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   2018| March-April  | Volume 7 | Issue 2  
    Online since July 11, 2018

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Vitamin D deficiency in India
P Aparna, S Muthathal, Baridalyne Nongkynrih, Sanjeev Kumar Gupta
March-April 2018, 7(2):324-330
DOI:10.4103/jfmpc.jfmpc_78_18  PMID:30090772
Vitamin D is a fat-soluble vitamin playing a vital role in human physiology. Vitamin D deficiency is prevalent worldwide. This deficiency has many consequences which are still being explored, apart from the well-known skeletal complications. With this review, we aim to summarize the existing literature on Vitamin D status in India and understand the enormity of the problem. The prevalence of Vitamin D deficiency ranged from 40% to 99%, with most of the studies reporting a prevalence of 80%–90%. It was prevalent in all the age groups and high-risk groups alike. With the consequences of Vitamin D deficiency, namely, autoimmune diseases, cardiovascular diseases, cancer, and tuberculosis being explored, we can imagine the burden it would cause in our country. We need to create awareness among the public and healthcare providers about the importance of Vitamin D and the consequences of deficiency. Our Indian diet generally fails to satisfy the daily requirement of Vitamin D for a normal adult. This stresses on the need for fortifying various food with Vitamin D, through the national programs. This silent epidemic should be addressed appropriately with concrete public health action.
  6,930 964 22
Evaluation of red flags minimizes missing serious diseases in primary care
R P. J. C Ramanayake, B M. T.K Basnayake
March-April 2018, 7(2):315-318
DOI:10.4103/jfmpc.jfmpc_510_15  PMID:30090770
Primary care physicians encounter a broad range of problems and therefore require a broad knowledge to manage patients. They encounter patients at early undifferentiated stage of a disease and most of the presentations are due to non sinister problems but in minority of patients same presentations could be due to serious conditions. One of the main tasks of a primary care doctor is to marginalize the risk of missing these serious illnesses. To achieve this they can look for red flags which are clinical indicators of possible serious underlying condition. Red flags are signs and symptoms found in the patient's history and clinical examination. Evaluation of red flags is of paramount important as decision making is mainly dependent on history and examination with the availability of minimal investigatory facilities at primary care level. Some Red flags like loss of weight and loss of appetite are general in nature and could be due to many pathologies while hematemesis and melena are specific red flags which indicate GIT bleeding. All red flags, whether highly diagnostic or not, general or specific, warn us the possibility of life-threatening disorders. The term 'red flag' was originally associated with back pain and now lists of red flags are available for other common presentations such as headache, red eye and dyspepsia as well. Identification of red flags warrant investigations and or referral and is an integral part of primary care and of immense value to primary care doctors.
  4,314 896 7
Prenatal diagnosis and management of fetal intra-abdominal umbilical vein varix
Krupa Hitesh Shah, Rema Nambiyar, Shashikala Bhat
March-April 2018, 7(2):458-460
DOI:10.4103/jfmpc.jfmpc_76_17  PMID:30090795
Fetal intra-abdominal umbilical vein varix (FIUVV) is a rare pathology and suggests an enlargement of the umbilical vein. Prenatal diagnosis is done through meticulous ultrasound imaging. Management variables are the diameter of varix, presence or absence of turbulent flow, and fetal anomalies. Color and power Doppler ultrasound helps in diagnosis and follow-up and has a critical role in decision-making for intervention. Clinical guidelines for management are not clear. The adverse fetal outcome is usually associated with multiple malformations, turbulent flow, and thrombotic varix. This case study presents the prenatal diagnosis, obstetric management, and neonatal development of a fetus, diagnosed with FIUVV along with a brief review of the literature.
  4,787 246 -
Nipah virus epidemic in southern India and emphasizing “One Health” approach to ensure global health security
Vijay K Chattu, Raman Kumar, Soosanna Kumary, Fnu Kajal, Joseph K David
March-April 2018, 7(2):275-283
DOI:10.4103/jfmpc.jfmpc_137_18  PMID:30090764
Nipah virus (NiV) encephalitis first reported in “Sungai Nipah” in Malaysia in 1999 has emerged as a global public health threat in the Southeast Asia region. From 1998 to 2018, more than 630 cases of NiV human infections were reported. NiV is transmitted by zoonotic (from bats to humans, or from bats to pigs, and then to humans) as well as human-to-human routes. Deforestation and urbanization of some areas have contributed to greater overlap between human and bat habitats resulting in NiV outbreaks. Common symptoms of NiV infection in humans are similar to that of influenza such as fever and muscle pain and in some cases, the inflammation of the brain occurs leading to encephalitis. The recent epidemic in May 2018 in Kerala for the first time has killed over 17 people in 7 days with high case fatality and highlighted the importance of One Health approach. The diagnosis is often not suspected at the time of presentation and creates challenges in outbreak detection, timely control measures, and outbreak response activities. Currently, there are no drugs or vaccines specific for NiV infection although this is a priority disease on the World Health Organization's agenda. Antivirals (Ribavirin, HR2-based fusion inhibitor), biologicals (convalescent plasma, monoclonal antibodies), immunomodulators, and intensive supportive care are the mainstay to treat severe respiratory and neurologic complications. There is a great need for strengthening animal health surveillance system, using a One Health approach, to detect new cases and provide early warning for veterinary and human public health authorities.
  3,956 520 15
Joint position statement Indian association of palliative care and academy of family physicians of India – The way forward for developing community-based palliative care program throughout India: Policy, education, and service delivery considerations
Jenifer Jeba, Shrikant Atreya, Sulagna Chakraborty, Nikki Pease, Ann Thyle, Alka Ganesh, Gayatri Palat, Lulu Matthew, Sahaya Anbarasi, Raman Kumar, Mary Ann Muckaden, Alan Barnard, Mhoira Leng, Dan Munday, Scott A Murray
March-April 2018, 7(2):291-302
DOI:10.4103/jfmpc.jfmpc_99_18  PMID:30090767
Purpose: This joint position statement, by the Indian Association of Palliative Care (IAPC) and Academy of Family Physicians of India (AFPI), proposes to address gaps in palliative care provision in the country by developing a community-based palliative care model that will empower primary care physicians to provide basic palliative care. Evidence: India ranks very poorly, 67th of 80 countries in the quality of death index. Two-thirds of patients who die need palliative care and many such patients spend the last hours of life in the Intensive care unit. The Indian National Health Policy (NHP) 2017 and other international bodies endorse palliative care as an essential health-care service component. NHP 2017 also recommends development of distance and continuing education options for general practitioners to upgrade their skills to provide timely interventions and avoid unnecessary referrals. Methods: A taskforce was formed with Indian and International expertise in palliative care and family medicine to develop this paper including an open conference at the IAPC conference 2017, agreement of a formal liaison between IAPC and AFPI and wide consultation leading to the development of this position paper aimed at supporting integration, networking, and joint working between palliative care specialists and generalists. The WHO model of taking a public health approach to palliative care was used as a framework for potential developments; policy support, education and training, service development, and availability of appropriate medicines. Recommendations: This taskforce recommends the following (1) Palliative care should be integrated into all levels of care including primary care with clear referral pathways, networking between palliative care specialist centers and family medicine physicians and generalists in community settings, to support education and clinical services. (2) Implement the recommendations of NHP 2017 to develop services and training programs for upskilling of primary care doctors in public and private sector. (3) Include palliative care as a mandatory component in the undergraduate (MBBS) and postgraduate curriculum of family physicians. (4) Improve access to necessary medications in urban and rural areas. (5) Provide relevant in-service training and support for palliative care to all levels of service providers including primary care and community staff. (6) Generate public awareness about palliative care and empower the community to identify those with chronic disease and provide support for those choosing to die at home.
