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   Table of Contents - Current issue
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January-February 2018
Volume 7 | Issue 1
Page Nos. 1-274

Online since Monday, April 30, 2018

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EDITORIAL  

Is my daughter still a virgin? Can you, please, check it, doctor? Highly accessed article p. 1
Sara Rigon
DOI:10.4103/jfmpc.jfmpc_40_18  
Gender-based violence is a pervasive public health problem, let alone a violation of human rights. The World Health Organization (WHO) has estimated that, overall, 35% of women worldwide have experienced physical and/or sexual intimate partner violence or nonpartner sexual violence. In 2016, the author had the privilege to work with an outstanding group of people that helps sexual and gender-based violence (SGBV) survivors in Port-au-Prince, Haiti. The clinic, run by an international nongovernmental organizations, open walk-in to anyone in need, is functioning to the present day. In its 1st year along, the clinic helped almost 1000 survivors, mainly underaged girls. At the clinic, a highly qualified staff of local doctors and nurses, psychologists, and social workers is available, free of charge, 24 h a day, 7 days a week, and accessible to SGBV survivors in absolute confidentiality. Survivors are offered all the support they might need as per the WHO guidelines, from medical assistance (treating of physical injuries, testing and preventing sexually transmitted diseases such as HIV or hepatitis B, and also gynecological and obstetric care) to psychological counseling, as well as specific referrals to shelters, legal aid, or secondary care as needed. Virginity still is highly valued in Haiti, and the father, mother, the beau-mare, or aunt of the survivor will often approach the doctor and anxiously whisper the question: “Is my daughter (goddaughter, niece) still a virgin?”, “Can you, please, check it, Doctor?” This article presents the perspective of SGBV survivors clinic in Port-au-Prince, Haiti.
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ORIGINAL ARTICLES Top

The use of quality circles as a support tool in the taking over of practices by young general practitioners p. 5
Norbert Král, Bohumil Seifert, Jan Kovář, Cyril Mucha, Jana Vojtíšková, Jáchym Bednár, Seifert Martin
DOI:10.4103/jfmpc.jfmpc_167_17  
Introduction: Although informal meetings of healthcare professionals in smaller groups are common in the area of primary care in the Czech Republic, the method of quality circles is not in wide use. The aim of our project is to use this method to help new general practitioners (GPs) when they take over a medical practice and to suggest measures to improve the organization and overall attractiveness of new practices, as well as patient satisfaction. Materials and Methods: For the purposes of this observation, an already existing informal group formed by healthcare professionals and their trainees was used. The group met a total of four times in a 6-month period. In the first meeting, problematic areas were identified. In the second, specific issues of newly starting to practice were discussed, with time to consider suggestions for improvements. The third meeting consisted of an analysis of the suggested measures and their implementation, and in the fourth, these measures and their effects were evaluated. Results: On the basis of the discussion in the first and second meetings, suggestions were made, and then, during the third meeting, structured into three dimensions: (1) The organization of work, including clinical activities, (2) the attractiveness of the practice and the satisfaction levels of the patients, (3) the satisfaction levels of the employees. In each area, specific measures were proposed. The new doctors' feedback in the fourth phase of the project was positive. The main problems the new doctors faced were related to their lack of knowledge and experience with buying or starting their own practice, as well as being an effective team leader. Conclusion: Despite the application of small groups being significantly larger, it was demonstrated that if GPs are given direction and clear goals in their meetings, these meetings can be very constructive. Small groups thus offer a good platform for young GPs in starting their own practice, giving them the capacity to do so.
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Health impact on women using solid cooking fuels in rural area of Cuttack district, Odisha p. 11
Ipsa Mohapatra, Sai Chandan Das, Sonia Samantaray
DOI:10.4103/jfmpc.jfmpc_21_17  
Background: Around 3 billion people use solid fuels (biomass and coal) for cooking and heating, and this number is expected to grow until at least 2030. Around 73.7% of households in rural Odisha use wood for cooking. This current study is an attempt to evaluate the impact of solid cooking fuels on health of rural women in age group of 20–40 years and to study the relationship between the duration of exposure to cooking fuels and various health problems. Materials and Methods: This cross-sectional study was carried out in a village which is under the field practice area of the rural health and training centre, under Department of Community Medicine, Kalinga Institute of Medical Sciences. Universal sampling technique was adopted for sample selection. Chi-square test was used to find the association between cooking fuel usage and self-reported symptoms. Results: Dry cough was the most common presenting symptom (15.03%), followed by eye and nose irritation present in nearly 12% each among the study participants. Headache, dry cough, and hypertension (HT) was found to associated with number of cooking years and was also found to be statistically significant (P = 0.03, 0.02 and 0.0065, respectively). Discussion: Our study clearly indicated that the exposure to biomass fuel smoke is significantly associated with the prevalence of symptoms of headache, dry cough, and HT. Further research is required for improving information on dose-response relationships between indoor air pollution and various health effects. Conclusion: The morbidities were increased with increase in duration of cooking . Knowledge related to health effects of cooking fuels seems to be poor among the participants.
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Comparing the frequency of polycystic ovary syndrome in women with and without epilepsy p. 16
Leila Amini, Marjan Hematian, Ali Montazeri, Korosh Gharegozli
DOI:10.4103/jfmpc.jfmpc_115_17  
Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders; the impact of epilepsy and antiepileptic drugs influences the function of hypothalamic–pituitary–gonadal axis and dysfunction of the endocrine system and reproductive hormones in women with epilepsy. This study was carried out with an aim of determining and comparing the frequency and intensity of the complications of the hirsutism in women with and without epilepsy in Tehran in 2016–2017. Materials and Methods: This is a cross-sectional-comparative study which was carried out on 338 women of 18–35-year-old women with and without epilepsy who were selected by continuous sampling method. Data were collected and analyzed by Chi-square statistical test. The quantity of P was considered to be 0.05 as the level of significance. Results: The results of this study indicated that there was a statistically significant difference between the two groups with and without epilepsy in terms of the frequency of some of the clinical symptoms of the PCOS and affected by it. The results of this study showed that a higher percentage of women with epilepsy were affected PCOS. In the group of epileptic patients, some of the clinical symptoms of PCOS such as hirsutism, acanthosis nigricans, disordered menstruation, and amenorrhea were higher which as a result led to an increase in the frequency of PCOS. Conclusion: As a result, epilepsy can lead to an increase in the frequency of PCOS and some other clinical symptoms.
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Prevalence of depression and anxiety among children in rural and suburban areas of Eastern Uttar Pradesh: A cross-sectional study p. 21
Shailendra Kumar Mishra, Mona Srivastava, Narendra K Tiwary, Abhinit Kumar
DOI:10.4103/jfmpc.jfmpc_248_17  
Background: Psychiatric morbidity in children and adolescents is a major concern as they become more complex and intense with children's transition into adolescence. Aim: The aim of this study is to assess and compare the prevalence of depression and anxiety among children residing in rural and suburban area of eastern Uttar Pradesh and understand the burden of these problems in our society. Materials and Methods: Children, in the age group 11–18 years, were divided into 2 groups: Group I – 100 children from rural area Tikri; Group II – 100 children from suburban area Sunderpur. Their sociodemographic details were recorded. Children's Depression Inventory and Revised Children's Manifest Anxiety Scale were used to screen for depression and anxiety in children, respectively. The final diagnosis was done using present state examination in accordance with International Classification of Mental and Behavioral Disorders 10. Data were statistically analyzed using Chi-square test. Results: The prevalence of depression was found to be 14.5% while that of anxiety disorder was found to be 15%. There was no significant difference in the prevalence of depression or anxiety in rural and suburban areas (P > 0.05). Depression and anxiety were more prevalent in middle adolescence, in females, and in lower-middle socioeconomic group. Depression was more prevalent in the students of class 9th –12th, whereas anxiety was more in students of lower classes. Depression was more prevalent in joint families. These differences show some important trends regarding factors affecting these problems. Conclusion: This study yields useful information which could be of use in early management of psychiatric disorders present in the community and prevent their development into chronic disorders.
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The impacts of Beliefs, Attitude, Subjective Norms, Enabling Factors-based educational program on cardiovascular risk factors through enhanced nutritional behaviors in water and wastewater organization employees p. 27
L Mozafari, R Amani, B Hamzeh, MH Haghighizadeh, M Bigvand
DOI:10.4103/jfmpc.jfmpc_122_17  
Introduction: Cardiovascular disease is the main cause of disability and morbidity in many countries. Considering the significance of education in correcting unhealthy eating habits and improving nutritional behaviors that prevents cardiovascular diseases, the current study has been carried out to investigate the impacts of Beliefs, Attitude, Subjective Norms, Enabling Factors (BASNEF)-based educational program on the employees' nutritional behaviors. Materials and Methods: This study was carried out on 120 randomly selected employees of Water and Wastewater Organization of Kermanshah. Individuals were divided into the control and intervention groups. Questionnaires devised based on BASNEF model and food frequency questionnaires were collected preintervention and 3-month postintervention. Educational program was performed in four training sessions. Results: Significant differences between mean scores of knowledge and other items of BASNEF model as well as nutritional improvements were observed in the intervention group after 3 months (P < 0.01). Conclusion: BASNEF educational model positively affected nutritional behaviors of the employees to reducing cardiovascular risk factors.
