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   Table of Contents - Current issue
Coverpage
June 2020
Volume 9 | Issue 6
Page Nos. 2593-3167

Online since Tuesday, June 30, 2020

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EDITORIAL  

Safe drinking water and toilet facility in public places in India: What we need to do! Highly accessed article p. 2593
Swapan Kumar Paul, Raman Kumar, Ranabir Pal, Amrita Ghosh
DOI:10.4103/jfmpc.jfmpc_318_20  
There is abundant literature on domestic safe water supply and hygienic sanitation. Yet, there is a paucity of research studies on adequate supply of safe drinking water and toilet facilities in places of population movement and congregation in India. This study stresses on the importance of availability of safe water and sanitation facilities in all the places of human congregation and movement in India. 49 research studies were identified from 169 potentially relevant publications. Studies were selected: first, all protocols of water and toilet facilities among published literature were meticulously searched. Second, information sources on sanitation facilities in public life, viz., railways, roadways, waterways, market places and shopping complexes, schools, and other higher educational institutions, fairs and festivals, entertainment establishments, healthcare facilities, were explored from publications of various resources of different levels. Third, published reports from apex bodies of national and international importance like Indian Council of Medical Research, World Health Organization (WHO), UNICEF, USAID, etc. were given due weightage. Of late, the concept of cleanliness and making communities free from open defecation are in limelight as the Government of India has taken up Swachh Bharat Mission (SBM); even then, contextual gaps remain. This is the cause for concern as both safe water supply and basic sanitation are directly linked to health promotion of the community. Further, this research group have noted that due importance has not been integrated in the planning of SBM regarding availability of safe water and scientific sanitation facilities in all the places of human movement and congregation. Hence, there is more need for creating awareness among general population as well as stakeholders regarding this aspect of cleanliness. It is noted that despite considerable improvement in safe water and sanitation facilities in domestic life, there is considerable population left, who are still lacking access to these facilities in public space.
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COMMENTARY Top

Retinopathy of prematurity: Addressing the emerging burden in developing countries Highly accessed article p. 2600
Suraj Singh Senjam, Parijat Chandra
DOI:10.4103/jfmpc.jfmpc_110_20  
Retinopathy of prematurity has emerged and continues to be one of the leading causes of avoidable childhood blindness in low- and middle-income countries over the past few years. A major reason is the lack of adoption of effective and efficient screening for retinopathy of prematurity in various neonatal or newborn units across the countries. At the same time, there is an improvement in the survival rate of high-risk newborn babies which causes a further rise in retinopathy of prematurity. Most of the associated risk factors for retinopathy of prematurity are avoidable, therefore, various preventive strategies can be developed at various levels of healthcare facilities ranging from primary to tertiary level. The integration of appropriate retinopathy of prematurity intervention programs between healthcare departments and partnerships with other non-governmental eye care institutions would be an important as well as critical step to prevent blindness and visual impairment due to retinopathy of prematurity in India and other developing nations.
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INVITED ARTICLE Top

The importance of wearing masks in curtailing the COVID-19 pandemic Highly accessed article p. 2606
Jose Humphreys
DOI:10.4103/jfmpc.jfmpc_578_20  
Primary care workers are the first point of contact for patients. Therefore, it is critical for this group of workers to understand the significant role of personal protective equipment and the importance of adhering to proper donning, doffing, and discarding protocols in epidemic control. These measures are crucial in curtailing disease transmission and the overall containment of the contagion.
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REVIEW ARTICLES Top

The prevalence and associated factors of depression among medical students of Saudi Arabia: A systematic review Highly accessed article p. 2608
Mohammed I AlJaber
DOI:10.4103/jfmpc.jfmpc_255_20  
The main purpose of our review study was to estimate depression prevalence among Saudi Arabian medical students according to the published articles and try to reveal the main associated factors. A systematic search was performed through PubMed/Medline and Google Scholar databases. A review of 18 studies published between January 2010 and March 2019 was composed of the following selection of necessary articles approved by PICO (population, intervention, control, and outcomes) criteria. The prevalence of depression among medical students of Saudi Arabia ranged from 30.9% to 77.6% with a mean prevalence of 51.5%. Depression severity was evaluated by various questionnaires, so we summarized the extracted data and revealed that medical students tend to have moderate to severe depression to a greater extent than mild depressive symptoms (33.27% vs 29.9%). The findings of this review suggest a high incidence of depression among medical students and the influence of associate sociodemographic factors. Females are considered to be at a higher risk of depression. First-year medical students are the most susceptible to develop depressive symptoms. Smoking is strongly associated with depression severity. Marital status, eating habits, usage of stimulants, and sleep disturbances are within significant findings of our review study.
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Nicotine replacement therapy: A friend or foe Highly accessed article p. 2615
Rajkumari E Devi, Diplina Barman, Shruti Sinha, Suranjana J Hazarika, Sreeparna Das
DOI:10.4103/jfmpc.jfmpc_313_20  
According to the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC), tobacco cessation is a primary health-care service that should be provided not only to the people having adverse habits of consuming tobacco but also to the nonconsumer, as they can also be harmed due to its deleterious effects. Tobacco has been regarded as a potential risk factor for oral diseases such as oral potentially malignant disorders and oral cancers. Various aids of achieving cessation have been studied, including education of the ill effects of tobacco to the patient, behavioral counseling, and pharmacotherapy. Various pharmacological interventions are available nowadays but nicotine replacement therapy (NRT) is most widely used. The various types of NRT products results in general and breakthrough craving relief with immediate release of nicotine. All of these products have different levels of efficacy and variable rates of nicotine absorption. Knowledge of these will be beneficial for the patients, the budding dentist and the nation in the upcoming days ahead.
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Cleft of lip and palate: A review Highly accessed article p. 2621
Tarun Vyas, Prabhakar Gupta, Sachin Kumar, Rajat Gupta, Tanu Gupta, Harkanwal Preet Singh
DOI:10.4103/jfmpc.jfmpc_472_20  
Cleft of lip and palate are most common serial congenital anomalies to affect the orofacial region . It can occur isolated or together in various combination and/or along with other congenital deformities particularly congenital heart diseases. .Patient with oro-facial cleft deformity needs to be treated at right time and at right age to achieve functional and esthetic well being. Successful management of the child born with a cleft lip and palate requires coordinated care provided by a number of different specialties including oral/maxillofacial surgery, otolaryngology, genetics/dysmorphology, speech/language pathology, orthodontics, prosthodontics, and other. This article aims to the review the point primary care physicians in literature knowledge about cleft lip and palate. A review of literature have made to discuss introduction, epidemiology, clinical feature, etiology factor and management of cleft lip and palate.
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Three dimensional (3D) imaging techniques in orthodontics-An update p. 2626
Fahad Abdullah Alshammery
DOI:10.4103/jfmpc.jfmpc_64_20  
3D imaging is a technique which develops or creates the impression of depth within an image by deploying 2D data into 3-dimensional format. To aid in quality regulating processes for industrial purposes, 3D imaging has become an extremely valuable factor. Owing to their various drawbacks, a wide range of investigative methods formulated for demonstration of facial structures and the dentition were dilapidated. Currently in medicine, the most prevalent method is perhaps 3D imaging technique renders thorough and problem specific information regarding hard and the soft tissues, such as Computerized Tomography (CT), Cone Beam Computerized Tomography (CBCT), Micro Computerized Tomography (MCT), 3D laser scanning, structured light technique, stereophotogrammetry or 3D surface imaging systems (3dMD), 3D facial morphometry (3DFM), Tuned Aperture Computed Tomography (TACT), and Magnetic Resonance Imaging (MRI). 3D imaging techniques in orthodontics plays an important role by facilitating more elaborated diagnostic information on the precise cases like patients having craniofacial anomalies. Hence, the aim of this study was to review advances in 3D imaging with in the field of orthodontics.
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Nurse-to-patient ratio and nurse staffing norms for hospitals in India: A critical analysis of national benchmarks Highly accessed article p. 2631
Suresh K Sharma, Ritu Rani
DOI:10.4103/jfmpc.jfmpc_248_20  
Optimum nurse-to-patient ratio is the concern of most of the nurse leaders globally. It has benefits both for nurses and patients; which is essential for patient's safety and quality of care. Some parts of the world such as California, USA, and Queensland, Australia has passed the law for the minimum nurse-to-patient ratio, which has scientifically found to be beneficial for the patients and healthcare system. Indian nurse staffing norms given by the Staff Inspection Unit, Indian Nursing Council, and Medical Council of India are developed through professional judgement models and are not updated. Five electronic databases were considered for literature search; in addition, grey literature and books were also searched. The primary outcome was to summarise exiting national nurse-to-patient norms and to find out the ideal nurse-to-patient ratio and nurse staffing norms as per Indian resources. It is concluded that nurse staffing norms must be immediately revised in the light of international norms and research evidence available in this regard. Further, there is a need for workload analysis based research evidence to have true nurse-to-patient ratio estimation for hospitals in India.
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Investigation of the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms: An evidence-based systematic review study p. 2638
Abed Ebrahimi, Naeimeh Tayebi, Ahmadinezhad Fatemeh, Marzieh Akbarzadeh
DOI:10.4103/jfmpc.jfmpc_1094_19  
Background: Menopause is an important physiological phenomenon in women's lives. Women's concern about taking the hormone treatment to ease menopausal symptoms is increasing. Over the past decade, the use of complementary and alternative medicine for the treatment of menopausal problems instead of hormone therapy has increased. Objective: This study aimed to investigate the role of herbal medicine, acupressure, and acupuncture in the menopausal symptoms. Methods: Data source: related articles were searched from internal scientific databases and external databases of “Web of Scopus, Cochrane, PubMed, Science Direct, Ovid, and Google scholar.” Study Eligibility Criteria: The keywords such as menopause, menopausal symptoms, complementary menopausal medicine, acupuncture in menopause, herbal medicine in menopause, and acupuncture in menopause were searched in the studies from 1987 to 2019. Exclusion criteria were inadequate information in the study, lack of access to full-text articles, animal studies, and reports. At the end of the search, 145 articles out of a total of 400 articles were reviewed. Results: In various studies, different herbs such as licorice, valerian, soy, sage, ginseng, etc., were used to improve menopausal symptoms. In addition, acupuncture and acupressure were used to reduce menopausal symptoms. Conclusion: The efficacy and use of complementary and alternative medicine, along with other classical medicine care, can be a new model for improving menopausal symptoms in women. It is recommended that further clinical and review studies be conducted to develop complementary and alternative medicine.
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Obesity and periodontal disease: A review p. 2650
Mohammad Shoyab Khan, Mohammed Alasqah, Lamia M Alammar, Yousef Alkhaibari
DOI:10.4103/jfmpc.jfmpc_283_20  
Periodontal diseases usually refer to inflammatory disorders that are caused by pathogenic bacteria in the subgingival biofilm in association with impaired host immune response and connective tissue breakdown. The bacterial challenge exacerbates the cytokine production by the gingival epithelium, resulting in an uncontrolled inflammation that leads to tooth loss in adults from different populations. The prevalence of these diseases increases with aging, longer retention of teeth, and increased incidence of obesity and diabetes among the population. The prevalence demonstrates an increasing trend and a correlation with numerous comorbidities. Hence, as a family physician one should have the in-depth knowledge regarding the relationship between obesity and periodontitis to create awareness among people to provide primary care. Thus, it is relevant to develop new methods capable of detecting these diseases in the early stages and following up on their progression.
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Clinical guideline and treatment planning decisions of single-tooth implants versus preserving natural teeth with nonsurgical endodontic therapy p. 2654
Sourav Bhattacharyya, DP Das, Anirban Bhattacharyya, Asim Bikash Maity, Debanjan Das
DOI:10.4103/jfmpc.jfmpc_128_20  
The outcomes of both dental implants and endodontically treated teeth have been extensively studied. An assessment of whether to rehabilitate a tooth requiring endodontic treatment or to replace it with a dental implant can often involve a challenging and complex decision making process for clinicians now a days. This review describes practical criteria and a systematic process to aid the treatment planning decision of whether to preserve teeth by root canal treatment (RCT) or extract and provide an implant. This article reviews the benefits and disadvantages of both treatment options and discusses success vs. survival outcomes.
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Gastric carcinoma: Insights into risk factors, methods of diagnosis, possible lines of management, and the role of primary care p. 2659
Aliyah M Marghalani, Thekra O Bin Salman, Fawaz J Faqeeh, Mohammed K Asiri, Ahmed M Kabel
DOI:10.4103/jfmpc.jfmpc_527_20  
Gastric carcinoma represents the second most common type of malignancy that contributes to cancer-related mortality worldwide. However, the geographic incidence of gastric carcinoma had changed over the last few decades, possibly due to increased hygiene, increased awareness of the importance of healthy nutrition, and increased rates of eradication of Helicobacter pylori infection. Gastric carcinoma consists of two pathological variants, intestinal and diffuse. Early cases of gastric carcinoma may be asymptomatic. However, advanced cases may present with significant weight loss, dysphagia, abdominal pain, vomiting, and even severe upper gastrointestinal bleeding. Patients at high risk of developing gastric carcinoma should be adequately screened at primary healthcare centers for early detection and effective management. Lines of treatment vary according to the stage of the disease but surgical resection of the tumor with regional lymphadenectomy remains the gold standard of therapy. This review sheds light on gastric carcinoma given the recent trends regarding its prevalence, risk factors, types, clinical picture, methods of diagnosis, possible lines of management, and the role of primary care.
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ORIGINAL ARTICLES Top

Barriers for full immunization coverage among under 5 years children in Mogadishu, Somalia p. 2664
T. Mohamud Mohamed Hayir, Mohamed A Magan, Lul M Mohamed, Mohamed A Mohamud, Abdishakur A Muse
DOI:10.4103/jfmpc.jfmpc_119_20  
Background: Immunization is amongst the most cost-effective public health interventions for reducing childhood morbidity and mortality. However, globally 9 million deaths of children occur as a result of vaccine-preventable diseases in which 4.4 million are from the sub-Saharan region. Therefore, this study aimed to assess barriers for complete vaccination coverage among under five years children in Mogadishu, Somalia. Methods: A community-based cross-sectional study was conducted between April to July 2019 in Mogadishu-Somalia. Two-stage cluster sampling with systematic random sampling was used to select a sample of 820 households. Data was collected through a structured, interviewer administrator questionnaire. In case more eligible children found at a single selected household, one child was randomly selected and the information related to immunization was interviewed from his/her caregiver. Results: The overall, fully vaccinated under 5 years children were found to be 45.2%. Immunization was found to be increased by being a younger caregiver (β=-0.024, P-Value=0.019) being father with secondary and above education (AOR = 1.755, 95% CI = 1.161–2.655, P-value = 0.008), being a young child (β = −0.018, P- value = 0.011), being children from birth order of fifth and above (AOR = 1.539, 95% CI = 1.011–2.343, P- value = 0.044), being a married caregiver (AOR = 4.101, 95% CI=1.062-15.835, P-value = 0.041), increased monthly family income (β =0.003, P- value = 0.000), availability of vaccine at the time of visit (AOR = 6.147, 95% CI = 1.943–19.441, P- value = 0.002), cost affordability of vaccine (AOR = 1.951, 95% CI = 1.238–3.076, P- value = 0.004), being born at health facility (AOR = 1.517, 95% CI = 1.104–2.086, P- value = 0.010), having good knowledge on immunization (AOR = 1.125, 95% CI = 1.070–1.181, P- value = 0.001), having good practice on immunization (AOR = 2.756, 95% CI = 2.233–3.402, P- value = 0.001) and having good perception on vaccine (AOR = 4.976, 95% CI = 2.183–11.340, P- value = 0.001). Conclusion: The result of this study has revealed that the proportion of fully immunized under-5 children in Mogadishu is very low. Several factors were found to the barriers achieving full immunization coverage. Steps to promote health education and vaccine availability should be lounged.
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Correlation between dermatoglyphics and dental caries in children: A case-control study p. 2670
Kishore Kumar Singh, Kumari Menka, Kumar Anand, Aashana Goel, Abhishek Dontulwar, Jagadish Prasad Rajguru
DOI:10.4103/jfmpc.jfmpc_108_20  
Background: Dental caries is a microbiological disease affecting teeth which has both genetic as well as environmental factors. Dermatoglyphics is the study of fingerprint patterns and is also genetically determined. This study is aimed to determine a correlation between dermatoglyphic patterns and caries susceptibility among children. Methods: A total of 250 children (125 each of case and control groups) were selected. Dental caries status was evaluated using the DMFT index while dermatoglyphic study was performed by recording impressions using stamp pad-ink method. Results: Higher frequency of all dermatoglyphic patterns was observed among female subjects with caries as compared to caries-free subjects as well as compared to male subjects. Conclusion: Dermatoglyphics can be employed as a positive indicator of caries susceptibility among children and holds importance in the area as future caries predictor.
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Level of awareness of diabetic ketoacidosis among diabetes mellitus patients in Riyadh Highly accessed article p. 2676
Bara'a Ahmad Farran, Rayan Ibrahim Bin Elaiwah, Abdullah Thamer Aldarsouny, Abdulmalik Mohammed Alshamrani, Abdulrahman Mohammed Almaslamani, Bader Faiz Alsubie, Mohammed Mwafaq Zainab, Mohammed Othman Alkulaib, Ammar Khalifah
DOI:10.4103/jfmpc.jfmpc_385_20  
Background: Diabetic ketoacidosis (DKA) is considered to be a serious acute life-menacing complication of diabetes type (1) and type (2). The study aims to assess the level of awareness regarding DKA among diabetic patients in the Riyadh population. Methodology: The study is an institution-based cross-sectional study with a sample size of 150 participants. The participants are chosen through systemic random sampling, who have type (1) or type (2) diabetes mellitus patients and are 18–35 years of age. The medical personnel were excluded from the study. A self-administered, precoded, and pretested questionnaire was developed especially for this study after consulting literature and epidemiologists containing data about the risk factor, management, and complication. Data were analyzed using (SPSS). A P value of less than 0.05 was considered significant. Results: 38.67% (58) participants have poor awareness regarding complications, 67.34% (101) have poor knowledge regarding management, and 6% (9) participants have a good knowledge, 38% (57) participants have poor knowledge regarding risk factors and 30% (45) of the participants have good awareness. The relation between having a first degree relative with diabetes and awareness regarding management is significant with a P value of 0.022; 73% (110) of the participants had no relatives with diabetes mellitus and 71% (79) had a poor level of awareness regarding the management of DKA. However, 55% (22) of respondents who had relatives with diabetes mellitus also had a poor level of awareness regarding treatment. Conclusion: The majority of the participants had a poor level of awareness. There is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA.
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The relationship between neuroticism and suicidal thoughts among medical students: Moderating role of attachment styles p. 2680
Mohsen Khosravi, Rashya Kasaeiyan
DOI:10.4103/jfmpc.jfmpc_1200_19  
Aim: The present study strives to find an experimental response to these questions: “Is the relationship between neuroticism and suicidal thoughts a simple relationship? Or are there other psychopathological variables such as attachment styles that also affect it?”Subjects and Methods: In this cross-sectional study, 376 medical students were selected from the three major cities of Iran using multi-stage sampling method from July 2018 to September 2018 and were evaluated using the demographic information questionnaire, Beck Scale for Suicidal Ideation (BSSI), the Revised NEO Personality Inventory (NEO-FFI), and the Adult Attachment Questionnaire (AAQ). Results: The overall prevalence of having suicidal thoughts among Iranian medical students was 17%. Moreover, the prevalence of suicide among the female, widowed, separated, and divorced students was higher than others. There was also a significant correlation between suicidal thoughts, gender, relational status, neuroticism, avoidant insecure attachment style, secure attachment style, and anxious/ambivalent insecure attachment style. Additionally, the attachment styles have a moderating role in the relationship between neuroticism and suicidal thoughts. Conclusion: Based on the current study, it is concluded that despite the presence of neuroticism in medical students, the attachment styles can reduce the risk of suicide as moderator variables. Hence, attachment styles can be considered a potential treatment goal in the prevention of suicide.