  3,461 278 5
Musculoskeletal problems in frequent computer and internet users
Tasneem Borhany, Erum Shahid, Wasim Ahmed Siddique, Hussain Ali
March-April 2018, 7(2):337-339
DOI:10.4103/jfmpc.jfmpc_326_17  PMID:30090774
Aim: This study was carried out to see the frequency of musculoskeletal problems in frequent Computer and Internet Users. Methods: This was a Cross Sectional Study performed in the community and we chose Office workers and students aged 18 to 50 years using Computers and Internet for not less than 3 hours per day. After a verbal consent, they were given a questionnaire in English. People having prior diagnosed musculoskeletal problems were excluded. Results: Total number of participants were 150, out of which 80% were males, and 67 (44.7%) suffered from musculoskeletal problems, affecting at least one of the four anatomical sites (low back, neck, shoulder, wrist/hand). Common symptoms were Headache, which was seen in 46% and neck pain in 41.3% of subjects. Whereas wrist pain was least commonly seen in 16% of subjects. Independent t test was used to compare the musculoskeletal problems with duration of computer use which has a significant value i.e. less than 0.05. Conclusion: Musculoskeletal symptoms are quite common, headache and back pain being most common symptoms. These symptoms are associated with prolonged use of computer and internet and often left unreported and unrelated.
  3,156 476 8
Principles of family medicine practice: Lessons gleaned over a lifetime in practice
BC Rao, Ramakrishna Prasad
March-April 2018, 7(2):303-308
DOI:10.4103/jfmpc.jfmpc_257_17  PMID:30090768
The term “principles” refers to a set of defining attributes and values that lie at the heart of a discipline. These are largely discovered by reflection and practice rather than learned by formal instruction. This article is written as a reflective dialogue between two teachers of family medicine, one who has been practicing for nearly five decades and another with training in contemporary academic family medicine, using a selection of case stories drawn from the practice of the first author. Several principles of family medicine such as “broad-based specialty”; “person and family orientation”; “continuity of care”; “community based care”; “building a trusting relationship”; “counseling”; and “an effective steward of resources” are highlighted. It is hoped that the above discussion will enable students and practitioners of family medicine to be more effective in delivering primary care and appreciate the privilege they have of serving as family physicians in the community
  3,304 306 1
Hyperacute liver injury following intravenous fluconazole: A rare case of dose-independent hepatotoxicity
Vijay Gayam, Mazin Khalid, Sumit Dahal, Pavani Garlapati, Arshpal Gill
March-April 2018, 7(2):451-454
DOI:10.4103/jfmpc.jfmpc_330_17  PMID:30090793
Fluconazole is a triazole antifungal medication used in the treatment of various fungal infections. It is available in both oral and parenteral formulations. Liver damage has been reported with fluconazole use, but most commonly it is benign elevated liver transaminases. Acute liver failure (ALF) in fluconazole use is rare, with cases being reported sporadically in literature and large cohorts describing incidence rates of acute liver injury ranging from 0.0 to 31.6/10,000 patients. We present a case of a 45-year-old African-American male with no history of liver disease who presented with superficial candidiasis and superimposed bacterial cellulitis. He was subsequently started on intravenous fluconazole and clindamycin. Shortly after he developed ALF and a drug-induced liver injury (DILI) was suspected. Fluconazole was stopped, and the clinical picture improved shortly afterward, leading to a diagnosis of fluconazole-induced ALF. Patient underwent laboratory and clinical evaluation to exclude competing etiologies of liver injury as well as a standardized assessment for causality and disease severity such as Roussel Uclaf Causality Assessment Method/Council for International Organizations of Medical Sciences score, which concluded a “Highly Probable” DILI, and a Naranjo score identifying adverse drug reaction (ADR) which concluded a “Definite ADR.” Due to the severity of ALF and the routine use of fluconazole in clinical practice, clinicians should be aware that fluconazole can be a causative agent of ALF, even in low-risk populations.
  3,249 311 4
Biopsychosocial etiology of premenstrual syndrome: A narrative review
Mojgan Zendehdel, Forouzan Elyasi
March-April 2018, 7(2):346-356
DOI:10.4103/jfmpc.jfmpc_336_17  PMID:30090776
Introduction: Premenstrual syndrome (PMS) is one of the most prevalent disorders at reproductive age and has a negative impact on emotions and performance of women. Since various factors play a role in the development of this syndrome, the present study was aimed to examine biopsychosocial etiology of PMS in the form of a narrative review. Materials and Methods: Relevant studies were collected based on the three subjects of biological, psychological, and social etiologies during 1987–2015. First, Medical Subject Headings was used to specify the relevant keywords such as biological, psychological, social, and premenstrual syndrome which were used to search Internet databases including Google Scholar, Scopus, PubMed, PMDR, Ovid, Magiran, and Iranmedex, which led to collection of 1 book and 26 Persian and English articles. Results: The results were classified into three sections. In the biological section, the effect and role of sex hormones and their changes in PMS were examined. In the psychological section, hypotheses on PMS and the role of psychological problems in the development of PMS were examined. In the social section, the role and social, religious, and cultural position of women and its relationship with PMS were examined. Conclusion: To reduce negative experiences of PMS, it is recommended that girls should be provided with necessary scientific information on puberty and premenstrual health. The results showed that paying attention to the complaint on premenstrual symptoms is significant in women's comprehensive assessment, and it plays an essential role in diagnosing psychological and physical annoying diseases.
