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   2016| July-September  | Volume 5 | Issue 3  
    Online since December 30, 2016

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Urinary tract cancers: An overview for general practice
Julian P Yaxley
July-September 2016, 5(3):533-538
DOI:10.4103/2249-4863.197258  PMID:28217578
Urinary tract cancers are common and comprise a gamut of lesions ranging from small benign tumors to aggressive neoplasms with high mortality. The predominant urinary tract malignancy is bladder cancer. The clinical challenge is early detection and adequate follow-up because recurrence is high and delayed diagnosis is associated with poor prognosis. Primary care physicians form a key part of the management apparatus for these patients and may be responsible for ensuring adequate ongoing surveillance. This article aims to outline the evaluation of patients in whom urinary tract cancer is suspected and briefly review the general principles of treatment.
  14 1,805 277
Prevalence of and risk factors for hypertension among urban communities of North Sudan: Detecting a silent killer
Sarra O Bushara, Sufian K Noor, Abd Alaziz H Ibraheem, Wadie M Elmadhoun, Mohamed H Ahmed
July-September 2016, 5(3):605-610
DOI:10.4103/2249-4863.197317  PMID:28217591
Background: Hypertension is a common global health problem in many countries including Sudan. The objective of this study was to determine the prevalence of and risk factors for high blood pressure (BP) in River Nile State (RNS), Sudan. Materials and Methods: A community-based, cross-sectional study was conducted by a house-to-house survey; all consented adults from the main four cities, Atbara, Shendi, Ed Damer, and Berber, were interviewed using standardized pretested questionnaire to record medical history, sociodemographic and lifestyle characteristics. BP was measured using the standardized technique. Body mass index, waist circumference, and blood glucose were also determined. Results: A total of 954 individuals were included in the study. The mean age was 39.5 ± 16.6 years and 54.3% were females. The prevalence of hypertension was 35.7% and the newly diagnosed cases were 22.4%. Increasing age, low educational level, diabetes mellitus, obesity, and central obesity were found to be risk factors for hypertension. Conclusion: Hypertension is diagnosed in more than one-third of the population living in urban communities of RNS and correlates well with features of the metabolic syndrome.
  7 1,681 234
Profile of trauma patients in the emergency department of a tertiary care hospital in South India
Kundavaram Paul Prabhakar Abhilash, Nilanchal Chakraborthy, Gautham Raja Pandian, Vineet Subodh Dhanawade, Thomas Kurien Bhanu, Krishna Priya
July-September 2016, 5(3):558-563
DOI:10.4103/2249-4863.197279  PMID:28217583
Background: Trauma is an increasing cause of morbidity and mortality in India. This study was done to improve the understanding of the mode of trauma, severity of injuries, and outcome of trauma victims in our hospital. Materials and Methods: This was a retrospective observational study of all adult trauma patients more than 18-year-old presenting to our emergency department (ED). Details of the incident, injuries, and outcome were noted. Results: The ED attended to 16,169 patients during the 3-month study period with 10% (1624/16,169) being adult trauma incidents. The gender distribution was 73.6% males and 26.4% females. The mean age was 40.2 ± 16.7 years. The median duration from time of incident to time of arrival to the ED was 3 h (interquartile range [IQR]: 1.5-6.5) for priority one patients, 3 h (IQR: 1.5-7.7) for priority two patients, and 1.5 h (IQR: 1-7) for priority three patients. The average number of trauma incidents increased by 28% during the weekends. Road traffic accident (RTA) (65%) was the most common mode of injury, followed by fall on level ground (13.5%), fall from height (6.3%), work place injuries (6.3%), and others. Traumatic brain injury was seen in 17% of patients while 13.3% had polytrauma with two-wheeler accidents contributing to the majority. The ED team alone managed 23.4% of patients while the remaining 76.6% required evaluation and treatment by the trauma, surgical teams. The in-hospital mortality rate was 2.3%. Multivariate analysis showed low Glasgow coma score (odds ratio [OR]: 0.65, 95% confidence interval [CI]: 0.55-0.76, P < 0.001) and high respiratory rate (OR: 1.15, 95% CI: 1.07-1.24, P < 0.001) to be independent predictors of mortality among polytrauma victims. Conclusions: RTA and falls are the predominant causes of trauma. A simple physiological variable-based scoring system such as the revised trauma score may be used to prioritize patients with polytrauma.
  6 2,328 347
Primary care hypnotic and anxiolytic prescription: Reviewing prescribing practice over 8 years
Lloyd D Hughes, Neil Raitt, Muhammed Awais Riaz, Sarah-Jane Baldwin, Kay Erskine, Gail Graham
July-September 2016, 5(3):652-657
DOI:10.4103/2249-4863.197312  PMID:28217600
Introduction: Over the last few years, hypnotic and anxiolytic medications have had their clinical efficacy questioned in the context of concerns regarding dependence, tolerance alongside other adverse effects. It remains unclear how these concerns have impacted clinical prescribing practice. Materials and Methods: This is a study reviewing community-dispensed prescribing data for patients on the East Practice Medical Center list in Arbroath, Scotland, in 2007, 2011 and 2015. Anxiolytic and hypnotic medications were defined in accordance with the British National Formulary chapter 4.1.1 and chapter 4.1.2. All patients receiving a drug within this class in any of the study years were collated and anonymized using primary care prescribing data. The patients' age, gender, name of the prescribed drug(s), and total number of prescriptions in this class over the year were extracted. Results: The proportion of patients prescribed a benzodiazepine medication decreased between 2007 and 2015: 83.8% (n = 109) in 2007, 70.5% (n = 122) in 2011, and 51.7% (n = 138) in 2015 (P = 0.006). The proportion of these patients prescribed a nonbenzodiazepine drug increased between 2007 and 2015: 30% (n = 39) in 2007, 46.2% (n = 80) in 2011, and 52.4% (n = 140) in 2015 (P = 0.001). There was a significant increase in the number of patients prescribed melatonin (P = 0.020). Discussion: This study reports a reduction in benzodiazepine prescriptions in primary care alongside increases in nonbenzodiazepine and melatonin prescribing, with an increase in prescribing rates of this drug class overall. Conclusion: Changes in this prescribing practice may reflect the medicalization of insomnia, local changes in prescribing practice and alongside national recommendations.
  6 1,458 224
Zika virus: An overview
Gautam Rawal, Sankalp Yadav, Raj Kumar
July-September 2016, 5(3):523-527
DOI:10.4103/2249-4863.197256  PMID:28217576
The Zika virus has been in the news for quite some time due to the ongoing recent outbreak in the Southern America, which started in December 2015. It has been declared a public health emergency by the World Health Organization in February 2016 owing to its association with the congenital deformities, particularly microcephaly in infants borne to the infected mothers. The rapid spread of the virus throughout the United States of America and subsequently to Asia has raised serious international concerns. Its spread to countries neighboring India is a serious threat to the Indian population. This review article gives an overview about the virus, its diagnosis, clinical features, and the management.
