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   2019| April  | Volume 8 | Issue 4  
    Online since April 25, 2019

 
 
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EDITORIAL
Universal health coverage – Time to dismantle vertical public health programs in India
Raman Kumar
April 2019, 8(4):1295-1296
DOI:10.4103/jfmpc.jfmpc_310_19  PMID:31143709
Primary care has traditionally meant different concepts for developed and developing economies/countries. Immediately after independence, India pushed aside the recommendations of the Bhore committee, which was for implantation of comprehensive primary healthcare. Instead, we opted for the path of selective primary care modeled on vertical disease–based programs under the guidance of international development agencies. After several decades of implementing selective primary healthcare, India has now embarked upon ambitious journey of universal health coverage (UHC) with announcement of Ayushman Bharat – National Health Protection Mission. How much we resolve and how much we refer (90% vs 10% and 10% vs 90%) within primary care will determine the overall cost of the health system, be it out of pocket or publicly funded. Implementation of comprehensive primary healthcare and UHC along with existing disease focused vertical public health programs is a unique situation to India. Will the Indian economy be able to sustain the double burden of UHC and the vertical programs? Or is it indeed the time to dismantle the vertical programs and implement comprehensive primary care towards containing over all cost of the health system to the country. Continuing both may be a good bankruptcy plan.
  767 176 -
COMMENTARY
NOMOPHOBIA: NO MObile PHone PhoBIA
Sudip Bhattacharya, Md Abu Bashar, Abhay Srivastava, Amarjeet Singh
April 2019, 8(4):1297-1300
DOI:10.4103/jfmpc.jfmpc_71_19  PMID:31143710
The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”. Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients' family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.
  655 123 -
REVIEW ARTICLES
Basthi Dawakhana of Hyderabad: The first Urban Local Body led community clinics in India
Chandrakant Lahariya
April 2019, 8(4):1301-1307
DOI:10.4103/jfmpc.jfmpc_380_18  PMID:31143711
Basthi Dawakhana initiative was launched by the Greater Hyderabad Municipal Corporation (GHMC) in Telangana state of India, in April 2018. This article documents, reviews, and analyzes the key design aspects of Basthi Dawakhana, delve into why such clinics are important for strengthening primary health care in Indian cities and urban settings, and proposes a few strategies for implementation effectiveness. In the main text of the article, evolution of urban health services, national urban health mission in India, and Mohalla clinics of Delhi has been provided. The implementation challenges and potetnial solutions for scaling up Basthi Dawakhana have been discussed. The author argues that Basthi Dawakhana initiative is aligned with the 73rd and 74th amendments in the Constitution of India, which transferred the responsibilities for primary care and public health to the Urban Local Bodies (ULBs). The article concludes that Basthi Dawakhana are arguably the first ULB-led community clinics initiative and an opportunities for ULBs in India to lead efforts to strengthen primary healthcare. These Dawakahna along with Mohalla Clinics, can serve platform to reform urban primary healthcare services and advance universal health coverage (UHC) in the country.
  554 66 -
Oral tuberculosis - Current concepts
Supriya Sharma, Jyoti Bajpai, Pankaj K Pathak, Akshyaya Pradhan, Priyanka Singh, Surya Kant
April 2019, 8(4):1308-1312
DOI:10.4103/jfmpc.jfmpc_97_19  PMID:31143712
Tuberculosis (TB) is a chronic infectious disease that can affect various parts of the body including the oral cavity. It primarily affects the lungs. TB bacilli can spread hematogenously to different parts of the body and this also involves maxilla or mandible. Although oral lesions are infrequent, they are crucial for the early diagnosis and interception of primary TB. Intercepting the disease early will limit the morbidity and mortality of the patients. It becomes the responsibility of the dentist to include TB in the differential diagnosis of suspicious oral lesions to prevent delay in the treatment of the disease. It would not be an exaggeration if the dental identification of the TB lesions has the potential of serving as a significant aid in the first line of control for this hazardous and often fatal disease. This article will also emphasize the advancing role of oral pathologists in making the final diagnosis of this dreaded disease.
  421 123 -
Medication concordance in modern medicine – A critical appraisal from an Indian perspective
Shubham Atal, Balakrishnan Sadasivam, Shah Newaz Ahmed, Avik Ray
April 2019, 8(4):1313-1318
DOI:10.4103/jfmpc.jfmpc_176_19  PMID:31143713
Modern medicine encompasses a holistic approach toward patient care that seeks to integrate the social, psychological, and pathological aspects of a disease. In line with this, the traditional model of improving treatment outcomes through improved compliance or adherence has given way to the concept of “concordance” that respects the integrity of the patient, autonomy, and self-determination. A self-conscious patient actively and equally participating in her or his comprehensive healthcare can bring a paradigm shift in the perceptions and functioning of the healthcare sector. Medication concordance can be expected to play a key role in improving patient well-being, clinical outcomes, and healthcare delivery. However, it is fraught with numerous questions to be addressed ranging from lack of clarity or standard protocol, medicolegal intricacies, cultural–linguistic barriers, illiteracy, shortage of time, infrastructure, and manpower. There are major challenges in the effective implementation of this initiative which has definite potential to prove beneficial in Indian healthcare settings. The success of this novel approach can only be accomplished by coordinated, inclusive, and persistent efforts from all participants of healthcare with fostering of a milieu of trust, belief, and communication. A systematic literature search was conducted using key words from relevant articles and MeSh terms on Google Scholar and PubMed. Data were abstracted according to their relevance to subheadings of the review and synthesis of concepts was done through multiple reviews by atleast two reviewers for any subsection.
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ORIGINAL ARTICLES
Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir – A cross-sectional study
Rabbanie Tariq Wani, Imrose Rashid, Sheikh Sahila Nabi, Hibba Dar
April 2019, 8(4):1319-1325
DOI:10.4103/jfmpc.jfmpc_96_19  PMID:31143714
Background: Researches have shown highest awareness but low utilization of contraceptives making the situation a serious challenge. Most of women in reproductive age group know little or have incorrect information about family planning methods. Even when they know the name of some of the contraceptives, they do not know where to get them or how to use it. These women have negative attitude about family planning, whereas some have heard false and misleading information, the current study aimed in assessing the knowledge, attitude, and practice of family planning among female healthcare workers in Kashmir valley. Method: A self-administered questionnaire was served to the female multipurpose health workers of District Anantnag and Baramulla at a training conducted in Department of Community Medicine, Government Medical College, Srinagar, Kashmir. Result: All the participants had heard about family planning methods. The major sources of information were trainers (78.8%). About 90.4% of the study participants gave correct response regarding the types of family planning. About 80.1% of the respondents had a favorable attitude toward family planning. Around three-fourths of the study participants practiced one or other method of family planning. Conclusion: Our study lead to the conclusion that the level of knowledge and attitude toward family planning was relatively low and FP utilization was quite low among the healthcare workers. In order to imbibe positive attitude among general public, the health workers need to be trained so as to inculcate the positive attitude in them leading to increased awareness among general public with regard to family planning.
  277 76 -
Prevalence of anemia among adolescent girls in a rural area of Tamil Nadu, India
Abilash Sasidharannair Chandrakumari, Pammy Sinha, Shreelakshmidevi Singaravelu, S Jaikumar
April 2019, 8(4):1414-1417
DOI:10.4103/jfmpc.jfmpc_140_19  PMID:31143731
Background: Anemia accounts for a majority of the nutritional problem across the globe. The prevalence of anemia is inordinately higher among developing nations, because of low socioeconomic status and indigent access to the healthcare services. Adolescent period is signalized by marked physical activity and rapid growth spurt; therefore they need additional nutritional supplements and are at utmost risk of developing nutritional anemia. This study was carried out to find out the prevalence of anemia among adolescent girls. Materials and Methods: This study was a cross-sectional study conducted among 255 adolescent girls. After getting informed consent from the subjects, the information regarding age, sociodemographic status, menstrual history, and short clinical details were recorded. Blood samples were collected and analyzed using automated hematology analyser. Results and Discussion: Overall prevalence of anemia was found to be 48.63% (n = 124). The majority of the anemic girls (55.64%, n = 69) were having mild degree of anemia. Among 255 girls, 188 (73.73%) were from the early adolescent age group (10–14 years). Prevalence of anemia (52.24%) was high among the late adolescents and those belonging to low socioeconomic class. Conclusion: There is a significant relationship between anemia and socioeconomic status, dietary modification, nutritional supplementation, and helminth control; in addition, compliance with consumption of iron and folic acid tablets will prevent anemia to a great extent among adolescent girls.
