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   2013| April-June  | Volume 2 | Issue 2  
    Online since August 31, 2013

 
 
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CLINICAL UPDATE
Hyfrecation for recalcitrant nongenital warts
Lawrence Leung
April-June 2013, 2(2):141-144
DOI:10.4103/2249-4863.117403  PMID:24479067
Background: Verruca vulgaris is a common skin condition in general practice, which often resolves without treatment. For lesions needing treatment, they often persist despite repeated treatment and become recalcitrant warts. Hyfrecation is a form of electrosurgery which has been used in treating common and recalcitrant warts. Objectives: This article describes the history and mechanisms of hyfrecation and also reviews available evidence on the effectiveness of hyfrecation for recalcitrant nongenital warts. Discussion: Hyfrecation provides controlled tissue destruction with carbonized desiccated wounds which are ideal for eradicating recalcitrant warts. A systematic literature search revealed very minimal, if any, good-quality clinical studies that compare the efficacy of hyfrecation against other treatments (i.e., liquid nitrogen) in treating recalcitrant nongenital warts. Other studies reported the benefits of hyfrecation for genital warts. The author illustrates with a case scenario, the benefits of hyfrecation in treating nongenital warts, and thereby, advocates its wider use in general practice.
  6,945 401 6
ORIGINAL ARTICLES
Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital
Vishal Sehgal, Sukhminder Jit Singh Bajwa, Rinku Sehgal, Anurag Bajaj, Upinder Khaira, Victoria Kresse
April-June 2013, 2(2):194-199
DOI:10.4103/2249-4863.117423  PMID:24479078
Background and Aim: Readmission to the hospital within 30 days of discharge from the hospital is a common occurrence. Congestive heart failure is the most common cause of readmissions in the hospital. We hypothesized that irrespective of the admission diagnosis polypharmacy and potentially inappropriate use of medications (PIM) leads to readmissions within 30 days of discharge from the hospital. Materials and Methods: A retrospective study was carried out by reviewing the hospital records of 414 patients who were readmitted to the hospital within 30 days of discharge from the hospital between January 2008 and December 2009. The data was stratified to see which patients were on polypharmacy and/or on PIM. Polypharmacy was defined as use of more than 5 medications. PIM was defined as per the modified Beers criteria. Day 0 was defined as the day of discharge and day1 was defined as the day-after Admission to the hospital. Statistical analysis was carried out using a two-way analysis of variance (ANOVA) on the data to see if polypharmacy and/or PIM was related to readmission within 30 days of discharge irrespective of admission diagnosis. Results: Polypharmacy was related to hospital readmission at day 1 and day 0, however inappropriate drug use was found to be not related at any day. Polypharmacy and PIM combined had a positive correlation to readmission only on days 1 and 0 and it was statistically significant. The use of minimal and appropriate use of drugs was statistically significant compared to polypharmacy and PIM use. Conclusions: Polypharmacy and PIM are under recognized cause of readmissions to the hospital.
  6,070 875 40
FAMILY MEDICINE PRACTICE
Structured printed referral letter (form letter); saves time and improves communication
R.P.J.C. Ramanayake
April-June 2013, 2(2):145-148
DOI:10.4103/2249-4863.117404  PMID:24479068
Referral of patients to hospitals, specialists and other institutions is an essential part of primary health care. Patients are referred to specialists when investigation or therapeutic options are exhausted in primary care or when opinion or advice is needed from them. Referral has considerable implications for patients, health care system and health care costs. Good communication between primary and secondary care is essential for the smooth running of any health care system. Referral and reply letters are the sole means of communication between doctors most of the time and breakdown in communication could lead to poor continuity of care, delayed diagnoses, polypharmacy, increased litigation risk and unnecessary testing. A referral letter also helps to avoid patient dissatisfaction and loss of confidence in family physician. Studies of referral letters have reported that specialists are dissatisfied with their quality and content. Inclusion of letter writing skills in the medical curriculum, peer assessment and feedback have shown to improve the quality of referral letters. . Form letters have shown to enhance information content and communication in referral process. In Sri Lanka referral letters are usually hand written and frequent complaints are that these letters do not contain adequate information and retrieval of information is a problem due to poor legibility and clarity. Sometimes Primary care doctors refer patients to hospitals and specialists with only verbal instructions. To address these short comings this form letter was introduced. Based on the guidelines and systematic review of published articles, items of information to be included were decided. Printed forms of the letter are kept in the practice and the doctor has to just fill up relevant information under each heading. The objectives of introducing this structured referral letter was to improve the quality and standard of referral letters and save time for both general practitioners and specialists.
