lives of the population from all age-groups and the effects have been way beyond the health dimension. Even though, the initial treatment outcomes have suggested that elderly people are more at risk to develop severe forms of the disease, but it is important to remember that even the younger people are not spared from the infection. In-fact, the epidemiological data obtained from most of the nations has revealed that people less than 50 years of age constitute a significant share of the patients. As it is a well-known fact that no nation or community or individual is immune to the infection, in these challenging times, each and every section of society, including the young people, should take adequate steps to restore their physical and mental well-being. In conclusion, the support of young people in minimizing the spread of the COVID-19 infection is extremely crucial and they should extend their complete support and adhere to the national recommendations in these difficult times of COVID-19 pandemic.
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