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   Table of Contents - Current issue
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March 2020
Volume 9 | Issue 3
Page Nos. 1281-1779

Online since Thursday, March 26, 2020

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EDITORIAL  

Family medicine takes center stage in India: National Medical Commission Act 2019 Highly accessed article p. 1281
Raman Kumar
DOI:10.4103/jfmpc.jfmpc_285_20  
The National Medical Commission—NMC—Act has been passed in the Indian parliament. NMC replaces the MCI—Medical Council of India act and promises to facilitate in delivering quality primary health care. Family medicine has been mentioned thrice in this act and both undergraduate and postgraduate boards of the NMC have been mandated to promote family medicine discipline.
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REVIEW ARTICLES Top

Pathogenetic mechanism of oral granulomatous diseases: An update Highly accessed article p. 1283
Nishath Sayed Abdul
DOI:10.4103/jfmpc.jfmpc_1162_19  
Oral granulomatous diseases are an intriguing group of lesions characterized by granuloma formation. Mechanisms of granuloma formation differ from disease-to-disease. This article provides an insight into common granulomatous pathogenic mechanisms involving these lesions including immunodeficient states. Understanding various pathogenic mechanisms underlying various granulomatous conditions affecting oral tissues which mainly revolve around inflammatory cells such as macrophages, T lymphocytes, and genetic mutations might aid in devising treatment modalities without having significant side-effects or morbidity in affected subjects.
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A review on management of gestational trophoblastic neoplasia Highly accessed article p. 1287
Seyedeh Reyhaneh Yousefi Sharami, Elham Saffarieh
DOI:10.4103/jfmpc.jfmpc_876_19  
Background: The rare presence of malignant cancerous cells afar any type of pregnancy is known as gestational trophoblastic neoplasia (GTN). GTN are benign lesions which mostly happen due to the activity of extravillous trophoblast cells and the placental villous tree development. These kinds of diseases would be occurring mainly due to the following clinicopathologic conditions: (I) existence of epithelioid trophoblastic tumor (ETT), (II) rare type of choriocarcinoma cancer, (III) gestational trophoblastic tumor of mole, and (IV) the rare malignant tumor of placental site trophoblastic tumor. Objective: This comprehensive study is trying to review the most recent approaches in comprehension of pathogenesis, more precise diagnosis, and also the most effective therapeutic procedures for patients who suffer from GTN disorders. Materials and Method: A comprehensive research was carried out on scientific databases of Science Citation Index (SCI), MEDLINE, EMBASE, HMIC, PubMed, CINAHL, Google Scholar, Cochrane Database of Systematic Reviews (CDSR), and PsycINFO over the time period of 2005 to 2019. The keywords which applied for discovering more related records were including: Gestational trophoblastic diseases (GTD), Gestational trophoblastic neoplasia (GTN), molar pregnancy, choriocarcinoma, human chorionic gonadotropin (hCG), diagnosis, management and treatment. Conclusion: In spite of the fact that GTN patients are treated with conventional surgical therapies or/and chemotherapy, in some patients with resistant disease, these therapies may not be effective and patients may die. Some novel remedial agents are required for decreasing the level of toxicity caused through administering conventional chemotherapy and also treating the patients who suffer from refractory or resistant disease. The newest issues are related to GTN diagnosis, process of progression of hydatidiform mole (HM) to GTN, and the issue of GTN drug resistance. In this regard, we should have a comprehensive knowledge on GTN genetics for answering all the available questions about this disorder.
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Common data elements of breast cancer for research databases: A systematic review Highly accessed article p. 1296
Esmat Mirbagheri, Maryam Ahmadi, Soraya Salmanian
DOI:10.4103/jfmpc.jfmpc_931_19  
Background: Common Data Elements (CDEs) are data-metadata descriptors used to collect research study data. CDEs facilitate the collection, processing, and sharing of breast cancer data. This study intended to explore the CDEs of breast cancer for research databases and primary care systems. Methods: This study was conducted using systematic search and review. This systematic literature review covered PubMed, Scopus, Science Direct, SID, ISC, Web of Science, and Google Scholar search engine. It included studies in English language with accessible full-text from the beginning of 2007 to September 2019. Results: Reviewing 25 studies revealed that 52 percent of studies were carried out in the US and most studies were conducted between 2013 and 2015. The most domains for using CDEs were: Pathology Report and Registry. The CDEs of breast cancer for research databases were categorized into three categories namely clinical, research, and non-clinical and indicate the importance of these data elements. Most of the studies focused on creating and deploying clinical CDEs as physical examination, clinical history and pathology data. Conclusion: The integration of biomedical and clinical data relevant to breast cancer enhances the power of research variable analysis and statistical analysis, thereby facilitating improved knowledge of effective therapeutic interventions. Also CDEs used to collect, store, and retrieve patient data in various health setting such as primary care and research databases.
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Effect of 38% silver diamine fluoride on control of dental caries in primary dentition: A Systematic review p. 1302
Zohra Jabin, V Vishnupriya, Nidhi Agarwal, Iffat Nasim, Meena Jain, Ankur Sharma
DOI:10.4103/jfmpc.jfmpc_1017_19  
Silver diamine fluoride (SDF) has been extensively researched and proven effective for caries prevention and arrest in children. Limited studies support its effectiveness in primary dentition at 38%. This systematic review examines the effectiveness of 38% silver diamine fluoride on control of dental caries in primary dentition. Multiple search engines and databases were searched in accordance with predefined inclusion-exclusion criteria. Quality assessment was done using Centre for Evidence-Based Medicine worksheets. Scientific works of literature were searched in October 2019 for articles. Four studies were identified that addressed the effectiveness of 38% SDF on deciduous dentition in children. All the four studies selected were controlled clinical trials. The cumulative results of the studies showed that 38% SDF application is efficacious and safe for the control of dental caries in primary teeth. Its advantages over different other techniques or placebo have been demonstrated. Based on this systematic review, 38% SDF is one of the best treatment approaches in control of dental caries in primary dentition.
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Comparison of different doses of daily iron supplementation for anemia prophylaxis in pregnancy: A systematic review p. 1308
Kapil Yadav, MC Arjun, Olivia Marie Jacob, Shashi Kant, Farhad Ahamed, Gomathi Ramaswamy
DOI:10.4103/jfmpc.jfmpc_960_19  
Different doses of iron are used for oral supplementation during pregnancy throughout the world. This objective of this review is to describe the effectiveness and side effect profile of different doses of oral iron supplementation for prophylaxis of anemia among pregnant women. Published literature was searched using keywords “iron,” “pregnancy,” and “supplementation” and related terms. Gray literature was searched in medical libraries including National Medical Library, Dr. B. B. Dikshit library, and library of ICMR. Intervention studies comparing different doses of oral iron given as prophylaxis for anemia during pregnancy, published till December 2017, were retrieved. Studies done only among anemic patients, and studies comparing oral iron with placebo were excluded. In total, 1588 studies were obtained and 11 of them met the objectives. In global studies, prophylactic dose of 30 mg and above is shown to maintain normal hemoglobin. Among the studies from India, prophylactic dose of 120 mg showed consistent results and 60 mg showed inconsistent results in increasing both hemoglobin and ferritin levels. No significant difference in side effects was reported up to 80 mg iron in global studies and the side effects were comparable with 60 to 240 mg doses in Indian studies. It was evident from the review that a state of clinical equipoise exists for the ideal dose of iron supplementation for the prevention of anemia in pregnancy in terms of efficacy and side effect profile. Robust clinical trial as well as technical consultation is required, especially in Indian setting to explore this question further.
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A review on the recent application of ketamine in management of anesthesia, pain, and health care p. 1317
Abolfazl Abdollahpour, Elham Saffarieh, Babak Hosseinzadeh Zoroufchi
DOI:10.4103/jfmpc.jfmpc_875_19  
Ketamine is considered as a promising drug for many clinical applications even after five decades since its discovery. Ketamine is a dissociative anesthetic agent with a variety of pharmacological effects from anesthetic induction and maintenance to analgesic and sedative depending on the consuming dose. It can be used solely or in combination with other co-adjuvant drugs, increasing their efficacy. Many therapeutic properties of ketamine have been attributed to its antagonism mechanism to N-Methyl-D-aspartate receptor. Identifying new properties of ketamine such as neuroprotective, antiinflammatory, and antitumor effects, on one hand, and taking advantage of subanesthetic regimens of ketamine, on the other hand, have resulted in a widespread use of ketamine in various clinical applications. Ketamine is solvable in aqueous and lipid solutions, providing convenient administration via multiple routes, including oral, nasal, rectal, intravenous, intramuscular, subcutaneous, transdermal, sublingual, and intraosseous administration. Application of ketamine has some advantages over other sedative and anesthetic agents. It produces bronchodilation status, allowing for most secure induction of anesthesia in patients with life-threatening asthma and intense acute bronchial constriction. Ketamine has an excellent hemodynamic profile, makes it the agent of choice for patients with unstable hemodynamics, such as shocked or hypotensive patients. Ketamine usage has been associated with a lower risk of respiratory depression and relatively more conserved airway reflexes. Although being an anesthetic agent, ketamine has been increasingly used in subanesthetic doses for acute and chronic pain as well as depression. Using ketamine in pre and postoperative pain management is well established. However, the studies on ketamine performance in pain management demonstrated contradicting results. On the other hand, various side effects along with no confirmatory data on long-term treatment demand great caution when using ketamine for treating complex chronic pains. The present study aimed to provide a general review on the recent applications of ketamine in anesthesia, pain management, and critical care.
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Superstition in health beliefs: Concept exploration and development p. 1325
Mohammad Taher, Shahzad Pashaeypoor, Mohammad Ali Cheraghi, Mahmood karimy, Akram Sadat Sadat Hoseini
DOI:10.4103/jfmpc.jfmpc_871_19  
Concept exploration and development of superstition is the aim of this research. Superstition is a complex concept, needs to be clarity, removes it from its mundane state, and gives it a scientific richness. To use a list of questions extracted from a review of the literature to analyze, develop, and explore superstition. It was assessed according to studies conducted in three fields sociology, psychology, and nursing. The maturity of the concept was determined in four areas, epistemology, practicability, semantics, and deduction/logic. Nurses must discover people's beliefs and superstitions. Although the concept of superstition is commonly used, many of its features and aspects were still unclear.
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ORIGINAL ARTICLES Top

Knowledge and practice toward seasonal influenza vaccine and its barriers at the community level in Riyadh, Saudi Arabia p. 1331
Alaa A Aljamili
DOI:10.4103/jfmpc.jfmpc_1011_19  
Background: The important role of vaccination and preventive health care has been shown in several studies conducted worldwide. Despite the annual high infection rate of influenza, there are still many people who opt not to get vaccinated and be protected. We conducted this study to explore the knowledge, practices, and barriers of a Saudi Arabian population toward influenza vaccination. Methods: We conducted a community-based cross-sectional study using a questionnaire that was distributed online through social media to adult males and females aged 18 years old and above in Riyadh, Saudi Arabia. Results: A total of 778 individuals responded to the survey, 193 (24.8%) males and 585 (75.2%) females. Male respondents tended to have a better knowledge of influenza and flu vaccine than females. However, there were more females who have been vaccinated. More males believed that they do not belong to the high-risk group compared to females (P < 0.001). The younger age group of respondents significantly had a better knowledge of flu vaccine and influenza (P < 0.05). On the other hand, the older age group of respondents (age 45–60 and age >60 years old) have more reasons and barriers to have the vaccine. Conclusion: Knowledge of influenza and flu vaccine is relatively high, but the translation of this knowledge into practice is poor. The paradigm shift should be focused not only on knowledge of vaccines and vaccination but to attitudes and practices that will address barriers to getting the vaccine.
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Comparative evaluation of role of hs C -reactive protein as a diagnostic marker in chronic periodontitis patients p. 1340
Shivangi Gupta, Prerna Suri, Pankaj Bajirao Patil, Jagadish Prasad Rajguru, Palak Gupta, Niraliben Patel
DOI:10.4103/jfmpc.jfmpc_1063_19  
Background and Aim: C-reactive protein (CRP) is a type I acute phase protein, which can increase up to 1000 fold after the onset of a stimulus. It is a phylogenetically highly conserved plasma protein with homolog in vertebrates and many invertebrates that participate in systemic response to inflammation. Serum C-reactive protein levels are raised in patients with myocardial infarction and periodontitis, providing a potential mechanism to link destructive periodontal disease with an increased risk for other atherosclerotic complications. The purpose of the present study was to estimate and compare the levels of hs- C Reactive protein in chronic periodontitis patients before and after non-surgical periodontal therapy. Methods: The study sample consisted of 45 individuals of age group 30-60 years that was divided into two groups Group I (control) and Group II (patients with chronic generalized periodontitis). The clinical parameters such as plaque index, calculus index, gingival index, probing pocket depth, clinical attachment level, and serum hs-CRP levels were recorded for these individuals. Results: The patients with healthy gingiva possessed a mean hs-CRP level of 0.252 ± 0.0393 which was lower as compared to the patients with chronic periodontitis. In periodontitis patients mean levels of hs-CRP was 0.106 ± 0.029 which reduced to 0.044 ± 0.027 after periodontal therapy. A significantly elevated CRP level was found in subjects with periodontitis compared to the controls. Conclusion: The serum levels of C-reactive protein were elevated in patients with periodontitis and this might be a diagnostic marker for cardiovascular diseases.
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Effect of heat sterilization and chemical method of sterilization on the polyvinyl siloxane impression material. A comparative study p. 1348
Swati Joshi Asopa, U Narendra Padiyar, Sumit Verma, Prerna Suri, Nagaveni S Somayaji, Indu Cherangapadath Radhakrishnan
DOI:10.4103/jfmpc.jfmpc_1122_19  
Background: Dental impression is a crucial part of the process of constructing a well-fitting prosthesis. In the clinical scenario, impressions can act as a vehicle for the transfer of bacteria and fungi. Therefore, an attempt was made to evaluate the dimensional accuracy of the newly introduced polyvinyl siloxane (PVS) impression material upon autoclaving and comparing it to the traditional means of chemical disinfection. Materials and Methods: A cross-sectional comparative in vitro study was conducted. Three groups were made for testing different sterilization methods. The sample size for the study was kept as 30 observations in each of the three groups. Test samples were prepared by making an impression of the die using the putty-wash technique. Statistical analysis was done by applying unpaired t-test, paired t-test, one-way analysis of variance (ANOVA) and post hoc Tukey's honestly significant difference (HSD). Results: Initial mean of samples of group I were compared to A (actual measurement of metal ruled block = 24.960), a dimensional change of 1.6% was found. Similarly, in group II, a change of 1.59% was found and in group III the change was 1.7%. There was mean shrinkage of 24.557 mm in group I, 24.586 mm in group II, and 24.535 mm in group III and these changes were found statistically significant. Conclusion: Dimensional changes in the impression material after disinfection with 2% glutaraldehyde were considered high compared to autoclaving and, hence, it may not be advisable to disinfect this material with 2% glutaraldehyde.
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Cystic fibrosis knowledge and practice among primary care physicians in southwest region, Saudi Arabia p. 1354
Ali Alsuheel Asseri
DOI:10.4103/jfmpc.jfmpc_1168_19  
Introduction: Cystic fibrosis (CF) is a multisystem autosomal recessive disease that affects 1 in 4,000 newborns in the United States and has high mortality and morbidity. In the Middle East, there is no exact estimation of CF prevalence and the survival rate is almost 50% of the reported survival in the developed countries. In this study, I aimed to determine the CF knowledge and practice (CF-KP) among primary care physicians (PCPs) and to propose effective educational programs to recognize children who suffer from CF early on and refer them to appropriate tertiary centers. Materials and Methods: This was a cross-sectional study among PCPs in the Aseer region. The principal investigator designed and formulated the used CF-KP questionnaire in this study. It was developed in the English language and distributed through Google and printed forms. Each question included right and wrong answers with the ability to choose more than one option. There were three categories for each question either answer completely, incompletely, or wrong answer. Results: Fifty-one PCPs were recruited and successfully completed the questionnaire. Around two-thirds of the responders were less than 40 years old while few were older than 50 years. The majority of the responding doctors were male 82.4% (42 out of 51) and have been practicing clinical medicine more than 5 years after graduation. The overall knowledge score percent was 56.7% with a mean of 20.4, maximum 31, and minimum 4, while the overall practice score percent was 68% with a mean of 3.4 and maximum and minimum scores were 5 and 1, respectively. Discussion: This study is the first study that assessed the CF-KP among PCPs in the Aseer region. The total score percent of knowledge and practice among the studied group were 56% and 68%, respectively. Around 20% of the responding physicians knew when to refer suspected cases of CF to a tertiary center for further diagnostic and therapeutic interventions. Most of the responders in this study did not know the long-term complications of CF and they did not think that it is a progressive disease and eventually cause death if untreated. Conclusion: This study highlighted the need for extensive educational programs for the PCPs in order to improve early recognition of CF and start the appropriate management. In the era of CF modulators and correctors, CF providers should maximize the other therapies to improve the outcomes and prevent long-term morbidities and mortalities.