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Predictors risk factors for acute complex appendicitis pain in patients: Are there gender differences? p. 2688
Cem Cahit Barisik, Abdulbari Bener
DOI:10.4103/jfmpc.jfmpc_140_20  
Objective: The purpose of this study is to determine the predictive risk factors for appendicitis and the cost-effectiveness of using abdominal helical computed tomography (CT) in comparison to abdominal ultrasonography (US) for the diagnosis of acute appendicitis in patients. Subjects and Methods: The typical case was a patient with abdominal pain in the right lower quadrant and suspicion of appendicitis. A total of 643 patients who were consequently treated with appendectomy upon diagnosis of acute appendicitis between January 2015 and December 2018 were included in the study. The four diagnostic alternatives chosen were US, CT, biochemistry parameters, and physical examination in the hospital. Results: There were statistically significant differences between male and female patients with regards to age, BMI, cigarette smoking, sheesha smoking, family history of diabetes, hypertension and family history of gastrointestinal discomfort (GI), anxiety (P < 0.001), red eye (P = 0.006), dizziness (P = 0.021), headache (P < 0.001), muscular symptoms, weakness and cramps (P < 0.001), bloating or swollen stomach (P < 0.001), UTI (P < 0.001), chest pain (P < 0.001), guarding (P < 0.001), loss of appetite (P = 0.004), nausea (P < 0.001) vomiting (P = 0.042), anorexia (P = 0.009), and constipation (P = 0.002). Moreover, there were statistically significant differences between male and female patients for pain (P < 0.001), pain right belly (P = 0.027), severe crumps (P = 0.007), high temperature and fever (P < 0.001), irritable bowel syndrome (P < 0.001), right iliac fossa (RIF) pain (P = 0.008), rebound tenderness (P = 0.024), positive bowel sounds (P = 0.029), and pointing tenderness (P < 0.001). Multivariate stepwise logistic regression showed nausea (P < 0.001), C-reactive protein (CRP) (P < 0.001), dizziness (P = 0.016), vomiting (P < 0.001), muscular symptoms (P = 0.007), irritable bowel syndrome (P = 0.034), guarding (P = 0.040), and loss appetite (P = 0.046) were considered at higher risk as predictors for appendicitis patients. Conclusions: CT is more cost-effective than the US and clinical examination for determining appendicitis. The current study suggested that nausea, C-reactive protein, dizziness, vomiting, muscular symptoms, irritable bowel syndrome, guarding, and loss appetite were considered as higher risk predictors for appendicitis patients.
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Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes p. 2693
Lajya Devi Goyal, Dapinder Kaur Bakshi, Jatinder Kaur Arora, Ankita Manchanda, Paramdeep Singh
DOI:10.4103/jfmpc.jfmpc_213_20  
Background and Aim: There is sparse data available on human subjects regarding the affect of excessive fluoride exposures on pregnancy. The aim of this study was to examine the association between elevated urinary fluoride levels during early pregnancy and maternal anemia and adverse fetal outcome. Patients and Methods: We enrolled 600 pregnant patients with gestational age less than 20 weeks and with a high urinary fluoride levels(>1 mg/L).We also documented the fluoride levels in the tap water and ground water samples collected from the areas where these women resided during pregnancy. These patients were also evaluated for hemoglobin levels and detailed fetal examination by ultrasound. Data was assessed by SSPS version 16.0 software and P < 0.05 was considered to be significant. Results: Urinary fluoride averaged 2.65 mg/L and ranged from 1.0 to 4.3 mg/L while all the water samples revealed fluoride levels greater than WHO prescribed the limit of 1.5 mg/L. A total of 402 patients (67%) were found to be anemic with hemoglobin levels ranging from 6.2 to 11.9 g/dl (9.28 ± 1.29). Eighty one patients (13.5%) had adverse fetal outcomes that comprised abortions, congenital abnormalities, and intrauterine deaths (IUDs). There was a negative correlation between urinary fluoride and hemoglobin levels (P = 0.031, r= -0.59) and females with elevated urinary fluoride levels were found to have a strong association with the pregnancy complications, i.e., anemia, miscarriage, abortion, and still birth (χ2 = 9.23, P < 0.05). Conclusions: Excess fluoride exposures can have deleterious effects on the expecting mother and fetus and is associated with adverse pregnancy outcomes.
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Prevalence of cognitive impairment in elderly population residing in an urban area of Belagavi p. 2699
Ambika B Khanna, Chandra S Metgud
DOI:10.4103/jfmpc.jfmpc_240_20  
Context: Cognitive impairment (CI) is emerging as an important health problem of the elderly population in India. As the impact of this illness at various levels is not well understood, so situation analysis is the need of the hour. Aims: (1) To know the prevalence of CI in elderly population residing in an urban area. (2) To assess the burden of health care among the care givers. Settings and Design: A cross-sectional study was carried out among 770 elderly aged ≥60 years residing in two Urban Health Centres of Belagavi District. Methods and Material: Socio-demographic profile of the participant was collected using a predesigned and pretested questionnaire by personal interview at the participants' residence. To assess the CI and burden of healthcare, Mini Mental State Examination and Zarit Caregiver Burden Scale were used, respectively. Statistical Analysis Used: IBM SPSS version 22 was used. Chi square test and Fisher's Exact test were applied. Results: The overall prevalence of CI was 8.4% in our study. The risk factors noted for CI were advancing age, female sex, unmarried or widow/widower, illiterate, not working presently, staying alone, and poverty. Out of 65 caregivers, 67.7% of them had mild or moderate burden of caring for the cognitively impaired elderly. Conclusions: It is important to assess older people for any CI, when planning geriatric health care. Priority must be given to the older age group and female, as they are more vulnerable to CI.
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Teachers and epilepsy: What they know, do not know, and need to know: A cross-sectional study of Taif City p. 2704
Sultan Alamri, Abdulellah Al Thobaity
DOI:10.4103/jfmpc.jfmpc_33_20  
Objective: The main aim of this study was to assess schoolteachers' knowledge of and attitudes toward epilepsy in Taif City, in the western region of Saudi Arabia. Method: A structured 28-item questionnaire was distributed to and collected from 290 schoolteachers between November 2017 and November 2018 in Taif City. Results: Generally, a negative attitude toward epilepsy was observed in this study. Of the 290 schoolteachers in this study, 80% had prior knowledge regarding epilepsy and 72% had witnessed a seizure. Only 2% of the participants expressed the thought that epilepsy is contagious but 59% of them expressed the thought that epilepsy is a mental disease. With respect to attitude, 64% of the participants reported that they would not approve of their daughter/son marrying someone with epilepsy. This attitude correlates with age and marital status as the prevalence of this attitude was higher among those who were either over 40 years old or married (P < 0.05). Although 73% of the participants stated that they know the correct management procedure to follow when helping an epilepsy patient during a seizure, inadequate practices are still performed by many. Finally, almost two-thirds of the respondents (66%) expressed the opinion that top-ranking professions are not suitable for people with epilepsy. This belief was twice as common among older respondents as it was among younger respondents (P < 0.05).Conclusion: This study concludes that schoolteachers' knowledge regarding epilepsy is limited and that an immediate intervention through educational campaigns is required to develop a well-informed community.
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Evaluation of job satisfaction of forensic medicine specialists and comparison with job satisfaction of some medical specialists in Tehran p. 2710
Azadeh Memarian, Kamran Aghakhani, Seyed Hossein Moosavi Nezhad Baboli, Seyed Abdolhadi Daneshi, Siamak Soltani
DOI:10.4103/jfmpc.jfmpc_1167_19  
Introduction: Job satisfaction is a main factor to increase efficiency, productivity, and individual satisfaction in the organization. The purpose of this study is to determine the forensic expertise amount of job satisfaction and to compare them with other specialists in different. Materials and Methods: In this cross-sectional study, 150 individuals were included in three groups of specialists including forensic, internal medicine, and pediatric. Data were collected by Brayfield and Rothe Job Satisfaction Questionnaire. SPSS software version 23 was used for statistical analysis. Results: High levels of job satisfaction among forensic professionals were higher than low job satisfaction, but the same was true for the other two groups. In this study, job satisfaction status in the three groups of specialists was not significantly correlated with their type of expertise (P = 0.19). There was no significant relationship between job satisfaction and gender (P = 0.19). In addition, the mean age of the specialists with low and high job satisfaction was not significantly different (P = 0.99). In this study, although the mean of work experience in professionals with high job satisfaction was higher than those with low job satisfaction, this difference was not significant (P = 0.23). Conclusion: The results of this study showed that job satisfaction was high among forensic medical professionals and was not significantly different from other specialist groups including pediatric and internal medicine. In addition, job satisfaction was not significantly different in terms of age, gender, and work experience.
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Effect of Trigonella foenum (fenugreek) vaginal cream on vaginal atrophy in postmenopausal women p. 2714
Fakhriyeh Mazalzadeh, Khadijeh Hekmat, Foroogh Namjouyan, Amal Saki
DOI:10.4103/jfmpc.jfmpc_1220_19  
Background and Objective: Menopause forms one-third of women's lives. During this period, many women continue their sexual activities. One of the most prevalent postmenopausal complications is vaginal atrophy whose symptoms could have destructive effects on the life quality among postmenopausal women. Complications of using estrogen hormone to improve these symptoms are inevitable. One of the objectives of the present study is the assessment of the vaginal cream of Fenugreek on vaginal inflammation of atrophic vaginitis in postmenopausal women. Materials and Methods: For assessment of the effect of fenugreek vaginal cream among postmenopausal women who suffer from vaginal atrophy, the present study was carried out in the form of a double-blind clinical trial among sixty postmenopausal women, mainly who had been referred to Health Center 1 located in the east of Ahvaz in 2017. All participants of the present study who were diagnosed with vaginal atrophy were assigned into two groups of 30 randomly. One of these groups received placebo and the other one fenugreek 5% vaginal cream for a period of 8 weeks. Symptoms related to vaginal atrophy were investigated by means of a 4-degree scale (none, mild, moderate, and severe) and maturation vaginal index (MVI) through preparing the vaginal smears technique at baseline and a period of 8 weeks after cytology and intervention experiment. Finally, the process of analyzing statistical data, at a statistical significance level of 0.05, was carried out by means of SPSS Software. Results: The results of the present study demonstrated that the fenugreek vaginal cream treatment group experienced a significant improvement in vaginal atrophy symptoms compared to the onset of the study (P < 0.001). Conclusion: Fenugreek vaginal cream was effective in treating vaginal atrophy; therefore, postmenopausal women are recommended to use this cream instead of synthetic estrogen to reduce the complications of this hormone.
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Pathological and clinical profile of hearing loss among Sudanese children attending the Khartoum Teaching Hospital p. 2720
Amr F. M. Khalifa, Amar F. M. Khalifa
DOI:10.4103/jfmpc.jfmpc_348_20  
Background: Hearing loss is a common disability affecting nearly 360 million people in the world and 75% of cases live in developing countries. Many children are vulnerable to diseases causing hearing loss that often go untreated. The aim of this study is to identify the possible etiological factors and clinical presentations of children who presented with hearing loss at the Khartoum Teaching Hospital. Materials and Methods: a descriptive, cross-sectional hospital-based study. A total of 100 (response rate of 94%) children aged 5–15 who presented with hearing loss at Khartoum Teaching Hospital were included in this study. A detailed structured, pretested, and pre-coded questionnaire was used. After data collection, hearing examination was performed by an E.N.T specialist, then audiometry performed to diagnose hearing loss and for classification of the hearing loss type. Discriptive Statisistics frequencies and cross-tabulation were done. A Chi-square test was used for proportions. A P value of less than 0.05 considered significant. Results: Out of 100 patients, 68 patients (68%) belonged to the 5–10 years age group. The mean age was 8.5 years. The male to female ratio was 1.00–1.13. Conductive hearing loss was found in 66% of the studied group, sensory-neural hearing loss in 23% and the mixed type in 11%. Regarding the etiology, otitis media was found in 41 of patients (41%), congenital hearing loss in 22% (22 patients), traumatic hearing loss in 4%, sickle cell anemia in 2%, mumps in 14%, diabetes mellitus in 3%, and measles in 8% of the patients. In conclusion, a number of preventable causes were shown to contribute significantly to the etiology of hearing loss. Conclusion: The commonest factors associated with hearing loss among participants were otitis media and hereditary causes, respectively. Further community-based studies of hearing-impaired children are necessary for planning effective preventive and curative programs.
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Study of determinants of immunization status among under-five children attending OPD in a rural health center of the tertiary health care institute p. 2724
Amandeep Kaur Ratta, Pravin D Meshram
DOI:10.4103/jfmpc.jfmpc_387_20  
Context: The risk of morbidities from vaccine-preventable diseases is highest in those who experience barriers in accessing immunization services. This spectrum could be affordability, accessibility, lack of awareness about immunization services and their health benefits or other limiting factors. The present study aimed to identify maternal and other determinants of immunization status. Aim: To identify maternal and other determinants of immunization status of under-five children. Settings and Design: An OPD based cross sectional survey. Methods and Materials: Non-randomized sample of 194 children (1-5 years) and mothers attending OPD in study duration were examined and interviewed. Statistical Analysis: Data was analysed with SPSS version 20 applying appropriate tests. Results: Out of 194 children, 128 (65.98%) were completely immunized, 45 (23.2%) were partially immunized and 21 (10.82%) were not immunized. Study showed significant association between immunization status and sex of children (P 0.0004), permanent residence (P 0.00001), birth order (P 0.0007), institutional births (P 0.00001), presence of the immunization card (P 0.00001), distance from centre (P 0.0002), age (P 0.00001) and education of mothers (P 0.0001). Association with Religion was statistically non-significant (P 0.0071). Nearness of immunization centre was the main motivating factor for full immunization, whereas unawareness about the need of immunization was prime cause of partial and non-immunization. Conclusion: Present study depicts low immunization completion rate and highlights determinants associated with it. This could be addressed through strong political commitment, infrastructure development and community outreach to achieve the goal of universal immunization.
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A study to assess the effect of stressful life events on psychological distress levels of participants living in an urban area p. 2730
Sayali C Tiwari, Swati R Deshpande
DOI:10.4103/jfmpc.jfmpc_96_20  
Context: Stressful life events affect the psychological wellbeing of individuals. Through this study, we aim to understand this effect and various other factors affecting the psychological wellbeing of the study participants. Aims: To determine the vulnerability of study participants to psychological distress following stressful life events Settings and Design: Cross-sectional observational study in an urban setting Methods and Materials: Systematic random sampling with a sample size of 178. Statistical Analysis Used: Analysis is done using SPSS version 22. Tests used are chi square test, Spearman's rank correlation test. Results: The number of life events and psychological distress scores had a positive correlation.The events that occurred in one month before history taking, a correlation was found to be strongest and no correlation was found between the events which occurred more than one year before study enrolment and the psychological distress. Factors like sleeping patterns, exercise, and marital status also had a significant correlation with the psychological distress score of participants. Conclusions: Mental health is dependent on many parameters with life events being a major factor at a given point of time. However, different factors apart from life events will affect psychological wellbeing, and mental health is an interplay of all those factors.
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The study of the factors affecting the time of ring fall off in circumcision using Plastibell p. 2736
Setareh Soltany, Arash Ardestanizadeh
DOI:10.4103/jfmpc.jfmpc_1261_19  
Introduction: Circumcision is one of the oldest surgeries and is commonly done in various communities. One of the most common methods of this operation is using a ring or plastible. Given that one of the complications of circumcision by the ring is a delay in the ring fall off, this study is done with the purpose of determining the factors that affect the time of the ring fall off. Materials and Methods: This study was done in case series—prospective way. At first, local anesthesia was performed in the form of ring block and using 0.2 cc lidocaine 2% per kg body weight with an insulin syringe and then, by making a linear incision on the foreskin, a ring of the right size was placed on the glans. The foreskin was stretched on the ring and the 0–2 or 0–3 suture was tied to the ring groove and finally, the foreskin was removed from the distal part to the ring. Parents were asked about age, size of suture used, time of ring fall off, and status of sitz bath usage and were recorded even they done completely, incompletely, or not. Results: Finally 465 patients started the study with the average age of 7.55 4 ± 4.72 months. The average time of the ring fall off was 66.7 ± 60.2 days. People who had used the sitz bath completely (92.6 ± 36.2 days), compared to those who had used incompletely (63.8 ± 06.2 days) or no use at all (93.9 ± 58.2 days), they had shorter ring retention time (P < 0.001). Also, people who were used 0–3 suture had shorter ring retention time compared to those who were used 0–2 suture (82.6 ± 42.2 days versus 56.2 ± 27.8 days and P < 0.001). There was a significant relationship between age of ring retention and age, and the time of the ring fall off is shorter in those who are younger and the “less than or equal to 3 months” age group had the least time of the ring fall off. Conclusion: The results of this study showed that there is a significant relationship between the duration of the ring fall off and the age of individuals and the use of a sitz bath and the use of thinner suture (0–3).
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Smokeless tobacco use and related oral mucosal changes in Bengali Women p. 2741
Tathagata Bhattacharjee, Pallab Mandal, Somnath Gangopadhyay
DOI:10.4103/jfmpc.jfmpc_100_20  
Background: Tobacco use is called the single most cause of preventable cause of death all over the world. The various study confirmed that smokeless tobacco use is directly related to oral cancer and pre-cancer. The prevalence of smokeless tobacco use varies widely in different countries and states based on age group, gender, with varied socioeconomic, cultural and educational backgrounds. Context: Bengali female population. Aim: Explore the pattern of smokeless tobacco use and oral mucosal changes caused by it. Methods: 155 women aged 15 years and above were selected. Face-to-face interview was conducted using a structured questionnaire. Data were summarized and statistically, analysis was done. Statistical Analysis Used: Chi-square test and univariate logistic regression done. Results: The prevalence of current smokeless tobacco use was found to be 18.7%. On univariate logistic regression, it was found that there was a significant association between smokeless tobacco use and less educated females, odds ratio 0.4209 (0.1855–0.9550) family income less than 10,000, odds ratio 3.9773 (1.3047–12.1242), and oral changes odds ratio 0.2693 (0.1027–0.7061). Conclusions: Health care providers, as well as social workers, should give all efforts to bring the women from behind the curtain and educate them about the hazards of smokeless tobacco use.
