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   Table of Contents - Current issue
Coverpage
July 2019
Volume 8 | Issue 7
Page Nos. 2169-2554

Online since Wednesday, July 31, 2019

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EDITORIAL  

Strengthening primary care in rural India: Lessons from Indian and global evidence and experience Highly accessed article p. 2169
Pavitra Mohan, Raman Kumar
DOI:10.4103/jfmpc.jfmpc_426_19  
India has made significant advances in health of its populations over more than a decade, reducing the gap between rural and urban areas and between the rich and the poor. Huge disparities, however, still remain, and access to healthcare in rural areas remains a huge challenge. A one-day National Consultation, nested within the World Rural Health Conference, was held to share learnings from experiences and evidence of rural primary healthcare within India and from across the world, to identify elements that may guide improvements in healthcare in rural India. From discussions, this article summarizes the evidence on what works for rural primary care, and then provides recommendations for strengthening healthcare in rural India.
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REVIEW ARTICLES Top

Management of radiation-induced proctitis Highly accessed article p. 2173
Pejman Porouhan, Negin Farshchian, Malihe Dayani
DOI:10.4103/jfmpc.jfmpc_333_19  
The occurrence of chronic proctitis as a side effect among radiotherapy patients is about 5%. Radiation proctitis and consequent development of chronic proctitis are not associated to each other. However, a lot of samples of proctitis that are limited easily could be treated by typical remedial techniques. Improvements in radiotherapy techniques that make possible the delivery of superior doses of radiation could easily reduce both chronic and acute proctitis. The step-by-step remedial procedure for treatment of this disorder starts with conservative remedial management and includes iron substitution as a second-line therapy. For patients who did not receive initial therapies, sucralfate injection, topical corticosteroids, and antidiarrhea therapy were provided as a means of aggressive care. In cases of continuous rectal bleeding, remedial laser techniques and formaldehyde administration should be attempted before surgical therapy. When surgical therapy is required, a descending or transverse colostomy must be carried out. Advanced methods such as intraperitoneal injections of formalin or novel methods of cold therapy and radiofrequency ablation (RFA) provide a wider remedial field. Exceptionally, unanticipated conclusion of neosquamous wound healing via RFA may have additional preponderances in stopping symptoms and may require better assessment through accurate randomized examination. Since aggressive treatments like coloanal anastomosis and colorectal surgery are correlated with remarkable mortality and morbidity, they must be considered as the final course of remedial treatment.
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Bias in clinical trials into the effects of complementary and alternative medicine therapies on hemodialysis patients Highly accessed article p. 2179
Mohsen Adib-Hajbaghery, Zohreh Nabizadeh-Gharghozar, Parisa Nasirpour
DOI:10.4103/jfmpc.jfmpc_186_19  
Background: Chronic renal failure is among the major health challenges in the world. Many clinical trials have been conducted to assess the effects of complementary and alternative therapies on hemodialysis-related outcomes. However, a number of biases may affect the results of these studies. Aims: This study aimed to assess biases in randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients. Settings and Design: A critical review on clinical trials into the effects of complementary and alternative therapies therapies on hemodialysis patients. Materials and Methods: This study was conducted on 114 randomized clinical trials which had been published in 2012–2017 into the effects of complementary and alternative therapies on hemodialysis patients. The Cochrane Risk of Bias Tool was employed to assess biases in the included trials. The collected data were presented using the measures of descriptive statistics, namely absolute and relative frequencies. Results: Among 114 included trials, 71.05% (81 trials) had used low bias methods for random sequence generation, while 60.52% (69 trials) had provided no clear information about allocation concealment. Moreover, respecting blinding, 57.89% of trials (66 trials) were low bias. Around 60.52% of trials (69 trials) had no attrition between randomization and final follow-up assessment and 84.21% (96 trials) had apparently reported all intended outcomes. Conclusions: This study shows that 50% of randomized clinical trials into the effects of complementary and alternative therapies on hemodialysis patients have low bias. Yet, quality improvement is still needed to produce more conclusive evidence.
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Fimasartan: A new armament to fight hypertension Highly accessed article p. 2184
Akshyaya Pradhan, Vikas Gupta, Rishi Sethi
DOI:10.4103/jfmpc.jfmpc_300_19  
Hypertension is a major public health problem of modern era. Fimasartan is a new Angiotensin Receptor Blocker approved for treatment of hypertension. It is more potent and longer acting angiotensin receptor blocker with effects lasting over 24 hours. Many clinical studies have affirmed its role in pharmacotherapy of hypertension. Further, it is renoprotective and has proven beneficial in diabetes also. This article briefly discusses the pharmacology and clinical evidence with fimasartan with a short summary of previous angiotensin receptor blockers.
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Ebola virus: A global public health menace: A narrative review Highly accessed article p. 2189
Shamimul Hasan, Syed Ansar Ahmad, Rahnuma Masood, Shazina Saeed
DOI:10.4103/jfmpc.jfmpc_297_19  
Ebola virus disease (EVD), a fatal viral hemorrhagic illness, is due to infection with the Ebola virus of the Filoviridae family. The disease has evolved as a global public health menace due to a large immigrant population. Initially, the patients present with nonspecific influenza-like symptoms and eventually terminate into shock and multiorgan failure. There exists no specific treatment protocol for EVD and only supportive and symptomatic therapy is the line of treatment. This review article provides a detailed overview of the Ebola virus; it's clinical and oral manifestations, diagnostic aids, differential diagnosis, preventive aspects, and management protocol.
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ORIGINAL ARTICLES Top

Prevalence and patient characteristics of Helicobacter pylori among adult in primary health care of security forces hospital Riyadh, Saudi Arabia, 2018 p. 2202
Rami Hamdan Alharbi, Medhat Ghoraba
DOI:10.4103/jfmpc.jfmpc_398_19  
Aim: To estimate the Helicobacter pylori prevalence and patients' characteristics in primary health care in security forces hospital Riyadh, Saudi Arabia. Methods: A cross-sectional study, using a fecal H. pylori antigen, is including adults (14-64 years) in the duration from 18 March 2018 to 18 April 2018 on Saudi male and female visiting Primary care center in Security Forces Hospital, Riyadh, Saudi Arabia. Results: The study came up with H. pylori prevalence is significantly correlated with age for those below 20 years and more than 50 years (P-value = 0.022 and 0.016, respectively) but with no correlation with the patient's sex. Conclusion: In conclusion, overall prevalence of H. pylori is low among primary healthcare patients, which is 10.2% and it is correlated to younger age <20 years old and elderly >50 years old.
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Content validity of the newly developed risk assessment tool for religious mass gathering events in an Indian setting (Mass Gathering Risk Assessment Tool-MGRAT) p. 2207
Upasana Sharma, BR Desikachari, Sankara Sarma
DOI:10.4103/jfmpc.jfmpc_380_19  
Background: Risk assessment (RA) for mass gathering events is crucial to identify potential health hazards. It aids in planning and response activities specific to the event but is often overlooked by the event organizers. This paper reports the content validity process of a newly developed tool called Mass Gathering Risk Assessment Tool (MGRAT), which intends to assess the risks associated with religious mass gathering events in Indian settings. Methods: Qualitative approach was followed to identify the risks associated with mass gathering events and to identify the domains and items to be included in the RA tool. The draft tool was shared with six experts who were selected by the convenient method; selected experts were requested to assess the tool and give their comments about the domains, items, relevant responses, and overall presentation of the tool using content validity questionnaire. Content validity index and Fleiss kappa statistics were calculated to assess the agreement between multiple raters. Results: Agreement proportion expressed as scale-level content validity index (S-CVI) calculated by the averaging method is 0.92. S-CVI; calculated by universal agreement is 0.78. Fleiss kappa statistics to measure the agreement between multiple experts after adjusting the component of the chance agreement is 0.522 (95% CI: 0.417, 0.628, P value: 0.001). Conclusion: MGRAT is a valid tool, which has an appropriate level of content validity. As the number of raters increases, there will be difficulty in achieving consensus among all the items, which is the reason for lower Content Validity Index/Universal Average (CVI/UA) when compared with Content Validity Index/Average (CVI/Ave). Fleiss kappa statistics also indicated moderate agreement among the raters beyond the chance agreement, which also supports the appropriate content validity of MGRAT.
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A pilot point prevalence study of antimicrobial drugs in indoor patients of a teaching hospital in Central India p. 2212
Ahmad Najmi, Balakrishnan Sadasivam, Ratinder Jhaj, Shubham Atal, Sunil Kumar, C Santenna
DOI:10.4103/jfmpc.jfmpc_430_19  
Aim: To evaluate the point prevalence of antimicrobial drug use by using point prevalence survey method. Methodology: A cross-sectional point prevalence study was done on patients admitted in AIIMS Bhopal hospital. This study included all inpatients receiving an antimicrobial that were on the ward at 8 AM on a specific day in May 2018. Information regarding age, gender, occupation, income group, diagnosis, patient's present/past medical history, treatment, any adverse drug reactions, and investigations are recorded in a pro forma. Results: A total of 77 patients (31.95%) were included out of total 241 patients who received at least one antimicrobial. Of patients who received at least one antimicrobial, diagnosis was mentioned in 83.11% of prescriptions. Targeted treatment was given to 10.38% of patients. Reasons for antimicrobial were recorded in 12.98% of patients. Most common healthcare infection recorded was catheter-associated urinary tract infections followed by postoperative surgical site infections. Penicillin with beta lactamase inhibitors was most commonly prescribed antibiotic group followed by third generation cephalosporins and fluoroquinolones. Stop or review date was recorded in 19.48% of patients. Parenteral administration was given to 30.55% of patients. Compliance to guidelines was followed in 64.11% of patients. Local antibiotic guideline and antibiogram were available in hospital. Biomarkers were utilized in 9.77% of patients to guide the choice of therapy. Conclusion: Availability of antibiotic policy, antibiogram, local antibiotic guidelines, drugs, and therapeutic committee were some of the encouraging findings. Diagnosis was mentioned in majority of prescriptions. Most patients were prescribed oral antimicrobial drugs, which can reduce complications with parenteral route. Underutilizations of microbiological facilities, prolonged use of antibiotics for surgical prophylaxis, and polypharmacy were areas of concern.
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Predictive components in the structure of an intensive, parent mediated, early intervention for children with autism spectrum disorders in India p. 2218
Shonima A Viswanathan, Paul S. S. Russell
DOI:10.4103/jfmpc.jfmpc_441_19  
Introduction: The predictive factors of parent mediated, Early Intervention (EI) for children with Autism Spectrum Disorders (ASD) have not been studied in India; we document the structural therapeutic factors, which predict the EI outcome. Methods: Data of 77 children with an ICD 10 diagnosis of Pervasive Developmental Disorder (ASD in DSM 5), and completed a 12-week EI with proven effectiveness was collected from the database of a teaching hospital. We studied the structural therapeutic factors associated with EI outcome, as measured by Psycho-Educational Profile-Revised (PEP-R), while controlling the confounders with multiple linear regression analyses. Results: The Fine-motor skills improved in residential patients (t = 2.54, P = 0.02; 15 units). As the duration of intervention decreased at home per day, there was a significant decrease in Gross-motor skills (t = -2.67, P = 0.02; -15 units). With increase in duration of intervention in hospital per day, there was a significant increase (t = 2.86, P = 0.01; 30 units) in the Eye-hand integration. Cognitive-verbal skills acquisition decreased (t = -2.90, P = 0.01; 33 units) as the duration of intervention decreased at hospital. The use of medication did not predict any of the outcome factors. Conclusion: The above mentioned predictive factors should be monitored and titrated in the family context when children with ASD undergo parent mediated, EI programme. It is important to that the multidisciplinary family medicine teams reinforce these parents, who are the main column of support in primary-care settings for children with neuro-developmental disabilities in India.
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Comparison of hemodynamic changes of magnesium sulfate and dexmedetomidine for an axillary brachial plexus block p. 2223
Yousef Shahtaheri, Alireza Kamali, Mohammad Tavakoli Rad, Bijan Yazdi
DOI:10.4103/jfmpc.jfmpc_318_19  
Introduction: Axillary brachial plexus block is used for anesthesia in hands and forearm surgery. The aim of this study was to compare the hemodynamic changes of magnesium sulfate and dexmedetomidine in axillary block. Materials and Methods: This randomized, double-blind clinical trial was conducted on 99 patients undergoing a forearm and hand surgery at the Vali-Asr Hospital. Patients were divided into three groups. Dexmedetomidine group consisted of lidocaine 1.5% plus 0.5 μg/kg dexmedetomidine, magnesium sulfate group included lidocaine 1.5% plus 100 mg magnesium sulfate, and the control group received lidocaine 1.5% with normal saline. The final volume was divided into 35 groups in three groups. Blood pressure, heart rate, and oxygen saturation were measured every 5 minutes during surgery, and data were analyzed by SPSS 23. Results: There was a statistically significant difference between the three groups in terms of the mean blood pressure during surgery (P < 0.05). At all times, blood pressure in the dexmedetomidine group was lower as compared to the other two groups. But in the 20th and 25th minutes, there was a relative increase in blood pressure. There was a significant difference between the three groups in terms of heart rate during surgery in minutes 20, 25, 65–100, and 110–120 (P < 0.05). Conclusion: The final result showed that the blood pressure and heart rate of the dexmedetomidine group patients at different times were less than the other two groups.
