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   Table of Contents - Current issue
Coverpage
September 2020
Volume 9 | Issue 9
Page Nos. 4505-5085

Online since Wednesday, September 30, 2020

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EDITORIAL  

15th August - Few thoughts for future Highly accessed article p. 4505
Raman Kumar
DOI:10.4103/jfmpc.jfmpc_1666_20  
India was not born on 15th August. India was always there and will remain so as the 'most ancient living civilization in continuity' free in spirit, despite centuries of colonization. Let us celebrate every day as 'India Day' and contribute towards a better future for all citizens. We are not just a nation or country but a civilization - a cultural biodiversity repository from prehistory to modern times!
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INVITED ARTICLE Top

Drawing inference from nationwide lockdown as a response towards novel Cornavirus-19 (CoVID-19) epidemic in India Highly accessed article p. 4507
Dinesh Kumar, Sunil K Raina, Raman Chauhan, Parveen Kumar, Sushant Sharma
DOI:10.4103/jfmpc.jfmpc_807_20  
Background: Lockdown effectively can only result in relative freezing of populations that is expected to slow down the disease spread rather than zeroing it. Flattening of epidemic curve Current analysis was carried out to observe a pattern in the rise of CoVID-19 cases along with concurrent announcements of strategies to control the spread of disease. Material and Methods: Data in from of daily number of cases and issued notifications were studied from the official website of Government of India from 30/01/2020 to 03/05/2020. Qualitative assessment with thematic analysis was carried out for notifications issued by the government. The fit to data on cumulative cases was observed with R2 and checked for linearity, logarithmic, polynomial, and exponential growth. Daily growth fraction (Gt) was calculated based on the difference between current and previous number of cases, thereafter daily doubling time (Td(t)) was estimated. Results: Daily reported cases were entered and cumulative growth of cases observed with a polynomial increasing pattern (third-order) with better fit (R2: 0.999). Total 108 notifications were issued, and as compared to phase-0 and 1 (87.0%), few (12.9%) notifications were issued in phase-2 of study period. As compared to phase-0 and 1, rising trend of cumulative cases and Td(t)was high in phase-2. Conclusion: Across phases of lockdown along with a rising trend of COVID-19 cases, the country has managed to increase the doubling time of cases with an effort to flatten the epidemic curve.
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COMMENTARIES Top

COVID 19 and diabetes: An endocrinologist's perspective Highly accessed article p. 4512
Kishore K Behera, Debasish Hota, Ashoka Mahapatra
DOI:10.4103/jfmpc.jfmpc_710_20  
The clinical manifestation of COVID-19 is diverse, oscillating from mild flu-like symptoms to more severe outcome, such as acute respiratory distress syndrome, multiple organ failure, and death. Advanced age and comorbidities, such as diabetes mellitus, high blood pressure, and history of cerebrovascular accidents are reported to have worse outcome. Chronic inflammation by cytokine storm and direct insult to pancreatic by COVID-19 might be postulated mechanisms of inducing or deteriorating diabetes. Individualized patient-centric treatment and optimal blood sugar control should be made based on disease severity, presence of comorbid condition, and complications related to diabetes, age, and other risk factors. Recent clinical trials have shown some hope to anti-interleukin antibody as a potential therapeutic option against COVID-19 especially in people with severe illness.
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Telemedicine: Embracing virtual care during COVID-19 pandemic Highly accessed article p. 4516
Suneela Garg, Navya Gangadharan, Nidhi Bhatnagar, MM Singh, SK Raina, Sagar Galwankar
DOI:10.4103/jfmpc.jfmpc_918_20  
Telemedicine and related e-health facilities facilitate care from a distance through electronic information systems. COVID-19 pandemic is establishing telemedicine in the health care delivery system of countries. Telehealth is contributing significantly in health care delivery during the COVID-19 crisis. For mild-to-moderate symptoms of COVID-19 or any illness, telehealth services might represent a better, efficient way to receive initial care and perform triaging. Telemedicine also has a significant role in screening for COVID-19 symptoms and delivering routine needs and follow-up care. The large-scale adoption of telemedicine in public health care delivery is still not visible in low- and middle-income countries like India. Adoption by patients and healthcare professionals is limited and their concerns need to be addressed to ensure its utilization in future of the care continuum. In the current paper, we aim to review recent measures of Telemedicine adopted during the course of pandemic and its impact on public health in lower-middle income countries like India.
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REVIEW ARTICLES Top

A systemic review of vertical transmission possibility in pregnant women with coronavirus disease 2019-positive status Highly accessed article p. 4521
Moath A AlQahtani, Sultan M AlDajani
DOI:10.4103/jfmpc.jfmpc_475_20  
An unknown pneumonia outbreak has been reported by hospitals in Wuhan, China, in late December 2019. A public health emergency of international concern announced by the World Health Organization (WHO) on the January 31, 2020. The virus named by the WHO as coronavirus disease 2019 (COVID-19). The cases reached (266,073 cases) and deaths (11,184 deaths) globally by the end of March 21, 2020, and considered as a pandemic. By a systemic review, articles and case reports revealed 74 pregnant women for the possibility of vertical transmission of the virus from COVID-19-infected mother to infant. Review also showed that there is no difference between pregnant and nonpregnant regarding clinical manifestations. Concerning the vertical transmission, none of the positive mothers had a positive infant with COVID-19 except 1 case report that showed the infant had positive COVID-19 by the throat swab, yet negative cord blood, placenta, and mother's breast milk.
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Cesarean bladder injury – obstetrician's nightmare p. 4526
Pal Manidip, Bandyopadhyay Soma
DOI:10.4103/jfmpc.jfmpc_586_20  
Urinary bladder is an adjacent viscus susceptible for intraoperative injury during cesarean section (CS). Prolonged labor, scarred uterus, intraabdominal adhesion, emergency CS, advanced labor, cesarean hysterectomy etc., are the predisposing factors for bladder injury during CS. While operating on such conditions, one should be meticulous to explore the possibility of bladder injury. Family physician practicing community obstetrics should be aware of this and know how to tackle this. Usually the dome of the bladder is injured and the trigonal area remains away from the injury field by 6–10 cm. Bladder rent is repaired in two layers either by continuous simple or interrupted suture with 3-0 & 2-0 polyglycolic acid suture. Suprapubic cystostomy and transurethral catheter are kept for 10–14 days. While postoperative adhesion, CS during full dilatation of cervix, abnormal anatomy etc., may not proceed for negligence, bladder injury in normal patients and unrecognized intraoperative bladder injury may attract penalty from the consumer court.
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Evaluating factors associated with fear and anxiety to dental treatment—A systematic review p. 4530
Muhannad H Murad, Navin A Ingle, Mansour K Assery
DOI:10.4103/jfmpc.jfmpc_607_20  
Introduction: Dental anxiety refers to a set of complex psychological issues bearing a significant impact in individual's lives reflecting in the form of dental visit avoidance, poor dental health status and decreases oral health related quality of life. Hence, it is imperative to consider those factors associated with dental anxiety so as to treat and promote better oral health. The review aimed to assess various factors associated with dental fear and anxiety. Materials and Methods: Literature search was done from Pubmed and Google scholar search engines to identify publications which explored factors associated with dental fear and anxiety. Results: Research evidence pointed a significant relationship of age, gender, maternal anxiety, previous dental experience, and number of siblings with dental fear and anxiety (DFA). Conclusion: Findings of the review clearly suggest that a better understanding of factors causing dental anxiety and phobia will help preventing dental avoidance and providing better care.
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COVID-19 in pregnancy: A review p. 4536
Shikhar Tripathi, Atul Gogia, Atul Kakar
DOI:10.4103/jfmpc.jfmpc_714_20  
COVID-19 has led on to a global healthcare crisis, similar to none in the recent past. Special emphasis must be laid on the status of pregnant women amid this outbreak, considering the vulnerability seen in pregnant women toward previous coronavirus diseases. In this review, we will try to elicit the correlation between the complications of previous coronavirus diseases (Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome) and COVID-19, the possibility of materno-fetal vertical transmission and the obstetric management protocol.
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Protecting Indian health workforce during the COVID-19 pandemic Highly accessed article p. 4541
Deepanjali Behera, Devarsetty Praveen, Manas Ranjan Behera
DOI:10.4103/jfmpc.jfmpc_925_20  
Rapidly growing rate of infection among health workers during the current COVID-19 pandemic, is posing a serious challenge to global health systems. Lately, India is also witnessing an intensifying COVID-19 disease burden and its impact on health workers. This paper aims to discuss the challenges to health worker protection in India and the possible ways forward. Given the inadequate and unequally distributed healthcare workforce, it is highly essential for the country to strategize prompt measures for ensuring occupational health and safety of its health workers. Information for this paper were gathered by searching PubMed and Google Scholar databases using “COVID-19”, “Infection Control”, “Health worker”, “India” as search keywords in different combinations. In addition, websites of Government of India, relevant UN agencies and leading news agencies were also searched manually for related reports and publications. India must take timely measures in rapid manufacturing and procurement of essential personal protective equipment (PPE) to ensure adequate stockpiling to meet the rising demands. Comprehensive and repeated training with sharply focussed content including usage of PPE kits as well as active surveillance of adherence to recommended protocol are critical in protecting health workers especially the primary care physicians and frontline health staff from the deadly COVID-19 infection. The provision of psychological and financial support for health workers and their families is absolutely critical in building trust and dedicated work efforts by the health workforce for a continuous fight against the deadly disease.
