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   Table of Contents - Current issue
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January 2020
Volume 9 | Issue 1
Page Nos. 1-451

Online since Tuesday, January 28, 2020

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EDITORIAL  

National Medical Commission Act 2019: White paper on accelerated implementation of family medicine training programs towards strengthening of primary healthcare in India Highly accessed article p. 1
Raman Kumar
DOI:10.4103/jfmpc.jfmpc_942_19  
Family medicine is the internationally recognized nomenclature for the academic discipline, knowledge domain, and medical specialty of primary care doctors, working in the community setting. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences in the community setting. The distinction of family medicine lies in the tradition of medical generalism, promoting whole person care, in a life cycle mode; providing optimal preventive, promotive, and curative healthcare services in a wide spectrum of setting from home to hospital. In 2016, 92nd report of the department-related parliamentary standing committee on health and family welfare on the “Functioning of the Medical Council of India” has emphasized the need for postgraduate in family medicine. The committee report has noted that “the medical education system is designed in a way that the concept of family physicians has been ignored. The committee recommends that the Government of India in coordination with State Governments should establish robust PG Programs in Family Medicine and facilitate introduction of 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 healthcare for the individuals and families. The successive National Health Policies of Government of India–NHP 2002 and 2017 have emphasized the need of family medicine training in India. The recently enacted National Medical Commission Act 2019 has mandated NMC to promote training in family medicine at both undergraduate and postgraduate levels. Therefore, in the background of the stated policies of the Government of India the concept of family doctors, which was earlier neglected should be institutionalized within the mainstream medical education system of India. It is now time to accelerate and upgrade family medicine training and thereby strengthen the concept of comprehensive primary care in India. This white paper presents the review of family medicine training in India and proposes a way forward.
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INVITED ARTICLE Top

Patient safety in primary and outpatient health care Highly accessed article p. 7
Rene Kuriakose, Amit Aggarwal, Ramandeep Kaur Sohi, Richa Goel, NC Rashmi, Ramandeep Singh Gambhir
DOI:10.4103/jfmpc.jfmpc_837_19  
Primary care services provide an entry point into the health system which directly impact's people well-being and their use of other health care resources. Patient safety has been recognised as an issue of global importance for the past 10 years. Unsafe primary and ambulatory care results in greater morbidity, higher healthcare usage and economic costs. According to data from World Health Organization (WHO), the risk of a patient dying from preventable medical accident while receiving health care is 1 in 300, which is much higher than risk of dying while travelling in an airplane. Unsafe medication practices and inaccurate and delayed diagnosis are the most common causes of patient harm which affects millions of patients globally. However, majority of the work has been focussed on hospital care and there is very less understanding of what can be done to improve patient safety in primary care. Provision of safe primary care is priority as every day millions of people use primary care services across the world. The present paper focuses on various aspects of patient safety, especially in the primary care settings and also provides some potential solutions in order to reduce patient harm as much as possible. Some important challenges regarding patient safety in India are also highlighted.
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COMMENTARY Top

The Saudi Medical Licensure Examination-Clinical Skills (SMLE-CS): A call for implementation Highly accessed article p. 12
Ahmed Abu-Zaid, Hany Salem, Khaled Alkattan
DOI:10.4103/jfmpc.jfmpc_128_19  
The Saudi Commission for Heath Specialties (SCFHS) was founded in 1992 to nationally regulate healthcare-related practices and accreditation. Specifically, SCFHS is the official organization that principally oversees the postgraduate residency training programs (RTPs). A crucial aim of SCFHS is to warrant that medical graduates, prior to their enrollment into RTPs as first-year resident physicians, have national minimum entry standards of learning competencies to practice safe and effective healthcare. Generally, there are three primary domains of learning competencies that should be assessed, namely: theoretical clinical knowledge, practical clinical skills and professional attitudes. SCFHS primarily evaluates the theoretical clinical knowledge of applicants through the administration of the Saudi Medical Licensure Examination (SMLE) and we call on SCFHS to rename the conventional SMLE to SMLE-Clinical Knowledge (CK), or shortly abbreviated as SMLE-CK. On the other hand, to date, there is no examination administered by the SCFHS that assesses the applicants' competencies of practical clinical skills and professional attitudes prior to admission to RTPs. Herein, we call on SCFHS to formally incorporate a mandatory national practical licensure examination. The suggested name is the SMLE-Clinical Skills (CS), or shortly abbreviated as SMLE-CS. The purpose, structure, content, rationale, potential counteractive views and future research directions regarding the SMLE-CS are presented. This proposal is not limited to Saudi Arabia only, and it may be contemplated by the other countries, too.
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EVIDENCE-BASED SUMMARY Top

Salutogenesis: A bona fide guide towards health preservation Highly accessed article p. 16
Sudip Bhattacharya, Keerti Bhusan Pradhan, Md Abu Bashar, Shailesh Tripathi, Arulmani Thiyagarajan, Abhay Srivastava, Amarjeet Singh
DOI:10.4103/jfmpc.jfmpc_260_19  
Preserving health requires a holistic approach involving the component of physical, mental, social, and spiritual well-being as stated by World Health Organisation. Salutogenesis concept focuses on the factors responsible for well-being rather than the disease pathogenesis in contrary to pathogenesis concept. This evidence-based summary tries to shed a light on existing concept called salutogenesis which is much required in the current scenario.
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REVIEW ARTICLES Top

Update on psoriasis: A review p. 20
Jagadish P Rajguru, Deepthi Maya, Dinesh Kumar, Prerna Suri, Shweta Bhardwaj, Nishitkumar D Patel
DOI:10.4103/jfmpc.jfmpc_689_19  
Psoriasis is a disease characterized by the presence of papules and plaques over the surface of skin with variable morphology, distribution and severity. The lesions of psoriasis are distinct from these other entities and are classically very well circumscribed, circular, red papules or plaques with a grey or silvery-white, dry scale. In addition, the lesions are typically distributed symmetrically on the scalp, elbows, knees, lumbosacral area, and in the body folds. The oral manifestations of psoriasis may involve the oral mucosa or the tongue. The dorsal surface of the tongue shows characteristic red patches surrounded with a yellow white border. The relationship between eye lesions and psoriasis are the current findings in the literature. The ocular complications along with the several extracutaneous manifestations are common complications seen in psoriasis. The pathogenesis of exact relationship between these two is still controversial. Immunological studies have shown a positive relationship between T helper cells and uveitis. Various signs and symptoms of ocular psoriasis may be overlooked. Thus, a complete understanding of ophthalmic involvement is important to the comprehensive care of patients with psoriasis. Almost any part of the body can be affected in psoriasis, but the ophthalmic complications of psoriasis usually remain clinically subtle. This review highlights the various manifestations of psoriasis with their clinical sign and symptoms.
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Nursing care (palliative medicine) in patients with neuropsychiatric disorders p. 25
Fatemeh Rezaei, Nasibeh Reamazannezhad, Maedeh Faraji Douki, Fataneh Sabzalipour Shayadeh, Elahe Nejati, Zaynab Ahmadian
DOI:10.4103/jfmpc.jfmpc_701_19  
Background and Purpose: Palliative medicine is a special status focusing on the quality of life of patients suffering from special or advanced diseases. Palliative medicine can be helpful at any stage of the disease, including the diagnosis. Thus, the present study aims at reviewing the application of palliative care in mental disorders. Method: In the present study, as many as 1,149 studies were found in the period of 1985 to 2018 by searching on different websites including Medline, Embase, ProQuest, Global Health, GoogleScholar, and Scopus. As many as 53 studies having to do with mental disorders were found, and more specifically, as many as 36 articles related to palliative medicine were applied. Findings: Reviewing the related literature indicates that the care needs of mental disorders patients are quite complicated. The findings indicated that predicting the complications of the disease, as well as advanced planning in terms of caring for these patients, are of significant importance. The findings indicated that over the last decade two palliative care models have been developed: integrative and consultative. Conclusion: With the growth development of palliative care in developed countries, the knowledge of palliative care can be shared with the nurses and practitioners of neurological diseases, and this knowledge can be applied to palliate and reduce the pains and sufferings of the patients and their families.
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Vogt–Koyanagi–Harada (VKH) syndrome: A new perspective for healthcare professionals p. 31
Yojana B Patil, Ruchira Garg, Jagadish Prasad Rajguru, Manjunath Sirsalmath, Varsha A Bevinakatti, Manish Kumar, Sonika Sharma
DOI:10.4103/jfmpc.jfmpc_787_19  
Vogt–Koyanagi–Harada syndrome (VKH syndrome) is a rare granulomatous inflammatory disease that affects the melanin pigment producing melanocytes and mainly affects the pigmented structures such as eyes, ear, skin, meninges, and hair. VKT is an autoimmune disorder, which is mainly a T CD4+ Th1 lymphocyte–mediated aggression to melanocytes, in individuals with a genetic predisposition, in particular, the presence of HLA-DRB1 * 0405 allele. Melanin usually gives color to skin, hair, and eyes. Melanin is also found in the retina, where it plays a role in normal vision. This disease mainly leads to vision and hearing disturbances, followed by dermal problems. The most common symptoms include vitiligo, headaches, hair loss (alopecia), and hearing loss. This article describes the various signs and symptoms of VKH disease and its pathogenesis.
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Viral infections of oral cavity p. 36
Arvind Babu Rajendra Santosh, Keerthi Muddana
DOI:10.4103/jfmpc.jfmpc_807_19  
Viral infections of the oral cavity usually manifest as either ulceration or blistering presentation of oral tissues. Oral viral infections are encountered in dental practice but received less clinical interest due to the lesser frequency of patients and diagnostic challenges. The clinical presentation, pathogenic mechanism, investigations, and management of oral viral infections are integrated into the article which will enable general dentists to develop critical thinking processes on differential diagnosis and management through a multidisciplinary approach with specialist dentists.
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Strategies for home nutritional support in dementia care and its relevance in low-middle-income countries p. 43
Sherin S Paul
DOI:10.4103/jfmpc.jfmpc_850_19  
Older people suffering from dementia are prone to develop malnutrition. Ensuring adequate nutrition among such patients has always been a challenge for the carers due to the pathological and chronic nature of the disease. In this article, the author tries to analyze the use of five different strategies in providing adequate nutrition for such patients in their own homes by the carers using a narrative literature review method. The strategies include nutrition screening and assessment, training and education program for the caregiver, mealtime environment and routine modification, provision of nutritional supplements, and role of artificial nutrition and hydration (ANH). An attempt was made to critically engage the readers while exploring the feasibility and challenges involved in implementing such strategies in resource-poor settings like low-middle-income countries. The article concludes that the first four strategies should be used in tandem to prevent the risk of malnutrition. It does not recommend ANH and concludes that it does not bring in any added benefit and may worsen the quality of life.
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Alcohol consumption in India– An epidemiological review p. 49
V M Anantha Eashwar, R Umadevi, S Gopalakrishnan
DOI:10.4103/jfmpc.jfmpc_873_19  
One of the most important products of global addiction demand is an alcoholic beverage. In developing countries like India, alcohol consumption tends to be a major problem because of the various socio-cultural practices across the nation, different alcohol policies and practices across the various states, lack of awareness of alcohol-related problems among the community, false mass media propaganda about alcohol use, various alcohol drinking patterns among the alcohol consumers and the emergence of social drinking as a habit because of the widespread urbanisation across the country. Stringent alcohol policies are needed across the various states to reduce alcohol consumption, and alcohol consumers have to be educated about the various harmful effects of alcohol consumption and the effects it can have on their mind, body and soul. This review article focuses on the burden of alcohol consumption in context with its various harmful effects on the mind and body with a note on the alcohol policies in the country.
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ORIGINAL ARTICLES Top

Estimation of the burden of bacteriologically positive Tuberculosis among Adults in Kashmir: A baseline for future surveys in the Valley p. 56
Saleem-ur- Rehman, Rehana Kausar, Syed M Kadri, Nasreen Jan, Bilal Bhat, S Najar, Vijay K Chattu
DOI:10.4103/jfmpc.jfmpc_179_19  
Background: India has the highest burden of both Tuberculosis and MDR-Tuberculosis based on estimates reported in the Global Tuberculosis Report 2016. The estimates have been revised upwards based on the newer evidence, and the current study was done to estimate the prevalence of bacteriologically positive pulmonary Tuberculosis among the adult population and to provide baseline information for future measurements of Tuberculosis burden and trends. Methods: A cluster-based sampling design was adopted in 10 districts of Kashmir valley in India. Assuming a prevalence of 217 per lakh population, a design effect of 2.5, a relative precision of 0.25% and the expected participation rate of 80%, a sample size of 49,716 was achieved. A total of 67 clusters were identified where each cluster had 750 subjects aged ≥15 years, and eligible individuals were questioned for pulmonary symptoms suggestive of Tuberculosis. Results: Of the total 42,805 that were interviewed, 3.85% had pulmonary Tuberculosis symptoms. A total of 1539 sputum samples were collected from symptomatic and 1351 chest X- rays were done. Cartridge based nucleic acid amplification test (CBNAAT) tests were done on individuals with suspicious X-ray findings. The prevalence of bacteriologically positive pulmonary Tuberculosis was found to be 147 per 100,000 population. Females are affected more than males, and the age of female Tuberculosis patients is less than that of males. Conclusion: The study is the first survey of its kind providing a baseline for further research in the state. CBNAAT is going to be game-changer which surmounts the drawbacks of sputum smear microscopy.
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A clinical study to evaluate efficacy and safety of AHPL/AYTAB/0313 tablet in subjects suffering from osteoarthritis of knee(s) p. 61
Sanjay U Nipanikar, Shailesh Deshpande, Ashutosh H Bhosale, Mayura V Jadhav-Shinde
DOI:10.4103/jfmpc.jfmpc_321_18  
Background: Osteoarthritis (OA) is the most common form of arthritis with unsatisfactory treatment outcomes. Objectives: To evaluate efficacy and safety of AHPL/AYTAB/0313 tablet in subjects with OA of knee joint. Study Design: Prospective, open-label, single-arm clinical study conducted in daily clinical practice setting. Method: Subjects were advised to take 2 AHPL/AYTAB/0313 tablets twice daily orally after meals for 180 days. 48 subjects completed the study. The primary endpoints were changes in mean visual analogue scale (VAS) pain score and WOMAC score. Secondary endpoints were quality of life, time to walk 50 feet, knee joint swelling, use of analgesic drug as rescue medicine, and safety parameters. Results: At baseline visit, the mean index knee joint pain (VAS) score was 82.29 ± 15.19, which reduced significantly to 19.38 ± 13.75 on day 180. The mean WOMAC combined score at baseline was 39.94 ± 11.67, which reduced significantly to 09.58 ± 05.77 (76.0%) on day 180. The mean WOMAC pain score at baseline was 09.65 ± 02.91, which reduced significantly to 02.06 ± 01.46 on day 180. The mean WOMAC stiffness score at baseline was 03.48 ± 01.58, which reduced significantly to 00.63 ± 01.08 on day 180. The mean WOMAC difficulty score at baseline was 26.81 ± 09.63, which reduced significantly to 06.90 ± 04.78 on day 180. The mean walking time to walk 50 feet reduced significantly by 40% on day 180. Not a single subject was known to have knee joint swelling from 150 days onwards. Only 5 subjects were using analgesic as rescue medicine on day 180. Twenty-six subjects had adverse events (AEs). Most of the AEs were not associated with the study medication. Vitals and all the safety laboratory parameters were within normal limits both at baseline and on day 180. Conclusion: “AHPL/AYTOP/0113” tablet is safe and significantly effective in reducing pain, swelling, and stiffness of knee joints and improving mobility of knee joints in patients with OA. CTRI registration No. is CTRI/2015/09/006177.