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H1N1 Influenza: Assessment of knowledge and awareness of private dental health professionals of a Tricity p. 2229
Iqbal Singh, Shveta Munjal, Mandeep Kumar, Mihir Jha, Ramandeep Singh Gambhir, Bikiran Talukdar
DOI:10.4103/jfmpc.jfmpc_381_19  
Background: Influenza like Swine flu virus has posed a greater risk of occupational transmission to dental professionals as it can spread through the aerosols. Aim: To assess knowledge and awareness of private dental health care professionals regarding swine flu of a Tricity in India. Materials and Methods: A cross-sectional study was conducted among 255 private dentists practising in the Tricity. A self-administered, anonymous, multiple choice type questionnaire was administered to gather information. The questionnaire contained 12 questions on knowledge and awareness regarding swine flu keeping in view the time constraints. Statistical analysis was done using ANOVA and student t-test. Results: Awareness regarding mode of transmission of swine flu were reported positively by 88.5% of subjects. About 24.6% of subjects reported about having encountered a swine flu patient at their clinic. Preventive measures to prevent spread of swine flu were known to 71.2% of subjects. Statistically significant association of mean knowledge scores was noted with education level (P = 0.015) and working profile (P = 0.017) of the subjects. Conclusion: The results of the present review showed that some knowledge gaps existed among dentists regarding some important aspects of swine flu. Therefore, there is an urgent need for training and continuous education programs regarding infectious diseases.
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A multicentric cross-sectional study to characterize the scale and impact of polypharmacy in rural Indian communities, conducted as part of health workers training p. 2234
Sangeetha Balaji, Monsurul Hoq, Jachin Velavan, Beulah Raji, Eva Grace, Sara Bhattacharji, Nathan Grills
DOI:10.4103/jfmpc.jfmpc_410_19  
Context: Polypharmacy and inappropriate medication usage is one of the world's most important public health issues. Yet in rural India, where medications are readily available, little is known about polypharmacy. Aim: This study explores factors related to polypharmacy in rural India to inform the response. Settings and Design: A household survey was conducted by community health trainees, across 515 Indian villages collecting medication prescription and usage information for single illness in the past month. Methods and Material: Polypharmacy was defined as the concurrent usage of four or more medications for single illness. Data from 515 rural India villages were collected on medication usage for their last illness. Respondents who consulted one healthcare provider for this illness were included for analysis. Statistical Analysis Used: Bivariate logistic regression and multivariate generalized estimating equation analysis were used to explore associations with polypharmacy. Results: Prevalence of polypharmacy was 13% (n = 273) in the sample and ranges between 1% and 35% among Indian states. Polypharmacy was common among prescriptions for nonspecific symptoms (15%, N = 404). People aged over 61 years compared with people aged between 20 and 60 years (OR 1.11, 95% CI 1.03–1.19) and people with income of over 3,000 INR/month (OR 1.04, 95% CI 1.00–1.07) were more likely to be prescribed four or more medications. Conclusions: The study demonstrates high rates of polypharmacy, identifies vulnerable populations, and provides information to improve the response to polypharmacy in rural India.
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How frail are our elderly? An assessment with Tilburg frailty indicator (TFI) in a rural elderly population of West Bengal p. 2242
Aparajita Dasgupta, Sayanti Bandyopadhyay, Lina Bandyopadhyay, Soumit Roy, Bobby Paul, Shamita Mandal
DOI:10.4103/jfmpc.jfmpc_445_19  
Context: “Frailty” is a multidimensional geriatric syndrome that increases the risk for adverse health outcomes, such as falls, hospitalization, increased morbidity, and mortality, among elderly persons. Aim: The objective of this study is to find out the proportion of frailty and its associates among elderly (aged ≥60 years) in a rural area of West Bengal. Settings and Design: It is a community-based cross-sectional observational study done during May–August 2018 among 165 elderly persons selected by systematic random sampling by probability proportionate to size method from three villages at the rural field practice area of our institute. Materials and Methods: Tilburg frailty indicator is used to measure frailty. An elderly is considered as frail if s/he scores ≥6 in this scale. Statistical Analysis: Data analysis is done by SPSS Version 16. The logistic regression is done to find out the associates of frailty. Results: Proportion of frailty is 38.8% (mean age ± SD: 67.03 ± 3.43 years) among the study subjects. Age, female gender, loss of spouse, illiteracy, economic dependency, no job/at home status, ≥2 chronic diseases are significantly associated with frailty in univariate logistic regression. In multivariable logistic regression, ≥2 chronic diseases [AOR: 8.4, CI: 4.6, 11.33] and illiteracy [AOR: 3.3, CI: 1.05, 9.8] retain their significance. Conclusion: Frailty should be recognized as a public health priority and awareness generation among elderly population for healthy ageing including self-motivation for proper management of their ailments should be emphasized for reduction of morbidity as well as for augmenting their quality of life.
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Safety and efficacy of alirocumab: A meta analysis of 12 randomized controlled trials p. 2249
Ajay K Shukla, Rekha Mehani
DOI:10.4103/jfmpc.jfmpc_406_19  
Background and Objective: Hypercholesterolemia is one of the major risk factor for atherosclerotic coronary heart disease, especially coronary heart disease. Most effective class of medications for prevention of cardiovascular events and LDL-C reduction are the statins. Approximately only one fourth of these high risk patients had achieved LDL-C levels <70 mg/dL with statins. Monoclonal antibody targeting PCSK9 is a novel class of drug used in the treatment of Hypercholesterolemia. Alirocumab is one such human monoclonal antibody directed against PCSK9. Binding of PCSK9 to the LDL-R on the hepatocytes promotes LDL-R degradation. Inhibition of PCSK9 binding to LDL-R leads to increased number of LDL-Rs to clear LDL, thus decreasing LDL-C levels. The purpose of this systematic study is to assess the safety and efficacy of Alirocumab in adults with hypercholesterolemia and Familial hypercholesterolemia. Materials and Methods: We searched Medline, PubMed Central database, Google scholar, EBSCO, Wiley library, conference proceedings and Clinical trials.gov registry through March 2017. Phase 3 randomized, controlled trials (RCTs) using Alirocumab in adults with hypercholesterolemia and Familial Hypercholesterolemia were selected. Results: In twelve RCTs comprising of 6019 patients included in the meta-analysis, significant favorable changes in LDL-C and HDL-C were found. Limitations: Results were derived from study level data rather than patient level data. Conclusions: Alirocumab substantially reduced the LDL-C level by over 50 %, increased the HDL-C level, and resulted in favorable changes in other lipids.
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Determinants of superficial surgical site infections in abdominal surgeries at a Rural Teaching Hospital in Central India: A prospective study p. 2258
Mekhla , Firoz Rajiv Borle
DOI:10.4103/jfmpc.jfmpc_419_19  
Introduction: Abdominal surgeries have high rate of surgical site infection (SSI), which leads to significant morbidity and financial burden. There is paucity of studies on SSI in rural Indian setup, where there is scarcity of adequate resources. The aim of this study was to determine the incidence and determinants of SSI after abdominal surgeries in a rural setup. Aim: To determine the incidence of and associated risk factors for superficial SSIs in abdominal surgery cases at a central Indian rural teaching hospital. Methods: This cohort study included 100 patients undergoing abdominal surgery between April 2016 and May 2017 at a central Indian rural teaching hospital. The outcome of interest was superficial SSI and the factors associated with it. Association between risk factors and SSI was calculated using either Chi-square test or odds ratio with 95% CI. Results: The cumulative incidence rate of superficial SSI was 39% with 95% CI (29.4%–49.2%). The analysis defined 12 variables significantly associated with superficial SSI: middle or elderly age, male gender, diabetes mellitus, preoperative anemia, preoperative hypoalbuminemia, tobacco smoking, higher ASA score, perioperative blood transfusion, drain placement, surgery duration >2 h, contaminated/dirty wound class and emergency surgery. However, economic status and BMI grade of the study subjects were not associated with development of superficial SSI.
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An investigation into the effect of biofeedback on urinary and fecal incontinence in patients with anal sphincter dysfunction p. 2264
Mohammad Islami Vaghar
DOI:10.4103/jfmpc.jfmpc_222_19  
Introduction: Fecal incontinence refers to the inability to control bowel movements, causing feces to leak unexpectedly from the rectum. People suffering from this disorder are emotionally distressed. This problem causes social degradation, anxiety, fear, and social isolation. The present study aimed to evaluate the effect of biofeedback (BFB) on fecal incontinence in patients with anal sphincter abnormalities in 2017. Methods: This quasi-experimental study was performed on 30 patients with fecal incontinence, referring to the gastroenterology clinic of Taleghani and Mehrad hospitals. Patients were first evaluated by Wexner criteria and then, with the aid of a manometer, information was obtained on the amount of sphincter muscle tone, squeeze pressure, and rectal sensation. Manometric results and Waxner's questionnaire were compared before and after BFB. Data were analyzed using SPSS (version 20). Findings: In this study, 18 women and 12 men were studied. There was no significant relationship between fluid intake, fiber, exercise, sex, and incontinence (P < 0.05). According to Wuxner's components, the sphincter muscle tone increased significantly after BFB in patients. The total score of the squeeze pressure increased significantly after the BFB application (P < 0.05). The mean total score of rectal sensation (individual awareness of rectal contents) decreased after the BFB application. Conclusion: In addition to the fact that it can improve incontinence in patients with anal sphincter abnormalities, BFB is also helpful for patients whose sphincter and rectum are not seriously affected and only show incontinence symptoms.
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Correlation of severity of chronic obstructive pulmonary disease with serum vitamin-D level p. 2268
Ummul Baneen, Sufia Naseem
DOI:10.4103/jfmpc.jfmpc_404_19  
Context: The global scenario of illness is shifting from infectious diseases to non-communicable diseases, with chronic conditions such as heart diseases, stroke and Chronic Obstructive Pulmonary Disease (COPD) now being chief causes of death globally and more than 90% of deaths due to COPD occur in low and midline income countries.[1] Low serum vitamin D level is associated with various lung diseases and decreased lung function.[2] Aims: This study was designed to study the serum vitamin D level and its correlation with severity of COPD as assessed by spirometry, COPD assessment test (CAT) and exercise capacity and BMI of COPD patients. Settings and Design: Observational cross sectional study conducted on patients of COPD attending the outpatient department. Materials and Methods: One hundred sixty consecutive patients of COPD attending the outpatient Department were included in the study. Pack years, CAT score, 6 minute walk distance, post bronchodilator spirometry values and BMI was recorded along with complete history and physical examination. Statistical Analysis Used: Data analysis was done using IBM SPSS 23 software. Descriptive statistics, Independent sample t test, ANOVA and Pearson correlation were applied. Results: A significant positive correlation was found between FeV1% of predicted and serum Vitamin D level(r = 0.291; P < 0.001). A negative correlation was found between serum Vitamin D level and severity of COPD as assessed by CAT score (r = -0.355; P < 0.001). Also, a significant positive correlation was found between vitamin D levels and exercise capacity as assessed by 6 minute walk test (6MsWT) (r = 0.648; P < 0.001). Conclusions: COPD patients with more severe disease tend to have lower serum Vitamin D levels. As it is an immunomodulator affecting various inflammatory pathways, it is imperative that we give due consideration to Vitamin D levels in managing patients of COPD.
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Household out-of-pocket expenditure on health care - A cross-sectional study among urban and rural households, Puducherry p. 2278
Uma Vasudevan, Sujiv Akkilagunta, Sitanshu S Kar
DOI:10.4103/jfmpc.jfmpc_302_19  
Context: A major proportion of health expenditure is by households as out-of-pocket expenditure (OOPE) in India. Recent estimates at district level are required for planning implementation of Universal Health Coverage. Aims: To estimate the proportion of households incurring OOPE and the average amount spent by the household for healthcare. Settings and Design: A cross-sectional study was conducted during August 2016 in the field practice areas of a medical college in Puducherry. A random sample of 240 households (120 rural and 120 urban) with 1,029 participants (531 rural and 498 urban) were surveyed. Subjects and Methods: A pretested questionnaire was used to collect information on sociodemographic details, morbidity, healthcare services utilized, and expenses incurred. Recall period of 1 month was fixed for OP/Pharmacy Services and 6 months for IP services. Results: In total, 120 rural and 120 urban households were surveyed; out of which, majority of the households were below poverty line [rural (83.3%, n = 100), urban (69.2%, n = 83)] and belonged to other backward classes [rural (60.8%, n = 73), urban (83.3%, n = 100)]. The proportion (95% CI) of households which incurred OOPE was 68.3% (59.5%–76%) in rural and 65.8% (57%–73.7%) in urban areas. The median (inter quartile range) proportion of OOPE out of the household budget was 3.31% (0.4%–10.96%) in rural and 5.15% (0.83%–16.3%) in urban areas. Conclusions: Even in a resource rich setting as the selected areas of Puducherry, majority of the households (67%) reported OOPE. The study estimates are lesser than the national estimates, but the availability and accessibility of resources are higher in Puducherry compared with the other parts of country.