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Rising visceral leishmaniasis in Holy Himalayas (Uttarakhand, India) – A cross-sectional hospital-based study p. 1362
Sweety Kumari, Piyush Dhawan, Prasan Kumar Panda, Mukesh Bairwa, Venkatesh S Pai
DOI:10.4103/jfmpc.jfmpc_1174_19  
Background: Apart from the rarity of the visceral leishmaniasis (VL) cases in high altitude (>2000 ft), the combination triad of VL, hemophagocytic lymphohistiocytosis (HLH) syndrome, and Himalayas is rarely being reported. Here, we studied the triad in the Himalayan region, attending a single tertiary care hospital over a period of 2 years. Methods: The study was a cross-sectional analysis of case records of seven confirmed VL patients. A systematic master chart review analyzed the demographic, clinical, laboratory, treatment, and outcome details of these patients. Results: These cases were diagnosed as VL by clinical findings and confirmed by rk-39 anti-body and demonstration of LD bodies in bone marrow smears. All cases without any travel history to endemic regions presented with prolonged fever (>1 months duration), anorexia, weight loss, and having hepatosplenomegaly and bi-or pan-cytopenia. All cases were having HLH, confirmed based on the HScore system (online calculation), and liver injury having transaminitis. Kidney involvement was seen in 27% cases. All cases improved with liposomal amphotericin-B, but one had cardiac arrest after blood transfusion reaction. Conclusion: Clinician of the non-endemic zone should suspect VL in patients with fever of unknown origin and have a high suspicion in cases of HLH and liver involvement and vice versa. Kidney involvement is seen in one-third of the VL cases. Liposomal amphotericin-B is recommended in this region. The leishmaniasis prevalent in these areas should further be subject to comparison with endemic parts, and a large-scale study is needed to find the reason of the rising vector from the holy Himalayas.
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Saudi Parents Awareness Regarding Burn, Choking, and Drowning First Aid in Children p. 1370
Kholood A Habeeb, Ghada Alarfaj
DOI:10.4103/jfmpc.jfmpc_1064_19  
Background: Children are the most affected age group by home and traffic accidents. Parents, as the primary caregiver to their children, play an important role in saving their lives during an accident, therefore, more attention should be focused to assess and improve the parents' knowledge and skills of first aid (FA). Aim: Determining the parent's awareness level regarding choking, drowning, and burn FA, their readiness to attend an FA course and solutions from their perspective to improve the awareness level regarding FA for children. Methodology: Cross-sectional analysis was conducted by using a simple random sampling that includes 300 parents attending a well-baby clinic in Wazarat primary health care center in Riyadh through self-administered questionnaires. Multiple variables were evaluated to assess their effect on the outcome. Results: Only 6% of the parents have a high and acceptable awareness level regarding choking, drowning, and burn FA. A lot of myths and incorrect practices are prevalent among parents regarding these injuries' management. Fortunately, two-thirds of the participants (78%) are willing to attend an FA course and 79% of them think that adding FA to school subjects is the solution for awareness improvement. Conclusions: Parents' knowledge level regarding FA methods of major home injuries are insufficient, therefore, more attention should be focused to improve the parents' knowledge and skills of FA in order to reduce morbidity, mortality from these injuries.
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Blood lead level among fuel station workers, Ganesh idol painters, persons with routine daily application lead containing black pigment to eyes and Garage workers p. 1376
Himmatrao Saluba Bawaskar, Pramodini H Bawaskar
DOI:10.4103/jfmpc.jfmpc_1202_19  
Background and Aims: The aim of this study is to determine the lead level in blood, workers expose to lead. Methods: 42 subjects blood was analyzes for Lead. 21,14,2,5 persons are from fuel station workers, idol painters, application of lead containing pigment to eyes and garage workers respectively. Studied from January 2012 to 2017. Analysis blood by method of inductivity coupled atomic emission spectroscopy. Results: 21 fuel outlet works 11 (45.83%) Lead levels in blood were from 35.4 to 190 (mean 72.77) mcg/dl, remaining 10 lead levels were < 10 mcg/dl. Out of 14 idol painters 9 (64.28%) persons blood Lead levels were 10.06 to 18.57 (12.57) mcg/dl, remaining 5 it was < 10 mcg/dl. 2 Surma application to eyes their Lead levels were 29.22 and 10.93 respectively. 5 garage workers Lead levels were 13.54 to 46.75 (mean23.52) mcg/dl. Conclusion: Occupation exposure to lead containing fuel, paints, surma and garage workers blood levels of lead is significant.
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Is child undernutrition associated with antenatal care attendance in Madhya Pradesh, India? p. 1380
Aparna G Shyam, Nigel J Fuller, Pankaj B Shah
DOI:10.4103/jfmpc.jfmpc_1041_19  
Context: There is a paucity of research investigating the association between antenatal care (ANC) attendance and child undernutrition in Madhya Pradesh, India. Aim: To determine whether body weight status in children under the age of 5 years is associated with ANC attendance in Madhya Pradesh. Methods: A cross-sectional study was carried out using data from India's National Family Health Survey (2005–2006). Bodyweight status (an indicator of undernutrition) was determined using weight-for-age. Descriptive statistics and logistic regression were used to estimate prevalence and obtain adjusted odds ratios (AOR) to investigate associations between ANC indicators and weight-for-age. Results: Majority of children were underweight (55.1%). ANC attendance was inadequate, with only 36.8% of women having four or more visits. None of the ANC indicators were associated with body weight status. Increased child age especially an age of 2 years (AOR 2.29; 1.66–3.15), belonging to a scheduled tribe [ST] (AOR 2.36; CI 1.64–3.39), scheduled caste [SC] (AOR 1.75; CI 1.25–2.45) or other backward caste [OBC] (AOR 1.43; CI 1.08–1.89) were associated with being underweight; a birth weight of ≥2.5 kg was associated with lower relative odds of being underweight (AOR 0.43; CI 0.29–0.64). Mothers who had a normal BMI (AOR 0.66; CI 0.53–0.82) or were overweight (AOR 0.42; CI 0.25–0.69) were less likely to have underweight children. Conclusions: ANC attendance was not associated with body weight status. Increased child age, low birth weight, poor maternal nutrition status and belonging to SCs, STs or OBCs increased the odds of child undernutrition.
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Cheiloscopy in gender determination: A study on 2112 individuals p. 1386
Tim Peter Thermadam, Laxmikanth Chatra, Auswaf Ahsan
DOI:10.4103/jfmpc.jfmpc_1046_19  
Background: Lip prints are seen to remain the same for an individual throughout his/her life. Cheiloscopy can be used as an effective tool in the identification of the persons from pieces of evidence that may be left behind from lip prints. Aim and Objectives: The aim of the current research was to evaluate the predominant lip groove pattern among Calicut population, Kerala. Materials and Methods: The study involved 2112 individuals (1056 males and 1056 females) in the Department of Oral Medicine and Radiology, KMCT Dental College, Calicut, Kerala. Lipstick was used to record the lip groove patterns and the patterns were visualized by magnifying lens after the institutional ethical clearance and informed consent from the individual. Statistical analysis was done using SPSS software 22.0. Results: Among the study population, Type 1', Type 1, Type 4, and Type 5 were found to be common lip groove patterns. Males showed predominance on Type 1' and Type 1 lip groove patterns, whereas females showed predominance on Type 4 and Type 5 lip groove patterns. The results were similar when analyzed on upper and lower lips separately on males and females. Conclusion: Cheiloscopy is a reliable tool in personal identification and gender determination of an individual. The geographical prevalence of lip groove patterns was reported in the current research and is added to the database of the anthropological data. Studies in different geographical regions will add lip groove patterns on the database in the future and henceforth the potential of cheiloscopy could be further utilized.
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Pattern and serological profile of healthcare workers with needle-stick and sharp injuries: A retrospective analysis p. 1391
Rakesh Sharma, Pratima Gupta, Prasuna Jelly
DOI:10.4103/jfmpc.jfmpc_1078_19  
Background: Needle-stick and sharp injuries (NSSIs) are very hazardous to healthcare workers (HCWs) working in any healthcare setting. The burden of NSSIs is more common in developing countries than in developed countries. Materials and Methods: A retrospective analysis was conducted in a multispeciality, tertiary level teaching medical institute. Total 78 NSSIs incidences from 2005 to 2013 were reviewed and included for the study. All the information were retrieved and entered in excel sheet for data analysis. Results: Total of 78 NSSIs cases were reported over a period of 9 years. Maximum incidences of NSSI were reported by nurses (61.5%). A higher proportion (41%) of cases occurred in critical units and emergency and the most common procedure (64.1%) was parenteral medication during which HCWs got NSSIs. Almost half (53.8%) of HCWs had received complete HBV vaccination. Out of 78, 40 HCWs only completed follow-up for 6 months and were found non-reactive for viral markers. Conclusion: The healthcare workers who were involved in patient care are at risk to get NSSIs. The primary prevention of NSSIs is very important. Every institute should have policies on ongoing training programme, HBV vaccination protocol, smooth system of NSSIs reporting, post-exposure prophylaxis (PEP) facilities and follow-up of HCWs with NSSIs to prevent the occurrence.
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Patient handling in India—Evidence from a pilot study Highly accessed article p. 1397
Nidhin Koshy, Sheetal Sriraman, Yogeesh D Kamat
DOI:10.4103/jfmpc.jfmpc_1173_19  
Background: Manual handling forms an important part of a health care worker's daily routine. Faulty techniques may result in musculoskeletal injuries in health workers and further injury to patients. Objectives: In our study, we assessed the techniques of patient moving and handling by health care workers in our hospital. Our aim was to educate them on standard moving and handling techniques and assess the impact of the same. Methods: We carried out a time-bound prospective clinical audit wherein we observed workers in the emergency department for a period of 2 weeks to evaluate their moving and handling techniques. This was followed by a training session where the workers were trained in “best-practices,” and a 2-week period of reevaluation to assess compliance with standard practices. Results: During bed-to-bed transfers, we found improvements in the following seven parameters after the training session: (a) the use of good posture, (b) the use of wheel stoppers, (c) adjustment of bed height, (d) positioning the receiving bed parallel to patient's bed, (e) general risk assessment before transferring a patient, (f) involvement of at least three carers, and (g) the use of a standard command like “GO” before the transfer. Conclusion: Apart from serving the purpose of an audit, our study has revealed that the training of health care providers in safe moving and handling of patients is a neglected subject in India.
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A study on PEI among private dentists in Mashhad, Iran p. 1403
Ali Labafchi, Amin Rahpeyma, Saeedeh Khajehahmadi
DOI:10.4103/jfmpc.jfmpc_900_19  
Aim: We aimed to identify the percutaneous exposure incident (PEI) by private dentists in Mashhad, Iran. Methods: Subjects included 199 dentists enrolled in this study. A questionnaire consisting of 11 questions was sent to the dentists for data collection. Information was collected on knowledge about dangers of PEI, a history of needlestick or sharps injuries over the past 12 months, types of devices causing the needlestick or sharps injuries, HBV vaccination, knowledge about PEI protective and therapeutic protocol, and reporting PEI to the specialist. The first ten questions were corrected and each sheet received a score ranging from 0 to 10. Result: 95 women (47.7%) and 104 men (52.3%) participated in this study aged between 27–72 years old. The findings showed that a total of 132 dentists (66.3%) had experiences with PEI. 45 (22.6%) of them had experiences with PEI in the past year. Files and needles were found to be the most frequent tools causing PEI, each with 29.7% of frequency. 16.6%, 8.6, 5.7, and 9.7% were obtained for dental burs, band, and surgical baled, respectively as other tools responsible for injuries. Results of the question about causes of needlestick injuries showed that personal carelessness is the most frequent reason (53.8%) followed by inappropriate disposal of the needles (7.6%). Conclusion: The personal carelessness and inappropriate disposal of needles were reported as the most common reasons for PEI injuries. It is suggested to educational programs for dentists should focus on preventing the PEI.
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Bacterial pathogens from lower respiratory tract infections: A study from Western Rajasthan p. 1407
Shambhavi Singh, Anuradha Sharma, Vijay Lakshmi Nag
DOI:10.4103/jfmpc.jfmpc_994_19  
Respiratory tract infections are the most common diseases that are associated with social burden for the patient. Western Rajasthan has cases of Cystic fibrosis due to migrant population. The dry and dusty environment has led to prevalence of silicosis and COPD. As per IDSA (2018) guidelines, patients attending Out-Patient Department do not need microbiological investigations for lower respiratory tract infections (LRTI) except for influenza and tuberculosis. Aims: This study was conducted to identify the bacterial aetiology of LRTI among patients who attended AIIMS, Jodhpur, and to ascertain the current scenario of bacterial susceptibility in respiratory tract infections in order to optimize empiric therapy in Hospitals ad community. Methods and Material: In total, 1,775 lower respiratory tract samples were received in Bacteriology Section of Microbiology Department (January 2017 to December 2018). Bartlett's criteria were stringently used to assess quality of specimen. Semiquantitative cultures were done for tracheal aspirate and bronchoalveolar lavage samples. Following culture, the isolated organisms were identified and antimicrobial sensitivity was performed according to CLSI. Results: Total 769 bacterial pathogens were isolated from 1,775 samples collected from cases of VAP, HAP, CAP, COPD, and cystic fibrosis. Pseudomonas species was the commonest isolate (31%), followed by Klebsiella pneumonia (21.3%), Acinetobacter species (17.5%), Escherichia coli (15.4%), and Staphylococcus aureus (5%). Others include Group A β-hemolytic Streptococcus, Burkholderia cepacia complex, Stenotrophomonas maltophilia, and Nocardia. Gram-negative organisms showed increased resistance to routinely used antibiotics. Gram-positive organisms showed 100% susceptibility to vancomycin, linezolid, and clindamycin. Conclusions: Cotrimoxazole, βL-βLIs, aminoglycosides, and all second-line antibiotics tested were effective for treatment of RTIs.
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A policy brief on improving the finance of family physician program: An experience from urban areas of Iran p. 1413
Mozhgan Fardid, Mehdi Jafari, Abbas Vosoogh-Moghaddam
DOI:10.4103/jfmpc.jfmpc_997_19  
In the current scenario, financing suffers from problems related to lack of specific line for UFFP, lack of resource pooling, delay in payment to physicians, and conflict of interests among family physician team. As a result, this policy brief was formulated based on the role of FPs in public access to general practitioner (GP) services in the referral system on one hand, followed by the impact of it on health costs reduction on the another hand, and further considering the necessity of financing system audit to find a sustainable resources for this program to be implemented at a national level in the country of Iran.
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Evaluation of clinical success, parental and child satisfaction of stainless steel crowns and zirconia crowns in primary molars p. 1418
Mebin George Mathew, Korishettar Basavaraj Roopa, Ashu Jagdish Soni, Md Muzammil Khan, Afreen Kauser
DOI:10.4103/jfmpc.jfmpc_1006_19  
Introduction: Stainless steel crowns are the most successful restoration for multisurface carious lesions in primary molars. The esthetics has been poorly accepted which led to the introduction of zirconia crowns. Objectives: The aim of the study was to evaluate and compare the clinical success, parental satisfaction, and child satisfaction of stainless steel and zirconia crowns in primary molars. Methods: Thirty healthy patients aged 6–8 years bilateral pulp therapy treated primary molars were randomly divided into two equal groups of stainless steel and zirconia crowns. Tooth preparation was done according to the manufacturers' recommendations depending upon the crown each patient would receive. All crowns were cemented with Type I GIC luting cement. Patients were evaluated at 6 months, 12 months, 18 months, 24 months, and 36 months. Results: Clinical success for stainless steel crowns and zirconia crowns were similar with no statistical difference between them. Zirconia accumulated less plaque than stainless steel crowns (P = 0.047). The parental satisfaction was high with both crowns. A highly significant statistical difference existed between the 2 groups in relation to the acceptance of color (P < 0.001) and child's satisfaction (P < 0.001). Conclusion: Zirconia can be considered as an esthetic alternative in the future.