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Redesigning routine antenatal care in low resource setting during COVID-19 pandemic p. 4547
Rinchen Zangmo, Archana Kumari, Deepali Garg, K Aparna Sharma
DOI:10.4103/jfmpc.jfmpc_831_20  
Obstetric population because of its unique and varying needs specific for different gestations justifies for distinctive considerations in times of pandemic like COVID-19. Healthcare facilities providing obstetric care need to develop contingency plans for minimizing antenatal visits to limit exposure of both healthy pregnant women and care providers from ill people. However, to mitigate any potential adverse effects of reduced antenatal visits, intelligent and smart use of evolving telemedicine capabilities can provide the continuum of care despite overwhelming burden due to pandemic. A collaborative work-model involving health workers in the community and the regional levels of health centres also has the potential to prevent the catastrophic collapse of obstetric care services during any pandemic like COVID-19.
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Asymptomatic COVID-19 patients and possible screening before an emergency aerosol related endodontic protocols in dental clinic-A Review p. 4552
Navdeep Jethi, Gaurav Pandav, Divya Nagri, Sakshi Pandav, Dibya Kumari, Manpreet Kaur
DOI:10.4103/jfmpc.jfmpc_796_20  
Dentistry is related to the cure of oral and dental infections, so exposure and proximity of dental practitioners to oral and nasal fluids of a patient is very obvious. Before you proceed for an aerosol-generating procedure like RCT, and crown preparations, diagnosis, and screening of COVID-19 is very important, as failure may end up infecting yourself and would become a source of infection to your patient community. Due to limitations of data, medicines, and PPE shortage all around the world, screening of asymptomatic carriers of COVID-19 is very troublesome but necessary. To avoid any silent positive patient, the possible way is to ensure mandatory testing of every patient before you treat it. As the door to door surveillance of COVID-19 patients seems near to impossible in the Pandemic era for densely populated developing countries like India. The possible screening regimes include personal surveillance and contact tracing in the very first appointments. So, on the basis of the knowledge and sources we have so far, we have tried to classify the asymptomatic patients seen in the clinics and their possible screening management there. As it is said classification of a disease, is the first step toward a deep understanding of it. After screening, suspects can be sent to more resourceful places for their managements, and incidences of community spread of the disease through dental clinics can be avoided.
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Socio-economic impact of first 21 days nationwide lockdown- 1 on the spread of SARS-COV-2 in India in relation to health p. 4557
Satish Kumar, Satyendra Kumar Sonkar, Isha Atam, Harish Gupta, Krishnapal Singh Parmar, Sudhir Kumar Verma, Virendra Atam
DOI:10.4103/jfmpc.jfmpc_662_20  
On March 11, 2020 World Health Organization (WHO) declared corona virus disease (COVID-19) to be a pandemic disease, which is caused by a novel coronavirus “severe acute respiratory syndrome coronavirus-2 (SARS CoV- 2)” and till now it has affected about 213 countries. A nationwide lockdown was announced by the Honorable Prime Minister of India on 24th March 2020 for 21 days to prevent the spread of the COVID-19. Our nation, being a developing nation and emerging market, there was a vast socio-economic consequence of this lockdown. Our health care services were at the war front. Due to this step, there was a reduction in the rate of the spread of COVID- 19. Other health hazards due to pollution, road traffic accidents, crimes including robberies, rapes, murders, thefts, etc., were decreased substantially. People learned good hygiene and family bonding, which was further strengthened. Negatively affected sectors were trading companies, schools, and education, economy, stock markets, ongoing events in sports, politics, entertainment industry, transportation, and activities related to religious places, tourists, and hotels. Due to starvation, poor people were worst affected as they were daily bread earners though, the government tried to provide money and food. Finally, it was the primary care physician, termed “corona warriors,” who suffered socially, economically, mentally, and physically. Despite all these hardships, the primary care physician learned the innovative way to help patients and ease their suffering with proper advice and awareness.
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ORIGINAL ARTICLES Top

Cutaneous manifestations of coronavirus disease 2019 in 458 confirmed cases: A systematic review Highly accessed article p. 4563
Rashmi Jindal, Payal Chauhan
DOI:10.4103/jfmpc.jfmpc_872_20  
Background: The coronavirus disease 2019 (COVID-19) pandemic has affected the whole world for a short span of time. As it is a novel virus, its manifestations have been slowly revealed. Cutaneous manifestations of COVID-19 have gradually been reported from different regions of the world. However, their significance in diagnosis, as well as predicting prognosis, remains to be established. Objective: This review describes the cutaneous manifestations of COVID-19 patients from diverse regions with the aim of highlighting any important associations. Methods: A literature search was conducted using “PubMed” for original articles, case series, and case reports using the search terms “cutaneous manifestations” and “skin manifestations” in combination with “COVID-19” published up to 31 May. Results: Nine original research articles and 35 case series or case reports were identified, including 458 confirmed COVID-19 cases. The ratio of male to female patients was 0.94, and the patients' age ranged from 2 months to 84 years. In 10% of cases, skin lesions appeared before systemic manifestations. The most common cutaneous manifestation was macular/maculo-papular rash (42.5%), followed by acute urticaria (17.9%), vesicular rash (15.3%), pseudo-chilblain or acral purpuric lesions (15.1), and livedo-reticularis (4.4%). The majority of reported cases were located in Spain, Italy, and France. These manifestations do not seem to be sex-, age-, or country-specific. Conclusion: It is necessary to conduct worldwide registries and prospective studies to assess the true incidence of cutaneous manifestations of COVID-19 and to streamline their categorization based on their pathogenesis. There appears to be no specific manifestation at present, but a high index of suspicion can help in the diagnosis of patients presenting with cutaneous lesions as the first manifestation.
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Breastfeeding practices and infant feeding pattern of a tribal population region of eastern India p. 4570
Deblina Sarkar, Chanchal Kumar Dalai, Kingsuk Sarkar, Shubra S Das, Saugat Banerjee
DOI:10.4103/jfmpc.jfmpc_631_20  
Background: Regular vigilance over infant feeding practices in the community is necessary for assessment of optimal growth and development and the intervention if needed. Objective: To illustrate infant feeding practices, and socio-demographically correlated time like when weaning starts, the challenges met by mothers, and the types of complementary feeding adopted. Methods: A structured pretested and predesigned questionnaire was used to collect information regarding sociodemographic, detail information regarding initiation and duration of breastfeeding, age of complementary feeding and type of food given during complementary feeding, minimum dietary diversity and minimum meal frequency, and also advice given during child feeding session. Results: The study revealed that it was a predominantly Hindu tribal community where majority of infant were female and belong to joint families. Most of the mother had completed high secondary school and were housewives and belong to upper lower social class. Majority of women had more than two children, and rate of delivery at government institution was more than private institution and home delivery. Exclusive breastfeeding was practiced among 78% of infants, 46% had started breastfeeding within 1 h of birth. In total, 48% of infants were given prelacteal feed, and colostrum feeding was practiced among 62% of infants. Complementary feeding was given by 82% of infants and minimum dietary diversity, and minimum meal frequency was found among 77 and 85%, respectively. Conclusion: This community-based study carried out among tribal population of Kalyani showed that exclusive breastfeeding and other domains like complementary feeding and minimum dietary diversity are almost satisfactory.
