International Journal of Medical Sciences and Education (IJMSE)
Vol. 7 Issue: 2 (March-April 2020), Date of Publication: 01.05.2020

Table of Contents
     Editorial

1.    Evaluation of Student’s Performance And Experience After Undergoing Lecture Based Learning And
​       Case Based Learning In An Integrated Session of The II MBBS Curriculum                                               1-6
       Dr. N. Kannan, Dr. D. Sudha                                                                                                         PDF FULL TEXT

ABSTRACT

Background: Integrated sessions are traditionally followed in our medical schools as a combination of lectures from subject experts at the same time. Students get to listen to the same lectures heard over the years in a single session and are left dry to integrate them by themselves. Case-based learning gives the facilitators’ liberty to include different methods of learning and can be an inquisitive tool to facilitate and teach students about integration at various levels. In this premise, we would like to see the difference in student’s performance and experience regarding these two modalities of learning. Aim: To assess student’s performance and experience in lecture-based learning of an integrated session in II MBBS curriculum and case-based learning of an integrated session in II MBBS curriculum and compare between these two groups. Materials and methods: 140 students undergoing II MBBS in MAPIMS was involved in the study. Group 1: (LBL) The first topic was discussed in traditional format (Lecture Based) for two Saturdays during which Pretest, Posttest and Feedback Questionnaire was done. Group 2: (CBL) Second topic was discussed in Case-Based Learning (CBL) format for two Saturdays during which Pretest, Posttest and Feedback Questionnaire were done.  Test scores of students before and after sessions, Likert scale rating of experience by students were compared and statistically analyzed with an appropriate statistical tool like independent “t” test. Results: There was statistically significant (p< 0. 001) improved performance in case based learning sessions when compared to lecture based learning sessions. Conclusion: Case based learning stimulates the desire to learn, develop clinical reasoning, and build confidence among learners. So this system of learning can be used in addition to strengthening the teaching-learning methods through active learning.
Keywords: Lecture Based Learning, Case Based Learning

2.    A comparative study of Platelet-Rich Plasma Versus Hyaluronic Acid Injections for the  treatment
       of knee osteoarthritis                                                                                                                                       7-11
       Karamdeep Singh Kahal, KS Sandhu, Jaspreet Singh, Gurleen Kaur                                     PDF FULL TEXT

ABSTRACT

Background: Osteoarthritis (OA) is an age-related condition that will bring about pain and reduce the capacity to work in about half the population. The aim of this study was to evaluate the benefit provided by PRP to treat early stages of joint degeneration in comparison with another injective treatment: Hyaluronic acid (HA). Materials and methods: The patients presenting to Orthopaedic OPD were enrolled after satisfying inclusion criteria. Patients were divided into 2 different treatment groups: those receiving 3 weekly intra-articular injections of PRP versus those receiving high-molecular-weight HA 3 weekly administrations. Patients were prospectively evaluated on 1st day in OPD and subsequently at follow-up on 2, 6, and 10 months after the last injection. The evaluation was done by assessing various scores like the International Knee Documentation Committee (IKDC) subjective measure score, Knee injury, and osteoarthritis outcome score (KOOS), visual analog scale (VAS). Results: A total of 50 patients were enrolled in the study. 25 patients were put in group A and received PRP. Another 25 patients were put in Group B and received HA injections. Both the groups were matched for age, sex, and grade of Osteoarthritis knee. A statistically significant improvement in the various clinical scores in both groups was documented. Conclusions: This study shows that leukocyte-rich PRP offers a modest clinical benefit at short term. Both treatments were effective in improving knee functional status and symptoms over time. PRP did not show significant improvement in symptoms as compared to HA.
Keywords: Platelet Rich Plasma, Hyaluronic Acid, Osteoarthritis

3.    A COMPARATIVE STUDY OF RESULTS OF CLOSE LATERAL PERCUTANEOUS PIN FIXATION V/S
       CROSS PERCUTANEOUS PIN FIXATION IN SUPRACONDYLAR FRACTURES OF HUMERUS IN CHILDREN                                                                                                                                                                                    12-16
       Dr. Sunil Kumar Rawat, Dr Sanjeev Kansotiya, Dr. Avtar Singh Balawat                               PDF FULL TEXT