  221 42 -
A study on the change in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus in generalized periodontitis
Akshay Munjal, Yashika Jain, Sowmya Kote, Vineesh Krishnan, Rafi Fahim, Samruddhi Swapnil Metha, Deepak Passi
April 2019, 8(4):1326-1329
DOI:10.4103/jfmpc.jfmpc_105_19  PMID:31143715
Aim: The aim of this study was to evaluate and investigate changes in HbA1c levels before and after non-surgical periodontal therapy in type-2 diabetes mellitus patients with generalized periodontitis. Materials and Methods: A statistically significant number of type-2 diabetes mellitus subjects diagnosed with chronic generalized periodontitis were included in the study. The selected subjects were randomly allocated to 2 groups. Group 1: Control group: Subjects who received only scaling and root planning. Group 2: Test group: Subjects received antibiotic coverage with non-surgical periodontal therapy (scaling and root planning). Clinical parameters included plaque index, gingival index, PRO MIG pocket depth, and clinical attachment level. In addition, the metabolic parameters were recorded at the same time intervals, which included fasting blood sugar, random blood sugar, and HbA1c levels. Statistical Analysis: ANOVA test was applied to the parameters. Results: HbA1c more significantly reduced by test group compared to the other group. Conclusion: there is definitely a positive effect of nonsurgical on HbA1c levels in type 2 diabetes mellitus. This point levels significantly reduced after conventional non-surgical periodontal therapy. Conclusion: There is definitely a positive effect of non-surgical periodontal therapy on HbA1c levels in type 2 diabetes patients with chronic periodontitis.
  216 43 -
CASE REPORTS
'Hand inside glove': Useful method of burn dressing in children
Ranjit K Sahu, Manojit Midya
April 2019, 8(4):1483-1485
DOI:10.4103/jfmpc.jfmpc_164_19  PMID:31143744
The use of sterile surgical gloves in wound dressing is not new. It has been used previously in dressing of fresh wounds and in adjunct to the negative pressure wound management. Herein we describe an interesting case of burn wound dressing of hand in a child. Low cost, easy availability, better patient compliance and lesser chances of wound infection are special attributes of glove dressing.
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ORIGINAL ARTICLES
An investigation into the sensitivity of shear wave ultrasound elastography to measure the anterior bladder wall pressure in patients with neurogenic bladder
Alireza Ghorbani Bavani, Mohammad Ghasem Hanafi, Mohsen Sarkarian
April 2019, 8(4):1342-1346
DOI:10.4103/jfmpc.jfmpc_84_19  PMID:31143718
Introduction and Objective: Urodynamic testing (urodynamics) is widely used for evaluating bladder function as a result of high detrusor compliance. This aggressive and uncomfortable test is especially difficult for children. This study aimed to determine the sensitivity of shear wave ultrasound elastography (SWE) as a new method for evaluating the biomechanical characteristics of bladder to measure the anterior bladder wall pressure in children with neurogenic bladder (NB). Materials and Methods: The present prospective clinical study was carried out on 30 children with allegedly NB and 20 healthy children as control group. These children referred to Ahwaz Golestan Hospital in 2018. After clinical evaluations, urodynamics was performed for children with NB and detrusor compliance was measured in cm/H2O. The ultrasonography of the SWE was performed on the anterior wall of the bladder (Estimated bladder capacity (EBC) 50%) for the two groups. The relationship between shear wave speed (SWS) and detrusor compliance was estimated using Pearson's correlation coefficient. Independent t-test was used to compare SWS between two groups. Results: In patients with NB, there was a significant relationship between the mean SWS of the anterior bladder wall and detrusor compliance (R = 0.89, P = 0.0001). The comparison between normal and NB groups showed that the mean SWS of the anterior bladder wall in the patients was significantly higher than the healthy group (1.88 ± 0.88 m/s vs. 0.94 ± 0.15; P = 0.0001). There was also no significant relationship between SWS, gender, age, weight, and body mass index of patients (P > 0.05). Conclusion: The results showed that SWE can be used as a useful alternative for urorodynamic testing in the evaluation of NB (bladder dysfunction) in children.
  180 37 -
Challenges in supervision, monitoring, and reporting in anemia programme implementation in Odisha, India: A qualitative process documentation
Vikas Bhatia, Preetam Mahajan, Swayam P Parida, Sourvav Bhattacharjee, Soumya S Sahoo
April 2019, 8(4):1365-1369
DOI:10.4103/jfmpc.jfmpc_68_19  PMID:31143722
Introduction: Anemia is a major public health challenge in India. Despite national programmes and targeted interventions over the years, the decline has been unsatisfactory. National Iron Plus Initiative (NIPI) was launched by the Government of India with a vision to combat anemia. In this context, we discuss the programmatic facilitators and issues in the monitoring, supervision, and reporting aspects of NIPI implementation. Materials and Methods: A process documentation study was undertaken in four districts of Odisha to assess the NIPI implementation. A total of 170 interviews were conducted during March–May 2016 among officials and frontline workers through qualitative techniques such as in-depth interviews, focus group discussions, and process observation. Data analysis was thematic using NVivo software. Results: Monitoring and supervision consisted primarily of visiting field sites by supervisors and review of the progress in meetings with inadequate documentation. Lack of coordination and ownership among the various departments involved were observed as revealed in the interviews. Some of the reporting formats were outdated and missed section for IFA syrup. Focus had been on the collection of data, but its utilization for informed decision-making and policy decisions was lacking. Conclusion: Better interdepartmental coordination and ownership, streamlining the reporting system and web-based monitoring system need to be prioritized to improve the effectiveness of the programme. The three key departments involved must strengthen the evaluation process for sustained outcomes to reduce anemia burden.
  181 31 -
Stigma toward mental illness among higher secondary school teachers in Puducherry, South India
Surendran Venkataraman, Rajkumar Patil, Sivaprakash Balasundaram
April 2019, 8(4):1401-1407
DOI:10.4103/jfmpc.jfmpc_203_19  PMID:31143729
Background: A majority of mental illness start during adolescent period, and teachers can be a major resource in provision of mental health services to them. Stigma is a major barrier between persons with mental illness and opportunities to recover. Materials and Methods: Cross-sectional analytical study was conducted to assess the stigma toward mental illness and associated factors among higher secondary school teachers in Puducherry from April 2017 to March 2018. Multistage sampling was used to select 566 teachers from 46 schools. A part of the vignette-based “Mental Health Literacy Scale” portraying depression was used to assess stigma toward mental illness. Sociodemographic and work characteristics were also obtained. Data were analyzed using SPSS v16. To identify factors associated with stigma, bivariate analysis was done using Chi-square test and multivariate analysis using logistic regression. Results: Among the teachers, 72.9% and 65.7% showed overall agreement to personal and perceived stigma, respectively, toward case in vignette. Teachers in lower age group [adjusted odds ratio (AOR): 4.6 (95% confidence interval (CI): 2.54–8.33)], male gender [AOR: 2.79 (95% CI: 1.85–4.24)], working in urban [AOR: 2.8 (95% CI: 1.91–4.15)], private schools [AOR: 2.58 (95% CI: 1.77–3.77)], and less teaching experience [AOR: 3.72 (95% CI: 2.4–5.88)] had significantly higher personal stigma. Similarly, lower age group [AOR: 4.6 (95% CI: 2.54–8.33)], male gender [AOR: 2.79 (95% CI: 1.85–4.24)], working in urban [AOR: 2.8 (95% CI: 1.91–4.15)] schools, and less teaching experience [AOR: 3.72 (95% CI: 2.4–5.88)] had significantly higher perceived stigma. Conclusion: About 70% teachers showed overall agreement to stigma toward the depressive case vignette. The significant factors influencing stigma were identified. This can act as a baseline to implementmental health training program for teachers therefore bringing an attitudinal shift to being positive toward the psychologically disturbed.