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Reporting of the core indicators on drinking water and sanitation from urban slums of Jammu: A cross-sectional study p. 2747
Sonika Sangra, Neha Choudhary, Akash Narangyal
DOI:10.4103/jfmpc.jfmpc_134_20  
Introduction: Water, sanitation, and hygiene (WASH) play an important role in decreasing the morbidity and mortality associated with poor WASH practices. Poor knowledge and awareness lead to an increase in communicable diseases. Objective: To assess and report the core indicators on sanitation and drinking water from urban slums using standardized WHO and UNICEF questionnaires. Materials and Methodology: The present observational cross-sectional study was conducted for 2 months i.e., from September 2019 to October 2019 in urban slums of Trikuta Nagar, a field practice area of Department of Community Medicine, GMC Jammu. Information was gathered from the head of the household as well as from other household members. About 50% of the population were selected randomly by lottery method i.e., 450 and consist of 112 households. However, at the time of the study, only 100 households were assessed because of the nonavailability of household members and some houses were locked at the time of the interview. Results: The study revealed that nearly 62% of families were of a joint type and most of the families were headed by male members. Around 82.5% of the slum members used water for drinking from improved source but only 21.5% of the household members used adequate water treatment method i.e., boiling. Besides, about 49.5% of the household members used improved sanitation facilities. Conclusion: Local administration needs to accelerate the process of supplying piped water connections to the underserved to improve their drinking water sources and also increase access to basic sanitation services at the household level.
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A cross-sectional study of awareness and practices regarding animal bites in rural community, North India p. 2751
Tarundeep Singh, Shuchi Mahajan, Neha Dahiya
DOI:10.4103/jfmpc.jfmpc_158_20  
Introduction: Repeated epidemiological studies to monitor trends of knowledge and practices are needed to guide strategies to control rabies. We conducted a study to assess the current knowledge, attitudes, and practices in relation to animal bites in the rural area of north India. Methods: House to house survey to collect data on animal bites was conducted among 300 households (assuming awareness regarding animal bites to be 25%, precision 95%, and power of 80%) from the rural area of Punjab, north India. A pretested semi-structured questionnaire comprising of items that explored sociodemographic details (age, educational qualification, occupation, socioeconomic status (assessed through Udai Pareek scale), and awareness regarding rabies, knowledge about first aid, attitude, and practices regarding anti-rabies vaccination (ARV) was used. Detailed questions were asked to those who owned pets. Results: A total of 300 households were included in the analysis. Among all respondents, 30.4% (117) had an episode of animal bite in their family giving a bite incidence rate of 78/1000 population. Bites were more frequent in males (65.8%, n = 77). The commonest site of the bite was lower limb (65%) followed by upper limb (21.4%), and head and neck (5.1%). The participants said that bites by pet animals (47%) are more common than those by stray animals (35.9%), followed by wild animals (12.8%). Almost 91% of respondents told that they would prefer govt. hospital for the treatment. Class I bite was most common (88.9%) followed by class II (8.5%) and class III (1.7%). A lot of respondents (41.4%) did not know about the symptoms of rabies in humans. Only 17.5% knew the appropriate wound care. Inappropriate practices like applying chilly (48.8%), lime (13.1%), tying the limb above the wound (5.1%), and others were common. Only 15.5% washed their wound with soap and water. Most of those who were bitten received post-exposure prophylaxis (PEP) (80%). Most of the respondents (98.3%) had heard about ARV but didn't know about the site of injection. Almost everyone (99.35) said that no awareness camps/programs had been conducted in their villages/school/health center to date. Conclusion: There is a high incidence of animal bites in rural areas. Awareness regarding the need for rabies vaccine of animals and PEP after an animal bite is quite high and is practiced. However, there is a lack of awareness regarding the course of action to be followed when an animal does develop rabies. Traditional and inappropriate practices of wound management persist and need to be countered. Improving the availability of ARV and rabies immunoglobulin through the public health system may further augment the uptake of PEP and completion of treatment while at the same time reducing out of pocket expenditure and the overall economic cost of rabies. Solid waste management in rural areas along with oral ARV is likely to reduce the incidence of rabies in rural areas.
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Economic impacts of the Bacillus Calmette-Guérin (BCG) therapy shortage and the proposed solutions for patients with non-muscle invasive bladder Cancer in Aseer Province, Saudi Arabia p. 2758
Mishari H M Alshyarba, Abdulaziz Alamri, Alhassan Alamer Assiri
DOI:10.4103/jfmpc.jfmpc_171_20  
Objective: To report the magnitude, the financial and the economic impact of Bacillus Calmette-Guérin (BCG) shortage in our institute and transfer of non-muscle invasive bladder cancer (NMIBC) patients to higher centers to receive the treatment. Methods: This is a retrospective study, between January 2015 and December 2017, the cases of NMIBC diagnosed at Aseer Central Hospital, Abha, Saudi Arabia were studied. Demographic features, clinical presentations, histopathological features, and the BCG therapy shortage and its economic impact were addressed. Results: Over a three years study review of 62 urothelial bladder cancer, NMIBC was diagnosed in 55 (89%) patients. Forty-three (78%) patients were males and 12 (22%) patients were females. The mean age ± standard deviation (SD) (range) in this cohort was 59 ± 12 years (38–87). Gross hematuria was the main presentation in 51 (92%) patients of this cohort. Dysuria and other lower urinary tract symptoms were the presentations in 18 (32%) patients. Smoking history was positive in 33 (60%) patients and the rest 22 (40%) patients denied any form of tobacco consumptions. The BCG eligible were 46 (84%) patients of all NMIBC patients in this study. Twenty-seven (59%) patients of them received BCG in our institute. The rest 19 (41%) patients were opted to be transferred to a higher medical center to receive the BCG because of the BCG shortage in our center. The financial cost of traveling to receive the six-weeks induction BCG therapy was on average of 7200 Saudi riyals (1.745 €) for every patient. Conclusions: The BCG shortage in our institute is almost approaching half of eligible BCG cases. This has had an economic impact on the health budget. Such health catastrophe could be mitigated with proper health plans of a provision of the BCG to all tertiary care centers. Alternative therapies for such cases should be considered in cases of global BCG shortage.
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Socioclinical profile of patients seeking treatment for cancer in a Teaching hospital in east Delhi, India p. 2763
Utsav Gupta, Madhu Kumari Upadhyay, Rahul Sharma
DOI:10.4103/jfmpc.jfmpc_308_20  
Background: Prevalence of cancer in urban India is seeing a discernible increase due to lifestyle modifications and adverse environmental exposures. The pattern of cancer incidence varies from one region to another within a large country like India. Aim and Objectives: This study was conducted to understand the socioclinical profile of the patients attending a tertiary care hospital in east Delhi for the treatment of cancer. Methods: Patients above the age of 18 years, who had been diagnosed with cancer, were recruited for our study and their socioclinical details were elicited. After 3 months they were reassessed and their treatment and side-effect profile were studied. Results: Majority of our patients were diagnosed with cancers of the oral cavity and were married men in age group of 40–60 years, residing in the National Capital Region. Patients diagnosed with breast cancer were more likely to receive chemotherapy and suffer from side effects of treatment like nausea, anorexia, and loss of weight. Conclusion: Physicians need to be aware of these complications and should incorporate a proper counselling mechanism before treatment is started in such patients. Family physicians play a defining role in the palliative management since he remains a trusted face in his community and can provide professional and psychotherapeutic support.
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Prevalence of alcohol use and the interventions needed among adults: A community study in a rural area in South India p. 2769
Anil Bindu Sukumaran, Divija Vijith, Jeesha C Haran
DOI:10.4103/jfmpc.jfmpc_38_20  
Background: The health issues and social problems associated with alcohol use are well known. This study seeks to identify the prevalence of alcohol consumption and dependence among alcohol users in a rural area of Trivandrum district. Objectives: To assess the prevalence of alcohol use among adults of Nellanad Panchayat, a rural area in Trivandrum, Kerala, to find out the interventions required among the alcohol users, and to identify persons with harmful and hazardous use of alcohol using AUDIT. Settings and Design: Cross-sectional study in Nellanad Panchayat, Trivandrum district, Kerala. Methods and Materials: A cross-sectional study was carried out among 1545 residents in Nellanad Panchayat, a rural area in Kerala, by interviewing adults with the help of a questionnaire. Data were analyzed using SPSS. Results: The overall prevalence of current alcohol use was 146 (9.5%). The prevalence among males was 143 (18.3%) and females was 3 (0.4%). ASSIST scores showed that 99 (50%) of ever users required health education, 74 (37.8%) required counseling, whereas 23 (11.7%) required de-addiction. Conclusions: Among males, the alcohol consumption is still as high as 18.3%. The most important factor affecting alcohol use is peer pressure. Health education is the most required intervention to reduce burden of alcohol use.
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Prevalence of diabetes among patients and the assessment of the awareness of the bidirectional relation between diabetes and periodontal disease p. 2774
Anisha A Mahtani, Caroline Jacob, Reema Lakshmanan
DOI:10.4103/jfmpc.jfmpc_63_20  
Aim: To assess the extent of self-awareness and knowledge of diabetes and its association with periodontal disease among patients seeking dental care. Materials and Methods: Data were collected in the form of a questionnaire from 150 consecutive adult patients from the outpatient department of Saveetha Dental College in Chennai, India. Complying patients were tested for diabetes mellitus by checking their random blood sugar and the results were correlated with the questionnaire and their periodontal findings. The findings were interpreted to examine the relationship between self-awareness and clinically diagnosed periodontitis. Results: One hundred fifty patients participated in the questionnaire and 70% were unaware of diabetes causing periodontal disease. A total of 47.3% of patients were also unwilling to get themselves tested for diabetes by their dentists as nearly 73.3% believed that they did not have diabetes. As a result, out of 150 patients, 41 consented to random blood sugar but only 23 patients followed up. Among these 23, 14 believed they were diabetic but only 12 of those 14 were proven to be so. Additionally, 20 patients were diagnosed with either localized or generalized chronic periodontitis while the remaining 3 patients had gingivitis. All 12 patients diagnosed with diabetes were affected by periodontitis as well. Conclusions: Patients are generally apprehensive and misinformed regarding the influence of periodontitis and diabetes between both diseases and must be educated by both the medical and dental practitioners regarding the implications of these chronic inflammatory diseases.
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Spectrum of leprosy among suspected cases attending a teaching hospital in Western Rajasthan, India p. 2781
Jitu Mani Kalita, Vijaya Lakshmi Nag, Kavita Yedale
DOI:10.4103/jfmpc.jfmpc_77_20  
Background: Leprosy is a chronic granulomatous infectious disease, which mainly involves skin, peripheral nerves, mucosa of the upper respiratory tract, and eyes. According to National Leprosy Eradication Programme 2017–18 annual report, the annual new case detection rate from Rajasthan is 1.27 per 1 lakh population and prevalence rate is 0.14. Aims and Objective: The main objective of this study was to determine the spectrum of Mycobacterium leprae infections among suspected cases attending a teaching hospital in western Rajasthan, India. Materials and Methods: This is a retrospective study conducted in the Department of Microbiology, in a teaching hospital, western Rajasthan, between the period of January 2017 and April 2019. The records of modified Ziehl–Neelsen staining during the study period were analyzed. The demographic data like age and sex along with clinical diagnosis were also recorded from laboratory register and hospital information system. Results: Out of total 91 suspected cases, 30.77% was microbiologically confirmed cases of leprosy. Out of total positive cases, 71.43% were male and 28.57% were female. A maximum number of positive (50%) were found in the age group of 31–50 years. Conclusion: Present study gives an insight about the spectrum of leprosy in the region. The large number of positive cases signifies that leprosy awareness and programs aimed at elimination need to be more vigorously implemented. To achieve complete eradication from this menace, newer strategies like effective vaccine development and drug-resistance testing should be implemented.
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Role of image-guided fine needle aspiration cytology of lung lesions in diagnosis and primary care of patients: Experience in a Government Medical College of Eastern India p. 2785
Preeti Rihal Chakrabarti, Kaushambi Chakraborty, Prachi Kukreja
DOI:10.4103/jfmpc.jfmpc_89_20  
Context: Lung cancer is the most common cancer affecting males worldwide. Its incidence in females is also on an increasing trend. Other conditions affecting lung-like tuberculosis are on a rise in middle-east countries due to overcrowding and poor living conditions. In developing countries, image-guided fine-needle aspiration cytology (FNAC) of lung lesions is a cost-effective method for early detection and apt treatment of patients by physicians. Aim: The main aim of this study is to identify the importance of computed tomography (CT)guided FNAC as an accurate and cost-effective tool in early diagnosis of lung lesions. Settings and Design: It was prospective and retrospective study done in a government medical college of West Bengal, India. Material and Methods: Over a period of two years, 42 cases were included in the study. These were further subjected to evaluation of pulmonary mass lesions by CT guided transthoracic fine needle aspiration cytology. Results: Out of these 42 cases majority were males with cough being most common clinical presentation. On CT guided FNAC of pulmonary lesions 69% of cases were malignant. Cytoradiological correlation in this study was 90.4%. Conclusion: CT guided FNAC of lung lesions is an accurate, cost effective and quick technique for early diagnosis, referral and appropriate treatment of patients in developing countries.
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A cross-sectional study of association of serostatus and extra-articular manifestations in patients with rheumatoid arthritis in a teaching hospital p. 2789
Bharat Kumar, Madhumita P Das, Arup Kumar Misra
DOI:10.4103/jfmpc.jfmpc_99_20  
Background: Rheumatoid arthritis (RA) is an autoimmune disease, which mistakenly attacks the joints and induces the inflammatory changes that thicken the joints (the synovium) resulting in swelling and pain in and around the joints. It causes pain, joint deformity, and also affects the quality of life. The joint is affected symmetrically. It also can affect body systems, such as the cardiovascular, respiratory systems, or other systems, which manifest as extra-articular manifestations. Extra-articular manifestations of RA are documented less in India hence this study was undertaken to correlate RA with extra-articular manifestations as well as its relationship with serostatus in patients with extra-articular manifestations. Materials and Methods: Sixty patients (age between 18–60 years) attending Medicine/Rheumatology outpatient department were included in the study (12 months) who fulfilled the 2010 RA classification criteria laid down by American College of Rheumatology (ACR)/European League against Rheumatism (EULAR) for RA. All the subjects underwent a thorough history, clinical examination, and laboratory investigations. The relevant data were analyzed with appropriate statistical methods after 12 months' duration. Results: Nearly 68.33% of the subjects were found to have extra-articular manifestations mostly in the age group of 31–40 years with prevalence higher in the female. In the seropositive patients, early morning stiffness (EMS) constitutes 63.82% of the total extra-articular manifestations in the patients followed by anemia (38.29%) and peripheral neuropathy (34.04%). On the other hand, in the seronegative cases, EMS (61.53%) followed by anemia (23.07), peripheral neuropathy (15.38%), and keratoconjunctivitis sicca (15.38%). Extra-articular manifestations in seropositive patients have a statistically significant relationship with the increase in the duration of the disease. Conclusion: Extra-articular manifestations need to be looked carefully as it is associated with more severe disease. Seropositivity and extra-articular manifestations both usually indicate that the RA is more severe and may affect the quality of life.
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The impact of empowerment model-based education on quality of life of transgender people under hormone therapy: A randomized clinical trial p. 2794
Maryam Asadi, Fariba Tabari, Shima Haghani, Mohammad Eghbal Heidari
DOI:10.4103/jfmpc.jfmpc_1201_19  
Introduction: Gender identity disorder is a complex psychological problem and people with this disorder are at risk of many problems, including reduced quality of life. Empowerment intervention is one of the methods that can be used to improve the quality of life of people. The present study aimed to investigate the effect of empowerment model-based training on the quality of life of transgender people undergoing hormone therapy. Methods: The present study is a randomized clinical trial that was conducted in 2012 on 81 transgender people at Tehran Welfare Center. The study samples were randomly assigned into two groups of intervention and control. The intervention group received training based on the empowerment model (threat perception, problem-solving, educational participation, and evaluation) and the control group received routine treatment. Results: According to the findings, after the intervention, a statistically significant difference was found between the two groups in terms of the mean level of overt anxiety (P = 0.045) and aspects of emotional health (P = 0.030), the general perception of health (P = 0.007), mental health (P = 0.008), and overall quality of life (P = 0.005). Also, although there was a statistically significant difference in the aspect emotional well-being in the intervention group before and after the intervention (P = 0.034), this difference was not significant between the two groups (P = 0.274). Conclusion: The results showed that the empowerment-based training program had a significant relationship with the improvement in aspects of emotional health, the overall perception of health, mental health, emotional well-being and overall quality of life.
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Investigation of the value of ultrasound-guided core needle biopsy from pathologic lymph nodes to the diagnosis of lymphoma p. 2801
Elham Elahamdoust, Azim Motamedfar, Mohammad Momen Gharibvand, Sayed Nematollah Jazayeri
DOI:10.4103/jfmpc.jfmpc_1260_19  
Introduction: In recent years, techniques with minimally invasive have been gradually developed and used in the diagnosis of lymphoma. Among minimally invasive techniques, core needle biopsy (CNB) has been widely accepted as an effective tool for the diagnosis of malignant lymphoma, carcinoma and deep tumors that are only accessible via CT or endoscopic-guided. This study was conducted to investigate of diagnostic value of ultrasound guided CNB in the diagnosis of lymphoma in all parts of the body compared to surgical excisional biopsy (SEB). Materials and Methods: This is an descriptive epidemiological study that was performed on patients with suspected lymphoma referred to the intervention ward of Golestan Hospital in Ahvaz in 2019. For all patients with suspected lymphoma, CNB of lymph nodes was performed by ultrasound-guided. Finally, the final diagnosis of CNB was compared with the results of surgical biopsy in the studied specimens. Results: In this study, 40 patients were evaluated with suspected lymphoma. At initial diagnosis with CNB, 12 (30%) had NHL, 19 (47.5%) had Hodgkin's lymphoma, and 2 had high-grade lymphoma. Of the 40 patients examined, 29 required IHC to confirm the diagnosis. In 8 cases, the final diagnosis was done using SEB. Final diagnosis in 9 (22.5%) patients was confirmed by CNB only. The CNB along with the IHC also led to the final diagnosis in 23 (57.5%) patients. However, another 8 patients required biopsy to confirm the diagnosis by SEB. Conclusion: The findings of this study indicated that US-CNB is a highly efficient method of diagnosis of lymphoma with high specificity, in the fastest possible mode and with the least complications.
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Use of teachers as agents of oral health education: Intervention study among public secondary school pupils in Lagos p. 2806
Augustine Ikponmwosa Edomwonyi, Abiola Adetokunbo Adeniyi, Michael A Adedigba, Afolabi Oyapero
DOI:10.4103/jfmpc.jfmpc_1269_19  
Background: Common oral diseases are preventable and if detected early are reversible and schools provide a setting in which the oral health behavior of pupils can be influenced. We aimed to assess the effectiveness of using teachers in place of oral health professionals to deliver oral health education (OHE) in public secondary schools in Lagos State. Methods: This quasi-experimental study was conducted in four phases from September 2016-April 2017. A multistage sampling method was adopted to enlist the research participants from four enlisted schools, which were randomly assigned into two groups. Trained dentists delivered OHE in the first group of schools while trained teachers did in the second group and the impact of the intervention was assessed over six months. P values for significant differences were set at 0.05. Results: At the 3 months evaluation, the mean oral health knowledge (OHK) scores were higher among pupils in the Teachers Intervention Schools (TIS) (71.3 ± 19.3) than that in the Dentist Intervention Schools (DIS) (61.3 ± 17.7) (P = 0.023). Subsequent evaluation sessions from baseline revealed a gradual increase in the proportion of pupils with positive oral health attitude scores; with a higher proportion of pupils in the DIS (34.5%) compared to the TIS (34.0%) at 6 months assessment time. At 6 months evaluation, the proportion of pupils with poor oral health practices decreased in both groups of schools (P = 0.104). Conclusion: The proportion of pupils with good OHK was higher in the TIS at post-intervention periods; this difference was statistically significant at 3 months. This result suggests that teachers are as effective as dentists in delivering OHE.
