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   2019| January  | Volume 8 | Issue 1  
    Online since January 31, 2019

 
 
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ORIGINAL ARTICLES
Organ donation – “attitude and awareness among undergraduates and postgraduates of North-East India”
Raktim Pratim Tamuli, Smritimala Sarmah, Bishwajeet Saikia
January 2019, 8(1):130-136
DOI:10.4103/jfmpc.jfmpc_206_18  PMID:30911493
Background: Organ donation is defined as “When a person allows an organ of theirs to be removed, legally, either by consent while the donor is alive or after death with the assent of the next of the kin.” Common transplantations after organ donations include kidney, heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and cornea. Although some organs such as kidney and tissues like part of the liver, pancreas, lungs, and intestines can be donated while the donor is alive, most of the donations occur only after the donor's death. In India, the legislative foundation for brain death and organ donation was officially established, under Transplantation of Human Organs Act, 1994 amended in 2011. It provided a much-needed legal and transparent system for organ donation. India's organ donation rate (ODR) stands at an abysmal 0.34 per million populations (PMP) when compared with donation rate of 36 PMP in countries like Spain. While in the rest of the country, states like Tamil Nadu, Maharashtra, Andhra Pradesh, and Gujarat have made efforts to ramp up their ODR, by facilitating public and private health sector activities, such vision is still a far cry for the states in the North-Eastern part of India. Materials and Methods: This study on awareness of organ donation was conducted in one of the premiere educational institutes at Guwahati. A predesigned performa (questionnaire) was used to collect data from 360 individual, of which 180 participants were undergraduate students and 180 participants were faculties having postgraduate degree. Results: The results show that 79.17% (285) of participants were aware about organ donation, and out of all participants, families of only three have donated organ in the past 5 years. A total number of 12 (3.33%) participants have signed up for organ donation. A significant portion of the study population (12.5%) opined that there might be some religious beliefs which are preventing certain strata of local population from donating or accepting organs. More than half (186) (51.67%) of the study group opined that there is lack of awareness among people which may be one of the reasons for low rates of organ donation. Conclusion: Organ donation programs are at a very primordial stage in India and are almost negligible in its North-Eastern region. It is high time for the policy makers and other stake holders of a global giant like India to understand the magnitude of the benefits from these programs. Making tangible policies that are reflected nationally, emphasizing attention to both the organ donors and recipients, is the need of the hour.
  2,281 143 -
Prevalence and risk factors of anemia among pregnant women attending a public-sector hospital in Bangalore, South India
J Vindhya, Anita Nath, G V. S. Murthy, Chandra Metgud, B Sheeba, V Shubhashree, P Srinivas
January 2019, 8(1):37-43
DOI:10.4103/jfmpc.jfmpc_265_18  PMID:30911478
Background: Anemia affects almost two-thirds of pregnant women in developing countries and contributes to maternal mortality and low birthweight. According to the National Family Health Survey-4 reports, maternal anemia continues to be a public health problem. Objective: To study the prevalence of anemia and its risk factors among pregnant women attending a public-sector hospital. Materials and Methods: This study was nested within an ongoing cohort study “ÇASCADE” which is exploring the effect of prenatal exposure to maternal cortisol and psychological distress on infant development in Bangalore. The respondents were enrolled from the antenatal clinic at Jayanagar General Hospital, which is a sub-district hospital. A total of 280 women who fulfilled the eligibility criteria were enrolled. Results: The prevalence of anemia was observed to be 33.9%; proportion of mild and moderate anemia was almost similar (48.4 and 49.5%). The mean hemoglobin level of all the participants was 11.33 ± 1.460 g/dl. The mean hemoglobin level concentration was high during early gestation with a slight decrease by 21–24 weeks. Prenatal depression but not anxiety appeared to be a strong predictor of anemia on bivariate as well as multivariate analysis. No association was observed with socio-demographic and obstetric variables. Conclusion: The burden of maternal anemia was considerably high in the study population. Although iron-folic acid supplementation is available under the national health program to address this issue, it is important to consider and address other risk factors when designing and implementing target interventions for anemia control in selected populations.
  1,527 178 -
Causative agents of urinary tract infections and their antimicrobial susceptibility patterns at a referral center in Western India: An audit to help clinicians prevent antibiotic misuse
Harshkumar B Patel, Sumeeta T Soni, Aroor Bhagyalaxmi, Neev M Patel
January 2019, 8(1):154-159
DOI:10.4103/jfmpc.jfmpc_203_18  PMID:30911498
Background: Urinary tract infections (UTIs) remain one of the most common infections in community and susceptibility of uropathogens to commonly used antimicrobials has declined over years. It is important to periodically study susceptibility patterns of uropathogens, so that empiric treatment can be determined using recent data, helping improve patient outcomes. Methods: Urine samples received by the laboratory for culture and susceptibility testing over a period of 3 months were analyzed and included in this study. Antimicrobial susceptibility testing was done on cultured isolates. Results: Of total 3,151 urine samples received, 3,066 were processed, and organisms were isolated from 1,401 (45.69%) samples. Isolation rate from male and female urine samples was 45.29% and 46.32%, respectively. The most commonly isolated organism was Escherichia coli (36.11%), followed by Candida spp. (18.56%), and Klebsiella spp. (18.06%). E. coli was most susceptible to meropenem (91.89%) and imipenem (91.69%). Klebsiella spp. was most susceptible to imipenem(75.89%) and meropenem(75.49%). Susceptibility of E. coli and Klebsiella spp. to nitrofurantoin, cotrimoxazole, and ciprofloxacin was 72.33%, 32.02%, and 18.97%, and 51.77%, 27.27%, and 22.13%, respectively. Candida spp. was most susceptible to amphotericin B (97.30%). Conclusion: Treatment for UTIs should be determined based on current local antimicrobial susceptibility patterns of uropathogens to minimise therapeutic failures and prevent antibiotic misuse.
  1,481 223 -
Barriers to exclusive breastfeeding in rural community of central Gujarat, India
Dinesh J Bhanderi, Yogita P Pandya, Deepak B Sharma
January 2019, 8(1):54-61
DOI:10.4103/jfmpc.jfmpc_329_18  PMID:30911481
Context: Exclusive breastfeeding (EBF) in first the 6 months of life is the most effective way to satisfy nutritional and psychological needs of a baby. However, EBF rate for India remained low at 54.9% during 2015–2016. It is therefore essential to understand the reasons for such a low EBF rate in the country so that appropriate interventions can be developed and implemented. Objectives: (1) To estimate the prevalence of EBF in rural community of central Gujarat and (2) to identify barriers to EBF in this community. Materials and Methods: A community-based cross sectional study was conducted among mothers of 330 infants of age 6 months to 1 year using pretested questionnaire. Two-stage cluster sampling technique was used to select the sample. χ2 test, t-test, and logistic regression were applied to assess the significance of associations. Results: EBF rate in the studied population was detected to be 49.7%. Early marriage of parents, less educated parents, male child, Christian religion, working mother, less number of antenatal visits, operative delivery, late initiation of breastfeeding, not feeding colostrum, lack of knowledge about EBF, and poor counseling of mother regarding EBF were identified as barriers to EBF. Conclusion: Prevalence of EBF was found to be lower than the national average in the rural community of central Gujarat. Effective strategies at local, state, and national levels should aim at addressing the barriers to EBF that are identified in this study.
  1,431 145 -
EDITORIAL
Cultural competence in family practice and primary care setting
Raman Kumar, Sudip Bhattacharya, Neha Sharma, Arulmani Thiyagarajan
January 2019, 8(1):1-4
DOI:10.4103/jfmpc.jfmpc_393_18  PMID:30911472
In primary care settings, cultural perception and competence attitude are imperative as notion of health, illness, sickness, and care means different to different people. The knowledge of cultural beliefs and customs facilitate healthcare providers to afford improved care and helps to avert misunderstandings among care provider's staff, patients, and their families. It is a very useful approach in family practice towards improving the health care to racial/ethnic minor groups and reducing the disparities.
  1,104 182 1
ORIGINAL ARTICLES
Food taboos in pregnancy and early lactation among women living in a rural area of West Bengal
Sreetama Chakrabarti, Abhik Chakrabarti
January 2019, 8(1):86-90
DOI:10.4103/jfmpc.jfmpc_53_17  PMID:30911485
Introduction: Pregnancy and lactation require greater need for nutrition for a mother but the situation becomes more complicated when a pregnant or a lactating woman follows or forced to undergo certain dietary restriction for the benefits of her baby. This study was conducted to know about the food taboos followed during pregnancy and early part of lactation by the women residing in a rural area. Methods: The study was conducted at different subcenters of Amdanga Community Development Block of North 24 Parganas district, West Bengal. The study was descriptive, observational with cross-sectional design, and was done through mixing of both quantitative and qualitative methods. Total four focus group discussions (FGDs) were conducted and 44 pregnant women and lactating mothers participated in those discussions. Notes and audio recording from FGDs were transcribed to written English language, analyzed, and principal domains were extracted. Result: Taboos were present regarding consumption of various fruits (banana, papaya, jackfruit, coconut), vegetables (brinjal, leafy vegetables), meat, fish, and eggs during pregnancy. These were followed mainly to prevent miscarriage, promote easy delivery, and prevent fetal malformations. Taboos in the lactation included avoidance of small fish, foods with multiple seeds, other “cold” foods, and fluid restriction in some areas. The taboos were followed spontaneously as the inhibitions were imposed only for a definite period. Conclusion: Though diminished, food taboos are still prevalent in the rural areas of West Bengal. Nutrition education in pregnancy and lactation may be strengthened in those areas.
  1,122 117 -
Impact of health education on knowledge, attitude, practices and glycemic control in type 2 diabetes mellitus
Sumit Pal Singh Chawla, Sarabjot Kaur, Aman Bharti, Ravinder Garg, Manjeet Kaur, Divya Soin, Amrita Ghosh, Ranabir Pal
January 2019, 8(1):261-268
DOI:10.4103/jfmpc.jfmpc_228_18  PMID:30911517
Background: Effective health education consequently improves knowledge, attitude, and practices (KAP) leading to better glycemic control and is widely accepted as an integral part of comprehensive diabetes care for affected individuals and their families in primary care settings. Aims: To assess the impact of health education on knowledge, attitude, practices, and glycemic control in type 2 diabetes mellitus patients. Settings and Design: This case control study was conducted in the department of Medicine of a tertiary care teaching hospital. Methods: The study was conducted on 100 diabetic subjects aged more than 40 years comprising of 50 cases and 50 controls. Cases were given education on their disease, drugs, dietary, and lifestyle modifications along with patient education leaflet at baseline and at first follow-up, while controls received neither of these. Subjects were assessed for KAP by administering KAP questionnaire and for glycemic control by measuring glycated hemoglobin (HbA1C) at baseline and at the end of the study. Results: In this study, end mean knowledge, attitude, practice, and KAP SUM scores of cases (10.28 ± 1.78, 3.46 ± 0.93, 3.14 ± 0.86, and 16.82 ± 3.40, respectively) showed significant increase from the baseline (3.86 ± 0.93, 1.00 ± 0.83, 0.40 ± 0.64, and 5.26 ± 2.10, respectively) compared to controls, accompanied by significant reduction in HbA1C of cases at the end of the study compared to the controls. Conclusions: Effective health education improves knowledge, attitude, and practices, particularly with regard to lifestyle modifications and dietary management, culminating into better glycemic control that can slow down the progression of diabetes and prevent downstream complications.