  3,005 395 9
Iatrogenesis: A review on nature, extent, and distribution of healthcare hazards
Rafia Farooq Peer, Nadeem Shabir
March-April 2018, 7(2):309-314
DOI:10.4103/jfmpc.jfmpc_329_17  PMID:30090769
Modern medicine is given overarching importance to tackle disease in the human body than environmental determinants. Although, most of the literature confirms that the determinants of disease are there in the environment. Yet in the modern times what is being emphasized is highly limited and reductionist approach of curing ailments in the human body only, which is one of the desired interventions but is full of other side effects and risks leading to iatrogenic reactions. Most of the literature establishes that modern medicine is one of the major threats to the world health. Besides treating disease at the clinical level, rational, and well-thoughtout changes in the overall environment can positively impact the nature, extent, and distribution of disease.
  2,795 461 5
Emotional intelligence and anxiety, stress, and depression in Iranian resident physicians
Maryam Kousha, Hossein Alizadeh Bagheri, Abtin Heydarzadeh
March-April 2018, 7(2):420-424
DOI:10.4103/jfmpc.jfmpc_154_17  PMID:30090787
Background: Residency is one of the most critical periods of medical education. Residents are susceptible in high risk for mental problems which can affect the doctor–patient relationship. Emotional intelligence (EI) correlates closely with stress and mental health. Considering the important role of EI in medical education and with regard to lack of studies in this group in Iran, this study conducted to determine the relationship between EI and stress, anxiety, and depression in a sample of resident physician in our university of medical sciences. Materials and Methods: In this cross-sectional study, 245 residents were invited, but only100 questionnaires were analyzed, and the response rate was 41%. From this, 26 were men and 74 were women. Bar-on EI questionnaire, Depression Anxiety Stress Scales-21, for evaluating the stress, anxiety, and depression and demographic characteristics were used. Results: The mean score of EI in resident physician was 330.24 ± 38.5. The mean score of stress, anxiety, and depression was 17.8 ± 8.6, 10.04 ± 7.99, and 10.49 ± 8.67 respectively. There was a negative relation between mean score of anxiety (R = −0.0525), stress (R = −0.639), and depression (R = −0.644) with a mean score of EI. Conclusion: Higher EI appears to be good predictors of lower stress, anxiety, and depression in resident physician.
  2,792 421 6
Burnout and depression among medical residents in the United Arab Emirates: A Multicenter study
Mahera Abdulrahman, Madiha Muhammad Farooq, Aisha Al Kharmiri, Farida Al Marzooqi, Frederick Robert Carrick
March-April 2018, 7(2):435-441
DOI:10.4103/jfmpc.jfmpc_199_17  PMID:30090790
Introduction: Persistent imbalance between work demands and resources seems to be a crucial contributor to the development of burnout among medical professionals. Yet, it seems that Middle East is lacking studies analyzing psychological well-being's of medical residents. Hence, we aimed to conduct a nationwide study to understand and address burnout and depression in medical residents in the UAE. Methods: A multicenter, cross-sectional study was designed to evaluate professional burnout and depression among medical residents to address the gap. Results: Our results indicate that 75.5% (216/286) of UAE medical residents had moderate-to-high emotional exhaustion (EE), 84% (249/298) had high depersonalization (DP), and 74% (216/291) had a low sense of personal accomplishment. In aggregate, 70% (212/302) of medical residents were considered to be experiencing at least one symptom of burnout based on a high EE score or a high DP score. Depression ranging from 6% to 22%, depending on the specialty was also noted. Noticeably, 83% (40/48) of medical residents who had high scores for depression also reported burnout. Conclusions: This study shows that burnout and depression are high among medical residents in UAE. There is a crucial need to address burnout through effective interventions at both the individual and institutional levels. Professional counseling services for residents will certainly be a step forward to manage resident burnout provided the social stigma associated with counseling can be eliminated with awareness. The work hour regulations suggested by the Accreditation Council for Graduate Medical Education partly provides a solution to improve patient safety and care quality. There is an urge to reconfigure the approach to medical training for the well-being of the next generation of physicians in the Arab world.
  2,442 315 12
Primary school female teachers' knowledge, attitude, and practice toward students with epilepsy in Riyadh, Saudi Arabia
Amira Fahad Al-Harbi, Leila Abdullah Alsaid, PJ Parameaswari
March-April 2018, 7(2):331-336
DOI:10.4103/jfmpc.jfmpc_58_18  PMID:30090773
Background: Epilepsy is the most neurological condition prevalent in humanity and it is associated with stigma and discrimination. Knowledge and practice of primary care teachers toward students with epilepsy, especially at young age, is imperative for their development. Objectives: This study was designed to assess the level of knowledge, attitude, and practice of female primary school teachers toward students with epilepsy in Riyadh, Saudi Arabia. Subjects and Methods: In this cross-sectional study, 582 female primary school teachers had volunteered. They were assessed on their knowledge, attitude, and practice toward students with epilepsy using a self-administrated questionnaire. The questionnaire was cross-culturally validated before the distribution. Results: The results suggest above-average familiarity with epilepsy (79.2%). Younger teachers are less likely to associate epilepsy with retardation (P = 0.038). In general, the attitude was positive among the teachers, and 36.9% felt that the students should be treated normally and 63.1% with compassion toward them. Only 14.3% answered that epileptic students should be transferred to special need schools. Highly educated teachers were less likely to feel that epileptic students can cause problems (P = 0.038). The practice was poor with 31.8% expressed the ability to provide first aid to epileptic students. Only 27.5% accepted to give the students prescribed medications. Conclusion: The knowledge about epilepsy needs improvement among primary school teachers in Riyadh. Public level interventions through proper courses can provide a leverage. The higher level of knowledge can be pivotal in increasing the positive attitude and practice of teachers toward epileptic students.
  2,295 275 3
A rare adverse drug reaction to escitalopram
Monika Pathania, Bhomik Goel, Puneet Dhamija, Ravi Kant, Minakshi Dhar, Sunita Mittal
March-April 2018, 7(2):466-467
DOI:10.4103/jfmpc.jfmpc_105_17  PMID:30090797
Selective serotonin reuptake inhibitors are considered to be low side effect profile drugs as compared to conventional antidepressants. The primary care physicians should be aware of the rare and depressing side effect of these drugs when they are prescribed in young, nonpregnant females. Mastalgia has been reported in <1% of the cases. Galactorrhea as an adverse drug reaction has been reported in very few case reports, and the frequency of this side effect is unknown.