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Study to assess the knowledge of caretakers regarding corticosteroid therapy in children with congenital adrenal hyperplasia – 21 hydroxylase deficiency p. 2814
Vasantha Singarayan, Anita David, Vageesh Ayyar, Saji James
DOI:10.4103/jfmpc.jfmpc_131_20  
Background: The primary aim of treating congenital adrenal hyperplasia (CAH) due to 21 hydroxylase deficiency is to replace the deficient glucocorticoids and mineralocorticoids, to minimize the excess androgen production and to facilitate normal growth. Children with CAH require daily treatment lifelong and increased dosage plan during acute stress, in order to obtain the benefit of optimal outcome from the ongoing treatment schedule. This emphasizes the need for the parents of affected children to be empowered with adequate knowledge regarding such lifesaving therapy. Aims & Objectives: This study was aimed to assess their knowledge regarding corticosteroid therapy. Materials and methods. Caretakers of children with CAH were recruited by using purposive sampling technique. Data was collected by using structured interview technique. Results: It was observed that only 10% of study group had adequate knowledge about therapy and the majority of them were from rural areas, lacking in awareness of essential steps of management. Conclusion: It was concluded that these caretakers need to be given appropriately planned education regarding corticosteroids, drug actions, and the need for enhanced steroid dosage during stress situations. They should also be given relevant instructional materials to read for improving their knowledge about their child's disorder.
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Effectiveness of autologous PRP therapy in chronic nonhealing ulcer: A 2-year retrospective descriptive study p. 2818
Muhammed Jaseem, Shana Alungal, Dhiyaneswaran, Jaseem Shamsudeen
DOI:10.4103/jfmpc.jfmpc_177_20  
Context: Chronic nonhealing ulcer is a troublesome condition in patients especially with diabetes. Autologous PRP therapy can safely and effectively heal a chronic nonhealing ulcer in such patients. Aims: To study the effectiveness of autologous PRP therapy in a chronic nonhealing ulcer. Settings and Design: A retrospective descriptive study from previous case records of chronic nonhealing ulcer patients who were treated with autologous PRP therapy at a specialty orthopedic hospital from September 2017 to August 2019. Methods and Materials: Data on patients who presented with chronic nonhealing ulcers of >4 weeks duration who were treated with autologous PRP therapy and followed up for 20 weeks. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 20 was used to calculate mean. Microsoft Excel was used for preparing the chart. Results: The mean age of patients treated with autologous PRP therapy was 61.24 years, and the follow-up period was 20 weeks. The mean duration of ulcer healing following PRP therapy was 11.25 weeks, 80% of the patient showed ulcer size reduction of >75% following therapy. Conclusions: In this retrospective descriptive study, it has demonstrated the effectiveness and safety of autologous PRP therapy in the healing of chronic nonhealing ulcers.
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Comparison of incidence of acute respiratory infection in exclusively breastfed infants and not exclusively breastfed infants from 61 to 180 days of age: A prospective cohort study p. 2823
Serin Kuriakose, Resmi S Kaimal, Varghese Cherian, Preethy Peter
DOI:10.4103/jfmpc.jfmpc_198_20  
Introduction: Acute respiratory tract infection (ARTI) is an important cause of morbidity and mortality among infants. Exclusive breastfeeding can considerably decrease the incidence as well as mortality due to ARTI. Aims and Objectives: To evaluate the effectiveness of exclusive breast feeding for the first six months of life in preventing acute respiratory tract infection in infants 61-180 days of age. To compare the incidence of acute respiratory tract infection in exclusively breastfed infants (61-180 days of age) and not exclusively breastfed infants. Material and Methods: A prospective cohort study was done among term babies with > 2500g birth weight born in Lourdes hospital during the period from 1st June 2012 to 31st May 2013. Based on feeding habits babies were classified into two groups. Infants were followed up from 61st day to 180th day of life to assess feeding habits and episodes of ARTI. Discussion and conclusion: 232 episodes of ARTI were recorded during the study of which 165 episodes were recorded in not exclusively breastfed infants. Incidence of ARTI was 2.04 in the exclusively breastfed infants group and 5.02 in the other group. Relative risk of developing ARTI in not exclusively breastfed infants was found to be 2.46. Odds ratio of having ARTI due to lack of exclusive breast feeding during the 61st to 180th day of life was 3.863. Data from this study confirmed the protective effect of exclusive breastfeeding against ARTI during the 61st to 180th day of life.
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Patterns and determinants of healthcare-seeking behavior among hypertensive patients in a rural population of north India: A mixed-method study p. 2830
Shubham Gupta, Amrit Virk, Anshu Mittal, BK Agarwal
DOI:10.4103/jfmpc.jfmpc_200_20  
The prevalence of hypertension in india over the last 30 years is known to have increased rapidly. Hypertension is a chronic disease that needs to be managed within its sociological context as experienced by individuals. This study was conducted to identify the quantitative and qualitative determinants of healthcare-seeking behavior among hypertensive individuals in a rural population of north india. Methodology: A mixed-method study involving 100 adult hypertensive patients was employed. Data were collected on demographic characteristics, health-seeking behavior, and the reasons for choosing a particular health service using a structured questionnaire and interview guide. Descriptive statistics were used to examine the influence of determinants on health-seeking behavior and utilization of healthcare facilities and expressed as percentages. Qualitative data were thematically analyzed. Results: A total of 100 participants with hypertension between 38 and 76 years of age were included in the study. Out of the total study participants, 66.0% of the respondents were males and 34.0% were females. Participants demonstrated a generalized knowledge of hypertension and showed significant gaps and misconceptions in their understanding of the disease and the need for seeking expert care. There was also a lack of sense of trust in the healthcare system. Various demographic, sociocultural, and economic determinants of healthcare-seeking behavior in these rural patients' services were explored. This evidence can prove helpful in streamlining interventional programs and realigning the existing interventions to prevent and control hypertension in rural settings.
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The growth trend of never-married elderly population in Iran in the third millennium p. 2837
Arya Hamedanchi, Yadollah Abolfathi Momtaz, Hamid Reza Khankeh, Nasibeh Zanjari
DOI:10.4103/jfmpc.jfmpc_264_20  
Background: Statistics show that the age of the Iranian population is advancing, and the marriage age is increasing as well. Clearly, an increase in the number of never-married older adults is expected. The aim of this descriptive, analytical study was to determine the growth trend of never-married older population and its association with education level in Iran. Methods: Based on the raw data collected from the Statistical Center of Iran, we studied the population of never-married older adults in the past 25 years and evaluated the growth pattern in different parts of Iran, using ArcGIS software. We also examined the association of singlehood in late life with education in men and women residing in rural and urban areas, using the Chi-square test in SPSS version 22. Results: A sharp increase was observed in the population of never-married older adults, particularly women, in the past 10 years. Women with formal education from urban and rural areas were more likely to be never married in late life (χ2 = 10455.35, P < 0.001 and χ2 = 271.31, P < 0.001, respectively). Older men with formal education from urban areas were more likely to be never married (χ2 = 35.44, P < 0.001), while men with formal education from rural areas were less likely to be never married (χ2 = 179.13, P < 0.001). Conclusion: The rate of increase in the population of never-married older women was much higher than the overall growth of older population. Women with formal education, particularly those with university and pre-university degrees, were more likely to be single in late life. It is strongly suggested to determine the causes and process of singlehood in old age in future research, including qualitative studies.
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Epidemiological profile of retinoblastoma in north India: Implications for primary care and family physicians p. 2843
Nidhi Gupta, Awadhesh Pandey, Kislay Dimri, Shankar Prinja
DOI:10.4103/jfmpc.jfmpc_265_20  
Background: Retinoblastoma is the most common primary intraocular malignancy among children. Despite being curable in early stages, majority of the cases in India present in late stages, when outcomes are very poor. Objectives: The aim of this study was to assess the epidemiological profile, clinical characteristics, and treatment practices among retinoblastoma patients in north India. Materials and Methods: Data on all patients with retinoblastoma, over a 10-year-time period from 2009 to 2018, who were treated in a tertiary care hospital in north India, were assessed. Data were analyzed to describe the demographic characteristics, clinical features in terms of stage at presentation, and management practices in terms of diagnostic investigations and treatment. The statistical significance for difference in percentages was assessed using Fischer's exact test at a 5% significance level. Results: A total of 25 retinoblastoma patients were enlisted, of whom one was excluded as it was adult onset retinoblastoma. The median age at presentation was 3 years, with a male to female ratio of 1:1.4. Bilateral presentation was seen in 16.6% cases. Majority (66.6%) of the patients underwent magnetic resonance imaging of brain and orbit as a part of the diagnostic workup. Intraocular disease was seen in 58.3% patients, whereas 41.6% patients had extraocular disease. Local therapy with vision preservation could be used only in 8.3% patients, whereas 87.5% patients were referred for enucleation. Chemotherapy with combination of vincristine, etoposide, and carboplatin was used extensively both, in neoadjuvant setting (83.3%) and in the adjuvant setting. Conclusion: Despite availability of treatment for eye preservation, its utility is limited due to the advanced stage at presentation. Awareness about the disease and its symptoms for early diagnosis, especially with the Mid-Level Health Provider at Health and Wellness Centers, is likely to improve early reporting and treatment and meeting the Vision 2020 goals.
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Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application p. 2849
Yahia Mater AlKhaldi, Ali Abdullah AlMosa, Mohammed Yahia AlQassem, Samaha Salmin Ahmad
DOI:10.4103/jfmpc.jfmpc_366_20  
Objective: The objectives of this study is to assess the quality of diabetic care at AlManhal PHCC based on CBAHI standards. Methods: This audit was conducted during 2018 at Al_Manhal PHCC through assessment all aspects of DM care ( structures, processes and outcomes) using CBAHI standards . Data entry and analysis were managed used SPSS. Results: Most of DM structures were available at the PHCC , however, health educational program , lab relevant facilities were partially met the standards. Records of 429 patients were assessed for process of care which were satisfactory except for laboratory investigations and eye examination which were partially met . Good DM metabolic control was (28%) , HTN control (71%) and lipid control( 54%), good compliance with appointment was 85% . The most common documented complications were retinopathy( 14%), nephropathy (4.5%) and CHD( 4%). Conclusion and Recommendations: This audit revealed that using of CBAHI standards for DM care at PHCC is simple and practical and could help to identify the weak areas that needs improvement. The present care of DM in our PHCC has acceptable infrastructures except for health education program , laboratory and referral system which should be scaled up to improve the processes and outcomes. DM control is still a big challenge and needs more collaborative effort between health care providers and patients.
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Role of calcium and phosphorous concentration as an intrinsic factor in the development of skull fracture following road traffic accidents p. 2854
Raktim P Tamuli, Bishwajeet Saikia, Smritimala Sarmah, Amar J Patowary
DOI:10.4103/jfmpc.jfmpc_368_20  
Introduction: Traumatic brain injury (TBI) or head injury is one of the leading causes of morbidity and mortality globally. TBI includes a fractured skull as an indicator of insult which can affect the treatment outcome as well. The development of any fracture depends on a combination of factors defining the intrinsic properties of the bone and the extrinsic factors related to the impact. A decrease in bone mass secondary to deficiency of calcium (Ca) and phosphorus (P) can be a significant factor intrinsic to the skull bone, which can modulate the outcome of the impact by increasing the susceptibility of bones towards fractures. We undertook this research to find out whether or not the Ca and P concentration in skull bone has a role to play as an intrinsic factor, in the development of skull fracture following Road Traffic Accidents (RTAs). Methodology: In this case–control study conducted for two years, we collected 94 bone samples, i.e. 47 each, from skull bones with head injuries following RTA, with (case) and without (control) fracture of the skull. The elemental analyses for the bony concentration of Ca and P in both the groups were then compared using energy dispersive X-ray (EDX). Unpaired t-test and Fisher's exact test was used for statistical analysis. Results: The elemental analysis of bones provided evidence that suggests that whilst; Ca is the only mineral that appears to have a significant correlation with the development of fracture skull, the overall Ca: P ratio of less than 1.99 increases the chances of skull fracture by 3.9 times. Conclusions: Both individual bony Ca concentration and Ca: P ratio can be regarded as important intrinsic factors for the development of skull fracture.
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Tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients in Ballabgarh tuberculosis unit, Haryana p. 2860
Rakesh Kumar, Shashi Kant, Ankit Chandra, Anand Krishnan
DOI:10.4103/jfmpc.jfmpc_373_20  
Introduction: This study was conducted to estimate the burden of tobacco use and nicotine dependence among newly diagnosed pulmonary tuberculosis patients to help inform effective implementation of tobacco cessation strategies among tuberculosis patients to improve treatment outcomes. Materials and Methods: This was a cross-sectional study conducted among 211 consecutive newly diagnosed pulmonary tuberculosis patients between July 2018 till January 2019 at Ballabgarh tuberculosis unit (TU) in Faridabad district of Haryana, India. All participants were administered a pre-tested questionnaire to assess tobacco use and the Fagerstrom test for nicotine dependence (FTND) to assess nicotine dependence. Current tobacco users were defined as those who smoked in the past 7 days. Nicotine dependence was classified as low, moderate, or high for the FTND score of 0-3, 4-6, and 7-10, respectively. Results: Majority of the participants (71.1%) were male, aged 26–50 years (45.5%), and married (65.4%). Fifty (23.7%, CI: 18.0–29.4) participants were currently using tobacco; 29 (13.7%, CI: 9.1–18.4) reported smoking tobacco while 23 (10.9%, CI: 6.7–15.1) reported using smokeless tobacco. In the last month, the proportion of patients who attempted to quit smoking and smokeless tobacco was 31% and 26.1%, respectively. 86.2% of the smokers and 69.6% smokeless tobacco users reported moderate to a high level of nicotine dependence. Conclusion: High prevalence of tobacco use, a higher level of nicotine dependence and inability to quit despite an attempt among a large number of tuberculosis patients, necessitates the inclusion of routine tobacco cessation advice and nicotine replacement therapy in tuberculosis care.
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Performance validation of different trauma scoring systems among polytrauma patients having predominantly blunt abdominal trauma p. 2866
Moorat Singh Yadav, Manoj Nagar, Ankur Joshi, Achal Gupta
DOI:10.4103/jfmpc.jfmpc_377_20  
Introduction: Blunt abdominal trauma substantially contributes to mortality and morbidity in patients with polytrauma. Appropriate clinical assessment is important in setups lacking facilities of advanced diagnostics (abdominal computed tomography scans and ultrasonography) to decide if the patients' needs exceed the facilities available. This study aimed to assess the utility of the commonly used trauma scores in predicting the outcome (favorable or unfavorable) in patients with predominantly blunt abdominal trauma. Study Design and Methods: In this prospective observational study of 12-month duration, we calculated three scores (Glasgow Coma Scale [GCS], Revised Trauma Score [RTS], and Injury Severity Score [ISS]) in patients brought to emergency department and fulfilling the inclusion criteria. These patients were categorized into two categories (favorable and unfavorable) depending on their treatment outcome. The difference in the mean scores for both outcomes in each score was calculated and further inferences were obtained by using the unpaired t test. A receiver-operating characteristic curve for each score was drawn to understand the trade-off between sensitivity and specificity at each cutoff value and for determining area under curve (AUC) for all three scores. Result: A total of 103 patients were recruited in the study (88 men and 15 women) with the mean age of 31.03 (±13.40) years and 34.47 (±18.04) years, respectively. The difference in the scores was maximum for ISS and minimal for RTS. The visual impression, as well as AUC values, shows that ISS performed well to discriminate between the favorable and unfavorable outcomes in each cutoff values (AUC –0.806, lower bound 0.678 to upper bound 0.934) compared to GCS and RTS scores. The Youden's J statistic for ISS value of 42 was maximum (0.298) and corresponding sensitivity and specificity were 0.651 and 0.647. Conclusion: ISS is superior as compared to GCS and RTS in predicting outcome in polytrauma patients with a blunt abdominal injury. ISS value of <42 predicts a favorable outcome.
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Effectiveness of formal training in bioethics of 3rd semester undergraduate medical students in recognizing bioethical issues and principles in patient care p. 2871
Bhupen Barman, Tripti K Srivastava, Amitav Sarma, Chandan K Nath
DOI:10.4103/jfmpc.jfmpc_405_20  
Introduction: Despite well-described code of conduct for physician the recent increase in litigation against doctors is an issue of concern which says that doctors and health professionals are confronted with many ethical problems regularly. The aim of the present study was to see the ability to recognize different bioethical issues in relation to patient care among 3rd semester undergraduate students and also the change in the pattern of recognition of bioethical issues after formal training. Methods: This cross-sectional study was carried out using self-administered questionnaire among the fifty 3rd semester undergraduate MBBS students. Each question was designed in a “Likert scale” pattern carrying a minimum score of 1 (1 = strongly disagree) and maximum score of 5 (5 = strongly agree). After 6 months of training and bedside clinical exposure, students were assessed again with same set of questionnaire. The statistical analyses were performed using SPSS 17.0. Results: All of the respondents in the study group were of the opinion that medical ethics is very important but only 24% aware about existence of ethics committee in the institute. Changes has been observed after clinical exposure in response like disclosure of patient's condition to close relatives (agreed 54% versus 84% pre and postexposure, respectively) and discussion of related ethical issues with clinical case discussion (agreed 74% versus 94% pre and postexposure, respectively). Some of the issues needs further clarification even after clinical exposure like doctors must not refuse to do abortion (56% disagreed and 38% agreed), consent regarding treatment in children (60% disagreed and 32% agreed), and uses of branded versus generic drugs (76% generic and 26% branded). Conclusion: There is a need to stress the importance of ethical practice in the undergraduate curriculum to make the doctors confident enough to deal the ethical dilemma for themselves and better professional efficiency.
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The role of oral vitamin D3 supplementation in the treatment of Chronic Rhinosinusitis in adults with Vitamin D deficiency p. 2877
Binayak Baruah, Ajay Gupta, Abhijit Kumar, Alok Kumar
DOI:10.4103/jfmpc.jfmpc_448_20  
Background: Chronic Rhinosinusitis (CRS) is a chronic inflammatory disorder of the mucosal lining of the nose and paranasal sinuses. The ability of Vitamin D (VD3) to augment innate and adaptive immune responses has sparked interest in its immunologic role in the treatment of CRS. In this study, the incidence of vitamin D deficiency in CRS patients was compared to normal population and the beneficial role of Vitamin D supplementation in its treatment was also evaluated. Materials and Methods: It is a retrospective 1-year study of 200 CRS patients with Vitamin D deficiency. The patients were divided into two groups, i.e. 100 patients were given oral Vitamin D supplements and the other group of 100 patients were treated as placebo. Both Vitamin D levels and the Total Nasal Symptom Score (TNSS) were assessed at the start and end of the study period. Results: Of the 200 subjects with CRS, 100 were given oral vitamin D supplementation in the form of Cholecalciferol 60000IU weekly once for 3 months and the other group were treated with placebo. Before the treatment, the average level of serum Vitamin D was 12.31 ng/ml. After 3 months, it increased significantly to 29.71 ng/ml. Similarly, the pretreatment TNSS score was on average 11.92. After 3 months, the scores fell by an average of 10.65 points, a significant statistical difference (P < 0.05). Conclusion: There is a higher prevalence of vitamin D deficiency in CRS patients and that vitamin D supplementation in these patients went a long way in alleviating their symptoms.