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Need for mobile application for disability assessment in India p. 2283
Ankur Agarwal, Shantanu Shah, Sheetal Agarwal
DOI:10.4103/jfmpc.jfmpc_304_19  
Introduction: Disability can be by birth or by any tragic event in life or medical illness. Such differently abled persons can become a valuable asset to the nation rather than a liability if we properly quantify their disabilities and help them rehabilitate into jobs best suited for them. The aim of this study was to develop a mobile application for easy quantification of disability of a differently abled person according to the latest Government of India guidelines. Material and Methods: The Government of India Gazette notification of January 2018 spells out revised guidelines approved by the Ministry of Social Justice and Empowerment for calculation of disabilities of differently abled persons. These were first converted into a spreadsheet, workflow, and interface modules. Subsequently, they were coded into a mobile application using a simple web language. Results: The result is an android App that can be downloaded from Google Play Store for free use. The rigorous testing of the App with all possible combination of input values was done to weed out errors. The results through the App were compared against manual calculation used as a control for validation purposes. Conclusion: To bring about uniformity, objectivity, ease in disability calculation for a large population of differently abled persons, a mobile App is truly justified.
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Discriminative nursing care: A grounded theory study p. 2289
Forough Rafii, Tahereh Najafi Ghezeljeh, Sepideh Nasrollah
DOI:10.4103/jfmpc.jfmpc_341_19  
Background: Discriminative nursing care is one of the most important challenges in the field of ethical care and the rights of patients. Experiencing discrimination has negative impacts. Objective: The aim of this study was to explore the process of the development of the discriminative nursing care. Methods: Sampling was begun purposefully and gradually continued, according to the obtained codes and categories, using theoretical sampling until data saturation. Data collection methods included semi-structured interviews, observations, and field notes. In this study, 13 clinical nurses and 5 patients in Iran were selected from public hospitals. The inclusion criteria were willingness to participate, having adequate experience about the considered phenomenon, and being able to discuss the subject. Data analysis was performed simultaneously to data collection using the method of Corbin and Strauss 2008. Results: Five categories were extracted. The categories include: “context,” “causal conditions,” “phenomena,” “strategies,” and “outcomes.” Each of these categories contained subcategories with specific characteristics. The context was classified into “nurse's characteristics” and “patient's characteristics. “”Complete conflict” and “hatred” were extracted from the category of causal conditions. The causal conditions and context led to “discriminative nursing care” phenomena. The two strategies were “avoiding the patients” and “robotic care.” Outcomes were located in a spectrum ranging from “annoyance and discomfort” to “imposition of costs.” Finally, the categories were connected together and the meaning of “care in the context of the sense of interaction with the patient” was theorized. Conclusions: It is important to provide nursing education on the development of discriminative nursing care and its associated complications. Nurses should understand the nature, components, and the process of discriminative care. Understanding discrimination improves the action of nurses.
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Physicians' awareness and practice toward influenza and pneumococcal vaccines for high-risk patients p. 2294
Hussein Saad Amin, Mostafa Ahmed Arafa, Bader Mohammed Al-Omair
DOI:10.4103/jfmpc.jfmpc_343_19  
Objectives: The aim of the study is to assess the awareness of family medicine residents about influenza and pneumococcal vaccination for high-risk patients and to verify the most significant variables that might affect residents' knowledge and the tools needed to enhance their practice. Materials and Methods: This cross-sectional study was conducted at four major hospitals in Riyadh, Saudi Arabia, during the period, October through December 2017. A pretested self-administered questionnaire was handed to 180 family residents. Descriptive statistics were used to analyze the study data. The Chi-square test was used to compare categorical variables data. The One-way ANOVA test was used to detect the significant difference. Results: The overall knowledge of physicians about influenza and pneumococcal vaccines was inadequate and was more toward pneumococcal vaccine, in spite their respectable knowledge about the target population. The main reasons for non- prescribing of vaccines were forgetfulness (59.4%), the availability of vaccines (33.9%), and the patients' refusal (23.3%). The tools that might help for prescribing were the need for the presence of electronic reminder (69.4%) and the patients should follow a regular family physician (47.2%). Conclusion: Knowledge and practice of influenza and pneumococcal vaccination are inadequate. This is mainly because of forgetfulness owing to minimal guideline awareness, lack of vaccine availability, and patients' refusal. The important recommendations to enhance vaccination practice among physicians are the implementation of electronic reminders, regular follow-up with the same physician in addition to educational programs during residency, and patient education about the importance of vaccinations as a means of disease prevention.
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An Investigation into the efficacy of nursing curriculum on elderly health problems via Delphi's method p. 2300
Shima Zinali, Mosayeb Mozafari, Masoumeh Shouhani
DOI:10.4103/jfmpc.jfmpc_393_19  
Introduction and Objective: Elderly people are a vulnerable group of society. Today, health authorities of the country pay a great deal of attention to the issue of aging. Given the fact that nurses are have direct contact with patients referring to health centers, it is necessary to develop a comprehensive and practical training program for future nurses. This can help provide adequate care for the elderly. The present study aimed to investigate the efficacy of nursing students' undergraduate curriculum on the elderly health problems via Delphi's method. Materials and Methods: This futuristic study was carried out at Iran Medical Sciences Universities between December 2016 and November 2017. The research sample consisted of 63 faculty members and non-faculty members who were randomly selected. The final document and data were collected using a researcher-made questionnaire. Descriptive statistics and SPSS (version 24) were used to analyze the data. Findings: In the first step, according to 70 percent of participants, the allocated time on providing “Elderly Care” content, as well as providing actual content by the professors of each credit is not sufficient. The findings of the second step revealed that 79 percent of participants indicated, adding the topic of “Elderly Care” to the mentioned syllabus, greatly contributes to improving the capabilities of graduates. Conclusion: The studies suggest that the curriculums of “Bachelor of Nursing” (BN) does not have an operational approach toward the problems of elderly period, and the necessity of some variations, such as increasing the number of credits and allocating distinct syllabus to the topic of aging, employing the faculty member in the major specialties of elderly, and involving them in teaching, seems critical.
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Vitamin B12 deficiency and the knowledge and practice of physicians regarding screening for vitamin B12 deficiency among type 2 diabetic patients on metformin in selected hospitals in Riyadh, Saudi Arabia p. 2306
Amal N Alshammari, Rafay Iqbal, Iqra Peer Baksh
DOI:10.4103/jfmpc.jfmpc_416_19  
Background/Aim: The worldwide prevalence of diabetes is high including Saudi Arabia. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Methods: We conducted a cross-sectional study at the diabetic clinics of four hospitals in Riyadh, Saudi Arabia. Type 2 diabetes mellitus patients who were on metformin for at least 1 year were included in the study. Associations between B12 deficiency and age, duration of type 2 diabetes mellitus (T2DM), duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) were determined. Results: Of 363 T2DM patients, 206 (56.7%) were males and 157 (43.3%) were females, mean age was 53.72 ± 11.31 years, the mean duration of T2DM was 9.89 ± 7.32 years, and the mean duration of metformin use was 9.84 ± 7.29 years. There were 205 patients 56.5% who had a daily dose of 750 mg of metformin. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. There were 107 patients (29.5%) who were on PPIs. There were 210 patients (57.9%) who were on vitamin B12 supplementation, of which 111 (30.6%) had a daily dose of 200 mcg. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. The use of vitamin B12 supplement was significant among patients who were 46 years old and above. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Only 44.0% of the physician respondents know the current recommendation of American Diabetes Association on vitamin B12 screening and supplementation among diabetic patients, and 21.0% never prescribe vitamin B12 to their patients. Conclusion: Routine testing for serum vitamin B12 level is not practiced in our institution. A large percentage of physicians are not aware of the current recommendations of the American Diabetic Association (ADA) regarding vitamin B12 supplementation and screening. Thus, there is a need for doctors involved in the management of diabetes to keep abreast with guidelines and current recommendations and routinely monitor vitamin B12 levels particularly those who were on long-term takers of metformin and the elderly patients to optimize management of diabetes and its complications.
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Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey p. 2312
Muaz A Elsayed, Nuha Musa El-Sayed, Safaa Badi, Mohamed H Ahmed
DOI:10.4103/jfmpc.jfmpc_405_19  
Background: Nonadherence to medication is widespread in epilepsy and other chronic diseases. Studies reporting adherence to antiepileptic medications are very limited in African countries. Adherence reports from low income African countries are few in contrast to multiple studies from high-income countries. Therefore, the aim of this study is to measure the level of adherence to antiepileptic medication in Sudanese population. Methods: A descriptive cross-sectional study of 96 individuals with epilepsy recruited from neurology outpatient clinics in three tertiary centers in Sudan. Data were collected by using a structured questionnaire containing Morisky Medication Adherence Scale-4 (MMAS-4) and Belief about Medication Questionnaire and analyzed by statistical package of social sciences. Results: About 35% of patients were estimated to be nonadherent. Most of the patients (93%) acknowledged their need for antiepileptic drugs. However, 35% had high concern score. Adherence is affected by attitude toward antiepileptic drugs (AEDs) and presence of side effects to AEDs. The relation between side effects and adherence was significant (P value 0.000). Furthermore, there was a statistically insignificant relation between the number of drugs used and adherence (P value 0.002). There was a significant relation between adherence, necessity mean score, concern mean score, and necessity concern differential P value 0.000 for all. Conclusion: Nonadherence to antiepileptic medication was reported in almost in one third of individuals in this cohort. There were statistically significant associations between nonadherence and both side effects and number of medications used in the treatment of epilepsy. Therefore, family physician should always check compliance with antiepileptic medication. Patient's education about adherence to medication through family physician may in part decrease the recurrence of epileptic seizures. Further research is needed to explore ways to increase adherence with AEDs in a low resource country like Sudan.
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Evaluating the awareness of ordinary people about relief operations and cardiopulmonary resuscitation when facing out-of-hospital cardiac arrest p. 2318
Yadollah Ghasemi, Shahram Molavynejad, Mina Jouzi, Akram Hemmatipour
DOI:10.4103/jfmpc.jfmpc_408_19  
Introduction: The aim of this paper is to evaluate the awareness of ordinary people about relief operations and accurate cardiopulmonary resuscitation when facing out-of-hospital cardiac arrest. Methods: This was a cross-sectional study including 500 ordinary people who were randomly selected over a 3-month period in Ahvaz County, Ahvaz, Iran, and then asked to perform resuscitation operation on medical moulages. Their performance was then evaluated using a 21-item checklist. Results: The awareness of participants about relief operations were only acceptable in 9 cases. Only 1 (0.2%) of them was able to detect a pulse and blood circulation as well as to relieve any airway obstruction. 7 (1.4%) were able to correctly find the position on the chest where external cardiac massage (ECM) should be performed. And only 1 could perform ECM at a rate of 100-120 compressions/min. Conclusion: Results obtained from the present study does not confirm the awareness of ordinary people when encountering OHCA. Hence, it is essential to hold related training courses at appropriate intervals to improve their skills and knowledge.
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Knowledge, attitude and practice of blood donation among health professions students in Saudi Arabia; A cross-sectional study p. 2322
Mohammed A Alsalmi, Hani M Almalki, Abdulrahman A Alghamdi, Badr A Aljasir
DOI:10.4103/jfmpc.jfmpc_415_19  
Introduction: World Health Organization advocates that 3-5% of the population should donate blood yearly. However, the donors in Saudi Arabia (SA) in 2011 represented 1.46% of the population. This study aimed to assess knowledge, attitude and practice concerning voluntary blood donation among health professions students in Saudi Arabia and to determine the associated factors. Methods: This is a cross sectional study on 598 students. Chi-square and Fisher tests were used to analyze the significant association of blood donation and influencing factors. Results: Majority of respondents (360; 60.2%) showed sufficient knowledge regrading blood donation. A total of 593 participants (99.2%) believed that blood donation is important for the community. Around 180 (30.1%) of the respondents have donated blood before. Out of the participants, 422 students (70.6%) reported that they did not take any courses concerning blood donation in their colleges. However, 502 (83.9%) showed a high willingness to donate blood if their colleges organize a blood donation camp within campus. There was a significant association between knowledge level, current academic level and gender with practice of blood donation. Conclusion: Saudi health professions colleges' role in promoting blood donation was notably missed. Students showed high willingness to donate blood if a blood camp was organized within the campus. The implementation of encouragement campaigns and educational sessions within the campus will have a great effect on blood donation.
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Overview of artificial intelligence in medicine p. 2328
Amisha , Paras Malik, Monika Pathania, Vyas Kumar Rathaur
DOI:10.4103/jfmpc.jfmpc_440_19  
Background: Artificial intelligence (AI) is the term used to describe the use of computers and technology to simulate intelligent behavior and critical thinking comparable to a human being. John McCarthy first described the term AI in 1956 as the science and engineering of making intelligent machines. Objective: This descriptive article gives a broad overview of AI in medicine, dealing with the terms and concepts as well as the current and future applications of AI. It aims to develop knowledge and familiarity of AI among primary care physicians. Materials and Methods: PubMed and Google searches were performed using the key words 'artificial intelligence'. Further references were obtained by cross-referencing the key articles. Results: Recent advances in AI technology and its current applications in the field of medicine have been discussed in detail. Conclusions: AI promises to change the practice of medicine in hitherto unknown ways, but many of its practical applications are still in their infancy and need to be explored and developed better. Medical professionals also need to understand and acclimatize themselves with these advances for better healthcare delivery to the masses.