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Effect of artificial sweeteners on insulin resistance among type-2 diabetes mellitus patients p. 69
Kushagra Mathur, Rajat Kumar Agrawal, Shailesh Nagpure, Deepali Deshpande
DOI:10.4103/jfmpc.jfmpc_329_19  
Introduction: Incidence of diabetes mellitus has increased over the past few years, mainly due to our eating habits and physical inactivity. This also includes the use of artificial sweetening agents which have broadly replaced other forms of sugars and have shown a paradoxical, negative effect on blood glucose. Ingestion of these artificial sweeteners (AS) results in the release of insulin from pancreas which is mistaken for glucose (due to their sweet taste). This increases the levels of insulin in blood eventually leading to decreased receptor activity due to insulin resistance. Methodology: It is a crosssectional study that was conducted on patients diagnosed with type-2 diabetes mellitus of a tertiary care hospital in Central India. All the diabetics that presented in the OPD were divided into 2 groups based on whether they use AS (group A) or not (group B). Insulin resistance was calculated for each group using HOMA-IR and graphs were plotted. Results: The HOMAIR values for Group A and B ranged from 0.9–24.33 and 0.12–10.83 with mean values 7.39 and 2.6, respectively, showing that the ones who used AS had a higher insulin resistance. The study also showed that the duration of use of artificial sweeteners had a direct impact on insulin resistance.
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Assessment of salivary antioxidant status and immunoglobulin E in patients with geographic tongue p. 72
Fatemeh Rezaei, Saeedeh Fatholahi, Farzad Rezaei
DOI:10.4103/jfmpc.jfmpc_375_19  
Objective: One of the possible ways of changing human health might be through the oral mucosa. One of tongue disorders is geographic tongue (GT), which classic manifestation is an area of erythema, with atrophy of filiform papillae of the tongue, surrounded by a serpiginous, white, hyperkeratotic border. Saliva is a rich source of antioxidant and fulfills an important role in maintaining the normal function of the oral cavity. The purpose of the present study was to investigate the status of salivary antioxidant and immunoglobulin E in patients with GT and healthy people. Materials and Methods: In this case-control study, samples were gathered from high school students in three municipal regions of Kermanshah, Iran by using multistage random cluster sampling method. The samples included 30 patients with GT (15 men and 15 women with the mean age of 17.6 ± 0.72) and 30 healthy volunteers (15 men and 15 women with the mean age of 17.1 ± 0.61). Saliva samples were collected through standard method, and total antioxidant capacity (TAC), catalase (CAT), and salivary immunoglobulin E were measured. Results: In patients with GT, unstimulated salivary shows increased level of immunoglobulin compared with that of control group (P = 0.013). However, there was no significant relationship between control and GT patient groups regarding TAC of saliva (P = 0.91) and CAT (P = 0.83). Conclusion: It seems that the activity of CAT enzyme and TAC of saliva does not play primary role in the pathogenesis of GT. However, the level of immunoglobulin E present in saliva can function as an indicator of increased sensitivity in GT.
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Comparison of stability changes of various palatal implants p. 77
Poonam K Jayaprakash, Jayaprakash Mugur Basavanna, Rudra Pratap Singh Thakur, Sridhar Kannan, Ningombam Robinson Singh, Hiten Kalra
DOI:10.4103/jfmpc.jfmpc_383_19  
Aim: The aim of this study was to comparatively evaluate stability changes in palatal implants during the early stages of bone healing with chemically modified sandblasted/acid-etched (modSLA) titanium surface compared with a standard sandblasted (SLA) titanium palatal implants. Materials and Methods: A statistically significant number (n = 40; 24 females and 16 males) of adult subjects who volunteered and have their informed consent for participating in the study were selected. These volunteers were randomly allocated to the experimental group (modSLA surface) and to the control group (SLA surface) with 20 subjects in each group. Documentation of implant stability was done by assessing resonance frequency analysis (RFA) at implant insertion, followed by subsequent assessments each week till 12th week from baseline (1–12 weeks). RFA values were expressed as an implant stability quotient (ISQ). Results: Immediately after installation of implant, the ISQ values for both surfaces tested were not significantly different and yielded mean values of 75.28 ± 5.23 for the control and 73.16 ± 4.81 for the test surface. In the first 2 weeks after implant installation, both groups presented only small changes and thereafter a reducing trend in the mean ISQ levels. In the test group, after 4 weeks a tendency toward increasing ISQ values was observed, and 6 weeks after surgery the ISQ values corresponded to those after implant insertion. For the SLA control group, the trend changed after fifth week and yielded ISQ values corresponding to the baseline after ninth week. After 12 weeks of observation, the test surface yielded significantly higher stability values of 78.68 ± 2.9 compared with the control implants of 75.5 ± 3.19, respectively. Conclusion: The results undoubtedly support and validate the potential for chemical modification of the SLA surface to positively influence the biologic process of osseointegration and also a faster healing.
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Prevalence of low physical activity, its predictors and knowledge regarding being overweight/obesity: A community-based study from urban South India p. 82
Jeffrey Pradeep Raj, Joshua Jonathan Norris, Shervin Ploriya
DOI:10.4103/jfmpc.jfmpc_497_19  
Introduction: Physical inactivity is the fourth leading risk factor for mortality and morbidity as per the World Health Organisation (WHO). The current study was conducted in the city of Erode, Tamil Nadu, South India, to estimate the prevalence and predictors of low physical activity (LPA) and assess their knowledge with regards to being overweight/obesity. Methods: It was a cross-sectional study conducted over 24 months from July 2015 to June 2017. Multi-stage random sampling was done in 12 randomly chosen corporation wards. All consenting individuals above 18 years of age were included. Data were collected using a semi-structured questionnaire incorporating the validated International Physical Activity Questionnaire (IPAQ). Results: For the study, 489 individuals were screened and 461 were included. Prevalence of LPA was 49.9% (95% confidence interval [CI]:45.34%, 54.46%). The significant predictors (adjusted odds ratio [OR] [95% CI]) of LPA were patient education 1.129 (1.006, 1.2670); unemployment (2.418 [1.610, 3.631]) and knowledge score (5.172 [1.314, 9.423] 27). In the knowledge assessment, 60.3% of the participants scored less than 50%. The significant predictors of poor knowledge were marital status (unmarried) (3.857 [1.341, 11.091]), lower educational status (1.191 [1.009, 1.362]) and low socioeconomic status (SES) (1.050 [1.005, 1.121]). Conclusion: Prevalence of LPA in our population is fairly high and there is gross knowledge inadequacy.
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Final year dental students' perception and practice of professionalism and ethical attitude in ten Sudanese dental schools: A cross-sectional survey p. 87
Nasr M A Elsheikh, Inshirah M A Osman, Nazik E Husain, Sally M A Abdalrahman, Hala E Y M Nour, Atif A Khalil, Heitham Awadalla, Mohamed H Ahmed
DOI:10.4103/jfmpc.jfmpc_499_19  
Introduction: Professionalism and ethics are essential components of all dental schools. Therefore, this study aimed to assess the level of professionalism among Sudanese undergraduate dental students. Materials and Methods: This descriptive cross-sectional study was conducted among 307 students in the final year undergraduate Dental Surgery Bachelor program with 155 public and 152 private university students. We collected data through a self-administrated, semistructured questionnaire. Results: Although most of the students enrolled in dental schools due to their performance at higher school (P value 0.00), this has no significant effect on their attendance and academic performance afterward (P value 0.25). The perception of the students toward ethics teaching was generally positive in both public (77.34%) and private schools (78.77%). Ethics was represented in the curriculum of both private (51.7%) and public (48.3%) dental schools as perceived by their students. 95.43% and 94.00% of public and private students, respectively, would always or sometimes work in teams, and 98.02% and 94.04% of public and private students, respectively, would always or sometimes respect patients' preference (P value 0.01). A total of 95.33% of the dental students would consult or refer patients with unexpected situations. Only 26% of all students would treat infectious diseases themselves. Conclusion: About three-quarters of Sudanese dental students showed a satisfactory level of perception toward the importance of teaching dental ethics and professionalism. It was reflected in an excellent attitude for teamwork and respecting patients' choices. The demand for teaching professionalism course in every dental school will increase gradually, and family physicians with interest in medical education may play a pivotal role in teaching professionalism to dental students.
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Patient satisfaction about services obtained from a teaching hospital, Port Blair: A cross-sectional study p. 93
Bhanu P S Gaur, G Jahnavi, Pandurang V Thatkar
DOI:10.4103/jfmpc.jfmpc_526_19  
Background: Periodic evaluation of health services delivered to the community is a part of total quality management of health care delivery system in developing countries. Objective: To assess the level of satisfaction among outdoor patients toward health care services available at teaching hospital, Port Blair. Methodology: The study included exit interview of 500 patients, sampled from 8 service delivery points of the health facility. Predesigned and pretested questionnaire based on PSQ-18 scale developed by Marshall and Hays was used as a study tool. Data entry was done in Microsoft excel sheet and analysis was done using IBM SPSS software version 21. Results: It has been observed that the majority of patients (62%) were from urban area. The highest number (32.40%) of respondents was in the age group of 30–39 years category. Mean satisfaction was the highest for communication (3.94 out of 5), followed by general satisfaction (3.69), technical quality (3.46), time spent with doctor (3.41), interpersonal manner (3.35), and least in accessibility and convenience (2.96). Conclusion: Our study showed a good level of satisfaction of patients with services obtained from the referral center. Among the different domains of measurements of patient satisfaction, only accessibility and convenience score was low. Findings of this study would serve as a baseline data for improving the quality of services and making them more clients centered.
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Knowledge, attitude, and practice of childbearing women toward epidural anesthesia during normal vaginal delivery in Alsanayeah Primary Health Care in Khamis Mushait p. 99
Sarah Sultan Ali Alahmari, Meterk ALmetrek, Anfal Yahya Alzillaee, Wafaa Jubran Hassan, Shatha Mahdi Ali Alamry
DOI:10.4103/jfmpc.jfmpc_530_19  
Background: Labor pain is a severe form of agony that females experience while giving birth. A lot of pregnant women prefer epidural anesthesia (EA) to avoid labor pain. Objective: This study focuses on women's general awareness about EA during the childbearing age. Methods: A cross-sectional, hospital-based study was conducted using a self-administered questionnaire. The study included all females of childbearing age getting routine antenatal care. The survey was designed to measure their awareness toward EA. A total of 328 females participated in the study. Of these, 205 (62.5%) women showed a low level of knowledge toward EA. Data were analyzed using the Chi-square test and Independent Samples t-test. Results: Participants in our study included 328 women of childbearing age. Most women (172 [52.4%]) participating in the study were aged between 30 and 40 years. In terms of education, 204 (62.2%) women had university-level education. Two hundred and ninety (88.4%) women were multipara. The majority of women (205 [62.5%]) had a low-level knowledge about EA with a significant relationship between the level of perception and primary education, as well as postgraduation with P < 0.023 and P < 0.001, respectively. Also, previous EA with pregnancy significantly related to the level of knowledge with P < 0.001. Through past pregnancies, 106 (32.3%) women had experience with EA. Of these, EA caused complications in only 13 (12.3%) women and side effects in 29 (27.4%) women. Conclusion: The majority of women of childbearing age had limited knowledge about the benefits and complications associated with EA. During the antenatal visit, it is essential to educate all women about EA. This could be done by the obstetrician, anesthesiologist, or midwives and/or through flyers and brochures.
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Trends in FDA drug approvals over last 2 decades: An observational study p. 105
Angelika Batta, Bhupinder Singh Kalra, Raj Khirasaria
DOI:10.4103/jfmpc.jfmpc_578_19  
Introduction: The discovery of novel drugs is critical for pharmaceutical research and development as well as for patient treatment. Repurposing existing drugs that may have anticipated effects as potential candidate is one way to meet this important goal. Systematic investigation and comprehensive analysis of approved drugs could provide valuable insights into trends in the discovery and may contribute to further discovery of newer drugs systematically. Food and drug administration (FDA's) Center for Drug Evaluation and Research (CDER) every year summarizes novel drugs, some of which are truly innovative and help in advancing clinical care. This study was conducted to find a trend in drug approvals by FDA in the last 2 decades. Awareness of these new drugs amongst the primary care physicians is also crucial as they have been prescribing these agents in the past. Methodology: In this cross-sectional study, we collected, surveyed, and analyzed drugs approved by U.S. Food and Drug Administration (USFDA) from the year 2000 till 2017 identified from ClinicalTrials.gov and online database of FDA. Drugs approved every year were assessed for total number, class of drug, indication, and category of approval. Type of accelerated regulatory pathways and reasons for speedy approvals every year were also studied. Microsoft Office Excel 2007 was used for tabulation and analysis. Results: Total 209 were approved from 2000 to 2008. Out of these 9.09% were indicated for cardiovascular disorders and 12.91% for neurological disorders. Antibiotics (5.26%) and antivirals (5.74%) were least contributed, whereas anticancer drugs (11.96%) and biologics (7.17%) approval remained constant. Whereas, out of three hundred and two drugs approved during 2009--2017, 5.29% were for cardiovascular disorders, 9.93% for neurological disorders. Antibiotics (5.29%) and antivirals (5.96%) were least in number, whereas anticancer drugs (17.54%) and biologics (15.56%) approval took a steep rise in these years. Also, a wide variation in the number and category of approval was observed over a period of years. The use of fast track, accelerated approval, and priority review programs have also been steadily increasing since 2000. Conclusion: There has been a steady rate of introduction of new drugs by CDER over the last two decades. Expedited approval of anticancer and biologics is seen as recent trend in drug development. Relatively, slow progress in approval of drugs for neurological disorders (depression, psychosis, multiple sclerosis, etc.) and lifestyle diseases like obesity, atherosclerosis, diabetes, etc., were seen. These findings reflect more emphasis being laid down in research for anticancer drugs and biologics.
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Prevalence and correlates of Attention Deficit Hyperactive Disorder (ADHD) risk factors among school children in a rural area of North India p. 115
Pawan Sharma, Rajiv K Gupta, Rakesh Banal, Mudasir Majeed, Rashmi Kumari, Bhavna Langer, Najma Akhter, Chandini Gupta, Sunil K Raina
DOI:10.4103/jfmpc.jfmpc_587_19  
Background: Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6–12 years in Government schools of a rural area in Jammu district of J and K. Methods: The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents—preferably the mother. The data thus collected was presented as proportions. Results: ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children. Conclusion: The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.