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The effect of pain management training in workshop on the knowledge, attitude and self-efficacy of pediatric nurses p. 2880
Soroor Parvizy, Sakineh Tarvirdinasab, Rasool Raznahan, Mahboobeh Aliakbari
DOI:10.4103/jfmpc.jfmpc_92_20  
Background and Aims: Pain is the fifth vital sign, and pediatric nurses plays a key role in the process of pediatric pain management. The present study aimed to determine the effect of pain management training on the knowledge, attitude and self-efficacy of pediatric nurses. Methods: This is a quasi-experimental study including two groups of test and control. The experimental group received a workshop method with a content including (ethical aspect, physiology, assessment tools, and pharmaceutical and non-pharmacological pain management) and was not given in the control group. The PNKAS self-efficacy questionnaires was completed by the participants before and one month after the beginning of the study. The data were analyzed using descriptive statistics and independent T-test, Fisher exact, and Chi-square tests using SPSS version 20 software. Results: The mean pre-test scores of knowledge and attitude in the control and experimental groups was 50.79-47.14, and after one month was 47.46-53.09, respectively, showed that, training was significantly effective in the knowledge and attitude of the experimental group (P value = 0.01). The mean pre-test score of self-efficacy in the control and experimental groups was (17.01-18.06), and one month later was 20.36-21.03 respectively. Although the self-efficacy score increased in both groups, training significantly increased the self-efficacy of pediatric nurses in the experimental group (P value <0.001). Conclusion: Pain management training is required due to the poor knowledge of pediatric nurses and the importance of pain management in improving the quality of nursing care and the satisfaction of patients with the In addition, feeling high self-efficacy without sufficient knowledge of pain management can disrupt pediatric pain management.
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Role of body visceral fat in hypertension and dyslipidemia among the diabetic and nondiabetic ethnic population of Tripura—A comparative study p. 2885
Bidhan Goswami, Taranga Reang, Swapan Sarkar, Shauli Sengupta, Bhaskar Bhattacharjee
DOI:10.4103/jfmpc.jfmpc_187_20  
Background: Excess fat in the upper part of human body correlates with increased mortality and risk for diabetes, dyslipidemia, and hypertension. In India, there are very limited data available on the association of excess body visceral fat with hypertension and dyslipidemia independent of obesity and diabetes. Objective: The objective of this study is to assess the role of body visceral fat percentage in hypertension and dyslipidemia among diabetic and nondiabetic indigenous ethnic population of Tripura. Methods: Random blood sugar test was done for each of the study subjects with the help of a standard and validated glucometer. Then, blood samples were obtained after an 8–12-h overnight fast using vacutainer. Later on, all the blood samples were transported to the MRU laboratory at Agartala Government Medical College maintaining cold chain for following investigations: (1) FBS, PP by GOD-POD method; (2) HbA1c by immunoturbidimetric method; (3) cholesterol estimation by CHOD-PAP method; and (4) triglyceride estimation by glycerol phosphate oxidase method. Results: In this study, it has been found that 62.5% diabetic subjects having high body visceral fat are suffering from Dyslipidemia, whereas only 42.9% nondiabetic subjects with high body visceral fat percentage are having dyslipidemia. Fisher's exact test showed association between diabetes status and body visceral fat (P = 0.048). It has been also observed that there was significant (P < 0.05) association between hypertension and body visceral fat among local indigenous ethnic population of Tripura. Conclusion: Body visceral fat percentage is significantly associated with hypertension, dyslipidemia, and type-2 diabetes among indigenous ethnic population of Tripura.
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Prevalence of self-medication in rural area of Andhra Pradesh p. 2891
Gaurav M Rangari, Roza G Bhaisare, Venkatasandhya Korukonda, Y Lakshmi Chaitanya, N Hanumanth
DOI:10.4103/jfmpc.jfmpc_204_20  
Background: The consumption of medicine without consulting a doctor is called self-medication. In the recent decade, the prevalence of self-medication was increased mainly in the developing countries. The reason varies from the nonavailability of doctors to economical reason. But people are not aware of the side effects and interactions of drugs. This is risky behavior and may lead to death. The objective of this study is to find out the prevalence and various reasons, sources, and common drugs used for self-medication. Materials and Methods: A cross-sectional community-based study conducted in Visakhapatnam district, Andhra Pradesh. 166 houses were selected by using a simple random sampling method. One respondent from one household was interviewed by using a semi-structured questionnaire. The data obtained were analyzed by using SPSS V22. Chi-square and Fisher exact tests were applied to find associations. Phi, Cramer Rao V, and contingency coefficient were applied to find the strength of association. A value of P < 0.05 was considered significant. Results: Among 166 subjects, the majority (58.4%) of participants were in the age group between 18-30 and most of them were female 142 (85.5%). The prevalence of self-medication was 68.1%. The main source of self-medication was directly from the pharmacy, that is, pharmacists (72.6%). Analgesics were commonly (85%) self-medicated drug. The main indication for self-medication was headache (78.8%) and fever (66.4%). Conclusion: The prevalence of self-medication was high and which is hazardous to health. This needs prompt legislative action.
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Pregnancy in women with previous two healthy children, associated factors, and acceptability of contraception among these women: A questionnaire-based, cross-sectional KAP study in world's second most populated country advocating two-child norm p. 2899
Namrata Kumar, Vinita Das, Anjoo Agarwal, Amita Pandey, Smriti Agrawal
DOI:10.4103/jfmpc.jfmpc_219_20  
Introduction: Indian subcontinent carries 17 % of world's population, being the second largest populated country. The maternal mortality rate of the country is still high. The study was aimed to study factors leading to pregnancy in women with previous two living children and their knowledge about limiting family and their practice for use of contraceptives. Methods: Questionnaire-based study was conducted in the Department of Obstetrics and Gynaecology. Results: 961 pregnant women attending antenatal outpatient department were interrogated and amongst them 167 (17.3 %) multigravida with previous two healthy children were enrolled in study and were asked to document in Questionnaire. Reasons for current pregnancy were gender bias, no desire to limit family, incorrect contraceptive use, contraceptive failure, doctor's mistake and religious belief. Desire for male child emerged as most common reason (37%) followed by improper or no use of contraception. Most significant associated factor was poor education of female partner (p = 0.010). Conclusion: This cross-sectional study evaluated the possible reasons of multiparity. We conclude that preference for male gender child is still very much prevalent in India, along with unmet need of family planning. Improving education of women might help to change attitude towards birth spacing and family size.
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Analysis of red cell alloimmunization in multi transfused patients at a Tertiary care teaching hospital p. 2907
Anjali Handa, Neetu Kukar, Ram N Maharishi, Neha Syal, Harkiran Arora
DOI:10.4103/jfmpc.jfmpc_351_20  
Background: Red blood cell (RBC) alloimmunization is an immune response against foreign RBC antigens; this generally occurs after sensitization due to multiple blood transfusions and pregnancies. Antibody detection plays a critical role in transfusion medicine as it can detect irregular or unexpected antibodies. This study was done to know the frequency and specificity of unexpected red cell antibodies in the multitransfused patients. Materials and Methods: This prospective study was done in the Department of Immuno-Haematology and Blood Transfusion. Antibody screening of 100 multitransfused patients with initial negative antibody screen was carried out prior to compatibility testing and followed for a period of 12 months for each transfusion. Depending on the results, patients were given corresponding antigen-negative blood units. Results: In this study, the rate of alloimmunization was 7%. Total number of samples that were positive for irregular alloantibodies were 4 of 54 cases of thalassemia, that is, 7.4%, whereas 3 of 40, that is, 7.5%, cases of solid malignancies developed alloantibodies. None of the patients of chronic kidney disease formed any alloantibody. Anti-K antibody was the most frequent antibody detected in 3 of 7, that is, 42.8% patients. Anti-E was the second most frequent antibody observed in 2 of 7, that is, 28.57%. However, anti-c and anti-M were detected in one each of 7, that is, in 14.28% each. Conclusion: It is concluded here that red cell alloimmunization should not be overlooked in multitransfused patients. To avoid the effects of alloimmunization, routine RBC antibody screening at set time intervals after transfusion should be performed.
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Self-care practices among type II diabetics in rural area of Kancheepuram district, Tamil Nadu p. 2912
Recharla Chenchu Karthik, A Radhakrishnan, A Vikram, Balaji Arumugam, S Jagadeesh
DOI:10.4103/jfmpc.jfmpc_356_20  
Introduction: Type 2 diabetes mellitus is one of the most prevalent noncommunicable diseases in India. The acute and chronic complications of diabetes impact the physical, mental, and social well-being of the patients, thereby, placing a major burden on the health care system. Studies have shown that adequate self-care practices among the patients will facilitate good glycemic control and prevent complications. Objectives: To study the patterns of self-care practice among diabetic patients and the factors associated with them. Methods: This descriptive cross-sectional study was carried out among 250 diabetics in the rural field practice area of a Tertiary Medical College and Hospital in Chennai. The participants were interviewed on their diabetic status and various components of self-care practices adopted from The Summary of Diabetes Self-care Activities (SDSCA) Measure. Adherence to medication was assessed by using Morisky Medication Adherence Scale-4 (MMAS-4). Results: Our study observed that the overall prevalence of good self-care practices was very low (5.6%). Moderate self-care practices were prevalent in 42% of the study participants whereas the majority (52.4%) of the study population had poor self-care practices. In our study, the association between self-care activity with educational status and occupation was found to be statistically significant. Adherence was high for blood sugar testing (75.2%) and medication (70.4%) in the study population whereas adherence for foot care was poor (17.6%). Conclusion: Our study emphasized on the need for knowledge and awareness to be provided in rural areas regarding diabetes care management and self-care practices. Structured programs need to be planned to improve the attitude and practices of diabetic patients to promote better compliance towards diet, exercise, adherence to drugs, and appropriate foot care.
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Prevalence and severity of periodontitis in patients with established rheumatoid arthritis and osteoarthritis p. 2919
Pooja R Disale, Sameer A Zope, Girish Suragimath, Alluri Siddhartha Varma, Apurva Pisal
DOI:10.4103/jfmpc.jfmpc_398_20  
Introduction: Periodontitis is associated with many chronic health conditions including diabetes, cardiovascular disease, and rheumatoid arthritis (RA). RA and periodontitis have similarities in inflammatory mechanism, morphology, and histopathology. Osteoarthritis (OA) is a chronic, multifactorial degenerative disease characterized by the deterioration of cartilage in joints. Objective: The aim of this study was to evaluate the prevalence and severity of periodontal disease in patients with established RA and OA. Materials and Methods: A total of 200 patients reporting to the Department of Orthopaedics, KIMSDU, Karad were included in the study. Patients were divided into two groups: Group 1 that included 100 patients with established RA diagnosed according to American College of Rheumatology (ACR) classification 1987 criteria and Group 2 that comprised 100 patients diagnosed with OA. Demographic profile, medical and dental history, oral hygiene practices, and smoking status of study participants were recorded. Periodontal status of the patients were evaluated using the simplified oral hygiene index (OHI-S), Loe and Silness gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL). On the basis of the CAL score periodontitis severity was defined as slight, moderate, and severe. Rheumatoid Factor (RF) and C-reactive protein (CRP) were considered as a serological marker in RA. Serological tests were performed to measure RF and CRP. Periodontal parameters and serological tests were correlated. Results: This study reported 45% severe periodontitis prevalence in RA compared to OA group, which was 33%. Severity of periodontitis is significantly greater in RF positive RA group with mean CAL 5.38 mm compared to RF negative RA group with mean CAL 2.81 mm (P = 0.001). There was moderate positive correlation found between RF titer and severity of periodontitis (r = 0.311). Conclusion: The severity of periodontitis was significantly higher among the patients with established RA as compared to patients with OA. RF positive patients had higher periodontal disease compared to RF negative patients. There was an increase in the mean clinical attachment loss with increase in RF titer.
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Cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus and its association with serum omentin and leptin p. 2926
R Vaishanavi Devi, Velkumary Subramaniam, Prashant S Adole, Gandhipuram Periyasamy Senthilkumar, Vadivelan Mehalingam
DOI:10.4103/jfmpc.jfmpc_461_20  
Cardiovascular autonomic neuropathy (CAN) is a major cause of morbidity and mortality in patients with diabetes as it is associated with a high risk of cardiac arrhythmias. Objectives: This prospective observational cross-sectional study was done to estimate the prevalence of CAN in patients with type 2 diabetes and to study its association with serum omentin and leptin levels. Methods: This study included 100 patients with type 2 diabetes mellitus attending the outpatient department of JIPMER Hospital, Pondicherry, India, from January 2017 to December 2018. CAN was assessed in all subjects using four cardiovascular autonomic function tests. Blood samples were collected and stored at - 80°C to estimate leptin and omentin levels. Comparison of leptin and omentin levels was done between diabetic patients with and without CAN. Results: CAN was present in 64% of the study subjects. Serum leptin levels were significantly higher in patients with CAN, whereas omentin levels, though elevated in those with CAN, were not statistically significant in diabetic patients without CAN. Conclusion: There is a high prevalence of CAN in patients with type 2 diabetes mellitus. Leptin levels were elevated in these patients, whereas omentin levels were not significantly different between diabetic patients with and without CAN.
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Prevalence of hypertension and associated cardiometabolic risk factors in urban Rishikesh, Uttarakhand p. 2931
Senkadhirdasan Dakshinamurthy, Vartika Saxena, Ranjeeta Kumari, Anissa Atif Mirza, Minakshi Dhar
DOI:10.4103/jfmpc.jfmpc_54_20  
Background: Hypertension is one of the leading causes of premature death worldwide and is a major risk factor for cardiovascular disease and all-of them cause mortality. Out of the estimated 1.13 billion people who have hypertension, less than 1 in 5 people have it under control. Aim and Objectives: To study the prevalence of hypertension and associated risk factors in the urban population of Rishikesh and the association of hypertension with other determinants. Methodology: A community based cross-sectional study was conducted in an urban area of Rishikesh. The World Health Organization (WHO) steps instrument and protocol was used for the assessment of risk factors and measurements. i.e. anthropometry and blood pressure. Sample size was calculated to be 478. Data was entered and analyzed using SPSS Version 20.0. Appropriate statistical tests were done. A P value of < 0.05 was considered significant. Results: The prevalence of hypertension in urban Rishikesh is 32.4%. The prevalence in male and female is 34.5% and 31.3% respectively. Among hypertensives 45.8% had hypertriglyceridemia, 32.2% had low high-density lipoproteins (HDL), 52.25% had fasting blood glucose more than 100, and 55.4% were obese individuals. Multivariate logistic regression analysis identified that age, waist circumference, body mass index, triglycerides level, and physical activity were independently associated with hypertension. Conclusions: As the prevalence of hypertension and cardiometabolic risk factors were higher, necessary health interventions were required to reduce the morbidity/mortality of the disease.
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A survey on the enablers and nurturers of physical activity in women with prediabetes p. 2940
Fereshteh Sohrabi Vafa, Seyed Saeed Mazloomy Mahmoodabad, Ali Akbar Vaezi, Hamid Karimi, Hosein Fallahzadeh
DOI:10.4103/jfmpc.jfmpc_583_19  
Background and Objective: Metabolic syndrome, especially prediabetes, is one of the most common health problems due to incomplete glucose metabolism that has a direct relationship with lifestyle. This study was conducted to determine the factors that enable and nurture physical activity in women with prediabetes based on the PEN-3 model. Material and Method: This descriptive-analytical study was conducted on 41 prediabetic women aged 30–65 years and 9 service providers in health centers. Data were collected from a semi-structured individual interview based on the PEN-3 model. The Graneheim and Lundman method was used to analyze the data. Results: During data analysis, two main themes that include enabling factors and nurturing factors in the domain of physical activity and 6 classes including enablers (positive, negative, and existential) and nurturers (positive, negative, and existential) were extracted from the data content. Conclusion: By determining enablers and nurturers, the providers of services can facilitate the participation of prediabetic women in physical activity by applying positive social and structural effects and also to eliminate negative environmental conditions.
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Study of the effectiveness of comprehensive, timely, and family-oriented interventions in reducing the symptoms of autism in children p. 2945
Katayoon Razjouyan, Mohammad Ali Miri, Mehdi Alizadeh Zarei, Hashem Farhangdoost, Sina Tavakoli
DOI:10.4103/jfmpc.jfmpc_947_19  
Background and Objectives: The onset of rehabilitation interventions in children with autism spectrum disorder below 5 years old has been associated with the reduction of autism symptoms in all developmental domains. The present study aimed to illustrate the importance of early family-oriented interventions in the reduction of the problems and symptoms of children with autism spectrum disorder. Methodology: This study was a pretest-posttest clinical trial without a control group. Fifty patients were selected using a convenience sampling method, of which forty patients were male and 10 females with a mean age of 3.2 ± 1.4. The efficacy assessment was evaluated using the Autism Behavior Checklist (ABC) and the Autism Treatment Evaluation Checklist (ATEC) as pretest and posttest. Data were analyzed by independent T-test using SPSS software. Results: The difference between pretest and posttest was significant in all aspects of the ATEC test (communication, health, sensory and cognitive awareness, socialization) at the level of P < 0.001. Moreover, the difference between pretest and posttest was significant at P < 0.001 for the aspects of speech, social and communication, and general performance, and at P < 0.002 for the sensory processing. Conclusion: Timely interventions under 6 years old with an emphasis on family-oriented and growth aspects over one year can help autistic children in the aspects of speech, social and communication, sensory processing, and sensory and cognitive awareness.
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Parental acceptance of human papillomavirus vaccination for adolescent girls in Lagos, Nigeria p. 2950
Kabiru A Rabiu, Taiwo G Alausa, Fatimat M Akinlusi, Nosimot O Davies, Khadijah A Shittu, Oluwarotimi Ireti Akinola
DOI:10.4103/jfmpc.jfmpc_102_20  
Background and Aims: Human papillomavirus (HPV) vaccination is recommended for adolescent girls and would offer a long-term solution to cervical cancer especially in developing countries. However, parental perception and acceptance is a critical success factor. This study examined the degree of parental acceptance of HPV vaccination for adolescent secondary-school girls in Lagos, Nigeria. Materials and Methods: A descriptive cross-sectional survey of adolescent girls' parents was undertaken in two urban and two rural secondary schools in Lagos. Univariate and multivariate analysis were carried out using logistic regression to determine correlates of parental acceptance of HPV vaccine. Results: Of the 318 respondents, 45.9% had poor knowledge of cervical cancer and HPV infection, whereas 29.6% had good knowledge. Majority (54.7%) also had poor knowledge of HPV vaccine, whereas 26.7% had good knowledge. Most (72%) would vaccinate their daughters if vaccines were free, whereas only 35.5% would, if not free. Poor knowledge of cervical cancer and HPV infection significantly reduced the likelihood of vaccination even if free (adjusted odds ratio [OR] =0.48; 95% confidence interval [CI] =0.24–0.94; P = 0.0325), whereas good knowledge of HPV vaccines (adjusted OR = 6.11; 95% CI = 1.37–27.34; P = 0.018) and tertiary education in the mother (adjusted OR = 29.17; 95% CI = 3.98–214.08; P = 0.0009) increased the likelihood, if not free. Conclusion: HPV vaccination was acceptable to most parents only if offered free. Poor knowledge of cervical cancer, HPV infection, and vaccine may hinder acceptability. It is recommended that HPV vaccination is offered free through the National Programme on Immunization in Nigeria.
