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   2015| October-December  | Volume 4 | Issue 4  
    Online since January 18, 2016

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Diagnosis and management of preeclampsia in community settings in low and middle-income countries
Rehana A Salam, Jai K Das, Anum Ali, Soumyadeep Bhaumik, Zohra S Lassi
October-December 2015, 4(4):501-506
DOI:10.4103/2249-4863.174265  PMID:26985406
Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these issues with special considerations and to challenges faced in low and middle-income countries. There is a need to focus on low-cost screening and interventions in the community to achieve a significant impact on preventable maternal and fetal mortality in order to control the burden of preeclampsia significantly as well as investing on more research at primary care level to improve the evidence base for community-level interventions.
  12 4,170 772
Depression and anxiety among middle-aged women: A community-based study
Priya Bansal, Anurag Chaudhary, RK Soni, Sarit Sharma, Vikram Kumar Gupta, Pushapindra Kaushal
October-December 2015, 4(4):576-581
DOI:10.4103/2249-4863.174297  PMID:26985419
Background: Anxiety and depressive disorders constitute a substantial proportion of the global burden of disease and are projected to form the second most common cause of disability by 2020. Objective: To assess the level of depression and anxiety among middle age women and the possible factors behind it. Materials and Methods: A total of 180 women aged 40-60 years were selected by proportionate sampling technique. Age, education, marital status, socioeconomic status, age at marriage, age at menopause, weight and height were noted. Zung-self-rating scales were used for calculating levels of depression and anxiety in these women. The data were analyzed by using statistical software SPSS. Results: The level of syndromal depression and anxiety was found to be 86.7% and 88.9%, respectively. Most of the subjects had the moderate type of depression (49.5%) followed by mild (29.4%) and severe depression (7.8%). While in case of anxiety, most of the subjects (69.4%) had a mild form of anxiety and 17.8% had moderate anxiety level. A significant difference was observed in the level of depression with respect to marital status (P = 0.009) and in the level of anxiety with respect to age (P = 0.021) in the study subjects. On applying logistic regression, none of the factors studied were found to be significant variables for anxiety or depression in the study population. Conclusion: Depression and anxiety are prevalent among the middle-aged women in rural Punjab. Provision of mental health services in this group is essential.
  10 3,276 500
Musculoskeletal disorders among municipal solid waste workers in India: A cross-sectional risk assessment
Endreddy Manikanta Reddy, Sandul Yasobant
October-December 2015, 4(4):519-524
DOI:10.4103/2249-4863.174270  PMID:26985409
Background: Waste management is a necessary activity around the world, but involves a variety of health hazards. In a developing country like India, municipal solid waste is collected manually requiring heavy physical activity. Among all occupational health issues, musculoskeletal problems are common among waste collectors in the form of nonfatal injuries because of the presence of such risk factors (lifting, carrying, pulling, and pushing). We have thus conducted this study to evaluate musculoskeletal disorders (MSDs) among municipal solid waste (MSW) workers. Methodology: A cross-sectional study using probability proportionate to size sampling, recruited 220 MSW workers from the Chennai Municipal Corporation, India for this study. A pretested validated questionnaire has been used to collect data on demographic and occupational history and information on musculoskeletal pain. Data analysis was performed using R software (3.0.1 version). Results: 70% of the participants reported that they had been troubled with musculoskeletal pain in one or more of the 9 defined body regions during the last 12 months, whereas 91.8% had pain during the last 7 days. Higher prevalence of symptoms in knees, shoulders, and lower back was found to be 84.5%, 74.5%, and 50.9% respectively. Female illiterate workers with lower socioeconomic status were found to have higher odds for MSDs. Similarly, higher body mass index having no physical activity increases the chance of odds having MSDs. Conclusion: The higher percentage of musculoskeletal symptoms among MSW workers could be attributed to the long duration of employment, the low job control, and the nature of their job, which is physically demanding. A workplace of health promotion model integration can minimize the reported high prevalence, and a prospective cohort study could be recommended further.