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A retrospective study: ABO and Rh phenotype blood group distribution among blood donors in H.N.B. Base Hospital, Srinagar, Uttarakhand, India p. 34
Satish Kumar, Purab Kalyan Modak, S Haroon Ali, SK Barpanda, Vimal Singh Gusain, Rupali Roy
DOI:10.4103/jfmpc.jfmpc_252_17  
Objective: To determine the prevalence of ABO and Rh blood groups based on the antigenic presence on the surface of red blood cells with respect to gender and calculate allele frequency of the blood groups. Globally, approximately 700 type red cell antigens have been identified till now. ABO and Rh blood groups play an important role in the process of blood transfusion, resolving certain medicolegal issues, parental testing, and various genetic studies. Methods: This study was conducted in H.N.B. Base Hospital, Srinagar, Uttarakhand, from January 2012 to December 2016. Relevant data of blood donors were collected from blood bank department of the hospital. Blood grouping was conducted using commercially available standard monoclonal antisera applying test tube and column agglutination techniques. Results: Out of 9883 individuals, 9333 (92.4%) were males and 750 (7.6%) were female individuals. The most common blood group found was B (31.68%) and least common being AB (11.70%). The prevalence of Rhesus positive and negative distribution in the present studied population was found as 93.51% and 6.49%, respectively. Overall, male ABO group pattern found was shown by formula B > A > O > AB which was similar among Rh-positive male individuals while Rh-negative males' pattern was found as A > B = O > AB. In females, ABO group pattern was B > O > A > AB which was similar to Rh-positive female pattern while differs in Rh negative. The estimated allele frequencies were found as 0.2403, 0.2475, and 0.5122 for IA (p), IB (q), and IO (r), respectively. Conclusion: The most common blood group found among the Gharwali donors was B positive while the least common was AB negative, which plays an important contribution for making government policies to develop National Health Program.
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Health-care utilization and expenditure patterns in the rural areas of Punjab, India p. 39
Tarundeep Singh, Nidhi Bhatnagar, Gopal Singh, Manmeet Kaur, Sukhvinder Kaur, Preeti Thaware, Rajesh Kumar
DOI:10.4103/jfmpc.jfmpc_291_17  
Objective: To determine pattern of health care utilization and extent of out-of-pocket healthcare expenditure in rural areas of Punjab in India. Methods: Using multi stage sampling procedure, 660 participants were selected from 110 villages, out of all 22 districts; 440 participants had utilized outpatient care in past 15 days, and 220 had been hospitalized in past one year. Pretested semistructured questionnaires were used to enquire about household and healthcare expenditures. Out-of-pocket (OoP) expenditure included only direct costs of healthcare. Sevety seven 77 (12%) participants could not provide expenditures, hence were excluded from analysis. More than 10% of total household expenditure on healthcare was considered catastrophic. Results: Majority of the participants had used public sector health facilities for outpatient (57%) and inpatient (51.5%) care. Public sector facilities were utilized more often for communicable diseases and gynaecological problems whereas private sector services were used more commonly for accidents and non-communicable diseases. Mean healthcare expenditure on outpatient and inpatient healthcare services was Indian Rupees (INR) 8501 and INR 53889 respectively. Expenditure in private sector was significantly higher compared to the public sector facilities. Catastrophic expenditure was incurred by 7% of the households while seeking outpatient care and by 53% while seeking inpatient care. To pay for outpatient and inpatient care, 23.3% and 61.5% of the participants respectively had to borrow money or sell their assets. Conclusions: Healthcare expenditure places households under considerable financial strain in rural areas of Punjab in India. Improvements of public hospitals may increase their utilization and decrease financial burden.
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Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India p. 45
Vyas Kumar Rathaur, Monika Pathania, Charu Pannu, Anand Jain, Minakshi Dhar, Nitish Pathania, Rahul Goel
DOI:10.4103/jfmpc.jfmpc_413_16  
Introduction: There is paucity of studies on infant feeding practices from the rural areas of garhwal Himalayas of the state of uttarakhand. The present study was designed to assess the infant feeding practices in Garhwal region. Infant feeding practices have significant implications on a child's health. Early nutritional status especially during the first year of life has been shown to have a significant effect on child health and development. Optimal infant feeding practices are crucial for nutritional status, growth, development, health, and ultimately the survival of infants and young children. The study of infant feeding practices is essential before formulation of any interventional programme. Settings and Design: A study was conducted in HNB Base Hospital and Teaching Institute with the aim to assess the infant feeding practices and the prevalence of malnutrition in the study population reporting at the hospital in garhwal region of uttarakhand. Methods and Material: This is an observational cross sectional study. 275 infants were included in the study. After taking informed consent, case study forms were filled by interviewing the infants' mothers. Weight, length and head circumference of each infant was also measured. The information thus obtained was compiled, tabulated and analysed statistically. Results: The study findings revealed that 46.4% infants in the age group 0-5 months were breastfed within 1 hour of birth. 52.8% infants aged 0-5 months of were exclusively breastfed. 33.6% infants in age group 0-5 months received prelacteal feeds. 53.12% infants in age group 6-8 months received solid, semi-solid or soft food, in addition to breast milk. 53.33% infants were partially or fully bottle fed. Age appropriate feeding was found in 56% infants. The percentage of wasting, stunting and underweight in 0-5 months was 33.6%,30.4% and 36.8% respectively . The percentage of wasting, stunting and underweight in 6-11 months was 28%, 26.5% and 30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age. Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI) in health facilities is recommended.
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Prevalence of pulmonary artery hypertension in patients of chronic obstructive pulmonary disease and its correlation with stages of chronic obstructive pulmonary disease, exercising capacity, and quality of life p. 53
Kamlesh Kumar Gupta, Bidyut Roy, Shyam Chand Chaudhary, Arvind Mishra, ML Patel, Jitendra Singh, Vivek Kumar
DOI:10.4103/jfmpc.jfmpc_18_17  
Background: Pulmonary arterial hypertension (PAH) is a complication of chronic obstructive pulmonary disease (COPD) in advance stages, and its presence indicates poor prognosis. Aims and Objective: The present study was design to know the prevalence of PAH in patients with COPD and its correlation with stages of COPD, exercising capacity, and quality of life. Materials and Methods: It is a cross-sectional prevalence study over a period of 1 year from August 2015 to July 2016. The study included 109 COPD patients, diagnosed by spirometry, and severity was determined according Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification criteria. Screening two-dimensional echocardiography was done to determine pulmonary arterial hypertension and exercising capacity assessed by 6 min walk test (6MWT) while the quality of life was assessed by St George respiratory Questionnaire for COPD (SGRQ-C) Questionnaires. Results: Out of 109 patients, PAH was present in 68 (62.4%) cases consisting of mild grade 41 (37.6%), moderate grade 11 (10.1%), and severe grade 16 (14.7%). In GOLD A stage, there were 20 cases of mild PAH and Stage B included 18 cases of mild and 3 cases of moderate PAH. Stage C had 3 cases of mild and 8 cases of moderate PAH while Stage D had 16 cases of severe PAH. In 6MWT, patients with severe grade PAH fail to perform the test while patients with mild to moderate PAH walked short distance. In SGRQ-C Questionnaires symptom, activity, impact, and total score were high with the severity of PAH. Conclusion: The prevalence of PAH in COPD was significant. Therefore, every COPD patient should be evaluated for PAH.
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Proficiency testing for admission to the postgraduate family medicine education p. 58
Birgitte Schoenmakers, Johan Wens
DOI:10.4103/jfmpc.jfmpc_163_17  
Theory: In Belgium, there are no family medicine admission requirements. A three-phase admission program is developed and implemented by the collaboration of four involved universities. Hypotheses: A pilot testing of phase 2, comprising actual proficiency test, is designed as answer to two research questions: What is the validity and reliability of a multicomponent proficiency test? How does a multicomponent proficiency test proportionate to the final grades of family medicine master candidates? Methods: The population consisted of all last master-phase students applying for family medicine education in Flanders. Students completed a machine-assisted test on knowledge and situational judgment skills and evidence-based medicine appraisal. Results: In total, 322 students completed the test. A regression analysis measuring the relationship between the master grades and the test score revealed an odds ratio of 1.1. Analysis of variance showed that the differences were significant between the upper quartile and the lowest quartile of the test results. A qualitative appraisal of the test results showed that the highest and lowest quartiles of the full-test score included the students who were, respectively, known as “very good” or “very poor.” Conclusion: The test scores were in agreement with the performance and profiling of the participating students. The test succeeded in identifying poor-performing students and in confirming competences of the average- and high-performing students. In the future, retesting will add to the statements on reliability and will refine the test construction. Follow-up will address validity.
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Adherence to treatment among hypertensives of rural Kerala, India p. 64
Arjun Balasubramanian, Sreejith S Nair, PS Rakesh, K Leelamoni
DOI:10.4103/jfmpc.jfmpc_423_16  
Introduction: Poor adherence is an important barrier to adequate blood pressure control among the diagnosed hypertensives. The study aimed at assessing the level of adherence to medication and to identify factors associated with it in people with hypertension in a rural population of Kerala. Subjects and Methods: A community-based cross-sectional study was conducted in July 2016 among 189 known hypertensives of a rural population in Kerala. Data was collected by interview method using a semistructured questionnaire. Medication adherence was assessed using 4-item Morisky Medication Adherence Scale. Chi-square was used to test the significance of association, and logistic regression was done to identify independent predictors along with odds ratio (OR). Result: The mean age of study participants was 65.12 ± 11.71 years and the mean duration of disease was 8.69 ± 7.99 years. High adherence was seen in 46% of the patients, while medium and low adherence was seen in 41.3% and 12.7%, respectively. Risk factors of poor adherence identified were poor knowledge of the complications (OR – 2.120; 95% confidence interval [CI] 1.110–4.048), availing government pharmacy (OR – 2.379; 95% CI 1.131–5.004), and being asymptomatic at the time of diagnosis (OR – 2.120; 95% CI 1.110–4.048). Conclusion: Adherence to medication among people with hypertension in the current study is poor. A comprehensive strategy to improve adherence to antihypertensive medications is the need of the hour.