ABSTRACT

Background: Supracondylar fractures of the humerus are the commonest injury around the elbow in the children accounting for 60% of all the fractures around the elbow in children. This study was conducted to evaluate the efficacy of close reduction and percutaneous pin fixation by lateral entry pin and crossed pin method and to compare any significant difference exist between losses of reduction by these two methods. Material and Methods - This study was done prospectively on the patients having a supracondylar fracture of the humerus with an average follow up 6 months. Patients were divided into two categories in the first category all 25 patients were managed by a cross percutaneous pin fixation method & while in the second category all 25 patients managed by lateral percutaneous pin fixation method with K wires. Final Functional Assessment was done according to the criteria laid down by Flynn. Results- In the lateral pin fixation group the overall results were satisfactory in 91.6% cases and the cross pin fixation group the overall results were satisfactory in 95.8% cases. Conclusion- We conclude that the lateral pin fixation method is as good as a cross pin fixation method while considering the biomechanical stability of construct, but it does not carry the risk of iatrogenic ulnar nerve injury.
Keywords: Supracondylar fractures, humerus, injury, children, lateral entry pin, fixation.

4.    RETROSPECTIVE STUDY OF ULTRASONOGRAPHIC FEATURES OF MACROCALCIFICATION IN
       THYROID NODULE AT TERTIARY CARE CENTER                                                                                     17-20
       Dr. Mahipal Singh, Dr. Devendra K Verma, Dr. Anil Jangid                                                      PDF FULL TEXT

ABSTRACT

​Background: Thyroid lesions vary from non-neoplastic to neoplastic, the most common thyroid lesion is multinodular goiter which is followed by thyroid tumors. Most of the thyroid tumors are benign and the malignant thyroid lesions are accounting only for 1.5% of all cancers. Material & Methods: The present cross-sectional, retrospective study was conducted at department of radiology of our tertiary care hospital. The study duration was of one year from January 2018 to December 2019. Clearance from Institutional Ethics Committee was taken before start of study. Results: Most common presentation was swelling in front on neck however 3 patients presented with lymphadenopathy at level 2 and 3. In the present study, on USG evaluation most common finding was multinodular goiter among 13 patients which was followed by colloid nodule among 13 patients. Solitary thyroid nodule was found among 10 patients which was followed by malignancy among 5 patients. In the present study, on USG evaluation the size of the nodule found to be ranges from 1.2x1.2 to 7x7 cm. Conclusion: We found that nodules with macrocalcification also had chances of microcalcification which could be a reason that nodules associated with macrocalcification have positive rates for malignancy.
Keywords: Thyroid nodule, Ultrasonography, Multinodular goiter.

5.    EVALUATION OF BLOOD UREA NITROGEN, URIC ACID AND URIC ACID /CREATININE RATIO IN
​       PATIENTS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)                                               21-24
       Mahadev Choudhary, Jai Prakash Yogi, Bushra Fiza, Maheep Sinha, Hitesh Kumar Rathor,
​       Vihan Chawdhary                                                                                                                         PDF FULL TEXT

ABSTRACT

Background: Chronic obstructive pulmonary disease (COPD) is a group of lung diseases that block airflow and long term breathing problems. The very common symptoms cough with sputum production and shortness of breath. Aim: The present study was planned to assess the blood urea nitrogen, uric acid & uric acid/creatinine ratio in COPD patients and compare with healthy control. Material & Method: Total 100 diagnosed patients of chronic obstructive pulmonary disease were enrolled for the study age between 18 to 60 years. Patients were further sub-grouped Acute exacerbation 50 patients, Stable COPD 50 patients and 50 age & sex-matched healthy subjects constituted the control group. Patients with pneumonia, neoplastic pathologies, and hepatic or renal diseases, pregnant females were excluded from the study. Results: The mean level of blood urea nitrogen was significantly in both subgroups. Serum creatinine level was significantly higher in acute exacerbations COPD patients (1.48±0.82) as compared to healthy subjects (1.02±0.29) (p = <0.0001). Serum uric acid significantly higher in acute exacerbations COPD patients (5.90±3.29) as compared to healthy subjects (3.86±0.82) (p = <0.0001).Uric Acid /Creatinine ratio was non- significant in acute exacerbation and stable COPD patients. Conclusion: Findings of the present study suggest that renal function tests specially BUN is significantly altered in COPD patients and strong association with the occurrence of acute exacerbation.
Keywords: Chronic obstructive pulmonary disease, BUN, Uric acid, Renal function

