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   2020| July  | Volume 9 | Issue 7  
    Online since July 30, 2020

 
 
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CLINICAL MANAGEMENT GUIDELINE
Short Term Home Oxygen Therapy for COVID-19 patients: The COVID-HOT algorithm
Indrani Sardesai, Joydeep Grover, Manish Garg, P W B Nanayakkara, Salvatore Di Somma, Lorenzo Paladino, Harry L Anderson III, David Gaieski, Sagar C Galwankar, Stanislaw P Stawicki
July 2020, 9(7):3209-3219
DOI:10.4103/jfmpc.jfmpc_1044_20  
Innovative solutions are required to effectively address the unprecedented surge of demand on our healthcare systems created by the COVID-19 pandemic. Home treatment and monitoring of patients who are asymptomatic or mildly symptomatic can be readily implemented to ameliorate the health system burden while maintaining safety and effectiveness of care. Such endeavor requires careful triage and coordination, telemedicine and technology support, workforce and education, as well as robust infrastructure. In the understandable paucity of evidence-based, protocolized approaches toward HOT for COVID-19 patients, our group has created the current document based on the cumulative experience of members of the Joint ACAIM-WACEM COVID-19 Clinical Management Taskforce. Utilizing available evidence-based resources and extensive front-line experience, the authors have suggested a pragmatic pathway for providing safe and effective home oxygen therapy in the community setting.
  19,209 729 1
ORIGINAL ARTICLES
An epidemiological study to assess periodontal status among sugar factory workers of Karad taluka using community periodontal index
S Sankethguddad, Keshava Abbayya, Girish Suragimath, KA Kamala, SG Sujith
July 2020, 9(7):3480-3486
DOI:10.4103/jfmpc.jfmpc_151_20  
Objectives: Oral health is an integral component of general health. Periodontal disease is one of the most prevalent dental diseases among the population. Researchers have identified an association of various risk factors with periodontal disease. The study aimed to assess the periodontal status among the sugar factory workers of Karad taluka. Materials and Methods: The study was conducted among 1200 subjects in the age group of 25-54 years. Personal and sociodemographic data were recorded in the proforma based on the WHO oral health survey form (1997). Periodontal status was assessed using community periodontal index (CPI). For statistical analyses, Chi-square test and Multiple Logistic Regression analyses was performed. Results: The sociodemographic characteristics (age, sex, and socioeconomic status) and deleterious habits like tobacco chewing and smoking were found to be significantly associated with the CPI and LoA scores for the population (P < 0.00001). Conclusion: The analysis of the results obtained in this epidemiological study evidenced that periodontitis is prevalent among the sugar factory workers of Karad taluka. There is a need for emphasis on the preventive care.
  11,301 73 -
Post cholecystectomy common bile duct dilatation and associated symptomatology
Rajan Sood, Dinesh Sharma, Girish Sharma, Shailendra Kaushik
July 2020, 9(7):3464-3469
DOI:10.4103/jfmpc.jfmpc_694_20  
Background: Relationship between postcholecystectomy bile duct dilatation and associated symptomatology is a potential dilemma for treating surgeon for which various studies with variable results have been documented. Materials and Methods: This study is a 1 year prospective study conducted at IGMC, Shimla after taking proper consent and ethical approval from institutional ethical committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in surgical wards of IGMC, Shimla for elective surgery were selected for present study. Cholecystectomy was done in all cases after doing all investigations. Results: Postoperatively within 48 h symptoms were observed in 29 patients. Out of these, flatulence was present in 1, nausea and vomiting in 7 and 8, respectively. Combined flatulence vomiting in 5 and flatulence-reflux-nausea in 1 patient. After 1 month of interval, all patients were symptom free. Conclusion: Symptoms which were present in the postoperative patients were unrelated to dilatation of common bile duct. Either these symptoms were the persistent symptoms present before the operation or related to anaesthetic drugs.
  3,475 99 -
Burden of internet addiction, social anxiety and social phobia among University students, India
Abhishek Jaiswal, Shubham Manchanda, Vaishali Gautam, Akhil D Goel, Jitender Aneja, Pankaja R Raghav
July 2020, 9(7):3607-3612
DOI:10.4103/jfmpc.jfmpc_360_20  
Background: Social anxiety disorder (SAD) is a common mental health disorder affecting adolescents often associated with comorbidities like depression, suicide ideation and substance abuse. The objective of this study was to estimate the prevalence of social anxiety in adolescents and to explore its correlation with internet usage. Methods: An exploratory cross-sectional study was conducted among 307 undergraduate students to screen for social anxiety and social phobia using a validated instrument, social interaction anxiety scale (SIAS). Young's internet addiction scale was used for measuring internet addiction. Respondents were categorised according to the scores obtained and later compared with their internet addiction behaviours. Results: Internet addiction was seen in 93.8% of respondents. The prevalence of SAD was estimated to be 15.3%. Internet addiction was positively correlated with social anxiety score (Pearson correlation = 0.994, P < 0.001). Conclusion: More than 90% of participants had internet addiction, the majority had mild-moderate internet addiction. Social anxiety was present in more than one-third of the participants. SAD was found to be associated with internet addiction.
  3,160 316 -
EDITORIAL
Community-based palliative care during the COVID 19 pandemic
Shrikant Atreya, Raman Kumar, Naveen Salins
July 2020, 9(7):3169-3175
DOI:10.4103/jfmpc.jfmpc_1144_20  
Novel Coronavirus (COVID 19) has usurped human peace and mobility. Since December 2019, the virus has claimed the lives of 87,816 people across the globe as of April 9, 2020 with India reporting a high case fatality of 3.4%. Among the vulnerable population, elderly people, and patients with comorbidities such as diabetes, chronic life-threatening illnesses, such as COPD and advanced malignancies are susceptible to COVID-19 infection and may have poor clinical outcomes. Considering the imbalance in demand and supply of healthcare resources, initiating palliative care will be essential to alleviate the suffering of such patients. The current paper deliberates on the following aspects of palliative care delivery in the community; the need for palliative care in a pandemic crisis, the role of telemedicine in palliative care delivery in the community, the vital role of a family physician in providing primary palliative care in the community and a “wholistic” community palliative care package to serve the needy in the community.
  2,820 355 2
ORIGINAL ARTICLES
Utilisation of Anganwadi services among pregnant women in rural Telangana: A cross sectional study
BN Harikrishna, Kishore Y Jothula, K Nagaraj, VG Prasad
July 2020, 9(7):3343-3348
DOI:10.4103/jfmpc.jfmpc_408_20  
Background: Anganwadi centers were providing integrated services comprising supplementary nutrition, immunization, health check-up, and referral services to children below six years of age and expectant and nursing mothers. After more than three decades of implementation, the success of Integrated Child Development Services (ICDS) program in tackling maternal and childhood problems still remains a matter of concern. Objectives: To estimate the proportion of pregnant women utilizing various services provided by the anganwadi centre. To assess the association between demographic factors and utilization of anganwadi services by pregnant women. Methods: A cross-sectional study with a sample size of 135 was conducted in three villages attached to a medical college. Pregnant women enrolled in anganwadi the center were included in the study. Data was collected by a predesigned pretested semi-structured questionnaire. Data was presented in proportions, odds ratio with confidence interval, and Chi-square test, Fisher test was applied to find the association between variables by using SPSS ver. 23. Results: The study showed 86.66% utilized supplementary nutrition services, 62.96% received health education, 85.92% took vaccines from anganwadi centre, 40.74% utilized referral services, and 82.22% utilized health checkups services provided by anganwadi centre. Distance from the centre was found to be an important determinant of the utilization of anganwadi services. Conclusions: There is a need to sensitize and motivate beneficiaries to utilize the services offered by anganwadi center.
  2,973 147 -
REVIEW ARTICLES
Primary care physician's approach for mental health impact of COVID-19
Jitendra Rohilla, Pinki Tak, Shubham Jhanwar, Shazia Hasan
July 2020, 9(7):3189-3194
DOI:10.4103/jfmpc.jfmpc_513_20  
As the world struggles to control coronavirus infection with the exhausting capacity of health care systems globally, the role of primary care physician and family physician becomes more important as the first point of contact with the community. Limited availability of mental health services in India requires general practitioners to deal with psychological disorders arising due to infection outbreak and its restrictive control strategies. This article discusses what and how primary physicians can manage the psychological burden of a pandemic, and therefore, reducing the reliance on mental health specialist.
  2,174 367 3
ORIGINAL ARTICLES
Japanese encephalitis in Uttar Pradesh, India: A situational analysis
Anil K Singh, Pradip Kharya, Vikasendu Agarwal, Soni Singh, Naresh P Singh, Pankaj K Jain, Sandip Kumar, Prashant K Bajpai, Anand M Dixit, Ramit K Singh, Tanya Agarwal
July 2020, 9(7):3716-3721
DOI:10.4103/jfmpc.jfmpc_449_20  
Introduction: Japanese encephalitis (JE) is a vector-borne, viral illness caused by the Japanese Encephalitis Virus. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis; hence, JE is a cause of major public health concern. For the ease of diagnosis and facilitation of surveillance, National Vector Borne Disease Control Programme uses the term Acute Encephalitis Syndrome (AES). In this study, an attempt has been made to ascertain the status and trends of AES and JE in Uttar Pradesh, India. Methodology: This is a record-based retrospective study. The data were obtained from the Directorate of Medical and Health Services of Uttar Pradesh and analyzed using software SPSS version 24.0. Results: In Uttar Pradesh, there were 47,509 reported cases of AES from 2005 to 2018,. With yearly fluctuations, the average Case Fatality Rate of AES was 17.49% with highest in 2005 (24.76%) and lowest in 2018 (8%). Among the patients with AES, 9.98% were found positive for JE. The most commonly affected age group is 1-5 years for both AES and JE, closely followed by the age group of 5-10 years. Peak occurrence of both AES and JE was recorded in month of September. Among the AES-affected patients 53.8% were males and 46.2% were females. Conclusion: The most commonly affected age group was 1-5 years with peak occurrence in the month of September. Though there was a downward trend in CFR, awareness activities like “Dastak” campaign and intersectoral preventive activities, needs to be strengthened.
  2,322 157 -
CASE REPORTS
Hepatitis A: A refreshing perspective through a rare symptom in a teaching hospital in south India
Shashank Shastry, Ramyasri Rajesh, Samarth Sangamesh, Gosavi Siddharth
July 2020, 9(7):3749-3752
DOI:10.4103/jfmpc.jfmpc_549_20  
Hepatitis A virus is a common cause of acute viral hepatitis in India, due to lack of clean water and sanitation. Usual presentations include gastroenteritis or a viral respiratory infection. Hepatitis A has a variety of extra-hepatic manifestations which, if failed to be recognized, evades diagnosis. A 28-year-old lady presented with pain abdomen for 1 week, fever with rashes for 1 day. Patient was febrile at the time of examination. Rash was maculopapular with irregular edges, tender. On examining abdomen, tenderness noted in right hypochondrium and epigastrium with hepatomegaly. Patient was then admitted. Working diagnosis was Viral hepatitis for evaluation. Hepatitis A serology was sent which came positive for Ig M. Patient was treated with IV fluids, bile acid sequestrants, IV PPI, IV and oral antibiotics, antihistamines and 3 doses of injection Vit K. Calamine lotion was also given for skin care. Patient improved symptomatically in 2 days and was discharged after 3 days of hospital stay. In our case, the maculopapular rash spreading to the whole body was the major presenting symptom. The presentation of Hepatitis A with rashes maybe seen in around 10% of patients with extrahepatic manifestations along with arthralgia. Differential diagnosis in this case should be erythema multiforme which is the most common maculopapular eruptive rash. Other viral hepatitis causing agents (Hepatitis B&E) have been documented to present with rashes. SLE and Kawasaki disease rarely present with fever with rash with nonspecific multisystemic involvement. Borrelia, Leptospira also have icterus in their presentations. Early diagnosis and management in this case prevented complication such as autoimmune hepatitis, pleural effusion, ascites acute kidney injury. This case presentation urges the need to consider Hepatitis A to be an important differential diagnosis of fever with rash especially in tropical/sub-tropical countries with poor sanitation.
  2,140 113 -
ORIGINAL ARTICLES
A prospective interventional study to evaluate the effects of medical therapy (Mifepristone 25 mg) on the management of uterine fibroids
Meeta Gupta, Narita Jamwal, Sumeet Sabharwal, Shalini Sobti
July 2020, 9(7):3230-3235
DOI:10.4103/jfmpc.jfmpc_467_20  
Background and Objectives: In India, the uterine fibroid is a common indication of hysterectomy. An effective option for medical treatment may decrease the morbidity associated with hysterectomy. We aimed to evaluate the effect of mifepristone (25 mg), progesterone antagonist, on uterine fibroids in perimenopausal women. Methods: Fifty-four perimenopausal women of age ≥18 years having symptomatic uterine fibroids were selected from Gynecology OPD and given 25 mg mifepristone once daily continuously for 2–4 cycles of 3 months each. Variables such as baseline fibroid size, position, and hemoglobin were measured and followed at 3, 6, 9, and 12 months. The data were entered in MS EXCEL spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. A P value of <0.05 was considered statistically significant. Results: Majority were intramural fibroids (70.37%) followed by submucosal in 16.67%. Size of fibroids ranged from <3 to >7 cm; the majority of fibroids were in 5–7 cm size. No significant association of location with the size of fibroid was found. Out of 54 cases included in the study, change in size in uterine fibroids was observed in 98.14% cases. There was an increase in hemoglobin, from 8.6 g% at baseline to 9.7 g% at 12 months. Conclusion: Mifepristone resulted in a reduction in uterine fibroids size and an increase in hemoglobin at the end of 12 months. It may be an option for uterine leiomyoma treatment, as it is given orally, cost-effective and has minimal side effects.
  2,066 172 -
A study on effect of yoga on emotional regulation, self-esteem, and feelings of adolescents
Yasmin Janjhua, Rashmi Chaudhary, Nishant Sharma, Krishan Kumar
July 2020, 9(7):3381-3386
DOI:10.4103/jfmpc.jfmpc_153_20  
Background: The present study has investigated the effect of yoga on the emotional regulation, self-esteem, and feelings of the adolescents. Methods: The participants of the study are 110 students aged 13–18 years and studying in the senior secondary schools of Mandi district (Himachal Pradesh). The sample consisted of 52 adolescents practicing yoga and 58 adolescents who have never practiced yoga. The primary data has been collected through standardized instruments. Results: The adolescents practicing yoga were noted to significantly differ from the non-yoga group on emotional regulation, self-esteem, and feeling components. Conclusions: The significant effect of yoga on emotional regulation, self-esteem, and feelings of the adolescents calls for attention of the policy makers for initiating yoga at the school levels through standardized yoga curricula and training teachers to motivate and inspire the students to learn and practice yoga at an early age.
  1,746 202 -
REVIEW ARTICLES
Planetary health and the role of community health workers
Manas R Behera, Deepanjali Behera, Sudhir K Satpathy
July 2020, 9(7):3183-3188
DOI:10.4103/jfmpc.jfmpc_328_20  
In this era, grand challenges lies in biodiversity loss, climate change, and global noncommunicable diseases signify that planet and humanity are in crisis. Scholarly evidence from human and animal kingdom suggest that there is an optimism in planetary health which can provide a unique and novel concept where efforts toward survival and remediation can be made. With accurate navigation, the current challenges can be mitigated leading to a new reality, one in which the core value is the well-being of all. This paper discusses the drivers of planetary health and the role of community health workers (CHWs) in making health-care system more resilient that can produce multiple benefits to community and overall planetary health. A web-based international database such as Google, Google Scholar, SCOPUS/MEDLINE/PubMed, and JSTOR was searched relevant to a planetary health framework. The study findings suggest that CHWs can offer health care interventions through environmental health cobenefits across the spectrum of health effects of climate change cause and effects. These actions have been divided into four major categories (i. health care promotion and prevention, ii. health care strengthening, iii. advocacy, and iv. education and research) that CHWs perform through a variety of roles and functions they are engaged in protecting planetary health. CHWs contribute toward achieving sustainable development goals such as planetary health and focus on environment sustainability and well-being of entire mankind.
  1,699 246 -
ORIGINAL ARTICLES
Smartphone addiction and its complications related to health and daily activities among university students in Saudi Arabia: A multicenter study
Abdulrahman Alkhateeb, Rashid Alboali, Waleed Alharbi, Olfat Saleh
July 2020, 9(7):3220-3224
DOI:10.4103/jfmpc.jfmpc_1224_19  
Aim: The aims of this study were to study the prevalence of smartphones addiction among college and university students in Kingdom of Saudi Arabia (KSA), and to determine the risk factors and complications associated with smartphone addiction. Method: This study was conducted in all provinces of KSA from December 2015 to June 2016 by sending questionnaire to student clubs of various universities through Survey Monkey. Questionnaire included (1) sociodemographics, (2) smartphone usage patterns and addiction behavior, (3) impact of smartphone usage on driving and medical complications, and (4) smartphone addiction scale. Result: The total number of participants was 1941 (response rate 80.9%) students representing most of the provinces of Saudi Arabia. The prevalence of smartphones addiction was 19.1%. Female participants were more addicted than male participants (P < 0.001). Smartphone addition was also significantly associated with musculoskeletal complication, upper limb, eyes and sleep complications. Conclusion: High frequent usage with prolonged duration of smartphone was associated with high risk to addiction. Furthermore, smartphone addiction had significant impact on performing daily activities, sleeping disorder, and health problems. Awareness about harm of smartphones addiction is required to provide to students and parents as well. Smartphones should not be given at younger age and it only be given when a child can differentiate its healthy and productive use from addiction.
  1,624 230 1
LETTERS TO EDITOR
Mock drill activity: Are we really prepared to tackle COVID-19 pandemic?
Harinder Singh, Sumit Chawla, Bharti , Ishan Arora
July 2020, 9(7):3778-3780
DOI:10.4103/jfmpc.jfmpc_626_20  
  1,638 142 -
ORIGINAL ARTICLES
Post-stroke BDNF concentration changes following proprioceptive neuromuscular facilitation (PNF) exercises
Poonam Chaturvedi, Ajai Kumar Singh, Vandana Tiwari, Anup Kumar Thacker
July 2020, 9(7):3361-3369
DOI:10.4103/jfmpc.jfmpc_1051_19  
Background: Brain-derived neurotrophic factor (BDNF) plays an important role in repairing normal as well as in the injured brain. Physical exercise may have a positive impact on the release of BDNF. Objective: PNF is a neurophysiological approach that facilitates the stimulation of central and peripheral nervous systems. In this study, our aim was to assess the levels of BDNF as well as functional recovery before and after the intervention of PNF in patients with acute stroke. Methods: A total of 208 patients with first time confirmed stroke were recruited and assessed for stroke severity, type, mini-mental state exam (MMSE), functional independence measure scale, and BDNF levels before and after PNF intervention. BDNF levels were also assessed in healthy individuals for control values. Results: A significant decline in levels of BDNF was observed after in stroke. BDNF levels in patients (with different risk factors) with diabetes, hypertension and DM+ HTN, alcohol, and smoking history were 8.8 ± 4.04 ng/mL, 8.86 ± 4.68 ng/mL, 8.65 ± 3.26 ng/mL, 8.51 ± 4.26 ng/mL, and 8.9 ± 3.4 ng/mL, respectively. A decline in BDNF levels was observed in accordance with the severity of stroke in both ischemic and hemorrhagic stroke with the least level being in severe stroke (NIHSS >15 and ICH >3). Despite the type of stroke and the presence of risk factors, a significant improvement in BDNF levels and FIM scale scores was seen in all subjects who received PNF exercises. Conclusion: Thus, PNF is efficient in improving functional level in acute stroke irrespective of the type of stroke and risk factors.
  1,450 256 2
LETTERS TO EDITOR
COVID-19 is accelerating the acceptance of telemedicine in India
Durjoy Lahiri, Sonali Mitra
July 2020, 9(7):3785-3786
DOI:10.4103/jfmpc.jfmpc_580_20  
  1,481 116 2
ORIGINAL ARTICLES
Oral versus intravenous iron therapy in iron deficiency anemia: An observational study
Samarendra N Das, Amruta Devi, Bibhuti B Mohanta, Anurag Choudhury, Abinash Swain, Pravat K Thatoi
July 2020, 9(7):3619-3622
DOI:10.4103/jfmpc.jfmpc_559_20  
Background: Intravenous (IV) iron sucrose is claimed to have better safety profile and efficacy in treatment of iron deficiency anemia than conventional oral iron supplements. Aim: The aim of the study was to compare the efficacy and safety of IV iron therapy with oral iron supplements in iron deficiency anemia. Methods: An observational study was carried out by allocating 100 patients with baseline hemoglobin between 5 and 10 g/dL into two groups of oral iron and IV iron group. Hemoglobin and serum ferritin levels were measured at admission, on day 14 and on day 28. Adverse effect profile for each group was tabulated. Mean and standard deviation were calculated for each group and compared. Results: A total of 100 patients participated consisting of 37 males and 63 females. Baseline hemoglobin and serum ferritin for both groups were comparable. After initiation of therapy, hemoglobin in oral iron group raised from 6.45 (0.72) to 8.84 (0.47) on day 14 and to 9.69 (0.47) on day 28. Hemoglobin in IV iron group increased from 6.34 (0.86) to 10.52 (0.61) on day 14 and to 11.66 (0.84) on day 28. Serum ferritin in oral iron group increased from 8.3 (1.9) to 33.8 (1.29) on day 14 and to 43.61 (8.8) on day 28. Serum ferritin in IV iron group raised from 8.23 (4.64) to 148.23 (11.86) on day 14 but decreased to 115.76 (15.3) on day 28. The data were statistically significant for IV iron therapy on day 14 and day 28. Of 100 patients, 18 patients (12 in oral and 6 in IV iron groups) had adverse effects. Among the oral iron group, metallic taste and constipation were major side effects followed by heart burn and nausea. In the IV iron group, arthralgia (4 patients of 6) was the major side effect observed. One patient (of 6) in IV group had hypotension. Anaphylaxis was not observed in any patient in either group. Conclusion: IV iron therapy is effective and safe for management of iron deficiency anemia.