  1,053 153 -
Prolactin and thyroid stimulating hormone affecting the pattern of LH/FSH secretion in patients with polycystic ovary syndrome: A hospital-based study from North East India
Chandan K Nath, Bhupen Barman, Ananya Das, Purnima Rajkhowa, Polina Baruah, Mriganka Baruah, Arup Baruah
January 2019, 8(1):256-260
DOI:10.4103/jfmpc.jfmpc_281_18  PMID:30911516
Introduction: Polycystic ovary syndrome (PCOS) is one of the most important endocrinal diseases in reproductive age group, clinically manifested by hyperandrogenism and anovulation and different other metabolic disturbances that may have important implications for long-term health. Aim and Objective: The aim of this study was to determine the incidence of abnormal luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio in women with polycystic ovary and to assess the influence of prolactin and thyroid-stimulating hormone (TSH) in the elevated LH/FSH ratio. Study Design: Retrospective observational study. Materials and Methods: Eighty-five women in reproductive age diagnosed with PCOS between June 2012 to June 2014 at the Department of Obstetrics and Gynecology in a tertiary care hospital were selected for the study. Serum LH and FSH levels were determined and LH/FHS ratio (normal range ≤2) calculated in the study subjects. They underwent a detailed clinical, hormonal, and metabolic evaluation, which was performed between the second and third days of a natural or induced menstrual period. Results: Elevated LH/FSH ratio was found in 60 women (70.58%). Normal gonadotropin ratio was detected in 25 women (29.41%). Statistically significant differences in serum TSH levels were noted between groups with normal and elevated LH/FSH ratio. However, no statistically significant difference was noted in other endocrine parameters. Further analysis revealed a slight negative correlation of TSH with prolactin in the study subjects of PCOS with an 'r' value of − 0.3. Conclusions: LH/FSH ratio is one of the characteristic attribute of PCOS women. In the present study, this abnormality was detected in 70% of patients. Hypothyroidism was a common endocrinal abnormality and prolactin was inversely correlated to TSH levels in PCOS patients.
  1,073 87 -
Epidemiology of obesity and its related morbidities among rural population attending a primary health centre of Odisha, India
Subrata Kumar Palo, Swagatika Swain, Subhadra Priyadarshini, Balabhadra Behera, Sanghamitra Pati
January 2019, 8(1):203-208
DOI:10.4103/jfmpc.jfmpc_255_18  PMID:30911507
Context: Overweight and obesity has become a major contributor to global burden of chronic diseases and disability. Obesity among rural India is emerging as a major health problem because of change in lifestyle and food habits, thereby increases the risk of multiple morbid conditions among rural population. Aims: This study aims to find out the association of overweight/obesity with different socio-demographic factors and explore the co-morbidities among overweight and obese in a rural setting. Settings and Design: A cross-sectional study was done in a randomly selected primary health centre of Khurda district, Odisha for 4 months. Materials and Methods: This study was done among 183 patients aged >20 years with BMI >25 kg/m2 after taking their consent. Anthropometric measurements were done and data were collected using a semi-structured questionnaire. Statistical Analysis Used: Descriptive statistics such as proportion, mean and standard deviation were calculated and inferential statistics such as Chi-square test, univariate and multivariate regression was done using the SPSS version 20.0. Results: Mean age of participants was 45.7 (±13.8) years. About 93.4% were Grade II obese while 51.9% were at risk according to their waist–hip ratio. Around 53.6% of participants had multi-morbidity. Age, occupation and number of children were significantly associated with obesity. Morbidity was significantly associated with age, occupation, marital status and number of children. Increased grade in obesity the more is the probability of having morbidity. Conclusions: There is an urgent need to screen for obesity at rural health facility and early management for prevention from co-morbidities.
  1,048 106 -
Prevalence and patterns of peripheral neuropathy in patients of rheumatoid arthritis
Nidhi Kaeley, Sohaib Ahmad, Monika Pathania, Rajesh Kakkar
January 2019, 8(1):22-26
DOI:10.4103/jfmpc.jfmpc_260_18  PMID:30911476
Background: Rheumatoid arthritis (RA) is an autoimmune disorder characterized by involvement of multiple small and large joints with multisystem extra-articular manifestations. Peripheral neuropathy is known extra-articular manifestation of RA with the incidence of around 39.19% as per previous studies. Early diagnosis and treatment of peripheral neuropathy has been shown to improve both physical and functional disabilities of patients with RA. Objectives: The primary objective was to study prevalence and patterns of peripheral neuropathy in patients with RA. The secondary objective was to study demographic, clinical parameters, disease severity, and extra- articular manifestations in patients with RA with and without peripheral neuropathy. Materials and Methods: Consecutive patients of RA were recruited. Detailed clinical examination and electrophysiological tests were done to diagnose peripheral neuropathy. The demographic and clinical parameters were noted and tabulated. Student's t-test was used to analyze continuous variable, whereas Chi-square test was used for analysis of categorical variables. Results: Of 89 patients with RA, 75.28% (n = 67) patients had peripheral neuropathy electrophysiologically, whereas 20.89% (14 patients of 67) had superficial touch sensory loss on examination. Subclinical neuropathy was present in 50.74% (n = 34) of patients. Statistically significant association between the presence of neuropathy and age of the patients, disease duration, use of disease-modifying antirheumatoid drugs, disease severity (disease activity score-28), and presence of subcutaneous nodules (P < 0.05). Conclusion: Patients with RA, especially elderly patients, should undergo electrophysiological testing to rule out peripheral neuropathy. Electrophysiological study is a diagnostic and gold standard tool to diagnose subclinical neuropathy in patients with RA. Presence of peripheral neuropathy in these patients has been found to be significantly associated with deteriorating health status, pain scores, and presence of extra-articular manifestations.
  989 141 -
Knowledge, attitude and practices toward health behavior and cardiovascular disease risk factors among the patients of metabolic syndrome in a teaching hospitalin India
Anjana Verma, Shefali Mehta, Aditi Mehta, Ashish Patyal
January 2019, 8(1):178-183
DOI:10.4103/jfmpc.jfmpc_257_18  PMID:30911502
Background: Indian subcontinent has highest rates of cardiovascular diseases (CVDs) worldwide. Metabolic syndrome (MS) is a condition which can lead to many complications including CVDs. Most of the studies in India have been done about prevalence of MS; this study intends to study their awareness and perceptions about CVD risk factors, which can help to plan and implement the educational health programs in a better and effective manner to prevent complications in these patients. Materials and Methods: It was a cross-sectional study conducted from April 2017 to March 2018 in a teaching hospital of Udaipur, Rajasthan. It involved 402 patients of MS diagnosed using National Cholesterol Education Program – Adult Treatment Panel III criteria with an anthropometric modification of waist circumference (WC) value that is specifically applicable to South Asians. A 43-item questionnaire was used to assess knowledge, attitude, and health-seeking behavior (KAP) toward CVD disease risk factors. KAP scores were characterized into poor, average, and good. Data were analyzed using descriptive statistics, Chi square, and ANOVA. Results: Majority (58%) of the MS patients were males and belonged to middle socioeconomic status (63%). The study subjects were found to have average knowledge and good attitude but poor practices. Males, patients with lower WC, and lower fasting blood sugar showed significantly better knowledge scores. Good attitude scores were associated with education and WC. Younger subjects, patients having better sugar control, and lower WC had significantly better practices. Conclusion: Despite having good attitude, MS patients were not following good lifestyle practices to prevent CVD. Results in this study call for intensive educational interventions required to prevent complications in these patients.
  953 99 -
Preintensive care: Thrombolytic (streptokinase or tenecteplase) in ST elevated acute myocardial infarction at peripheral hospital
Himmatrao S Bawaskar, Pramodini H Bawaskar, Parag H Bawaskar
January 2019, 8(1):62-71
DOI:10.4103/jfmpc.jfmpc_297_18  PMID:30911482
Background: Coronary artery disease is a major cause of death in India. Sudden death preceded by chest pain is due to acute myocardial infarction. Villagers are aware and afraid of chest pain. Majority of chest pain victims attend the primary physician in golden hours. Hence, primary doctors can play important role for early thrombolysis and salvage the myocardium from irreversible injury. This study determined year mortality in a patient who received the rapid thrombolysis at primary care hospital (streptokinase or tenecteplase) at rural setting. Setting: Peripheral General Hospital Mahad on Mumbai–Goa highway. Patients and Methods: Patients with typical chest pain with electrocardiogram showed ST segment elevated myocardial infarction (STEMI) with or without risk factors admitted from 2005 to march 2016 were studied. Details clinically studied: time interval between chest pain to hospital, hospital to needle time, reperfusion and arrhythmias. Time required for regression of elevated ST segment, a response to thrombolytic (streptokinase or tenecteplase) therapy, is studied. Results: Total 244 patient reported with chest pain of these 35 cases brought dead with history of chest pain and convulsive moment before they died. Of these, 209 patients had acute STEMI. Of these, 162 received streptokinase (STK) and 47 received tenecteplase (TNP)]. Analysis of STK Vs TNP patients 18 (11.11%) versus 3 (6.38%) (P = 0.361) died during the treatment. Around 17 (18.49%) vs 5 (10.63%) (P = 0.941) did not show signs of reperfusion, respectively. Re infarction occurred during hospitalization 3 (2.5%) versus 3 (6.38%) (P = 0.094) cases. Around 12 (7.40%) versus 0% (P = 0.072) died at the end of 12 months of thrombolytic therapy. Conclusion: Thrombolysis of STEMI within golden hours improved the reperfusion. However, 1-year fatality is significance with streptokinase as compared with tenecteplase.
  857 118 -
Disrespect and abuse during facility-based childbirth and its sociodemographic determinants – A barrier to healthcare utilization in rural population
Tabassum Nawab, Uzma Erum, Ali Amir, Najam Khalique, Mohammed A Ansari, Ambreen Chauhan
January 2019, 8(1):239-245
DOI:10.4103/jfmpc.jfmpc_247_18  PMID:30911513
Context: The provider-driven disrespect and abuse (DA) of women during childbirth is a marker for quality of maternal care and violation of basic human rights. Aims: This study was done to assess prevalence and sociodemographic determinants of DA experienced during facility-based childbirth. Settings and Design: This is a cross-sectional, community-based study done in six villages in the district of Aligarh, north India. Subjects and Methods: In all, 305 women who underwent facility-based childbirth were interviewed by pretested and structured questionnaire at home between 4 and 6 weeks postpartum period. Statistical Analysis Used: Descriptive statistics, Chi-square test, and bivariate regression analysis using SPSS 20.0 were used. Results: A total of 257 (84.3%) of 305 women reported any form of DA. Nonconsented services (71.1%) and nonconfidential care (62.3%) were the most common types. Abandonment/neglect during childbirth was reported by 10.2% women, nondignified care by 9.2%, physical abuse by 5.9%, detention in the health facility by 3.3%, and discrimination by 3.9%. Women who had undergone vaginal birth [odds ratio (OR) 3.36; confidence interval (CI) 1.7–6.5], at public health facility (OR 2.65; CI 1.4–5.0), given care by providers other than doctors (OR 2.89; CI 1.5–5.5), who belonged to low socioeconomic status (OR 3.68; CI 1.4–9.7), and who did not decide place of delivery themselves (OR 4.49; CI 2.0–12.1) were more at risk of DA. Out of all females unwilling to attend facility in future, 93.8% reported experiencing DA. The association between any DA and decision to attend the facility in future was statistically significant. Conclusion: More than 8 of 10 women experienced any DA during facility-based childbirth. It can be a barrier to utilization of facility for childbirth. Preventing DA is important to improve quality of maternal care and institutional deliveries.
