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   Table of Contents - Current issue
April-June 2017
Volume 6 | Issue 2
Page Nos. 175-454

Online since Thursday, December 7, 2017

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Need of department of general practice / Family medicine at AIIMS (All India Institute of Medical Sciences): Why the apex medical institute in India should also contribute towards training and education of general practitioners and family physicians Highly accessed article p. 175
Ranabir Pal, Raman Kumar
Family medicine or general practice is the practicing discipline of the majority doctors in India, however formal academic departments of general practice (or family medicine) do not exist in India, as it is not a mandatory requirement as prescribed by the Medical Council of India; the principal regulator of medical education. Currently India has capacity to produce more than 60,000 medical graduates per year, majority of whom are expected to become general practitoners or primary care doctors without under going any vocational training in general practice or family medicine. The 92nd parliamentary standing committee report (on health and family welfare) of the Indian Parliament recommended that Government of India in coordination with State Governments should establish robust postgraduate programs in Family Medicine and facilitate introducing Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous health care for the individuals and families. The authors concur with the parliament of India and strongly feel that “Family Medicine” (community-based comprehensive clinical practice) deserves dedicated and distinct department at all medical colleges in India in order to availability of qualified medical doctors in the community-based health system. AIIMS, New Delhi, along with other newly established AIIMS, should rise to their foundation mandate of supporting excellence in all disciplines of medical science and to this historic responsibility; and not just remain an ivory tower of tertiary care based fragmented (into sub specialties) hospital culture.
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The spice route's perspective on family medicine via the social media project “#1WordforFamilyMedicine” Highly accessed article p. 180
Kyle Hoedebecke, Tasneem Borhany, Sanam Shah, Zakiur Rahman, Hiranthini De Silva, Bipin Nepal, Bhavna Matta
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Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers p. 182
Gurmeet Kaur, Tanu Anand, Nidhi Bhatnagar, Abhimanyu Kumar, Diwakar Jha, Shekhar Grover
Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.
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Searching cause of death through different autopsy methods: A new initiative p. 191
Abhishek Das, Ranadip Chowdhury
A lawful disposal of human dead body is only possible after establishment of proper and valid cause of death. If the cause is obscure, autopsy is the only mean of search. Inadequacy and unavailability of health care facility often makes this situation more complicated in developing countries where many deaths remain unexplained and proper mortality statistics is missing, especially for infant and children. Tissue sampling by needle autopsy or use of various imaging technique in virtopsy have been tried globally to find out an easier alternative. An exclusive and unique initiative, by limited autopsy through tissue biopsy and body fluid analysis, has been taken to meet this dire need in African and some of Asian developing countries, as worldwide accepted institutional data are even missing or conflicting at times. Traditional autopsy has changed little in last century, consisting of external examination and evisceration, dissection of organs with identification of macroscopic pathologies and injuries, followed by histopathology. As some population groups have religious objections to autopsy, demand for minimally invasive alternative has increased of late. But assessment of cause of death is most important for medico-legal, epidemiological and research purposes. Thus minimally invasive technique is of high importance in primary care settings too. In this article, we have made a journey through different autopsy methods, their relevance and applicability in modern day perspective considering scientific research articles, textbooks and interviews.
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Chasing viruses feverishly p. 196
Chandrakant Lahariya
A number of viral diseases have emerged and re-emerged in India and globally, in the last few years. Effective prevention and control of these diseases require, in addition to a functioning disease surveillance system, interventions both before and after disease occurrence, and a combination of personal and population services. However, the current efforts to control emerging viral diseases in India has major therapeutic focus (and attention on diagnostic and curative services) and there is limited attention on preventive and promotive components. It is proposed that for an effective and successful control, a systematic approach is adopted with an appropriate selection of personal and population health services, delivered by government through participation of private sector. This is possible through commitment and leadership of Government and other public health agencies, supplemented by multi agency coordination, sufficient funding and an accountability mechanism.
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Theory of scientific investigation by Hempel and a case of Semmelweis p. 198
Syed Ahsan Raza
Carl Gustav Hempel brought our attention to 19th century Hungarian physician Ignaz Semmelweis and his investigations in “systematic discovery” of solution to a “scientific problem.” The historical account of Semmelweis provided an impetus for Hempel to ponder upon the role of “induction” in “scientific inquiry.” By considering various conjectures, Hempel examined through this case, how a hypothesis once proposed is tested and rejected on the basis of test implication. Somewhere around this account lies the lesson for family practitioners of modern age in how to fight age-old-dogmatic beliefs with simple answers, but the ones that require appreciation from larger academia.
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Nuclear medicine consultation: A useful tool in primary care to enable more accurate diagnosis p. 201
Asif Ali Fakhri
In the high volume general practitioner setting, there is a need for triaging clinical questions pertaining to specific patients into ones that are readily answered, and those that would more effectively and efficiently be answered by the subspecialist. In this way, the nuclear medicine consultation provides the general practitioner a physiologic imaging specialist's perspective for answering complex clinical questions. A formal nuclear medicine consultation can be a valuable tool in identifying a targeted molecular imaging approach to answering a specific clinical question and can prove useful in both appropriate diagnostic study selection as well as accurate image interpretation.
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In the dark even after a decade! A 10-year analysis of India's National Rural Health Mission: Is family medicine the answer to the shortage of specialist doctor in India? p. 204
Pavan Pandey, Sushrut Sharma
The National Rural Health Mission (NRHM) has been successful in reducing maternal, infant, and child mortality rates in India. In addition, it has tremendously improved the infrastructure of India's public health system. It has also placed at least one Accredited Social Health Activist worker in every village of India. However, the NRHM has not been able to overcome the shortage of specialist doctors at Community Health Centre (CHC) level. During 10 years of NRHM, only 81 gynecologists, 34 physicians, and 290 pediatricians have been added at the CHC level. Family medicine specialist can be a viable alternative to these specialist doctors, fill the existing gap, and drastically improve the quality of health care provided at CHC level.
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Are our subcenters equipped enough to provide primary health care to the community: A study to explore the gaps in workforce and infrastructure in the subcenters from North India p. 208
MA Bashar, Sonu Goel
Background: A Sub-Centre (SC) is most peripheral and first point of contact between the primary healthcare system and the community in the rural areas. The success of any nationwide program largely depends on well-functioning SCs providing services of acceptable standards to people. Indian Public Health Standards (IPHS) for SCs was prepared keeping in view the minimum standards required to provide quality and need sensitive health care to the community. Materials and Methods: A cross-sectional study was conducted in Ambala District of Haryana to assess the availability of physical infrastructure, manpower, drugs and equipment in the SCs. A total of 30 SCs from a rural block was selected. The data was statistically analyzed using Microsoft Excel. The deficiencies in the availability of health workers male and female were found to be 66.6% and 50%, respectively. The residential facility for health workers was available only in 33.3% SCs but none being utilized. Although labour room with labour table was present in half of the Sub Centers, the deliveries were found to be conducted in none of those. Only 40% and 26.6% of SCs had stethoscope and functional B.P apparatus. The availability of essential drugs and equipment was also poor. Conclusion: The physical infrastructure and manpower availability at the SCs needs considerable improvement as per the Indian Public Health Standard (IPHS). Poor availability of essential drugs and equipment needs to be addressed at the earliest.
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Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study p. 211
Anurag Minz, Monika Agarwal, JV Singh, VK Singh
Context: Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. Aims: The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. Settings and Design: Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. Subjects and Methods: A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregiver's treatment seeking practices. Results: Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation. Conclusions: Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.
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Prevalence of self-care practices and assessment of their sociodemographic risk factors among diabetes in the urban slums of Bengaluru p. 218
Hemavathi Dasappa, Shankar Prasad, M Sirisha, S V. N Ratna Prasanna, Shruthi Naik
Objective: The objective of this study was to determine the prevalence of self-care practices in the urban slums of Bengaluru among diabetes and also to assess their sociodemographic risk factors. Materials and Methods: A cross-sectional study was done in the two slums of Bengaluru comprising 163 diabetes patients. The prevalence of self-care practices and their sociodemographic risk was analyzed. Results: Maximum adherence was seen for blood sugar testing (77.91%), and least adherence was seen for diet (12.26%). Adherence to exercise was 30.67%, adherence to foot care was 48.46%, and adherence to medication was 60.73%. Some of the sociodemographic factors associated with good self-care practices are young age, gender, formal education, occupation, and religion. Good adherence to medication is associated with better control of blood sugars. Conclusion: A clinician should be able to identify these risk factors and give special attention to these groups of patients and make realistic recommendations for self-care activities.