  1,403 179 1
Psychometric analysis of multiple-choice questions in an innovative curriculum in Kingdom of Saudi Arabia
Karim Eldin. M. A Salih, Abubakar Jibo, Masoud Ishaq, Sameer Khan, Osama A Mohammed, Abdullah M AL-Shahrani, Mohammed Abbas
July 2020, 9(7):3663-3668
DOI:10.4103/jfmpc.jfmpc_358_20  
Background and Aims: Worldwide, medical education and assessment of medical students are evolving. Psychometric analysis of the adopted assessment methods is thus, necessary for an efficient, reliable, valid and evidence based approach to the assessment of the students. The objective of this study was to determine the pattern of psychometric analysis of our courses conducted in the academic year 2018-2019, in an innovative curriculum. Methods: It was a cross-sectional-design study involving review of examination items over one academic session -2018/2019. All exam item analysis of courses completed within the three phases of the year were analyzed using SPSS V20 statistical software. Results: There were 24 courses conducted during the academic year 2018-2019, across the three academic phases. The total examination items were 1073 with 3219 distractors in one of four best option multiple choice questions (MCQs). The item analysis showed that the mean difficulty index (DIF I) was 79.1 ± 3.3. Items with good discrimination have a mean of 65 ± 11.2 and a distractor efficiency of 80.9%. Reliability Index (Kr20) across all exams in the three phases was 0.75. There was a significant difference within the examination items block (F = 12.31, F critical = 3.33, P < 0.05) across all the phases of the courses taken by the students. Similarly, significant differences existed among the three phases of the courses taken (F ratio = 12.44, F critical 4.10, P < 0.05). Conclusion: The psychometric analysis showed that the quality of examination questions was valid and reliable. Though differences were observed in items quality between different phases of study as well as within courses of study, it has generally remained consistent throughout the session. More efforts need to be channeled towards improving the quality in the future is recommended.
  1,443 106 -
Compliance to iron-folic-acid supplementation and associated factors among pregnant women: A cross-sectional survey in a district of West Bengal, India
Saha Debi, Gandhari Basu, Reshmi Mondal, Sreetama Chakrabarti, Suman K Roy, Shubhamoy Ghosh
July 2020, 9(7):3613-3618
DOI:10.4103/jfmpc.jfmpc_392_20  
Background: Iron-deficiency anemia is considered to be a major health problem in India. This can complicate a normal pregnancy resulting in poor maternal and fetal outcomes. Iron-folic-acid (IFA) supplementation to antenatal and postnatal mothers given through the National Health Mission (NHM) serves as a major tool to combat this problem. Aim: This study aimed to assess compliance to IFA supplement and associated factors among antenatal mothers in a district of West Bengal, India. Methods: A cross-sectional observational study was conducted among 208 pregnant mothers attending different subcenters, using multistage sampling technique. Data were collected on their demographic, obstetric profile, compliance to IFA tablets, and knowledge on various health care-related factors through direct interviews. Data were analyzed using SPSS 22.0 (licensed) considering the confidence interval to be 95%. Results: Compliance rate was 81.74%. The most common cause of noncompliance was forgetfulness (73.7%). On multivariate regression analysis, age, history of deworming, and education became the significant predictors for noncompliance to IFA. Conclusions: Compliance to IFA supplementation was better than the national average, although deworming and education can lead to a better outcome. Health workers played a pivotal role for the success of this national program.
  1,332 147 -
Factors associated with deaf-mutism in children attending special schools of rural central India: A survey
Sirjan Singh, Shraddha Jain
July 2020, 9(7):3256-3263
DOI:10.4103/jfmpc.jfmpc_222_20  
Background: Effects of hearing loss on the development of a child's ability to learn, to communicate, and to socialize can be devastating. If no auditory rehabilitation is done by peri-lingual period, the child develops permanent speech problems. The cases included in this category will be those having hearing loss more than 90 dB in the better ear or total loss of hearing in both the ears. Brainstem Evoked Response Audiometry (BERA)/Auditory Brainstem response (ABR) has been established as the most reliable screening tool for hearing assessment in neonates. Objectives: To perform a questionnaire-based survey of parents of children attending special schools for deaf–mutism, to find out the major medical, socio-demographic, and health service-related risk factors for deaf–- mutism. To perform screening for all these children in special schools for deaf and mute to get the major cause leading to their deaf–mutism in a given rural area in central India. Methodology: A cross-sectional study was done with deaf and mute students from special schools. A questionnaire was used to assess any complications in the antenatal, perinatal, and postnatal period. Thorough otorhinolaryngologic clinical examination was carried out with special attention to branchial arch anomalies and BERA was done to evaluate the deafness in individual and appropriate response is mentioned. Result: This study concluded neonatal septicemia, prematurity, low birth weight, consanguinity, and birth asphyxia as the most common risk factor for deafness in children. In this study, waiting for improvement on behalf of parents and misguidance by doctors posed the most common additional risk factor for mutism. Financial constraint and taking the matter of lack of hearing lightly were the most important reasons, which forced parents to opt for special schools and their inability to utilize the benefit of the cochlear implant.
  1,294 152 -
Knowledge, attitude, and breast-feeding practices of postnatal mothers in Jammu: A community hospital based cross sectional study
Kiran Bala, Bhavna Sahni, Shalli Bavoria, Akash Narangyal
July 2020, 9(7):3433-3437
DOI:10.4103/jfmpc.jfmpc_333_20  
Context: In spite of convincing evidence of the benefits of breastfeeding, breast feeding rates are less than satisfactory, thus pinpointing large gaps, which need to be identified and addressed.Aims: To examine the knowledge, attitude and practices of postnatal mothers towards breast feeding.Settings and Design: Community Hospital-based CrossSectional study. Methods and Materials: The study was done for a period of 4 months among 178 women attending outpatient department of paediatrics. Data collection was done with the help of face to face interview using pre-tested pre-designed structured questionnaire having information about demographic profile of study participants and knowledge, attitude and practices of breast feeding.Statistical Analysis Used: The data was presented as frequencies and percentages. Results: Majority (89.9%) of the mothers were breast feeding, however, only 42.7% of the mothers exclusively breast fed their kids. 82.5% of the mothers believe that cow's milk can be substituted for breast milk. All the mothers continue to breast fed their babies during sickness. Almost all respondents were aware of the importance of colostrum, while 80.3% had the misconception that they should stop breast feeding once when weaning was started.Conclusions: Mothers should be counselled during antenatal period and all the misconceptions regarding breast feeding should be appropriately addressed.
  1,292 142 -
Neck pain among undergraduate medical students in a premier institute of central India: A cross-sectional study of prevalence and associated factors
Prateek Behera, Anindo Majumdar, G Revadi, John Ashutosh Santoshi, Vivek Nagar, Nitu Mishra
July 2020, 9(7):3574-3581
DOI:10.4103/jfmpc.jfmpc_206_20  
Context: Competitive exams conducted for undergraduate and postgraduate medical courses in India are tough. The undergraduate course is additionally taxing to the students' health. Lack of physical activity, the stress of studies, and universal adoption of different gadgets make the undergraduate medical students prone to develop musculoskeletal pain-related issues. Aims: This study aimed to evaluate the prevalence of neck pain and the associated factors including gadget use among undergraduate medical students of a premier medical college in central India. Settings and Design: All undergraduate medical students including the interns of our institute were enrolled for this cross-sectional study. Methods and Materials: A self-explanatory internet-based questionnaire prepared using Kobo Toolbox was circulated via WhatsApp and email by the class representative of each batch of students. The responses obtained were analyzed using Statistical Package for the Social Sciences (SPSS). Statistical Analysis Used: Proportions and means were calculated. Chi-square test and univariable logistic regression analysis were used. Results: Three hundred thirty-one valid responses out of 423 responses were analyzed. In total, 58.3% of 331 students suffered from neck pain within the last one year. Students in the 3rd and 4th year had 2.9 times higher odds of current neck pain in comparison to 1st-year students. History of neck pain before joining the course was associated with a higher risk of having current neck pain. Self-perceived aggravation of pain from gadget use had significantly higher odds of contributing to the current episode of neck pain. Conclusions: Neck pain is not uncommon among undergraduate medical students. History of previous neck pain including that during schooling makes a student prone for the current episode of pain. Academic stress, smartphone and laptop use tend to aggravate the pain in those who have neck pain.
  1,212 162 -
REVIEW ARTICLES
How bitter taste influences nutrition and health in primary care
Stefania C Bray, Peter J Carek
July 2020, 9(7):3205-3208
DOI:10.4103/jfmpc.jfmpc_305_20  
Sensitivity to bitter tastes has a genetic basis which is partly mediated by the TAS2R3 gene. Existing research on how this gene influences dietary habits and successful strategies for encouraging the incorporation of additional fruits and vegetables into individuals' diets is discussed. We propose that knowledge of a patient's status TAS2R3 genotype could help physicians develop personalized nutritional strategies using exposure and associative conditioning techniques to encourage optimal nutrition.
  1,200 107 -
ORIGINAL ARTICLES
Prevalence of hypertension and diabetes morbidity among adults in a few urban slums of Bangalore city, determinants of its risk factors and opportunities for control – A cross-sectional study
Vinod K Ramani, KP Suresh
July 2020, 9(7):3264-3271
DOI:10.4103/jfmpc.jfmpc_234_20  
Introduction: In World Health Organization's(WHO) South-East Asia region(SEAR), India accounts for >2/3rd of total deaths due to non-communicable diseases(NCD). Annually, NCDs account for ~60% of all deaths in India. Apart from the known risk factors, an individual's physical environment, behavioral and biological susceptibility are known to associated with NCDs. Social factors tend to create barriers for accessing healthcare among the poor people. Objectives: i)To screen and diagnose hypertension and diabetes among individuals aged >30 years, and its associated risk factors such as obesity and tobacco consumption. ii) To deliberate on the social determinants influencing this survey, and suggest suitable recommendations for the National Programme for prevention and control of Cancer, Diabetes, Cardiovascular disease and Stroke (NPCDCS). Methods: As a component of NPCDCS, the present survey was conducted in a few urban slums of Bangalore city during 2010. The collaborators for the conduct of this survey include the Ministry of health and family welfare, Director of health and family welfare services and Medical colleges in Bangalore city. Results: In our study, we found a prevalence proportion of 21.5% for hypertension, 13.8% for diabetes and 30.4% were co-morbid with both the diseases. Consumption of tobacco(any form) was present in 5.1% of the study subjects, overweight among 32.4% and obesity among 20.0%. The study population comprises 18.96% of the source, and the main reason for inadequate utilization was lack of Programmatic awareness. Conclusion: NPCDCS program needs to conceptualize the relevant social factors which determine access to screening and diagnostic healthcare services, including behavior change initiatives. For Program effectiveness, changes at the level of healthcare system need to adopted.
  1,101 133 -
REVIEW ARTICLES
Novel coronavirus- A comprehensive review
Aparna M Nair, PH Shilpa, Vijay Shekhar, Rahul V C Tiwari, Izaz Shaik, Bhargavi Dasari, Heena Tiwari
July 2020, 9(7):3200-3204
DOI:10.4103/jfmpc.jfmpc_496_20  
Recently coronavirus outbreak which started in Wuhan, China, has caused international concern that has affected more than 29 lakh people worldwide and with no vaccine or specific antiviral drugs present as well as oblivious testing of carriers who are generally asymptomatic, the use of general health intervention techniques are failing to comply. As compared to other epidemics like severe acute respiratory syndrome-coronavirus (SARS-CoV) and the Middle-East respiratory syndrome (MERS-CoV), coronavirus (also named as COVID-19) exhibit mild symptoms in the majority of cases. But in the case of a vulnerable population, it can prove to be life-threatening. Relying on proper barrier technique, use of chest computed tomography scans, managing co-morbid conditions of susceptible patients, identifying the pattern of disease spread as well as the use of polymerase chain reaction to assess the specificity of cases will eventually prove to be efficacious since most of the positive cases are asymptomatic at the beginning which poses a challenge to the primary health care physicians. The development of vaccines will also take some time so it is better to know about COVID-19 better and also follow quarantine restrictions properly till then. In this review, we try to put forward all the relevant studies which have been published by the end of March 2020 so as to summarize the natural history, diagnosis as well as treatment strategies for eradicating COVID-19, which will help in managing this pandemic.
  993 187 1
INVITED ARTICLE
The boy's painting (Spain): Thanking health workers during COVID-19 pandemic
Elena Klusova Noguina
July 2020, 9(7):3176-3177
DOI:10.4103/jfmpc.jfmpc_1398_20  
Unlike most countries in the world, Spain has a unique and huge system of highly specialized out-of-hospital emergency service, led by the best trained family doctors, specialists in Emergency Medicine. While the ambulance went down the street at 20th with sirens and music to cheer on the people of city Ibiza, Balearic Islands, Spain, on April 7, 2020, a BOY approached unsurely, under the supportive and complicit eyes of the people from the balconies and without saying a word passed the ambulance health workers, his drawing through the window.
  1,050 124 -
ORIGINAL ARTICLES
Lifestyle behavior of budding health care professionals: A cross-sectional descriptive study
Suresh K Sharma, Shiv K Mudgal, Kalpana Thakur, Rakhi Gaur, Pradeep Aggarwal
July 2020, 9(7):3525-3531
DOI:10.4103/jfmpc.jfmpc_491_20  
Background: College life is a crucial period and at this age, students are more likely to get involved in unhealthy lifestyle behavior like poor dietary habits, physical inactivity, and use of substances, etc. Objectives: Study objectives were to determine the lifestyle behavior of budding healthcare professions and to determine the association of bio-physical profiles with their personal profile, activity, sleep, and dietary pattern. Settings and Design: The current study adopted a cross-sectional design and carried out during May - June 2019 among 284 participants of tertiary care institute. Methods and Material: Participants were selected through a proportionate stratified sampling technique. Self-structured questionnaire and Likert scale were used to assess the lifestyle behavior of participants. Descriptive and inferential statistics were used for data analysis. Results: Majority of participants (70.7%) preferred junk food as a substitute of meal. Significant number (68.3%) of students did not exercise regularly and 30.9% have disturbed sleep pattern. One-third of them (34.5%) were in pre-hypertensive stage and alarming number of them having unacceptable body mass index (BMI) (24.7%) and waist hip ratio (28.5%). Increased BMI was significantly associated with male gender (P = 0.01) and sleep deprivation (P = 0.03). Significantly more male participants were hypertensive and pre-hypertensive (P = 0.001). Conclusions: Study data indicated that having knowledge regarding health is not enough to ensure that health professionals will follow healthy lifestyle and it is important to motivate budding health care professionals to practice healthy lifestyle with an aim of health promotion and prevention of diseases.
  1,048 104 -
Serum GGT and serum ferritin as early markers for metabolic syndrome
Eli Mohapatra, Ritu Priya, Rachita Nanda, Suprava Patel
July 2020, 9(7):3458-3463
DOI:10.4103/jfmpc.jfmpc_570_20  
Background: In India, the prevalence of lifestyle diseases like diabetes, hypertension, and metabolic syndrome (MetS) is showing an upward trend. Gamma glutamate transferase (GGT) and ferritin increase oxidant stress in the body through their role in glutathione homeostasis and iron metabolism, respectively. The increase in oxidant stress increases the inflammatory load, a risk factor for metabolic syndrome. These parameters are cheap, patient-friendly, and available in routine diagnostic labs compatible for follow-up, relieving the already overburdened healthcare system. Methodology: In a case-control study, samples of 77 cases of metabolic syndrome and 77 age and sex-matched controls were analyzed for serum GGT (by modified IFCC) and serum ferritin (by CLIA). Statistical analysis was done by SPSS 20.0 version. Results: The mean ± SD for ferritin and GGT were 101.58 ± 84.20 ng/dL and 36.67 ± 26.40 IU/L, respectively in cases, whereas in control group these values were 38.38 ± 29.26 ng/dL and 16.5 3 ± 6.79 IU/L (P < 0.001). Positive and significant correlation was seen between GGT with TG (r-value- 0.376/P-value-0.001) and GGT with waist circumference (r-value- 0.298/P-value- 0.022). A positive and significant correlation was seen between GGT and ferritin in cases with an r-value of 0.307 (P-value - 0.01). Conclusion: The increased values of GGT and ferritin in cases suggest an inflammatory load. The positive and significant correlation between GGT and triglyceride indicates its role in increasing oxidants' stress leading to inflammation and the development of MetS. The association of ferritin with MetS though insignificant may be considered as a biomarker.
  1,022 124 1
Cost-utility analysis of Macitentan Vs. Bosentan in pulmonary atrial hypertension
Marzieh Nosrati, Nikinaz Ashrafi Shahmirzadi, Monireh Afzali, Pardis Zaboli, Hasti Rouhani, Haleh Hamedifar, Mirhamed Hajimiri
July 2020, 9(7):3634-3638
DOI:10.4103/jfmpc.jfmpc_1166_19  
Objective: Endothelin (ET) receptor antagonists (ERAs) have considerable improvements in pulmonary arterial hypertension (PAH) patients’ symptoms. Macitentan, a novel ERA, has more significant positive effects like reduction of morbidity and mortality in PAH patients by 45% and decreases PAH hospitalization. Besides, macitentan was able to improve both the physical and mental aspects of patients’ lives. This study aimed to evaluate an incremental cost-utility analysis of macitentan compared with bosentan in PAH patients in the Iranian health care system. Methods: We developed a hybrid model consisting of a decision tree in which PAH patients would take and continue either macitentan or bosentan with different probabilities. Subsequently, each patient would enter one of the 4 Markov's, each consisting of 5 states, PAH fraction I, PAH fraction II, PAH fraction III, PAH fraction IV, and death. The cycles and time horizon were considered 3 months and lifetime, respectively. We assessed the impact of each medicine on patients’ quality-adjusted life-years (QALYs) and costs, consequently calculated the ICER (Incremental Cost-Effectiveness Ratio). The costs were measured in the dollar (1 dollar is equal to 42000 rials) with the perspective of the payer. The discount rates were assumed 3% for utility and 5% for costs. In addition, a sensitivity analysis was conducted. Results: The costs are about 14163 dollars for bosentan and 13876 dollars for macitentan for each patient in a lifetime. The QALY produced per patient by macitentan was 0.81 more than that of bosentan. The calculated ICER was -357.47 which means that for each incremental QALY, the payer is charged less. Conclusion: Macitentan is preferable to and dominant over bosentan in both effectiveness and expenditure. Thus, the therapeutic regimen containing macitentan is introduced as a favorable treatment strategy.
  1,014 131 -
Utility of quick sepsis-related organ failure assessment (qSOFA) score to predict outcomes in out-of-ICU patients with suspected infections
Sanal Fernandes, Mukta Wyawahare
July 2020, 9(7):3251-3255
DOI:10.4103/jfmpc.jfmpc_150_20  
Background: Referral of sepsis patients at the level of primary care is often delayed due to the lack of an assessment tool which effectively predicts sepsis. The quick Sepsis-related Organ Failure Assessment score (qSOFA) can be used in such scenarios to improve patient outcomes. Aim: To assess the prognostic accuracy of qSOFA score in predicting adverse outcomes in patients with suspected infections and to compare it with the SIRS (Systemic Inflammatory Response Syndrome) and the SOFA (Sequential Organ failure Assessment Score). Methods: This study included 180 participants admitted in the emergency wards of the Department of Medicine, over a period of one year with suspected infection. The primary outcome was the combined outcome of mortality and/or ICU stay of more than three days. Secondary outcomes were the duration of ICU stay, duration of inotrope use, and duration of mechanical ventilation. Statistical Analysis: Descriptive statistics using SPSS version 19.0 was applied in the study. Results: Of the 180 participants, 54 had a qSOFA score of 2 at admission, 52 participants had an SIRS score of 2. The qSOFA score had the highest AUC for both mortality and the combined outcome of mortality and prolonged ICU stay (0.740 and 0.835, respectively). For a combined outcome of mortality and ICU stay >3 days, the qSOFA score had a sensitivity of 75% and a specificity of 82%. The positive likelihood ratio was 4.17. Conclusion: In a primary care setting, the qSOFA score of more than 2 can be used reliably to refer patients for admission and intensive care as they are likely to need longer hospital stay and can have worse outcomes.