  2,051 231 1
Plasma cell leukemia
Shaylika Chauhan, Priya Jaisinghani, Jaivir Rathore, Hassan Tariq, Yesenia Galan, Arjun Madhavan, Haris Rana, Douglas Frenia
March-April 2018, 7(2):461-465
DOI:10.4103/jfmpc.jfmpc_310_17  PMID:30090796
We present a rare case report of a patient diagnosed with primary plasma cell leukemia (PCL) who presented with atypical signs and symptoms which acutely evolved into life-threatening multi-organ failure. This case raises questions regarding the latest diagnostic guidelines and therapeutic options in the management of acute PCL and reinforces the need for prompt treatment after diagnosis.
  1,979 241 1
Relationship between serum gamma-glutamyltransferase activity and cardiometabolic risk factors in metabolic syndrome
Eman Mokbel Alissa
March-April 2018, 7(2):430-434
DOI:10.4103/jfmpc.jfmpc_194_17  PMID:30090789
Objectives: The objective of this study was to examine the associations of serum gamma-glutamyltransferase (GGT) levels with the metabolic syndrome (MetS) and its components in Saudi adults. Methods: The study comprised 400 participants (70 men and 330 women), aged between 40 and 88 years, randomly selected from the medicine clinics at the King Abdulaziz University Hospital in Jeddah, Saudi Arabia, in a cross-sectional study design. A standardized questionnaire was used to determine demographics variables, general health, lifestyle habits, and medical history. Anthropometric and biochemical variables measurements were taken for all study participants. MetS was defined according to the American Heart Association/National Heart, Lung, and Blood Institute report, by the presence of abdominal obesity. Results: Higher means for triglycerides and insulin resistance indices (P < 0.0001) was found among those in the second, third, and fourth GGT quartiles as compared with their counterparts in the first quartile. McAuley index (β = −0.239, P < 0.0001, 95% confidence interval: −4.1–−1.5) was shown to be a major determinant of circulating GGT in a multivariate analysis. Conclusion: Elevated serum GGT could be a cardiometabolic risk factor either as a mediator of low-grade systemic inflammation and as a mediator of oxidative stress through mediation of extracellular glutathione transport into cells of organ systems.
  1,951 238 3
Knowledge and practice of first aid among parents attending primary health care centers in Madinah City, Saudi Arabia, A cross sectional study
Ala'a A. S Al-Johani, Samia Sabor, Samia A. R Aldubai
March-April 2018, 7(2):380-388
DOI:10.4103/jfmpc.jfmpc_64_18  PMID:30090781
Background: Rapid and right intervention of parents can limit disability and increase the chances of survival of the injured child and make a big difference in the outcome. Objectives: The objective of this study is to assess the knowledge and practice of first aid among parents attending PHCs in Al-Madinah city, 2017. Methods: A cross-sectional study was conducted in governmental primary healthcare centers in Al-Madinah Al-Munawwarah city (Saudi Arabia) during the year 2017. A representative sample of Saudi parents who live in Madinah and came to family medicine clinic in PHC was included. A pre-validated and self-administered questionnaire was used for data collection. Results: The study included 390 parents. More than half of them (55.6%) were males. The age of 40% of them ranged between 31 and 40 years whereas that of 31.5% ranged between 20 and 30 years. Majority of the parents (97.2%) were aware of first aid. The most commonly reported source of information about first aid was mass media (59%). Majority of the parents (93.3%) believe there must be training in first aid, and only 34.6% of them claimed that they attended a training course in first aid. The highest average knowledge percentage was observed regarding the first aid of diabetes mellitus (68.8%), followed by epilepsy (49.7%), incidents (37.5%) and finally injuries/fractures (36.7%). Higher educated parents, those with a moderate number of children (4–6), those reported nurses as the main source of information, those previously attended training in first aid, and those who had experience with incidents among their children expressed higher significantly first aid knowledge compared to their counterparts. Conclusions: First aid of various illnesses among parents in Al-Madinah city is not satisfactory, particularly regarding incidents, injuries, and fractures. However, the majority of them were willing to attend training courses in first aid at primary healthcare centers.
  1,920 248 2
Investigation of factors affecting the tendency to choose the type of delivery in pregnant women referring to hospitals of Ardabil Province in 2016
Vahid Izadi, Vahid Zamanzadeh, Mehri Seyedjavadi, Rahele Mohammadi, Effat Mazaheri
March-April 2018, 7(2):406-413
DOI:10.4103/jfmpc.jfmpc_235_17  PMID:30090785
Background and Purpose: Childbirth is one of the most challenging events in a married woman's life and it has important emotional consequences for each woman. It is also a multidimensional process that has physical, physiological, psychological, emotional, cultural, and social dimensions. The aim of this study was to investigate the factors affecting the tendency to choose the type of delivery in pregnant mothers in hospitals of Ardabil Province in 2016. Methodology: This study is a cross-sectional research that was conducted on 300 pregnant women who were referred to the hospitals for delivery during 3 months in 2016. Data collection tools was a five-part questionnaire including demographic, awareness, attitude, abstract norm questionnaires (other's role) in choosing delivery method, and Behavioral Intention Questionnaire was used in choosing the type of delivery. Results: Statistically, there was not any significant relationship between level of awareness and type of delivery in pregnant mothers (P = 0.07). The mean scores of attitude in mothers with a tendency to natural delivery were 35.75 ± 14.43, and in mothers with a tendency to cesarean was 46.3 ± 10.96. ANOVA test showed statistically a significant relationship between attitude toward cesarean and type of delivery (P < 0.05). Chi-square test showed statistically a meaningful relationship between the recommendations of acquaintances, mothers, husbands, and doctors with choosing a type of delivery (P < 0.05). Conclusion: Regarding the results of research, especially the positive attitude and high level of awareness in the choice of natural delivery, the promotion of natural delivery will be possible with education.
