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   2015| April-June  | Volume 4 | Issue 2  
    Online since April 8, 2015

 
 
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FAMILY PRACTICE
Childhood obesity: causes and consequences
Krushnapriya Sahoo, Bishnupriya Sahoo, Ashok Kumar Choudhury, Nighat Yasin Sofi, Raman Kumar, Ajeet Singh Bhadoria
April-June 2015, 4(2):187-192
DOI:10.4103/2249-4863.154628  PMID:25949965
Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. Childhood obesity can profoundly affect children's physical health, social, and emotional well-being, and self esteem. It is also associated with poor academic performance and a lower quality of life experienced by the child. Many co-morbid conditions like metabolic, cardiovascular, orthopedic, neurological, hepatic, pulmonary, and renal disorders are also seen in association with childhood obesity.
  174 30,998 5,096
ORIGINAL ARTICLES
Reliability of dipstick assay in predicting urinary tract infection
Anith Kumar Mambatta, Jayalakshmi Jayarajan, Vinitha L Rashme, Sanchitha Harini, Sujaya Menon, Jayachandran Kuppusamy
April-June 2015, 4(2):265-268
DOI:10.4103/2249-4863.154672  PMID:25949979
Aims: Urine dipstick analysis is a quick, cheap and a useful test in predicting Urinary Tract Infection (UTI) in hospitalized patients. Our aim is to evaluate the reliability (sensitivity) of urine dipstick analysis against urine culture in the diagnosis of UTI. Materials and Methods: Patients admitted to our hospital suspected of having UTI, with positive urine cultures were included in this study from a 2-year period (January 2011 to December 2012). Dipstick urinalysis was done using multistix 10 SG (Siemens) and clinitek advantus analyzer. The sensitivity of dipstick nitrites, leukocyte esterase and blood in these culture-positive UTI patients was calculated retrospectively. Results: Urine dipstick analysis of 635 urine culture-positive patients was studied. The sensitivity of nitrite alone and leukocyte esterase alone were 23.31% and 48.5%, respectively. The sensitivity of blood alone in positive urine culture was 63.94%, which was the highest sensitivity for a single screening test. The presence of leukocyte esterase and/or blood increased the sensitivity to 72.28%. The sensitivity was found to be the highest when nitrite, leukocyte and blood were considered together. Conclusions: Nitrite test and leukocyte esterase test when used individually is not reliable to rule out UTI. Hence, symptomatic UTI patients with negative dipstick assay should be subjected to urine culture for a proper management.
  20 4,577 647
Drug-induced hepatitis and the risk factors for liver injury in pulmonary tuberculosis patients
Gajanan S Gaude, Alisha Chaudhury, Jyothi Hattiholi
April-June 2015, 4(2):238-243
DOI:10.4103/2249-4863.154661  PMID:25949974
Introduction: Short-course chemotherapy containing rifampicin and isoniazid in combination has proved to be highly effective in the treatment of tuberculosis, but one of its adverse effects is hepatotoxicity. Various risk factors have been found to be associated with drug-induced liver injury (DILI) in general population. The study aimed to determine the prevalence of drug-induced hepatitis and the risk factors associated with the DILI among the patients of pulmonary tuberculosis in Indian patients. Setting and Design: Prospective nested case control study. Materials and Methods: Out of the cohort of 3900 tuberculosis patients who were initiated on anti-tubercular therapy, 150 patients who developed drug-induced liver injury due to short-course chemotherapy under RNTCP were included in the analysis. Thirty cases were being followed up in our hospital and other 120 were referred to us for the management of drug-induced hepatitis from the primary health centers. The diagnostic criteria's for DILI were made according to the American Thoracic Society criteria. Analyses of various risk factors were done for the development of DILI. Results: The prevalence of DILI in the present study was 3.8%. It was observed that DILI patients were older and their serum albumin levels were lower, and they had multiple co-morbid conditions. Regular alcohol intake, more extensive disease associated with radiological and female gender were observed to be independent risk factors for the development of DILI. Conclusions: Of the various risk factors analyzed, advanced age, hypoalbuminemia, regular alcohol intake and advanced nature of the disease were independent risk factors for the development of DILI. The risk of development of hepatitis is increased in the presence of one or more of these risk factors.