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Factors associated with childhood asthma control in a resource-poor center p. 222
Bankole Peter Kuti, Kehinde Oluyori Omole, Demilade Kehinde Kuti
Introduction: Optimal asthma control is a major aim of childhood asthma management. This study aimed to determine factors associated with suboptimal asthma control at the pediatric chest clinic of a resource-poor center. Methods: Over a 12-month study period, children aged 2–14 years with physician-diagnosed asthma attending the pediatric chest clinic of the Wesley Guild Hospital (WGH), Ilesa, Nigeria were consecutively recruited. Asthma control was assessed using childhood asthma control questionnaire. Partly and uncontrolled asthma was recorded as a suboptimal control. Relevant history and examinations findings were compared between children with good and suboptimal asthma control. Binary logistic regression analysis was used to determine the predictors of suboptimal asthma control. Results: A total of 106 children participated in the study with male:female ratio of 1.5:1, and majority (83.0%) had mild intermittent asthma. Suboptimal asthma control was observed in 19 (17.9%) of the children. Household smoke exposure, low socioeconomic class, unknown triggers, concomitant allergic rhinoconjunctivitis, and poor parental asthma knowledge, were significantly associated with suboptimal control (P < 0.05). Low socioeconomic class (odds ratio [OR] =6.231; 95% confidence interval [CI] =1.022–8.496; P = 0.005) and poor parental asthma knowledge (OR = 7.607; 95% CI = 1.011–10.481; P = 0.007) independently predict suboptimal control. Conclusion: Approximately, one in five asthmatic children attending the WGH pediatric chest clinic who participated in the study had suboptimal asthma control during the study. More comprehensive parental/child asthma education and provision of affordable asthma care services may help improve asthma control among the children.
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Regional variation in utilization of Antenatal care services in the state of Andhra Pradesh p. 231
Satyendra Nath Ponna, Venkata Prasad Upadrasta, JJ Babu Geddam, Shankar Reddy Dudala, Renuka Sadasivuni, Hemalatha Bathina
Background: Delivery of maternal health care services is a major challenge to the health system in developing countries. Provision of antenatal care (ANC) services is the major function of public health delivery system in India to improve maternal health outcomes and its impact on maternal morbidity and mortality. Studies are lack in documenting variation in utilization of ANC services between geographical regions of Andhra Pradesh (AP). Objective: The objective of this study is to assess variation in utilization of ANC services stratified by geographical region, type of delivery and determinants of utilization of ANC services in AP. Methodology: It is a cross-sectional study of District Level Household and Facility Survey-4 of the state of AP. Multistage, stratified and probability proportional to size sample with replacement was used. Around 3982 women who delivered after the year 2007 were considered for analysis. Binomial logistic regression was carried out to determine association of demographic, system level variables with adequate ANC. Results: Study reveals wide variation across four regions of AP in utilization of ANC services. Reception of adequate ANC was low in Rayalaseema region (27.9%) and high in North-coastal region (42.4%). The utilization of private health facilities for ANC services were highest in South-coastal region (73.2%) and lowest in North-coastal region (43.2%). Conclusion: Policy measures are to be adopted and implemented by government to address the demand-supply imbalance such as public health infrastructure and quality of services in underperforming districts of AP and to increase outreach of current programs by engaging communities.
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Prevalence of HIV infection in pregnant women in Mumbai, India: Experience from 1993-2004 and 2008 p. 240
Ira Shah, Mamatha Lala, Kaizad Damania
Aim: Prevalence of HIV among pregnant women in India is of great concern, especially to prevent HIV in children. Mother–to-child transmission of HIV is the most common cause of transmission of HIV in children. Prevalence of HIV infection in pregnant women in India has ranged from 0.7% to 1.2%. Thus, estimating prevalence of HIV in pregnant women would aid in developing and prioritizing prevention of parent-to-child transmission of HIV programs. Materials and Methods: All pregnant women referred to the antenatal clinic from 1993 onward were tested for HIV infection by ELISA test after pretest counseling. A woman was diagnosed to be HIV infected if she tested positive on more than two HIV ELISA tests. Prevalence of HIV infection in them was calculated and also whether there was an increasing trend was determined. Results: A total of 123,439 pregnant women were tested for HIV from 1993 to 2004, of which 1797 women were HIV infected. Overall, the prevalence rate was found to be 1.4%. Prevalence rose from 0.76% in 1993 to 2.37% in 1998. However, from 2004, the prevalence has decreased to 0.6%. Conclusion: Prevalence of HIV in pregnant women in Mumbai is decreasing.
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Association of social anxiety disorder with depression and quality of life among medical undergraduate students p. 243
Imran Jahangirali Ratnani, Ashok Ukabhai Vala, Bharat Navinchandra Panchal, Deepak Sachchidanand Tiwari, Smruti S Karambelkar, Milankumar G Sojitra, Nidhi N Nagori
Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001). Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.
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Epidemiological characteristics of dengue disease in Saurashtra region, India, during year 2015 p. 249
Madhulika Mistry, Rajesh K Chudasama, Yogesh Goswami, Chintan Dalwadi, Aarohi Mitra, Garima Mehta
Background: Dengue is an important vector-borne disease with a spectrum of classical fever to hemorrhagic fever to dengue shock syndrome. The present study was conducted with objective to study epidemiological and demographic characteristics of dengue infections during the year 2015 in Saurashtra region, Gujarat state, India. Materials and Methods: The study was conducted at Tertiary Care Hospital, Rajkot, during the year 2015. A total of 3312 blood samples were collected and tested for dengue NS1 antigen and IgM antibody by capture ELISA testing from various districts of Saurashtra region. A pretested structured data sheet was used as a tool for data collection, and data analysis was done. Results: Out of 3312 tested samples, 33.4% samples were found positive for dengue. Suspected cases were reported from all age groups, including majority from 15 to 24 years (31.1%) and 25 to 44 years (30.0%) and also 8.4% from 0 to 4 years. More than two-third (68.7%) of males were dengue positive than female cases. Significant numbers of cases (P < 0.01) were residing in urban areas (65.7%). Two-third cases (66.8%) diagnosed after 7 days of fever by IgM antibody test. Increasing number of dengue cases reported from July and reached to peak during October 2015. Conclusion: The present study reported that dengue mainly affected males and urban population. Perennial occurrence with seasonal increase during monsoon and postmonsoon months was reported. Effective implementation of vector control measures through efforts toward vector breeding source reduction and with the use of personal prophylactic measures against mosquito bites will help in reducing the dengue prevalence in the community.
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Introducing gender equity to adolescent school children: A mixed methods' study p. 254
Saba Syed
Background: Over the past decade, gender equality and women's empowerment have been explicitly recognized as key not only to the health of nations but also to social and economic development. The aim of the present study was to assess the effectiveness of a mixed methods' participatory group education approach to introduce gender equity to adolescent school children. It also assessed baseline and postintervention knowledge, attitudes, and practices regarding gender equity, sexual and reproductive health among adolescent students in government-aided schools, and finally, compare the pre- and post-intervention gender equitable (GE) attitudes among the study participants. Methodology: A government-aided school was selected by nonprobalistic intentional sampling. On 5 predesignated days, willing students were included in the intervention which included a pretest, a group of educational-based participatory mixed methods' intervention followed by a posttest assessment. A total of 186 students participated in the study. Results: Girls had better baseline GE scores as compared to boys and they also improvised more on the baseline scores following the intervention. Conclusion: The present mixed method approach to introduce gender equity to adolescent school children through a group education-based interventional approach proved to be effective in initiating dialog and sensitizing adolescents on gender equity and violence within a school setting.
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The prevalence of elevated high-sensitivity C-reactive protein in normal pregnancy and gestational diabetes mellitus p. 259
Renu Kumari, Harkaran Singh
Objective: The objective of this study is to determine the prevalence of elevated high-sensitivity C-reactive protein (hs-CRP) in normal pregnancy and gestational diabetes mellitus (GDM) and to compare the prevalence in both groups. Materials and Methods: We conducted a case–control study between April 2015 and April 2016. Statistical analysis was performed by the SPSS program version 17. Categorical variables were analyzed using either the Chi-square test or Fisher's exact test. Pregnant women who underwent oral glucose tolerance test at 24–28 weeks of gestation were enrolled. We took 25 women with GDM as cases and 25 normal pregnant as control. These patients were analyzed for the level of hs-CRP. Results: The prevalence of elevated hs-CRP in controls was 28% whereas in cases was 76%, with a P = 0.002 which is significant in this study. When compared to elevated hs-CRP in GDM with body mass index and gravid state a P = 0.430, 0.378 was obtained respectively which was not significant whereas age had a P = 0.049 which was significantly associated with elevated hs-CRP (≥3 mg/L). Conclusion: Our result shows an increased level of hs-CRP in GDM as compared to normal pregnant subjects. In this study, we also observed an association of increasing age with elevated level of hs-CRP in GDM. Therefore, hs-CRP can be used as a screening tool for early detection and risk assessment of GDM.