6.    DEPRESSION AND ANXIETY IN PATIENTS WITH CHRONIC MYOFASCIAL PAIN SYNDROME AND ITS
       CORRELATION WITH PAIN INTENSITY                                                                                                       25-28
       Kamal Kant Sain, Mrinal Joshi                                                                                                   PDF FULL TEXT

ABSTRACT

Background: Chronic myofascial pain is a regional pain syndrome characterized by myofascial trigger points (MTrP) causes a specific referred pain pattern. The symptoms of anxiety and depression have been shown to be involved in the genesis and perpetuation of chronic pain. The purpose of this study was to found the correlation between pain intensity with depression and anxiety. Objectives: To correlate pain intensity with depression and anxiety. Materials and methods: Total 100 participants were included in this study who presented with chronic regional myofascial pain in neck and upper back. Pain intensity severity was measured with sf-mpq-2 scale and correlated with HAM-A and HAM-D. Results: Pain intensity is significantly correlated with anxiety and depression. Higher pain intensity is associated with an increased level of anxiety and depression. Conclusion: Myofascial pain patients with high pain intensity have increased level of anxiety and depression.
Keywords: Myofascial pain, pressure algometry, trigger point, ham-a, ham-d, sf- mpq-2.

7.    STUDY OF CORRELATION IN TUMOR MARKERS STATUS AND VITAMIN B12 DURING CHEMOTHERAPY
       IN CANCER PATIENTS                                                                                                                                 29-37
       Hemkar Neelima, Hemkar Shalini, Rathore Nisha                                                                  PDF FULL TEXT

ABSTRACT

​Background: The study was carried out to find out alteration and correlation in the behavior of tumor markers of interest (CEA, AFP, CA-125, TSH &Vitamin B12) in the cancer patients (n=25), who were picked randomly for the study, irrespective of the type, particular stage, and involvement of a specific organ. Materials and methods: The studied tumor markers were  (CEA, AFP, TSH, CA-125 & Vitamin B12) evaluated before chemotherapy (which was being done through the drug of choice for the specific type of cancer), after 1st cycle & after 2nd cycle (post-treatment) of chemotherapy. The tumor markers were estimated by chemiluminescent immunometric assays, their values at three different stages were compared and evaluated statistically (by ‘p’ & ‘t’ values), Vitamin B12 was correlated with all other four tumor markers and statistical evaluations are done to calculate ‘p’, ‘t ’& ‘r’ values. Results: All tumor markers besides Vitamin B12 followed a decreasing pattern from pretreatment to till 2nd cycle of chemotherapy (CEA=9.5>5.0>2.6; AFP=7.3>4.2>2.7; TSH=5.5>3.6>3.0; CA-125=185>93>45.5 & Vitamin B12=292<662<1262). Before chemotherapy , a  negative correlation was found between vitamin B12  and each  of the tumor markers (CEA r= -0.44;p< 0.019: AFP r= -0.25;p<0.20: TSH r=-0.44;p,0.019:CA-125 r= -.0108;p<0.5).After 2nd cycle of chemotherapy only CEA was found negatively correlated with vitamin B12 significantly(r=-0.108;p<0.16),while  the correlation with other markers  altered in positive correlation (AFP r=0.12;p<0.54 : TSH r=0.08;p<0.66 : CA-125 r=0.42;p<0.02). Conclusion: Such findings of change in correlation pattern, suggest the role of Vitamin B12 similar to a potent tumor marker as well as its synchronizing pattern with other markers. It may help in deciding the direction of the treatment for betterment, in spite of the fact that it is a micronutrient. Dramatically, its (Vitamin B12) correlation alters with all tumor markers leaving CEA as treatment proceeds, i.e. different from initial stages. This alteration can define the protective measures taken by the stressed normal cells undergoing the process of chemotherapy along with the destruction of cancer cells, however, they try to achieve the homeostasis as soon as possible.
Key Words: Vitamin B, Tumor Markers, Chemotherapy Correlation, Homeostasis, etc.