  802 144 -
Menstrual disorders and quality of life of women in an urban area of Puducherry: A community-based cross-sectional study
Karthik Balajee Laksham, Ramya Selvaraj, Sitanshu Sekhar Kar
January 2019, 8(1):137-140
DOI:10.4103/jfmpc.jfmpc_209_18  PMID:30911494
Background: Menstrual disorders are common among women in reproductive age group and affect their normal functioning and social life. Due to cultural reasons, menstrual problems often get unreported. In India, the literature on the effect of menstrual disorders on the quality of life (QOL) of women is limited. Objectives: To estimate the prevalence of menorrhagia and dysmenorrhea among women in an urban field practice area and to compare their QOL with women without menstrual disorders. Methods: This is a community-based cross-sectional study among women who have attained menarche and not yet attained menopause in an urban field practice area of a tertiary care teaching institute in Puducherry. Households were selected by systematic random sampling, and a door-to-door survey was done using an Android-based mobile phone app Epi Info. A pretested questionnaire was used for collection of sociodemographic details. QOL was measured using World Health Organization BREF scale. Results: A total of 119 women were interviewed, and their mean (standard deviation) age was 33 (10) years. The majority was homemakers (63%), belonging to lower socioeconomic status (60%) and one-fifth had no formal education. The prevalence of dysmenorrhea was 45% [95% confidence interval (CI): 36.6%–54.4%] and that of menorrhagia was 17% (95% CI: 11.6%–25.3%). QOL in women with dysmenorrhea was poor compared with normal women in physical, psychological, social, and environmental domains (mean score 57.9 vs. 69.7, P < 0.001). Conclusions: Prevalence of dysmenorrhea and menorrhagia is comparatively high in this study area. QOL of women with these disorders was poor.
  812 103 -
CASE REPORTS
Systemic lupus erythematosus camouflaging: As refractory acne in a young girl
Bijaya Mohanty, Binod Kumar
January 2019, 8(1):276-279
DOI:10.4103/jfmpc.jfmpc_376_18  PMID:30911520
Cutaneous manifestations of systemic lupus erythematosus (SLE) are important diagnostic criteria as described by the revised American College of Rheumatology and Systemic Lupus International Collaborating Clinics. Patients usually present with various lupus-specific cutaneous manifestations such as malar rash, discoid rash, photosensitivity, and alopecia. Acneiform presentation of SLE is extremely rare. Review of the literature using PubMed has found only nine other reports so far. Here, we report a case who was initially treated as acne and later diagnosed as SLE.
  768 70 -
ORIGINAL ARTICLES
The effect of short-term exposure to red and blue light on the autonomic tone of the individuals with newly diagnosed essential hypertension
Pratibha Modi, Kamlesh Jha, Yogesh Kumar, Tribhuwan Kumar, Ramji Singh, Abhilasha Mishra
January 2019, 8(1):14-21
DOI:10.4103/jfmpc.jfmpc_375_18  PMID:30911475
The research study aimed to study the effect of short term exposure to light basically red, blue and white on the autonomic tone of essential hypertensive individuals. The objective was to find out the baseline cardiac autonomic function along with the effect of these lights on the cardiac autonomic function among them. Till date few if any study have been conducted upon the individuals with certain disorder as common as essential hypertension. This was a cross sectional observational study conducted in the institute itself that included 77 newly diagnosed hypertensive subjects who willingly participated in the study. After written informed consent, brief history taking with the help of self-made questionnaire and clinical examination, they were randomized to different intervention groups (IG) namely IG I (red) IG II (blue) and IG III (white). HRV analysis of the last 5-6 minutes of both the baseline and color exposure was finally analyzed using MS Excel version 13 and Graph Pad Prism version 7.05. Different HRV parameters have been found to be affected differently on different color exposures. Red has shown to have an impact, mainly on the sympathetic system whereas white showed a dominant vagal component thus acting as a parasympathetic regulator. On one hand, where no conclusive result was found on blue light exposure, white light showed the most prominent results affecting various time and frequency components of HRV like SDRR, TP, LF etc. The present study, both, contradicts as well as supports various other works done on the similar area of interest. One reason of such high variation in different results is because HRV is itself a very dynamic function affected by even a slight change in both the internal and external environment of the subject. As artificial lights of various colors are part and parcel of the aesthetics and designing of most of the work environment all over world, it is very pertinent to study its impact upon human health status. The outcome of the study may play a decisive role in the diagnostics and therapeutics of essential hypertension in days to come. Furthermore, on the basis of the present findings, a future study could be undertaken with bigger data base addressing the limitations of the present study to find some conclusive evidence in the area highlighted.
  684 104 -
Diabetic patients' awareness of diabetic retinopathy symptoms and complications
Abdullah Eid Abdulaal, Omar Majed Alobaid, Abdulaziz Gassam Alotaibi, Khalid Abdulaziz Aldihan, Abdulmalik Yousef Alnasyan, Abdullah Abdulrahman Albassam, Mesaed Ibrahim AlSenani, Abdulrahman Alnasyan
January 2019, 8(1):49-53
DOI:10.4103/jfmpc.jfmpc_349_18  PMID:30911480
Background: Diabetes is a very common chronic endocrinological disease. A total of 8.8% of the adult population worldwide was diabetics. Diabetic retinopathy is a silent disease, early detection and intervention is essential for its management and prognosis. Aim: To assess the diabetic patients' awareness of diabetic retinopathy symptoms and complications. Methods: This is a cross-sectional community-based study which was conducted in Saudi Arabia using a survey from the period between June and September 2018 on all diabetic Saudi participants between 15 and 75 years of age. Results: This study involved 385 participants. The average age of the participants was 47.82 ± 14.49. The study only involved patients who were diagnosed with type 1 diabetes mellites (DM) or 2 DM. And 81% of the samples were diagnosed with type 2 DM. A total of 311 participants were aware of the DM effect on the eye. There was a significant difference between gender regarding the effect of DM on the retina in good control patients. On the subject of the source of participants' knowledge of DM and its complication, there was a notable difference between groups. Conclusion: An acceptable level of knowledgewas noted among patients. However, some points of knowledge should be increased.
  676 104 -
Comparative study of silver-sulfadiazine-impregnated collagen dressing versus conventional burn dressings in second-degree burns
Milind A Mehta, Sankit Shah, Vikrant Ranjan, Pradnya Sarwade, Atul Philipose
January 2019, 8(1):215-219
DOI:10.4103/jfmpc.jfmpc_291_18  PMID:30911509
Background: The advantages of biological skin dressings like collagen are well-known. It makes wound impermeable to bacteria and creates the most physiological interface between the wound surface and the environment. Silver-sulfadiazine-impregnated collagen (SIC) is a type 1 collagen impregnated with silver sulfadiazine (SSD)-loaded alginate microspheres to deliver SSD in a controlled fashion to manage infected burn wounds for an extended period of time with lesser dressing changes. Materials and Methods: In this study, we used SIC for the treatment of second-degree burn wounds in 25 patients and compared with similar burn wounds in 25 patients treated with conventional dressings. Results: For SIC-treated group, we observed improved wound healing in all the patients after 7 days except two patients who required skin grafting, and none of them had any serious complications. For conventionally treated group, improved wound healing was seen in 14 patients, whereas the rest of the patients required prolong dressing or skin grafting. All the patients who were treated with SIC were satisfied with healing of wound and pain relief. Conclusion: Second-degree burn wounds are well-treated with SIC in the form of good healing, control of infection, and reducing pain without any serious complications when compared with conventional dressing.
  689 86 -
Development of simplified body mass index–based field charts to assess nutritional status and weight gain in adult patients with tuberculosis
Madhavi Bhargava, Anurag Bhargava
January 2019, 8(1):115-119
DOI:10.4103/jfmpc.jfmpc_226_18  PMID:30911490
Tuberculosis (TB) is a cause and effect of undernutrition. Patients with active TB in India have a high prevalence of severe undernutrition, an important comorbidity, which increases the risk of mortality, serious adverse effects, relapses after cure and impairs functional status. The World Health Organization and Revised National Tuberculosis Control Programme have now recommended that nutritional assessment, counseling, and support be considered as integral parts of TB care. Nutritional assessment requires calculations of body mass index (BMI) to classify severity of undernutrition at diagnosis and ascertain nutritional recovery at follow-up. We present BMI-based field charts constructed for use by healthcare workers which obviate calculations of BMI and provide weights corresponding to BMI categories, and body weight corresponding to a desirable BMI of 21 kg/m2. These simplified BMI-based field charts will enable appropriate assessment, counseling, and monitoring of undernourished patients with active TB by peripheral health workers in programmatic settings.
  678 88 -
CASE REPORTS
Rhabdomyolysis - Exercise induced nightmare
Ashok Sunder, Bijaya Mohanty, Abha Singh, Prabhakar Yadav
January 2019, 8(1):305-307
DOI:10.4103/jfmpc.jfmpc_370_18  PMID:30911528
The term rhabdomyolysis refers to the disintegration of striated muscle which results in the release of muscular cell constituents into the extracellular fluid and circulation. Exertional rhabdomyolysis is occasionally seen after strenuous exercise. The progression to compartmental syndrome or renal failure is a rare complication that requires prompt recognition and treatment to prevent morbidity. We present the case of a 35-year-old male who came to our emergency department after a strenuous workout followed by fasting for a day. He presented with generalized weakness, decreased urine output, and one episode of dark-colored urine. He was found to have rhabdomyolysis with acute kidney injury (AKI). His condition progressed to frank renal shutdown requiring several sittings of dialysis and a very stormy course in hospital lasting about a month.
  624 87 -
ORIGINAL ARTICLES
Conflicts women with breast cancer face with: A qualitative study
Seyyede Zahra Ghaemi, Zohreh Keshavarz, Sedigheh Tahmasebi, Majid Akrami, Seyed Taghi Heydari
January 2019, 8(1):27-36
DOI:10.4103/jfmpc.jfmpc_272_18  PMID:30911477
Background and Aim: The prevalence of cancer in women under 50 years of age has been increased in recent years. Cancer treatment methods can lead to infertility in women with cancer. Fertility and childbearing, as the most important conflicts in the life of women with breast cancer, significantly affect their quality of life. Materials and Methods: This research is a qualitative study of content analysis type. Purposeful sampling and semi-structured individual interviews were performed for data collection. The participants were women with breast cancer referred to the Breast Disease Research Center of Shahid Motahari Clinic in Shiraz. The data were saturated after 15 interviews. To assess the validity and reliability, we used the four criteria provided by Lincoln and Guba. The conventional qualitative data analysis and MAXQDA10 software were used to analyze the qualitative data. Results: Explaining the conflicts which women with breast cancer are faced has led to the extraction of four main categories: (1) paradox of decision-making to childbearing, (2) fear, (3) sinister emotions, and (4) challenges. The results showed that the paradox of decision-making on childbearing is the most important challenge with which the patients with breast cancer are faced, causing a state of fear, anxiety, and the emergence of sinister emotions in them. Conclusion: It seems that paying more attention to preserving reproductive capacity before starting the treatment plays an important role in solving the biggest conflict in the life of breast cancer patients.