  11 3,945 581
FAMILY MEDICINE EDUCATION
Master's and doctoral theses in family medicine and their publication output, Suez Canal University, Egypt
Hebatallah Nour-Eldein, Nadia M Mansour, Abdulmajeed A Abdulmajeed
April-June 2015, 4(2):162-167
DOI:10.4103/2249-4863.154622  PMID:25949959
Background: The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers. Objective: This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014. Materials and Methods: GP/FM degree theses were  reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described. Results: Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of  research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The "Patient" category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles. Conclusion: The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended.
  7 3,116 281
FAMILY PRACTICE
Menstruation related myths in India: strategies for combating it
Suneela Garg, Tanu Anand
April-June 2015, 4(2):184-186
DOI:10.4103/2249-4863.154627  PMID:25949964
Menstruation is a phenomenon unique to girls. However, it has always been surrounded by taboos and myths that exclude women from many aspects of socio-cultural life. In India, the topic has been a taboo until date. Such taboos about menstruation present in many societies impact on girls' and women's emotional state, mentality and lifestyle and most importantly, health. The challenge, of addressing the socio-cultural taboos and beliefs in menstruation, is further compounded by the low girls' knowledge levels and understandings of puberty, menstruation, and reproductive health. Thus, there is the need to follow a strategic approach in combating these issues. The current paper aims to discuss menstruation related myths prevalent in India, their impact on women's life, relevance of addressing these issues in primary care and a brief description about various strategies to combat them.
  7 8,400 683
ORIGINAL ARTICLES
Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India
Parveen M Aabidha, Anne G Cherian, Emmanuel Paul, Jasmin Helan
April-June 2015, 4(2):257-260
DOI:10.4103/2249-4863.154669  PMID:25949977
Background: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population. Materials and Methods: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus. Results: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%). Conclusions: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes.
  7 3,261 438
FAMILY PRACTICE
Resistant hypertension: an approach to management in primary care
Julian P Yaxley, Sam V Thambar
April-June 2015, 4(2):193-199
DOI:10.4103/2249-4863.154630  PMID:25949966
Hypertension is widely encountered in family medicine. Despite its prevalence, many patients have uncontrolled or difficult-to-control blood pressure. Resistant hypertension is defined as hypertension that is poorly responsive to treatment and requires the use of multiple medications to achieve acceptable blood pressure ranges. It may be a consequence of secondary hypertension or have no identifiable cause. Resistant hypertension is important to recognise because it places patients at risk of end-organ damage. Primary care physicians should be aware of the therapeutic approach for hypertension when traditional therapy fails. This article aims to familiarise readers with the evaluation and management of resistant hypertension by outlining the most recent evidence-based treatment options.
  6 4,555 638
ORIGINAL ARTICLES
Mothers' understanding of childhood malaria and practices in rural communities of Ise-Orun, Nigeria: implications for malaria control
Adebola Emmanuel Orimadegun, Kemisola Stella Ilesanmi
April-June 2015, 4(2):226-231
DOI:10.4103/2249-4863.154655  PMID:25949972
Introduction: Regular evaluations of communities' understanding of malaria-related practices are essential for control of the disease in endemic areas. This study was aimed at investigating the perceptions, prevention and treatments practices for childhood malaria by mothers in rural communities. Materials and Methods: We conducted a community-based cross-sectional study at rural communities of Ise-Orun local Government area, Nigeria. We randomly sampled 422 mothers of children less than 5 years and administered a validated questionnaire to assess their perceptions and practices relating to childhood malaria. We used a 10-point scale to assess perception and classified it as good (≥5) or poor (<5). Predictive factors for poor perceptions were identified using logistic regression. Results: Approximately 51% of the mothers had poor perception and 14.2% ascribed malaria illness to mosquito bite only. Majority (85.8%) of the mothers practiced malaria preventive measures, including: Insecticide treated nets (70.0%), chemoprophylaxis (20.1%) and environmental sanitation (44.8%). Of the 200 mothers whose children had malaria fever within the 3 months prior to the study visits, home treatment was adopted by 87.5%. Local herbal remedies were combined with orthodox medicine in the treatments of malaria for 91.5% of the children. The main reasons for not seeking medical treatment at existing formal health facilities were "high cost", "challenges of access to facilities" and "mothers' preference for herbal remedies". Lack of formal education was the only independent predictor of poor malaria perceptions among mothers (OR = 1.91, 95% CI = 1.18, 3.12). Conclusions: Considerable misconceptions about malaria exist among mothers in the rural communities. The implications for malaria control in holoendemic areas are highlighted.