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Learn to live with it: Lived experience of Palestinian women suffering from intimate partner violence Highly accessed article p. 2332
Suha Baloushah, Nooredin Mohammadi, Ziba Taghizadeh, Asma Taha, Farnaz Farnam
DOI:10.4103/jfmpc.jfmpc_330_19  
Background and Aim: Intimate partner violence has become a growing concern all over the world and causes numerous consequences and provokes various reactions among women. The present study was aimed to understand the lived experience of Palestinian women who suffered domestic violence by an intimate partner. Methods: In this hermeneutic phenomenological study, van Manen's methodical steps were used to conduct the study. An in-depth face-to-face semi-structured interview was conducted to 11 survivors of intimate partner violence. Data were analyzed by thematic analysis method. Results: “learn to live with it” was the core theme, which extracted from four subthemes including “failure to change for better,” “failure to gain support,” “failure to enjoy sexual life,” and “failure to make decisions.” Learn to live with it refers to participants' acceptance to their unpleasant situation because they could not change it. Conclusion: Palestinian women who suffer from violence fail to cope with appropriately due to traditional culture and lack of familial and economic dependence.
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Prevalence and risk indicators of oral mucosal lesions in adult population visiting primary health centers and community health centers in Kodagu district p. 2337
Sendhil Kumar, Veena S Narayanan, SR Ananda, AP Kavitha, R Krupashankar
DOI:10.4103/jfmpc.jfmpc_344_19  
Background and Objective: Utilization of primary health center (PHC) and community health center (CHC) could be one of the few practical approaches in early detection of oral cancers and potentially malignant disorder (PMD). This study was designed to estimate the prevalence and distribution of oral mucosal lesion (OML) and its associated risk factors among the adult population of Kodagu district. Methodology: 1048 patients, 18 years of age and above, attending the outpatient department of PHC and CHC in Kodagu district comprised the study population. The World Health Organization Oral Health Assessment Form, cinical examination, and demographic factors were recorded using a proforma. Chi-square test and contingency coefficient and logistic regression were applied to check statistical differences. Results: The overall prevalence of OML was found to be 18.89%. Prevalence of PMD was 5.63%. Prevalence of PMD was highest among the elementary occupation (15.63%). Two cases of oral cancer were identified. There was a significant association of PMD with the age group of 41–60 years. Leukoplakia was strongly associated with male gender [odds ratio (OR) 2.83, P < 0.001]. Smoking and chewing were significant risk factors associated with leukoplakia (OR 11.05, P < 0.001) and oral submucous fibrosis (OR 4.63, P < 0.001), respectively. Conclusion: The overall prevalence of OML in the study population was 18.89%. A high prevalence of PMD in the population could be attributed to the associated risk factors such as smoking, chewing habits, and alcohol use. Utilization of PHC and CHC could be a useful strategy to detect previously undiagnosed OML including PMD and cancerous lesions among the population.
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Correlation of spot urinary protein: Creatinine ratio and quantitative proteinuria in pediatric patients with nephrotic syndrome p. 2343
Richa Singh, Kapil Bhalla, Sanjiv Nanda, Ashish Gupta, Shuchi Mehra
DOI:10.4103/jfmpc.jfmpc_403_19  
Introduction: Nephrotic Syndrome is the commonest glomerular disease in children and is often characterized by multiple relapses. 24 hour urinary protein excretion is the accepted method used in quantification of proteinuria, but it's a time consuming, inconvenient and cumbersome method and difficult in very young children. Spot urine examination would be a simpler, easy, acceptable, and less time consuming method for detection of proteinuria in children. Aim: To evaluate the utility of protein: Creatinine ratio in random urine samples as a reliable diagnostic tool to quantify proteinuria and to determine the correlation of protein: Creatinine ratio to 24 hour protein excretion which is the gold standard reference method. Materials and Methods: The study was done on forty pediatric patients with nephrotic syndrome admitted in relapse, or presenting for the first time. Nephrotic syndrome was diagnosed on the basis of massive proteinuria (>40 mg/m2/hr), hypoalbuminemia (<25 mg/l) and generalized oedema. Urine protein analysis was done using the sulphosalicylic acid method and creatinine estimation by a modified Jaffe's method. Result: The correation between spot protein and creatinine ratio and 24 hour proteinuria was statistically significant with r = 0.833 (P < 0.01) using Pearsons correlation coefficient. Conclusion: Spot protein creatinine ratio can be used as reliable test for detection of proteinuria in the pediatric age group in pateints with nephrotic syndrome.
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Comparative evaluation of adjunctive antibiotics given post periodontal flap surgery p. 2347
Kratika Baldua Porwal, Anand Porwal, N Ravikiran, Sameer Ahmed, Vatsala Singh, Abhishek Singh Tanwar
DOI:10.4103/jfmpc.jfmpc_313_19  
Background: Antibiotics are known to improve clinical parameters in patients with periodontitis, so they should be capable of enhancing the surgical treatment outcome by improving clinical parameters when given adjunctively following periodontal flap surgery. Methods: Thirty subjects with moderate to severe periodontitis were randomly divided into three groups: Group I: 10 patients without antibiotic prescription after flap surgery, Group II: 10 patients prescribed with metronidazole 400 mg t.i.d. for 14 days, and Group III: 10 patients prescribed with doxycycline 200 mg o.d. as booster dose followed by successive doses of 100 mg o.d. for 21 days. Plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) were recorded at baseline, 2 weeks, and 2 months. The mean values and standard deviation values for each parameter were calculated using analysis of variance. Group comparison was done using paired t- and unpaired t-tests. Results: Reduction in PI, GI, PPD, and CAL after 2 weeks and 3 months from baseline in all the three groups was seen; intergroup comparison showed more reduction in PPD and GI and more gain in CAL in Groups II and III after 3 months when compared with Group I. No statistical difference was seen between Groups II and III. Conclusion: Within the limits of this study, it can be concluded that antibiotic administration as an adjunct to conventional flap surgery helps in improving clinical parameters.
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Knowledge, attitude, and practice study on hepatitis B among medical and nursing undergraduate students of an apex healthcare institute at Uttarakhand foothills: A descriptive analysis p. 2354
Disksha Chhabra, Surabhi Mishra, Kanchan Gawande, Anusha Sharma, Surekha Kishore, Ajeet Singh Bhadoria
DOI:10.4103/jfmpc.jfmpc_331_19  
Background: Viral hepatitis is preventable, yet a global health priority. As hepatitis B (Hep B) remains an occupational risk for healthcare workers (HCWs), the Government of India recently mandated universal adult Hep B vaccination for all HCWs. However, in the absence of institutional policy, its real-time utilization in a hospital was dependent on individual's general awareness. Therefore, this study was designed to assess baseline knowledge, attitude, and practices among undergraduate medical and nursing students, the future HCWs, regarding Hep B at an apex healthcare institute at Uttarakhand. Materials and Methods: A descriptive survey was carried out using self-administered questionnaire among undergraduate medical and nursing students of a medical college between July and September 2018. Statistical Package for Social Sciences (SPSS Ver 22.0) was used for analysis. Results: The study comprised 180 medical and 183 nursing students. About 55.0% of medical and 33.9% of nursing students were correctly aware about the disease; 98.3% of medical and 86.9% of nursing students were aware about vaccine. About 80.6% of medical and 87.4% of nursing students showed positive attitude, recognizing disease as a public health problem. However, only 82.8% of medical and 70.0% of nursing students underwent vaccination; mere 62.4% and 49.2% of vaccinated completed three-dose vaccination schedule, respectively. Furthermore, around 7% of them checked their titer post vaccination. Conclusion: Despite comparatively low awareness level about the disease, most students had sufficiently high knowledge about vaccine and underwent vaccination. However, only half of them could complete three-dose vaccination schedule. Only a handful of subjects underwent post-vaccination titer assessment, an instrumental approach to safeguard them against accidental Hep B exposure.
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Investigating the effect of sildenafil on improving lung function and quality of life in the patients with severe asthma p. 2361
Hamid Borsi, Hanieh Raji, Maryam Haddadzadeh Shoushtari, Heshmatollah Tavakol, Mohammad Hossein Haghighizadeh, Mehrdad Dargahi Mal-Amir
DOI:10.4103/jfmpc.jfmpc_334_19  
Introduction: Phosphodiesterase inhibitors (PDEs) increase intracellular cyclic adenosine monophosphate, which results in a wide range of anti-inflammatory effects and pathologically leads to improve asthma disease. Because no human study has surveyed the effect of PDEs on pulmonary function, except some case reports and animal researches, we decided to perform a pilot study for evaluating the effect of sildenafil (PDE5) on pulmonary function in patients with severe asthma. Methods: This randomized controlled trials study was conducted on 20 patients with severe asthma in 2019 in Iran. For case group, was prescribed sildenafil (50 mg) daily and the control group received the placebo. In the beginning of the study and one month later, volume parameters, 6-minute walk distance (6MWD), and the quality-of-life questionnaire were measured and compared in the two groups. Results: Twenty patients were entered into this study. 8 patients (40%) were male and 12 (60%) were female. The results showed that mean forced vital capacity 1 in the sildenafil group turned from 1259 ± 170 to 1603 ± 527, while in the placebo group it changed from 1135 ± 125 to 1365 ± 251 (P-value = 0.215). There is no statistically significant difference between two groups. In addition, in comparison with placebo, sildenafil did not show any significant improvement in the volume parameters, the quality-of-life questionnaire scale, and 6MWD at the end of the study. Conclusion: According to present result can be concluded that sildenafil does not improve the severity of asthma and the quality of life in patients with severe asthma.
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Clinical, demographic and radiological profile of smoker COPD versus nonsmoker COPD patients at a tertiary care center in North India p. 2364
Jyoti Bajpai, Surya Kant, Darshan K Bajaj, Akshyaya Pradhan, Kanchan Srivastava, Akhilesh K Pandey
DOI:10.4103/jfmpc.jfmpc_347_19  
Introduction: Cigarette smoking is the most predominant risk factor for development of chronic obstructive pulmonary disease (COPD). However, a considerable amount of patients do develop COPD without exposure to cigarette smoking. We aimed to analyze the incidence, demographic and clinical profile of nonsmoker COPD subjects at a tertiary care center. Methods: In this prospective observational study, 410 patients were screened for dyspnea. On the basis of spirometry findings, 360 patients were diagnosed as COPD and enrolled into the study. Patients were categorized into 2 groups on the basis of smoking habits (smoker and nonsmoker COPD). Clinical and demographic attributes were compared in between these two groups. This study was conducted over a period of one year, from August 2014 to July 2015. All statistical analyses were performed using Statistical Package for the Social Sciences version 19.0 (SPSS Inc, Chicago, IL, USA). Values were considered to be statistically significant at P < 0.05. Results: Out of 360 COPD cases, about 2/3rd (60%) were smokers and the rest nonsmokers. Majority of the patients were in the age group of 51-70 years. The mean age of smokers with COPD was significantly higher than nonsmokers with COPD (59.29 ± 10.28 years vs. 53.90 ± 8.77 years; P = 0.0001). Overall, males were predominant (57.2%) but there were higher number of female patients in nonsmoker group (25% vs. 70%; P = 0.001). At presentation, majority of nonsmoker with COPD were in GOLD severity grade II while in the smoking cohort majority were in GOLD severity Grade III. Among the 144 nonsmoker COPD patients, the most important and statistically significant risk factor was exposure to biomass smoke (68.06%). Other risk factors were long-standing asthma (37.50%), lower respiratory tract infection in childhood (32.60%), exposure to outdoor air pollution (17.92%). Conclusion: Nonsmoker COPD is emerging as a distinctive phenotype. They have less impairment in airflow limitation, and a lower prevalence of emphysema, chronic cough, and sputum compared with their smoking counterparts.
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Prevalence and awareness of nutritional anemia among female medical students in Karad, Maharashtra, India: A cross-sectional study p. 2369
Nupura A Vibhute, Unnati Shah, Uzma Belgaumi, Vidya Kadashetti, Sushma Bommanavar, Wasim Kamate
DOI:10.4103/jfmpc.jfmpc_353_19  
Introduction: Anemia is a global public health problem affecting both developing and developed countries. According to the World Health Organization, the highest number of individuals affected by anemia is observed in nonpregnant women aged 15–49.99 years. Though nutritional anemia can affect any age group, female medical students form a vulnerable population due to their hectic schedules, erratic mealtimes, and long working hours while staying in hostel for majority of times. Therefore, this study is aimed at determining the prevalence and awareness of anemia among the apparently healthy female students studying at a health institute. Methods: A cross-sectional study is conducted among 300 female students studying at a health institute in western Maharashtra after their written informed consent. A structured questionnaire elicits their general information, the knowledge about signs and symptoms of anemia, and dietary habits. Basal metabolic index and hemoglobin using the spectroscopy method are estimated for each participant. Results: Anemia prevalence in our population is 86 (28.6%). Based upon the severity of anemia, about 54 (18%) has mild anemia and 32 (10.6%) has moderate anemia. No case of severe anemia is noted in our study sample. Conclusion: The findings of the study highlight that anemia can affect even medical female students who are a vulnerable group unexpectedly suffering from nutritional deficiencies. Thus, this study highlights the need for interventional programs at primary health-care systems and colleges for improvement in the nutritional status of anemic students to reduce its complications.