  4,676 683 7
EDITORIAL COMMENTARY
Healthcare and medical education reforms in India: What lies ahead?
Raman Kumar
April-June 2013, 2(2):123-127
DOI:10.4103/2249-4863.117394  PMID:24479063
Since India became a republic in 1951, there has been steady progress on all fronts of human and economic development. India has matured as the largest democracy in the world and and also earned the reputation of being one of the fastest growing economies during last two decades. However, the country remains challenged with several pressing issues which includes maintaining good health for the second largest population in world. As a signatory of Alma Ata declaration, provision of primary health care has remained a priority area in the planning process. Although the targets of "Health for all by 2000" were missed, several programs are under implementation targeted towards achieving MDGs (Millennium Development Goals). Recent years shall be marked as very eventful from the perspective of health care reforms in India. For the first time a basic framework for Universal Health Coverage (UHC) has been proposed. A brief review of the programs and policies rolled out recently, provides us an insight into the future direction of the dynamic health system of India.
  3,884 577 3
ORIGINAL ARTICLES
Morbidity pattern and health-seeking behavior of aged population residing in Shimla hills of north India: A cross-sectional study
Deepak Sharma, Salig Ram Mazta, Anupam Parashar
April-June 2013, 2(2):188-193
DOI:10.4103/2249-4863.117421  PMID:24479077
Background: Population aging is a global phenomenon. In India, the size of the elderly population is growing fast. Many older adults have multiple medical conditions. Understanding elderly health problems and health-seeking behavior is prerequisite for proving comprehensive geriatric care to them. Objectives: To assess the morbidity pattern and study the health-seeking behavior of the elderly people of Shimla district in Himachal Pradesh. Materials and Methods: A total of 400 elderly people aged 60 years and above were selected from urban and rural areas of Shimla hills in North India by simple random sampling. Statistical software Epi info software version 3.2 was used for analyzing data. Descriptive statistics were used to describe sociodemographic and morbidity variables. Results: The most common morbidity identified among them were musculoskeletal problems (55.0%) followed by hypertension (40.5%). Two third were seeking treatment for their health problems. Among older persons not seeking treatment for their medical condition, most considered these morbidities as an age-related phenomenon. Many perceived that the health services were too far. Conclusion: The high morbidity load among elderly in the present study stresses for efforts to provide better health care to them and thus ensure that they remain active members of our society. Residence emerged out to be most significant determinant of healthcare-seeking behavior. Policy makers must focus on rural elderly and their beliefs which prevent them from seeking healthcare.