8.    COMPARISON OF THYROID PROFILE IN CRITICALLY ILL PATIENTS DURING ILLNESS AND POST
       RECOVERY: A HOSPITAL BASED CROSS SECTIONAL STUDY                                                            38-41
       Ashish Sharma, Kanishka Sharma, Pooja Sharma, Shubham Gupta                                  PDF FULL TEXT

ABSTRACT

​Background: Non thyroidal illness (NTI), arises through diverse alterations in the hypothalamus pituitary- thyroid axis often observed in critically ill patients,. However, the causal relationship between underlying disease and NTI diversity in critically ill patients is poorly understood. Aims: To find out the association of thyroid profile in critically ill patients and to compare thyroid profile at the time of critical illness v/s recovery after critical illness. Material methods: 100 critically ill patients from ICU of department of medicine Mahatma Gandhi hospital Jaipur were selected as cases and comparison of Thyroid profile during illness and post recovery done. Results: Out of 100 cases 63 survived and recovered. In these patients serum TSH levels in survivors during illness was 2.54 + 1.06 µIU/ml and after recovery of these patients it was 2.82 ± 1.07 µIU/ml. This difference was statistically significant (p value <0.001).while mean serum FT3, FT4 levels in survivors during illness and post recovery was statistically non-significant.
Keywords: FT3,FT4,TSH, Non thyroidal illness syndrome

9.    A STUDY OF CLINICAL PROFILE AND PROGNOSTIC IMPLICATION IN PATIENTS WITH
       ALCOHOLIC LIVER DISEASE                                                                                                                     42-48
       Dr. Vats Gupta, Dr. Pankaj Gupta, Dr. D.C. Kumawat                                                              PDF FULL TEXT

ABSTRACT

Background: Consumption of alcohol is directly associated with the morbidity and mortality of liver. The study was conducted to know the various clinical features, laboratory parameters, radiological investigations and to access complications & prognosis via Child Pugh score in patients of Alcoholic. Material and Methods: A total of 120 cases of Alcoholic liver disease for this study were obtained from wards and ICU of Medicine and gastroenterology department in Geetanjali Medical College & Hospital, Udaipur, and Rajasthan over a period of 12 months from January 2018 to December 2018. The patients were studied their clinical profile, laboratory parameters and radiological investigations and to correlate development of complications and prognosis via Child Pugh score. Results: Out of the 120 individuals, 51.6% had severe hypoalbuminemia; the percentage of patients with elevated AST, ALT, and Total bilirubin and INR were 68.3%, 30.8%, 59.2% and 64.17% respectively. 61.7% had ratio of AST to ALT more than 1 with 30% having more than 2. 51.7% had hyponatremia. 53.3 % of patients had chief complaint of abdominal distension. Splenomegaly was found in 68.3%. Upper GI bleeding (55%) and ascites (53.3%) were commonest complications. USG revealed cirrhosis in 71.7% Pts. 55% oesophageal varices were found in upper GI endoscopic investigation. The P value for association of Child Pugh category with duration & quantity of alcohol consumption was 0.01. Conclusion: Amount and duration of alcohol consumption is directly related with severity of liver disease which can be judged by hepatic enzyme elevation, prolonged PT/INR, hypoalbuminemia, ultrasonographic findings, oesophageal varices on UGI endoscopy and child pugh category.
Keywords: Liver Cirrhosis,  Child Pugh score, hypoalbuminemia, Splenomegaly, Upper GI bleeding.

10.  ASSESSMENT OF ACUTE RENAL OBSTRUCTION BY USING DOPPLER SONOGRAPHY                 49-53
       Dr. Harish Chandra Chaturvedi                                                                                                 PDF FULL TEXT

ABSTRACT

Background: Acute renal colic disease is among the commonest presentation observed in outpatient departments of urologic practice. Urolithiasis is among the most common cause of renal obstruction and seen frequently. Unilateral obstruction encountered more frequently than bilateral obstruction and resultant for maximum patient load, however bilateral obstruction presents with deteriorate renal functions but it is less common. Material & Methods: The present case-control, study patients who were presenting to the emergency department with unilateral acute renal colic from 24 hours of symptoms were enrolled for the study. The obstructed kidney was taken as a case kidney and the normal kidney was taken as the control. Results: The site of obstruction was proximal in 47% of patients and distal in 63% of patients. The mean RI of the obstructed kidneys which were proximally obstructed was (0.71±0.02) and the mean RI of the obstructed kidneys which were distally obstructed was (0.69±0.02). However, this difference was statistically non-significant. Out of total patients, 68 patients had a complete obstruction, while 32 patients had a partial obstruction. The mean RI values in completely obstructed kidneys were 0.73 ±0.02 and mean RI values in partially obstructed kidneys were 0.70±0.01. This difference was statistically significant; p<0.05. Conclusion: Doppler sonography has high sensitivity and specificity in the detection of acute unilateral renal obstruction and better diagnostic tools than conventional USG. The resistivity index values are significantly higher incomplete obstruction than partial obstruction. The resistivity index values were also higher in proximal obstruction than distal obstruction.
Keywords: Acute renal obstruction, Doppler sonography, Resistivity index.