  603 96 -
EVIDENCE BASED SUMMARY
Minimum data set (MDS) based trauma registry, is the data adequate? An evidence-based study from Odisha, India
Sanghamitra Pati, Rinshu Dwivedi, Ramesh Athe, Pramod Kumar Dey, Subhashisa Swain
January 2019, 8(1):7-13
DOI:10.4103/jfmpc.jfmpc_307_18  PMID:30911474
Background: In majority of the low- and middle-income countries (LMICs), the societal cost of injuries are alarming. The severity and magnitude of the road traffic injuries (RTI) in India are not estimated accurately due to the lack of availability of data. The data are limited on the aspects such as demographics, cause, severity of injury, processes of care, and the final outcome of injuries. This study aimed to determine the feasibility of setting up a sustainable trauma registry in Odisha, India, and to determine the demographics, mechanism, severity, and outcomes of injury reported to the facilities/hospital. Materials and Methods: A prospective observational study was conducted at Srirama Chandra Bhanja Medical College and Hospital (SCB-MCH), Cuttack, India. Injured patients who reported/admitted to the emergency department were observed, and data were collected by using a minimum data set (MDS) developed by the World Health Organization (WHO). Data were collected for a period of one month in June 2015. Observations were collected on 20 variables. The completeness of data collection ranged from 60% (19 variables) to 70% (23 variables) out of total 33 variables. Results: This study uses 145 cases of injury reported in SCB-MCH. Out of the total reported population at the trauma registry, about 21% were females. Nearly 45% of the injury occurred on road/street. RTI accounted for 36.6% of injury. Out of the total admitted cases, 2.8% died in the emergency department, 11% were discharged to home, and 7.6% left against medical advice. Majority of the respondents have reported single injuries (77%). Head injuries were more common and severe among majority of the reported cases (44.1%), followed by neck injury (28.3%) and chest (15.9%). Conclusions: This study indicates the challenges in obtaining complete data on injury. Data were missing in terms of admission, discharge, and Glasgow Comma Scale (GCS) among the studied population. This study suggests that individual GCS scoring should be done instead of total GCS scoring in each trauma patient. By collection and storage of adequate data, better policy decisions can be implemented, which will minimize and prevent trauma cases and maximize the utilization of the available resources.
  582 97 -
ORIGINAL ARTICLES
Assessment of vaccine coverage and associated factors among children in urban agglomerations of Kochi, Kerala, India
Teena M Joy, Sobha George, Nimitha Paul, BA Renjini, PS Rakesh, Aswathy Sreedevi
January 2019, 8(1):91-96
DOI:10.4103/jfmpc.jfmpc_276_18  PMID:30911486
Context: Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate. Aims: This study aims to estimate routine immunization coverage and associated factors among children (12–23 months and 60–84 months) in the urban Kochi Metropolitan Area of Kerala. Settings and Design: A cross-sectional study was conducted in Kochi Metropolitan area. Materials and Methods: A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months. Statistical Analysis: Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage. Results: Among the children aged 12–23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20–4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06–3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4–5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease. Conclusion: Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas.
  602 67 -
Correcting inhaler technique decreases severity of obstruction and improves quality of life among patients with obstructive airway disease
Alkesh Kumar Khurana, Kapil Dubey, Abhishek Goyal, Kamendra Singh Pawar, Chaiti Phulwaria, Abhijit Pakhare
January 2019, 8(1):246-250
DOI:10.4103/jfmpc.jfmpc_259_18  PMID:30911514
Background: Asthma and chronic obstructive lung disease (COPD) together constitute a huge burden on healthcare all around the world. Treatment of these patients is largely dependent on the way the inhalation devices are used. This study aimed at measuring the impact of rectification of inhalation technique on quality of life and severity of obstruction in patients with asthma and COPD. Materials and Methods: A total of 45 asthma (partly controlled) and 38 patients with COPD (categories B and C) were enrolled after applying optimal exclusion criteria. These patients underwent Asthma Control Test (ACT)/COPD Assessment Test (CAT) questionnaire as a measure of quality of life and forced expiratory volume in one second (FEV1) as a measure of severity of obstruction at 0 and 4 weeks, respectively. Results: In asthmatics, the mean FEV1 improved from 2.0 to 2.15 L after 4 weeks of technique correction (P < 0.001). In addition, the mean ACT scores improved from 18.0 to 20.75 (P < 0.001). In patients with COPD, the mean FEV1 improved slightly from 1.54 to 1.56 L after 4 weeks of technique correction (P = 0.28). In addition, the mean CAT scores improved from 21.86 to 19.83 (P < 0.001). Conclusion: Demonstration of correct inhalation technique should be an indispensible part of the treatment prescription of patients with obstructive airway disease. This simple and important task can be undertaken at the level of primary care physicians in a community-based setting to improve patient compliance.
  583 82 -
Chronic musculoskeletal pain among elderly in rural Tamil Nadu: Mixed-method study
S Kirubakaran, Amol R Dongre
January 2019, 8(1):77-85
DOI:10.4103/jfmpc.jfmpc_290_17  PMID:30911484
Objectives: (1) To determine the prevalence of chronic pain of musculoskeletal origin at different body sites among elderly (≥60 years). (2) To study the determinants of chronic pain and the healthcare seeking behavior among elderly with chronic pain. (3) To explore the perceptions of chronic pain among elderly. Materials and Methods: This study was done in 55 field practice villages of the Rural Health Training Centre (RHTC) of the Department of Community Medicine, SMVMCH, Puducherry. An Exploratory Mixed-Method study design, where a qualitative phase (in-depth interviews [IDI]) followed the quantitative phase (Survey). A representative sample of 850 respondents was selected by two-stage cluster sampling. A trained investigator did a house-to-house visit and interviewed selected elderly respondents by using predesigned and pretested questionnaire. The intensity of chronic pain was measured using the Functional Rating Scale and Numeric Rating Scale. The manual content analysis was done for qualitative data. Multiple logistic regression was performed on quantitative data. Results: Qualitative data were described under two broad themes: (1) perceptions of elderly people about chronic pain and 2) healthcare seeking and coping mechanisms. Prevalence of chronic pain among the elderly respondents was found to be 47.6%. Most common site for chronic pain was knee joint (64.5%) followed by a low backache (21.7%). Most of the older people with chronic pain had mild-to-moderate and tolerable pain. Two predictors for chronic pain were the age of the respondent (adjusted OR -1.03, 95% CI = 1.01–1.05) and the presence of at least one chronic morbidity (adjusted OR -1.37, 95% CI = 1.03–1.82). Conclusions and Recommendations: Since the chronic pain was found to be associated with aging and the presence of at least one of the chronic morbidities, it is crucial for treating community physicians to consider the comorbid conditions while managing chronic pain in elderly. Considering the complex nature of chronic pain in old age, the primary care physician should be trained in drug and context-specific nondrug interventions to address the biomedical causes and other cognitive-behavior factors, respectively, through active support from their family and neighborhood.
  583 74 1
CASE REPORTS
An interesting case of acute disseminated encephalomyelitis following E. coli infection
Kandan Balamurugesan, Rajangam Ponprabha, Prem Davis
January 2019, 8(1):292-295
DOI:10.4103/jfmpc.jfmpc_402_18  PMID:30911524
Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of central nervous system (CNS), characterized by multifocal white matter involvement with neurological deficits and accompanied by encephalopathy. ADEM is thought to be caused by autoimmune etiology. CNS autoantigens are produced by molecular mimicry triggered by an environmental stimulus, mostly infection (viral/bacterial) or post vaccination, in genetically susceptible individuals. ADEM is sometimes referred to as post/para-infectious or post-immunization ADEM. ADEM is characterized by multifocal neurological signs and occasionally it rapidly progresses to coma. Magnetic resonance imaging (MRI) is used to confirm the diagnosis. The treatment is based on intravenous high-dose methylprednisolone, which usually leads to a rapid improvement. Recently, the use of intravenous immunoglobulins and plasma exchange (PLEX) has also been suggested. We report a case of a 6-year-old girl who was admitted for urinary tract infection but developed neurological complications which was treated successfully.
  577 63 -
ORIGINAL ARTICLES
Myositis associated with Salmonella paratyphi A bacteremia appears to be common
Adline Harris, Stalin Viswanathan, Rajeswari Aghoram
January 2019, 8(1):125-129
DOI:10.4103/jfmpc.jfmpc_202_18  PMID:30911492
Background: Fever and severe myalgia in a tropical country like India bring to mind leptospirosis, rickettsioses, dengue, and other viral fevers. Enteric fever is widely prevalent in Asia, but myositis has not been previously described in Salmonella paratyphi A bacteremia. Materials and Methods: Retrospectively, we recruited patients with enteric fever admitted to our treating unit over a 6-month period. Demography, historical, clinical, and laboratory data were obtained. Data of culture-positive S. paratyphi A patients were analyzed and were compared with those patients with culture-negative enteric fever. Results: Forty-three cases were found in total with 19 of S. paratyphi A bacteremia. Elevations in creatine kinase (CK) ranged from one-and-half to six times normal. Forty-seven percent had thrombocytopenia and alanine transaminase elevations, while aspartate transaminase elevations were seen in 17 patients, which corresponded to those with elevated CK levels. Conclusions: Myositis associated with S. typhi and S. paratyphi is very rare and is more often due to non-typhoidal Salmonellae. Elevated creatine kinase was seen in most of our patients with S. paratyphi A bacteremia. Such myositis has not been described previously and hence, myalgia with fever in a tropical country could be a harbinger of paratyphoid fever.
  577 57 -
Intimate patient examinations: The awareness, acceptance and practice preference of transvaginal ultrasound scan among women in a South-southern State of Nigeria
Akintunde O Akintomide, Uzoma O Obasi
January 2019, 8(1):109-114
DOI:10.4103/jfmpc.jfmpc_207_18  PMID:30911489
Background: Transvaginal ultrasound scan (TVS) is a relatively new routine intimate examination in Nigeria carried out only in fertility clinics, specialist radio-diagnostic centres and a few public hospitals. It is a procedure, which many patients find intrusive and may result in anxiety. The gender of the practitioner and the presence of a third person in the room may influence patient's acceptance to undergo the procedure. Centres offering this service do not routinely ask for the patient's opinion, which negates the patient-centred care principle. The aim of this study is to assess women's awareness, acceptance and practice preference of TVS to get their opinion about the preferred gender of sonologist and presence of a third person during the procedure in comparison to other intimate examinations. Materials and Methods: It is a questionnaire-based prospective survey involving women referred for various indications to the radiology department of a Navy Hospital in south-southern Nigeria for 1 month. Results: We recruited 204 women. Although only 20.6% knew about TVS, 98.5% accepted to undergo TVS. Forty-six percent were indifferent about the gender of the sonologist, while 45% and 9% preferred a female and a male, respectively. About 50.3% wanted a third person in the room during the TVS and majority preferred their husbands (44.7%) to a chaperone (35.8%). Conclusion: The awareness of TVS is low, but it enjoys wide acceptance. Patient's preference for practitioner's gender and chaperone use are variable similar to findings from other intimate examinations, so consent should be sought before the procedure.
  561 42 -
Perception of primary health care providers of plastic surgery and its influence on referral
Abdulmajeed A Alharbi, Faris S Al-Thunayyan, Khalid A Alsuhaibani, Khalid A Alharbi, Mana A Alharbi, Amr Y Arkoubi
January 2019, 8(1):225-230
DOI:10.4103/jfmpc.jfmpc_204_18  PMID:30911511
Objectives: The aim of this study is to understand the level of knowledge and awareness of plastic surgery among primary health care (PHC) providers in Qassim region, Kingdom of Saudi Arabia. Methods: This is a cross-sectional study conducted from February 2018 to March 2018 among health care providers in PHC in Qassim region, Saudi Arabia. Overall, 82 health care providers were recruited using simple random sampling. Filling the questionnaire was considered as approval to join the study. The study included general practitioners and family medicine specialists. Other specialties working in PHC were excluded from the study. Results: In total, 82 physicians were enrolled in this study. Physicians considered that out of 28 listed disorders 16 of them have chosen a plastic surgeon as the best surgeon to perform the necessary surgery. The selection of plastic surgeon as the best doctor for a specific disorder was as follows: Burn deformities (93%), liposuction (87.7%), breast reduction/enhancement (86.8%), skin grating (84.4%), surgery for facial wrinkles (79.2%), electrical burns (71.6%), Botox (64.4%), cuts over the face (63.5%), abdominoplasty (62.9%), burns (59.4%), congenital anomalies of ear and nose (51.5%), deformities of leprosy (51.4%), sex change surgery (49.2%), non-healing wound over legs (47.1%), cleft lip and palate (41.7%), and totally, amputee thumb, finger, or hand (36.1%). The selection of other disorders was distributed almost similarly. Conclusion: General practitioners need more orientation for plastic surgery discipline. In this study, the majority of the study physicians do not have enough knowledge about the meaning of plastic surgery. As a PHC physician, knowledge about this topic is very essential because the patient is very likely to ask about the best surgeon for referral and the potential positive and negative effect of the reconstructive procedure.