  5 2,259 384
Distribution of ABO and Rh types in voluntary Blood donors in Jharkhand area as a study conducted by RIMS, Ranchi
Anu Singh, Ramesh Kumar Srivastava, Kabita S Deogharia, Kranti Kumar Singh
July-September 2016, 5(3):631-636
DOI:10.4103/2249-4863.197319  PMID:28217596
Background: This study was done to know the distribution and frequencies of blood groups among blood donors attending voluntary blood donation camps organized by the Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand so that demand and supply ratio of the four blood groups can be maintained so that no patient dies due to lack of a particular blood group. Context: Up till now about 400 red cells antigen have been identified. The majority follow Mendelian inheritance. The ABO and Rhesus (Rh) blood group system are most important for blood transfusion purposes, parental testing, legal medicine, and in population genetic study. Aims: This study was conducted to determine and compare the frequency and distribution of ABO and Rh blood groups among voluntary blood donors attending blood donation camps in Jharkhand organized by RIMS. The aim is to know the demand and supply ratio of a particular blood group in light of their distribution in the society so that no patient dies due to the deficient supply of blood. Settings and Design: It is a retrospective study carried out at blood bank. Materials and Methods: A study was conducted at Blood bank, RIMS, Ranchi, Jharkhand, over a period of 4 years from January 1, 2012, to December 31, 2015. Blood group of the blood donors was determined by commercially available standard monoclonal antisera by test tube agglutination technique accompanied by reverse grouping. Results: Out of 20,455 subjects, 18,717 (91.73%) were male and 1738 (8.27%) were female subjects. The ABO blood group present was B (35.15%) followed by O (34.73%), A (22.09%), and AB (8.03%) in blood donors while in Rh system, (96.46%) donors were Rh +ve and (3.54%) donors were Rh −ve. The study has a significant implication regarding the inventory management of blood bank and transfusion services for the indoor patients of RIMS and for emergency supply to other hospitals of Jharkhand in dire need of blood. Conclusions: The knowledge of distribution of blood group is very important for blood banks and transfusion services which play an important role in the patient's health care. This study will also throw light on the reasons of deficiency of a particular group in a particular area so that deficient group donors may be encouraged to donate more frequently.
  4 2,258 253
Relationship between attachment styles and happiness in medical students
Marzyeh Moghadam, Farzin Rezaei, Ebrahim Ghaderi, Negar Rostamian
July-September 2016, 5(3):593-599
DOI:10.4103/2249-4863.197314  PMID:28217589
Background: Attachment theory is one of the most important achievements of contemporary psychology. Role of medical students in the community health is important, so we need to know about the situation of happiness and attachment style in these students. Objectives: This study was aimed to assess the relationship between medical students' attachment styles and demographic characteristics. Materials and Methods: This cross-sectional study was conducted on randomly selected students of Medical Sciences in Kurdistan University, in 2012. To collect data, Hazan and Shaver's attachment style measure and the Oxford Happiness Questionnaire were used. The results were analyzed using the  SPSS software version 16 (IBM, Chicago IL, USA) and statistical analysis was performed via t-test, Chi-square test, and multiple regression tests. Results: Secure attachment style was the most common attachment style and the least common was ambivalent attachment style. Avoidant attachment style was more common among single persons than married people (P = 0.03). No significant relationship was observed between attachment style and gender and grade point average of the studied people. The mean happiness score of students was 62.71. In multivariate analysis, the variables of secure attachment style (P = 0.001), male gender (P = 0.005), and scholar achievement (P = 0.047) were associated with higher happiness score. Conclusion: The most common attachment style was secure attachment style, which can be a positive prognostic factor in medical students, helping them to manage stress. Higher frequency of avoidant attachment style among single persons, compared with married people, is mainly due to their negative attitude toward others and failure to establish and maintain relationships with others.
  3 1,939 345
Health worker posting and transfer at primary level in Tamil Nadu: Governance of a complex health system function
Surekha Garimella, Kabir Sheikh
July-September 2016, 5(3):663-671
DOI:10.4103/2249-4863.197310  PMID:28217602
Background: Posting and transfer (PT) of health personnel - placing the right health workers in the right place at the right time - is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation. Objective: To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level. Methodology: We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through 'counselling' of health workers (individualized consultations to determine postings and transfers). Results: PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system. Conclusions: For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the public, but rather are intertwined within the complexities of delivery of a public service. This complexity blurs conventional boundaries of private and public ownership and behaviour, and raises critical questions for the interpretation of coordinated governance. Hence, the imperative of enforcing rules may need to be complemented with bottom-up policy approaches, including treating PT not merely as system dysfunction, but also as a potential instrument of governance innovations, procedural justice and the accountability of health services to communities they seek to serve.
  3 1,739 155
Occult endocrine dysfunction in patients with cirrhosis of liver
K. V. S Hari Kumar, AK Pawah, Manish Manrai
July-September 2016, 5(3):576-580
DOI:10.4103/2249-4863.197293  PMID:28217586
Background: Liver dysfunction leads to endocrine disturbance due to the alteration in protein metabolism or synthesis. We studied the presence of occult endocrine dysfunction in liver cirrhosis and compared the same with underlying etiology. Materials and Methods: We evaluated thirty patients with liver cirrhosis in this cross-sectional, observational study. All subjects were assessed for pituitary, thyroid, adrenal, and gonadal function. The patients were divided into Group 1 (cirrhosis, n = 30) and Group 2 (controls, n = 15) and the data were analyzed with appropriate statistical tests. Results: The study participants (20 males, 10 females) had a mean age of 54.5 ± 12.4 years and duration of the cirrhosis 5.1 ± 2.7 years. Four patients were in Child Class A, 11 and 15 patients were in Child Classes B and C, respectively. Eleven out of thirty patients (37%) had endocrine disorders, that include subclinical hypothyroidism (n = 3), primary hypothyroidism (n = 1), Sick Euthyroid syndrome (n = 3), central hypothyroidism (n = 2), secondary hypogonadism (n = 3) and growth hormone deficiency in three patients. Two patients had partial hypopituitarism and one patient had complete hypopituitarism. Conclusion: Occult endocrine dysfunction of thyroid and gonadal axes is common in patients with cirrhosis of the liver. The hormonal abnormalities are not different based on the etiology of the cirrhosis.
  3 1,501 218
Impact of pre-hospital care on the outcome of children arriving with agonal breathing to a pediatric emergency service in South India
Debasis Das Adhikari, Krishna Mahathi, Urmi Ghosh, Indira Agarwal, Anila Chacko, Ebor Jacob, Kala Ebenezer
July-September 2016, 5(3):625-630
DOI:10.4103/2249-4863.197321  PMID:28217595
Background: Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES) is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing. Methods: Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes. Results: Out of 75 children studied, 69% were infants. The duration of illness among 65% of them (75) was less than 3 days. Majority of them (81%) had received treatment prior to arrival. Government sector physicians (72%), half of them (51%) being pediatricians were the major treating doctors. 37% of the children had arrived to the Emergency in an ambulance. Cardiopulmonary Resuscitation (CPR) was given to 27% on arrival in PES. Other interventions included fluid boluses to correct shock (92%) and inotrope infusion (56%). Sepsis (24%) and pneumonia (24%) were the most common diagnoses. Out of 75, 57 (76%) children who were stabilized and shifted to PICU and among them 27 (47%) survived to discharge. Normal blood pressure (p=0.0410) and non-requirement of CPR (0.0047) and inotropic infusion (0.0459) in PES were associated with a higher chance of survival. Conclusion: 36% (27/75) of children who arrived to our PES with agonal breathing survived to hospital discharge. Survival was significantly better among those who did not need CPR.
  3 1,245 160
Concurrent central nervous system infective pathology in a severely immunocompromised patient
Thein Swe, Bordes P Laurent, Nickul N Shah
July-September 2016, 5(3):685-687
DOI:10.4103/2249-4863.197304  PMID:28217607
To our knowledge and literature search, concurrent cryptococcal meningitis and neurosyphilis in a patient have rarely been reported. Here, we report a 37-year-old male with HIV infection presented with headache and dizziness for 5 days along with memory difficulty and personality changes for about 1 week. During the hospital stay, cryptococcal meningitis was confirmed with positive cerebral spinal fluid (CSF) cryptococcal antigen titer (1:320) and positive CSF culture. Diagnosis of neurosyphilis was made based upon CSF white blood cell count of 85 cells/mL, with CSF total protein of 87 mg/dL, reactive CSF treponemal antibody, and fluorescent treponemal antibody. The patient was treated with amphotericin B, flucytosine, fluconazole, and benzathine penicillin G, and the patient was recovered and discharged. HIV patients are at high risk of developing severe infections of the central nervous system. Awareness should be made not only to single infection but also for dual pathology for a better and life-saving management.