11.  EVALUATION OF SIGNIFICANCE OF FEV1/FEV6 WITH FEV1/FVC IN THE DIAGNOSIS OF CHRONIC
​       OBSTRUCTIVE PULMONARY DISEASE                                                                                                  54-57   
        Dr. Manish Kumar Jain, Dr. Nalin Joshi                                                                                   PDF FULL TEXT

ABSTRACT

Background: The incidence of COPD has been accounted for approximately 3.5% in India. COPD additionally puts a great deal of additional weight on the pockets of the patients along with additional out of pocket expenditure. It can cost about 30% of the patient's salary on treatment and different issues identified with the COPD. COPD likewise contributes essentially to the disability adjusted life years loss (DALY) in patients. Material & Methods: The present prospective study was conducted at department of respiratory medicine of our tertiary care hospital. In present study, we enrolled 100 study participants from outdoor and from ward by simple random sampling, who were presented with signs and symptoms of chronic obstructive pulmonary disease. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study, Spirometry examination findings of total study participants were recorded. On the basis of the Spirometry examination finding, the mean value of FEV1 (L) was 1.38±0.68, the mean value of FEV6 (L) was 2.17±0.60 and the man value of FVC(L) was 2.24±0.71. on assessment the mean value of FEV1/FVC proportion (postbronchodilator) was 61.6 ±11.3 and the mean value of FEV1/FEV6 proportion (postbronchodilator) was 63.6 ±10.99. Out of the total study participants, 88% patients were diagnosed for COPD by using FEV1/FVC proportion of < 70 % and 81% patients were diagnosed for COPD by using FEV1/ FEV6 proportion of < 70 %.  Conclusion: We concluded from the present study that FEV1/FEV6 proportion is an adequate option to FEV1/FVC proportion in the finding of COPD in patients more than 40 years of age and also who had predisposing factors for COPD.
Keywords: COPD, spirometry, FEV1/FEV6 proportion.

12.  ASSESSMENT OF IMMUNIZATION STATUS OF CHILDREN ADMITTED TO A TERTIARY CARE
       CENTRE                                                                                                                                                      58-62
       Dr. Jaywant R. Deore                                                                                                               PDF FULL TEXT

ABSTRACT

Background: Vaccination has been one of the most huge and practical general wellbeing intercessions to diminish youth bleakness and mortality. The mortality is Approximately 3,000,000 youngsters every year due to vaccine preventable infections. Ongoing assessments suggest that roughly 30 million children having incomplete or partial immunization status, with practically 98% of them living in developing nations. Material & Methods: The present prospective study was conducted at department of pediatrics of our tertiary care hospital. The study was an observational study conducted during a period of six months. The sample size of 200 included children of age 12 months to 23 months admitted to Pediatric ward of the hospital. Critically ill patients were excluded from the present study. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant and parents. Results: In the present study 112 (56%) were males and 88 (44%) were females. Out of the total 143 (71.5%) children were fully immunized and 57 (28.5%) children were partially immunized. There were not any case of unimmunized child in present study. According to Mothers education 136 (68%) had Primary/secondary education and 64 (32%) had Graduate and above education. Out of the Primary/secondary education group 88 (44%) were completely immunized and 48 (24%) were partially immunized. Out of the Graduate and above education group 55 (27.5%) were completely immunized and 9 (4.5%) were partially immunized. This difference was statistically significant (p value< 0.05). Conclusion:  We concluded from the present study that the current study illuminates the vaccination status of children and it had statistically significant association with mother’s education. Better correspondence with training of parents/guardians during antenatal visits, and during routine wellbeing visits may help in diminishing the quantity of partially immunized children.
Keywords: vaccination status, immunization, partially immunized children.

