Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : July | Volume : 16 | Issue : 7 | Page : FC01 - FC06 Full Version

Knowledge, Attitude and Practice Related to the Use of Nutraceuticals for Prophylaxis against COVID-19 among Undergraduate Medical and Nursing Students in a Tertiary Care Teaching Hospital, Bihar, India


Published: July 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55408.16582
Shruti Singh, Soni, CM Singh, Pallavi Lohani, Sunil Kumar Singh, Pratibha Singh

1. Assistant Professor, Departent of Pharmacology, AIIMS, Patna, Bihar, India. 2. Assistant Professor, Department of Pharmacology, Manipal Tata Medical College, Jamshedpur, Jharkhand, India. 3. Professor, Department of Community and Family Medicine, AIIMS, Patna, Bihar, India. 4. Assistant Professor, Department of Community Medicine, Madhubani Medical College, Madhubani, Bihar, India. 5. Assistant Professor, Departent of Pharmacology, AIIMS, Patna, Bihar, India. 6. Senior Resident, Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Pallavi Lohani,
Flat No. 201/B Azam @90, Nohsa, Phulwarisharif, Patna-801505, Bihar, India.
E-mail: pallavilohani_5122006@yahoo.com

Abstract

Introduction: Nutritional supplements modify immune response and protect against viral infections. Health related behaviour of medical and nursing students governs their attitude towards counselling patients. This study assessed the differences in the Knowledge, Attitude, and Practice (KAP) between undergraduate medical and nursing students regarding the role of nutraceuticals in Coronavirus Disease-2019 (COVID-19).

Aim: To assess the differences in the KAP between undergraduate medical and nursing students regarding the role of nutraceuticals in COVID-19.

Materials and Methods: An analytical cross-sectional study was conducted in a tertiary care teaching hospital, Patna, Bihar, India in September 2020. A questionnaire was administered to assess the KAP of 265 medical and 150 nursing undergraduates regarding nutraceuticals. The total knowledge score varied between 0 and 12. The score of the attitude was based on 5 points Likert scale. The data was collected through self-administered google forms. Chi-square test and Fisher’s exact test was used to compare the difference in categorical data.

Results: There were total 273 (65.8%) participants with good knowledge and only 47 (11.3%) with positive attitude. About 68.7% medical students and 82.7% nursing students felt that regular intake of nutraceuticals has a positive role in protecting against COVID-19 (p=0.007). Out of 415, 264 participants (63.6%) had used nutraceuticals. About 156 (58.9%) medical students and 103 (68.7%) nursing students felt that the safety of nutraceuticals is a grave concern. Two- fifth of the participants (202, 48.7%) had consumed a dietary supplement to maintain good health.

Conclusion: Although the knowledge score was good, but positive attitude was lacking. Thus, Health Care Personnels (HCP)s should be trained regarding proper usage and recommendations of nutraceuticals.

Keywords

Dietary supplements, Health personnel, Immune response, Micronutrients

The Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2) is a novel coronavirus, responsible for the current pandemic (1). Antibiotics, dexamethasone, pronging and oxygen support have been the only approaches with a clearly established benefit in COVID-19; maximally effective only when given to the right patient at the right time (2). Several therapeutic agents like hydroxychloroquine, remdesivir, tocilizumab, convalescent plasma, immunoglobulins, monoclonal antibodies and different types of vaccines offering chemoprevention against the virus like Astra zeneca- Covishield , Moderna, Pfiser-BionTech, Covaxin, Sputnik V etc.) are constantly being investigated to reduce the viral load. However, all of these drugs have shown inadequate efficacy as well as undesirable toxicity and vaccines are able to attenuate the morbidity and mortality due to COVID-19, only to a limited extent (2),(3),(4),(5). Reducing the risk of infection and transmission by employing respiratory hygiene measures (masks, social distancing and sanitisers) has remained the most effective measure from the start of the pandemic (6). However, the virus continues to take a huge toll on the lives of humanity worldwide and we are yet to figure out a truly curative drug regimen.

Therefore, apart from hygiene changes, a boosting of the immunity through food or dietary supplements to prevent infection and ameliorate disease severity which seems to be the most useful approach right now. COVID-19 morbidity and mortality is largely related to the huge inflammatory response of the host against the virus. For this reason, it seems advisable to invest in the use of nutritional supplements with multipronged action against the virus e.g immunomodulatory, anti-inflammatory, antiviral, lung protective etc (7). There is increasing evidence that Vitamin C, D, Zinc, probiotics and various other micronutrients modify the immune system and a number of activities in the body in a manner that protects us against various viral infections particularly cold and cough (8),(9),(10).

