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   2019| August  | Volume 8 | Issue 8  
    Online since August 28, 2019

 
 
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EDITORIALS
Lord Mountbatten's The Last Supper: How the British empire botched up the futures of India, Pakistan and Bangladesh
Raman Kumar
August 2019, 8(8):2555-2557
DOI:10.4103/jfmpc.jfmpc_674_19  PMID:31548929
The Lancet, a leading health science journal, has published a political editorial, raising interest in the impact of British colonization on the current status of healthcare, economy and development of the Indian subcontinent. Over two centuries, the East India Company and the British empire siphoned out at least £ 9.2 trillion- or $44.6 trillion; since the exchange rate was $4.8 per pound sterling during much of the colonial period. It is to be noted that the life expectancy of Indians at birth was just 22 years in 1911. Food grain was available, however the purchasing power of ordinary Indians was being squeezed. The per capita annual consumption of food grains went down from 200kg in 1900 to 157kg on the eve of World War II, and further down to 37kg by 1946 (Prof Utsa Patnaik).. The Indian sub-continent has still not come out of the systemic malnutrition inflicted upon the population. Today, just under two billion people, or a quarter of the earth's population, live in India, Pakistan and Bangladesh. The landlocked populations of these countries are known as the black hole of humanity, waiting for ultimate catastrophe- either natural or man-made humanitarian crisis. What happens to these countries now was determined long ago and planned by the British empire when their representatives packed bags and transferred power to the local natives. The partition of India was the most tragic ever human genocide artificially perpetrated in the human history. More than 14 million people were displaced and close to two million people died or went missing. It was the parting gift by the British empire to the people of the Indian sub-continent. This was more tragic than the holocaust. A permanent scar and hatred that would not heal even after a century was created by the British empire. The 200 years of anti-incumbency and hatred against the British was forgotten and used to build a civil war. Enough hatred was fumed between the native population of India and Pakistan. This hatred was further institutionalized between the two countries by having them develop separate militaries. It was a grand exit plan for the empire leaving behind no traces of the crime, while keeping their aura of pride and benevolence intact. After seventy years, it is important to revisit the political circumstances prevailing during the colonial period. It is important for the people India, Pakistan and Bangladesh to think about the future and not be victims of the political game rolled out as an exit plan by the empire.
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CASE REPORTS
Detection of coexisting toxigenic Clostridium difficile and nontyphoidal Salmonella in a healthcare worker with diarrhea: A therapeutic dilemma
Amos Lal, Raul Davaro, Ajay Kumar Mishra, Kamal Kant Sahu, George M Abraham
August 2019, 8(8):2724-2727
DOI:10.4103/jfmpc.jfmpc_227_19  PMID:31548964
Introduction: Clostridium difficile infection (CDI) and nontyphoidal Salmonella infection (NSI) have similar clinical manifestations and are seldom seen simultaneously. The decision-making in terms of antibiotic therapy becomes difficult when both the pathogens are isolated from the same patient. Case Presentation: We describe a case of Clostridium difficile (CD) enterocolitis in a healthcare provider who concomitantly tested positive for nontyphoidal Salmonella. Discussion: To the best of our knowledge after extensive literature review (English), this is only the fourth report highlighting this association. Conclusion: Although Salmonella is not a risk factor for CDI, it can cause intestinal inflammation and alteration in the intestinal flora. When two pathogens are isolated from the same patient, it is tempting to treat both with antibiotics as highlighted. When it involves healthcare workers, there is no difference in guidelines and should not be prescribed antibiotics with intent of reducing secondary transmission.
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Customized nasal prosthesis in continuous positive airway pressure treatment, current trend in treating obstructive sleep apnea for better patient compliance
Nagam Raja Reddy, Nijamala Sasikala, K V. Guru Charan Karthik, Garikapati Krishna Priya
August 2019, 8(8):2728-2731
DOI:10.4103/jfmpc.jfmpc_473_19  PMID:31548965
Snoring is common disorder in India, which is caused due to obstructive sleep apnea. Nasal continuous positive airway pressure (CPAP) is an effective treatment for this condition. Prefabricated nasal masks lack intimate adaptation and cause air leakage producing discomfort for patient and decrease the compliance for treatment. This article describes a simple method for customizing nasal CPAP mask and fabrication using maxillofacial prosthodontic laboratory techniques currently available.
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Recurrent cranio-oculo-facial diabetic complication
Anupam Dey
August 2019, 8(8):2732-2734
DOI:10.4103/jfmpc.jfmpc_476_19  PMID:31548966
Diabetic cranial neuropathy is one of the important complications of diabetes with up to 10-fold increase in incidence. It usually affects 3rd, 4th, and 6th cranial nerves. Recurrent cranial neuropathy is lesser reported, and its incidence is not very clear. Course is usually benign with spontaneous remission within months. A 47-years diabetic male presented with acute onset diplopia and right sided ptosis with history of 3 previous episodes of sudden facio-ocular complications of diabetes over a period of 5 years all of which had improved completely over 6 to 8 weeks. On examination he was found to have right-sided pupil sparing 3rd cranial nerve palsy. Visual acuity was normal. Examination of fundus showed early nonproliferative diabetic retinopathy changes. Motor, sensory system, bladder, and bowel were normal. Blood tests revealed FBS 133 mg%, PPBS 333 mg%, HbA1C 8.8, Creatinine 1.8 mg%, normal electrolytes, and LFT. CSF study showed 4 cells with Protein 68 mg% and Sugar 83 mg%. CT scan of the brain showed normal brain parenchyma. MRI of brain did not reveal any acute infarct or mass lesion and visualized cranial nerves were normal. Other work ups were negative. His sugars were controlled with oral antidiabetic drugs. Patient improved with oral steroids.
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Odontogenic keratocyst with metaplastic epithelium: A case report
Neethu Telagi, B R Mujib Ahmed
August 2019, 8(8):2735-2737
DOI:10.4103/jfmpc.jfmpc_378_19  PMID:31548967
Correct treatment begins with correct diagnosis. Arriving at a correct diagnosis require knowledge skill and art. Because many diseases have similar symptoms, the clinician must be astate in determining the correct diagnosis.[1] One lesion mimicking the other poses the diagnostic dilemma. Periapical lesions resulting from necrotic dental pulp are among the most common pathologic conditions within the alveolar bone.[2] Odontogenic cysts of the jaws include various pathological entities. Keratocystic odontogenic tumour (KCOT) is defined as “a benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium and potential for aggressive, infiltrative behaviour.” In relation to OKC, there are two significant diagnostic issues. Firstly, they commonly show active epithelial growth which has prompted the belief that they should perhaps be regarded as neoplasm rather than a cyst. Secondly, they are known to occur in two fashions solitary (or sporadic) and as part of the BCNS.[3] The aggressive clinical behavior and frequent recurrence following curettage has been the focus of several studies, which indicated that the odontogenic keratocyst epithelial lining may have some intrinsic growth potential.[4] In light of the epithelial behavior here, we present a case of odontogenic keratocyst with metaplastic epithelium attributed to the presence of inflammation.
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Social media smartphone app and psychopathology – A case report
Santosh Kumar, Kavitha Natrajan, Ajeet Singh Bhadoria, Annya Das
August 2019, 8(8):2738-2740
DOI:10.4103/jfmpc.jfmpc_421_19  PMID:31548968
Thought circulation in social media has always been contributed to psychological morbidity among youth. Although social media smartphone makes a comfort communication among generation it is also responsible for causing psychopathology among youth by circulating video depicting violent scene. The symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life. The purpose of this case report is to study the impact and consequences of social media (WhatsApp) on the mental health and stability among younger generation. A 30-year-old male patient presented at Family Medicine outpatient department with phobic and anxiety symptoms after witnessing a car accident in WhatsApp video which shows transaction of human body. His clinical presentation, management approach, and details of treatment are presented.
