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   2014| October-December  | Volume 3 | Issue 4  
    Online since December 31, 2014

 
 
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REVIEW ARTICLES
An epidemiological overview of child sexual abuse
Mannat Mohanjeet Singh, Shradha S Parsekar, Sreekumaran N Nair
October-December 2014, 3(4):430-435
DOI:10.4103/2249-4863.148139  PMID:25657958
Child sexual abuse (CSA) is a universal problem with grave life-long outcomes. The estimates vary widely depending on the country under study, the definitions used, the type of CSA studied, the extent of coverage, and quality of data. This study intended to assess the magnitude and the issues related to CSA. We searched databases such as PubMed, Google scholar, web (newspaper reports), and government websites. The relevant data was extracted from these sources for gathering evidence on CSA and secondary data analysis was done. The prevalence of CSA was found to be high in India as well as throughout the world. CSA is an extensive problem and even the lowest prevalence includes a huge number of victims. It also has various adverse effects on the psychological, physical, behavioral, and interpersonal well-being of the victim. Hence, stringent measures should be taken for the prevention and control of this hidden public health issue.
  23 3,210 562
FAMILY PRACTICE
Fractures of distal radius: An overview
Sanjay Meena, Pankaj Sharma, Abhishek Kumar Sambharia, Ashok Dawar
October-December 2014, 3(4):325-332
DOI:10.4103/2249-4863.148101  PMID:25657938
Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed.
  8 6,423 815
Consultation content not consultation length improves patient satisfaction
Thomas I Lemon, Rebecca H Smith
October-December 2014, 3(4):333-339
DOI:10.4103/2249-4863.148102  PMID:25657939
The suggestion that increased consultation length leads to improved patient satisfaction has some evidence, albeit uncertain. Importantly there are other determinants within the doctor-patient consultation that themselves may be responsible for this improved satisfaction and it is these we investigate in this paper. A systematic review of PubMed and associated papers was carried out using search terms 'family practice consultation length', 'general practice consultation length', 'local health authority consultation length' and 'primary care consultation length'. 590 papers were originally selected using these search terms, post scoring this number became 9. The results obtained support the idea that consultation length does not directly improve consultation outcome, but rather there are variables integrated within the consultation affecting this. Increased time purely allows a physician to implement management, particularly relating to psychosocial aspects.
  8 1,549 310
FAMILY MEDICINE EDUCATION
Management of emergencies in general practice: Role of general practitioners
R. P. J. C. Ramanayake, Sudeshika Ranasingha, Saumya Lakmini
October-December 2014, 3(4):305-308
DOI:10.4103/2249-4863.148089  PMID:25657933
Introduction: Management of emergencies is an integral part of primary care. Being first contact care providers general practitioners may encounter any type of emergency. Acute attacks of asthma, myocardial infarction, anaphylactic shock, hypoglycemic coma, convulsions, head injuries and trauma are some of the common emergencies encountered by GPs. Updated knowledge, communication and procedural skills, trained paramedical staff, necessary equipment and medications and appropriate practice organization are vital to provide optimum care which may even save lives of patients. The wide range of problems and the rarity of the problems make it difficult for primary care doctors to be updated and competent in providing emergency care. Role of GP: Some of the emergencies can be managed completely at a general practice while others should be referred to hospital after initial management. The extent to which a patient should be managed may be determined by the degree of severity of the condition, expertise of the doctor and distance to the nearest hospital. Apart from pharmacological management, explanation about the condition and the need for admission and appropriate advice on care prior to admission are also vital components of management. Writing an appropriate referral, arranging transport facilities, informing the hospital about the referral are also important steps in the process as these measures could prevent crucial delays. Conclusion: Emergency care is a responsibility of primary care doctors and they should be knowledgeable and skilled and organize their practices to provide prompt and effective management whenever the need arises.
  7 1,460 1,031
ORIGINAL ARTICLES
Role of ultrasound with color doppler in acute scrotum management
Alka M Agrawal, Prem Siddharth Tripathi, Amit Shankhwar, C Naveen
October-December 2014, 3(4):409-412
DOI:10.4103/2249-4863.148130  PMID:25657954
Background and Objective: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Physical examination adds only a little information. Color Doppler ultrasound (US) is the modality of choice to differentiate testicular torsion from inflammatory conditions and can thus help in avoiding unnecessary surgical explorations. Subjects and Methods: A study on 50 patients was conducted who were referred with history of acute scrotal pain to our department between January 2013 and January 2014. Trauma and scrotal mass were excluded from the study. The clinical presentation, outcome, and US results were analyzed. Results: Color Doppler sonography yielded a positive and negative predictive value (PPV and NPV) of 100% each for torsion, whereas, 93.9 and 70.6% for epididymo-orchitis, respectively; a sensitivity and specificity of 100% for torsion, whereas, for epididymo-orchitis it was found to be 86.1 and 85.7%, respectively. In cases of incomplete or early torsion, some residual perfusion may be detected leading to false-negative results. Conclusion: We therefore conclude that color Doppler sonography can reliably rule out testicular torsion and can thus help in avoiding unnecessary surgical explorations. Hence, it can significantly improve outcome and decrease morbidity of patient. It is an accurate, rapid, nonexpensive, nonionizing, important adjunct to clinical assessment of scrotum.