  6 3,048 288
CASE REPORTS
Ciprofloxacin induced bullous fixed drug reaction: three case reports
Pragya A Nair
April-June 2015, 4(2):269-272
DOI:10.4103/2249-4863.154673  PMID:25949980
Cutaneous adverse drug reactions (ADRs) are seen in about 1-2% cases. Fixed drug reaction (FDR) is responsible for about 10% of all ADRs. It is a delayed type of hypersensitivity reaction that occurs as lesions recurs at the same skin site due to repeated intake of an offending drug. The most common drugs causing fixed drug eruption (FDE) are analgesics, antibiotics, muscle relaxants and anticonvulsants. FDE due to ciprofloxacin has been reported earlier also, but bullous variant of FDR is rare. We hereby report three case reports of bullous FDR caused due to ciprofloxacin.
  5 3,095 295
ORIGINAL ARTICLES
How healthy is our geriatric population? a community-based cross-sectional study
Sherin S Paul, Vinod Joseph Abraham
April-June 2015, 4(2):221-225
DOI:10.4103/2249-4863.154653  PMID:25949971
Introduction: With the rise in aged population there is a greater need to look into their nutritional and physical disability aspects which is otherwise neglected. The study aimed to assess the prevalence of malnutrition, anemia and physical disability among the community-dwelling aged population. Materials and Methods: A cross-sectional study was carried out in a rural block of north Tamil Nadu. Seventeen villages were selected using cluster sampling based on probability proportional to size. A total of 340 participants of age 60 years and above were selected from these clusters using simple random sampling. Nutritional status and physical disability were assessed using mini nutritional assessment scale and Barthel index. Blood samples were collected for anemia. Appropriate data entry and statistical analysis were done in EPIDATA and SPSS 16. Statistical Analysis Used: Besides calculating prevalence chi square and logistic regression tests were done to identify associated risk factors. Results and Conclusions: The overall prevalence of "at risk of malnutrition," anemia and physical disability were 10.9%, 38.2% and 20.6%, respectively. None of the community-dwelling aged population was found to be malnourished. Anemia and physical disability were significantly higher among the older age group [(OR 2.29 (1.17-4.89), (OR 2.81 (95% CI 1.31-6.04), respectively]. Similarly women were more affected with physical disability than men (OR 2.27 (1.28-4.02)). Further studies need to be done to explore the reasons for high prevalence of anemia.
  4 2,967 331
CASE REPORTS
Kyrle's disease in a patient of diabetes mellitus and chronic renal failure on dialysis
Pragya A Nair, Nidhi B Jivani, Nilofar G Diwan
April-June 2015, 4(2):284-286
DOI:10.4103/2249-4863.154678  PMID:25949985
Kyrle's disease (KD) is an acquired perforating dermatosis associated with an underlying disorder such as diabetes mellitus or chronic renal failure. It presents as multiple discrete, eruptive papules with a central crust or plug, often on the lower extremities. A keratotic plug is seen histologically in an atrophic epidermis and may penetrate the papillary dermis with transepidermal elimination of keratotic debris without collagen or elastic fibers. Various therapies have been reported that include cryotherapy, laser therapy, narrow-band ultraviolet B and use of topical or systemic retinoids. Hereby a case of 64-year-old male, a known case of diabetes mellitus, hypertension and chronic renal failure who developed KD is presented.
  3 3,031 214
COMMENTARY
Addressing inequalities in oral health in India: need for skill mix in the dental workforce
Manu Raj Mathur, Ankur Singh, Richard Watt
April-June 2015, 4(2):200-202
DOI:10.4103/2249-4863.154632  PMID:25949967
Dentistry has always been an under-resourced profession. There are three main issues that dentistry is facing in the modern era. Firstly, how to rectify the widely acknowledged geographical imbalance in the demand and supply of dental personnel, secondly, how to provide access to primary dental care to maximum number of people, and thirdly, how to achieve both of these aims within the financial restraints imposed by the central and state governments. The trends of oral diseases have changed significantly in the last 20 years. The two of the most common oral diseases that affect a majority of the population worldwide, namely dental caries and periodontitis, have been proved to be entirely preventable. Even for life-threatening oral diseases like oral cancer, the best possible available treatment is prevention. There is a growing consensus that appropriate skill mix can prove very beneficial in providing these preventive dental care services to the public and aid in achieving the goal of universal oral health coverage. Professions complementary to dentistry (PCD) have been found to be effective in reducing inequalities in oral health, improving access and spreading the messages of health promotion across entire spectrum of socio-economic hierarchy in various studies conducted globally. This commentary provides a review of the effectiveness of skill mix in dentistry and a reflection on how this can be beneficial in achieving universal oral health care in India.