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Evaluation of treatment satisfaction, efficacy and safety of dipeptidyl peptidase-4 inhibitors in geriatric patients with type 2 diabetes mellitus: A cross-sectionalcomparative study p. 70
Harmanjit Singh, Avinash Chakrawarti, Harjit Singh, P Guruprasad, Yogendra Kumar Gupta
DOI:10.4103/jfmpc.jfmpc_89_17  
Introduction: Dipeptidyl peptidase 4 (DPP4) inhibitors are attractive agents to be used in the elderly patients with Type 2 diabetes mellitus (T2DM ) because of their beneficial effects. Methods: In this cross-sectional, observational study, we evaluated and compared the treatment satisfaction using Diabetes Treatment Satisfaction Questionnaire (DTSQ) in two groups (i.e., regimens containing DPP4 inhibitors vs. other regimens). Efficacy was evaluated by assessing and comparing the glycosylated hemoglobin (HbA1c) values and the percentage of patients who achieved the glycemic control (HbA1c <7%). The adverse drug reactions (ADRs) were also recorded and compared among two groups. Results: A total of 115 patients participated in the study (42 in Group 1 and 73 in Group 2). Significantly better DTSQ scores were observed among Group 1 patients in terms of DTSQ score total (P = 0.01) and DTSQ score for perception of hyperglycemia (P = 0.008) as compared to Group 2 patients. Significant difference was observed in HbA1c values among two groups (P = 0.02, 95% confidence interval [CI], 0.06–1.14). Also, significantly higher proportion of patients had achieved glycemic control, i.e., HbA1c <7% in Group 1 as compared to Group 2 (P = 0.002, 95% CI, 11.8%–48.1%). Significantly higher number of ADRs were observed among Group 1 patients as compared to Group 2 (P = 0.003). Conclusion: DPP4 inhibitors seem to offer better treatment satisfaction and efficacy in geriatric T2DM patients but at the expense of increased frequency of ADRs; however, further research is warranted.
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Effectiveness of iron-fortified infant cereals on hemoglobin levels of children aged 12–24 months: A cross-sectional study from New Delhi, India p. 77
Arun Fotedar, Jasjit Singh Bhasin, Ashok Chakravarty, Avinash Kulkarni, Gaurav Bhalla, Fahmina Anwar, Shashidhar Rao
DOI:10.4103/jfmpc.jfmpc_239_17  
Introduction: Iron deficiency anemia represents 3rd largest disease burden, with an estimated 6.9 billion disability-adjusted life years.Iron-fortified cereals (IFIC) can contribute substantially in preventing iron deficiency anemia and maintaining an adequate body iron status. The aim of this study is to assess the effectiveness of IFIC intake along with other complementary food/s on the hemoglobin (hb) level of children from 12 to 24 months of age. Materials and Methods: A cross-sectional study was conducted from November 2015 to February 2016 in three pediatric outpatient clinics of New Delhi, India. A predesigned questionnaire was used to elicit information on socio-demography, complementary feeding, and intake of IFIC from 66 mother and child pairs. Child's anthropometric measurement and hb levels were recorded by the pediatrician. Chi-square and Student's t-tests were used to compare the key study variables between IFIC (minimum 1–2 serving/day) and non-IFIC groups. Multiple logistic regression analysis was applied to explore the independent correlates of anemia in the study groups. Results: Out of 66 children, 60.6% (n = 40) of children were boys. The prevalence of anemia (hb% <11 g/dl) was 42.4% (95% confidence interval (CI): 30.5%–55.2%, n = 28). Multiple logistic regression analysis revealed that the children in IFIC group were unlikely to be anemic (adjusted odds ratio (OR): 0.007, 95% CI: 0.001–0.079, P < 0.001). On the contrary, boys (adjusted OR: 11.6, 95% CI: 1.23–108.9, P = 0.032) and children with low birth weight (adjusted OR: 11.7, 95% CI: 1.23–111.76, P = 0.032) were associated with anemic status. Conclusion: Intake of IFIC (minimum 1–2 serving/day) was associated with the lesser chance of anemia in children of 12–24 months. However, gender and low birth weight were also associated with anemia. IFIC may have a role in mass fortification programs. However, further larger and controlled studies are recommended to test this hypothesis.
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Failure to achieve goal blood pressure and its associated factors among hypertensive patients registered in a primary health centre in South India p. 81
Bharathnag Nagappa, Pruthu Thekkur, Marie Gilbert Majella, Divya Nair, Gomathi Ramaswamy, Palanivel Chinnakali
DOI:10.4103/jfmpc.jfmpc_134_17  
Introduction: Uncontrolled blood pressure (BP) among hypertensive patients leads to life-threatening complications, hospitalization, and premature mortality. Knowledge on the burden of uncontrolled BP and its correlates will help in devising strategies to achieve goal BP. We aimed to determine the proportion who have not achieved goal BP and its associated factors among hypertensive patients in a Primary Health Centre (PHC). Materials and Methods: A facility-based cross-sectional analytical study was conducted among the hypertensive patients attending chronic disease clinic of PHC at Ramanathapuram, Puducherry. BP was measured and goal BP was defined based on Joint National Committee-8 criteria. The interview was conducted using semi-structured questionnaire capturing sociodemographic details, behavioral characteristics, physical activity with the International Physical Activity Questionnaire (IPAQ), medication adherence with Morisky Medication adherence scale-8 (MMAS-8), and stress with perceived stress scale. The data were entered and analyzed using EpiData software. The proportion “not achieved goal BP” was expressed as percentage and association were measured using prevalence ratios (PRs) with 95% confidence interval (CI). Results: Of total 259 hypertensives studied, 140 (54.1%) were aged above 60 years, and 161 (62.2%) were females. Overall, 63 (24.3%) participants had not achieved goal BP. On univariate analysis, individuals aged 45–59 years (PR-2.1 [95% CI: 1.4–3.4]), being male (PR-1.6 [95% CI: 1.1–2.4]) and employed (PR-2.0 [95% CI: 1.1–3.5]) were associated with not achieving goal BP. Conclusion: One-fourth of patients treated for hypertension in PHC failed to achieve goal BP. Considering the consequences of uncontrolled BP, cost-effective, context-specific interventions at the primary health-care level are needed.
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Awareness of colorectal cancer among public in Asir region p. 87
Mohammad Nassir Al-Sharif, Khalid Ali Fayi, Abdulsalam Ali Alobaidi, Bader Awadh Alshamrani
DOI:10.4103/jfmpc.jfmpc_264_17  
Introduction: Colorectal cancer (CRC) has different forms of colon cancer or rectal cancer. CRCs are often considered together because they possess many similar features. A severe form of the disease with higher mortality rate increases with increase in age. The most common CRC risk factors include smoking, diabetes, and obesity. This study aims to evaluate the awareness of CRC in a random population of Asir region and to identify the subpopulation that can be recipients of awareness and screening programs. Material and Methods: Cross-sectional nonprobable random sampling study using a self-administered questionnaire survey which was employed to include healthy males and females from Asir region. The questionnaire included ten questions in Arabic language and data were categorized according to gender, marital status, age, and level of education to determine whether these demographic groups possess difference in knowledge about CRC. Results: Most of the respondents (51% and 71.6%) knew what is colon and rectum. About 33.8% know the correct function of the colon while 22.5% know the correct incidence and 22.1% know the correct time of screening for CRC. Very few respondents know the symptoms, risks, and screening modalities of CRC.Pearson's Chi-square test was employed to evaluate the differences in responses in four demographic categories of the study population. P <0.05 was considered as statistically significant Conclusions: Single less educated males lack knowledge of CRC. In addition, there is very low awareness of CRC symptoms, risk factors, and screening modalities among the entire surveyed population.
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A study on the altered glycemic and lipid parameters and prevalence of insulin resistance in nonalcoholic fatty liver disease p. 93
Sangeetha Suresh, Bijayraj Rajanbabu, Vimal Mavila Veetil, Abeed Hussain, Jaseena Nadu Veetil
DOI:10.4103/jfmpc.jfmpc_352_16  
Introduction: Nonalcoholic fatty liver disease (NAFLD) is a hepatic disorder that develops in the absence of alcohol intake. Obesity and diabetes are considered risk factors for the development of fatty liver; however, whether fatty liver is the cause or consequence of these conditions is not yet clear. Insulin resistance (IR) is found to be a common risk factor for the development of diabetes, obesity and fatty liver. Aims and Objectives: The aim and objective of this study is to determine the prevalence of undetected diabetes, dyslipidemia, and IR in subjects with NAFLD. Materials and Methods: In apparently healthy 100 subjects, with ultrasound diagnosis of fatty liver, fasting and postprandial blood sugar levels, fasting insulin levels, and fasting lipid profile were checked. IR value was estimated using homeostatic model assessment-IR formula. Appropriate statistical methods were adopted to analyze the data. Results: A total of 66 subjects out of the 100 had IR. It was noted that IR significantly correlated with raised fasting blood sugar and fasting plasma insulin values. There was no significant correlation between IR and lipid profile values. Conclusion: The chance of developing NAFLD was high if the subjects are having IR, or vice versa. There was an increased prevalence of prediabetes and diabetes in the subjects with NAFLD. Waist circumference, rather than body mass index, was found to be a strong predictor of central adiposity and IR.