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A sleep disturbance after total knee arthroplasty p. 119
Rebar M Noori Fatah, Binar Burhan Abdulrahman
DOI:10.4103/jfmpc.jfmpc_595_19  
Background: Knee osteoarthritis (OA) is common arthritis in elderly. Total knee arthroplasty; (TKA) is effective to restore mobility and improve quality of life in patients with OA. One of TKA complications is sleep disturbance. Objective: Aim was to evaluate sleep disturbance after TKA despite differences in postoperative pain managements. Methods: Prospective cohort study was performed on 67 patients who underwent primary TKA by different surgeons during May to March 2019. Samples were collected randomly from different hospitals in Sulaimani, Kurdistan, Iraq. Sleep pattern was assessed by Pittsburgh Sleep Quality Index (PSQI) and pain was assessed by visual analogue scale (VAS) for three months postoperatively. Results: Mean ± standard deviation (SD) age (year) and body mass index (BMI; kg/m2) of participants were 64.2 ± 7.5 (range: 40–82) and 27.3 ± 3.7 (range: 21.3–41.6), respectively. About 83.6% were females with male to female ratio of (0.2:1). There were statistically insignificant associations of age, gender, BMI, and history of diabetes mellitus with PSQI. Degree of pain was gradually decreasing during follow-up, but sleep was better at beginning followed by peaked disturbance after one month, then it started to improve gradually at end of follow-up. Conclusions: Sleep disturbance assessment needs multimodal approaches in order to improve it and satisfy patients.
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AgNOR as an effective diagnostic tool for determining the proliferative nature of different types of odontogenic cysts p. 125
Krishan Kumar Tyagi, Lokesh Chandra, Manoj Kumar, Sameep Singh, Deepak Passi, Jyoti Goyal, Utkarsh Gupta
DOI:10.4103/jfmpc.jfmpc_617_19  
Objective: To determine the proliferative nature of different types of odontogenic cysts using silver-stained nucleolar organizer region (AgNOR) staining. Materials and Methods: Forty histopathological sections of each of odontogenic keratocyst, dentigerous, and radicular growth were taken into study. Two sections were produced using the paraffin block of separate cases, one was stained with hematoxylin and eosin and another segment was stained with silver nitrate method. Results: AgNOR staining shows black dots and other parts of nuclei show yellow-brown dots. Conclusion: AgNOR, which stain for NOR-related proteins, corresponds to cell multiplication. Their amount regarding the number of AgNORs per cyst can be a good marker of the proliferative action of the cell in aggressive cystic lesion having malignant potential.
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Perceived oral health beliefs, traditional practices, and oral health status of nomads of Tamilnadu: A cross-sectional study p. 131
R Sindhu, Sunayana Manipal, Raj Mohan, VV Bharathwaj, N Divya Lalitha, D Prabu
DOI:10.4103/jfmpc.jfmpc_618_19  
Aim: To assess the perceived oral health beliefs, traditional practices, and oral health status of nomads. Methods: A cross-sectional study was conducted among 115 nomads residing in various places of Tamilnadu. Information regarding socio-demographics such as age, gender, occupation, and place of residence were obtained. Study participants were interviewed with a pre-tested questionnaire consisting questions related to oral health beliefs and oral health practices. Clinical examination was carried out to record the oral health status using a proforma. Results: A significant Chi-square association was found with oral health-related beliefs (P < 0.01). However, 30.9% had perceived strong beliefs, 64.3% of the subjects used toothbrush, and 20% had at least one oral mucosal lesion. Conclusion: A significant proportion of nomads had perceived oral health beliefs, which had a significant association with their traditional practices and their oral health was much deteriorated.
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Acute oleander poisoning: A study of clinical profile from a tertiary care center in South India p. 136
Gunasekaran Karthik, Ramya Iyadurai, Ravikar Ralph, Vijay Prakash, K P Prabhakar Abhilash, Sowmya Sathyendra, OC Abraham, Catherine Truman, Alex Reginald
DOI:10.4103/jfmpc.jfmpc_632_19  
Introduction: Yellow oleander (Thevetia peruviana), which belongs to the Apocyanaceae family, is a common shrub seen throughout the tropics. All parts of the plant contain high concentrations of cardiac glycosides which are toxic to cardiac muscle and the autonomic nervous system. Here, we describe the clinical profile of patients with oleander poisoning and their outcomes. Methods and Materials: This retrospective study was conducted over a period of 12 months (March 2016 to February 2017). The data was extracted from the inpatient electronic medical records. Adult patients with a diagnosis of acute yellow oleander poisoning were included in the study. Descriptive statistics were obtained for all variables in the study and appropriate statistical tests were employed to ascertain their significance. Results: The study comprised 30 patients aged 30.77 ± 12.31 (mean ± SD) who presented at 12.29 ± 8.48 hours after consumption of yellow oleander. Vomiting (80%) was the most common presenting symptom. Metabolic abnormalities at presentation included hyperchloremia in 22 patients and metabolic acidosis (bicarbonate <24 mmol/L) in 29 patients. Fifteen (50%) patients had abnormal ECG, of which second-degree AV block was the commonest ECG abnormality seen in 4 (13.3%). Fifteen (50%) patients had transvenous temporary pacemaker insertion (TPI). Having a TPI significantly prolonged the duration of hospital stay (OR 1.85, 95% CI 1.06–3.21, P 0.03). The mortality in the cohort was 2 (6.7%). Conclusion: In patients with yellow oleander poisoning, dyselectrolytemia with ECG abnormalities was common. TPI prolonged the duration of hospital stay. Further studies are required to know the indication for and to ascertain the effect of temporary pacing on survival.
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Assessment of the oral health seeking behavior of patients with premalignant lesions p. 141
Shravani G Deolia, Mrunmayee V Khare, Ritika P Arora, Rana N Chikhale, Revti D Korde, Amit M Reche
DOI:10.4103/jfmpc.jfmpc_636_19  
Background: Before choosing/visiting any dental facility for their treatment, patients consider several factors. These factors may be related to the patient or service provider. The health-seeking behavior of a society defines how health services are used. Aims: To assess the health seeking behavior of patients with premalignant lesions. Material and Method: A cross sectional study using questionnaire was done among the patients who consulted in the Department of Oral Medicine and Radiology, of age 18 and above suffering from precancerous lesions. The questionnaire included 25 close-ended questions which collected information about the demographic details, oral hygiene habits, oral health issues, deleterious habits. The responses were either on dichotomous scale (yes and no) or on the frequency habits. A total of 218 subjects were included in the study. The data were analyzed using the Chi-square test. The acceptable level of significance was reduced to P < 0.05. Result: Slightly over 50% of study participants visited the dentist for their dental problems. Most of the participants visited dental clinic whenever needed. Maximum positive health seeking behavior is seen in fourth and fifth decade and minimum seen in second and third decade. Conclusion: The oral premalignant lesions have high chances of transformation into malignancies. The progression of these lesions can be prevented by stopping the progression at an early stage and thus instilling positive health seeking behavior serves as an important key to it.
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Relationship of subclinical hypothyroidism and obesity in polycystic ovarian syndrome patients p. 147
Prasanta K Nayak, Subarna Mitra, Jayaprakash Sahoo, Eli Mahapatra, Sarita Agrawal, Zamir Lone
DOI:10.4103/jfmpc.jfmpc_654_19  
Objectives: To determine the prevalence of obesity and its relationship with subclinical hypothyroidism in women with polycystic ovarian syndrome (PCOS). To compare the clinico-biochemical parameters of obese and lean PCOS patients. Materials and Methods: A total of 287 women with PCOS were included in this study after consent. The demographic, anthropometry, clinical, and hormonal (thyroid-stimulating hormone [TSH] and total testosterone) parameters were recorded along with pelvic ultrasonography (USG) for all PCOS subjects. They were divided into lean (body mass index [BMI] between 18.5 and 22.9) and overweight (BMI ≥23), and the number of subclinical hypothyroid patients were calculated in each group. The clinico-biochemical parameters of both groups were compared. Results: The majority (61%) of our patients were overweight. There was no significant difference in the prevalence of subclinical hypothyroidism between overweight and lean PCOS patients. The obese PCOS patients were older than lean PCOS patients, and they had higher serum testosterone with elevated systolic and diastolic blood pressure (BP). Conclusion: The majority of our patients were found to be overweight and there was no association between obesity and subclinical hypothyroidism among PCOS patients.
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Prevalence and correlates of depression in a rural adult population in Northwest India p. 151
Chandini Gupta, Manu Arora, Rajiv K Gupta, Najma Akhtar, Bhavna Langer, Rashmi Kumari, Pawan Sharma, Mudasir Majeed, Sunil K Raina
DOI:10.4103/jfmpc.jfmpc_656_19  
Background: Mental disorders are showing a discerning upward trend globally and it is projected that by 2030, depression would be the leading cause of disease burden globally. Depression has not only confined the developed world but is increasingly seen as a major public health problem in the developing world too. Methods: A stratified two-stage design was used to conduct a house-to-house survey in selected villages among consenting eligible members of the family. A three-part questionnaire, with the first part eliciting sociodemographic information was used. Patient Health Questionnaire (PHQ-9), the second part of the questionnaire was used to screen those positive for depression and Beck's Depression Inventory (BDI-II). The third part was used for rating the depression. Data thus collected was analyzed and Chi-square test was used as test of significance. Results: The prevalence of depression was found to be 8.94% (73/816). Beck's Depression Inventory (BDI- II) for rating the depression revealed that mild depression was present in nearly half of the cases (47.95%), while 39.7% and 9.5% of the cases had moderate and severe depression, respectively. Among the various variables, literacy level, marital status, alcohol intake, chronic illness, and socioeconomic status were significantly associated with the depression. Conclusions: Prevalence of depression to the tune of 8.94% in rural adults seems to be a cause of concern for the health planners. Prevention and treatment of depression must be taken on priority and as a challenge by the health professionals.
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An exploratory study on traditional practices of families during the perinatal period among traditional birth attendants in Uttarakhand p. 156
Vartika Saxena, Prasuna Jelly, Rakesh Sharma
DOI:10.4103/jfmpc.jfmpc_697_19  
Introduction: India has a current maternal mortality rate of 130 which contributes to 20% of the total mortality rate in the world and more than a quarter of neonatal deaths; nearly 0.75 million neonates have died in India. The present study aimed to explore the cultural practices during the perinatal period including newborn care in Uttarakhand. Materials and Methods: A qualitative descriptive design to explore self-experience for significant years in the field of maternal care and deliveries among 990 traditional birth attendants from 13 districts of Uttarakhand. Focused one-to-one in-depth interviews were done to collect the data. The data was expressed by participants in the form of narrations, picturizations, songs, and role-plays to show the techniques which were translated from the language of interviews to English before analysis of the data. Results: Wide variety of cultural practices have been identified during various stages of the perinatal period. Most of the participants (80%) expressed that families believe that the pregnant women should not eat green vegetables, yam, pulses, red grams, papaya, and mangoes and that she should eat less during pregnancy. The routine activity should be done regularly to make labor process easier. Most of the mothers (90%) delivered on the floor of the cowshed demarcated with cow dung. Participants expressed that the mother had to walk for 2 km for taking bath after delivery before she touches the baby. Sprinkling cow's urine is also a common practice after delivery in and around the house and on the mother. It was also found that they don't breastfeed the baby for 3 days since colostrum is not considered good for the baby. Conclusion: The practices which are proven to be beneficial to the mother and baby should be advocated to keep our cultural practices alive, at the same time it is important to discourage communities from harmful practices concerning the mother and the baby.
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Impact of guidelines implementation for the rational use of prophylactic antibiotics in elective cesarean sections at Elqutainah Teaching Hospital p. 162
Sara M Suliman, Bashir A Yousef, Afrah A Hamadelnil
DOI:10.4103/jfmpc.jfmpc_903_19  
Background: The clinical pharmacists have a sensible role in the implementation of guidelines by ensuring proper patient selection and medication use. This study aimed to implement a hospital guideline for the rational use of prophylactic antibiotics in elective cesarean sections (ECS) by establishing compliance with international guidelines regarding prophylactic antibiotic use in ECS at Elqutainah Teaching Hospital in White Nile State, Sudan, and define the area of medication cost-saving. Methods: A quasi-experimental design without control group was used from April to June 2018. 195 participants were included, 94 participants before and 101 participants after the intervention and data were collected using a designed checklist by the researchers. The intervention is based on withdrawal metronidazole dosage forms from prophylactic antibiotics for ECS according to international guidelines in antibiotics prophylaxis toward ECS. Finally, the data were compared between pre- and post-intervention. Findings: Before intervention; all participants had received intravenous cefuroxime and metronidazole infusions prior ECS and oral cefuroxime or amoxicillin-clavulanic acid, and metronidazole for 7 days upon discharge. While after the intervention, all participants didn't receive any metronidazole dosage forms before and after ECS also didn't receive amoxicillin-clavulanic acid. However, the dosage regimen of cefuroxime didn't change. This intervention was meaningful in minimizing overuse of antibiotics prophylaxis in the ECS, and reducing staff workload along with medication cost. Conclusions: Clinical pharmacist intervention was concisely changing the physicians' practice toward using updated guidelines of the rational use of prophylactic antibiotics for ECS.
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A cross-sectional study of epidemiological factors related to road traffic accidents in a metropolitan city p. 168
Rujuta S Hadaye, Sachin Rathod, Shruti Shastri
DOI:10.4103/jfmpc.jfmpc_904_19  
Background: Traffic injuries are one of the major causes of morbidity in India. It involves human sufferings in terms of physical, emotional, and financial losses to the individual, family, and the country. A better insight into the epidemiological determinants will help prevent such injuries. Objectives: To estimate the proportion of fatal and nonfatal accidents and to determine the epidemiological factors related to nonfatal accidents. Methods: It was a cross-sectional study carried out in a tertiary care hospital over a period of 6 months. A simple random sampling technique was used for the selection of sample size of 476. Nonfatal accident victims were interviewed. Results: The proportion of nonfatal to fatal accidents was found to be 1.8:1. Around 72.9% of drivers did not use any safety measure while driving. Two-wheelers (39%) and light motor vehicles (28.3%) were mostly involved, 45% of drivers had speed more than 60 km/h. Obstacles in the road (41%), defective roads (36.5%), and poor street lighting (11.4%) were reported as contributing factors of the accident. Lower extremities and head neck and face were involved in 47.2% and 27.1% of cases, respectively. Around 40.4% of cases had a single-site fracture. Conclusion: Traffic injuries result from the interaction between agent, host, and environmental factors. Preventing these interactions is very well possible with little extra care given towards road safety and traffic behavior of individuals.