  3 3,835 483
ORIGINAL ARTICLES
Sleep-patterns, sleep hygiene behaviors and parental monitoring among Bahrain-based Indian adolescents
Bindu John
April-June 2015, 4(2):232-237
DOI:10.4103/2249-4863.154659  PMID:25949973
Introduction: Sleep plays an important role in adolescent's health and undergoes substantial changes with puberty and physical maturation with a preference for later bed times. Evidence shows that many adolescents are not obtaining the required amounts of sleep which is 9.25 h, due to inadequate sleep practices, academic and societal demands. This study aims at describing the (1) sleep patterns of adolescents on school days and weekends, (2) sleep hygiene practices and the extent of parental monitoring and (3) gender and grade level differences in sleep duration and sleep hygiene practices among Indian adolescents in Bahrain. Materials and Methods: Study used a descriptive correlational design. A total of 145 adolescents from 11 to 17 years from grade 6 to 12 were selected using convenience sampling. Data was collected from November 2012 to March 2013. A structured questionnaire for sleep patterns and Mastin et al.'s Sleep Hygiene Index for assessing sleep hygiene practices were used. Results: The adolescents' total sleep duration was 7.07 ΁ 1.13 hours. A highly significant difference in sleep duration on school days and weekends between adolescents of various grade levels (P < 0.001 and 0.001, respectively) and between parental monitoring at the time of getting up on school days and sleep duration (P value 0.026 at 0.05 level of significance) was found. Gender was not significant with the sleep duration, and also with Sleep Hygiene Index scores. Conclusion: The results suggest that there is a high prevalence of insufficient sleep and irregular bed-time schedule among Indian adolescents in Bahrain. Interventions directed toward improving sleep and promoting good sleep hygiene strategies are required to improve the physical and emotional health of adolescents.
  3 3,355 288
Availability of Village Health and Nutrition Day services in Uttarakhand, India
Vartika Saxena, Praveer Kumar, Ranjeeta Kumari, Bhola Nath, Ranabir Pal
April-June 2015, 4(2):251-256
DOI:10.4103/2249-4863.154667  PMID:25949976
Background: Village Health and Nutrition Day (VHND) was identified to provide primary care services (health, nutrition and sanitation) at village level under National Rural Health Mission. Aim: The study aimed to assess availability of health, nutrition and sanitation services, required instruments/equipment and medicines at VHND with client satisfaction from the VHND services. Materials and Methods: A cross-sectional study was conducted in three districts of Uttarakhand at Nainital, Tehri-Garhwal and Chamoli involving 24 villages in six blocks using multistage stratified sampling using predesigned pretested observation checklists (quantitative data). All the concerned functionaries of health, Integrated Child Development Services and Panchayati Raj Institution were interviewed (qualitative data) to understand the gap in services and remediation. Results: Of the 24 VHNDs observed, blood pressure measurement was done at 11 (45.83%) and weight at 13 (54.17%) sites in ante-natal care services; non-availability of blood pressure instrument and adult weighing machine were 45.83% and 41.66% sites, respectively. Immunization for children was provided at 22 sites; however, availability of other services were poor-vitamin A (three), growth monitoring of children (seven); supplementary nutrition (five); identification of households for construction of toilet (eight). Yet, one-third of clients provided three and four for satisfaction from VHND services on the scale score of 1-5. Conclusion: It was noted that none of the VHND site was providing all the stipulated services, though immunization was provided mostly. Anganwadi centers were lacking availability of various essential instruments and equipment. So regular orientation of village functionaries for ensuring all the VHND services with the availability of required logistic is recommended.
  3 3,222 253
CASE REPORTS
Immunosuppressive treatment for immune thrombocytopenia which masked Graves' disease
Suleyman Baldane, Suleyman Hilmi Ipekci, Levent Kebapcilar
April-June 2015, 4(2):276-277
DOI:10.4103/2249-4863.154675  PMID:25949982
A 71-year-old female patient followed primary immune thrombocytopenia (ITP) was admitted to endocrinology unit with excessive sweating. We started methimazole for Graves' disease. Without any additional immunosuppressive treatment, at week 12 of methimazole therapy, thyroid stimulating hormone (TSH) levels returned to normal, and platelet counts rose to tolerable levels. When her hospital records were analyzed, they revealed that a year ago, when she had been diagnosed with ITP, her TSH values had been suppressed. After immunosuppressive therapy, her platelet values were maintained at normal levels, and during her control visits, her TSH levels were measured twice and were within normal limits. We think that immunosuppressive therapy for ITP without considering thyroid function tests may result in a transient euthyroid state, which potentially masks Graves' disease accompanying immunosuppressive therapy and associated recurrent ITP attacks.