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Etiological spectrum of infectious keratitis in the era of MALDI-TOF-MS at a tertiary care hospital p. 4576
Ranjana Rohilla, Suneeta Meena, Aroop Mohanty, Neeti Gupta, Neelam Kaistha, Pratima Gupta, Amit Mangla, Anshu Singh
DOI:10.4103/jfmpc.jfmpc_630_20  
Background: Infectious Keratitis (Ik) Is A Potential Vision-Threatening Ocular Infection Caused By A Variety Of Microorganisms. Aim: To Explore Risk Factors And Etiological Agents Associated With Ik. Design: A Prospective Cross-Sectional Study In Which Corneal Scrapings From 120 Suspected Cases Were Evaluated At A Tertiary Health Care Institute From January To December 2019. Methods: Scrapings Were Subjected To Direct Microscopy, Culture, And Identification By Both Conventional Methods And Maldi-Tof-Ms. The Patient's Demographic Data And Predisposing Factors, If Any Were Recorded. Results: The Mean Age Of Patients Was 48.9 Years And Predisposing Factors Were Documented In 46% (55/120) Of Cases. Overall, Infective Etiology Could Be Established In 51% (N = 61/120) Of Cases. Fungal Growth In 26% (N = 31/120) Of Cases And Bacterial Growth In 22% (N = 27/120) Of Cases Was Obtained. Growth Of More Than One Species Of Fungi Or Growth Of Bacteria Along With Fungus Were Observed In 2% (N = 3/120) Of Cases. Of All The Fungal Isolates Obtained (N = 34), The Most Common Isolate Was Fusarium (18/34) Followed By Aspergillus (8/34), Curvularia (4/34), Pseudallescheria Boydii (3/34), And Geotrichum (1/34). Among The Gram-Positive Bacterial Isolates (N = 16), Staphyloccus Species (15/16) Were Isolated In Maximum Number Followed By Streptococcus Pneumoniae (1/16). Among The Gram-Negative Isolates (N = 13), Pseudomonas Species (8/13) Were Isolated In Maximum Number Of Cases, Followed By Acinetobacter (3/13), Klebsiella Pneumoniae (1/13), And Escherichia Coli (1/13). Conclusion: For Initiating Appropriate Empirical Therapy, The Knowledge Of The Epidemiological Pattern Of Infectious Keratitis Of A Particular Geographical Region Is Crucial.
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Ophthalmologic outcome of premature infants with or without retinopathy of prematurity at 5-6 years of age p. 4582
Seyed Ahmad Rasoulinejad, Parisa Pourdad, Abdollah Pourabdollah, Afsaneh Arzani, Zahra Geraili, Horrieh Yosefi Roshan
DOI:10.4103/jfmpc.jfmpc_528_20  
Purpose: Vision is the main source of sensory information to the brain in most species of living and human beings and is one of the most important senses for the normal physical and mental development of children. Retinopathy of Prematurity (ROP) is one of the leading causes of blindness and visual impairment worldwide. Refractive errors such as myopia, astigmatism, and anisometropia are common in premature infants with or without ROP. Methods: A prospective cohort study was performed on the population of premature infants. Screening for Retinopathy of Prematurity in neonatal period was performed according to the protocol of ophthalmologic examination and between 4 and 6 weeks after birth by retinal specialist. The case group included 90 children with or without ROP during infancy. Primary and measurable outcomes in the studied children, including visual acuity, refractive errors, strabismus, and amblyopia, were assessed by an optician and retina ophthalmologist. Results: In our study, at the age of 5–6 years, 26.67% of case group and 48.89% of control group had visual impairment. Amblyopia 3.33%, strabismus 6.67% and refractive errors 16.67% were found in the case group. In control group amblyopia was reported 12.22%, strabismus 6.67%, and refractive errors 30%. In this study, visual impairment was higher in the control group than in the case group. Conclusion: Considering the high prevalence of visual impairment in the control group children who were all without ROP, it is necessary to emphasize the importance of careful visual examination of the children at a younger age and remind them of the importance of visual impairment.
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Association between socioeconomic status and influenza-like illness: A study from Western part of India p. 4587
Ravindra K Hadakshi, Dhruvkumar M Patel, Mukundkumar Vithalbhai Patel, Maitri M Patel, Palak J Patel, Maurvi V Patel, Krishnat S Yadav, Himil J Mahadeviya, Ritesh A Gajjar, Prathana N Patel, Harsh D Patel
DOI:10.4103/jfmpc.jfmpc_856_19  
Objectives: Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI). Materials and Methods: This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income <2000 INR) and non-lower SES groups. Results: 810 cases and 830 controls were compared. Many cases were from lower SES, had poor hand hygiene, and were using soil, mud, ash (SMA) for hand cleaning as compared to the control. Among the cases significant numbers were from lower SES (543/810[67%],P < 0.02), many were alcoholics, smokers, had poor hand hygiene, were using SMA for hand cleaning, and had preexisting chronic obstructive pulmonary disease (COPD), while few were having diabetes in the lower SES group as compared to the non-lower SES group. ILI was more common among lower SES class in unadjusted analysis (odds ratio [OR] 1.58, 95% CI 0.89–2.76) and the results were significant even after the adjustment of covariates (OR 1.62, 95% CI, 0.94–2.85). Conclusion: Lower SES people were 2.8 times more prone to ILI as compared to the age- and sex-matched control in western part of India.
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Risk reduction in anesthesia and sedation—An analysis of process improvement towards zero adverse events p. 4592
Manasij Mitra, Maitraye Basu, Kumar Shailendra, Nupur Biswas
DOI:10.4103/jfmpc.jfmpc_722_20  
Introduction: Anesthesia is a complex domain that is highly technical and skill based. Primary Care Physicians often have to do the initial evaluation of surgical patients they encounter during their daily practice before referring them to the surgical team. Thus, the Primary Care Physician's preliminary knowledge in anesthesia processes, risks involved and interventions that can be done to minimize these risks can improve patient-centered care and ultimately patient safety. Materials and Methods: The study was conceptualized and conducted in the Department of Anesthesiology from January 2018 to December 2018 in a 600 bed Multispecialty teaching hospital in Bihar, India. The study aimed towards Anesthesia Care related Risk Identification and Reduction and encompassed process improvements. Results: Risk Severity Analysis of the Critical Steps of Anesthesia Care was done. The average Hazard Score reduced from 21.59 during January 2018 to March 2018 to 8.23 during April 2018 to June 2018 subsequently to 3.53 during July 2018 to September 2018 and finally to 2.12 during October 2018 to December 2018. Thus, there was an overall reduction of 90.18% in the Hazard Score from April'18 to June'18 quarter to October 2018 to December 2018 quarter. Conclusion: Adverse Anesthesia/Sedation Events reported during the period from January 2019 to December 2019 was “Zero”. A systematic approach towards Risk Reduction not only lead to reduction in Hazard Score and Process Improvement but also made the Anesthesia Care Safe which is evident in the consistency of reporting “Zero” Adverse Anesthesia/Sedation Events for the last one year.
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Cognitive impairment and its predictors: A cross-sectional study among the elderly in a rural community of West Bengal Highly accessed article p. 4603
Aparajita Dasgupta, Sauryadripta Ghose, Bobby Paul, Lina Bandyopadhyay, Pritam Ghosh, Akanksha Yadav
DOI:10.4103/jfmpc.jfmpc_604_20  
Context: With the aging of Indian society, maintaining salubrious cognitive health in late life is a public health priority. Early detection and possible prevention of cognitive impairment (CI), thus, will help in increasing the quality of life of elderly people and decreasing the social, psychological, and economic burden of their families and caregivers. Aims: The study aimed to assess proportion of CI and its predictors. Settings and Design: This community-based cross-sectional study was conducted among 135 elderly people selected from 15 villages out of a total 64 villages in rural field practice area Singur of AIIH&PH, Kolkata. Methods and Material: Cluster sampling technique was used and villages were selected according to probability proportional to size method. Data was collected using a predesigned, pretested structured schedule, which included sociodemographic and behavioral variables, Montreal cognitive assessment tool, Geriatric depression scale short form (GDS 15), and mini nutritional assessment tool. Statistical Analysis Used: Predictors of CI were assessed by univariate and multivariable logistic regression using MS-Excel 2016 and SPSS version 16 software. Results: Mean age of the study participants was 67.03 ± 6.7 years with 51.9% of them being females. Proportion of CI was observed to be 48.1% which was significantly associated with increasing age [AOR = 1.1 (1.02–1.13)], decreasing years of schooling [AOR = 1.1 (1.01–1.2)], depression [AOR = 2.7 (1.3–5.8)], and malnourished group [AOR = 4.5 (1.01–20.3)] Conclusion: The burden of CI among the study population was found to be quite high. It is an alarming situation which needs improved screening facility for early detection. Nutritional upliftment and screening for depression should also be done on a regular basis.
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Factors affecting nutritional status of Anganwadi children: A cross-sectional study p. 4613
Ira Jain, Simmi Oberoi, Ankur Jain, Rajinder S Balgir, Manhardeep K Sandhu, Yogita Lugani
DOI:10.4103/jfmpc.jfmpc_410_20  
Introduction: As per the National Family Health Survey (NFHS) 2015-16, 35.7% children below 5 years of age are underweight. In light of Malnutrition rates still remaining alarming in children, it becomes pertinent to elicit the factors that affect nutritional status of children. So, this study was undertaken. Materials and Methods: After obtaining ethical approval from institutional ethics committee, data were collected on a pretested questionnaire. Information from mothers of 1085 children attending Anganwadi center in an urban block of Patiala was collected and analyzed. Results: Among females, 35.85% were underweight, whereas the proportion for males was 28.68%. The proportion among immunized children who were underweight was 31.34%, whereas the proportion among unimmunized children was 38.91%. Those who received supplementary nutrition were also in more in numbers in normal weight range than those who did not. Conclusion: Gender, birth order, and immunization status of child are significantly associated with nutritional status. This study showed that prevalence of malnutrition was less among those who received supplementary nutrition as compared to ones who did not.