  6 1,944 348
CASE REPORTS
Concurrent malaria and dengue fever: A need for rapid diagnostic methods
Manish Bhagat, Sujata Kanhere, Varsha Phadke, Riya George
October-December 2014, 3(4):446-448
DOI:10.4103/2249-4863.148146  PMID:25657963
Malaria and dengue fever are endemic in the South-East Asian region including India. Both the illnesses share similar symptomatology, but differ in certain respects such as different- causative organisms and mosquito vector with diverse habitat. Hence, concurrent malaria and dengue fever in the same patient is said to be unusual. There have been cases of concurrent malaria and dengue, but they are scarce from highly endemic region like ours. Here, we describe three unusual cases of Plasmodium vivax and dengue co-infection diagnosed by use of rapid diagnostic tests. Early diagnosis and timely intervention is crucial in managing such patients.
  3 1,878 204
Intravesical migration of intrauterine contraceptive devices with stone formation
Simmi Aggarwal, Rajinder Paul Jindal, Anupam Deep
October-December 2014, 3(4):449-451
DOI:10.4103/2249-4863.148147  PMID:25657964
Intrauterine contraceptive devices (IUCD) have been associated with the multitude of complications. We present a rare case report of a 30-year-old female in whom the IUCD (Cu-T) migrated into the urinary bladder leading to calculus formation. The migrated IUCD encrusted with stones was successfully retrieved.
  3 2,112 189
ORIGINAL ARTICLES
Quality of life of a patient with type 2 diabetes: A cross-sectional study in Rural South India
K Manjunath, Prince Christopher, Vijayaprasad Gopichandran, PS Rakesh, Kuryan George, Jasmin Helan Prasad
October-December 2014, 3(4):396-399
DOI:10.4103/2249-4863.148124  PMID:25657951
Background: With a high prevalence of diabetes in India, there is a need to study the impact of this disease on the quality of life (QoL) of the patients. Materials and Methods: This facility-based cross-sectional study assessed the QoL of patients attending the diabetic clinic using the World Health Organization (WHO) QoL BREF instrument in Tamil Nadu. The QoL was analyzed domain-wise and various socio-demographic factors affecting the QoL were studied. Results: The mean total score of the QoL scale was 58.05 (95% CI, 22.18-93.88). Domain-wise, 63% had good physical, 69% had good psychological, 27% had good social and 85% had good environmental QoL scores. Males, currently married and those with BMI more than 25 had a statistically significantly better QoL compared to their counterparts. Conclusions: Diabetes does impair the QoL of patients but not to a great extent. There is a need to specifically target and improve the QoL of women, widowed and separated, and non-obese diabetics who are at risk of a poor QoL. QoL assessment should be routinely practiced in diabetic clinics.
  3 1,346 303
Study of general awareness, attitude, behavior, and practice study on dog bites and its management in the context of prevention of rabies among the victims of dog bite attending the opd services of chc muradnagar
Piyush Jain, Garima Jain
October-December 2014, 3(4):355-358
DOI:10.4103/2249-4863.148107  PMID:25657942
Objectives: This is a recent study conducted during 15th September 2013 to 15th December 2013 at the community health centre (CHC), Muradnagar, distt Ghaziabad, among the victims of dog/animal bite attending the daily OPD services of CHC. To identify the level of general awareness and knowledge of wound management and rabies among the cases of dog bite and to study the awareness of people about antirabies vaccines and health service utilization. Methods: The study population composed of 250 victims of dog or animal bite, Patients were selected and approached after proper briefing, with well-prepared two page structured questionnaire designed in local language to assess their knowledge about the wound management, information about the epidemiology of dog bite. Results and conclusion: The result of the study reflect the very low level of awareness about the postdog bite management of wounds as well as about the disease rabies group of people questioned and also reveals serious gaps in understanding of wound severity ,classification and correct application of PEP with ARV vaccine and RIG. There is definitely a gap in people's knowledge, attitude, and practices about dog bite and its management and there is need of taking serious measures for the control of stray dog population at the block level.
  3 1,828 347
Prevalence of depression in elderly population in the southern part of Punjab
Anita Goyal, KS Kajal
October-December 2014, 3(4):359-361
DOI:10.4103/2249-4863.148109  PMID:25657943
Background: Depressive symptoms are often not detected properly in elderly. The aim of this study was to explore the prevalence of depressive symptoms and possible co relational factors among elderly population. Materials and Methods: In a cross-sectional study, 100 elderly persons were screened. Geriatric depression scale (GDS) was used to assess depressive symptoms. A self-rating questionnaire was used to detect some sociodemographics and clinical variables. Results: 100 respondents interviewed, 40 were 70 years and above and 41% were male. Sixty individuals (25 males and 35 females) were found to be mildly depressed. Seventeen (4 males and 13 females) were suffering from severe depression. Conclusion: This study is in line with previous studies showing the high prevalence of depression in elderly. Results suggest a proper screening for depression among elderly.
  3 1,651 266
Determinants of contraceptive practices among eligible couples of Urban Slum in Bankura District, West Bengal
Avisek Gupta, Tapas Kumar Roy, Gautam Sarker, Bratati Banerjee, Somenath Ghosh, Ranabir Pal
October-December 2014, 3(4):388-392
DOI:10.4103/2249-4863.148119  PMID:25657949
Background: Primary care physicians should be aware of the alarming population growth in the developing countries including India. Objectives: To find couple protection rate (CPR) and risk variables that affect contraceptive practice among eligible couples in an urban slum of Bankura district. Materials and Methods: A cross-sectional observational study of 3 months was undertaken on 200 eligible couples in Bakultala urban slum, Lokepur, Bankura district, West Bengal to get relation between various factors that could affect contraceptive practices. Results: Majority of the study population (59%) was young adults (20-29 years age); 65% belonged to nuclear families; one-third were married in less than 18 years of their age. CPR was 67.50%; 49% used permanent methods. Among contraceptive users, significantly higher numbers of couples were married during 18-24 years of age (75%), belonged to nuclear family (70%), literate up to class 10 (73%), having three or more living children (77.50%), and from socioeconomic status of class II (80%). Female literacy rate was higher than national average; 92.50%wives of eligible couple were literate; and tubectomy was commonest contraceptive methods. Conclusion: CPR was high, though different factors like age at marriage, type of family, number of living children, literacy status of female partner, and socioeconomic status significantly affected contraceptive behavior of the study population.