  181 31 -
Awareness and perceptions of anganwadi workers about female feticide and girl child discrimination in district Ludhiana, Punjab
Anurag Chaudhary, Priya Bansal, Mahesh Satija, Anubhuti Dhanuka, Manvi Sagar, Sarit Sharma, Sangeeta Girdhar, Vikram Kumar Gupta, Pushapindra Kaushal
April 2019, 8(4):1460-1464
DOI:10.4103/jfmpc.jfmpc_148_19  PMID:31143739
Background: It is a matter of grave concern that a girl child continues to be insecure and vulnerable in the state of Punjab. To ingrain gender equality in social system, it is very important to make community an important stakeholder to deal with the situation. This study focuses on the awareness and perceptions of anganwadi workers regarding girl child discrimination and female feticide. Materials and Methods: A total of 2206 anganwadi workers between the age group of 20–70 years of different blocks of Ludhiana district, Punjab, were enrolled. They had come for Anganwadi Worker (AWW) Training Workshop, organized at Urban Health Centre, Ludhiana, Punjab. Data were analyzed in terms of proportions. Results: Study subjects showed high level of awareness about female feticide (98.8%). A majority of the subjects (93.3%) agreed to the fact that practice of discrimination is being followed between boys and girls. They were also of the opinion that this practice is harmful and it should be stopped (98.9%). Various contributing factors enumerated by them included sons are intelligent, carry on family lineage, and they take care of their parents in old age. Regarding perception of anganwadi workers for curbing this social evil, 70.7% of subjects were of the view that by giving equal opportunities, equal status to girls, and empowering girls, this practice can be stopped, while 42.4% of the subjects were of the view that increasing awareness among the rural women, parents, and family is the solution to stop this practice. Conclusion: The anganwadi workers had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.
  184 27 -
VIEW POINT
Strengthening primary health care through e-referral system
Md Abu Bashar, Sudip Bhattacharya, Shailesh Tripathi, Neha Sharma, Amarjeet Singh
April 2019, 8(4):1511-1513
DOI:10.4103/jfmpc.jfmpc_184_19  PMID:31143753
Referral is a dynamic process, in which a health worker at one level of the health system, having insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the help of a better or differently resourced facility at the same or higher level to assist in. Health care systems of every country are designed in such a way to encourage patients to first attempt to get care at the primary level and then to approach a higher level of care according to the need. This protocol minimizes the costs for the caretaker/patients. However, in most of the countries, patients often bypass primary care facilities and directly go to the higher center thereby, increasing the burden on higher level facilities, the picture is not very different in India also. Health care system in India is plugged by: overpopulation, lack of expert clinicians, skewed distribution of physicians, lack of motivation among existing health care personnel and an ineffective referral mechanism. Due to failure of conventional paper-based referral systems in our country, we can introduce an e-referral system in the era of internet. It is evident from our experiences, that this artificial intelligence enabled e-referral system has many advantages over the traditional paper-based referral system. It will aid health workers for timely management of cases. Most importantly, it will streamline the existing unorganized referral process. Although, for effective e-Referral system, there should be a collaborative platform where easy search and discovery for health care providers is possible and help in decision making. e- Referral should be incorporated in our health system to strengthen it by bridging the access gap may be through Public Private Partnership model.
  172 35 -
ORIGINAL ARTICLES
A retrospective cross-sectional study of maxillofacial trauma in Delhi-NCR Region
Lokesh Chandra, D Deepa, Mansi Atri, Souvir Mohan Pandey, Deepak Passi, Jyoti Goyal, Abhimanyu Sharma, Utkarsh Gupta
April 2019, 8(4):1453-1459
DOI:10.4103/jfmpc.jfmpc_89_19  PMID:31143738
Aim and Objectives: To evaluate the pattern, prevalence, etiology, site of fractures, and their management in patients with maxillofacial injury in Delhi-NCR region. Materials and Methods: A total of 1278 maxillofacial trauma patients visiting different registered hospitals from Delhi-NCR region from January 2012 to December 2017, treated by open reduction and internal fixation under general anesthesia (GA)/local anesthesia (LA) or closed reduction/conservatively, were taken into the study. The parameters considered in the study were age and sex distribution, etiological factors and incidence of maxillofacial trauma, pattern and site distribution of maxillofacial fractures, and management. Results: From a total of 2250 trauma patients, 1278 patients (1053 males and 225 females) had maxillofacial injury. The average prevalence rate was 56.8%. Yearly incidence rate was 20.4%. Road traffic accident (RTA) was the most common cause of trauma in 1029 (80.5%) patients, followed by physical assault [158 (12.3%)] with significant male predominance in different age groups. Isolated mandibular fractures were the most common [48.6% (parasymphysis 31.6%, condyle 28.2%)], followed by midface with maxilla fracture [27.6% (zygomatic bone and arch 50.2% and Lefort II fractures 18%)]. Treatment modalities were conservative management, closed reduction, and open reduction with internal fixation under GA/LA. Conclusion: RTA followed by physical assault is still the leading cause of maxillofacial trauma in young males in Delhi-NCR region. Mini plate osteosynthesis is the main treatment procedure for maxillofacial trauma. We need to enforce strict traffic rules, road safety law, and preventive measures along with improvement in education and socioeconomic status in the population to avoid maxillofacial injuries.
  160 45 -
Knowledge, attitude and Perception Regarding Risk Factors of Overweight and Obesity Among Secondary School Students in Ikeja Local Government Area, Nigeria
Azeezat A Oyewande, Amosu Ademola, Taofik A Okuneye, Felix O Sanni, Aderinola M Hassan, Paul A Olaiya
April 2019, 8(4):1391-1395
DOI:10.4103/jfmpc.jfmpc_160_19  PMID:31143727
Context: Childhood obesity has risen dramatically in the last four decades. Childhood obesity is likely to continue through adulthood and increases the risk of non-communicable diseases later in life. Aims: This study assessed the knowledge, attitude, and perception of the secondary school students in Ikeja local government, Lagos state towards the risk factors of overweight and obesity. Methods and Materials: This descriptive cross-sectional study was carried out using a structured questionnaire administered on consenting participants. The completed questionnaires collected from the participants was then analyzed. Statistical Analysis Used: Data were analyzed using SPSS version 22.0. Results: The prevalence of overweight and obesity were 6.6% and 1.4%. Overall knowledge (<50%) of students regarding the risk factors of overweight and obesity was very low. Majority of the students (97.4%) do daily exercise, 48.4% spend at least 30 minutes doing exercise daily. However, 62.0% watching television, 18.7% play video games, and 35.8% sleep for more than 8 hours daily. Participants also showed negative perception towards the effects of overweight and obesity. There was a significant association between age, gender, class, and body mass with knowledge, attitude, and perception of respondents towards risk factors and effects of overweight and obesity (P < 0.05). Conclusions: Despite the low prevalence of overweight and obesity, low knowledge, poor attitude and negative perception regarding risk factors of overweight and obesity, the majority of the students perceived regular exercise as an important means of reducing overweight and obesity.
  174 29 -
Osteoporosis knowledge and beliefs among postmenopausal women: A cross-sectional study from a teaching hospital in southern India
Manickavasagam Senthilraja, Kripa Elizabeth Cherian, Felix K Jebasingh, Nitin Kapoor, Thomas Vizhalil Paul, Hesarghatta Shyamasunder Asha
April 2019, 8(4):1374-1378
DOI:10.4103/jfmpc.jfmpc_95_19  PMID:31143724
Objectives: Osteoporosis continues to be underrecognized in many parts of India. This study was undertaken to assess the level of knowledge of osteoporosis among postmenopausal women referred for a dual-energy X-ray absorptiometry (DXA) scan in a teaching hospital in southern India. Methodology: This cross-sectional study assessed the state of awareness in consecutive postmenopausal women referred for a DXA scan using a validated questionnaire – Osteoporosis Knowledge Assessment Tool. The proportion of correct responses was expressed as percentages. The mean scores obtained were also compared between different educational groups. Results: A total of 302 consecutive postmenopausal women who were referred for DXA participated in this study. The mean (standard deviation) age of the postmenopausal women included in this study was 58.8 (6) years. Although most subjects were aware of the consequences of osteoporosis, there was generalized lack of awareness with regard to risk factors and available treatment options. Overall about 60% had poor awareness about osteoporosis. Conclusion: This study showed a gross deficit in awareness of osteoporosis in Indian postmenopausal women. There is a need to prioritize on designing appropriate awareness campaigns in subjects at risk, according to their level of literacy.