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Pregnancy-related emergencies: Profile and outcome p. 4618
Ankita C Nekkanti, Darpanarayan Hazra, Reshma M George, Sruthi Yalamanchili, Pushpalata Kumari, Santosh T Samuel, Kundavaram P. P. Abhilash
DOI:10.4103/jfmpc.jfmpc_713_20  
Background: National efforts to reduce maternal mortality with respect to community services have primarily focused on upgrading transportation infrastructure and formalizing training for care providers. There is, however, a paucity of baseline data on the profile and outcomes of pregnant women presenting to the Emergency Department (ED) in India. Methods: This retrospective study enrolled all pregnant women presenting to a large tertiary medical care center in India, between November 2016 and November 2017. Results: There were 696 ED visits by pregnant women during the study period. The mean age was 26.85 (SD: 4.88) years. Pregnant women in the first trimester contributed to 50.8% of all visits, and 54% being multigravida. The most common presenting complaints were bleeding/spotting per vaginum (PV) (38.2%) and abdominal pain (37.6%) followed by fever (21.6%) and vomiting (21.5%). Obstetric causes contributed to 53.2% of the ED visits, while nonobstetric causes amounted to 43.2%. Over a third (39.7%) required hospital admission. Of these patients, 73% delivered in CMC with live births amounting to 62.3% while 3.5% ended in fetal deaths. The miscarriages rate was as high as 28%. More than half (51.1%) of the deliveries were by normal vaginal delivery. There were no maternal deaths during the time of admission. Conclusions: Our study sheds new light on the profile of emergency visits among pregnant patients and their relationship to the outcome of pregnancy. First trimester visits were most common with complaints of bleeding PV and abdominal pain. This could explain the high rate of miscarriages among this population.
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Adiposity contributes to poor glycemic control in people with diabetes mellitus, a randomized case study, in South Kashmir, India p. 4623
Gowher Ahmad Wagai, Ghulam Jeelani Romshoo
DOI:10.4103/jfmpc.jfmpc_1148_19  
Background: Diabetes mellitus (DM) is a significant health burden and recent reports suggest that the incidence of diabetes is increasing. Poor knowledge, fear of use of new drugs, and lack of awareness of the importance of the control of the disease are common among primary care physicians caring for diabetes patients. Many diabetes patients continue to be underdiagnosed, undertreated, increased use of expensive acute health-care services, and reduced quality of life. Aims and Objectives: The aim was to study the poor control of DM and the associated risk factors associated with Type 2 DM, to spread awareness about DM, to assess the prevalence, treatment, and control of diabetes, to examine the relationship of obesity with raised blood glucose, and finally, to evaluate the effect of the educational level on glycemic control. Study Material: This study was conducted to evaluate the control of diabetes in South Kashmir, India. It was done among patients in the Outpatient Department of Medicine, MMAB Memorial Hospital (GMC Associated Hospital) Anantnag, Kashmir. A random sampling procedure was adopted for the study, and a total of 300 patients were studied over a period of 5 months, which included 155 men and 145 women. During a period of study, within the age group of 36–50 years with adiposity were assessed for glycemic control. Methodology: All patients underwent anthropometric assessment and blood pressure measurements. Fasting blood sample was obtained for plasma glucose and lipids. Patients were assessed for weight and body mass index. Results: The prevalence of uncontrolled glycemia was more frequent in women as compared to men because of adiposity.
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Prevalence of major neurological disorders in predominantly rural northwest India p. 4627
Manoj K Gandhi, Sunil K Raina, Amit Bhardwaj, Abhilash Sood
DOI:10.4103/jfmpc.jfmpc_1048_19  
Background: Epidemiological studies based on hospital population, geographic isolates, smaller population, and focused groups provide valuable information on the pattern of diseases, but do not reflect on the true prevalence rates or the changing trends of disease over a period of time in different communities. The present study was undertaken to determine the prevalence and pattern of various neurological disorders in Himachal Pradesh. Methodology: Study was carried out in urban and rural population of district Kangra of Himachal Pradesh. A proportional representation was given to each area in the allocation of sample size as per probability proportional to size (PPS) method using a two-phase design: 1) A screening phase and 2) a clinical evaluation phase. All subjects were screened and a subset (screen positive and 10% of screen negative) was identified for the detailed clinical evaluation after screening. A standardized screening battery (NIMHANS protocol) was used for this purpose. An individual was confirmed as a case of neurological disorder only after clinical evaluation. Results: A total of 260 (out of 10,000 studied) individuals were found positive for neurological disorders yielding a crude prevalence of 2.6%. The crude prevalence for rural areas was found to be 2.28% (206/9000), whereas the crude prevalence in urban area was found to be 5.4% (54/1000). Migraine was the most common disorder. Conclusion: In view of the high crude prevalence of major neurological disorders, there is a need to develop capacity among healthcare professionals regarding them.
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Interpretation of maternal blood glucose during pregnancy at high altitude area, Abha-Saudi Arabia p. 4633
Bahaeldin Hassan
DOI:10.4103/jfmpc.jfmpc_747_20  
Background and Aims: In women who reside at high altitude, fasting plasma glucose is lower than at sea level, and further decrease of fasting blood glucose was noticed during pregnancy. This study aimed to set cutoff level of fasting plasma glucose during pregnancy at high altitude. The obtained data intended for interpretation of gestational blood sugar results and early detection of those who at risk of developing gestational diabetes. Methods: A cross-sectional study was conducted to determine the cutoff level of fasting plasma glucose during pregnancy at high altitude. The subjects were pregnant women who attending the routine antenatal care at Abha Maternity Hospital and Mahayil Aseer Maternity hospital. Plasma glucose concentrations and Body Mass Index (BMI), socio-demographic and obstetric data were entered into the Statistical Package for Social Sciences (SPSS) version 20. Comparison amongst these variables were carried out through t test (numerical variables) and Chi Square test (proportions). A P value of <0.05 was considered as statistically significant. Results: The overall results obtained indicated that the fasting plasma glucose concentrations and BMI were significantly lower (p = 0.0001) at high altitude area (Abha) than low altitude area (Mahayil Aseer). Age was the only socio-demographic factor that showed significant difference between the two groups (p-value was <0.05). Conclusion: Up to our knowledge, this is the first study addressing the interpretation of fasting blood glucose during pregnancy at high altitude area in Saudi Arabia. Our findings support the importance of careful interpretation of fasting blood glucose of pregnant women who reside at high altitude areas. The implementation of this policy at high altitude areas in the Kingdom of Saudi Arabia is recommended for early detection of gestational diabetes and timed intervention to avoid complications.
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Idiopathic post prandial glucose lowering, a whistle blower for subclinical hypothyroidism and insulin resistance. A cross-sectional study in Tertiary Care Centre of northeast India p. 4637
Chubalemla Longkumer, Chandan Kr Nath, Bhupen Barman, Alice Abraham Ruram, Vizovonuo Visi, MD Yasir, Merrycka Agitok Sangma
DOI:10.4103/jfmpc.jfmpc_867_20  
Background and Aims: There has been a lot of confusion in management of apparently healthy individuals whose post prandial plasma glucose levels were lower than fasting levels. It has been observed that many clinicians do send for repeat tests to rule out analytical error since there is common knowledge that post prandial glucose should be higher than fasting glucose level. Blood glucose level is regulated by a fully integrated mechanism with complex interplay of hormones and enzymes on metabolic pathways. Increase or decrease of thyroid hormones can break this equilibrium leading to alterations of carbohydrate metabolism. The objective for this study was to look for subclinical hypothyroidism (SCH) and insulin resistance (IR) in Idiopathic Post prandial glucose lowering and the correlation between thyroid stimulating hormone (TSH) with IR in them. Methods: A cross-sectional study with subgroup analysis, 34 cases and 34 controls. Cases comprises of otherwise healthy individuals whose post prandial glucose is lower than fasting glucose and controls as those healthy individual whose post prandial glucose is higher than fasting. Thyroid hormones and insulin were measured in fasting serum samples. Homeostasis model assessment for IR was calculated as per formula. Results: Among the 34 cases with idiopathic post prandial glucose lowering, 76% (n = 26) had subclinical hypothyroidism and 61% (n = 21) had insulin resistance. A positive correlation (r = 0.55) was observed between Thyroid-Stimulating hormone (TSH) and Index of insulin resistance and homeostatic model assessment (HOMA-IR) and was statistically significant with P < 0.1. Conclusions: The study highlights the importance of evaluating glycoregulatory hormones like thyroid hormones and insulin in cases with idiopathic post prandial glucose lowering for early diagnosis and prevention of overt clinical diseases like Hypothyroidism and Diabetes Mellitus.