  3 1,114 184
CASE REPORTS
Severe hypoglycemia masquerading as cerebellar stroke
Naman Agrawal, Nayer Jamshed, Praveen Aggarwal, Meera Ekka
October-December 2014, 3(4):440-442
DOI:10.4103/2249-4863.148144  PMID:25657961
Hypoglycemia is a common presenting feature of diabetes in the emergency department. Cardiovascular and neuroglycopenia features are well documented in the literature. We here report a case of 55-year-old female who came to our emergency with clinical features suggestive of cerebellar stroke. Laboratory investigations revealed severe hypoglycemia. The cerebellar signs and symptoms improved completely with intravenous dextrose infusion. Her MR imaging and Doppler of carotid and vertebrobasilar arteries were noncontributory. Hypoglycemia causes behavioral changes, confusion, loss of consciousness, and seizures. It is also well known to cause hemiplegia and aphasia. Hypoglycemia presenting as cerebellar stroke is rarely reported in the literature. This case highlights an uncommon manifestation of a common clinical condition. Physician must rule out hypoglycemia in every stroke patients.
  2 1,209 179
FAMILY PRACTICE
Pregnancy and skin
Rita V Vora, Rajat Gupta, Malay J Mehta, Arvind H Chaudhari, Abhishek P Pilani, Nidhi Patel
October-December 2014, 3(4):318-324
DOI:10.4103/2249-4863.148099  PMID:25657937
Pregnancy is associated with complex of endocrinological, immunological, metabolic, and vascular changes that may influence the skin and other organs in various ways. Pregnancy is a period in which more than 90% women have significant and complex skin changes that may have great impact on the woman's life. The dermatoses of pregnancy represent a heterogeneous group of skin diseases related to pregnancy and/or the postpartum period. The dermatoses of pregnancy can be classified into the following three groups: Physiologic skin changes in pregnancy, pre-existing dermatoses affected by pregnancy, and specific dermatoses of pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy. Correct diagnosis is essential for the treatment of these disorders. This article discusses the current knowledge of various skin changes during pregnancy and the evaluation of the patient with pregnancy dermatoses with special emphasis on clinical features, diagnostic tests, maternal and fetal prognosis, therapy, and management.
  2 3,910 592
ORIGINAL ARTICLES
A comparative study on menstrual hygiene among urban and rural adolescent girls of West Bengal
Baishakhi Paria, Agnihotri Bhattacharyya, Sukes Das
October-December 2014, 3(4):413-417
DOI:10.4103/2249-4863.148131  PMID:25657955
Background: Menstruation is a normal physiological process to the females but sometimes it is considered as unclean phenomenon in the society. Objectives: To compare the perceptions of different aspects of menstrual hygiene between adolescent girls of rural and urban area. Materials and Methods: A community-based cross-sectional study was conducted from April 2013 to September 2013 in urban and rural area of South 24, Paraganas, West Bengal among 541 adolescent school girls in the age group of 13-18 years. Data were collected by the predesigned and pretested questionnaires. Result: Only 37.52% girls were aware of menstruation prior to attainment of menarche. The difference in the awareness regarding menstruation in urban and rural area was highly significant. Only 36% girls in the urban and 54.88% girls in the rural area used homemade sanitary pads and reused the same in the subsequent period. Satisfactory Cleaning of external genitalia was practiced by only 47.63% of the urban and 37.96% of the rural girls. This study found differences in hygienic practices followed by adolescent girls in urban and rural area. Conclusion: Hygienic practices during menstruation were unsatisfactory in the rural area as compared to the urban area. Girls should be educated about the proper hygienic practices as well as bring them out of traditional beliefs, misconceptions, and restrictions regarding menstruation.
  2 2,082 387
International classification of primary care: An Indian experience
Sajitha M. F. Rahman, Ruby P Angeline, Sharon Cynthia, Kirubah David, Prince Christopher, Venkatesan Sankarapandian, Yashvanth Kumar
October-December 2014, 3(4):362-367
DOI:10.4103/2249-4863.148111  PMID:25657944
Background: India is in the process of transition to universal health coverage for Indian citizens. The focus is to strengthen the primary and secondary level services. Coupled with this national scenario, the development of Family medicine as a distinct discipline is in a crucial stage. There is a nation-wide urge to build family medicine training units and service centers across the country to fulfill the unmet health needs of the population. Objectives: This study aimed to bring out reasons for encounter (RFE) and morbidity pattern of patients seen in a family physician run urban health center in South India. Methods: The study was conducted in an urban health center of a tertiary care hospital. Clinicians entered the data using International Classification of Primary Care (ICPC) codes. Data included were demographics, 3 RFE, 3 diagnoses, 3 outcomes of care that include prescriptions, investigations, procedures, and referrals made. Results: During 47,590 patient encounters, 59,647 RFE, 62,283 diagnoses and 68269 outcomes of care were recorded. The majority of RFEs and diagnoses are in the following ICPC chapters: Endocrinology (38.6%), cardiovascular (35.91%), respiratory (20.26%), digestive (7.68% and musculo-skeletal (6.8%). The most frequent outcome of care was prescriptions, followed by counseling and nebulization. Conclusion: This study is the first to report on the RFE in India. This study demonstrated the breadth of clinical conditions seen by family physicians across all ages and in both genders. This study attempts to highlight the need for family physician based services as a training ground for trainees.