  164 32 -
CASE REPORTS
An integrated therapy approach for the management of obesity-associated disorders: A case report
Anita Verma, Sanjay U Shete, Gururaj Doddoli
April 2019, 8(4):1491-1494
DOI:10.4103/jfmpc.jfmpc_200_19  PMID:31143747
Obesity (sthoulya), in general, is a significant health problem and is associated with several comorbidities and various discomforts that can cause negative impact on physical, mental, and social well-being of a person. In this case study, an obese patient was suffering from severe multiple joint pains (aam vata) and shortness of breath (shwaas) was unable to climb stairs, and had extreme difficulty in walking. The patient also suffered from stress-related complaints, such as sleep disturbances (anidra) and poor digestion. The treatment was aimed at restoring psycho-physiological and physical health of the patient. Ayurveda panchakarma therapy involves treatments such as snehana (oleation), svedana (sudation), and virechana (purgation), which are the line of treatment for obesity-related disorders. Furthermore, the patient was given special yoga postures to improve flexibility and movement of joints. The integrative therapy of Ayurveda panchakarma and yoga showed significant improvement in functional capacity, quality of life, and musculoskeletal pain.
  169 21 -
ORIGINAL ARTICLES
Prevalence of visual impairment and its association with vision-related quality of life among elderly persons in a resettlement colony of Delhi
Dwarakanathan Vignesh, Noopur Gupta, Mani Kalaivani, Anil Kumar Goswami, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
April 2019, 8(4):1432-1439
DOI:10.4103/jfmpc.jfmpc_188_19  PMID:31143735
Background: The population of India is ageing. The number and percentage of elderly persons is increasing. Visual impairment is common among elderly persons and affects their vision-related quality of life. The objective of this study was to estimate the prevalence of visual impairment among elderly persons aged 60 years and above residing in a resettlement colony of Delhi and study its association with socio-demographic variables and vision-related quality of life. Methods: A total of 604 elderly participants were selected by simple random sampling. House-to-house visit was done, and a self-developed pre-tested semi-structured interview schedule was used to collect socio-demographic information. Visual acuity was measured using Snellen's chart, and distant direct ophthalmoscopy was done to diagnose cataract. Vision-related quality of life was assessed by Indian Vision Function Questionnaire-33 (IND-VFQ-33). Results: Of the 604 participants, 555 (91.9%) were available for interview. The prevalence of visual impairment was 24.5% (95% CI: 20.9% - 28.1%). Cataract was the leading cause of visual impairment (50.7%), followed by uncorrected refractive error (36.8%). Illiteracy (aOR: 3.49, 1.37-8.87), economic dependence on family members (aOR: 1.92, 1.04 – 3.54), not currently working (aOR: 1.89, 1.20-2.98) and chewing of tobacco products (aOR: 2.56, 1.48-4.42) were significantly associated with visual impairment among study participants. Vison-related quality of life was worse among those with visual impairment. Conclusion: Burden of visual impairment is high among elderly persons living in urban resettlement colonies. It is largely avoidable. Eye-care services should be accessible and affordable to them.
  165 22 -
Comparison of psychiatric screening Instruments: GHQ-28, BSI and MMPI
Jamileh Jahangirian, Hossein Akbari, Ehsan Dadgostar
April 2019, 8(4):1337-1341
DOI:10.4103/jfmpc.jfmpc_135_18  PMID:31143717
Background: Clinical interview comprises a method for of psychiatric disorders diagnosis. Given the cost, time, and expertise required for clinical assessment; alternative tools to accurately substitute clinical interviews are having high value. We conduct this study to compare the screening accuracy of GHQ-28, BSI, and MMPI. Materials and Methods: Considering a diagnostic value, this study was conducted on 983 students and 3 psychiatric screening tools; GHQ-28, BSI, and MMPI were completed by students. Among the whole participants, 237 students were interviewed by the clinical psychiatrists on the basis of DSM-IV-IR Criteria. Based on ANOVO and Chi-square, results compare was made. Kappa correlation -coefficient was calculated in a pairwise manner; eventually the diagnostic accuracy of each tool was determined by the means of ROC analysis. Results: The diversity of psychiatric disorders by GHQ-28, was about 39.1, on the basis of BST was 44.8% and 44% for MMPI. The sensitivity and specificity of GHQ-28 was 85.9% and 87.8% considering 21.5 as the cut-off point; respectively. Considering 41/5 as the cut-off point for the BSI test, sensitivity and specificity were 81.2% and 90.8%; respectively, and 88.2% and 91.4% for the MMPI test with the cut-off point of 63.5 compared to clinical interview, the MMPI test was associated with the greatest accurate staging, ranging about 90.3%. Conclusions: The results of this study according to clinical assessment reveal that GHQ-28, BSI, and MMPI psychiatric tools have high sensitivity and specificity and MMPI possessed the greatest efficiency compared to other evaluated tools.
  152 34 -
CASE REPORTS
Proton pump inhibitors induce hemolytic anemia
Asayil Nasser Al-Nasser, Raja Saleh Husain, Ahmed Abdullah Al-Marhabi
April 2019, 8(4):1486-1487
DOI:10.4103/jfmpc.jfmpc_169_19  PMID:31143745
Proton pump inhibitors (PPIs) are generally safe, and their short-term use commonly does not induce hemolytic anemia. The underlying mechanisms are unknown, and the literature insufficiently explores hemolytic anemia as an adverse event induced by PPIs. In this case study, we report a 31-year-old female who had developed hemolytic anemia with symptoms of jaundice, hyperbilirubinemia, and high reticulocytes, after treatment with PPI. Interestingly, the patient completely recovered after PPI withdrawal. This present case study highlights the need for physicians to exercise caution when treating patients with PPI.
  163 21 -
ORIGINAL ARTICLES
Relation of systolic and diastolic epicardial adipose tissue thickness with presence and severity of coronary artery disease (The EAT CAD study)
Bhupendra Verma, Deepak Katyal, Akhilesh Patel, Vivek Raj Singh, Senthil Kumar
April 2019, 8(4):1470-1475
DOI:10.4103/jfmpc.jfmpc_194_19  PMID:31143741
Background: Recent studies have shown EAT to be an indicator of cardiovascular risk and atherosclerotic plaque development. However, such data is sparse from Indian sub-continent. The present study evaluated the relationship of EAT as determined by echocardiography to the presence and severity of coronary artery disease (CAD). Materials and Methods: This was a cross-sectional observational study constituting 500 patients including 250 with angiographically normal coronary arteries (non-CAD group), and 250 patients with significant CAD on coronary angiogram (CAD group). CAD severity was assessed by Gensini and SYNTAX scores. Results: The mean systolic and diastolic EAT thickness in the CAD group (5.7 ± 1.5 mm and 4.3 ± 1.1 mm) were significantly higher than the non-CAD group (4.2 ± 1.2 mm and 3.2 ± 1.2 mm), both P < 0.001. EAT thickness showed a significant positive correlation with waist circumference, LDL-C levels, Gensini score, and SYNTAX score. On multivariate logistic regression analysis, both systolic and diastolic EAT thickness were found to be independent predictor of CAD in addition traditional risk factors. Receiver operating characteristics (ROC) analysis showed that systolic EAT thickness of 5 mm and diastolic EAT thickness of 4 mm had similar sensitivity (85% vs 83%, respectively) and specificity (70% vs 72%, respectively) to detect presence of CAD. Conclusion: Systolic and diastolic EAT thicknesses are increased in CAD patients and related to both presence and severity of CAD. EAT, being modifiable, may be an attractive target for future interventions to reduce CV risk and has potential to monitor the response to life-style modification and therapy. However, larger and prospective studies required to validate these findings.