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Mental health services provided by medical officers in primary health centres in Kolar district in Karnataka, India: A situational assessment p. 173
Gautham Melur Sukumar, Bujabali D Yalgudri, Manjunatha Narayana, Girish N Rao
DOI:10.4103/jfmpc.jfmpc_906_19  
Context: Mental health services are integrated into primary healthcare and delivered by medical officers (MOs). Assessment of mental health services provided by MOs and their ability to manage mental disorders in primary health centers (PHCs) would provide evidence to strengthen the quality of this integration. Aims: To conduct a situational assessment of mental health services provided by medical officers in PHCs in Kolara district in terms of availability and nature of services. To assess the ability of MOs to diagnose and treat mental disorders in PHCs. Materials and Methods: We interviewed all eligible and available PHC medical officers (45). The nature of mental health services provided (diagnosis, treatment, counseling and referral) was enquired. A case-vignette based assessment of the ability of MOs to diagnose and treat mental disorders was conducted. Results: Nearly 87% of MOs delivered psychiatric out-patient services on all working days. MOs were significantly better in diagnosing compared to providing treatment (P = 0.04). In spite of being trained in mental health, concerns exist in translating training into quality service delivery. MH drugs were available in regular supply and utilised to great extent. Conclusion: MOs are providing psychiatric out-patient services in PHCs regularly but their ability is limited. The study recommends the reorientation of existing training from a service delivery perspective.
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Antibacterial activity of Syzygium aromaticum (clove) against uropathogens producing ESBL, MBL, and AmpC beta-lactamase: Are we close to getting a new antibacterial agent? p. 180
Sameer S Faujdar, Dakshina Bisht, Amisha Sharma
DOI:10.4103/jfmpc.jfmpc_908_19  
Introduction: The present study was done to access the antibacterial activity of clove (Syzygium aromaticum) against extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL), and AmpC beta-lactamase-producing gram-negative bacteria causing urinary tract infection. Methods: A total of 221 gram-negative uropathogens were isolated and screened for beta-lactamase (ESBL, MBL, and AmpC) production and further tested against ethanolic extract of clove (S. aromaticum) for its antibacterial activity. Results: Clove was effective against all gram-negative isolates but the best antibacterial activity was shown against Proteus species with 19 mm zone of inhibition, 0.39 mg/ml minimum inhibitory concentration (MIC) and 0.19 mg/ml minimum bactericidal concentration (MBC).Conclusions: Clove extract showed different antibacterial potential against all gram-negative uropathogens. Clove activity for particular strain was found to be similar between isolates producing beta-lactamase and non beta-lactamase.
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Impact of severity of tooth loss on oral-health-related quality of life among dental patients p. 187
Nada M Anbarserri, Kirat Mohammed Ismail, Hanaa Anbarserri, Dalya Alanazi, Abdulrahman Dahham AlSaffan, Mohammad Abdul Baseer, Rakan Shaheen
DOI:10.4103/jfmpc.jfmpc_909_19  
Background: Tooth loss has a negative impact on the person's life so this study was done to assess the impact of tooth loss on oral-health-related quality of life (OHRQoL) in adult patients seeking dental care in private university dental clinics using Arabic version of 14-item Oral Health Impact Profile (OHIP-14) questionnaire in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among 152 patients seeking dental care at a private university dental clinics in Riyadh city, Saudi Arabia. A structured and close-ended OHIP-14 questionnaire was self-administered by the study participants. Descriptive statistics, Kruskal–Wallis, Mann–Whitney, and Spearman's correlation tests were applied to the data. Results: Patients with categories 1–5, 6–10, and >10 teeth loss showed a mean OHIP-14 scores of 10.51 ± 10.36, 13.46 ± 10.06, and 21.46 ± 14.41, respectively. A statistically significant difference in OHIP-14 score was observed among different categories of tooth loss (P = 0.005). Participants with >10 teeth loss showed significantly higher OHIP-14 score compared with 1–5 and 6–10 teeth loss categories (P < 0.05). Teeth loss significantly affected the functional limitation (P = 0.000) and social disability (P = 0.044) subscales. Conclusion: Tooth loss adversely affected the OHRQoL among the dental patients. As the severity of teeth lost increased, the OHIP-14 score also increased with higher oral health impairments.
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Saudi neurology residents' knowledge and attitudes toward intravenous thrombolysis in patients with acute ischemic stroke p. 192
Fatimah Ali Alharbi, Nadia Magbul Maghfuri, Dalia Mohammed Abdu, Misoon Yahya Redine
DOI:10.4103/jfmpc.jfmpc_924_19  
Background: Although intravenous (IV) thrombolysis is an effective treatment for patients with acute ischemic stroke (AIS), it remains underused by neurologists worldwide. This study assessed the knowledge and attitudes toward IV thrombolysis in patients with AIS among neurology residents in Saudi Arabia. Materials and Methods: An online survey was conducted using a sample of 81 neurology residents in and around Saudi Arabia. Statistical analysis included descriptive studies and Chi-square or Fisher's exact test. Results: Of the 81 respondents, 50 (61.7%) were males and 31 (38.3%) females. Regarding IV thrombolysis use in AIS patients; 61.7% thought that they would consider it, a vast majority about 72.8% showed positive attitudes toward performing IV thrombolysis for AIS patients, 69.1% thought that IV thrombolysis is safe, 79.0% did not think that they have good knowledge about IV thrombolysis, and 53.1% felt not confident about their ability to employ IV thrombolysis. Confidence with knowledge was associated with the residency stage (P = 0.000). Attitudes toward IV thrombolysis was found associated with sex (P = 0.044) and residency stage (P = 0.002). Residents from the central region were more likely to have positive attitudes (P = 0.043). Conclusion: The surveyed neurology residents showed a positive attitude towards the safety and use of IV thrombolysis for AIS patients. However, knowledge and confidence along with knowledge about the treatment are lacking. Therefore, theoretical and practical training is warranted to improve knowledge about IV thrombolysis.
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Diabetic peripheral neuropathy among Saudi diabetic patients: A multicenter cross-sectional study at primary health care setting p. 197
Rayan Abdullah Sendi, Amani Mohammed Mahrus, Ruba Mohammed Saeed, Moneer Adnan Mohammed, Sami Abdo Radman Al-Dubai
DOI:10.4103/jfmpc.jfmpc_927_19  
Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes and is responsible for morbidity and disability among diabetic patients. Objectives: The aim of this study was to assess the prevalence of painful DPN and its associated risk factors in patients with diabetes mellitus. Materials and Methods: A cross-sectional study was conducted among 430 diabetic patients attending primary healthcare centres (PHC) in AL Madinah city, Saudi Arabia. The validated Douleur Neuropathique-4 (DN4) questionnaire was used to identify the presence of painful DPN. Results: The majority were female (54.7%) and had type 2 diabetes mellitus (74.9%). The prevalence of DPN was 30.1% in type 2 diabetic patients and 25.9% in type 1 diabetic patients with an overall prevalence of 29.1%. DPN was associated significantly with age, duration of diabetes milieus, uncontrolled A1c, and positive family history of diabetes mellitus (P < 0.05). All the investigated comorbidities were also associated significantly with DPN (P < 0.05). Conclusions: The prevalence of DPN was 25.9% and was associated with age duration of DM and uncontrolled HbA1c. PHC physicians treating diabetes should be more aware of the importance of screening for DPN and the treatment plan.
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Knowledge of first aid skills among medical and nonmedical students in Saudi Arabia p. 202
Moath A AlQahtani, Shoog F Alfadhel, Rawan H Aljehani, Khalid A Bakri, Zaina F Ahmed, Maryam O Elemem, Salwa M Alrouh, Lubna W Baker, Ammar Khalifa
DOI:10.4103/jfmpc.jfmpc_928_19  
Background: First aid is the first treatment a health care worker provides at the site of an accident to a patient who is injured or very sick before the ambulance arrives. First aid providers are those who have the skill and knowledge to deal with life-threatening conditions outside the facilitated environment of a hospital. This study aims to assess the knowledge of first aid among university students in Saudi Arabia. Methodology: An observational descriptive cross-sectional study was conducted from 17 August 2018 until 2 February 2019 on Saudi universities' students, including medical and nonmedical students and excluding postgraduate. The sample size was 384 students using a cluster sampling technique. The questionnaire was developed specifically for the purpose of this study after searching the literature and consulting an epidemiologist. It contains questions that assess the level of knowledge regarding first aid. It was subjected to a prop to test for validity and liability. Data were analyzed using (SPSS, version 22.0) and (P values of ≤ 0.05) considered significant. The consent was obtained before data collection. Result: Only 40.35% (157/389) of the total participants had basic life support (BLS) course in their college syllabus. Good knowledge was generally observed in both medical (61.2%) and nonmedical (53.2%) student participants. Medical students' knowledge regarding first aid was better than nonmedical students in all questions, whereas the results were not statistically significant. Conclusion: Medical students were more familiar with the knowledge of first aid than other colleges' students. Researches should investigate the willingness of medical students to apply their first aid knowledge when necessary using a health belief model.
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Assessment of diagnostic accuracy of a direct digital radiographic-CMOS image with four types of filtered images for the detection of occlusal caries p. 206
Rohit Kumar Sahu, Jagadish P Rajguru, Naina Pattnaiak, Debajyoti Bardhan, Bikash Nayak
DOI:10.4103/jfmpc.jfmpc_934_19  
Background: Digital imaging has the potential to improve diagnostic accuracy and make quantitative diagnoses. In the recent decades, software for radiographic analysis has been investigated and developed for the detection of lesions and the quantitative assessment of the depth of a caries lesion. In addition, the accuracy of diagnosis may also be enhanced by programs that filter the images. These programs can adjust the brightness and contrast, determine the gray level, invert the shades of gray, and apply pseudocolors. Few studies compared different types of digital images in the diagnosis of changes in the tooth crown. Aim: The main aim of this study was to assess the the diagnostic accuracy of a direct digital radiography (DDR)-CMOS image with four types of filtered images for the detection of occlusal caries. Materials and Methods: Fifty randomly selected patients' teeth were clinically examined and digitally radiographed. Radiographed images are converted into four filter images with the help of software. Filtered images were then selected for inter- and intraobserver examination and the result was subjected to statistical analysis. Conclusion: DDR-CMOS and negative image were found to be more useful in diagnosing occlusal caries.
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Study of correlation of urodynamic profile with symptom scoring and ultrasonographic parameters in patients with benign prostatic hyperplasia p. 215
Ankur Garg, Shweta Bansal, Sudipta Saha, Ajay Kumar
DOI:10.4103/jfmpc.jfmpc_698_19  
Context: Urodynamic study (UDS) and ultrasonography (USG) both are established investigations to assess the patients of benign prostatic hyperplasia (BPH). It is known that the prostate mass (PM) and post-void residual urine volume (PVR) are not significantly related to the patients' symptoms and degree of obstruction; however, the relation between the UDS, USG and patient's International Prostate Symptom Scoring (IPSS) has not been defined. Aims: To correlate the urodynamic parameters with IPSS, PM and PVR in patients with lower urinary tract symptoms (LUTS) suggestive of BPH. Settings and Design: An observational study carried out as a thesis project. Methods and Materials: Thirty male patients aged more than 40 years with LUTS suggestive of BPH were selected and underwent USG, UDS and IPSS. In UDS, the parameters studied were the maximum flow rate (Qmax), detrusor pressure (Pdet) and bladder compliance (BC). PM and PVR were studied in the USG. Statistical Analysis Used: IBM Statistical Package for the Social Sciences (SPSS) software version 16 (SPSS Inc., Chicago, USA). Pearson's correlation and two-sided significance levels were determined. Results: 1. Significant negative correlation between Qmaxand PVRUSG (r = −0.404, P= 0.027); PMUSG (r = −0.655, P= <0.001) and IPSS (r = −0.563, P= 0.001). 2. Significant positive correlation between Pdetand PVRUSG (r = 0.535, P= 0.002); PMUSG (r = 0.719, P= <0.001) and IPSS (r = 0.649, P= <0.001). 3. Significant negative correlation between BC and PVRUSG (r = −0.490, P= 0.006); PMUSG(r = −0.654, P= <0.001) and IPSS (r = −0.667, P= <0.001). Conclusions: UDS has a significant correlation with IPSS and USG findings and urodynamic parameters give a more specific diagnosis in BPH patients when it is combined with USG and IPSS.
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Mammography uptake among the female staff of King Saud University p. 221
Sulaiman Abdullah Alshammari, Ali Mohsen Alhazmi, Hanan Awad Alenazi, Hotoon Sulaiman Alshammari, Abdullah Mohammed Alshahrani
DOI:10.4103/jfmpc.jfmpc_706_19  
Background: Breast cancer is having a major impact on women's health worldwide. Early detection is the best defense against the associated morbidity and mortality of the disease. Objectives: To assess the level of mammography uptake among working Saudi women and identify the obstacles and barriers that negatively affect it. In addition, to identify the most effective sources of breast-cancer-related information and early detection screening. Method: We conducted a cross-sectional study of women employees of King Saud University aged 40 years and above on March–May 2015 using a self-report questionnaire. Results: A total of 229 participants were recruited from the female staff of King Saud University. Of the participants, 34% were aged 41 years or above, approximately 66% were married, 53.3% had a bachelor's degree, and 61.1% worked as administrators; further, 64.6% had a history of breastfeeding. The rate of mammography uptake was 51.5%. Univariate logistic regression indicated that age, education, and being single predict the rate of mammography uptake. However, multivariate logistic regression indicated that earlier age significantly predicts a higher risk of a low rate of mammography uptake. The main obstacle negatively affecting mammography uptake was ineligible criteria (21.8%). The main sources of information regarding breast cancer were awareness campaigns and television and radio (45.4% and 43.7%, respectively). Conclusion: The participants' rate of mammography uptake, awareness of mammograms, the risk factors, and signs of breast cancer were low. To improve breast-cancer mortality rates in Saudi Arabia, earlier detection of breast cancer through increasing awareness of mammograms is of paramount importance.
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Crestal bone loss around dental implants after implantation of Tricalcium phosphate and Platelet- Rich Plasma: A comparative study p. 229
Sravani Uppala, Anuj Singh Parihar, Varsha Modipalle, Litto Manual, Vinni Mary Oommen, Pallavi Karadiguddi, Parkhi Gupta
DOI:10.4103/jfmpc.jfmpc_707_19  
Background and Aims: Bone loss around dental implants is generally measured by monitoring changes in marginal bone level using radiographs. After the first year of implantation, an implant should have <0.2 mm annual loss of marginal bone level to satisfy the criteria of success. However, the success rate of dental implants depends on the amount of the crestal bone around the implants. The main aim of this study was to evaluate and compare the crestal bone loss around implants placed with particulate β-Tricalcium Phosphate Bone Graft and platelet concentrates. Methods: 50 individuals received hundred dental implants. Each individual received one dental implant in the edentulous site filled with β-Tricalcium Phosphate Bone Graft along (β-TCP) with Platelet- Rich Plasma (PRP) (Group A) and another in edentulous site filled only with β-Tricalcium Phosphate Bone Graft (Group B) in the posterior edentulous region. All the 100 implants were prosthetically loaded after a healing period of three months. Crestal bone loss was measured on mesial, distal, buccal and lingual side of each implant using periapical radiographs 3 months, 6 months and 9 months after implant placement. Results: The average crestal bone loss 9 months after the implants placement in Group A and Group B was 2.75 mm and 2.23 mm respectively, the value being statistically significant (P < 0.05). In both Group A and Group B, the average crestal bone loss was maximum on the lingual side followed by buccal, distal and mesial sides. Conclusion: β-TCP is a promising biomaterial for clinical situations requiring bone augmentation. However, the addition of PRP results in decreased bone loss around the dental implants.