  3,551 687 6
Comparison of cold water sponging and acetaminophen in control of fever among children attending a tertiary hospital in South Nigeria
Tony M Aluka, Abraham N Gyuse, Ndifreke E Udonwa, Udeme E Asibong, Martin M Meremikwu, Angela Oyo-Ita
April-June 2013, 2(2):153-158
DOI:10.4103/2249-4863.117409  PMID:24479070
Background: A wide range of childhood illnesses are accompanied by fever, leading to varied attempts at treatment by caregivers at home before coming to a hospital. Common modalities of treatment include use of antipyretics and physical methods such as cold water sponging, fanning and removal of clothing. These treatment modalities have been received with varied attitudes among physicians and the scientific community. This study was to assess the efficacy of both modalities in first-line management of fever in our area. Objectives: The main aim of the study is to compare the effectiveness of cold water sponging with that of oral paracetamol in the treatment of fever in children attending the University of Calabar Teaching Hospital, Calabar. Subjects and Methods: This is a randomized clinical trial. Eighty-eight children aged 12-120 months who presented to the Children Outpatient Clinic (CHOP) and the Children Emergency Room (CHER) of University of Calabar Teaching Hospital, Calabar, with acute febrile illness and axillary temperatures spanning ≥ 38.0-40.0°C. All children within the age limit whose caregivers gave consent were recruited into the study and were randomized to receive either cold water sponging or oral paracetamol. Axillary temperature, pulse rate, respiratory rate and assessment of discomforts (crying, shivering, goose pimples and convulsions) were recorded every 30 min for 2 h. The results were analyzed using the SPSS statistical software and have been presented in the tables. Results: Cold water sponging was very effective in temperature reduction within the first 30 min, with 29 (70.73%) having their temperature reduced to within normal limits. This declined to 12 (29.26%) at 60 min and 4 (10.53%) at 120 min, with the mean temperature differences from the baseline value following the same trends (1.63°C by 30 min, 0.91°C by 60 min and 0.39°C by 120 min). When compared with paracetamol, cold water sponging was more effective in temperature reduction within the first 30 min ( P = 0.000), with the difference in effect at 60 min less significant between these two groups ( P = 0.229). Paracetamol demonstrated a gradual and sustained reduction in temperature with the proportions of afebrile children in this group increasing from 7 (16.27%) at 30 min to 33 (78.57%) at 120 min. The mean temperature differences from the baseline value also showed the same trend. Children who received cold water sponging had more discomforts compared with those who received only oral paracetamol. Conclusions: It is concluded that cold water sponging, although producing rapid reduction in temperature compared with paracetamol, has effects that last only for a short time. Paracetamol on the other hand produces a gradual but sustained effect. The discomforts experienced should not be a limiting factor to the use of cold water sponging in reducing the body temperature of febrile children. Cold water sponging is safe and its use by mothers and primary caregivers should be encouraged while preparing to take the child to the nearest health facility for definitive treatment of the underlying cause of the fever.
  3,517 676 1
IN FOCUS
Open Access: The changing face of scientific publishing
Pranab Chatterjee, Tamoghna Biswas, Vishala Mishra
April-June 2013, 2(2):128-130
DOI:10.4103/2249-4863.117400  PMID:24479064
The debate on open access to scientific literature that has been raging in scholarly circles for quite some time now has been fueled further by the recent developments in the realm of the open access movement. This article is a short commentary on the current scenario, challenges, and the future of the open access movement.
  3,505 339 8
ORIGINAL ARTICLES
Third angle of RSBY: Service providers' perspective to RSBY-operational issues in Gujarat
Mayur Trivedi, Deepak B Saxena
April-June 2013, 2(2):169-172
DOI:10.4103/2249-4863.117415  PMID:24479073
Context: Government of India in 2008, launched its flagship health insurance scheme for the poor. The Rashtriya Swasthya Bima Yojana (RSBY) combines cutting edge technology with an unusual reliance on incentives to provide inpatient insurance coverage. The scheme allows for cashless hospitalization services at any of the empaneled hospitals. Stakeholders in RSBY include members of the community, Insurance Company and the service provider. Aim: The study manuscript is an attempt to get an insight to understand the bottle necks in faced by the service providers with an overall goal to understand issues in complete roll out of RSBY and its successful implementation across country. It was conducted to undertake the stakeholder analysis and understand the service providers' perspective to RSBY. Setting and Design: The present study was conducted in the Patan district of Gujarat state. Qualitative tool mainly in-depth interview of service providers of RSBY in Patan district of Gujarat state was utilized for the data collection. Results and Conclusion: Service providers opined an ineffective IEC around the utility of the RSBY service in the community. In spite of the claim that scheme relies heavily on technology to ensure paperless cashless services, on field, it was observed in the present study that the claim settlements are done through physical documents. The service providers had a perceived threat of being suspended from the list/de-empanelment of the provider by the insurance company. There is an urgent need for improved and effective IEC for the service and possibilities of an arrangement for to settle the case of grievances around suspensions ao that genuine hospitals can have fair deal as well. There definitely remains a greater and more serious role of government, which ranges from ownership to larger issue of governance.