  159 25 -
Assessment of knowledge of obstetric danger signs among pregnant women attending a teaching hospital
Mubeena Haleema, Pracheth Raghuveer, R Kiran, Ibrahim M Mohammed, Ibrahim Sherief A. Mohammed, Mazina Mohammed
April 2019, 8(4):1422-1426
DOI:10.4103/jfmpc.jfmpc_149_19  PMID:31143733
Introduction: Knowledge of obstetric danger signs among pregnant women is of paramount importance in improving maternal, and fetal health outcomes. This study aims to determine the knowledge of danger signs among pregnant women seeking antenatal care in a teaching hospital. Materials and Methods: A cross-sectional study was carried out for two months among pregnant women who visited the antenatal clinic of a teaching hospital. A pre-tested and pre-designed proforma was used. Mean knowledge scores were computed and knowledge was classified into adequate and inadequate. Results: A total of 170 pregnant women fulfilling the inclusion criteria were included. Mean age of the study participants was found to be 26.40 ± 4.14 years. Nearly 67.10% were aware of bleeding per vagina being a danger sign, 50.0% stated excessive vomiting as a danger sign, 23.50% knew that blurring of vision was a danger, while a mere 20.0% reported that convulsions were a danger sign. Overall, adequate knowledge (total knowledge score of 5 and above) was observed in 54.70% of the participants. Conclusion: Majority of the study participants had adequate knowledge of danger signs in pregnancy. However, when knowledge about specific individual danger signs were further assessed, a high proportion had very poor knowledge. The mean knowledge scores were found to be low.
  151 30 -
Malaria in pregnancy: A community-based study on the knowledge, perception, and prevention among Nigerian women
Ifeoma P Okafor, Chinonso Ezekude, Esther O Oluwole, Olanrewaju O Onigbogi
April 2019, 8(4):1359-1364
DOI:10.4103/jfmpc.jfmpc_295_18  PMID:31143721
Background: Malaria accounts for approximately 1 million deaths annually and about 300,000 deaths in Nigeria alone. Pregnant women and their unborn babies are particularly vulnerable to the adverse consequences of malaria. This study assessed the knowledge, perception, and preventive practices for malaria in pregnancy (MiP) among women in Lagos, Nigeria. Materials and Methods: A cross-sectional, descriptive study design was adopted. A total of 422 respondents were selected using multistage sampling technique. Data were collected using a structured, interviewer-administered questionnaire in the first quarter of 2016. Analysis was done with Epi Info™ 7 software with level of significance set at P < 0.05. Results: All respondents were aware of MiP, and almost all the respondents (96.2%) were aware that malaria is caused by infected mosquito bite. Majority (89.3%) of the respondents registered for antenatal care in their last pregnancy, but 56.6% did so in the second trimester. A little over half (55.5%) had good knowledge of MiP. There was poor knowledge of the complications of MiP in mothers, with 27% unaware of any complications. Majority (51.6%) of them did not know the complications of malaria in the fetus. Better educated respondents had statistically significant better knowledge of MiP (P = 0.001). Only two-fifths of the respondents (39.8%) agreed that MiP can lead to death of the fetus. Most (41.9%) used insecticide spray and coils in the prevention of MiP, whereas only 36.9% used intermittent preventive treatment. Only 24.1% used insecticide-treated nets and almost 20% used no form of prevention. Conclusion: Respondents' knowledge, perception, and preventive practices for MiP were not satisfactory. Public health education on MiP should be intensified at the community level in order to improve knowledge and prevention and also to correct misconceptions.
  150 31 -
Assessment of risk factors for coronary artery disease in military personnel: A study from Iran
Farshid Mirzaeipour, Marjan Seyedmazhari, Amir Hosein Pishgooie, Mahsa Hazaryan
April 2019, 8(4):1347-1351
DOI:10.4103/jfmpc.jfmpc_109_19  PMID:31143719
Introduction: Cardiovascular diseases are the most significant cause of mortality. Although the risk factors of this disease are well known, the strength of these factors varies in different populations and needs to be investigated. Aim: The aim of this study is to estimate the amount of the effect of each classic risk factor on CAD (coronary artery disease) among Aja personnel. Materials and Methods: This matched case-control study was conducted on 1000 male Aja personnel admitted selecting Aja hospitals in Tehran in 2017. The samples were selected using purposive-graded sampling method. The 250 military patients hospitalized for CAD were considered as a case group. Each case was individually matched for age and service force with tree military patients without CAD. Data were gathered using standard demographic information and history of risk factors questionnaire and analyzed using SPSS 23 and statistical tests. Odds ratio measured trough Cochran–Mantel–Haenszel test and used to estimate the amount of the effect of each classic risk factors on CAD. Results: Data analysis indicated that the risk factors including diabetes, hyperlipidemia, smoking, hypertension, and positive family history of CAD enhance the probability of CAD as much as 79.2%, 77.3%, 67.7%, 64.1%, and 56.6%, respectively. Conclusion: Diabetes and other modifiable risk factors have the greatest impact on CAD among the concerned Aja personnel. Hence, the authorities can consider the independent amount of the effect of each risk factor and modify them in order to prevent the disease more effectively and purposefully among the personnel.
  135 41 -
Family medicine residents' educational environment and satisfaction of training program in Riyadh
Abdullah H Al Helal, Yousef Al Turki
April 2019, 8(4):1330-1336
DOI:10.4103/jfmpc.jfmpc_63_19  PMID:31143716
Background: Improving health outcome indicators worldwide needs well-trained family physicians, and the Kingdom of Saudi Arabia is of no exception from that need. Objectives: To address the level of satisfaction and assess the educational environment among residents of family medicine (FM) in Riyadh city. Methodology: A cross-sectional study; the Postgraduate Hospital Educational Environment Measure (PHEEM) was used to assess the educational environment for all FM residents in fully structured training centers that include all levels of residents in Riyadh during 2016. Results: About 187 surveys were distributed and 140 were collected, with a response rate of 74.87%. Cronbach's alpha scored at 0.917 for overall items. Out of 160 maximum score, the overall score of the PHEEM was 86.73 (standard deviation [SD]: 19.46). The perception of teaching score was 33.11 (SD: 8.80) out of 60, the perception of role autonomy score was 28.60 (SD: 7.35) out of 56, and the perception of social support was 25.02 (SD: 5.43) out of 44. Conclusion: The educational environment is an important determinant of medical trainees' achievements and success. The results are better than what had been found in the previous studies, but more attention and effort should be done, especially for the poorly rated points in this study. We recommend a continuous evaluation and reconstruction of the Saudi Board of FM program, and such results could be a tool that might help in fostering better and stronger educational program.
  125 50 -
Connecting forensic odontology among medical practitioners in central Kerala – An original study
Milcah Roy, S Akhil, R B Vinod Kumar, Jubin Thomas, Ajish M Saji, Amal K Iype
April 2019, 8(4):1427-1431
DOI:10.4103/jfmpc.jfmpc_166_19  PMID:31143734
Introduction and Background: The word forensic, defined by Clark, is derived from the Latin word “forensis,” which means “before the forum.” Odontology refers to the study of teeth. Even though the scope of forensic odontology is well established among dental professionals, its practical application lies largely in the hands of medicolegal professionals. The interaction between the above mentioned two communities is highly crucial for the proper application of forensic odontology in medicolegal issues. Aim: The main aim of this study is to analyze the knowledge, attitude, and practice of forensic odontology among medical practitioners in central Kerala since they are the connecting link between victims and the forensic odontologists. Results: A total of 200 medical practitioners had participated in the study, and the response rate was 100%. The study indicated that medical practitioners who are having an experience of above 15 years had more knowledge regarding forensic odontology when compared with those below 15 years of experience. However, the awareness of modern technologies in forensic odontology and latest techniques to register dental markings were found to be more prevalent among doctors with less than 15 years of experience.