  2 1,089 142
Recurrent first-trimester abortion in a young female: Rare presentation of Takayasu arteritis
Suruchi Gupta, Puneet Chhabra, Nikhil Gupta, Parul Aggarwal
July-September 2016, 5(3):719-721
DOI:10.4103/2249-4863.197291  PMID:28217618
Takayasu arteritis (TA) is a chronic, progressive, autoimmune, idiopathic, and large-vessel vasculitis that usually affects young adults, especially females. TA primarily affects the aorta and its major branches, the coronary arteries, and the pulmonary arteries. Recurrent pregnancy loss is usually defined as three or more consecutive losses occurring at <20 weeks' gestation of a clinically recognized pregnancy. Common causes of recurrent fetal loss include anatomic, chromosomal, hormonal, infectious, or antiphospholipid antibody syndrome. However, to the best of our knowledge, TA causing recurrent fetal loss has not been described in the literature. We present such a rare case of a patient who presented with hemoptysis as her presenting complaint and also had a recurrent first-trimester abortion.
  2 1,063 148
Acute pancreatitis due to malaria: A case report of five patients and review of literature
Kundavaram Paul Prabhakar Abhilash, Atif Shaikh Iqbal Ahmed, Sowmya Sathyendra, Ooriapadickal Cherian Abraham
July-September 2016, 5(3):691-694
DOI:10.4103/2249-4863.197302  PMID:28217609
Malaria is endemic in large parts of India and can cause multiorgan failure and death. Acute pancreatitis as a complication is rare and is potentially fatal. This case series describes five adult patients between 2005 and 2010 who presented with a short duration febrile illness and diagnosed to have malaria with acute pancreatitis. The mean age of the five patients with acute pancreatitis was 40.4 years and four of them were males. None of them were alcohol consumers and did not have any other risk factor for acute pancreatitis. Plasmodium falciparum was responsible for all the cases. Pancreatic enzymes were significantly elevated in all the patients with a mean serum lipase level of 1795 U/L (normal value: <190 U/L) and a mean serum amylase level of 584 U/L (normal value: <100 U/L). Ultrasonography evidence of acute pancreatitis (bulky pancreas) was seen in two patients, and a further two patients had minimal left-sided pleural effusion. Thrombocytopenia (platelet count <100,000/cumm), renal dysfunction (serum creatinine >1.4 mg/dl), and hyperbilirubinemia were seen in all the patients. One patient died due to multiorgan failure. Acute pancreatitis is a very rare complication of malaria, and a high index of suspicion is required in patients presenting with severe malaria and abdominal pain.
  2 1,205 142
Disseminated tuberculosis in a newborn infant
Tanu Sagar, Kavita Gupta, Mayuri Rani, Iqbal Rajinder Kaur
July-September 2016, 5(3):695-697
DOI:10.4103/2249-4863.197301  PMID:28217610
Tuberculosis (TB) remaining as one of the deadliest communicable diseases. Congenital infection by vertical transmission is rare but high neonatal mortality (up to 60%) and morbidity warrant early and accurate diagnosis of newborns suffering from TB. Intrauterine infection of tuberculosis is most commonly caused by haematogenous spread from the mother causing placental seedling. The organisms reach the fetus via the umbilical vein and the primary focus is often in the fetal liver in hematgenous spread. Another route of infection is by direct ingestion or aspiration of infected amniotic fluid if the placental caseous lesion ruptures directly into the amniotic cavity. Transplacental infection occurs late in pregnancy and aspiration from amniotic fluid occurs in the perinatal period. We report here one case of disseminated tuberculosis in a new born infant.
  2 1,387 234
Pyoderma gangrenosum: A clinician's nightmare
Bindhu Bhaskaran, Mittu John Mathew, KN Vijayan, Asha Zacharia
July-September 2016, 5(3):698-700
DOI:10.4103/2249-4863.197300  PMID:28217611
Pyoderma gangrenosum (PG) is a rare disease and that affecting specifically the sole of the foot, is even rarer. Here, we report the case of a 54-year-old female admitted with a painful ulcer on the sole of the right foot which was initially treated with empirical antibiotics and debridement. The disease was found to spread rapidly after each debridement. The culture reports were negative; rheumatology workup and Doppler study were within normal limits. A clinical suspicion of PG was made and was confirmed with tissue biopsy. She was started on oral steroids following which she dramatically improved. Thus, when a patient presents with a rapidly expanding painful ulcer in a vascular limb that is refractory to antibiotic treatment and exacerbating on debridement, it is imperative to consider the possibility of PG.
  2 1,324 160
The prevalence of domestic violence and its associated factors among married women in a rural area of Puducherry, South India
Jismary George, Divya Nair, Nancy R Premkumar, Nirmala Saravanan, Palanivel Chinnakali, Gautam Roy
July-September 2016, 5(3):672-676
DOI:10.4103/2249-4863.197309  PMID:28217603
Background: Violence against women is an emerging problem worldwide and more so in India. Considering its adverse effects on women's health, assessing the burden of violence in the community will help in planning services for the victims. Objectives: To determine the prevalence of domestic violence and to identify factors associated with domestic violence among married women in reproductive age group in rural Puducherry. Materials and Methods: A community-based cross-sectional study was carried out in a rural area of Puducherry, South India. Married women in reproductive age group were interviewed using structured pretested questionnaire. Domestic violence was assessed using 12 questions that were used in National Family Health Survey-3. Adjusted odds ratios (AORs) were calculated using multivariate logistic regression to identify factors associated with violence. Results: Of 310 study participants, 56.7% of them reported some form of domestic violence, 51.3% reported psychological violence, 40% reported physical violence, and 13.5% reported sexual violence. A statistically significant association was found between illiteracy of women and domestic violence (AOR: 4.3, 95% confidence interval: 1.1-15.7  P: 0.03). The other factors such as love marriage and nonregistration of marriage were significantly associated with violence. Conclusion: The prevalence of domestic violence was found to be high in this rural setting. Multisectoral response such as improving literacy, creating awareness regarding legal aid and screening the victims of violence at primary health centers, should be initiated to mitigate this public health issue.
  2 2,879 367
Is small town India falling into the nutritional trap of metro cities? A study in school-going adolescents
Tabassum Nawab, Zulfia Khan, Iqbal Mohammed Khan, Mohammed Athar Ansari
July-September 2016, 5(3):581-586
DOI:10.4103/2249-4863.197296  PMID:28217587
Introduction: There has been an increasing secular trend in the prevalence of overweight and obesity in developing countries. The prevalence reported among children and adolescents of some metro cities in India are comparable to that in some developed countries. Westernization of culture, rapid mushrooming of fast food joints, lack of physical activity, and increasing sedentary pursuits in the metro cities are some of the reasons implicated for this. The nutritional changes in small town school children might be following the same pattern of larger cities. Aims and Objectives: To study the prevalence of overweight and obesity among school-going adolescents of Aligarh and to study the sociodemographic and behavioral correlates of the same. Materials and Methods: A cross-sectional study done in two affluent and two nonaffluent schools in Aligarh, taking 330 adolescents from each group (total-660). Study tools included a predesigned and pretested questionnaire, Global Physical Activity Questionnaire, and anthropometric measurement. Overweight and obesity were defined based on World Health Organization 2007 Growth Reference. Chi-square test and multiple logistic regression analysis were done. Results: Prevalence of overweight and obesity was 9.8% and 4.8% among school-going adolescents. The difference in prevalence of overweight and obesity among affluent schools (14.8% and 8.2%) and nonaffluent schools (4.8% and 1.5%) was significant. Risk factors for overweight and obesity were affluence, higher maternal education, parental history of obesity, frequent fast food intake, and television (TV) viewing more than 2 h/day. Conclusion: Overweight and obesity among school-going adolescents is a crisis facing even smaller cities in India. Behavior change communication should be focused to adolescents, especially of the affluent section, toward restricting fast food intake, and TV viewing.