  1,014 129 1
Prevalence and risk factors of depressive symptoms among dialysis patients with end-stage renal disease (ESRD) in Khartoum, Sudan: A cross-sectional study
Habab Khalid Elkheir, Arwa Siddig Wagaella, Safaa Badi, Abbas Khalil, Tarig Hassan Elzubair, Atif Khalil, Mohamed H Ahmed
July 2020, 9(7):3639-3643
DOI:10.4103/jfmpc.jfmpc_1229_19  
Background: Depression is the most common prevalent psychiatric condition among patients with chronic kidney disease (CKD), and especially during dialysis. This study aimed to evaluate depression symptoms in Sudanese patients with end-stage renal diseases (ESRD) who undergo hemodialysis. Methods: This is a case finding, hospital-based study recruited 75 patients on dialysis in Khartoum, Sudan. Data were analyzed by statistical package for social science (SPSS, version 23). Results: The percentage of depression symptoms that satisfies the criteria for the diagnosis of major depression disorders in patients with ESRD undergoes dialysis was 68%. The new patients who undergo dialysis for less than 1 year had more depression symptoms (66.7%) than those on dialysis for 2–3 years (21.6%) or more than 3 years with a percentage of11.8%. Chi-square test showed significant associations between depression and age, the duration of dialysis, signs of significant weight loss when no dieting, and when the clinical symptoms related to distress or social or functional impairment (P = 0.016, 0.000, 0.004, and 0.000, respectively). Logistic regression test showed that age and duration of dialysis were significantly associated with depression with (odds ratios [OR]: 0.724, 0.211) Conclusion: More than two-thirds of patients on dialysis have depressive symptoms. Risk factors associated with depression in Sudanese patients on dialysis were age, duration of dialysis, weight loss, and social and functional impairment. Future research is needed in order to assess the benefit of antidepressants in patients on dialysis. Family physicians should be aware of the association between depression and dialysis, in order to provide early treatment and prevent suicide.
  964 140 -
Why are our elderly distressed? A cross-sectional study in a rural community of West Bengal
Mukesh Kumar, Aparajita Dasgupta, Rabindranath Sinha, Madhumita Bhattacharyya, Bobby Paul
July 2020, 9(7):3532-3538
DOI:10.4103/jfmpc.jfmpc_72_20  
Context: Population across the globe are aging rapidly due to demographic transition. More than 50% of the elderly in India suffer from one or more chronic diseases and psychological distress is one of the most common morbidities among them. Aims and Objective: This study was conducted with the objective to assess the status of psychological distress among the elderly. Settings and Design: Acommunity based, cross-sectional study among 347 elderly aged 60 years and above. Methods and Materials: This study was done in 30 villages (clusters) in Singur block of West Bengal. A predesigned and pretested schedule was used to collect data. Statistical Analysis: Data were analysed by univariate and multivariate analyses. Results: The mean (± SD) age of the elderly was 67.67 (± 7.15) years, majority (67.4%) were in the 60–69 years age group. Most (62.8%) of the elderly were suffering from psychological distress which is significantly associated with below primary education level [AOR (95% CI)] = [25.09 (11.88-52.96)], living without spouse and child [AOR (95% CI) =7.88 (3.90-15.89)], financial dependence [AOR (95% CI) =20.23 (7.58-54.00)], dependent functional activity (assessed by ADL) [AOR (95% CI) =3.84 (1.25-11.76)], and decision for healthcare taken by others [AOR (95% CI)] = [3.84 (1.25-11.76)]. Conclusions: Alarmingly, the proportion of psychological distress was found to be high among the elderly of this rural area. Therefore, all steps must be taken with special focus on the mental health of the old people so that they may continue to contribute to the upliftment of the society.
  980 81 -
Sexual behaviour and knowledge of prevention of sexually transmitted infections among students in coeducational and non-coeducational secondary schools in Ibadan, Nigeria
Adebola A Adejimi, Folashade O Omokhodion, Funmilola M OlaOlorun
July 2020, 9(7):3288-3298
DOI:10.4103/jfmpc.jfmpc_179_20  
Introduction: Sexual interaction between students may be different in coeducational (CE) and non-coeducational (NC) schools. The objective was to compare sexual behaviour and knowledge of prevention of sexually transmitted infections (STIs) among senior secondary school students in CE and NC institutions in Ibadan, Nigeria. Method: A comparative cross-sectional study was carried out using a multistage sampling technique. A total of 510 respondents (250 from CE schools and 260 from NC schools) completed semi-structured self-administered questionnaires which included a 30-point STI knowledge scale with scores classified as good and poor. Chi-square statistics were significant at P ≤ 0.05. Results: The mean age of respondents was 15.9 ± 1.5 years, 47.5% were girls. There were no significant differences in sexual behaviour and knowledge of STIs between the students in the two types of schools. However, there were gender differences, as a significantly higher proportion of girls in CE than NC schools had ever had sexual intercourse with the opposite sex (25.6%-CE, 12.4%-NC) and had multiple sexual partners (29.0%-CE, 0%-NC). Girls in NC schools had better knowledge of causes and prevention of STIs than those in CE schools (28.8%-CE, 45.5%-NC). There were no significant differences in the sexual practices and knowledge of STIs among boys in the two types of schools. Conclusion: More girls in CE schools have had sexual intercourse compared to NC schools whereas girls in NC schools had better knowledge of the prevention of STIs. There is a need for strategies to increase reproductive health education in schools, particularly in CE schools.
  935 125 -
Efficiency of new custom-made pulse oximeter sensor holder in assessment of actual pulp status
Krishnamachari Janani, P Ajitha, Raghu Sandhya, Haripriya Subbaiyan, Jerry Jose
July 2020, 9(7):3333-3337
DOI:10.4103/jfmpc.jfmpc_73_20  
Aim: This study aims to assess the diagnostic accuracy of new custom-made pulse oximeter sensor holder in assessment of actual pulp status with three pulp sensibility tests. Materials and Methods: Seventy-nine single canal teeth requiring endodontic therapy was included in the study. The tooth that was requiring root canal treatment was tested with heat test, cold test, electric pulp test, and pulse oximeter. Between each test, a time period of 2 min was allowed. The response from three pulp sensibility tests and the reading from pulse oximeter were recorded. Following which root canal treatment was performed. The result obtained from four pulp tests were correlated with the clinical finding after access cavity preparation. The data obtained was statistically assessed. Receiver operator characteristic (ROC) curve analysis was performed to assess the efficacy of the pulp tests. In the above statistical tools, the probability value. 05 is considered as significant level. Results: The overall diagnostic accuracy was found to be significantly higher with pulse oximeter when compared with other three pulp sensibility tests. The ROC curve demonstrates the results obtained from pulse oximeter was found to be more reliable than other pulp tests. Conclusion: Within the limitation of the study, diagnostic accuracy of pulse oximeter with custom made sensor holder was reliable and accurate in assessment of actual pulp status.
  925 130 -
Knowledge, attitude, and practice about myopia in school students in Marat city of Saudi Arabia
Anas Abdulaziz Almujalli, Abdulaziz Abdullah Almatrafi, Anas Abdullah Aldael, Hamad Abdullah Almojali, Abdulaziz Ibrahim Almujalli, Aslam Pathan
July 2020, 9(7):3277-3280
DOI:10.4103/jfmpc.jfmpc_86_20  
Background: The prevalence of youth myopia has increased significantly in the local communities of Saudi Arabia; school children and parents are unaware of the knowledge and complications of myopia. Objective: To initiate and increase the awareness of myopia among school students and to prevent future complications. Method: An organized, questionnaire with 14 questions was prepared to analyze the school students' knowledge attitudes and practice about myopia. The study was conducted in a local school in Marat city, Saudi Arabia, between April 2019 and September 2019. The sample size includes 100 male students of age group 7 years to 14 years. Results: 82% of students have heard about myopia with the majority source of information being parents (62%) and teachers (35%). 45% of the students reported a negative attitude toward the eye-glasses users. 20% of students have reported the use of eye-glasses. Most of the students reported uncomfortable feel and shyness due to wearing of eye-glasses which limits their use. Conclusion: The public awareness programs by the local governing bodies, local hospitals, health workers, medical colleges, and non-government organizations should be organized in each local school to increase the school students' knowledge, positive attitude, and practice toward myopia.
  917 136 -
REVIEW ARTICLES
Cancer stem cells and field cancerization of head and neck cancer - An update
Richa Bansal, Bikash Bishwadarshee Nayak, Shweta Bhardwaj, CN Vanajakshi, Pragyan Das, Nagaveni S Somayaji, Sonika Sharma
July 2020, 9(7):3178-3182
DOI:10.4103/jfmpc.jfmpc_443_20  
Oral cancer results due to multiple genetic alterations that transform the normal cells in the oral cavity into neoplastic cells. These genetic changes in a particular tumor field lead to a rapid expansion of preneoplastic daughter cells producing malignant phenotype but the malignancy results due to such genetic changes occurr over several years. The morphological changes in these transformed cells help in the diagnosis of malignancy. Thus, the early changes at the gene level are present in the population of daughter cells in the organ, which explains the concept of field cancerization. Cancer stem cells (CSCs) represent a group of cells that have the capacity of self-renewal and have the potential to differentiate into other types of tumor cells. This review explains the cellular and genetic basis of field cancerization and the role of cancer stem cells in field cancerization.
  887 165 -
ORIGINAL ARTICLES
Translation, reliability, and validity of the avoidance endurance questionnaire in Iranian subjects with chronic non-specific neck pain
Sarvenaz Karimi Ghasem Abad, Behnam Akhbari, Mahyar Salavati, Ahmad Saeedi, Mahsa Seydi, Mohammad Ali Shakoorianfard
July 2020, 9(7):3565-3573
DOI:10.4103/jfmpc.jfmpc_194_20  
Background: To cross-cultural adaptation, test-retest reliability, construct validity of the Persian version of avoidance endurance questionnaire (AEQ) in Iranian subjects with chronic nonspecific neck pain (CNSNP). Objective: The AEQ differentiates endurance responses [ER; positive mood scale (PMS), thought suppression scale (TSS), pain persistence behavior scale (PPS), humor/distraction scale (HDS), and behavioral endurance scale (BES) from fear-avoidance responses (FARs; anxiety/depression scale (ADS), catastrophizing scale (CTS), helplessness/hopelessness scale (HHS), avoidance of social activities scale (ASAS), and avoidance of physical activities scale (APAS)]. Methods: One hundred and thirty persons with CNSNP took part in this psychometric study. The translation process was done by Beaton guideline. Test–retest reliability and internal consistency were presented by intraclass coefficient (ICC) and Cronbach's alpha, respectively. The construct validity was measured by the correlation between AEQ subscales and the Short-form health survey (SF-12), visual analog scale (VAS), fear-avoidance beliefs questionnaire (FABQ), pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK), and neck disability index (NDI). Results: The Cronbach's alpha of all FAR and ER subscales was more than 0.7, and ICCs of all FAR subscales were more than 0.8 and ICCs of ER subscales were reported between 0.59 and 0.86. The correlation between FAR subscales and TKS, FABQ, FABQ.PA, FABQ.W, NDI, PCS, and VAS were the limit between -0.239 and 0.199, and the association between ER subscales and the abovementioned questionnaires was the limit between 0.179 and 0.644. Conclusions: The Persian version of AEQ showed acceptable reliability (test–retest, internal consistency) for FAR and ER, and also the construct validity was acceptable. The Persian version of AEQ had acceptable psychometric properties, thus it is a good instrument to identify fear avoidance and ERs of the pain.
  922 121 -
Postendodontic pain in asymptomatic necrotic teeth prepared with different rotary instrumentation techniques
Talal Al-Nahlawi, Ahmad Alabdullah, Alaa Othman, Raghad Sukkar, Mazen Doumani
July 2020, 9(7):3474-3479
DOI:10.4103/jfmpc.jfmpc_342_20  
Objectives: to investigate the postendodontic pain in asymptomatic necrotic teeth prepared with different rotary instrumentation techniques after single-visit root canal treatment. Materials and Methods: A total of 60 single-rooted teeth with single root canal were treated endodontically. Teeth were divided randomly into four equaled groups (n = 15) according to instrumentation systems as follows: group I were shaped using ProTaper Universal (control group) (Dentsply/Maillefer, Ballaigues), group 2 were shaped with 2Shape (Micro-Mega) till TS2 (25.06), group 3 were shaped with XP-endo Shaper file (FKG Dentaire) till #30.04, and group 4 were shaped with Reciproc blue (VDW) till R25 (25.08). All groups were prepared according to manufacturer's instructions and obturated with lateral condensation technique. Pain levels were assessed by visual analog scale (VAS) and verbal evaluation of pain questionnaire after 6, 12, 24, 48 h, and 7 days of canal obturation. Data were then analyzed using Kruskal–Wallis and Mann–Whitney U tests at P value of 0.05. Results: Postendodontic pain started after 6 h of treatment with highest values and then decreased gradually until almost vanished after 1 week of treatment, with no significant differences in VAS among studied groups (ProTaper, 2 shape, XP endo Shaper, and Reciproc Blue) after 6,12, and 48 h of treatment. On the other hand, XP endo Shaper group, showed the lowest pain values after 24 h of treatment, and the highest pain values were found in 2 shape group after 1 week with significance (P < 0.05). Conclusion: Root canals prepared with XP endo Shaper resulted in the lowest pain levels after 24 h of treatment. Root canal preparation with 2Sshape rotary system resulted in the highest pain levels after 1 week of treatment.
  882 148 -
Situation of labour room documentation at secondary level public health facilities of Cuttack district, Odisha, India – A SWOT analysis
Subrata Kumar Palo, Patel Kripalini, Pati Sanghamitra
July 2020, 9(7):3308-3314
DOI:10.4103/jfmpc.jfmpc_376_20  
Background: Poor documentation practices in labour rooms have been a challenge especially in resource limited countries. This hinders the efforts towards improving quality of maternal healthcare services. Little effort has been made on this regard in many countries including India. SWOT analysis on labour room documentation would be the first step in understanding the situation, barriers and to formulate strategies for improvement. Materials and Methods: Facility based cross-sectional study was carried out in five secondary health facilities of Cuttack district, Odisha, India. A qualitative method using in-depth interviews among 26 healthcare providers was adopted for data collection and inductive content analysis approach for analysis. Strategies like pioneering, positive, conservative and resistive were formulated under each of the three major components identified. Results: Three major components emerged were i) Adherence and completeness of labour room records and reports, ii) Status of the monitoring and supervision and iii) Utilization of labour room data. Improving knowledge and skill through training and supportive supervision, adopting computer-based application for data management, better coordination among supervisors and labour room staff, infrastructural strengthening for documentation and its security, making documentation a priority, more accountability would improve the documentation. Ensuring data analysis and interpretation, discussion in review meetings and regular monitoring and supervision will improve performance. Conclusion: Ensuring documentation of labour room records, regular quality monitoring and supervision, and analysis and interpretation of data are critical to improve labour room performance. Making it a priority and adopting the strategies will achieve the same, thereby better labour outcome.
  897 112 -
Infant and young child feeding practices among mothers of children aged 6 months -2 years in a rural area of Haryana: A qualitative study
Bhushan Dattatray Kamble, Ravneet Kaur, Bhabani Prasad Acharya, Mehul Gupta, 2015 Batch B
July 2020, 9(7):3392-3398
DOI:10.4103/jfmpc.jfmpc_164_20  
Background: India, a low-middle income and a developing country is combating with a triple burden of malnutrition with a very cost-effective measure, infant and young child feeding (IYCF) practices. But there are a lot of challenges in its implementation which need to be catered. The objective of the present qualitative study was to assess IYCF practices among mothers of children aged 6 months to 2 years in a rural area of Haryana. Method: Qualitative study was carried out among mothers of children 6 months–2 years in villages of Ballabgarh block of Haryana using focussed group discussion (FGD) and in-depth interview methods. All recordings of FGDs and IDIs were transcribed into verbatim and codes were generated. Thematic analysis of the transcript of in-depth interview and FGD was performed with the help of Doc Tools in MS Word 2016. Results: The mothers had good knowledge about breastfeeding, importance of colostrum, and weaning practices of infants and children of less than 2 years. Though there is evidence of some cultural misbeliefs, most of the taboos are obsolete now. There was a knowledge gap regarding initiation and composition of complementary feeding practices. The awareness about food diversity, effects of junk food, and recommended complementary feeding practices was less. Conclusion: There is need of creating awareness among mothers regarding importance of IYCF practices to reduce infant and under 5 mortality in rural area.
  879 118 -
Oral healthcare-seeking behavior and perception of oral health and general healthcare among WHO indexed age groups in East-Coast India
Suresh Chand Yaddanapalli, SK Parveen Sultana, Asha Lodagala, Palli Chinna Babu, Srinivas Ravoori, Srinivas Pachava
July 2020, 9(7):3600-3606
DOI:10.4103/jfmpc.jfmpc_350_20  
Introduction: In a country where 30,570 dentists graduate per year, it is staggering to acknowledge that only 10% of dentists serve the rural people, who constitute around 68.8% of the country's population. Aim: To find out the oral healthcare-seeking behavior, profile, and pattern in Tenali Mandal among WHO recommended index age groups. Materials and Methods: A cross-sectional, multilocality, single-visit study was done to acknowledge the oral healthcare-seeking behavior, profile, and pattern in Tenali Mandal, Guntur, Andhra Pradesh. There are 9 villages, 2 peri-urban, and 1 town present in the Tenali Mandal and the study was conducted following the National Pathfinder Survey. Results: Around 35.4% of the study participants utilized dental services while most of them sought care in the last 1–6 months (23.4%) and the main reason for the last dental visit was tooth pain (13.1%), followed by decayed tooth without pain (6.9%). Dental care-seeking behavior among the age group of 12 years was 1.611 times more when compared to 65–74 years age group which was statistically significant (P ≤ 0.010). For dental care-seeking behavior among gender, the males utilized 0.982 times less when compared to females which was not statistically significant (P ≤ 0.881), while for the place of residence, urban place was 2.707 times more utilizing the services when compared to rural place which was statistically significant (P ≤ 0.001). Conclusion: The results of the study indicates that the barriers of oral healthcare-seeking behavior among dental health conditions poses public health problems in the study area, as well as it is an important baseline indicator against which target for oral health improvement can be set and monitored.
  885 88 -
Extent of and influences on knowledge of Alzheimer's disease among undergraduate medical students
Abdulaziz M Shadid, Abdulrahman Yousef Aldayel, Asem Shadid, Ali M Alqaraishi, Maha M Gholah, Fay A Almughiseeb, Yara Abdullah Alessa, Haima F Alani, Salah Ud Din Khan, Saleh Algarni
July 2020, 9(7):3707-3711
DOI:10.4103/jfmpc.jfmpc_113_20  
Background: Alzheimer's disease (AD) is a major health problem, which is of increasing concern because of rising yearly incidence and estimated cost. Early diagnosis and treatment is essential to manage AD effectively and improve the outcomes. Inadequate knowledge can delay the diagnosis. General practitioners should play a more effective role in the identification and diagnosis of AD, and medical education is key to solving this issue. Objectives: This study aimed to assess the knowledge of undergraduate medical students and to identify the factors that influenced their knowledge. Methods: This study used a quantitative cross-sectional evaluation of 327 Saudi Arabian medical students from the first and final years in Riyadh, Saudi Arabia, who participated in an online survey via email between March and May 2018. Knowledge of AD was assessed using the 12-item AD Knowledge Test for Health Professionals from the University of Alabama at Birmingham (UAB ADKT). General linear models were used to identify the most significant influence on AD knowledge scores. Results: Only 10.73% of first-year and 33.33% of final-year students scored ≥ 50% on the UAB ADKT. Students pursuing specialties related to AD (adult neurology, geriatrics, or psychiatry) and students aged ≥ 27 years had higher scores (P < 0.05). Conclusion: Undergraduate medical students lacked proper knowledge of AD, suggesting that improvements in education programs can help. Future studies are needed to assess the quality and effectiveness of AD education in the curriculum of Saudi medical schools.
  862 89 -
A study of morbidity profile among geriatric population in Uttarakhand: A community based cross-sectional study
Preeti Usha, Surekha Kishore, Mahendra Singh, Bhavna Jain, Deepak Kumar, Navuluri Kranthi Kumar Reddy, Abu Rehan, Satish Kumar Ranjan
July 2020, 9(7):3677-3681
DOI:10.4103/jfmpc.jfmpc_256_20  
Context: Population of elderly in India is growing day by day. Elderly population of India is 8.6% and in Uttarakhand it is 8.9%. Health needs of geriatric people differs from others. This study was an attempt to study the morbidity profile of geriatric people that may serve as a baseline data and also help in planning the health services. Aims: To study Morbidity profile of geriatric population in Uttarakhand. Settings and Design: Acommunity-based cross-sectional study was conducted among geriatric people in rural and urban areas of Uttarakhand. Study participants aged 60 years and above were included in the study and a sample size of 400 was calculated. Methods and Materials: Predesigned, pretested and semistructured questionnaire was used to collect information on sociodemographic characteristics and morbidity status of study participants. Statistical Analysis Used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: Among 400 elderly people most common organ system affected was musculoskeletal (77.20%). Other commonly affected health systems were psychological (75.90%), digestive (73.60%), eye (56.67%), endocrine (35.90%), cardiovascular (33.08%), general and unspecified health problems (32.05%), ear (24.62%) and respiratory system (19.74%). Very few elderlies had neurological (6.67%) and urological (1.28%) problems. Conclusions: As shown in the present study very high percentage of morbidities were found in the study population. As a result, there is a need to further strengthen existing geriatric health care services at primary, secondary and tertiary level.