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Dying to be Ill: Munchausen meets warfarin overdose
Padmastuti Akella, Vishal Jindal, Sandhya Maradana, Ahmad D Siddiqui
August 2019, 8(8):2741-2743
DOI:10.4103/jfmpc.jfmpc_453_19  PMID:31548969
Patients with severe coagulopathy related to vitamin K deficient proteins can be associated with surreptitious ingestion of vitamin K antagonists. Our patient presented acutely with extensive ecchymosis, gingival bleeding and hematuria. Her initial PT and PTT were prolonged and INR was >12.0. She denies contact with potent rodenticides or warfarin use. She is a healthcare professional. Within a week, she was readmitted with similar complaints and her warfarin levels were markedly high which raised the possibility of Munchausen syndrome. Warfarin overdose can lead to harmful consequences. Therefore, immediate diagnosis and prompt treatment is critically important to minimize morbidity and mortality.
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Radiological diagnosis of rare pancreatic serous cystadenoma
Somen Chakravarthy, Rohit Chakravarty, Nilanjan Sarkar, Riti Chitrotpala
August 2019, 8(8):2744-2746
DOI:10.4103/jfmpc.jfmpc_454_19  PMID:31548970
Serous cystadenoma of the pancreas, also known as microcystic adenoma, is a very rare type of pancreatic neoplasm. It is a benign cystic lesion. It is composed of many small cysts lined by cuboidal or flattened cells containing glycogen. Herein, we report a rare case of serous cystadenoma of the pancreas in an 82-year-old male. The tumor was located in the body and tail of the pancreas and postoperative sample revealed a sponge-like appearance due to multiple tiny cysts containing clear serous fluid. Microscopic analysis showed cystic spaces lined by cuboidal cells with intracytoplasmic glycogen.
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EDITORIALS
Personal or family history of metabolic traits predispose to higher hepatotoxic effects of alcohol
Ajeet Singh Bhadoria, Surabhi Mishra, Kanchan Gawande, Raman Kumar
August 2019, 8(8):2558-2560
DOI:10.4103/jfmpc.jfmpc_439_19  PMID:31548930
World Health Organization Global Status 2018 Report on alcohol and health states that global total alcohol per capita consumption has drastically risen from 2005 to 2016. Presence of inherited metabolic traits (MTs) such as diabetes, hypertension, and obesity predisposes to early and more severe liver damage, even with smaller quantity and shorter duration of exposure to alcohol. This editorial highlights the need for screening of individuals with either addiction of alcohol or alcoholic liver disease for personal and family history of diabetes, hypertension, obesity, and other MTs for risk stratification and specific interventions. Health education and awareness regarding deleterious effects of alcohol among those who have a personal or family history of MTs should be ensured.
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INVITED ARTICLES
#1WordforFamilyMedicine Korea and 2018 WONCA World Conference highlights
Kyle Hoedebecke, SeoYoung Kang, Eonchi Shin
August 2019, 8(8):2561-2562
DOI:10.4103/jfmpc.jfmpc_246_18  PMID:31548931
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Primary palliative care competency framework for primary care and family physicians in India-Collaborative work by Indian Association of Palliative Care and Academy of Family Physicians of India
Shrikant Atreya, Jenifer Jeba, Nikki Pease, Ann Thyle, Scott Murray, Alan Barnard, Dan Munday, Lulu Mathews, Mhoira Leng, Gayatri Palat, Alka Ganesh, Sulagna Chakraborty, Sahaya Anbarasi, Raman Kumar, Maryann Muckaden, Elizabeth Grant
August 2019, 8(8):2563-2567
DOI:10.4103/jfmpc.jfmpc_451_19  PMID:31548932
The discrepancy in the demand for palliative care and distribution of specialist palliative care services will force patients to be eventually cared for by primary care/family physicians in the community. This will necessitate primary care/family physicians to equip themselves with knowledge and skills of primary palliative care. Indian National Health Policy (2017) recommended the creation of continuing education programs as a method to empower primary care/family physicians. With this intention, a taskforce was convened for incorporating primary palliative care into family/primary care practice. The taskforce comprising of National and International faculties from Palliative Care and Family Medicine published a position paper in 2018 and subsequently brainstormed on the competency framework required for empowering primary care/family physicians. The competencies were covered under the following domains: knowledge, skills and attitude, ethical and legal aspects, communication and team work. The competency framework will be presented to the National Board of Examinations recommending to be incorporated in the DNB curriculum for Family Medicine.
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LETTERS TO EDITOR
Child neglect and inadequate stimulation related to speech and language delay
Denelle Mohammed
August 2019, 8(8):2747-2747
DOI:10.4103/jfmpc.jfmpc_470_19  PMID:31548971
  - 243 38
Impact of family medicine practice in combating Violence against Doctors
Pranay Tanwar, Ritesh Kumar, Chitresh Kumar, Showket Hussain
August 2019, 8(8):2748-2749
DOI:10.4103/jfmpc.jfmpc_475_19  PMID:31548972
  - 238 42
ORIGINAL ARTICLES
Medical students' life and virtual social networks a guide for educational managers and parents
Yousef Mehdipour
August 2019, 8(8):2573-2576
DOI:10.4103/jfmpc.jfmpc_336_19  PMID:31548934
Introduction: Social networks have revolutionized the world. Students in Iran after entering the university often enter the college far from family, so the effects of such networks become more evident during the students' period. However, considering the role of the university in the training of specialist human resources, the researcher in this study, the status and application of virtual social networks in the life of students of Zahedan University of Medical Sciences were studied. Materials and Methods: This is a descriptive-analytical study that was conducted cross-sectional in 2018. All students of Zahedan University of Medical Sciences were the statistical population (4,600) that a sample of 900 people was selected as the final sample. The data gathering tool was a researcher-made questionnaire. To determine the content validity of the questionnaire and its confirmation, the opinions of professors and experts were used, and its reliability was measured by a test-retest method and confirmed by Cronbach's alpha (0/75). After data collection, SPSS software version 16 was used to analyze the data. Results: The average daily student use of social networks was 2 h and 40 min, most of them were subscribed to Telegram, and connecting with friends was the main motive for joining social networks. There was no significant relationship between the use of social networks and the average student's lessons and also most of them had a moderate dependence on the Internet and had a high dependence on the social networks. In addition, there was a significant difference between Internet dependence and the gender of students. Conclusion: A large percentage of students have become members of various social networks. There was excessive and unplanned use of the internet and social networks among them. Hence, by creating good opportunities and attractive social activities in universities to provide more participation of students in the real world, this can provide suitable times for them and prevent their dependence on virtual social networks.
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Determination of antifungal minimum inhibitory concentration and its clinical correlation among treatment failure cases of dermatophytosis
Vinod K Maurya, Dileep Kachhwaha, Archana Bora, Prabhat K Khatri, Laxmi Rathore
August 2019, 8(8):2577-2581
DOI:10.4103/jfmpc.jfmpc_483_19  PMID:31548935
Introduction: Dermatophytes are most common infectious agents causing superficial mycosis worldwide. A number of topical as well as systemic antifungal drugs are available for treatment of dermatophytosis. Superficial mycosis caused by dermatophytes can be easily treated by topical or oral antifungal drugs, but in the course of time, an increased number of treatment failure cases are appearing. Possible cause for treatment failure could be poor patient compliance, poor drug penetration into affected lesion, and also drug resistance in dermatophytes. The aim of this study is to investigate minimum inhibitory concentration and clinical correlation in treatment failure cases of dermatophytosis. Methods: Skin, hair and nail samples were collected from treatment failure cases of dermatophytosis. A total 75 isolates were tested for MIC against four antifungal drugs in the study. Fluconazole, itraconazole, ketoconazole and terbinafine were the antifungal drugs tested using broth microdilution method. MIC50 and MIC90values were recorded. Results: A total of 75 dermatophytic isolates were tested. Dermatophytic isolates in this study were Trichophyton mentagrophytes (n = 31), T. rubrum (n = 13), T. tonsurans (n = 12), T. verrucosum (n = 9), M. gypseum (n = 5), E. floccosum (n = 4) and T. violaceum (n = 1). MIC90 value for fluconazole and terbinafine was significantly higher. Conclusion: MICof 17.33% isolates for fluconazole and 33.33% isolates for terbinafine were lower than cut-off value, which indicates that not all treatment failure cases are due to drug resistance.