  2 2,531 173
EDITORIAL
The leadership crisis of medical profession in India: ongoing impact on the health system
Raman Kumar
April-June 2015, 4(2):159-161
DOI:10.4103/2249-4863.154621  PMID:25949958
By 2030 India will have one million additional MBBS doctors; currently being produced @50,000 per year. Contrary to perception of scarcity of medical doctors, a large section of newly qualified physicians are spending considerable years in dysfunctional status due to mismanagement in human resource in health in India. There are very few employment opportunities for qualified doctors in public sector; at the same time the average salary of MBBS doctors in urban private hospitals is very low. Paradoxically, in a country of 1.3 billion populations there is no actual demand for medical professionals. While the popular perception is that young doctors are not willing for community service, a reality check is required on the count of intent and capacity of public sector as well as industry towards engagement of medical doctors in the process of service delivery. The visible leaders of medical profession are unable to reflect the ground reality. There is a leadership crisis among medical doctors in India.
  2 21,550 839
HEALTH POLICY
Misplaced priorities in the Union Health Budget 2015
Soumyadeep Bhaumik
April-June 2015, 4(2):174-176
DOI:10.4103/2249-4863.154624  PMID:25949961
The Union Budget presented on 28 February 2015 in the Indian parliament has allocated only INR 33,000 crores for health. It allocates more funds for building newer tertiary care hospitals and increases income tax exemptions for buying health insurance. The article explains that model that is being followed, as indicated by these measures, will create havoc to the lives of Indians and make them sicker and healthcare costlier. The budget is not in line with the actual priorities of India's health system and nor paves the road map for Universal Health Coverage. The Government of India needs to gets its priorities right.
  2 3,890 301
ORIGINAL ARTICLES
Awareness, perception and practice of stakeholders in India regarding Village Health and Nutrition Day
Sandeep K Panigrahi, Bijayeeni Mohapatra, Kaushik Mishra
April-June 2015, 4(2):244-250
DOI:10.4103/2249-4863.154663  PMID:25949975
Background: Village Health and Nutrition Day (VHND) is a community-based health service package delivered on a fixed day approach. Services like early registration of pregnancy, regular antenatal care and postnatal care, growth monitoring and referral of sick children, discussion of health topics to generate awareness, and convergence between health and ICDS, are delivered every month at VHND at the Anganwadi Center. This study explores the awareness, perception and practice of service providers, and beneficiaries, regarding VHND. Materials and Methods: It was a cross-sectional study conducted in Odisha during December 2009-November 2010. Personal interviews were conducted at the VHND sessions with 111 beneficiaries and 45 service providers using a semi-structured schedule to know their awareness, perception and practice regarding VHND sessions. Data analysis was done and reported as simple percentages. Results: Most of the health worker females and anganwadi workers considered health awareness as a key component of VHND. 52% of HWFs and 41% of AWWs had misconception about additional roles and responsibilities. 34% of beneficiaries had knowledge regarding fixed day approach of VHND, while 24% did not have knowledge regarding any of its purpose. Only 8% of referral cases had complete knowledge on the reason of referral. There was significant difference in between awareness and practice among the blocks. Conclusion: Service providers' orientation should be improved. Behavior change communication activities should also be increased by the state. Referral cases should be properly counseled. The community believed that such a program should continue with better package and quality of services.