  2 1,259 161
Physical activity correlates of overweight and obesity in school-going children of Dehradun, Uttarakhand
Madhavi Bhargava, SD Kandpal, Pradeep Aggarwal
July-September 2016, 5(3):564-568
DOI:10.4103/2249-4863.197281  PMID:28217584
Background: Physical activity is important for prevention of overweight and obesity in growing children. Objective: The present study aims to explore the association of overweight and obesity in school children of the district of Dehradun with physical activity, sports, and recreation at home and school. Materials and Methods: A cross-sectional survey of 1266 schoolchildren of select private and government schools in urban and rural areas was done. Results: Overall 15.6% of children were overweight, of which 5.4% were obese. Overweight and obesity were significantly associated with physical inactivity related to passive transport to school, missed opportunities for play during lunch breaks, lack of participation in household work, and excessive viewing of television. Conclusion: We found a significant association between the lack of physical activity and overweight and obesity. There is a need to enhance physical activity, sports, and recreational opportunities at school as well as home to prevent overweight and obesity in children. Family physicians should include counseling for this important and cheap modifiable risk factor in their family care practice.
  2 1,422 235
Blood pressure (BP) control and perceived family support in patients with essential hypertension seen at a primary care clinic in Western Nigeria
Oluwaseun S Ojo, Sunday O Malomo, Peter T Sogunle
July-September 2016, 5(3):569-575
DOI:10.4103/2249-4863.197284  PMID:28217585
Context: Nonadherence to therapeutic plans has been reported among hypertensive patients. Researchers have also shown that adherence to therapeutic plans improves if motivation in the form of social support is provided. There is a dearth of local studies that explore the influence of family support on treatment outcomes of hypertensive patients. Aims: The aim of the study was to determine the relationship between BP control and perceived family support in patients with essential hypertension seen at a primary care setting in Western Nigeria. Settings and Design: This was a cross-sectional hospital-based study. Subjects and Methods: Systematic random sampling technique was used in selecting 360 hypertensive respondents between April and July 2013. Data were collected through a pretested interviewer-administered questionnaire and a standardized tool, Perceived Social Support Family Scale, which measured the respondents' level of perceived family support. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) version 17.0 was used to analyze data. Results: The majority of the respondents were middle-aged (61.1%) and female (59.4%). Blood pressure (BP) was controlled in 46.4% of the respondents. Most of the respondents (79.4%) had "strong" perceived family support. Strong perceived family support (odds ratio [OR] 4.778, 95% confidence interval [CI] =2.569-8.887) and female gender (OR 1.838, 95% CI = 1.177-2.869) were independent predictors of controlled BP. Conclusions: The proportion of hypertensive patients with optimal BP control is low in this practice setting. The positive association between BP control and perceived family support emphasizes the need for physicians to reflect on the available family support when managing hypertensive patients.
  2 1,827 340
Profile of infections in renal transplant recipients from India
Arun Kumar, Chaturbhuj Agarwal, Ashok K Hooda, Ashutosh Ojha, Mukesh Dhillon, K. V. S. Hari Kumar
July-September 2016, 5(3):611-614
DOI:10.4103/2249-4863.197320  PMID:28217592
Background: Infectious disorders are a major cause of concern in renal transplant recipients (RTRs) leading to considerable morbidity and mortality. We studied the profile and outcomes of infectious disorders in a cohort of RTR. Materials and Methods: In this prospective, observational study, we evaluated all RTR who presented with the features of infection. We also included asymptomatic patients with microbiological evidence of infection. We excluded patients with acute rejection, drug toxicity, and malignancy. Descriptive statistics were used to analyze the results. Results: The study population (n = 45, 35 male and 10 female) had a mean age of 35.5 ± 10.4 years and follow-up after transplant was 2.1 ± 1.7 years. Urinary tract infection (UTI, n = 15) is the most common infection followed by tuberculosis (TB, n = 8), cytomegalovirus (n = 6), candidiasis (n = 7), and hepatitis (n = 11). Miscellaneous infections such as cryptosporidiosis and pneumocystis were seen in 10 patients. Simultaneous infections with two organisms were seen in 7 patients. Four patients succumbed to multiorgan dysfunction following sepsis, another 4 patients developed chronic graft dysfunction, while the remaining 35 RTR had a good graft function. Conclusion: Infectious complications are very common in the posttransplant period including UTI and TB. Further large scale studies are required to identify the potential risk factors leading to infections in RTR.
  2 2,146 343
Guillain-Barré syndrome in pregnancy: A conservatively managed case
TNMS Fernando, AMAS Ambanwala, Probhodana Ranaweera, Athula Kaluarachchi
July-September 2016, 5(3):688-690
DOI:10.4103/2249-4863.197303  PMID:28217608
Guillain-Barré syndrome (GBS) is an autoimmune disease. Estimated population incidence ranges from 0.62 to 2.66 cases per 100,000 person-years across all age groups. We report a case of GBS in a 22-year-old primigravida who presented at 36 weeks of the period of gestation (POG), with complaints of bilateral progressive lower limb numbness and weakness for 2 weeks duration. Magnetic resonance imaging of the brain was done to exclude other possible causes. Diagnosis of GBS was made according to the Brighton criteria, which our patient falls into Level 2. She received intensive care management. The patient improved rapidly without any specific management. She went to labor spontaneously and delivered a healthy baby with a birth weight of 2.8 kg at 38 weeks of POG. She continued to receive supportive therapy and improved significantly.
  1 1,923 211
Cocaine-induced vasculitis with cutaneous manifestation: A recurrent episode after 2 years
Thein Swe, Mona Pervil-Ulysse, AAM A Baqui
July-September 2016, 5(3):712-715
DOI:10.4103/2249-4863.197294  PMID:28217616
Cocaine is a popular recreational drug in the United States, and up to 70% of the seized cocaine contains levamisole which is an antihelminthic that can cause cutaneous vasculitis with necrosis and positive antineutrophil cytoplasmic antibodies (ANCAs). Here, we report a unique case of recurrent cocaine-induced vasculitis in a patient who smokes cocaine for more than 20 years. A 38-year-old woman complained of painful erythematous rash in her right arm and right thigh which appeared some hours after smoking cocaine. Physical examination revealed tender, erythematous base, retiform purpura with necrosis and bullae. Serological test showed high atypical perinuclear ANCA titer of 1:320 and antimyeloperoxidase antibody level of 20.4 U/mL. Cocaine-induced vasculitis should be one of the differential diagnoses in cocaine abusers who present with painful rash and areas of necrosis. Early diagnosis is important since it is an emerging public health concern.
  1 1,480 143
Temporomandibular joint ankylosis in ankylosing spondylitis: A case report and review of literature
Nishtha Gupta, Nikhil Gupta, Laxmikant Ramkumarsingh Tomar, Nikhil Nair
July-September 2016, 5(3):716-718
DOI:10.4103/2249-4863.197292  PMID:28217617
Ankylosing spondylitis (AS) is a chronic systemic inflammatory disorder. It primarily affects the axial skeleton through involvement of the peripheral joint scan occurs. Temporomandibular joint (TMJ) involvement in AS varies from 4% to 35%. Here, we present a case of a 35-year-old male, follow-up of AS from last 8 years on nonsteroidal anti-inflammatory drugs, presented with fresh complaints of painfully restricted movements of jaw during swallowing. Computer tomography of patient demonstrates articular cartilage changes with disc and joint abnormalities.