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Factors influencing the place of delivery in rural Meghalaya, India: A qualitative study p. 98
Amrita Sarkar, Ophelia Mary Kharmujai, Wallambok Lynrah, Neilatuo U Suokhrie
DOI:10.4103/jfmpc.jfmpc_45_17  
Background: In Meghalaya, only 51.4% expectant mothers go for any institutional delivery with a wide rural-urban gap causing morbidity and mortality in the mothers and the neonates. Objectives: The objective of this study is to find out the factors influencing the choice of the place of delivery in rural women. Methodology: The present qualitative cross-sectional study was conducted from October to December 2016 in Bhoirymbong community health center (CHC) and the area catered to by it. This CHC was selected by purposive sampling. Data collection methods included focused group discussions and in-depth interviews. The data were analyzed manually using thematic content analysis. Results: Most of the women in the study area opted for home delivery by traditional birth attendants (TBAs), on whose skills the community had strong faith. Financial constraints, fear of out-of-pocket expenditure, ignorance of available schemes, unavailability of transport, bad roads, and distant hospitals were found to be important causes of this choice. Home delivery apparently offered the women privacy and the opportunity to attend to their household chores and older children. Illiteracy, increasing age, and parity were risk factors for home delivery. Perceived need for institutional delivery was low. Staff attitudes and unnecessary referrals had an impact on the choice of place of delivery. Conclusion: In the rural areas of this study, home deliveries are the preferred norm. The wide range of factors identified in this study for the preference of TBA and home deliveries could help policy makers and program implementers to adopt socially and culturally appropriate community-based interventions that can contribute to the reduction of maternal, fetal, and neonatal mortality and morbidity and increase service utilization.
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Prevalence and determinants of undernutrition among children under 5-year-old in rural areas: A cross-sectional survey in North Sudan p. 104
Amel Abdalrhim Sulaiman, Sarra O Bushara, Wadie M Elmadhoun, Sufian K Noor, Mutaz Abdelkarim, Ilham Nasr Aldeen, Meissa M Osman, Ahmed O Almobarak, Heitham Awadalla, Mohamed H Ahmed
DOI:10.4103/jfmpc.jfmpc_73_17  
Background: Child malnutrition is a major public health problem in developing countries. Therefore, the aim of this study was to estimate the prevalence of undernutrition among children <5 years in River Nile state (RNS) in North Sudan. Subjects and Methods: A cross-sectional household survey was done in four localities in RNS. Using Multistage Cluster sampling, 1635 under 5 years' children had participated. Pretested questionnaire and anthropometric measures were used during data collection. The analysis was done using SPSS software program version 21 and World Health Organization (WHO) Anthro 2005 software. Indices were reported in z-scores and compared with the WHO 2005 reference population to determine the nutritional status of children. Results: Among 1,447 surveyed children, the prevalence of stunting, underweight, and wasting were 42.5%, 32.7%, and 21%, respectively. Stunting was highest among the 48–60 months of age group (82.5%). Boys had poorer indicators of undernutrition in comparison to girls. Geographically stunting was more prevalent in Berber locality. Infectious diseases (gastroenteritis and respiratory symptoms) and incomplete vaccination were significantly associated with wasting (P = 0.007, P = 0.013, and P = 0.008). Poor socioeconomic status (P = 0.043), poorer household sanitation (P = 0.022), large family size, lack of family spacing, and infants weaned suddenly were regarded as risk factors for undernutrition. Conclusion: There was a high prevalence of undernutrition in the 4th and 5th year of life in RNS population, with significant gender imbalance. Our survey highlighted the importance of urgent need to improve child health in this region.
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Correlates of secondhand smoke exposure among nonsmoking youth (15–24 years) in India: Secondary analysis from Global Adult Tobacco Survey, 2009–10 p. 111
Mahendra M Reddy, Srikanta Kanungo, Sitanshu Sekhar Kar
DOI:10.4103/jfmpc.jfmpc_409_16  
Introduction: Nonsmoking youth form a high-risk group and are at increased risk of ill-effects caused due to secondhand smoke (SHS). The objective is to determine the prevalence and correlates of SHS exposure among the nonsmoking youth in India from global adult tobacco survey (GATS), 2009–10. Methods: Secondary data analysis of GATS, 2009–10 was done to find the correlates of SHS at three different settings – house, workplace - indoor, and public place. All the sociodemographic variables were tested for association with SHS exposure using multivariate analysis. Prevalence ratio with 95% confidence interval [CI] was used to report the risk. Results: The prevalence of SHS was 48.6% (95% CI: 47.7%–49.5%) at house, 25.5% (95% CI: 23.5%–27.6%) at workplace - indoors, and 42.7% (95% CI: 41.7%–43.7%) at public places. SHS exposure among females was found to be higher at house; youth living in rural area were found at increased risk to SHS at both household and public places; and inverse relationship was seen between SHS exposure and education level at both household and workplace - indoors. Overall, the study showed that smokeless tobacco users were at increased risk of SHS exposure at all the three settings. Conclusion: Being female, living in rural area, lower education status, lower socioeconomic status, and use of smokeless tobacco were found to be associated with SHS exposure among nonsmoking youth in India.
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Prevalence of metabolic syndrome crossing 40% in Northern India: Time to act fast before it runs out of proportions p. 118
Yasmee Khan, Arati Lalchandani, Ajesh Chandra Gupta, Sagar Khadanga, Sanjeev Kumar
DOI:10.4103/jfmpc.jfmpc_10_17  
Background: Metabolic syndrome (MetS) is a constellation of high blood pressure, hyperglycemia, obesity, and dyslipidemia. Its presence makes the patient more prone for cardiovascular events. Its prevalence has been documented as 11%–41%. The present study was undertaken to find out the demographic profile of the MetS in Kanpur region of northern India. Materials and Methods: This is a hospital based, cross-sectional study with adequate sample size. Results: Out of the randomly selected 420 patients (232 males and 188 females), 172 cases (61 males and 111 females) were found to have MeTS adopting the National Cholesterol Education Program Adult Treatment Panel III criteria. The overall prevalence of MeTS was found to be 40.9% (26.2% of total males and 59% of total females). Among the 172 cases of MeTS, females were more than males (64.5% vs. 35.4%). Maximum numbers of MeTS cases were in the age range of 50–59 years (55/172 = 31.9%) followed by 40–49 years (50/172 = 29%), >60 years (35/172 = 20.3%), 30–39 years (30/172 = 17.4%), and <30 years (2/172 = 1.1%). In the total study population of 420 cases, hyperglycemia was the most common (29.2%) and hyperglycemia, obesity, and high triglyceride were significantly higher prevalence in females. Among the participants of 111 cases of MeTS, hyperglycemia was the most common (71.5%) and high blood pressure, and low high density lipoprotein was significantly higher among males. Conclusion: The prevalence of MetS was more than 40% and its prevalence in <40 years age group is rapidly increasing. Its high time to be more active physically, before fatal cardiovascular events.
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A comparison of the frequency, risk factors, and type of self-medication in pregnant and nonpregnant women presenting to Shahid Akbar Abadi Teaching Hospital in Tehran p. 124
Malihe Botyar, Maryam Kashanian, Zahra Rezaei Habib Abadi, Maryam Heidarian Noor, Rozita Khoramroudi, Monire Monfaredi, Golnar Nasehe
DOI:10.4103/jfmpc.jfmpc_227_17  
Background: Self-medication is a serious health problem that leads to an increased per capita consumption of medications, drug resistance, lack of optimal treatment, drug poisoning, and other unwanted complications. This study was conducted to compare self-medication in pregnant and nonpregnant women presenting to Shahid Akbar Abadi Teaching Hospital in Tehran, Iran. Materials and Methods: To conduct this cross-sectional study, 210 pregnant women and 210 nonpregnant women aged 15–45 years presenting to Shahid Akbar Abadi Teaching Hospital, Tehran, Iran, were selected through random sampling. Data were collected through interviews using a semi-structured questionnaire. The Chi-square test, t-test, and logistic regression model were used to analyze the data. Results: The prevalence of self-medication was 34.8% in the pregnant and 77.1% in the nonpregnant women. The age group in which the most frequent instances of self-medication were observed (53.4%) was the 21–30 age group in the pregnant women and the 31–40 age group (44.4%) in the nonpregnant women, suggesting a statistically significant intergroup difference in terms of age (P = 0.0001). Medicinal plants were the most common medications used by the pregnant women (19.6%) and synthetic medications were the most common used by the nonpregnant women (38.1%). The reasons for using medications without a prescription included believing in the illness being mild (22.8%), not having health insurance (9%), easy access in the pregnant women, a previous history of the illness, and easy access in the nonpregnant women. Conclusions: As medicinal plants are the most common medications used by pregnant women and since assessing the risk of herbal substances is difficult, pregnant women should be advised against the arbitrary use of these substances.
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A study on prevalence of diabetes and associated risk factors among diagnosed tuberculosis patients registered under Revised National Tuberculosis Control Programme in Bhopal District p. 130
Vivek Nagar, Devendra Gour, Dinseh Kumar Pal, Akash Ranjan Singh, Ankur Joshi, Lokendra Dave
DOI:10.4103/jfmpc.jfmpc_289_17  
Context: Tuberculosis (TB) and diabetes mellitus (DM) remains a worldwide global public health problem. About 95% of patients with TB live in the low and middle-income countries and more than 70% of patients with DM also live in the same countries, especially in South East Asia. Screening for diabetes in patients with TB will not only ensure early case detection but also better management of diabetes and will lead to better TB treatment outcome. Aims: This study aims to determine the prevalence and its associated factors of diabetes and prediabetes among diagnosed cases of TB patients registered under Revised National Tuberculosis Control Programme (RNTCP) in Bhopal city. Settings and Design: The current study was a longitudinal follow-up study conducted among registered TB patients under RNTCP in all 5 TB units of Bhopal District. Subjects and Methods: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested Performa during October 2013–September 2014. Statistical Analysis Used: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. Results: Out of the total 662 TB patients, 352 were male and 310 were female. Out of the total, 82 (12.39%) patients were diagnosed as diabetic and 108 (16.3%) were prediabetic. significant association found with six variables which are age, sex, body mass index, type of TB, Category of TB, and smoking. Conclusion: This study shows feasibility and importance of screening of TB patients.