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Perception and practice of placebo use among physicians in Mangalore p. 1424
Ravinder Singh Aujla, Ritika Agarwal, Smriti Sinha, Avinash Kumar
DOI:10.4103/jfmpc.jfmpc_1052_19  
Background: Placebo use falls under two contexts: clinical care and research. In today's pharmacological era where treatment is available for almost all illnesses, there exists a lot of questions about the perceived efficacy and usage of placebos. This study focuses on assessing the knowledge, attitude, and practice of placebo use in clinical medicine. This study also aimed to pay attention to the ethical dimensions of using a placebo in clinical practice. Subjects and Methods: A cross-sectional study was conducted among 86 physicians in five hospitals and various private clinics in Mangalore, India, using a self-administered questionnaire. Results: About 72% of physicians were found to be prescribing placebos. Vitamins were the most commonly prescribed placebos. Pure placebos were prescribed by 69.4% and impure placebos by 83.9% of physicians. Pure placebos were deemed acceptable by 70.9% of physicians if used for their psychological effect, but only 46.5% said the same for impure placebos. Placebos were most commonly prescribed to conform to the patients' requests for some sort of medicine. Among our physicians, 54.8% and 62.8% of placebo prescribers felt that many or some patients would be disappointed if they were to find out that they had been treated with pure or impure placebos, respectively. Conclusion: Physicians agreed that placebos were acceptable in some circumstances in clinical practice. Physicians think that the information and training about placebos during their medical studies was insufficient. Perhaps, more time should be put into teaching about placebos during medical studies and proper guidelines should be laid down about placebo usage.
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Compliance to the secondary prophylaxis and awareness of rheumatic heart disease: A cross-sectional study in low-income province of India p. 1431
Arun Prasad, Abhiranjan Prasad, Birendra K Singh, Sanjeev Kumar
DOI:10.4103/jfmpc.jfmpc_1056_19  
Background: Rheumatic heart disease is a preventable problem and regular secondary prophylaxis and proper awareness about this disease among common people may reduce the burden of this disease in any region. Objectives: To find out compliance to the secondary prophylaxis of Rheumatic heart disease and awareness about this disease among common people of Bihar. Methodology: This was a questionnaire based cross sectional study to find out compliance to the secondary prophylaxis and awareness of Rheumatic heart disease, conducted at two tertiary care referral hospitals of Bihar. Result: 19/41 (46%) study participants were non-compliant to regular secondary prophylaxis. Most of the participants (34/42,81%) had poor knowledge of Rheumatic heart disease. Low socioeconomic condition was not a statistically significant risk factor for poor adherence to the secondary prophylaxis (odds ratio-5.29,95% CI- 0.55-50.08, P-0.11). Low level of education was not a statistically significant risk factor for poor awareness as compared to the participants with education of 10th standard or above (odds ratio 4.0, 95% CI- 0.65-24.24, P- 0.15). Conclusion: Approximately half of the participants of this study were non-compliant to the regular secondary prophylaxis of rheumatic heart disease and most of them had poor awareness of this disease. Ensuring regular secondary prophylaxis and improving awareness to Rheumatic heart disease among common people may reduce its prevalence in regions with significant burden of Rheumatic heart disease.
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Comparison of sensitivity, specificity, and accuracy of Wilson's score and intubation prediction score for prediction of difficult airway in an eastern Indian population—A prospective single-blind study p. 1436
Sri Vidhya, Brahmanand Sharma, Bhanu P Swain, UK Singh
DOI:10.4103/jfmpc.jfmpc_1068_19  
Introduction: Unidentified difficult airway leads to significant adverse events and therefore prediction of a difficult airway is of importance. Independent bedside tests for the prediction of a difficult airway have poor accuracy. The airway assessment scores have not gained popularity as they are cumbersome to perform at the bedside. They also have a varying degree of interobserver variability because of their subjective parameters. Therefore, there is a need to search for a simple score with objective parameters that can be performed at the bedside. Aim: To determine the diagnostic accuracy of the Wilson score andiIntubation prediction score for predicting difficult airway in the Eastern Indian population. Material and Method: A prospective single-blind study was done including 150 consecutive patients, ASA grade I and II between the ages of 18 and 70 years, undergoing surgery requiring general anesthesia with endotracheal intubation. Preoperatively, the airway was assessed in all patients using Wilson Score and Intubation Prediction Score. General anesthesia with endotracheal intubation was done in all patients. The airway was assessed for ease laryngoscopy and intubation using the Intubation Difficulty Scale. An IDS >5 was taken as difficult airway. The sensitivity, specificity, PPV, NPV, and accuracy of the two predictive tests to predict a difficult was calculated. Results: The sensitivity, positive predictive value and accuracy of Intubation Prediction Score was 77.8%, 58.3%and 90.7% respectively as compared to 38.9%, 25.95% and 78.33% respectively of Wilsons score. Conclusion: Intubation Prediction score with its objective parameters can be preferred as a simple and accurate bedside test to predict a difficult airway in an Eastern Indian population.
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Associations of obesity and serum leptin level with elevated blood pressure among urban secondary school students of a northeastern city of India: A baseline observation p. 1442
Bidhan Goswami, Himadri Bhattacharjya, Shauli Sengupta, Bhaskar Bhattacharjee
DOI:10.4103/jfmpc.jfmpc_1118_19  
Background: Elevated blood pressure has been found to be associated with body mass index (BMI) and serum leptin levels among adults. But there is a paucity of reports regarding such associations among adolescents. Objectives: To estimate the prevalence of prehypertension and hypertension and its associations with BMI and serum leptin levels among the secondary school going students of the Agartala Municipal Corporation area. Materials and Methods: This school-based cross-sectional study was conducted from 1st April 2018 to 31st December 2018, among 1,000 students studying in different secondary level schools located in Agartala municipal corporation area chosen by multistage sampling ensuring proportionate representation in the sample. Result: Prevalence of prehypertension and hypertension were found to be 42.40% and 15.70%, respectively, 55.20% had normal, 22.80% had low, and 22.00% had high BMI. Serum leptin levels were found to be normal among 54.70% of the students, whereas, 36.70% had high and 8.60% had low levels, respectively. Logistic regression analysis has identified male sex (OR = 0.231, 95% CI = 0.172–0.310, P = 0.000) and high BMI (OR = 4.289, 95% CI = 2.857–6.440, P = 0.000) as the significant determinants of elevated blood pressure, but the effect of serum leptin level and family history of hypertension did not attain the level of statistical significance. Conclusion: Prevalence of prehypertension and hypertension among urban school-going adolescents were found to be 42.40% and 15.70%, respectively and were significantly associated with their sex and BMI and serum leptin level, but regression analysis failed to detect any significant effect of serum leptin level in determining the blood pressure of the study subjects.
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Knowledge about and determinants for diagnosing hidradenitis suppurativa by ministry of health primary healthcare physicians in Jeddah city 2019: An analytical cross-sectional study p. 1448
Ebtisam M. F Alhawsawi, Ghufran A Hariri, Randa J Alzuhayri, Yahya Makhdoom
DOI:10.4103/jfmpc.jfmpc_1151_19  
Context: Hidradenitis suppurativa is a noncontagious, inflammatory, chronic and recurrent disease. The prevalence of HS is estimated to be between less than 1 and 4%. It is more common in females than males at a 2:1 ratio. Many cases of HS are either misdiagnosed or remain undiagnosed. Aims: To assess knowledge of diagnosing hidradenitis suppurativa by Ministry of Health primary health care physicians in Jeddah city, 2019 and to identify the determinants and knowledge of diagnosing hidradenitis suppurativa. Settings and Design: An analytical cross-sectional study conducted in Jeddah city, 2019, among primary health care physicians of the MOH. Methods and Material: Estimated sample size was 114. The required primary health care centers were 38 centers. The centers were chosen by a simple random sampling technique. A reliable self-administered questionnaire was used. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross tabulation and charts). Categorical variables were compared using the chi–square test to determine significant relationships between variables. Results: 65.4% (68) diagnosed the disease correctly. Most of their knowledge came from clinical practice (39.4%). There was a significant relationship with current job title and medical degree (P-value < 0.0005). Conclusion: The present study showed good knowledge about and ability to diagnose HS. A more advanced medical degree and more years of clinical experience was positively associated with the ability to diagnose HS.
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Skin diseases in geriatrics and their effect on the quality of life: A hospital-based observational study p. 1453
Meghna Kandwal, Rashmi Jindal, Payal Chauhan, Samarjit Roy
DOI:10.4103/jfmpc.jfmpc_1188_19  
Background: World's population is aging at a very fast pace with 8.5% of current population being aged 65 years and above. Indian figures also reflect the exponential growth in number of older people. With advancing age a myriad of health-related problems arise. Due importance is given to diseases associated with high mortality such as malignancies, diabetes, and cardiovascular illness. However, skin diseases though being prevalent lack priority. This study is being conducted to identify the common geriatric dermatoses prevalent in sub-Himalayan region of Uttarakhand and also to assess their effect on the quality of life. Aims: The aims of this study are to study the pattern and frequency of dermatoses in patients aged 60 years and above and to assess the effect of dermatoses on their quality of life. Methods: In total, 117 patients aged 60 years and above presenting to Dermatology outpatient department were recruited from 1st August 2018 to 31st October 2018 after obtaining written informed consent. Socio-demographic details, presence of co-morbidities, and dermatological complaints were recorded on a data collection form. Skin diseases were categorized into seven categories for statistical analysis. For assessing the effect of dermatoses on the quality of life of participants, Dermatology Life Quality Index was administered. Results: Out of 117 patients, two-thirds were males. Mean age of patients was 68.60 ± 7.011. Out of total, 40% patients had one or more comorbidity. Erythemato-squamous disorders were the commonest dermatoses seen in 40% patients. This was followed by infections and infestations (33.3%). In total, 17% patients had senile pruritus and age-related skin disorders. Around 16% reported moderate to large effect on their quality of life. Conclusion: Skin diseases are an important cause of psycho-social morbidity among geriatric population. Their special needs must be addressed by making appropriate changes in national health policies. It is imperative to include skin health as a component to assess the overall wellbeing of geriatrics.
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Specialty preferences and factors affecting future career choice among medical graduates in Saudi p. 1459
T Al-Hariri Mohammed, A Alghamdi Abdulrahman, K Alkhaldi Saud, N Turkistani Alaa
DOI:10.4103/jfmpc.jfmpc_1199_19  
Aims: Our study was conducted to study the future specialty choices and the influencing factors among Saudi medical students. Settings and Design: Convenience study. Methods and Materials: An online questionnaire was sent to medical students during the period from February to April 2019 with the aim of analyzing the most desired specialty, the reasons behind choosing, and the different factors playing a role in choosing those specialties. Statistical Analysis Used: The results were analyzed by the Statistical Package for Social Sciences software version 21. Differences in means were analyzed using t-test. The Chi-square test was used to identify significant differences among groups with a significance level set a P ≥ 0.05. Results: A convenience sample of 579 students has completed the survey. Most of the students did not receive any advice for choosing their specialty preferred. The three most desired specialties by both genders (males/females) are surgery, internal medicine, and cardiac surgery, respectively. The data revealed that nearly 42% of students did not receive any advice regarding their preferred career. Interesting cases, challenging, good lifestyle, and impact on patient quality of life were important reasons in selecting all specialties. Conclusion: A variety of factors appear to inspire medical students to choose a future career intention in Saudi Arabia. Some career measures and guidance are needed by university mentors and health policymakers to encourage those specialties that are scarce in Saudi Arabia.
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A comparative study of automated blood pressure device and mercury-free LED blood pressure device using Lin's concordance correlation coefficient and other validity measures in Indian population p. 1464
Shashi B Singh, Dewesh Kumar, Vivek Kashyap, Surendra Singh
DOI:10.4103/jfmpc.jfmpc_796_19  
Introduction: Automated blood pressure (BP) monitor is widely used to assess the blood pressure (BP) of the study subjects in community-based researches. This study aims at the detection of hypertension by automated BP device and examines the concordance and validity between automated and mercury-free LED BP devices. Materials and Methods: This cross-sectional study was conducted in the tribal state of Jharkhand in India from January 2017 to June 2017. A total of 300 study participants aged more than 18 years were enrolled in this study. BP of the patients in the sitting position was measured three times each by automated device and mercury-free LED BP device. The different sets of readings were assessed by concordance correlation coefficient (CCC) and other validity measures. Results: The CCC for systolic and diastolic BP measured by automated and mercury-free LED BP is 0.88 and 0.85, respectively. The mean difference between systolic and diastolic BP by both the instruments is statistically insignificant (P > 0.05). The sensitivity, specificity, PPV, NPV, and accuracy of automated BP devices to predict hypertension is 96.61%, 92.21%, 75%, 99%, and 93%. The area under ROC for systolic and diastolic BP is 0.984 and 0.97, respectively with P values < 0.0001 in both the cases. Conclusions: This study concluded that the overall automated BP machine has fair degree of agreement (CCC) with a manual BP device. The validity of this monitor to screen hypertension may also be considered in field settings.
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Diagnosing thyroid disorders: Comparison of logistic regression and neural network models p. 1470
Shiva Borzouei, Hossein Mahjub, Negar Asaad Sajadi, Maryam Farhadian
DOI:10.4103/jfmpc.jfmpc_910_19  
Background: The main goal of this study was to diagnose the two most common thyroid disorders, namely, hyperthyroidism and hypothyroidism, based on multinomial logistic regression and neural network models. In addition, the study evaluated the predictive ability of laboratory tests against the individual clinical symptoms score. Materials and Methods: In this study, the data from patients with thyroid dysfunction who referred to Imam Khomeini Clinic and Shahid Beheshti Hospital in Hamadan were collected. The data contained 310 subjects in one of three classes—euthyroid, hyperthyroidism, and hypothyroidism. Collected variables included demographics and symptoms of hypothyroidism and hyperthyroidism, as well as laboratory tests. To compare the predictive ability of the clinical signs and laboratory tests, different multinomial logistic regression and neural network models were fitted to the data. These models were compared in terms of the mean of the accuracy and area under the curve (AUC). Results: The results showed better performance of neural network model than multinomial logistic regression in all cases. The best predictive performance for logistic regression (with a mean accuracy of 91.4%) and neural network models (with a mean accuracy of 96.3%) was when all variables were included in the model. In addition, the predictive performance of two models based on symptomatic variables was superior to laboratory variables. Conclusions: Both neural network and logistic regression models have a high predictive ability to diagnose thyroid disorder, although neural network performance is better than logistic regression. In addition, as achieving less error prediction model has always been a matter of concern for researchers in the field of disease diagnosis, predictive nonparametric techniques, such as neural networks, provide new opportunities to obtain more accurate predictions in the field of medical research.