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Clinical, radiographic, and histological findings of chronic inflammatory periapical lesions – A clinical study p. 235
Prabu Mahin Syed Ismail, K Apoorva, N Manasa, R Rama Krishna, Siddhartha Bhowmick, Shilpa Jain
DOI:10.4103/jfmpc.jfmpc_715_19  
Aim: The present study aimed at comparing clinical, radiographical, and histological findings in chronic periapical lesions such as cysts, granuloma, and abscess. Methodology: The present study was conducted on 148 teeth having chronic inflammatory periapical lesions with or without nonsurgical endodontic treatment. Endodontic surgery was performed by single trained endodontist. After surgical endodontic treatment, biopsy sections of teeth were assessed histologically. All slides stained with hematoxylin/eosin and Gomori trichrome for light microscopy assessment. Results: Out of 148 teeth, 41 had chronic inflammatory lesions, 34 had inflammatory cysts, and 25 had indefinite lesions. Chronic inflammatory lesions assessed histologically found chronic apical periodontitis in 86 cases and inflammatory cysts in 62 cases. The difference was significant (P < 0.05). Out of 86 cases of chronic apical periodontitis confirmed clinical radiographically, 64% found positive, whereas 36% were not histologically. Out of 62 cases of inflammatory cysts confirmed clinically and radiographically, 78% found positive while 36% were not histologically. Out of 25 indefinite lesions, 56% found chronic inflammatory lesions while 44% found inflammatory cyst. Conclusion: There was significant disagreement in clinical radiographic as well as histological diagnosis.
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Evaluation of role of periodontal pathogens in endodontic periodontal diseases p. 239
Abhaya Chandra Das, Sanjit Kumar Sahoo, Anuj Singh Parihar, Smita Singh Bhardwaj, Prashant Babaji, Joel G Varghese
DOI:10.4103/jfmpc.jfmpc_725_19  
Aim: This study aimed to correlate periodontal pathogens in endodontic periodontal diseases. Methodology: This study was conducted on 40 patients of both genders. All the participants were obtained from department of endodontics and periodontology with history of endo-perio lesion in same teeth. Polymerase chain reaction was performed and correlation was established. Results: This study included 18 males and 22 females. The mean age of male was 42.5 years and female was 41.3 years. Specimens of Tannerella forsythia were isolated from 94% endodontium and 92% periodontium, Porphyromonas gingivalis from 71% endodontium and 55% periodontium, Aggregatibacter actinomycetemcomitans from 12% endodontium and 58% periodontium. The difference was significant (P < 0.05). Bacteria in endodontic-periodontal infection confirmed statistically significant correlation between absolute quantitation of T. forsythia and P. gingivalis (r = 0.412, P < 0.05), P. gingivalis and A. actinomycetemcomitans (r = 0.524, P < 0.05), and T. forsythia and A. actinomycetemcomitans (r = 0.427, P < 0.05). Conclusion: There was correlation between targeted bacterial species levels from concurrent endodontic-periodontal diseases. Thus, it can be suggested that dentinal tubules may be the pathway for spread of bacteria.
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Assessment of correlation of periodontitis in teeth adjacent to implant and peri- implantitis p. 243
Mahantesh Achanur, Sami Aldhuwayhi, Anuj Singh Parihar, Atul Bhardwaj, Rahul Das, KS Anad
DOI:10.4103/jfmpc.jfmpc_726_19  
Aims: The present study was conducted to determine correlation between peri-implantitis and periodontitis in adjacent teeth. Materials and Methods: The present study was conducted on 58 patients with 84 dental implants. They were divided into two groups, group I (50) was with peri-implantitis and group II (34) was without it. In all patients, probing depth (PD), gingival recession (GR), and clinical attachment loss (CAL) was calculated around implant, adjacent to implant and on contralateral side. Obtained data were statistically analyzed using statistical software IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp with one-way analysis of variance. Results: Males were 30 with 52 dental implants and females were 28 with 32 dental implants. CAL was 5.82 ± 0.52 in group I and 3.62 ± 0.63 in group II (P = 0.001) around implants. PD was 4.28 ± 1.26 in group I and 2.20 ± 0.52 in group II around adjacent teeth (P = 0.002). PD around contralateral teeth was significant (P = 0.05) in group I (3.18 ± 1.01) and group II (2.71 ± 0.73). Conclusion: Periodontitis has negative effect on implant success. Teeth adjacent to dental implant plays an important role in deciding the success or failure of implant. Maintenance of periodontal health is of paramount importance for successful implant therapy.
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Clinical-biochemical profile and etiology of acute viral hepatitis in hospitalized young adults at tertiary care center p. 247
Hardik D Desai, Ajaz Ahmed Z Ansari, Darshana Makwana, Dhigishaba M Jadeja, Jigar Gusani
DOI:10.4103/jfmpc.jfmpc_727_19  
Background: Acute viral hepatitis (AVH) is a major health concern in developing nations like India in regard to morbidity and mortality. Objective: To identify incidence, clinical presentation, laboratory abnormalities, severity, and complication of AVH in young adults. Materials and Methods: A prospective study was conducted from August 2016 to August 2018 among 70 young adult patients of AVH at Civil Hospital, Ahmedabad. Data on clinical presentation, laboratory values, complication, and severity were obtained, and analysis was performed. Results: Hepatitis E viral (HEV) infection was seen in 70% case and was more common in age group of 21–30 years followed by Hepatitis B and Hepatitis A, 15.8% and 12.8% case respectively. Most common presenting symptom was jaundice in 80–85% of patients followed by anorexia 65.7% and nausea and vomiting 57.1% of patients. Most common clinical sign was icterus followed by hepatomegaly. Total serum bilirubin and serum SGOT elevated in all cases. Acute liver failure was seen in seven cases. Six cases were due to hepatitis E and one case was due to hepatitis A. Acute kidney injury was present in seven cases. Coagulopathy was found to be major complication in 25.7% cases. Conclusion: HEV is the major etiological agent of AVH in young adults. It is not possible to differentiate viral hepatitis based on clinical features and biochemical parameters. However, cholestasis is found to be significantly associated with hepatitis-E infection.
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Functional disability among elderly: A community-based cross-sectional study p. 253
Kriti Vaish, Somdatta Patra, Pragti Chhabra
DOI:10.4103/jfmpc.jfmpc_728_19  
Background: Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi. Methods: A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability. Results: Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression. Conclusions: Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.
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“Is there a difference in treatment outcome of tuberculosis patients: Rural Healthcare Providers versus Community Health Workers?” Highly accessed article p. 259
Banuru M Prasad, Sarabjit S Chadha, Pruthu Thekkur, Sashikant Nayak, Vikas S Rajput, Rajesh Ranjan, Rakesh Dayal
DOI:10.4103/jfmpc.jfmpc_729_19  
Introduction: Rural healthcare providers (RHCPs) are the first point of contact for majority of patients in rural parts of India. A total of 75 RHCPs were trained and engaged in Hazaribagh to identify presumptive tuberculosis (TB) patients (PrTBPs) and refer them for diagnosis. Patients diagnosed with TB were initiated on directly observed treatment short course (DOTS) under the programme. Based on patients' choice, the treatment providers were either RHCPs or community health workers (CHWs). In this paper, we aim to compare the treatment outcomes of TB patients who received DOTS from RHCPs with CHWs. Method: This is a retrospective cohort study using secondary data routinely collected through project and Revised National TB Control Programme. Results: Over the period of 24 months, 57 RHCPs continued to be engaged with project and a total of 382 referrals were made out of which 72 (19%) were diagnosed with TB. Based on choice made, 40 (55%) of TB patients chose RHCPs and 32 (45%) CHWs as their treatment provider. The mean successful treatment completion rate was 87% in the RHCP group compared with 81% for CHWs (P value 0.464). The percentages of unsuccessful outcomes were similar for both groups. Conclusions: Our study demonstrates the process to engage RHCPs in TB prevention and care. The study highlights community preference for RHCPs as DOT provider who can produce similar TB treatment success rates as that of CHWs identified by programme.
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Screening for common mental health problems and their determinants among school-going adolescent girls in Gujarat, India p. 264
Abha Mangal, Archana Thakur, Khyati A Nimavat, Deepti Dabar, Sudha B Yadav
DOI:10.4103/jfmpc.jfmpc_732_19  
Background: The school health program is a flagship program of Government of India with a focus on improving the physical and mental health of school children, but there is no specific strategy to screen for mental health disorders under the school health program. Also, the estimation of the prevalence of common mental disorders (CMDs) such as anxiety, depression, and psychosocial distress among school children is lacking. Methods: The author conducted a cross-sectional study among 742 adolescent schoolgirls from one government, one government-aided, and one private school in an urban area in Gujarat. We used the pre-validated instrument, general health questionnaire-12 (GHQ-12) to screen for CMDs. We estimated adjusted odds of association between screening positive for CMDs and various determinants. Results: 48.78% adolescent girls screened positive for CMDs which is alarming. Among sociodemographic characteristics, the type of school (adjusted odds of private is 1.8 and government 1.6), mother's higher education (3.0), father's less education (3.1), and working mother (1.5) had shown significant association with positive cases of the girls. Among psychosocial factors, abnormal sleep patterns (1.9) and disturbance in studies (2.3) have been found statistically significant for the presence of mental health problems among adolescent girls as per the GHQ score. Conclusion: CMDs such as anxiety, depression, and psychosocial distress were indeed very common among adolescent school-going girls in an urban area of Gujarat, India. There is an urgent need to focus attention on the mental health of adolescent girls.
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Perception of undergraduates enrolled in health science courses from Asmara Eritrea towards Hepatitis B p. 271
Nikhil Holla, Anmol Mathur, Aditi Mathur, Habtom Bahta, Nada Abrar, Vikram Pal Aggarwal
DOI:10.4103/jfmpc.jfmpc_741_19  
Introduction: Hepatitis B (HB) is one of the highly infectious and the most common cause of chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. It is transmitted through blood and body fluids. Most healthcare related personnel are at very high susceptibility towards this infection from the infected patients. Aims: To evaluate the knowledge and practice towards the hepatitis disease and its cross-infection among dental and medical undergraduate students for the first time ever from Eritrea. Settings and Design: It is a cross-sectional survey conducted in the only institute offering undergraduate courses in the field of health sciences. Materials and Methods: A total of 115 medical and 50 dental undergraduate students from a health science institute situated in Asmara Eritrea filled the form and submitted for evaluation. The questionnaire consisted of the demographic variables such as college of study, year of course, age, gender, apart from questions regarding the knowledge, attitude, and practice towards hepatitis and its transfusion. All the data was transferred to excel and applied statistical test using SPSS software. Statistical Analysis Used: Chi-square test was to test the association between the knowledge and practice variable within the stream of study. Results: The overall knowledge of the undergraduate students was found to be very high when assessed through this survey although practice scores were not satisfactory. When asked, “Do you think you can be affected by Hepatitis?”, in regular practice 33 individual gave incorrect answers. Conclusion: There is no doubt that the overall knowledge of the undergraduate students is found to be very high but practice scores and awareness towards chances of cross-infection is poor which requires further sessions of education and practice-based courses to be planned for the students.
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Dental esthetic and the likelihood of finding a job in Saudi Arabia. A cross-sectional study p. 276
Raghad Almedlej, Reem Aldosary, Rana Barakah, Abeer Alkhalifah, Abdallah Adlan, Abdulrahman D AlSaffan, Mohammad A Baseer
DOI:10.4103/jfmpc.jfmpc_742_19  
Background: Person's physical, dental appearance, and sexual identity are the characteristics most obvious to others. Prior researches suggest that visible sign of unhealthy dental status may lead to an individual's social or professional exclusion, so the aim of the study was to measure the influence of dental appearance on hiring managers' perception of intelligence, honesty and efficiency of job applicants in Saudi Arabia, and the likelihood of employment opportunity. Materials and Methods: This cross-sectional study comprised 280 hiring managers. All participants were assigned randomly into two groups and received a survey with 10 different images for hypothetical job applicants. The images were digitally manipulated to have the Saudi national dress and to represent different dental conditions. The photos in both surveys were the opposite with no repetition except for 3 for reliability. Each evaluator randomly received one survey without knowing of the other. Participants were asked questions about their perception of honesty, intelligence, efficiency, and potential employability of the provided applicants' photos. Results: There was no statistically significant difference in demographics data between the hiring managers assigned to both groups. Hypothetical job applicants with smiles affected by malocclusion were perceived to be less intelligent with P value = 0.0001, but there was no altered perception for honesty and efficiency. Moreover, applicants with caries were perceived to be less honest, intelligent, and efficient by the hiring managers with P value of 0.0007, 0.0011 and 0.0138, respectively. Applicants with dental imperfections compared to normal smile were 52% less likely to be employed. Conclusion: Dental appearance might alter people perception about the character of the affected person, and it might influence the judgment of future employers when screening for candidates; as a result, we recommend more educational programs for the public and hiring managers.
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Knowledge, attitude, and practice of general dental practitioners toward following proper standards of endodontic practice and use of latest technology in Dehradun: A cross-sectional study p. 282
Mehak Dogra, Devashish Singh Sawai, Sai Kumar Ganapathy, Utsav Sharma, Isha Singh, Pulkit Gupta
DOI:10.4103/jfmpc.jfmpc_751_19  
Background: Choosing latest technology for the treatment improves the chances of favorable prognosis and saves the time of the clinician; hence, the aim of the study was to explore their knowledge, attitude, and practice (KAP) toward following proper standards of endodontic practice and use of latest technology. Materials and Methods: The present study was a cross-sectional, descriptive questionnaire study conducted among general dental practitioners (GDPs). The survey was conducted among 156 GDPs. In the present study, a close-ended interview schedule was prepared to test the KAP of GDPs. Results: For diagnosis, most of the study participants (58 [37.08%]) relied on case history and radiograph. Apex locator was used by 71 (45.51%) of the study subjects. Among all the study participants, 58 (37.17%) dental practitioners used rotary nickel–titanium (NiTi) files with normal saline and preheated disinfectants for cleaning and shaping of root canal. It was observed that the knowledge of majority of the dental practitioners was fair (58 [37.17%]). However, the attitude and practice toward following proper standards of endodontic practice and use of latest technology were poor. Conclusion: It was concluded that very few general practitioners used the latest technology in endodontics. Knowledge was fair while attitude and practice regarding following proper standards of endodontic practice and use of latest technology were poor among study participants.