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Audit of emergency obstetric referrals from a secondary level hospital in Haryana, North India p. 137
Shashi Kant, Ravneet Kaur, Sumit Malhotra, Partha Haldar, Akhil Dhanesh Goel
DOI:10.4103/jfmpc.jfmpc_16_17  
Background: The maternal mortality ratio in India is high. An effective emergency obstetric care (EmOC) strategy has been identified as a priority to reduce maternal deaths. Since the capacity of different levels of public health facilities to provide EmOC is varied, an effective referral system is crucial. However, few studies have evaluated the functioning and quality of referral systems in India. A systematic monitoring of referrals helps to identify current gaps in the provision of essential obstetric care. Objective: This study was conducted to identify the medical and logistic reasons for emergency obstetric referrals from a subdistrict hospital (SDH). Methods: An audit of emergency referrals during the period January 2015–December 2015 was carried out. Records of all obstetric patients referred from the maternity ward during the study period were reviewed. Results: The referral rate was found to be 31.7%. Preterm labor (30.6%), pregnancy-induced hypertension (17%), and fetal distress (10.6%) were the main reasons for referral. Deficiencies were found in critical determinants of functionality, that is, nonavailability of emergency cesarean, neonatal care unit, and blood bank. Conclusions: The referral rate at the SDH was high. Lack of workforce and infrastructural facilities led to referrals of women who ought to have been managed at this level of the hospital.
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Evaluation of inter-arm difference in blood pressure as predictor of vascular diseases among urban adults in Kancheepuram District of Tamil Nadu p. 142
S Gopalakrishnan, AK Savitha, R Rama
DOI:10.4103/jfmpc.jfmpc_62_17  
Introduction: An “Inter-Arm Difference” (IAD) in blood pressure (BP) is defined as a variation in systolic BP of >10 mmHg. Various studies conducted in different population show that there are wide variations in the prevalence of IAD, which ranges from 5% to 46%. The aim of this study is to evaluate the prevalence of IAD in BP among adults and its association with risk factors. Methods: This community-based cross-sectional study was carried out among urban adults in Kancheepuram district. The study sample size of 1634 was calculated, and simple random sampling method was used. Data analysis was performed using SPSS software version 16. Prevalence of IAD in BP was calculated using percentages, and statistical significance was tested to look for an association. Results: This study shows that 26.2% were at moderate risk for vascular events with IAD in systolic BP of 10–15 mmHg and 17.3% were at high risk with IAD >15 mmHg. About 14.2% had diastolic BP difference of 10–15 mmHg indicative of moderate risk and 6.1% had a difference of >15 mmHg indicative of high risk for vascular events. The statistical significant association was found between IAD in systolic BP and risk factors such as hypertension, smoking, alcoholism, and between IAD in diastolic BP with overweight/obesity (P < 0.05). Conclusion: This study outcome shows that the prevalence of IAD in BP is on the higher side. Hence, specific guidelines should be brought in to practice for measuring BP in both arms to detect IAD in every health-care settings.
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Internet addiction and psychological well-being among college students: A cross-sectional study from Central India Highly accessed article p. 147
Arvind Sharma, Richa Sharma
DOI:10.4103/jfmpc.jfmpc_189_17  
Background: Internet provides tremendous educational benefits for college students and also provided better opportunities for communication, information, and social interaction for young adults; however, excessive internet use can lead to negative psychological well-being (PWB). Objective: The present study was conducted with the objective to find out the relationship between internet addiction and PWB of college students. Materials and Methods: A multicenter cross-sectional study was carried out in college students of Jabalpur city of Madhya Pradesh, India. A total of 461 college students, using internet for at least past 6 months were included in this study. Young's Internet addiction scale, consisting of 20-item, based on five-point Likert scale was used to calculate internet addiction scores and 42-item version of the Ryff's PWB scale based on six-point scale was used in this study. Results: A total of 440 questionnaire forms were analyzed. The mean age of students was 19.11 (±1.540) years, and 62.3% were male. Internet addiction was significantly negatively correlated to PWB (r = –0.572, P < 0.01) and subdimensions of PWB. Students with higher levels of internet addiction are more likely to be low in PWB. Simple linear regression showed that internet addiction was a significant negative predictor of PWB. Conclusion: PWB of college students negatively affected by internet addiction. Hence, it is essential to develop strategies for prevention of internet addiction which is very important for promoting PWB of college students.
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Access and availability of essential medicines in Chhattisgarh: Situation in public health facilities p. 152
Narayan Tripathi, Fidius Kerketta, Prabir Chatterjee, VR Raman, Denny John, Kamlesh Jain
DOI:10.4103/jfmpc.jfmpc_78_17  
Background: In 2013, the Government of Chhattisgarh announced a policy guaranteeing access to free generic medicines in all the public health facilities. This study was conducted with the objectives of evaluating the prescribing patterns of physicians in public health facilities with regard to generic medicines, and whether the prescribed generic medicines were made available to patients. Materials and Methods: This cross-sectional study was conducting from December 2013-October 2014, using exit interviews of patients. Out of the total 27 districts of the state, 15 districts were selected, and one district hospital, three community health centers, and three primary health centers were selected from each of these districts, as per logistics feasibility. Descriptive statistics in the form of frequencies and percentages were calculated. Results: During the data collection period, a total of 1290 prescriptions were reviewed from 100 public health facilities. Around 68.89% of the medicines prescribed were generic and were from the 2013 generic drugs list. Around 58.28% of the prescribed generic medicines were available to the patients from these public health facilities, and the rest of the medicines were procured from private pharmacies. Conclusion: Chhattisgarh has made considerable progress in increasing access of generic medicines to patients in public health facilities. Our study shows that for the year 2013-14, about 58% of the prescribed medicines were available in various public health facilities. There is opportunity to further improve the state financial allocation for generic medicines, to improve supply chain and logistics for better distribution, and to mandate that physicians in these facilities prescribe generic medicines.
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Incidental detection of hepatitis B and C viruses and their coinfection in a hospital-based general population in tertiary care hospital of Uttar Pradesh p. 157
Loveleena Agarwal, Amit Kumar Singh, Amitabh Agarwal, Ravinder Pal Singh
DOI:10.4103/jfmpc.jfmpc_196_16  
Introduction: Substantial proportion of liver diseases worldwide is caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) infections which manifest not only as an acute illness but also lead to chronic sequelae. Together HBV and HCV cause chronic infection in more than 500 million persons and about one million deaths annually. Most of the people with chronic infection are not aware of the infection thus enabling it to go unnoticed, and undiagnosed and act as a potential source of infection for the community at large. Therefore, we aimed to find the prevalence of HBV and HCV in Barabanki, Uttar Pradesh among individuals attending the tertiary care hospital. Materials and Methods: From February 2015 to January 2016, 3750 patients attending the outdoor patient departments or admitted to the indoor patient departments of teaching hospital and advised to undergo HBV and HCV for screening before any invasive/surgical procedure were included in the study. Screening was done by rapid card test followed by the confirmation of all samples by enzyme immunoassay. Results: Seroprevalence of HBV and HCV was found to be 3.9% and 1.76% respectively with higher seroprevalence among males and in married participants in both infections. Blood transfusion is statistically a significant risk factor for HCV infection (P < 0.05). Coinfection with HBV/HCV was seen in 0.16% of the individuals visiting the hospital. Conclusion: Higher seroprevalence of HBV and HCV among the hospital-based population mandates screening of high-risk individuals. Awareness by health education of safe sexual practices and improved safety of blood and its products are among the most important preventive measures to control HBV and HCV infection.
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Prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus among schoolchildren of Barabanki district, Uttar Pradesh, India p. 162
Amit Kumar Singh, Loveleena Agarwal, Akash Kumar, Chandrim Sengupta, Ravinder Pal Singh
DOI:10.4103/jfmpc.jfmpc_345_16  
Introduction: The study aimed to determine the prevalence of nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA), the minimum inhibitory concentration (MIC) of oxacillin and vancomycin, inducible clindamycin resistance, and antimicrobial resistance pattern of S. aureus among children of Barabanki district, Uttar Pradesh, India. Materials and Methods: School-going children of age group of 5–15 years were identified and selected according to the inclusion and exclusion criteria. Two nasal swabs were collected from each child as per the Centers for Disease Control and Prevention guidelines and transported to laboratory. Swabs were cultured on mannitol salt agar and 5% blood agar and incubated for 18–24 h at 37°C. Identification was done as per routine laboratory protocol. Detection of MRSA was done through cefoxitin 30 μg discs and D-zone test. Antibiotic susceptibility pattern of S. aureus by Kirby–Bauer disc diffusion method along with MIC for oxacillin and vancomycin was performed simultaneously according to Clinical Laboratory Standards Institute guidelines. Results: Out of 300 children, 140 (46.67%) were found to be nasal carriage for S. aureus, among which MRSA was found to be 23 (7.67%). All S. aureus and MRSA isolates were sensitive to vancomycin with MIC <2 μg/ml, whereas 23 S. aureus were found resistant to oxacillin with MIC value >4 μg/ml. Resistance to penicillin and co-trimoxazole was highest, whereas all were sensitive to linezolid. MRSA showed 100% susceptibility to linezolid, followed by gentamicin (91.4%) and tetracycline (87%). Conclusion: With the risk involved in transmission of infection, steps for identifying the carriers and its eradication should be carried out. Rational use of antibiotics should be given preference too.
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A retrospective cohort study on effect of literacy status of HIV-positive pregnant women on possibility of child getting HIV infected p. 167
Suman Ganguly, Dipendra Narayan Goswami, Soumya Mondal, Soma Chakrabarti, Malay Mundle
DOI:10.4103/jfmpc.jfmpc_88_17  
Introduction: Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected. Materials and Methods: A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed. Results: HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy. Conclusion: Maternal literacy status favorably influences vertical transmission of HIV.