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Knowledge and awareness of nasal allergy among patients in a developing country p. 1477
Waheed Atilade Adegbiji, Shuaib Kayode Aremu, Abdul Akeem A Aluko, Rasaq Kayode Adewoye
DOI:10.4103/jfmpc.jfmpc_914_19  
Background: Nasal allergy is a common public health disorder seen in clinical practice worldwide. This disorder affected activities such as sleep, education, trading, economy, and social life.This study aimed at determining the level of knowledge and awareness of nasal allergy among patients seen in the otorhinolaryngology clinical practice of a developing country. Methods and Materials: This was a descriptive cross-sectional study, which was carried out among patients seen in Ekiti state university teaching hospital, Nigeria. Each patient completed a pretested interviewer assisted questionnaire on socio-demographic features, awareness, and knowledge on nasal allergy.Data obtained were documented, collated, and analyzed by SPSS version 18.0. Results: There were 16.4% patient's awareness and knowledge on nasal allergy, and 10.6% had allergic rhinitis.The patients included 59.2% males and male to female ratio was 1.5:1.Most common sources of information on nasal allergy were from ear, nose, and throat specialist/other doctors in 62.6%. Other sources were friends/relatives and media/Internet in 28.5% and 9.0%, respectively. Knowledge and awareness on if the nasal allergy was common in Nigeria and worldwide among the patients were 26.6% and 24.9%, respectively. However, 56.7% patients were aware that nasal allergy were commonly seen and diagnosed in the hospital.On the basis of knowledge and awareness of etiology of nasal allergy, majority 55.2% believed micro-organisms caused nasal-allergy. Minority 40.4% agreed nasal allergy was caused by parents genetic transmission from parents to offspring.On the awareness and knowledge of nasal allergy and its manifestations, the most common symptoms was 63.4% itching ear, throat, and eyes others were 63.2% catarrh and 56.3% bout of sneezing.There were 64.6% patients awareness of nasal allergy causes impairing concentration. However, 68.2% believed nasal allergy were curable diseases. On the awareness and knowledge, treatment was 52.7% prayer/spiritual intervention, 34.3% herbs, and 57.1% over-the-counter medication. However, 45.4% were aware and knowledgeable on the significance of avoidance of allergens. Conclusion: The level of awareness and knowledge on nasal allergy low with high levels of prevalence. Patients awareness and knowledge on etiology, clinical manifestations, effects, and management of nasal allergy is low.
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Long-term impacts of tonsillectomy on children's immune functions p. 1483
Masoud Radman, Asiyeh Ferdousi, Hossein Khorramdelazad, Pooneh Jalali
DOI:10.4103/jfmpc.jfmpc_935_19  
Background: There exist a wide level of discrepancy regarding the role of tonsils and its indication among pediatricians and ENT specialists. This fact sometimes causes confusion and delay in making the right decisions by parents and specialists for appropriate treatment of patients. Objectives: Thus, the aim of this study was to investigate the effects of long-term tonsillectomy on the immune system of patients. Methods: In this case-control study we measured the status of immune system in 34 children (aged 9-15 years) following 4 to 6 years of tonsillectomy. We have also enrolled 30 healthy children with similar age group. Venous blood samples were taken and the serum levels of IgG, IgA, and IgM were detected along with expression of CD4, CD8, CD10 and CD56. Data were analyzed by SPSS version 18 software and a P < 0.05 was considered as significant. Results: We found that the mean serum levels IgM, IgA, and IgG in the case group was significantly (P < 0.0001) lower than the control group. Whereby, the CD4, CD8 and CD56 expressions was examined, there was no significant difference in both groups while only CD10 expression was lower in tonssiloctomized patients (P = 0.108). Conclusion: Overall, according to these findings, CD10 as a marker of B lymphocytes in children undergoing tonsillectomy was significantly less than those healthy children. This may indicate a decrease in B cells and further reduced antibody production in these patients.
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The effect of intensive hemodialysis on LVH regression and blood pressure control in ESRD patients p. 1488
Forough Darabi, Shahla A Halili, Maryam Moradi
DOI:10.4103/jfmpc.jfmpc_946_19  
Introduction: Cardiovascular diseases are considered the major cause of death in dialysis patients with end-stage renal disease (ESRD). Recently, intensive hemodialysis has increasingly used and replaced conventional hemodialysis. The present study aimed to evaluate the effect of intensive hemodialysis on LVH regression and blood pressure control. Methods: The present study is self-control, pre- and post-intervention clinical trial on hemodialysis ESRD patients with hypertension (52.5% female with a mean age of 55.55 ± 12.96), who were admitted to Imam Khomeini Hospitals, Golestan Ahvaz in 1396. All patients underwent intensive hemodialysis treatment 4 times a week for 2 months. 2-D color Doppler echocardiography was performed for all patients before the intervention and following 2 months of intensive hemodialysis. The results of chest echocardiographic were used to determine left ventricular thickness. Results: In this study, 40 patients with hypertension were studied. The results of this study showed a significant decrease (P < 0.0001) in the levels of LVH, SBP, DBP and mean BP after intervention in ESRD patients. The level of LVH was decreased from 15.42 ± 1.67 mmHg to 13.86 ± 1.39 mmHg, SBP from 161.50 ± 12.16 mmHg to 141.12 ± 8.87 mmHg, DBP from 25.25 ± 5.15 mmHg to 81/75 ± 2.89 mmHg, and mean BP from 114.66 ± 6.82 mmHg to 101/54 ± 3.98 mmHg. Conclusion: Based on the results, it can be concluded that intensive hemodialysis resulted in improved LVH regression and blood pressure control, and fewer requirements for blood pressure-lowering medications.
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Evaluation of forced oscilometry technique's parameters in severe obstructive sleep apnea patients without breathing disorder p. 1492
Besharat Rahimi, Maryam Edalatifard, Khosro Sadeghniiat Haghighi, Hossein Kazemzadeh
DOI:10.4103/jfmpc.jfmpc_954_19  
Background: Forced oscillometry technique (FOT) is a noninvasive technique that measures reactance and resistance capacity of the lung and is a practical and less time-consuming technique for respiratory effort assessment. Recently, FOT has provided beneficial data regarding the screening of the patients with obstructive sleep apnea (OSA) and assessing the disease progression. The current study aimed to evaluate the correlation of FOT parameters with severity of the apnea-hypnea index (AHI). Methods: In the current case series, all patients who had a body mass index ranging between 30 and 35, suffering severe OSA with AHI of more than 30 times per hour, were enrolled. Patients underwent FOT before treatment to measure the following FOT parameters: Respiratory resistance at 5 and 20 Hz (R5 and R20, respectively), resistance difference between R5 and R20, reactance at 5 Hz (X5), and resonant frequency (Fres). Results: In the current study, 22 patients were enrolled; whereas 12 (54.5%) were male and 10 (45.5%) were female with a mean age of 5.27 ± 4.34. A statistically significant, strong negative correlation was observed between Fres and AHI, during Pearson correlation analysis (r (20) =0.59, P < 0.0001). However, the relationship between the AHI and R5, R20, R5-R20 and X5 was not statistically significant. Similarly, the multiple regression model showed that, only Fres variable added statistically significantly to the prediction, P = 0.01. Conclusion: FOT is a useful tool in evaluation of AHI severity in patients suffering OSA and can be used as a diagnostic material in monitoring and management of these patients.
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Understanding barriers in implementation and scaling up WIFS from providers perspective: A mixed-method study, Rishikesh, India p. 1497
Meenakshi Khapre, Hemant D Shewade, Surekha Kishore, Gomathi Ramaswamy, Amol R Dongre
DOI:10.4103/jfmpc.jfmpc_1014_19  
Context: Since the implementation of Weekly Iron and Folic acid Supplementation (WIFS) program in India in 2013, little effort has been made to comprehensively evaluate the program. Aims: This study was carried out to assess the coverage of WIFS among adolescent girls, explore implementation barriers, and suggest solutions to improve WIFS through public schools in Rishikesh, India (2018–19). Methods and Materials: This was a sequential explanatory mixed-methods study. Quantitative component was a community-based cross-sectional survey to determine the prevalence of anemia and coverage of WIFS. Qualitative component added an explanation to understand WIFS implementation through document review and nonparticipant observation of WIFS session. We invited stakeholders for nominal group discussion on barriers and solutions. Statistical Analysis Used: Variables were described as proportion and mean. Group discussion transcript was analyzed using content analysis. Results: Of 400 adolescent girls, 16% (95% CI: 12.4, 19.6) received weekly and 45% ever received iron tablets over the last 3 months and 79% were anemic. From ten schools, one school never implemented WIFS. There was iron-folic acid (IFA) stock out for 10 months last year. Major barriers identified were nonavailability of IFA, and irregularity in submitting IFA consumption report. Suggested solutions were ensuring IFA stock, strengthening supervision, ownership, training, and regular meetings of stakeholders. Conclusions: To conclude, in a setting with high anemia prevalence, WIFS was poorly implemented. Ownership and strengthening supervision is essential for the success of the program.
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Sleep Quality and its various correlates: A community-based study among geriatric population in a community development block of Purba Bardhaman district, West Bengal p. 1510
Soumyaneel Das, Rabindra Nath Roy, Dilip Kumar Das, Amitava Chakraborty, Raston Mondal
DOI:10.4103/jfmpc.jfmpc_1021_19  
Background: In the elderly population, sleep problems are prevalent and have known to be associated with many factors. There are many adverse consequences of decreased sleep such as heart disease, diabetes, depression, accidents, impaired cognition, and poor quality of life. Correlates of poor sleep quality have not been well explored in Indian research. Objectives: The present study aimed to measure prevalence of poor sleep quality among elderly and its association with different factors. Methods: A cross-sectional study was conducted during June-November 2018 in a randomly selected block of Purba Bardhaman district. Cluster random sampling was applied to select required sample of 180 elderly people (≥60 years) from 30 villages. Study tools used were Pittsburgh Sleep Quality Index (PSQI), 5-Item Geriatric Depression Scale (GDS), Generalized Anxiety Disorder 7-item scale (GAD-7), Global Physical Activity Questionnaire (GPAQ), and a pretested schedule for sociodemographic and other variables. The study had approval from Institutional Ethics Committee. Chi-square tests and multivariable logistic regression were performed using SPSS V16. Results: Prevalence of poor sleep quality (GPSQI ≥5) was 68.89%. Median Global PSQI (GPSQI) score was 7.00 (4.00–11.00). Multivariable logistic regression revealed that marital status, vital events in past one month, anxiety status, and depression were significantly associated with sleep quality. Those who were unmarried/widowed, having vital events in past one month in the family, and severe anxiety and depression were having significantly higher odds of developing poor sleep quality. Conclusion: Poor sleep quality is high among elderly and measures toward the significant correlates are thus emphasized.
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Pain profile of premature infants during routine procedures in neonatal intensive care: An observational study p. 1517
Arindrajit Ganguly, Pranav J Bhadesia, Ajay G Phatak, Archana S Nimbalkar, Somashekhar M Nimbalkar
DOI:10.4103/jfmpc.jfmpc_1033_19  
Background: Premature neonates receive a large number of painful procedures during their stay in the neonatal intensive care unit (NICU). However, there are many other processes that happen in the NICU, which may not be considered painful but can cause discomfort and/or stress to the neonate. Method: Pain profile during routine procedures in NICU was assessed using the premature infant pain profile (PIPP) score. Neonates of gestational age >26 weeks, less than 7 days old and admitted for less than 7 days in the NICU were included. Results: A total of 662 procedures were observed in 132 (78 M, 54 F) neonates. The mean (SD) age of the neonates was 2.4 (1.8) days and the mean (SD) birth weight was 2.3 (0.6) kg. 63 (54.5%) were of low birth weight (LBW), 85 (64.39%) were full term. High PIPP score was noted in blood sampling, heel prick, suction, and weight measurement. Significant differences were observed in the PIPP score during blood sampling and suction across gender. Some ordinary and non-stressful procedures also scored very high on the PIPP scale. Conclusions: The validity of PIPP needs to be reexamined. Our understanding of pain during routine procedures may need to be revisited.
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Assessment of the current knowledge and willingness to conduct medical research work of future healthcare providers: A cross-sectional study in Jeddah, Saudi Arabia p. 1522
Ali S AlSayegh, Sara K Enayah, Wedyan N Khoja, Reem K Enayah, Naser S Sendi
DOI:10.4103/jfmpc.jfmpc_1047_19  
Background and Objectives: Healthcare research work contributes significantly to the advancement and development of medical education. Numerous studies have demonstrated the efficiency and productivity of student participation in medical research work, which has a positive impact on the health system. In this study, we intended to examine medical students' knowledge and attitudes regarding, and actual participation in, medical research work. Methods: This cross-sectional study was conducted on 184 medical students of Batterjee Medical College. The students received a paper-based survey questionnaire, containing multiple parts that related to their knowledge and attitudes regarding, and actual participation in, research work. One-way analysis of variance was utilized for the comparison of the average scores of the academic specialization groups. Results: One hundred and forty-three participants completed the questionnaire, with a response rate of 78%. The overall average scores for the students' knowledge and attitudes regarding, and actual participation in, research work were 57.2%, 76%, and 31.5%, respectively. Medicine students obtained significantly higher average scores than the students of other specializations in terms of the scale of knowledge and attitudes regarding, and actual participation in, research work. The principal barriers that deterred the students from undertaking research work were poor time management (68.5%), inadequate feedback (64.3%), and a lack of research skills (54.5%). Conclusion: Medical students showed a low level of knowledge relating to research work and infrequently participated in them, but they reported a positive attitude toward research work activity. Extensive work is needed to overcome several barriers, such as poor time management and insufficient research skills.
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Sociodemographic and clinical profile of geriatric patients with cervical cancer—An audit from a tertiary cancer center in India p. 1528
Divyesh Kumar, Treshita Dey, Pooja Bansal, GY Srinivasa, Bhavana Rai
DOI:10.4103/jfmpc.jfmpc_1067_19  
Background and Aim: Cervical cancer is a major health problem among the female population worldwide. Its incidence among the elderly group of patients seems to be increasing. Sociodemographic along with clinical profile of patients is the first step in planning preventive and curative measures; we thus conducted a retrospective analysis of demographic and clinical profile of elderly patients suffering from cervical cancer visiting at our institute. Patients and Methods: Records of 88 elderly patients (age> =65 years) suffering from cervical cancer from the year 2011 to 2014 were analyzed for a sociodemographic profile, symptoms, histology, and staging. Fisher's exact test was applied using R software (version 3.5.2) for statistical analysis. Results: The median age of the cohort was 74 years. The majority of patients were from a rural background and were nonsmokers. All patients were multiparous. The most common presenting symptoms were discharge, bleeding from vagina and pain in the abdomen; present in 45 (51.13%), 25 (28.40%) and 18 (20.45%) patients, respectively. 78 (88.63%) patients' had advanced stage (II, III, IV) at the time of presentation while the number of cases diagnosed at early stage were only 10 (11.36%). 69% had associated comorbidities. Prolonged duration of symptoms was also found to be associated with higher stage (P < 0.05). Conclusion: The study brings forth the background profile of the elderly patients suffering from cervical cancer. Since the majority of patients present in an advanced stage of disease appropriate preventive steps and also the possibility of initiating screening measures should be sought among an elderly group of cervical cancer patients.
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Prevalence of anemia and its association with dietary pattern among elderly population of urban slums in Kochi p. 1533
Charutha Retnakumar, Maya Chacko, Devraj Ramakrishnan, Leyanna S George, Vijayakumar Krishnapillai
DOI:10.4103/jfmpc.jfmpc_1113_19  
Background: Anemia is common among the elderly and it is the reason behind their poor survival. Anemia among the elderly is consistently disregarded, which can even incite cardiovascular complexities. The risk of physical decline for the elderly with iron insufficiency is twofold than that of others in the same age. The elderly populace dwelling in urban slums is progressively influenced. Hence, the objective was to study the prevalence of anemia among elderly dwelling in urban slums of Kochi corporation and its association with the dietary pattern. Methodology: A cross-sectional study was carried out among 165 elderly (60 years of age and above), residing in urban slums of Kochi corporation. The hemoglobin level was measured using Heamocue and the dietary pattern was assessed by a structured pretested questionnaire eliciting a 7-day dietary recall. Results: The prevalence of anemia among the elderly was observed to be 60.6%, out of which 66% were females and 49% were males. The elderly females were found to be more vulnerable to anemia. Conclusion: Anemia was found to be significantly high among the elderly population in urban slums of Kochi. Regular screening and management of anemia along with dietary awareness have become the need of the hour.
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High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India p. 1538
Manju Madhavan, Mahendra M Reddy, Palanivel Chinnakali, Sitanshu S Kar, Subitha Lakshminarayanan
DOI:10.4103/jfmpc.jfmpc_1128_19  
Context: Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs. Aims: To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry. Settings and Design: A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry. Methods and Material: Data on sociodemographic details, selected risk factors of NCDs—alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using “Fagerstrom Addiction Scale” and “Alcohol Use Disorder Identification Test” scales, respectively. Statistical Analysis Used: Data were single entered using EpiData and analyzed using EpiData Analysis. Results: Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence. Conclusion: Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.
