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   2013| January-March  | Volume 2 | Issue 1  
    Online since April 3, 2013

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Systematic reviews and meta-analysis: Understanding the best evidence in primary healthcare
S Gopalakrishnan, P Ganeshkumar
January-March 2013, 2(1):9-14
DOI:10.4103/2249-4863.109934  PMID:24479036
Healthcare decisions for individual patients and for public health policies should be informed by the best available research evidence. The practice of evidence-based medicine is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient's values and expectations. Primary care physicians need evidence for both clinical practice and for public health decision making. The evidence comes from good reviews which is a state-of-the-art synthesis of current evidence on a given research question. Given the explosion of medical literature, and the fact that time is always scarce, review articles play a vital role in decision making in evidence-based medical practice. Given that most clinicians and public health professionals do not have the time to track down all the original articles, critically read them, and obtain the evidence they need for their questions, systematic reviews and clinical practice guidelines may be their best source of evidence. Systematic reviews aim to identify, evaluate, and summarize the findings of all relevant individual studies over a health-related issue, thereby making the available evidence more accessible to decision makers. The objective of this article is to introduce the primary care physicians about the concept of systematic reviews and meta-analysis, outlining why they are important, describing their methods and terminologies used, and thereby helping them with the skills to recognize and understand a reliable review which will be helpful for their day-to-day clinical practice and research activities.
  123 20,850 4,553
Determinants of utilization of antenatal care services in rural Lucknow, India
Manas P Roy, Uday Mohan, Shivendra K Singh, Vijay K Singh, Anand K Srivastava
January-March 2013, 2(1):55-59
DOI:10.4103/2249-4863.109946  PMID:24479045
Background: Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. This is the key component for achieving Millennium Development Goals by 2015. But India's performance continues to be poor in providing antenatal care services to its huge population, particularly in the rural areas. Objective: To assess the determinants of utilization of antenatal services by rural beneficiaries in Lucknow, a district of north India. Materials and Methods: The study, cross-sectional in design, was conducted from August 2009 to July 2010. Multistage random sampling was used for selecting villages. A total of 352 recently delivered women were selected following systematic random sampling. Logistic regression was used to find out the determinants of three antenatal care services. Results: Overall, 85.5% of the beneficiaries surveyed were found to receive at least three antenatal care services from any health facility. Community health centre was the most common source for such care. Significant difference was found between beneficiaries who took three antenatal care visits and who did not in terms of age, socio economic status, and timing of registration. On multiple regression, only age (OR = 2.107, 95% CI = 1.132 - 3.923) and timing of registration (OR = 2.817, 95% CI = 1.487 - 5.338) were found to be the predictors for three antenatal care visits. Conclusion: Intervention should be focused on young and late registered women for ensuring sufficient care during pregnancy.
  14 5,044 810
Infant rearing practices in south India: A longitudinal study
Nitin Joseph, B Unnikrishnan, Vijaya A Naik, NS Mahantshetti, MD Mallapur, Shashidhar M Kotian, Maria Nelliyanil
January-March 2013, 2(1):37-43
DOI:10.4103/2249-4863.109942  PMID:24479041
Background: Rearing practices are a major determinant of nutritional and health status of infants. Therefore these practices need to be better understood. Objectives: To find out infant rearing practices in the study area. Materials and Methods: A longitudinal study was conducted on a birth cohort of 194 infants. Information on rearing practices and anthropometric measurements were recorded every month for a period of 1 year. Results: Only 67 (34.5%) newborns were breast fed within half an hour of delivery. Prelacteal feeds was given to 65 (33.5%) newborns and this was seen more among home deliveries (P=0.018). Demand feeding was practiced by 169 (87.1%) mothers. Exclusive breast feeding (EBF) for 6 months was practiced by 81 (41.7%) mothers. Bottle feeding was seen in 7 (3.6%) cases. Weight gain during infancy was found to be maximum when infants were EBF for 6 months (P<0.001) and weaned with semi-solid and solid diet alone in the following 6 months (P=0.002). Gain in all anthropometric measurements was more in the initial 6 months of infancy compared to latter. Four (2.1%) infants were malnourished. Oil massage before bath was practiced by 189 (97.4%) mothers. Over 50% mothers practiced oil application to eyes or ears of infants. Delayed initiation of bath (beyond 1week) was seen in 15 (7.7%) cases. Conclusion: Faulty rearing practices need to be corrected in order to improve the health status of infants.