  2 3,712 232
WONCA YOUNG DOCTORS MOVEMENT
Young Doctor Movements: motives for membership among aspiring and young family physicians
Kenneth Yakubu, Kyle Hoedebecke, Nagwa Nashat
April-June 2015, 4(2):177-181
DOI:10.4103/2249-4863.154625  PMID:25949962
Background: Over the past decade, young doctor movements (YDMs) have gained recognition for their efforts in promoting the discipline of family medicine. With growth and expansion comes the need for an inquiry into the membership motives of current/intending members. Aim and Objectives: This study was aimed at determining the main reasons why young and aspiring family physicians (FPs) joined their regional YDM. It was also concerned with determining the main factors that will make non-members want to join a YDM as well as assessing for differences in the responses within YDM members on the one hand, and between YDM members and non-members on the other. Materials and Methods: This was a cross-sectional web-based study. Using a list of 11 items generated following a series of discussions and feedback among selected FPs and FP trainees, respondents annotated levels of agreement on reasons for current or desired YDM membership. The Mann-Whitney U test was used to determine the distribution and differences in the mean of rank scores of the responses from YDM and non-YDM members while the Kruskal-Wallis test was used to describe same for the various YDMs. Results: The total number of respondents was 200, out of which 102 (51.0%) were current YDM members, 97 (48.5%) were non-members and 1 (0.5%) respondent did not state his/her membership status. Non-YDM members indicated a predominantly academic/professional motive for membership while YDM members indicated the opportunity to socialise with FPs abroad and in their country as their foremost reasons for membership. A mixture of academic, professional and social motives was observed for respondents from Vasco da Gama; predominantly academic and professional motives for respondents from Spice route. Conclusions: While gaining recognition and improving one's practice may be the ultimate goal of an aspiring FP, socialising within a network of like-minded professionals maybe the young FP's way of coping with demands of the discipline.
  2 3,499 293
CASE REPORTS
T-cell lymphoma masquerading as extrapulmonary tuberculosis: case report and review of literature
Piyush Ranjan, Sourabh Dutta, Aanchal Kakkar, Ankur Goyal, Naval K Vikram, Mehar C Sharma, Rita Sood
April-June 2015, 4(2):280-283
DOI:10.4103/2249-4863.154677  PMID:25949984
It is often difficult to establish confirmatory diagnosis in cases of extrapulmonary tuberculosis (TB) because of its paucibacillary nature and difficulty in accessing the involved organs. In several cases, empirical anti-tubercular treatment is started, and the patient is followed-up closely for response. In countries with high prevalence of TB, it is a reasonably good strategy and works most of the times. However, catastrophe may occur when aggressive lymphomas masquerade as TB.
  1 2,603 143
LETTERS TO EDITOR
Tobacco based dentifrices: still not squeezed out
Gaurav Sharma, Archna Nagpal
April-June 2015, 4(2):287-287
DOI:10.4103/2249-4863.154680  PMID:25949986
  1 2,309 124
Pulmonary edema − cardiogenic or noncardiogenic?
Binit Sureka, Kalpana Bansal, Ankur Arora
April-June 2015, 4(2):290-290
DOI:10.4103/2249-4863.154684  PMID:25949989
  1 3,309 313
ORIGINAL ARTICLES
Tobacco use, attitudes and cessation practices among healthcare workers of a city health department in Southern India
Prem K Mony, NS Vishwanath, Suneeta Krishnan
April-June 2015, 4(2):261-264
DOI:10.4103/2249-4863.154670  PMID:25949978
Objective: To assess tobacco use, attitudes and cessation practices among healthcare workers of a municipal health department in southern India. Materials and Methods: We undertook a cross-sectional epidemiologic study to investigate 558 healthcare workers from three groups (doctors, auxiliary nurses and community link workers (LWs)) employed by the Bangalore city corporation in southern India. Outcomes included self-reported tobacco use status and attitudes (for all workers), and (for doctors) self-report of performance of "5-A" tobacco cessation interventions: Asking, advising, assessing, assisting, or arranging follow-up for tobacco control, in their client population. Results: Doctors reported higher tobacco use rates (6.9%) compared to LW (2%) and nurses (<1%) but were less interested in further tobacco control training (77%) compared to the others (>95%). Many doctors reported asking (100%) and advising (78%) about tobacco use but much fewer were assessing intention/motivation to quit (24%), assisting with quitting (19%), and arranging follow-up for quitting and relapse prevention (9%). Conclusion: Tailored training in tobacco control would enable doctors, nurses and outreach workers involved in primary healthcare delivery to be better equipped to deal with a major cause of morbidity and mortality among urban communities in the 21 st century.