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Perception toward the family medicine services among the Physicians of Prince Sultan Military Medical City, Riyadh City, 2018: Cross-sectional study p. 1544
Abrar A Alzahrani, Osamah K Alfentokh, Abdullah S Aloggaael, Ayman A. M Afifi, Mostafa A Kofi
DOI:10.4103/jfmpc.jfmpc_1131_19  
Background: Family medicine is the medical specialty that continuously provides comprehensive type of health care for individuals and families. Although the family physician role is essential, this specialty faces underestimation by other physicians of other specialties, thus resulting in a considerable gap in their cooperation and coordination, as some studies around the world had shown. The present study aimed to estimate the perception of other physicians toward the practice of family medicine physicians to improve the relationship between family physicians and other physicians, which in turn may lead to enhance healthcare system by high quality of work and higher efficiency. Objective of the Study: To estimate the perception among the physicians of Prince Sultan Military Medical City, Riyadh City by measuring the satisfaction toward the family medicine medical practices. Subjects and Methods: Through a cross-sectional design, the study had recruited 289 physicians who were actively practicing and working at Prince Sultan Military Medical City and fulfill the inclusion and exclusion criteria during the period from October 2018 until June 2019. Data collection carried out by questionnaire designed and revised by an expert panel of health professionals. An appropriate statistical test, such as the Chi-square test, was used to record the statistical significance between participants' answers and their demographic characteristics. Results: According to the study design, 289 patients were included in the study; the mean age was 42 years that ranged between 25 and 74 years. Two-Third of them (66%) were male and had Saudi nationality. Half of the participants are medical consultant, and a third of all participants worked under the department of internal medicine. The majority expressed their good perception with the family physician practice (91%). Most of the medical departments satisfied with statistically significant (P value < 0.05) with the need for family medicine services. There was less satisfaction from physicians in different departments with effective communication between family medicine services and other departments but didn't reach up to significant statistical level. Higher qualified physicians with high-rank job categories were less satisfied with the performance of family medicine services. Conclusion: Among other physicians in different departments, family medicine physicians have a good perception, and most of the physicians agreed that family medicine physicians should work more in their referral letters to improve their communication between them and other departments.
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Metabolic changes in the patients on second-line highly active antiretroviral therapy (HAART): A prospective cohort study from north India p. 1550
Durga S Meena, Madhukar Rai, Surya K Singh, Jaya Tapadar, Deepak Kumar
DOI:10.4103/jfmpc.jfmpc_1208_19  
Introduction: In India, there is a genetic predisposition to insulin resistance and cardiovascular risk, the impact of ART (antiretroviral therapy) on lipid profile and blood sugar may be significant. The study of potential implications of highly active antiretroviral therapy (HAART)-associated metabolic syndrome is critical to prevent cardiovascular diseases in the Indian population. Aims: This study was done to determine the prevalence of metabolic changes (dyslipidaemia, hyperglycemia and insulin resistance) among HIV patients on second-line ART. Settings and Design: A prospective cohort study. Methods and Materials: We enrolled 150 patients, who were started on second-line HAART. Patients were investigated for fasting blood sugar, lipid profile and insulin level at baseline and after 6 months. Statistical Analysis: The data were analysed using SPSS software (version 20; IBM Corp., Armonk, N.Y., USA). Student's t-test was used to compare numerical variables in the two groups. P value < 0.05 was considered as statistically significant. Results: There was a significant increase in serum cholesterol, LDL and triglyceride in patients with protease inhibitors (PIs) containing regimens. LDL levels were increased from 65 to 80 mg/dL (P = <.003) after treatment. Triglycerides were increased from 138 to 152 mg/dL. (P = < 0.001). Median fasting blood sugar was increased from 85 to 96 mg/dL (P = < 0.002). HOMA-IR was also significantly increased in the PI group (1.54 vs. 2.1, P <.003). However, serum HDL did not change significantly. Conclusions: Appropriate drug selection with timely switching of ART is crucial to prevent metabolic complications in patients taking long-term PIs.
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Awareness and perception regarding tuberculosis among patients and their relatives attending a tertiary care hospital in Uttarakhand: A hospital-based exploratory survey p. 1555
Suresh K Sharma, Prasuna Jelly, Ajeet S Bhadoria, Kalpana Thakur, Kanchan Gawande
DOI:10.4103/jfmpc.jfmpc_932_19  
Background: Awareness about disease among tuberculosis (TB) patients plays a crucial role toward successfully achieving targets for control, prevention, and their relatives treatment adherence and is not well studied or documented. This study sought to explore the awareness and perceptions of TB patients in a tertiary care centre in northern India. Methods: This was an exploratory study conducted between January and December 2016 among 1,000 pulmonary TB patients and their relatives. Structured and validated interview schedule was used to assess participants knowledge and perception regarding TB, which comprised of 41 questions. Ethical clearance was taken and written informed consent was obtained from each study participants. Data analysis was done using SPSS 22.0 version. Results: A total of 1,000 study participants (mean age 40.2 ± 9.6 years, females 51%) were enrolled. More than two-third of the study participants were from Uttarakhand. Study participants had highest knowledge score (61.85%) regarding sign and symptoms, followed by scores in the aspect of prevention and treatment of TB (52.7%). However, a lower proportion (51.5%) knew about its causation. Overall knowledge score was 54.8%. Around half of the subjects (49.7%) disagreed that TB is a major health problem. Conclusions: Regardless of non-satisfactory knowledge of participants, their perception regarding TB was better. As to the associated factors, we found that participants' knowledge had significant association with religion, educational status, occupation, family income per month, type of family, and source of health information. Although there was insignificant difference between family monthly incomes, source of health information and perception regarding TB.
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Therapeutic properties of botulinum toxin on chronic anal fissure treatment and the patient factors role p. 1562
Setareh Soltany, Hamid Reza Hemmati, Jafar Alavy Toussy, Dina Salehi, Parisa Alavi Toosi
DOI:10.4103/jfmpc.jfmpc_944_19  
Background: One of the most frequent distressing diseases which causes anal pain and bleeding after defecation is anal fissure. Despite a poorly understood pathogenesis, the internal anal sphincter spasm has been identified to play a central role in pathogenesis. Recently, botulinum toxin is being used increasingly for the treatment of chronic anal fissure to achieve chemical sphincterotomy and reduce internal sphincter tonicity. Based on the heterogeneity among the published studies, we aimed this study to evaluate its healing rate and for recognizing the factors of patients which may affect the outcome. Subjects and Methods: In a prospective case series medical research, 106 patients who suffer from chronic anal fissure were treated by botulinum toxin injections. All patients received 30 units of botulinum toxin and were physically examined every week for 2 months. They were evaluated for bleeding, pain, hematoma, thrombosis, infection, incontinence, and healing of the fissure. At the end of the follow-up period, the fissure healing rate and its relation to age, gender, prior topical therapy, duration of symptoms, and the position of the fissure were assessed. Results: At the end of the study (8 weeks), the healing rate was 84.9% (90 patients responded to injections). Healing rate was higher in females and in patients who experienced a shorter duration of symptoms before injection. The mean healing time was 4.68 weeks. In addition, patients with one fissure (anterior or posterior) demonstrated higher healing rate and shorter healing time compared to patients with two fissures (anterior and posterior). Conclusion: This study demonstrated that botulinum toxin injection is safe and effective for the treatment of chronic anal fissures, with a low complication rate. In addition, the healing rate was higher in females, patients with shorter duration of symptoms, and those with one fissure.
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Prevalence of migraine and non-migraine headache and its relation with other diseases in the adults of Aseer Region, Saudi Arabia p. 1567
Mohammed Abdullah AlQarni, Khalid Ali Fayi, Mohammad Nassir Al-sharif, Aesha Farheen Siddiqui, Adel ALI Alhazzani
DOI:10.4103/jfmpc.jfmpc_962_19  
Background and Aims: Headache is a common yet neglected health problem. There is a lack of information about its distribution, disease characteristics and associated co morbidities in Aseer region of KSA. This study aims to estimate the migraine and headache prevalence, its epidemiological and disease characteristics and relation with other co morbid conditions among general population of Aseer region, Saudi Arabia. Methods: A descriptive cross-sectional survey of 1123 adult participants during the period from Apr 2018 to Dec 2018. The questionnaire was sent to total of 1420 participants, but only 1123 agreed to participate and completed the questions (response rate 79.1%). Participants were recruited through an online survey from 4 main cities in Aseer region. Participants who refused were excluded. Adults were invited to answer a 25-question electronic survey to assess the prevalence of headache (migraine and non-migraine) and its relations with other diseases. Results: The participant's ages ranged from 17 to 60 years old, with mean age of 32.4 ± 10 years. No history of frequent headaches was reported by 152 (13.5%) while 833 (74.2%) had non-migraine headache (NMH) and 138 (12.3%) had migraine headache (MH). Female gender (2:1), poor sleep duration, cerebrovascular disease, dyslipidemia, chronic sinusitis and depression showed a significant association with migraine. Conclusions and Recommendations: The current research revealed a high prevalence of headache either migraine or non-migraine, twice as common in females and in those with insufficient sleeping hours. Most headache attacks were associated mainly with light in form of flashes, sensitivity or aggravated episodes.
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Investigating the etiologic agents of aseptic meningitis outbreak in Iranian children p. 1573
Abdolkarim Ghadimi Moghadam, Eslam Yousefi, Mohamad Amin Ghatie, Ali Ghadimi Moghadam, Gholam Reza Pouladfar, Marzieh Jamalidoust
DOI:10.4103/jfmpc.jfmpc_1003_19  
Introduction: This study aimed to determine the viral agent (s) and their genome burden associated with an aseptic meningitis outbreak that occurred in Yasuj, Iran. Materials and Methods: During April to August 2015, 104 CSF samples from 104 patients under 14 years old admitted to the hospital of Yasuj, Iran, with aseptic meningitis associated clinical signs were collected. 200 μl CSF specimens was prepared for DNA and RNA viral genome extraction each and then subjected to diagnostic Taq-man real time PCR assays for the present of Enteroviruses, HSV, VZV, mumps, measles and rubella in the samples. Results: The majority of them had experienced clinical meningitis sign. Primary laboratory differentiated tests were in favor of viral meningitis. Among a total of 104 patients diagnosed with clinically aseptic meningitis, enterovirus as the most significant viral agent was detected in 53 subjects. However, mumps, HSV and VZV, as the endemic causes of viral meningitis, were detected in 6, 6 and 2 of the affected patients. It was revealed that two HSV and one VZV affected patients were co-infected with enteroviruses. All affected children with relatively variable viral load recovered without any sequels. Conclusion: The present study revealed enterovirus as the main predominant cause of pediatric aseptic meningitis that broke out in Yasuj-Iran. Also, the co-circulation of mumps, HSV and VZV, as the endemic cause during the same aseptic meningitis outbreak, was demonstrated in some cases.
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Double burden of malnutrition among women residing in tenements in a resettlement area, Kancheepuram district p. 1578
M Buvnesh Kumar, TK Raja, M Jasmine, Fasna Liaquathali, V Pragadeesh Raja, NV Manju
DOI:10.4103/jfmpc.jfmpc_1040_19  
Introduction: The double burden of malnutrition is the co-existence of undernutrition along with overweight/obesity. The underweight can cause cognitive impairment, increase mortality, and over nutrition increases the chance of noncommunicable diseases like type 2 diabetes and hypertension. Women are vulnerable for early marriages, early conception, and so forth, which have an impact on their nutritional status. Objective: To estimate the prevalence of double burden of malnutrition among women residing in tenements in a resettlement area, Kancheepuram district. Materials and Methods: This is a cross-sectional study conducted among women aged above 18 years residing in a tenement in a resettlement area, Kancheepuram district using a semi-structured questionnaire. The sample size was 211. Results: The median age of the participants was 44. 78; 2% were married; 30.8% belong to class III. Based on BMI 1.4% were underweight, 17.1% had normal BMI, 48.8% were pre-obese, and 19.9% were under obese stage 1. Based on the waist circumference, 23.7% were under high risk and according to the waist–hip ratio, 69.7% were under high risk. The prevalence of diabetes among the high-risk category for waist–hip ratio was higher (80.3%) with statistical significance. Conclusion: The national programs are concentrating more on the undernutrition. The importance of obesity as a risk factor for many noncommunicable diseases should be stressed in the nutritional programs thereby providing proper interventions to prevent them, which could be done by interlinking with NPCDCS.
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Paediatric trauma aetiology, severity and outcome p. 1583
CB Albin, R Feema, L Aparna, H Darpanarayan, Jolly Chandran, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/jfmpc.jfmpc_1081_19  
Background: Paediatric injuries are a major cause of mortality and disability worldwide and account for a significant burden on countries like India with limited resources. There are very few studies from developing nations describing the outcome of paediatric trauma. Methodology: This retrospective study was done to assess the pattern and outcome of unintentional paediatric trauma in the paediatric population. The patients were categorised into four age groups of < 1 year, 1–5 years, 6–10 years and 11–15 years. The data were compared regarding the mode of trauma, new injury severity score (NISS), type of injury and place of injury among different age groups. Results: A total of 1587 paediatric patients below 15 years of age presenting in the Emergency Department of CMC, Vellore were studied over a period of 1 year. Two-thirds were boys (1039: 66.6%). Fall on level ground (28.2%) and road traffic accidents (RTA) (26.5%) were the two most common modes of injury. A gradual change in the place of incident from home to the road with advancing age was noticed. The upper limb (30.8%) and the face (26.2%) were the most common parts of the body to be injured. One-third (35.8%) of the sustained serious injuries was a fracture or a dislocation. RTA (OR: 1.56; 95%CI: 1.08-2.26) and age ≥5 years (OR: 1.17; 95%CI: 1.08-1.26) were found to be independent predictors of severe injury (NISS >8). Only 15% required hospital admission. Conclusion: Fall on level ground and RTAs are the most common modes of injury in the paediatric population. The place of injury shows a gradual change from the confines of home to the open dangerous roads and playgrounds with increasing age with RTA and age ≥5 years being independent predictors of severe injury.
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Profile and outcome of patients presenting with agrochemical poisoning to the emergency department p. 1589
A Sivanandan, SR Abel, M Sanjay, Jolly Chandran, Karthik Gunasekaran, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/jfmpc.jfmpc_1096_19  
Background: Deliberate self-harm (DSH) is one of the leading causes of mortality and morbidity in India. Agrochemicals are the most commonly used compounds for DSH. The spectrum of Agrochemicals in use varies from region to region and time period with newer compound being regularly introduced into the market. Methodology: This retrospective cohort study included patients presenting with agrochemical poisoning to the ED during January 2017 to December 2018. Patient data was retrieved form the ED triage registry software and clinical workstation, following which their hospital outcome was determined. Results: During the study period, 1802 patients presented with DSH among which Agrochemical poisoning comprised 33.5% (604/1802). The mean age was 31 years and incidence of agrochemical poisoning was found to be higher in young adults (16–30 years–55.8%). The prevalence was more common in males (62.4%). The common agrochemical compounds consumed were insecticides (91%), herbicides (4.3%), fungicides (1.5%), fertilizer (1.5%), and plant growth regulators (1.5%). Majority (80.96%) of the patients were discharged alive from the hospital, 17% left against medical advice due to bad prognosis and 12 patients (2%) died in the hospital. Conclusion: Insecticides (mainly Organophosphates) are the most common agrochemicals used for DSH. Their management is better understood leading to better outcomes compared to other chemicals. The proportion of agrochemical use in DSH has reduced over the last decade. Imidacloprid (Insecticide) and Plant growth regulators are the new compounds for which appropriate management is not yet established and more research is needed.
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Knowledge and attitude of male schoolteachers towards primary dental care p. 1594
Inderjit Murugendrappa Gowdar, Sulaiman Abdulaziz Aldamigh, Mohammed Saad Wabran, Abdullah Saleh Althwaini, Tamim Abdullah Alothman, Abdulrahman Mohammed Alnafisah
DOI:10.4103/jfmpc.jfmpc_1100_19  
Introduction: Children are the most important natural resources. School is a location which helps to promote the health of staff, families, and community members along with the students. Teachers are the most resourceful manpower available to deliver any healthcare at school setup. Aims and Objectives: To assess the knowledge and attitude towards primary dental care among male schoolteachers at Al-Kharj Saudi Arabia. Methodology: A descriptive cross-sectional questionnaire survey was carried out involving male teachers working in primary schools at Al-Kharj KSA. A total of 350 teachers were included in this study. The data were collected using a self-administered questionnaire survey consisting of 17 questions related to knowledge and attitude towards dental care and oral hygiene practices. Results: The overall knowledge was fair among the schoolteachers (65.4%). Al-Kharj male schoolteachers were having a positive attitude. Teaching experience and knowledge showed a statistically significant relation (P < 0.05. Conclusion: Although primary schoolteachers had a fair knowledge and good attitudes towards dental care, there is a need to conduct training programs about oral health education in schools and check how teachers educate their children to maintain dental care.