  849 96 -
Prevalence and public knowledge regarding tooth bleaching in Saudi Arabia
Ghada AlOtaibi, Majed S AlMutairi, Mofareh Z AlShammari, Mohammed AlJafar, Turki F AlMaraikhi
July 2020, 9(7):3729-3732
DOI:10.4103/jfmpc.jfmpc_996_20  
Background: Nowadays, cosmetic dentistry has become one of the most important sections of dentistry because patients care about the appearance of their smile with their general health. Hence, the present study was conducted to find the prevalence of public knowledge regarding tooth bleaching in Saudi Arabia. Methods: A cross sectional study with cluster sampling method was carried out in the central, northern, southern, eastern, and western regions of the Kingdom of Saudi Arabia. A modified close ended questionnaire in Arabic/English language was distributed among randomly selected shopping malls and social media (WhatsApp and Twitter) via link in Google Sheet. The survey questionnaires were distributed systematically to individuals entering the malls. The survey items were divided into two sections that included sociodemographic data and knowledge subscales. Regression analysis was done to measure the factors influencing the overall impression of bleaching/tooth whitening. Results: The sample comprised a total of 2543 respondents, of whom there were 1190 males (46.8%) and 1353 females (53.2%). When the population was asked the perceived or actual complication of bleaching, it was observed that the majority of those surveyed felt that there was either a real or perceived threat of tooth sensitivity followed by burning of the gums. Conclusion: Most of the participants heard about tooth bleaching via advertisements, and most of them have used home bleaching more than professional bleaching. Respondents with frequent dental visits had higher levels of knowledge on tooth bleaching compared to respondents with a lack of dental visits.
  828 110 1
Sociodemographic profile and pattern of substance abusers: A retrospective study to unveil the public health problem of Punjab
Avneet Randhawa, Manmohan S Brar, Bandana Kumari, Neha Chaudhary
July 2020, 9(7):3338-3342
DOI:10.4103/jfmpc.jfmpc_499_20  
Introduction: Substance abuse refers to the harmful or hazardous use of any psychoactive substance including licit and illicit drugs, other than when medically indicated. According to a UN report, 1 million heroin addicts are registered in India, and unofficially, there are as many as 5 million. Among all the states Punjab stood third in substance abuse and also injectable drug use. The present study was thus conducted to assess the sociodemographic profile and pattern of substance abuse among patients attending a Drug de-addiction centre. Material and Methods: A record-based analysis from March 2015 to March 2019 was done. Substance dependence was diagnosed post detailed clinical interview by a consultant psychiatrist at the center using DSM -10. For the 966 registered patients admitted in the last four years, the record was checked for completeness of data and relevant information on socio-demographic profile, substance abused, duration of hospital stays, drop out and relapse rates was extracted. Results: Of the total admitted patients (n= 966) 100% addicts were of male gender and natives of Punjab. 514 (53.21%) were married followed by 434(44.93%) never married. Maximum patients 456(47.20%) were self-employed. Heroin was the most abused drug. The injecting route of drug abuse was used by most of the abusers i.e. 51.66%. Only 173 (17.90%) patients dropped out of the treatment followed by relapse in 192 (19.88%). Conclusion: In this paper we demonstrated the vulnerability of young population towards drug addiction. Easy accessibility of drugs, peer pressure and difficult family circumstances raises the fragility to restore for substance use. However, community-based studies are imperative in order to estimate how big is the problem at the bottom.
  827 107 -
The medicolegal importance of establishing human identity by using dactyloscopy and rugoscopy: A comparative study
Tamanna Sharma, SM Chaitan, Nagaveni S Somayaji, Bela Mahajan, Jagadish P Rajguru, Sahar Hajibabaei, Shilpa Hegde
July 2020, 9(7):3236-3241
DOI:10.4103/jfmpc.jfmpc_545_20  
Background: Palatal rugae are irregular and asymmetric mesenchymal ridges that extend in a lateral direction away from the incisive papilla and mid-palatine raphe. Their unique characteristics and environmental stableness justify their inclusion in forensic investigations. Dermatoglyphics or fingerprint patterns are epidermal ridges, which are genetically controlled and are specific to an individual. Hence they are used as a forensic tool. Objectives: The study aimed to assess the reliability of Rugoscopic and Dermatoglyphic patterns for gender identification. Materials and Methods: A total of 200 subjects were recruited in this prospective study. All subjects were between the age range of 18 and 55 years. The subjects were categorized into 100 males and 100 females. Fingerprint dermatoglyphic patterns were recorded using stamp pad, ink, and A4 size white sheets. A subject's fingers were pressed onto the stamped ink pad and lightly pressed over a sheet of paper. Obtained patterns were coded and analyzed as per Galton's criteria into arch, loop, and whorl patterns. Palatal rugae patterns were obtained by making alginate impression material and impression trays. Obtained casts were analyzed for rugae pattern analysis using Kapali's classification. An unpaired t test was used as a statistical tool. Results: On analyzing dermatoglyphic patterns, the arch pattern was most common among male subjects, whereas loop pattern was found to be most common among females. On rugoscopic pattern analysis, Straight pattern was most frequent among males, whereas the circular pattern was common among females. Conclusion: A statistically significant difference was noted between gender and rugoscopic patterns (P = 0.02) and dermatoglyphic patterns (P = 0.03).
  828 102 -
Accuracy of Karman endometrial aspiration in comparison to conventional D and C in women with AUB at tertiary care hospital in North West Rajasthan
Ankur Nama, Swati Kochar, Neha Suthar, Arun Kumar, Kirti Solanki
July 2020, 9(7):3496-3501
DOI:10.4103/jfmpc.jfmpc_291_20  
Background: Approximately 33% of all gynaecological consultations are associated with abnormal vaginal bleeding, and this proportion increases to 70% in the peri and postmenopausal years. Aims and Objective: To compare the diagnostic accuracy of Karman's cannula endometrial aspiration histopathology versus dilatation and curettage in patients with abnormal uterine bleeding. Methodology: In total 100 women of all age groups with a clinical diagnosis of AUB were included in this prospective comparative study. Endometrial aspiration with Karman cannula was performed in the operation theatre prior to curettage to maintain synchronization during sampling. Results: In our study, no significant difference was observed between Karman and D and C regarding sample adequacy (P = 0.07), HPE findings (P = 1) and concordance rate with hysterectomy specimen (P = 1). 95% of the samples obtained by Karman and 98% of those obtained by D and C were adequate. For obtaining an adequate sample by Karman the sensitivity and accuracy was 96.94% and 96% when compared with D and C. Karman and D and C had comparable concordance rates (95% and 95%) with hysterectomy specimen. Karman endometrial sampling is an easy procedure when compared to D and C (P = 0.007). With considering D and C as gold standard Karman endometrial sampling demonstrated 100% accuracy for diagnosing adenocarcinoma, endometrial hyperplasia. Conclusion: Endometrial aspiration with Karman cannula is an easy, safe, cost-effective, accurate, convenient method of achieving histopathological diagnosis. It can be done as an outpatient procedure without analgesia and anaesthesia when compared to D and C which is expensive and invasive method and requires hospitalization and general anaesthesia.
  827 69 -
Expectant versus immediate delivery in women with PPROM between 34 and 35+6 weeks: A Retrospective cohort
Shruthi Sreedhar, Swati Rathore, Santosh Benjamin, M Gowri, Jiji E Mathews
July 2020, 9(7):3225-3229
DOI:10.4103/jfmpc.jfmpc_146_20  
Context: Studies comparing the efficacy of expectant management (EM) and immediate delivery (ID) in the management of women with preterm prelabor rupture of membranes (PPROM) between 34 and 35+6 weeks have not been done in a developing country. Although large multicentric studies show better outcomes with EM, the economic implications have not been studied. Aims: This study compared women with PPROM between 34 and 35+6 weeks, managed expectantly with women who were delivered immediately. Settings and Design: Large tertiary center and retrospective cohort. Methods and Materials: Data of 206 women with PPROM between 34 and 35+6 weeks managed with immediate delivery in the years 2014 and 2015 were compared with seventy-five women with PPROM managed expectantly in the years 2016 and 2017. Statistical Analysis Used: Data was summarized using mean standard deviation (SD) or median interquartile range for continuous variables and frequency and percentage for categorical variables. Continuous variables were compared using independent t-test and categorical variables were compared using Chi-square statistics. Results: Neonatal sepsis was seen in 1/75 (1.3%) in the group managed expectantly and 12/206 (5.8%) in the ID group (P = 0.109). Respiratory distress was seen in 3/75 (4%) in the group managed expectantly and 22/206 (10.7%) with ID (P = 0.08). Chorioamnionitis was similar in both groups. Cesarean rate was 17.3% with expectant management and 28% with ID (P = 0.065). The mean hospital bill was ₹.33,494/- in the ED group and ₹.27,079/- in the ID group (P < 0.001). Conclusions: Expectant management was more expensive.
  781 109 -
Active case finding of tuberculosis among household contacts of newly diagnosed tuberculosis patients: A community-based study from southern Haryana
Suraj Chawla, Vikas Gupta, Neeraj Gour, Kashish Grover, Pawan Kumar Goel, Pankaj Kaushal, Navraj Singh, Ravish Ranjan
July 2020, 9(7):3701-3706
DOI:10.4103/jfmpc.jfmpc_532_20  
Background: Active case-finding is provider-initiated and implies systematic searching for TB in individuals who would not spontaneously present to a health service, and bringing them into care for diagnosis and treatment. Aim: The present study was carried out with the objective to assess the yield and feasibility of active case finding strategy among household contacts of newly diagnosed pulmonary TB cases and to determine risk factors in household contact. Methods: This community-based study with cross-sectional design was conducted among the household contacts of all newly diagnosed microbiologically confirmed pulmonary TB patients registered at Tuberculosis Unit (TU), Nuh. Investigator conducted house to house visit and met respective index case and his/her household contacts to build the rapport. Results: In the present study, there were 55 sputum smear-positive index cases and 356 household contacts of index cases. The most common symptom among screening positive household contacts was cough followed by weight loss. A substantial proportion (83.8%) of symptom positive household contacts were investigated for tuberculosis and among them, 18.9% were found to be positive for tuberculosis. The overall prevalence of TB cases among household contacts was found to be 1.97%. Conclusion: The present study concludes that household contact screening for active case finding for TB is a feasible and efficient tool that can potentially result in earlier diagnosis and treatment of active TB, thus minimizing the severity and decreasing transmission. It can also contribute toward improving treatment outcomes, health sequelae, and the social and economic consequences of TB.
  798 88 -
Behavioral risk factors for hypertension among adults living with HIV accessing care in secondary health facilities in Lagos State, Nigeria
Oluwakemi Odukoya, Oluwabusayo Badejo, Kolawole Sodeinde, Tope Olubodun
July 2020, 9(7):3450-3457
DOI:10.4103/jfmpc.jfmpc_544_20  
Background: Excess risk for cardiovascular disease, especially hypertension, may exist among human immunodeficiency virus infection (HIV)-positive persons. This study was carried out to assess the prevalence of the behavioral risk factors for hypertension, including their awareness of these factors and their attitudes toward them. Methods: This descriptive cross-sectional study was conducted among 400 HIV-infected adults who accessed care in nine secondary health facilities in Lagos State, Nigeria. Respondents were selected by multistage sampling and data elicited using a structured, interviewer-administered questionnaire. Blood pressure (BP) was measured thrice and a respondent was considered as having raised BP if the mean of the last two measurements is ≥140 mm Hg (systolic BP) or ≥90 mm Hg (diastolic BP) or if respondents are currently taking anti-hypertensive. Results: Prevalence of key behavioral risk factors for hypertension was high. For instance, 82.0% of the respondents were physically inactive. Stress and physical inactivity were the two most known risks of hypertension, identified by 87.3% and 70.5% of the respondents, respectively. Majority (66.0%) had positive attitudes toward hypertension risk factors and 26.7% of them had raised BP. Lower age, that is, 30 years and below (OR = 2.89, 95% CI = 1.26–6.64), BMI of less than 25 (OR = 1.87, 95 CI = 1.16–3.01), and being diagnosed of HIV for 5 years and less (OR = 1.62, 95% CI = 1.006–2.62) were significantly associated with normal BP measurements among respondents. Conclusion: The proportion of people living with HIV/AIDS who show known behaviors that place them at risk for hypertension is high. Measures to address these risk factors among them are warranted.
  796 86 -
CASE REPORTS
Herbal medicine-induced multiple pulmonary pseudotumors
Shin Takayama, Tetsuya Akaishi, Masakazu Hanagama, Yuko Itakura, Ryutaro Arita, Akiko Kikuchi, Tadashi Ishii
July 2020, 9(7):3773-3775
DOI:10.4103/jfmpc.jfmpc_420_20  
Japanese herbal medicines (HMs) cause adverse drug reactions (ADRs); however, solid nodule formation is uncommon. In this report, we aimed to show that ADRs with HM can mimic lung cancer. A 63-year-old man complained of back pain. His physician prescribed a traditional Japanese HM, Keishikajutsubuto, which alleviated his symptoms. After 4 weeks, a chest radiograph showed multiple lung nodules that were absent 6 months earlier; the patient did not have cough, fever, or dyspnea. Computed tomography (CT) showed multiple, bilateral lung nodules; however, blood tests and lung biopsy showed no abnormalities, ruling out interstitial pneumonia and lung cancer. Three months after the HM was discontinued, CT showed resolution of the lesions. Interstitial pneumonia was reported as a side effect of HM; however, no such side effect was reported for Keishikajutsubuto. When a patient presents with multiple lung nodules, a side effect of HM should be considered as a differential diagnosis.
  789 91 -
ORIGINAL ARTICLES
Vitamin D status of overweight and obese Bangladeshi adults
Ajit K Paul, A B M Kamrul-Hasan, Palash K Chanda, Dulal C Nandi
July 2020, 9(7):3444-3449
DOI:10.4103/jfmpc.jfmpc_502_20  
Background: Both obesity and vitamin D deficiency are pandemics and both have influences on cardiovascular parameters. The reported prevalence of vitamin D deficiency in obesity is high. Data relating to vitamin D status in obese is currently lacking in Bangladesh. Objective: To discover the vitamin D status in Bangladeshi overweight and obese adults. Subjects and Methods: This cross-sectional study, conducted in a specialized endocrine center of Bangladesh, evaluated 500 consecutive overweight or obese subjects, diagnosed according to body mass index (BMI) categories applicable to the south Asian population. Serum 25(OH)D was measured by using the enzyme-linked fluorescent assay (ELFA) method, and the cutoffs described by the Endocrine Society were used to define vitamin D status. Results: The mean age of the study subjects was 45.85 (±11.41) years; most (59.6%) of them were in the age group 40–59 years; almost three-fourth (72.4%) were females; an almost equal number of them came from urban (33.8%), semi-urban (29.6%), and rural (36.6%) areas; three-fourth (74.2%) were homemaker. Their mean BMI was 29.54 (±3.11) kg/m2; the frequencies of overweight, class I obesity, class II obesity, and class III obesity were 27.6%, 57.4%, 12.2%, and 2.8%, respectively. The mean serum 25(OH)D level was 25.25 (±11.97) ng/mL. 27.4% were sufficient, and 33.4% were insufficient for vitamin D, whereas 39.2% had vitamin D deficiency. The 25(OH)D level did not differ across different age groups, gender, residence, education status, occupation, and income status. The 25(OH)D levels were also indifferent in overweight, obese class I, obese class II, and obese class III subjects. None of the demographic, anthropometric, and biochemical variables (except low-density lipoprotein cholesterol) correlated with 25(OH)D levels. Conclusions: The prevalence of vitamin D deficiency in overweight and obese Bangladeshi adults is very high.
  767 106 -
Oral health status and treatment needs among HIV/AIDS patients attending antiretroviral therapy center in Western India: A cross-sectional study
Pankaj Chaudhary, Kanika Manral, Rahul Gupta, Aroon Kamal Singh Bengani, Bhumit Ishvarlal Chauhan, Deepanshu Arora
July 2020, 9(7):3722-3728
DOI:10.4103/jfmpc.jfmpc_411_20  
Aims and Objectives: Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem across the globe. Among 37.9 million people are living with HIV in the world and 21.40 lakh are in India itself. The aim of this study was to assess the oral mucosal, periodontal, and dentition status of HIV/AIDS patients attending ART (antiretroviral therapy) center in Jaipur city, India. Methods and Materials: A total of 588 HIV/AIDS subjects at the ART center in Jaipur city were examined. Oral mucosal, periodontal, and dentition status was recorded using a modified WHO Oral Health Assessment form 1997. A pilot study was conducted among 50 patients. The data were analyzed using Statistical Package for the Social Sciences (SPSS) software, version 20.0. The statistical tests that were applied for the analysis included Chi-square test, Fisher exact test, and one-way analysis of variance (ANOVA). Results: Of 588 study subjects examined, 65.6% were men and 34.4% were women. Candidiasis was the most prevalent oral lesion (32.5%) followed by acute necrotizing gingivitis (26%), hyper melanotic pigmentation (15.8%), and ulcerations (8.7%), respectively. Oral hairy leukoplakia was observed in only 3.9% and not a single case of Kaposi's sarcoma was reported. Buccal mucosa (36.7%) was the most common site of the presence of oral mucosal lesions. The mean decayed, missing, and filled teeth (DMFT) score was 4.03 ± 1.54. Almost all the subjects needed one or other form of dental treatment. Only 12% of the patients had healthy periodontium. Conclusion: Candidiasis was the most prevalent oral lesion. Efforts should be made to meet the increased treatment needs in these patients.
  780 92 1
Frequency, nature, severity and preventability of adverse drug reactions arising from cancer chemotherapy in a teaching hospital
Saravana Kumar Ramasubbu, Rajesh K Pasricha, Uttam K Nath, Biswadeep Das
July 2020, 9(7):3349-3355
DOI:10.4103/jfmpc.jfmpc_352_20  
Background: An adverse drug reaction (ADR) is defined by the World Health Organization (WHO) as “Any response to a drug which is noxious, unintended and occurs at doses used in man for prophylaxis, diagnosis or therapy”. Cancer chemotherapy is associated with the occurrence of ADRs, which is a worldwide problem. Monitoring and reporting of these ADRs are essential to safeguard the patient and to manage it accordingly. The outcome would create alertness and prevent their recurrence. Hence, we have undertaken a hospital-based study to study the frequency and nature of ADRs due to chemotherapeutic agents. Methods: A total of 500 patients developed ADRs due to cancer chemotherapy from 13th April 2018 to 18th September 2019. Demographics of the patient, drugs taken, and ADRs encountered were recorded in a predesigned form. Results: A total of 665 ADRs were recorded from 500 patients. Anemia was the most common ADR encountered followed by nausea/vomiting and leucopenia. Leukemia (s) were common cancer observed followed by lung and breast cancers. The most common drugs implicated were cisplatin, paclitaxel, carboplatin, and doxorubicin. Naranjo's scale showed 92% of ADRs as probable and 7% as possible. Severity scale showed 80.2% of ADRs were of moderate (level 3 and 4) severity, 11.6% of mild (level 1 and 2) severity, and 8.2% of level 5 severity. A total of 26.8% of ADRs were deemed preventable and 73.2% were not preventable. Conclusions: Our study provides safety data regarding the usage of anti-cancer drugs. Hence, it creates alertness among the treating doctors to prevent its recurrence.
  748 118 -
The effectiveness of training program based on protective motivation theory on improving nutritional behaviors and physical activity in military patients with type 2 diabetes mellitus
Saeid Dashti, Parviz Dabaghi, Shahnaz Tofangchiha
July 2020, 9(7):3328-3332
DOI:10.4103/jfmpc.jfmpc_70_20  
Introduction: Diabetes is considered as one of the most common metabolic disorders and one of the biggest worldwide health problems; first-line treatment is suggested as a changing diet and physical activity by experts. The aim of the present study was the determination of the effectiveness of a training program based on a protective motivation theory on improving nutritional behaviors and physical activity in type 2 military diabetic patients. Methods: In this controlled intervention study, 76 military diabetic individuals (2 groups with 38 individuals in each) were participated. Data gathering instrument was a researcher-made questionnaire based on structures of conservation motivation theory. The data were entered into SPSS19 software and analyzed by using paired t-test and Pearson's correlation coefficient. Results: Findings showed that except in perceived sensitivity in the test and control groups, there was a significant difference between the mean scores of all the components of the Protective Motivation Theory. In the test group, there was a significant difference between the mean scores of all constructs of the Protective Motivation Theory before and after the educational intervention, while in the control group, there was a significant difference between the mean scores of fear, effectiveness of response, severity, and perceived sensitivity structures before and after educational intervention. Glycated hemoglobin (Hb-A1c) and weight of the intervention group were significantly decreased after the intervention. In addition, adherence to diet and physical activity were increased. Conclusion: The results of this study showed that conservation motivation theory can be used as a framework in designing educational programs to improve the diet and physical activity among diabetics.