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Evaluation of levels of Interleukin-1b, intensity of pain and tooth movement during canine retraction using different magnitudes of continuous orthodontic force p. 2373
Rajeshwar Singh, Poonam K Jayaprakash, Ankit Yadav, Meeta Dawar, Harpreet Grewal, Amit Mishra
DOI:10.4103/jfmpc.jfmpc_357_19  
Aim: The present study was conducted for the evaluation of Interleukin (IL)-1b levels in human gingival crevicular fluid (GCF), intensity of pain, and the amount of tooth movement measured during canine retraction using different magnitudes of continuous orthodontic force. Materials and Method: A statistically significant number of subjects were included for the study (n = 16, 6 male subjects and 10 female subjects). The age ranged from 18 to 24 years and all were diagnosed with Class I bimaxillary protrusion. They underwent first premolar extractions prior to participating in the study. The maxillary cuspids were then retracted using a continuous force of either 50 or 150 g. This was executed using nickel–titanium coil springs on segmented archwires. The opposite counterpart, that is, mandibular cuspid was used as control. GCF was then drawn from the distal aspect of each tooth at defined time intervals. This was followed by the assessment of IL-1b concentrations, pain intensity, using the visual analogue scale (VAS), and the amount of tooth movement. ANOVA test, Friedman test, and paired t-tests were used for comparisons of IL-1b in GCF, the plaque and gingival indices, and the efficiency of tooth movement on pain perception, respectively. Results: The 150 g group showed the highest level of IL-1b concentration at 24 h from baseline and at 2 with significant differences compared with the control group (P < 0.05). The mean VAS score of pain intensity from the 150 g force was significantly greater than from the 50 g force at 24 h (P < 0.01). Conclusion: No significant difference in the amount of tooth movement was found between these two different magnitudes of continuous force at 2 months. A 50 g force could effectively induce tooth movement similar to 150 g with less pain and less inflammation.
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Reasons for obstetric referrals from community facilities to a tertiary obstetric facility: A study from Southern Karnataka p. 2378
Sudha Nagavarapu, Varsha Shridhar, Nora Kropp, Leela Murali, Swathi S Balachandra, Ramakrishna Prasad, Asha Kilaru
DOI:10.4103/jfmpc.jfmpc_308_19  
Context: Pregnancy-related preventable morbidity and mortality remain high in India. Safe delivery services should focus on improving neonatal and maternal outcomes while also enabling a positive childbirth experience. However, high rates of intrapartum obstetric referrals are common. Objective: To describe the timing and the reasons for obstetric referrals to a public tertiary care hospital in Bangalore and characteristics of the referring facilities. Methods: We interviewed 320 women who delivered at the tertiary care hospital within a one-month time frame prior to the interview and who originally planned to deliver elsewhere. Results: Ninety four percent of women in the study reported that the decision to transfer to the tertiary hospital was made after the onset of labour. Referrals were made for medical as well as non-medical reasons. About a third (35%) had to take loans to cover the expenses of childbirth. Conclusions: Referrals frequently occurred after the onset of labour. Our data imply that improving obstetric referral protocols will improve the birth experience and reduce the burden on tertiary care facilities and on the women themselves.
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Medicated adhesive dressing is a safe and non-inferior cutaneous seal as compared to compound tincture benzoin dermal seal for percutaneous interventions p. 2384
Rudradatt C Parmar, Dhruvkumar M Patel, Mukundkumar V Patel, Bhagirath B Solanki, Maitri M Patel, Jayanti K Gurumukhani, Himil J Mahadevia, Rohan A Gajjar, Parth R Patel
DOI:10.4103/jfmpc.jfmpc_354_19  
Background: Compound tincture benzoin (CTB) is used as a post-procedure skin seal antiseptic agent since ancient times; but this drug is reported to cause allergic contact dermatitis and other unwanted side effects. Our aim of the present study was to compare alternative agent like Medicated Adhesive dressing (MAD) with CTB as a post-procedure skin seal dressing. Design: This prospective randomized controlled experimental study included an equal number of patients in MAD and CTB as a post-operative seal dressing material for percutaneous interventions. Both the groups were graded for various efficacy parameters like comfort, applicability, dressing material, and immediate post-operative complications by operating doctor and attending nurse with a maximum 10 points in each group. Results: 120 patients were studied in each MAD and CTB group. Out of total patients 31.25% were males and the mean age of the patient was 33.56 ± 11.10. Allergic contact dermatitis developed in 9 (7.49%) of CTB group and in 1 (0.83%) of MAD group (P < 0.002), while local site skin infections were noted in 8 (6.67%) of CTB group and in 1 (0.83%) of MAD (P < 0.002). Operating doctor graded MAD and CTB to 7.60 ± 0.49 and 3.62 ± 0.48 (P < 0.003); and attending nurse 7.40 ± 0.49 and 3.41 ± 0.49 (P < 0.003) respectively. Conclusion: MAD is a safe, efficient and non-inferior alternative dressing material for post-procedure skin incision seal in comparison to CTB.
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Vitamin D level and its determinants among Sudanese Women: Does it matter in a sunshine African Country? p. 2389
Nazik Elmalaika Husain, Ahmed Abdel Badie Suliman, Ismail Abdelrahman, Shahinaz A Bedri, Rasha M Musa, Hind E Osman, Ayda H Mustafa, Nahla Gafer, Ehab Farah, Ali Abdel Satir, Mohamed H Ahmed, Mugtaba Osman, Atif A Khalil, Abbas Agaimy
DOI:10.4103/jfmpc.jfmpc_247_19  
Background: Vitamin D deficiency is a worldwide concern. The aim of the current study was to determine the vitamin D level and its contributing factors in Sudanese women. Methods: In this cross-sectional study, 251 Sudanese women attending Family Health Centers in Khartoum, Sudan were interviewed. Following the exclusion of confounding factors, samples from 190 women were analzsed. Serum 25 hydroxyvitamin D “25(OH) D” was quantified using competitive electrochemiluminescence immunoassay. Results: Participants' age ranged from 18 to 85 years with a mean age (±SD) of 40.2 (±14.06) years. The mean (±SD) vitamin D level was 13.4 (±6.72) ng/ml, ranged 3.00–36.5 ng/ml and the median was 12.7 ng/mL. In total, 157 out of 190 (82.6%) had vitamin D serum levels below 20 ng/ml (deficient); of whom, 52 (27.4%) were in the age group 21–30 years (P value = 0.228). The correlation between vitamin D level and residence outside Khartoum, sun-exposed face and hands, and face and limbs in comparison with being completely covered were found to be statistically significant (p values 0.008, 0.023, and 0.036). Conclusion: This study displayed a high percentage (82.6%.) of vitamin D deficiency among women in Sudan, and this in part may indicate that sunshine alone cannot guarantee vitamin D sufficiency in the tropics. Family physicians in tropical countries should screen those with clinical presentations related to vitamin D deficiency.
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Bullying in school children: How much do teachers know? p. 2395
Nida I Shamsi, Marie Andrades, Hiba Ashraf
DOI:10.4103/jfmpc.jfmpc_370_19  
Context: Bullying is an emerging serious problem in schools worldwide resulting in physical and mental health problems in victimized children. Teachers play a critical role in identifying the acts of bullying, assisting the children who are victimized, linking up with healthcare providers for managing physical and emotional consequences of bullying, as well as managing bullying at school. Aims: To determine teachers' knowledge regarding bullying among secondary school children. Settings and Design: A cross-sectional study conducted in five public and five private schools of Jamshed Town, Karachi, Pakistan. Methods and Materials: The study continued from October 2012 to February 2013. Stratified random sampling was used to select teachers. Data were collected through a pre-piloted structured questionnaire. Statistical Analysis Used: Data were analyzed using the SPSS v19.0. Descriptive analysis was done by calculating frequencies and percentages of the categorical variables such as teacher's age, educational level, and presence of adequate knowledge regarding bullying. The outcome variable of interest was knowledge about bullying. Results: Almost half of the153 teachers (n = 82, 53.6%) lacked adequate knowledge about bullying in school children. A statistically significant association was present between knowledge of bullying with gender (P-value = 0.02), educational level of the teachers (P-value = 0.05), years of teaching experience (P-value = 0.04), and educational training of teachers (P-value = 0.01). Conclusions: More than half of the teachers were deficient in their knowledge about bullying in school children
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Career destination and reason for career destination preferences among medical graduates from Christian Medical College Vellore – Does rural service obligation increase retention of medical graduates in rural service? p. 2401
Ramya Iyadurai, Suekha Viggeswarpu, Anand Zachariah
DOI:10.4103/jfmpc.jfmpc_388_19  
Objectives: To find out the career destination of a cohort of doctors who have graduated from Christian Medical College (CMC) and to identify the reasons for their choice. Background: CMC is a training institution for medical graduates among a network of mission hospitals in India. After their graduation, most students complete a sponsorship obligation of 2 years in primary or secondary, rural and semi-urban hospitals. Methods: Study population: The study population was obtained from the electronic database of the medical graduates. The batches of medical graduates from 1966 to 1995 were analyzed. Quantitative data regarding the career destination were obtained from this database. Survey Instrument: A structured qualitative questionnaire was devised with both open and closed questions regarding their present area of work and the reason for their choice. This questionnaire was sent via email and posted to others who did not have email access; 17.5% responded to this questionnaire. Results: Data revealed that 57.4% of our alumni were working in India and 42.3% were working abroad. In India, 29% were working in the corporate sector, 21% in CMC, and 10% in rural hospitals. The pull factors for the doctors who stayed in India and in rural area were a felt need to serve. The pull factors for doctors to go abroad were pursuit of academic excellence and perceived better quality of life. The push factors against the pursuit of rural career were prior adverse experiences in the rural hospitals they had worked in. Conclusion: The career destinations depend mainly on satisfaction with work and familial expectations.
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Comparison of the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb orthopedic surgeries p. 2405
Ali Nami Damirchi, Alireza Kamali, Mehran Azami, Mohsen Ebrahimi Monfared
DOI:10.4103/jfmpc.jfmpc_396_19  
Introduction: Proper control of postoperative pain is one of the major challenges after surgery. Such pains result in physical complications, increased metabolism, exacerbations of underlying diseases, and increased blood pressure. The aim of the present study was to compare the effect of apotel and pregabalin on postoperative pain among patients undergoing lower limb surgery. Materials and Methods: This study is a double-blind randomized clinical trial. About 75 patients undergoing lower limb orthopedic surgeries in Valiasr Hospital in Arak, Iran, were enrolled in the study. Patients were divided into three groups as follow: The first group received a 150-mg pregabalin capsule 2 h before the surgery. The placebo group received capsule that was replaced by starch. Furthermore, other group received 1 g of apotel in 200 mL of normal saline, 20 min before surgery. Pain at 2, 4, 12, and 24 h after surgery was recorded based on visual analogue scale. The amount of opioid use was recorded in the first 24 h in milligrams. Patient sedation was recorded by Ramsey Sedation Scale at 2, 6, 12, and 24 h after surgery. Finally, the data were analyzed using SPSS-20. Results: Pain in the apotel group was found to be lower when comparing with other group in 2, 4, 12, and 24 h after surgery (P = 0.0001). Ramsey score was found to be more in the pregabalin group at 2.6, 12, and 24 h after surgery (P < 0.05). In addition, the lowest opioid use was in the apotel group (P = 0.0001). Conclusion: Our findings revealed that apotel had a better effect on pain management, whereas pregabalin exhibited better effect on the sedation of patients.
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Efficacy of diffusion-weighted imaging in symptomatic and asymptomatic multiple sclerotic plaques p. 2409
Farzad Tahmasebi Arashloo, Farnaz Fahimi Hanzaei, Behnaz Sedighi, Ghazaleh Amjad, Ladan Younesi
DOI:10.4103/jfmpc.jfmpc_420_19  
Introduction: Magnetic resonance imaging (MRI) currently accompanies clinical findings in disease diagnosis, patients' follow-up, assessment of drugs complications, and evaluation of treatment response. Although contrast-enhanced MRI (CE-MRI) is considered as the imaging modality of choice for multiple sclerosis (MS), due to disease chronicity, applying multiple doses of gadolinium-based contrast agents (GBCAs) increases the risk of nephrogenic syndrome in patients with acute (ARF) and chronic renal syndromes (CRF). Moreover, the effect of gadolinium on the fetus is not well-known in pregnant patients. Therefore, this study evaluates the possibility of replacing postcontrast images with physiologically based MRI sequences such as diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC). Method: We prospectively evaluated 26 patients with known multiple sclerosis. The patients with MS attacks and the asymptomatic patients who were referred for follow-up were enrolled. Conventional MRI including postcontrast T1W, DWI, and ADC were performed for all patients. The signal intensity (SI) of all enhancing and nonenhancing plaques of more than 10 × 10 mm size were investigated in all sequences and analyzed. Results: A total of 83 plaques were detected in T2-FLAIR sequences of which 51 plaques were enhanced (68%) after gadolinium administration. While 42 MS plaques had hypersignal intensity in DWI (56%), 32 plaques had iso- or hyposignal intensities in DWI (44%). No statistically significant values were obtained. Conclusion: Although DWI could not replace CE-MRI, using these two modalities together could increase detection of active MS plaques and alter patients' therapy and prognosis.