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Factors influencing the use of modern contraceptive methods among rural women of child bearing age in the Democratic Republic of the Congo
Freddy Rukema Kaniki
August 2019, 8(8):2582-2586
DOI:10.4103/jfmpc.jfmpc_345_19  PMID:31548936
Context: This study reports the unique findings of factors influencing the use of modern contraceptives (MC) among women of childbearing age in Minembwe, a rural community of the Democratic Republic of the Congo. Aims: The study aimed at assessing the contributing factors to the use of MC in African rural communities. Methods and Materials: This descriptive study used a structured questionnaire to collect primary data distributed to women after obtaining their consent. Statistical Analysis Used: The data collected were analyzed using IBM-SPSS version 21.0. Results: Totally, 370 respondents comprising 53.2% women of over 30 years of age. All the 18 health facilities were stock out for both implants and injectable contraceptives during the study period. There were only 3 Medical doctors, 84 Nurses, and 180 other healthcare workers in a population of 86,153 including 18,092 women in reproductive age. About 22.0% spend between 31 and 45 minutes walking to the nearest healthcare facility. The majority (85.7%) of the women did not use any contraceptive. The major factors influencing the uptake of MC are religion inclination (67.4%) disapproval by husbands (40.9%), fear of health problems/side effects (32.6%), and the urge to have more children (20.5%). Conclusions: There is a need to further enlighten women of rural African communities on the need to use MC methods for birth control and other benefits. There is a need to enlighten the religious and traditional leaders and the community to support the use of family planning in order to minimize maternal and child mortality rate.
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Comparison of salivary epidermal growth factor in patients with recurrent aphthous stomatitis, smokers, and healthy individuals
Fatemeh Rezaei, Erfan Hosseini, Farzad Rezaei
August 2019, 8(8):2587-2591
DOI:10.4103/jfmpc.jfmpc_397_19  PMID:31548937
Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral ulcerative diseases with unknown etiology. Epidermal growth factor (EGF) has been suggested to play a similar role in RAS. Therefore, this study investigated the salivary EGF level in patients with RAS, the patients without RAS, and smokers. Materials and Methods: A total of 91 samples were recruited in this case-control study: 30 RAS patients, 30 controls, and 31 smokers. Age and gender were matched in the groups. In the case group, the salivary sample was taken during the infection and remission periods. Salivary EGF concentration was measured by Crystal Dibiotic assay (made in China) using ELISA technique. Finally, the data were analyzed by SPSS software (Version 18.0, Inc., Chicago, IL, USA). Results: The results of paired t-test showed no statistically significant difference in salivary EGF between the infection and remission periods (P = 0.987). ANOVA test showed a statistically significant difference in EGF between the study groups (P < 0.001), as the mean salivary EGF was significantly lower in the smokers than the case and control groups during the infection and remission periods. Conclusion: The present study showed a lower level of salivary EGF in the smokers without a history of RAS. There was no statistically significant difference between the infection and remission periods in salivary EGF in the patients with RAS. Furthermore, salivary EGF showed no statistically significant difference between the patients with RAS and the controls.
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Impact of practice modification on oral health status of students: An interventional study from a tribal area of India
Aritra K Bose, CP Anusha, Dilip Dhaku Kadam, Lekshmi A Neethu
August 2019, 8(8):2592-2596
DOI:10.4103/jfmpc.jfmpc_467_19  PMID:31548938
Context: Tooth decay precipitated by poor oral hygiene is one of the most common oral diseases that affect 60–90% of school children. It not only interferes with speech, self-esteem but pain caused by decay also affects nutrition intake, resulting in malnutrition with abnormal cognitive development. Aim: To evaluate the impact of health education and supervised brushing intervention on their oral health status. Settings and Design: Cross-sectional interventional study. Methods and Materials: The study was conducted on students of class 8th, 9th, and10th of an Ashramshala (tribal residential school). All the students present in the school on the day of data collection were included in the study. A semistructured questionnaire was used for data collection. A qualified dentist, who is part of research team, conducted oral examination of the students. They were asked to demonstrate their brushing method and relevant observation was noted. The oral health status of the students was analyzed using DMF (decayed, missed, and filled) index and oral hygiene index- simplified score (OHI-S). Three training and educational sessions of one hour each were conducted separately for each class and a separate session was conducted for the teachers and caretakers of the school. Thereafter, randomly selected students (peers) were asked to demonstrate the technique to their peers to ensure proper understanding. Compliance was ensured through weekly follow ups to the school by the research team. DMF score and OHI-S were recalculated after 3 months and compared with their previous scores. Statistical Analysis: Chi-square test, one-way analysis of variance and paired t-test were used for analysis. Results: The mean DMF and OHI-S score of the students was 2.61+/-2.309 and 2.11+/-0.96, respectively. A significant change (P = 0.021) in OHI scores was observed as a result of intervention. Conclusions: Promoting healthy dental practice with supportive supervision form the cornerstone for good health and hygiene.
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Effect of mint aroma on nausea, vomiting and anxiety in pregnant women
Azam Amzajerdi, Maryam Keshavarz, Ali Montazeri, Reza Bekhradi
August 2019, 8(8):2597-2601
DOI:10.4103/jfmpc.jfmpc_480_19  PMID:31548939
Aims and Objectives: Various researches reported about the association between anxiety with nausea and vomiting of pregnancy. This study was designed to determine the effect of mint aroma on nausea, vomiting, and anxiety in pregnant women. Methods: This quasi-experimental interventional study was carried out on 66 pregnant women, with a range from the mild to moderate nausea and vomiting of pregnancy, who were admitted to the prenatal care unit. During one week, twice a day, samples in mint and placebo groups, used mint and sesame oil, respectively. Rhodes nausea and vomiting questionnaire and state anxiety inventory scale (STAI) (Spiel Berger) was completed by all mothers before and after the intervention. Results: After intervention, there was a significant difference in the overall mean score of Rhodes index (P < 0.001), also in the severity of nausea and vomiting (P < 0.016) between the two groups, but not in the overall mean score and severity of maternal state anxiety (MSA). In both groups, the mean of Rhodes index score and MSA was significantly decreased after intervention (P < 0.001). Conclusion: The results showed that mint aroma can be effective in reducing nausea and vomiting of pregnancy without any effect on state anxiety.
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Urban and rural pattern of Internet use among youth and its association with mood state
Ameer Hamza, Manoj Kumar Sharma, Nitin Anand, P Marimuthu, P Thamilselvan, Pranjali Chakraborty Thakur, N Suma, Happy Baglari, Priya Singh
August 2019, 8(8):2602-2606
DOI:10.4103/jfmpc.jfmpc_428_19  PMID:31548940
Introduction: The problematic use of internet is associated with dysfunction life style. The emerging evidence do also suggest its impact on user's mood profile. There is need to establish the urban and rural difference in relation to internet use as well as its association with mood states and its implications for primary care setting. Methods: The present work explored the pattern of internet use in Urban and Rural area and its impact on mood states. 731 individuals (403 males and 328 females) in the age group of 18-25 years from urban and rural areas were approached for the study. The internet addiction test and Depression Anxiety Stress Scale were administered in group setting. Results indicated no significant difference in term of internet use as well as in term for gender. Significant difference was seen for internet use and mood states. Results: The results indicate no significant difference in terms of internet use pattern and gender in relation to urban and rural areas. However, a significant difference exists with respect to Internet use and its relation to depression, anxiety and stress. Conclusions: It implies the development of early brief intervention for Primary Physicians to enable them to screening psychological conditions along with internet use as well as help users to have healthy use of technology.