  1 1,611 232
India in search of right Universal Health Coverage (UHC) model: The risks of implementing UHC in the absence of political demand by the citizen
Raman Kumar, Pritam Roy
July-September 2016, 5(3):515-517
DOI:10.4103/2249-4863.197252  PMID:28217574
Amid the global push for Universal Health Coverage (UHC), the agenda is being set for India's health care. In the absence of a constitutional mandate, a national policy and citizen-led political demand for UHC, there exist specific risks in rushing toward its implementation in India. As the debate of UHC continues, the health-care delivery system in India is at cross roads. UHC in India could take two different trajectories. The first one takes India toward becoming "Global Bazaar" of morbidity and ill health, founded on the pillars of a vibrant rapidly multiplying healthcare industry. The other path takes India on a course of preventing wasteful, expensive health-care expenditure by maintaining healthy populations. A poor professional blood donor cannot become rich by selling his or her own blood beyond medically permissible levels; similarly, India cannot become a developed economy by  merely allowing exploitation of disease, illness, and morbidity of her citizen. It is the duty of the state and governments to protect individual citizen, population under consideration, as well as country's economy from wasteful and potentially harmful expenditure incurred to address ill health. In the economic sense, any sensible UHC implementation mechanism would seek to regulate wasteful preventable health-care expenditure for the purpose of future economic stability and growth of the country. Due diligence toward safeguarding "public health in public interest," during the process of UHC implementation, is the need of the hour.
  1 1,775 335
Speed detection device in preventing road traffic accidents: A realistic approach in India!
Bijaya Nanda Naik, Mahendra M Reddy, Srikanta Kanungo, Sitanshu Sekhar Kar
July-September 2016, 5(3):741-742
DOI:10.4103/2249-4863.197278  PMID:28217627
  1 965 119
Can the recent public notice by the Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy be helpful in combating the irrational use of herbal drugs?
Janmejaya Samal
July-September 2016, 5(3):732-733
DOI:10.4103/2249-4863.197286  PMID:28217622
  1 1,010 108
Validity of tuberculous pleuritis diagnosed in a resource-constrained setting in Dindigul district of Tamil Nadu
Baranidharan Chennaiyan, Arun N Bhatt, Roopa Kancherla, Cijoy K Kuriakose, Anand Vimal Dev, George A Philip
July-September 2016, 5(3):615-618
DOI:10.4103/2249-4863.197322  PMID:28217593
Context: Majority of the Indians live in rural areas where resource constrained settings depend on cheaper and less invasive tests to diagnose extrapulmonary tuberculosis (TB). The decline in prevalence of TB in the country could affect the validity of the diagnosis. The aim was to measure validity of the pleural fluid study of proteins, lactate dehydrogenase (LDH), and cell counts in diagnosis of tuberculous pleuritis. Materials and Methods: This was a cross-sectional study conducted in a 300 bedded secondary care hospital in rural Tamil Nadu. Exhaustive sampling was performed during April 2013 to March 2014. Pleural fluid study of 54 patients with exudative pleural effusion was conducted. Diagnosis was established by closed needle pleural biopsy. Receiver operator curves were plotted and area under curve (AUC) was calculated for various parameters. Sensitivity, specificity, and predictive values were calculated for different cut-off values of the parameter with significant AUC. Results: Prevalence of tuberculous pleural effusion was 56% (95% confidence interval [95% CI] - 42.5-69.5%). Lymphocyte predominance in pleural fluid was the only valid test, and cut-off >80% had sensitivity of 70.0% (95% CI - 53.3-86.7%) and specificity of 70.8% (95% CI - 52.2-89.4%). Pleural fluid pH, protein or its ratio with serum protein, sugar, total leukocyte count, LDH or its ratio with serum LDH; erythrocyte sedimentation rate were not valid screening tests. Conclusions: Lymphocyte predominance > 80% can be used as a marker of tuberculous pleuritis. Since the prevalence of tuberculous pleuritis in India has come down considerably, newer tests need to be included to make a valid diagnosis.
  1 1,030 112
Partnerships for organizing blood donation camp: An experience from rural North India
Shashi Kant, Sumit Malhotra, Farhad Ahamed, S Archana, Chandrakant S Pandav
July-September 2016, 5(3):600-604
DOI:10.4103/2249-4863.197315  PMID:28217590
Background: Rural areas pose challenges for motivating villagers to donate blood. We organized a blood donation camp in a rural setting by engaging multiple stakeholders. We examined the factors that influenced blood donation. Methods: Local level stakeholders were involved in planning of the camp. Mobilization of donors was attempted through intensive awareness generation activities utilizing multiple channels. A list of willing blood donors was prepared. Results: Out of 152 willing donors, 88 reported to donation camp, and after screening, 67 donated the blood. Most of the willing donors were males (89.8%), and the mean standard deviation age was 31.9 (9.4) years. Deferral rate was 23.8%. Involvement of local stakeholders can result in creating a pool of donors in rural area which can mitigate the existing gap between demand and supply of blood in India.
  1 1,632 150
Prevalence of rubella-specific IgG antibodies in unimmunized young female population
Jayakrishnan Thayyil, Vidya Kuniyil, Anitha P Moorkoth, Bhaskar Rao, Paramasivam Selvam
July-September 2016, 5(3):658-662
DOI:10.4103/2249-4863.197311  PMID:28217601
Context: Rubella is a mild self-limiting disease all over the world; nevertheless, it is of significant public health importance due to its teratogenic effect of congenital rubella syndrome. Rubella vaccine is currently not included in the national immunization program in India. Rubella-specific IgG in the unvaccinated population is a marker of previous rubella infection. Rubella IgG estimation in children will provide data for initiation and necessary modification to the immunization strategy. Aims: In this background, this study was conducted with an aim to know the age-specific susceptibility of acquiring rubella infections and future risk of congenital rubella syndrome (CRS) among girls. Settings and Design: This was a community-based, observational study. Participants and Methods: The study was conducted at a randomly selected rural area Mavoor Panchayath of Kozhikode District, Kerala, among adolescent girls. The estimation of rubella-specific IgG antibody was done by quantitative enzyme-linked immunosorbent assay method. IgG titer value of >15 IU was taken positive, 8-15 IU as equivocal, and <8 IU as negative. Statistical Analysis Used: Statistical analysis was performed using Statistical program for Social science version 16 for Windows. Chi-square test was applied to find out significant difference and Fisher's exact test wherever applicable. Results: The data and blood sample collection was done from 250 girls. The mean IgG titer was 151.93 ± 128.78 IU, and as per the criteria, 68.3% were positive, 28.5% were negative, and 3.2% were equivocal. At this age, majority (68.3%) of the girls get protection by natural infection without any vaccine. Some girls (32%) may remain susceptible to infection during adulthood and pregnancy. Conclusions: Natural rubella infection was widely prevalent among child population and at this age. An immunization policy recommending rubella-containing vaccine is highly desirable to prevent rubella and CRS.
  1 1,588 247
Five-year comparison of diabetic control between community diabetic center and primary health-care centers
Mazen S Ferwana, Abdulaziz Alshamlan, Wedad Al Madani, Bader Al Khateeb, Amen Bawazir
July-September 2016, 5(3):641-645
DOI:10.4103/2249-4863.197316  PMID:28217598
Context: Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes. Aims: The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers. Settings and Design: This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia. Subjects and Methods: Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare. Statistical Analysis Used: SPSS (V21) was used to analyze the univariate and bivariate analysis, Student's t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is <0.05. Results: The mean difference for HbA1c from first to last visits increased significantly +0.2 ± 1.67 with P = 0.002 while the low-density lipoprotein (LDL) on the other way around improved by decrease of -0.159 ± 0.74 and P < 0.000. Body mass index (BMI) among the sample increased by +0.134 ± 1.57 with no significant, P = 0.078. Among the sample, 39.5% improved their HbA1c while 56.8% deteriorated and 3.6% of the samples' readings remain the same. 55.3% of the sample improved in LDL and 52.4% in the high-density lipoprotein while 53.7% improved in triglycerides. The BMI was improved among 43.4% of diabetic patients. Conclusions: The 5-year management of diabetic patients failed to improve the A1c or BMI, at both CDC and primary health-care centers.