  551 49 -
Depression and its determinants among elderly in selected villages of Puducherry – A community-based cross-sectional study
Karthik Balajee Laksham, Ramya Selvaraj, C Kameshvell
January 2019, 8(1):141-144
DOI:10.4103/jfmpc.jfmpc_235_18  PMID:30911495
Background: Depression is the leading cause of disease burden in most regions of the world. But depression among the elderly is usually unrecognized and they have higher morbidity and mortality than those without depression. Aims: To estimate the prevalence of depression among the elderly and identifying its determinants in selected villages of Puducherry. Materials and Methods: This is a community-based cross-sectional study conducted in three villages in Puducherry. Systematic random sampling is done to select households. Any person above the age of 60 years is considered as elderly. After obtaining informed consent, a pretested questionnaire is administered to obtain sociodemographic characteristics. Height and weight were measured. Chronic illnesses such as diabetes, hypertension, asthma, osteoarthritis, reduced vision, hard of hearing, and substance use were self-reported. Geriatric Depression Scale – Short form questionnaire was used as a screening tool for depression. Results: Among the 359 participants, 57% were females. The mean (standard deviation) age of the participants was 67.4 (5.9) years. The majority of them belonged to nuclear family (88%), had no formal education (62%), were unemployed (69%), currently married (68%), and receiving a pension (81%). The prevalence of depression among elderly age 60 years and above is 69% [95% confidence interval (CI) 63.6–73.1). Binary logistic regression showed that single/widow [adjusted odds ratio (aOR) = 3.9, 95% CI 2.0–7.5] and hard of hearing (aOR = 2.2, 95% CI 1.1–4.1) are significant risk factors for depression. Conclusion: Prevalence of depression among elderly in this rural area is high. All elderly persons must be screened for depression and appropriate treatment should be initiated.
  523 69 1
Diagnosis and treatment of pulmonary tuberculosis in one day : Way forward for END TB Strategy 2015
Gourahari Pradhan, Manoranjan Pattnaik, Hemanta Kumar Sethy, Jyoti Patnaik, Thitta Mohanty, Pradeep Kumar Giri
January 2019, 8(1):184-188
DOI:10.4103/jfmpc.jfmpc_358_16  PMID:30911503
Background: According to Revised National Tuberculosis Control Program (RNTCP), diagnosis of pulmonary tuberculosis (TB) in India requires examination of two sputum samples collected over 2 days, that is, “spot” and next day “morning” samples. Objective: To assess the feasibility of diagnosing pulmonary TB by examining two spot sputum samples in 1 day and to compare this approach with the current RNTCP protocol. Materials and Method: A total of 375 subjects having cough >2 weeks were enrolled into the study. Three sputum samples were collected from each of the study participant; first spot (S1), second extra-spot (S2) sample 1 h after collection of the first sample, and third morning (M) sample collected next day morning. These specimens were subjected to standard sputum smear microscopy for acid-fast bacilli as per RNTCP guidelines. For 1-day protocol, results of “S1 and S2” samples and for 2-day protocol results of “S1 and M” samples were considered. Results: The number of sputum-positive pulmonary TB cases diagnosed with standard 2-day protocol was 119, whereas the experimental 1-day protocol diagnosed 120 cases (P = 0.7). Comparing with standard 2-day protocol, this new 1-day protocol had sensitivity 98.32%, specificity 100%, positive predictive value 100%, and negative predictive value 99.17%. Conclusion: Single-day method can be adopted as the standard diagnostic approach for pulmonary TB after large-scale multicenter randomized controlled trials.
  527 61 -
Prevalence of complaints of arm, neck, and shoulders among computer professionals in Bangalore: A cross-sectional study
Vijay Mohan, Leeberk Raja Inbaraj, Carolin Elizabeth George, Gift Norman
January 2019, 8(1):171-177
DOI:10.4103/jfmpc.jfmpc_253_18  PMID:30911501
Introduction: Complaints of arm, neck, and shoulders (CANS) is a common problem among patients whose work involves computer use, but often ignored most importantly by the physicians partly due to not being able to appreciate the importance of taking a careful detailed occupational history of exposure to a repetitive activity involving upper arms. Upper extremity musculoskeletal disorders constitute a major portion of occupation-related illness with annual costs related to treatment and absenteeism from work ranging between $45 and 54 billion in the United States. Materials and Methods: A cross-sectional study was done to assess the factors contributing to CANS among computer professionals in Bangalore. We screened 206 professionals and 181 were administered Maastricht Upper Extremity Questionnaire (MUEQ). Chi-square and logistic regression were used. Results: Prevalence of CANS in the study group was 58.6%. Neck complaints topped the list followed by shoulder, wrist, hand, elbow, upper arm, and lower arm complaints in the descending order. Women had overall higher prevalence and significantly higher prevalence of upper limb complaints than men. Inadequate space, maintaining good posture, and repetition of same tasks have emerged as an independent factors associated with CANS. Conclusion: CANS is highly prevalent among computer professionals working in small and medium-sized companies. Provision of adequate workspace and ergonomic designs of workstations are the modifiable risk factors which can be addressed by the employers to reduce the morbidity associated with CANS. Employees could correct postures and improve work habits.
  510 69 -
A cross-sectional study of knowledge regarding rabies among attendees of anti-rabies clinic of a teaching hospital, Jaipur
Priyanka Kapoor, Vaseem Naheed Baig, Sudhanshu Kacker, Mahima Sharma, Mohit Sharma
January 2019, 8(1):194-198
DOI:10.4103/jfmpc.jfmpc_205_18  PMID:30911505
Background: Being a fatal and 100% preventable disease, all efforts must be made by the health system to prevent even a single case of rabies. By assessing the knowledge of people regarding rabies prevention, we can make plans and policies for its prevention. The aim of this study was to assess the knowledge regarding rabies among attendees of anti-rabies clinic of a teaching hospital, Jaipur. Methods: This observational cross-sectional study was conducted among attendees of anti-rabies clinic, Govt. R.D.B.P. Jaipuria hospital, Jaipur from February 2018 to July 2018. A total of 107 participants were included in the study. Data was collected using preformed questionnaire. Continuous data were expressed in mean and standard deviation and count data were expressed in proportion. Results: In our study population, only 22.5% respondents had good knowledge, 56% had fair, and 21.5% had poor knowledge. Fatality of rabies was known to 68.2% of participants. One fourth of the participants knew that rabies is not curable, however, approximately 83% knew that it is preventable. Fifty-six percent of the participants were aware about washing the bite wound with soap and water. Approximately one-third (36%) of the participants knew that it is an infectious disease, however, only 7.5% knew that saliva, vomitus, tear, and urine of rabies patient may have rabies virus. Approximately 15% of the attendees had a wrong concept that a single injection is sufficient for immunization. Conclusion: Although this study was done at a teaching hospital, lack of knowledge is still a big issue in urban population as well. This study concludes that knowledge regarding rabies should be highlighted in national programs of India to acknowledge Indian population regarding fatal rabies.
  512 65 -
Prevalence of anemia among tribal women
IK Rohisha, Tessy Treesa Jose, Jyothi Chakrabarty
January 2019, 8(1):145-147
DOI:10.4103/jfmpc.jfmpc_249_16  PMID:30911496
Background: A healthy citizen contributes to the development of a country. Tribes are considered as the primitive groups who are backward and have a shyness to contact with the community for their health services. Hence, there is a need to look into their health status. The study aimed to assess the prevalence of anemia among tribal women of Kasaragod district, Kerala. Methods: The tribal settlements of Karadukka block panchayath of Kasaragod district were selected randomly as the setting, and the design adopted was a descriptive survey design. A descriptive survey was undertaken among 445 tribal women in the reproductive age group from the selected tribal settlements, and hemoglobin level was assessed using hemoglobin strip apparatus and classified as nonanemia, mild, moderate, and severe anemia based on World Health Organization classification. Analysis was done using SPSS Version 16. Frequency and percentage distribution was done for identifying the prevalence of anemia. Results: The study found that the majority (89%) of the tribal women had anemia in which 62% and 11% of tribal women had moderate and severe anemia, respectively. Conclusion: Among tribal women, the majority have anemia which is an indicator of health status. To provide them with good health status, government and health professionals have to identify the causes and interfere in that through various promotive and therapeutic activities.
  488 67 -
CASE REPORTS
Abdelazim and AbuFaza ELLP syndrome as a variant of HELLP syndrome: Case reports
Ibrahim A Abdelazim, Mohannad AbuFaza
January 2019, 8(1):280-284
DOI:10.4103/jfmpc.jfmpc_381_18  PMID:30911521
Background: The hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a serious complication in pregnancy occurring in 0.5–0.9% of all pregnancies and in 10–20% of cases with severe pre-eclampsia. Previous studies described HELLP syndrome without hemolysis without any further details. Objectives: This report represents the criteria for the diagnosis of Abdelazim and AbuFaza elevated liver enzymes, low platelet count (ELLP) syndrome as a variant of HELLP syndrome. Case Reports: A 39-year-old woman, pregnant 32 weeks' gestation, previous five cesarean sections, admitted with severe pre-eclampsia (blood pressure 160/110 mmHg, proteinuria +3, 700 mg proteins/24 h urine, and protein/creatinine ratio ≥0.9 in spot urine sample). Laboratory investigation showed elevated liver enzymes, low platelet (PLT) count, and no evidence of hemolysis. A 31-year-old woman, pregnant 33+4 weeks' gestation, previous one cesarean section, admitted with severe pre-eclampsia (blood pressure 170/120 mmHg, proteinuria +2, 1200 mg proteins/24 h urine, and protein/creatinine ratio 1.1 in spot urine sample). Laboratory investigations showed elevated liver enzymes, low PLT count, and no evidence of hemolysis. Both patients delivered by cesarean section after stabilization of their blood pressure and dexamethasone for induction of fetal lung maturity and MgSO4 for prevention of eclampsia. Both patients had uneventful intraoperative and postoperative stay in the hospital. The liver enzymes and the PLT count were completely normal on the 5th postoperative day, and they were discharged from the hospital in good general condition. Conclusion: Abdelazim and AbuFaza ELLP syndrome is variant of HELLP syndrome without hemolysis in women with severe pre-eclampsia. Abdelazim and AbuFaza ELLP syndrome diagnostic criteria are as follows: (1) Elevated liver enzymes; (2) Low PLT count; and (3) Absence of hemolysis (normal total and unconjugated bilirubin, absence of schizocytes, and polychromatic red cells in peripheral blood smear, and normal reticulocyte count).