  13 4,132 522
Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India
Hanu George, PS Rakesh, Manjunath Krishna, Reginald Alex, Vinod Joseph Abraham, Kuryan George, Jasmin H Prasad
January-March 2013, 2(1):27-32
DOI:10.4103/2249-4863.109938  PMID:24479039
Background: Diabetes mellitus is a multifaceted disease and foot ulceration is one of its most common complications. Poor foot care knowledge and practices are important risk factors for foot problems among people with diabetes. Aims: To assess the knowledge and practices regarding foot care and to estimate the proportion of people with peripheral neuropathy among people with diabetes. Settings and Design: The cross-sectional study was conducted in 212 consecutive diabetes patients attending the out-patient department of a rural secondary care hospital Materials and Methods: A questionnaire which included demographic details, knowledge questionnaire, and Nottingham assessment of functional foot care was administered. The Michigan Neuropathy Screening Instrument was used to identify peripheral neuropathy. Statistical Analysis Used: Descriptive analysis with frequency distribution for knowledge and practice scores, univariate analysis, and multiple logistic regressions to find significant variables associated with good knowledge and practice scores. Results: About 75% had good knowledge score and 67% had good foot care practice score. Male gender (OR 2.36, 95% CI 1.16-4.79), poor education status (OR 2.40, 95% CI 1.19-4.28), and lesser duration of diabetes (OR 2.24, 95% CI 1.15-4.41) were significantly associated with poor knowledge on foot care. Poor knowledge was associated with poor foot care practices (OR 3.43, 95% CI 1.75-6.72). The prevalence of neuropathy was 47% (95% CI 40.14-53.85) and it was associated with longer duration of the disease (OR 2.18, 95% CI 1.18-4.04). Conclusion: There exist deficiencies in knowledge and practices regarding foot care. Male gender, low education, and lesser duration of diabetes are associated with poor knowledge scores. The prevalence of diabetic peripheral neuropathy is high.
  13 6,536 1,167
Drug rash with eosinophilia and systemic symptoms syndrome due to anti-TB medication
Dharmesh H Kaswala
January-March 2013, 2(1):83-85
DOI:10.4103/2249-4863.109958  PMID:24479051
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, idiosyncratic, multi-system reaction characterized by the clinical triad of fever, rash, and internal organ involvement. The mortality rate is estimated to be 8%, especially among patients with liver involvement, so early recognition is imperative. Drugs commonly associated with the development of DRESS syndrome include anticonvulsants, long-acting sulfonamides, and anti-inflammatory medications; however, there are no reported cases implicating anti-tuberculosis (anti-TB) medications. We report a case of DRESS syndrome from anti-TB therapy. A 68-year-old male with pulmonary TB presented with pruritic skin eruption and sore throat, 8 weeks after starting Rifampin, Isoniazid, Pyrazinamide, and Ethambutol (RIPE) therapy. He takes metformin and glyburide for diabetes. Physical exam was significant for diffuse, exfoliative erythematous macules with target lesions involving the entire skin surface, without mucosal involvement. Laboratory data was significant for mild transaminitis and new onset eosinophilia. Given suspicion of drug eruption, RIPE therapy was discontinued. Skin biopsy confirmed erythema multiforme. Despite discontinuation of the implicated medications, eosinophilia and transaminitis continued to worsen, and so systemic corticosteroids were started. After 4 weeks of discontinuation of RIPE therapy, the cutaneous eruption resolved and laboratory data returned to normal. The patient is finishing course of anti-TB with cycloserine and moxifloxacin. Upon follow up as outpatient, the rash was resolving and disappeared in 1 month. DRESS syndrome is always considered when there is high eosinophil counts and multisystem involvement with skin eruptions. It can be potentially life threatening with certain drugs and infectious agents in predisposed individuals. It is imperative to discontinue the causative medication and avoid re-exposure.
  12 8,148 908
Guillain-Barré syndrome in pregnancy: An unusual case
Mir Sadaqat Hassan Zafar, M Mubarik Naqash, Tariq A Bhat, GM Malik
January-March 2013, 2(1):90-91
DOI:10.4103/2249-4863.109965  PMID:24479054
Guillain-Barré syndrome (GBS) is rare in pregnancy with an estimated incidence between 1.2 and 1.9 cases per 100,000 people annually, and it carries a high maternal risk. We report a 29-year-old primigravida who had pain and progressive heaviness of both lower limbs in her third trimester of pregnancy. The attending gynecologist ascribed these symptoms to ongoing pregnancy. The intrapartum period (lower segment caesarian section) passed uneventfully. On third postpartum day, the patient developed weakness of all the four limbs. A detailed history and physical examination pointed toward GBS although there was no antecedent infective episode. Subsequent nerve conduction velocity studies and cerebrospinal fluid analysis confirmed GBS. All other investigations including electrolytes were normal. The patient improved without the introduction of immunomodulating therapy.