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Perception of premarital counseling among King Khalid University students
Faisal Saeed Al-Qahtani, Mohammed Ibrahim Alfahad, Abdulaziz Mohammed M. Alshahrani, Haitham Saeed Almalih, Adnan Saeed Qassm Al-Malki, Turki K Alshehri, AbdulAziz Ali N. Alqhtani, Awad Mohammed Al-Qahtani, Sami Hassan Alfaifi, Raid Fayez Abdullrahman Alasmari, Rishi K Bharti, Shweta Chaudhary
August 2019, 8(8):2607-2611
DOI:10.4103/jfmpc.jfmpc_364_19  PMID:31548941
Background: Genetic blood disorders are common in Arab countries which are related to many physical and mental disorders. Premarital counseling has been one of the strongest ways to prevent hereditary diseases. It can provide a capability to intervene according to identified risks, vaccinations, genetic consulting, nutrition, consulting regarding behavior and advice regarding contraception. This study aimed to assess university students' knowledge, attitude and practice of pre-marital counseling (PMC) in king Khalid University. Methodology: A cross-sectional study was conducted at King Khalid University in Abha city from May to August 2018. The students were selected using two stage stratified cluster sampling technique (medical and non-medical). A total sample of 541 students were included. A structured questionnaire with close-ended questions was designed by the authors following an extensive review of the literature on knowledge, practice, and attitude of premarital screening program. The questionnaire was developed in English and then translated to Arabic by experts at the College of Medicine. Results: A total sample of 541students were involved with ages ranged from 18 years to 27 years old and 56.6% at medical colleges. Exact 73.4% of the students were aware of PMC and 95.2% reported its importance. 96.5% of the students reported their welling to do PMC on marriage and 72.1% see that it should be mandatory. Conclusions: Nearly three out of each four students had good awareness level regarding PMC. Most of the students have a positive attitude towards PMS and their readiness to adopt the counseling before marriage.
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Prevalence of oral submucous fibrosis in patients visiting dental OPD of a dental college in Kanpur: A demographic study
Rahul Srivastava, Bhuvan Jyoti, Devina Pradhan, Zeba Siddiqui
August 2019, 8(8):2612-2617
DOI:10.4103/jfmpc.jfmpc_465_19  PMID:31548942
Background: Oral submucous fibrosis (OSMF) is now globally accepted as an Indian disease. It has one of the highest rates of malignant transformation among potentially malignant oral lesions and conditions, therefore, a cause of concern for oral healthcare professionals. The present study aims to evaluate the prevalence of OSMF among betel nut chewers in different age groups in patients visiting Dental College and Hospital Kanpur city, India. Materials and Methods: A total of 860 patients of OSMF visiting the dental outpatient clinic of the Department of Oral Medicine and Radiology Rama Dental College Hospital and research center, Kanpur over a period of 24 months (1 January 2016 to 31 December 2018) were selected for the study. A detailed case history and clinical examination was carried out under visible light. The diagnosis of OSMF was based on difficulty in opening the mouth and associated blanched oral mucosa, with palpable fibrous bands. Other diagnostic features included burning sensation, salivation, tongue protrusion, habits, and associated malignant changes. Study was done on the basis of age group, habit duration, frequency of habit, and type of habit. Simple correlation analysis was performed. Results: Of the 860 cases of OSF studied, 390 (46.42%) cases were stage II, 290 (34.52%) were stage III, 90 (10.73%) stage I, and 70 (8.33%) stage IV. Based upon age group, group III (30--40 years) showed more prevalence than the others. Areca nut (gutkha) was a significant etiological factor (55.8%) as compared with other etiological factors. Conclusion: The high prevalence of OSMF requires significant awareness and management of these lesions among general population. Primary healthcare professionals and dentists should be knowledgeable and familiar with the etiopathogenesis, clinical presentation, diagnosis, and management of these lesions.
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Early management of clubfoot by the Ponseti method with complete percutaneous tenotomy of tendoachillis
Mushtaq Abdulkhaleq Khorsheed, Las Jamal Khorsheed Hwaizi
August 2019, 8(8):2618-2622
DOI:10.4103/jfmpc.jfmpc_291_19  PMID:31548943
Background and Objective: As a highly common congenital deformity which can lead to serious walking problems, clubfoot has long been treated using the Ponseti method which is usually carried out without complete percutaneous tenotomy of tendoachillis. The present study was aimed at investigating the effects of early management of clubfoot by the Ponseti method with a complete percutaneous tenotomy of tendoachillis in Erbil Teaching Hospital located in Erbil, the Kurdistan Region of Iraq. Methods: Thirty neonates <3 months of age who had congenital idiopathic clubfoot were randomly selected. They were treated by the Ponseti method. For this purpose, successive casts were applied for them for 3 weeks, with changing the casts on a weekly basis. For those who did not respond to the first 3 weeks of casting, the classical Ponseti method was utilized along with complete percutaneous tenotomy of tendoachillis based on the theory of stem cell regeneration. Then, the casting was performed for 6 weeks, followed by foot abduction brace and maintained using a foot abduction brace (Dennis brown splint) until school age 5-6 years. The collected data were analyzed using the χ2 test through SPSS 22.0. Results: The results of the present study indicated that the most prevalent type of clubfoot was the unilateral type with 73.3% prevalence rate. Treating the newborns with clubfoot by the Ponseti method along with complete percutaneous tenotomy of tendoachillis led to good results in 86.7% of the cases, medium in 3 cases (10%), and poor only in 1 case (3.3%). Conclusion: Ponseti method along with complete percutaneous tenotomy of tendoachillis was proved to be an efficient method to treat clubfoot during the first few weeks of life.
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Evaluation of gingival melanin pigmentation in pediatric population– An observational study
Jerusha Santa Packyanathan, G Lavanya
August 2019, 8(8):2623-2627
DOI:10.4103/jfmpc.jfmpc_332_19  PMID:31548944
Aim: The aim of this study is to evaluate the gingival melanin pigmentation in the Indian pediatric population. The aim of this study is to find any association between age and melanin distribution, age and intensity of melanin distribution, sex and melanin distribution, sex and intensity of melanin distribution, skin tone and melanin distribution, skin tone and intensity of melanin distribution and finally the association between melanin distribution and intensity. Background: Pigmentation on the interdental papilla, attached and marginal gingiva is commonly found in various races across the world. There is lack of literature for documentation of the same in the pediatric population. Materials and Methods: Intensity of melanin pigmentation was observed by the gingival melanin pigmentation index (class 1- class 6) as given by Ponnaiyan et al. This cross-sectional, observational study was conducted in the Institution. 100 children were selected from the age group of 1-12 years of age. The association between the various parameters were verified using Chi square test. Results: With the findings of the present study, it can be concluded that the distribution of melanin pigmentation is not affected by age, sex and skin color. The intensity of melanin pigmentation is not affected by age and sex. The skin colour can be used as a predictor to know the intensity of melanin pigmentation in both anteriors and posteriors.
  - 387 46
Sleep hygiene awareness: Its relation to sleep quality among medical students in King Saud University, Riyadh, Saudi Arabia
Mohsin Alshahrani, Yousef Al Turki
August 2019, 8(8):2628-2632
DOI:10.4103/jfmpc.jfmpc_359_19  PMID:31548945
Background/Objective: Sleep hygiene (SH) is considered to be an effective method to treat sleep disturbances, especially among adolescents and young adults. This study aimed to find out the relationship of SH awareness and its importance in overall sleep quality among medical students and to assess the prevalence of sleep disturbance among them. Methodology: This was a cross-sectional study conducted in the College of Medicine, King Saud University during the period between April and July 2016. A total of 225 students participated in this study and were recruited by a convenience sampling method. Two validated questionnaires were used, Pittsburg Sleep Quality Index (PSQI) to assess sleep quality and the Sleep Beliefs Scale (SBS) to assess the awareness of students about SH. Data were entered into, and analyzed by SPSS Version 20. Results: Overall, more than half of the participants, 113 (56.5%), had a poor sleep quality. Sixty one (30.5%) students got excellent score in SH awareness and the rest of the participants (n = 139; 69.5%) scored poor/intermediate. Thirty-five (57.4%) poor sleepers and 42.6% of good sleepers scored excellent in SH awareness. Conclusion: This study showed a higher prevalence of sleep disturbance among medical students and no significant correlation between SH awareness and good sleep quality, which means that SH awareness may not necessarily ensure a good sleep quality.