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Evaluation of mandibular third molar position as a risk factor for pericoronitis: A CBCT study p. 1599
Rohit Singh, Raghu Devanna, Pavan Tenglikar, Ashesh Gautam, Anubhuti , Priyanka Kumari
DOI:10.4103/jfmpc.jfmpc_1101_19  
Aims: The present study was conducted to evaluate mandibular third molar position as a risk factor for pericoronitis. Materials and Methods: The present study was conducted on 145 subjects of both genders. The clinical symptoms and signs such as redness, pus discharge, pain, and tenderness over pericoronal flap were assessed. All candidates were subjected to CBCT scan evaluation for a third molar position such as vertical, mesioangular, distoangular, and horizontal type. Results: Maximum number of cases of pericoronitis was observed in the age group 18–28 years (80) followed by 28–38 years seen in 47 cases, and 38–48 years seen in 28 cases. The most common type of impaction was mesioangular seen in 48 females and 42 males, followed by vertical in 22 females and 18 males, distoangular in 8 females and 10 males and horizontal in 2 females and 5 males. Maximum clinical features of swelling, trismus, dysphagia, and enlarged lymph nodes were seen in patients with mesioangular impaction followed by vertical impaction. Conclusion: Maximum number of pericoronitis cases was seen in the age group 18–28 years and most commonly mesioangular impactions were observed with pericoronitis.
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Role of natural salivary defenses in the maintenance of healthy oral microbiota in children and adolescents p. 1603
Mohammed Ahsan Razi, Seema Qamar, Adya Singhal, Ankit Mahajan, Shandar Siddiqui, Ruchi Staffy Mohina Minz
DOI:10.4103/jfmpc.jfmpc_1134_19  
Aim: The present study served the purpose of assessing the levels of salivary immunoglobulin A (IgA), immunoglobulin G (IgG), proteins, calcium, inorganic phosphorus, and alkaline phosphatase levels in caries-free and caries active children. Materials and Methods: Stratified randomized sampling method was used to include 40 subjects in the age group 12–15 years having a full complement of permanent dentition except for third molars. The selected pediatric subjects were further divided into two groups of 20 each based on DMFS score, Group-I – Caries free (DMFS score = 0) and Group-II – Caries active (DMFS score ≥10). Unstimulated midmorning saliva samples were collected and analyzed colorimetrically and by radial immunodiffusion method for constituents of saliva understudy. Results: The mean salivary IgA levels in children in Group-I (caries-free children) was 10.63 ± 2.85 mg/dL which was statistically higher as compared to caries active children in Group-II (8.50 ± 1.43 mg/dL).The mean salivary protein level in children of Group-II was statistically higher at 3.28 ± 0.12 mg/dL as compared to Group-I (2.89 ± 0.11 mg/dL). Conclusion: The present study showed decreased levels of salivary immunoglobulin A and high concentration of salivary protein in children with increased caries experience which is indicative of the protective role of salivary constituents in caries-free children.
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Assessment of Saudi parent's awareness towards space maintainers at Alkharj city: A cross-sectional study p. 1608
Hamad Sulaiman Alduraihim, Sultan R Alsulami, Saud Z Alotaibi, Mohamed Abd-Ellatif El-Patal, Inderjit M Gowdar, Praveen N Chandrappa
DOI:10.4103/jfmpc.jfmpc_1146_19  
Background: Premature extraction or loss of a tooth due in primary dentition may lead to malocclusion in permanent dentition. Space maintainers are very important to children in mixed and primary dentition for preventing problems of malocclusion. The utilization of space maintainers depends on parental knowledge and awareness about space maintainers. Aims and Objectives: To assess the of Saudi parent's awareness toward space maintainers in Alkharj city. Material and Methods: A descriptive cross-sectional questionnaire-based study was planned among Saudi parents who visited the College of Dentistry, Prince Sattam Bin Abdulaziz University. Questions related to space maintainers awareness, use, source of information, and utilization of space maintainers were asked. Results: Around 312 (82.1%) parents were not aware of space maintainers and did not receive any information about the same. About 166 (43.7%) parents did not have any personal experience of a child's missing deciduous teeth. Only 115 (30.26%) respondents received some information about space maintainers. The majority of parents 298 (78.4%) were unaware whether space maintainers aid in the eruption of permanent teeth. Similarly, 73.7% did not know when to use space maintainers. Conclusions: Knowledge of space maintainers among Saudi parents is very less. Dental professionals hence need to create awareness of interceptive orthodontics rather than curative approaches, to achieve better oral health outcomes.
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Gender and side distribution of urinary calculi using ultrasound imaging p. 1614
Sultan Abdulwadoud Alshoabi, Dahhan Saleh Alhamodi, Moawia Bushra Gameraddin, Mahmoud S Babiker, Awatef Mohammed Omer, Sami A Al-Dubai
DOI:10.4103/jfmpc.jfmpc_1153_19  
Introduction: Urinary calculi constitute a significant medical problem worldwide. Due to lack of previous studies on gender and side distribution of urinary calculi, the current study was conducted. Patients and Methods: This retrospective study involved 590 urinary calculi from the electronic reports of 266 patients. Gender and side distribution were compared using Chi-square test. Relationship between gender and side of urinary calculi was analyzed using cross tabulation test. Results: This study involved 590 urinary calculi reported in 266 patients. Among 590 calculi; 565 (95.8%) were in adults, and 25 (4.2%) were in children. Urinary calculi were in male in 397 (67.3%) and in female in 193 (32.7%). Calculi were 304 (51.5%) in right side, and 286 (48.5%) in left side. Exactly 507 (85.9%) of calculi were in the kidneys, and 83 (14.1%) in the ureters. No significant relationship between gender and side of the calculi (P = 0.238), (Odds ratio 0.869, 95% Confidence interval 0.615-1.226). Conclusion: Urinary calculi affect male more than female and adults more than children. No significant relationship between calculi and right or left side of the body.
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A 10 years retrospective study of assessment of prevalence and risk factors of dental implants failures p. 1617
Rohit Singh, Anuj Singh Parihar, Vikas Vaibhav, Kunal Kumar, Revati Singh, Jeethu John Jerry
DOI:10.4103/jfmpc.jfmpc_1171_19  
Aim: The present study was conducted to determine the prevalence rate of dental implants failure and risk factors affecting dental implant outcome. Materials and Methods: The present retrospective study was conducted on 826 patients who received 1420 dental implants in both genders. Length of implant, diameter of implant, location of implant, and bone quality were recorded. Risk factors such as habit of smoking, history of diabetes, hypertension, etc., were recorded. Results: In 516 males, 832 dental implants and in 310 females, 588 dental implants were placed. Maximum dental implant failure was seen with length < 10 mm (16%), with diameter < 3.75 mm, and with type IV bone (20.6%). The difference found to be significant (P < 0.05). Maximum dental implant failures were seen with smoking (37%) followed by hypertension (20.8%), diabetes (20.3%), and CVDs (18.7%). Healthy patients had the lowest failure rate (4.37%). Conclusion: Dental implant failure was high in type IV bone, dental implant with < 3.75 mm diameter, dental implant with length < 10.0 mm, and among smokers.
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Evaluation of existing knowledge, attitude, perception and compliance of hand hygiene among health care workers in a Tertiary care centre in Uttarakhand p. 1620
Ankit Goyal, Himanshu Narula, Puneet Kumar Gupta, Anita Sharma, Ajeet Singh Bhadoria, Pratima Gupta
DOI:10.4103/jfmpc.jfmpc_1183_19  
Background and Aims: To evaluate existing knowledge, attitude and perception and compliance of hand hygiene activity among various healthcare workers in a tertiary care centre in Uttarakhand. Methods: A cross sectional study was done for a period of two months. WHO hand hygiene and compliance form with slight modification were used to study knowledge, attitude, perception and compliance (overt and covert) by direct observational technique. Statistical analysis was done using Microsoft Excel 2010 and IBM SPSS 23.0 version software. Results: A total of 220 participants were given questionnaire out of which 172 participated in study. 159 (92.4%) had already received training in HH in the past 3 years and were using alcohol based hand rub routinely. The overall correct knowledge score of various professional categories of HCW was good i.e. 71.6% Most of the healthcare workers knew the importance of adhering to this simple practice in prevention of healthcare associated infections. Most of them were aware of the conditions before or after when HH activity has to be performed. Poor compliance of hand hygiene was noted among healthcare workers on covert observation. For given hand hygiene opportunities the HH was started in 53.2% and 15.7% of overt and covert observations, respectively. However, HH compliance decreased drastically among HCW, which was 15.7% and 1.6% of overt and covert observations, respectively. Interpretation and Conclusions: The acceptance of the fact by most of the HCW that direct vigilance over this activity helped them performed better, suggested the demand of regular surveillance and several other promotional activities in the centre.
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A prospective, cross-sectional study on association of serum vitamin D level with musculoskeletal symptoms and blood pressure in adult population p. 1628
Vikram Singh, Arup Kumar Misra, Mridu Singh, Bharat Kumar, Naresh Kumar Midha, Sneha Ambwani
DOI:10.4103/jfmpc.jfmpc_872_19  
Background: Vitamin D is an important vitamin required to maintain an important physiological function of the body. The body should maintain an optimal level of vitamin D to maintain skeletal and metabolic functions. It was observed that inverse relationship is maintained by vitamin D level in the body with musculoskeletal symptoms and metabolic disorders. Objective: The study is conducted to associate between serum levels of vitamin D with self-reported symptoms (musculoskeletal) and blood pressure. Material and Methods: Venous blood sample was collected from 126 adults with musculoskeletal symptoms. The subjects were stratified based on their vitamin D levels. Groups were tested for the frequency of symptoms and the relationship of different parameters with vitamin D. Results: The frequency of subjects in the study was more in the deficient category (<20 ng/dL). In the study, vitamin D was found to have a significant association with “weakness.” Body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were found to have an inverse relation with serum vitamin D level. Conclusion: The study showed the effect of vitamin D level in musculoskeletal symptoms and inverse association of vitamin D with BMI and blood pressure.
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Risk assessment of obstructive sleep apnea among gastroesophageal reflux disease patients in Taif, Saudi Arabia p. 1633
Muhannad M Alharthi, Meshari H Altowairqi, Sultan S Alamri, Hosam T Mashrah, Mazen A Almalki, Eidha Fawzan Eidha Aljuaid
DOI:10.4103/jfmpc.jfmpc_882_19  
Background: Previous studies have reported the association between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA). Objectives: The aim of the present study was to assess the prevalence of GERD among Saudi population, and to determine the risk of OSA among those diagnosed with GERD in Taif city of Saudi Arabia. Materials and Methods: A cross-sectional online survey was done among 843 Saudi participants using a questionnaire by collecting demographic data, weight, height, blood group, and having a previous nose or throat surgery. The GERD questionnaire and the sleep apnea symptom index were used to determine GERD and OSA prevalence. Results: The prevalence of GERD and OSA was 17.6% and 2.4%, respectively. A significantly higher prevalence of GERD was found among males, those with age >50 years, employees and obese participants, and those having OSA. Participants with an age >50 years and males, had a significantly higher prevalence of OSA. Being a male and older age were predictors for GERD, and the presence of GERD was an independent predictors for OSA. Conclusion: Future population-based studies including a representative sample of the population should be done to confirm the revealed association between GERD and OSA. It is necessary to assess GERD in patients with OSA in clinical practice.
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Management of short clinical crowns by utilizing horizontal groove retentive technique in crown/tooth or both with different luting cements – An analysis on extracted teeth p. 1640
J Haritha, M Reddi Narasimha Rao, B Indira Padmaja, N Raja Reddy, N Suresh Babu, K V Guru Charan Karthik
DOI:10.4103/jfmpc.jfmpc_939_19  
Purpose: The aim of the present study was to compare and evaluate the retention of dislodged crowns by addition of one horizontal circumferential groove (HCG) to preparation and/or casting and with two luting cements. Materials and Methods: A total of 80 recently extracted human maxillary first molar teeth of appropriate sizes were collected and mounted in the resin blocks using surveyor. Standardized full coverage tooth preparations were prepared and impressions were obtained. Dies were prepared for casting and were then subjected to tensile loading using UTM. The data obtained was statistically analyzed. Results: Obtained values were statistically analyzed using ANOVA, STUDENT “t” TEST and BONFERRONI TEST. The results showed that the mean tensile force (TF) was in the range from 49.05 to 264.87 for group A and 255.06 to 588.60 for group B. The highest TF was recorded for subgroup 3B, whereas the lowest for subgroup 1A. Conclusion: Within the limitations of the study, it was concluded that by addition of one HCG to tooth preparation or casting and to both showed significant increase in retention, when compared to control groups. The highest retention value was obtained for sample with groove on the internal surface of crown luted with SARC.
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Interplay of multimorbidity and polypharmacy on a community dwelling frail elderly cohort in the peri-urban slums of Delhi, India p. 1647
Meely Panda, Rambha Pathak, Farzana Islam, Rashmi Agarwalla, Vishal Singh, Farishta Singh
DOI:10.4103/jfmpc.jfmpc_945_19  
The United Nations Population Fund suggests that the number of elderly persons is expected to grow to 173 million by 2026. The aging phase is further made adverse by conditions such as failty, multimorbidity and polypharmacy. Aim: To assess the status and associates of frailty among elderly (>60 years) residing in a peri-urban slum area in Delhi by using the EDMONSTON Frail scale and evaluate the interplay of multimorbidity (MM) and polypharmacy (PP) on the frail pre-frail spectrum of the community-dwelling elderly cohort. Method: A community study from Dec 2018 till July 2019 with a sample size of 300 participants who were willing and consented to the study. Frailty was assessed and the STOP criteria was used for PP assessment. Result: There were 76 frail, 51 pre-frail, and 173 non-frail elderly. A higher prevalence (51%) of multimorbidity among the pre-frails and a higher probability (74%) of polypharmacy among the frails were found. Of the total in the frail-prefrail spectrum (127), 29.1% had multimorbidity (MM) and 39.4% had polypharmacy (PP). MM and PP were significantly higher among the old. Factors such as sex, marriage, loneliness, social circle, and education also had a positive bearing on the frailty-prefrailty spectrum. The working group had an increased (86%) probability of PP with statistical significance. Regression analysis depicted significant increased odds of MM and PP among female, illiterate, very old, lone, and single subjects. Discussion and Conclusion: Thus, we recommend earlier and timely intervention for the frail-prefrail which can revert their adversities.
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Evaluation of root coverage with pedicled buccal fat pad in class III and class IV gingival recession defects p. 1656
K Monika, Lokesh Sunkala, N Sandeep, K Keerthi, B Vimal Bharathi, Gajula Venu Madhav
DOI:10.4103/jfmpc.jfmpc_1104_19  
Background: Gingival recession (GR) is a common clinical feature of periodontal disease and is an undesirable condition. More than 50% of the population has one or more sites with GR ≥ 1 mm. Material and Methods: In this study 15 subjects were subjected to initial periodontal therapy such as ultrasonic scaling and root planning with hand instruments and curettes. Patient is motivated for home care. The buccal fat pad is harvested and sutured in the gingival recession area and followed up for 6 months and root coverage was calculated. Results: At baseline mean recession of 5.60 ± 1.18 mm, probing depth of 0.73 ± 0.59 mm, clinical attachment loss of 6.40 ± 1.18 mm were recorded. At the end of 6 months, the mean recession was reduced from 5.60 ± 1.18 mm to 2.87 ± 0.74 mm, probing depth was increased from 0.73 ± 0.59 mm to 1.73 ± 0.70 mm and clinical attachment loss was decreased from 6.40 ± 1.18 mm to 4.53 ± 0.83 mm.The difference between baseline score and six months score for all three parameters are statistically significant. Conclusion: Buccal fat pad is a predictable procedure to cover Miller's class III and class IV gingival recession defects. There was a definitive improvement in clinical parameters (reduction in gingival recession, increased probing depth, gain in clinical attachment) after 6 months. There was 46.78% improvement in root coverage which was statistically significant.