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Maternal health-care seeking behavior in North India p. 265
Anjali Jain, Sujan Singh, Alpana Choudhary, Ashish Jain, Alok Chouudhary
Introduction: Pregnancy and labour, if not kept under constant vigil, can end in serious complications or even death at any moment. The aim of the study was done to know the practices of community regarding maternity care during pregnancy, delivery and postnatal period. Methods: A cross-sectional, community based study was conducted on 120 rural, 120 urban elite and 120 urban slum areas mothers, who delivered within last three months. Results: One-fourth mothers in rural area faced one or the other problem during antenatal period while in urban slum and urban elite only 15% and 9.2% mothers had some problems, this percentage being 19.4 at district level. 14.5% respondents faced some kind of complication during delivery and more problems were faced by rural (17.5%) while least common by urban elite (7.5%) but the area wise difference was not significant. The most common source of treatment was ANM/ LHV/ Nurse (47.1% in rural, 40% in urban elite and 60% in urban slum). 12.8%, mothers took treatment from doctor (Government- 7.2%; Private- 5.6%). More than 10% did not take any treatment (11.8% in rural, 20% in urban elite). Conclusion: Still the large numbers of mothers are not seeking care of their ailments, during prenatal, natal or postnatal especially rural mothers
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An epidemiological study of mortality among mothers admitted in a rural tertiary hospital of West Bengal p. 270
Banasree Bhadra, Ronita Roy Choudhury, Dhrubajyoti Sarkar, Suvobrata Sarkar
Background: Maternal mortality reflects the quality of obstetric services given to pregnant women in the community. Objectives: The objectives of this study were to calculate the maternal mortality rate in a teaching institution, to assess the epidemiological aspects of maternal mortality, and to assess the different causes of maternal mortality. Materials and Methods: This was a retrospective study where individual records of all maternal deaths occurring in our hospital during the past 6 years from 2009 to 2014 were studied. The cause of death and the factors which led to death in each individual case were analyzed. Results: A total of 105 maternal deaths occurred during the study period. The mean maternal mortality ratio in the study period was 233/100,000 live births. Most maternal deaths (37.14%) occurred in the age group of 20–24 years, multiparous women (74.28%) and in women from rural areas (70.47%). Most of the women were unbooked or unregistered patients (64.76%), and 40.95% cases were referred cases. Direct causes accounted for 90.47% of maternal deaths whereas 9.52% of maternal deaths were due to indirect causes. Hemorrhage (26.6%) and eclampsia (27.6%) were the major direct causes of maternal deaths. Conclusion: There is scope for improvement as a large proportion of the observed deaths are preventable. Improving the rural health centers, upgrading the referral centers, and proper transport system is the need of the hour.
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Need for revisiting the role of sexually transmitted disease clinics in government hospitals in India p. 274
Madhulekha Bhattacharya, Hema Gogia
Introduction: The Government of India provides treatment for sexually transmitted infections (STIs) through government's sexually transmitted disease (STD) clinics with the mandate of providing curative and preventive services for clients in the context of STIs. However, besides the patients suffering from STDs, other clients with problems related to reproductive and sexual health also attend these clinics. This study aimed to assess the profile and treatment-seeking behavior of clients attending STD clinics in government hospitals in India. Materials and Methods: This multicentric, cross-sectional study with 5098 participants was conducted over 2 months in identified 19 Indian states. Chi–square test was used for statistical analysis. Results: The percentage with STDs (62.98%) was nearly double than those with non-STDs (37.1%). Around 8.2% of patients had an STD and were also HIV positive. Compared to the total STD cases, only 9% of the partners had turned up for screening. Of significance were the non-STD cases who presented with both physical and psychological symptoms including infertility. Among males, it was mainly sexual dysfunction and balanoposthitis, and in females, lower abdominal pain and bacterial vaginosis. Only 27.3% reported that they had come directly to the government facility/clinic. Nearly 38% of males and 30% of females had tried home remedies before coming to the government clinic. Majority (77.9%) of the clients reported that they had never been counseled on any aspect of STD or HIV. Conclusion: The profile of clients in the various clinics across the country indicates that the name “STD Clinic” is a misnomer since the presenting complaints of clients are varied, and related not only to STDs but also to other reproductive tract problems. Furthermore, the average new patient load observed in our study is low and this was attributed to the name “STDs” given to these clinics. Renaming them as “Reproductive Health Clinics” would attract more patients and lead to better utilization.
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Does being under treatment improve knowledge attitude practice for hypertension: A hospital-based study from North India p. 279
Rajiv Kumar Gupta, Shahid Hussain, Zahida Parveen, Sunil Kumar Raina, Bhavna Langer, Rashmi Kumari
Background: Studies suggest that approximately half of patients with raised blood pressure (BP) are undetected, that half of those detected are not treated, and that half of those treated are not controlled, famously described as the “rule of halves.” Importantly, the cornerstone of the primary prevention of cardiovascular diseases is early detection and drug treatment (antihypertensive) of patients with high BP. Studies across populations in developed world have shown that awareness and management of high BP levels are far from optimal. The present study was planned with the aim to assess the knowledge, attitude, and practices (KAP) regarding hypertension in hypertensive patients visiting Tertiary Care Hospital in North-West India. Materials and Methods: Already diagnosed hypertensive patients seeking care at the tertiary care center were selected for this study. The participants were recruited using consecutive sampling technique. All participants were interviewed with the help of a semi-structured questionnaire after obtaining a written informed consent. The components of the KAP were recorded using a score sheet. Results: In all, 394 hypertensive patients of whom majority (239/394; 61%) were males, were included in the study. The KAP score among the study subjects was 88.4%, 90.83%, and 95.83%, respectively. Males had higher knowledge about normal BP levels which was statistically significant (P < 0.01). Among the attitude, regular intake of anti-hypertensive drugs, regular investigations, lifestyle changes, avoidance of salt and allopathic medicines being the best for the treatment of hypertension were found to be significant statistically (P < 0.01). Conclusion: The high score among the study population can be attributed to the fact that all study participants were diagnosed patients of hypertension seeking care in a tertiary care hospital.
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Knowledge, attitude, and practice of foot care in patients with diabetes at central rural India p. 284
Bharati Amar Taksande, Mukesh Thote, UN Jajoo
Introduction: Diabetic foot syndrome is one of the common and most devastating preventable complications of diabetes mellitus (DM). It is associated with morbidity and premature mortality due to long-term complications affecting foot. The American Diabetes Association recommends that people with diabetes should have a comprehensive foot examination once per year. Most of the foot problems can be prevented with careful foot care. It may take effort and time to build up good foot care habits, but self-care is essential. Aim: The main aim of the study is to analyze the knowledge, attitude, and practice of foot care in patients with DM in central rural India. Methodology: This study was conducted at a rural educational hospital in central part of India over 200 patients who have Type 1 and Type 2 diabetes. They were evaluated for their knowledge about foot care and footwear practices. A structured and validated questionnaire was administered to cases. Results: Around 82.9% of the patients were aware of the disease and 23.2% were aware of the complications of the DM. In 63% of the patients, foot care examination and education regarding foot complications were not suggested by their treating physicians. Annual examination of feet by the physician and self-examination were not known facts to the diabetic population. Conclusion: It is necessary to firstly develop awareness of diabetes mellitus and the related complications, one amongst which is foot care. Certain educational strategies should be established for both the consultant physician and also the common man to create awareness for effective foot care.
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Exercise in patients with Type 2 diabetes: Facilitators and barriers - A qualitative study p. 288
TS Advika, Jyothi Idiculla, S Jaya Kumari
Introduction: Diabetes is a major noncommunicable disease affecting more than 65 million Indians. Although treatment algorithms suggest lifestyle measures (diet and exercise) along with medications data regarding adherence to exercise as well as facilitators and barriers to the practice of physical activity in such patients are limited. Hence, this qualitative study was conducted. Objectives: The objective of this study is to describe the factors which (1) Facilitated and (2) hindered the practice of regular exercise in patients with Type 2 diabetes. Methodology: The study was conducted on 13 diabetic patients admitted to a tertiary care center in Bengaluru - St. John's Medical College Hospital, to explore factors that acted as facilitators and barriers to physical activity. Data saturation with the coded themes was achieved on interviewing 13 patients, after which, thematic analysis was done, and final themes reported. Results: The age of the study participants (7 males, 6 females) ranged from 40 to 80 years. Among those who did exercise, factors such as awareness regarding the benefits of exercise and complications linked with diabetes, positive family support, and emphasis by nursing staff emerged as facilitators. Lack of time, obligations to others, inability to link exercise with blood sugar control, lack of perception of obesity as a health issue, inadequate emphasis by physicians, social/cultural issues, lack of infrastructure, and physical restriction were the factors that acted as barriers to physical activity. In addition to the above, a clear lack of adherence to standard guidelines, while advising patients by physicians was also noted. Conclusion: A comprehensive approach by both doctors and nurses, based on standard guidelines, could help in implementing adherence to exercise in patients with diabetes.
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Sputum smear grading and treatment outcome among directly observed treatment-short course patients of tuberculosis unit, Jagdalpur, Bastar p. 293
Kishor Parashramji Brahmapurkar, Vaishali K Brahmapurkar, Sanjay P Zodpey
Introduction: Tuberculosis (TB) is a major global health problem. In 2014, worldwide, 1.5 million deaths were reported from TB. The study was planned to assess sputum smear grading and treatment outcome among TB patients attending tuberculosis unit (TU), Jagdalpur of Bastar district in Chhattisgarh. Materials and Methods: It was a record-based analysis for the year 2014 data from TU, Jagdalpur, Bastar of Chhattisgarh. Statistical Analysis Used: Data entry and analysis were done using STATA/SE 14.1 software. Results: Out of total registered 496 TB patients in 2014, 207 were sputum smear positive with 83 (40.1%) having 3 + and 14 (6.8%) having scanty sputum grading. The percentage of successfully treated was lowest, 71.4% in scanty followed by 1+ (80.2%), compared to 84.1% in sputum smear negative (P = 0.02335). Overall rate of unfavorable outcome was 16.9%. Factors associated with unfavorable outcome were age more than 40 years (P = 0.01894), male gender (P = 0.06722), and retreatment cases (P = 0.0001136). Death rate was higher (6.6%) among patients of Category II. Higher default rate in new smear positive (8.3%), new smear negative (7.8%), and retreatment (16.7%) was noted. Conclusions: Overall rate of unfavorable outcome was higher in patients with scanty and 1+sputum grading. Age more than 40 years, male sex, and retreatment category were factors associated with unfavorable outcome.