  1 1,173 148
Glycosylated hemoglobin values in nondiabetic pregnant women in the third trimester and adverse fetal outcomes: An observational study
P Shobha, Sherly Mathen, Joison Abraham
July-September 2016, 5(3):646-651
DOI:10.4103/2249-4863.197313  PMID:28217599
Objective: The objective of the study is to estimate the level of glycosylated hemoglobin (HbA1c) for a safe fetal outcome and to estimate the relation between this level and various adverse fetal outcomes. Materials and Methodology: Primigravidas who are diagnosed as not having gestational diabetes mellitus as per the glucose challenge test done at 24 weeks with a cutoff value up to 140 mg/dl are followed up at 30-34 weeks for the estimation of HbA1c in the blood and further till the time of delivery and postnatal period for the fetal outcomes. Data were collected based on detailed patient interview, clinical examination, and laboratory investigations. Data were analyzed to obtain the mean value of HbA1c in the third trimester. Fetal outcomes were analyzed with the HbA1c value using Chi-square test. Results: The HbA1c values in the third trimester of pregnancy in this study ranged from 4.5% to 6%. Discussion: Unfavorable outcomes were found the least in the 4.5%-5%. The average plasma blood glucose corresponding to HbA1c value of 5% is 101 mg/dl. The majority of the newborn were admitted for observation for transient tachypnea (49.5%) and hyperbilirubinemia (16.5%) requiring phototherapy, hypocalcemia requiring calcium supplements (12.6%), hypoglycemia requiring glucose (7.8%), and persistent tachypnea of newborn (5.8%) and all the outcomes correlated significantly with HbA1c values. Conclusion: Hence, HbA1c can be utilized for the monitoring of glycemic level and as screening test.
  1 1,520 206
Physicians of colonial India (1757-1900)
Anu Saini
July-September 2016, 5(3):528-532
DOI:10.4103/2249-4863.197257  PMID:28217577
The period of British rule from 1757 to 1900 is marked by major sociopolitical changes and scientific breakthroughs that impacted medical systems, institutions, and practitioners in India. In addition, historians have debated whether the colonial regime used Western medicine as a tool to expand and legitimize its rule. This paper reviews the secondary literature on this subject with emphasis on the individual physicians. During this period, the practice of "Doctory" or Western medicine gained momentum in India, buoyed with the support of the British as well as Western-educated Indians. Many Indians were trained in Western medicine and employed by the administration as "native doctors" in the subordinate medical service, and the superior medical service by and large comprised Europeans. The colonial regime gradually withdrew most of its patronage to the indigenous systems of medicine. The practitioners of these systems, the vaidyas and the hakims, suffered significant loss of prestige against Western medicine's claims of being a more rational "superior" system of medicine. Some of them became purists and defended and promoted their systems, while others adopted the methods and ideas of Western medicine into their education and practice. European doctors now rarely interacted with practitioners of Indian systems, but seriously pursued research into medicinal plants and tropical diseases. There is no mention of specialist physicians in this period, and all physicians and surgeons were generalists. Folk practitioners continued to be popular among the masses.
  1 1,714 210
BOHS: For informal industry
Priyanka Roy
July-September 2016, 5(3):730-731
  - 791 85
Diagnostic difficulty of liver lesion
Jayabal Pandiaraja
July-September 2016, 5(3):722-724
DOI:10.4103/2249-4863.197290  PMID:28217619
Liver abscess is mostly either pyogenic or amebic. Fungal and mycobacterial liver abscesses are rare and mostly associated with immunosuppression. The occurrence of fungal liver abscess with hydatid cyst was never reported previously. This case created diagnostic difficulty, whether we are dealing with liver abscess or hydatid cyst. Sometimes, it may be possible that concurrent occurrence of hydatid cyst with liver abscess or hydatid cyst become infected and mimic like liver abscess.
  - 963 147
Human immunodeficiency virus polyarthropathy
Priyanka Lakshmanan, Ira Shah
July-September 2016, 5(3):725-726
DOI:10.4103/2249-4863.197289  PMID:28217620
Articular manifestations are a frequent but often underdiagnosed manifestation in patients infected with the human immunodeficiency virus (HIV). We present a 7-year-old HIV-infected malnourished girl who presented with recurrent joint pain and effusion in the left knee joint. Her antistreptolysin O, dsDNA, antinuclear antibody and rheumatoid arthritis factor were negative. She responded to antiretroviral therapy.
  - 949 108
Refractory anemia in human immunodeficiency virus: Expect the unexpected
Sumeet Prakash Mirgh, Vikas A Mishra, Virti D Shah, Jehangir Soli Sorabjee
July-September 2016, 5(3):727-729
DOI:10.4103/2249-4863.197288  PMID:28217621
Pure red cell aplasia (PRCA) is an uncommon hematological disorder affecting selectively the erythroid cell lines. PRCA is defined as anemia with normal leukocyte and platelet counts, a corrected reticulocyte count <1%, <5% erythroid precursors in the bone marrow and an absence of hemolysis. We describe a case of Zidovudine (AZT) induced PRCA causing severe anemia in a patient taking antiretroviral therapy (ART) after 4 months of starting therapy and in whom all other causes were excluded. The hematological abnormalities resolved after AZT was replaced with tenofovir and the patient remained transfusion independent thereafter. A slowly progressive normocytic-normochromic anemia and reticulocytopenia, without leukopenia and thrombocytopenia in a patient, should raise the suspicion of PRCA. Search for underlying diseases, infections and drugs may help in the diagnosis and etiology of acquired PRCA. Elimination of potentially causative factors may induce complete recovery. AZT is a well-known cause of anemia and thus should be used with caution in the initiation of ART.
  - 1,046 122
Quincke's disease
Ladan Mohammadi, Anthony Miller, John V Ashurst
July-September 2016, 5(3):677-679
DOI:10.4103/2249-4863.197308  PMID:28217604
Marijuana smoke can cause thermal injury, and since legalization and increased use of marijuana in our society, differentiating, diagnosing, and managing this condition have become mandatory. A case of a 28-year-old male with Quincke's disease secondary to marijuana inhalation is presented.
  - 1,363 149
A rare cause of misdiagnosis in chest X-ray
Carlos Manuel Ortiz-Mendoza
July-September 2016, 5(3):680-681
DOI:10.4103/2249-4863.197307  PMID:28217605
Chest X-ray is a usual tool for family physicians; however, unexpected findings in chest X-ray are a frequent challenge. We present a rare case of pulmonary hilar nodule misdiagnosis in a chest X-ray. An 84-year-old woman was sent with a diagnosis of a right pulmonary hilum nodule. She had a history of chronic obstructive pulmonary disease; so in a chest X-ray, her family physician discovered a "nodule" in her right lung hilum. Her physical exam was not relevant. In our hospital, a thoracic computed tomography (CT) scan verified the mass in the right pulmonary hilum; nevertheless, in a coronal CT scan, the "hilum lump" was the tortuous descending aorta that created an angle. This case illustrates how anatomical changes associated with vascular aging may cause this exceptional pitfall in chest X-ray.
  - 1,101 123
A mixed toxidrome presenting with bilateral ptosis with normal pupils: The first case in the literature
Sanket Mahajan, Janki Shah
July-September 2016, 5(3):682-684
DOI:10.4103/2249-4863.197306  PMID:28217606
Snakebite is an environmental hazard associated with a significant morbidity and mortality. Two main types of toxicity occur due to snakebite, namely vasculotoxicity and neurotoxicity. Neurotoxic snakebites present mainly with bilateral ptosis with dilated pupils and/or difficulty in breathing. Jatropha curcas belongs to the family Euphorbiaceae and is commonly referred to as " Ratanjyot" in Gujarati. It has got many medicinal uses such as anticancerous properties and bio-oil. There are very few cases of its toxicity in adults. Toxicity from it causes meiosis, vomiting, diarrhea, etc., We will hereby discuss one such patient who consumed J. curcas seeds intentionally, became drowsy and accidentally got bit by a snake, and then, the patient started having bilateral ptosis, but with normal-sized pupils. There is no case reported yet in the literature mentioning the combined toxicity of snakebite and J. curcas, so we thought to publish this first case report of its kind in the world, thus discussing its diagnosis, symptoms, and treatment modalities.