  501 51 -
ORIGINAL ARTICLES
Barriers for involvement of private doctors in RNTCP – Qualitative study from Kerala, India
Sanjeev Nair, Sairu Philip, Ravi Prasad Varma, PS Rakesh
January 2019, 8(1):160-165
DOI:10.4103/jfmpc.jfmpc_208_18  PMID:30911499
Introduction: Engaging the private sector effectively has been considered as the single most important intervention required for Revised National TB Control Program (RNTCP) to achieve the overall goal of universal access and early detection. This study attempts to identify the barriers and facilitators in the involvement of private practioners in signed schemes of RNTCP. Materials and Methods: Six focus group discussions - four among private sector doctors and two among RNTCP TB key workers and 10 key informant interviews were conducted. Themes were divided into private sector involvement in RNTCP, barriers for private sector involvement, facilitators for private sector involvement and suggestions for better PPP. Results: General feel was that private sector involvement in RNTCP was increasing. Public sector at ground level has not really understood the need to engage the private sector. Lack of capacity for public sector staff to understand and deal with private sector, power relations and not taking hospital managements to trust emerged as important barriers for engagement while private sector doctors expressed concerns over patient confidentiality and patient choices, apprehension of losing patients, inability of program to keep commitments and timely payments, poor recognition to private sector, bureaucratic hurdles and cumbersome formalities. Building locally customised partnership schemes, behaviour change for PPP, building managerial capacity of Public sector to deal with private sector, presence of an interphase agency and quality control through a participatory body were important suggestions for improvement of PPP. Conclusion: Strategies have to be formulated to customise partnership for private sector doctors using the flexibilities of the program. Strengthening PPP will be possible in presence of strong administrative will and the understanding that personal relationships are the best key to Public Private Partnerships.
  476 54 -
Strengthening growth monitoring among under-5-year children to fight childhood undernutrition in India
Swaroop Kumar Sahu, Sathish Rajaa, Mathavaswami Vijayageetha, Kalaiselvi Selvaraj, Perumal Murthy Sambath, Gautam Roy
January 2019, 8(1):231-238
DOI:10.4103/jfmpc.jfmpc_225_18  PMID:30911512
Introduction: Growth monitoring of children in India is usually done by Anganwadi workers using weight-for-age growth charts. We wanted to assess the magnitude of various types of undernutrition among under-5 children using multiple growth charts and risk factors of undernutrition. We also wanted to assess if prevalence of undernutrition improves following sensitization of various stakeholders. Methodology: This is a single-arm prospective study conducted at a selected urban primary health center area in Puducherry. All the eligible 366 under-5 children and their mothers were included. Data were collected using pretested structured questionnaire. Assessment of nutritional status was done using three types of growth charts. Three home visits were made, at an interval of around 6 months, for monitoring the nutrition status of children. Results: The prevalence of undernutrition at baseline was 15.8% (95% CI 12–19.6). The prevalence of underweight, wasting, and stunting were 9.6%, 7.6%, and 7.3%, respectively. Weight-for-age growth chart could identify only 67% with stunting and 50% of children with wasting. The decrease in prevalence of wasting, underweight, and stunting were 63.6%, 44.8%, and 31.5%, respectively, over 1-year follow-up. Nutrition status could improve by prevention of low birth weight, ensuring gaps between births and promotion of breastfeeding and hand hygiene. Conclusion: It is important to use multiple growth charts for assessing nutritional status of children, instead of relying only on weight-for-age growth chart. Overreliance on use of weight-for-age growth chart will fail to identify more children with wasting. Under-5 undernutrition status can be decreased following intensive growth monitoring and planning appropriate actions involving various stakeholders.
  469 59 -
Knowledge and attitude about emergency contraception among Saudi women of childbearing age
Malak S Alharbi, Ahmad S Almujil, Fatma F Alreshid, Emad H Kutbi
January 2019, 8(1):44-48
DOI:10.4103/jfmpc.jfmpc_292_18  PMID:30911479
Context: Emergency contraception (EC) use is rare in Saudi Arabia. Aims: The aim of this study is to determine the knowledge, attitude, and practice of EC among Saudi women of childbearing age. Settings and Design: This study is a cross-sectional descriptive study using a survey questionnaire tool. Materials and Methods: We conducted a survey of married women of childbearing age (18–45 years) attending the Obstetrics and Gynecology Clinic at Riyadh, Saudi Arabia between January and April 2018. Statistical Analysis Used: Pearson's Chi-square test is used for this study. Results: This study included 370 of 525 (70.5%) women, with a mean age of 32.3 ± 6.3 years. Of these, 117 (31.6%) knew how to prevent pregnancy after unprotected sex, and 62 knew about EC. Forty-two women (67.7%) thought EC should be widely advertised, and 30 (48.4%) thought it should be made available even without prescription. Forty-seven women (75.8%) said that they were not shy to ask for EC, and 37 (59.7%) claimed that both partners should decide about the use of EC. The most common reason for not using EC was medical concerns (n = 30, 48.4%). Thirty three (53.2%) of the 62 women with knowledge about EC would use it immediately after sex. Knowledge, awareness, and use of EC were significantly correlated with higher monthly income, educated women, having three or more children, and working women. Conclusions: Among Saudi women, knowledge, awareness, and use of EC remain low, although a positive attitude for future use of EC exists. Health information campaigns are necessary to reach women, particularly those of low socioeconomic status, less educated women, and housewives to explain EC, its availability, and its proper use.
  442 85 -
Reciprocate and nonreciprocate spousal violence: A cross-sectional study in Haryana, India
Anuradha Nadda, Jagbir Singh Malik, Anu A Bhardwaj, Zahid Ali Khan, Varun Arora, Sachin Gupta, Mukesh Nagar
January 2019, 8(1):120-124
DOI:10.4103/jfmpc.jfmpc_273_18  PMID:30911491
Background: Prevention of intimate partner violence is an important public health goal owing to its negative psychological and physical health consequence. Objectives: Estimate the prevalence of reciprocate and nonreciprocate violence, severity of injuries, and related risk factors. Materials and Methods: The present study was a community-based cross-sectional study using multistage random sampling in which a total of 880 currently married women in the age group 15–49 years were interviewed using modified conflict tactics scale. Logistic regression was used to identify factors associated with both the types of domestic violence. Results: Total prevalence for spousal violence was 33.2% (283), out of which 14.84% (42) were reciprocally violent. Alcoholic husband [Adjusted Odds Ratio (AOR): 3.262, P = 0.001], late year of marriage (>2 years) [AOR: 0.359, P = 0.001], low education of the participants [AOR: 1.443, P = 0.033], and low socioeconomic class [AOR: 0.562, P = 0.004] are the risk factors for nonreciprocate domestic violence. Alcoholic husband [AOR: 4.372, P = 0.001] and nuclear family [AOR: 3.115, P = 0.001] were found as significant risk factors for reciprocate domestic violence. Women indulging in reciprocate violence were associated with more severe injuries than nonreciprocate violence. Conclusion: This study depicts that every third female has experienced spousal violence and also highlights the existence of reciprocate violence in India. Alcoholism, low education of husbands, and living in nuclear family are the important determinants for reciprocate violence. Also, reciprocate violence is associated with severe injuries.
  469 57 -
Pediatricians' view on early childhood caries and oral health in a north region of India: A cross-sectional study
Suneel Kumar Gupta, Sonal Gupta, Sushma Gojanur, Gurpreet Kour, Kuldeep Singh, Priya Rani
January 2019, 8(1):220-224
DOI:10.4103/jfmpc.jfmpc_201_18  PMID:30911510
Background: The majority of oral diseases in children are preventable. The pediatricians owing to the unique position they occupy in child care are invaluable in achieving standard oral and dental healthcare in children. This study was aimed to assess pediatrician's knowledge, attitude, and awareness toward early childhood caries (ECC), oral health, and treatment needs of their patients. Methods: A total of 65 pediatricians were randomly selected for the study and were requested to fill out an objective questionnaire pertaining to individual details, approach toward pediatric dentistry, and knowledge level of oral health, without providing any oral health information. Results: About 58.5% of pediatricians acknowledged the importance of pediatric dentistry. About 72.7% of pediatricians perform oral examination regularly. Around 17% of pediatricians have knowledge of the ECC. Only 32.3% of pediatricians acknowledged the cariogenicity of medicated syrups. Conclusion: This study shows those pediatricians who were surveyed had poor knowledge regarding ECC, oral health, and dental treatment need in children. Pediatricians need to update themselves on recent recommendations.
  452 70 -
Impact of self-instruction manual-based training of family caregivers of neurosurgery patients on their knowledge and care practices – A randomized controlled trial
K Madhanraj, Upasana Sharma, Sukhpal Kaur, Manoj K Tewari, Amarjeet Singh
January 2019, 8(1):209-214
DOI:10.4103/jfmpc.jfmpc_287_18  PMID:30911508
Background: Family caregivers of operated neurosurgery patients function as informal extensions of the health system. But they are untrained and unprepared for their new role. It has been felt that their problems related to care provision can be resolved by appropriate training. Aim: This study aimed to compare the impact of self-instruction manual-based training of family caregivers of operated neurosurgery patients on their knowledge regarding care provision and care practices. Setting: Tertiary care hospital setting located in North India. Design: Randomized controlled trial. Materials and Methods: A randomized controlled trial was done among the operated neurosurgery patients and their caregiver dyads (n = 90). They were randomly allocated to receive either self-instruction manual and one-to-one training (TP1) or self-instruction manual only (TP2). Block randomization method was used. Sequentially numbered sealed envelope was used for allocation concealment. Monthly follow-up was done for 3 months. The primary outcome measure was knowledge gain of the caregivers. Statistical Analysis Used: Chi-square test, Student's t-test, paired t-test, repeated measures analysis of variance, and Bonferroni's correction were used. Results: The attrition rate was 15.5%. Intention-to-treat analysis was followed. Caregivers in the TP1 group had significant knowledge gain (95% confidence interval of mean difference 9.4–14.5, P < 0.05). The number of caregivers who had followed correct caregiving practices was significantly more in the TP1 group. Conclusion: Training of caregivers by providing information along with one-to-one training is an effective strategy for improving the knowledge and skills of caregivers regarding care provision of the operated neurosurgery patients.
  469 53 -
Oral health taking a back seat at primary health centers of Bangalore urban district, India – A situation analysis
Kiran Iyer, Archana Krishnamurthy, Mridusmita Pathak, Lakshmi Krishnan, Nandita Kshetrimayum, Mahmood Moothedath
January 2019, 8(1):251-255
DOI:10.4103/jfmpc.jfmpc_270_18  PMID:30911515
Background: Even though a dramatic change in pattern of oral diseases has been observed at a global level, oral health equality still remains as a dream to achieve. Studies have documented disparities in delivery and utilisation of oral health services among urban, suburban, and rural regions of India. Therefore, the aim of the present study was to conduct a situation analysis at PHCs to understand resource availability and oral health seeking behavior from perspective of medical officers of Bangalore City, India. Materials and Methods: A structured questionnaire was validated using Lawshe technique and was given across medical and dental officers present at 65 Primary Health Centers. Data collected was entered in Excel sheet and further subjected to Descriptive statistics using SPSS version 20. Results: Among 65 PHCs, about 18 PHCs had dental officers posted. In those 18 PHCs only 2 were maintained by the state government and others by Private dental college. In the 65 PHCs , only one PHC maintained a separate register for dental complaints, whereas 48 of them had maintained a combined register for both general and oral complaints .With regard to the management of tooth-related complaints, about 48 of medical officers reported that they dispense the patients affected by providing antibiotics and pain killers (analgesics) and recall, whereas 12 medical officers reported that they get the existing condition treated and refer and the rest refer the patients directly to hospitals. clinics. Conclusion: The results highlight the challenges experienced by nondental primary-care providers and their views on access to oral health to be improved. It is high time that the state government should put oral health policies into practice by recruiting adequate dental officers and providing separate dental infrastructure at the urban PHCs for better utilisation of dental care services.