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Serum fucose level in oral cancer, leukoplakia, and oral sub mucous fibrosis: A biochemical study p. 2414
Satish Kumar, Ankit Suhag, Sumanta Kumar Kolay, Puneet Kumar, Anumeha Narwal, K Srinivas, Safiya Haideri
DOI:10.4103/jfmpc.jfmpc_301_19  
Aims: To estimate the serum fucose levels in clinically and histopathologically diagnosed oral cancer, oral leukoplakia, and oral submucous fibrosis cases. To compare and correlate the severity of dysplasia or histopathological grading of the premalignant and malignant lesions with serum fucose levels. Objective: To determine the role of serum fucose as a reliable biomarker for early detection of malignant transformation of potentially malignant lesions and conditions and prediction of biologic behavior of the malignant lesions. Material and Method: The intended study shall include 100 participants divided into 4 groups. Groups I, II, and III will include 25 clinically and histological diagnosed cases of oral leukoplakia, oral submucous fibrosis, and oral cancer, and 25 normal control group. Fucose was measured according to the method of Dische and Shettles as adopted by Winzler. Statistical Analysis: Statistical analysis will be done using SPSS statistical software (Version 10), and the levels of significance will be analyzed using the paired and unpaired t-tests. Result: In subjects of 4 groups were age- and gender-matched and comparable thus these may also not influence the study outcome measure (fucose levels). ANOVA revealed significantly different fucose levels among the groups (F = 17.00, P < 0.001). Mean fucose level did not differ (P > 0.05) between oral leukoplakia, oral submucous fibrosis, and oral cancer (84.5%) groups. The increase in mean fucose levels with severity was the highest in the oral cancer group followed by oral submucous fibrosis and oral leukoplakia group. The mean fucose levels did not differ between mild and moderate grades (P > 0.05) in all the 3 groups. Conclusion: The evaluation of serum l-fucose would be of good help in assessing early malignant change in increasing the accuracy of clinical diagnosis and also in assessing the spread and invasiveness of oral cancer, oral submucous fibrosis, and leukoplakia.
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Simultaneous detection of IgM antibodies against dengue and chikungunya: Coinfection or cross-reactivity? p. 2420
Kumar S Abhishek, Anita Chakravarti
DOI:10.4103/jfmpc.jfmpc_365_19  
Background: Dengue and chikungunya sharing same mosquito vector are two most important arboviruses circulating in northern India including Delhi and are responsible for frequent outbreaks. Antigen and antibodies detection ELISA kits are the major tool to diagnose these viral illnesses, and are sometimes associated with cross–reactivity, giving a false picture of coinfection, although simultaneous harboring of both the viruses is not uncommon. Various studies have reported coinfection up to 25% from the same region. Procedure: This study was conducted in the Department of Microbiology, Maulana Azad Medical College, New Delhi, during the month of September 2016 which included 200 blood samples from clinically suspected cases attending Medicine OPD of associated Lok Nayak Hospital, New Delhi. Diagnosis of dengue and chikungunya was made using NS-1 antigen and IgM MAC ELISA for dengue and IgM MAC ELISA for chikungunya as per manufacturer's instructions. Results: Out of 200 suspected cases, 34 (17%) were positive for dengue serology, 77 (38.5%) were positive for chikungunya serology, and 29.9% of positive chikungunya cases were simultaneously affected with dengue. This higher percentage of coinfection might be because of cross-reactivity of the ELISA kits. Discussion: India being a hyperendemic region for dengue and chikungunya, frequent outbreaks are quite common. Circulation of both the virus and huge susceptible population are the major causes for frequent outbreaks. Restricting our attention to diagnose one of them is not sufficient, and coinfection further complicates the illness. Conclusion: Simultaneous diagnosis of dengue and chikungunya is need of time to diagnose dual infection and prevent complications by starting supportive treatment well in time. Molecular technique if ever possible should be employed whenever the coinfection number is higher than expected to rule out cross-reactivity.
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Potential for a comprehensive stroke education: Assessing awareness about stroke among community health workers - A qualitative study from Urban Bangalore, Karnataka, India p. 2424
Meena K. S. Murthy, Priya T Thomas, Madhuporna Dasgupta
DOI:10.4103/jfmpc.jfmpc_303_19  
Context: The incidence of stroke is evolving to be a major public health issue in recent years. The situation is aggravated by the limited public awareness about its risk factors and treatment procedures. It is important to explore the level of awareness of the Accredited Social Health Activists (ASHAs) about stroke as they work in the community as part of the public healthcare delivery systems. Aims: The aim of this study was to explore the awareness about stroke among the ASHAs through a qualitative study. Settings and Design: The study was conducted in the institution using a cross-sectional qualitative approach. Methods and Material: A focus group discussion with 12 ASHAs from Bengaluru district of Karnataka was conducted. Statistical Analysis Used: Data were analyzed manually through direct content analysis. Results: It was revealed that the ASHAs did not have adequate general awareness about stroke, its causes, and related treatment procedures. The ASHAs overgeneralized the causes to lifestyle factors, such as smoking, drinking, and so on. Conclusions: The study showed the level of awareness of stroke among the ASHAs is inadequate at present, and they would benefit from systematic sensitisation programmes. Limited awareness could lead to failure to identify the early warning signs and appropriate, timely help. A need of a comprehensive educational program to increase their awareness is emphasized.
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Effect of intravitreal anti-vascular endothelial growth factor on corneal endothelial cell count and central corneal thickness in Indian population p. 2429
Mukesh Joshi, Mayuresh P Naik, L Sarkar
DOI:10.4103/jfmpc.jfmpc_314_19  
Purpose: To evaluate the effect of intravitreal anti-VEGF on corneal endothelial cell count and central corneal thickness as well as to compare these in phakic and pseudophakic eyes. Material and Methods: The study was conducted in 102 eyes selected, as per selection criteria, over a time period of 18 months. At first patient visit, examination included: 1. Fundus examination. 2. Specular microscopy was done to look for endothelial cell count and Central corneal thickness. At second visit, Injection 0.5 mg/0.05 ml of ranibizumab was administered. Visits at day 1, day 7 and 1 month were done for Endothelial cell density and central corneal thickness was measured by specular microscope Results: The mean CCT value in pseudophakic group was 502.08 ± 19.91, 501.9 ± 20.31, and 501.72 ± 21.55 on day 1, 7 and 30, respectively. The mean CCT value in phakic group was 506.53 ± 22.61, 505.96 ± 20.12, 505.92 ± 20.3 and 505.69 ± 21.47. The mean value of ECD in pseudophakic eyes on day 1, 7, and 30 were 2284.24 ± 299.86, 2281.39 ± 289.46 and 2284.06 ± 312.65 cells/mm2, respectively. The mean value of ECD in phakic eyes on day 1, 7, and 30 were 2314.51 ± 212.08, 2313.92 ± 212.7 and 2313.63 ± 216.86 cells/mm2, respectively. Conclusion: There is no significant change in endothelial cell density, central corneal thickness, coefficient of variation and intraocular pressure before and after intravitreal injection over one month of follow-up. The results are similar between phakic and pseudophakic eyes.
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Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in primary health care in security forces hospital Riyadh, Saudi Arabia p. 2433
Aseel Awad Alsaidan, Medhat Ghoraba
DOI:10.4103/jfmpc.jfmpc_324_19  
Background: Diabetes mellitus (DM) is a metabolic disease that is characterized by distortion in the metabolism of carbohydrates, lipids, and proteins and involves hyperglycemia. DM has different types. Several complications are associated with diabetes including diabetic retinopathy (DR). DR can further results in bad outcomes that can be avoided by early diagnosis and management. Aim: The aim of this paper is to assess the awareness and knowledge level about DR among type 2 DM patients in primary health care in security forces hospital. Methods: This is a cross-sectional study that was conducted on Saudi patients with type 2 DM who visited primary health care in security forces hospital. Results: This study included 174 participants, with equal male to female ratio was 1:1, there were 64.9% participants who reported controlled blood glucose level, and 47.1% reported that eye was affected by diabetes. There were 82.8% participants who had awareness about DR; the level of awareness differs significantly with sex (P value = 0.04) and the level of DM control (P value = 0.02). Conclusion: There was high level of knowledge regarding DR; however, there were few percent of participants who had no awareness and still at risk.
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A study of the cardiac risk factors emerging out of subclinical hypothyroidism p. 2439
Anupam Dey, Vineetha Kanneganti, Debasish Das
DOI:10.4103/jfmpc.jfmpc_348_19  
Introduction: Subclinical hypothyroidism is defined as a serum TSH level above the upper limit of normal with normal levels of serum free thyroxine. It is a common thyroid disorder affecting 3-15% of the adult population. Aims and objectives: To study the cardiovascular profile of patients with subclinical hypothyroidism, and to establish cardiac risk factors emerging out of subclinical hypothyroidism. Methodology: Adult patients attending General Medicine department and diagnosed with subclinical hypothyroidism over a period of 2 months were enrolled. History and general examination was done. Fasting lipid profile, hsCRP, electrocardiography and echocardiography were done. Results: The mean age was 35.1 (SD = 10.26). Most common age group affected is 20-30 years. There are about 12% of the enrolled patients were overweight (OW), and 24% were obese (OB). 16% had stage 1 hypertension, and 4% had stage 2 hypertension. 92% of the patients had dyslipidemia. 64% patients had raised LDL. 44% of the patients had raised hsCRP levels. 44% patients showed abnormal findings and the most common abnormality was found to be grade 1 left ventricular diastolic dysfunction. Conclusion: Subclinical hypothyroidism is seen to be associated with a rise in hsCRP independent of other cardiac risk factors. A large number of patients have dyslipidemia which is a significant cardiac risk factor. Early Diagnosis and treatment of subclinical hypothyroidism will have possible cardioprotective advantages.
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Prevalence, characteristics, and predictors of tuberculosis associated anemia p. 2445
Anirudh Mukherjee, Nidhi Kaeley, Minakshi Dhar, Subodh Kumar, Bharat Bhushan
DOI:10.4103/jfmpc.jfmpc_311_19  
Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. It is one of the deadliest disease and a major burden on the healthcare system in India. India, a second most populous country in the world, has a very high global annual incidence of tuberculosis. Multiple hematological changes have been reported in patients with tuberculosis such as iron deficiency anemia, folate deficiency, and sideroblastic anemia. Aims and Objectives: The present study was planned to find the prevalence and characteristics of anemia in the new cases of pulmonary tuberculosis. The secondary objective was to assess the predictors of anemia in new cases of pulmonary tuberculosis. Methods: The retrospective study was carried out at a tertiary care hospital of Uttarakhand and included all the new cases of tuberculosis aged more than 18 years attending medicine outpatient and inpatient departments over a period of 1 year. Detailed demographic, clinical, and biochemical data were obtained from the hospital record section and tabulated. Results: Most patients with tuberculosis and anemia were more than 50 years of age. Clearly, males outnumbered females. Approximately, 80% patients were illiterates. A majority (71, 39.2%) of the patients had BMI within the range of 18.5 to 24.9 kg/m2. The most common symptoms of tubercular patients with and without anemia were cough, fever, breathlessness, and hemoptysis. However, pallor was the most common sign. Clearly, hematological indices were lower in patients with anemia. In total, 112 (60%) patients had mild anemia and 103 (56.9%) patients had normocytic normochromic anemia. Significant association was found between Body Mass Index (BMI) and anemia in patients with pulmonary tuberculosis. Similarly, severity of anemia co-related significantly with BMI of patients with pulmonary tuberculosis. BMI showed a significant correlation with hemoglobin, packed cell volume, mean corpuscular cell volume, and red cell distribution width (RDW). In addition, age showed a significant correlation with hemoglobin and RDW.Conclusion: Normocytic normochromic anemia is a common hematological abnormality in patients with pulmonary tuberculosis. Thus, it warrants frequent screening for anemia in all the cases of pulmonary tuberculosis to improve morbidity and mortality in these patients.
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A study to determine the clinical, hematological, cytogenetic, and molecular profile in CML patient in and around Eastern UP, India p. 2450
Sandip Kumar, Vikas Kumar Gupta, Anju Bharti, Lalit Prashant Meena, Vineeta Gupta, Jyoti Shukla
DOI:10.4103/jfmpc.jfmpc_307_19  
Introduction: Myeloproliferative disorders are characterized by proliferation of one or more myeloid lineages cells. In order to assess the burden of these illness for public health planning, it is important to know their frequency. Objectives: A study to determine the clinical, hematological, cytogenetic, and molecular profile in chronic myeloid leukemia (CML) patient in and around Eastern UP, India. Materials and Methods: Newly diagnosed and follow-up adult and pediatric cases of myeloproliferative disorder were taken into study. Detailed history, physical, and systemic examination was done with informed consent. Investigations like complete blood count including hemoglobin level, platelet count, total and differential leucocyte count, general blood picture, and bone marrow aspiration/biopsy were done. Molecular and cytogenetic studies were also done whenever required. Results: In total, 90 patients were enrolled in the study. The median age of presentation of CML was 37 years and the mean age was 38.6 years. M: F ratio of 1.4:1.75 patients (83%) were in CML-chronic phase (CP), 11 patients (12%) in CML-accelerated phase (AP) phase, and 4 patients (5%) were found in CML-blast crisis (BC) phase. The common symptoms of the patients were fullness of the abdomen (66.6%). Among these 69 cases, Philadelphia chromosome was present in 65 (94.2%) cases. Revers transcriptase polymerase chain reaction (RT–PCR) was done in 40 out of 90 cases, breakpoint cluster region (BCR)-Abelson oncogene (ABL) gene came out to be positive in all the 40 cases. Conclusion: Most CML patients in eastern UP (India) are relatively young (31–40 years). In addition, males were more commonly affected.