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Birth preparedness and complication readiness in pregnant women attending urban tertiary care hospital p. 297
Vasundhara Kamineni, Anuradha D Murki, Venkata Lakshmi Kota
Background: Birth preparedness and complication readiness (BP/CR) is a strategy to promote the timely use of skilled maternal and neonatal care and is based on the theory that preparing for childbirth and being ready for complications reduce delay in obtaining care. Study Objective: The objective of this study was to evaluate the incidence and predictors of birth preparedness, knowledge on danger signs, and emergency readiness among pregnant women attending outpatient clinic of a tertiary care hospital. Patients and Methods: Six hundred pregnant women attending the outpatient department of a tertiary care hospital for the first time in an urban setting were interviewed using a tool adapted from the “Monitoring BP/CR-tools and indicators for maternal and new born health” of the “JHPIEGO.” The outcomes of the study were birth preparedness, knowledge of severe illness, and emergency readiness. Results: Six hundred pregnant women were in the study. Mean age of respondents was 25.2 (±4) years. The mean gestation at enrolment was 18.7 ± 8 weeks. Among the women who participated in the survey, 20% were illiterate, 70% were homemakers and nearly 70% had a monthly family income >Rs. 15,197 (n = 405). Three hundred and sixteen mothers (52%) were primigravida. As defined in the study, 71.5% were birth prepared. However, 59 women (9.8%) did not identify a place of delivery, 102 (17%) had not started saving money, and 99 mothers (16.5%) were not aware of purchasing materials needed for delivery. The predictors of birth preparedness are multiparity (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.4–3.1), registration in the antenatal clinic in the first trimester (OR: 3.7, 95% CI: 2.2–6.1), educational status of women (OR: 1.9, 95% CI: 1.2–3.0), and pregnancy supervison by a doctor (OR: 5, 95% CI: 2.8–6.6). One hundred and sixty-four women (27%) made no arrangements in the event of an emergency, 376 women (63%) were not aware of their blood group, and 89% (n = 531) did not identify any blood donor. Only 20% (n = 120), 15.8% (n = 95), and 12% (n = 73) of the respondents had knowledge of at least 3 danger signs of pregnancy, labor, and severe illness in newborn, respectively. Conclusions: Nearly three-fourth pregnant women attending a tertiary care hospital in an urban area are birth prepared. However, emergency readiness and awareness of danger signs are very poor. Maternal education and early booking have an independent association with birth preparedness.
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Morbidity pattern and its relation to functional limitations among old age rural population in Kerala, India p. 301
R Anil Das, S Ganesh Kumar, Gautam Roy
Background: In the present era of demographic transition, morbidity pattern among geriatric population and its relation to functional limitations is an important health issue in developing countries. Objective: The objective of this study was to assess the reported morbidities and its relation to functional limitations among rural geriatric population. Materials and Methods: A community-based cross-sectional study was carried out among 167 old age participants aged ≥60 years to assess morbidities and its relation to functional limitations in a rural area of Kerala, India. Sociodemographic details, blood pressure, diabetes, visual impairment, and other reported diagnosed morbidities were assessed by interview using structured pro forma. Functional limitations for activities of daily living were assessed by 10-item Barthel index scale. Results: Overall prevalence of any morbidity was 89.2% (149/167) and moderate or severe functional limitation was 9% (15/167). One morbidity was reported by 34.1% (57), two morbidities 24% (40), three or more 31.1% (52) of the participants. Most common morbidities include hypertension (63, 37.7%), diabetes and visual impairment (61, 36.5% in each), joint pains or backache (51, 30.5%). Age group was significantly associated with joint pain/backache and visual impairment while gender with diabetes, hypertension, and chest diseases. Higher functional limitation is significantly more among those with joint pain or backache (P < 0.05). Among those with moderate and severe functional limitation, majority (12, 80%) had ≥3 morbidities. Conclusion: The reported morbidities are high, but moderate or severe functional limitation is more common among those with joint pain or backache and ≥3 morbidities.
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Psychiatric morbidity in spouses of patients with alcohol related disorders p. 305
Aruna Dandu, S Bharathi, Shankar Reddy Dudala
Context: Alcohol dependence is on rise world over, especially in developing countries such as India. According to the World Health Organization, about 30% of Indians consume alcohol, out of which 4%–13% are daily consumers and up to 50% of them, fall under the category of hazardous drinking. Another worrying trend from India is that the average age of initiation of alcohol use has reduced from 28 years during the 1980s to 17 years in 2007. In India, alcohol abuse also amounts to huge annual losses due to alcohol-related problems in workplaces. This was a cross-sectional, noninterventional study which was carried out at the Department of Psychiatry, Sri Venkateswara Ramnaraian Ruia Government General Hospital (SVRRGGH), Tirupati, Andhra Pradesh. Aim: The aim of this study was to determine the frequency and nature of psychiatric morbidity in spouses of patients with alcohol-related disorders (ARDs). Methods: Study design - Hospital-based cross-sectional study. Study setting - Psychiatry Department of SVRRGGH, Sri Venkateswara Medical College, Tirupati. Study period - October 1, 2014 to September 30, 2015. Study units - the spouses of adult patients attending the Department of Psychiatry, with a diagnosis of ARDs. After the ethical clearance from the Institutional Ethical Committee, the spouses of adult patients attending the Department of Psychiatry with a diagnosis of ARDs according to the International Classification of Diseases-10 classification of mental and behavioral disorders constitute the population for the investigation. After obtaining written informed consent from each of the concerned subjects, demographic details and history of psychiatric illness were noted as per the structured pro forma. Results: The age of the alcohol-dependent men and spouses of men with ADS ranged from 23 to 67 years (mean ± standard deviation [SD] 41.24 ± 10.101) and 21–60 years (mean ± SD 35.04 ± 8.98), respectively. Among the study population, 36.6% of alcohol-dependent men were in the age group of 31–40 years and 43.6% of wives were in between 31 and 40 years. Conclusion: The findings of association of duration of alcohol abuse by husband, marital life satisfaction, poor family support, low socioeconomic status with psychological morbidities in spouses of men of alcohol related disorder are in agreement with earlier studies. But community studies with adequate sample size are required to estimate the effect of these key determinants.
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Prevalence of bronchial asthma and factors associated with it among higher secondary school children in Ernakulam district, Kerala, Southern India p. 311
Jishnu Sathees Lalu, PS Rakesh, K Leelamoni
Context: Bronchial asthma is one of the leading causes of hospitalization and cause of frequent absenteeism among children and adolescents. Studies reporting the prevalence of bronchial asthma among adolescents from India are limited and the available studies report wide geographic variations in the prevalence of bronchial asthma. Aims: The current study was aimed to estimate the prevalence of bronchial asthma among higher secondary school children and to identify various factors associated with it in Ernakulam district, Kerala, Southern India. Settings and Design: The study was conducted in Ernakulam district, the industrial capital of Kerala. A school-based cross-sectional study was conducted. Subjects and Methods: Data were collected from 629 students from 4 randomly selected higher secondary schools using a structured questionnaire. Section on details of respiratory symptoms was adapted from International Union Against Tuberculosis and Lung Disease bronchial symptoms questionnaire. Statistical Analysis Used: Descriptive statistics was done with frequencies and percentages and confidence intervals (CIs) were calculated. Univariate and multivariate analysis was done for factors associated with bronchial asthma generating odds ratios (ORs) and 95% CIs. Results: A total of 629 students participated in this study. The prevalence of bronchial asthma was estimated to be 9.9% (95% CI = 7.53%–12.27%). Students residing in a rural area (adjusted OR = 1.95, 95% CI = 1.10–3.46) having family history of bronchial asthma (adjusted OR = 2.84, 95% CI = 1.57–5.11) and usual exposure to friend's smoke (adjusted OR = 2.16, 95% CI = 1.17–3.97) were significantly associated with bronchial asthma. Conclusions: The prevalence of bronchial asthma was higher among higher secondary school students of Ernakulam district. Considering high prevalence and its contributions to morbidity and mortality, a comprehensive program to tackle the issue of chronic respiratory diseases may be needed. The issue of active and passive smoking at schools exists and need to be resolved.