  464 46 -
Biological risk factors for coronary artery disease among adults residing in rural area of North Karnataka, India
Avinash Kavi, Padmaja R Walvekar, Rekha S Patil
January 2019, 8(1):148-153
DOI:10.4103/jfmpc.jfmpc_278_18  PMID:30911497
Background: Coronary artery disease (CAD) accounts for 60% of all deaths and 47% of burden of diseases which is progressively increasing in rural population in terms of absolute numbers. Biological risk factors contribute significantly to the cardiovascular burden. Hence, this study was undertaken to assess the biological risk factors among adults residing in rural area. Materials and Methods: A community-based cross-sectional study conducted among 980 adults aged between 20 and 60 years residing in rural area of Belagavi district, India. World Health Organization-STEPS-based predesigned questionnaire was used for data collection by house-to-house visit after obtaining written informed consent. Sociodemographic variables and biological risk factors which included hypertension, self-reported diabetes mellitus, overweight, and obesity were assessed. Statistical analysis was done using Pearson's Chi-square test and P value less than 0.05 was considered significant. Results: In the present study, 48.8% were men and 51.2% were women. Prevalence of hypertension was 26.6%, self-reported diabetes mellitus 6.3%, overweight 26.7%, and obesity was 7.0%. Men had higher prevalence of hypertension and overweight, whereas women had higher prevalence of diabetes and obesity. A significant gender difference was noted with the biological risk factors for CAD (P < 0.05). Advancing age, lesser education, and retirement from the job were the contributors for the increasing prevalence of these risk factors (P < 0.05); however, the socioeconomic status did not show any influence (P > 0.05). Conclusion: Biological risk factors, which included hypertension, diabetes, and overweight, were observed in a significantly higher proportion among men, whereas women were more obese with a significant higher proportion. Advancing age, lesser education, and retirement from the job were the contributors for the increasing prevalence of these risk factors.
  465 43 -
Hypertension control status and quality of care for hypertension among patients availing treatment from private sector: A cross-sectional study in urban field practice area of JIPMER, Puducherry
Veena Babu, Swaroop Kumar Sahu, Srikanta Kanungo
January 2019, 8(1):72-76
DOI:10.4103/jfmpc.jfmpc_248_18  PMID:30911483
Introduction: In low-income countries like India, there is paucity of evidence regarding hypertension control status and the quality of care pertaining to hypertension care among the patients availing treatment from private sector. We wanted to determine the hypertension control status and quality of care pertaining to hypertension received by patients seeking care from private sector. Materials and Methods: This was an community based analytical cross-sectional study carried out in an selected urban area of Puducherry. This study was conducted among 265 adults with hypertension, availing treatment from private sector. Blood pressure was measured according to standard protocol. Data were collected using pre-tested semi-structured questionnaire by doing home visits. Results: The proportion of patients who were optimally controlled for hypertension were 43.9%. More than half (64%) of the participants had not checked their blood pressure in the last 1 year. There were 21.3%, 20%, 18.2%, and 9.5% of the participants who had optimally undergone fundus examination, blood sugar, serum cholesterol and serum creatinine examinations, respectively, as per recommended frequency. More than half (64%) of the study participants had not availed follow-up blood pressure monitoring in the last 1 year. The adherence to medication among the study participants was found to be 76.5%. Conclusion: Around 4 out of 10 patients had their blood pressure status controlled. More than half of the patients did not have any sort of follow-up investigations for the last 1 year. There was a scope for improvement in frequency of follow-up investigations as per recommendations.
  424 79 -
CASE REPORTS
Early onset type 2 diabetes mellitus in a Saudi child misdiagnosed as type 1 diabetic: A case report
Hassan M Al-Musa
January 2019, 8(1):313-315
DOI:10.4103/jfmpc.jfmpc_426_18  PMID:30911531
Objective: To report a Saudi young patient with early onset type 2 diabetes, who was misdiagnosed for 6 years as type 1 diabetic. Case Report: A Saudi male aged 18-year old presented with uncontrolled diabetes. He was diagnosed 6 years earlier to have type 1 diabetes mellitus. He was kept insulin, but he was not compliant to treatment and his blood glucose kept on fluctuating and not controlled. He came to our diabetes center for management of his uncontrolled diabetes. There was no past history of hospitalization. His father was type 2 diabetic. His body mass index was 46.7 kg/m2. His glycosylated hemoglobin (HbA1c) level was 9.9%. Immune dysfunction was evaluated using serum antibody levels of glutamic acid decarboxylase, which proved to be negative (0.7 U/mL), while serum C-peptide level was not low (2.2 ng/mL). Therefore, the patient was diagnosed as early onset type 2 diabetic, not type 1 diabetic. The patient was advised to start physical exercise through daily walking for at least 1 h. The dietitian planned a strict diet plan for him to follow. Insulin injections and Metformin tablets were started. The patient received detailed health education on nature and management of his condition. After 4 months, his body mass index became 39.4 kg/m2 and his HbA1c became 6%. Insulin was stopped, and he was advised to continue on metformin, the diet, and daily walking. Two months later, his body mass index was 37.7 kg/m2 and his HbA1c became 5.41%. Conclusions: Early onset type 2 diabetes should be suspected among obese children with symptoms of diabetes. Proper health education and patient's compliance to medication, diet, and physical activity are essential for successful management of early onset type 2 diabetes. Moreover, primary care physicians need to be aware that type 2 diabetes is not necessarily adult-onset.
  435 63 -
ORIGINAL ARTICLES
Effectiveness of multipurpose health-worker-led exercise therapy on pain reduction among patients with chronic nonspecific low backache in primary health-care setting: A randomized control trial
Hitesh Das, Venkatachalam Jayaseelan, S Manikandanesan, Deep Sharma, Tanveer Rehman
January 2019, 8(1):199-202
DOI:10.4103/jfmpc.jfmpc_252_18  PMID:30911506
Objective: The trial aimed to study the effectiveness of multipurpose health-worker-led exercise therapy on women patients of 30–50 years of age with chronic nonspecific low backache (LBA) in a primary health center. Materials and Methods: The multipurpose health worker had undergone 2 days training for exercises to relief chronic nonspecific LBA in the Department of Orthopaedic, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry. Patients were allocated to either intervention arm (who received exercise therapy) or control arm (who received pharmacological therapy of analgesics). Patients with less than 3 months of pain, acute onset of pain, localized pain, or straight leg raising test positive were excluded. The pain score on three different positions (motion, sitting, and standing) was assessed on visual analogue scale before starting the exercise therapy or the pharmacological therapy and after 1 month of the exercise therapy or pharmacological therapy. Statistical Analysis: Data were analyzed using SPSS Software. Wilcoxon sign-rank test is used to compare the scores before and after intervention depending upon normality of distribution. Difference in difference analysis is used to compare the scores between the two groups. Results: Multipurpose health-worker-led exercise therapy is found to be equally effective as compared to pharmacological therapy. Significant difference in reduction of pain score was not obtained between control and intervention arm (P value: 0.343, 0.819, and 0.335 in motion, standing, and sitting position). However, significant reduction in pain score in all the three positions was obtained in intervention (P value < 0.001, <0.001, <0.001 in motion, standing, and sitting, respectively). Therefore, it can be suggested that multipurpose health-worker-led exercise therapy may be implemented in a primary health-care setting which will help to reduce the analgesics load on the health center and prevent the adverse effect profile of the drugs on patients.
  440 52 -
CONFERENCE STATEMENT
Rio Declaration: Global peace – A prerequisite for attainment of sustainable development goals
Raman Kumar
January 2019, 8(1):5-6
DOI:10.4103/jfmpc.jfmpc_232_18  PMID:30911473
The representatives of the WONCA Young Doctors Movement met face to face for the first time in Rio de Janeiro on 2nd November 2016 and unanimously adopted the Rio Declaration 2016 calling for global peace.
  423 64 -
CASE REPORTS
Joubert syndrome: A classic case
Puneeth Kumar, Amit Dey, Kartik Mittal, Rajaram Sharma, Anmol Goyal, Priya Hira
January 2019, 8(1):311-312
DOI:10.4103/jfmpc.jfmpc_165_18  PMID:30911530
Joubert syndrome is a rare autosomal recessive disorder characterized by hyperpnoea and eye movements, hypotonia, ataxia, developmental retardation with neuropathologic abnormalities of cerebellum and brainstem including inherited hypoplasia or aplasia of vermis. Cerebellar vermin anomalies are described in other disorders such as Dandy-Walker and rhombencephalon synapsis. These disorders should be distinguished from Joubert syndrome on the basis of imaging. Comparison with typical imaging and clinical findings may be helpful for appropriate diagnosis.
  430 54 -
Uterine suspension using I. Abdelazim sacrohysteropexy technique for treatment of uterine prolapse: Case series
Ibrahim A Abdelazim, Svetlana Shikanova, Bakyt Karimova, Gulmira Zhurabekova, Mukhit Sarsembayev, Tatyana Starchenko
January 2019, 8(1):316-318
DOI:10.4103/jfmpc.jfmpc_405_18  PMID:30911532
Surgical treatment of uterine prolapse in woman who wishes to preserve her uterus remains a major surgical challenge. This case series describes a new surgical technique for uterine suspension in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory. Four women with genital prolapse (two with stage 1 uterine prolapse and two with stage 2 uterine prolapse and stage 1 vaginal walls prolapse) who requested a uterine conserving procedure were offered I. Adelazim sacrohysteropexy technique as a new surgical option for treatment of the uterine prolapse. This surgical technique is formed of three basic steps: (1) exposure of the anterior longitudinal ligament over the sacral promontory and exposure of the uterosacral ligaments on the back of the uterine cervix; (2) fixation of the Mersilene tape as Y-shaped artificial uterosacral ligament extended from the sacral promontory to the back of the uterine cervix; and (3) closure of the incised visceral peritoneum over the artificial Y-shaped uterosacral ligament. The mean operative duration of I. Abdelazim sacrohysteropexy technique was 50.5 ± 8.4 min and the mean estimated blood loss was 480 ± 67.8 ml. No intraoperative or postoperative complications or recurrence of the uterine prolapse were recorded in the studied cases. I. Abdelazim sacrohysteropexy technique is an effective uterine suspension technique for treatment of uterine prolapse in women who wish to preserve their uteri, using the Mersilene tape as an artificial uterosacral ligament to suspend the uterus to the sacral promontory.
  418 63 -
ORIGINAL ARTICLES
Outcomes and factors influencing outcomes of critically ill HIV-positive patients in a tertiary care center in South India
I Ramya, Shubankar Mitra, Shilpa D'Sa, Sowmya Sathyendra, Anand Zachariah, C Vignesh Kumar, Ronald Albert Benton Carey, George M Verghese
January 2019, 8(1):97-101
DOI:10.4103/jfmpc.jfmpc_156_18  PMID:30911487
The incidence of (Human immune deficiency) HIV in India has fallen by 58% since the onset of the HIV epidemic. As of 2016 there are 2.1 million people living in India with HIV and only 49% of the adults with HIV are on ART (1). The HIV infected individuals may require intensive care due to various reasons. This study attempts to look at the outcomes of these patients admitted in the intensive care unit and the predictors of these outcomes. Aims: 1. To assess the outcomes of critically ill HIV infected patients admitted in the medical intensive care unit. 2. Assessment of the factors that are likely to influence the outcome. Materials and Methods: it is a retrospective medical review of all the patient records available on our electronic database. The study period was January 2008 – October 2013. Results: in our study cohort the commonest reason for admission into the intensive care unit was sepsis associated with multi organ dysfunction (64%).A low CD 4 count, renal failure acute respiratory distress syndrome, and hypotension and multi organ dysfunction were predictive of a poor outcome in our study. Conclusion: The most common cause of admission of PLHIV in ours study cohort was Infections, ART associated side effects and low CD4 counts, presence of multi organ dysfunction, acute respiratory distress syndrome (ARDS), hypotension were associated with adverse outcomes.