  1,975 161 -
Nonalbuminuric chronic kidney disease: A dominant presentation in noncommunicable disease population of rural central India
Piyush Shankarrao Kodgirwar, Sumedh Ulhas Jajoo, Ulhas Narayan Jajoo, Bharti Amar Taksande, Subodh S Gupta
March-April 2018, 7(2):442-446
DOI:10.4103/jfmpc.jfmpc_87_17  PMID:30090791
Background: India has largest number of people with diabetes mellitus (DM), and hypertension (HTN) is expected to double in next 25 years, which are common causes of chronic kidney disease (CKD). The focus for prevention of end-stage renal disease has shifted to detection of the iceberg of DM and HTN and its adequate control. Prevalence studies of CKD in India rural community are lacking. Methodology: We did community-based cross-sectional study with 3 monthly diagnostic camps in adults ≥20 years (n = 6278), from 13 villages for early detection of CKD in rural population around Sevagram in a group of noncommunicable disease (NCD) with DM, HTN, ischemic heart diseases (IHD), and stroke in year 2015–2016. Results: Study achieved 87% (5440/6278) coverage for albuminuria screening. Prevalence of CKD in NCD population was 19.6% (220/1121) where 86% (181/220) were nonalbuminuric CKD. Prevalence of persistent albuminuria in the study population was 0.8% (45/5440); in NCD population (DM, HTN, IHD, and stroke), it was 2.8% (31/1121). Prevalence of CKD was 19% in HTN and 18.9% in diabetes. The prevalence of nonalbuminuric versus albuminuric CKD was 17.1% versus 1.9% (9 times) in hypertensive individuals and 11.3% versus 7.5% (1.5 times) in individuals with DM. Conclusion: Predominance of nonalbuminuric CKD in NCD participants raises suspicion of CKD with undetermined risk factors. Further studies are needed to find the prevalence of nonalbuminuric CKD in overall population and to find out if exposure of pesticides, chemical fertilizers over long duration play an important role in agrarian rural community.
  1,726 165 -
Social anxiety and its effect on self-efficacy among family medicine residents in Riyadh
Mohammed Abdullah Al-Ruwaili, Yousef Abdullah Al-Turki, Abdulrahman Alardan
March-April 2018, 7(2):389-393
DOI:10.4103/jfmpc.jfmpc_360_17  PMID:30090782
Background: Social anxiety is a common disorder that characterized by fear of social situations. Social anxiety disorder causes several problems including alcohol abuse. Its prevalence is high, and it affects work and education. Self-efficacy influences any action the individual takes. Aim: The aim of this study is to evaluate the prevalence of social anxiety disorder and its effect on self-efficacy on family medicine residents. Materials and Methods: This study included 200 participants of family medicine residents; two validated scales were incorporated in one questionnaire to investigate the social anxiety and self-efficacy. Results: The prevalence rate of social anxiety was low among family medicine residents, and there was no difference between the levels of anxiety and other demographics, there was a negative correlation between social anxiety levels and self-efficacy. Conclusion: There was a negative correlation between social anxiety and self-efficacy, where high levels of social anxiety were related to low levels of self-efficacy.
  1,561 155 1
Evolution of the Dubai health authority's residency training program: A 25-year review, challenges and outcomes
Ashraf Ahmed, Mahera Abdulrahman, Richard Withnall
March-April 2018, 7(2):319-323
DOI:10.4103/jfmpc.jfmpc_359_17  PMID:30090771
Background: The Dubai Residency Training Program (DRTP) is a structured postgraduate educational training program started on 1992 to improve healthcare in the United Arab Emirates (UAE) through education and training; align doctors' training in the UAE with internationally recognized standards; deliver educational best practice; and achieve a balance between clinical service delivery and continuing professional development. The aim of this paper is to review the experiences, challenges and outcomes of the DRTP over the last 25 years. Methods: All documentation relating to the DRTP was reviewed and reevaluated. Results: The DRTP has become a very solid foundation; yet, one of the major challenges we are facing is containing the balance between the health service and education. Another challenge is that our capacity for training is limited, in spite of demand, we are not yet able to open all specialties needed in the UAE. Finally, there is a mandate to separate the educational body from service to better govern the education. Conclusions: The time has come, however, for the UAE to have its own medical specialty board. This would further support high quality, comprehensive specialty training to deliver the bespoke workforce required by the Dubai Health Authority. The concept of structured training where the resident knows what, when, and how to learn the required knowledge and skills is already established, and the UAE has the required numbers of highly trained professionals to form the board. Nevertheless, we should neither be complacent nor underestimate the challenges that remain to deliver the UAE specialty board.
  1,552 136 1
Strengths and limitations of a family physician
Derek Hellenberg, Farion R Williams, Mohan Kubendra, Resmi S Kaimal
March-April 2018, 7(2):284-287
DOI:10.4103/jfmpc.jfmpc_297_17  PMID:30090765
Family physicians (FP) practising in different parts of the world may require different sets of knowledge and skills to satisfy the needs of the communities in which they work as well as the requirements of the professional bodies with which they are registered. This article gives an overview of the strengths and limitations of the FP globally and more specifically within India, South Africa, and the United States of America. The historical context and evolution of FM as a clinical and academic discipline is discussed in this article. The article recommends suggestions for a better future for Family Medicine as a specialty thereby providing quality primary healthcare to the community, based on the needs of the population of each country.
  1,497 165 -
Comparative morbidity profile of patients attending an Ayurveda clinic and a modern medicine clinic of a primary health center in rural Haryana, India
Shashi Kant, Ayush Lohiya, Farhad Ahamed, Rizwan Suliankatchi Abdulkader, Arvind Kumar Singh, Vijay Silan
March-April 2018, 7(2):374-379
DOI:10.4103/jfmpc.jfmpc_347_17  PMID:30090780
Context: There is a paucity of data on the profile of patients accessing traditional systems of medicine. A comparison of profile of patients attending an Ayurveda clinic with that of modern medicine clinic will help in better understanding of utilization of services and preference for system of medicine by the patients seeking health care. Aim: The aim was to study the morbidity profile of patients who attended the Ayurveda clinic of a primary health center (PHC) in rural Haryana over 1 year and compared it with that of the modern medicine clinic attendees at the same facility. Materials and Methods: The study site was PHC, Dayalpur in block Ballabgarh, district Faridabad, Haryana, India. All new patients who attended the Ayurveda clinic of PHC Dayalpur in the year 2012 were included in the study. New attendees of modern medicine clinic of the same PHC in the year 2012 were used for comparison of profile of patients. Results: In year 2012, of the total new patients registered at PHC, 26% attended Ayurveda clinic. The male-to-female ratio (0.8:1) was similar in both clinics. The representation of children up to 5 years and elderly was significantly higher (12.0% vs. 6.7% and 19.5% vs. 11.0%) in modern medicine clinic as compared to Ayurveda clinic. The most common morbidities seen in Ayurveda clinic were twak vikar or skin disease (12.3%), sandhivata or osteoarthritis (10.3%), and kasa or cough (8.5%). Three most common morbidities in modern medicine clinic were acute respiratory infection (35.7%), hypertension (10.6%), and acute febrile illness (9.2%). Conclusions: The study provided evidence that Ayurveda was popular among rural population in North India. Therefore, the Government of India's initiative of setting up Ayurveda clinic in PHCs is well founded.