  9 2,926 417
Epidemiological predictors of metabolic syndrome in urban West Bengal, India
Sasthi Narayan Chakraborty, Sunetra Kaviraj Roy, Md Abdur Rahaman
October-December 2015, 4(4):535-538
DOI:10.4103/2249-4863.174279  PMID:26985412
Introduction: Metabolic syndrome is one of the emerging health problems of the world. Its prevalence is high in urban areas. Though pathogenesis is complex, but the interaction of obesity, sedentary lifestyle, dietary, and genetic factors are known as contributing factors. Community-based studies were very few to find out the prevalence or predictors of the syndrome. Objectives: To ascertain the prevalence and epidemiological predictors of metabolic syndrome. Materials and Methods: A total of 690 study subjects were chosen by 30 clusters random sampling method from 43 wards of Durgapur city. Data were analyzed in SPSS version 20 software and binary logistic regression was done to find out statistical significance of the predictors. Results: Among 32.75% of the study population was diagnosed as metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III definition with a modification for Asia Pacific cut-off of waist circumference. Odds were more among females (2.43), upper social class (14.89), sedentary lifestyle (17.00), and positive family history. Conclusion: The overall prevalence of metabolic syndrome was high in urban areas of Durgapur. Increased age, female gender, higher social status, sedentary lifestyle, positive family history, and higher education were the statistically significant predictors of metabolic syndrome.
  7 1,962 301
"Health system approach" for improving immunization program performance
Chandrakant Lahariya
October-December 2015, 4(4):487-494
DOI:10.4103/2249-4863.174263  PMID:26985404
Immunization programs are one of the most well-recognized and successful public health programs across the world. The immunization programs have achieved significant successes in a number of countries; however, the coverage with available vaccines remains sub-optimal in many low- and middle-income countries (LMICs). This article, based upon extensive review of literature and using universal immunization program (UIP) in India as a case study, summarizes the latest developments and initiatives in the area of vaccination and immunization in the last few years. The article analyzes initiatives under UIP in India from the "health system approach" and argues that it is possible to increase coverage with available vaccines and overall program performance by focused attention on various functions of health systems. It also discusses the emerging evidence that health systems could be strengthened prior to the introduction of new interventions (vaccines included) and the introduction of new interventions (including vaccines) could be planned in a way to strengthen the health systems. It concludes that immunization programs could be one of the entry points for strengthening health systems in the countries and lessons from vaccine introduction could pave pathway for scaling up other health interventions and therefore, could contribute to advancing Universal Health Coverage (UHC).
  6 2,860 1,521
Physician's self-perceived abilities at primary care settings in Indonesia
Wahyudi Istiono, Mora Claramita, Fitriana Murriya Ekawati, Aghnaa Gayatri, Adi Heru Sutomo, Hari Kusnanto, Mark Alan Graber
October-December 2015, 4(4):551-558
DOI:10.4103/2249-4863.174286  PMID:26985415
Background: Southeast Asian countries with better-skilled primary care physicians have been shown to have better health outcomes. However, in Indonesia, there has been a large number of inappropriate referrals, leading to suboptimal health outcomes. This study aimed to examine the reasons underlying the unnecessary referrals as related to Indonesian physicians' standard of abilities. Materials and Methods: This was a multiple-case study that explored physicians' self-evaluation of their abilities. Self-evaluation questionnaires were constructed from the Indonesian Standards of Physicians Competences of 2006-2012 (ISPC), which is a list of 155 diseases. This study was undertaken in three cities, three towns, and one "border-less developed" area during 2011-2014. The study involved 184 physicians in those seven districts. Data were collected using one-on-one, in-depth interviews, focus group discussions (FGDs), and clinical observations. Results: This study found that primary care physicians in Indonesia felt that they were competent to handle less than one-third of "typical" primary care cases. The reasons were limited understanding of person-centered care principles and limited  patient care services to diagnosis and treatment of common biomedical problems. Additionally, physical facilities in primary care settings are lacking. Discussions and Conclusions: Strengthening primary health care in Indonesia requires upscaling doctors' abilities in managing health problems through more structured graduate education in family medicine, which emphasizes the bio-psycho-socio-cultural background of persons; secondly, standardizing primary care facilities to support physicians' performance is critical. Finally, a strong national health policy that recognizes the essential role of primary care physicians in health outcomes is an urgent need.