  422 38 -
CASE REPORTS
A rare case of quadriparesis
Ashok Kumar Pandey, Swati Sharma, Vaishali Upadhyay
January 2019, 8(1):302-304
DOI:10.4103/jfmpc.jfmpc_293_17  PMID:30911527
Snakebite is a public health problem. Common krait is nocturnally active with painless bite. Patients exhibit neuromuscular weakness.
  416 33 -
Infantile endobronchial tuberculosis
Amit Dey, Ira Shah
January 2019, 8(1):299-301
DOI:10.4103/jfmpc.jfmpc_164_18  PMID:30911526
Endobronchial tuberculosis (TB) is a specific form or complication of pulmonary tuberculosis. We report four infants with endobronchial TB presenting with secondary complications such as obstructive emphysema and atelectasis and their response to appropriate anti-tuberculous therapy (ATT) with steroid treatment. Early diagnosis and prompt treatment before the development of fibrosis is important to prevent complications such as bronchiectasis.
  397 39 -
ORIGINAL ARTICLES
Gallstone disease and its correlates among patients attending teaching hospital of North India
Deepak Dhamnetiya, Manish K Goel, BalRaj Dhiman, Om Prakash Pathania
January 2019, 8(1):189-193
DOI:10.4103/jfmpc.jfmpc_358_18  PMID:30911504
Background: Gallstone disease (GSD) represents a significant burden for healthcare systems worldwide and is one of the most common disorders among patients presenting to emergency rooms with abdominal discomfort. Aim and Objective: This study was aimed to find correlates (demographic, dietary, and behavioral) of GSD in patients attending teaching hospital in North India. Methodology: A case–control study was conducted from January 2013 to December 2013 among subjects attending outpatient department of general surgery in a teaching hospital. Data collection for both cases and controls was done on a self-designed pretested “interview schedule” which assessed the sociodemographic profile, personal history, medical history, comorbidities, physical examination including anthropometry, and dietary intakes. To measure the strength of association, odds ratio (OR) was calculated. Binary logistic regression was used for multivariate analysis. Results: A total of 120 cases and the same number of age- and sex-matched controls were included in final analysis. In binary logistic regression, maximum association was seen with physical inactivity [OR 3.93, confidence interval (CI): 1.98–7.78] followed by current consumption of smokeless tobacco (OR 3.65, CI: 1.65–8.09), current smoking (OR 2.69, CI: 1.13–6.37), nonvegetarian diet (OR 3.10, CI: 1.65–5.83), and fat intake (OR 2.14, CI: 1.14–4.02). Current alcohol consumption (OR 0.90, CI: 0.41–1.98), high waist–hip ratio (OR 1.54, CI: 0.67–3.56), and intake of fruits and green leafy vegetables (OR 1.86, CI: 0.61–5.61) were not significantly associated with GSD. Conclusion: Physical inactivity, smokeless tobacco, nonvegetarian diet, current smoking, high fat intake, and family history were found to be risk factors for the development of GSD.
  383 47 -
CASE REPORTS
Parotid gland swelling after upper gastrointestinal endoscopy
Sangey C Lamtha, Uma Rai, Parvez T Hassan
January 2019, 8(1):274-275
DOI:10.4103/jfmpc.jfmpc_331_18  PMID:30911519
Upper gastrointestinal (UGI) endoscopy is a routine procedure done in field of gastroenterology. It is a safe procedure which can be done with or without sedation with rare post procedure complications. Our case illustrates that parotid gland swelling is a uncommon event post upper g.i endoscopy and it a benign event which resolves on its own.
  389 30 -
Falciparum malaria mimicking acute myocardial infarction
Manish Ruhela, Gaurav Khandelwal, Samiksha Gupta, Agam Bansal, Nidhi Gyanchandani
January 2019, 8(1):308-310
DOI:10.4103/jfmpc.jfmpc_229_18  PMID:30911529
Severe malaria is a concerning problem in developing country and is mostly due to Plasmodium Falciparum. Common organs involved are liver, central nervous system, lungs, kidneys, and vasculature. Cardiac involvement is very rare and is mostly underestimated. Cardiac involvement occurs in the form of myocardial dysfunction, arrhythmia, and ventricular systolic dysfunction. This is the rare case of acute pericarditis due to plasmodium falciparum mimicking as inferolateral ST elevation myocardial infarction (STEMI) due to suggestive electrocardiography (ECG) findings.
  361 49 -
ORIGINAL ARTICLES
Are the subcenters adequately equipped to deliver primary healthcare? A study of public health manpower and infrastructure in the health district in Andhra Pradesh, India
Shyamkumar Sriram
January 2019, 8(1):102-108
DOI:10.4103/jfmpc.jfmpc_223_18  PMID:30911488
Background: India has a vast public health infrastructure, with 23,391 primary health centers (PHCs) and 145,894 subcenters (SCs) providing health services to 72.2% of the country's population living in rural areas. Although the numbers look impressive, their functional status needs to be studied in terms of physical infrastructure, manpower, equipment, drugs, and other logistical supplies that are greatly needed for ensuring quality services. This work aims to study the infrastructure facilities and manpower in a sample of SCs in the district of Nellore in the state of Andhra Pradesh in India. Methods: Thirty SCs selected by multistage sampling have been studied using a structured and pretested performance standard questionnaire. Data have been analyzed with reference to the Indian Public Health Standards (IPHS) for SCs. Results: Many deficiencies were identified in the infrastructure and manpower in the SCs studied. Some of the important findings were that the deficiency of health workers (HWs) (male) was 76.7%. Only 6.7% of the SCs operate in a designated government building. Communication facilities, such as telephones, are present in only 3.3% of the SCs. About 73% of the SCs were located more than 5 km from the remotest village in the coverage area. Residential accommodations for HWs (female) were available in only 3.3% of the SCs. There is also a severe deficiency of drugs and equipment in the SCs as per the IPHS. Conclusion: SCs lack the manpower and vital infrastructure necessary to function and deliver services effectively to the rural population.
  361 47 -
CASE REPORTS
Bridging therapy for achalasia in a second trimester pregnant patient
Zachary S Neubert, Edward T Stickle
January 2019, 8(1):289-297
DOI:10.4103/jfmpc.jfmpc_389_18  PMID:30911523
We present the case of a 28-year-old female who presented for primary care at 22-week gestation with type II achalasia and worsening solid/liquid dysphagia leading to pregnancy weight loss. Considering that durable therapies such as surgical myotomy and pneumatic dilatation have considerable risk, botulinum A toxin injection was selected as a temporizing bridging therapy. She had an uncomplicated post procedure course and had significant rapid improvement in dysphagia symptoms, which enabled her to progress to normal peripartum weight. This case highlights the need for early recognition of achalasia and an unique niche for use of botulinum toxin A as a temporizing therapy in this risk averse population.
  360 40 -
ORIGINAL ARTICLES
Smoking habits and attitude toward smoking cessation interventions among healthcare professionals in Pakistan
Madeeha Malik, Danyal Javed, Azhar Hussain, Ekere James Essien
January 2019, 8(1):166-170
DOI:10.4103/jfmpc.jfmpc_230_18  PMID:30911500
Background: Tobacco smoking is considered as the second main cause of increased mortality rate and one of the major preventable causes of cardiovascular and pulmonary diseases worldwide. Although the damages caused by smoking are known, the prevalence of smoking is increasing among healthcare professionals (HCPs). Increased smoking rates among HCPs may compromise the ability to effectively counsel patients who are addicted to smoking. The purpose of this study was to assess the smoking habits and attitude toward smoking cessation interventions among HCPs in Pakistan. Methods: A descriptive cross-sectional study design was used. A prevalidated semi-structured question developed by the University of Arizona was used. The sample size was calculated to be 382 with 95% confidence interval and 5% level of error. Data were cleaned, coded, and analyzed statistically using SPSS 21. Chi-square test (P ≥ 0.05) was used to find association among different variables. Results: The results of the study showed that a majority of the HCPs were smokers (57.6%, n = 220). Use of nicotine patches and other cessation medications, educational programs, and discussion with other healthcare providers were most effective methods for quitting smoking. Significant association (P < 0.05) was found among smokers and nonsmokers regarding self-respect and feeling of loneliness. Conclusion: The study concluded that a majority of the HCPs in twin cities were smokers and smoke more than five cigarettes a day. Training programs should be designed and implemented for HCPs to reduce the rate of tobacco smoking.
  352 47 -
CASE REPORTS
Nephrocalcinosis in a patient with extrapulmonary tuberculosis – A rare entity
Sayan Malakar, Bhagwan Dass Negi, Guriqbal Singh, Tarun Sharma
January 2019, 8(1):296-298
DOI:10.4103/jfmpc.jfmpc_385_18  PMID:30911525
Nephrocalcinosis is a rare condition in clinical practice where there is an increased renal deposition of calcium. Varied causes of this condition have been given in literature, and tuberculosis (TB) has been an important one. Hypercalcemia is a known complication of granulomatous diseases. We report a rare case explicitly showing relationship of extrapulmonary (genitourinary) TB with nephrocalcinosis.
  348 41 -
LETTERS TO EDITOR
Vitamin D deficiency: It is time to act
Jogender Kumar, Arushi Yadav
January 2019, 8(1):321-321
DOI:10.4103/jfmpc.jfmpc_408_18  PMID:30911534
  309 67 -
ORIGINAL ARTICLES
The performance of rural family physicians in Fars province, Iran
Seyyed Mansour Kashfi, Maryam Yazdankhah, Seyyed Hannan Kashfi, Ali Khani Jeihooni
January 2019, 8(1):269-273
DOI:10.4103/jfmpc.jfmpc_22_17  PMID:30911518
Background: Family physician (FP) program is a complete health-care system whose most important results are elimination of individuals' confusion when going to the doctor and increase in their satisfaction with health services. This study aimed to evaluate the performance, strengths, and weaknesses of FP program. Materials and Methods: In this cross-sectional study, 52 FPs in Fars province were selected via stratified sampling and their performance was investigated. The data were collected using FPs performance questionnaire that included five domains, namely, management, performance, contract guidelines, community involvement, and outcomes. Then, the data were entered into the SPSS statistical software, version 19, and were analyzed using t-test, ANOVA, and Pearson's correlation coefficient. Results: Among the 52 FPs under study, 56.9% were male and 43.1% were female. The lowest and highest scores were related to community involvement (3.93 ± 0.81) and outcomes (23.52 ± 3.04), respectively. The results showed significant relationships between most domains (P < 0.05). However, no significant correlation was found between gender and different domains (P < 0.05). Conclusion: Considering diverse activities done by FPs, the wide area of our country, and issues related to increasing satisfaction among physicians and individuals covered by the program, further researches are required in this area.
  326 29 -
LETTERS TO EDITOR
Need for a novel health care delivery model focusing on primary care
Sunil K Raina
January 2019, 8(1):319-320
DOI:10.4103/jfmpc.jfmpc_401_18  PMID:30911533
  301 43 1
CASE REPORTS
Evaluation of cystic schwannoma of masticator space – A case report
Biyas Bhowmik, Rupam Sinha, Atul P Sattur, Ishita Banerjee
January 2019, 8(1):285-288
DOI:10.4103/jfmpc.jfmpc_280_18  PMID:30911522
Schwannoma is a benign neoplasm originating from the neural sheath and occurring in up to 45% of the cases of extracranial neurogenic tumors. Schwannomas of masticator spaces are rare. This article reports the case of an intraoral schwannoma occupying the masseteric and buccal spaces of a 55-year-old woman, for whom detailed imaging investigations were performed, comprising conventional extraoral radiographs, ultrasound, and plain and contrast enhanced magnetic resonance imaging. The lesion was surgically resected.
  280 27 -
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