  2 1,080 209
Research publications in medical journals (1992-2013) by family medicine authors - Suez Canal University-Egypt
Abdulmajeed A Abdulmajeed, Mosleh A Ismail, Hebatallah Nour-Eldein
October-December 2014, 3(4):368-373
DOI:10.4103/2249-4863.148112  PMID:25657945
Background: Research in family medicine (FM) provides an important contribution to its discipline. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Publication productivity is important in academic settings as a marker for career advancement. Objective: To describe the publications by family medicine researcher authors between 1992 and 2013. Materials and Methods: All full text, original articles published by family medicine researcher; author with affiliation to the Suez Canal University were collected using the internet and hand search. The journals that published for family medicine researcher authors were identified. Author characteristics were described. The trend of publications was described. All articles were analyzed for their characteristics, including the themes and study designs according to predefined criteria. Results: Along 22 years, 149 research articles were published by 48 family medicine authors in 39 medical journals. The largest category in publications was related to Family physician/Health service (FP-HS, n = 52 articles), followed by 'Patient' category (n = 42). All the studies were quantitative; the largest group was represented by cross-sectional studies (76.5%). Conclusions: The publication productivity by family medicine researchers are going to be increased. FP-HS and patient topics were mostly addressed in publications. Cross-sectional studies exceeded any other designs. There is need to put more emphasis on intervention studies. Continuous assessment and improvement of FM research production and publication is recommended.
  2 1,031 191
CASE REPORTS
Ingested foreign bodies in children: A report of two cases
Gurjit Singh, Surendra Sharma, Shrikant Khurade, Somnath Gooptu
October-December 2014, 3(4):452-455
DOI:10.4103/2249-4863.148148  PMID:25657965
Introduction: Accidental foreign body ingestion and impaction of food bolus present as an emergency. Pediatric population is the most vulnerable. Since the act may go unnoticed, the child may present late. However, most foreign bodies pass spontaneously in the stools. Case Capsule: Two children were brought with history of battery ingestion. In one case, an emergency gastro intestinal endoscopy had to be done for the foreign body removal which was made up of corroded battery. In the other case, no interventation was undertaken & an uncorroded battery passed per anum along with stools after 15 days of ingestion. Conclusion: Decision regarding immediate intervention or conservative approach will require consideration of the level of lodgement & type of foreign body. Prevention is possible if parents/ guardians exercise control on their wards & are aware of implications of such an event.
  1 1,010 132
Noncardiac pulmonary edema induced by sitagliptin treatment
Tahir Belice, Suleyman Yuce, Bayram Kizilkaya, Aysel Kurt, Erkan Cure
October-December 2014, 3(4):456-457
DOI:10.4103/2249-4863.148149  PMID:25657966
A 74-year-old male patient with type 2 diabetes mellitus admitted to the emergency department with the complaints of progressive breathlessness, dry cough, and swollen lower extremities. Our patient had type 2 diabetes mellitus and hypertension for 3 years. His HbA1c was not within the target range so sitagliptin was added to on-going therapy. After 1 week of starting sitagliptin therapy, even though the patient had not heart failure he applied to the emergency department with a complaint of dyspnea. The cardiovascular safety and efficacy of many anti-hyperglycemic agents such as sitagliptin, saxagliptin are unclear. Our case has shown that dipeptidyl peptidase 4 inhibitors may cause pulmonary edema. Hence, it should be used with cautious, especially in patients with heart failure.
  1 1,011 163
EDITORIAL
Future direction of family medicine training in India
Ranabir Pal, Raman Kumar, Vidyasagar , Neeti Rustagi, Bijoy Mukherjee, Debabrata Sarbapalli
October-December 2014, 3(4):295-299
DOI:10.4103/2249-4863.148086  PMID:25657931
  1 2,130 8,429
LETTERS TO EDITOR
Acute bilateral leg edema due to levofloxacin
Beuy Joob, Viroj Wiwanitkit
October-December 2014, 3(4):475-476
DOI:10.4103/2249-4863.148158  PMID:25657974
  1 669 112
Symptomatic vitamin D deficiency in an adolescent girl
Vijay Gaikhe, Gurumukh Kotwaney, Preeti Shanbag
October-December 2014, 3(4):476-477
DOI:10.4103/2249-4863.148159  PMID:25657975
  1 600 97
ORIGINAL ARTICLES
Hospital waste management in nonteaching hospitals of Lucknow City, India
Manish Kumar Manar, Krishna Kumar Sahu, Shivendra Kumar Singh
October-December 2014, 3(4):393-395
DOI:10.4103/2249-4863.148122  PMID:25657950
Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices.