  - 428 81
Association of passive smoking with dental caries and salivary biomarkers among 5–10 years old children of Muradnagar, Ghaziabad
Ipseeta Menon, Nagesh Bhat
August 2019, 8(8):2633-2639
DOI:10.4103/jfmpc.jfmpc_369_19  PMID:31548946
Objectives: The purpose of this study is to assess the association of passive smoking (PS) with dental caries and salivary biomarkers among 5–10 years old children of Muradnagar, Ghaziabad. Methods: A case–control study was conducted among 160 children of age group 5–10 years who visited the outdoor patient department of a dental college. Regular smoking households were recognized and children who lived in smoking households were identified as PS subjects. Two categories of children were formed – PS (80 children) and control group (80 children). Parents completed a pretested questionnaire and clinical examination of children was done using dmft index and gingival index. This was followed by collection of stimulated saliva of children which was further subjected to determine salivary buffering capacity and pH. Inoculation on mitis salivarius-bacitracin agar for counting streptococcus colonies and Rogosa SL agar (Difco) for counting lactobacillus colonies was done. Cotinine level was then measured using enzyme-linked immunosorbent assay kit. Student's independent t-test, Mann–Whitney U test, and one-way analysis of variance test were used for analyzing data. Results: The mean streptococcus and lactobacillus colony count was higher in PS case subjects, that is, 348.9 ± 166.509 and 247.3 ± 15.86 in comparison to control group where the mean streptococcus and lactobacillus colony count was 63.03 ± 23.082 and 63.825 ± 12.638, respectively. The mean cotinine level among PS case subjects was 1.08 ± 0.265 which was higher than the control group, that is, 0.00 ± 0.00. The mean cotinine level was directly proportional to streptococcus colonies, lactobacillus colonies, dmft and gingival index (GI) scores, and smoking exposure. Conclusion: PS has deleterious impact on children which was reflected by their increased cotinine levels, streptococcus colonies, lactobacillus colonies, and poor dmft and GI scores in comparison to the control group.
  - 462 75
Attitudes of participants of master degree in family medicine in Gezira University, Sudan towards Psychiatry: A vision to sustain continuous gain
Anas Ibn Auf, Mohamed H Ahmed
August 2019, 8(8):2640-2643
DOI:10.4103/jfmpc.jfmpc_429_19  PMID:31548947
Introduction: Family medicine physicians are first contact of patients in the community and their role in treating mental health is highly recommended. The aim of the current study is to assess attitudes towards psychiatry among doctors enrolled in master degree in family medicine in Gezira University before and after training in psychiatry. Methods: This study was a quantitative cross-sectional study with two stages – pre- and post-psychiatry training. It has included one batch of master students of family medicine at Gezira University, Sudan. The whole master program lasts for 18 months, of which 3 weeks are dedicated to psychiatry training. All students in the batch were invited to participate in both stages – before and after psychiatric training. Result: 31 students participated in the study, 35.5% of them were males (N = 11). Mean age was 39.4 (SD ± 5.34) and mean number of years after graduation was 13.3 (SD ± 4.96). 26 students (83.9%) earned Attitudes Toward Psychiatry (ATP) scores >90, which indicates a positive attitude. The ATP mean score for all participants was 104.26 (SD ± 12.56). The least score was 79 while the maximum was 130. Doctors' attitudes toward psychiatry became more positive after psychiatric training and this difference was statistically significant (P value = 0.038) and this was found to be statistically significant only among participants below age of 40 years and those who have been graduated less than 15 years ago. Conclusion: Psychiatric training for family physicians in training was associated with significant improvement in attitudes towards psychiatry.
  - 259 20
COPD from an everyday primary care point of view
Antonio L Aguilar-Shea, Julio Bonis
August 2019, 8(8):2644-2650
DOI:10.4103/jfmpc.jfmpc_477_19  PMID:31548948
Introduction: The purpose of this study is to use real world evidence on treatment use to evaluate drug superiority within the same treatment group. Methods: Retrospective cohort analysis using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP). Data includes longitudinal routine clinical data extracted from practice records of 7,890,485 patients. All subjects with an incident diagnosis of COPD in the database BIFAP between January 1 2010 and December 31 2012 were included in the cohort study. Cox regression analysis was performed to compare the hazard of COPD exacerbation outcome of the four principal cohorts (no therapy, monotherapy, double therapies with and without corticoids, and triple therapy) and within each principal cohort between the different treatment combinations. Results: 27,739 patients with COPD were included in the analysis. The median age was 64 years, male proportion was 69% and 70% were smokers. 58,042.9 person--years of follow-up were obtained for the cohort with a mean follow-up of 2.09 years per subject. The strongest factor associated with an increased risk of exacerbation was suffering an exacerbation the previous year (HR = 1.82[1.76--1.87 95%CI]). No differences were found between the most frequent monotherapies, double therapies without corticoid, or triple therapy. When comparing the different combinations of double therapies with corticoid, salmeterol/fluticasone combination (HR = 1.16[1.08--1.24]) revealed a higher adjusted hazard of exacerbation when compared with formoterol/budesonide. Conclusions: Treatment with a combination of budesonide/formoterol was associated with lower exacerbations than the treatment with fluticasone/salmeterol. The analysis did not reveal any differences in terms of exacerbation in monotherapy, double therapy without corticoids, and triple therapy combinations.
  - 425 59
Diagnostic utility of triple antibody (AMACR, HMWCK and P63) stain in prostate neoplasm
Santosh G Rathod, Deelip G Jaiswal, Rajan S Bindu
August 2019, 8(8):2651-2655
DOI:10.4103/jfmpc.jfmpc_432_19  PMID:31548949
Aims and Objective: In recent period, basal cell markers high molecular weight cytokeratin (HMWCK), P63 and prostate biomarker AMACR have been used as adjuvant to morphology in diagnostically challenging cases with a very high sensitivity and specificity. Materials and Methods: In this prospective study, total of 80 cases including 40 cases of malignant lesions and 40 cases of benign lesions of the prostate were taken. Tumor grade was determined according to Gleason's grading system. AMACR, HMWCK, P63 expressions were determined by immunohistochemical staining. Results: This study showed AMACR had a sensitivity of 90%, specificity of 100%. AMACR was not expressed in any of the 40 cases of benign lesions of the prostate while in malignant lesions of prostate it was expressed in 36 of 40 (90%) cases; 15 of 16 (93%) of well-differentiated carcinoma were positive for AMACR expression; 17 of 19 (89.47%) moderately differentiated and 4 of 5 (80%) cases of poorly differentiated tumors were positive for AMACR. There was statistically significant difference in expression of AMACR between benign and malignant lesions of the prostate (P = 0.001). In benign lesions, HMWCK and P63 were expressed in all the 40 (100%) cases, while in malignant lesions of prostate it was not expressed in any of the (0%) case. AMACR expression was not seen in any of the benign lesion. Out of 40 malignant cases, 4 cases were negative for AMACR, HMWCK and P63, 36 cases were positive only for AMACR, but no case was positive for HMWCK and P63. Conclusions: As an adjunct to biopsy, AMACR, HMWCK and P63 have potential for combating diagnostically challenging cases.