  3,149 344 5
A Cross-sectional study of common psychiatric morbidity in children aged 5 to 14 years in an Urban Slum
Rakesh N Patil, Shashikant N Nagaonkar, Nilesh B Shah, Tushar S Bhat
April-June 2013, 2(2):164-168
DOI:10.4103/2249-4863.117413  PMID:24479072
Aim: Study of the prevalence of common psychiatric disorders in children aged 5 to 14 years in a health post area of an urban slum. Objectives: (1) To study frequency of specific psychiatric disorders in the study population, (2) To study the relationship between sociodemographic variables and psychiatric morbidity. Settings and Design: The present study was conducted in one of the five health posts of an urban slum, which is a field practice area of the teaching medical institute. It was a cross-sectional study. Materials and Methods: Sample size was estimated by using 20% as a prevalence of psychiatric morbidity which was obtained from previous studies done in developing countries. Household was used as a sampling unit and systematic random sampling method was used for selecting household. Total 257 children aged 5 to 14 years were included in the study. A pre-designed, semi-structured diagnostic interview schedule based on DSM-IV criteria was used for data collection. Statistical Analysis Used: The tests of significance used were Chi-square and Logistic regression analysis. Results: The prevalence of psychiatric morbidity in this study was 14.8%. Non-organic enuresis, Attention deficit hyperactivity disorder, Conduct disorder, and Mental retardation were identified as the common mental health problems. Conclusions: Factors like nuclear family, parents not living together, large family size, and positive family history of psychiatric disorder were associated with psychiatric morbidity in children.
  3,031 427 1
FAMILY MEDICINE TRAINING: INTERNATIONAL PERSPECTIVES
Family medicine specialty in Singapore
Santosh Lional Thomas
April-June 2013, 2(2):135-140
DOI:10.4103/2249-4863.117402  PMID:24479066
Family Medicine in Singapore has its roots in a generalist ethos and found its origin as a counter culture movement to the increasing sub-specialisation of medicine which resulted in a complex healthcare system where that patients are often cared for by multiple specialists potentially resulting in fragmentation of care. The aim of the discipline of Family Medicine was to train and develop more generalist physicians so as to promote holistic care. Family physicians are the largest pool of generalists who are trained to provide general medical care to patients in the context of the person, the family and the community that they live in.
  2,345 355 1
ORIGINAL ARTICLES
Knowledge, attitude and practice of family physicians regarding smoking cessation counseling in family practice centers, suez canal university, Egypt
Hebatallah Nour Eldein, Nadia M Mansour, Samar F Mohamed
April-June 2013, 2(2):159-163
DOI:10.4103/2249-4863.117411  PMID:24479071
Introduction: Family physicians are the first point of medical contact for most patients, and they come into contact with a large number of smokers. Also, they are well suited to offer effective counseling to people, because family physicians already have some knowledge of patients and their social environments. Aims: The present study was conducted to assess family physicians' knowledge, attitude and practice of smoking cessation counseling aiming to improve quality of smoking cessation counseling among family physicians. Materials and Methods: The study was descriptive analytic cross sectional study. It was conducted within family medicine centers. Sample was comprehensive. it included 75 family physicians. They were asked to fill previously validated anonymous questionnaire to collect data about their personal characteristics, knowledge, attitude and practice of smoking cessation counseling, barriers and recommendations of physicians. Equal or above the mean scores were used as cut off point of the best scores for knowledge, attitude and practice. Statistical Analysis: SPSS version 18 was used for data entry and statistical analysis. Results: The best knowledge, attitude and practice scores among family physicians in the study sample were (45.3 %, 93.3% and 44% respectively). Age (P = 0.039) and qualification of family physicians (P = 0.04) were significant variables regarding knowledge scores while no statistically significance between personal characteristics of family physicians and their attitude or practice scores regarding smoking cessation counseling. More than half of the family physicians recommended training to improve their smoking cessation counseling. Conclusions: Favorable attitude scores of family physicians exceed passing knowledge scores or practice scores. Need for knowledge and training are stimulus to design an educational intervention to improve quality of smoking cessation counseling.