  1 1,519 229
Pyoderma gangrenosum: A commonly overlooked ulcerative condition
Daniel Zunsheng Tay, Ki-Wei Tan, Yong-Kwang Tay
October-December 2014, 3(4):374-378
DOI:10.4103/2249-4863.148113  PMID:25657946
Background: Pyoderma ga ngrenosum (PG) is a rare, inflammatory, destructive neutrophilic dermatosis, which mimics other ulcerative conditions. Materials and Methods: In a retrospective study based on patients diagnosed with PG over a 3-year period (2010-2013), we evaluated demographics, anatomical sites, number of lesions, subtypes, histopathology, associated conditions, treatment regimens, healing time, and recurrence. Results: Of our five patients, there were three males and two females, age ranging between 19 and 58 years (mean age 38 years). Four had single lesions localized to the lower limbs while one had multiple lesions (more than five) over bilateral hands and legs. Ulcerative subtype was observed in all the patients. One exhibited pathergy. Skin biopsies were done in four patients, revealing dense neutrophilic infiltrates in three cases and leukocytoclastic vasculitis in one. Associated systemic diseases were observed in all patients, four having inflammatory bowel disease and one having both systemic lupus erythematosus and anti-phospholipid syndrome. The patients were all treated with systemic corticosteroids either alone or in combination with immunosuppressants (e.g., azathioprine, mycophenolate mofetil, tacrolimus), and wound dressing. Split-thickness skin graft was done in one patient. Complete healing was achieved in all patients, ranging from one to 3 months after diagnosis. No recurrence was reported. Conclusions: Systemic corticosteroids, either alone or in combination with steroid-sparing agents are the mainstay of treatment. Should family physicians encounter a rapidly progressing ulcer that has poor response to usual wound management, timely referral to dermatology should be made.
  1 1,288 186
Earwax impaction: Symptoms, predisposing factors and perception among Nigerians
Waheed Atilade Adegbiji, Biodun Sulyman Alabi, Oyebanji Anthony Olajuyin, CC Nwawolo
October-December 2014, 3(4):379-382
DOI:10.4103/2249-4863.148116  PMID:25657947
Background and Aim: Earwax impaction is a common ear disorder with presentation worldwide. This study aimed at determining the clinical presentation, patients' perception of earwax, and its predisposing factors among Nigerians. Materials and Methods: This prospective study was conducted on consented patients with diagnosis of earwax impaction at the Ear, Nose, and Throat Clinic of the University Teaching Hospital, Ado Ekiti, Ekiti state, south west, Nigeria. The research was carried out over a period of one year (April 2008 and March 2009). All consented patients were told about the aim and scope of the study and their biodata were taken. Detailed history of the presenting complaints and otological complaints were taken and all data entered into structured questionnaires. Full-ear examination and otoscopy were performed and our findings were documented. From all these exercise, data obtained were collated and statistically analyzed. Results: A total of 437 patients were diagnosed with earwax impaction and prevalence of 20.1% was found. There was 52.2% male preponderance with male to female ratio of 1:1. Bimodal peak age distribution of patients was found at the extreme ages of life. Most common sources of our patients referrals were 39.6% general medical practitioners with least from 6.2% self-reporting. Common presentations were 277 (63.3%) hearing loss, 268 (61.3%) earache (otalgia), and 234 (53.5%) tiinitus. Unilateral earwax impaction, 75.1% was more common than bilateral earwax impaction. Right ear was more affected than left ear. Recurrent earwax impaction of 66.1% was found in our study. About 382 (87.4%) believed earwax was due to dirt or dust. Most common predisposing factors among our patients were self-ear cleaning. Conclusion: Common predisposing factor of this high recurrent earwax impaction were wrong perception and preventable self-ear cleaning with indiscriminate objects including cotton tip swab. This condition could be reduced by health education of the community.
  1 1,374 184
The perfect marriage: Solution-focused therapy and motivational interviewing in medical family therapy
Gage Stermensky, Kristina S Brown
October-December 2014, 3(4):383-387
DOI:10.4103/2249-4863.148117  PMID:25657948
Medical family therapy has many potential uses in behavioral medicine and primary care. Current research was reviewed to determine the most advantageous way to apply solution-focused therapy and motivational interviewing as a perfect marriage in medical family therapy. An extensive literature review was done in the following databases for medical family therapy: Proquest, EBSCO, Medline, and PsychInfo. The search resulted in 86 relevant articles, of which 46 of the most recent were selected for review. Medical family therapy lacks current research that supports solution-focused therapy or motivational interviewing. However, evidence supports the use of solution-focused therapy as a brief format, as well as the closely related intervention, motivational interviewing. While medical family therapy presents many hopeful possibilities in the fields of behavioral medicine, psychology, and marriage and family therapy, little evidence currently exists for the most effective implementation. This review found evidence supporting solution-focused therapy and motivational interviewing as the perfect marriage of the collaborative team approaches for the future implementation and use of specific interventions in medical family therapy.
  1 2,573 567
Knowledge, attitudes, and practices of public sector primary health care physicians of rural north karnataka towards obesity management
Manjunath S Somannavar, Jayaprakash S Appajigol
October-December 2014, 3(4):400-403
DOI:10.4103/2249-4863.148126  PMID:25657952
Introduction: Obesity is a risk factor for cardiovascular disease (CVD), diabetes mellitus (DM), and hypertension (HTN). In an era of rapidly growing prevalence of obesity, it is important to explore the current knowledge, attitude, and practices of primary care physicians. Materials and Methods: Study participants were medical officers (MOs) of primary health centers in three districts of North Karnataka. The questionnaire was developed by a review of literature in the field and validated with five participants for scope, length, and clarity. Results/Discussion: Of the 102 participants, only 15% were aware about the burden of obesity in India. HTN, DM, and CVD were indicated as comorbidities by 73, 78, and 60 participants, respectively. Only 25 and 12 participants indicated appropriate body mass index (BMI) cut-off values for overweight and obesity diagnosis. Of the 102 participants, 54 were not aware of the guidelines for obesity management. Practices and attitudes of the participants were encouraging. Nearly all of them felt that the adults with BMI within the healthy range should be encouraged to maintain their weight and, three-fourth of them agreed that most overweight persons should be treated for weight loss and small weight loss can achieve major medical benefit. However, nearly half of the participants' responses were stereotypical as they felt only obese and overweight with comorbidities should be treated for weight loss. Two-thirds of them use BMI to diagnose overweight/obese and nearly all of them advice their patients to increase physical activity and restrict fat. Most of the participants were advising their patients to restrict sugar intake, increase fruits and vegetable consumption, reduce red meat, and avoid alcohol consumption. Conclusion: Present study exposed the lack of knowledge regarding obesity. However, practices and attitudes of the participants were promising. There is a need of in-service training to MOs to further improve their knowledge and practices towards management of obesity.