  149 23 -
Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India
Ariarathinam Newtonraj, Emilie Venables, Kalaiselvi Selvaraj, Debashish Kundu, Anil Jacob Purty, Mani Manikandan, Hemant Deepak Shewade
April 2019, 8(4):1379-1385
DOI:10.4103/jfmpc.jfmpc_421_18  PMID:31143725
Introduction: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert. Materials and Methods: Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program). Results: The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016–2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy–negative patients for Xpert, and incompletely filled referral forms. Conclusion: Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing.
  134 30 -
Diagnosis of envenomation by Russell's and Echis carinatus viper: A clinical study at rural Maharashtra state of India
Himmatrao S Bawaskar, Pramodini H Bawaskar
April 2019, 8(4):1386-1390
DOI:10.4103/jfmpc.jfmpc_156_19  PMID:31143726
Background: Envenoming by vipers Russell's and Echis Carinatus are common accidents faced by farmers and labors. Both viper venom toxins alter coagulation mechanism in the victim. The dose of snake antivenin to neutralize the venom is empirical and varies. Though the clinical manifestations in both vipers bite envenoming are nearly similar but dose of antivenin required is more in Russell's viper. We studied in detail about the correlation of clinical manifestations and confirmed species of snake. Methods: Cases of vipers snake bites admitted for last two successive years were studied. Analysis by local manifestations, systemic involvement, 20 minute whole blood clotting test (20WBCT), identification of snake responsible for clinical effects are confirmed by the snake species brought by victims or bystanders, in case of where victim saw the snake bur failed to kill. The victims identified from pictures of big four poisonous snakes (Russell's viper, Echis carinatus, Cobra, and krait). Further confirmation from the species responsible is done by showing the hospital preserved specimen to identify the culprits. Findings: About 77 cases of viper bite studied of these 57 has clinical syndrome suggestive of Russell's viper (RV) bite, one has dry bite, 23 victims brought the killed specimen confirmed RV, of these 18 identified the specimen picture and 5 wrongly locate the species in pictures, 20 victims correctly identified the hospital preserved specimen while 3 failed to recognize. There were 28 patients who saw the snake while bitten but failed to kill, of these 20 patients identify correctly the species on picture while 8 failed to identify. Only 22 correctly identified the culprit by looking at the hospital preserved specimen and 6 were confused. One dry bite victim correctly identified the bitten snake species in picture and hospital preserved specimen. Interpretation: In viper bite poisoning clinical pictures and hospital specimen help to confirm the species are highly supportive for clinical diagnosis.
  131 27 -
Parental perception of fluoridated tap water
Mohamed A Hendaus, Khaled Siddiq, Mohanad AlQadi, Faisal Siddiqui, Shafeeque Kunhiabdullah, Ahmed H Alhammadi
April 2019, 8(4):1440-1446
DOI:10.4103/jfmpc.jfmpc_192_18  PMID:31143736
Purpose: The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%. Materials and Methods: A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey. Results: A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients. Conclusion: Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.
  136 21 -
Dermatophytoses and spectrum of dermatophytes in patients attending a teaching hospital in Western Rajasthan, India
Jitu Mani Kalita, Anuradha Sharma, Abhishek Bhardwaj, Vijaya Lakshmi Nag
April 2019, 8(4):1418-1421
DOI:10.4103/jfmpc.jfmpc_159_19  PMID:31143732
Introduction: About 20–25% of the world's populations are infected with dermatophyte and the incidence of the disease is increasing steadily. In India, the cause of dermatophytoses is adversely influenced by economic factors such as poverty, poor hygiene and social conditions like overcrowding. The main objective of this study was to determine the prevalence, etiological agents, and distribution patterns of the disease among the patients attending a teaching hospital, Jodhpur. Materials and Methods: This is a retrospective study conducted in the Department of Microbiology and Department of Dermatology of a teaching hospital, Jodhpur from January 2017 to May 2018. The microbiological records of potassium hydroxide (KOH) mount examination and the fungal culture report of skin, hair, and nail samples during the study period were analyzed. Results: A total 363 skin, hair, and nail samples were received for fungal culture as investigations requested by dermatologist. Out of total 363 samples, KOH mount was positive in 58.4% and the culture was positive in 44.07% cases. Dermatophyte was isolated in 40.22% cases. Trichophyton mentagrophytes was the predominant dermatophyte (55%) isolated followed by T. tonsurans (22.5%) and T. rubrum (6.25%). Conclusion: The present study gives an insight about the prevalence and distribution pattern of dermatophytoses in Jodhpur, India. Tinea corporis was the most commonly diagnosed clinical condition followed by Tinea cruris. T. mentagrophytes was implicated as the predominating species.
  128 28 -
Central hemodynamics and arterial stiffness in Gujarati diabetics not receiving any antihypertensive: A case–control study based on oscillometric pulse wave analysis
Jayesh D Solanki, Hirava B Munshi, Hemant B Mehta, Chinmay J Shah
April 2019, 8(4):1352-1358
DOI:10.4103/jfmpc.jfmpc_117_19  PMID:31143720
Introduction: Diabetes is a modern epidemic imposing significant cardiovascular risk. Immediate and discrete parameters such as arterial stiffness and central hemodynamics are studied scarcely. Pulse wave analysis (PWA) offers noninvasive measurement of the same and we performed that in diabetics. Materials and Methods: We performed a case–control study on 148 treated diabetic not on antihypertensive and 148 nondiabetic normotensive controls. Oscillometric PWA was performed by Mobil-O-Graph (IEM). Parameters were further analyzed for effect of gender, physical activity, body mass index (BMI; cut-off 23), glycemic control, and disease duration (cut-off 4 years). Multiple linear regressions were used to find significant predictors. P <0.05 was taken as statistical significance. Results: Cases had significantly raised brachial hemodynamics (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥ 23, and physical inactivity were the significant factors affecting results (arterial stiffness more than central hemodynamics); glycemic control and duration were not. Heart rate was the major predictor of study parameters. Brachial pressure parameters were not significant predictors of corresponding central pressure parameters. Conclusion: Gujarati diabetics not using any antihypertensive had adverse profile of beyond brachial blood pressure discrete cardiovascular parameters, independent of duration and glycemic control, related to gender, BMI, and physical activity, indicating vascular progeria in the absence of hypertension. This baseline study suggests further work on these potential parameters.
  137 19 -
CASE REPORTS
Simultaneous development of Kawasaki disease in identical twins: A case report
U Namita, MH Saddiq, Zulfikar Ahamed
April 2019, 8(4):1481-1482
DOI:10.4103/jfmpc.jfmpc_153_19  PMID:31143743
Kawasaki disease (KD) is the most common vasculitis in childhood that affects medium-sized arteries, particularly coronary arteries. The etiology remains unknown; however, many studies suggest that specific genetic factors and/or some infectious agents underlie the onset. Here, we report a set of identical twin boys who simultaneously developed KD, emphasizing the genetic component of etiology. The patients were 4-year-old twin boys who previously had been healthy and had no family history of KD. Twin A, on admission, met four of five diagnostic criteria for KD. Echocardiogram ruled out coronary artery lesion, and he was treated with 2 g/kg IVIG and aspirin, to which he responded well. Twin B, unlike his brother, met only three of the diagnostic criteria, so was diagnosed as incomplete KD. However, due to the history and shared genetic potential for KD, laboratory investigations and echocardiogram were done. His echocardiogram revealed coronary artery lesion. He was also treated with IVIG and aspirin.