  770 95 1
Association between mid-upper arm circumference and body mass index in pregnant women to assess their nutritional status
Kumar Guru Mishra, Vikas Bhatia, Ranjeeta Nayak
July 2020, 9(7):3321-3327
DOI:10.4103/jfmpc.jfmpc_57_20  
Background: Underweight/ Undernourished is a state when the body mass index (BMI) falls below 18.5 kg/m2 and as per National Family and Health Survey-4, 22.9% of women in the reproductive age group fall into this category. Despite being considered as an important anthropometry marker, it is not measured in most of the healthcare facilities across India due to lack of basic amenities and resources. In such instances, how helpful other indicators like mid-upper arm circumference (MUAC) can be to measure the undernourished status of pregnant needs to be determined. Objectives: To estimate the prevalence of undernutrition in pregnant women (PW) based on baseline BMI and MUAC and to determine the association between them. Materials and Methods: A cross-sectional study was conducted in Tangi Block of Odisha among 440 PW (in the first trimester) from July 2018 to November 2018 using a pre-tested, validated questionnaire and anthropometric instruments. Results: PW having BMI <18.5 kg/m2 were found to be 16.6% and having MUAC <23.5 cm were 19.5%. A significant association was found between BMI and MUAC [aOR 7.91 (4.27–14.65)]. Also, a moderate correlation was established between the indicators (r = 0.57). Conclusion: MUAC can be used instead of BMI as it is easier to measure, cheaper, does not require any training or calculations, and insensitive to changes during the period of gestation unlike BMI. This can be beneficial to the healthcare workers at primary level who are in resource-limited settings.
  746 102 2
Prevalence of fatty liver in metabolic syndrome
Anita Goyal, Hobinder Arora, Sumit Arora
July 2020, 9(7):3246-3250
DOI:10.4103/jfmpc.jfmpc_1108_19  
Background: In Western world, non-alcohlic fatty liver disease (NAFLD) is considered to be the commonest liver problem, and it is being recognised as a major cause of liver-related morbidity and mortality. As the prevalence of overweight/obesity and metabolic syndrome increases, NASH may become one of the more common causes of end stage liver disease and hepatocellular carcinoma. But much information is not available in this association. So an attempt has been made to correlate both. Aims: The aims of this study are: 1. to study the prevalence of non-alcoholic fatty liver in metabolic syndrome; and 2. to study the correlation between the non-alcoholic fatty liver and metabolic syndrome along with its individual components. Materials and Methods: The study was an observational and analytical study of patients attending OPD and indoor patients of the Department of Medicine, G.G.S. Medical College and Hospital Faridkot. In total, 100 patients diagnosed as metabolic syndrome according to the NCEP ATP III criteria were subjected to ultrasonography; age and sex matched 100 controls were also taken; and the relationship between metabolic syndrome and NAFLD was studied. Results: In total, 73% cases of metabolic syndrome according to NCEP ATPIII were having fatty liver, while in controls 38% persons were having fatty liver which is statistically significant. Conclusions: Fatty liver was found to be highly prevalent in metabolic syndrome, and the early detection of fatty liver can help in modifying the disease course and delaying more serious complications like cirrhosis of liver and hepatocellular carcinoma.
  711 135 -
CASE REPORTS
Lichenoid dysplasia- report of 2 cases and review of literature
Shiladitya Sil
July 2020, 9(7):3733-3736
DOI:10.4103/jfmpc.jfmpc_507_20  
Oral lichen planus (OLP) and oral lichenoid lesions (OLL) have an annual malignant transformation rate of 0.5–2.1%. Lichenoid dysplasia (LD) appears clinically similar to OLP, OLL but histologically harbors atypical cells for which it has a greater potential for malignant transformation. The case reports of two female patients are reported here, which were clinically diagnosed as OLP, later as LD following histopathological confirmation. Both had positive tobacco history and extensive intra-oral lesions. Habit cessation was supplemented by non-steroidal therapeutics with periodic follow-up. There was reduction in the burning sensation, lesion size, and the degree of inflammation of the lesions. Clinical lichenoid like features warrants a biopsy to rule out OLP, OLL from LD. Except for palliation, lesion oriented proper therapeutic treatment should be instituted only after histopathological confirmation.
  762 80 -
ORIGINAL ARTICLES
Prevalence of oral mucosal lesions, dental caries, and periodontal disease among patients with systemic lupus erythematosus in a teaching hospital in Chennai, Tamil Nadu
Nesa Aurlene, Sunayana Manipal, D Prabu, Rajmohan
July 2020, 9(7):3374-3380
DOI:10.4103/jfmpc.jfmpc_1263_19  
Background: The presence of oral symptoms and signs in many systemic diseases is not uncommon knowledge. Investigations that explore the relationship between systemic diseases and their oral manifestations are of particular interest to dentists, as this enables them to be better clinicians with an acumen to recognize, treat, or refer patients with the systemic disease to general physicians. This study was undertaken to understand the oral manifestations of systemic lupus erythematosus (SLE) with an emphasis on oral mucosal lesions, dental caries, and periodontitis. Methods: Asingle institutional cross-sectional survey was conducted from September 2017 to July 2018 on a sample of 500 SLE patients attending the Institute of Rheumatology, Rajiv Gandhi Government General Hospital, Chennai. The dentition status, periodontal status, and oral mucosal lesions were assessed by a single trained and calibrated examiner using the World Health Organization (WHO) proforma, 2013. Besides, disease activity in SLE patients was assessed by rheumatologists using the SLEDAI index with a cutoff score of more than 4 indicating the presence of active disease. Demographic characteristics including age, gender, occupation, monthly income, and education status were assessed using a questionnaire. Data were entered into an Excel Sheet and all statistical analyses were performed using SPSS for Windows version 20.0 (SPSS Inc., Chicago, IL, USA). Results: In the present study, the prevalence of dental caries was found to be 87.6% in patients with SLE. The prevalence of severe periodontitis defined as the presence of at least one tooth with a 6 mm or deeper pocket was found to be 85% and the prevalence of oral mucosal lesions was found to be 86%. The prevalence percentage for dental caries, periodontal disease, and oral mucosal lesions were found to be higher than the rates reported for the general population in India. Patients with active SLE had a higher prevalence of dental caries, periodontitis, and oral mucosal lesions than patients with inactive SLE. Conclusion: It can be concluded from the present study that SLE patients are more vulnerable to oral diseases than the general population. Furthermore, disease activity in SLE patients has a strong positive correlation with oral health status in SLE patients.
  733 108 -
Impact of critical care medicine publications from intensive care department at King Abdulaziz Medical City, Riyadh in the last two decades
Abdullah Alshimemeri, Farhan Alenezi, Luay Alyamani, Osama Alsumari, Feras Alsulaiman, Karam Basham, Fahad Alnafisah
July 2020, 9(7):3669-3672
DOI:10.4103/jfmpc.jfmpc_440_20  
Introduction : The volume and quality of biomedical research publications from an institution are considered adequate indicators of the quality of medical care in that institute. King Abdulaziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia (KSA), is one of the oldest and most distinguished medical centers in the country. Methods: In this study, we analyzed the number of publications from the Critical Care Unit of the hospital in the past two decades, from 1996 to 2016. The research publications were evaluated on various parameters. Moreover, the impact of their study on global medicine was determined. Results: Our results indicate a steady progression in the number of publications from the institute in the past two decades. An average of 17.3 papers was published each year during this time. Out of the 283 publications from KAMC included in this study, the majority of the publications were original articles, 61 were review articles, 66 were multicenter trial studies and 28 were randomized control trials. The citation profile of the publications was good indicating global impact of the studies. Conclusion: The global impact of research as evaluated through published manuscripts in KAMC is overall good. This was deduced from both the increase in the number of publications each year and also the quality of papers as evidenced by the citation index of the papers published between 1996 and 2016.
  778 58 -
Participation of medical students in patient care: How do patients perceive it?
Muhammad Zafar Iqbal, Eman Yasin Bukhamsin, Fatimah Yousef Alghareeb, Norah Mohammed Almarri, Laila Mohammed Aldajani, Hawraa Ahmed Busaleh
July 2020, 9(7):3644-3651
DOI:10.4103/jfmpc.jfmpc_130_20  
Introduction: Clinical teaching helps students develop clinical reasoning, decision-making, professionalism, empathy, and patient management. These benefits can only be obtained if patients show reasonable acceptance towards medical students. The aim of this study was to assess patients’ perceptions regarding their level of acceptance towards students’ participation in their healthcare. Methods: This descriptive cross-sectional study was conducted at King Fahd University hospital between December 2018 and March 2019. The data were collected via face-to-face interviews with patients from four clinical departments using a self-administered questionnaire. A total of 196 patients were approached for an interview, of whom 187 agreed to participate (a response rate of 95.4%). Results: Overall, patients showed a positive attitude towards students’ participation in their care. The acceptance rate was higher in cases where there was minimal or no student–patient physical contact, such as reading patient's medical records (88.8%) and attending outpatient clinics (83.3%). On the other hand, the refusal rate increased dramatically (from 11% to 43.3%) when permission was sought from patients to perform diagnostic procedures. In a comparison of specialties, the highest refusal rate was observed in the obstetrics/gynecology department, whereas the lowest refusal rate was observed in the pediatrics department. Conclusions: Patients seeking healthcare services in a tertiary care teaching hospital have an overall positive attitude towards the involvement of undergraduate students in their medical care. The higher refusal rate with regard to students performing a physical examination and diagnostic procedures is alarming and demands alternative clinical teaching solutions, such as simulation-based training.
  711 111 -
Effect of peer educator-PRAGATI (PeeR Action for Group Awareness through Intervention) on knowledge, attitude, and practice of menstrual hygiene in adolescent school girls
Rakhi Dwivedi, Charu Sharma, Pankaj Bhardwaj, Kuldeep Singh, Nitin Joshi, Prem Prakash Sharma
July 2020, 9(7):3593-3599
DOI:10.4103/jfmpc.jfmpc_309_20  
Context: Majority of the adolescent girls all over the world, suffer from anxiety, shame, discomfort, and isolation during menstruation. Awareness about menstrual hygiene and health can help them to overcome this situation. Aims: The study aims to elicit the existing knowledge, attitude, and practices regarding menstruation and to assess the effectiveness of a structured training program through peer educators-PRAGATI (PeeR Action for Group Awareness through Intervention) on menstrual hygiene among adolescent school girls. Subjects and Methods: This was a prospective interventional study. A structured training program through peer educators (PRAGATI) was used on adolescent females for evaluating menstrual hygiene awareness and practices through pre- and posttest. McNemar's test was used for paired nominal data and the difference between pretest and posttest was assessed by the paired t-test. Results: In the pretest, only 20.5% had adequate knowledge, 32.5% had poor knowledge, while 48.7% of girls had moderate knowledge about menstruation and menstrual hygiene. Post-intervention, 56.41% girls gained adequate knowledge (an increase of ~36%), 30.76% had moderate knowledge, and only 12.8% of them (a reduction of ~20%) still had poor knowledge. The mean increase of knowledge on menstrual hygiene in pretest and posttest analysis was statistically significant with P < 0.01. Conclusion: The training by the peer educators (PRAGATI) in creating awareness about menstrual hygiene and bringing about a significant change in attitude and practice is an effective method of spreading awareness among adolescents on menstrual hygiene related sensitive issues. However, repeated sessions are required to create momentum and enthusiasm for learning new things.
  711 107 -
Sleep quality and restless leg syndrome among antenatal women attending government healthcare facilities in urban bangalore
Sakthi Arasu, Nancy Angeline, Sangeeth Steephan, Varindhu Shekhar, Sabin Sebastian, Naveen Ramesh
July 2020, 9(7):3630-3633
DOI:10.4103/jfmpc.jfmpc_81_20  
Introduction: Sleep changes are more common in pregnancy and lack of sleep in antenatal women can lead to hypertension, postpartum depression, abortions, and preterm babies. Objectives: 1. To assess sleep quality and daytime sleepiness among pregnant women attending government health care facilities in Urban Bangalore. 2 To measure the association between sleep quality, daytime sleepiness with restless leg syndrome (RLS) in the same study population. Methodology: Across-sectional study was conducted in March and April 2018 among all antenatal women attending the Government District Hospital, Anekal Taluk and Primary Health Centre, Sarjapur, in Urban Bangalore. The calculated sample size was 255 and we interviewed 260 women using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale and RLS rating scale along with details on socio-demography. Results: According to PSQI, 83.1% had good sleep quality, 14.2% had daytime sleepiness and 21.9% had RLS. The RLS was significantly associated (P < 0.05) with trimester, sleep onset position, sleep quality, and daytime sleepiness. On logistic regression, there are 3.6 times the chances of having RLS when the sleep quality is bad and 5.3 times more chances of having RLS when there is daytime sleepiness. Conclusion: RLS is significantly associated with daytime sleepiness and sleep quality in antenatal women. Health education on the importance of sleep and about RLS should be included during antenatal visits.
  712 102 -
Effectiveness of various health education methods amongst primary healthcare workers of western Uttar Pradesh, Delhi (National Capital Region), India: A promotive intervention study
Preeti Bhagia, Ipseeta Menon, Ricky Pal Singh, Ritu Gupta, Jyoti Goyal, Dipshikha Das
July 2020, 9(7):3555-3564
DOI:10.4103/jfmpc.jfmpc_143_20  
Objectives: The purpose of this study was to assess the effectiveness of various health education methods for improving oral health knowledge of accredited social health activists (ASHA) and Anganwadi workers of Muradnagar Block, Ghaziabad-Delhi NCR. Methods: A promotive interventional study was conducted amongst 301 ASHA and Anganwadi workers of Muradnagar block at three steps such as baseline, oral health education programme (OHEP), and reinforcement to assess their oral health knowledge using predesigned, close-ended, validated, questionnaire. Four different methods were used in OHEP to disseminate knowledge, namely, health talks, posters, and pamphlets, PowerPoint presentations, and a combination of all methods. Post-assessment was done one week after OHEP followed by reinforcement after 1 month which was followed by final post-assessment after 1 week. Students’ independent t-test and one-way ANOVA were used for analysing data. Results: At baseline, primary healthcare workers had mean knowledge scores as 14.67 ± 1.152 which was increased to 20.96 ± 1.053 after the intervention and 27.6 ± 0.762 after reinforcement. There was an increase of 7.6% and 14.3% of primary healthcare workers giving correct responses after OHEP and reinforcement, respectively. Conclusions: The combination method was the most effective in improving oral health knowledge of study population followed by posters and pamphlets and the least effective method was PowerPoint presentation. Dentists can play a vital role in mobilising the primary healthcare workers by consequently contributing towards improving the oral health status of the community.
  693 106 -
Maternal health-related barriers and the potentials of mobile health technologies: Qualitative findings from a pilot randomized controlled trial in rural Southwestern Uganda
Wilson Tumuhimbise, Esther C Atukunda, Sandrah Ayebaza, Jane Katusiime, Godfrey Mugyenyi, Niels Pinkwart, Angella Musiimenta
July 2020, 9(7):3657-3662
DOI:10.4103/jfmpc.jfmpc_281_20  
Background: Maternal mortality rate remains unacceptably high in Uganda. In-depth evidence about the barriers to access and utilization of maternal health services specifically among the rural illiterate pregnant women remains lacking. The potentials of mobile health technologies in addressing the maternal health challenges remain unclear. Aim: To explore the maternal health-related barriers among illiterate pregnant women in rural Southwestern Uganda and highlight the potentials of mobile health technologies. Material and Methods: This is a midline qualitative study conducted with the participants of a pilot randomized controlled trial. Between October 2019 and December 2019, we carried out semi-structured interviews with 30 illiterate pregnant mothers. Interviews elicited information on the barriers to access and utilization of maternal health services. An inductive, content analytic approach was used to analyze qualitative data. Quantitative sociodemographic and socioeconomic data were summarized descriptively. Results: Participants reported that lack of money (for transport and medical costs), unfriendly maternal health services, and delays at the maternal health clinic constrain access and utilization of maternal health services. Given their widespread adoption, mobile technologies can potentially address some of these barriers e.g., money for transport or microenterprise start-up can be sent to women through their mobile phones or maternal health-related services (such as health education and consultation) can be provided electronically. Conclusion: Future efforts should focus on utilizing mobile health technologies to not only enable women overcome the critical financial challenges but also facilitate remote access and utilization of maternal health services.
  707 84 -
LETTERS TO EDITOR
Does India need ‘mandatory flour fortification with folic acid’ policy to prevent neural tube defects?
Vikas Yadav, Deepti Dabar, Pankaj Prasad, Narendra Singh Patel, Sanjay S Agarwal
July 2020, 9(7):3787-3788
DOI:10.4103/jfmpc.jfmpc_396_20  
  720 68 -
ORIGINAL ARTICLES
Effect of psychoeducation on short-term outcome in patients with late life depression: A randomized control trial - Protocol
Archana Singh, Shrikant Srivastava, Bhupendra Singh
July 2020, 9(7):3299-3303
DOI:10.4103/jfmpc.jfmpc_311_20  
Background: This is the PhD thesis protocol of an ongoing study entitled 'Effect of Psychoeducation on short- term outcome in patients with Late Life Depression: A Randomized Control Trial'. Psychoeducation is a proof-based therapeutic intervention for patients and their caretakers/family members that provides plenty of information and support for better understanding and coping up with the illness, which is being diagnosed. Aim: The aim is to examine the effect of psychoeducation on short- term outcome in patients with late life depression. Hypothesis: The hypothesis is that psychoeducation will improve outcome in patients with late life depression at 4 weeks. The sample size is 154. Material and Methods: The methodology is that patients aged 60 years and above coming to Out Patient Department (OPD) of the Department of Geriatric Mental Health, King George's Medical University and having the first episode of depression, which has been clinically diagnosed, will be taken. Then, Mini International Neuropsychiatric Interview (MINI) 6.0.0 will be applied for the confirmation of diagnosis. After confirmation, Hindi Mental Status Examination (HMSE) will be done to know the cognitive status, those scoring 24 and above on HMSE will be included in the study. The included patients will be evaluated on Hamilton Depression Rating Scale (HAM-D), Geriatric Depression Scale (GDS) and Knowledge Attitude Experience (KAE) Questionnaire. Next, the patients will be randomized in case group and control group. Case group will be given intervention of 'psychoeducation' through a video, and control group will be given 'placebo' through a video. For both the groups, the first follow up termed as 'booster session' will be at 2 weeks +/- 4 days from the baseline and second follow up will be at 4 weeks +/- 4 days from the baseline. Statistical Analysis: Data will be recorded on the spreadsheet and the results will be analyzed using the statistical software.
  695 89 1
A study of C-reactive protein and D-dimer in patients of appendicitis
Satendra Kumar, Jayant Maurya, Sandip Kumar, Shashi Kant Patne, Amit Nandan Dhar Dwivedi
July 2020, 9(7):3492-3495
DOI:10.4103/jfmpc.jfmpc_197_20  
Background: Acute appendicitis is the most common abdominal surgical emergencies across the world. Objective: The aim of this study was to determine the value of C-reactive protein (CRP) and D-dimer as diagnostic markers of acute appendicitis. Study Design: It was a Prospective observational clinical study. Method: The present study was carried out in General Surgical Unit of University Hospital, Institute of Medical Sciences, Banaras Hindu University, Varanasi from September 2015 to July 2017. All data including patient's demography, clinical examination, laboratory test results, and appendix histology were summarized. Receiver operating characteristic (ROC) curve of TLC, CRP, and D-dimer was analyzed. Results: Total 65 patients who presented with periumbilical pain or pain in right iliac fossa (RIF) were included in the study. The mean age of the patients was 31.18 ± 14.59 years (range: 15 to 65 years) with male : female ratio was 2.21:1. The most common symptom was pain in right iliac fossa (100%) followed by nausea/vomiting (69.2%). The mean leucocyte count, CRP, and D-dimer levels were significantly raised in appendicitis group as compared to negative appendicectomy group (P = 0.025, P = 0.036, and P = 0.025, respectively). The receiver operating characteristic (ROC) curve for TLC was not helpful for differentiating between appendicitis and negative appendicitis (P = 0.073). In addition, D-dimer was helpful for differentiating between appendicitis and negative appendicitis (P = 0.002). However, CRP was also found to be helpful for differentiating between appendicitis and negative appendicitis (P = 0.030). Conclusion: The diagnosis of appendicitis remains multifactorial and biochemical markers like CRP and D-dimer may help to guide the surgeon in the decision making.
  692 82 1
Assessment of pulmonary functions among traffic police personnel in Chennai city - A comparative cross-sectional study
S Sasikumar, K Maheshkumar, K Dilara, R Padmavathi
July 2020, 9(7):3356-3360
DOI:10.4103/jfmpc.jfmpc_1126_19  
Background: Air pollution due to road traffic is a solemn health hazard and vehicular emissions due to huge population in the cities are the main reason for the air quality crisis. The study was conducted to assess the degree of impairment in lung function in traffic police personnel exposed to traffic pollution compared to less-exposed healthy subjects. Materials and Methods: This comparative cross-sectional study was conducted among 250 traffic police personnel, aged 20–55 years, working in Chennai city, as compared to a matched control group, consisting of 250 less-exposed subjects. Measurement of pulmonary function testing was done with an RMS Helio 401. Statistical analysis was carried out with R statistical software. Results: The traffic police personnel had significantly (P < 0.05) declined FEV1 and FEV1/FVC ratio and FEF 25–75% (L/s) as compared to controls. Traffic personnel with longer duration of exposure showed significantly (P < 0.05) reduced lung functions than those with shorter duration. We have found a significant negative correlation with all pulmonary function parameters such as FVC, FEV1, FEV1/FVC, PEFR, and FVC 25%–75% among the traffic police personnel. Conclusion: The impairment of pulmonary function among the traffic police personnel might be due to the effect of pollution by vehicular exhausts and they should be offered personal protective or preventive measures.