  1 1,079 166
REVIEW ARTICLES
Standard treatment guidelines in primary healthcare practice
S Gopalakrishnan, PM Udayshankar, R Rama
October-December 2014, 3(4):424-429
DOI:10.4103/2249-4863.148134  PMID:25657957
In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice.
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CASE REPORTS
Cholelithiasis presented as chronic right back pain
Francesc Bobé-Armant, Maria Eugenia Buil-Arasanz, Griselda Trubat-Muñoz, Carles Llor-Vilà, Vicente Vicente-Guillen
October-December 2014, 3(4):458-460
DOI:10.4103/2249-4863.148150  PMID:25657967
Chronic right back pain is a symptom in both biliary lithiasis and chronic cholecystitis. Ten percent of the population in the world suffers from biliary lithiasis. Only 20% are symptomatic. The first diagnostic test of choice is an abdominal ultrasound. When a suggestive clinical sign of biliary colic with negative abdominal ultrasound is identified, we should consider the option of carrying out an endoscopic ultrasound in order to rule out microlithiasis. The case discussed in the report presented with chronic right back pain, which is an atypical manifestation of biliary lithiasis and chronic cholecystitis. It is important to know about the atypical manifestations of the prevalent illnesses as well as the limits of the diagnostic tests, in order to avoid diagnostic delays which may cause complications that could worsen a patient's prognosis. This case should contribute to the medical knowledge and must have educational value or highlight the need for a change in clinical practice, especially in primary care.
  - 7 0
An atypical case of right-sided bochdalek hernia in an adult
Syed A Safdar, Sami Abdul Jawad, Javier Dieguez, Vikram Doraiswamy, Jennifer Kam, Hamid Shaaban, Richard A Miller
October-December 2014, 3(4):461-463
DOI:10.4103/2249-4863.148152  PMID:25657968
Bochdalek hernias are usually congenital in nature and normally present after birth. However, in rare cases, these hernias are present in adulthood. We report an unusual case of a posttraumatic right-sided Bochdalek hernia found incidentally in an adult and treated successfully with conservative management.
  - 972 122
Hyper vitaminosis D: are we overprescribing vitamin D?
R Hemachandar, Lokesh Shanmugam, Balakrishna Malepati, Suresh Venugopal
October-December 2014, 3(4):464-466
DOI:10.4103/2249-4863.148153  PMID:25657969
Vitamin D, the sunshine vitamin is now considered to be a hormone due to its important role in many physiological functions. Vitamin D deficiency has been associated with many disorders ranging from bone diseases, cardiovascular diseases to cancer. Hence, there is a recent surge in the empirical prescription of vitamin D for various disorders without documentation of vitamin D deficiency and monitoring the treatment. We report a case of iatrogenic hypercalcemia and acute kidney injury due to vitamin D toxicity after empirical and overzealous use of vitamin D and calcium supplements. We present this case to remind clinicians the importance of monitoring the patients treated with mega doses of vitamin D.
  - 973 185
Ocular side effect of tinidazole: A rare case report
Hina Kauser, Maniah Qadir, Waseem Anwar
October-December 2014, 3(4):467-469
DOI:10.4103/2249-4863.148154  PMID:25657970
Ocular side effects in the form of punctate epithelial erosions with the use of tinidazole - a 5-nitroimidazole group of drugs is very rare. A 32-year-old male was prescribed tablet tinidazole for the treatment of amoebiasis but developed adverse effects in the form of blisters on both upper and lower lips with itching and burning sensation, itching and burning on penile and anal area associated with punctate epithelial erosions of cornea of both the eyes. All these are rare manifestations but punctate epithelial erosions of cornea has never been reported in the literature so far. Punctate epithelial erosions of cornea have not previously been reported and should be added to the list of complications of tinidazole. Hence, this case is being reported .
  - 1,442 128
Uncontrolled diabetes resulting in diabetic cardiomyopathy in a young male patient and eventually presenting with a stroke
Konstantinos Kritikos, Kristina Soitou, Roxani Kapranou, Nikolaos Mavroidis
October-December 2014, 3(4):470-472
DOI:10.4103/2249-4863.148155  PMID:25657971
Diabetic cardiomyopathy (DCP) is defined as the cardiovascular damage present in diabetes patients, which is characterized by myocardial dilatation and hypertrophy, as well as a decrease in the systolic and diastolic function of the left ventricle, and its presence is independent of the coexistence of ischemic heart disease or hypertension. As in the case of the patient that we present here, DCP may be subclinical for a long time, before the appearance of serious clinical symptoms, signs and complications. DCP is poorly recognized by most physicians. Currently, there is no specific treatment for this pathologic entity. However, proper treatment of diabetes and its metabolic abnormalities in the primary care setting reduces the rates of this serious metabolic complication of diabetes. As this high-risk diabetic population is constantly rising, increasing the awareness of physicians for the serious metabolic complications of diabetes, especially in the primary care setting, will help in taking appropriate and early action towards the prevention of full -blown disease and decreasing disability and mortality.