  2,142 378 6
Gender difference in blood pressure, blood sugar, and cholesterol in young adults with comparable routine physical exertion
TS Anish, Safraj Shahulhameed, K Vijayakumar, Teena Mary Joy, PR Sreelakshmi, Anu Kuriakose
April-June 2013, 2(2):200-203
DOI:10.4103/2249-4863.117424  PMID:24479079
Context: Gender differences in the risk of developing non-communicable diseases (NCD) are a matter of debate. The susceptibility of a woman to NCD should be evaluated taking into consideration the social factors that limit the physical activity among women. It will be interesting to note what will happen if women are allowed to take part in physical exercise to the extent of men. Aims: To find out the gender difference in the pattern of the clinical and biochemical indices related to NCD in young adults with comparable daily physical activity. Settings and Design: This is an institution-based cross-sectional study and the setting was Lekshmibhai National College for Physical Education (LNCPE), Thiruvananthapuram, Kerala, India. Materials and Methods: The study participants were students who were regularly involved in more than three hours of physical exercise daily at least for the previous one year. The information on socio-demography, anthropometry, and blood pressure was recorded. Blood samples were taken for laboratory examination. Results: Out of 150 students registered, 126 (84%) in the age group of 17 to 25 years who fulfilled the eligibility criteria were studied. Fifty-five (43.7%) of them were women. Systolic blood pressure, fasting blood sugar, and low-density lipoprotein were found significantly lower in women. No significant difference was noted in the case of diastolic blood pressure and total cholesterol. Conclusion: Gender differences exist for NCD risk factors among young adults with comparable physical activity and physical exertion seems to be more protective for females.
  2,098 418 11
An evaluation of mass drug administration compliance against filariasis of Tikamgarh district of Madhya Pradesh-A household-based community study
Sandeep Singh, Meena Patel, Sugriv Singh Kushwah
April-June 2013, 2(2):178-181
DOI:10.4103/2249-4863.117395  PMID:24479075
Background: Mass drug administration (MDA) means once-in-a-year administration of diethyl carbamazine (DEC) tablet to all people (excluding children under 2 years, pregnant women and severely ill persons) in identified endemic areas. It aims at cessation of transmission of lymphatic filariasis. Objective: To study the coverage and compliance of MDA in Tikamgarh district during the campaign in April 2010. Materials and Methods: The activities under MDA involved administration of DEC tablets to eligible population from endemic area by health staff and Integrated Child Development Scheme (ICDS) functionaries referred as drug distributors (DD) make house-to-house visits on select dates in 2010. DEC was administered to all people (excluding children under 2 years, pregnant women and severely ill persons) with the instruction to ingest the tablet preferably on the spot. Study Design: Cross-sectional population based house-to-house visit. Setting: Urban and rural areas in Tikamgarh district identified as endemic for filariasis where MDA 2010 was undertaken. Study Variables: Exploratory - Rural and urban clusters of Tikamgarh district; Outcome - coverage, compliance, actual coverage, side effects. Analysis: Percentage and proportions. Results: Four clusters, each comprising 30 households from Tikamgarh endemic district, yielded an eligible population of 641. The coverage rate was 607 (94.6% of eligible) with variation across different areas. The compliance with drug ingestion was 89.9% with a gap of 10.1% to be targeted by intensive IEC. The effective coverage (85.2%) was just above the target (85%). Side effects of DEC were minimum, transient and drug-specific. Overall coverage was marginally better in rural areas. The causes of poor coverage and compliance have been discussed and relevant suggestions have been made.