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The association of stress with sleep quality among medical students at King Abdulaziz University Highly accessed article p. 1662
Maha A Safhi, Raghad A Alafif, Nouf M Alamoudi, Malak M Alamoudi, Wejdan A Alghamdi, Shatha F Albishri, Hisham Rizk
DOI:10.4103/jfmpc.jfmpc_745_19  
Objective: This study aims to determine the prevalence and the association of stress with sleep quality among medical students at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Methods: A cross-sectional study was done among 326 medical students of KAU using a stratified random sampling technique. An electronic self-administered questionnaire was used. Kessler Psychological Distress Scale (K10) and Pittsburgh Sleep Quality Index (PSQI) were used to assess the stress and sleep quality, respectively. Results: The overall students who experienced stress were 65%. The prevalence of poor sleep quality (total PSQI score ≥5) was 76.4%. There was a strong association between stress and poor sleep quality (value of Cramer's V = 0.371, P < 0.001), and it showed that the increase in stress level is a significant predictor of poor sleep quality. Conclusion: A high prevalence of stress and poor sleep quality was found among the students and the study confirms a strong association between them. We recommend establishing courses focusing on educating the students about proper sleep hygiene and how to deal with the stressful environment.
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Vitamin-D deficiency and its association with breast feeding among children at 1 year of age in an urban community in South India p. 1668
R Gnanaraj, B Arul Premanand Lionel, Meghana Paranjape, Prabakar Devarajan Moses, Jacob John, FS Geethanjali, Winsley Rose
DOI:10.4103/jfmpc.jfmpc_995_19  
Context: High prevalence of Vitamin D deficiency is reported among healthy infants, children and adolescents. Maternal Vitamin-D deficiency, poor vitamin-D content of breast milk even in Vitamin-D replete mothers, exclusive breastfeeding without Vitamin-D supplementation and inadequate sunlight exposure are important risk factors for Vitamin D deficiency in infants. Aim: To determine the prevalence of hypovitaminosis-D and its relation with breast feeding and childhood illness among healthy infants at 1 year of age. Settings and Design: A prospective cohort study was conducted among the infants in an urban community in south India. Methods and Material: A total of 495 children were followed up at 1 year of age. Clinical history, anthropometric measurements, and serum blood samples for vitamin-D were obtained. The effects of breastfeeding duration and infections on Vitamin-D status were assessed by univariate and multivariate analysis. Results: The prevalence of Vitamin D deficiency was 22% in these infants. Univariate analysis showed risk of hypovitaminosis-D in children breast fed for more than 6 months (p 0.02); however, multivariate analysis did not prove an association. Other risk factors analysed were not significantly associated with Hypovitaminosis D. Conclusion: The prevalence of hypovitaminosis-D in this study was low compared to previous studies from India. This study emphasizes the issue of hypovitaminosis-D in otherwise normal children. Routine Vitamin-D supplementation for antenatal women and infants may be needed to overcome this public health problem.
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Knowledge and attitudes toward vaccination among Saudi medical students p. 1672
Khadijah Abdulrhman Madkor, Eman Hazza Somily, Abdulmlik Abdullah Hassan Najmi, Asim Bishi Mohammed Hakami, Manssour Mohammed Alfaifi, Khaled Muhammed Mashhour, Al-Muhannad Yahya Ali Khabrani, Mohammed Eid Yahya Hamdi
DOI:10.4103/jfmpc.jfmpc_1015_19  
Background: Studies have identified healthcare providers as an important determinant of vaccination acceptance. However, knowledge and attitudes toward vaccination have not been sufficiently studied in Saudi Arabia, especially among medical students. Therefore, we conducted this study to explore vaccination knowledge and attitudes among medical students at a large Saudi university. Methods: A cross-sectional survey was conducted on 182 Saudi medical students between February 2019 and May 2019. Participants were invited to fill out a self-administered questionnaire assessing knowledge and attitudes toward vaccination. The statistical analysis included descriptive analysis, Chi-square test, independent samples t-test, and analysis of variance (ANOVA). The relationship between knowledge and attitudes was assessed using Pearson's correlation test. Results: A total of 182 respondents completed the questionnaires, giving a response rate of 91%. The study included male (52.7%) and female (47.3%) students from study years 2, 3, 4, 5, and 6. The overall mean knowledge score was under average [3.05/9, standard deviation (SD) = 1.86] and the respondents showed generally moderate attitudes toward vaccination (mean = 30.60/45, SD = 6.07). While there was no sex difference in both the scores on knowledge and attitudes domains, the year of study was significantly associated with the mean knowledge score (F = 6.48, P < 0.01) and attitudes score (F = 7.12, P < 0.01). As predicted, there was a significant linear relationship between vaccination knowledge and attitudes (r = 0.71, P < 0.01). Conclusion: The study revealed generally moderate attitudes of Saudi medical students toward vaccination. However, several knowledge gaps were detected. The implications of the current findings are discussed.
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The outcome of hypertensive disorders with pregnancy p. 1678
Ibrahim A Abdelazim, Yerbol Bekmukhambetov, Raisa Aringazina, Svetlana Shikanova, Osama O Amer, Gulmira Zhurabekova, Makhmutsultangali A Otessin, Akezhan R Astrakhanov
DOI:10.4103/jfmpc.jfmpc_1054_19  
Background: Hypertensive disorders (HTDs) with pregnancy remain a major health problem because of the associated adverse maternal and perinatal adverse outcomes. Objectives: To evaluate the outcomes of HTDs with pregnancy. Patients and Methods: Four hundred and five (405) hypertensive women included in this retrospective multicenter study. Data of the studied women including maternal age, parity, gestational age at delivery, pregnancy outcome [preterm delivery (PTD), birth weight (LBW), Apgar scores, neonatal intensive care unit admission (NICU), intrauterine fetal death (IUFD), intrapartum and/or early neonatal deaths] were collected. Collected data analyzed statistically to evaluate the outcome of HTDs with pregnancy. Results: Preeclampsia (PE)/superimposed PE group had significantly high relative risk (RR) and Odds ratio (OR) for PTD (RR 2.1; OR; 3.3; P = 0.0001 and P = 0.0001, respectively), LBW (RR 2.01; OR; 3.17; P = 0.0001 and P = 0.0001, respectively), and low Apgar score at 1st min (RR 1.7; OR 1.9; P = 0.01 and 0.01, respectively) and at 5th min (RR 2.2; OR; 2.36; P = 0.2 and 0.2; respectively). In addition, PE/superimposed PE group had significantly high RR and OR for NICU admission (RR 1.6; OR 2.2; P < 0.0002 and P < 0.0001, respectively) and IUFD (RR 2.9; OR 3.1; P = 0.01 and 0.01, respectively). Conclusion: women with PE/superimposed PE have high RR and OR for PTD, LBW, and low Apgar score at 1st and 5th min, NICU, and IUFD compared to the gestational and chronic hypertension with pregnancy.
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Association of elderly age and chronic illnesses: Role of gender as a risk factor p. 1684
Bandar Alhumaidi Alharbi, Nazish Masud, Fahad Abdullah Alajlan, Nwaf Ibrahim Alkhanein, Fares Thamer Alzahrani, Zaid Majed Almajed, Reema Khalid Mohammed Alessa, Ali Ibrahim Al-Farhan
DOI:10.4103/jfmpc.jfmpc_1060_19  
Background and Aims: Chronic diseases are the leading cause of death as well as disability worldwide. There is a little information about the prevalence of these diseases among Saudi elderly population. The aim of the study was to assess the role of gender as risk factor for chronic diseases among elderly patients seen at primary health care centers and identify the most common chronic comorbidities among the elderly. Methods: A cross-sectional study was conducted by reviewing charts of elderly patients having chronic illnesses seeking consultation between January to December 2016. Based on WHO classification data for 19 chronic diseases were extracted using electronic charts of the patients. Chi-square test and logistic regression was used to access the gender as predictor for chronic illnesses with statistical significance was set at P < 0.05. Results: The total number 319 elderly patients were included in the study after random sampling with a mean age of 75 ± 7 years. Around 83 (26%) of patients were severely obese (BMI >35) with a mean BMI of 30 ± 6.7. The most common chronic illnesses were cardiovascular diseases 229 (71.8%), dyslipidemia 183 (57.4%) and diabetes 179 (56.1%). The chronic respiratory and endocrine diseases were common among the elderly females (P value 0.004, P value < 0.001). The most significant problem among males was disease of genitourinary system. There was significant positive correlation of multimorbidity with number of times of consultation in a year (r = 0.442, P value < 0.001). Conclusion: The study concludes that females are more likely to have chronic diseases at elder age than males. However, disease of the genitourinary system was significantly higher among male elderly. Multimorbidity significantly increased the need for frequent visits to the hospital.
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A study to assess prevalence of anaemia among beneficiaries of Anaemia Mukt Bharat Campaign in Uttarakhand p. 1691
Surekha Kishore, Mahendra Singh, Bhavna Jain, Neha Verma, Kanchan Gawande, Sanjeev Kishore, Pradeep Aggarwal, Shikhar K Verma
DOI:10.4103/jfmpc.jfmpc_941_19  
Context: Anaemia is defined as a decreased concentration of blood haemoglobin. It is one of the most common nutritional deficiency diseases observed globally affecting both developing and developed countries. Aims: To find out the prevalence of anaemia among the beneficiaries of Anaemia Mukt Bharat and its association with age and gender. Settings and Design: A cross-sectional study was conducted in Uttarakhand by AIIMS Rishikesh in a month-long campaign including 5,776 beneficiaries. Camps were organized at the hospital campus, schools, district hospitals, Community Health Centre (CHC), Primary Health Centre (PHC), subcentres (SC), Anganwadi Centres (AWCs), slum areas, adolescent health day celebration sites and Village Health and Nutrition Day (VHND) sites. Methods and Material: Data on age and gender along with haemoglobin level using HemoCue Haemoglobinometer was collected. Statistical Analysis Used: These data were entered into Microsoft Excel and analysed to calculate the prevalence of anaemia and its association with age and gender using Epi Info software version 7. Pearson's Chi-square test was applied. P value < 0.05 was considered as significant. Results: Out of 5,776 participants 53.2% were anaemic. Females (54.6%) were more anaemic than males (45.1%). 33.5% of pregnant females were found to be anaemic. Conclusions: Prevalence of anaemia was very high among the study participants. It shows that anaemia is a major public health problem so efforts should be taken to reduce the prevalence of anaemia and promote the health of an individual, community as well as the country.
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Esophageal carcinoma: An epidemiological analysis and study of the time trends over the last 20 years from a single center in India p. 1695
Dhaval Choksi, Kailash M Kolhe, Meghraj Ingle, Chetan Rathi, Harshad Khairnar, Shamshersingh G Chauhan, Vipul Chaudhary, Akash Shukla, Vikas Pandey
DOI:10.4103/jfmpc.jfmpc_1111_19  
Background and Aims: Esophageal carcinoma is a common gastrointestinal malignancy. There is a paucity of literature about the time trends from India. The aim of the study was to evaluate the time trends over 20 years and observe how they differ from the West. Material and Methods: We retrospectively evaluated the data of 552 patients from the gastroenterology database (single department, single-center) over a period of 20 years from 1996 to 2015. The study period was split into two groups, namely, Group A (1996 to 2005) and Group B (2006 to 2015). Results: There were 263 patients in Group A and 289 patients in Group B. The mean age was 54.83 years (range 25–89 years). There were 345 males and 207 females, with the ratio being 1.67. The most common histological type was squamous cell carcinoma (SCC) with 443 patients (80.25%). The most common location was mid esophagus with 229 patients (41.48%) followed by 208 patients (37.68%) in the lower esophagus. There was no significant increase in the lower esophageal malignancy. However, there was a significant increase in the gastroesophageal junction (GEJ) and adenocarcinoma (AC). There were no other time trend changes in gender, location, or histology. Conclusion: SCC is still far more common than AC in India. The mid esophagus is the most common site. There is no evidence of an increase in the lower esophageal malignancy in our study for over 20 years. However, the rates of GEJ-AC were found to be increasing.
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Study of internet addiction and its association with depression and insomnia in university students p. 1700
Akhilesh Jain, Rekha Sharma, Kusum Lata Gaur, Neelam Yadav, Poonam Sharma, Nikita Sharma, Nazish Khan, Priyanka Kumawat, Garima Jain, Mukesh Maanju, Kartik Mohan Sinha, Kuldeep S Yadav
DOI:10.4103/jfmpc.jfmpc_1178_19  
Introduction: Use of internet has increased exponentially worldwide with prevalence of internet addiction ranging from 1.6% to 18 % or even higher. Depression and insomnia has been linked with internet addiction and overuse in several studies. Aims and Objectives: Present study has looked in to pattern and prevalence of internet addiction in university students. This study has also explored the association of internet addiction with depression and insomnia. Material and Methods: In this cross sectional study 954 subjects were enrolled who had been using internet for past 6 months. Information regarding pattern of use and socio demographic characteristics were recorded. Internet addiction Test (IAT), PHQ-9,and insomnia Severity Index (ISI) were applied to measure internet addiction, depression and insomnia respectively. Results: Among 954 subjects, 518 (60.59%) were male and 376 (39.41%) were female with mean age of 23.81 (SD ± 3.72). 15.51% study subjects were internet addicts and 49.19% were over users. Several parameters including graduation level, time spent per day on line, place of internet use, smoking and alcohol had significant association with internet addiction. Internet addiction was predominantly associated with depression and insomnia. Conclusion: Internet addiction is a rising concern among youth. Several parameters including gender, time spent on line, alcohol, smoking predicts higher risk of internet addiction. Depression and insomnia are more common in internet addicts and overusers.
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Investigating the impact of silymarin on liver oxidative injury p. 1707
Mohammad Jamalian, Behnam Mahmodiyeh, Sahar Saveiee, Hasan Solhi
DOI:10.4103/jfmpc.jfmpc_929_19  
Introduction: Various drugs affect liver problems caused by general hypoxia, including silymarin. Due to the fungal killer toxins, nowadays, silymarin (milk thistle) is used as an effective drug in the prevention and treatment of liver diseases and liver toxicity. In addition, silymarin protects the liver cells from solvents and chemical substances. The aim of this paper is to investigate the impact of silymarin on liver problems induced by general hypoxia. Material and Methods: This study was a double-blinded clinical trial on patients with hypoxia who referred to the hospital emergency department. Patients were randomly divided into case and control groups. The case group was treated with silymarin at a dose of 280 mg with orally gavage technique and the control group was treated with a placebo every 8 h for 3 days. To investigate the leukocytosis, liver enzymes levels of alanine transaminase (ALT), aspartate aminotransferase (AST), creatine phosphokinase (CPK), prothrombin time (PT), partial thromboplastin (PTT), international normalized ratio (INR), and white blood cell (WBC) were measured before and after the intervention. SPSS 21 software was used to analyze the data. Results: In the silymarin group, liver enzymes were lower than the placebo group on the third day after treatment (P < 0.05). There was no significant difference between the two groups in terms of coagulation factors and WBC count on the third day after treatment (P > 050). On the third day after treatment, the amount of GGT was lower in the silymarin group (P < 0.05). Conclusion: Silymarin decreased liver enzymes (ALT, AST, and CPK) and the level of GGT. Therefore, it is recommended to be used in patients with hypoxic liver injury.