  681 90 -
The accuracy of anthropometric measurements of general and central obesity for the prediction of impaired glucose tolerance among the adult population of South India
Ronnie Thomas, Prashanth Varkey Ambookan, Jobinse Jose, UG Unnikrishnan
July 2020, 9(7):3416-3420
DOI:10.4103/jfmpc.jfmpc_269_20  
Background: The distribution of body fat and its variation is of great importance in determining the pathogenesis of insulin resistance. Central obesity has been recognized as an independent risk factor for diabetes. The objective of the study was to evaluate the predictive accuracy of various anthropometric measures of body fat in determining impaired glucose tolerance (IGT) or prediabetes among South Indian population. Methodology: This was a community-based comparative cross-sectional study where the anthropometric measures of a representative sample of 171 individuals with glycosylated hemoglobin (HbA1c) in the range for IGT were compared with age- and gender-matched controls with HbA1c in the normal range. The predictive accuracy of the various anthropometric measures of obesity to identify individuals with IGT was estimated using the area under the receiver operating characteristic (ROC) curve. Results: Patients with IGT in both genders had significantly higher BMI, waist circumference (WC), neck circumference (NC), and waist-to-height ratio (WHtR). ROC analysis revealed WHtR in females and NC among males to have the largest area under the curve for predicting IGT. In both genders, WC, WHtR, and NC had better predictive accuracy for prediabetes as compared to BMI and waist-to-hip ratio (WHR). Conclusion: It is suggested that the WHtR and WC are better screening tools for prediabetes in comparison to BMI and WHR among the South Indian population.
  691 79 -
LETTERS TO EDITOR
Preventive oral care for geriatric population in the outbreak of COVID-19 pandemic
Manu Rathee, Prachi Jain
July 2020, 9(7):3783-3784
DOI:10.4103/jfmpc.jfmpc_517_20  
  669 94 -
ORIGINAL ARTICLES
Awareness about tuberculosis and RNTCP services among rural people in Nalgonda district, Telangana
Sreeharshika Dumpeti, Kishore Yadav Jothula, Navya K Naidu
July 2020, 9(7):3281-3287
DOI:10.4103/jfmpc.jfmpc_415_20  
Background: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis discovered in ancient centuries still remains a major public health problem in India. Lack of awareness about the cause, risk factors, treatment and prevention of TB among rural people is a major challenge to be addressed to reduce disease transmission. Aims: To assess the knowledge of TB among rural people. To assess the awareness about RNTCP services. Settings and Design: Cross-sectional study was conducted in six randomly selected villages attached to a medical college. Methods and Materials: Houses were selected by systematic random sampling method and younger person was identified as study subject. Data were collected from a sample of 300 by predesigned pretested semi-structured questionnaire. Statistical Analysis Used: Data were presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23. Results: The study showed that 79.6% knew that the cause of TB is bacteria. Majority of the participants 93.6% (95% CI: 90.3, 96.1) knew that TB primarily affects lungs. Subjects were aware of free diagnostic services (85.3%), free treatment services (89%) available in the govt setup. Conclusions: Although the awareness of symptoms, causative agent, mode of spread was reasonably good, knowledge on availability of DOTS centres, services offered through RNTCP is still poor among rural population.
  648 89 -
CASE REPORTS
Idiopathic autoimmune hemolytic anemia along with concomitant vitamin B12 deficiency in an adolescent girl: A rare occurrence
Kapil Bhalla, Nisha Verma, Sanjiv Nanda, Ashish Gupta, Shuchi Mehra
July 2020, 9(7):3756-3758
DOI:10.4103/jfmpc.jfmpc_401_20  
Vitamin B12 deficiency is seen in countries like India mainly because of predominantly vegetarian diet and is a significant health problem. Patients present with various neurological and hematological manifestations of megaloblastic anemia. In this case report, we present a 14-year-old girl child having a history of past blood transfusions and iron deficiency anemia currently presenting with severe anemia due to idiopathic autoimmune hemolytic anemia (AIHA) and later found to have concomitant vitamin B12 deficiency. On investigating, she had vitamin B12 deficiency, raised homocysteine and methylmalonic acid levels, positive Direct Coombs Test (DCT), and negative glucose-6-phoshphatase deficiency and osmotic fragility tests. Thyroid profile and tissue transglutaminase IgA (tTg-IgA) tests were negative. Antinuclear antibodies (ANA) and anti-double stranded DNA antibody (anti-dsDNA) serum immunoglobulin were also normal. Bone marrow showed megaloblastic anemia picture. Although AIHA and vitamin B12 deficiency anemia are not common, clinicians should have a high index of suspicion when patients present with hemolytic picture and severe megaloblastic anemia.
  631 102 -
ORIGINAL ARTICLES
Correlation between lip print patterns and skeletal class I and II malocclusions – A tool to diagnose early
Anuradha Pandey, Naveen Kumar, Aaysha Tabinda Nabi, Kumari Kavita, Pallawee Choudhary, Rachna Raj
July 2020, 9(7):3539-3543
DOI:10.4103/jfmpc.jfmpc_115_20  
Background: Cheiloscopic analysis has been shown to have close association with skeletal malocclusion. Hence, aim of the present study was to explore any association between lip prints patterns and skeletal class I and II malocclusions. Materials and Methods: A study sample of 90 subjects aged between 18 and 25 years was selected from individuals opting for orthodontic therapy. Skeletal malocclusion using ANB angle was assessed using lateral cephalograms while lip print patterns were analyzed using the cellophane-adhesive method. Statistical analysis: Mean ± SD was analyzed and significance was assessed using ANOVA. Results: Skeletal class I group showed more branched pattern (29%). Other patterns in decreasing order were intersected (25%), reticular (24%), and vertical lip patterns (22%), while the skeletal class II group showed branched pattern as most common (32%), followed in decreasing order by reticular (29%), intersected (25%), and vertical lip patterns (14%). No statistical significance was derived between lip pattern type and skeletal malocclusion. Conclusion: Lip print patterns are important indicators of malocclusion and can help in predicting the same at an earlier stage.
  639 93 -
Employability of people with mental illness and substance use problems: Field realities
Bergai Parthasarathy Nirmala, Tania Roy, Vidya Naik, Pallerla Srikanth
July 2020, 9(7):3405-3410
DOI:10.4103/jfmpc.jfmpc_212_20  
Background: There has always been a strong association between mental illness and work-related disability. According to the “World Health Organization,” of all disabilities, severe mental illness is associated with the highest rates of unemployment. People with mental illness and problems with substance use have especially low employment rates. Aim: To identify the employability factors among people with mental illness and substance use problems. Objectives: To assess the barriers and to identify various strategies to overcome barriers to employment for persons with mental illness and substance use problems and to identify instructors' responses about the functionality of the person who works in the vocational training center, to assess the social support experienced by the respondents. Materials and Methods: This is a qualitative study used the purposive sampling method to conduct the study on 15 respondents (five people with mental illness, five caregivers, five instructors) from Department of Psychiatric and Neuro Rehabilitation, NIMHANS, Bengaluru. Results: Various themes have identified to assess the barriers, aiding factors, and strategies to employment. Barriers to employment have categorized into individual factors, interpersonal factors, employment factors, and social factors. Health, communication, family support, treatment, and training are strategies to improve employability. Proper treatment and continuous adherence to medication, emotional support by family members and colleagues are the employment aiding factors. Conclusion: Identification of barriers and facilitators in the Indian context will help us to address the employability of persons with mental illness and substance use problems.
  642 85 -
H-FABP: A beacon of hope for prediabetic heart disease
Priyamvadha Ramesh, Ajay Chauhan, Parul Goyal, Akanksha Singh
July 2020, 9(7):3421-3428
DOI:10.4103/jfmpc.jfmpc_296_20  
Background: Prediabetes is increasingly being studied in the context of its association with cardiovascular disease (CVD). Besides raised HbA1c and sugar levels, the major underlying defect seems to be insulin resistance (IR). Subclinical atherosclerosis, measured by high sensitivity C reactive protein (hsCRP) and carotid artery intima media thickness (CIMT) underlies the pathogenesis of CVD in prediabetes. Heart-type fatty acid binding protein (H-FABP), a novel cardiac biomarker also might have a role in predictin prediabetic heart disease. Aims: The aim of the study is to compare serum levels of H-FABP in prediabetics and controls and correlate them with the atherosclerotic markers, hsCRP and CIMT. Setting and Design: 50 prediabetic patients and 50 age, sex and BMI matched controls were employed in the case control study. Serum F & PPBS, (HbA1c), fasting insulin levels were measured in cases and controls. Serum H-FABP was measured in both cases and controls. All cases and controls were subjected to bilateral CIMT measurements and Serum hsCRP levels. The values were compared between both the groups and subjected to appropriate statistical analysis. Statistical Analysis Used: Categorical variables were presented in number and percentage (%) and continuous variables were presented as mean ± SD and median. Normality of data was tested by Kolmogorov-Smirnov test. If the normality was rejected then non parametric test was used. Quantitative variables were compared using Independent t test/Mann-Whitney Test (when the data sets were not normally distributed) between the two groups. Qualitative variables were correlated using Chi-Square test/Fisher's Exact test. Spearman rank correlation coefficient was used to find out the correlation of various parameters with each other. Univariate linear regression was used to find out the cause and effect relationship between various parameters. A p <0.05 was considered statistically significant. The data analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The mean serum levels of H-FABP among cases and controls were 6.38± 2.76ng/ml and 3.24 ± 2.47 ng/ml respectively (p <0.0001). Mean CIMT was found to be higher in prediabetics (0.59 ± 0.11 mm ) compared to controls (0.45 ± 0.07mm) (p <0.0001). Serum hsCRP levels were also statistically higher in prediabetics (5.75± 4.16 mg/l) then that of controls (1.86± 1.67 mg/l) (p <0.0001). The correlations of the two variables, hsCRP and CIMT with H-FABP were both strongly positive (r = 0.687) & (r = 0.779) respectively [both cases (p < 0.0001)]. Conclusion: The novel cardiac biomarker H-FAPB might be a good predictor of cardiovascular risks in prediabetics.
  622 96 -
Exploring the care received by HPV-positive married women at a colposcopy clinic in Tehran, Iran: A qualitative study
Fereshteh Jahdi, Effat Merghati-Khoei, Abbas Ebadi, Maryam Kashanian, Fatemeh Oskouie, Shayesteh Jahanfar
July 2020, 9(7):3549-3554
DOI:10.4103/jfmpc.jfmpc_1243_19  
Objectives: Patient experience is the focus of individual care and services to meet patient needs, but this depends on how health care providers deliver their services. The aim of this study was to explore the perceptions of human papilloma virus (HPV)-positive married women from the care they received from health professionals at a colposcopy clinic in Tehran, Iran. Materials and Methods: Three focus group discussions were conducted between September and December 2016 with 30 women who had recently been referred to the clinic for cervical screening or colposcopy. Samples were collected by a purposeful sampling method in Tehran, the capital of Iran. The focus group discussions were carefully recorded at the same time as data collection. After ensuring the data saturation, interviews were terminated and data were categorized. Data was analyzed by direct conventional content analysis using MAXQDA-10. Results: Two themes and three sub-themes resulted from the data analysis, including emotional responses (anxiety and fear of women), and appropriate/inappropriate behavior of the healthcare providers. Conclusion: Healthcare providers, by identifying factors that affect patient's stress, could help reduce the negative outcomes such as patients’ emotional responses to HPV positive results.
  631 68 -
Formative assessment in practical for Indian postgraduates in health professions education: A strategic initiative towards competency-based education
Alka Rawekar, Sonali G Choudhari, Vedprakash Mishra, Sunita Vagha
July 2020, 9(7):3399-3404
DOI:10.4103/jfmpc.jfmpc_185_20  
Background: Observational assessment (OA) or Workplace Based Assessment (WPBA) is being increasingly used to assess the trainees by direct observation to shape their learning. The current deficiencies in our conventional assessment system are due to lack of conceptualization of assessment as a process for continuous improvement and learning, leading to non-utilization of many available tools of assessment. Objective: The present study aimed to introduce formative assessment (FA) for postgraduates at all the constituent colleges (Medical, Dental, Ayurveda, Nursing) under the ambit of Datta Meghe Institute of Medical Sciences (Deemed University) Sawangi (M) Wardha, (Maharashtra), India. Methodology: Observational Assessment tools used for FA were Mini CEX (Mini Clinical Evaluation Exercise) and DOPS (Direct Observation of Procedural Skills)in addition to Objectively Structured Clinical/Practical Examination (OSCE/OSPE). Six encounters of OAs were conducted at the end of each semester. The OA tool used was either the MiniCEX or/and DOPS, depending on the type of subject (Preclinical, Para-clinical, Clinical). Results: A significant improvement in scores from one semester to other as the postgraduate learner progresses, was observed. The overall response from the postgraduate students and faculty for FA was satisfactory. Conclusion: Formative assessment in practical's, was feasible, acceptable and effective program to improve the overall learning and competency of postgraduates.
  580 117 -
Capacity building of primary care physicians of the tea garden hospitals in Dibrugarh, Assam: A demonstration project
Roopa Hariprasad, Amrita John, HK Das, Kaustubh Bora, Lucky Singh, Purnananda Khaund, Aizaz Hussain, Shalini Singh
July 2020, 9(7):3688-3700
DOI:10.4103/jfmpc.jfmpc_40_20  
Background: The three most commonly occurring cancers in India are those of the breast, uterine cervix, and lip or oral cavity, together accounting for approximately 34% of all cancers. All the three cancers are amenable to prevention, early detection, and treatment through which the morbidity and mortality due to these cancers can be reduced. This pilot study was conducted to assess the operational feasibility of the national cancer screening guidelines. Method: This study was conducted in the Dibrugarh district of Assam in seven tea garden hospitals which serve as the primary health centers for the tea estate population in the Northeast region of India. The study intervention was a three-day training package designed to train primary care physicians in population-based screening for oral, breast, and cervical cancers. Knowledge evaluation and skill assessment were performed with a validated questionnaire and checklist, respectively. Results: Pre and posttraining knowledge assessment showed significant gain in the knowledge levels of the participants in all topics. The greatest knowledge increase was seen in breast cancer (96.3%), followed by cervical cancer (57.5%), oral cancer (35.5%) and general cancer-related information (16.7%). The skill assessment done for each participant individually at the end of the training indicated a need for retraining all participants in breast cancer screening. Conclusion: The learnings from this study will be of great help in scaling up the capacity building programme for cancer screening when the nation-wide population-based cancer screening programme will be rolled out in the country.
  628 64 -
REVIEW ARTICLES
Cardiovascular disease-related mortality risk in end stage renal disease and type 2 diabetes: A systematic review
Arwa A Al-Hajji, Hibah A Alsubaie, Hanan T Albaqshi, Hayat I Al-Hajji, Fatemah M A AlEssa, Batool M Abu Ali
July 2020, 9(7):3195-3199
DOI:10.4103/jfmpc.jfmpc_244_20  
Background: Patients with uncontrolled type 2 diabetes can have microvascular and macrovascular complications, including renal impairment and cardiovascular diseases. However, it is unknown how diabetes and renal disease could influence cardiovascular mortality. Objective: This study aims at examining the medical literature to evaluate the risk of cardiovascular death in concomitant end stage renal disease with type 2 diabetes. Method: Medical literature was reviewed through Medline, PubMed, Embase, and Ovid database in the duration between 2009 and 2019. Searching terms included were a combination of “type 2 diabetes mellitus” AND “end-stage renal disease” AND “cardiovascular mortality”. Following this, results were filtered to include only original research articles investigating cardiovascular mortality in concomitant diabetes and end-stage renal disease. Selected trials mentioned diabetes control as well as the follow-up duration of the included patients. Result: A total of 1508 articles were retrieved. Following the exclusion of articles on animals and including only trials on humans, 32 articles appeared. A total of eight articles were identified as eligible, covering a total of 2,06,492 diabetic patients with end-stage renal disease. All the studies were prospective studies, except for three studies that were retrospective. Conclusion: There is an elevated cardiovascular mortality risk in concomitant type 2 diabetes mellitus and end-stage renal disease, especially with uncontrolled blood glucose levels.
  581 109 -
CASE REPORTS
The great masquerader: Hemophagocytic lymphohistiocytosis secondary to cytomegalovirus infection in an immunocompetent young man
Akanksha Singh, Ajay Chauhan, Vaibhav Padole, Devyani Chhabra, Raghav Upneja
July 2020, 9(7):3762-3765
DOI:10.4103/jfmpc.jfmpc_274_20  
Hemophagocytic lymphohistiocytosis (HLH) is a rare, poorly recognized and underdiagnosed syndrome of excessive immune activation, which is rapidly fatal. HLH can occur as a familial or secondary disorder. Secondary HLH is most commonly associated with infections, malignancies, or autoimmune diseases. It primarily affects patients with a compromised immune system and rarely presents in immunocompetent individuals. Acute cytomegalovirus (CMV) associated HLH in the immunocompetent individual is extremely rare and only documented in five case reports till date. We, hereby, report a case of 18 years old young immunocompetent man who was diagnosed to have HLH secondary to CMV infection.
  606 73 -
ORIGINAL ARTICLES
Poststroke depression among stroke survivors in Sub-Himalayan region
Rajesh Kumar, Neetu Kataria, Niraj Kumar, Mritunjai Kumar, Yogesh Bahurupi
July 2020, 9(7):3508-3513
DOI:10.4103/jfmpc.jfmpc_444_20  
Introduction: Stroke is a leading cause of long-term disability and loss of productive life in developing countries, including India. Ischemic stroke accounts for 85% of all types of stroke with a prevalence of 5%–15% among acute stroke incidents. The prevalence of poststroke depression among acute stroke survivors is varied from 5 to 54%. The study focused on depression among stroke survivors who actively involved in a home-based rehabilitation. Materials and Methods: A descriptive cross-sectional survey was conducted by enrolling 138 stroke survivors consecutively at tertiary care public hospital, North India. A sociodemographic and clinical profile sheet was used to seek information on personal and clinical variables. Information on disability, depression, performance in the activity of daily living, and degree of stroke severity was ascertained by using the Modified Rankin Scale (MRS), Physical Health Questionnaire (PHQ-9), Barthel Index, and National Institutes of Health Stroke (NIHSS). After binary logistic regression model, a multivariate logistic regression was applied to detect the independent predictor of depression. Results: Over 86% (119) of the stroke survivors had no symptoms of depression, and only 14% (19) were reported to have symptoms of depression. Poststroke depression found significant association with disability (P = 0.029) and functional independence (P = 0.0001). A significant difference was observed in the gender (P = 0.018), types of stroke (P = 0.0001), and location of lesion (P = 0.0001) with depression. Binary logistic regression model shows that disability (MRS) status of stroke survivor (P < 0.0001; 95% CI 1.998–2.638) and functional independence (BI) (P < 0.0001; 95% CI –0.034–0.020) are same as independent predictors for depression. Conclusion: Clinician should use the community reintegration, referral, and mandatory screening of the stroke survivors at follow-up visit to rule out the probability of occurrence of poststroke depression.
  590 88 1
SHORT COMMUNICATION
Microdroplets are more infectious of COVID-19 spread in a closed door
Fahad Al Qahtani, Modi Fahd Al Qahtani, Ahad Fahd Al Qahtani, Nagesh Bhat
July 2020, 9(7):3776-3777
DOI:10.4103/jfmpc.jfmpc_526_20  
  586 88 -
ORIGINAL ARTICLES
The effect of ‘THE MOTOR VEHICLES (AMENDMENT) ACT, 2019’on the clinico-epidemiological profile of road traffic accident patients presenting to a tertiary care trauma centre in Bhubaneswar
Prakash K Sasmal, Chitta R Mohanty, Mantu Jain, Rakesh V Radhakrishnan, Sangeeta Sahoo, Vuppala S Krishna, Sunil K Doki, Ram Venkat Manoj K Dungala
July 2020, 9(7):3682-3687
DOI:10.4103/jfmpc.jfmpc_293_20  
Context: Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders. Aims: To find out the early impact of “THE MOTOR VEHICLES (AMENDMENT) ACT, 2019”. Settings and Design: A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department. Methods and Materials: Patients studied in two groups – One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016). Conclusions: The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity
  591 77 -
Correlation of obesity indices with heart rate recovery as a marker of autonomic function in healthy young adults
Avinash Anand, Narsingh Verma, Sunita Tiwari, Dileep Verma
July 2020, 9(7):3370-3373
DOI:10.4103/jfmpc.jfmpc_112_20  
Introduction: Obesity has become a challenge for global public health. The global prevalence of obesity has nearly doubled in the past decades (World Health Organization). Obesity may lead to changes in the sympathetic regulation of cardiovascular function, thus favoring the development of cardiovascular complications. Aim: To find a correlation between various obesity indices (body mass index, waist-height ratio, waist circumference and waist-hip ratio) and heart rate recovery in healthy subjects. Materials and Methods: A total of 100 apparently healthy subjects aged 18–30 years were enrolled and were divided into two groups on the absence and presence of a family history of cardiovascular disease. The treadmill testing was done in the exercise lab of the physiology department of the medical institute. Exercise testing of the subjects was conducted according to the standard Bruce protocols. Results: There was a negative correlation between various obesity indices and heart rate recovery but we did not get a statistically signification association between them. Conclusion: In our study, we have found no statistically significant association between various obesity indices and heart rate recovery. Thus measuring obesity indices in the younger age group will not lead to much significance in terms of heart rate recovery and may be avoided.