  - 568 51
Use of dabigatran for treatment of left ventricular thrombus: A tertiary care center experience
Bhupendra Verma, Amrita Singh, Manu Kumar
August 2019, 8(8):2656-2660
DOI:10.4103/jfmpc.jfmpc_459_19  PMID:31548950
Objectives: Direct oral anticoagulants (DOACs) are now replacing vitamin K oral anticoagulants (VKAs) owing to superior efficacy, rapid action, less bleeding, wider therapeutic range,and fewer food and drug interactions.Unfortunately, the available data on the use of DOACs, particularly dabigatran, for treatment of left ventricular thrombus (LVT) issparse.We have hereby presented the largest study on use of dabigatran in LVT. Methods: Retrospective data of patients having LVT as diagnosed by transthoracic echocardiography (TTE) was screened. Patients on dabigatran were included in the study and follow up data of 6 months was obtained through medical records. Results: f the 15 patients included in the study, the most frequent etiology was ischemic heart disease (67%), including 7 patients of STEMI (47%), followed by non-ischemic cardiomyopathy in 5 patients (33%). Only one patient, with STEMI, developed mild gastrointestinal bleeding at 3 months. Complete clot resolution was seen in 2 patients (13%) at first week of follow up and total 5 patients (33%) at the end of second week. The rate of clot resolution at 1 month, 3 months, and 6 months were 80%, 93% and 100%, respectively. The median duration required for complete clot resolution was 30 days (IQR=14-30). Conclusion: Dabigatran appears to be safe, highly efficacious and results in rapid LV clot resolution. DOACs may be a suitable alternative to warfarin in treatment of LV thrombus. However, larger studies are required to validate this hypothesis.
  - 897 71
Health needs of adolescent girls living in an urban slum of a metropolitan city- A mixed method approach
Dilip D Kadam, US Saurabha, Sayali C Tiwari
August 2019, 8(8):2661-2666
DOI:10.4103/jfmpc.jfmpc_481_19  PMID:31548951
Context: Adolescents constitute nearly 21% of the population in India. They are more likely to be constrained than adults from access to and timely use of appropriate care. Adolescence in girls is a turbulent period. The changes that take place during this period need to be made stress free. These are mostly physiological, for which simple family remedies can be found out. Objectives: 1. Assessing the health needs of adolescent girls living in an urban slum. 2. Identifying the barriers in accomplishing the health needs. Methodology: This was a community-based cross-sectional study with mixed method approach. A focus group discussion was held with 13 adolescent girls. FGD results were used to prepare a questionnaire to interview 80 adolescent girls. Results: The FGD revealed adolescent girls needed more information on menstrual hygiene, reproductive health, and its associated illness. Totally, 45% of the adolescent girls belonged to the age group 17–19 years. About 90% had inadequate knowledge on reproductive health. They preferred group sessions over one-to-one session on these topics and their mother as the source of information. Conclusion: The reproductive and sexual healthcare education that is currently being imparted to the girls need to be devised in such a way that it empowers them. A family member—the mother needs to be trained so that she can make this age transition smooth and stress free. The correct scientific knowledge will help in ensuring sustainable development.
  - 321 47
Prenatal and postnatal echocardiography in NT fetuses with normal karyotype
Abdolrahman Emami-Moghaddam, Mojgan Barati, Razie Amirpour, Kobra Shojaei
August 2019, 8(8):2667-2670
DOI:10.4103/jfmpc.jfmpc_395_19  PMID:31548952
Introduction: Targeted fetus echocardiography at midpregnancy can detect major defects in major cardiovascular organs. The present study aimed to evaluate prenatal and postnatal echocardiography in fetuses with increased nuchal translucency (NT) with normal karyotype. Methods: In this retrospective study, data on the screening of fetuses in pregnant women between 2014 and 2015 were evaluated. The fetuses at the gestational age were 14–11 weeks, and NT ≥ 95 percentile (or 3 mm). For all fetuses with increased NT, follow-up anomaly scan was performed at 18–22 weeks of pregnancy, while fetal echocardiography was performed at weeks 16–19 of pregnancy. The results were analyzed by Statistical Package for the Social Sciences (version 22) and the level of significance was less than 0.05. Results: A total of 26.27% of the fetuses were diagnosed with prenatal heart defects and confirmed after birth. The strongest relationship was observed between increased NT and the diagnosis of prenatal heart defects at 2.5–5.3 mm. The increased NT was higher in younger mothers. Moreover, increased NT was higher in mothers with less body mass index. Conclusion: By measuring NT in the 11–13 weeks of pregnancy and considering the risk factors, it is possible to evaluate the probability of cardiac abnormalities in the fetus and perform the necessary diagnostic evaluations for high-risk cases.
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Physical activity level and its barriers among patients with type 2 diabetes mellitus attending primary healthcare centers in Saudi Arabia
Abdullah M Alzahrani, Sarrah B. BinSadiq Albakri, Taher T Alqutub, Abdulrahman A Alghamdi, Ali A Rio
August 2019, 8(8):2671-2675
DOI:10.4103/jfmpc.jfmpc_433_19  PMID:31548953
Introduction: Physical activity (PA) plays an important role in diabetes management. This study aimed to evaluate the level of PA and the barriers toward practicing regular PA among patients with type 2 diabetes mellitus (T2DM) attending primary healthcare centers (PHCs) in Jeddah during 2018. Materials and Methods: A total of 250 patients were interviewed face-to-face in three PHCs. Two questionnaires were used in this study. The first questionnaire measured the level of PA of the participants. The second questionnaire aimed to identify barriers to PA. For analysis, simple descriptive statistics, Chi-square, T-test, and analysis of variance were used. Results: The prevalence of physical inactivity was found to be 38.4%. Males and females composed 40% and 37.4% of the participants, respectively. Lack of social support, lack of energy, fear of injury, and lack of skills were identified as significant barriers to PA according to the level of PA. Conclusion: Our findings may provide baseline data for future research on this topic and information for healthcare professionals to improve their efforts in promoting the overall health of patients with T2DM.
  - 337 43
An analysis of the use of antimicrobial agents in outdoor patients of ophthalmology
Drashti Rakeshkumar Patel, Prakruti Parth Patel, Purvi R Bhagat, Anuradha M Gandhi, Mira K Desai
August 2019, 8(8):2676-2680
DOI:10.4103/jfmpc.jfmpc_436_19  PMID:31548954
Objectives: The study was aimed to analyze commonly used antimicrobials in outdoor patients of ophthalmology department. Materials and Methods: The study was an observational, cross-sectional study carried out in the Department of Pharmacology and Ophthalmology after approval from the head of departments and Institutional Ethics Committee. All the patients age 18 years and above who were prescribed antimicrobials and gave consent were included in study. Data were recorded in a case study form containing relevant patient information and results of general, ocular, and special examinations along with the details of antimicrobials prescribed. Data were analyzed according to the World Health Organization/International Network for Rational Use of Drugs indicators and appropriate statistical tests. Results: A total of 900 patients who were prescribed antimicrobial agents (AMAs) were included in the study. The most common chief complaint was diminution of vision (25.78%). The most common indication of use of AMAs was for treating ocular infections (50.22%). The most commonly prescribed antimicrobial group was fluoroquinolone (FQ) (63.8%) and the most common drug was moxifloxacin (35.95%). The most common dosage form of AMAs was eye drops (68.55%). The average number of drugs per encounter was 4.41. The percentage of encounters with injectables prescribed was 0.67%. The percentage of use of antibiotics was 100%. The percentage of total drugs and AMAs prescribed by generic name was 41.5 and 11.92, respectively. The percentage of antimicrobial drugs prescribed from essential drugs list was 34.24%. The mean duration of antimicrobial therapy was 7.2 ± 4.54 days. Conclusion: More than half of the patients are prescribed multiple AMAs. Moxifloxacin, a newer generation FQ , was the most commonly prescribed AMA in our study. Educational interventions and strict adherence to hospital antimicrobial use policy are needed to restrict the use of AMAs and increase rational prescribing.