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The prevalence of foot pain and its associated factors among Saudi school teachers in Abha sector, Saudi Arabia p. 4641
Turki A Alqahtani
DOI:10.4103/jfmpc.jfmpc_898_20  
Background: The heel is the prominence at the posterior end of the foot. It is based on the projection of one bone, the calcaneus or heel bone, behind the articulation of the bones of the lower leg. Foot pain is not rare finding in the general population, particularly in older adults. The prevalence in adults ages ≥18 year's ranges from 17 to 24%. Heel pain is a general term used to describe pain and discomfort felt anywhere in or around the rear of the foot. This study aimed to estimate the prevalence of heel and foot pain and their determinants among teachers in Abha sector. Methodology: A deceptive cross-sectional approach was applied for the current research. All accessible teachers working in governmental and private schools in Abha sector. To be included, teachers should be teaching but not in administrative positions, free of musculoskeletal disorders due to causes other than teaching. Teachers with foot congenital anomalies, newly employed teachers. A self-administered questionnaire was personally distributed to included school teachers in Abha sector. Questionnaires were distributed and collected on second day after being filled by teachers. Posterior HP health Survey questionnaire was used to assess foot and foot pain. Results: The study included 1,439 teachers from different districts of Abha sector with their ages ranged from 24 to 60 years old with mean age of 41 ± 9 years. Female teachers constituted 72.8% of the sample and teachers' weight ranged from 45 to 185 kg with mean weight of 76.6 ± 18.2 kg. Exact of 85.5% of the teachers had foot pain during the last 12 months. Foot pain was mild among 17.3% of the teachers with foot pain and severe among 25.5% of them. Low back pain was recorded among 81% of the teachers followed with knee pain (62%), neck pain (58%), shoulder pain (55%), and wrist pain (28%). Conclusions and Recommendations: In conclusion, the study revealed that majority of teachers complained of foot pain. The pain was moderate especially after long standing. The pain was more among old aged teachers with high load of teaching sessions. The pain altered the traditional daily activities among majority of teachers but very few number who asked for medical consultation.
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Life's crucial transition and leads for comprehensive trajectory: Adolescents survey at physiological stages for prudent policies and refinements for practice p. 4648
Sunil Jain, Rajeev K Thapar
DOI:10.4103/jfmpc.jfmpc_339_20  
Context: Adolescent health information within new global health initiatives is advocated. Global School-based Student Health Survey (GSHS) is among young people 13 to17 years. Early prevention and promotion is beneficial. Aim: To find health behaviors and protective factors at different adolescence physiological stages. Settings and Design: School-based survey in an Army Public School. Methods and Materials: The study parameters were dietary behaviors, hygienic practices, mental health, physical activity, and protective factors. A total of 1232 adolescents were surveyed. Early adolescence (10–13 years) participants were 760 and middle adolescence (14–17 years) were 472. Male: female ratio was 1.819:1. Statistical Analysis: Calculation of percentage ± Standard error using standard methods. Results: The study reveals interesting trends. There is a disparity between body mass index (BMI) findings and effort direction for weight. There is a sharp rise in girls making efforts to lose weight from early to middle adolescence (27.8% and 40.7%, respectively). Hygienic practices are marginally short of 100%. Worry causing the inability to sleep at night most of the time or always reported by 9.2–18.7%. There is a sharp rise in the number of girls feeling this from early to middle adolescence (9.8%–18.7%). Adolescents spending three or more hours per day doing sitting activities are 25.6–38.6%. This is rising from early to middle adolescence, and sharply in girls. Protective factors are trending towards the positive side. Conclusions: First, for advancements of adolescents' health, top priorities are (i) Popularizing importance of ideal BMI, (ii) Betterment of mental health for a smooth transition across stages and being proactive for preventing worsening, (iii) Promoting physical activity early and sustaining efforts, especially amongst girls. Second, the 'GSHS Questionnaire' needs to be modified for fruits and vegetable consumption to how many servings/what part of plate and include questions for details of physical activity likings of girls.
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Level and determinants of job satisfaction among Saudi physicians working in primary health-care facilities in Western Region, KSA p. 4656
AbdulLateef A Allebdi, Hanan M Ibrahim
DOI:10.4103/jfmpc.jfmpc_428_20  
Introduction: Job satisfaction is an important factor influencing the health of workers and is directly related to quality of care. Objectives: To assess the level of job satisfaction and factors contributing to dissatisfaction of Saudi physicians in primary health care centers in Jeddah. Methods All Saudi physicians working in primary health care centers in a city in the Western region, KSA, were included in this web-based survey using the “Job Satisfaction Survey” questionnaire adopted by Paul E. Spector (1994). In addition, socio-demographic data (age, sex, marital status, work facilities, qualification, work experience and income) were collected (response rate 83% ). Results: 63% of the physicians are satisfied about the nature of work in the primary health care centers, while 25.2% were satisfied about the payment. A large proportion of respondents were dissatisfied about the contingent rewards and fringe benefits (83.2%, 76.5%respectively). None of the specialists were satisfied about the work compared to 10.6% of the general practitioners. Conclusion: Slightly less than half of the physicians are satisfied. Financial incentives (contingent rewards and fringe benefits) impose a negative impact on job satisfaction for primary care physicians. On the other side, the nature of work has had the most positive impact on job satisfaction. Specialists were found to have less satisfaction. Investing in the physicians' satisfaction about the nature of work in the primary healthcare facilities to create a sense of ownership that would be reflected on the quality of patient care is required. There is a need to conduct further studies on the fiscal privileges that lead to job satisfaction among physicians.
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Relation of health-related quality of life with abnormal weight: A cross-sectional study prior to the weight reduction intervention p. 4662
Abdolreza Sotoodeh Jahromi, Karamatollah Rahmanian
DOI:10.4103/jfmpc.jfmpc_667_20  
Objective: Obesity is a major health issue that is well-documented association with morbidity and mortality. The aim of this study was to investigate the associations between health-related quality of life (HRQOL) and abnormal body mass index (BMI) levels. Materials and Methods: This descriptive study assessed 134 healthy individuals with abnormal BMI aged 18–39 years, clustered into three weight categories. The Short-form (SF)-36 Questionnaire was used for measuring of HRQOL. Results: Linear-regression analyses discovered the negative correlation between BMI and the general health element of HRQL, however, a positive relation to role emotional dimension. But BMI was not associated with other six dimensions, and also with physical and mental component summary and with total health quality of life. Conclusion: BMI was an important detriment factor for the general health dimension of HRQL with regression analysis. The higher grade of abnormal BMI had a negative influence on general health and positive effect on the role emotional dimension of HRQOL.
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Which obesity index is a better predictor for cardiometabolic risk factors in a young adult rural population of Telangana State, India? p. 4667
GN Kusneniwar, Guru R Jammy, D Shailendra, CH Bunker, PS Reddy
DOI:10.4103/jfmpc.jfmpc_864_20  
Background: Waist-to-height ratio (WHtR) has recently been found to be a useful marker of cardiovascular disease (CVD) risk in populations in developed countries; the comparison of various obesity indices, particularly WHtR, has received little study in India and other developing countries. Aim: This study aimed to compare the associations of common obesity indices, body mass index (BMI), waist circumference, waist-hip ratio (WHR), and WHtR, with cardiometabolic risk factors in a young, rural Indian population. Subjects and Methods: Anthropometric measurements and cardiometabolic risk factors (hypertension, diabetes, and dyslipidemia) were measured using standardized protocols at the baseline visit of the Longitudinal Indian Family hEalth Pilot Study, a population-based cohort study of child-bearing age women and their husbands in rural Telangana, India. Results: In comparison with most previously studied populations, this population sample (642 males and 980 females) was younger; had lower BMI; and lower rates of diabetes, hypertension, and abnormal lipids (exception of high rates of low high-density lipoprotein). With regard to each of the cardiometabolic risk factors, the associations across the obesity indices tended to be significant, but weak, and similar to each other, whereas the association with WHR was less strong. Conclusion: Although WHtR was not a better predictor of cardiometabolic risk than conventional obesity indices, in this young adult Indian population, it was equally good. This raises the prospect of using WHtR as an alternative to BMI for assessing cardiometabolic risk in Indians considering the ease with which it can be easily done and interpreted.