  1,927 382 -
Characteristics of hospitalized patients with severe and non-severe pandemic influenza a (H1N1) in Saurashtra Region, India (two waves analysis)
Rajesh K Chudasama, Umed V Patel, Pramod B Verma
April-June 2013, 2(2):182-187
DOI:10.4103/2249-4863.117397  PMID:24479076
Background: In India, the first case of 2009 pandemic influenza A (H1N1) virus infection was reported in May 2009 and the same in Saurashtra region in August 2009. We describe the epidemiology and factors associated with severe and non-severe cases of 2009 influenza A (H1N1) infection reported in the Saurashtra region. Materials and Methods: From September 2009 to January 2011, we reported 511 patients who were infected with 2009 influenza A (H1N1) virus and admitted in different hospitals of Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) testing was used to confirm infection. Factors associated with severe cases were determined by comparing with non-severe cases. Results: Out of 511 patients, 140 had severe disease (requiring intensive care or died) and 371 non-severe diseases (admitted in wards and survived). Median age of 30 years; median time of 5 days from onset of illness to diagnosis, and 4 days median time was reported for hospital stay among severe disease patients. More than half (60.7%) were females. Out of the patients with severe disease, 52.1% patients residing in urban area (OR = 1.68, CI = 1.13-2.49). Significant association was reported among severe disease patients for delayed referral from general practitioner/physician after initial treatment. All patients received antiviral drug, however, only 27.1% received within 2 days of illness. Presence of coexisting condition (pregnancy (OR = 0.19, CI = 0.08-0.48) was strongly associated with severe disease. Conclusion: Delayed referral from general practitioner/physician, duration of antiviral treatment, presence of coexisting condition (i.e., pregnancy) were responsible for intensive care or mortality among severe influenza A (H1N1) illness.
  1,880 275 3
FAMILY MEDICINE TRAINING: INTERNATIONAL PERSPECTIVES
Historical evolution and present status of family medicine in Sri Lanka
R. P. J. C. Ramanayake
April-June 2013, 2(2):131-134
DOI:10.4103/2249-4863.117401  PMID:24479065
Sri Lankan health system consists of Allopathic, Ayurvedic, Unani, and several other systems of medicine and allopathic medicine is catering to the majority of the health needs of the people. As in many other countries, Sri Lankan health system consists of both the state and the private sector General practitioners, MOs in OPDs of hospitals and MOs of central dispensaries, provide primary medical care in Sri Lanka. Most of the general practices are solo practices. One does not need postgraduate qualification or training in general practice to start a general practice. There is no registered population for any particular health care institution in the state sector or in the private sector and there is no strict referral procedure from primary care to secondary or tertiary care. Family doctors have been practicing in Sri Lanka for well over 150 years. The first national organization of general practitioners was Independent Medical Practitioner (IMPA)'s organization which was founded in 1929 and the College of General Practitioners of Sri Lanka was founded in 1974. College conducts its own Membership Course and Examination (MCGP) since 1999. Family Medicine was introduced to undergraduate curriculum in Sri Lanka in early 1980s and now almost all the medical faculties in the country have included Family Medicine in their curricula. In 1979, General Practice/Family Medicine was recognized as a specialty in Sri Lanka by the postgraduate institute of Medicine. Diploma in Family Medicine (DFM) and MD Family Medicine are the pathways for postgraduate training in Sri Lanka. At present 50 to 60 doctors enroll for DFM every year and the country has about 20 specialists (with MD) in Family Medicine. The author's vision for the future is that all the primary care doctors to have a postgraduate qualification in Family Medicine either DFM, MD, or MCGP which is a far cry from the present status.
  1,760 330 1
CASE REPORTS
Liver abscesses and hyper IgM syndrome
Ira Shah, Aarti Rahangdale, Sushmita Bhatnagar
April-June 2013, 2(2):206-208
DOI:10.4103/2249-4863.117429  PMID:24479081
Hyper IgM (HIGM) syndrome is an immunodeficiency that can lead to liver disease in more than 80% of affected males by an age of 20 years. Hepatitis, sclerosing cholangitis, and hepatocellular malignancies are common among them. We encountered two cases in children of less than 12 years who presented with typical manifestations of liver abscess and were later detected to have a concomitant underlying HIGM syndrome.