  1 2,867 212
CASE REPORTS
Myriad presentations of penile fracture: report of three cases and review of literature
MS Faridi, Nitin Agarwal, Pradeep Saini, Navneet Kaur, Arun Gupta
April-June 2015, 4(2):273-275
DOI:10.4103/2249-4863.154674  PMID:25949981
Penile fracture is an unusual though not a rare condition but underreported. It is defined classically as the disruption of the tunica albuginea with rupture of the corpus cavernosum. Penile fracture can be misdiagnosed with rupture of corpus spongiosum clinically. Therefore, we are presenting three cases due to its varied clinical presentation and management. In first patient, there was a tear in the corpus spongiosum and a partial tear in the ventral urethra. Both defects were repaired with interrupted sutures. In the second patient, there was a rupture of corpus cavernosum, which was primarily repaired. After 1-year of primary surgery, patient again came with similar complaints, and diagnosis of scar dehiscence was made. Patient was treated conservatively with satisfactory results on follow-up. Third patient came with a history of 1-week. Intra-operative findings revealed only hematoma without any defect in corpora cavernosum, corpus spongiosum, and urethra. Only evacuation of hematoma was done. Early surgical treatment of penile fracture is advantageous. In recurrent penile fracture, if no penile deformity or any reasonable clinical and radiological evidence, then conservative management is advocated. Even when presentation is delayed up to 1-week, operative management has shown good results.
  - 5,241 171
Hypokalemic quadriparesis in dengue
Vikas Mishra, Rishit Harbada, Akhilesh Sharma, Meenakshi Mishra
April-June 2015, 4(2):278-279
DOI:10.4103/2249-4863.154676  PMID:25949983
Dengue infection is the leading cause of illness and death in tropical and subtropical regions of the world. The common complications associated with dengue fever are usual hematological abnormalities, shock, and organ failure. The neurological complications of dengue are uncommon. However, evidence of dengue virus neurotropism and complications has been slowly but surely rising as seen from increased literature on this subject over the last decade. We report an uncommon case of hypokalemic quadriparesis with dengue that had a favorable outcome.
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EVIDENCE BASED SUMMARY
Is intermittent short-course anti-TB regimen as efficient and safe as daily anti-TB regimen for treating childhood TB?
Soumyadeep Bhaumik
April-June 2015, 4(2):182-183
DOI:10.4103/2249-4863.154626  PMID:25949963
Childhood tuberculosis (TB) is a common clinical condition in low- and middle-income nations like India where TB is endemic. Different guidelines vary in the recommendations on treatment regimes for childhood TB. Apart from clinical outcomes the decision to use one regimen over another also has an implication in the form of health system burden. The evidence summary presents the comparison between the intermittent regimens with the daily anti-TB regimen for childhood TB.
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FAMILY MEDICINE EDUCATION
Training medical students in general practice: a qualitative study among general practitioner trainers in Sri Lanka
R.P.J.C. Ramanayake, A.H.W. De Silva, DP Perera, R.D.N. Sumanasekera, L.A.C.L. Athukorala, K.A.T. Fernando
April-June 2015, 4(2):168-173
DOI:10.4103/2249-4863.154623  PMID:25949960
Introduction: Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students. Methodology: This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified. Results: Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge. Conclusions: GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.
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LETTERS TO EDITOR
A comment on the drug utilization pattern in chronic obstructive pulmonary disease
Renu Chauhan
April-June 2015, 4(2):288-288
DOI:10.4103/2249-4863.154681  PMID:25949987
  - 2,137 133
Author reply: comment on the drug utilization pattern in chronic obstructive pulmonary disease
Sajesh Kalkandi Veettil, Kingston Rajiah, BR Suresh Kumar
April-June 2015, 4(2):289-289
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ORIGINAL ARTICLES
A retrospective non-comparative analysis of the quality of care for osteoarthritis at the general out-patient department of Jos University Teaching Hospital, Nigeria
Festus E Osajie, Kenneth Yakubu
April-June 2015, 4(2):217-220
DOI:10.4103/2249-4863.154648  PMID:25949970
Background: Osteoarthritis is a common condition in primary care and is often associated with disability and limitation of function requiring holistic care. Aim: The aim of this audit was to assess the quality of care provided by family physicians in the management of osteoarthritis at the General Out-patient Department (GOPD) of Jos University Teaching Hospital (JUTH) as well as ascertain if such care was in line with evidence-based medicine. Methods: This was a retrospective noncomparative study. The recommendations of the Nigerian Standard Treatment Guidelines 2008 and the National Institute for Health and Care Excellence 2014 guidelines were used to form standard targets for each of the structural, process and outcome components of the care process. Each of the consultation rooms was inspected for the structure components of the care process. For the process and outcome components of care, the medical records of all patients being managed for osteoarthritis at the GOPD of JUTH over a 1-year period were retrieved and studied. Results: For one aspect of the structural component (i.e. availability of weighing scale for each consultation room), 80% of the standard target was met which was below the standard target of 100%. The highest performance under the process component was for the documentation of risk associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and documentation for NSAID/cyclooxygenase-2 inhibitors use with a gastro-protective agent. For both of these, 22.4% of the standard target was met; less than the standard target of 100% and 80% respectively. None of the standard targets for the outcome component were met. Conclusion: The quality of care for patients with osteoarthritis in this practice setting was sub-optimal. More can be done by family physicians with regards provision of comprehensive care for patients suffering from osteoarthritis.