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Effect of obesity on cardiovascular responses to submaximal treadmill exercise in adult males p. 4673
Afreen Begum H. Itagi, MK Jayalakshmi, GY Yunus
DOI:10.4103/jfmpc.jfmpc_543_20  
Context: Obesity is a major risk factor for chronic diseases. Abnormal changes in cardiovascular responses to exercise indicate the alteration in autonomic activity in obese. Aims: To assess and compare the cardiovascular parameters before and after exercise among obese and nonobese adult males. Subjects and Methods: Thirty each obese and normal-weight males between the age group 18-45 years were selected as cases and controls, respectively. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), corrected QT intervals were measured before and after submaximal treadmill exercise (QT and QTc) were done according to Bruce protocol. HR, SBP, DBP, MAP, QT, and QTc were also measured during passive recovery at 1 min and 5 min after exercise. Statistical Analysis Used: One-way analysis of variance and t-test were used to assess changes before and after exercise. Results: Resting HR was significantly higher in obese when compared to nonobese (P < 0.05). SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001). Immediately after exercise HR, SBP, DBP, MAP, QT, and QTc were significantly higher in obese when compared to nonobese (P < 0.001) 1 min after exercise. Conclusions: Obese individuals had elevated resting cardiovascular parameters and showed increased responses to steady exercise which could be due to alteration in autonomic functions with sympathetic hyperactivity. Delayed rate of decrease in HR and BP after exercise was also observed in obese, which indicates that they are at risk of developing cardiovascular diseases.
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A study on effectiveness of video assisted counselling in establishing and sustaining appropriate breast feeding practices p. 4680
Vani Aditya, Harish Chandra Tiwari, Richa Mishra
DOI:10.4103/jfmpc.jfmpc_622_20  
Background and Aims: Breast milk is the only food for the neonate with vast benefits. Although breastfeeding process is natural but extensive research has revealed that mother requires active support for establishing and sustaining appropriate breast feeding practices. Due to high patient load, effective counselling of all pregnant ladies becomes a huge task. Video-assisted counselling has been tried for establishing and sustaining breastfeeding practices as it helps mothers to understand the procedure and process better as the video image is animated with a narrative voice. The objective is to study the effectiveness of video assisted breast feeding counselling in establishing and sustaining breast feeding practices. Materials and Methods: A Quasi experimental study was done in Obstetrics and Gynaecology department of BRD Medical College Gorakhpur from September 2019 to February 2020. Study subjects were pregnant ladies admitted in labour room for delivery. A total of 60 study subjects were allocated in Video-assisted breast feeding counselling group and same number in routine counselling group. Video-assisted counselling group breast feeding counselling was done with use of two videos (Video 1 is of 5 minute and 34 seconds duration and Video 2 is of 2 minutes and 50 seconds duration) demonstrations in labour room and post natal ward. Routine breast feeding counselling group received routine counselling as done by resident or consultants during their care. After the delivery the study participants were interviewed regarding their profile and breast feeding knowledge, motivation and behaviour and a scoring was done with Min. -0 to Max. 20 score. Result: Higher proportion of early initiation of breast feeding was observed in the video assisted counselling group as compared with the routine counselling group. The mean knowledge score of the subjects' video-assisted counselling group the mean knowledge score was significantly higher. Motivation of mother for breast feeding and improvement in their behaviour and skill in video-assisted counselling group was higher in comparison to routine counselling group. Conclusion: Video-assisted counselling was found effective in successful initiation and establishment of breast feeding.
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Autologous non-cultured keratinocyte cell suspension in non-healing diabetic ulcers: A preliminary study p. 4686
Shruti Barnwal, Ravi Kant, Poonam Yadav
DOI:10.4103/jfmpc.jfmpc_627_20  
Background: Diabetic ulcers are a common morbidity associated with poorly controlled glycemic status. Most patients often have neuropathy and vasculopathy as the etiology behind such ulcers. These factors not only lead to poor wound healing but also nonhealing ulcers. Nonhealing ulcers pose therapeutic challenges as they are usually not amenable to be treated with simple wound care and hence require newer modalities to effectively cure this condition that leads to a plethora of poor health outcomes. This study was conducted to see the effect of autologous noncultured keratinocyte cell suspension in chronic nonhealing diabetic ulcers that failed to normal wound care. Material and Methods: It was an observational pilot study. A total of 05 patients with nonhealing ulcers, attending the tertiary care teaching hospital in North India, were included in the study. Inclusion criteria was type 2 DM with more than 5 years duration of diabetes mellitus and glycated hemoglobin (HbA1c) <9 g%. History was taken in detail; name, age, sex, address, duration of disease and various other treatments taken from outside were noted; and size of ulcer was recorded as per Proforma. Results: A total of 5 patients were enrolled in the study, three (60%) and two (40%) patients were male and female, respectively. Three (60%) patients were habitual for tobacco use. Mean age of patients was 45 ± 6.51 years. Mean duration of ulcers was 4.8 ± 1.48 months. Area of ulcers ranged from 31.2 to 122.2 cm2. Majority of cases, three (60%) of diabetic foot ulcers, were improved at 9–12 weeks and remaining two cases with large size of ulcer were healed at 13–16 weeks and 17–20 weeks, respectively. Majority (80%) of patients revealed >50% reduction in the size of ulcer within 2 weeks. Conclusion: Noncultured keratinocytes are useful in healing of nonhealing diabetic ulcer.
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An assessment of age-appropriate infant and young child feeding practices among children in Kancheepuram district, Tamil Nadu, India p. 4692
Fasna Liaquathali, Jasmine Maruthupandian, Ravivarman Govindasamy
DOI:10.4103/jfmpc.jfmpc_668_20  
Background: Appropriate Infant and Young Child Feeding (IYCF) practices are a cornerstone to reduce child morbidity and mortality. Assessment of IYCF practices among the mother of young children is the need of the hour to find the breaches in their performance and to find out the influencing factors for these gaps. The study was undertaken with the objectives to assess the IYCF practices and the factors influencing among the children of age 7–24 months. Methodology: A cross-sectional study was undertaken in the rural area of Kancheepuram district, Tamilnadu from June 2019 to December 2019. One hundred forty-three children of age less than 2 years were selected by two-stage random sampling method. Data was collected house-to-house using the pretested questionnaire and WHO Infant and Young Child feeding questionnaire. Proportions were calculated and Chi-square test was applied. Results: The mean age of the children was 14 ± 5 months. Among the study participants, only 10.2% were exclusively breastfed for 6 months. 58.6% of children were introduced on soft/solid/semisolid food at the end of 6–8 months. The minimum acceptable diet of breastfeeding children was 31.5% and nonbreastfeeding children was 14%. Age of mother, educational qualification of mother, working status of mother, and mode of delivery were statistically associated with appropriate Infant and Young Children feeding practices. Conclusion: The results revealed that there is only improvement in early infant practices and there are indigent practices of complementary feeding among the mothers.
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Menstrual hygiene practices among women aged 15-49 years attending a medical college hospital in Kolkata: A cross-sectional study p. 4699
Kalyan Kumar Paul, Susmita Chaudhuri, Anindita Maiti
DOI:10.4103/jfmpc.jfmpc_718_20  
Background and Aims: Menstruation is a normal physiological process and a key sign of reproductive health in women in the reproductive age group. Poor menstrual hygiene affects the educational activities as well as the day to day activities of women. The objective of this study is to assess the practices of menstrual hygiene among women aged 15-49 years attending a tertiary care hospital in Kolkata and to assess their knowledge regarding menstrual hygiene. Materials and Methods: This was a hospital-based cross-sectional study conducted among the women belonging to the age group of 15-49 years attending the outpatient department of Gynaecology. Predesigned, pretested, semi-structured questionnaire was used as a study tool. Interview method was used for data collection after obtaining informed consent from the participants. Data were analysed by SPSS 20v software. Association between variables was checked by Chi-square test & P < 0.05 was considered as significant. Results: Mean age of respondents was 28.03 ± 7.01 years. The cause of menstruation as a normal body function constituted maximum response (43.5%) whereas the reason was unknown to many (37%). Regarding restrictions during menstruation, it was mentioned that avoiding worshipping was the commonest restriction (90.2%), followed by restriction in diet (32.6%). Use of readymade absorbents was found in most of the subjects (91%) followed by homemade reusable (6.5%) and homemade disposable (2.2%). Around 77.2% of them packed the napkins and disposed in garbage. Those who were aware about menstrual hygiene were found to be practicing satisfactory perineal cleaning (p < 0.05). Conclusion: Health education and awareness programme focusing on menstrual hygiene must be intensified. School curriculum can play a vital role in implementing health education.