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Fasting and postprandial lipid parameters: A comparative evaluation of cardiovascular risk assessment in prediabetes and diabetes p. 287
Montosh Chakraborty, Prerna Singh, Jyothi M P Dsouza, Karthikeyan Pethusamy, Pandurang V Thatkar
DOI:10.4103/jfmpc.jfmpc_769_19  
Context: Dyslipidemia plays a crucial role in atherogenesis, in both prediabetes and diabetes. There persists a lacuna in the evaluation of postprandial lipid parameters in prediabetes. Aims: To comparatively evaluate fasting and postprandial blood lipid parameters and atherogenic lipid ratios for cardiovascular risk assessment, in prediabetes and diabetes. Materials and Methods: Fifty-one patients diagnosed with diabetes mellitus and thirty-two with prediabetes were selected for the study. Lipid profile and blood glucose were analyzed in fasting and postprandial blood samples. Statistical Analysis Used: Kolmogorov–Smirnov test, Shapiro–Wilk test, one-way ANOVA, and Pearson's regression analysis were applied. Results: Postprandially, triglycerides (TG) was increased significantly in diabetes compared to controls (P < 0.01) and prediabetics (P < 0.05). Among the lipid ratios, triglyceride/high density lipoprotein (TG/HDLc) was significantly increased postprandially in diabetes compared to controls (P < 0.05). A comparative analysis of fasting and postprandial parameters within each group showed a significant increase in postprandial TG/HDLc compared to the fasting state in prediabetes (P < 0.001) and diabetes (P < 0.001). Postprandial TG (P < 0.01) and TG/HDLc (P < 0.01) showed a stronger correlation with HbA1ccompared to fasting TG (P < 0.05) and TG/HDLc (P > 0.05). The prevalence of dyslipidemia and insulin resistance was higher in postprandial state than the fasting state in prediabetes and diabetes. Conclusions: Postprandial TG and the TG/HDLc reflect lipid abnormalities than the corresponding fasting variables in diabetes and prediabetes. Postprandial TG and TG/HDLc are better reflectors of cardiovascular status in prediabetes and diabetes.
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Dengue in children and young adults, a cross-sectional study from the western part of Uttar Pradesh p. 293
Manoj Kumar, Rajesh Kumar Verma, Suchitra Nirjhar, Monika Singh
DOI:10.4103/jfmpc.jfmpc_770_19  
Background: Dengue has emerged as a major public health problem in India. It presents more aggressively among younger age groups as compared to adults. Therefore, it necessitates the accurate estimation of prevalence in younger age groups. Materials and Method: Of all the 1026 clinically suspected cases of dengue up to the age of 18 years were enrolled in this study and grouped into four age groups (Group I - <0 to 1 year, Group II- 1 to 6 years, Group III- 7 to 12 years, and Group IV- 13 to 18 years). Their blood samples were aseptically collected from different clinical departments and were submitted to the Viral Research and Diagnostic Laboratory (VRDL), Department of Microbiology during the outbreak of 2016–17. Serum was separated and processed for dengue Non Structural Protein 1 antigen (NS1 Ag)and Immunoglobuline M antibody (IgM Ab) enzyme-linked immunosorbent assay (ELISA). All the relevant variables like age, sex, and demographic profile were recorded and statistically analyzed. Results: A total 295 of the 1026 cases were detected positive for dengue either by NS1 Ag or IgM Ab ELISA. The results show the susceptibility to dengue being increased in the order of age Group I to IV. We analyzed the outbreak of year 2016 and 2017, of these 159/483 (33%) cases and 136/543 (25%) cases, respectively, were found seropositive during these years. The months of September, October, and November are more prone to dengue infection. Conclusion: Group III and IV were more susceptible to dengue fever (DF). The months of postmonsoon season are more favorable for spread of dengue among different age groups of the population.
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Evaluation of esthetics of incisor position in relation to incisive papilla to replicate in the denture prosthesis p. 298
K V. Guru Charan Karthik, B Indira Padmaja, N Suresh Babu, J Haritha, M Nikhil, K Shanthi Priya
DOI:10.4103/jfmpc.jfmpc_772_19  
Background: The distance between the central incisor to incisive papilla (CI-IP) is constant and regarded as one of the landmarks for the placement of artificial teeth in the prosthesis. Earlier studies were done in relation to anterior border of papilla but after extraction the incisive papilla recedes changing the position of anterior border. Materials and Methods: In this study, 100 dentulous subjects were divided into two groups (males and females) with 50 in each group. Maxillary alginate impressions were made and base poured using levelling instrument to standardize all casts and surveyed on the surveyor for uniformity of the casts. The measured distances were analyzed using Student t-test analysis. Results: The ovoid arch was the commonest arch form found in both males and females with slightly more prevalent in females. Analysis was done using Student t-test analysis and found that the mean distance from CI-IP was found to be at 12.85 mm and 12.39 mm in males and females, respectively. Conclusion: When square arch form (both male and female) mean CI-IP was compared with the total sample mean CI-IP, the mean CI-IP of square arch form was less than that of total sample with greater significance (P < 0.05). When ovoid arch form (both male and female) mean CI-IP was compared with the square arch form (both male and female) mean CI-IP, the mean CI-IP of ovoid arch form was greater than that of square arch form with greatest significance (P = 0).
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Perception of family planning and reasons for low acceptance of NSV among married males of urban slums of Lucknow city - A community based study p. 303
Shazia Shafi, Uday Mohan
DOI:10.4103/jfmpc.jfmpc_779_19  
Background and Aims: Population explosion has been India's major problem since independence. It is a major obstacle to the overall progress of the nation. Adoption of family planning methods is one of the best solutions to tackle this problem. The roots of the factors influencing family planning issues are entrenched in the socio-cultural milieu of Indian society. Uttar Pradesh is the most populated state of the country having population of 199.581 million and TFR of 3.3 (AHS 2012-2013) with high fertile trajectory. Among the family planning methods currently, male sterilization accounts for only 0.3% of all sterilizations in Uttar Pradesh (AHS 2012-2013). A strategy to promote men's involvement in effective birth control is needed to reduce the population growth. The aim of this study is: i) To access the perception of married males towards family planning. ii) To access knowledge about NSV iii) enumerate the causes for low acceptance of NSV. Methods: A cross-sectional study was carried out. Multi-stage random sampling technique was used. In the first stage, two urban slums from each Nagar-Nigam zone was selected randomly. In the second stage, from each selected slum, a sample of 24 eligible households was selected at random to achieve the desired sample size. Results: Female sterilization technique was considered as the most effective family planning method by the male respondents. Socio-cultural barriers were the most important reason for the low acceptance of NSV. Educational status was found to be the most important predictor for these socio-cultural barriers. Conclusion: Measures should be taken to remove misconceptions, to increase uptake of NSV.
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Normative reference values on handgrip strength among healthy adults of Dhulikhel, Nepal: A cross-sectional study p. 310
Inosha Bimali, Regmi Opsana, Shrestha Jeebika
DOI:10.4103/jfmpc.jfmpc_785_19  
Context: Handgrip strength (HGS) is the amount of static force that the hand can generate around the dynamometer and can be defined as the ability of the hand to hold the objects between the thumb and fingers. Handgrip measurement is simple but also a valid measure of overall muscle strength and also provides an objective index of functional integrity of upper extremity. Aims: To provide population-based HGS reference values for Nepalese adults from 19 to 70 years of age. Settings and Design: A cross-sectional study was conducted in Dhulikhel community among 526 participants. Methods and Materials: Jamar Dynamometer was used for measuring HGS based on the recommendation provided by the American Society of Hand Therapists. Statistical Analysis Used: Data were analyzed using STATA version 14. Results: Men exhibited higher HGS compared to women with maximum grip strength observed in age group of 19–29 which were 47.24 kg and 32.51 kg for men and women, respectively. HGS decreases with increasing age in both dominant and nondominant hands. Conclusions: The normative reference values provided in this study may serve as a guide for interpreting grip-strength measurements obtained from tested individuals.
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Smoking behavior, knowledge, attitude, and practice among patients attending primary healthcare clinics in Dubai, United Arab Emirates p. 315
Fatima H Alraeesi, Farnoosh J Farzin, Khuloud A Abdouli, FatmaElzahraa Y Sherif, Khawla A Almarzooqi, Noorah H AlAbdool
DOI:10.4103/jfmpc.jfmpc_805_19  
Introduction: Tobacco smoking is one of the largest and highly preventable public health threats worldwide. In the United Arab Emirates, around 15.7% adult males and 2.4% adult females are current tobacco smokers. Primary healthcare clinics (PHCs) have an important role in battling the smoking epidemic by raising awareness among patients attending them daily. The aim of our study was to assess the knowledge, attitude, and practice regarding smoking among patients attending PHCs. Methods: A cross-sectional descriptive study was conducted on patients attending primary healthcare clinics in Dubai. Data was collected using a pretested self-administered questionnaire developed by the researchers and was adopted from the Global Adult Tobacco Survey. Results: Among a total of 500 patients, around 66.4% were never smokers, 23.6% were current smokers, and 10.0% were ex-smokers. The age of first time smoking among current smokers was the highest between 18 and 19 years, with friends being the source of first attempt of smoking (53.4%). Around 53.4% of the current smokers had poor knowledge, while most of never and ex-smokers had a good knowledge level (47.9%, 70.0%), respectively (P value for both <0.05). Majority (71.2%) of current smokers had negative attitude toward anti-smoking statements, while never and ex-smokers had a positive attitude (54.5% and 58.0%), respectively (P value <0.05). Conclusion: The majority of never and ex-smokers had good knowledge level and positive attitude toward anti-smoking statements; however, poor knowledge level and negative attitude was found more among current smokers.
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Patient awareness about the indications and complications of sleeve gastrectomy Highly accessed article p. 321
Zaki H Al Watban, Omar A Al Sulaiman, Mohammad S Al Suhaibani, Ibrahim Y Al Nafisah, Ibrahim M Al Ateiq, Yousef A Al Samil, Yousef A Al Turki
DOI:10.4103/jfmpc.jfmpc_806_19  
Objectives: To assess patients' awareness of the indications and complications of sleeve gastrectomy in King Khalid University Hospital, Riyadh, Saudi Arabia. Methods: The cross-sectional study conducted from December 2017 to May 2018 in KKUH, Riyadh, Saudi Arabia included all patients aged 18 years and older. Data collection was conducted through self-administered questionnaires. Chi-square test was performed to determine the significant differences between variables. A P value of < 0.05 was considered statistically significant. Result: Of 480 participants, 247 (51.5%) of them were male. The educational level of most was bachelor's degree (253; 52.7%). Most of the participants (326; 67.9%) are not aware about BMI. However, 80 (16.7%) participants knew the true answer to obese BMI. Of the total participants, 283 (59.0%) did not knew about sleeve gastrectomy indications; however, 311 (64.8%) of the participants had heard about the complications of sleeve gastrectomy. All these results are correlated with the educational level of the participants. Conclusion: Our study shows a lack of awareness of sleeve gastrectomy indications and complications among study population. We need to increase public awareness about sleeve gastrectomy indications and complication by proper scientific health education in the community.
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Antioxidant activity of eugenol in Piper betel leaf extract p. 327
Anjum Aara, Vani Chappidi, Madhavan N Ramadas
DOI:10.4103/jfmpc.jfmpc_809_19  
Background: Extracts of Piper betel are used for the treatment of various ailments since ages due to its essential properties like antioxidant, anticancer, anti-allergic etc. In the present study antioxidant activity for Piper betel leaf extract and Eugenol was assessed. Eugenol was taken as marker compound. Methods: Nitric oxide, Hydroxyl radical and Reducing power assay methods were carried out for assessment of antioxidant activity of Piper betel. Results: The antioxidant activity for Nitric oxide, Hydroxyl radical and Reducing power assay at 1000 to 62.5μg/ml was performed. The antioxidant activity of Piper betel leaf extract exhibited the IC50 value for Nitric oxide and Hydroxyl radical >1000 whereas Eugenol exhibited the IC50 value 114.34± 0.46 and 306.44 ± 5.28 respectively, for reducing power assay (RPA) Piper betel leaf extract and Eugenol revealed the RPA value ranging from 0.44-0.08 and 0.53-0.12. Conclusion: The benefits of Piper betel have been mentioned in our ancient texts. Keeping in view the emergence of various diseases and the benefits of Piper betei, there is need that every effort should be made to revive this treasure of nature into our daily supplement.
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Quality of life of children with sleep bruxism p. 332
Sruthi Suguna, Deepa Gurunathan
DOI:10.4103/jfmpc.jfmpc_820_19  
Aim: The aim of this study was to compare the Quality of life (QoL) of children with and without sleep bruxism in Chennai population. Materials and Methods: A cross-sectional study was conducted with participants of both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) from different regions of Chennai with the age range of 6–12 years. Parents/Caregivers answered a questionnaire in the waiting room. The QoL was assessed using the Oral Health Impact Profile (OHIP-14). OHIP-14 was analyzed by Mann–Whitney U test. Results: The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers (P > 0.005). There was a significant difference in QoL between the case and control group (<0.001). Bruxers had worse QoL than controls. Conclusion: Sleep bruxism may be associated with a negative impact on QoL.
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“Pattern of ocular morbidities among pilgrims attending religious mega festive event-'Kumbh Mela 2019' at Prayagraj, India” p. 337
Sanjeev K Mittal, Neeraj K Saraswat, Sweety Kumari, Rimpi Rana, Shrinkhal , Siddharth Patel, Vinita Gupta, Ajai Agrawal, Anupam Singh, Neeti Gupta, Ramanuj Samanta, Santosh Kumar, Ajeet S Bhadoria, Anjana Singh, Ravi Kant
DOI:10.4103/jfmpc.jfmpc_826_19  
Background: Globally, ocular morbidities are one of the most underdiagnosed, underreported, and undertreated public health concern. Among estimated 39 billion blind in world, India shares major proportions, with majority of them living in rural population. In India, religious festivals like Kumbh Mela that involve mass gatherings are mainly attended by middle and elderly population who are usually susceptible to various ocular diseases. Therefore, we analyzed the data of our eye camp to document pattern and magnitude of ocular morbidities among pilgrims attending a mega religious festive event. Methods: In a cross-sectional, descriptive study, we included all those patients who participated in a mega eye camp “Netrakumbh” from January to March 2019 at Kumbh Mela, Prayagraj, India and were attended by voluntary ophthalmologist from All India Institute of Medical Sciences, Rishikesh. Presenting chief complaints and detailed history were collected from all participants. All patients underwent comprehensive eye examination including visual acuity, slit lamp biomicroscopic examination, tonometry, etc., Data were compiled and analyzed utilizing SPSS 22.0. Results: A total of 47142 eyes of 23571 persons of all age groups (range 5 years to 70 years) with approximate equal gender distribution attending the mega eye camp were examined. The most common ocular morbidity noticed after ocular examination was refractive error with underlying cause majorly as presbyopia, followed by cataract, after cataract, convergence insufficiency, lids, and adnexal disease, etc. Conclusions: This study highlights the changing pattern of common ocular morbidities presently among middle and elderly populations in developing countries like India.