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SYSTEMATIC REVIEW
Intrauterine device survival in Iranian women: systematic review and meta-analysis
Ziba Farajzadegan, Narges Motamedi, Rasool Nouri, Maryam Kheyri
April-June 2015, 4(2):203-207
DOI:10.4103/2249-4863.154634  PMID:25949968
Introduction: The intrauterine device (IUD) is one of the modern contraception methods that is reversible, safe, effective, and with long-term efficacy. The problem of using this method is early discontinuation. The survival of the IUD use has been reported differently in different studies. In this meta-analysis, we estimated average time of surviving in Iranian women. Materials and Methods: We evaluated the incident of IUD removed in the Iranian women with a broad systematic review of the literature regarding MOOSES criteria. ISI, Scopus, Medline, WHO, Cochrane, Web of Science, Biological abstracts, Google Scholar and DARE and Iran Medex, SID, Magiran and IranDoc were searched. We defined inclusion and exclusion criteria for selection of articles. All chosen articles were appraised using Critical Appraisal Skills Programme checklist. Data were extracted regarding prepared sheets. We used a Cochrane Q-test with a significance <0.1 for checking of heterogeneity of results. We defined I 2 = 50-75% as a medium heterogeneity and I 2 >75% as high heterogeneity. We applied both fix and random effect model by comprehensive meta-analysis software. Results: A total of 14 articles was included in the systematic review. These were obtained from screening 63 potentially relevant citations and reviewing 17 full-text study articles. One-year survival of IUD, for the random effects model was 78.4% (69.8-85.1%). Three-year survival for the random effects model was 69.4% (53.3-81.9%). Five years for the random effects model was 49.7% (36-63.4%). Conclusion: Above half of Iranian IUD users discontinued it within 5 years after insertion, it means half of IUD expected lifetime was used and make additional costs to the state and the consumer. To reduce these costs, it is recommended for Iranian women to use the IUD with 5-year survival, and they should be consulted before insertion.
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Effect of practice management softwares among physicians of developing countries with special reference to Indian scenario by Mixed Method Technique
Sanjeev Davey, Anuradha Davey
April-June 2015, 4(2):208-216
DOI:10.4103/2249-4863.154637  PMID:25949969
Introduction: Currently, many cheaper "practice management software" (PMS) are available in developing countries including India; despite their availability and benefits, its penetration and usage vary from low to moderate level, justifying the importance of this study area. Materials and Methods : First preferred reporting items for systematic-review and meta-analysis (2009) guidelines were considered; followed by an extensive systematic-review of available studies in literature related to developing countries, on key search term from main abstracting databases: PubMed, EMBASE, EBSCO, BIO-MED Central, Cochrane Library, world CAT-library till 15 June 2014; where any kind of article whether published or unpublished, in any sort or form or any language indicating the software usage were included. Thereafter, meta-analysis on Indian studies revealing the magnitude of usage in Indian scenario by Open Meta-(analyst) software using binary random effects (REs) model was done. Studies from developed countries were excluded in our study. Results : Of 57 studies included in a systematic review from developing countries, only 4 Indian studies were found eligible for meta-analysis. RE model revealed although not-significant results (total participants = 243,526; range: 100-226,228, overall odds ratio = 2.85, 95% confidence interval = P < 0.05 and tests for heterogeneity: Q [df = 3] = 0.8 Het. P = 0.85). The overall magnitude of usage of PMS on Indian physicians practice was however found between 10% and 45%. Conclusion : Although variable and nonsignificant effect of usage of PM software on practice of physicians in developing countries like India was found; there is a need to recognize the hidden potential of this system. Hence, more in-depth research in future needs to be done, in order to find a real impact of this system.
  - 2,738 154
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