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Low-dose isotretinoin therapy and blood lipid abnormality: A case series with sixty patients p. 171
Tanusree Sarkar, Somenath Sarkar, Aparesh Patra
DOI:10.4103/jfmpc.jfmpc_104_16  
Background: prolonged isotretinoin therapy for various skin diseases causes change in various parameters of lipid profile. Aim: to find out the effect of low dose isotretinoin on various parameters of lipid profile. Methods: A clinic based observational study with 60 patients of various skin diseases carried out in a skin outpatient department of a tertiary care hospital in eastern India. Patients were prescribed isotretinoin for relevant indications. Baseline lipid profile was checked and repeated after three months. The results were compared with the baseline lipid levels. Result: Out of 60 patients (male-32, female-28) hyperlipidemia was present in 25% (15 out of 60) patients at the end of three month's therapy. Among the hyperlipidemia, hyper triglyceridemia was the commonest (16.67%, 10 out of 60 patients) followed by elevation of VLDL (11.67%, 7 out of 60 patients), elevation of LDL (10%, 6 out of 60), hypercholesterolemia (5%, 3 out of 60). Combination of hyperlipidemia was present in 11.67% patients. Among the male patients 28.12%, while in females 21.43% had hyperlipidemia at the end of the study. Among the hyperlipidemic females, hypertriglyceridemia was present in 83.3% (5 out of 6) of patients, while in male it was 55.5% (5 out of 9 patients). Conclusion: Low dose Isotretinoin therapy causes variable rise in various parameters of lipid profile. It should be used cautiously in patient with risk factors of metabolic syndrome and frequent monitoring of serum lipid profile is needed.
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Knowledge, attitudes, and practice behaviors of medical specialists for the relationship between diabetes and periodontal disease: A questionnaire survey p. 175
Vishnu Teja Obulareddy, Sreenivas Nagarakanti, Vijay Kumar Chava
DOI:10.4103/jfmpc.jfmpc_425_16  
Introduction: Increased risk of periodontal disease has been associated with diabetes mellitus (DM) and also periodontitis is considered as the sixth complication of DM. Medical physicians may have an advantageous position compared to the dentists to provide early patient counseling about oral health because patients attend medical offices more often than to dental offices and are more likely to be affiliated to medical than to dental insurance. Hence, the medical practitioners should have sufficient knowledge in this regard. The study aimed to assess the knowledge, attitudes, and practice behaviors of endocrinologists, general medicine practitioners, and diabetologists on the relationship between periodontal disease and DM. Materials and Methods: Data were collected from sixty participants practicing in Nellore, using a structured questionnaire survey. The obtained data were analyzed through percentages. Results: All the participants (100%) were aware that there existed a relation between oral health and general health. However, only 17.8% (10) of the participants refer their patients to dentists without patients asking for referral. Conclusion: The endocrinologists were aware of the didactic relationship, whereas general medicine practitioners and diabetologists are not much well-equipped with the knowledge on relationship between DM and periodontitis. There exists a wide gap between their practice behaviors and current scientific evidence. Therefore, more emphasis must be made by medical practitioners for the diabetic patient toward periodontal health which is most important yet neglected aspect of comprehensive health care.
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Ethephon, an organophosphorous, a Fruit and Vegetable Ripener: Has potential hepatotoxic effects? p. 179
Pooja Bhadoria, Mahindra Nagar, Veena Bharihoke, Ajeet Singh Bhadoria
DOI:10.4103/jfmpc.jfmpc_422_16  
Introduction: In the recent years, ethephon, 2-chloroethylphosphonic acid, is one of the most commonly used plant growth regulators. At present, it is being used on fruits, vegetables, and cereals for promoting pre- and post-harvest ripening. The effect of artificial ripening has become questionable because of various health-related issues. This study was conducted to note the morphology of liver after ethephon administration as it is the site where chemicals undergo first pass metabolism and probably will be affected by ethephon. Materials and Methods: Adult Wistar albino rats were divided into experimental and control groups (10 each). Ethephon was administered at a dose of 200 mg/kg/day by a gavage tube in the experimental rats for 14 days. The animals were sacrificed within 24 h of the last dose; liver was dissected and processed for light microscopy. Hematoxylin and eosin-stained sections were studied using an image-pro express analyzer. The data obtained from control and experimental groups were statistically analyzed. Results: In the experimental rats, the body weight was found to be significantly decreased. The orderly arrangement of hepatocytes was disrupted and was replaced by blood-filled sinusoids. At sites, hepatocytes appeared to be degenerated. Councilman bodies with pyknotic nuclei and inflammatory infiltrations were seen. The population per unit area of the hepatocytes and Kupffer cells was 29.53 ± 10.65 versus 44.18 ± 10.31 and 25.12 ± 4.41versus 13.05 ± 6.5 in experimental and control groups, respectively. The decrease of hepatocytes and increase of Kupffer cells were found to be statistically significant. Conclusions: The observations in the liver are probably indicative of degenerative changes associated with ethephon. Hence, we can conclude that this plant growth regulator, Fruit and Vegetable Ripener, has hepatotoxic potential. General awareness and regarding the use of such plant growth regulators is must to reduce the intake.
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Public knowledge awareness and attitudes toward epilepsy in Al-Kharj Governorate Saudi Arabia p. 184
Khaled K Al-Dossari, Sameer Al-Ghamdi, Jamaan Al-Zahrani, Imad Abdulmajeed, Maher Alotaibi, Humoud Almutairi, Abdulrahman BinSwilim, Omar Alhatlan
DOI:10.4103/jfmpc.jfmpc_281_17  
Introduction: Epilepsy is one of the most stigmatizing disorders. Stigmas and negative attitudes associating epilepsy are due to poor public awareness and knowledge. This study evaluated Saudi public Knowledge, awareness, and attitude towards epilepsy. Materials and Methods: A cross-sectional study conducted during the period from September 16, 2014 to January 1st 2015. A 20-item questionnaire adapted from the literature was validated and distributed to 422 adults living in Al-Kharj governorate, and 22 participants were excluded as they have never heard or read about epilepsy. Results: About 94.79% of participants have heard or read about epilepsy, 63% of them knew someone with epilepsy, and 49.75% have witnessed a seizure attack. Seventy per cent of subjects thought that epilepsy is a neurological disease and 59% believed it is a brain disease. Almost 46.5% selected possession by demons or evil spirits and 51.25% cited envy or evil eye. More than half of subjects selected the medical treatment and follow-up as the most effective treatment of epilepsy. Rather, 41% believed in the faith healing. Most of respondents (81.5%) believed that epileptic children could be successful in normal classes. The vast majority agreed with that epileptic woman can get married and have children. Moreover, 65.25% would allow their offspring to play with epileptic persons and surprisingly, 59% would let their offspring marrying a person with epilepsy. As much as 82.75% agreed to work with epileptic persons and 85.5% would easily become a close friend of them. The equal job opportunity for epileptic and normal persons should be practiced to about 53.75% of subjects. The predictors of good knowledge, limited misconception, and positive attitudes were female gender, being a relative of an epileptic person, and having high educational level. Conclusion: The public knowledge, awareness of and attitudes toward epilepsy were acceptable with regard to this study. However, the negative attitudes and misconceptions still exist.
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Adult onset seizures: Clinical, etiological, and radiological profile p. 191
Sarabjot Kaur, Ravinder Garg, Simmi Aggarwal, Sumit Pal Singh Chawla, Ranabir Pal
DOI:10.4103/jfmpc.jfmpc_322_16  
Introduction: Adult onset seizure disorder is a major public health concern in terms of burden of disease, nature of illness, and its impact on individual, family, and community. This study was done to assess the clinical profile and etiology of adult onset seizures and correlates of clinical and radiological pattern. Materials and Methods: This was a prospective cross-sectional hospital-based study conducted on 100 cases presenting with adult onset seizures. Results: Adult onset seizures were most prevalent in the young and middle-aged adults than elderly; generalized seizures were more common than focal seizures. However, the incidence of generalized seizures showed a falling trend as the age advanced whereas focal seizures increased in incidence with advancing age. Overall, the most common etiology of seizures was stroke, followed by idiopathic and central nervous system infections; yet, most common etiology of adult onset generalized and focal seizures was idiopathic and stroke, respectively. Regarding etiology, among younger adults, idiopathic seizures were predominant, whereas among middle aged and elderly, stroke was the most common etiology. Conclusions: It is mandatory to deal carefully with each case of adult onset seizure with a tailor-made approach. Identification and awareness about the etiological factors and seizure type help in better management of these patients. Primary care physicians play a pivotal role in identifying patients with adult onset seizures and should encourage these patients to undergo neuroimaging so as to arrive at an appropriate etiological diagnosis. In the face of recent advances in neuroimaging techniques, the future prospective management of adult onset seizures appears bright and convincing.
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Adverse eating behavior and its association with obesity in Indian adolescents: Evidence from a nonmetropolitan city in India p. 198
Nafis Faizi, Mohammad Salman Shah, Anees Ahmad, Mohammad Athar Ansari, Ali Amir, Najam Khalique
DOI:10.4103/jfmpc.jfmpc_139_17  
Introduction: With the so-called modernization, the epidemiological and sociocultural context of adolescents in developing countries is rapidly changing and is affecting their eating behavior and dietary choices. The objective of our study is twofold. First, our study seeks to find whether there is a prevalence of the adverse eating behaviors among the adolescents. Second, our study seeks to examine whether the prevalence of the adverse eating behavior is related to obesity and quantifies their association of with body mass index (BMI) status. Materials and Methods: A cross-sectional school-based study was conducted in 13–15-year-old adolescents from schools of Aligarh, India, with prevalidated study tools and standardized anthropometric measures. The Z-scores were found by the WHO recommended AnthroPlus. Results: The results indicate a high prevalence of different adverse eating behaviors. The dietary behavior was found to be poor in 19.3%, fair in 54.4%, and good in only 26.3% of the study population. The mean BMI for age Z-score was found to be 0.87 and 0.02 in poor and fair dietary behavior. The odds of being overweight and obese were high (1.82 [1.20–2.78]) in those with poor dietary behavior. Conclusions: Our findings suggest that more research and timely intervention in adverse eating behaviors are much needed in India before this widely neglected problem acquires even more alarming and gigantic proportions.