  5 1,811 227
Family medicine education in India: A panoramic view
Sanghamitra Pati, Anjali Sharma, Sandipana Pati, Sanjay Zodpey
October-December 2015, 4(4):495-500
DOI:10.4103/2249-4863.174264  PMID:26985405
Introduction: In the recent years, there has been renewed interest in strengthening primary care for improved health services delivery. Family medicine with its holistic principles is an effective approach for building primary care workforce in resource constraint settings. Even though this discipline is well established and mainstreamed in Western countries, the same is yet to occur in low- and middle-income nations. India with its paradigm shift for universal health coverage is strategically poised to embrace family medicine as a core component of its health system. However, till date, a clear picture of family medicine teaching across the country is yet to be available. Methods: This paper makes an attempt to assess the landscape of family medicine teaching in India with an aim to contribute to a framework for bolstering its teaching and practice in coming years. The objective was to obtain relevant information through a detailed scan of the health professional curricula as well as mapping independent academic programs. Specific areas of interest included course content, structure, eligibility criteria, and accreditation. Results: Our findings indicate that teaching of family medicine is still in infancy in India and yet to be mainstreamed in health professional education. There are variations in family medicine teaching across academic programs. Conclusion: It is suggested that both medical and nursing colleges should develop dedicated Departments of Family Medicine for both undergraduate and postgraduate teaching. Further, more number of standalone diploma courses adopting blended learning methods should be made available for in-service practitioners.
  4 3,613 542
A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome
Mihir D Mehta, Simbita A Marwah, S Ghosh, Hitesh N Shah, Amit P Trivedi, N Haridas
October-December 2015, 4(4):570-575
DOI:10.4103/2249-4863.174295  PMID:26985418
Aim: The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS). Materials and Methods: This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals. Results: Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96-111.70] vs. 41.11 [95% CI: 38.55-43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2-99.5), 61.3% (95% CI: 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0-6 h were 0.932 (95% CI: 0.87-0.97, P < 0.001) and 0.797 (95% CI: 0.71-0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively. Conclusion: hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.
  4 1,761 302
Identifying gaps in research prioritization: The global burden of neglected tropical diseases as reflected in the Cochrane database of systematic reviews
Soumyadeep Bhaumik, Chante Karimkhani, Christopher A Czaja, Hywel C Williams, Monica Rani, Mona Nasser, Lindsay N Boyers, Sergei Dmitruk, Robert P Dellavalle
October-December 2015, 4(4):507-513
DOI:10.4103/2249-4863.174266  PMID:26985407
Background: Neglected tropical diseases (NTDs) impact disadvantaged populations in resource-scarce settings. Availability of synthesized evidence is paramount to end this disparity. The aim of the study was to determine whether NTD systematic reviews or protocols in the Cochrane Database of Systematic Reviews (CDSR) reflect disease burden. Methods: Two authors independently searched the CDSR for reviews/protocols regarding the NTDs diseases. Each review or protocol was classified to a single NTD category. Any discrepancy was solved by consensus with third author. NTD systematic review or protocol from CDSR were matched with disability-adjusted life year (DALY) metrics from the Global Burden of Disease 2010 Study. Spearman's rank correlation coefficient and associated P values were used to assess for correlation between the number of systematic reviews and protocols and the %2010 DALY associated with each NTD. Results: Overall, there was poor correlation between CDSR representation and DALYs. Yellow fever, echinococcus, onchocerciasis, and schistosomiasis representation was well-aligned with DALY. Leprosy, trachoma, dengue, leishmaniasis, and Chagas disease representation was greater, while cysticercosis, human African trypanosomiasis, ascariasis, lymphatic filariasis, and hookworm representation was lower than DALY. Three of the 18 NTDs had reviews/protocols of diagnostic test accuracy. Conclusions: Our results indicate the need for increased prioritization of systematic reviews on NTDs, particularly diagnostic test accuracy reviews.