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Addressing comprehensive primary healthcare in Gujarat through mHealth intervention: Early implementation experience with TeCHO+ programme p. 340
Somen Saha, Priya Kotwani, Apurvakumar Pandya, Chintan Patel, Komal Shah, Deepak Saxena, Tapasvi Puwar, Shrey Desai, Dashrath M Patel, AV Sethuraman, Jayanti S Ravi
DOI:10.4103/jfmpc.jfmpc_835_19  
Background: The Health and Family Welfare Department of Gujarat implemented a mHealth Programme called TeCHO+ (Technology for Community Health Operations) in 2018. TeCHO+ is aimed at making progress across all dimensions of the comprehensive primary healthcare services. Objective: The objective of this study is to record the document rollout and early implementation experience of TeCHO+ programme in Gujarat. Methods: The present participatory process documentation exercise was undertaken in Gujarat. The various steps for process documentation were decided after participation in multiple task force meetings and state/district- and taluka-level action seminars and reviewing the TeCHO+ programme data and progress reports. The perceptions of the health officials and field staff were gathered using key informant interviews from five districts of Gujarat: Bharuch, Narmada, Gandhinagar, Mahisagar, and The Dangs. In addition, stakeholders involved with TeCHO+ Programme were interviewed to understand the process of rollout, implementation challenges, and success. Results: In the initial phase, the TeCHO+ application focussed only on updating the Family Health Survey to improve the quality of data captured in the system. FHWs log-in the mobile application daily to access their daily work plan for which SMS alerts were are also generated. Most FHWs were in their 50s and were first-time smartphone users. Although, they were enthusiastic and open to the new technology, initially they faced certain difficulties in operating the application. The programme had a strong troubleshooting mechanism in terms of the use of WhatsApp group, helpline numbers, and voice calls in addition to supportive supervision. Discussion: TeCHO+ showed the potential to enhance the quality of the collected data and also service coverage. However, poor technology literacy of old FHWs, the launch of multiple programme memes at the same time, and target-driven task assignments pose major challenges.
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Referral chain of patients with obstetric emergency from primary care to tertiary care: A gap analysis p. 347
P Prathiba, R Niranjjan, Dilip Kumar Maurya, Subitha Lakshminarayanan
DOI:10.4103/jfmpc.jfmpc_836_19  
Background: The referral system plays a crucial role in antenatal care and childbearing by providing access to emergency obstetric care. Excess referral from primary care and bypassing secondary levels of care leads to overcrowding of high risk and normal mothers in tertiary centers. Hence, this study aims to assess the gaps in the referral of patients with obstetric emergency from primary care to tertiary care. Methodology: In this hospital-based descriptive study, all obstetric patients referred to the Obstetric emergency facility and admitted in postnatal wards during the study period were included. They were interviewed using a pretested questionnaire. Data entry was performed using EpiData version 3.1 and analysis was done using SPSS version 22 software. Results: Of the 505 eligible women who attended the facility, 286 (56%) were referred from other institutions, while 44% were self-referred. Among those referred, one-third were from tertiary level facility and 40% from primary care facility. More than half of the referral was through verbal communication to the patient (60%); only one-third had referral slips. Around 40.4% chose bus and private vehicles (37.6%) as their means of transport; only around 10% traveled in 108 ambulances. Conclusions: Measures to improve the capacity building at primary setting, hierarchy of referral, quality of documentation, and emergency transport mechanism for obstetric patients are vital. The deficits identified in the existing referral system will be useful to give feedback to the health systems of the neighboring regions on emergency obstetrics referrals and to propose referral guidelines.
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Efficacy of remineralizing agents to occlude dentinal tubules in primary teeth subjected to dentin hypersensitivity in vitro: SEM study p. 354
Mebin George Mathew, Ashu Jagdish Soni, Md Muzammil Khan, Afreen Kauser, Vunnam Sri Sai Charan, Sunil Kumar Akula
DOI:10.4103/jfmpc.jfmpc_853_19  
Aim: Comparison of casein phosphopeptides (CPPs) and amorphous calcium phosphate (ACP), tricalcium phosphate, and hydroxyapatite on assessment of dentine tubule occlusion on primary enamel using scanning electron microscope (SEM). Materials and Methods: A total of 20 freshly extracted noncarious primary molars were randomly divided into four groups (A to D) with five sections in each group; group A: negative control, group B: CPP-ACP, group C: tricalcium phosphate, and group D: Hydroxyapatite (HA). To assess tubule occlusion, 20 dentin sections of 2 mm thickness were obtained from cervical third of sound primary molars. Each section were processed to simulate the hypersensitive dentin and the test agents were brushed over the sections with an electric toothbrush and observed under SEM for calculation of the percentage of occluded tubules. Results: Group B and D showed greater percentage of tubule occlusion than group C. Intergroup comparison of tubule occlusion potential of Group B and D was not significant. Conclusion: HA showed significantly higher dentinal tubule occlusion when compared to CPP-ACP and tricalcium phosphate.
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Morbidities of rice mill workers and associated factors in a block of West Bengal: A matter of concern p. 359
Soumit Roy, Aparajita Dasgupta, Lina Bandyopadhyay, Bobby Paul, Sayanti Bandyopadhyay, Mukesh Kumar
DOI:10.4103/jfmpc.jfmpc_858_19  
Context: Rice mill workers usually belong to unorganized sector and lack in training regarding hazard prevention. Unprotected exposure to suspended particles and fumes can lead to respiratory morbidities among them. Workers, especially loaders, were susceptible to work-related musculoskeletal diseases. Aim: To find out the morbidity profile and associated factors among rice mill workers. Methodology: A cross-sectional workplace-based study was conducted during July--September 2018 among 143 workers of two rice mills in Indas block, West Bengal. Workers, employed for at least 6 months in the rice mills and who gave informed written consent was interviewed using a predesigned pretested questionnaire and were clinically examined. Nonfasting capillary blood glucose estimation and spirometry were carried out. Workers contraindicated to spirometry were excluded. Result: Commonest morbidities were musculoskeletal discomfort (65%), hypertension (20.9%), and chronic respiratory morbidity (16.9%). No personal protective equipment (PPE) was used by these workers. Significant association of musculoskeletal discomfort was found with tobacco abuse (Adjusted Odds Ratio (AOR) =2.90), job of loader (AOR = 3.51), and central obesity (AOR = 3.39). Hypertension was significantly associated with increasing age (AOR = 1.06), and increasing body mass index (AOR = 1.17). Whereas increasing age (AOR = 1.08), working inside mill (AOR = 7.58), working more than 48 hours a week (AOR = 7.37) were significantly associated with chronic respiratory morbidity. Conclusion: Optimization of working hours, effective continuous use of PPE, and use of proper ventilation technology are recommended. Proper work placement, preplacement examination, and periodic health screening with spirometry are also needed.
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Educating patients of diabetes mellitus for diabetic foot care p. 367
Satyam Singh, Suhas Jajoo, Samarth Shukla, Sourya Acharya
DOI:10.4103/jfmpc.jfmpc_861_19  
Background and Purpose: Diabetes mellitus (DM) is a global pandemic. Among the spectrum of diabetic complications, diabetic foot is a leading cause of morbidity and hence awareness and education regarding primary healthcare inclusive of self-care pertaining to diabetic foot care is of paramount importance. Aim: The aim of the study was to educate patients of DM regarding the disease and its associated complications, specifically pertaining to diabetic foot care. Methodology: The study was carried out in three phases, first was to assess the diabetic patients related to their awareness on disease complications and diabetic foot care, through pretest questionnaire, the second phase was to sensitize patients and educate them on the same, the third phase was to re assess the knowledge gained by the patients through posttest assessment. Results: The study evaluated the absolute and relative learning gain regarding the awareness and knowledge of foot care among diabetic individuals. The absolute learning gain was 40.92% and the relative learning gain was 76.48% and normalized learning gain was 0. 88, the normalized gain was assessed to be high. Conclusion: The study concluded that training and sensitizing individuals with diabetes will definitely help reduce morbidity of diabetic foot and hence the medical and paramedical staff need to spread awareness regards the same.
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Awareness, knowledge, and attitude toward nonmelanoma skin cancer and actinic keratosis among the general population of western Saudi Arabia p. 374
Reem N Basyouni, Hussein M Alshamrani, Sirin O Al-Faqih, Sara F Alnajjar, Fadi Ali Alghamdi
DOI:10.4103/jfmpc.jfmpc_874_19  
Background: This study evaluated the levels of awareness, knowledge, and attitude, including sun-protection habits, toward basal cell carcinoma and actinic keratosis among the Saudi population. Materials and Methods: A cross-sectional study was conducted among the general population of Jeddah, Saudi Arabia using a 12-item survey concerning the knowledge and awareness of basal cell carcinoma and actinic keratosis, as well as associated preventive measures. A Chi-square test was used to determine associations among variables. Results: The majority of participants were unaware of basal cell carcinoma and actinic keratosis (80.7%), while 8.6% were aware of both, and 9.8% and 1% were aware of only basal cell carcinoma or actinic keratosis, respectively. The majority of participants who were educated up to high school level had no knowledge of either condition (96%, P < 0.0001). Among participants with high levels of awareness of basal cell carcinoma and actinic keratosis, medical practitioners were identified as the main source of information (72.5%, P < 0.0001, and 70.6%, P < 0.0001, respectively). The majority of participants whose knowledge of the relationship between sun exposure and skin cancer was insufficient also lacked sufficient awareness of either basal cell carcinoma or actinic keratosis (92.6%, P < 0.0001). The majority of participants (62.8%) declared using sunscreen “rarely”. Conclusion: This study showed a low level of knowledge about the risks associated with sun exposure and suitable protection methods, with only a small fraction of participants declaring a regular use of sunscreen. Public education campaigns are required to increase the awareness of cancer risks and protection methods among the Saudi population.
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Awareness and knowledge about anterior cruciate ligament injury among the general adult population of Saudi Arabia p. 379
Elsayed S Gharbawi, Mohammed S Al-Mubaddil, Ghusoon F Al-Moaibed, Shoq O Al-Shammri
DOI:10.4103/jfmpc.jfmpc_877_19  
Background: The literature shows that data regarding the Saudi public's knowledge about anterior cruciate ligament (ACL) injury is still limited. Aims: This study aimed to determine the knowledge toward ACL injury in the general population of Saudi Arabia, as well as to investigate the main sources of information about ACL among the public. Materials and Methods: A cross-sectional online survey was conducted among a sample of 408 participants from all regions of Saudi Arabia. All participants completed an anonymous self-administered questionnaire, which included questions about their sociodemographic details and a structured tool to measure their knowledge about ACL injuries. Results: The present study showed that among 408 participants, 233 (57.1%) had adequate knowledge about ACL injuries, and 253 (62.0%) appreciated the seriousness of ACL injuries. The level of knowledge about ACL injuries was significantly associated with higher educational level (P = 0.000), but not with sex (P = 0.424) and region of residence (P = 0.404). Most of the participants agreed that ACL injury is a multi-factorial condition that results from a combination of factors, including sports, lack of warm-up before exercise, car accidents, old age, and lifting heavy objects. Internet, TV, and books were the most common sources of information about ACL injuries. Conclusions: While over half of the participants were aware of ACL injury, its seriousness, and its common risk factors, there are still knowledge gaps regarding ACL injury symptoms. Therefore, we recommend increasing public awareness about ACL injury, specifically through health education websites and TV programs.
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Parents' knowledge, attitude, and practice regarding the pit and fissure sealant therapy p. 385
Lakshimi Lakshmanan, Deepa Gurunathan
DOI:10.4103/jfmpc.jfmpc_881_19  
Context: Parents' interpretation on children's oral health care practices plays a vital role in improving children's oral health. Aim: This study sought to evaluate parents' knowledge, attitude, and practice regarding dental sealants. Materials and Methods: A cross-sectional study was conducted among parents of school-going children in Chennai, India. Knowledge, attitude, and practice toward sealant therapy were assessed through a questionnaire survey among 250 parents (45% fathers and 55% mothers). Results: A statistically significant difference was noted in the knowledge and attitude scores at various age groups; 71% of the participants agreed that pit and fissure sealants are effective in preventing dental caries. Only 34% of the study participants' children had received dental sealants. Conclusion: The parental knowledge and awareness of preventive practices appear to support dental sealants as a preventive strategy for dental caries. But most parents did not practice the preventive measures despite knowing its effectiveness and benefits. Greater efforts should be made to encourage the parents to provide their children with primary care.
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Association of high-sensitivity C-reactive protein (hs-CRP) with non-alcoholic fatty liver disease (NAFLD) in Asian Indians: A cross-sectional study Highly accessed article p. 390
Rahul Kumar, YC Porwal, Nishanth Dev, Priyadarshi Kumar, Sanjay Chakravarthy, Ashok Kumawat
DOI:10.4103/jfmpc.jfmpc_887_19  
Background: Non-alcoholic fatty liver disease (NAFLD) is an important etiology for the development of chronic liver disease worldwide. Its pathophysiology includes chronic low-grade inflammation. There are limited studies on the association of inflammatory markers with NAFLD. Hence, in the present research, we aimed to study the association of one such inflammatory marker hs-CRP with NAFLD in north Indian population. Materials and Methods: For this cross-sectional study, 100 subjects of either sex above 18 years of age, being diagnosed as a case of NAFLD on the basis of ultrasonography and age, sex and BMI matched subjects fulfilling the inclusion and exclusion criteria were included. Anthropometric profile, high-sensitivity C-reactive protein (hs-CRP), HbA1c, and hepatic function tests were recorded. Results: The baseline variables were matched for age, weight, BMI, waist-hip circumference ratio, and blood pressure. The HbA1c (P < 0.001), alanine aminotransferase (P = 0.002), alkaline phosphatase (0.002), and hs-CRP (P < 0.001) were elevated in subjects with NAFLD. The mean level of hs-CRP was significantly higher in subjects with NAFLD as compared to the control group (3.12 ± 1.42 mg/L vs 1.05 ± 0.44 mg/L, P < 0.001). The mean hs-CRP level was 1.42 ± 0.55 mg/L in grade 1, 0.98 ± 0.72 mg/L in grade 2 with P < 0.001, and 4.5 ± 1.11 mg/L in grade 3 with P < 0.001 when compared to grade 1.The comparative value of hs-CRP in the control group was found to be 1.05 ± 0.44 mg/L. On univariate analysis waist-hip circumference ratio (P = 0.035), HbA1c (P < 0.001), and hs-CRP (P < 0.001), showed a significant association with NAFLD. On logistic regression hs-CRP was found to have significant association with NAFLD even after adjusting waist-hip circumference ratio and HbA1C (odds ratio 1.311, 95% confidence interval 1.146–1.488, P < 0.001). Conclusion: In this cohort of north Indian population, hs-CRP showed independent relationships with NAFLD. Thus, hs-CRP may be used as a surrogate marker for the disease severity in NAFLD.