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A chart review of morbidity patterns among adult patients attending primary care setting in urban Odisha, India: An International Classification of Primary Care experience p. 316
Subhashisa Swain, Sandipana Pati, Sanghamitra Pati
Introduction: Disease burden estimations based on sound epidemiological research provide the foundation for designing health services. Patients visiting a primary care often present with symptoms and signs. Understanding the burden is crucial for developing countries including India. The project aimed to record the reasons for encounter (RFE) at primary care settings for estimating the burden at the health-care facility. Methodology: This cross-sectional study was undertaken at four urban health dispensaries of Bhubaneswar, Odisha, with the aim to explore the prevailing patterns of diseases among patients attending these facilities. Data collection spanned from May to October 2012. At each center, patients' information on age, sex, religion, and presenting illness was extracted from the outpatient records over these time period. Data were entered and analyzed in SPSS version 20, and the International Classification of Primary Care-2 was used for coding the illnesses. Results: In total, 2249 patient's records were extracted over 12 weeks. Out of them, 1241 (55.2%) were male with mean age of 41.8 (±15.8) years vis-à -vis 38.2 (±14.1) years for females. Around 151 (6.7%) had 2 or more symptoms or conditions. Overall, the most common categories were general and unspecified followed by digestive-related symptoms in both sexes. The most common symptoms among males were fever (11.4%), heart burn (8.1%), and vertigo or dizziness (3.6%). Similar pattern was seen among females. Respiratory (17.0%) and cardiovascular (10.2%) problems were the most common RFEs among males and females. The most common RFEs for acute care among males and females were fever, allergic rhinitis, upper respiratory tract infection, and acute bronchitis. Leading RFEs for chronic care among males were hypertension uncomplicated, heart burn, low back pain, whereas among females, hypertension and heartburn were mostly seen. Conclusion: Primary care settings are experiencing both communicable and non-communicable diseases along with injuries. Understanding the distribution of the diseases are essential to design appropriate service package at primary care.
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Anemia in pregnancy and its associated factors among primary care clients in Sagamu, Southwest, Nigeria: A facility-based study p. 323
Oluwafolahan Olugbenga Sholeye, Victor Jide Animasahun, Tessie O Shorunmu
Introduction: In Nigeria, anemia in pregnancy is one of the leading causes of poor pregnancy outcomes. This study, therefore, determined the prevalence of anemia and its associated factors, among pregnant primary care clients in Sagamu, Nigeria. Materials and Methods: A cross-sectional descriptive study was carried out among 400 pregnant, primary care clients in Sagamu, selected through multi-stage sampling. Data were collected with the aid of an interviewer-administered, semi-structured questionnaire, a stadiometer, measuring tape, and a hemoglobinometer. Data were analyzed using SPSS version 17.00. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Results: The mean age of respondents was 25.4 ± 4.2 years. Most respondents (51.8%) were traders. About a third (32.5%) of respondents were anemic; of these, 72.1% were mildly anemic, while 27.1% were moderately anemic. Anemia was associated with household food security (P = 0.044) and level of food insecurity (P = 0.001) but not with age, occupation, educational status, household size, number of previous pregnancies, body mass index, mid-upper arm circumference, snacking, vegetable intake, and food avoidance (P > 0.05). Conclusion: Anemia in pregnancy is still high among respondents and associated with household food insecurity. Interventions targeted at improving household food security, dietary intake, and socioeconomic conditions will significantly reduce the prevalence and severity of anemia in pregnancy.
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Compliance to treatment among type 2 diabetics receiving care at peripheral mobile clinics in a rural block of Vellore District, Southern India p. 330
Divya Elizabeth Muliyil, Kanagalakshmi Vellaiputhiyavan, Reginald Alex, Venkata Raghava Mohan
Background: Providing treatment to patients with diabetes mellitus in rural areas at a cost they can afford is a public health challenge. Aims: This study aims to measure the rate of compliance to oral hypoglycemic agents among patients with type 2 diabetes mellitus attending peripheral mobile clinics in rural South India. To study factors that impact glycemic control. Setting and Design: A cross-sectional study was done among patients attending peripheral mobile clinics in a rural block in Southern India. Materials and Methods: Pill counts were done to assess compliance. Participants' dietary intake was measured using a 24 h diet recall and their level of physical activity was measured using the WHO Global Physical Activity Questionnaire. Glycated hemoglobin (HbA1c) was measured for all participants. Statistical Analyses Used: Data were entered on EpiData and analyzed using SPSS. The prevalence of good glycemic control and good compliance was measured. A multiple linear regression was done to study factors affecting glycemic control. Results: Overall 52% of the participants were compliant to at least one drug and 50% had achieved good glycemic control. Compliance increased by 2.1% with every passing year since the diagnosis of diabetes. HbA1c reduced by 0.09% for every 10% increase in overall compliance. Conclusions: Levels of compliance and glycemic control achieved through this primary care team is comparable to those achieved through other systems.
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Level of tobacco dependence among tobacco users in an urban slum of Puducherry: A pilot study p. 336
Bijaya Nanda Naik, Marie Gilbert Majella, S Parthibane, Sitanshu Sekhar Kar
Context: Successful tobacco quit by the tobacco users can avoid millions of premature death. However, the physical dependence on tobacco use results in frequent relapse most commonly due to withdrawal symptoms. Aims: The aim of this study was to study the level of tobacco dependence among tobacco users in an urban slum of Puducherry. Materials and Methods: This facility-based descriptive pilot study was conducted among patients aged 15 years or above attending an urban health and training center in an urban slum of Puducherry. A total of 90 consecutive current tobacco users were included after obtaining verbal informed consent and interviewed using a pretested questionnaire. The information on tobacco dependence was collected using Fagerstrom Addiction Scale for smokers and smokeless tobacco users separately. Results: Of the 90 current tobacco users, 95% were daily tobacco users. Of the current tobacco users, 48.8%, 45.6%, and 5.6% were smokers, smokeless tobacco users, and dual users, respectively. Majority of the smokers (61%) and most of the smokeless tobacco users (41%) had medium dependence for tobacco use. However, physical dependence was much higher among smokeless tobacco users (41.3%) than smokers (20.4%). Conclusion: Proportionately high physical dependence on tobacco is a concern in the study population. Community-based interventions are required to curb the problem; however, study with representative sample should be carried out before that.
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Morbidity pattern and its sociodemographic determinants among elderly population of Raichur district, Karnataka, India p. 340
Leyanna Susan George, Sanjay Deshpande, MK Krishna Kumar, Ramesh S Patil
Context: India is an “aging nation” with 7.7% of its population being above 60 years of age. It has resulted in a rise of both physical and mental health morbidities. Aims: This study aimed to gather information regarding the morbidity pattern and its sociodemographic determinants among the elderly residing in the rural villages of Raichur, to understand the need for geriatric health-care facilities. Settings and Design: This community-based cross-sectional study was carried out in six rural villages of Raichur District, of which 230 elderly were selected randomly. Subjects and Methods: The data were collected using a questionnaire, clinical history, examination, and cross-checking of medical records. Statistical Analysis Used: Data were analyzed using Epi Info version-3.5.3. Results: The prevalence of morbidity was 91.7% with an average of 3/person. Females (58.9%) had more morbidities than men (41.1%). The 3 most common morbidities were orthopedic (50.5%), cataract (50.4%), and respiratory (31.3%). 26.6% suffered from gastrointestinal morbidities while 23.9% had dental problems. 20.9% had hypertension with equal prevalence among both sexes. Only 17.4% were diabetics with majority being women. Central nervous system morbidities were 14.2% while 9.6% suffered from hearing loss and varicose veins. 8.2% had genitourinary-urinary morbidities and incontinence (1.7%) was common among both sexes. Depression (71.1%) and dermatological morbidities (4.7%) were prevalent among women. Only 3.5% suffered from cardiac morbidity and 0.4% from cancer. Significant association was found between age and morbidity and also between socioeconomic class and morbidity pattern. Conclusions: Geriatric care should become an integral part of primary health care. Regular screening and Information, Education, and Communication activities need to be provided early in life for ensuring healthy aging.
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Morbidity pattern and health-seeking behavior of elderly in urban slums: A cross-sectional study in Assam, India p. 345
Kabita Barua, Madhur Borah, Chandana Deka, Rana Kakati
Background: Elderly population in India is increasing fast which indicates a growing share of population with more special needs for health and support. Understanding the morbidities and health-seeking behavior of elderly is essential for strengthening geriatric health-care services delivery. Objectives: The objective of this study was to study the morbidity profile of elderly in urban slum areas and assess their health-seeking behavior. Methodology: A cross-sectional study was conducted in urban slums of Jorhat district of Assam, among 125 elderly selected by simple random sampling. Statistical Analysis Used: The statistical analysis was performed by Chi-square and proportions. Results: The most common morbidity found was arthritis (70.4%) followed by visual impairment (58%). Majority (83.7%) were seeking treatment for their health problems. Among those elderly who did not seek treatment, the most common reasons given were “lack of money” (81.2%) and “not feeling necessary to go to doctor as conditions were age related” (62.5%). Conclusions: More than two-third of slum-dwelling elderly in the present study were suffering from chronic morbidities; a few could not afford proper health care due to lack of money and self-medication practices were prevalent among some. This stresses the need to provide suitable health facilities and affordable health care to the elderly in slum areas to ensure their active aging. Living arrangement of the elderly was found to have significantly influenced their health-seeking behavior. Strategic implementation of policies focusing on the problems and beliefs of slum-dwelling elderly which prevent them from seeking healthcare is the need of the hour.