  9 3,614 507
Seroprevalence of chikungunya in southern Odisha
Indrani Mohanty, Muktikesh Dash, Susmita Sahu, MV Narasimham, Pritilata Panda, Sanghamitra Padhi
January-March 2013, 2(1):33-36
DOI:10.4103/2249-4863.109939  PMID:24479040
Background: The emergence of chikungunya (CHIK) infection was observed in Odisha, India in 2006. Thereafter many cases with symptoms suggestive of CHIK were reported from different districts of Southern-Odisha. This study was aimed to know the seroprevalence, clinical presentations and seasonal trends of CHIK infection in this region. Materials and Methods: This study was conducted in a tertiary hospital of this region. Serum samples received in the Department of Microbiology from various districts of Southern-Odisha from April 2011 to March 2012 were included in the study. The samples were tested for CHIK and dengue Immunoglobin M (IgM) antibodies by enzyme-linked immunosorbent assay and malaria parasite by immunochromatographic test (ICT) method. Results: Out of the 678 serum samples tested, 174 were positive for CHIK, 15 for dengue and two samples were positive for both CHIK and dengue IgM antibodies. The most affected age group was 16-45 years. Females were more affected than males. Conclusion: The seroprevalence of CHIK among the suspected cases was 25.7%. Co-infection with CHIK and dengue was found to be 1.15%. The infection had spread to new areas during this outbreak.
  9 3,282 562
Purple urine bag syndrome
Ahmed Al Montasir, Ahmed Al Mustaque
January-March 2013, 2(1):104-105
DOI:10.4103/2249-4863.109970  PMID:24479059
Purple urine bag syndrome (PUBS) is rare disease entity, occurs predominantly in constipated women, chronically catheterized and associated with bacterial urinary infections that produce sulphatase/phosphatase. The etiology is due to indigo (blue) and indirubin (red) or to their mixture that becomes purple. We present a case report of this rare phenomenon occurring in an 86-year-old woman.
  7 4,029 543
An exploratory study on socio economic status scales in a rural and urban setting
NR Ramesh Masthi, Gangaboraiah , Praveen Kulkarni
January-March 2013, 2(1):69-73
DOI:10.4103/2249-4863.109952  PMID:24479048
Background: There are many different scales to measure socioeconomic status (SES). The present study was conducted with the objective to compare the most commonly used SES in rural and urban setting. Materials and Methods: This exploratory study was conducted in the rural and urban field practice area of a medical college situated in Bangalore for a period of 3 months between January and April 2010. Statistical Analysis Used: To measure the agreement between the scales spearman's rank correlations was applied. Results: A total of 120 families were included in the study. Among the 60 families surveyed at rural setting, it was observed that, majority 40 (67%) belonged to high class when the Standard of Living Index (SLI) scale was applied. Among the 60 families surveyed at urban setting, majority 30 (50%) belonged to high class when the SLI scale was applied. Conclusions: The SLI scale gives a more accurate and realistic picture of the SES of the family and hence should be the scale recommended for classification of SES in urban and rural setting.
  7 11,944 1,464
Acute renal failure due to rhabdomyolysis following a seizure
Ajay Mishra, Nikhil Dave
January-March 2013, 2(1):86-87
DOI:10.4103/2249-4863.109962  PMID:24479052
Acute renal failure, oliguric or nonoliguric, is the most common complication of rhabdomyolysis. Rhabdomyolysis should be suspected in patients presenting with states of increased muscular activity, such as seizures, agitation, strenuous muscle exercise, or dystonia. We report an adult who developed acute renal failure associated with rhabdomyolysis following a seizure. The patient made complete recovery with hemodialysis. This report illustrates importance of early recognition of rhabdomyolysis following a seizure episode to prevent the risk of acute renal failure.