  572 91 -
Should screening voluntary blood donors be used as strategy to diagnose diabetes and diabetic nephropathy?
Prabhat Agarwal, Ashish Gautam, Nikhil Pursnani, Apoorva Jain, Neetu Singh, Boentika Singh, Awantika Parihar
July 2020, 9(7):3582-3585
DOI:10.4103/jfmpc.jfmpc_229_20  
Introduction and Aim: The present study aims to assess the glycemic status during voluntary blood donation as a strategy to detect undiagnosed diabetes mellitus and diabetic nephropathy. Material and Method: Study was conducted at a tertiary care hospital and medical college. All voluntary blood donors underwent random capillary blood glucose screening and patients who had random blood sugar exceeding 200 mg/dl were subjected to undergo oral glucose tolerance test (OGTT). The subjects thus detected diabetic by capillary blood sugar and OGTT underwent screening diabetic kidney disease with urine albumin to creatnine ratio (UACR). Data collected was statistically analyzed using SPSS 16 using Student's t test. Results: Seven hundred and sixty five males and 443 females were enrolled for the study. Capillary blood sugar of 54 subjects was ≥200 mg/dl. 48 subjects gave consent for OGTT, stratified data showed 22 subjects (12 males and 10 females) were in range of 200–300 mg/dl. 20 subjects (12 males and 8 females) were in range of 300–400 mg/dl, whereas 6 subjects (5 males and 1 female) had blood sugar more than 400 mg/dl. The HbA1C ranges in respective glycemic groups were 200–300 mg/dl – 7.4% to 8.6% (mean – 8.05%), 300–400 mg/dl – 8.7% to 11.8% (mean 9.63%), more than 400 mg/dl – 11.8% to 14.2% (mean – 13%). Male preponderance was observed in all glycemic groups, though the difference was statistically insignificant. Of the 48 diabetic subjects, 13 (27.08%) were detected to have albuminuria, of these 11 (22.91%) had microalbuminuria (UACR 30 – 300 mg/gm), whereas 2 (4.16%) had overt proteinuria (UACR exceeding 300 mg/gm). Conclusion: Glycemic screening with random capillary blood glucose screening, 75 gm 2 hour OGTT and HbA1C amongst voluntary blood donors can be used to detect pre diabetes and undiagnosed diabetes mellitus and diabetic nephropathy.
  584 78 -
Epidemiological profile and mapping geographical distribution of road traffic accidents reported to a tertiary care hospital, Mangaluru using quantum geographic information system (QGIS)
Habeena Shaira, Poonam R Naik, R Pracheth, Abhay S Nirgude, Subhashree Nandy, MM Hiba, S Karthika
July 2020, 9(7):3652-3656
DOI:10.4103/jfmpc.jfmpc_190_20  
Background: The worldwide annual average of road traffic accident (RTA) is approximately 7,00,000 and out of that 10% occur in India. It is estimated that in India, by 2020 RTA would have its fatal effect on about 5,50,000 people annually. This study was conducted to describe the epidemiological profile and spatial distribution of RTAs using quantum geographic information system (QGIS) software reported to a tertiary care hospital in Mangaluru. Methods: It was a record based descriptive study conducted in a tertiary care hospital of Mangaluru. The complete enumeration of all RTAs reported to Yenepoya Medical College Hospital (YMCH) during January 2018 to June 2018 was followed. QGIS software was used to depict spatial distribution of the road traffic accident on open street map. Results: A total of 180 cases of RTA was reported to the hospital during the study period, of which 86.1% were males. The mean age of the study participants was 33.99 years. The lower limb was the most common site of injury (48.3%) and fractures were the most common type of injury (55.6%). As per the type of RTA majority (55.6%) was motorbike accidents and drivers (47.8%) were the most common RTA victims. Predominantly RTAs occurred during evening hours of the day (40%). QGIS plotting revealed clustering of RTAs in Dakshina Kannada district, North Karnataka and neighboring districts of Kerala. Conclusion: QGIS can be used at the health care system level as an important tool to plan preventive measures and early intervention measures at the site of RTA.
  572 87 -
CASE REPORTS
Extramedullary hematopoiesis causing spinal cord compression with excellent durable response after radiation therapy: Case report and review of the literature
James Fontanesi, Harold Margolis, Giovanni R Fontanesi
July 2020, 9(7):3741-3744
DOI:10.4103/jfmpc.jfmpc_22_20  
Extramedullary hematopoiesis (EMH) is a rare occurrence in the setting of spinal cord compression. We report on a 72-year-old who was initially diagnosed with polycythemia vera (PV) which after approximately 15 years converted to myelofibrosis which confirmed on bone marrow biopsy. In 2016, he presented to our ED with clinical symptoms suggested of spinal cord compression at the T3–8 region. This was confirmed by MRI imaging. After a review of existing literature, it was elected to treat the affected area with radiation consisting of 15 fractions of 200 cGy. Within 10 days, the patient had begun to regain strength in the affected regions both motor and sensory. At the 2 month follow-up, he was symptom-free and imaging also showed a complete response. In January 2019, the patient again presented with clinical symptoms of spinal cord compression in the T10–12 area. Again, this was confirmed by MRI imaging. The same fractionation scheme was used and again the patient had a complete resolution of all symptoms both motor and sensory at the 1-month follow-up. Of interest is that during both the courses of treatment there was not a significant in any blood indices from baseline presentation. In the setting of EMH-causing cord compression, the use of radiation is warranted with excellent early response that appears durable. In addition, we present a review of the literature on this topic.
  575 78 -
Lean Cushing's
Yashendu Sarda, Damodar Shenoy, Shrinath Shetty, Sonali Ullal, Sanyam Katyal
July 2020, 9(7):3759-3761
DOI:10.4103/jfmpc.jfmpc_230_20  
This is a case report of 59 years old male with adrenocorticotropic hormone ACTH-independent macronodular adrenal hyperplasia (AIMAH), which is a rare cause of Cushing's syndrome. He was detected to have adrenal lesions incidentally on imaging. The biochemical evaluation was suggestive of endogenous ACTH-independent Cushing's syndrome. Contrast Enhanced CT of the abdomen done to characterize the lesion was suggestive of bilateral macro-nodular adrenal hyperplasia. There was no evidence of cushingoid features except for type 2 diabetes mellitus suggestive of subclinical Cushing's. He was not planned for any immediate medical/surgical management since metabolic control was achieved with oral anti-diabetics (OADs) and anti-hypertensive medications. He is on regular follow up with well-controlled sugars and blood pressure.
  570 79 -
ORIGINAL ARTICLES
Factors affecting patient satisfaction among patients undergone removable prosthodontic rehabilitation
Kumari Kavita, Md Asad Iqubal, Rohit Singh, Supriya Singh, Jazib Nazeer, Revati Singh
July 2020, 9(7):3544-3548
DOI:10.4103/jfmpc.jfmpc_120_20  
Background: Patient's satisfaction is of utmost importance to the dental professionals among all those who have undergone prosthodontic rehabilitation.The success of every dental prosthesis lies in the patient wearing those removable prostheses thereby restoring masticatory function and Phonatics, hence the aim of the present study is to determine various factors affecting the patient satisfaction among patients undergone removable Prosthodontic rehabilitation. Materials and Methods: The present study is a cross-sectional questionnaire descriptive study. The study is conducted among 183 patients undergone removable Prosthodontic rehabilitation and visiting private dental clinics for follow-up. The study was conducted in October to December 2019. The study was conducted among patients age between 21 and 60 years of age wearing removable prosthesis. Results: Among all study participants, majority of study participants were moderately satisfied with the Retention {79 (43.16%)}, Esthetics {87 (47.54%)}, Mastication {68 (37.15%)}, Finish of the denture {89 (48.63%)}, and Overall satisfaction for maxillary and mandibular dentures {93 (50.81%)}. Patient's behavior was significantly associated with overall patient satisfaction (P = 0.00*). Conclusion: Factors affecting any parameter of patient satisfaction was age, Gender, Smoking habits, duration of wearing prosthesis, no. of removal prosthesis used, number of times denture was repaired, patient behavior was significantly associated with overall patient satisfaction.
  568 81 -
LETTERS TO EDITOR
Telemedicine during COVID-19 crisis in resource poor districts near Indo-Pak border of western Rajasthan
Aliza Mittal, Amar Pal Singh, Binit Sureka, Kuldeep Singh, Puneet Pareek, Sanjeev Misra
July 2020, 9(7):3789-3790
DOI:10.4103/jfmpc.jfmpc_1041_20  
  573 71 1
ORIGINAL ARTICLES
Comparison of cardiac output measured by carotid artery Doppler ultrasound and echocardiography in patients admitted to Golestan and Imam Khomeyni Hospitalsl in Ahvaz
Zahra Fazelinejad, Mohammad Ghasem Hanafi, Forough Amiripebdani, Aslan Mosavi
July 2020, 9(7):3304-3307
DOI:10.4103/jfmpc.jfmpc_32_20  
Introduction: Ultrasound is highly effective, safe, and cost-effective for monitoring the hemodynamics and measuring the cardiac output of patients. This study aims to investigate the value of cardiac output by the measurement of common carotid artery flow, which is an inexpensive, simple, and accessible method. Method: Doppler ultrasound of the carotid artery at thyroid level was obtained from the patients admitted to Golestan and Imam Khomeyni Hospitals in Ahvaz (the result is recorded medially from the bilateral outputs unless otherwise prescribed on one side due to a problem such as a catheter or specific position). A transthoracic echocardiography was also recorded using a portable device to measure the left ventricular outlet of diameter 0.5 cm below the aortic valve in the left parasternal with a long axis view. Results: Of the 94 patients studied between the ages of 25 to 87 years, 53 (56.4%) were males and 41 (43.6%) females with a mean age of 53.61 with a standard deviation of 14.56. There was a direct and significant relationship between age and cardiac output using both echocardiography and color Doppler carotid ultrasound (P < 0.001). Discussion: The results of this study showed that the measurement of cardiac output using color Doppler ultrasound in the case of inaccessible emergency echocardiography is a cheap, simple, and accessible method for the hemodynamic evaluation of patients.
  558 85 -
BCG vaccination: Effects on the patterns of pediatric leprosy
Tanusree Sarkar, Somenath Sarkar, Aparesh Chandra Patra, Arghyaprasun Ghosh, Jayanti Dutta, Indrayudh Sen, Dhiman Tarafder
July 2020, 9(7):3673-3676
DOI:10.4103/jfmpc.jfmpc_478_20  
Introduction: Leprosy in pediatric population continues to remain as one of the major public health problems in India. BCG vaccination has been implicated in producing some protection against leprosy. Objectives: The present study intended to find out the patterns of leprosy in the pediatric age group (<12 years) and to determine the proportion of paucibacillary (PB) and multibacillary (MB) leprosy cases among the BCG-vaccinated and nonvaccinated groups. Methodology: It is a cross-sectional study among patients with leprosy up to the age of 12 years attending a tertiary care hospital in Eastern India by comprehensive history taking and through clinical examination. The history of BCG vaccination was enquired and the BCG scar was looked for to determine the BCG-vaccinated and nonvaccinated group. After collecting the data in a predesigned case sheet, the data were analyzed. Result: Of the 137 patients included in this study, 71.53% belonged to the 11–12 years age, 27.74% the 5–10 years age, and 1 patient the <5 year age group. The sex ratio was 1:1.63. PB leprosy was more common than MB leprosy. Smear positivity, deformity, and reaction were not very frequent. Among the vaccinated patients, the ratio of PB and MB leprosy was 5.3:1, while in the nonvaccinated group the ratio was 1.2:1. Data analysis showed that the proportion of MB leprosy was statistically significant in the nonvaccinated group than in the vaccinated group (p = 0.0352). Conclusion: Our study pointed that BCG vaccination might have a role in enhancing the cell-mediated immunity (CMI).
  551 91 -
Knowledge and practice of mothers of school-going children regarding iodized salt and its association with the psychology testing of the students
Sonali Kar, PC Samantaray, Snigdha Singh, Bhagawati C Das
July 2020, 9(7):3411-3415
DOI:10.4103/jfmpc.jfmpc_260_20  
Context: Iodized salt is the mainstay intervention to tackle iodine-related disorders. In spite of the government's efforts to make iodized salt available in more than 90% of the households across the country, there are sketchy details on its use. Since the main propagators of this intervention are the mothers cooking in kitchen, this study was conceived, as a corollary to a larger micronutrient assessment study among school-going children. Aims: The aim of this was to assess knowledge, practice of mothers of school-going children (6-16 years) regarding use of iodized salt, and to see any association between the simple psychological testing of the children and the iodine content of the salt used in home kitchen and the contributing factors thereof. Methods and Materials: A cross-sectional study was conducted by interviewing mothers of 240 school-going children of age groups 6-11 years and 12-16 years from six schools of Bhubaneswar using a semi-structured questionnaire regarding their knowledge on iodine and its deficiency and the practice of using iodized salt. MBI kit was used to assess the iodine content of salt used at home. The psychology adeptness of students was assessed using the standardized and validated coding, standard progressive matrices, and colored progressive matrices tests. Statistical Analysis: Analysis was done using SPSS version 16, wherein the sociodemographic data were shown in proportions, and the iodine content was taken as the dependent continuous variable and means reported. For the sake of associations with intelligence and cognition, a binary logistic regression model was drawn. Results: It reports that 47.5% of mothers knew that iodized salt is good for health and iodine content measured using MBI kit was 15 ppm and above for 71.7% of the sample. Further, iodine content in salt is seen as protective for cognition and also for IQ. Conclusions: The knowledge of the mothers' needs reinforcement regarding iodine and related disorders and the benefits of iodized salt. The aim of the National Iodine Deficiency Disorders Control Program can only be achieved by generating awareness, regular follow-up, and improving the iodization of salt.
  572 69 -
Assessment of the services of ASHA workers on antenatal and postnatal care in a district of western Uttar Pradesh, India
Shailendra K Chaurasiya, Naresh P Singh, Sushil K Shukla, Prashant K Bajpai, Debora J Mathew
July 2020, 9(7):3502-3507
DOI:10.4103/jfmpc.jfmpc_381_20  
Context: India accounts for 17% of the population, contributes to about 19% of maternal deaths, and 21% of childhood deaths of the world. Antenatal and postnatal services were one of the most important works done by ASHA workers. Aims: The objective of this study was to assess the services provided by ASHA workers in a district of western Utter Pradesh to her beneficiaries regarding antenatal and postnatal care. Settings and Design: A cross-sectional study was done in four randomly selected blocks of the district with the help of simple random sampling technique. Subjects and Methods: A total of 384 study participants (mother having child up to 2 years of age) who availed services from the ASHA of their village. Statistical Analysis: Data were analyzed using SPSS-24.0, IBM Corp., Chicago, USA. Differences between the groups were compared using the Chi-square test and Fisher's exact test. P value <0.05 was considered statistically significant. Results: Out of 384 beneficiaries of ASHA workers regarding antenatal and post-natal services, only 25% educated up to ≥higher secondary. Most of the beneficiaries (>55%) escorted less than four times for ANC, whereas only 0.5% of beneficiaries received the correct number i.e., 180 or > 180 IFA tablet from the ASHA workers. Only 57.2% of beneficiaries replied ≥6 times the post natal care home visit done by ASHA. Conclusion: Services provided by ASHA workers regarding ANC and PNC were not adequate.
  576 62 1
Knowledge, attitude, and practice regarding diabetic dermopathy among physicians in Riyadh, Saudi Arabia
Rania Naguib, Abeer S Al Shahrani, Muneera R Al Saleh, Manar M Alhawsawi, Hala N Elmorshedy
July 2020, 9(7):3518-3524
DOI:10.4103/jfmpc.jfmpc_447_20  
Context: Type 2 diabetes mellitus (T2DM) is expanding at an epidemic rate. Diabetes and the prediabetes are associated with a number of skin manifestations which are seen in a minimum of 30% of diabetics as first sign or during the course of their illness. To the best of our knowledge, this is the first study in Saudi Arabia that assess physicians' knowledge, attitude and practice regarding this common problem. Aims: To assess the level of knowledge, attitude, and practice (KAP) about diabetic dermopathy among a representative sample of physicians in Saudi Arabia; and to identify determinants of good KAP. Settings and Design: A cross-sectional study was conducted among physicians at university and governmental hospitals in Riyadh, KSA Materials and Methods: 112 physicians from different specialties and experiences were interviewed using an English self-administered questionnaire. Statistical analysis used: Data was analyzed using IBM SPSS Statistics for Windows, version 20, with appropriate statistical test. P value < 0.05 was considered significant. Results: It included 112 physicians in which 43.8%, Family medicine, 31.3% endocrinologist/Internal Medicine, and 25.0% GPs/Interns. Physicians above 35 year-old, master/PhD holders, consultants, endocrinologist/Internal Medicine, and those in practice for more than 10 years scored the highest in the overall knowledge. However, only 47% were confident to diagnose diabetic dermopathy. Moreover, majority of physicians regardless of the specialty, had educated their patients, examined them for other lesions, and followed conservative protocols. As much as 74.3% of endocrinologists seek for dermatologists' consultation. Conclusions: Physicians' knowledge regarding diabetic dermopathy is suboptimal, this may impact quality of diabetes care.
  563 72 -
CASE REPORTS
A case of H. pylori infection presenting as refractory hypothyroidism
Pragya Gupta, Johns T Johnson, Sudarsanababu Lalitha Soumya, Kripa Elizabeth Cherian, Nitin Kapoor, Thomas Vizhalil Paul
July 2020, 9(7):3770-3772
DOI:10.4103/jfmpc.jfmpc_729_20  
We present the case of a 45-year-old lady with long standing hypothyroidism who was euthyroid on replacement for many years, but stopped responding even to supraphysiological doses of LT4 since the last five years. She complained of abdominal discomfort, bloating, and nausea. She did not have diarrhea or weight loss. Levothyroxine absorption test was done which was suggestive of malabsorption and she was started on triple therapy for H. pylori eradication after confirmation of diagnosis. After 10 days of treatment initiation, she developed symptoms of thyrotoxicosis with her supraphysiological dose of LT4, which was then tapered to a lower dose. Euthyroid state was ultimately achieved with lower doses of LT4 replacement.
  552 67 -
ORIGINAL ARTICLES
Epidemiological determinants of low birth weight: A prospective study
Wahida Kouser, Kiran Bala, Bhavna Sahni, Najma Akhtar
July 2020, 9(7):3438-3443
DOI:10.4103/jfmpc.jfmpc_414_20  
Context: Infant and child survival is recognized as an essential ingredient for the overall health of a society. Aims: To study the magnitude and epidemiological determinants of LBW. Settings and Design: Community-based longitudinal study. Subjects and Methods: A prospective study was conducted for a period of 1 year in Block R.S Pura, Jammu where 364 pregnant women registered at four randomly selected PHCs were followed to assess the magnitude of LBW and to study its association with various determinants. Statistical Analysis Used: Data was analyzed using MS Excel and Open epi version 3.01. Results: Severe anemia, heavy physical activity, low socioeconomic status, illiteracy, extreme ages, and short stature of women were found to be significantly associated with a higher incidence of LBW babies. Conclusion: There is a need to focus on the sensitization of grass-root level health workers as well as pregnant females and their families on the importance of antenatal care, good dietary practices, etc., Thus, strengthening the primary health care system is vital in ensuring optimum health of both mothers and newborns.
  528 83 -
Curriculum Evaluation of Physiology subject of medical undergraduate using ‘FIPO model’
Sonali Choudhari, Alka Rawekar, Vedprakash Mishra, Tripti Srivastava, Sunita Vagha
July 2020, 9(7):3487-3491
DOI:10.4103/jfmpc.jfmpc_175_20  
Background: After the formal process of developing/revising and implementing the curriculum, the need arises for its ‘Evaluation'. A plan of evaluation is an integral part of the process of curriculum development, which ultimately yields an evaluation report, giving us the directives for the curriculum reforms in the future. ‘Curriculum Evaluation’ is one of the six steps of curriculum development as given by David E Kern. Objective: The present study was undertaken with an objective to evaluate the whole process of curriculum revision and effectiveness of the Physiology curriculum in achieving the goals, objectives, and outcomes. Methodology: A framework or model is developed named ‘FIPO model’ of curriculum evaluation. According to this, all four components (Formative phase, Input, Process, Output and Outcome) are evaluated for the ‘Curriculum'. In addition, the model also states the key/concerned person/persons responsible and the assessment/monitoring modality for each component. Result: All parameters included in the ‘Formative phase’ of the model, helped to evaluate the initial preparation for carrying out the curriculum revision. For ‘Input’ evaluation, various resources of Physiology department for curriculum revision, implementation, and evaluation, were assessed. It includes Manpower, Infrastructure, Material, Time, Money, etc. The third component of the FIPO model, i.e. process evaluation dealt with two processes, i.e. curriculum revision and curriculum implementation. Evaluation of ‘Output and Outcome’ of the entire exercise of undertaking curriculum revision was undertaken. Conclusion: The curriculum evaluation report stated that the curriculum of Physiology subject of MBBS (Phase I) is revised, implemented and evaluated systematically as per the prescribed guidelines using the available resources in an effective and efficient manner. The demonstrable output for the same was the document of ‘Revised Curriculum’ and significant outcomes were in the form of satisfactory result and distinctions for the subject Physiology.