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A study on the prevalence of depression and its risk factors among adult population of Siliguri subdivision of Darjeeling district, West Bengal p. 351
Sudip Banik Chaudhuri, Pankaj Kumar Mandal, Manasi Chakrabarty, Gautam Bandyopadhyay, Sharmistha Bhattacherjee
Introduction: Considering morbidity and mortality, depression is a burning issue in the modern civilization. Early diagnosis and treatment significantly reduces the incidence of morbidity and mortality. In this context, the present study was conducted to find the prevalence and associated factors of depression among adult population of Siliguri subdivision, Darjeeling district, West Bengal. Materials and Methods: A community-based cross-sectional study was conducted among adult population (≥18 years) of Siliguri subdivision of Darjeeling district, West Bengal. Thirty-cluster sampling method was used to identify the study participants. Beck's depression inventory–II was used as the screening tool. Binary logistic regression was done to find the associated factors of depression using IBM SPSS software Version 20.0 (Armonk, New York). Results: Overall, 36% of the study participants were depressed and 11% were significantly depressed. In binary logistic regression, female gender, rural resident, and lower educational status were found to be significantly associated with depression. Conclusion: Screening of depression and early identification of associated factors helps in reducing the adverse outcome of depression. More than one-third of the population depressed and there were some modifiable associated factors such as educational status and rural residence.
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Can mid-upper arm circumference and calf circumference be the proxy measures to detect undernutrition among elderly? Findings of a community-based survey in rural Puducherry, India p. 356
Kalaiselvi Selvaraj, R Jayalakshmy, Arjumand Yousuf, Arvind Kumar Singh, Gomathi Ramaswamy, C Palanivel
Introduction: Major proportion of the elderly with under nutrition is undetected in the community. One of the feasible ways to detect under nutrition among elderly would be screening in the field settings. in this study, we aimed to identify the utility of alternate anthropometric measures such as mid-upper arm circumference (MUAC), calf circumference, and skin fold thickness in identifying under nutrition among elderly. Materials and Methods: A community-based cross-sectional survey was done among elderly in one of the randomly selected subcenters. Anthropometric measures such as weight, arm span, MUAC, and triceps skinfold thickness were measured as per the standard measurement guidelines by a trained medical graduate. The elderly were identified as undernourished if body mass index (BMI) is <18.5 kg/m2. Utility of alternate anthropometric markers against BMI is represented by area under the curve (AUC) value from receiver operating characteristic curve and correlation coefficient (r). Results: Mean MUAC, calf circumference, and triceps skinfold thickness measured among 271 elderly were 25.6 cm ± 3.7 cm, 27.6 cm ± 3.7 cm, and 3.0 mm ± 1.3 mm, respectively. Among all three proxy anthropometric measures, MUAC had the highest AUC value (AUC = 0.88) Triceps skinfold thickness had the least AUC (AUC = 0.61). The correlation of anthropometric measurements such as MUAC, calf circumference, and triceps skinfold thickness with BMI was 0.74, –0.04, and 0.64, respectively. Conclusion: As MUAC and calf circumference are easy to measure and they are highly correlating with BMI, they can be used routinely by peripheral field workers to assess undernutrition in elderly during their regular house visits.
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A descriptive cross-sectional study on menstrual hygiene and perceived reproductive morbidity among adolescent girls in a union territory, India p. 360
Prakash Mathiyalagen, Birundhanjali Peramasamy, Kavita Vasudevan, Mausumi Basu, Johnson Cherian, Buvaneshwari Sundar
Introduction: Menstruation is a milestone event in a girl's life and the beginning of reproductive life. Lack of knowledge and poor sanitary practices during menstruation has been associated with serious ill-health ranging from genital tract infections, urinary tract infections, and bad odor. Aim: This study aims to explore the knowledge, attitude, and practices about menstrual hygiene and perceived reproductive morbidity among adolescent school girls in Puducherry. Materials and Methods: A school based cross-sectional study was conducted from June 2015 to July 2015 in Puducherry among 242 adolescent school girls in the age group of 12–18 years using multistage random sampling technique. Data were collected using a predesigned pretested, structured proforma by personal interview method after having informed written consent. Results: The mean age for menarche was 12.99 ± 0.9 years; 51.7% of respondents were not aware of menstruation before attaining menarche; 71.5% and 61.2% were not known about the cause and source of the menstrual bleeding, respectively; 78.1% used only sanitary pads whereas 21.9% used both old clothes and sanitary pads as the absorbents. Unsatisfactory cleaning of the external genitalia was practiced by 12% of respondents. Higher prevalence of dysmenorrhea (82.2%) was mentioned by the respondents; 25.2% reported excessive genital discharge. Statistically significant association was found between perceived reproductive morbidity and poor menstrual hygiene practices. About 88.4% of the study population reported any one of the reproductive morbidity, and only 37.4% sought for medical treatment from a health facility. Conclusion: The present study has underscored the necessity of adolescent girls to have adequate and precise knowledge about menstruation before menarche. Proper menstrual hygiene practices which could be imparted through appropriate interventions at earlier stages of life can prevent the girls and women from suffering reproductive morbidities.
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Validity of Indian Diabetes Risk Score and its association with body mass index and glycosylated hemoglobin for screening of diabetes in and around areas of Lucknow p. 366
Mohammad Mustufa Khan, Gyanendra Kumar Sonkar, Roshan Alam, Sudhir Mehrotra, M Salman Khan, Ajay Kumar, Satyendra Kumar Sonkar
Objectives: The present study aimed to assess the validity of Indian Diabetes Risk Score (IDRS) and its association with body mass index (BMI) and glycosylated hemoglobin (HbA1c) for screening of diabetes and obesity. Methodology: A cross-sectional study was designed, and samples were randomly enrolled from Lucknow and its adjoining areas. Totally, 405 subjects were included in the study. We used diabetes risk factors (age, waist circumference, physical activity, and family history of diabetes) for screening of diabetes and abdominal obesity (AO) and BMI for screening of general obesity. HbA1c was used for confirming the diabetes patients in this population. Statistical analysis was applied to all data using SPSS software (version 20.0). P < 0.05 was considered statistically significant. Results: All 405 subjects were assessed for diabetic risk factors, BMI, and glycated hemoglobin. Of these, 56.3% subjects were aged ≥50 years. 1° and 2° AO was found in 47.9% and 40% subjects, respectively. About 27.1% subjects were found to have sedentary lifestyle, and 72.6% were found to have no family history of diabetes. According to IDRS, 272 subjects (67.2%) were found at high risk of diabetes (score ≥60). Based on BMI calculation, 198 subjects were obese, of which 79.3% were found at high risk for diabetes. A significant association was found between subjects with higher risk score and BMI (P < 0.001). Assessment of HbA1c showed that 97 (23.9%) were prediabetic and 204 (50.4%) were diabetic, of which 63.9% and 77%, respectively was at high risk for diabetes as per IDRS. A significant association was found between subjects with higher risk score and HbA1c (P < 0.001). Conclusion: Our study fully supports the validity of IDRS, as it can be used as a cost-effective tool for primary mass screening of diabetes. Moreover, its combination with BMI value and HbA1c can be used for strict monitoring for diabetes and obesity at primary health care centers to reduce the early development of diabetes complications and severe obesity comorbidities.
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Metabolic control targets in Sudanese adults with type 1 diabetes: A population-based study p. 374
Ahmed O Almobarak, Sufian K Noor, Wadie M Elmadhoun, Sarra O Bushara, Reham S Salim, Sittana A Forawi, Heitham Awadalla, Einas S Elwali, Mohamed H Ahmed
Background: Type 1 diabetes is a challenging metabolic disorder for health authorities in Sudan. The objective of this study was to assess the level of glycemic control and to determine the prevalence of dyslipidemia and complications among individuals with type 1 diabetes in Sudan. Materials and Methods: Individuals with type 1 diabetes, who were having the disease for at least 1 year, were invited to participate in this study. Data were collected from two diabetes centers, in the Capital Khartoum and Atbara City, North of Sudan. Participants were interviewed using standardized pretested questionnaire to record medical history, sociodemographic data, and life style characteristics. Blood pressure, body mass index, and waist circumference were measured. Blood samples were taken for measurement of lipid profile and glycosylated hemoglobin. Results: A total of eighty individuals with type 1 diabetes volunteered to participate in this study, 37.5% of males and 62.5% of females. Majority of the patients were aged between 40 and 70 years old. There was poor glycemic control (glycosylated hemoglobin >7%), in 83.8%. Age and sex were significant factors associated with poor glycemic control in this cohort. High cholesterol, triglyceride, and low density lipoprotein were seen in 76.2%, 27.5%, and 48.8% of participants, respectively. Low high density lipoprotein was seen in 33.8%. Hypertension was determined in 21.3%. Peripheral neuropathy, visual impairment, diabetic foot, and myocardial infarction were seen in 50%, 48.8%, 18.8%, and 2.5% of patients, respectively. Conclusion: Sudanese adults with type 1 diabetes have poor glycemic control, high prevalence of dyslipidemia, and long-term complications.