  - 1,114 102
Isolated pulmonary hydatid cyst: Misinterpreted as metastatic pulmonary lesion in an operated case of carcinoma breast in young female
Ravish Kshatriya, Dhaval Prajapati, Nimit Khara, Rajiv Paliwal, Satish Patel
July-September 2016, 5(3):701-703
DOI:10.4103/2249-4863.197299  PMID:28217612
Hydatidosis is caused by Echinococcus granulosus. Humans may be infected incidentally as intermediate host by the accidental consumption of soil, water, or food contaminated by fecal matter of an infected animal. Hydatidosis is one of the most symptomatic parasitic infections in various livestock - raising countries. Lung is the second most commonly affected organ following the liver. The symptoms depend on the size and site of the lesion. It can present as an asymptomatic pulmonary lesion to hemoptysis, chest pain, coughing anaphylaxis, and shock. There are very few reported cases of isolated lung hydatidosis without exposure to animals or nonvegetarian diet. For hydatidosis, serology and imaging are diagnostic tools. Surgical removal and/or chemotherapy are the main-stay of treatment. Here, we discuss a case of persistent left lower lobe cystic lesion in young female with a history of operated left breast carcinoma which was thought to be of metastatic lesion but ultimately confirmed as pulmonary hydatid cyst after unintended aspiration of cystic fluid to rule out malignancy. Pulmonary hydatidosis should always be considered as a differential diagnosis when dealing with a cystic lesion on radiology.
  - 933 98
An uncommon cause for vomiting
Samantha Sathyakumar, Sahana Shetty, Nitin Kapoor, Sunil Abraham, Thomas Vizhalil Paul
July-September 2016, 5(3):704-705
DOI:10.4103/2249-4863.197298  PMID:28217613
Thyrotoxicosis may present with a variety of non specific symptoms in elderly patients. Gastrointestinal symptoms such as nausea, vomiting and abdominal discomfort can occasionally be the presenting feature of thyrotoxicosis in this age group. We describe an elderly patient in whom thyrotoxicosis was diagnosed after extensive evaluation for nausea, vomiting and anorexia. This patient was also found to have hypercalcemia. This case highlights the importance of recognizing thyrotoxicosis in older patients presenting with GI symptoms and mild hypercalcemia
  - 994 113
Somatic symptoms after sexual behavior with fear of four sexually transmitted diseases: A proposal of novel disorder
Kentaro Iwata, Yoshiaki Katsuda
July-September 2016, 5(3):706-708
DOI:10.4103/2249-4863.197297  PMID:28217614
Somatic symptom disorder (SSD) often leads to frequent doctor visit not only to psychiatrists but also to various kinds of physicians. We encountered four cases of SSD, particularly associated with sexual intercourse and fear of sexually transmitted diseases (STDs). To best of our knowledge, there is no independent clinical entity assigned to this phenomenon. Here, we propose a variation of SSD called four STD as an independent clinical entity since the presentation of this disorder is very distinctive, and lack of awareness of it may lead to unnecessary laboratory workup and antimicrobial prescription as well as augmented anxiety of the patients with potential "doctor shopping." Further studies are needed to elucidate the pathophysiology, diagnosis, and treatment of this disorder.
  - 3,475 140
Type 1 Brugada pattern electrocardiogram induced by hypokalemia
Thein Swe, Muhammad Hassan Dogar
July-September 2016, 5(3):709-711
DOI:10.4103/2249-4863.197295  PMID:28217615
Coved-type ST-segment elevation in the right precordial leads are the characteristics of Brugada syndrome, an inherited arrhythmogenic ion channel disease, which could lead to ventricular arrhythmia and sudden death. Hypokalemia alone may induce Type 1 Brugada pattern electrocardiogram (EKG), and the association has rarely been reported. We describe a patient with hypokalemia 2.9 mmol/L and the appearance of new right bundle branch block pattern with coved ST-segment elevations with inverted T wave in leads V1-V2. Serum potassium was corrected and repeated EKG 6 h later revealed disappearance of Type 1 Brugada pattern. Although there is no definite value of serum potassium level that can induce Brugada pattern EKG, hypokalemia may unmask Type 1 Brugada EKG pattern. Awareness of its appearance should be made by all physicians since patients with a family history of arrhythmia or sudden cardiac death (SCD) are at the high risk of developing SCD.
  - 1,263 159
Working as a family physician in Canada and Portugal: How different is it?
Ana Nunes Barata
July-September 2016, 5(3):518-522
DOI:10.4103/2249-4863.197255  PMID:28217575
Background: The work of a family physician is quite different in each country, and if we consider different continents, differences are even more remarkable. Social and cultural contexts justify a particular organization, not only of the health-care system but also its providers as well. Objectives: By analyzing different health-care systems, new ideas may come about which may trigger positive changes in a health-care service to diminish healthcare disparities. Methods: Description and comparison of the Primary Healthcare Service in Canada and Portugal. Results: Although both health-care systems are mainly public, organizational differences can be found that condition primary healthcare access. Conclusion: Exchanges in other health-care systems contribute for an active knowledge exchange that prompts participants to analyze options on how to improve healthcare access to citizens. This ultimately, leads to the development of primary care, the pillar of a well-functioning health-care system.
  - 1,729 223
Pseudo hypertension: Clue from Osler sign
Milind M Patil, Sadishkumar Kamalanathan, Jaya Prakash Sahoo, Muthupillai Vivekanandan
July-September 2016, 5(3):743-743
DOI:10.4103/2249-4863.197277  PMID:28217628
  - 1,207 127
How does mid-day meal scheme shape the socialization value in rural India?
Janmejaya Samal, Ranjit Kumar Dehury
July-September 2016, 5(3):734-735
DOI:10.4103/2249-4863.197285  PMID:28217623
  - 1,425 111
Aripiprazole cardiosafety: Is it overestimated?
Ahmed Naguy
July-September 2016, 5(3):736-737
DOI:10.4103/2249-4863.197283  PMID:28217624
  - 1,027 110
Nonhemorrhagic complications in dengue fever with thrombocytopenia
Anirban Mandal, Puneet Kaur Sahi
July-September 2016, 5(3):738-738
DOI:10.4103/2249-4863.197282  PMID:28217625
  - 850 110
A type of Monteggia fracture, highly susceptible to misdiagnosis
Mosoud Bahrami-Freiduni, Behnam Baghianimoghadam, Reza Erfani
July-September 2016, 5(3):739-740
DOI:10.4103/2249-4863.197280  PMID:28217626
  - 847 113
Status of governmental oral health care delivery system in Haryana, India
Ashish Vashist, Swati Parhar, Ramandeep Singh Gambhir, Ramandeep Kaur Sohi, Puneet Singh Talwar
July-September 2016, 5(3):547-552
DOI:10.4103/2249-4863.197267  PMID:28217581
Background: Health system should be organized to meet the needs of entire population of the nation. This means that the state has the direct responsibility for the health of its population and improving the quality of life through research, education, and provision of health services. The present study was conducted to evaluate the government oral health care delivery system in Haryana, India. Materials and Methods: The present cross-sectional study was conducted among 135 dental care units (DCUs) of various primary health centers (PHCs), community health centers (CHCs), and general hospitals (GHs) existing in the state by employing a cluster random sampling technique. Data regarding the provision of water and electricity supply, dental man power and their qualification, number and type of instruments in the dental operatory unit, etc., were collected on a structured format. Statistical analysis was done using number and percentages (SPSS package version 16). Results: Alternative source of electricity (generator) existed in only a few of health centers. About 93.4% (155) of the staff were graduates (BDS) and 6.6% (11) were postgraduates (MDS). Ultrasonic scaler was available at dental units of 83.1% (64) of PHCs, 73.1% (19) of CHCs, and 93.8% (30) of GHs. Patient drapes were provided in 48.1% (65) of the DCUs, doctor's aprons were provided in 74.1% (100) of the places. Conclusion: There is a shortfall in infrastructure and significant problem with the adequacy of working facilities. A great deal of effort is required to harmonize the oral health care delivery system.