  3 2,225 411
Knowledge of hand hygiene in undergraduate medical, dental, and nursing students: A cross-sectional survey
Vaishnavi S Thakker, Pradeep R Jadhav
October-December 2015, 4(4):582-586
DOI:10.4103/2249-4863.174298  PMID:26985420
Background: Hand hygiene is of paramount importance for the prevention of healthcare associated infections and the spread of antimicrobial resistance. There is a need to explore the concept of hand hygiene among the cross-disciplinary undergraduate healthcare students. Aim: To evaluate and compare the knowledge of hand hygiene among medical, dental, and nursing undergraduate students. Materials and Methods: A cross-sectional survey was conducted among 84 medical, 74 dental, and 40 nursing undergraduate students in a Tertiary Care Teaching Institute in Navi Mumbai, Maharashtra, India. Knowledge was assessed using the World Health Organization hand hygiene questionnaire. The scores for each were calculated and compared. The scores were further graded as low, moderate, and good. Results: Overall, only 7.5% of the participants had good knowledge regarding hand hygiene while majority (69.1%) had moderate knowledge. Medical students' hand hygiene knowledge was significantly (P < 0.01) higher than that of dental and nursing students. Conclusion: The overall low scores on hand hygiene knowledge indicate that undergraduate healthcare students require increased emphasis on hand hygiene education, behavior, and improvement in their current primary training as well as undergraduate curricula.
  3 3,576 668
Seatbelt submarining injury and its prevention countermeasures: How a cantilever seat pan structure exacerbate submarining
Chandrashekhar K Thorbole
October-December 2015, 4(4):587-590
DOI:10.4103/2249-4863.174299  PMID:26985421
The purpose of this study and a case report was to demonstrate seat belt webbing induced injury due to seatbelt submarining during the frontal motor vehicle crash. Submarining is an undesired phenomenon during a frontal crash scenario and is dependent on design features of the seat pan and seatbelt system. The lack of adequate anti-submarining features at any seating position with three-point restraint can cause abdominal solid and hollow organ injuries. This paper reports a case of submarining and factors that exacerbated this phenomenon leading to critical occupant abdominal injury. This case report and the following injury causation analysis demonstrate the shortcomings of a cantilever seat pan design in context to the occupant safety. The inadequate seat pan anti-submarining feature in association with lack of seatbelt load-limiter and Pretensioner reduces the level of occupant protection offered by the seat belt system in the rear seat. This case report shows the dangers of cantilever seat pan design and its association with increased risk of submarining causing severe abdominal injuries.
  2 1,795 219
System level approaches for mainstreaming tobacco control into existing health programs in India: Perspectives from the field
Rajmohan Panda, Swati Srivastava, Divya Persai, Emily Mendenhall, Monika Arora, Manu Raj Mathur
October-December 2015, 4(4):559-565
DOI:10.4103/2249-4863.174288  PMID:26985416
Introduction: India is the second largest consumer of tobacco in the world, and varieties of both smoked and smokeless tobacco products are widely available. The national program for tobacco control is run like a vertical stand-alone program. There is a lack of understanding of existing opportunities and barriers within the health programs that influence the integration of tobacco control messages into them. The present formative research identifies such opportunities and barriers. Methods: We conducted a multi-step, mixed methodological study of primary care personnel and policy-makers in two Indian states of Andhra Pradesh and Gujarat. The primary purpose of our study was to investigate health worker and policy-maker perceptions on the integration of tobacco control intervention. We systematically collected data in three steps: In Step I, we conducted in-depth interviews (IDIs) and focus group discussions with primary care health personnel, Step II consists of a quantitative survey among health care providers (n = 1457) to test knowledge, attitudes and practices in tobacco control and Step III we conducted 75 IDIs with program heads and policy-makers to evaluate the relative congruence of their views on integration of the tobacco control program. Results: Majority of the health care providers recognized tobacco use as a major health problem. There was a general consensus for the need of training for effective dissemination of information from health care providers to patients. Almost 92% of the respondents opined that integration of tobacco control with other health programs will be highly effective to downscale the tobacco epidemic. Conclusions: Our findings suggest the need for integration of tobacco control program into existing health programs. Integration of tobacco control strategies into the health care system within primary and secondary care will be more effective and counseling for tobacco cessation should be available for population at large.