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Prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad district, Uttar Pradesh p. 2456
Jyoti Goyal, Ipseeta Menon, Ricky Pal Singh, Ritu Gupta, Anubhav Sharma, Preeti Bhagia
DOI:10.4103/jfmpc.jfmpc_315_19  
Background: Tobacco is the second driving reasons for mortality worldwide and its broad utilization in the smoking and smokeless form have added to the expanding weight of non-communicable disease. Aim: To study the prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad District, Uttar Pradesh. Methods: A cross-sectional study was conducted on 800 individuals with the age range of 35-44 years. A pre-tested questionnaire was used to gather information about the sociodemographic profile and the pattern of substance use. Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST) and for smokers; Fagerstrom Test for Nicotine Dependence (FTND) for testing dependence. Periodontal status was assessed by Community Periodontal Index (Modified CPI WHO 2013) and loss of attachment (LOA). Statistical analysis was done by the Statistical Package for Social Sciences (SPSS) version 20.0. Result: The prevalence of periodontal disease was found to be 78.5% with maximum disease prevalence among males of 42-44 age. Majority of male consumed a smokeless form of tobacco (50.23%), followed by smoke (14.19%) form whereas females predominantly consumed smokeless form (37.36%). The mean number of teeth with pocket (3.37 ± 1.86) and mean of loss of attachment of more than 9 mm (0.67 ± 0.88) was higher among smokeless form of tobacco users as compared to other habit groups Conclusion: Higher prevalence of periodontal disease was seen among nicotine dependent individuals. A model for a comprehensive program in the dental office including the five A's and five R's for tobacco counseling must be applied at every institute.
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A study to determine the prevalence, clinical profile and incidence of formation of inhibitors in patients of hemophilia in north eastern part of India p. 2463
Sandip Kumar, Sachidanand Sinha, Anju Bharti, Lalit P Meena, Vineeta Gupta, Jyoti Shukla
DOI:10.4103/jfmpc.jfmpc_316_19  
Introduction: Deficiency of factor VIII (Hemophilia A), factor IX (Hemophilia B) and Von Willebrand's factor are the most frequent coagulation defects. The incidence of inhibitors in patients of factor VIII deficiency is varies in different regions of India. Aim: To determine the prevalence, clinical profile and incidence of formation of inhibitors in patients of Hemophilia in north eastern part of India. Methods: Selected patients were under went for complete Blood Count (CBC), General Blood Picture (GBP), Prothrombin time (PT), Activated partial thromboplastin time (APTT), Thrombin time, Correction experiment to know the specific factor deficiency or inhibitors present by Normal Plasma, Normal aged serum, Al(OH)3 adsorbed plasma. Results: 92 patients diagnosed as suffering with Hemophilia A or B were included in study. The age of patients ranged from 2.5 month to 53 years. Out of 92, seventy nine (85.87%) were Haemophilia A and thirteen were (14.13%) Hemophilia B patients. 3.50% (2/55) cases of treated Hemophilia A patient develop inhibitor. Conclusion: The prevalence of hemophilia and incidence of inhibitors in these patients is varies in different regions of India. This variation may be due to the type of product used as treatment, intensity of treatment or the genetic characteristics of the patients.
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Correlation of soft palate morphology to growth pattern: A retrospective cephalometric study p. 2468
Poonam K Jayaprakash, Palash Modi, Pranav Sapawat, RudraPratap Singh Thakur, Tanuj Choudhari, Jayant Chandrakar
DOI:10.4103/jfmpc.jfmpc_322_19  
Aim: The aim of the present study was to evaluate the radiographic length of velum (LV), width of velum (WV), velum angle (AV), depth of pharynx (PD), Need's ratio (NR), inclination angle (AI) in different morphological types of soft palate according to growth patterns in skeletal class I individuals. Methodology: 80 pretreatment lateral cephalograms of patients with skeletal class I malocclusion (ANB 2--4°) were divided on basis of six types of soft palate and further into three subgroups according to growth pattern and evaluation of LV, WV, angle with the palatal plane, and NR was done. Kruskal--Wallis test was used for the comparison between the groups. Results: Statistically significant difference was verified among all groups for measurement of NR. The highest NR was seen in Crook type of soft palate (mean 0.9). Similarly, the vertical growth pattern in all the six types of soft palate exhibited a higher NR than the average and horizontal growth pattern group; the highest being exhibited by vertical group in type VI (crook shaped). Velopharyngeal insufficiency is directly related to NR. Conclusion: Vertical growth pattern has the highest susceptibility to velopharyngeal insuffiency and speech and sleep apnea disorders.
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Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India p. 2473
Gajendra Kumar Medhi, Jogesh Sarma, Himashree Bhattacharyya, Star Pala, Vizovonuo Visi, Parash Jyoti Bora
DOI:10.4103/jfmpc.jfmpc_340_19  
Background: Elderly population is growing rapidly in India. To direct public health actions to improve quality of life among elderly, it is important to understand the sociodemographic factors associated with quality of life. The aim of study was to assess health-related quality of life (HRQOL) among urban elderly in a setting of Assam, India, and to examine how HRQOL varied across different sociodemographic groups among the elderly populations. Materials and Methods: A cross-sectional study was carried among elderly aged ≥60 involving 300 participants. Eight domains of HRQOL of participants were measured using RAND SF-36. Analysis of variance test was used to examine sociodemographic differences in HRQOL. Results: The BP domain had highest (71.78 ± 22.25) and GH had lowest mean HRQOL score (48 ± 16.93). Males had significantly higher HRQOL score than females only in BP domain. Age gradients were observed with respect to HRQOl scores in five domains, with youngest age group having the best and oldest age group having the poorest HRQOL. Financially dependent subjects had lower HRQOL in five domains than those who were financially independent. Significant associations between education and HRQOL were found only in physical components of HRQOL, with lowest educated group being the most disadvantaged in terms of HRQOL. Marital status was found to be significantly associated with lower HRQOL scores. Conclusion: The study highlights sociodemographic inequalities in HRQOL among urban elderly in an Indian setting. The results may help reducing sociodemographic health inequalities among elderly in this region initiating public health actions paying more attention toward more vulnerable sections of populations.
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Effectiveness and importance of powered tooth brushes in tooth movement p. 2478
Sridhar Kannan, Sajna Fassul, Ashish Kumar Singh, Nitin Arora, Abhita Malhotra, Neeraj Saini
DOI:10.4103/jfmpc.jfmpc_352_19  
Introduction: Effectiveness of vibratory stimulus from a commonly available battery-powered tooth brush in accelerating orthodontic tooth movement was tested by a randomized controlled split-mouth study. Materials and Methods: Twenty-three subjects with bimaxillary protrusion, requiring extraction of all first premolars and requiring maximum anchorage, were chosen. After initial leveling and aligning, miniscrews were placed between the first molar and the second premolar in the maxillary right and left quadrants and loaded with 150-g nickel–titanium closed-coil springs for individual canine retraction. Additional 5 min of vibratory stimulus thrice daily was applied on the experimental side. The mean treatment duration was 3 months. Results: There was no significant difference of means of the canine distal movement between the experimental and the control sides (P = 0.70). Conclusion: Application of vibratory stimulus with powered tooth brush during canine retraction was not seen to have an acceleratory effect on orthodontic tooth movement.
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Socio-demographic determinants of childhood immunization coverage in rural population of Bhojpur district of Bihar, India p. 2484
Sanjay Pandey, Alok Ranjan, CM Singh, Pragya Kumar, Shamshad Ahmad, Neeraj Agrawal
DOI:10.4103/jfmpc.jfmpc_356_19  
Introduction: Avoidable sickness, disabilities and death among under 5 children are prevented by routine immunization against some specific diseases. The percentage fully immunized children was 69.9% in Bihar, India, and was almost same in rural area. Immunization coverage is also associated with various socio-demographic factors. The aim of this study is to assess the immunization coverage among children in rural areas of Bhojpur district and identify socio-demographic factors associated with it. Methods: A cross-sectional study was conducted in rural areas of Bhojpur district during January to May 2015. 2 stage cluster sampling was done. 36 villages were selected randomly as primary selection units and within each village, 10 children of age 12-36 months were selected from the sampling frame of all eligible children in selected village. A pre-designed, pre-tested checklist was used by the trained investigators during their visits. Results: A total of 360 children of age 12-36 months were included in the study, of which 65% of children were fully immunized, 33.9% were partially immunized, and 1.1% were not immunized at all. Mother's education (AOR 2.28 (1.28-4.05), P value = 0.005), place of birth (AOR 29.04 (10.75-78.43), P value = 0.0001) and availability of immunization card (AOR 120.04 (15.82-916.47), P value = 0.001) were significantly associated with immunization status. Conclusion: Immunisation coverage in this area was lower. Socio-demographic factors like mother's literacy, place of birth and availability of immunization cards were significantly associated with full immunization of children. It is needed to focus on health related education among parents regarding immunizing services.
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A survey on orthodontic services provided by general dental practitioners Highly accessed article p. 2490
Poonam K Jayaprakash, Palash Modi, Pranav Sapawat, RudraPratap Singh Thakur, Tanuj Choudhari, Jayant Chandrakar
DOI:10.4103/jfmpc.jfmpc_371_19  
The aim of this survey-based study was to recognize professional determinants that account for variations in the level of orthodontic services provided and which distinguish providers and nonproviders of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 43% of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients (1) treated more general practice patients, (2) frequently used multiple sources to keep up to date in orthodontics, (3) perceived their patient base to contain more children, and (4) were likely to have attended an orthodontic course. The null hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education and treating more general practice patients, especially children.
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Prevalence and predictors of depression among dermatology clinic patients in a teaching hospital, Jeddah, Saudi Arabia p. 2496
Nouf T Mleeh, Hussein M Alshamrani, Reem N Basyouni, Khalid A Alshehri, Mohammed R Algethami, Mohammad Gamal Sehlo
DOI:10.4103/jfmpc.jfmpc_399_19  
Context: Depression in patients with a skin condition can lead to severe consequences that affect the quality of life. To our knowledge, the estimated prevalence of depression in patients who visited dermatological clinics in Jeddah remains unknown. Aims: To assess the prevalence of depression among patients with dermatological conditions and evaluate the association between clinical and demographic characteristics and depressive symptoms. Settings and Design: A cross-sectional study was conducted among dermatological patients at King Abdulaziz University Hospital in Jeddah, Saudi Arabia. Materials and Methods: The Patient Health Questionnaire-9 (PHQ-9) was used for screening depression. Statistical Analysis Used: Chi-square test and odds ratios (ORs) were used to determine the association among variables. Results: The study included 273 participants. More than two-thirds (194) of the participants were women (71.1%). Depressive symptoms were prevalent in 43 (15.8%) participants. Depression was the most prevalent among patients with psoriasis (39.5%, P < 0.001), followed by those with acne (30.2% P = 0.04) . Conclusion: Psychosocial assessment should be addressed when evaluating and treating dermatological diseases. Screening tools, including PHQ-9, can facilitate the early detection of depressive symptoms and improve clinical outcomes. Addressing psychosocial aspects of skin conditions may help in reducing exacerbation of symptoms, mainly for conditions aggravated by stress, including dermatitis and psoriasis.
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Sleep quality and insulin resistance in adolescent subjects with different circadian preference: A cross-sectional study p. 2502
Anita Rawat, Anil Kumar Gangwar, Sunita Tiwari, Surya Kant, Ravindra Kumar Garg, Prithvi Kumar Singh
DOI:10.4103/jfmpc.jfmpc_400_19  
Background: Studies have shown that alterations in the sleep cycle can predispose to several disorders. Most of the previous studies were done on the adults. Hence, the aim of the study was to see the effect of circadian disruption on the health of adolescent population. Materials and Methods: In this cross-sectional study, 203 subjects were enrolled. Study subjects were divided into three groups: definite evening chronotype, intermediate chronotype, and definite morning chronotype. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Daytime sleepiness and chronotype were measured by Epworth Sleepiness Score and Morningness-Eveningness Questionnaire Self-Assessment version, respectively. Two hours postprandial glucose was measured after oral glucose tolerance test. Fasting blood glucose and fasting insulin were measured. Homeostasis model of assessment for insulin resistance (HOMA-IR) was calculated. Data were summarized as mean ± standard deviation. Crude odds ratios and Karl Pearson's correlation coefficient of metabolic parameters with poor sleep were calculated. Results: Statistically significant difference was found in the mean value of poor sleep quality, 2 h postprandial blood glucose level, and insulin resistance among subjects of three groups. Subjects of evening chronotype have more significant positive correlation of 2 h postprandial blood glucose level and HOMA-IR value with poor sleep quality when compared with subjects of intermediate and morning chronotypes. Conclusion: Subjects with evening chronotype are more prone for development of metabolic syndrome compared with subjects of intermediate and morning chronotypes if proper health policies are not adopted for adolescents.