  1,468 164 -
Carotid intima-media thickness, flow-mediated dilatation and proteinuria in patients of human immunodeficiency virus-positive patients: A case–control study
Aarti Sharma, Nikhil Gupta, Dinesh Srivastava
March-April 2018, 7(2):362-367
DOI:10.4103/jfmpc.jfmpc_34_17  PMID:30090778
Introduction: Endothelium-dysfunction (ED) is a surrogate marker of coronary atherosclerotic disease. Carotid intima-media thickness (CIMT), flow-mediated dilatation (FMD), and proteinuria are surrogate markers of ED. Few studies have shown that patients with HIV have impaired endothelial function and are thus at risk of accelerated atherosclerosis. Materials and Methods: The present study assessed ED in HIV patients by various biophysical parameters as brachial artery FMD, CIMT, and proteinuria. A total of 43 HIV-infected patients were compared with 25 healthy controls who were healthy. Results: Mean age of patients with HIV was 33.84 ± 5.61 years while that of healthy controls was 31.48 ± 5.40 years. Male to female ratio among cases was 24:19 while among controls was 17:8. Mean CIMT was significantly higher among cases than control (0.513 ± 0.079, 0.452 ± 0.050 mm, respectively, P = 0.001). Percentage change in FMD was significantly lower among cases than control (3.27 ± 2.01, 6.96 ± 1.28, respectively, P = 0.001). Urine protein grading was significantly different between cases and controls (P = 0.007), with stable HIV cases having significantly higher urine protein grading compared to healthy controls. However, no correlation was seen between CIMT, FMD, and proteinuria overall among cases and controls. Conclusions: HIV-infected patients have significant impairment of endothelial function, in the form of increased CIMT, impaired FMD, and more proteinuria as compared to healthy controls.
  1,392 187 2
Determinants of appropriate knowledge on human immunodeficiency virus postexposure prophylaxis among professional health-care workers in Sokoto, Nigeria
Oche Mansur Oche, Abubakar Sadiq Umar, Godwin Jiya Gana, Nneka Christina Okafoagu, Remi Abiola Oladigbolu
March-April 2018, 7(2):340-345
DOI:10.4103/jfmpc.jfmpc_32_17  PMID:30090775
Introduction: The prevention of human immunodeficiency virus (HIV/AIDS) among health-care workers (HCWs) has remained a major topical issue worldwide. Accidental transmission of HIV infection to HCWs during occupational exposure is a real threat today. The study aimed to assess the knowledge, attitude, and practice of postexposure prophylaxis (PEP) among HCWs in a tertiary health institution in Sokoto, Northwestern Nigeria. Methodology: The study was carried out at Usmanu Danfodiyo University Teaching Hospital, Sokoto, through a cross-sectional descriptive study design; a total of 156 participants were recruited using a stratified sampling technique. Data were collected using a semi-structured, self-administered questionnaire and analyzed using SPSS computer software after obtaining ethical clearance from the Health Ethics and Research Committee of the teaching hospital. Results: A total of 87.2% (136) of the respondents had heard of PEP and 71.8% (112) thought that HIV/AIDs could be prevented through PEP. A total of 71.2% (111) had good knowledge about PEP, whereas 86.8% (118) had a positive attitude toward PEP. Conclusion: Although the study demonstrated high knowledge and positive attitude toward PEP, the observance of safety measures against needlestick injuries that could result in HIV infections was abysmally low. There is the need to create more awareness and strengthen the use of PEP protocol by all cadres of health workers as this will go a long way in minimizing blood-borne infections.
  1,429 141 2
The relationship between job motivation and its dimensions with organizational commitment and its dimensions in midwives of sanitary and therapeutic centers, Arak University of Medical Sciences, 2017
Masoomeh Kheirkhah, Mojgan Javedani Masrour, Maryam Sefidi, Ezzat Jafar Jalal
March-April 2018, 7(2):368-373
DOI:10.4103/jfmpc.jfmpc_343_17  PMID:30090779
Introduction and Aim: Human resources with the quality of desirable performance are the most important assets of the organization and increase the probability of success, survival, and progress of the organization. Midwives have a critical role in promoting the health of mothers and infants and survey the relationship between job motivation and organizational commitment can help health system managers and planners to improve the quality of the services provided. Methods: This is a cross-sectional and correlational study; samples of midwives in Arak University of Medical Sciences were selected by stratified sampling with proportional allocation method. The instrument of gathering was demographic information questionnaire, Herzberg's job motivation, and organizational commitment of Allen and Meyer. Data were analyzed by SPSS 16 software and (P < 0.05) were considered significant. Results: There was a significant relationship between job motivation and organizational commitment and their dimensions (r = 0.68, P < 0.001). The highest correlation between job motivation and emotional commitment (r = 0.77), normative commitment (r = 0.62), and continuous commitment (r = 0.55). The most related emotional commitment by way of communication (r = 0.74), continuous commitment to salary and wages (r = 0.54), and normative commitment with the nature of midwifery was r = 0.61. Conclusion: The results show the importance of communication dimensions, salaries, and wages and the nature of job in the commitment of midwives in Markazi Province. More attention from health system administrators to these dimensions can be useful in increasing the motivation and organizational commitment of midwives in this province.
  1,384 182 1
Is there a misuse of computed tomography in the diagnostic workup of headache? A retrospective record-based study in secondary health-care facility in Saudi Arabia
Ali Hassan A. Ali, Sameer Al-Ghamdi, Mohammed H Karrar, Saud A Alajmi, Osama S Almutairi, Ahmed M Aldalbahi, Yazeed M Alotaibi, Sattam A Alruwaili, Abubaker Y Elamin
March-April 2018, 7(2):357-361
DOI:10.4103/jfmpc.jfmpc_338_17  PMID:30090777
Introduction: Headache disorders are one of the most prevalent global public-health problems that require placing high demand on health-care Services. Since it is one of the most frequent complaints in clinical practice worldwide, it causes a considerable burden in terms of the social cost. The study aimed to give a guide for the decision on the utilization of computed tomography (CT) in the diagnostic workup and identify if patients require neurological imaging (CT) for proper diagnosis or not. Material s and Methods: The study was carried out in the Radiology Department in King Khalid Hospital, Al Kharj, Saudi Arabia from October 15, 2016, to February 15, 2017. A retrospective record-based study conducted using the documented CT reports in the files of patients whom were referred to the radiology department complaining of any type of a headache. Results: The data included 210 patients 51% were males and 49% were females. The patients were distributed into age groups; the mean age was 38.46 standard deviation ± 13.56. Among Saudi population, the etiology of headache was varying; the most prevalent type of headache was tension headache 25.71% of the total headache patients followed by cluster 25.24% and the migraine with the lowest proportionality. The majority of the patients' headache pain was mild 60%. Moreover, the CT reports for most of the patients were normal. Spearman Correlation test was used to see if there is a significance in using the CT for any patient who comes with symptoms including headache, and the results have shown that there is no association and clinical significance in using the CT for patients with headache without suspecting other clinical condition (P = 0.177). Conclusion: Headache disorders must be on the public-health agenda. Tension, migraine, and cluster-type headaches represent the majority of primary headaches. Statistically no significance or need to obtain CT if there are no life-threatening conditions expected or trauma presented.