The research has shown that Vitamin C causes leads to an improvement in oxygenation, and a decrease in the level of inflammatory biomarkers in infected individuals while ability of Zinc to retard the interaction between SARS-CoV-2 S protein and Angiotensin Converting Enzyme 2 (ACE2) ACE-2 that might prove to be lifesaving in the ongoing battle against the disease (11),(12),(13). Similarly, a recent study reported that 5000 International Unit (IU) of vitamin D reduces the time to recovery of cough and gustatory symptoms in patients with suboptimal Vitamin D and mild to moderate COVID-19 symptoms (14).

Thus, it is clear that these essential micronutrients, vitamins and minerals have burst into focus during the current pandemic with anecdotal, mechanistic and clinical evidence in COVID-19. These micronutrients/ dietary supplements generally come under the broad umbrella term of Nutraceuticals - any product derived from food sources or herbal products, dietary supplements (nutrients), specific diets, and processed foods such as cereals, soups, and beverages with extra health benefits in addition to the basic nutritional value found in foods. Nutraceuticals is a term derived from “nutrition” and “pharmaceutics”. Nutraceuticals, also referred as medical foods, designer foods, phytochemicals, functional foods and nutritional supplements, includes “bio” yoghurts, vitamins, herbal remedies and genetically modified foods and supplements (15),(16),(17).

Since, the health related behaviour of medical and nursing students governs their attitude regarding counselling of patients about the pros and cons of nutraceuticals usage in COVID-19 and overall health, therefore this study was conducted to assess the differences in the KAP between undergraduate medical and nursing students regarding the role of nutraceuticals in COVID-19.

Material and Methods

An analytical cross-sectional study was conducted in a tertiary care teaching hospital, Patna, Bihar, India in the month of September, 2020 after getting the clearance from the Institutional Research and Ethics Committee (AIIMS/Pat/IEC/2020/462 dated 25.06.2020). The study participants were the undergraduate medical and nursing students.

Inclusion criteria: The medical undergraduate and nursing students aged between 18-25 years, irrespective of gender and willing to participate and give consent in the study were included.

Exclusion criteria: Students, who did not give consent were excluded from the study.

Sample size: A minimum sample size was calculated using the formula (3.96 pq/L2) where p is proportion of students having knowledge of dietary supplements, “q” is (1-p) and L represents margin of error, which was set at 5%. On the basis of previous literature, p was assumed as 61% (18),(19). Thus, a minimum sample size of 366 was calculated at 95% confidence level. However, on consecutive sampling and after taking consent, 415 undergraduates were included in the study. The medical undergraduates were 265 in number while there were 150 nursing students.

Data Collection: Data collection was done using a pretested semi-structured questionnaire (20),(21). The questionnaire was self- administered through online channels. The structured questionnaire contained four sections. The first section was related to data about demographic characteristics of the participants and certain background characteristics. It had one question each for age, gender, course (medical or nursing), year of course, diet, addiction to smoking and daily exercise duration. Thus, there were a total of seven questions in the first section. The second section had 12 questions which included items regarding the knowledge about the role of nutraceuticals in COVID-19. The response was recorded as true/false, and 1 score was given for correct answer and 0 for wrong answers. The total knowledge score varied between 0 (with no correct answer) and maximum score;12 (for all correct answers). The overall median score was 5 and a cut-off level of less than median i.e. 5, was evaluated as poor knowledge, and ≥5 as good knowledge.

The third section assessed attitude of the participants with 11 questions which was measured on 5-Likert Scale. The score of the attitude was based on 5 points Likert scale, in which the score of 1 to 5 was given from strongly agree to strongly disagree. A mean score of 2 (answering for strongly agree or agree) was considered as a positive attitude and a score of 3 to 5 was considered as a negative attitude (answering strongly disagree or disagree or undecided) for each question. The score ranged between 11 to 55. Based on the aforementioned criteria the score ranging from 11 to 22 was taken as positive attitude and more than 22 i.e. 23-55 was labelled as negative score. The last section contained items based on practice which had 10 questions. Data for practice was collected in number and percentage.

The final questionnaire was created on google forms and the link was sent to the potential participants. The cover page of the google form included an introductory page mentioning the purpose of the study and a consent form of the participants at the beginning of the survey. The survey part of the form got activated only after getting the consent of the participant. No personal identification was recorded in the survey form, and hence, the confidentiality of the participants was maintained.

Data management: Since the data was collected through a web-based survey, it was automatically transferred to the designated server through the link. The final data was transferred to excel sheet.

Statistical Analysis

Data analysis was performed using Stata Version 12 (Stata Corp., College Station, TX, USA). Descriptive analysis was presented as mean with 95% Confidence Interval (CI) for normally distributed variables. Students’ t-test was used to compare the mean difference of normally distributed continuous variables. Chi-square test and fisher’s-exact test was used to compare the difference in categorical data accordingly. For all the differences of estimated variables statistically significant was considered if p<0.05.