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Aspiration of hijab pin is sharply rising among young women---A preventable health problem
Anil Kakunje, Rahyanath Pookoth, Asma N Ahmed, Sowmya Puthran, Anjali Nambiar
August 2019, 8(8):2681-2684
DOI:10.4103/jfmpc.jfmpc_458_19  PMID:31548955
Introduction: Foreign body aspiration is a common life threatening emergency but largely a preventable problem. There is an increase in the number of headscarf pin aspiration cases among young girls as a result of increase in the number of veiling population. With the number of hijab wearing population increasing all over the world, attention must be brought to the risk associated with holding the hijab pins in the mouth. Aim: To study the practice of holding hijab pin in the mouth among Muslim women. Methods: In a first study of its kind, we interviewed 270 Muslim women with varied background to study the practice of hijab pin use and holding it in the mouth. Results: Among 270 Muslim women, 260 (96.3%) of them wear hijab. 221 (81.85%) women use hijab pins to hold different layers of hijab. 191 (70.74%) of them hold the hijab pins in between the lips when they adjust the layers of hijab. 72 (26.67%) women had occasions when the hijab pin slipped into their mouth and 10 (3.70%) of them have aspirated the hijab pin accidentally. Maximum hijab pin use is in the age group between 21 and 40 years (89.44%) and least in the elderly (6.66%). Occasions when the pin slipped into the mouth or aspirations both are maximum in the below 20 years group. Both are nil in elderly. Conclusion: Appropriate education and intervention need to be planned as more young population are getting involved. Most importantly refrain from holding the pin in the mouth!
  - 523 50
Intrapartum monitoring using partograph at secondary level public health facilities—A cross-sectional study in Odisha, India
Subrata Kumar Palo, Kripalini Patel, Shalini Singh, Subhadra Priyadarshini, Sanghamitra Pati
August 2019, 8(8):2685-2690
DOI:10.4103/jfmpc.jfmpc_472_19  PMID:31548956
Context: Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha. Aim: To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities Settings and Design: A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers. Statistical Analysis Used: Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method. Results: Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level. Conclusions: On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting.
  - 514 62
Effect of metformin on insulin levels, blood sugar, and body mass index in polycystic ovarian syndrome cases
Nidhi Sharma, Siriesha , Yogita Lugani, Avneet Kaur, Vineet Kaur Ahuja
August 2019, 8(8):2691-2695
DOI:10.4103/jfmpc.jfmpc_490_19  PMID:31548957
Introduction: Polycystic ovarian syndrome (PCOS) presents as an extremely heterogeneous condition that includes chronic anovulation, hyperandrogenism, hyperlipidemia, and hyperinsulinemia along with enlarged polycystic ovaries. Insulin resistance is thought to be a pathogenic factor in women having PCOS along with increased incidence of metabolic disturbances. Materials and Methods: After obtaining ethical clearance, the girls of various colleges in Patiala were verbally sensitized to the symptoms of PCOS, and then given semistructured proformas subsequent to written informed consent. The students suspected on self-evaluation, and on evaluation of the proformas were investigated in the Out Patient Department, and patients reporting to Obstetrics and Gynecology Department with similar symptoms were also included after written informed consent. The patients were divided with simple randomization into two groups of 25 each. Group 1 (treatment group) was put on metformin therapy for three months (500 mg thrice a day), and Group 2 (control group) were given placebo thrice a day for the same duration. The patients were followed up after three months of metformin therapy (500 mg thrice a day) in Group 1, and placebo therapy in Group 2. Body weight, fasting blood glucose, blood glucose after 2 h of 75 g of glucose, and fasting serum insulin levels were assessed initially, and then after three months. Results: The mean age of patients in the present study was 21.46 ± 4.45 years. About 54% patients in the present study had BMI ≥25 kg/m2. About 68% of the patients had menstrual irregularity and PCO on ultrasonography (USG). About 44% patients in Group 1 (metformin) had increased insulin levels initially (>20 μU/ml), which were decreased to 16% after three months of metformin therapy. About 52% patients in Group 2 had increased insulin levels that were decreased to 48% after the placebo therapy. Conclusion: It has been concluded from this study that metformin significantly lowers insulin levels in patients with PCOS; in both obese and nonobese; which points towards its potential usefulness in treatment of PCOS patients, though it had no significant effect on body mass index in 12 weeks.
  - 475 86
The effect of gingival bleeding on oral home care practices in Saudi Arabia
Mohammed Alasqah, Sultan Almalki, Khalid Gufran, Yousef Alkhaibari, Abdul Rahman Bin Bossayes, Mohammed Alshammari
August 2019, 8(8):2696-2698
DOI:10.4103/jfmpc.jfmpc_335_19  PMID:31548958
Aim: The aim of this study was to determine the relationship between self-reported gingival bleeding, oral health perception, practices, and concerns. Materials and Methods: This cross-sectional survey among undergraduates of University of Prince Sattam Bin Abdulaziz, Al-Kharj, Saudi Arabia using a self-administered item structured questionnaire. Data analysis was done using Statistical Packages for the Social Sciences and P < 0.05 was considered significant. Results: The response rate was 96.3%. The prevalence of self-reported gingival bleeding among respondents was 48.79%. Individuals with gingival bleeding were significantly more likely to rate their dental and gingival health as fair/poor, use of strong brushing stroke during tooth brushing and worsening condition of teeth despite daily tooth brushing. They also expressed worry about the gingival color and less likely to be satisfied about the appearance of their teeth and to have received professional instruction on tooth brushing. Conclusion: Data from this survey revealed an established relationship between gingival bleeding, perceived dental and gingival health, worry about the color of gingiva, satisfaction with the appearance of the teeth, and visiting dental office because of gingival bleeding.
  - 326 35
Effect of using tobacco on taste perception
Yugandhara S Kale, Nupura Vibhute, Uzma Belgaumi, Vidya Kadashetti, Sushma Bommanavar, Wasim Kamate
August 2019, 8(8):2699-2702
DOI:10.4103/jfmpc.jfmpc_457_19  PMID:31548959
Background: Impaired taste perception has impact on quality of life. Tobacco is a perilous factor that contributes to an impaired taste. Objective: To evaluate and compare taste perception among tobacco chewers and nonchewers. Materials and Methods: Sixty subjects (30 tobacco chewers + 30 nonchewers as controls) were enrolled in the study for evaluating taste perception. Taste identification time using four aqueous solutions of basic tastes – sweet, salty, sour, and bitter – was recorded (in seconds) and compared between tobacco chewers and controls. The data were analyzed using Student's t-test and analysis of variance using SPSS 20 version software. Results: A statistically significant increase in taste identification time for salty taste in tobacco chewers (12.32 s) was noted compared with nonchewers (10.21 s) (P = 0.03). The average taste identification time was higher for tobacco chewers than nonchewers for sweet and salty taste. However, the average taste identification time was lower for tobacco chewers than nonchewers for sour and bitter taste. In nonchewers, the average taste identification time was 13.01, 10.21, 8.43, and 7.56 s for sweet, salty, bitter, and sour taste, respectively. In tobacco chewers, the average taste identification time was 15.16, 12.32, 7.75, and 7.04 s for sweet, salty, bitter, and sour taste, respectively. Conclusion: The results of the study demonstrated noticeable decrease in taste perception to salty taste among tobacco chewers when compared with tobacco nonchewers. There is a remarkable difference in taste perception to basic tastes among tobacco chewers and controls.