  1,420 126 -
A case of hypertension with dementia: Common but underdiagnosed
Monika Pathania, Amisha , Paras Malik, Vyas Kumar Rathaur, Sunita Mittal
March-April 2018, 7(2):447-450
DOI:10.4103/jfmpc.jfmpc_312_17  PMID:30090792
We report a case of a 55-year-old known hypertensive female who presented with features suggestive of dementia, which, on further workup unveiled background dyslipidemia and type 2 diabetes mellitus. An magnetic resonance imaging of the brain revealed findings suggestive of Binswanger's disease. This is a discussion of this unusual disease and its presentation and the differentials of this presentation which may be encountered in general clinical practice.
  1,367 153 1
Development of a quality scoring tool to assess quality of discharge summaries
Stavros Savvopoulos, Tara Sampalli, Ruth Harding, Gail Blackmore, Sandra Janes, Kothai Kumanan, Rick Gibson, Chris MacKnight
March-April 2018, 7(2):394-400
DOI:10.4103/jfmpc.jfmpc_407_16  PMID:30090783
Introduction: Timely, precise, and relevant communication between hospital-based clinicians and primary care physicians post-discharge (DC) ensures quality transitions, thereby reducing patient safety incidents and preventing readmission. At the present time there is limited knowledge of elements of quality or methods to score the quality criteria in the context of DC summaries. The Nova Scotia Health Authority, a provincial health system responsible for the delivery of services in a small Canadian province, embarked on a system-level approach to the standardization of DC summaries in an effort to improve quality and safety at care transitions from hospital to primary care. Materials and Methods: A comprehensive literature review to retrieve items relevant to quality in DC summaries, retrospective audit of charts, a consensus development process, and, finally, validation of a scoring tool were conducted in order to develop a quality scoring tool for DC summaries. Results: Relevant items were identified through the literature review and consensus development process. Corresponding definitions that were established assisted the development of the quality criteria, which were subsequently used to score the quality of DC summaries in our organization. Conclusion: The scoring tool developed through this work will be applied to help us gain a more in-depth understanding of quality in DC summaries and support the development of suitable education and quality processes in the health authority that can best support safe care transitions for patients.
  1,305 152 3
A pilot study to determine the occurrence of concomitant diseases and drug intake in patients on antituberculosis therapy
Ratinder Jhaj, Shweta Sharma, Mohammed Sabir, Arun Kokane
March-April 2018, 7(2):414-419
DOI:10.4103/jfmpc.jfmpc_103_17  PMID:30090786
Introduction: Altered pharmacokinetics of antituberculosis (anti-TB) drugs due to interaction with non-TB medications or concomitant diseases may lead to suboptimal plasma levels of the affected drugs and hence contribute to the emergence of drug resistance in mycobacteria. Yet, few studies have investigated the prevalence of concomitant drug intake or concurrent diseases in patients on anti-TB therapy (ATT). The objective of this study is to study the prevalence of concomitant diseases and intake of non-TB drugs in patients on ATT. Methods: Adult patients who were undergoing treatment for TB at a directly observed treatment short-course (DOTS) center were interviewed to find out any concomitant drug intake and ailments they were suffering from. Data were also collected from the patients' treatment cards. Results: A total of 105 patients were interviewed for the study over a period of 1 month. Among these, 66 (62.9%) patients reported having taken a non-ATT drug in the last 3 months, 61 (58.1%) of which were drugs that may affect the ATT. A comparable number of patients (61 [58.1%]) reported suffering from one or the other concurrent illnesses or symptoms while on DOTS, including one patient with AIDS and eight with diabetes mellitus. Fluoroquinolones had been prescribed to four patients while on DOTS. Conclusion: A large proportion of the patients with TB were found to be on non-TB concomitant medications including drugs with potential for interactions that are capable of affecting ATT outcomes. It is, therefore, important that the patients and prescribing physicians be aware of any possible drug interactions.
  1,333 118 -
Evolution of family medicine residency training program in Dubai Health Authority: A 24-year review, challenges, and outcomes
Wadeia Mohammad AlSharief, Mahera Abdulrahman, Hamda Hassan Khansaheb, Shaima Amin Abdulghafoor, Ashraf Ahmed
March-April 2018, 7(2):425-429
DOI:10.4103/jfmpc.jfmpc_183_17  PMID:30090788
Introduction: It is well known that family medicine (FM) is a cornerstone for developing a community-based health-care system, and training family physicians is critical for the society. In Middle East, only 5%–10% of physicians, nurses, and health technicians are citizens. This demands more efforts toward having national FM practitioners in the country. The development of FM residency training program through the past two decades in Dubai has played a crucial rule in this aspect. Methods: The primary purpose of this study is to review the status of FM specialty training in the Emirates of Dubai throughout the past two decades. Results: The FM residency training program started since 1993 and had intake of 230 residents till 2017; out of which, 200 (87%) were female and 211 (92%) were the United Arab Emirates national. From 176 residents who are supposed to be graduated by 2017, 162 (92%) completed 4-year training, 132 (75%) has got the Arab Board certificate, and 116 (66%) qualified by the Membership of the Royal College of General Practitioners (MRCGP) international. Conclusion: The present study revealed that despite all challenges, the well-structured FM program enabled the graduates to reach high clinical, administrative, leadership, and academic positions such as consultant (40), chief executive officer (1), chief advisor for primary care (1), director (9), head of sections (9), head/deputy head of primary health center (55), head of academic affair center (1), chair of MRCGP international (1), program director of FM (4), MRCGP convener (6), MRCGP coordinator (6), and MRCGP examiner (42). However, the program is still lacking certification by an international accreditation body. This will help in reaching a better balance between education and clinical duties for all trainers and faculty; and will positively advocate support for an environment conducive to learning for residents as well as faculty members.