  2 1,416 167
What are we drinking? Assessment of water quality in an urban city of Punjab, India
Amanjot K Singh, Vikram Kumar Gupta, Bhuvan Sharma, Bhavna Singla, Paramjeet Kaur, Geeta Walia
October-December 2015, 4(4):514-518
DOI:10.4103/2249-4863.174267  PMID:26985408
Introduction: Ground water is the ultimate and most suitable fresh water resource for human consumption in the urban areas of India. Studies regarding ground water quality have shown that the higher rate of exploration as compared to the rate of recharging, inappropriate dumping of solid, as well as liquid waste, lack of strict enforcement of law has led to the deterioration of ground water quality. The present study was thus, carried out to evaluate physicochemical, as well as a microbiological profile of tap water, and filtered water in urban areas of Patiala, Punjab. Materials and Methods: The three zones under Municipal Corporation and two areas under Public Health Department were chosen according to the simple random sampling from Patiala city. From each area, 10 houses were chosen according to the systematic random sampling technique (n = 50). Water was taken from two sources, tap water, and from the water filter. Two samples were taken from each source one for the physicochemical analysis and another for bacteriological analysis. The samples which were sent for bacteriological assessment were collected in a sterile container. Results: The number of water samples found to be within desirable limits with respect to physicochemical parameters were significantly more with the filter water sample than the tap water samples. Suspicious/unsatisfactory microbiological quality of water was observed in 28% and 4% of tap and filter water samples, respectively. Conclusion: The results indicate that certain chemical parameters such as hardness, chloride, and fluoride levels were beyond the permissible limits. Therefore, we recommend that home filters should be installed, serviced appropriately, and their water quality should be checked routinely. Also, any leak from sewage pipes should be promptly repaired to prevent contamination of drinking water.
  2 2,643 326
Some interesting observations regarding TB patient management from a rural area of Madhya Pradesh: TB case series
Akash Ranjan Singh, Abhijit Pakhare, Ashish Chauhan, Abhishek Singh
October-December 2015, 4(4):591-593
DOI:10.4103/2249-4863.174300  PMID:26985422
Despite many serious efforts, tuberculosis (TB) is still a recognized public health problem. The Government of India has adopted the Directly Observed Treatment, Short-Course (DOTS) strategy for the entire country through the Revised National Tuberculosis Control Programme (RNTCP) for the treatment of TB. In this report, we have presented the trajectories for care seeking of two TB cases who suffered from either "patient level delays" or "health system-related delays" in seeking DOTS for the treatment of TB.
  1 1,550 138
Spontaneous puerperal extraperitoneal bladder wall rupture in young woman with diagnostic dilemma
Debabrat Kumar Sabat, Pradeep Kumar Panigrahi, Ranjan Kumar Sahoo, Mousumi Acharya, Mahesh Ch Sahu
October-December 2015, 4(4):601-603
DOI:10.4103/2249-4863.174329  PMID:26985426
A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.
  1 1,873 175
Healthcare is primary
Raman Kumar
October-December 2015, 4(4):479-482
DOI:10.4103/2249-4863.174262  PMID:26985402
India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.
  1 3,640 9,413
Same day sputum smear microscopy for the diagnosis of pulmonary tuberculosis: Ziehl-Neelsen versus fluorescent staining
T Jaya Chandra, R Selvaraj, YV Sharma
October-December 2015, 4(4):525-528
DOI:10.4103/2249-4863.174273  PMID:26985410
Background: Sputum smear microscopy is the main tool for the diagnosis of pulmonary tuberculosis (TB), especially in low- and middle-income countries (LMICs). Limited sensitivity of smear microscopy and patient dropouts (PDs) are the important obstacles of national TB control programs. Objectives: (1) To assess the diagnostic utility of the same day (SS2) approach (2) To compare the smear results of the spot morning (SM) and the SS2 approaches. Materials and Methods: The study was conducted in the Department of Microbiology, GSL Medical College, Rajahmundry, Andhra Pradesh, India from January 2011 to February 2015. Three sputum samples were collected [spot (S), second spot (S2) 1 h after S, and morning sample (M)] from the volunteers. The sputum smears were stained by Ziehl-Neelsen (ZN), modified ZN (MZN), and fluorescent staining (FS) techniques and the results were pooled and compared under SM and SS2 approaches. Results: Of the 3,186 study participants, sputum smear positivity (SSP) for SM approach was 9.6% and 10.8% and for SS2 approach, it was 9.4% and 10.6%, respectively, with ZN and FS and the results were statistically insignificant (Mann-Whitney U test, P > 0.05). Conclusion: Technically SSP was similar for both the approaches and no improvement was observed with the SS2 approach. Hence, there is an urgent need to improve SSP.