  - 1,355 173
Detection of anti-filarial antibody among hydrocele patients living in an endemic area for filariasis
Amit Kumar Singh, Loveleena Agarwal, Krishna Lakhmani, Chandrim Sengupta, Ravinder Pal Singh
July-September 2016, 5(3):553-557
DOI:10.4103/2249-4863.197324  PMID:28217582
Background: The knowledge of the current prevalence of lymphatic filariasis and its transmission will be helpful in its elimination. Thus, the present study is aimed to determine its prevalence among hydrocele patients which is a common presentation in chronically infected cases. Materials and Methods: One hundred patients suffering from hydrocele admitted to the surgical ward were included in the study. Blood samples were collected from the patients during the day hours for the detection of anti-filarial antibody and during night hours to detect the presence of microfilaria by smear examination. Blood samples were also collected from the family member attending the ward along with the patients to determine the presence of anti-filarial antibodies. Serum IgE level and eosinophil count were also determined in the patients showing a positive result for the anti-filarial antibody test. Results: Out of 100 hydrocele patients, 21% patients showed anti-filarial antibody card test positive with maximum patients belonging to age group of 20-40 years. Microfilaria was detected in 5% of the hydrocele patients, whereas none of the family members showed positive anti-filarial antibody test. Serum IgE level and eosinophil count were more than 1000 ng/ml and 500/mm 3 , respectively. Conclusions: The study has found a high prevalence of filariasis among hydrocele patients. It is suggested that more studies are needed to know the real time prevalence of the cases showing manifestations of the filariasis in the acute stage which will help the eradication program to formulate new strategies.
  - 2,088 227
Effectiveness of yoga program in the management of diabetes using community health workers in the urban slums of Bangalore city: A non-randomized controlled trial
Hemavathi Dasappa, Farah Naaz Fathima, Rugmani Prabhakar
July-September 2016, 5(3):619-624
DOI:10.4103/2249-4863.197323  PMID:28217594
Trial Design: Nonrandomized controlled trial. Methods: Nonrandomized controlled trial. This was an interventional study that was conducted in 4 slums of Bengaluru . Of the 256 diabetes participants, only 109 people agreed to participate in the program. Of 109 people, 52 people agreed to participate in the intervention (agreed to learn and practice Yoga) while the remaining 57 people were assigned to nonintervention group. Randomization and blinding could not be done. Objective and Outcome: The study was conducted with objective of assessing the effectiveness of Yoga, Pranayama, and Sudarshan Kriya in the community-based management of diabetes mellitus. The primary outcome variable was Hb1Ac and secondary outcome variables were systolic blood pressure (SBP), diastolic blood pressure (DBP), adherence to medication, and changes in lifestyle. Results: The study was conducted for 40 days. Community health workers made a total of 6 visits during the study. All the 109 participants were available for weekly follow-up. There were no drop outs among the study population. Statistically significant change was seen in the consumption of vegetable (c2 = 15.326, P < 0.005), fruits (c2 = 16.207, P < 0.005), salty food (c2 = 14.823, P < 0.005), bakery food (c2 = 10.429, P < 0.005) and fried food (c2 = 15.470, P < 0.005), adherence to metformin (c2 = 41.780, P < 0.005) and other medication(c2 = 21.871, P < 0.005) and proportion of patients with DBP under control (c2 = 9.396, P < 0.005) and proportion of people with glucose random blood sugar under control (c2 = 29.693, P < 0.005) between the two groups following the intervention. Statistically significant change was also seen in the proportion of people with SBP/DBP ≤140/90 (c2 = 10.635, P < 0.005) between the two groups. Conclusion: The Yoga program was successful in improving dietary practices and medication adherence and in increasing the proportion of diabetics and hypertensive patients under control.
  - 1,524 262
Promotion of sanitation and hygiene in a rural area of South India: A community-based study
Nagapraveen Veerapu, P Subramaniyan, BA Praveenkumar, G Arun
July-September 2016, 5(3):587-592
DOI:10.4103/2249-4863.197305  PMID:28217588
Introduction: Globally, billions of people do not have access to improved sanitation and many defecate in the open air. Poor hand washing practices and limited access to sanitation facilities perpetuate the transmission of disease-causing germs. The objectives of the study were to find out the level of knowledge, attitudes, and practices (KAPs) on sanitary latrine, footwear, and hand washing among rural people and to assess the improvement in KAP after health education intervention. Materials and Methods: A health education intervention study was conducted from November 2012 to January 2014 in a rural area of Kuppam, Andhra Pradesh, South India among the people aged 15 years and above. The individuals were selected by multistage random sampling and interviewed using a structured questionnaire. After a baseline KAP assessment, intervention activities were conducted twice. The intervention activities were group level talks and discussions, free soap distribution, and display of posters at anganwadi centers. Post-KAP was assessed twice, and the significance of difference was found by using McNemar's test. Results: After the intervention, there was a significant improvement in the overall KAPs among the subjects in post test-1 and post test-2 (P1 < 0.0001, P2 < 0.0001), respectively. Conclusions: Health education as an intervention has significantly increased KAP more than 30%. Hence, it is imperative that education interventions are needed to bring or sustain positive change.
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Gap analysis between provisional diagnosis and final diagnosis in government and private teaching hospitals: A record-linked comparative study
Sudeshna Chatterjee, Krishnangshu Ray, Anup Kumar Das
July-September 2016, 5(3):637-640
DOI:10.4103/2249-4863.197318  PMID:28217597
Aims: 1. To identify the extent of clinical gaps at the context of knowledge, practice and systems. 2. To formulate necessary intervention measures towards bridging the gaps. Settings and Design: Comparative, cross-sectional and non-interventional study. Methods and Material: It is retrospective, record-based study conducted upon inpatients (n = 200) of major disciplines of two teaching hospitals. Major outcome variables were to observe the matching and un-matching of final and provisional diagnosis by using ICD-10 criteria. Statistical Analysis Used: Comparative analysis of specific and selective gaps were estimated in terms of percentage (%). Results: Pilot observation showed the existence of gaps between provisional and final diagnosis in both private and government institution. Both knowledge and skill gaps were evident in caregivers and gap in documentation was existent in medical records. Conclusions: The pilot data is may be an eye-opener to public and private governance systems for understanding and revising the process service planning and service delivery. Necessary intervention measures may be contemplated towards enhancing diagnostic skill of doctors for quality hospital care.
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Urinary catheterization from benefits to hapless situations and a call for preventive measures
Gunjan Garg, Naveen Chawla, Atul Gogia, Atul Kakar
July-September 2016, 5(3):539-542
DOI:10.4103/2249-4863.197261  PMID:28217579
Catheter-associated complications are common, expensive, and often preventable by reducing unnecessary catheter usage. These complications range from most common nosocomial infection to uncommon conditions such as urethral diverticula and ischemic necrosis of the penis. Often, removal of a single known essential cause may be sufficient to prevent a disease. This review raises issues associated with urinary catheterization and emphasizes on the need of preventive measures a physician should take to reduce disappointing situations. The main objective of this literature review is to intercept or oppose unwanted catheter use and thereby, the disease processes associated with urinary catheterization. There is well-described literature available on catheter-associated urinary tract infection, but little is known about noninfectious complications resulting from catheter use; therefore, we also tried to draw attention on these unusual complications.
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How to strengthen primary health care
Pratyush Kumar
July-September 2016, 5(3):543-546
DOI:10.4103/2249-4863.197263  PMID:28217580
Realization of health care as primary objective is necessary to strengthen primary health care (PHC). There is a need to build financial viable and sustainable PHC based on rational principles to fulfill the goals of providing quality health services on an affordable and equitable basis and also ensuring fiscal prudence. Health-care leadership, innovations in primary care, family medicine specialists, and effective and accountable health governance are the key steps toward our goal.
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