13.  EVALUATION OF A PERSONALIZED PROFORMA FOR ADMINISTRATION OF INTRAVESICAL BCG IN
       PATIENTS OF CARCINOMA BLADDER                                                                                                     63-65
       Dr. Lokesh Sharma, Dr. Nisar Ahmed, Dr. Mahakshit Bhat, Dr. Hari Ram,
       Dr. Sharan Kumar Jab Shetty, Dr. Rajeev Mathur                                                                   PDF FULL TEXT

ABSTRACT

Background: Carcinoma bladder is a common malignancy of the genitourinary tract and NMIBC is the most common presentation. The management involves TURBT followed by intravesical instillation of BCG in cases with intermediate and high risk of progression. The schedule of BCG instillation is long and difficult to follow with high dropout rates specially in patient of poor socioeconomic status. Materials and methods: We provided 30 patients with a personalized schedule of BCG administration and gave each patient a questionnaire regarding the ease of understanding of the schedule. Result: All 30 patients in the study reported that the schedule was easy to understand and follow. All patients also preferred to be given the entire schedule of BCG instillations at the beginning of the treatment. Conclusion: A personalized complete schedule for the administration of BCG therapy is easy understand and may reduce dropout rates.
Keywords: BCG, personalized, proforma, carcinoma, bladder

14. PREVALENCE OF CHILDHOOD OVERWEIGHT AND OBESITY AMONG RURAL AND URBAN                                  ADOLESCENTS (10-19 YEARS) IN NORTH INDIA:A POPULATION BASED STUDY                              66-75
 
      Dr. Anmol Goyal , Nabeel Ahmed Gadi , Randhir Kumar                                                        PDF FULL TEXT

ABSTRACT

Background: Various chronic diseases of adult life are the resultant of childhood overweight and obesity. However, there are no studies available regarding the direct or indirect increase of chronic diseases related to overweight and obesity in district Ambala (Haryana), India, especially in urban areas.  Objectives The objectives of the present study are to determine the prevalence of adolescents overweight and obesity. Methods A cross sectional study was conducted among 1600 school going adolescents (10-19 years) from 5th to 12th class of government and private schools in rural and urban area of district Ambala, Haryana. A self-designed, semi- structured questionnaire was used to assess the socio-demographic profile, socio-economic status, socio-environmental factors, nutritional status and level of physical activity followed by anthropometric measurement of the children. Results The overall prevalence of overweight and obesity was found to be 18.02% and 7.98% respectively. Prevalence of overweight and obesity was 16.16% and 8.96% among males and 20.32% and 6.77% among females. Higher prevalence was also seen in urban area, private schools, nuclear family, and upper socio-economic class. Conclusion Overweight and obesity has multi-factorial causes and needs multi-prolonged interventions at the earliest for control and prevention. 
Keywords obesity, overweight, children, chronic diseases.

15. CLINICAL PROFILE OF CHILDHOOD ASTHMA AND ITS COMORBIDITIES                                            76-80
       
       Dr. Dinesh Rajwaniya                                                           .                                                      PDF FULL TEXT

ABSTRACT

Background. Bronchial asthma is a heterogenous disease characterized by chronic airway inflammation. It is defined by history of various respiratory symptoms such as wheeze, shortness of breath, cough and chest tightness that may vary over time and intensity with variable, expiratory airflow limitation. Objective. To evaluate clinical profile of childhood asthma and its association with risk factors at our tertiary care hospital. Methods. Prospective observational study was conducted at Department of Pediatrics at Pacific Medical college and Hospital, Udaipur, India. Results. Out of total 202 children included in the study, 131 (64.9%) were males and 71 (35.1 %) were females. In present study, 65 children (32.2 %) had mild persistent asthma. History of exposure to passive smoking at home obtained in 24 children that constitute 11.9 % children of this study. In this study, 55% of children in this study had at least one of the above as trigger factor. Conclusion. When there is the above 2 risk factors i.e. family history of asthma as well as exposure to aeroallergens, there was an increased risk of moderate to severe asthma. A comprehensive management strategy which includes change in environment wherever possible, attending to risk factors and judicious use of medications can ensure us normal life style and prevents school absenteeism in children and financial stress to the family.
Keywords: Asthma, childhood, airway, Aeroallergen.