  1 1,691 253
A retrospective review of 911 calls to a regional poison control center
Adam Bosak, Daniel E Brooks, Sharyn Welch, Angie Padilla-Jones, Richard D Gerkin
October-December 2015, 4(4):546-550
DOI:10.4103/2249-4863.174285  PMID:26985414
Background: There is little data as to what extent national Emergency Medical Services (EMS; 911) utilize poison control centers (PCCs). A review of data from our PCC was done to better understand this relationship and to identify potential improvements in patient care and health care savings. Methods: Retrospective chart review of a single PCC to identify calls originating from 911 sources over a 4-year study period (1/1/08-12/31/11). Recorded variables included the origin of call to the PCC, intent of exposure, symptoms, management site, hospital admission, and death. Odds ratios (OR) were developed using multiple logistic regressions to identify risk factors for EMS dispatch, management site, and the need for hospital admission. Results: A total of 7556 charts were identified; 4382 (58%) met inclusion criteria. Most calls (63.3%) involved accidental exposures and 31% were self-harm or misuse. A total of 2517 (57.4%) patients had symptoms and 2044 (50.8%) were transported to an Emergency Department (ED). Over 38% of calls (n = 1696) were handled primarily by the PCC and did not result in EMS dispatch; only 6.5% of cases (n = 287) with initial PCC involvement resulted in crew dispatch. There were 955 (21.8%) cases that resulted in admission, and five deaths. The OR for being transported to an ED was 45.4 (95% confidence interval [CI]: 30.2-68.4) when the crew was dispatched by the PCC. Hospital admission was predicted by intent for self-harm (OR 5.0; 95% CI: 4.1-6.2) and the presence of symptoms (OR 2.43; 95% CI: 1.9-3.0). The ORs for several other predictive variables are also reported. Conclusions: When 911 providers contact a PCC about poisoning-related emergencies, a history of intentional exposure and the presence of symptoms each predicted EMS dispatch by the PCC, patient transport to an ED, and hospital admission. Early involvement of a PCC may prevent the need for EMS activation or patient transfer to a health care facility.
  1 1,432 170
Concurrent meningitis and vivax malaria
Tuhin Santra, Sumana Datta, Neha Agrawal, Mita Bar, Arnab Kar, Apu Adhikary, Kunal Ranjan
October-December 2015, 4(4):594-595
DOI:10.4103/2249-4863.174301  PMID:26985423
Malaria is an endemic infectious disease in India. It is often associated with other infective conditions but concomitant infection of malaria and meningitis are uncommon. We present a case of meningitis with vivax malaria infection in a 24-year-old lady. This case emphasizes the importance of high index of clinical suspicion to detect other infective conditions like meningitis when fever does not improve even after anti-malarial treatment in a patient of malaria before switching therapy suspecting drug resistance, which is quite common in this part of world.
  - 1,388 151
Immune reconstitution syndrome in a human immunodeficiency virus infected child due to giardiasis leading to shock
Sneha Nandy, Ira Shah
October-December 2015, 4(4):596-597
DOI:10.4103/2249-4863.174302  PMID:26985424
Human immunodeficiency virus (HIV)-associated immune reconstitution inflammatory syndrome has been reported in association with tuberculosis, herpes zoster (shingles), Cryptococcus neoformans, Kaposi's sarcoma, Pneumocystis pneumonia, hepatitis B virus, hepatitis C virus, herpes simplex virus, Histoplasma capsulatum, human papillomavirus, and Cytomegalovirus. However, it has never been documented with giardiasis. We present a 7-year-old HIV infected girl who developed diarrhea and shock following the initiation of antiretroviral therapy, and her stool showed the presence of giardiasis.