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A family physician's journey in exploring sexual health perceptions and needs in a boarding school community p. 395
Jachin Velavan
DOI:10.4103/jfmpc.jfmpc_888_19  
Introduction and Context: Sexual health in schools is neglected in most developing countries,[1] however, it is emerging as a major need of the hour. This article captures the author's experience as a family physician in a boarding school setting in India highlighting the need and possible solutions pertaining to sexual health in the school community. Setting: An international boarding school in India with approximately 600 students, 500 teachers, and administrators who lived on the school campus and 500 support staff who lived off-campus. Materials and Methods: Three events prodded the author to explore perceptions and needs pertaining to sexual health in the school community. Being a difficult area of inquiry, this was done as informal qualitative research by dialoguing with six groups of people in the school community: School counselors, parents, student supervisors such as teachers, advisors and dorm parents, school administrators, support staff, and the students and the responses were collated. Observations: A mere 17.9% of grade 5 to 12 students, of age-groups 10 to 19 never had a conversation with their parents about sexuality. Students were largely ignorant or misinformed on most sexuality-related issues but engaged well when offered anonymity or safe space. Though all stakeholders in the school agreed that students needed an age-appropriate, gender and culture-sensitive, scientific and comprehensive sex education, parental responses were mixed. Conclusion: The author's journey as a family physician in a school setting has prompted exploration of a wholistic model for the provision of comprehensive sexual health in schools and the emerging role of a family physician in schools.
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Prescription patterns of antipsychotics in the management of first episode psychosis at three psychiatric hospitals in Khartoum, 2018: A descriptive cross-sectional study Highly accessed article p. 402
Malaz M A Mohamed, Bashir A Yousef
DOI:10.4103/jfmpc.jfmpc_892_19  
Background: First-Episode Psychosis (FEP) is defined as the first treatment contact with psychiatric service, regardless of the duration of symptoms. This study aims to determine the antipsychotics prescription patterns in FEP patients at three psychiatric hospitals in Khartoum. Method: A descriptive cross-sectional retrospective hospital-based study was conducted at Eltigani Elmahi, Taha Baasher, and Abd Elaal Aledrissi Psychiatric hospitals in Khartoum State, Sudan, during the period March to July 2018. Medical records of patients with FEP were identified and reviewed to look for demographic data, the onset of symptoms, investigations requested, and medications prescribed. Data were recorded and subjected to statistical analysis using the Statistical Package for Social Sciences. Result: Reviewing the medical records of the 98 FEP patients (66 males and 32 females) included in the study showed that the majority of patients (94.8%) were medicated with combinations of psychotropic medications. The most commonly used combination was Haloperidol, Olanzapine, Promethazine, and Benzodiazepines. And only 5.1% of the whole population was treated with an atypical antipsychotic (Olanzapine) as a monotherapy. Conclusion: Based on prescription patterns and requested investigations, there was a wide gap between the actual practice regarding antipsychotics prescriptions for FEP at the three psychiatric hospitals and the evidence-based guidelines in this respect.
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Complications of arteriovenous fistula in dialysis patients: Incidence and risk factors in Taif city, KSA p. 407
Majed Mansour Aljuaid, Nawaf Najim Alzahrani, Abdulrahman Abdulaziz Alshehri, Lama Humaied Alkhaldi, Faisal Sultan Alosaimi, Nawwaf Waiel Aljuaid, Omar Ahmed Asiri, Ayman Ahmad Atalla
DOI:10.4103/jfmpc.jfmpc_848_19  
Aim: The aim of this study was to measure the prevalence of arteriovenous fistula (AVF) and its complications in patients undergoing hemodialysis (HD) in Taif Region, Saudi Arabia. Methods: This was a prospective hospital-based study conducted on 196 patients aged above 18 years who were undergoing dialysis in two hospital Taif City. Data collected and documented using a pretested questionnaire, which included sociodemographic details and also information about fistula-related complications. Hospital records were also reviewed to match the complication and related risk factors. Appropriate statistical tests were used and analyzed with SPSS software ver. 23. Results: Majority of the study patients were in the age group of 41–60 years and the prevalence in male and female were 49.5% and 50.5%, respectively. The most prevalent chronic illness in the patients was hypertension (41.7%) and more than 30.6% had multiple chronic illness. The most common type of AVF was radiocephalic fistula (RCF). The most common complication associated with the patients with AVF was ischemic neuropathy (29.6%). Smokers had significant history of myocardial infarction than non smokers. Conclusion: Early and timely detection of complications in AVF is essential for proper management. Health professional should have thorough knowledge regarding the complications related to AVF. Early diagnosis and appropriate treatment are essential to improve the quality of life in patients on HD.
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Clinical and hematological features among β-thalassemia major patients in Jazan region: A hospital-based study Highly accessed article p. 412
Mohammed Mansour Khawaji, Ahmad Ali Hazzazi, Mohssen Hassen Ageeli, Yahya Hassan Mawkili, Abdulrahman Hussain Darbashi, Anwar Mohammed Ali Abo Kathiyah, Rehab Abdalrhman Humedi
DOI:10.4103/jfmpc.jfmpc_1007_19  
Context: Beta-thalassemia is a prevalent hereditary blood disorder in Saudi Arabia. Various clinical manifestations and hematological abnormalities are common among these patients. Aims: To evaluate the clinical manifestations and hematological parameters of β-thalassemia patients in Jazan, Saudi Arabia. Settings and Design: This is a cross-sectional study conducted in Jazan region, Saudi Arabia. Methods and Materials: We included 36 β-Thalassemia major patients who admitted to PMNH during the period from February 1, 2016 to December 31, 2017. Clinical features were obtained via physical examination. The hematological parameters were obtained from the patients' medical records. Statistical Analysis Used: Descriptive and inferential statistics were conducted using SPSS. Continuous data was evaluated using independent sample t-test and Chi-square was used to evaluate categorical variables. P < 0.05 indicated statistical significance. Results: Mean age was 18.56 ± 6.89 years. Males were 23 (63.9%). About 41.4% of patients were underweight. Exposing of the upper teeth was the most prominent feature (n = 19, 59.4%). The majority of patients were splenectomized (62.1%). About two-thirds have moderate anemia. More than half of the patients (58.8%) had high WBCs counts and 35.3% had a high platelet count, especially among those who underwent splenectomy. Approximately, two-thirds had a ferritin level higher than 2500 ng/ml. O+ blood group was the most frequent blood group among the patients (n = 15, 46.9%). Conclusions: Deteriorated clinical and hematological parameters in our study justify the need for more efforts for regular evaluation and follow-up of the βTM patients and reevaluation of the management protocols to be improved or modified.
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CASE REPORTS Top

Facts and figures on medical record management from a multi super specialty hospital in Delhi NCR: A descriptive analysis p. 418
Stuti Verma, Manish Midha, Ajeet Singh Bhadoria
DOI:10.4103/jfmpc.jfmpc_612_19  
Aim of Study: A study of the medical records department of a multi super specialty secondary care hospital in NCR. Materials and Methods: Primary data was collected through direct observation and retrospective study of documents maintained in MRD. Secondary data was collected from quality control department books, journals, scholarly articles, and internet. Results and Conclusion: Sample sizes of 350 retrospective and current medical records were thoroughly scrutinized. Conclusion revealed the hospital has published as exhaustive medical records manual listing and the scope, objective, hierarchy chart, job description, policies, procedures, and processes. The MRD has a well-documented flow process of medical records, but on checking the flow of patient records between Nov 2016 to Feb 2017; it was revealed that in month of Nov 2016, out of the total 278 patients discharged only 276 files were received in MRD and 0.72% files were not received. Moreover, it took over 31 days for 71 patients (23.67%) to receive files in MRD. In Jan 2017, out of 286 patients discharged, only 237 files were received in MRD contrasting to 10.14% files not received. Moreover, it took over 31 days for 28 patients (9.80%) to receive files in MRD. In Feb 2017, out of 268 patients discharged, only 206 files were received in MRD and 22.39% files were not received as on 11 March 2017. This study concluded that there is no effective system in place to monitor/track files from ward/billing section to MRD once the patient is discharged. Clinical Significance: Medical records are valuable to patients, physicians, healthcare institutions, researchers, National Health agencies, and International health organizations. Memories fade, people lie, witnesses die; however, medical records live forever. A thorough system of flow process of monitoring/tracking files is to be in place to ensure accountability, smooth functioning, and quality of care being provided without violating basic patient sight of confidentiality of information.
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Tubercular granuloma mimicking pyogenic liver abscess p. 424
Mohit Garg, Yasmeen Khan, Monika Pathania
DOI:10.4103/jfmpc.jfmpc_630_19  
Hepatic Tuberculosis (TB) is extremely rare without miliary involvement in immunocompetent patients. Even in countries like India where TB is a major public health problem only few cases have been diagnosed and treated. We report a case of an immunocompetent patient who presented with undiagnosed pyrexia of 11 days, was initially diagnosed as pyogenic liver abscess, he did not responded to treatment and on liver biopsy was diagnosed as hepatic tuberculoma. Antitubercular treatment (ATT) was started and the patient responded well. We concluded that though hepatic TB is rare in immunocompetent patient, it is important to keep it as a differential diagnosis in patients of liver abscesses who are not responding to treatment in order to avoid needless investigations.
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A novel approach to regenerate bone loss in an adolescent using concentrated growth factors: One-year follow-up p. 428
Mebin George Mathew, Ashu Jagdish Soni, Md Muzammil Khan, Afreen Kauser
DOI:10.4103/jfmpc.jfmpc_919_19  
Destructive periodontal diseases are rare occurrences in the paediatric population. Moreover, the regenerative potential of the periodontal tissues and supporting structures of teeth is even rare, once irreversible damage has occurred. The aim of this paper is to discuss the regeneration of alveolar bone defect in a 14-year-old using concentrated growth factors (CGF). Following crown removal, scaling, debridement and site preparation, CGF was placed and secured in one-walled defect in the mesial side of the lower right permanent molar. The crown was replaced on to the tooth and the patient was followed up at 1, 3, 6, 9 and 12 months for clinical and radiographic evaluation. After 12 months, the radiographic evaluation revealed the defect to be filled with alveolar bone and probing pocket depth had reduced significantly. Thus, CGF can be an effective agent and can act as a potential scaffold for periodontal regeneration in adolescents with bone loss.
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An uncommon cause of fever in a patient with hyperthyroidism p. 432
Krishna P Gautam, Kanakkankotil U Lijesh, John Jude, Riddhi D Gupta, Thomas V Paul
DOI:10.4103/jfmpc.jfmpc_933_19  
Fever as an indicator of disease has always been and remains a clinical symptom of great importance. It may be a manifestation of any inflammatory process of the thyroid and also may be presenting feature of thyroid storm. Melioidosis, is an infection caused by the gram negative bacterium Burkholderia pseudomallei and the commonest co-morbidity observed in India is diabetes mellitus. Here we present a case of Graves disease (hyperthyroidism) who was referred by primary care physician with history of prolonged fever of more than one month duration and later diagnosed to have melioidosis. It is important in primary care setting as family physicians need to be aware of this infection as it can affect many organs and early diagnosis and treatment will result in cure of this condition.
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Yoga therapy for fibromyalgia syndrome: A case report p. 435
Anita Verma, Sanjay U Shete, Gururaj Doddoli
DOI:10.4103/jfmpc.jfmpc_816_19  
Fibromyalgia is a rheumatologic syndrome leading to increased pain sensitivity, sleep disturbance, fatigue, stiffness, and tenderness of joints, muscles, and tendons due to dysregulation of neurophysiological functions. In the present case report, a 42-year-old, non-Indian, nonsmoking, nonalcoholic, female presented with complaints of severe difficulty in walking, joint pains, and generalized loss of balance of the body. The patient was an established case of fibromyalgia. The treatment plan for the patient included 9 months of yoga therapy. No concomitant allopathic medication was given during this whole treatment period. The patient was given special yoga postures to improve flexibility and movement of joints, daily 1 hour, 6 days/week in the morning, and evening for 9 months. The muscle fatigue, quality of life and sleep was assessed at the baseline, 3rd, 6th, and 9th month. The result of present case study demonstrated reduction in muscle fatigue and improvement in quality of life and sleep.
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Emergent airway management in blunt tracheal trauma: A novel use of the mini-tracheostomy kit p. 439
Rajiv Shukla, Seelora Sahu, Shashi Kant, KP Dubey, Amlan Swain, Vamsi K Uppalapati
DOI:10.4103/jfmpc.jfmpc_865_19  
Aim: To report and discuss a novel way of managing the airway in a difficult case of anterior tracheal wall disruption caused by blunt trauma to the neck. Background: Tracheal injury resulting in laceration of the windpipe may present with either one or many of the multitude of problems such as respiratory distress, hoarseness of voice and subcutaneous emphysema. Most often it requires surgical intervention. Case Description: We hereby present the novel use of a mini-tracheostomy kit as an aid in the cannot-intubate-cannot-ventilate situation of a 30-year-old patient presenting with severe features of blunt tracheal injury. The airway was established critically with the use of the mini-tracheostomy kit in a “cannot-intubate-cannot-ventilate” situation during surgical tracheostomy and a potentially disastrous cardiorespiratory arrest situation was averted. Conclusion: Timely presence of airway equipment, adequate preparation, a willingness to innovate and a team approach are of paramount importance in dealing with difficult airway situations that are presented in myriad and complex ways. Clinical Significance: The stylet of mini-tracheostomy kit can be used in emergent airway management especially in clinical situations mimicking ours specifically as a guide for insertion of the standard tracheostomy tube.
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Ovarian lymphoma in a patient on long-term sulfasalazine for ulcerative colitis p. 442
Athula Kaluarachchi, B G. I. K. Bambaranda, UG Jayawardena, HJ De Silva, S M. A. Matwani, U Rameshkumar
DOI:10.4103/jfmpc.jfmpc_886_19  
We report a case of ovarian lymphoma in a 59 year old woman with ulcerative colitis for over 20 years. She presented with intermittent high fever and right sided abdominal pain for 3 weeks. An ultrasound scan and CT scan revealed a right adnexal mass measuring 71 X 54 mm which was well defined with a thick wall and internal septations and enlarged pelvic and para aortic lymph nodes. The patient underwent bilateral salpingo oophorectomy and omentectomy. Histology confirmed a diffuse large B cell Non Hodgkin's lymphoma and she was referred for chemotherapy. After 6 cycles of chemotherapy she showed a good response. Lymphoma of the gastrointestinal tract arising in a background of ulcerative colitis has been known to occur,ovarian lymphoma with a background of ulcerative colitis has not been reported.
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LETTERS TO EDITOR Top

Experience sharing of flood relief health activities at Sangli, Maharashtra p. 445
Dhikale Prasad Tukaram, Balkrishna B Adsul
DOI:10.4103/jfmpc.jfmpc_963_19  
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'Beehive-like'appearance in thoracic tuberculous lymphadenopathy p. 447
Parag M Tamhankar, Manoj Sangoi
DOI:10.4103/jfmpc.jfmpc_878_19  
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Disaster-related media exposure and its impact on mental health p. 448
NA Uvais
DOI:10.4103/jfmpc.jfmpc_981_19  
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Ranitidine-induced galactorrhea: Exploring the intricacies p. 450
Avik Ray, Ahmad Najmi, Balakrishnan Sadasivam
DOI:10.4103/jfmpc.jfmpc_987_19  
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