  1,314 124 -
Evaluation of out-patient prescriptions in rural part of central Gujarat
Nitin Kothari, Anuradha Joshi, Jatin Buch
March-April 2018, 7(2):401-405
DOI:10.4103/jfmpc.jfmpc_424_16  PMID:30090784
Background: The prescription error is a failure in the prescription writing process leading to wrong instructions about the identity of the recipient, the identity of the drug, the formulation, dose, route, timing, frequency, and duration of administration. This study is an effort directed to find errors in prescription writing and interventions to improve on such error-prone practices of prescription writing. Methods: This was a cross-sectional, observational study conducted to analyze the prescription writing errors in the outpatient department in the rural area of Anand district of Central Gujarat. Prescriptions were collected from two nearby rural areas of Anand city-Petlad and Anklav. The prescription copies so-obtained were analyzed as per the WHO guidelines for “Prescription Writing Errors.” Results: Overall, 191 prescriptions were collected from both rural areas in the study. The highest number of prescriptions was collected from general practitioners, followed by surgeons and gynecologists. Name, qualification, and address of prescribers were mentioned in all the prescriptions while registration number was mentioned only in 14.10% of prescriptions. The esoteric symbol was mentioned in 63% of prescriptions. Prescribers signed their prescription only in 48% of prescriptions. A total of 420 drugs were prescribed to the patients in the study. All but one drug were prescribed by brand name. Dosage form and route of administration of drugs were mentioned in >60% of drugs. Conclusion: Most medical schools provide some training in prescribing to medical undergraduates; however, this training is perceived to be suboptimal by medical students and junior doctors. Such training programs are the need of the hour.
  1,268 121 -
An uncommon cause of osteoporosis
Rohit Barnabas, Basavaraj Soora Gauda, Kripa Elizabeth Cherian, Nitin Kapoor, Hesarghatta Shyamasunder Asha, Thomas Vizhalil Paul
March-April 2018, 7(2):455-457
DOI:10.4103/jfmpc.jfmpc_350_17  PMID:30090794
Osteoporosis in the younger age group is an important cause of morbidity. Prolactinoma is an uncommon but reversible cause of osteoporosis. The main mechanisms of osteoporosis in prolactinoma are reduced osteoblast activity and hypogonadism. A high index of suspicion is the key in diagnosis and management of this treatable entity.
  1,183 124 -
A case of liver cirrhosis and Chilaiditi syndrome with atypical pneumonitis
Priyanka Krishna, Prasan Kumar Panda, Sudarsan Hariprasad, Shiv Shankar Singh, SR Gedela
March-April 2018, 7(2):471-474
DOI:10.4103/jfmpc.jfmpc_202_17  PMID:30090799
Respiratory distress is very uncommon as a presenting symptom of Chilaiditi syndrome. Furthermore, pneumonia is not documented with the syndrome, compromising further to the distress. We describe a middle-aged man, chronic alcoholic, recently diagnosed with liver cirrhosis, presented with a 1-year history of slowly progressive breathlessness. Recently, he developed mild-to-moderate hemoptysis and cough with aggravation of breathlessness. He did not have fever, chest pain, or orthopnea. He was cyanosed, requiring high-dose oxygen therapy. Later on, he stabilized with noninvasive ventilation. Chest imagings showed incidental Chilaiditi sign, liver cirrhosis, and atypical pneumonitis. With empirical antibiotics and high-dose steroid, he recovered completely but with baseline breathlessness. Here, we outline Chilaiditi syndrome as a rare association or manifestation of liver cirrhosis, and it can present with a respiratory compromise by both obstructive lung disease and atypical interstitial pneumonia. Early identification, vaccinations against common organisms, and possible early surgery may prevent morbidity and mortality of this type of patients.
  1,169 116 -
A fluttering coronary event
Ali Zakaria, Bayan Al Share, Georgy Kaspar, Delano Small
March-April 2018, 7(2):468-470
DOI:10.4103/jfmpc.jfmpc_117_17  PMID:30090798
Acute coronary syndrome (ACS) is a term used to describe a spectrum of diseases associated with sudden reduced blood flow to the heart. Coronary artery thromboembolism is recognized as an important nonatherosclerotic cause of acute myocardial infarctions in 2.9% of ACS cases, with a long-term outcome indicating that coronary embolism patients represent a high-risk subpopulation. There are various risk factors for developing a coronary thromboembolism, with atrial fibrillation being the most frequently reported cause. Herein, we are presenting a case of a 65-year-old female patient who presented to the emergency department with sudden-onset pressure-like chest pain diagnosed as ACS due to nonatherosclerotic thromboembolism secondary to atrial flutter.
  1,159 98 2
Wonca rural South Asia and WONCA SAR conference: All about empowering rural health care
Pratyush Kumar
March-April 2018, 7(2):477-478
DOI:10.4103/jfmpc.jfmpc_77_16  PMID:30090801
  1,121 83 -
Sitagliptin-induced diffuse alveolar hemorrhage mimicking pulmonary edema
Ryota Kikuchi, Hiroyuki Nakamura, Kazutetsu Aoshiba
March-April 2018, 7(2):480-481
DOI:10.4103/jfmpc.jfmpc_160_17  PMID:30090803
  996 102 1
Profession's future: A concerned physician easily available
Ajay Kumar Khandal
March-April 2018, 7(2):482-483
DOI:10.4103/jfmpc.jfmpc_184_17  PMID:30090804
  976 84 -
Doctor in default?
Ajaya K Upadhyaya
March-April 2018, 7(2):288-290
DOI:10.4103/jfmpc.jfmpc_51_18  PMID:30090766
  951 96 -
Purple urine bag as indicator of multidrug-resistant vulvar abscess: Lessons for primary caregivers
Ganesh Singh Dharmshaktu, Tanuja Pangtey
March-April 2018, 7(2):484-485
DOI:10.4103/jfmpc.jfmpc_230_17  PMID:30090805
  933 97 1
Coxsackie encephalitis in a child in Western India: Correspondence
Anirban Mandal, Puneet Kaur Sahi
March-April 2018, 7(2):479-479
DOI:10.4103/jfmpc.jfmpc_294_17  PMID:30090802
  932 82 -
A comment on “lacunae in noncommunicable disease control program: Need to focus on adherence issues”
Saurav Basu
March-April 2018, 7(2):475-476
DOI:10.4103/jfmpc.jfmpc_365_17  PMID:30090800
  904 89 -