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Prevalence of severe acute malnutrition and associated sociodemographic factors among children aged 6 months–5 years in rural population of Northern India: A population-based survey p. 380
Ajeet Singh Bhadoria, Umesh Kapil, Rahul Bansal, RM Pandey, Bhawana Pant, Amit Mohan
Introduction: National Family Health Survey (NFHS)-3 documented that nearly 57 million children are undernourished in India, which is one-third of the world's share. We planned a study to identify the prevalence of severe acute malnutrition (SAM) among children aged <5 years in a rural population of Northern India. Materials and Methods: A cross-sectional study was conducted at 2 blocks of District Meerut during 2012–2014. A total of 70 villages were identified and all children in the age group 6–60 months were approached through house-to-house visits. Data on sociodemographic profile and anthropometry were collected utilizing standards methods and equipment. The Z-scores for weight-for-age, height-for-age, and weight-for-height (WHZ) were calculated using the World Health Organization (WHO) reference data as standard. SAM (severe wasting) was defined as per the WHO criteria (WHZ score <−3 standard deviation or severe visible wasting or bipedal edema). Results: A total of 19,449 children were screened and 18,463 children (age, 32.6 ± 15.4 years, and 53.4% males) were enrolled, and 466 were excluded due to erroneous age estimation and physical deformities. The prevalence of SAM was 2.2%, 95% confidence interval (CI) 2.02–2.44%, (409/18,463). Multivariate logistic regression documented age (odds ratio [OR]: 0.97, 95% CI 0.96–0.98), nuclear family (OR: 1.25, 95% CI 1.01–1.54), lower occupation of head of family (OR: 1.29, 95% CI 1.05–1.59), and lower paternal education (OR: 1.49, 95% CI 1.16–1.91) as independent predictor of SAM. Conclusion: The prevalence of SAM was lower (2.2%) in this Northern district of India as compared to national prevalence (7.9%). Younger age, nuclear family, lower parental education, and poor occupation of the head of the family predispose a child to SAM.
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Complementary feeding practices among children aged 6–23 months in Aligarh, Uttar Pradesh p. 386
Istiyaq Ahmad, Najam Khalique, Salman Khalil, Urfi , Mohd Maroof
Context: Complementary feeding practices play an important role in the growth and development of the children. Aims: The aim of this study is to determine the prevalence of complementary feeding practices among children aged 6–23 months and its association with various sociodemographic factors. Settings and Design: The study was a community-based, cross-sectional study conducted at field practice area of Urban Health Training Centre and Rural Health Training Centre, Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. Materials and Methods: Mothers of children aged 6–23 months of age interviewed using the infant and young child feeding questionnaire for complimentary feeding indicators, namely, minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). The sample size drawn was 326 using systematic random sampling with probability proportionate to size. Statistical Analysis Used: Wald's statistics, bivariate and multivariate logistic regression. Results: MDD was adequate in 42.6% children, MMF in 50.9% children, and MAD in 35.6% children. MDD was significantly associated with area of residence, birth order of child, and Standard of living index (SLI); MMF was significantly associated with area of residence, sex of child, and literacy status of mother; MAD was significantly associated with area of residence, sex of child, birth order of child, and SLI. Conclusion: The study revealed that approximately 50% of mothers practiced inadequate complementary feeding. The feeding practices were found to be significantly associated with various sociodemographic factors highlighting the importance of addressing these factors if we aim an improvement in feeding practices.
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Breastfeeding practice and knowledge among women attending primary health-care centers in Riyadh 2016 Highly accessed article p. 392
Norah Faleh Al-Mutairi, Yousef Abdullah Al-Omran, PJ Parameaswari
Introduction: Breast milk is the best natural essential nutrition to newborns and infants. However, the practice of breastfeeding (BF) has declined in Saudi Arabia. Objective: The objective of this study was to assess the knowledge and practice of BF with their determinants among mothers in Riyadh. Materials and Methods: In this cross-sectional study, 252 mothers attending the well-baby clinics in Riyadh from March 2016 to May 2017 were selected randomly with their consent and studied by a standardized questionnaire. Results: Of the 252 women, 69.4% were 25–35 years of age and 56.7% with a bachelor degree or higher education. Nearly 75% mothers had education on BF before our study. Mixed feeding was the most preferred method (51.6%) followed by artificial milk (29.4%). The most reported reason for discontinuing BF was breast milk insufficiency (37.3%) and of breastfeed continuation was their perceived benefit (36.6%). Excellent knowledge was observed among 12.7%, good knowledge in 57.1%, and unsatisfactory level in 30.2% mothers. The regression model shows that high school education improved the knowledge by 10.9 points (P = 0.024) and undergraduate by 18.7 points (P value = 0.001) when compared to women who were literate. Women with parity >5 improved knowledge score by 17.3 points (P < 0.001). Conclusion: We observed that majority (57.1%) of Saudi mothers had a moderate level of knowledge on BF benefits and 19% had practiced exclusive BF. There is a need for better educational programs to increase awareness on its benefits for the health situation in the country on the long term.
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Sexual behavior of adolescent students in Chandigarh and their perceptions regarding family life education p. 399
Dinesh Kumar, Naveen Krishan Goel, Ravleen Kaur Bakshi, Manoj Kumar Sharma, Abhik K Ghosh
Background: With rapidly changing lifestyle and exposure to the Internet and mass media, lifestyle and sexual behavior of adolescent students are also changing rapidly. Objectives: To investigate the sexual behavior of adolescent students and to study misconceptions prevailing among them. Methods: A cross-sectional survey of 1022 adolescent students aged 14–19 years as a part of an Indian Council of Medical Research sponsored survey. Sexual behavior explored by interview method. Logistic regression analysis for finding correlates. Results: Intimate friendship was reported by 19.2% respondents. The sexual behavior included 89% exposure to sex-related material, 74.7% were aware of sexual intercourse. Awareness regarding at least one contraceptive was found among 95.5% (94.5% of condoms and 67.2% of emergency contraception). About 6% respondents reported some sex-related problems and 2.5% of all respondents consulted some doctors for these problems. Awareness of HIV/AIDS was quite high (about 99%), and 96.4% of them were of the opinion that it is spread through sexual intercourse. Knowledge regarding transmission of sexually transmitted infections (STIs) through sexual contact was found among 89.2% respondents. Avoidance/abstinence from sex (84.7%), faithful to one partner (81.7), and use of barrier methods (90.3%) was main reported preventive measures for STI's. About 33% want that the discussion about sex should be open and frank, and 69.4% showed the need of sex education in the schools mostly by doctors. Conclusions: Sexual behavior of adolescent students is changing, and awareness about sex acts is also increasing. There is likelihood of indulging in risky behavior by adolescents. Family life education was felt necessary mainly by qualified medical staff.
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Prevalence of depression, anxiety and stress among school going adolescent in Chandigarh p. 405
Raman Kumar Sandal, Naveen Krishan Goel, Manoj Kumar Sharma, Ravleen Kaur Bakshi, Navpreet Singh, Dinesh Kumar
Context: Depressive disorders often start at a young age. There is a need for early identification of depression, anxiety, and stress (DAS) and prevention. The present study was undertaken to find the magnitude of DAS among adolescents. Aims: To find the mental health status of school going adolescents in Chandigarh. The objectives were (i) to study the prevalence of DAS among school going adolescents and (ii) to study the correlates of DAS. Settings and Design: A Cross-sectional survey of students of four classes from 9th to 12th studying in government schools. Subjects and Methods: Ten government schools in Chandigarh were randomly selected through lottery method. In each school, for each of the four classes, a section was randomly selected again by the lottery method. Forty students were selected from each school reaching sample size of 470. DAS scale 21 questionnaires were used. Statistical Analysis Used: The data entry was done in MS Office Excel 2007. The analysis was done in the form of frequency tables, charts cross tables. For statistical significance, Chi-square test and correlation was found between various factors. Results: The prevalence of DAS was 65.53%, 80.85%, and 47.02%, respectively. Overall, comorbidity between depression and anxiety was 57.65%. Extremely severe depression was very less (3%). The prevalence of DAS was higher in females. For depression and anxiety, the peak age was 18 years. Conclusions: The prevalence of DAS was high among school going adolescents in Chandigarh. There is a need for early and effective identification of DAS that can prevent many psychiatric disorders at their nascent stage.
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Process evaluation of child health services at outreach sites during health and nutrition day (Mamta Day) in urban slums of Western India Highly accessed article p. 411
Kedar Mehta, Chandresh Pandya, Paragkumar Chavda, Dipak Solanki
Introduction: Health indicators of rural and urban India show a wide variation. Rural areas have received large focus in child health services, but on the flip side, urban areas have been the last to receive such attention. Materials and Methods: A cross-sectional study was conducted to include one randomly selected outreach session from all the 19 urban primary health centers of Vadodara city from April 2013 to May 2014. Nineteen session sites were observed for the process evaluation of three components of child health care, namely, “planning of Health and Nutrition Day,” “availability of vaccines/logistics,” and “direct observation of actual immunization process” at the site using a structured checklist. Results: Most of the vaccines and logistics were present at all 19 sites visited, but adverse events following immunization kit were observed at ten sites (52%) only. Open vial policy, no-touch technique, and immediate cutting of syringe with hub cutter were implemented at all sites; however, completely filled Mamta Card was observed at 9 (47%) sites only. All four key messages were given at 5 (26%) sites only. Conclusion: Immunization services such as proper vaccine administration with no-touch technique and open vial policy were mainly focused; however, other services such as biomedical waste management, record keeping, and delivery of all four key messages need to be strengthened during Mamta Divas. Strengthening of other child health care services such as growth monitoring, Integrated Management of Neonatal and Childhood Illnesses, and referral services is required in urban areas.