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Perception, knowledge, and practice of endodontists and general dental practitioners toward evidence-based practice and factors associated with it—A cross-sectional study p. 2958
Neetu Bansal, Mehak Dogra, Parul Mehta, Shabab Ahmed Khan, Nitin Jhunjhunwala, Pulkit Gupta
DOI:10.4103/jfmpc.jfmpc_1132_19  
Background: Evidence-based practice is the cornerstone of dentistry and especially endodontics. Diagnosis, treatment planning, and treatment with recent advancement based on evidence would be a great help for the patent satisfaction and treatment prognosis; hence, the aim of present study was to explore difference between perception, knowledge, and practice of endodontists and general dental practitioners (GDPs) towards evidence-based practice and factors associated with it. Materials and Methods: The present study is a cross-sectional descriptive questionnaire study conducted among specialists in the subject of conservative and endodontic dentistry and GDPs working in private clinics in Modinagar city, Uttar Pradesh. The study was conducted in October 2019. In the present study, a close-ended questionnaire was prepared to determine the perception and practice of dental specialists. Results: The majority of endodontists (31 [35.22%]) belonged to the age group of 36–45 years of age while most of the GDPs (32 [36.36%]) belonged to 25–35 years of age group. The majority of endodontists were females (56[63.64%]) and most of the GDPs were males (50 (56.81]). More endodontists (47 [53.42]) had a positive perception of evidence-based practice than GDPs (15[16.42]). Practice toward evidence was fair among most of the endodontists (49 [55.68%]) and GDPs (54 [61.36%]). Conclusion: There was a more positive perception regarding evidence-based practice among endodontists than GDPs, knowledge was high among endodontists regarding evidence-based practice and practice was also good among endodontists. Factors associated with perception, knowledge, and practice among endodontists and GDPs were age in years, gender, year of practice, number of endodontic patients treating per month.
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Association between health-related quality of life and sense of coherence among health professionals working in primary health centers consuming tobacco in Jaipur, India p. 2963
Ashish Sharma, Kumar Gaurav Chhabra, Sunita Agarwal, Suman Bhansali, Pooja Singh, Renuka G Nagrale
DOI:10.4103/jfmpc.jfmpc_155_20  
Background: Health-related quality of life (HRQOL) and senses of coherence (SoC) can be affected by the use of tobacco. Hence, the aim of the present study was to explore the association between HRQOL and SoC among health professionals working in primary health centers (PHCs) consuming Tobacco. Materials and Methods: It was a cross-sectional descriptive study where sampling technique used was systematic stratified random sampling. Jaipur District has 37 PHCs retrieved from site of NRHM Rajasthan. A close-ended questionnaire was prepared to conduct the interview. Results: Majority of study participants (57; 37.01%) were of 36–40 years of age. Males respondents (86; 55.85%) consuming tobacco were more in number than female respondents. Majority of study subjects (91; 59.09%) consumed smoked kind of tobacco, in which most contributed were nurses (49; 62.82%). On applying a linear regression model, it was determined that all subscale of SF-36 was significantly (P ≤ 0.000) associated with SoC. Conclusion: From above, it was concluded that there was a strong association between HRQOL and SoC among health professionals working in primary health centers consuming tobacco.
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Factors affecting awareness and practice of primary health care professionals towards interaction of various medications used in systemic conditions, and its effect on periodontal health p. 2969
Anant Raghav Sharma, Neha Sethi, Abhishek Sinha, Shalini Gupta, Divya Sushil, Jitender Sharma
DOI:10.4103/jfmpc.jfmpc_195_20  
Background: Interaction of various drugs and its effects on gingival and periodontal health is the area of concern; hence the aim of the present study was to explore factors affecting the awareness and practice of primary health care professionals towards the interaction of various medications used for systemic diseases on periodontal health. Materials and Methods: It was a cross-sectional, descriptive, questionnaire study conducted among 203 primary health care professionals which include 94 medical officers and 109 nurses working in primary health centers in rural areas of Udaipur district. The study was conducted in December 2019. Sampling techniques was stratified random sampling technique. A close-ended questionnaire was prepared to conduct an interview schedule. Results: The majority of health professionals had poor awareness (157 [77.33%]) and poor practice (168 [82.75%]) regarding the interaction of various medications used in systemic conditions and periodontal health. Factors that significantly affect awareness and practice of study participants were age (0.01*), degree (0.05*), and number of patients with oral problems seen in a week (0.05*), gender (0.05*), designation (0.05*). Conclusion: From above it was concluded that awareness and practice of primary care health professionals were poor. The factors that affect significantly affect awareness and knowledge of study participants was age, degree and number of patients with oral problems seen in a week, gender, designation, no. of patient attended in a day.
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A study of contralateral occult inguinal hernia in adult male patients undergoing total extraperitoneal herniorraphy p. 2975
SK Tiwary, Satendra Kumar, Raghunath More, Vijay Shankar, Sandip Kumar, A N. D. Dwivedi
DOI:10.4103/jfmpc.jfmpc_207_20  
Background: The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%. Objective: The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unilateral inguinal hernia patients using USG as diagnostic modality and to compare the clinical outcomes of unilateral TEP vs. bilateral TEP with respect to pain, duration of hospital stay, time for return to normal work, and postoperative complications. Setting and Design: This was a prospective observational, single-center study. Materials and Methods: A total of 30 male patients were included in the study who was having clinically diagnosed unilateral hernia. All patients were assessed by USG for contralateral occult inguinal hernia. Results: Incidence of COH was 10%, two (6.7%) had indirect defect, and 1 (3.3%) had direct defect. Two (6.7%) patients underwent bilateral TEP and 28 (93.3%) underwent unilateral TEP. No significant difference was observed in terms of mean duration of hospital stay, duration of surgery, and visual analog scale score for pain in both unilateral and bilateral TEP. The mean for resuming daily work in unilateral TEP was 4.86 ± 0.833 days and in bilateral TEP the mean was 7.50 ± 0.70 days and this showed statistically significant difference (P < 0.001). Conclusion: Patients with COH should be counselled for synchronous repair as there is no significant difference in clinical outcomes of unilateral and bilateral TEP. On the basis of this pilot study, it can be concluded that preoperative USG is mandatory for diagnosis and simultaneous management of preexisting contralateral hernia.
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Correlation of dental caries and dermatoglyphic patterns: A study in pediatric population p. 2980
Sumaiya Nezam, Shabab A Khan, Puja Singh, Roquaiya Nishat, Amit Kumar, Samar Ali Faraz
DOI:10.4103/jfmpc.jfmpc_208_20  
Introduction: Dental caries is the most prevalent chronic disease among children worldwide irrespective of the advancements in oral healthcare. The basis of considering dermatoglyphic patterns as marker for dental caries is that the epithelium of finger buds and enamel are both ectodermal in origin and develop during the same period of intrauterine life. Aim and Objective: To record and evaluate the dermatoglyphic patterns, its correlation with early childhood caries (ECC) and to predict its efficacy in assessing the caries risk. Method: The study was carried out on 100 school going children within the age group of 36–71 months. Study population was divided into two groups comprising of 50 individuals each on the basis of def score, experimental group (def ≥ 1) and control group (def score 0). Dermatoglyphic patterns of all ten palmar digits were recorded using Cummins and Midlo method and assessed using a magnifying glass (2×). Results: Statistically significant increase in number of whorls was found in ECC group, whereas higher number of loops was seen in control group. In ECC group, value of both, the mean axial t triradius angle and mean total ridge count was low as compared to the caries-free group. Conclusion: There is definite variation in dermatoglyphics between the ECC and caries-free group, indicating that dermatoglyphic patterns can be used as a non-invasive predictive tool for children with ECC.
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Evaluation of salivary flow rate, pH, and buffer capacities in end-stage renal disease patients versus control – A prospective comparative study p. 2985
Tanoj Kumar, Jay Kishore, Minti Kumari, Anurag Rai, Shweta Rai, Abhinav Jha
DOI:10.4103/jfmpc.jfmpc_242_20  
Background: Saliva plays a major role in preserving the integrity of oral tissues. Chronic renal failure patient undergoes many oral and salivary changes for which they require special oral health care. The patient undergoing hemodialysis session has altered salivary composition. Many changes occur during hemodialysis that severely affect the flow rate and the biochemical composition of saliva. Methods: A total of 50 patients of end-stage renal disease undergoing hemodialysis for renal insufficiency were selected based on inclusion and exclusion criteria set prior to the study. These patients were compared with the control group who had already undergone hemodialysis. A total of 30 patients were selected as a control group. In this study, unstimulated whole saliva was collected by the spitting method before and after the dialysis session. Salivary flow rate, pH, and buffering capacities were measured. Results: Hemodialysis had a significant effect on the salivary flow rate. The mean pH of unstimulated whole saliva showed no significant changes before and after dialysis. The concentrations of urea, creatinine, chloride, and potassium in the whole saliva changed markedly before and after a hemodialysis session, whereas no significant difference was seen in the concentration of sodium and calcium. Conclusion: Through this study, we came into a conclusion that hemodialysis had a significant effect on salivary secretion and the biochemical composition of saliva. We conclude that the observed changes in salivary concentrations and the flow rate are mainly due to an increased watery secretion from the salivary glands and also saliva can be used as a tool for monitoring hemodialysis.
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Factors associated with strain among informal care providers of patients with traumatic brain injury in Malaysia p. 2990
Amena Awadh Bamatraf, Abdulhadi A AlAmodi, Meryam Abdella Ali, Chong Mei Chan, Mazlina Mazlan, Mohammad Abrar Shareef
DOI:10.4103/jfmpc.jfmpc_247_20  
Purpose: This study aims to investigate the level of strain and various influencing factors among informal care providers of traumatic brain injury (TBI) patients. Methods: A cross-sectional study was conducted in a single center in Malaysia via recruiting care providers of patients with TBI. The modified caregiver strain index (MCSI) questionnaires were utilized to ascertain the level of strain. The demographic data of informal care providers were also obtained. Independent sample t-test, analysis of variance (ANOVA), and a linear regression model were processed for data analysis. Results: A total of 140 informal care providers were included in the study. More than half of informal care providers claimed to have strain (54.3%). Factors associated with increased strain include receiving tertiary education, being of Chinese background, and employed experience higher strain level. Informal care providers with characteristics such as being single, retired and provided care for 5 years experienced a lower level of strain. Conclusion: Guidance on integrating the TBI knowledge into practice, assessing the care provider's level of strain regularly and providing supportive measures may aid in supporting informal care providers at risk.
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A minimum data set of user profile or electronic health record for chemical warfare victims' recommender system p. 2995
Elham Aalipour, Marjan Ghazisaeedi, Mohamad Reza Sedighi Moghadam, Leila Shahmoradi, Batool Mousavi, Hamid Beigy
DOI:10.4103/jfmpc.jfmpc_261_20  
Background: There are many people who are suffering from a variety of physical and mental illnesses due to the chemical attacks. There are various technologies such as recommender systems that can identify the main concerns related to health and make efforts to address them. To design and develop a recommender system, preparation of data source of this system should be considered. The aim of this study was to determine the minimum data set for user profile or user's electronic health record in chemical warfare victims' recommender system. Methods: This applied descriptive, cross-sectional study which was conducted in 2017. A questionnaire was developed by the authors from the data elements that were collected using the data extraction form from the studied sources. Content validity of the questionnaire was confirmed by using the experts. Test–retest method was used to determine the reliability of the questionnaire. The reliability of the questionnaire with Cronbach's alpha coefficient was confirmed as 84%. The questionnaire were submitted for related experts based on Delphi method by email or in person. Data resulting from the Delphi technique with descriptive statistics methods in SPSS software were analyzed. Results: Forty-seven nonclinical data elements and 181 clinical data elements were classified. Conclusion: Determining minimum data set of user profile or electronic health record in the recommender system for chemical warfare victims helps the health authorities to implement the recommender system which demonstrates chemical warfare victims' needs.
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Comparison of prevalence of depression among medical, dental, and engineering students in Patna using Beck's Depression Inventory II: A cross-sectional study p. 3005
Sumaiya Nezam, Amesh Kr Golwara, Prakash Chandra Jha, Shabab Ahmed Khan, Sunita Singh, Aditi S Tanwar
DOI:10.4103/jfmpc.jfmpc_294_20  
Background: Depression, a multi-dimensional disorder adversely affects the interpersonal, social and occupational spheres of students' life. It is the 11th leading cause of global disease burden. Aims and Objectives: To assess the prevalence of depressive symptoms among various professional course students including medical, dental, and engineering students in Patna, Bihar. Materials and Methods: The present investigation was a questionnaire-based cross-sectional descriptive study. A total of 3,100 students attending government and private medical, dental, and engineering colleges in Patna were approached during the course of this study. Students were briefed about the study and questionnaire. BDI-II (Beck's Depression Inventory-II) was administered to the students and they were instructed to fill it. Beck's scores were recorded and a descriptive analysis performed. Results: 2798 students out of 3,100 responded positively to the survey by completely filling out the form. The overall response rate was 90.25%. The overall prevalence of depressive symptoms was found to be 47.78%. Of the three streams, students belonging to the engineering stream (40.28%) showed a maximum prevalence of depressive symptoms followed by dental (38.50%) and medical students (34.74%). Conclusion: Our study showed an alarming prevalence of depression among professional course seeking students. This multi-dimensional disorder continues to affect student's performance and professionalism, thus, extending its negative impact to the community at large. This may carry out later in their lives, thus leaving a long-term negative impact. Considering the high rate of depressive symptoms, establishing a unit or facility to identify or diagnose it at an early stage and providing psychological support to students is recommended.
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A hospital-based cross-sectional study on suicidal poisoning in Western Uttar Pradesh p. 3010
Narendra Singh Patel, Nidhi Choudhary, Nitin Choudhary, Vikas Yadav, Deepti Dabar, Mahendra Singh
DOI:10.4103/jfmpc.jfmpc_306_20  
Background and Aims: Poisoning is most common method of committing suicide in India. Objectives of this study to assess prevalence of suicidal poisoning among all poisoning cases, its socio-demographic profile and its reasons in all admitted cases of suicidal poisoning in hospital. Methods: A cross-sectional study was conducted on cases of poisoning of any age group admitted in the Chhatrapati Shivaji Subharti Hospital, Meerut. Poisoning cases with history or evidence of suicide were further interviewed. A semi-structured interview schedule in Hindi was used to collect data. Microsoft Excel 365 and R software version 3.6.0 were used for data entry and analysis respectively. Results: Among total 135 poisoning cases admitted in hospital, 126 provided consent and included in the study. Prevalence of suicidal poisoning was 77.7% (98). Most common age group involved was 11-20 years (36.7%) and 21-30 years (35.7%) and most of the participants were males (59.2%). Most suicidal poisoning cases took Aluminum Phosphide (31.6%), followed by Organophosphates (20.4%) as poison. Most frequent reasons for suicide as described by participants were 'Family quarrel or family unhappiness' (29.6%), 'failure in examination or interview or business' (23.5%), 'ill treatment by spouse or in laws' (16.3%) and 'unemployment' (9.2%). Conclusion: Our study shows that consuming Agriculture poisons (Aluminum Phosphide and Organophosphates) are most common (52%) poisons consumed by suicidal poisoning cases. Agriculture poisons (Aluminum Phosphide and Organophosphates) are easily available in markets in India. There should be some restriction on their purchase to reduce suicidal incidences.
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Oral health knowledge among a cohort of pregnant women in south India: A questionnaire survey p. 3015
S Venkata Lakshmi, A Srilatha, D Satyanarayana, L Swetha Reddy, Suma B Chalapathi, S Meenakshi
DOI:10.4103/jfmpc.jfmpc_329_20  
Aim: To assess oral health knowledge of pregnant women visiting Government Maternity Hospital, Hyderabad. Materials and Method: A cross-sectional survey was carried out among 606 pregnant women aged 18–40 years old. Oral health knowledge of respondents was assessed using the 14-item self-administered questionnaire and responses were recorded on a dichotomous scale (yes/no). The data were analyzed using Statistical Package for Social Sciences (SPSS) package version 20.0. Results: Overall inadequate knowledge regards to oral health was observed among 55.8% pregnant women. Based on knowledge regarding tooth decay, 71.6% of study participants believed that every painful tooth has to be removed and 81% of respondents were unaware of brushing with fluoridated toothpaste prevents tooth decay. Similarly, with respect to gum disease, 77.7% of subjects were not aware of gum disease and around 49.8% unacquainted that bleeding during tooth brushing indicates gum problems. It is enriching to observe, 94.1% of respondents felt oral health is important for general health. On the other hand, a quite alarmingly high percentage (73.9%) of subjects does not know the relationship between oral health and pregnancy. Furthermore, 91.1% and 65.5% of participants were ignorant that pregnancy can increase the tendency of gums to swell or bleed and poor oral health affect their unborn baby, respectively. More than three-fourths of the study participants (84%) had never visited dentist Conclusion: The study highlights limited knowledge allied to oral health among pregnant women and problem-oriented dental visits indicating an urge among this group to scale up their knowledge.
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QTc prolongation in patients of cirrhosis and its relation with disease severity: An observational study from a rural teaching hospital p. 3020
Abhinav Bhardwaj, Sandeep Joshi, Ruby Sharma, Sakshi Bhardwaj, Rishabh Agrawal, Nitin Gupta
DOI:10.4103/jfmpc.jfmpc_341_20  
Introduction: Cirrhotic cardiomyopathy is characterised by increased baseline cardiac output, systolic and diastolic dysfunction, diminished cardiovascular response to stressful stimuli and electrophysiological abnormalities in patients of cirrhosis in the absence of any underlying cardiac disease. QTc prolongation has been described as a common electrocardiographic abnormality in cirrhosis patients. Aims and Objectives: This study was done to evaluate the prevalence of QTc changes in patients of cirrhosis coming to a rural tertiary care centre and to analyse its correlation with disease severity. Materials and Methods: The present study was conducted on 100 patients suffering from cirrhosis of liver presented to the department of medicine. Around 100 age and sex-matched individuals were recruited as controls. The Child-Pugh score was used to determine the disease severity in cirrhosis patients. Standard 12-lead ECG was recorded in all cases and controls. Results: Prolongation of QTc interval on ECG was observed in the majority (80%) of cirrhosis patients and it was significantly higher as compared to the healthy controls (P <0.01). The prolongation of QTc was significantly associated with the duration of disease (P <0.05) and disease severity as measured by the Child-Pugh score (P <0.01). Conclusion: QTc prolongation on ECG may be an early marker of cardiac involvement in patients of cirrhosis and is significantly associated with disease severity.