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High prevalence of anemia among postnatal mothers in Urban Puducherry: A community-based study
Ramya Selvaraj, Jayalakshmy Ramakrishnan, Swaroop Kumar Sahu, Sitanshu Sekhar Kar, Karthik Balajee Laksham, KC Premarajan, Gautam Roy
August 2019, 8(8):2703-2707
DOI:10.4103/jfmpc.jfmpc_386_19  PMID:31548960
Background: Anemia is a common problem across all life stages and ages with a higher burden among women. The postnatal period is an often-neglected period for the provision of effective care to the mothers. Anemia burden is also high during this period, which leads to many morbidities and poor quality of life. Methods: A community-based cross-sectional study was done in the field practice area of two Urban Primary Health Centres (PHCs) in Puducherry between March 2015 and February 2016. A total of 227 postnatal mothers were selected by simple random sampling from the list of mothers delivered from the field practice area. House visit was done within 4 weeks of completion of their postnatal period. Socio-demographic details and third-trimester hemoglobin levels were collected using a pretested questionnaire. Hemoglobin level during post-partum was measured using Sahli's Hemoglobinometer. Paired t-test is done to assess the difference in hemoglobin antepartum and post-partum. Multiple Logistic Regression is done to identify factors associated with postpartum anemia. Results: The mean (SD) hemoglobin during postpartum was 10.95 (1.1) gm% ranging from 7.4 gm% to 13.8 gm%. The prevalence of anemia among postnatal mothers is 76.2% (n = 173, 95% CI: 70.4%-81.4%). Around 26% (59) had mild anemia, 49.8% (113) had moderate anemia and 0.4% (1) had severe anemia. One-fourth of the mothers who had a normal hemoglobin level in their third trimester had developed anemia in the postnatal period. There was a significant difference in mean hemoglobin during postpartum and that of third trimester (10.95 vs 10.69 gm%, t = 3.4, df 226, P = 0.001). Birth order of two or more is significantly associated with postpartum anemia (aOR 2.2, 95% CI: 1.07-4.39). Conclusions: The prevalence of anemia among postnatal mothers is high. Routine hemoglobin estimation, advice on consumption of iron-rich foods and Iron and Folic Acid (IFA) supplementation have to be provided to postnatal mothers to improve this situation.
  - 485 66
Prevalence of depression among hypothyroid patients attending the primary healthcare and endocrine clinics of King Fahad Hospital of the University (KFHU)
Maryam Y. H. Mohammad, Naimah A Bushulaybi, Aishah S AlHumam, Arwa Y AlGhamdi, Hala A Aldakhil, Nesreen A Alumair, Marwa M Shafey
August 2019, 8(8):2708-2713
DOI:10.4103/jfmpc.jfmpc_456_19  PMID:31548961
Context: Hypothyroidism is the most prevalent endocrine disorder worldwide, with a prevalence of 4%–5%. Thyroid hormone has a role in neurological development, and hormone deficiency can be manifested by many neurological signs and symptoms such as behavioral disturbances, anxiety, and depressive symptoms. Aims: To estimate the prevalence of depression among hypothyroid patients attending primary healthcare and endocrine clinic of King Fahad Hospital of the University (KFHU) and to assess the relationship between depression and different factors. Settings and Design: A cross-sectional study was conducted to estimate the prevalence of depression among hypothyroid patients attending the primary healthcare and endocrine clinics of KFHU in Al Khobar. Materials and Methods: Patients were screened for depression using Patient Health Questionnaire-9 screening tool, in addition to obtaining their sociodemographic data, details of their thyroid function status, and other risk factors for depression. Also, patient medical files were used to obtain the laboratory results. Statistical Analysis Used: Data were analyzed using the Statistical Package for the Social Science (SPSS) version 23. Continuous data were displayed using mean and standard deviation; categorical data were displayed in numbers and percentage. Chi-square test was used to assess the relationship between the variables. A P value of less than 0.05 was considered as statistically significant. Results: It was found that 33.9% of patients were depressed with varying degree of depression. Certain symptoms were found to be associated with higher risk of depression such as fatigue, memory problems, hair loss, and gland enlargement. Conclusion: Depression was concluded to be prevalent among hypothyroid patients. And screening for depression among hypothyroid patients is recommended.
  - 448 41
Assessing health-seeking behavior among Asthma and COPD patients in urban South India
Padmanabhan Arjun, Sanjeev Nair, G Jilisha, Jyolsna Anand, Veena Babu, Hisham Moosan, Anitha K Kumari
August 2019, 8(8):2714-2719
DOI:10.4103/jfmpc.jfmpc_485_19  PMID:31548962
Context: Health-seeking behavior of patients with chronic obstructive pulmonary disease (COPD) and asthma and the diagnosis told to them by doctors before they reach tertiary care is not well documented. Aims: This study aimed at describing the health-seeking behavior of asthma and COPD patients before they present to a tertiary care hospital in Trivandrum in South India. Methods and Materials: The hospital-based cross-sectional study was done at one government and one private tertiary care hospital in Trivandrum, Kerala, including diagnosed COPD and asthma patients. Data were collected using a pretested semistructured questionnaire paired with the results of clinical evaluation and spirometry. Results: Among the studied population, about half (53%) of the patients in this study sought initial treatment from government facilities and most patients continued the same pattern of government care or private providers till the final level. Most of them (91%) were likely to have a history of first care from modern medicine system. High proportion of patients (89%) did not have a diagnosis known after the initial consultations, among patients with asthma only 3.4% were given a correct diagnosis and only one person was given a correct diagnosis of COPD out of 129 patients with COPD as the final diagnosis. Out of 739 patients, only 135 patients had done pulmonary functtion test as investigation. Conclusions: High proportions of patients do not know the diagnosis of their disease when they reached tertiary care. Patients tended to follow the same sector of health care (private/government) where they sought initial care.
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Perception of dental professionals regarding integration of dental auxiliary into dental health delivery system
Saurav Purbay, Neha Kumari, Aditi Singh Tanwar, Azhar Malik, Mishan Manohar Jaiswal, Sumaiya Nezam
August 2019, 8(8):2720-2723
DOI:10.4103/jfmpc.jfmpc_355_19  PMID:31548963
Background: The practical solution to handle increasing awareness toward dental treatment and cost of the dental treatment is integration of dental auxiliary into dental healthcare delivery system, and hence the objective of this study was to assess the perception of dental professionals regarding integration of dental auxiliaries into dental health delivery system in India. Materials and Methods: This cross-sectional study of Indian dentists was conducted using self-administered closed-ended questionnaire. Questions were asked to assess the opinions of the dentists on expanding the roles of dental auxiliaries and its consequences on dental services. The data were analyzed using Statistical Package for the Social Sciences version 22.0. The level of significance was kept at P < 0.05. Results: Of 230 dentists who participated in the study, 155 (67.39%) reported unfavorable opinion toward expanded duty dental auxiliaries. Among the studied consequences of expanding the functions of dental auxiliaries, cost-effectiveness of treatment had the highest mean score, followed by redundancy of dentists. Undergraduates reported that expanded function dental auxiliaries would lead to redundancy of dentists. Conclusion: It is recommended to train the auxiliaries to meet the expectations of patients, but this should be considered keeping in mind the existing situation of dental professionals in the country. Nonetheless, this study gives us information necessary to tailor health policies and improve the standards of the existing oral healthcare delivery in India.
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REVIEW ARTICLE
Health problems in healthcare workers: A review
Aroop Mohanty, Ankita Kabi, Ambika P Mohanty
August 2019, 8(8):2568-2572
DOI:10.4103/jfmpc.jfmpc_431_19  PMID:31548933
Much has been written about the well-being and quality of patients in recent years but little attention has been focused on well-being of healthcare workers (HCWs) who provide comprehensive healthcare to patients. It has been found that the HCWs are more stressed because of less staffs, increasing work load, longer working hours, high clientele expectation and peculiar problems and hazards of work place. There is increased morbidity in HCWs in comparison to general population. Though they are aware, measures of well being, engaging the HCWs in promotion of their workplace and making changes to enhance its realization needs to be done to improve their health by themselves, at administrative and institutional level.
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