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Association of obesity and pulse pressure with hypertension in an Iranian urban population p. 4705
Mohammad Shojaei, Abdolreza Sotoodeh Jahromi, Rahmanian Karamatollah
DOI:10.4103/jfmpc.jfmpc_723_20  
Objective: Nowadays, obesity is an important health problem and pulse pressure (PP) is a good predictor of cardiovascular events. The aim of study was to determine the association of obesity and PP with hypertension (HTN) in individuals aged 30 years or older in the urban population of Jahrom, Iran. Materials and Methods: In this study, we used a multistage stratified sampling method to select participants among the urban population aged 30 years or older. Height, weight, and blood pressure were obtained by a trained physician. Obesity was defined according to the World Health Organization classification. Angina was assessed with reliable and validate Rose questionnaire. Data were record by SPSS-16. Categorical and continues variables analyzed by Chi-squared, independent t-test, and one-way ANOVA test. Binary logistic regression analysis method was used for the association of PP and obesity with HTN and Rose angina that adjusted for age, gender, education class, marital status, smoking, total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein. A P < 0.05 was considered as statistical significance. Results: The prevalence of obesity was 18.1% that was greater in women (24.8% vs. 9.9%, P < 0.001). The prevalence of Rose angina and HTN in obese individuals were more than in normal weight individuals (24.8% vs. 16.4%, P = 0.027) and (42.0% vs. 31.1%, P < 0.001), respectively. Furthermore, patients in higher PP groups were older, were more possible to had HTN and had greater diastolic blood pressure (DBP), systolic blood pressure (SBP), and mean arterial pressure (MAP) in compared to individuals in the lower PP group. The individuals with HTN had greater DBP, SBP, MAP, PP, and body mass index (BMI) than individuals without HTN. However, individuals who had Rose angina, only had higher PP and BMI in compared to ones without Rose angina. The obese individuals had 1.97 (1.22–3.17, P = 0.005) fold for HTN risk than individuals with normal weight. In addition, PP weakly increased the risk of HTN about 1.09 fold (1.07–1.10, P < 0.001). However, Rose angina was associated only to overweight status (odds ratio = 1.51, confidence interval 95%: 1.03–2.20), P = 0.035) than individuals in normal weight group. Conclusion: Obesity and PP were higher in hypertensive individuals and overweight in individuals with Rose angina. It is time to pay more attention to abnormal BMI.
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Evaluation of village health sanitation and nutrition committee in Himachal Pradesh, India p. 4712
Anchal Dhiman, Poonam Khanna, Tarundeep Singh
DOI:10.4103/jfmpc.jfmpc_736_20  
Introduction: Decentralization through introduction of Village Health Sanitation and Nutrition Committees (VHSNCs) was a key initiative introduced in 2007 under the National Health Mission (NHM), India to address local health and sanitation issues. This study was done to assess the functioning of the VHSNCs. Aims and Objectives: 1. To assess the level of awareness among the VHSNC members about their roles and responsibilities 2. To assess the level of awareness among the community members about the committee and its functions. 3. To assess the pattern of disbursement and utilization of untied funds under VHSNCs. Methodology: A cross-sectional study of 30 VHSNCs conducted in district Kangra of state Himachal Pradesh. Information was collected through a review of records and in-depth interviews with community and VHSNC members. Results: All committee members knew about VHSNCs but the level of awareness among community members was comparatively less (67%). Some members were confused about their roles and responsibilities. Most active members were the FHWs, AWWs, ASHAs, Mahila mandal representatives, and the female ward panch. A major chunk (65%) of the funds is utilized on the cleanliness activities. For the nutritional part, the majority of the work is already being undertaken by the AWCs so there is no clarity regarding the functioning of the committee on this aspect.
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Level of awareness of risk factors and danger signs of pregnancy among pregnant women attending antenatal care in PHC, Nandagudi p. 4717
Amrita N Shamanewadi, MB Pavithra, Suwarna Madhukumar
DOI:10.4103/jfmpc.jfmpc_743_20  
Danger signs of pregnancy are warning signs that women encounter during pregnancy, child birth and post-partum period. It is important, to know these warning signs for women and health care providers to rule out serious complications and initiate treatment immediately. Objectives: 1. To assess the awareness of danger signs of pregnancy among pregnant women attending antenatal care in Nandagudi PHC. 2. To give health education to the pregnant women about the risk factors and danger signs. Methodology: A cross sectional study was conducted in PHC, Nandagudi , field practise area of MVJMC and RH. Study was carried out from September 2017 to November 2017. A total of 210 pregnant women who attended the ante natal clinic at PHC, Nandagudi were the study subjects. A pre designed pretested questionnaire was used. Data collected was thus entered in M S excel and was analysed using SPSS 21 version. Results: 60% of the study population belonged to the age group 23-27. Majority (90%) of them knew the importance of iron and folic acid. 72% of the cases knew the importance of blood group in pregnancy. Majority (91%) preferred hospital delivery compared to home delivery (9%). All 210 women knew about only 3 danger signs, they are bleeding per vagina, loss of consciousness and convulsions. Conclusion: Every pregnant woman faces the risk of sudden, unpredictable complication that could end in death or injury to herself or to her infant. Hence, it is necessary to employ strategies to overcome such problems as they arise.
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Determinants of home deliveries - Findings from India DLHS 4 analysis Highly accessed article p. 4723
Prafulla Kumar Swain, Priyanka Singh, Subhadra Priyadarshini
DOI:10.4103/jfmpc.jfmpc_751_20  
Background: Place of delivery has major implication on decreasing maternal morbidity and mortality. India has adopted various policies to encourage institutional births, still there are large numbers of deliveries which occur at home. Thus, it is imperative to understand the risk factors associated with home deliveries among women in India. Methods: The national representative district level household data-4 (2012-13) have been used for this analysis. A multiple logistic regression model has been used to determine the significant factors associated with home deliveries. Results: A total of 22,363 live births were selected for analysis for the year 2012. Out of which 3,602 (15.4%) are found to be home delivery births, remaining are either private or government institutional births. North-east states are found to be high prevalence of home deliveries. The potential factors viz., age of women, educational level of both husband and wife, age at first birth, higher order parity and not registered for ANC check-up, etc., are significantly associated with home delivery birth preferences among women in India. Conclusion: Our analysis demonstrates that targeting the significant predictors particularly education of family members and compulsory registration for ANC check-up will significantly reduce the preference for home delivery.
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Coronavirus and Its effect on the respiratory system: Is there any association between pneumonia and immune cells p. 4729
Besharat Rahimi, Ahmad Vesal, Maryam Edalatifard
DOI:10.4103/jfmpc.jfmpc_763_20  
Background: With a new mutation, coronavirus has now become an important pandemic that gripped the entire world. Coronavirus infection often begins in the nasopharynx and destroys the olfactory epithelium. Despite many studies, little progress has been made in the treatment of coronavirus. This study aimed to further investigate the pathogenicity of coronavirus to reduce its infection by examining the virus function in the body and its stages of infection. Material and Methods: With the aim of investigating the coronavirus and its effect on the human respiratory system from 1992 to 2020, this study examined the coronavirus and its different aspects and tried to answer whether there is an association between pneumonia and immune cells. This study was conducted in April 2020 and to obtain the related papers on the characteristics of the virus, Nature, ISC Pubmed, Medline WHO, NCBI, and PsycINFO databases were used. Out of 284 papers, 53 were used in this study. Result: Studies have shown that avoiding infected areas and strengthening the immune system inhibit the virus to bind the mucosal layers. Given the important role of acquired immunity and lymphocytes against coronavirus, it is necessary to pay attention to boost the immune system in adults and the elderly. Antioxidants help reduce the oxidative stress and inflammation in the immune system thus help it regenerate better. The results showed that children are susceptible to the virus though have lower mortality and clinical manifestations than adults. Conclusion: The vaccine should receive further attention and in the long run, antiviral drugs and broad-spectrum vaccines are produced for infectious diseases.
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An epidemiological study on depression among women during postpartum period in an urban slum of Bhubaneswar p. 4736
Krishna Mishra, Ipsa Mohapatra, RN Rout
DOI:10.4103/jfmpc.jfmpc_793_20  
Background and Aims: Depression accounts for the greatest burden of all mental health problems, and is expected to become the second-highest among all health problems by 2020. Postpartum depression (PPD) is a major public health problem with a peak incidence at 4-6 weeks postpartum, affecting 22% of women within a year of childbirth in India. It has an impact on the mother, her partner, the family, mother-baby bonding and the long-term emotional and cognitive development of the baby. The aim of the study was to: 1.To find out the prevalence of depression among women during the postpartum period 2.To identify the factors associated with depressive symptoms among them. Methods: A cross-sectional study was conducted in an urban slum of Bhubaneswar from July 2017 to January 2018, among a sample of 60 postnatal mothers who had delivered in the last six months; selected by simple random sampling technique. Edinburgh Postnatal depression scale (EPDS) was used to identify mothers at risk of postnatal depression. A score of ≥13 was considered as positive for depressive symptoms. Results: The prevalence of PPD was found to be 8.57%. Religion was found to be a statistically significant factor associated with PPD. Other factors like literacy status, socio-economic status, high parity, sex of the newborn, mode of delivery were also found to have an association with PPD. Conclusion: This study identified certain socio-demographic and obstetric risk factors for postnatal depressive symptoms in a community setting of an urban slum; screening of risk factors will help in designing preventive strategies for identifying PPD.