  535 74 -
Gender diversity of insulin sensitivity markers among patients of type 2 diabetes mellitus in northern India: A cross-sectional analytical study
Ravi Kant, Poonam Yadav, Surekha Kishore
July 2020, 9(7):3315-3320
DOI:10.4103/jfmpc.jfmpc_400_20  
Background: Diabetes mellitus is a worldwide health problem with more than 80% diabetics living in LMIC. Biological and psychosocial factors are also responsible for gender diversity in T2DM which highlights the need for action to combat T2DM in India. The current study was undertaken to evaluate the gender diversity of insulin sensitivity markers among patients of T2DM in northern India and secondly, to assess and compare the quality of life among T2DM patients in northern India. Material and Methods: It was a cross-sectional analytical study enrolling 78 patients from tertiary care teaching hospital, India. Inclusion criteria was patients within the age group of 18–60 years, diagnosed with T2DM and on insulin therapy. Case reporting form, anthropometric measures, laboratory investigations, and diabetes quality of life (DQoL) instruments were used for data collection for the period of 3 months. Results: The mean age of T2DM patients for males was 48.00 ± 9.92 years and for females was 49.96 ± 10.39 years. Male and female patients were 50% and 50%, respectively. WHR (P = 0.032), DBP (P = 0.000), body fat % (P = 0.04), and duration of diabetes (P = 0.001) had statistically significant association with insulin resistance (binary logistic regression analysis (P- value <0.05). Results show the statistically significant difference between means of WHR (t value = 4.702, P = 0.000) and body fat % (t value = 3.035, P = 0.000) in male and female T2DM patients (Independent't'-test) (P- value <0.05). Conclusions: The study concludes that WHR, DBP, body fat %, and duration of diabetes were significant markers of insulin sensitivity. WHR and body fat % were the differential insulin sensitivity markers in male and female patients of T2DM in northern India. Diabetes adversely affects the quality of life in a nearly similar pattern in both male and female patients.
  526 79 -
Geographic information system and foldscope technology in detecting intestinal parasitic infections among school children of South India
D Sunil Kumar, Praveen Kulkarni, Nayanabai Shabadi, Arun Gopi, Aparna Mohandas, MR Narayana Murthy
July 2020, 9(7):3623-3629
DOI:10.4103/jfmpc.jfmpc_568_20  
Background: Effective and efficient use of technological advances will ease public health interventions and also help in reaching a larger population. Geographic Information System (GIS) and Foldscope are two such technologies, which have promising utilities in public health. Identifying intestinal parasitic infections early through feasible technologies will help in their effective management. With this objective, this study was conducted to assess the prevalence of intestinal parasitic infections among school children in southern districts of Karnataka, India. Methods: This cross-sectional study was conducted among randomly selected 10 urban, 10 rural, and 5 tribal schools of southern districts of Karnataka. A total of 1052 children studying in these schools were selected. Stool samples were collected and examined under Foldscope for parasitic infestation. The schools where children with worm infestations present were plotted in the GIS map. Findings: Among 1052 children included in this study, 139 (13.2%) were found to have an intestinal parasitic infestation. Among these children, 24.6% were in the age group of 5–9 years, 12.2% were males, and 14.4% were females. Urban students had higher odds (2.765) of parasitic infections compared to rural students. Mean age, height, and weight were significantly lesser among subjects with a worm infestation. Interpretation: Utility of Foldscope and GIS was found to be feasible and effective in the detection and mapping of parasitic infestations. The prevalence of parasitic infestation was found to be high among urban school children. Age, weight, height, and urban residence were found to be the major predictors of outcome.
  524 76 -
LETTERS TO EDITOR
Are we missing the bus in COVID-19 by under-utilizing primary and private health care system?
Sunil K Raina
July 2020, 9(7):3781-3782
DOI:10.4103/jfmpc.jfmpc_770_20  
  522 76 -
ORIGINAL ARTICLES
Evaluation of knowledge and practice of ASHAs, regarding child health services in Vijyapaura District, Karnataka
M Rohith, MM Angadi
July 2020, 9(7):3272-3276
DOI:10.4103/jfmpc.jfmpc_371_20  
Background and Aims: NHM has created a cadre of trained female community health activists called Accredited Social Health Activists (ASHAs) to mobilize the community toward increased utilization of existing health services. ASHAs play an important role in the rollout of government health programs such as the Janani Suraksha Yojana (JSY), a conditional cash transfer scheme to incentivize women to give birth in a health facility. The ASHAs work closely with other frontline workers like Auxiliary Nurse Midwives (ANMs) and Anganawadi Workers (AWWs) to conduct community-level activities. Method: A cross-sectional study was conducted in 11 months. A pre-designed, semi- structured questionnaire was prepared in accordance with the study objectives. The questionnaire was prepared in English and the interview was conducted in Kannada language by explaining them questions one by one. Data collection was done by interview technique. Results: Out of 617 ASHAs interviewed, 580 (94%) ASHAs had proper knowledge about exclusive breast feeding and the duration, 560 (90.7%) told colostrum was necessary to the baby. Only 323 (52.3%) ASHAs had correct knowledge regarding schedule of immunization. 580 (94%) ASHAs could tell when the weaning should be started correctly and 611 (99%) ASHAs knew about ORS packets and the steps that went in preparing it. Conclusion: Generally, knowledge of ASHAs about care of new-born and child health care was considerably good. However, knowledge of ASHAs about the immunization schedule was found to be inadequate.
  501 96 -
CASE REPORTS
Epistaxis presenting as sentinel feature of metastatic renal cell carcinoma: A case report and review of literature
Satish K Ranjan, Ankur Mittal, Sunil Kumar, Kim J Mammen, Shiv C Navariya, Deepak P Bhirud
July 2020, 9(7):3766-3769
DOI:10.4103/jfmpc.jfmpc_497_20  
About 30% of all newly diagnosed renal cell carcinoma (RCC) patients present with synchronous metastatic disease. Usual organs of involvement are lung (75%), soft tissues (36%), bone (20%), liver (18%), cutaneous sites (8%), and central nervous system (8%). Metastases to the paranasal sinuses (PNS) are relatively common and may be a part of synchronous multiorgan involvement or present in follow-up after radical nephrectomy (metachronous); but primary presentation as isolated paranasal mass before the diagnosis of RCC is extremely rare. Here, we report a case of 74-year-old female presented with epistaxis and nasal obstruction. On evaluation by magnetic resonance imaging (MRI), a heterogeneously enhancing mass was found involving left PNS. Biopsy from mass revealed clear cell RCC. Later on, contrast-enhanced computed tomography (CECT) of chest, abdomen, and pelvis showed enhancing mass from the upper pole of the left kidney with no evidence of metastasis elsewhere. The patient was started on pazopanib 800 mg once a day. At 6 months follow-up scan, there was a partial response at both primary as well as metastatic site.
  512 68 -
ORIGINAL ARTICLES
A comparative study to assess general health status and oral health score of tobacco users and nonusers in geriatric population in central India
Rashmi Bhujade, Tarique Ibrahim, Arun Kumar Wanjpe, Dharampal Singh Chouhan
July 2020, 9(7):3387-3391
DOI:10.4103/jfmpc.jfmpc_157_20  
Background: Globally about 5 million deaths every year can be ascribed to tobacco use. It leads to many systemic and oral diseases. These diseases in geriatric population are common and more hazardous. Methods: Cross-sectional study was conducted in rural area of a teaching hospital to assess general health status and oral health scores of 500 geriatric age group tobacco users and non users. Data analysis was done with SPSS version-20. Chi square test and Mann Whitney U rank test were applied. Results: Poor self assessed health status was found in tobacco users as compared to nonusers. Significant limitation was found among the tobacco users as compared to nonusers. Significant association was found between the presence of diabetes, COPD, and tobacco use. Tobacco use was found to be significantly associated with poor oral health. Conclusion: Statistically significant poor general and oral health was found in tobacco users than nonusers.
  505 73 -
Association between the socioeconomic determinants and soil-transmitted helminthiasis among school-going children in a rural area of Haryana
Rohit Dhaka, Ramesh Verma, Aparna Parmar, Vinod Chayal, Meenakshi Kalhan, Kapil Bhalla, Suraj Chawla, Ginni Agrawal, Gopal Kumar, Aman Sachdeva
July 2020, 9(7):3712-3715
DOI:10.4103/jfmpc.jfmpc_383_20  
Background: WHO indicates that India has the highest burden of soil-transmitted helminthiasis (STH) in the world, contributing to 25% of the total global cases, with 220 million children aged 1–14 estimated to be at risk. Aim and Objective: To study the association between the socioeconomic factors and STHs among primary school children in a rural area of Haryana. Methodology: The study was conducted among children aged 6–10 years studying in the rural government primary schools in the rural areas of Haryana. A total of 300 children were enrolled from government school. Results: The study found that the prevalence of helminthiasis was 28.7% (86/300) and of these 14.0% children were infected with Ascaris lumbricoides and sex wise association with Helminthic infection was observed as statistically nonsignificant. One third of the (31.39%; 27/86) children were pallor and 5.81% subjects were having Bitot's spot while 13.95% children were having constitutional symptoms such as weakness, 6.97% subjects have fatigue, and 5.81% children have body ache. Discussion: The morbidity can be reduced with appropriate inputs to improve the environmental factors. This may need investment for sanitary latrines, food hygiene, and safe drinking water, anti-helminthic drugs, and health education. Conclusion and Recommendations: The results of the study concluded and recommended that proper implementation of national deworming day and other long-term strategies like sanitation, clean drinking water, adequate sanitation, and also improvement in nutritional status through various nutritional health programmes.
  502 73 -
Health seeking behavior of β-thalassemia major children and its attributes: An epidemiological study in Eastern India
Bijit Biswas, Narendra Nath Naskar, Keya Basu, Aparajita Dasgupta, Rivu Basu, Bobby Paul
July 2020, 9(7):3586-3592
DOI:10.4103/jfmpc.jfmpc_243_20  
Background: Health seeking behaviour (HSB) of thalassemic children is one of the rarely explored entity. Aim: To explore HSB of β-Thalassemia Major (β-TM) children and its attributes. Materials and Methods: It was a cross-sectional design, observational study, conducted among 328 β-TM children and their caregivers attending a tertiary care health facility of Kolkata; West Bengal situated in Eastern India in between May 2016 and April 2017 with a structured schedule. The data were analyzed using SPSS 16.0 version. Results: At the disease onset, 79.6% of them consulted an allopathic doctor. In multivariable logistic regression model, those who were residing in urban area [adjusted odds ratio, AOR: 3.2 (1.2-8.7)], Hindu by religion[AOR: 3.0 (1.2-7.4)], had educated parents [AOR: 3.2 (1.1-9.2)], no family history of the disease [AOR: 3.6 (1.5-8.5)], belonged to higher socio-economic status (Class II, III and IV) [AOR: 2.9 (1.2-6.8)] and had caregiver with satisfactory knowledge related to the disease (≥4)[AOR: 12.2 (5.1-29.6)] were significantly more likely to seek healthcare from an allopathic doctor at onset of the disease. When we consider their HSB till date, 61.0% continued to consult allopathic doctors only. The multivariable determinants of satisfactory HSB till date were place of residence [AOR: 2.7 (1.4-5.2)], caste [AOR: 3.3 (1.6-6.7)], religion [AOR: 3.4 (1.7-6.9)], family history of the disease [AOR: 2.3 (1.2-4.6)] and caregiver's knowledge related to the disease [AOR: 5.3 (3.1-9.2)]. Conclusions: HSB of the study participants were significantly associated with their caregiver's knowledge regarding the disease, parents' educational level, socio-economic status, caste, religion and family history of the disease.
  502 67 -
CASE REPORTS
Influenza B presenting with bicytopenia in an adult – An unusual presentation and failure of antimicrobial stewardship by a practicing physician
Rajat Ranka, Deepjyoti Kalita, Prasan Kumar Panda
July 2020, 9(7):3737-3740
DOI:10.4103/jfmpc.jfmpc_711_20  
Influenza is a very common cause of upper respiratory illness, rarely presented with bicytopenia, and is being wrongly treated with antimicrobials many-a-times. We report a case of 36-year-old North-Indian man, physician by profession who presented with a 5-day history of typical upper respiratory tract symptoms (sore throat, irritative cough, hoarseness of voice, coryza) and high-grade fever for which he took antibiotics (initially levofloxacin for 2-days, followed by azithromycin) after self-prescription. He developed hematological involvement (leukopenia and thrombocytopenia) for which he was admitted. Throat swab tested positive for Influenza B by RT-PCR. This case highlights a rare presentation of influenza as bicytopenia which rapidly improved with oseltamivir given for 5-days. This is also a classic case of lack of antimicrobial stewardship practice by a physician while self-treating viral pharyngitis. There is a pressing need to create more awareness regarding appropriate use of antimicrobial resources among doctors, only then will others follow.
  488 69 -
Impaled roadside guardrail in the neck: Case of a failed motorcycle stunt
Ahmad Ozair, Arjumand Faruqi, Yadvendra Dheer, Syed F Abbas
July 2020, 9(7):3753-3755
DOI:10.4103/jfmpc.jfmpc_573_20  
Trauma is currently the leading cause of death in the age group 15 to 44 years globally, with road trauma now representing the sixth leading cause of death worldwide. We present a case of a young male, who was brought to the apex trauma centre of the province with a metallic roadside guardrail impaled in his neck up to his oral cavity, which had to be cut to transport him to the hospital. A meticulous local exploration resulted in the successful removal of the spiked guardrail, with no damage to critical structures. We discuss the paradigm changes in and the expertise required for the management of such penetrating neck injuries (PNIs). For family physicians, this case represents one of the wide variety of cases they will be called to help upon and administer prehospital care. Thus, utilization of principles of basic life support, recognition of the severity of road trauma cases, and ensuring urgency of referral by general practitioners are all critical.
  493 58 -
ORIGINAL ARTICLES
Audit of level II scans in a tertiary center of a middle-income country (MIC)
Ross Benjamin, Yenuberi Hilda, Rathore Swati, Prasanthi Annie, Beck Manisha, E Mathews Jiji
July 2020, 9(7):3242-3245
DOI:10.4103/jfmpc.jfmpc_88_20  
Context: Significant anomalies are those that are lethal or those that require prolonged follow-up and unaffordable treatments. Detection of these anomalies allows early termination or the support systems necessary for pregnancies with these diagnoses. Anxiety associated with overdiagnosis makes the woman a victim of modern imaging technology. However, accurate detection of significant anomalies in a busy scan room of a developing country with the need to cater to large numbers is particularly challenging. Aims: The aim was to audit the diagnostic accuracy in a busy scan room. Settings and Design: Retrospective cohort in a tertiary center. Methods and Materials: Audit of significant anomalies identified at the 20-week scan was performed after the expected date of confinement. Anomalies that were missed or overdiagnosed were noted. Statistical Analysis Used: All the categorical variables in this research were summarized using counts and percentages. Results: Twenty-eight thousand women underwent morphology ultrasound during the study period. 963 (3.4%) women were detected to have anomalies at birth. Multiple anomalies were seen in 285 (30%) cases and isolated ones in 678 (70%) cases. Anomalies of the genitourinary system were the commonest followed by the anomalies of central nervous system. Only 53 (0.2%) anomalies were missed. They were mainly syndromes and anomalies of the cardiovascular system. The most significant anomalies that were identified could be diagnosed with a basic ultrasound machine. Conclusions: 910/963 (95%) of significant anomalies can be identified even in busy centers if a systematic assessment approach is ensured.
  480 68 -
An exploratory analysis of factors contributing to resident pass rates on a national licensure OSCE in the United Arab Emirates
Halah Ibrahim, Thana Harhara, Reima Al Marshoodi, Ashraf Kamour, Satish C Nair
July 2020, 9(7):3470-3473
DOI:10.4103/jfmpc.jfmpc_332_20  
Purpose: To explore resident perceptions of factors contributing to pass rates on a high-stake licensing objective structured clinical exam (OSCE). Materials and Methods: A cross-sectional survey was administered to all 51 applicants of the April 2019 internal medicine Arab Board OSCE examination in Abu Dhabi, United Arab Emirates (UAE), and included questions on preparedness, stress level, and prior educational experiences. Exposures were evaluated for correlation against Arab Board pass rates using Pearson correlation and the two-tailed significance was recorded. Results: All 51 examinees completed the survey (100% response rate). Participants were primarily female n = 35 (67%) and all completed residency training in the UAE. Gender differences were noted, with higher pass rates for the male residents (13/35, 37% females vs. 8/16, 50% males, P < 0.05). Further, 65% (P < 0.001) of female examinees reported higher levels of anxiety than male residents. Examinees reported regular exposure during residency to clinical skills training (74%), standardized patients (71%), simulation (66%), and OSCEs (72%) but none of these educational modalities correlated with higher pass rates. Of multiple exam preparation modalities, only self-directed learning with deliberate practice, the intentional repetition of a task with feedback, was associated with higher pass rates. Conclusion: Clinical exam skills are vital for trainees to deliver high-quality primary healthcare services. National licensure OSCEs have become the norm in the Arab world for assessing resident clinical exam skills. Our results suggest that residency programs should encourage residents' intentional deliberate practice and mastery learning in the acquisition and retention of physical examination techniques.
  461 63 -
CASE REPORTS
Detection of slow growing Actinomadura species proved a key formanagement of mycetoma: A case report from Chhattisgarh
Pratibha Sharma, Archana B Wankhade, Ujjwala Gaikwad, Padma Das
July 2020, 9(7):3745-3748
DOI:10.4103/jfmpc.jfmpc_481_20  
Mycetoma is disorder of subcutaneous tissue, skin, and bones, mainly the feet. Etiologically divided in Eumycetoma and actinomycetoma, since the treatment of both is different, the diagnosis is mandatory. This is the case of 35-year-old lady with swelling in left foot with multiple discharging sinuses for 5 years that was none responding to antifungal treatment. Change of treatment after the culture confirmation of Actinomadura species improves patient condition drastically.
  433 63 -
ORIGINAL ARTICLES
To evaluate the status and need for dental prosthesis among the geriatric population of Central India reporting to the dental colleges
Gokul Chhabra, Vikram Belkhode, Sharayu Nimonkar, Yogesh Rao, Kavita Raghotham, Tushar Khandagale
July 2020, 9(7):3429-3432
DOI:10.4103/jfmpc.jfmpc_316_20  
Aims and Objectives: The study aimed at evaluating the dental prosthetic status and its need among the geriatric population of Central India reporting to the dental colleges. Materials and Methods: A descriptive cross-sectional study was carried out to evaluate prosthetic status and needs among geriatric individuals in Wardha city, Maharashtra reporting to dental colleges. A detailed inspection of the oral cavity of the study subjects was done using Basic Oral Health Surveys, World Health Organization (WHO) 1997. Results: A total of 110 individuals were evaluated for the study. A total of 26.36% study participants had some prosthesis at the time of examination, whereas 79.99% needed prosthesis. A total of 51.82% needed complete dentures. About 12.71% of the participants needed combination prosthesis. Conclusions: The result of this study concluded that the prosthetic status of the geriatric individuals in Wardha city (MH) of Central India is poor and needs prosthetic rehabilitation. A well-structured approach is required to fulfill these needs.
  437 57 -
ERRATUM
Erratum: Are we prepared? Lessons from Covid-19 and OMAG position paper on epidemic preparedness

July 2020, 9(7):3791-3791
DOI:10.4103/2249-4863.290852  
  417 62 -
ORIGINAL ARTICLES
Digital glomus tumor: An experience of 57 cases over 20 years
Satendra Kumar, Satyendra K Tiwary, Raghunath More, Puneet Kumar, Ajay K Khanna
July 2020, 9(7):3514-3517
DOI:10.4103/jfmpc.jfmpc_446_20  
Background: Glomus tumors are rare tumors and may affect any area of the body, but digits, palms, and soles are commonly affected due to higher number of glomus body. We present our experience with the management of 57 cases of glomus tumors of the fingertips treated over a period of 20 years (2000–2019). Materials and Methods: Medical records of 57 cases with glomus tumors treated over a period of 20 years were reviewed for patient demographics, presenting characteristics, duration, previous treatment history, physical examination, investigation, treatment, follow-up, and recurrence. Results: In our study, the mean age was 49 years, with age 47 years among women and 53 years among men suggesting glomus tumor as a disease of past middle age. The total number of cases was 57 with 44 women and 13 men. Site of lesion was nail bed in 50 cases (87.7%) and tip of finger in 7 cases (12.3%). In clinical assessment pinpoint tenderness was present in all 57 cases (100%) and pain in 56 cases (98.8%). Other features at the time of presentation were nodularity in 38 cases (66.6%), deformed nail in 14 cases (24.6%), and cold hypersensitivity in 20 cases (35.1%). The mean duration of the disease was 2.3 years (1.2–5.6 years). Conclusion: One of the most painful clinical conditions confirmed by comprehensive clinical assessment and cured dramatically by complete surgical excision.
  413 59 -
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