  6 2,920 413
Health impact of supplying safe drinking water on patients having various clinical manifestations of fluorosis in an endemic village of West Bengal
Kunal K Majumdar, Shunmuga N Sundarraj
January-March 2013, 2(1):74-78
DOI:10.4103/2249-4863.109953  PMID:24479049
Background: Excessive fluoride in drinking water causes dental, skeletal and non-skeletal fluorosis which is encountered in endemic proportions in several parts of the world. The World Health Organization (WHO) guideline value and the permissible limit of fluoride as per the Bureau of Indian Standards (BIS) is 1.5 mg/L. Studies showed that withdrawal of sources identified for fluoride, often leads to reduction of fluoride in the body fluids (re-testing urine and serum after a week or ten days) and results in the disappearance of non-skeletal fluorosis within a short duration of 10-15 days. Objective: To determine the prevalence of signs and symptoms of suspected dental, skeletal and non-skeletal fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among participants taking water with fluoride concentration above permissible limit and to assess the changes in clinical manifestations of the above participants after consumption of safe drinking water with fluoride concentration below permissible limit. Materials and Methods: A longitudinal intervention study was conducted from October 2010 to December 2011 in a village selected randomly in Purulia District of West Bengal which is endemic for fluorosis. Thirty-six families with 104 family members in the above village having history of taking unsafe water containing high level of fluoride were selected for the study. The occurrence of various dental, skeletal and non-skeletal manifestations of fluorosis along with food habits, addictions and use of fluoride-containing toothpaste among the study population was assessed; the impact of taking safe water with fluoride concentration below permissible limit from a supplied community filter on these clinical manifestations was studied by follow-up examination of the above participants for six months. The data obtained is compared with the collected data from the baseline survey. Results: The prevalence of signs and symptoms of dental, skeletal and non-skeletal fluorosis was (18.26%), (18.26-43.26%) and (12.49-38.46%) among the study population. Withdrawal of source(s) identified for fluoride by providing community filters supplying safe water along with nutritional interventions lead to 1.92% decrease of manifestation of dental fluorosis, 2.88-18.26% decrease of manifestations of skeletal fluorosis and 3.8-5.77% decrease in manifestations of non-skeletal fluorosis within six months. Following repeated motivation of participants during visit there was also 2.88% decrease in the usage of fluoride-containing toothpaste, 4.81% decrease in consumption of black lemon tea, supari and tobacco which are known sources of fluoride ingestion in our body. Conclusion: Increased prevalence of dental, skeletal and non-skeletal fluorosis was found among the study population. Withdrawal of sources(s) identified for fluoride by supplying community filter, dietary restriction and other nutritional interventions led to decrease of manifestations of the three types of fluorosis within six months. The government should play a vital role in ensuring drinking water safety at the household and community level by supplying domestic filters at affordable costs and community filter along with nutritional intervention to the fluorosis-affected villages on a priority basis to mitigate the problem.
  5 2,398 354
Seroprevalance of rubella in women with bad obstetric history
BV Ramana, B Kailasanatha Reddy, DS Murty, KH Vasudevanaidu
January-March 2013, 2(1):44-46
DOI:10.4103/2249-4863.109943  PMID:24479042
Rubella is a common cause of rash and fever during childhood. However, its public health importance relates to the teratogenic effects of primary rubella infection occurring in pregnant women, which can lead to fetal death with spontaneous abortion or to congenital defects in surviving infants. Most of the cases are asymptomatic and difficult to diagnose on clinical grounds. Detection of specific IgM antibodies by the enzyme-linked immunosorbent assay (ELISA) technique is a useful method for diagnosis.The present study was conducted on 180 pregnant women attending antenatal clinics at Government Maternity Hospital, Tirupati. All the serum samples were tested for Rubella-specific IgM antibodies. A seropositivity of 12.67% was observed among cases with bad obstetric history and 6.67% in normal pregnant women. Within the test group, high sero-positivity (13.33%) was observed in women with repeated abortions followed by in cases of intrauterine death (12.73%). The results indicate high prevalence of rubella in our population. All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and fetal outcome.
  5 2,220 356
Meckel gruber syndrome: Report of two cases with review of literature
Aneel Myageri, Vandana Grampurohit, Ravikala Rao
January-March 2013, 2(1):106-108
DOI:10.4103/2249-4863.109971  PMID:24479060
Meckel Gruber syndrome (MKS) is a lethal, autosomal, recessive, multisystemic disorder, associated with mutations affecting ciliogenesis. Since the time it was first reported; only 200 cases have been reported. From January 2004 to December 2010, we evaluated 268 fetal autopsies in our institute, in the Department of Pathology; two of these fetuses were diagnosed as MKS. MKS is characterized by occipital meningoencephalocele, cystic kidneys, postaxial polydactyly, and fibrosis in the liver. MKS cases show genetic heterogeneity. MKS results in 100% fetal or neonatal mortality. As MKS has a high risk (25%) of recurrence; parents should be counseled for future pregnancies.