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Oral hygiene habits, oral health status, and oral health care seeking behaviors among spinning mill workers in Guntur district: A cross-sectional study p. 3025
Vikram Simha Bommireddy, Sai Siva Naga Gayathri Naidu, Tulasi Priya Kondapalli, Harish Chowdary Kommineni, Rammohan Madem, Gowtham Manikanta Yadav Padagala
DOI:10.4103/jfmpc.jfmpc_349_20  
Introduction: Though the oral health status of workers from different industries was reported in literature, there is little information with regard to spinning mill workers. The aim of this study was to document the oral health status, oral hygiene routine, and frequency of utilization of oral health care services among spinning mill workers in Guntur district. Materials and Methods: 458 spinning mill workers in Guntur district participated in this study. Data on hygiene practices, self-reported dental problems, past dental visits, type and place of availed treatments, and barriers for utilizing dental services were recorded. Oral health status was examined using Simplified Oral Hygiene Index, DMFT index, and Community Periodontal Index. Results: Female participants were found to have better oral hygiene status compared to males, which is partially significant. Similar was the scenario when caries experience was considered. Majority of the study subjects (74%) have a DMFT score of 1–6. There were 86 participants without any coronal caries experience. The mean coronal caries experience was more among older spinning mill workers compared to the younger workers. The difference in DMFT scores between males and females was not significant. Majority of the participants (46.3%) were with CPI score 2, while only 10.2% were observed to have all healthy sextants. 136 subjects (30.15%) demonstrated loss of attachment of some severity. Conclusion: Though the oral hygiene habits reported by the spinning mill workers were fair, oral health care seeking behaviors were found to be less informed. There is a serious need to improve the oral health awareness and care seeking behaviors among these workers.
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Medical students vs general public awareness regarding disc prolapse in Jeddah p. 3030
Zeyad A Alamri, Nawaf K Althobaiti, Anas T Halabi, Hussam O Bashraheel, Abdulrahman R Shalwala, Mohammed A Alyousef
DOI:10.4103/jfmpc.jfmpc_36_20  
Background: Disc herniation is a condition where tearing occurs in the outer annular layer of the intervertebral pad leading the inner gel-like material to bulge ouwards the spinal cord, due to the high load of the vertebrae. This will produce back pain and symptoms in different sites according to the level of the herniation in the vertebral column. Aim: To compare the level of awareness regarding disc herniation among the general population and medical students in Jeddah. Methodology: A descriptive cross-sectional study was conducted through an electronic questionnaire to assess the level of awareness regarding disc prolapse among the general population and medical students in Jeddah. The questionnaire was in the Arabic language, it was taken and validated by the previous study which took place in Taif. Results: Our studied sample involved 1026 individuals aged between 11 and 99 years, with a mean age of 34.03 ± 13.28 years old. More than half of the respondents were female (55.4%), most of them were Saudi nationals (90.1%), and most of them have received a higher education (67.7%). Results showed that 54.1% of the general population and 77.7% of medical students reported good knowledge regarding this condition. Conclusion: This study revealed that the level of awareness regarding disc prolapse among the general population and medical students was poor in some respects such as: knowledge about the preventive measures, symptoms of the disease, the most common site in the spine affected by the disease, and the gold standard imaging method to diagnose this disease.
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Influence of Social Media towards the Selection of Hollywood Smile among the University Students in Riyadh City p. 3037
Shahzeb Hasan Ansari, Abdullah Abdulrahman Abdullah Alzahrani, Abdullah Mohammed Said Abomelha, Alaa Emadeldin Attia Elhalwagy, Tariq Nouraldin Mustafa Alalawi, Talal Walid Mahmoud Sadiq
DOI:10.4103/jfmpc.jfmpc_442_20  
Background: Hollywood smile refers to the aesthetic development of dental appearance inspired by the beauty displayed by the movie actors. Therefore, the present study was conducted to determine the extent of social media effect on the decision making of university students towards selecting Hollywood smile as the choice of their aesthetic treatment. Materials and Methods: This cross-sectional study was conducted by utilizing a self-designed closed-ended questionnaire among under-graduate students from the various public as well as private universities of Riyadh city. The questionnaire was constructed online using Google forms and began with questions related to demographics; questions like Do you notice celebrity's smile on social media? Have you visited a dentist solely after getting inspired by a celebrity's smile? etc., Responses were on a 5-point likert scale ranging from highly dissatisfied or strongly disagree to highly satisfied or strongly agree whenever applicable. Chi-square test was used to compare the differences among the groups with the value of significance kept under 0.05 by using SPSS version 19. Results: The majority of the female participants reported noticing the celebrity's smile on social media. Influence by the celebrity smiles on social media was found more in the older age group participants. However, the term “Hollywood smile” was slightly more known among the younger aged participants. Conclusion: The overall effect of social media in decision making of opting for Hollywood smile was found to be moderate. More studies should be conducted to investigate how much social medial is effecting the perceptions of youngsters.
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Assessment of newly introduced foundation course for medical undergraduates: students' vs faculty's perspective p. 3042
Shalini Sobti, Meeta Gupta, Vanita Gupta, Aditya Gupta, Satish Parihar, Vikrant Singh
DOI:10.4103/jfmpc.jfmpc_521_20  
Background and Objectives: In compliance with MCI's recommendation, a month-long Foundation Course was conducted in our institution in Aug'19. The present study was conducted to seek the opinion of the students and faculty regarding relevance of the topics included in the course to enable revisions to be made in designing the course for the subsequent sessions, to make it more effective and student-oriented. Methods: A questionnaire-based cross-sectional study was conducted to seek the opinion of 100 students who underwent the Foundation Course and 35 faculty members who were involved in teaching the topics allotted. Results: Positive feedback was recorded from63% of the students and 69% of the faculty regarding the overall experience of the course. Among the different modules, Skills module was voted as relevant by majority (73%) of students, whereas a module on Enhancement of Language and Computer Skills was found relevant to the course by a mere 52% students. In contrast, module on Sports and Extracurricular activities was adjudged as most relevant while as module on Enhancement of Language and Computer Skills got the least positive feedback (81.43% vs. 60.36%, respectively) from the faculty. Interpretation and Conclusions: Foundation Course recommended by MCI for MBBS students at the entry level is a welcome step. This can further be made more beneficial by making necessary modifications in the planning of the course in light of suggestions received from the participants.
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Knowledge, attitude, and practice of bariatric surgery among adult Saudi community, Saudi Arabia, 2019 p. 3048
Shoog F Alfadhel, Hakem S. S. Almutairi, Tuqa H. G. Al Darwish, Leenah T Almanea, Reoof A Aldosary, Amani H Shook
DOI:10.4103/jfmpc.jfmpc_953_19  
The prevalence of overweight and obesity is higher in developed countries than in developing countries of all ages (data from 2013). This study is aimed at assessing the knowledge and attitudes of people in Saudi Arabia toward bariatric surgery. To do this, the specific objectives sought to determine the satisfaction of people who underwent bariatric surgery and to determine the importance of bariatric surgery among the community. Methods: The study is a cross-sectional, community-based study conducted among the Saudi adult population. The final sample size was 891 respondents from different regions of Saudi Arabia. Data collection was through online questionnaires that consisted of 26 questions to assess the perceived knowledge and attitudes toward obesity and bariatric surgery adopted from Abouhamda (2016). Results: More than 70% of the study participants were aged between 18 and 25 years. There were more males than there were females 76.0% versus 24.0%, while most of the respondents were living single. The proportion of respondents across listed regions of Saudi Arabia significantly varied at a 5% level (P = 0.000). Sixty percent of the study respondents were within the normal weight range (BMI 18.5–25), 9% were marked as obese (BMI >30). Age group was not significantly associated with knowledge of quantization and perceived the knowledge that quantization can cause death (P > 0.05 in both cases). Conclusion: The knowledge about obesity in Saudi Arabia is generally good and most Saudis would rather take the approach of proper diet as opposed to surgery, with the bigger percentage being in the normal range (BMI 18.5–25).
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Child abuse and neglect in a rapidly developing country: Parents' perspectives p. 3053
Mohamed A Hendaus, Amna M Al-Khuzaei, Osama Samarah, Sara G Hamad, Basma A Selim, Walid El Ansari
DOI:10.4103/jfmpc.jfmpc_971_19  
Purpose: To identify parental awareness and knowledge regarding child abuse and neglect in the State of Qatar. Methods: A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Parents of children of all ages were offered a questionnaire that included demographic details, parental knowledge, and awareness of child abuse and neglect. Results: 300 questionnaires were completed (response rate = 95%). More than 70% of parents were older than 30 years of age, 60% of them were females, and 66% were college graduates. The majority of the participants stated their familiarity about child abuse, and 6% witnessed morbidity or mortality due to child abuse in the society. Despite the identified laws, only 50% of the parents were aware of laws restricting child abuse. In regards to children with special needs, only 16% of the participants agreed that disabled children are at a higher risk of abuse compared to healthy children, while 33% were neutral and 52% disagreed. In addition, one-fifth of the respondents stated that hitting is discipline, while 63% disagreed. Almost one-third of the respondents agreed that hitting hands and buttock or hitting with soft objects is acceptable form of discipline. Unexpectedly, one-quarter of participants stated that it is okay to hit a child as long as no damage incurs. As for verbal abuse, around one-third of parents stated that yelling is not a form of child abuse, and that yelling does not affect growth and development. Comparing both corporal and verbal abuse, approximately 70% of parents stated that yelling is less harmful than hitting. In terms of child neglect, around half of the respondents agreed with the statement “Leaving a child (<5 years) unattended at home is a form of neglect,” while 42% were neutral. Finally, approximately 50% of the participants believed that it is okay to depend on nannies in assisting their children in eating and using the bathroom. Conclusion: Parents residing in the State of Qatar believe that they have a good knowledge regarding child abuse and neglect. However, this study shows many deficiencies in parental knowledge of child abuse and neglect. Parents' attitudes and perceptions are considered indispensable targets for community health intervention.
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Evaluate the prevalence of depression in type 2 diabetics with microvascular complications p. 3060
Niloofar Khodabandehloo, Mitra Zarifkar, Delaram Eskandari, Nonasadat Ariashokooh, Amir Ziaee, Sahar Zandpoor, Alireza Hejrati
DOI:10.4103/jfmpc.jfmpc_123_20  
Introduction: Diabetes is one of the most common diseases in the world that is accompanied with many microvascular complications. Any chronic disease such as diabetes can cause types of mood disorders such as depression in patients. The aim of this study was to evaluate the prevalence of depression in type 2 diabetics with microvascular complications. Execution Method: In this cross-sectional study, type 2 diabetics with microvascular complications that referred to Hazrat Rasoul Akram Hospital during 2016–2017 were studied. After verification of retinopathy and nephropathy in patients, 100 patients were enrolled in the study and correlated between variables such as age, sex, body mass index, medication, education, retinopathy, nephropathy, marital status, hemoglobin A1c (HbA1c), triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL), blood pressure, and fasting blood sugar was investigated in patients given the possibility of depression. Results: The results of this study showed that 72% of patients were with depression and by evaluating the mentioned variables with depression disorder it was found that there was a significant relationship between fasting blood sugar, HbA1C, retinopathy, medication, and LDL with depression. Conclusion: Given the high prevalence of depression (72%) in diabetics in this study, it seems that psychiatric consultation is needed to diagnose depression in diabetics.
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Utilization of guideline-directed medical therapy in patients with de novo heart failure with reduced ejection fraction: A Veterans Affairs study p. 3065
Mohamad Khattab, Purvi Parwani, Mubasher Abbas, Huzair Ali, Pedro M Lozano, Udho Thadani, Tarun W Dasari
DOI:10.4103/jfmpc.jfmpc_174_20  
Background: The utilization of guideline-directed medical therapy (GDMT) significantly reduces morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF). Previous studies have documented the underutilization of GDMT in HFrEF. The present study aimed to determine reasons for underutilization and achievement of target doses of GDMT in patients with de novo diagnosis of HFrEF. Methods: Patients presenting with de novo HFrEF at the Veterans Affairs Medical Center were included. Baseline demographic, clinical, and echocardiographic data were collected. The utilization of target doses of GDMT was assessed at the time of discharge and 1-, 3-, 6-, and 12-month follow-up. Results: Of the 95 patients who met the criteria for de novo HFrEF, 48 were included in the final analysis. Dose titration of either beta-blocker or angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was attempted in 20 patients (42%) at 1 month, 21 patients (44%) at 3 months, 13 patients (27%) at 6 months, and 14 patients (29%) at 12 months. Nine (19%) patients were on a target dose of beta-blockers and three (6%) patients were on a target dose of an ACEi/ARB at 12 months. The most common reasons for underutilization were patient-level factors, such as hypotension, acute kidney injury/hyperkalemia, and patient noncompliance. Conclusions: Utilization and achievement of target doses of GDMT were suboptimal among patients discharged with de novo HFrEF during a 1-year follow-up. Although patient factors may limit the up-titration of therapies, concerted efforts are needed to support primary care physicians in improving adherence to target doses of GDMT in patients with HFrEF.
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Prevalence and perceptions of e-cigarette use among medical students in a Saudi University p. 3070
Eiad Habib, Mayar Helaly, Amani Elshaer, Dalia Sriwi, Mohammad Sharique Ahmad, Mohamed Iesar Mohamed, Akef Obeidat
DOI:10.4103/jfmpc.jfmpc_235_20  
Background and Aims: We hypothesized that the prevalence of electronic cigarette vaping among the medical student population is on the rise. Our aims were to assess the prevalence of electronic cigarette vaping among medical students in Saudi Arabia, to understand and analyze the reasons that led them to try it, and to investigate students' perceptions towards electronic cigarette vaping. Methods: An anonymous, paper-based, cross-sectional questionnaire was distributed amongst 401 undergraduate medical students from years 1-5 at Alfaisal University in Riyadh, Saudi Arabia. Prevalence, intensity of e-cigarette use and reasons for it, relation of electronic cigarettes to cessation of tobacco smoking, and side effects were studied. Results: The prevalence of vaping was 49/401 (12.2%). There was a strong association between gender and vaping, with males being 3 times more likely to vape compared to females (χ2 (1) =13.62, P<.001). The three most common reasons for using electronic cigarettes were to enjoy the variability in flavours (61.4%, n = 30), to reduce or quit tobacco cigarettes (29.5%, n = 14), and to avert the public smoking ban (13.6%, n = 7). The three most common side effects experienced by users were coughing (26.7%, n = 13), dry mouth/throat (24.4%, n = 12), and dizziness (20%, n = 10). Conclusion: Use of the electronic cigarettes is not uncommon amongst medical students, mostly due to their appealing flavor variability. Further research is required to define long-term safety and side effect profiles, and to generate evidence-based guidelines concerning e-cigarette safety and efficacy for smoking cessation.
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Study to evaluate the etiology of iron deficiency anemia at a teaching hospital in northeastern part of India p. 3076
Abhishek Kumar, Saumya Gupta, Lalit P Meena, Mukti P Meher, Madhukar Rai, Sandip Kumar, Anju Bharti
DOI:10.4103/jfmpc.jfmpc_3_20  
Introduction: The causes of iron deficiency may be either due to excessive loss or, less frequently, decrease absorption. Data related to etiology are not available from this part of the country. Objective: A study to evaluate the etiology of iron-deficiency anemia at a teaching hospital in the northeastern part of India. Materials and Methods: In this cross-sectional study, cases of iron-deficiency anemia were selected from the OPD and indoor, after taking proper written consent. Iron-deficiency anemia was diagnosed by sending the complete hematological investigations. Other specific investigations including imaging were done in selected patients as per indications. Results: A total of 102 patients of iron-deficiency anemia were included in the study. The age of the selected population was between 18 and 80 years. 37.3% were male and 62.7% were female patients. Upper gastrointestinal endoscopy was done in 56, out of these, 9.7% had antral gastritis and 2.9% had a duodenal ulcer. Lower gastrointestinal endoscopy was done in 30 patients and out of these seven patients had hemorrhoids, one patient had multiple ulcers in the colon, one had ulcers in the sigmoid colon, and one had ulceroproliferative mass in the transverse colon. Biopsy through the upper gastrointestinal endoscopy showed chronic duodenitis in three patients (2.9%), carcinoma stomach in one (0.98%), and periampullary carcinoma in one (0.98%). Biopsy after lower gastrointestinal endoscopy showed one case each of carcinoma colon, ulcerative colitis, nonspecific colitis, and nonspecific enteritis. Conclusion: Diagnosis of iron-deficiency anemia is not sufficient without the diagnosis of underlying etiology. Special concern will be taken to gastrointestinal malignancies like colorectal cancers in which iron-deficiency anemia may be the only manifestation and diagnosis that can be missed if we do not investigate properly.
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Steering the predictors to improve the knowledge and utilization of partograph by skilled birth attendants: An intervention study p. 3082
Manoj K Gupta, Pankaja Raghav, Vaishali Gautam, Pankaj Bhardwaj, Neeti Rustagi, KH Naveen, Meenakshi Gothwal
DOI:10.4103/jfmpc.jfmpc_345_20  
Context: It was hypothesized that knowledge of skilled birth attendants (SBAs) about partograph and its utilization can be improved by modifying their predictors through training workshops. Aim: To upgrade the knowledge regarding partograph and its utilization by SBAs by modifying their predictors through training workshops. Settings and Design: This was an intervention study, which was conducted in a rural area of the Jodhpur district of Rajasthan state. Subjects and Methods: The SBAs were interviewed through pre and postintervention with the help of a prevalidated semi-structured interview schedule. As a part of an intervention, a series of half-day training workshops were conducted in the intervention block. Data were analyzed using SPSS version 23. Statistical Analysis Used: Descriptive statistics, univariate (Chi-square, t-test), and multivariate (logistic regression) analysis. Results: A total of 213 SBAs (105 from intervention and 108 from control block) were included in the study. SBAs who had received training related to the partograph were having significantly higher odds of knowing (AOR = 22.6[10.7–47.9]) as well as utilization (AOR = 22.5[7.05–72.1]) of partographs as compared to their counterparts. Knowledge was also a significant predictor of the utilization of partograph. Intervention could significantly improve the knowledge of SBAs about partograph as well as its utilization in the intervention block. Conclusion: Significant impact of the intervention on knowledge about partograph and its utilization was evidenced in the present study. There is a need to conduct training and refresher courses for healthcare workers on partograph use.
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Knowledge regarding teratogens among women of childbearing age at a large tertiary care center in Saudi Arabia p. 3088
Wejdan Alhamdan, Afaf Moukaddem, Nourh AlOtaibi, Adibah Aledrees, Nada Alhatem, Nada Alshehri, Samaher Alfaraj, Maysoon Aladham
DOI:10.4103/jfmpc.jfmpc_173_20  
Aim: To investigate the knowledge of Saudi women regarding the teratogenic effects of environmental agents such as fever, some chronic conditions and medications and its association with certain socio-demographic factors. Materials and Methods: A survey based cross-sectional study was conducted on 315 Saudi women of childbearing age visiting OB/GYN clinics at a large tertiary care centre in Riyadh, Saudi Arabia. Knowledge of subjects on teratogenic risk of common entities was measured and nonparametric Mann–Whitney and Kruskal–Wallis tests were used to associate knowledge score with various predictors. Results: The response rate was 75%. Most of the participants were between 28 and 37 years. Knowledge on teratogenic risk was generally poor with specifically higher knowledge regarding insulin intake and isotretinoin. Older age, higher education, being employed, and having a high monthly income were significantly associated with a higher knowledge score (P < 0.05). Conclusion: Women's knowledge regarding teratogenic risks is crucial in ensuring a safe pregnancy and a healthy fetus. Our study revealed inadequate knowledge of teratogens among the participants which implies an urgent need to increase awareness of mothers regarding the harmful effects of common teratogens.