  - 981 131
Acute disseminated encephalomyelitis: Case report and brief review
Pratyush Kumar, Praveen Kumar, RK Sabharwal
October-December 2014, 3(4):443-445
DOI:10.4103/2249-4863.148145  PMID:25657962
Acute disseminated encephalomyelitis (ADEM) is a rare disease of central nervous system with myriads of presentation. It is a diagnosis of exclusion and relies on neuroimaging which may be normal at the onset. It is a diagnostic challenge at its first attack. Here we present a case of ADEM which initially presented with atypical feature and normal neuroimaging but later turned out to be a case of ADEM. Early diagnosis and treatment holds the key for favorable outcome.
  - 1,174 195
Meningococcal meningitis C in Tamil Nadu, public health perspectives
Kirubah Vasandhi David, Ruby Angeline Pricilla, Beeson Thomas
October-December 2014, 3(4):438-439
DOI:10.4103/2249-4863.148143  PMID:25657960
Meningococcal meningitis has rarely been reported in Tamil Nadu. We report here two children diagnosed with meningococcal meningitis in Vellore, Tamil Nadu, on May 2014. The causative strain was Neisseria meningitidis serotype C. The role of the primary care physician in early diagnosis, appropriate referral, and preventive measures of this disease to the immediate family and community is stressed.
  - 924 151
COMMENTARIES
Quaternary prevention: Need of the hour
Harshal T Pandve
October-December 2014, 3(4):309-310
PMID:25657934
Prevention is primarily categorized as Primordial, Primary, Secondary and Tertiary. Now the concept of "Quaternary Prevention" is also introduced. This editorial article discusses need of Quaternary prevention in current scenario of clinical practice.
  - 1,309 527
National health service in India: Be aware of what it means
Makani Hemadri
October-December 2014, 3(4):311-312
PMID:25657935
India welcomes international partners and businesses. Indians and Indian health care need to understand the nature and role of foreign collaborators so that appropriate use of expertise and resources can happen. India will initially need to find a balance and eventually need to 'grow its own' to achieve success in healthcare.
  - 1,116 244
FAMILY MEDICINE EDUCATION
Family medicine in undergraduate medical education in India
Venkatesan Sankarapandian, Prince R.H. Christopher
October-December 2014, 3(4):300-304
DOI:10.4103/2249-4863.148087  PMID:25657932
The Medical Council of India has set appropriate and relevant objectives to train each medical student into a basic doctor for the country. Even though they envisage that these basic doctors would work as physicians of first contact, providing for the health needs of India at primary and secondary care level, the site of training and the context of clinical teaching do not seem to empower the students to become a basic doctor. 'Vision 2015', the document written by the board of governors of medical council of India suggests reforms in medical education such as early clinical exposure, integration of principles of family medicine, and clinical training in the secondary care level. Family medicine training with trained family medicine faculty might add this missing ingredient to our basic doctor training. This article discusses the role of family medicine in undergraduate medical training. We also propose the objectives of such training, the structure of the training process, and the road blocks with possible solutions to its implementation.
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FAMILY PRACTICE
Breast screening revisited
Alka Agrawal, Prem Tripathi, Abhinav Sahu, Jalpa Daftary
October-December 2014, 3(4):340-344
DOI:10.4103/2249-4863.148103  PMID:25657940
Breast screening is the medical screening of asymptomatic, apparently healthy women for breast lump in an attempt to achieve an earlier diagnosis. The assumption is that the early detection will improve outcomes. In western countries, breast screening programs have led to a significant reduction in mortality and improved prognosis of patients with breast cancer. However in India, although the number of breast cancer are on the rise there is no such organized program. This article emphasizes on the importance of breast screening and protocol to be followed in our country where it can have significant impact on the prognosis.
  - 1,519 171
The transplant patient and transplant medicine in family practice
Lloyd D Hughes
October-December 2014, 3(4):345-354
DOI:10.4103/2249-4863.148106  PMID:25657941
Over the last two decades in particular there has been a remarkable increase in the number of solid organ transplants being performed worldwide alongside improvements in long-term survival rates. However, the infrastructure at transplant centres has been unable to keep pace with the current volume of the transplant patient work load. These pressures on transplant specialist centres has led to calls for an increased role of the general practitioner (GP) managing particular aspects of transplant patients' medical care. Indeed, many aspects of follow-up care such as screening for malignancies, preventing infection through immunisation programmes, and managing cardiovascular risk factors are already important aspects of family practice medicine. This paper aims to review some of the aspects of transplant patient care that is important for healthcare workers in family practice to manage.
  - 1,293 146
HEALTH POLICY
Health and beyond… strategies for a better India: Incorporating evidence to strengthen health policy
Soumyadeep Bhaumik
October-December 2014, 3(4):313-317
DOI:10.4103/2249-4863.148098  PMID:25657936
India plans to roll-out universal health coverage in spite of having one of the lowest governments spending on health in the world. A scenario such as this means that health policy decisions particularly with respect to priority setting and resource allocation are often difficult and riddled with difficult choices. Moreover, a variety of decisions and determinants beyond the barriers of the health system has to be taken into account in a pluralistic and diverse nation like India during the healthy policy making process. The review provides a brief overview on the current policy making scenario, where often decisions are not based on latest research evidence, but on placating powerful activist groups and is more problem oriented rather than being solution oriented. Various opportunities which exist in order to incorporate evidence in order to inform health policy are discussed. The article highlights the need to develop a transparent, inclusive and independent mechanism to prospectively appraise all available evidence and help inform policy-making based on predetermined criteria and to as evaluate the impact of policy decisions thereby helping in knowledge creation, translation as well as its implementation.