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Family medicine: Perception and attitudes among Indian medical students p. 205
Ilhaam Ashraf, Wendy W T Chan, Ramakrishna Prasad, Mohan Kubendra, D Hemavathy, Shailendra Prasad
DOI:10.4103/jfmpc.jfmpc_72_17  
Context: Currently, family medicine is not taught as a part of the undergraduate medical curriculum in India. In this context, the perceptions and attitudes of Indian medical students regarding family medicine as a career choice were studied. Aims: This study aims to study the perceptions and attitudes prevalent among Indian medical students regarding family medicine as a career choice and discuss its future implications. Settings and Design: Cross-sectional survey study design. Methods and Material: We conducted a cross-sectional survey of undergraduate medical (MBBS) students attending the 2016 medical student conference DEMEDCON at Sri Devaraj Urs Medical College in Kolar, Karnataka, India. Besides demographics, the survey included questions pertaining to awareness, exposure, and interest in family medicine in India. We also asked an open-ended question regarding the respondent's perception of the future of family medicine in India. Statistical Analysis: Simple statistics such as mean and frequency (%) were calculated. Given the small sample size, no formal tests for statistical significance were performed. Results: Responses were collected from 45 students between the ages of 18–24 from 6 medical colleges across Karnataka and Puducherry. The majority (64%) of respondents were in their 3rd or 4th year of medical college. 98% of respondents expressed a desire to learn more about family medicine as a specialty, and 82% expressed a need to introduce it as a subject in medical college. However, only 58% were aware of the Medical Council of India accredited status of family medicine in India. Conclusions: There exists a significant lack of awareness and inadequate exposure among Indian medical students toward family medicine. Nonetheless, there is widespread optimism and a desire to learn more about the subject. Increased awareness and avenues for exposure to family medicine in the formal undergraduate medical curriculum is the need of the hour.
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The ultrasound identification of fetal gender at the gestational age of 11–12 weeks p. 210
Farideh Gharekhanloo
DOI:10.4103/jfmpc.jfmpc_180_17  
Introduction: The early prenatal identification of fetal gender is of great importance. Accurate prenatal identification is currently only possible through invasive procedures. The present study was conducted to determine the accuracy and sensitivity of ultrasound fetal gender identification. Materials and Methods: The present cross-sectional study was conducted on 150 women in their 11th and 12th weeks of pregnancy in Hamadan in 2014. Ultrasound imaging performed in the 11th and 12th weeks of pregnancy for fetal gender identification identified the fetus either as a girl, a boy, or as a “gender not assigned.” Frequency, sensitivity, specificity, positive and negative predictive values, and accuracy of the gender identification was assessed using SPSS version 20. The significant level was 0.05 in all analyses. Results: Of the total of 150 women, the gender was identified as female in 32 (21.3%), as male in 65 (43.3%), and not assigned in 53 (35.3%); overall, gender identification was made in 64.6% of the cases. A total of 57 male fetuses were correctly identified as boys, and 8 female fetuses were wrongly identified as boys. As for the female fetuses, 31 were correctly identified as girls, and 1 was wrongly identified as a boy. The positive predictive value for the ultrasound imaging gender identification was 87.6% for the male fetuses and 96.8% for the female fetuses. Conclusion: The present study had a much higher gender identification accuracy compared to other studies. The final success of fetal gender identification was about 91% in the 11th and 12th weeks of pregnancy.
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Investigating the relationship between the quality of life and religious coping in mothers of children with recurrence leukemia p. 213
Sedigheh Khanjari, Marjan Damghanifar, Hamid Haqqani
DOI:10.4103/jfmpc.jfmpc_236_17  
Background: Leukemia is a life-threatening chronic disease for children. The recurrence of the disease causes tension and reduces the quality of life for the family, especially for mothers. Religion is an important humanitarian aspect of holistic care that can be very effective in determining the health level of the patient and the family members. The present study aims at investigating the role of religious coping (RCOPE) in the quality of life for mothers of children with recurrent leukemia. Methods: This is a cross-sectional study of the descriptive-correlational type. Two-hundred mothers with children aging 1–15 years suffering from leukemia were selected using a continuous sampling method. The data were collected using questionnaires eliciting information about personal information, Persian version of the Caregiver Quality of Life Index-Cancer, and RCOPE. The collected data were analyzed in SPSS using descriptive tests and independent samples t-test. Results: The result of examining the relation between life quality and demographic features of mothers showed that education level, income, and occupation had a significant statistical relationship with general quality of life mothers. The results of examining the relationship between quality of life and RCOPE of mothers showed that RCOPE was positively correlated only with the positive coping dimension quality of life (P < 0/001). Negative RCOPE had a significant reverse statistical correlation with general quality of life and all its aspects. Conclusion: The quality of life for the participants in this study was significantly related to RCOPE. Mothers with negative RCOPE faced low scores for quality of life, and religious support can improve their life quality. Further longitudinal studies are required to investigate the effects of establishing support communities.
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The prevalence of posttraumatic stress disorder during pregnancy and postpartum period p. 220
Rozita Khoramroudi
DOI:10.4103/jfmpc.jfmpc_272_17  
Introduction and Objective: The majority of formerly conducted studies have focused on the prevalence of posttraumatic stress disorder merely during pregnancy period; however, pregnancy period is by itself accompanied with the stress of getting pregnant again; therefore, the present study was conducted to evaluate the prevalence of posttraumatic stress disorder (PTSD) during pregnancy and postpartum period. Methods: A total of 3475 articles were found by searching keywords of PTSD, pregnancy, stress, and birth, through various research databases, including PubMed, Google Scholar, and Science Direct; 37 papers turned out to be completely relevant, 18 of which had provided through examination of the prevalence of intended disorder. Results: The prevalence rate varied from 0% to 21% in community-related samples; this rate varied from 0% to 43% in high-risk samples. Conclusion: PTSD is a common phenomenon during pregnancy and postpartum period, and it might get worse and worse unless it is diagnosed and treated after delivery. Thus, it is recommended to assess pregnancy and postpartum services.
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An investigation into symptoms, diagnosis, treatment, and treatment complications in patients with retrosternal goiter p. 224
Manouchehr Aghajanzadeh, Mohammad Reza Asgary, Fereshteh Mohammadi, Haniye Darvishi, Yasaman Safarpour
DOI:10.4103/jfmpc.jfmpc_286_17  
Introduction: Retrosternal goiter refers to any thyroid enlargement in which over 50% of the thyroid permanently located under the thoracic inlet or the lower pole of thyroid is not palpable with the neck in hyperextended position. Due to the increasing number of surgical procedures of retrosternal goiter, the present study was carried out to examine the symptoms, diagnosis, treatment, and treatment complications in retrosternal goiter patients. Materials and Methods: Data related to demographic data (age and gender), clinical symptoms (dyspnea, dysphagia, dysphonia, lumps in neck, and hoarseness), methods of diagnosis (computed tomography [CT], chest X-ray [CXR], ultrasonography, and magnetic resonance imaging), and postoperative complications (bleeding, early and late dysphonia, early and late dyspnea, transient and permanent hypocalcemia, transient, and permanent recurrent laryngeal nerve paralysis) were collected. Results: According to the results 71.4% of patients were women and most of the participants (67.1%) aged 45–60 years. Mass in the neck was the most frequent symptoms before surgery (88.6%). The most common incision for thyroidectomy (95/7%) was neck Collar incision. Diagnosis method in 82.9% and 17.1% of cases was, respectively, based on CT scans with CXR and CT scans with CXR and ultrasound. According to the postoperative pathologic findings, 58.5% of the cases were multinodular goiter, 22.9% were papillary cell carcinoma, 7.1% were medullary carcinoma, 5.7% were anaplastic carcinoma, 5.7% were thyroid lymphoma, and only 1.4% were thyroid adenoma. Postoperative complications occurred in 47.14% of patients. Most common complication was early transient dysphonia. Conclusion: This study recommends that retrosternal goiter should be operated early under suitable conditions, and the best diagnosis tool and best surgery methods are CT scan and surgery with collar incision, respectively.
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The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: A qualitative study p. 230
Simin Jahani, Heidarali Abedi, Masoud Fallahi Khoshknab, Nasrin Elahi
DOI:10.4103/jfmpc.jfmpc_233_17  
Background: To respond to the growing and emerging needs of the people in the health sector, the nurses need to develop their working domain from the hospitals to the community and be prepared to provide entrepreneurial roles at different care levels. Thus, to discover how to identify entrepreneurial opportunities in the field of nursing entrepreneurship, a study was conducted with the aim of describing the experiences of Iranian entrepreneurs on the identification of proper opportunities in entrepreneurship. Materials and Methods: This study was a qualitative research in which the Graneheim and Lundman's content analysis was used to collect and analyze the data. Thirteen entrepreneurial nurses were purposefully selected, and the data were collected by unstructured interviews. Results: As a result of data analysis, three main themes were obtained including the resources for opportunity identification and opportunity assessment and identification of proper opportunities. Conclusion: The findings indicate how to identify entrepreneurial opportunities in the field of health by entrepreneurial nurses which is the first step in the entrepreneurial process. Therefore, the findings of this study can be used to educate nurses who are interested in entering the field of nursing entrepreneurship.