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Breast cancer knowledge and awareness among females in Al-Qassim Region, Saudi Arabia in 2018 Highly accessed article p. 1712
Asma A Alsowiyan, Hadeel M Almotyri, Najd S Alolayan, Lamees I Alissa, Bashayer H Almotyri, Sultan H AlSaigh
DOI:10.4103/jfmpc.jfmpc_1065_19  
Aim: This study aimed to measure breast cancer (BC) awareness among women in Al-Qassim and to compare the results to previous studies in Saudi Arabia and international studies. Method: This is a cross-sectional study conducted in Al-Qassim region, Saudi Arabia. All women above 18 years of age were included and those who could not complete the questionnaire for any reason were excluded. The data were collected by using a valid pretested structured questionnaire taken from previous studies. Descriptive statistics were presented using frequency and proportion for all categorical variables and mean ± standard deviation for continuous variable. The relationship between dependent variable versus independent variables had been conducted using Chi-square test. P value of ≤0.05 was considered as statistically significant. Results: Nearly all participants were highly aware of BC (95.4%) and half of them correctly identified that not only females are affected by BC. With regards to personal breast assessment, more than a half of them have done breast self-examination; however, only one out of four females had done clinical breast examination and mammography test. The most common risk factor of BC was family history and the commonest signs and symptoms were the size and shape changes of the breast. The prevalence of poor knowledge was 202 (38.9%) while good knowledge was 317 (61.1%). Age group in years and use of oral contraceptives were the independent significant factors of poor knowledge. Conclusion: The overall knowledge of women about BC in this study was inadequate. While half of the women performed breast self-examination on the contrary, the actual clinical breast examination found to be low. The most common risk factor being identified was family history of BC and smoking. Size and shape changes of breast as well as breast lump were the most common signs and symptoms. Age group in years and the use of contraceptives pills were being identified as the significant factors of knowledge toward BC.
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Disability-inclusive compassionate care: Disability competencies for an Indian Medical Graduate Highly accessed article p. 1719
Satendra Singh, Kamala Gullapalli Cotts, Khan Amir Maroof, Upreet Dhaliwal, Navjeevan Singh, Tao Xie
DOI:10.4103/jfmpc.jfmpc_1211_19  
The new curriculum of the Medical Council of India (MCI) lacks disability-related competencies. This further involves the risk of perpetuating the medicalization of diverse human experiences and many medical students may graduate with little to no exposure to the principles of disability-inclusive compassionate care. Taking into consideration the UN Convention, the Rights of Persons with Disabilities, Act 2016, and by involving the three key stakeholders – disability rights activists, doctors with disabilities, and health profession educators – in the focus group discussions, 52 disability competencies were framed under the five roles of an Indian Medical Graduate (IMG) as prescribed by the MCI. Based on feedback from other stakeholders all over India, the competencies were further refined into 27 disability competencies (clinician: 9; leader: 4; communicator: 5; lifelong learner: 5; and professional: 4) which the stakeholders felt should be demonstrated by health professionals while they care for patients with disabilities. The competencies are based on the human rights approach to disability and are also aligned with the competencies defined by accreditation boards in the US and in Canada. The paper describes the approach used in the framing of these competencies, and how parts of these were ultimately included in the new competency-based medical education curriculum in India.
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Sociobehavioural matrix and knowledge, attitude and practises regarding HIV/AIDS among female sex workers in an international border area of West Bengal, India p. 1728
Abhik Sinha, Dipendra Narayan Goswami, Dibakar Haldar, Kanti Bhusan Choudhury, Malay K Saha, Shanta Dutta
DOI:10.4103/jfmpc.jfmpc_1196_19  
Background: HIV/AIDS is still a big public health challenge of India. Female Sex Workers (FSWs) belong to an important high risk group (HRG) in the transmission of HIV/AIDS. International borders have intermingling of population and also plenty of migrant population. Thus study on FSW s with relation to HIV/AIDS in an international border area is an important area of Research. Aims: The present study was planned with the objectives of: to determine the sociodemographic profile of the FSW under the study, to assess their knowledge and attitude towards HIV/AIDS and to find out their sexual practices. Settings and Design: It was a community based descriptive cross sectional study, done at the Indo-Bhutan border town of Jaigaon in Alipurduar District of West Bengal with the help of a Non-governmental organization (NGO) working on Targeted Interventions (TI) for FSW. Methods and Material: Total 90 FSWs were interviewed using predesigned pretested questionnaire. The questionnaires used were prior validated by National AIDS Control Organisation (NACO). Statistical Analysis Used: The data were analysed by SPSS 14.0. Results and Conclusions: The analysis revealed that 35 % of the study population were illiterate. It was also found that 81% of respondents had heard about HIV/AIDS; 76.7% had knowledge about its spread through vaginal sex, 67.8% had idea regarding its Mother to Child transmission. 92% felt PLHIV should not be kept away from others, 93% felt they shouldn't be deprived from property. Regarding sexual activity, 76.7% had sexual activity more than 3 times/week and 97.8% used condom persistently in last one year. Coordinated Efforts is required to be taken in this regard to tackle these problems.
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CASE REPORTS Top

Management of siblings with Glanzmann's thrombasthenia: A case report p. 1733
Mebin George Mathew
DOI:10.4103/jfmpc.jfmpc_1083_19  
Glanzmann's thrombasthenia is a rare, genetically inherited platelet disorder characterized by a lack of platelet aggregation. Until date, only close to 500 cases have been reported. GT is associated with clinical variability: some patients have only minimal bruising while others have frequent, severe and potentially fatal hemorrhages often making diagnosis difficult. Children are mostly diagnosed very early in life due to the spontaneous and unexplained mucocutaneous bleeding. The present case report deals with two siblings who reported with spontaneous gingival bleeding who were successfully managed by removal of local irritant factors and proper supportive care.
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Survival in human rabies but left against medical advice and death followed – Community education is the need of the hour p. 1736
Mohd Nadeem, Prasan Kumar Panda
DOI:10.4103/jfmpc.jfmpc_1079_19  
Human survival after developing rabies is very scary to humanity. We report a case of a 58-year-old woman from Uttar Pradesh (north India), who presented with 5-days of fever and 1-day of altered sensorium associated with agitation, hydrophobia, and bedwetting after 20 days of WHO category 3 bite in the face by a rabid dog. She had taken three doses of anti-rabies vaccinations but not immunoglobulin of postexposure prophylaxis. Laboratory investigation showed a rising titer of virus-neutralizing antibodies in both serum and cerebrospinal fluid (CSF). We treated the patient according to the modified Milwaukee protocol. The patient remained to survive and had a recovery trend during hospital stays of 15 days before relatives took her left against medical advice (LAMA). As we know rabies has approximately 100% mortality rate but by using the aggressive treatment approach (like Milwaukee protocol), the patient may survive. Rabies can be effectively prevented by using adequate postexposure vaccine prophylaxis and rabies immunoglobulin (in category-3) after bite of a rabid animal. Our report along with other published reports should give more motivation to clinicians and education to the public to have an intensive treatment approach and patience, respectively to make rabies survival.
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Rootless and prematurely erupted tooth: A case report p. 1741
Pooja Singh, Manish Jha
DOI:10.4103/jfmpc.jfmpc_1198_19  
Tooth eruption is defined as the movement of a tooth from its site of development within the alveolar process to its functional position in the oral cavity. It is a complex process that can be influenced by a number of general factors like genetics, nutrition, preterm birth, socioeconomic factors, hormonal factors, various systemic diseases and some local factors. Timing of tooth eruption depends on the chronologic age. Marked deviation in eruption timing and developmental stage at which tooth erupts may confuse a clinician and affect the treatment planning so knowledge of such cases helps in delivering proper treatment. This article reports a case where eruption of rootless premolar is seen in a child of 7 year of age.
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Odontogenic myxoma of posterior maxilla – A rare case report p. 1744
Soundarya Ramesh, Poornima Govindraju, Balaji Pachipalusu
DOI:10.4103/jfmpc.jfmpc_1189_19  
Odontogenic myxoma is a benign, rare neoplasm of mesenchymal origin comprising of 3%–6% of all odontogenic tumors. Odontogenic myxoma occurs more commonly in the second and third decade and is more commonly seen in mandible compared with maxilla but behaves more aggressively in maxilla as it spreads through the maxillary antrum. It is usually associated with a painless swelling without any symptoms. The radiographic features are similar to other odontogenic tumors, and hence, it leads to diagnostic dilemma. Therefore, thorough knowledge regarding clinical, radiographical, and histopathological features are important to arrive at a proper treatment protocol as it shows a high recurrence rate. The aim of this paper was to present a rare case of 21-year-old male with a chief complaint of swelling in the left maxilla that infiltrated the maxillary sinus in a very short duration.
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Dose-dependent L-dopa/carbidopa-induced hyponatremia presenting with hiccups p. 1749
P Shihabudheen, PC Anver, NA Uvais, TP Mohammed
DOI:10.4103/jfmpc.jfmpc_1044_19  
Levodopa (L-dopa) is the most effective antiparkinsonian agent and is well tolerated at all stages of the disease. However, both motor and nonmotor adverse events are reported with the use of L-dopa. Electrolyte imbalances such as hyponatremia and hiccups with L-dopa/carbidopa are very rare. For the first time, we are reporting a case of L-dopa/carbidopa-induced hyponatremia and hiccup cooccurring in a 75-year-old male. He symptomatically improved after reducing the dose of levodopa/carbidopa, indicating a dose-dependent nature of these adverse events. Clinicians who prescribe L-dopa/carbidopa should be mindful of the potential for precipitating SIADH and hiccups, especially in elderly patients.
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Periodontally accelerated osteogenic orthodontics: A perio-ortho ambidextrous perspective p. 1752
Anuj Singh Parihar, Sumit Narang, Nandini Singh, Anu Narang
DOI:10.4103/jfmpc.jfmpc_1055_19  
The interdisciplinary collaboration of periodontics and orthodontics has allowed teeth to be moved 2–3 times faster, reducing the time required for traditional orthodontic therapy considerably. Periodontally accelerated osteogenic orthodontics (PAOO), also known as Wilckodontics, is a combination of a selective decortication facilitated orthodontics and alveolar augmentation. With this technique, there is no dependence on the pre-existing alveolar volume. This case report describes the treatment of permanent mandibular molar protraction in a 14-year-old patient undergoing orthodontic therapy using PAOO with piezosurgery.
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Florid cemento-osseous dysplasia associated with chronic suppurative osteomyelitis and multiple impacted tooth an incidental finding – A rare case report p. 1757
Jayanta Saikia, Balaji Pachipulusu, Poornima Govindaraju
DOI:10.4103/jfmpc.jfmpc_1130_19  
Florid cemento-osseous dysplasia (FCOD) is a rare, benign, fibro osseous, and multifocal dysplastic lesion of the jaw that consists of cellular fibrous connective tissue with bone and cementum-like tissue. The word 'florid' was introduced to describe the wide spread, extensive manifestations of the disease in the jaws. FCOD is most commonly found in middle-aged, black women with the prevalence of 5.5%. Reports from Indian population is even rarer, with only 5 cases in literature, Florid cemento-osseous dysplasia is generally asymptomatic, and is usually detected during radiological examination. In this report, we present a case of a 44-year-old female patient diagnosed with Chronic diffuse osteomyelitis of the mandible later, on radiographic examination revealed FCOD, secondarily infected with Chronic diffuse osteomyelitis and multiple impacted tooth.
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A rare case of cellulitis after tetanus toxoid (TT) vaccination p. 1762
Tala K AlBassri, Saleh AlShaibi, Fahad Khan, Nazish Masud
DOI:10.4103/jfmpc.jfmpc_1194_19  
Cellulitis is a bacterial infection of the deeper layers of the skin, namely, the dermis and the subcutaneous tissue. The most common organisms involved in causing cellulitis are group A β-hemolytic streptococci and Staphylococcus organisms. Rare causes include Pseudomonas aeruginosa in case of puncture wounds, anaerobes, Eikenella, Viridans streptococci in human bites. Cellulitis is mainly a clinical diagnosis but blood counts and ESR can be done to confirm its occurrence. Risk factors for cellulitis include breaks in the skin which allows an entry point for the bacteria, other risk factors include immune deficient states such as HIV/leukemia, conditions that affect the vascular system, and skin conditions such as eczema and psoriasis. Vaccination is an extremely rare cause of cellulitis with no cases of cellulitis reported since 1998 due to complication of vaccination. In our case, patients presented signs and symptoms of cellulitis 2 days after receiving the tetanus prophylaxis vaccine. He was treated with broad-spectrum antibiotics after admission and discharged once the condition settled.
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Hashimoto's encephalopathy in association with retinitis pigmentosa – First reported case p. 1765
Ritwik Ghosh, Subhankar Chatterjee, Devlina Roy, Souvik Dubey, Biman Kanti Ray
DOI:10.4103/jfmpc.jfmpc_1197_19  
Hashimoto's Encephalopathy (HE), also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT), is a proteiform disorder known for its wide spectrum of presentations from subtle neuropsychiatric manifestations, movement disorders, seizures, stroke-like episodes to coma. Here, we report a case of HE which initially masqueraded as bipolar affective disorder (BPAD) and ultimately progressed to generalized tonic clonic seizures and coma. Although SREAT is characterized by exquisite responsive to steroid, in our case it was unresponsive to pulse methylprednisolone therapy. Rapid recovery was noted with intravenous immunoglobulin (IVIG) therapy. This case was also peculiar for its association with non-sydnromic retinitis pigmetosa (RP). To the best of our knowledge, this was the first reported case of HE which was associated with RP.
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Waldenstrom's Macroglobulinemia: A case report p. 1768
Nejima Kolikkat, Shamsudeen Moideen, Aysha Khader, TP Mohammed, NA Uvais
DOI:10.4103/jfmpc.jfmpc_972_19  
Waldenstrom's macroglobulinemia (WM) is a rare and slowly progressive disorder, a variant of lymphoplasmacytic lymphoma, which needs therapy only when patient becomes symptomatic. WM presents usually with constitutional symptoms, organomegaly, cytopenias, and hyperviscosity syndrome. This neoplasm is composed of small lymphocytes, plasmacytoid lymphocytes, and plasma cells that typically involve the bone marrow, and it is associated with an immunoglobulin M (IgM) gammopathy. Here we report the case a 60-year-old male with WM who initially presented with anemia and fatigue. The patient had no lymphadenopathy or any organomegaly. The diagnosis of WM was made after morphological and immunohistochemical examination of bone marrow of the patient along with an elevated serum IgM level. The patient responded well to plasmapheresis and chemotherapy. This case is unusual because the patient lacked the common clinical features of WM. A thorough clinical and hematological work up including serum electrophoresis, bone marrow study, and immunohistochemistry helps in distinguishing WM from other lymphomas and plasma cell dyscrasias.
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Uncontrolled diabetes: A difficult mother or a mother in difficulty? p. 1772
Amir Babiker, Bothainah Alaqeel, Mohammed Alsaeed, Ghadeer Aljahdali, Abdulrahman Almunif, Sundeep Sandhu
DOI:10.4103/jfmpc.jfmpc_1157_19  
Young children with diabetes (YCD) are a particularly vulnerable group because they are reliant on adult carers in their management. Diabetes treating teams (DTT) have a responsibility towards YCD targeting good glycemic control (GC) to improve quality of life and reduce risk of complications. It can be difficult, however, in occasions to balance between providing support for struggling families and considering safeguarding YCD who are not well looked after by carers in their management. We report a 6-year-old girl with type 1 diabetes with HbA1c ranged between 10.7% and 15.7%. A number of social factors have influenced her diabetes control including parental separation, maternal mental health concerns and lack of family support. Each time, these issues have been addressed, and also when grandparents were involved, a transient short-lived improvement in GC was observed. However, there were always ongoing concerns about mother's lack of engagement with the DTT. Similar cases continue to pose significant challenges for DTT, worldwide. A balance should be kept between providing adequate support for such families against a possible need for safeguarding YCD. Using a patient centered approach, if there is no improvement in GC despite taking all measures to support mothers or families who struggle with their YCD management, it becomes difficult to justify not involving the safeguarding team and social services.
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Lingual schwannoma in an adolescent girl- A diagnostic challenge p. 1775
Suhael Ahmed, Omar Al Dayel, Nafeesa Tabassum, Maryam H Al Qanabr, Hassan Abu Ali, Nada Mathekor, Gafran A Albannawi, Fatemah Z Al Taqi, Asma H Al Shehri, Sarah M Shaker
DOI:10.4103/jfmpc.jfmpc_1142_19  
Shwannoma, a benign neurogenic neoplasm consisting of schwann cells is a slow growing solitarily found pathology. We present a case of shwannoma in a 14 year old girl and its identifying features which can be a diagnostic challenge owing to its similarity with many lesions. The patient visited our center with a nodular growth on her tongue. Transoral excision was performed and pathologic examination confirmed the diagnosis of schwannoma.
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LETTER TO EDITOR Top

Reinvigorating comprehensive primary healthcare is the way to resolve declining doctor-patient relationship p. 1778
Jayanta Bhattacharya
DOI:10.4103/jfmpc.jfmpc_1247_19  
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