  - 2,103 311
LETTERS TO EDITOR
Further strategies to improve the working experience of rural doctors
Kieran Walsh
October-December 2014, 3(4):473-473
DOI:10.4103/2249-4863.148156  PMID:25657972
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Dietary pattern amongst obese and nonobese children in national capital territory of Delhi: A case control study
Ajeet Singh Bhadoria, Umesh Kapil, Supreet Kaur
October-December 2014, 3(4):473-475
DOI:10.4103/2249-4863.148157  PMID:25657973
  - 855 155
Helicobacter pylori : A common infection
Rashmi Patnayak, Amitabh Jena, Venkat Rami Reddy
October-December 2014, 3(4):477-477
DOI:10.4103/2249-4863.148160  PMID:25657976
  - 592 104
'Euthanasia: Right to die with dignity'
Kalaivani Annadurai, Raja Danasekaran, Geetha Mani
October-December 2014, 3(4):477-478
DOI:10.4103/2249-4863.148161  PMID:25657977
  - 2,584 565
ORIGINAL ARTICLES
Prevalence and correlates of overweight/obesity among adolescents in an Urban City of North India
Ravi Rohilla, Meena Rajput, Jyoti Rohilla, Manisha Malik, Dinesh Garg, Madhur Verma
October-December 2014, 3(4):404-408
Background and objectives: Obesity and overweight is a growing pandemic affecting millions of adolescents in developed as well as developing countries. Obesity is associated with the onset of major chronic diseases leading to complications and also psychosocial problems in adolescents. The greater concern is that the risks of obesity during childhood will persist into adolescence and adulthood. The objectives of the study were to assess the prevalence of being overweight and obesity and to study the associated risk factors. Materials and Methods: 1900 adolescents in the age group of 10-19 years were included in the study. A predesigned and pretested questionnaire which included the variables such as going to school by bus or cycle, eating habits, playing video/computer games or outdoor games and sibling count were recorded. Body weight and height were recorded in subjects for calculating body mass index (BMI). International Obesity Task Force (IOTF) classification was used for the estimation of being overweight and obese. Results: The mean age of the study subjects was 14.84 years (SD = 2.81). Mean weight increased from 34.7 to 55.09 kg from the age group 10-13 to 17-19 years. Mean height also increased from 1.34 to 1.57 m from the age group 10-13 to 17-19 years. Similarly, the mean body mass index was 19.23 at 10-13 years, followed by 21.11 at 14-16 years and 22.46 at 17-19 years. On binary logistic regression analysis, female gender, bus as a mode of transport, not playing games, and single sibling were found to have independent association with prevalence of being overweight.
  - 1,399 193
Level of awareness regarding some zoonotic diseases, among dog owners of Ithaca, New York
Gursimrat Kaur Sandhu, Devinder Singh
October-December 2014, 3(4):418-423
DOI:10.4103/2249-4863.148132  PMID:25657956
Objectives: Worldwide, dogs and cats are the two most common household companion animals. Because of this, they can be direct or indirect source of many human infections. Fortunately, most of these zoonotic infections can be clinically prevented by appropriate prophylactic interventions. Materials and Methods: Present kind of cross-sectional study, for the first time, was conducted in city of Ithaca, New York. People visiting local animal hospitals, dog parks, library and shoppers at Walmart supermarket were personally interviewed and a pre-tested questionnaire was got filled from every individual. The collected data were analyzed for percentage proportions using Microsoft Excel ® and the results had been presented in graphical as well as tabulated forms. Results: Out of 100 participants responding to the request for participation, gender-wise, 45% of the participants were male while 55% of the participants were females. Demographically, 50% participants lived in rural, 35% in urban while 15% participants lived in suburban areas. Educational background of the participants ranged from High school pass-outs to Graduates. Conclusions: Participants were aware about the zoonotic potential of leptospirosis, giardiasis, rabies, hookworms, coccidiosis, lyme disease, roundworms, toxoplasma, leishmaniasis, salmonellosis and ringworm disease. Knowledge gaps in the sampled population, in terms of lack of awareness about zoonotic diseases vectored by mosquitoes, ticks and fleas; practice of not doing regular deworming and prophylactic control of fleas and ticks on pet dogs; and lack of practice among physicians to discuss zoonotic canine diseases with their clients were revealed by this study.
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REVIEW ARTICLES
The family medicine specialty, learning from experience
Soheil Soltanipour, Abtin Heidarzadeh, Tolou Hasandokht
October-December 2014, 3(4):436-437
DOI:10.4103/2249-4863.148142  PMID:25657959
Family medicine has been accepted as a model for Iranian health-care reform, but many debates have been raised since its establishment. Despite many successes achieved, this area of medicine is very challengeable. Family practice as a specialty is an innovation that has been introduced by the ministry of health and medical education in Iran. Although this approach seems sophisticated, learning from experience is the first step to avoid difficulties that may occur from this selection. Our goal is to declare strengths, weaknesses, opportunities, and threats of family medicine specialty.
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