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Assessment of implementation and compliance of (COTPA) Cigarette and Other Tobacco Products Act (2003) in open places of Delhi p. 3094
Irfan Ali, Basavaraj Patthi, Ashish Singla, Kuldeep Dhama, Mohnish Muchhal, Ananthalekshmy Rajeev, Monika Kumari, Ambar Khan
DOI:10.4103/jfmpc.jfmpc_24_20  
Background: The use of tobacco in modern life leads to major epidemic disease resulting in social, financial, and environmental problems. In 1975, the first anti-tobacco legislation was passed which was incompetent; however, in 2003 “Cigarettes and Other Tobacco Products Bill” was passed which represents effectiveness in tobacco control. Thus, the aim was to assess the implementation of various sections of COTPA like Sections 4, 5, 6-a, and 6-b, and 7, 8, and 9 in public places of Delhi. Materials and Methods: The study was conducted in open places of Delhi in which 376 public places were visited for observing the compliance of Section 4 of COTPA, 350 places for observing the compliance of Section 5 of COTPA, and 70 educational institutions for observing the compliance of Section 6(a) and 6(b) of COTPA, and data were recorded through direct observation. Results: From a total of 376 places visited, smoking was seen in 59.28% of the places visited in Delhi which is against Section 4 of COTPA. For the compliance of Section 5, 97.42% were as per the COTPA specification; however, the compliance of Section 6-a was 68.57% and Section 6-b was 52.85%. In Delhi, 100% compliance of Sections 7, 8, and 9 has been observed. Conclusion: The finding of our study suggests that after years of implementation of the COTPA Act 2003, it is executed only to a certain degree in Delhi. For effective implementation of act, various health policy makers, institutions, media, NGOs, and so on can help in minimizing the usage.
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Awareness of cardiovascular disease associated risk factors among Saudis in Riyadh City Highly accessed article p. 3100
Ahmed H Mujamammi, Yousef M Alluhaymid, Mohammed G Alshibani, Fawzan Y Alotaibi, Khalid M Alzahrani, Abdulmajeed B Alotaibi, Ahmed A Almasabi, Essa M Sabi
DOI:10.4103/jfmpc.jfmpc_458_20  
Objective: The aim of this study was to estimate the awareness of Saudi population in Riyadh regarding cardiovascular diseases (CVDs) and their risk factors. Methods: This was a cross-sectional study that used self-administered questionnaires conducted in universities, primary care centers, and electronic copies distributed in social media websites. Results: Overall, 47.1% of the respondents had a good awareness of CVD and associated risk factors. However, awareness of the symptoms of stroke and heart attack was low. Pulmonary embolism and deep vein thrombosis were the most commonly identified types of CVD, with 39.2% aware of these conditions. The most well-known symptom of heart attack was shortness of breath (known by 54.4% of the respondents). In relation to stroke, the most commonly recognized symptom was “sudden dizziness, trouble walking, or loss of balance” (45.4%). Respondents' awareness of CVD risk factors was moderate. The most common factors—identified by over two-thirds of participants—were unhealthy diet, smoking, dyslipidemia, and physical inactivity. Independent predictors of good CVD awareness were age 35–44 years, living in the north of Riyadh and following a healthy diet. Conclusions: The awareness of CVD and associated risk factors is insufficient among Saudis in Riyadh City. This study emphasizes the necessity for effective education to increase the awareness about CVD in Saudi Arabia. High awareness may lead to early recognition of the risk factors and lead to early implementation of primary prevention which the cornerstone of family medicine practice.
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Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes p. 3106
Garima Yadav, Shailja Chambial, Neha Agrawal, Meenakshi Gothwal, Priyanka Kathuria, Pratibha Singh, Praveen Sharma, Prem Prakash Sharma
DOI:10.4103/jfmpc.jfmpc_78_20  
Objectives: Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes. Materials and Methods: This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels. Results: We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 μg/dl–16.9 μg/dl with a mean BPb of 8.1 μg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels. Conclusions: We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.
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Prevalence rates of impaired glucose tolerance and gestational diabetes mellitus amongst expectant mothers and undiagnosed diabetes mellitus in walk-in patients at health centres in North Central Trinidad p. 3112
Raveed Khan, Jeren Bisnath, Jhonel Blackmann, Raqiba Bissessar, Sajay Bidhesi, Neila Boodoo, Tricia Bobb, Jodi Benjamin, Afiah Mohammed, Amrita Mahabir
DOI:10.4103/jfmpc.jfmpc_124_20  
Objective: To assess the prevalence rates of impaired glucose tolerance and gestational diabetes among expectant mothers, as well as the prevalence rate of undiagnosed diabetes mellitus in walk-in patients at selected health centres in North Central Trinidad. Design: A cross-sectional study over the period January 2012 to December 2016. Setting: Primary health care centres. Sample Population: Pregnant women aged 18–45 years who were within their second and third trimester of pregnancy, and for undiagnosed diabetes mellitus the sample population consisted of males and females over the age of 18. Methodology: Medical records of 90 pregnant women and 174 walk-in patients who received care at the selected health centres during the period January 2012 to December 2016 were examined and the following were recorded: age, ethnicity, parity, gravidity, past medical/surgical history, past obstetric history, oral glucose tolerance test results, random blood glucose results, HbA1c results, and family history of diabetes mellitus (DM). Results: The sample population was 90 expectant mothers and 174 walk-in patients. However, valid results were available for 50 expectant mothers and 78 walk-in patients. Of the 50 valid results for expectant mothers, 1 mother had a confirmed diagnosis recorded for gestational diabetes mellitus (GDM) yielding a prevalence of 2% for GDM. Age was positively correlated with the diagnosis of impaired glucose tolerance (IGT). (P = 0.028). Of the 141 valid entries for walk-in patients, 25 had a confirmed diagnosis of DM yielding a prevalence of ~ 18% for undiagnosed DM. A family history of diabetes was positively correlated with a subsequent diagnosis of DM among previously undiagnosed diabetes. Conclusion: The prevalence rate for GDM was found to be 2% and the prevalence rate for undiagnosed DM in walk-in patients was 18%.
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Patients' perceptions and preferences for physicians' attire in hospitals in south western Saudi Arabia p. 3119
Hassan M Alzahrani, Ahmed A Mahfouz, Shehata Farag, Nabil J Awadalla, Ahlam Abu Melha, Mohammed Almobarak, Makki H Meri, Othman M Omair, Afnan S Alqarni, Fatma M Alqahtani
DOI:10.4103/jfmpc.jfmpc_166_20  
Purpose: Data regarding patients' perception and satisfaction about physicians providing the medical care based on their attires in Southern Region of Saudi Arabia are scarce and even lacking. The aim of this study was to assess the patients' opinion regarding the suitable attires of physicians. Materials and Methods: A descriptive cross-sectional survey was performed on a random sample of patients from Aseer Central Hospital, Southern Military Hospital and Abha Maternity Hospital. The questionnaire collected data on their perception of physicians' attire as well as reflection of dress on trust and willingness to discuss personal issues. Results: The study included 248 patients. The majority (81.9%) of the participants agreed on the importance for physicians to wear their medical attires. Also 84.3% of them confirmed that physician's appearance is important source of their confidence. Skirt plus lab coat was the most favored for female physicians (39.3%). As for male physicians, scrub plus lab coat was the most preferred (33.6%) attire. Conclusion: Patients attending hospitals in southwestern Saudi Arabia preferred for their physicians to wear formal attire with white coats, rather than the Saudi national dress. Skirt plus lab coat was the most preferred for female physicians. As for male physicians, scrub plus lab coat was the most preferred attire. Patients approved the importance for physicians to wear their medical attires and confirmed that physician's appearance is important source for their confidence. The study recommends that physicians should adopt formal attire and the institutional dress code policy should be modified to fit these preferences.
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Sleep hygiene, sleep-related problems, and their relations with quality of life in a primary-care population in southwest Saudi Arabia p. 3124
Nabil J Awadalla, Ahmed A Mahfouz, Shehata F Shehata, Suha A Al Thibiait, Asmaa H Aljihani, Souad M Hafez, Malak H Assiri, Dalia A Al-Mubark, Hassan M Al Shiban, Awad S Alsamghan, Abdullah Alsabaani
DOI:10.4103/jfmpc.jfmpc_525_20  
Background: Little is recognized about factors affecting poor sleep hygiene and relations of sleep problems with the quality of life among adults. Aims: To evaluate sleep hygiene, explore its associated factors, assess the prevalence of excessive daytime sleepiness (EDS) and insomnia, and their relations with sleep hygiene. Besides, correlate sleep problems with life quality. Methods: A representative sample of primary healthcare population was surveyed using questionnaires comprising sociodemographic characters, personal lifestyles, validated Arabic versions of Epworth sleepiness scales, Athens insomnia scale, short-form health survey questionnaire (SF-12), and developed Arabic sleep hygiene index (SHI). Results: A total of 401 adults participated in the study. The average SHI score was 17.25 ± 7.33. Poorer sleep hygiene was significantly detected in younger age, unmarried, unemployed, smokers, and energy drinks consumers (P < 0.05). Positive significant correlations were correlated with cellphone and video-gaming duration. About 56.61% and 39.90% of participants suffered insomnia symptoms and EDS, respectively. Significant poorer SHI was detected among insomnia and EDS sufferers. Negative significant correlations were observed between scores of both components of SF-12 and EDS, insomnia, and SHI. Conclusion: Significant negative associations were detected between SHI, EDS, insomnia, and both components of life quality. The role of sleep hygiene education programs in the promotion of sleep and quality of life need to be considered.
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A survey of public restrooms microbial contamination in Tehran city, capital of Iran, during 2019 p. 3131
Esfandiar Matini, Farzad Shayeghi, Mohammad E Vaghar, Javad Nematian, Sadaf Sadat Hosseini, Nima Mojri, Negin Tahanpour Taherabadi, Roqayeh Hakimi, Niloofar Ahmadi, Niloufar Badkoubeh, Hossein Esmaeili, Morteza Akhlaghi, Hamidreza Vaseghnia
DOI:10.4103/jfmpc.jfmpc_300_20  
Introduction: Daily use of public restrooms may have a significant impact on spreading infectious diseases. Human society could be affected by spreading of transitional infectious diseases through feces, urinary tract infection and poor personal hygiene. According to the World Health Organization reports, plenty of people's developed diseases caused by contaminated public restrooms that may result in severe health problems. Methods: This descriptive cross-sectional study was conducted on 7,482 samples that were collected randomly in 6 months (spring and summer 2019) in different regions of Tehran. The Data were obtained by analyzing 804 restroom's indoor and outdoor handles, 1062 toilet faucet, 826 washbasin taps, 1,062 toilet hoses, 804 flush tank levers, 643 soap dispenser bottoms, 643 liquid soaps, 99 bar soaps, 169 toilet papers and paper towels, and 50 hand dryer machines. Samples which were tested, based on bacteriology standard methods. Result: 7,482 samples were gathered of which 6,678 contaminated cases (89.25%) were observed and 804 cases (10.75%) were found non-contaminated. Escherichia coli with 28.48% and Pseudomonas with 0.39% were the most and the least common bacteria, respectively, in this study. Conclusion: The required tests to identify the bacteria that cause contamination through the use of public restrooms have been done. It is essential to inform the public of the mentioned items and teach how to prevent infectious diseases.
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Experiences of nurses within a nurse-led multidisciplinary approach in providing care for patients with diabetic foot ulcer Highly accessed article p. 3136
Nahid Dehghan Nayeri, Nasrin Samadi, Nasrin Mehrnoush, Irandokht Allahyari, Fatemeh Bezaatpour, Mansour NaseriAsl
DOI:10.4103/jfmpc.jfmpc_1008_19  
Background and Aims: Diabetic foot ulcers require special attention due to their complex and chronic nature and special care and the Nurse-led approach has emerged in the current situation in response to the increasing need for health care as a way to treat chronic patients and provide them with ongoing care. Providing this specialized duty in nursing can be promoted and enhanced the professional independence of nurses and presents challenges. This study has been conducted to make an understanding of the nurses' experiences about their participation in a nurse-led multidisciplinary team to providing care for patients with Diabetic Foot Ulcer. Methods: This was a qualitative, phenomenological research, carried out with the participation of 8 nurses of Shariaty Hospital of Tehran. Data collection was done through in-depth and semi structured interview. Dieklemann method was used for data analysis. Results: 2 themes and 4 categories emerged during data analysis: antecedents (background and nursing skills) and manifestation of multidisciplinary function (from despair to tranquility, professional worthiness, promotion of self-confidence, preference of multidisciplinary approach). Conclusion: The findings of this study, which were the lived experiences of the participants, indicated that most of them had experienced positive effect of nurse-led multidisciplinary team care, training and development, appropriate skill mix, quality and outcome of care. Therefore, despite working on a multidisciplinary team is complex and demanding, management attributions and communication strategies is well situated to meet the challenge.
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CASE REPORTS Top

Coexistence of hyperparathyroidism and peripheral giant cell granuloma of the jaw: A rare case report p. 3142
Naina Pattnaik, Jagadish P Rajguru, Samarjeet J Pattanaik, Debajyoti Bardhan, Bikash Nayak, Md Mustaq Fizur Islam
DOI:10.4103/jfmpc.jfmpc_479_20  
Peripheral giant cell granuloma (PGCG) known as “giant cell epulis” is a benign, reactive exophytic gingival lesion that accounts for less than 10% of all gingival lesions. PGCG affects females more than males with middle age predilection. Till now the etiology of PGCG remains unclear but various factors that can cause PGCG include poor oral hygiene, food impaction, following an extraction, dry mouth, hormonal disturbance, and hyperparathyroidism. The reported recurrence rate of the lesion is 5.0%–70.6%. The present case report describes the rare case of PGCG with primary hyperparathyroidism in a male patient with a history of swelling in the mandibular anterior region.
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Amyopathic dermatomyositis with diffuse lung disease p. 3147
Sumeera Bandi, Vidushi Jain, Ashish K Jaiswal
DOI:10.4103/jfmpc.jfmpc_106_20  
A 38-year-old woman presented with progressively increasing breathlessness, recurrent productive cough, and intermittent fever of 1 year duration. Examination revealed cutaneous eruptions on the dorsal aspects of the hands and on face. Histopathologic features of skin biopsy revealed acanthosis, hyperkeratosis with focal vacuolar alteration of the basal-cell layer, and perivascular inflammatory infiltrates in upper dermis. CT scan showed diffuse lung disease and pulmonary function tests showed severe restrictive lung disease. There was no muscular involvement clinically or on electromyography and magnetic resonance imaging. She was diagnosed as a case of amyopathic dermatomyositis with diffuse lung disease and managed with topical and systemic steroid and topical sunscreen with fairly good response.
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Primary neuroendocrine tumor of liver: An eye opener for a pathologist p. 3151
Arvind Kumar, Tushar Kalonia, Vandna Bharati, Amit Gupta
DOI:10.4103/jfmpc.jfmpc_224_20  
Introduction: Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine. While the liver is a common site of metastases. Case Presentation: We describe a 73-year-old female who reported to our center with complains of swelling and pain in the right upper quadrant of stomach. CECT revealed large well-localized multicystic mass in the right lobe of the liver. A suspicion of hydatid cyst was given. However, immunogenic tests results were negative for hydatid cyst. The AFP level was also unremarkable. Conclusion: Histopathological examination with immunohistochemical panel along with other serological and radiological investigations made the diagnosis possible due to its vague clinical presentation.
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An atypical presentation of multiple myeloma in a young patient with pathological fracture p. 3154
Bharat Kumar, Prakrati Yadav, Mohd Nadeem, Mahendra K Garg
DOI:10.4103/jfmpc.jfmpc_343_20  
We report a case of a 34-year-old male with a history of pulmonary tuberculosis and pathological fracture of shaft of long bone presented with symptoms of lower respiratory tract infection. The patient did not have any typical symptoms of multiple myeloma or hypercalcemia on presentation. Throughout his hospitalization, his serum globulin level was very high along with mild normocytic normochromic anemia and mild renal function derangement without apparent cause. Acute phase markers of inflammation, for example, erythrocyte sedimentation rate (ESR) were not elevated in this patient and there was no lytic lesion in bone radiographs. He was eventually diagnosed as a case of stage 3 multiple myeloma by immuno-fixation electrophoresis and bone marrow study. Multiple myeloma represents a pathology of diverse distribution and has varied unusual presenting symptoms. We consider it an underdiagnosed disease often missed especially in young because it is not considered by clinicians.
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Ofloxacin-ornidazole fixed-dose combination medication-induced pancreatitis with positive rechallenge p. 3157
Nikhil Bush, Vishal Sharma, K Chandrahasan, Amol N Patil
DOI:10.4103/jfmpc.jfmpc_531_20  
Although ofloxacin-ornidazole fixed-dose combination (FDC) is a rampantly used antibiotic combination for mixed-infection diarrhea in India, the adverse drug reaction (ADR) associated with these FDCs remains underreported. Herein, the authors present a case report of a definitive ofloxacin-ornidazole FDC-induced pancreatitis. The nonalcoholic adult male patient showed a sharp piercing epigastric pain flowing to the back, gradually rising in severity, which started after taking ofloxacin-ornidazole FDC tablet over the counter. Serum lipase concentration measured in the emergency room was 635 units per liter (normal range- 13–60 units/L) and serum amylase was 377 units/L (normal range- 30–110 units/L). Ultrasonography and an axial computed tomography of the abdomen confirmed the diagnosis of acute pancreatitis. Ofloxacin-ornidazole FDC tablet was stopped immediately. Past treatment records confirmed accidental rechallenge. In conclusion, this is a first case report of ofloxacin-ornidazole FDC-induced pancreatitis.
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Hemoglobinopathy E in 4 siblings of a North Indian family: A hidden malaise of social problem p. 3160
Kapil Bhalla, Jatin Mangla, Ashish Gupta, Sanjiv Nanda, Deepak Nehra
DOI:10.4103/jfmpc.jfmpc_135_20  
The preference for male child and neglect of girl child for long has resulted in a hazardously poor sex ratio, but bride buying seems to be no solution for it as it has its own inherent consequences on society and public health. This article tries to look at a relationship between a state's poorly kept secret like bride buying and its unseen complications. Here, we report a family of six members, where all 4 children have hemoglobin E disease a relatively rare entity seen in this part of the country. Hemoglobin E (β26 Glu → Lys) is usually seen in northeastern parts of India. This case report has tried to highlight a relatively rare disease afflicting all children of the family due to gene mutations which are rarely seen in Haryana/Punjab.
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Cefdinir associated bloody stool in Riyadh infant: A case report p. 3162
Haytham Ali Bahkali, Renad Abdullah Alshuraim, M Alghalbi, Yahya Ali Mohzari, Syed Mohammed Basheeruddin Asdaq
DOI:10.4103/jfmpc.jfmpc_505_20  
Cefdinir is one of the broad spectrum cephalosporin used as a replacement to amoxicillin in allergic pediatric population. There are reports of forming red stool in patients receiving cefdinir along with iron or iron containing preparations. This is a benign interaction and wane upon completion/discontinuation of cefdinir therapy. This case report describes a 6-month-old boy whose parents were distressed when they found reddening of their ward's diaper while taking cefdinir in presence of iron supplements.
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POETRY Top

Blood donation must go on p. 3165
Manish Raturi
DOI:10.4103/jfmpc.jfmpc_325_20  
Reacting to the repeated messages on his phone, the blood donor goes to a blood center and donates his AB Rh D negative blood. There, he sees the blood center technician whose mother requires this rare blood unit as she is undergoing treatment at the hospital. The very act of blood donation is soul-satisfying for him as he pens down his experience in the configuration of a poem.
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LETTER TO EDITOR Top

Check indexing status of a journal Highly accessed article p. 3166
Himel Mondal, Shaikat Mondal
DOI:10.4103/jfmpc.jfmpc_423_20  
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