  4 3,294 378
Two case reports indicating the dilemma in diagnosing lupus cerebritis
Dharitri Goswami, Shuddhosatta Chatterjee, Bashar Imam Ahmad, Shantanu Das
January-March 2013, 2(1):111-114
DOI:10.4103/2249-4863.109973  PMID:24479062
Systemic Lupus Erythematosus (SLE) is a connective-tissue disorder commonly affecting females of reproductive age group. Lupus Cerebritis is a serious neurological complication encountered in a good percentage of SLE cases. In this report, we discuss two Lupus Cerebritis patients, who were successfully diagnosed and treated. The first case, presented with generalized seizure, severe metabolic acidosis, and shock, with a history of fever of one-month duration. The second case manifested with an attack of generalized seizure after suffering from low-grade intermittent fever and joint pains for a duration of one-and-a-half months. Central Nervous System (CNS) involvement in SLE is caused by an inflammatory response of the autoimmune system, precipitated by an increased concentration of cytokines. Prompt identification of Lupus Cerebritis is extremely difficult, mainly because there is no single laboratory or radiological confirmatory test. Assessment of the clinical features and neurological signs, along with detection of antibodies in the serum and cerebrospinal fluid are necessary to arrive at a diagnosis. Lupus Cerebritis should be included in the provisional diagnosis of a female patient of reproductive age group, who presents with complicated neurological manifestations and with no clear-cut clinical, pathological, or image finding.
  4 5,232 653
Evaluation of immunization coverage in the rural area of Pune, Maharashtra, using the 30 cluster sampling technique
Pankaj Kumar Gupta, Prasad Pore, Usha Patil
January-March 2013, 2(1):50-54
DOI:10.4103/2249-4863.109945  PMID:24479044
Background: Infectious diseases are a major cause of morbidity and mortality in children. One of the most cost-effective and easy methods for child survival is immunization. Despite all the efforts put in by governmental and nongovernmental institutes for 100% immunization coverage, there are still pockets of low-coverage areas. In India, immunization services are offered free in public health facilities, but, despite rapid increases, the immunization rate remains low in some areas. The Millennium Development Goals (MDG) indicators also give importance to immunization. Objective: To assess the immunization coverage in the rural area of Pune. Materials and Methods: A cross-sectional study was conducted in the field practice area of the Rural Health Training Center (RHTC) using the WHO's 30 cluster sampling method for evaluation of immunization coverage. Results: A total of 1913 houses were surveyed. A total of 210 children aged 12-23 months were included in the study. It was found that 86.67% of the children were fully immunized against all the six vaccine-preventable diseases. The proportion of fully immunized children was marginally higher in males (87.61%) than in females (85.57%), and the immunization card was available with 60.95% of the subjects. The most common cause for partial immunization was that the time of immunization was inconvenient (36%). Conclusion: Sustained efforts are required to achieve universal coverage of immunization in the rural area of Pune district.
  4 9,486 712
Obesity and its cardio-metabolic co-morbidities among adult Nigerians in a primary care clinic of a tertiary hospital in South-Eastern, Nigeria
Gabriel Uche Pascal Iloh, Austin Obiora Ikwudinma, Nnadozie Paul Obiegbu
January-March 2013, 2(1):20-26
DOI:10.4103/2249-4863.109936  PMID:24479038
Background: Obesity once thought the medical problem of affluent countries now exist in Nigeria and has been described as a time bomb for the future explosion in the frequency of cardio-metabolic diseases. The most deleterious health consequences of obesity are on the cardiovascular system and associated disorder of lipid and glucose homeostasis. Aim: This study was designed to determine the magnitude of obesity and its cardio-metabolic co-morbidities among adult Nigerians in a primary care clinic of a tertiary hospital South-Eastern, Nigeria. Materials and Methods: A cross-sectional study carried out on 2391 adult Nigerians who were assessed for obesity using body mass index (BMI) criterion. 206 patients who had BMI ΃30kg/m 2 were screened for cardio-metabolic co-morbidities. The data collected included basic demographic variables, weight, height, blood pressure; fasting plasma glucose and lipid profile. Results: The prevalence of obesity was 8.6%. Grade I obesity (67.5%) was the most common pattern; others included grade II obesity (23.3%) and grade III obesity (9.2%). Hypertension (42.7%) was the most common cardio-metabolic morbidity. Others included low HDL-cholesterol (22.8%), diabetes mellitus (15.1%), high triglyceride (12.6%), high total cholesterol (9.2%), and high LDL-cholesterol (6.8%). Conclusion: Obesity and its cardio-metabolic morbidities exist among the study population. Anthropometric determination of obesity and screening for its associated cardio-metabolic co-morbidities should constitute clinical targets for intervention in primary care clinics.