Results

Demographic data of the study participants: There was a total of 415 participants with 265 medical undergraduates and 150 nursing students. The mean age of medical students was significantly lower 20.94±1.75 years) than nursing students (21.35±1.58 years) (p=0.018). The gender wise distribution of medical and nursing students was also statistically different (p<0.01). This difference was attributed to the fact that only female students were enrolled in nursing course. Most of the study participants, 174 (65.7%) medical students and 89 (59.3%) nursing students were nonvegetarian (p-value=0.199). About 256 (96.6%) medical students and 149 (99.3%) nursing students never smoked (p=0.211). Thus, the distribution of medical and nursing students based on aforementioned factors was comparable (Table/Fig 1).

Assessment of knowledge of the study participants regarding nutraceuticals: The study participants were asked 12 questions to assess their knowledge about nutraceuticals. The most correctly answered question was whether nutraceuticals are different from herbal medicine, 234 (88.3%) and 127 (84.7%) gave the correct answer. The students were then enquired about what comprises of nutraceuticals. Significantly lower proportion of nursing students 65 (43.3%) were aware that vitamin and minerals are included under nutraceuticals, than medical students 154 (58.1%) (p=0.004). Similarly, 131 (49.4%) out of 265 medical students compared to 46 (30.7%) of nursing students knew that probiotics and yoghurt are included among nutraceuticals (p<0.001). However, 68 (45.6%) out of 150 nursing students knew that phytoestrogens, carotenoids and flavonoids are also nutraceuticals (p=0.033). Almost 157 (59.2%) medical and 77 (51.3%) nursing students were aware that there are specific vitamins, minerals and herbals that boost immunity against cough and cold (Table/Fig 2).

Assessment of attitude of the study participants regarding nutraceuticals: Positive attitude towards role of vitamin C in COVID- 19 was noted among 167 (63%) medical students and 123 (82%) nursing students (p<0.001). About 182 (68.7%) medical students and 124 (82.7%) nursing students felt that regular intake of nutraceuticals has a positive role in protecting against COVID-19 (p=0.007). About 156 (58.9%) medical students and 103 (68.7%) nursing students felt that the safety of nutraceuticals is a grave concern and maximum number of participants 232 (87.5%) medical students and 135 (90%) nursing students felt the need of more events to educate people regarding use of nutraceuticals. Significant difference in attitude towards replacement of natural foods with dietary supplements was observed among medical and nursing students (p <0.001) (Table/Fig 3).

Assessment of practise of the study participants regarding nutraceuticals: The participants were enquired about their usage of nutraceuticals. Almost three-fifth of the students (264, 63.4%); 165 (62.3%) medical students and 99 (66.0%) nursing students; gave an affirmative response when asked whether they have ever used any nutraceuticals. Multivitamins and minerals were consumed by most of the participants both in present (55, 20.8%) and past (175, 66.3%) (Table/Fig 4). Two-fifth of the participants (202, 48.7%) had consumed a dietary supplement to maintain good health. Almost 60 (22.6%) of the medical students felt that these supplements could also be used to treat minor illness. Only 88 (33.2%) and 67 (44.7%) of medical and nursing students respectively consumed it on a daily basis. It was also reported that almost 147 (55.5%) medical students had researched about nutraceuticals and 237 (89.4%) medical students had sought professional/ medical help for the same (Table/Fig 5).

When inquired about the source of information about nutraceuticals, it was observed that the internet was the most sought medium (75.9%) followed by inquiry from a HCP (57.8%) and learning from classroom teaching/books (46.3%) (Table/Fig 6).

Distribution of study participants on the basis of poor and good knowledge and positive and negative attitude is shown in (Table/Fig 7).

The knowledge of the study participants was scored for every correct answer. Overall, there were total 273 (65.8%) participants with good knowledge and 47 (11.3%) with positive attitude. Significant difference in knowledge score was seen among medical and nursing students (p <0.001), between male and female students (p=0.02) and with increasing seniority (p<0.001).

Discussion

The current study suggests that greater proportion of nursing students than medical students and female than male students respectively had a good knowledge and positive attitude towards the role of nutraceuticals in human health. This finding the female participants were more likely to use nutraceuticals was consistent with the findings of a study conducted by Sharma A and Adiga S in South India Mohsen H et al., and Tirodimos I et al., among Greek university students (20),(21),(22).