  126 28 -
ORIGINAL ARTICLES
Assessment of subclinical atherosclerosis and endothelial dysfunction in chronic kidney disease by measurement of carotid intima media thickness and flow-mediated vasodilatation in North Indian population
Munna Lal Patel, Rekha Sachan, Gaurav Prakash Singh, SC Chaudhary, KK Gupta, Virendra Atam, Anit Parihar
April 2019, 8(4):1447-1452
DOI:10.4103/jfmpc.jfmpc_191_19  PMID:31143737
Background: Chronic kidney disease (CKD) predisposes to accelerated atherosclerosis that is measured by carotid artery intima media thickness (CIMT) and brachial artery flow-mediated dilation (FMD). The aim of this study was to assess the noninvasive risk markers of subclinical atherosclerosis and endothelial dysfunction and their correlation with disease severity. Methods and Results: This was a cross-sectional study conducted in 62 patients with CKD: 38 predialysis and 24 on hemodialysis and 50 age- and gender-matched controls. In both the patients and controls, high-sensitivity C-reactive protein (CRP) levels, %FMD, and CIMT were measured. Patients with CKD had increased CRP levels {[5.8 (1.0–6.0)] mg/L vs [1.0 (0.5–2.20)] mg/L; P < 0.001}; %FMD was significantly lower in patients on hemodialysis (5.51%) compared with stage IV (7.62%) and stage III (15.02%) and 17.95% in control subjects (P < 0.001); and CIMT values in hemodialysis patients (0.88 ± 0.06 mm) were significantly higher compared with stage IV (0.67 ± 0.10) and stage III (0.61 ± 0.12) (P < 0.001). Increased CIMT values were seen in patients with CKD (0.82 ± 0.21 mm) than in the healthy controls (0.55 ± 0.16 mm). In patients with CKD, a significant negative correlation was found between CRP levels and FMD responses (r = −0.315; P < 0.001), while a significant positive correlation was found between CRP and CIMT values (r = 0.327; P < 0.001). Compared with predialysis, hemodialysis subjects had significantly lower FMD and higher CRP and IMT values. Conclusion: CKD confers a higher inflammatory status when compared with apparently healthy general population. Abnormal FMD responses and CIMT values are more commonly found in dialysis patients. Our findings suggest that CIMT and FMD can be used as noninvasive markers for early risk assessment and stratification in various stages of CKD.
  134 20 -
A study of utilization of sanitary facilities by adolescent girls in an urban slum of Central India
Utsav Raj, Abhiruchi Galhotra, VR Roja
April 2019, 8(4):1396-1400
DOI:10.4103/jfmpc.jfmpc_195_19  PMID:31143728
Background: Hygienic sanitation facilities are crucial for public health. Investment on sanitation brings the single greatest return for any development intervention. Poor sanitation, open defecation and lack of awareness about hygiene have detrimental effect on the health of women and children living in slums. Objective: The objective of this study was to perceive/assess the barriers to access of hygienic sanitary facilities for adolescent girls in an urban slum. Methodology: This study included 98 adolescent females (10-19years) living in urban slums Ward no 19 Raipur. Simple random sampling by 'note method' was used to select one administrative division of this area. Result: Mean age of adolescent girls in the present study was 15.44 ±2.2years (Range: 12 to 19 years) and a majority of them were in High School 60 (60.2%). About half (42%) of the study subjects were living in Semi pucca house and only 38% had access to an independent toilet facility, 9% were practicing open defecation and remaining (51%) were using public toilets. Conclusion: The availability of sanitation facility and latrine utilization rate of the households were satisfactory. Privacy is a concern in public toilet, uses of sanitary pad was also less and changing of absorbent material in toilets was also a matter of concern for the girls.
  124 26 -
CASE REPORTS
Linezolid-resistant Enterococcus faecalis in leukemia patients: Rare cases with review of literature
Naveen Kumar, Sonu Kumari Agrawal, Aishwarya Govindaswamy, Vijeta Bajpai, Tej Bahadur
April 2019, 8(4):1508-1510
DOI:10.4103/jfmpc.jfmpc_441_18  PMID:31143752
Resistance to linezolid is rare in clinical isolates of Enterococcus faecalis. Here, we report cases of linezolid resistant Enterococcus fecalis in leukemia patients with review of literature.
  124 24 -
Hemophagocytic lymphohistiocytosis as a diagnostic consideration of fever of unknown origin with pancytopenia and chronic liver disease
Amisha , Paras Malik, Monika Pathania, Vyas K Rathaur, Nidhi Kaeley
April 2019, 8(4):1504-1507
DOI:10.4103/jfmpc.jfmpc_190_19  PMID:31143751
Hemophagocytic lymphohistiocytosis (HLH) is a severe disorder of systemic immune dysregulation which can be primary or secondary to autoimmune disorders, malignancy, or infections. We hereby describe a case of a 23-year-old male with severe hepatitis along with pancytopenia and prolonged fever of unknown origin that developed HLH triggered by staphylococcal urinary tract infection. This is a discussion of this unusual disease and its presentation and the diagnostic difficulties which may be encountered in general clinical practice.
  129 18 -
ORIGINAL ARTICLES
Prostate volume measured by magnetic resonance imaging is not a predictor of lower urinary tract symptoms
Mustafa Deebajah, Mahdi Bazzi, Eric Walton, Milan Pantelic, Hakmin Park, Ali Dabaja, Shaheen Alanee
April 2019, 8(4):1370-1373
DOI:10.4103/jfmpc.jfmpc_94_19  PMID:31143723
Purpose: Prostate volume is frequently utilized to counsel patients presenting to family medicine physicians with voiding complaints. We evaluated the relation between International Prostate Symptom Score (IPSS) and prostate volume measured by phased-array surface coil magnetic resonance imaging (MRI). Methods: We performed an institutional review board (IRB)–approved retrospective study of all patients who received a prostate MRI between 2015 and 2017. Correlation between the overall IPSS, IPSS components, prostate volume stratified by prostate specific antigen (PSA) (<1.4 vs. ≥1.4 g/dL), and race (black vs. white) was examined. Results: In all, 592 patients had prostate MRIs performed between 2015 and 2017. Two hundred and twenty-nine of these patients had IPSS and prostate volume information available in their medical records. The mean age of the cohort was 64.67 (SD = ±7.82) and mean PSA was 7.75 (SD = ±8.3). The mean IPSS was 9.77 (SD ± 7.2), and mean prostate volume was 55.88 cubic cm (SD = ±38.9). The correlation coefficient between prostate volume and IPSS was 0.12789 (P = 0.05). The correlation between prostate volume and IPSS was also not significant in 128 men with prostate volume above 40 cubic cm. Stratifying analysis by race and PSA showed no significant correlation between volume and IPSS. Analysis of the correlation between the different dimension of prostate volume and IPSS revealed significant but weak associations. Conclusions: Even with more precise estimation with MRI, prostate volume does not predict obstruction complaints. This finding is of importance when treating males presenting with voiding dysfunction to primary care.
  126 16 -
LETTERS TO EDITOR
Vitamin D deficiency pandemic among pregnant women
Jogender Kumar, Arushi Yadav
April 2019, 8(4):1515-1516
DOI:10.4103/jfmpc.jfmpc_202_19  PMID:31143755
  112 27 -
Clofazimine induced methemoglobinemia –Points to be focussed
Pugazhenthan Thangaraju, Sajitha Venkatesan
April 2019, 8(4):1517-1518
DOI:10.4103/jfmpc.jfmpc_165_19  PMID:31143756
  113 20 -
ORIGINAL ARTICLES
Design and implementation of clinical competency evaluation system for nursing students in medical-surgical wards
Forough Rafii, Tahereh Najafi Ghezeljeh, Sepideh Nasrollah
April 2019, 8(4):1408-1413
DOI:10.4103/jfmpc.jfmpc_47_19  PMID:31143730
Background: In nursing, it is important to ensure the evaluation of students' clinical competency and using a valid and reliable evaluation system is necessary. The aim of this study was to design a clinical competency evaluation system for nursing students in medical-surgical wards and determine its validity and reliability. Methods: This cross-sectional study was conducted on the nursing students who were spending their practicum courses at the medical-surgical wards. First, the educational objectives and applicable evaluation tools were determined. Then, three tools of: Direct Observation of Procedural Skills (DOPS), Mini Clinical Evaluation Exercise (Mini-CEX), and Clinical Work Sampling (CWS) were determined as appropriate tools. Finally, the evaluation system was designed and its validity was confirmed using content validity index (CVI) and content validity ratio (CVR). Reliability of the tools was calculated using Cronbach's alpha coefficient. Results: CWS tool had CVI = 0.91 and CVR = 0.93, DOPS tool had CVI = 0.98 and CVR = 0.94, and Mini-CEX tool had CVI = 0.93 and CVR = 1. These results indicated desirable validity of the designed evaluation system. In addition, all items had appropriate CVR. Reliability was also higher than 0.7. Significant difference was found between the results of students' evaluation using the School's current evaluation method and the designed evaluation system. From the perspective of teachers and students, the designed evaluation system was accepted. Conclusion: The designed evaluation system had high reliability and validity. Its application satisfied the majority of teachers and students. Therefore, it can be used as a useful evaluation system for assessing clinical competencies in medical-surgical wards.