  3 3,286 451
Evaluation of paperless partogram as a bedside tool in the management of labor
Kiran Agarwal, Lata Agarwal, Vijender Kumar Agrawal, Ashok Agarwal, Mahender Sharma
January-March 2013, 2(1):47-49
DOI:10.4103/2249-4863.109944  PMID:24479043
Introduction: The partogram has been heralded as one of the most important advances in modern obstetric care. However, some healthcare practitioners, especially in high-income countries, have questioned its effectiveness. The purpose of this study is to evaluate prospectively the use of a paperless partogram as a bedside tool in the management of labor. Materials and Methods: Women were invited to participate in the trial if they were at 36 to 42 weeks of gestation, and carrying a singleton pregnancy, with a cephalic presentation. All women who met the criteria and gave informed consent were included in the study till the required sample size of 91 was obtained. Progress of labor was monitored on the basis of Alert estimated time of delivery (ETD) and Action ETD. At the time of the Action ETD, if woman had not yet delivered, a diagnosis of abnormal labor was made and arrangements were made for emergency obstetric care. Results: Out of 91 women who participated in the study 55 (60%) were primigravida and 36 (40%) were multipara. The mean age of the participants was 25.36 years and the mean duration gestation was 281.9 days. The mean duration for delivery after Alert ETD was 4.3 hours. In our study, out of 91 participants, labor was induced only in 13% of the cases. The mean duration for delivery after Alert ETD was 4.7 ± 1.9 hours in the primigravida and 3.7 ± 1.8 hours in multipara, but these differences were not statistically significant. Conclusion: In our study, the paperless partogram was found to be convenient and effective in the management of labor. The mean duration for delivery after Alert ETD was 4.3 hours in our study, which was similar to the World Health Organization's (WHO) recommendation for partograms, with a four-hour action line, denoting the timing of intervention for prolonged labor.
  3 2,998 576
Oculoauriculovertebral spectrum with radial anomaly in child
Amar Taksande, Krishna Vilhekar
January-March 2013, 2(1):92-94
DOI:10.4103/2249-4863.109966  PMID:24479055
Oculoauriculovertebral spectrum (OAVS) or Goldenhar syndrome is a wide spectrum of congenital anomalies that involves structures arising from the first and second branchial arches. It is characterized by a wide spectrum of symptoms and physical features. These abnormalities mainly involve the cheekbones, jaws, mouth, ears, eyes, or vertebrae. Other conditions with ear and/or radial involvement, such as, the Nager syndrome, Holt-Oram syndrome, Radial-renal syndrome, facioauriculoradial dysplasia, Fanconi anemia, and Vertebral, Anal atresia, Cardiac, Trachea, Esophageal, Renal, and Limb (VACTERL) association should be considered for differential diagnosis. Here we report a child who had facial asymmetry, microsomia, microtia, congenital facial nerve palsy, conductive hearing loss, skin tags, iris coloboma, and preaxial polydactyly.
  2 2,736 385
Differences between rural and urban primary care units in Turkey: Implications on residents' training
Hulya Yikilkan, Suleyman Gorpelioglu, Cenk Aypak, Zekai Uysal, Osman O Ariman
January-March 2013, 2(1):15-19
DOI:10.4103/2249-4863.109935  PMID:24479037
Context: Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care. Aims: The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural. Settings and Design: Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009. Results: Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis. Conclusion: In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners' field training should take place at different primary care units according to sociodemographic characteristics of each country.