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A comparative study on the level of satisfaction among regular and contractual health-care workers in a Northern city of India p. 416
Jyoti Dixit, Sonu Goel, Vijaylakshmi Sharma
Introduction: Job satisfaction greatly determines the productivity and efficiency of human resources for health. The current study aims to assess the level of satisfaction and factors influencing the job satisfaction among regular and contractual health-care workers. Materials and Methods: A cross-sectional quantitative study was conducted from January to June 2015 among health care workers (n = 354) at all levels of public health-care facilities of Chandigarh. The correlation between variables with overall level of satisfaction was computed for regular and contractual health-care workers. Stepwise multiple linear regression was done to elucidate the major factors influencing job satisfaction. Results: Majority of the regular health-care staff was highly satisfied (86.9%) as compared to contractual staff (10.5%), which however was moderately satisfied (55.9%). Stepwise regression model showed that work-related matters (β = 1.370, P < 0.01), organizational facilities (β = 1.586, P < 0.01), privileges attached to the job (β = 0.530, P < 0.01), attention to the suggestions (β = 0.515, P < 0.01), chance of promotion (β = 0.703, P < 0.01), and human resource issues (β = 1.0721, P < 0.01) are strong predictors of overall satisfaction level. Conclusion: Under the National Rural Health Mission, contract appointments have improved the overall availability of health-care staff at all levels of public health facilities. However, there are concerns regarding their level of motivation with various aspects related to the job, which need to be urgently addressed so as to improve the effectiveness and efficiency of health services.
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Report on a rare single coronary artery anomaly: Need for comprehensive investigations p. 424
Rishi Tuhin Guria, Utkarsh Gupta
Single coronary artery anomaly (SCAA) is a very rare disorder with an incidence of about 0.024%–0.066% which presents with the diverse feature but is mostly asymptomatic. It has found to be one of the pathological states to cause sudden death. We report a case of R-III type of SCAA as classified by Lipton et al. which is only about 15% of all the cases of SCAA which makes it even rarer. Hypoxic environment is thought to be an important cause for the development of such anomalies which gives us clues to determine the predisposing factors to be ruled out in patient's history. Coronary angiography is the key toward definitive diagnosis which can be later supported by computed tomography scan and determination of its subtypes. Depending on the findings and physical state of the patient, medical or surgical treatment can be defined but only after correct diagnosis by comprehensive investigations.
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Peripheral T-cell lymphoma, not otherwise specified p. 427
Kunal Kishor Jha, Suresh K Gupta, Harpreet Saluja, Nuwadatta Subedi
The peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) belongs to a heterogeneous class of aggressive neoplasms. Although several morphologic subtypes of this tumor have been described, no particular genetic, immunological, or distinct clinical features define this disease. Patients can experience night sweats, fever, lymphadenopathy, weight loss, splenomegaly, and/or skin changes. Common laboratory tests reveal that patients have anemia, thrombocytosis, lymphocytosis, eosinophilia, hypergammaglobulinemia, or increased lactate dehydrogenase. In this case study, a patient presented with massive lymphadenopathy and right lower limb swelling, which he developed over 6 weeks. A tissue biopsy and supporting investigations confirmed the diagnosis of PTCL, NOS.
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Benzodiazepine maintenance for alcohol dependence: A case series p. 431
Shivanand Kattimani, Balaji Bharadwaj, Anand Babu Arun
Alcohol addiction is a chronic relapsing syndrome. Benzodiazepines remain as the mainstay for detoxification, taking care of the acute withdrawal syndrome. There is fear of dependence and abuse of benzodiazepines on prolonged use. Here, we selectively interviewed ten cases who were on longer duration of benzodiazepines to elicit their potential perceived benefits, attitudes, and any adverse effect. Three patients experienced adverse effects. None of them had features of benzodiazepine dependence. We opine that in select cases, benzodiazepine use should persist beyond detox period, and its benefits continue beyond the acute withdrawal phase while monitoring their safety/adverse effects.
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Low backache in adults as an initial presentation of acute lymphoblastic leukemia p. 434
Gunjan Garg, Naveen Chawla, Atul Gogia, Atul Kakar
Low backache as an initial manifestation of acute lymphoblastic leukemia (ALL) in adults has been rarely reported. In this hematological disorder, although bone marrow is replaced by malignant cells, not many cases of low backache as an initial presentation of ALL are reported. We present a series of clinical cases with low backache, which on evaluation found to have ALL.
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Idiopathic palatal palsy p. 437
Saud Ahmed, Altaf Hussain, Tejaswini Patel, Husna Rafeeq Ahmed, Mohammed Idris Shariff, Mohammed Yunus Kafil
We report a case of isolated palatine paralysis in a 10-year-old boy. This kid presented with complaints of nasal regurgitation of liquids with nasal speech. Brain magnetic resonance imaging was done which was normal. The patient recovered in 10 days without any residual paralysis. Various causes which include infections, trauma, tumor, and brainstem lesions were investigated, but no predisposing factor was found. The patient responded well to conservative management and had been asymptomatic for 3 months.
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Hemiplegia as a presentation of HIV infection in children: A report of 3 cases p. 439
Ira Shah, Sneha Nandy, Renu Kumari
Strokes are a rare neurological manifestation of HIV infection in children with multifactorial etiologies. We present three HIV-infected children who presented to us with stroke out of which two had cerebral infarcts and who responded to antiretroviral therapy (ART). Third patient had tuberculous meningitis who was lost to follow-up before ART could be initiated.
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Caseous mitral annular calcification mimicking a lung tumor on chest X-ray p. 442
Philip Dingli, Herbert Felice, Adrian Mizzi, Stephen Montefort
Mitral annular calcification (MAC) is a common condition of the mitral valve apparatus. A case involving caseous calcification, a rare variant of MAC is presented. This variant which has a benign course can present as an intracardiac mass and needs to be differentiated from more sinister causes of calcified cardiac masses such as tumor, abscess, and infective vegetation. Often, this requires multimodality imaging with echocardiography, computed tomography, and magnetic resonance imaging. Features of caseous calcification of the mitral valve on these imaging modalities are reviewed as the associations and clinical features.
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Candidate for a live vaccine? p. 445
Justin Ralph Abbatemarco, Alan Taege
Immune dysfunction is a well-known phenomenon in end-stage liver disease (ESLD). The pretransplant period offers a unique window for primary care physicians to optimize the transplant's vaccine protection before antirejection medications are initiated. Live vaccinations are selected cautiously but the varicella-zoster virus (VZV) vaccine, Zostavax, is recommended for pretransplant candidates. This case highlights an ESLD patient who developed disseminated cutaneous VZV within 30 days of vaccination.
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Bridging the gap between observation and brace treatment for adolescent idiopathic scoliosis p. 447
Eric Chun Pu Chu, Kevin Hsu Kai Huang
Adolescent idiopathic scoliosis (AIS) remains the most common and potentially severe form of scoliosis during the rapid growth period. It is generally accepted that AIS is a multifactorial disease controlled by genetic, hormonal, neuromuscular, and environmental factors. Herein, we describe a case of 12-year-old scoliotic girl with a double curve of initially 26° thoracic and 23° lumbar, seeking chiropractic care. The therapy was provided three times/twice a week for 6 months. Adjustments of the spine through chiropractic, both soreness and mobility, were shown to improve. A total correction in Cobb angle of 6° (23%) in the thoracic curve and 7° (30%) in the lumbar curve was illustrated on consequent radiographs. This case highlights the advantage of chiropractic adjustment of early scoliosis primarily because the medical community does not offer any treatment for such a mild scoliosis. Further, randomized trial is warranted to support this viability for AIS.
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A rare case of schizencephaly in an adult with late presentation p. 450
Vijaya Kamble, Amol Madanlal Lahoti, Avinash Dhok, Abhijeet Taori, Nilufer Pajnigara
Schizencephaly, i.e., split brain, is a rare, congenital cerebral malformation. Magnetic resonance imaging is the best neuroimaging modality for its diagnosis. In literature, only few cases have been reported causing symptoms in adults. Symptomatic patients present as hemiparesis, developmental deficits to seizures. This condition is usually found at birth and presents during early years. Appropriate diagnosis of the disease is necessary to avoid incorrect treatment. Here, we present a rare case of left, unilateral, open lip schizencephaly in an adult patient presenting with partial seizures but with an asymptomatic childhood.
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Severe hyponatremia associated with escitalopram p. 453
Gautam Rawal, Raj Kumar, Sankalp Yadav
Hyponatremia is a rare but potentially fatal complication of selective serotonin reuptake inhibitor (SSRI) therapy with only limited cases of escitalopram as the causative drug. We report the case of a 54-year-old hypertensive female who was admitted to the hospital with seizure episode and subsequently diagnosed to have severe hyponatremia due to SSRI-induced syndrome of inappropriate antidiuretic hormone (SIADH) with the cause attributed to the short history of intake of escitalopram for depression. All SSRIs, including escitalopram, can cause SIADH and should be used with caution in the depressive patients with regular monitoring of electrolytes, especially in the elderly.
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