Vitamins and minerals were reportedly used by 22.5% of students in the current study. The most-used dietary supplements were vitamins (18.0% in medical sciences students and 9.8% in non-medical sciences students) in research conducted by Žeželj SP et al., in University of Croatia (23). The knowledge and usage of other nutraceuticals such as probiotics, yoghurt and phytoestrogens, carotenoids and flavonoids was less and similar findings was reported in studies by Al Tamimi JZ in Saudi Arabia and Sotoudeh G et al., in Tehran (24),(25).

More than half the participants had the knowledge that vitamins and minerals boost immunity to fight off bacterial and viral infections but were relatively unaware about the beneficial effects of zinc and Vitamins D. Vitamin D in recently conducted systematic reviews has shown that it improves viral respiratory tract infections especially in those with Vitamin D deficiency (26). Evidence suggests that zinc deficiency decreased survival odds in COVID-19 patients and also served as reliable prognostic biomarker (27).

In the current study, 79.5% of undergraduates had an attitude that regular intake of nutraceuticals has a positive role in protecting against various disorders. Similar findings were reported in a study conducted by Jahan I et al., among undergraduate female students in Chittagong, Bangladesh. In the study, 81% students knew the beneficial use and 53.3% recommended its regular use (28).

This trend of increasing nutraceuticals usage was evident among the medical and nursing undergraduates with about 50% of them agreeing to having used dietary supplements at some point and almost 30% consuming them on a daily basis. Kobayashi E et al., conducted a nation-wide survey in Tokyo, Japan, which reported a 35% prevalence of dietary supplements usage among students (29).

Nearly half of the student used the nutraceuticals to maintain good health and to ensure adequate nutrition. Similar reasons were cited by 49% of medical students in a study conducted in Serbia by Stanojević-Ristić Z et al., (30). Consequently, over the years the prevalence of nutraceuticals usage has significantly increased, but the reasons have remained the same i.e., for the maintenance of overall health and to fill nutrient gaps (31).

In the current study, 76% of the study participants had researched on the internet to learn more about the utility of nutraceuticals. Likewise, a study conducted among medical and non-medical students in Croatia by Žeželj SP et al., observed that the main source of information was internet for 66.1% of students (23). Most of the participants in present study conducted their own research about nutraceuticals and depended upon the internet to answer their queries. However, Al Naggar RA and Chen R in their study suggests that professional help was sought by only 26.7% students (32). This implies a healthy curiosity and proactive mindset towards optimal health in the students. However, it also implies that the recommendations on using nutraceuticals in an adequately nourished population is ill advised. Additionally, in present study 42.2% of students felt that the nutraceuticals can substitute the nutrients in daily diet which is a misconception. This finding was corroborated by Aina BA and Ojedokun OA in their study conducted among students of College of Medicine, University of Lagos, where 64.5% students had similar thought (33). This observation clearly indicates the need for teaching students about appropriate nutraceutical concept and usage and earlier integration of dietary supplements in curriculum, so that they could benefit society and themselves. Appropriate doses of vitamins and minerals as per the most recent literature should be taught about and personally used by all HCPs. A small step that can go a long way towards a healthier community.

In the current study, majority of medical and nursing students raised grave concern over safety of nutraceuticals. Pharmacological education of young medical students was advocated on this topic to achieve far reaching impact and reduce adverse effects (30).

Most of the participants in present study conducted their own research about nutraceuticals and depended upon the internet to answer their queries. This suggests a deficiency in our curriculum for medical and nursing undergraduates where not enough material is available in their standard textbooks to educate them about the role of nutraceuticals in preventive as well as therapeutic medicine. Sign posters, magasines, newspapers, journal article also served as an important source of information for the students; suggesting that these could serve as useful tools for mass education, clearing myths and creating a favorable atmosphere for nutraceuticals usage.

Limitation(s)

A main limitation of the study was representation of only female nursing students and this could be owed to difference in academic preferences and admission.

Conclusion

Present study concludes that although the knowledge score among health personnel was on an average good, but the positive attitude was lacking. This led to usage of multivitamins and minerals driven by information gathered from internet. Thus, the source of information was not appropriate and thus, this led to certain misconception. Therefore, appropriate doses of vitamins and minerals as per the most recent literature should be taught about and personally used by all HCPs. Hopefully, the COVID-19 scare will guide us to teach the undergraduates in a more comprehensive manner by focusing on this as yet neglected but integral aspect of wholesome health. A small step that can go a long way towards a healthier community.

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DOI and Others

DOI: 10.7860/JCDR/2022/55408.16582

Date of Submission: Feb 02, 2022
Date of Peer Review: Mar 22, 2022
Date of Acceptance: May 09, 2022
Date of Publishing: Jul 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 08, 2022
• Manual Googling: May 05, 2022
• iThenticate Software: Jun 17, 2022 (7%)

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