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Comparing the effects of shallomin lotion and cryotherapy on treating plane warts p. 237
Reza Yaaghubi, Mohammad Hassan Pipelzade, Mansur Amin, Mohammad Ali Shakeri Hosseinabad
DOI:10.4103/jfmpc.jfmpc_334_17  
Background: Wart is a common transferable skin disease that is caused by human papilloma virus. Choosing the best treatment method can vary based on age, therapeutic goal, complications, and wart place. Due to antibacterial effect of shallomin (hirtifolium Boiss extract) and since its effect has not been studied yet, it was compared to cryotherapy therapeutic methods for treating patients with plane warts. Methods: The present study was a randomized clinical trial that was carried out on 40 patients. Sampling was conducted simply by 4 block randomization method. The selected patients were assigned into two Groups of A and B. Data analysis was conducted by descriptive methods, and then, statistical tests including Chi-square, Fisher's exact test, and t-test were run to determine the relationship between qualitative and quantitative variables. In so doing, SPSS software version 16.0 was utilized. Results: Comparing the means showed that as opposed to cryotherapy, shallomin could not lead to a significant decrease in the size and number of warts. Conclusion: According to the results of this study, which is the first and the only investigation into the effects of shallomin on treating plane warts, it can be stated that despite of its antibacterial, antifungal, and anti-herpetic properties, shallamin cannot be a clinically effective option for treating plane warts.
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CASE REPORTS Top

A novel surgical correction and innovative splint for swan neck deformity in hypermobility syndrome p. 242
Karthik Vishwanathan, Deepak Ganjiwale
DOI:10.4103/jfmpc.jfmpc_14_17  
Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an uncommon condition, and it can be seen in rheumatoid arthritis, cerebral palsy, and after trauma. Conservative treatment of the swan neck deformity is available by different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. This case report describes the result of novel surgical intervention and an innovative hand splint in a 20-year-old female with a history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS) tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work sometimes for as static and some time as dynamic for positional and correction of the finger. After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and can work independently.
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Presentation of an unusual metallic foreign body in a child p. 246
Ravikiran Vernekar, Maninder Singh Setia
DOI:10.4103/jfmpc.jfmpc_410_16  
Ingestion of foreign object is a common problem with children. These foreign bodies (FBs) can be in the respiratory tract of the aerodigestive tract. A 14-month-old male child presented to the emergency department of our hospital at 6.30 pm with irritability and continuous crying. On radiology, we found that the metallic body in the shape of a cycle was lodged in the upper esophagus. We decided to remove the FB endoscopically using an esophagoscope. We used meticulous and gentle manipulation around the edge of the metallic FB and did over a sufficient amount of time so as to dislodge the body from the impacted esophageal mucosa without causing any trauma or bleeding from the adjacent site. The child was placed under overnight observation in the hospital. The stay in the hospital was uneventful, and the child was discharged the next day. We would like to present this case due to unusual shape and nature of the FB and the difficulty encountered in clinical management of the patient.
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Rhupus syndrome and Chiari's network p. 249
Gokhan Sargin, Taskin Senturk, Songul Cildag
DOI:10.4103/jfmpc.jfmpc_197_17  
A 69-year-old female patient was admitted to our clinic with photosensitivity, symmetric erosive polyarthritis, and cutaneous vasculitis of lower extremities. Rhupus syndrome was diagnosed, and Chiari's network in the right atrium and interatrial septum patent foramen ovale was achieved on transthoracic and transesophageal echocardiography. If it is thought that increased prevalence of antiphospholipid antibodies in patients with rhupus, this congenital remnant is important for the thrombosis risk, cardiac event, and stroke. The association of both diseases may lead to more serious events and cause worse prognosis. Here, our aim is to present a 69-year-old female patient with rhupus syndrome presenting with cutaneous vasculitis and Chiari's network in the right atrium.
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Frontal meningioma with psychiatric symptoms p. 252
Suria Hussin, Siti Suhaila Mohd Yusoff, Faridah Mohd Zin, Ab Rahman Izaini Ghani
DOI:10.4103/jfmpc.jfmpc_157_17  
Frontal meningioma is often asymptomatic and patient may present with psychiatric symptoms. We report a case of 45- year-old female patient with no premorbid medical illness presented with 6 months history of depressive symptoms and changes in personality. Her worsening cognitive impairment brought her to psychiatry clinic and led to further investigation with contrast-enhanced computed tomography (CECT) Brain. The result showed well defined markedly enhancing lesion in the frontal region measuring 5.5 cm X5.2 cm X 4.4 cm with mass effect to the adjacent brain parenchyma and associated surrounding edema. Diagnosis of bifrontal tumour-olfactory Groove Meningioma was made. Patient underwent bifrontal craniotomy and tumour excision. The quality of life improved after surgical excision.
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Necrotizing lymphadenitis: If not tuberculosis then what? p. 255
Rhea K Punjabi
DOI:10.4103/jfmpc.jfmpc_162_17  
We present a rare case of Kikuchi disease in a young lady presenting with fever and cervical lymphadenopathy. Clinically, the disease mimics tuberculosis and lymphoma. Lymph node biopsy is diagnostic and treatment is symptomatic. Although tuberculosis is endemic, clinicians should be aware of uncommon conditions as early recognition of the disease will minimize unnecessary evaluation and treatment.
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Quadriceps tendon rupture p. 257
Subhadra Nori
DOI:10.4103/jfmpc.jfmpc_341_16  
Acute knee pain is a frequently encountered problem in the clinical settings. In 2003, American Orthopedic Association recorded that 19.4 million people visited a physician because of a knee problem. Knee pain due to injuries is increasing even among the older population, as a greater number of persons are participating in recreational activities. The quadriceps tendon rupture is not a common condition among acute causes of knee pain. However, it can be quite debilitating. The usual clinical presentation includes a middle-aged person presenting with a history of fall accompanied by swelling and inability to extend the knee. Providers who are faced with this clinical situation should be able to recognize this condition sooner than later. It is very important that precise clinical decisions be made, so as to achieve best outcomes. This article reviews the etiology, epidemiology, clinical presentation, differential diagnosis, and management of quadriceps tendon rupture.
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A rare case of acute intermittent porphyria with ichthyosis vulgaris in a young boy p. 261
Garima Agrawal Varshney, Purti Agrawal Saini, Upendra Ghure
DOI:10.4103/jfmpc.jfmpc_141_17  
Acute intermittent porphyria (AIP) and ichthyosis vulgaris both are autosomal dominant disorders with incomplete penetrance caused by the deficiency of porphobilinogen deaminase enzyme and filaggrin protein, respectively. We report a rare case of a 9-year-old boy having two genetic diseases with an unclear association. An acute attack of AIP is characterized by gastrointestinal symptoms and neuropsychiatric manifestations. Although rare in the first decade of life, the presence of reddish urine with a typical presentation such as abdominal pain, hypertension, seizure, and paresthesias lead us to the diagnosis of AIP. The precipitating factor in the present case was prolonged fasting in Ramadan.
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A case report of hypohidrotic ectodermal dysplasia: A mini-review with latest updates p. 264
Girish Gulab Meshram, Neeraj Kaur, Kanwaljeet Singh Hura
DOI:10.4103/jfmpc.jfmpc_20_17  
Ectodermal dysplasia (ED) is a rare hereditary disorder involving two or more of the ectodermal structures, which include the skin, hair, nails, teeth, and sweat glands. The two most common forms of the disease are hypohidrotic/anhidrotic ED and hidrotic ED. They are caused by the mutations of several genes. We present a case of a 9-year-old child with hypohidrotic ED, who presented with hypodontia, dyshidrosis, hypotrichosis, and raised body temperature. We treated the raised body temperature symptomatically with cooling techniques and antipyretics. A multidisciplinary approach with physicians from several fields is required to provide comprehensive medical care to patients with ED.
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Severe hypertriglyceridemia presenting as eruptive xanthomatosis p. 267
Sameera S Vangara, Kyle D Klingbeil, Raymond M Fertig, Jason L Radick
DOI:10.4103/jfmpc.jfmpc_270_17  
Eruptive xanthomatosis is described as the sudden eruption of erythematous yellow papules in the presence of hypertriglyceridemia, often associated with serum triglyceride levels above 2000 mg/dl. Severe hypertriglyceridemia can be caused by primary genetic mutations, secondary chronic diseases, or a combination of both. Uncontrolled diabetes mellitus is a known risk factor. It is imperative for physicians to be aware of eruptive xanthomatosis as a warning sign for severe hypertriglyceridemia due to the underlying risk for the potentially fatal complication of acute pancreatitis. Herein, we discuss a case of a 52-year-old man with uncontrolled diabetes mellitus who presented with eruptive xanthomata and a triglyceride level of 7157 mg/dl, the highest recorded value in the absence of acute pancreatitis, with a remarkable response to drug therapy. A review of the literature is included to discuss the clinical relevance and appropriate treatment of this disease entity.
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Splenic granuloma: Melioidosis or Tuberculosis? p. 271
Fibi Ninan, Ajay Kumar Mishra, Ajoy Oommen John, Ramya Iyadurai
DOI:10.4103/jfmpc.jfmpc_171_17  
Melioidosis well known as a 'great mimicker' is caused by Burkholderia pseudomallei. Even though majority of the patients present with acute infection, around 18 % can present as chronic infection. These latent foci of infection may reactivate to cause fulminant infection at a later date. Due to lack of clinical suspicion and good laboratory facility latent infections are often misdiagnosed and treated as tuberculosis. Chronic splenic granuloma is a rare manifestation of Melioidosis . Deep seated abscess requires atleast 4 weeks of intensive treatment with intravenous antibiotics. Ceftazidime , the drug of choice for melioidosis can cause drug induced thrombocytopenia. Simultaneous use of diclofenac may potentiate this phenomenon. Treatment with meropenem may be life saving in such situitations.
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LETTER TO EDITOR Top

Eighty-eight year-old demented woman lives alone independently p. 274
Koh Iwasaki, Shin Takayama
DOI:10.4103/jfmpc.jfmpc_69_17  
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