  1,745 267 2
ORIGINAL ARTICLES
HIV in females: A clinico-epidemiological study
Mahesha Padyana, Raghavendra V Bhat, Dinesha , Alam Nawaz
April-June 2013, 2(2):149-152
DOI:10.4103/2249-4863.117405  PMID:24479069
Background: Human Immunodeficiency Virusinfected women account for almost half the number of cases of HIV worldwide. Despite reduction in HIV prevalence among the population, the percentage of Indian women contracting the disease seems to have increased. The social implications are also different in females. Materials and Methods: This prospective observational study was conducted from September 2009 to July 2011 at tertiary care hospitals attached to the Kasturba Medical College Mangalore, on a group of 200 HIV-positive patients. Patients above 18 years of age diagnosed with HIV as per National AIDS Control Organisation guidelines were included in the study. Clinical profile among women and men was compared with respect to clinical presentation, disease detection, CD4 count and response of family and society. Results: Clinical presentation was similar among both men and women. Eighty-one percent men had promiscual sexual exposure, 19% of women had so. Males were identified to be HIV-positive earlier than their spouse (tested later), time lag being 27.6 weeks. After detection of positivity 77% of females felt being less cared for by the in-laws. CD4 count less than 50 was detected in more number of females as compared to men (11% females and 1% males). Death of spouse was seen more often in females (among 35% of women and 11% of men). Conclusion: Most of the females were likely to acquire infection from their spouse. Females tend to seek and get medical attention at the late stage of disease as compared to men. HIV in females has different social implications which includes discrimination within the family.
  1,533 247 4
Assessment of validity and reliability of IMNCI algorithm in comparison to provisional diagnosis of senior pediatricians in a tertiary hospital of Kolkata
Agnihotri Bhattacharyya, Shuvankar Mukherjee, Chitra Chatterjee, Samir Dasgupta
April-June 2013, 2(2):173-177
DOI:10.4103/2249-4863.117393  PMID:24479074
Background: Integrated management of childhood illness (IMNCI) is already operational in many states of India, but there are only limited studies in Indian scenario comparing its validity and reliability with the decisions of pediatricians. Aims and Objectives: To assess the validity and reliability of the IMNCI algorithm with provisional diagnosis of senior pediatricians for each IMNCI classifications. Materials and Methods: The present study is done with all the young infants between 0-2 months presented during the study period with a fresh episode of illness to test the validity and reliability of the algorithm in comparison to provisional diagnoses of senior pediatricians. The study was done in a tertiary care hospital. Validity characteristics such as sensitivity, specificity, positive predictive value, negative predictive value, and reliability characteristics such as percent agreement and Kappa were assessed for individual IMNCI classifications. Results: The sensitivity of possible serious bacterial infection, local bacterial infection, jaundice, no dehydration and possible serious bacterial infection, not able to feed were 88.89, 14.29, 66.67, 25 and 44.44% respectively. The specificities for the same conditions were 71.72, 99.09, 99.07, 94.50 and 86.87%. Percent agreements for similar conditions were 74, 94, 97, 90 and 80% respectively and the Kappa ratios were 0.38, 0.20, 0.73, 0.19 and 0.29 respectively. Conclusion: It could be concluded that IMNCI is quite a sensitive strategy and could identify severe illnesses of young infants requiring referral to higher facility. Further studies, particularly in primary health care setting, are required.
  1,429 240 1
CASE REPORTS
Influenza a infection unmasking an underlying mitral valve stenosis in a 19-year-old boy
Shafali Nandwani, Apurva Pande, Mahip Saluja
April-June 2013, 2(2):204-205
DOI:10.4103/2249-4863.117427  PMID:24479080
Infection with Influenza virus is uncommon in the present times, though a number of cases were reported during pandemics in 1918 in various regions of America. We report a case where a young male patient presented to the hospital with a clinical picture of acute respiratory distress syndrome that turned out to be a viral pneumonia caused by Influenza A virus and it aggravated an underlying yet undiagnosed mitral valve stenosis.
  1,440 216 -
LETTERS TO EDITOR
Patient education: Boon or Bane?
Chandrashekhar A Sohoni
April-June 2013, 2(2):209-210
PMID:24479082
  1,071 186 -
Healthcare technician delivered screening of adults with diabetes to improve primary care provider recognition of depression
Sunil Kumar Raina
April-June 2013, 2(2):209-209
DOI:10.4103/2249-4863.117430  PMID:24479083
  1,038 181 -
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