  2 2,858 406
Right to healthcare: The way forward
Rafia F Peer
January-March 2013, 2(1):4-8
DOI:10.4103/2249-4863.109929  PMID:24479035
From the Bhore Committee Report of 1946 to the present Universal Health Coverage (UHC) 2011, nothing much has changed in terms of health status in India. The overall health status continues to be dismal and disappointing. One factor that is mainly responsible for this state of affairs is that healthcare has not been realized as a right. If healthcare becomes a right, the state will become responsible and accountable to the people, for enhancing their health. If people are invoked into a sense of belonging to the health system and made to look at healthcare as their right, there is a strong possibility of a positive change in the overall health status of the people. The article looks at healthcare from the rights perspective and explores the methods in which it can be translated into reality. It tries to look at the moral basis of the right to healthcare. For healthcare to be achieved as a right, the state can no longer be a mute spectator of the predominant market forces dictating the healthcare delivery system. The article argues that translation of healthcare as a right is only possible if the state takes full responsibility to improve the health status of the people.
  2 3,575 518
Recurrent hydrocoele
Kelly Parks, Lawrence Leung
January-March 2013, 2(1):109-110
DOI:10.4103/2249-4863.109972  PMID:24479061
Hydrocele is a common cause of scrotal swelling in general practice and is caused by a patent space in the tunica vaginalis. Treatment is often conservative unless the hydrocele grows to a critical size that leads to discomfort or difficulty in walking, in which case drainage is necessary. Depending on the communication of the tunica vaginalis with the peritoneal cavity and other coexistent morbidities, hydrocoele may recur despite repeated drainage posing a problem to management in general practice. We hereby presented a 72-year male with a huge hydrocoele that recurred despite repeated drainage and hernia sac repair, arousing thoughts on this subject and discussions as to the most appropriate management.
  1 4,205 299
Nocturnal frontal lobe epilepsy presenting as excessive daytime sleepiness
Jocelyn Y Cheng, Douglas M Wallace, Maria R Lopez, Enrique J Carrazana
January-March 2013, 2(1):101-103
DOI:10.4103/2249-4863.109969  PMID:24479058
Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE.
  1 4,514 354
Inadvertent intramuscular administration of high dose bacillus Calmette Guerin vaccine in a pre-term infant
Asima Banu, Eswari Loganathan
January-March 2013, 2(1):95-97
DOI:10.4103/2249-4863.109967  PMID:24479056
This case report examined the natural course of reaction after accidental intramuscular administration of high dose Bacille Calmette-Guιrin (BCG) vaccine into the anterolateral aspect of thigh of a pre-term infant as a part of routine vaccination instead of intra-dermal injection into the arm. There is no consensus on the best management of this complication, although in this case healing was prolonged but was spontaneous without anti-tubercular chemotherapy.
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Atypical presentation of allergic bronchopulmonary aspergillosis: An unusual cause of difficult-to-treat asthma
Sudipta Pandit, Sabyasachi Choudhury, Anirban Das, Samadarshi Datta, Sibes K Das
January-March 2013, 2(1):98-100
DOI:10.4103/2249-4863.109968  PMID:24479057
Allergic Bronchopulmonary aspergillosis (ABPA) commonly presents with persistently uncontrolled asthma, despite of the therapy with highest possible anti-asthma medications. Most common cause of ABPA is Aspergillus fumigates. Hence, ABPA is one of the important differential diagnoses of difficult-to-treat asthma. Atypical presentation of ABPA misleads the diagnosis and asthma remains uncontrolled. Here we present such a case of 28-year-old non-smoker, normotensive male office worker who presented with persistent cough with scanty white, mucoid expectoration and gradually progressive breathlessness with bilateral crackles for last two years. Diagnosis of asthma was made based on clinical evidences and spirometry. Anti-asthma treatment was started and gradually stepped up. Further evaluation was done due to lack of clinical improvement, and diagnosis of ABPA was made from bilateral reticulonodular lesions on HRCT thorax, increased levels of serum IgE and Aspergillus fumigates specific IgE, and positive aspergillin skin test. Oral prednisolone and itraconazole were started with anti-asthma medications.
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Early diagnosis of a large vesical calculus complicating pregnancy
Ruby Angeline Pricilla, Kirubah Vasandhi David, Sankarapandian Venkatesan, Santosh Joseph Benjamin
January-March 2013, 2(1):88-89
DOI:10.4103/2249-4863.109964  PMID:24479053
Vesical calculus-complicating pregnancy is rare. This is a case report of a large vesical calculus-complicating pregnancy. The early diagnosis and appropriate surgical management of the large vesical calculus prevented complications like recurrent urinary tract infections and obstructed labor. It enabled the mother to have an uneventful vaginal delivery.