  - 1,510 192
An undiagnosed cause of chronic cough
Ketan Malvi, Arjun Padmanabhan, TA Hari
October-December 2015, 4(4):598-600
DOI:10.4103/2249-4863.174303  PMID:26985425
Tracheomalacia (TM) refers to loss of tracheal rigidity and resulting susceptibility to collapse. It is usually an incidental finding during investigations of other illness. The main symptoms are dyspnoea, cough, sputum production and hemoptysis. Most cases are considered as respiratory infection and are treated symptomatically. Acquired TM results from damage to trachea due to various conditions such as inflammation, chronic pressure, or medical/surgical procedures. The diagnosis is done by end-expiratory dynamic tracheal imaging, which demonstrates typical crescentric narrowing of trachea and reduced antero-posterior diameter <50% of normal. Management include conservative measures like cough suppressants or surgical measures like tracheoplasty, stenting or surgical repair. We are reporting a case of chronic cough, which was subsequently diagnosed as TM.
  - 1,599 204
Challenges of parents having developmentally challenged children: An intervention approach using acceptance and commitment therapy
Shuvabrata Poddar, VK Sinha, Urbi Mukherjee
October-December 2015, 4(4):604-605
DOI:10.4103/2249-4863.174330  PMID:26985427
  - 1,376 191
Why do some parents prefer private vaccine providers in urban area?
Satyajit Pattnaik, Kokila Selvaraj, GH Midhun Kumar, R Elango
October-December 2015, 4(4):606-607
DOI:10.4103/2249-4863.174331  PMID:26985428
  - 1,400 162
Modified measles versus rubella versus atypical measles: One and same thing
Surender Nikhil Gupta, Naveen Gupta, Shivani Gupta
October-December 2015, 4(4):566-569
DOI:10.4103/2249-4863.174290  PMID:26985417
Introduction: In outbreak settings, more than one virus may be infecting the given population. In twin or triple outbreak of measles, German measles (rubella), and varicella in highly immunized hilly areas, maximal number of the case patients in all the hilly villages belonged to the older age group. It suggested an obvious shift to the higher age group, warranting second dose opportunity in such case scenario. The clinical presentations of viral diseases are too similar to differentiate. The aim is to clearly categorize the case patients of modified measles, rubella, and atypical measles in outbreak settings. Results: Four outbreaks are listed. In the first one, sixty case patients were identified from 1026 people in 5 villages. Of these, 41 were diagnosed by clinically, 8 were laboratory confirmed as measles and 11 were epidemiologically linked German measles case patients. Seventy percent of the cases were vaccinated for measles. In second case, we identified 29/35 measles and 6/35 were confirmed as epidemiologically linked unvaccinated chickenpox case patients. In third one, we identified 116 cases in eight villages (112/116 clinically and 04/116 laboratory confirmed). Majority of cases were immunized against measles, but only minor cases for rubella. In fourth case, we identified 505 case patients from mixed outbreaks of varicella, measles and rubella (30/505 clinically, 467/505 epidemiologically linked and 8/505 laboratory confirmed case patients from a study population of 3280). In all the four outbreaks, prima facie, the clinical presentations of both rubella and modified measles were difficult to differentiate. Discussion: On the basis of outbreak investigation and analytical inference, it has been observed that the symtomatology of modified measles and laboratory confirmed rubella case patients/epidemiologically linked cases are so similar placed that many a time, it becomes much difficult to line list the cases in one section of modified measles or rubella or atypical cases. Conclusion: Similarities of morphological symptoms between modified measles and rubella is the point of challenge and it causes debate between pediatrician and field epidemiologist to differentiate and classify them.