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Life course approach in the assessment of association between dental caries and health capital with family-related characteristics among 12-year-old school children p. 2506
Gollapalli Gouri Priyanka, Sowmya Kote, Karukonda Veera Sravanthi, Megha Chethan, Anjana Anand, Meena Jain, Shilpi Singh
DOI:10.4103/jfmpc.jfmpc_305_19  
Aim: To assess the association of dental caries with health capital among 12-year old in Private and Government school children with differing family-related characteristics. Objectives: To know the influence of height, weight, and family-related characteristics on dental caries. Materials and Methods: A cross-sectional study was done on a sample of 800 students. Stratified systematic random sampling technique was used. Data were collected on health variables that include their height and weight; family characteristics include type of family and time spent with their mothers in a school day and number of children in their family. Clinical examination was done using dentition status and treatment needs. Results: The prevalence of dental caries in government school was 64% and in private school was 59.2%. Logistic regression analysis identified that dental caries was significantly associated with type of school, height, and socioeconomic status and the factors which are not significantly associated are weight, time spent with their mothers, number of siblings, dental visits, and type of family. Conclusion: This study reported dental caries prevalence to be 61.6% with a mean DMFT (Decayed Missing Filled Teeth) of 1.26 ± 1.32 in 12-year old children. The cooperation of dentists and pediatricians is necessary in assessment of general and dental health in a holistic context throughout the life course to enhance the well-being of adolescents.
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Mortality in systemic lupus erythematosus at a teaching hospital in India: A 5-year retrospective study p. 2511
Gangadharaiah Bharath, Prabhat Kumar, Nayani Makkar, Paras Singla, Manish Soneja, Ashutosh Biswas, Naveet Wig
DOI:10.4103/jfmpc.jfmpc_362_19  
Objective: Systemic lupus erythematosus (SLE) is an autoimmune disease with an unknown etiology that can be life threatening. This study aimed to study the cause of mortality among admitted SLE patients over a period of 5 years at a teaching hospital in India. Methods: A 5-year retrospective analysis of mortality in SLE patients admitted under department of medicine of our institute was done. The presenting complaints, treatment history, clinical parameters, laboratory investigations, organ involvement, systemic lupus erythematosus disease activity index (SLEDAI), and cause of mortality were collected from the medical records on a predesigned proforma. A further analysis of two groups based on the cause of mortality was done. Results: In total, 53 death records were analyzed. Mortality in 28 SLE patients was due to high disease activity (Group I) and mortality in 25 patients was attributed due to both high disease activity and concomitant infection (Group II). Most of the patients were female (98%) and mean age of patient was 30.6 years. About 19 patients (35.8%) were diagnosed with SLE during hospital admission. Fever was the most common presenting complaint (69.8%) and lupus nephritis was the most common organ dysfunction seen (84.9%). Myocarditis was observed in 11 patients and 9 patients had cerebrovascular accident. The mean hemoglobin was lower in Group II (7.4 vs. 8.7 g/dL, P = 0.02). The median total leukocyte count was significantly higher in Group II (10,200 vs. 6600, P = 0.02). The mean serum urea and creatinine levels were also significantly higher in Group II (141.41 vs. 87.8 mg/dL, P = 0.006 and 4.7 vs. 1.7, P = 0.0001), respectively. The mean SLEDAI in Group I was 20.8 ± 8.9 and in Group II was17.7 ± 7.5. Bacterial pneumonia (17) was the most common infection, followed by tuberculosis (2) and fungal infection (2). Conclusion: Mortality among SLE patients could be due to disease flare or concomitant infection. Lung is the most common organ affected by infection in these patients.
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Bedside sonography by medicine residents in critically Ill patients: A retrospective study from a teaching hospital in India p. 2517
Manjit Mahendran, Kartik Gupta, Arvind Kumar, Manasvini Bhatt, Maroof A Khan, Surabhi Vyas, Nayani Makkar, Upendra Baitha, Ranveer S Jadon, Naveet Wig
DOI:10.4103/jfmpc.jfmpc_379_19  
Context: Ultrasonography has become the frontline diagnostic tool for emergency care because of its non-invasive nature and the feasibility to perform repeated quick assessments in sick patients. The effectiveness of this modality, when used by trainee doctors to take clinically important decisions in patients requiring emergency care, is not much explored. In this pilot study, we analyzed whether use of this technology by Medicine resident doctors can help in better decision making in acutely and critical ill patients.Setting and Design: This is a retrospective study conducted in the Department of Medicine, All India Institute of Medical Sciences, New Delhi. Methods and Materials: The study was conducted using patient data collected from acutely ill and critical care patients, who underwent bedside ultrasonography from August 2017 to August 2018. In all cases, resident doctor's finding had been assessed by an experienced operator before a treatment decision was made. Statistical Analysis Used: Continuous variables with normal distribution were computed using t test. Ordinal variables and variables following non-normal distribution were analyzed using the Wilcoxon rank-sum test. Results: Thirty-two patients were recruited. There was agreement on 78% (25/32) ultrasound records between the trainee and the experienced operator. Among patients evaluated for shock, agreement reached 83% (15/18). Among patients who underwent transthoracic echocardiography, agreement was 66.7% (4/6). Among patients who underwent lung ultrasound, agreement was 70% (7/10). In both the patients in whom abdominal ultrasound was done, final inferences were consistent between the residents and experts. Conclusions: The results show that in majority of critically ill patients, Medicine residents made sonographic observations correctly and took clinically precise sonography guided decisions on par with expert sonologists even with minimal training and ultrasound exposure.
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Mental health effects of domestic violence against women in Delhi: A community-based study p. 2522
Kamlesh Kumari Sharma, Manju Vatsa, Mani Kalaivani, Dayanand Bhardwaj
DOI:10.4103/jfmpc.jfmpc_427_19  
Background: Domestic violence (DV) against women is an all-pervasive phenomenon considered to have serious health consequences for women. This study aimed to assess the association of DV against women with their mental health status. Materials and Methods: This community-based, cross-sectional study was carried out among 827 ever married women from Delhi selected through cluster sampling followed by systematic random sampling. Data were collected using structured and in-depth questionnaires. Mental health status was estimated using self-reporting questionnaire 20. Results: The prevalence of psychological, physical, sexual, physical, or sexual violence and any form of violence was very high. A quarter of the women (25.3%) reported unhealthy mental status (>8 score) in the past 4 weeks. Women who had experienced DV showed poor mental health status and more suicidal tendencies when compared with women who had not experienced violence. Conclusion: DV has significant effect on women's mental health underscoring the need to develop public health interventions.
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Household “rain water harvesting” – Who are practicing? Why are they practicing? A mixed methods study from rural area of Kolar district, South India p. 2528
Nagesh Ramya, Mahendra M Reddy, Prasanna BT Kamath
DOI:10.4103/jfmpc.jfmpc_417_19  
Background: “Rain Water Harvesting” is one of the identified strategies to replenish the ground water system in India. Household level of rain water harvesting could serve as an indicator for assessment of participation of local community. Objectives: To assess the proportion of household rainwater harvesting and factors associated with it and to find the reasons behind adoption of this practice in a rural area of Kolar district, Karnataka. Methods: An exploratory sequential mixed methods study design with an initial cross-sectional quantitative study followed by qualitative in-depth interviews was done to assess the factors affecting household rain water harvesting and reasons behind the practice. Household survey with interview of one person from each household was done. Quantitative data were reported using proportions and qualitative data were reported using categories and verbatim quotes. Results: Of the 82 households surveyed, 31 (37.8%, 95% CI: 27.8–48.6) had adopted at least crude method of rain water harvesting. Household belonging to either joint or three-generation family type was practicing rain water harvesting higher compared with nuclear family type. Reasons for adoption were included under the categories - purity, fresh, tradition, less work, passion, and why waste? Conclusion: About one in three households practiced rain water harvesting in the rural area under study with households belonging to joint or three-generation family practicing more compared with nuclear families. The reason for adoption was mostly based on beliefs and also felt needs by families.
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CASE REPORTS Top

Post-mumps acute disseminated encephalomyelitis in an adolescent p. 2533
Varun Rehani, Subodh Kumar Mahto, Ankita Sheoran, Akanksha Singh, Pooja Verma, Kulsaurabh Kaushik
DOI:10.4103/jfmpc.jfmpc_437_19  
Mumps is an acute communicable self-limiting swelling of the parotid or other salivary glands. Various organs can be involved including the testes, central nervous system, mammary glands, ovary, pancreas, kidneys, and heart. We hereby present a rare case of an 18-year-old unvaccinated male with acute disseminated encephalomyelitis following mumps without parotitis.
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Recurrent empty follicle syndrome with different stimulation protocols – A case report p. 2536
Athula Kaluarachchi, Harshalal Rukka Seneviratne, Tuan Milhan Batcha, Sumedha Wijeratne, Gardie Role Malwattage Udara Ganthika Peiris Jayawardena
DOI:10.4103/jfmpc.jfmpc_418_19  
We report a case of recurrent empty follicle syndrome (EFS) where no oocytes were aspirated in two separate IVF cycles using two different protocols. In the second cycle, oocyte aspiration in one ovary was delayed for 24 hours after administering a second dose of human chorionic gonadotropin injection (hCG) and still no oocytes were recovered. In view of the presence of severe male factor infertility and failure to retrieve oocytes in 2 stimulated cycles, the couple was offered donor embryo transfer which resulted in a singleton pregnancy. A baby girl weighing 2800 g was delivered by an elective caesarean section at term. This case highlights that the change of protocol or repeat hCG administration is unlikely to change the outcome of genuine empty follicle syndrome.
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Esthetic management of complicated crown fracture of three permanent maxillary teeth by grout technique -A case report p. 2538
Tarun Kumar Singh, Deepak Passi, Sumit Aggarwal, Stuti Mohan, Abhimanyu Sharma, Utkarsh Gupta
DOI:10.4103/jfmpc.jfmpc_425_19  
Dental injury particularly anterior teeth trauma has severe effects on the social and mental prosperity of a patient hence requiring useful and esthetic repair at the most urgent. Customarily, fracture anterior teeth have been reestablished with composite tars; in any case, they have the essential disservice of shading bungle and variable wear. On the off chance that the tooth's fracture section is accessible and sound, reclamation of the tooth utilizing its own particular piece has likewise been recommended. Reattachment of tooth part ought to be considered and is a practical other option to customary methodologies as a result of effortlessness, unmatched characteristic style, and preservation of tooth structure. It can give great and dependable style in light of the fact that the tooth's unique anatomic shape, shading, and surface are kept up. Patient collaboration and comprehension of the restrictions of the treatment is of most extreme significance for the good result. This case report accentuation the inventive strategy of overseeing crown root break treated effectively utilizing tooth part reattachment.
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A case of idiopathic GGT elevation with acute hepatitis A p. 2542
Jaspreet Singh, Geoffrey Jones, David Mahan
DOI:10.4103/jfmpc.jfmpc_342_19  
Ursodeoxycholic acid modifies the bile acid pool and its effect on lowering liver enzymes is well documented in certain cases like chronic hepatitis but on the other hand it is known to worsen when given in advanced stages of liver disease. Also, it's effects are still unknown for variety of liver insults. We hereby report a case of Idiopathic Gamma Glutaryl Transferase (GGT) elevation which responded well to Ursodeoxycholic acid.
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Chloroquine induced urticaria: A newer adverse effect p. 2545
Kandan Balamurugesan, Prem Davis, Rajangam Ponprabha, Malaimala Sarasveni
DOI:10.4103/jfmpc.jfmpc_413_19  
Malaria an endemic disease of India caused by plasmodium species. Chloroquine, a member of quinolone group of drugs is used to treat malaria. Although it has a very safety profile as it is used during pregnancy, many adverse effects have also been reported. Here we report a case of 30-year-old male admitted with fever diagnosed to be having malaria, who developed urticaria immediately after being treated with first dose of chloroquine which was treated successfully. This is the first case reported ever in an adult having chloroquine induced urticaria.
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Managing a case of acute calculous cholecystitis at home: Highlighting the role of family physicians in providing home-based care p. 2548
Ashoojit Kaur Anand, Praneeth Pilala, Swathi S Balachandra, Prathamesh Sharad Sawant, Ramakrishna Prasad, BC Rao
DOI:10.4103/jfmpc.jfmpc_259_19  
Laparoscopic cholecystectomy is the generally recommended management of acute calculous cholecystitis. It is important for family physicians to be taken into consideration that for some patients the surgical risk–benefit profile favors conservative management. Here, we highlight the possibility of safe, home-based, conservative management of acute calculous cholecystitis in a patient-centered and evidence-based manner by a team of family physicians with backup support of their specialist referral network. We use this case to highlight the value of family physicians providing home-based care.
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LETTER TO EDITOR Top

Monotherapy with liraglutide – Points to be focussed p. 2551
Pugazhenthan Thangaraju, Sajitha Venkatesan
DOI:10.4103/jfmpc.jfmpc_435_19  
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ERRATA Top

Erratum: Factors influencing the choice of otolaryngology (ORL) head and neck surgery as a future specialty for Saudi medical students p. 2553

DOI:10.4103/2249-4863.263824  
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Erratum: Awareness of asthma and its management in primary school teachers in Eastern Province p. 2554

DOI:10.4103/2249-4863.263823  
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