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The politics of medical practice license and its impact on primary care workforce: International developments and Indian perspective
Raman Kumar
January-March 2013, 2(1):1-3
DOI:10.4103/2249-4863.109924  PMID:24479034
As a country India has to her credit the largest number of medical colleges in the world. More than 40,000 seats of MBBS (Bachelor of Medicine and Bachelor of Surgery) are available annually but only a fraction would enter into primary health care vocation. It is a matter of common perception and also of great concern that a large majority of young Indian doctors are not willing to serve the rural, remote and underserved population. An observation on human resource policies of several developed countries reveals interesting patterns. Beyond willingness and interest of the medical students and young doctors, there are real factors which prohibit their engagement with the health care delivery system in India, especially in the area of primary health care.
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Experiences of junior public health nurses in delivery of maternal healthcare services to tribal women in Kerala
Jinu A Jose, Sonali Sarkar, Sitanshu S Kar, S Ganesh Kumar
January-March 2013, 2(1):60-63
DOI:10.4103/2249-4863.109948  PMID:24479046
Background: The maternal health care indicators are better in Kerala even in the tribal districts than the national averages. The tribal population scattered in hilly areas or other difficult terrains heavily constraints the MPHW female (Junior Public Health Nurse in Kerala) from providing services. The study was intended to describe the experiences of the Junior Public Health Nurses (JPHN) in delivery of maternal health care services to tribal women in Kerala. Materials and Methods: JPHNs posted in Thariode panchayat under the sub centers of CHC Thariode in Wayanad district of Kerala. This is a Qualitative study with in-depth interview of the JPHNs using an interview guide. Results and Inferences: The various difficulties experienced by JPHNs in delivering the services in tribal areas were lack of sufficient time for field work, travel difficulties faced due to the hilly terrain and lack of public transport facilities, more time spent on travel than actual time spent for field work, cultural and language barriers and extra inputs put up in service delivery to tribal women. Conclusion and Recommendations: The JPHNs serving in tribal areas overcame various constraints in service delivery like hilly terrain, limited public transport facilities, long hours spent in travelling, cultural and language barriers by putting in extra effort, time and personal money to fulfill their responsibilities. It is suggested that the JPHNs be given compensatory off to complete records and extra remuneration to cover their out of pocket expenditure on travelling to difficult areas.
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Socio-demographic and racial differences in acute coronary syndrome: Comparison between Saudi and South Asian patients
Mazen Ferwana
January-March 2013, 2(1):64-68
DOI:10.4103/2249-4863.109950  PMID:24479047
Introduction: Acute coronary syndrome (ACS) is the leading cause of death in Saudi Arabia as elsewhere. Although, many studies found that South Asians had increased rates of ACS, others did not. The aim of the study is to explore the extent of difference between South Asians and Saudi presentation and risk factors of ACS patients. Materials and Methods: All patients who were diagnosed as having acute myocardial infarction (AMI) based on World Health Organization (WHO) criteria in 6 month period were included in the study. Results: A total of 190 patients confirmed ACS were included; 121 (63.70%) were Saudi, 50 (26.3%) were South Asians, and 19 (10.0%) were other Arab nationalities. The mean age was 53.9 (SD 14.6). Out of the total South Asians 82% had normal body mass index (BMI) ( P = 0.000). Saudi patients were the lowest of the three groups who smoked cigarette and/or shisha (26.6%; P = 0.000). 52.9% of Saudi patients were diabetics and 41.3% were hypertensive ( P = 0.004). More South Asians were presented with chest pain (94% vs 76%). Discussion: South Asians had a double rate of ACS incidence; they were younger, lower socio-economic status, more cigarette smokers, and less diabetics and hypertensive than other patients. An association between the apolipoprotein E (apoE) genotype with the incidence of ACS in young South Asian is proposed. Conclusion: South Asians had double rate of ACS incidence; they were younger, lower socio-economic status, more cigarette smokers, and less diabetics and hypertensive than other patients.
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A day in the life of a British general practitioner
Sahadev Swain
January-March 2013, 2(1):79-82
DOI:10.4103/2249-4863.109956  PMID:24479050
General Practitioners are key providers of patient related services in National Health Service (NHS) in United Kingdom. The general practitioner have enjoyed enormous trust from the general public. Author shares his day today work giving an interesting insight into the model of care general practitioners engage with in UK
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