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Involving parents in road safety decision making: Keeping our children safe
Mohamed A Hendaus, Reem Wassef, Marwa Salah, Tasneem Riyad Abdel-karim, Ahmed H Alhammadi
April 2019, 8(4):1476-1480
DOI:10.4103/jfmpc.jfmpc_195_18  PMID:31143742
Purpose: The purpose of the study was to delineate parental concept of road safety in the state of Qatar, integrate parental thoughts and ideas into public safety, and share our data with authorities to assist in implementing campaigns against speeding in a country with a high rate of motor vehicle accidents. Methods: A cross-sectional prospective study was conducted at Hamad Medical Corporation (HMC), the only tertiary care and academic hospital in the state of Qatar. Parents of children younger than 18 years of age and residents of the State of Qatar were offered an interview survey. Results: A total of 200 questionnaires were completed (response rate = 98%). Approximately 80% of parents were in between 20 and 40 years of age, and 61% of them were females. Almost 40% of participating families reside outside of the city of Doha. Interestingly, only 1 in 2 parents thought their children were safe while riding with them in the car. Moreover, only 47% of parents always used car seats, seatbelts, and proper restraints. This is inspite that nearly 82% of parents felt that these restraints protect children in case of an accident. Parents were also asked of the best place to receive information regarding road safety. Almost 50% preferred to receive the information through social media, whereas 44.3% opted for local television. Role modeling was also assessed and it showed that 85% of parents believed that the most effective way in teaching children and young people to use roads in a safe way is to always provide a positive role model when using the roads. Conclusion: A large proportion of residents in the state of Qatar perceive that children are not safe while commuting in roads. Social media, a space where most of our community inhabit, seems to be the best setting to target our people.
  112 18 -
LETTERS TO EDITOR
Primary care is the key to health for all
Jayanta Bhattacharya
April 2019, 8(4):1514-1514
DOI:10.4103/jfmpc.jfmpc_201_19  PMID:31143754
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CASE REPORTS
Clinical and laboratory correlates of selective autonomic dysfunction due to Ross syndrome
Samhita Panda, Diwakar Verma, Anil Budania, Jyotsna N Bharti, Rajesh K Sharma
April 2019, 8(4):1500-1503
DOI:10.4103/jfmpc.jfmpc_151_19  PMID:31143750
Ross syndrome is diagnosed by the presence of the characteristic triad of segmental anhidrosis, depressed deep tendon reflex, and tonic pupils. It is a rare, misdiagnosed autonomic disorder with less than 80 cases reported in the world literature. Two representative cases of Ross syndrome are presented with their laboratory correlates and relevant review of literature. Both cases (aged 35 and 58) presented with complaint of decreased sweating over one half of the face and ipsilateral upper limb and trunk and contralateral lower limb. There was compensatory increased sweating and hyperpigmentation over the remaining parts of the body. The duration of symptoms was 2 years and 15 days. The patients had variegated skin color as per the above distribution and hyporeflexia in lower limbs. One patient also had Holmes-Adie pupil. Iodine test showed hypohidrosis in the described areas, which was confirmed by skin biopsy in both cases. The patients were treated symptomatically with incomplete relief. The authors aim to highlight this rare disorder that can be one of the causes of pathological sweating encountered in general practice and the challenges in its management.
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Concurrent syphilis and Chlamydia trachomatis infection in bisexual male: A rare case of proctitis
Naveen Kumar, Tej Bahadur, Sonu K Agrawal
April 2019, 8(4):1495-1496
DOI:10.4103/jfmpc.jfmpc_43_19  PMID:31143748
Unsafe sexual practices in men who have sex with men population lead to emergence of high-risk networks for sexually transmitted infection transmission. The atypical clinical presentation of proctitis, the unawareness of physicians and patients in this regard, and the nonavailability of molecular diagnostic methods in routine practice may have contributed to its underdiagnosis. We report a case of syphilis in a bisexual male with a concurrent rectal Chlamydia trachomatis infection not previously reported from India. Reporting such cases has public health importance.
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Non-functional retroperitoneal paraganglioma: A case report
Ashok K Chattoraj, Uma M Rao, Nilanjan Sarkar, Sridevi Jakka
April 2019, 8(4):1497-1499
DOI:10.4103/jfmpc.jfmpc_189_19  PMID:31143749
Paragangliomas are extra-adrenal tumors of the autonomic nervous system and may be found within the skull base, neck, chest, and abdomen. When presenting within the abdominal cavity, they may arise as a primary retroperitoneal neoplasm and can mimic vascular malformations or other conditions related to specific retroperitoneal organs such as the pancreas, kidneys.[1] They synthesize, store, and secrete catecholamines because of which they may present with headache, sweating, palpitation, and symptoms of hypertension (functional).[2] In the absence of histological diagnosis and symptoms of catecholamine excess (non-functional), these may be mistaken for GISTs.[3] We are reporting a case of a 36-year-old female who was clinically diagnosed as GIST, underwent excision, and postoperative histopathological examination was found to be paraganglioma.
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ORIGINAL ARTICLES
Vulvar cancer in Iran: Retrospective study over 20 years (1998-2018)
Azamosadat Mousavi, Azadeh Yousefnezhad, Mitra Modarres-Gilani, Setareh Akhavan, Shahrzad Sheikh-Hasani
April 2019, 8(4):1465-1469
DOI:10.4103/jfmpc.jfmpc_145_19  PMID:31143740
Background: We did not have any data about vulvar cancer — as a fourth cause of gynecological cancer in the worldwide — in our country. Study Design: Our study is designed to evaluate the frequency, stage and outcome of patients with vulvar cancer. Materials and Methods: In this retrospective observational study, we studied patients' records with diagnosis of vulvar cancer who referred to department of gynecology oncology, Emam-Khomeini Hospital (EKH), Tehran, Iran, between January 1998 and December 2018. A total of 106 cases of vulvar cancers were found in the records of outpatient oncology clinic of medical university of Tehran university. Survival was estimated using the Kaplan-Meier analysis with SPSS version of 24. Results: Mean age of the 106 patients in the study was 59.2 years. The most site of tumor involvement was major labial (39.1%). Vulvar cancer significantly was more in multiparous (P < 0.001) and menopause patients (P < 0.001). Squamous Cell Carcinoma was the most pathology of vulvar cancer (72.2%). Ninety patients (84.9%) had surgery as a primary treatment and 48 (53.3%) of these patients received adjuvant radiotherapy or chemoradiation after surgery. Mean duration of patient's follow up was 82.4 ± 68.3 month. Five-year survival of our patients in all stages was 71%. Conclusions: Our findings are located between developed and underdeveloped countries. Our patients are diagnosed nearly in earlier stages of disease and 84.9%t of them had surgery as a primary treatment, so earlier surgery resulted in good survival of patients.
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CASE REPORTS
An interesting case report of acute renal failure due to wasp bite
Rajesh Kumar, Chandan Kumar, Harshit Khosla
April 2019, 8(4):1488-1490
DOI:10.4103/jfmpc.jfmpc_178_19  PMID:31143746
Wasp bite usually presents with local complications. It may very unusually present with acute renal failure (ARF) and multiple organ dysfunctions. We present an interesting case of a 24-year-old female with multiple wasp bites all over the body leading to ARF, hepatic dysfunction, and rhabdomyolysis. Intensive hemodialysis and other conservative measures led to complete recovery. Proper management and early intervention is necessary for recovery from even drastic complication and is beneficial in terms of improvement of overall morbidity and mortality.
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