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Process evaluation of community monitoring under national health mission at Chandigarh, union territory: Methodology and challenges
Jaya Prasad Tripathy, Arun Kumar Aggarwal, Binod Kumar Patro, Himbala Verma
October-December 2015, 4(4):539-545
DOI:10.4103/2249-4863.174282  PMID:26985413
Background: Community monitoring was introduced on a pilot mode in 36 selected districts of India in a phased manner. In Chandigarh, it was introduced in the year 2009-2010. A preliminary evaluation of the program was undertaken with special emphasis on the inputs and the processes. Methodology: Quantitative methods included verification against checklists and record reviews. Nonparticipant observation was used to evaluate the conduct of trainings, interviews, and group discussions. Health system had trained health system functionaries (nursing students and Village Health Sanitation Committee [VHSC] members) to generate village-based scorecards for assessing community needs. Community needs were assessed independently for two villages under the study area to validate the scores generated by the health system. Results: VHSCs were formed in all 22 villages but without a chairperson or convener. The involvement of VHSC members in the community monitoring process was minimal. The conduct of group discussions was below par due to poor moderation and unequal responses from the group. The community monitoring committees at the state level had limited representation from the non-health sector, lower committees, and the nongovernmental organizations/civil societies. Agreement between the report cards generated by the investigator and the health system in the selected villages was found to be to be fair (0.369) whereas weighted kappa (0.504) was moderate. Conclusion: In spite of all these limitations and challenges, the government has taken a valiant step by trying to involve the community in the monitoring of health services. The dynamic nature of the community warrants incorporation of an evaluation framework into the planning of such programs.
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Patient safety in maternal healthcare at secondary and tertiary level facilities in Delhi, India
Chandrakant Lahariya, Ankita Choure, Baljit Singh
October-December 2015, 4(4):529-534
DOI:10.4103/2249-4863.174276  PMID:26985411
Background: There is insufficient information on causes of unsafe care at facility levels in India. This study was conducted to understand the challenges in government hospitals in ensuring patient safety and to propose solutions to improve patient care. Materials and Methods: Desk review, in-depth interviews, and focused group discussions were conducted between January and March 2014. Healthcare providers and nodal persons for patient safety in Gynecology and Obstetrics Departments of government health facilities from Delhi state of India were included. Data were analyzed using qualitative research methods and presented adopting the "health system approach." Results: The patient safety was a major concern among healthcare providers. The key challenges identified were scarcity of resources, overcrowding at health facilities, poor communications, patient handovers, delay in referrals, and the limited continuity of care. Systematic attention on the training of care providers involved in service delivery, prescription audits, peer reviews, facility level capacity building plan, additional financial resources, leadership by institutional heads and policy makers were suggested as possible solutions. Conclusions: There is increasing awareness and understanding about challenges in patient safety. The available local information could be used for selection, designing, and implementation of measures to improve patient safety at facility levels. A systematic and sustained approach with attention on all functions of health systems could be beneficial. Patient safety could be used as an entry point to improve the quality of health care services in India.
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The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink
Rakesh Aggarwal, Nithya Gogtay, Rajeev Kumar, Peush Sahni, for the Indian Association of Medical Journal Editors
October-December 2015, 4(4):483-486
DOI:10.4103/2249-4863.174332  PMID:26985403
Note: This editorial is being published simultaneously in the Indian Heart Journal, Indian Journal of Anaesthesia, Indian Journal of Gastroenterology, Indian Journal of Medical Ethics, Indian Journal of Medical Microbiology, Indian Journal of Occupational and Environmental Medicine, Indian Journal of Pathology and Microbiology, Indian Journal of Pharmacology, Indian Journal of Physiology and Pharmacology, Indian Journal of Urology, Indian Pediatrics, International Journal of Health Research & Medicolegal Practice, Journal of Anaesthesiology Clinical Pharmacology, Journal of Ayurveda and Integrative Medicine, Journal of Clinical and Scientific Research, Journal of Conservative Dentistry, Journal of Family Medicine and Primary Care, Journal of Indian Academy of Forensic Medicine, Journal of Mahatma Gandhi Institute of Medical Sciences, Journal of Postgraduate Medicine, National Journal of Integrated Research in Medicine, and The National Medical Journal of India. It may also be published in forthcoming issues of other journals. This editorial is not endorsed by all members of the Indian Association of Medical Journal Editors (IAMJE).
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