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Knowledge and practice of hand hygiene among undergraduate students and junior doctors in the Regional Institute of Medical Sciences, Imphal p. 4741
Gitashree Dutta, T Gambhir Singh, Tarun Kumar
DOI:10.4103/jfmpc.jfmpc_794_20  
Context: Maintenance of proper hand hygiene among treating doctors and nurses is one of the most important measures to curb health-care-associated infections.Hand hygiene can prevent the spread of germs including those that are resistant to antibiotics and are becoming difficult, if not impossible, to treat.There are few published articles on similar topic in different settings in India but not in Manipur. Keeping this in mind, the study was conducted. Aims: To assess the knowledge and practice of hand hygiene among undergraduate students and junior doctors in rims, imphal and its association with the selected variables of interest. Settings and Design: Regional Institute of Medical Sciences (RIMS). Methods and Material: A cross-sectional study was done on 924 participants by using a self-administered questionnaire. The data was analyzed using the software SPSS 21 version. Results: Of the participants, 49.1% had poor knowledge about hand hygiene; 14.3% had average knowledge, and 36.6% had good knowledge. Knowledge was significantly associated with the frequency of washing hands after patient contact or any laboratory procedure or after the removal of hand gloves (P < 0.001) and the frequency of following the six steps of hand washing (P = 0.001). Conclusions: Nearly half (49.1%) of the participants had poor knowledge about hand hygiene; more than one-tenth (14.3%) had average knowledge, and more than one-third (36.6%) had good knowledge.
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Level of knowledge of mothers (18-35 years of age) of under 5 children regarding ORS therapy p. 4747
Divasha , Rachna Pasi, Kumar Satish Ravi
DOI:10.4103/jfmpc.jfmpc_853_20  
Context: Diarrhea is a preventable cause of under 5 years of mortality. Mothers are a primary caregiver for children at home during an illness so this study was planned. Aims: To estimate the demographic variables and level of knowledge of mothers (18-35 years of age) of under 5 children regarding ORS therapy. Settings and Design: The study was conducted in selected rural areas Chandandih (a small village in Raipur district). There is one sub-center and four Anganwadi's in Chandandih. The population of this study was the mother (18-35 yr.) of under 5yr children. In this study non-probability, purposive sampling was adopted for selecting the sample, and the sample size is 60 mothers. Methods and Material: In this study, 60 mothers were enrolled and their demographic variables were asked, then a self-structured questionnaire was administered. Statistical Analysis Used: The data were analyzed by using descriptive statistics. Demographic variables were analyzed by using descriptive measures (frequency and percentage) and knowledge was analyzed using descriptive statistics (means, standard deviation). Results: This study showed that little and average levels of knowledge regarding ORS therapy of mothers were around 63.34% which may be attributable to their qualification level which was maximum till primary education. Moreover, many were housewives. Only 16.66% had a good level of knowledge regarding ORS therapy. Conclusions: 63.34% had little or average knowledge regarding ORS therapy.
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Factors influencing delay in initiating post-exposure prophylaxis for rabies prevention among animal bite victims: a cross sectional study p. 4751
Rabbanie Tariq Wani, Iqra Nisar Chowdri, Hibba Dar
DOI:10.4103/jfmpc.jfmpc_890_20  
Background and Aims: The aim of this study was to identify the delay and the factors associated with delay in initiating post exposure prophylaxis. Methods: A consecutive sampling method was proceeded, and 199 patients attending the anti-rabies clinic with a history of animal bite reported at SMHS Hospital were the subjects of the study. Results: Majority of the patients (72.36%) reported a delay within 6 h after exposure, 18.59% within (6-48) h and 9.04% after 48 h of exposure. Conclusion: Increasing the number of accessible anti-rabies clinics as well as increasing the awareness among general public about timely post exposure prophylaxis in the community are some of the factors that need to be implemented.
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COVID-19 preparedness among public and healthcare providers in the initial days of nationwide lockdown in India: A rapid electronic survey p. 4756
Limalemla Jamir, Shaista Najeeb, Rajeev Aravindakshan
DOI:10.4103/jfmpc.jfmpc_902_20  
Background and Aims: The COVID-19 Pandemic has been raging across continents in recent months. Public health measures are crucial in preventing COVID-19. The Government of India declared a nationwide lockdown on 24 March, 2020. The objective of this study is to assess preparedness among general public and healthcare providers against COVID-19 by way of adopting public health measures at the very beginning of the nationwide lockdown in India. Settings and Design: A rapid cross sectional electronic survey was conducted across the country between 25 and 27 March, 2020. Methods and Materials: Participants were general public and healthcare providers. Online questionnaire was generated in Google Forms. This included precautionary measures such as staying home, hand hygiene, wearing masks, cough hygiene and advisory against face touching. The web link to the form was shared through WhatsApp. Statistical Analysis Used: Descriptive data analysis was done using Epi Info software (version-7). Results: A total of 226 persons (general public = 183; healthcare providers [HCPs] = 43) participated in the study. During the lockdown, HCPs spent more time outside than the general public (p = 0.009). Only 47% of the participants claimed to practise frequent hand washing and majority (72%; n = 163) did not wear masks while outdoors. Almost a half (45%) of the participants touched their face frequently and very few (8%) participants covered their mouth or nose while coughing or sneezing. There was no significant difference between HCPs and general public in frequent hand washing (p = 0.456), wearing masks (p = 0.255), face touching (p = 0.632) or covering mouth/nose while coughing or sneezing (p = 0.428). Conclusion: There is lack of preparedness among general public and healthcare providers against COVID-19 at the beginning of the nationwide lockdown in India.
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Knowledge of oral health among family medicine physicians in Riyadh, Saudi Arabia 2020 p. 4761
Buthainah Alshathri, Nourah Aljasser, Mostafa Kofi
DOI:10.4103/jfmpc.jfmpc_907_20  
Background: Preventive oral health care (OHC) is an important part of preventive health care and needs to be started early in life. Family physicians are in a position where they can help to initiate preventive OHC. From previous literature, oral health has an impact on the general health and quality of life of individuals with a large burden on the health care system. In addition, pediatricians and family physicians lack knowledge in oral health and can be unwilling to participate in preventive OHC. We aim to increase family physicians' knowledge of oral health. Objectives: This study aimed to measure the level of knowledge about oral health and identify some of its determinants among family physicians working in Riyadh, Saudi Arabia. Methods: This is a cross-sectional study that included 187 family physicians to measure the knowledge of family doctors about oral health using a self-administered questionnaire. Results: The total mean score was 119.28 ± 11.26 out of 175, indicating a poor level of knowledge level about oral health. Conclusion: Family physicians in Riyadh, Saudi Arabia lack knowledge of oral health. These findings make it necessary to include oral health topics during residency and continuing medical education programs.
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Knowledge, attitude, and practices regarding COVID-19: A cross-sectional study among rural population in a northern Indian District p. 4769
Preeti Gupta, Anshi Gupta, Sumeet Dixit, Hemant Kumar
DOI:10.4103/jfmpc.jfmpc_1206_20  
Background: First case of COVID-19 was reported in December 2019 and within a timespan of few months, it has become a pandemic. It has created havoc globally and India is no exception. Globally, it is emphasized that preventive measures play an important role in controlling the rapid spread of COVID-19. In India, 68% of population is rural and this population is going to play a crucial role in the containment of the pandemic. Realizing the key position of rural population in COVID control, this study was conducted to assess the knowledge, attitude, and practices of rural population about the disease. Method and Material: A cross-sectional questionnaire-based study was conducted on patients and their relatives from 1st April, 2020 to 31st May, 2020. A total of 372 participants hailing from rural areas were enrolled. Results: Most common source of information for the participants was through television (54.8%) and radio (49.2%). Only 77% claimed that they were using face mask and 72% claimed to be following social distancing. A large (60%) proportion of the participants did not know that COVID-19 could spread from asymptomatic patients. Education of participants was a key determinant for use of social distancing and face mask as a preventive tool. With increasing age, the practice of social distancing and the use of face mask were decreasing in our study. Conclusion: Television/Radio channels form an important source of information and need to be used more effectively to educate the people about the disease and create awareness about effective preventive measures. People need to be educated about the role of asymptomatic carriers in spreading the disease.
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Comparative analysis of oral health and treatment necessities in hemophilia individuals of Davangere population — A case control study p. 4774
Varsha Kanjani, Rajeshwari G Annigeri, Suresh Hanagavadi, MR Manjunath
DOI:10.4103/jfmpc.jfmpc_413_20  
Background: The integrated approach towards the oral care of individuals with special needs requires proper motivation and prophylactic guidance by primary health care professionals, including musculoskeletal support to psychological therapy. In developing countries like India, oral care is not of primary importance as oral hygiene practices are less performed by compromised individuals suffering from hemophilia. Here, primary health care professionals play a significant role. The present study was commenced to evaluate oral health and treatment necessities in hemophilic individuals of Davangere population, Karnataka. Objective: The present study was conducted to assess and compare the oral hygiene, dentition status, and treatment needs of individuals with hemophilia. Methods: Simplified Oral Hygiene Index (OHI-S), decayed, missed, filled tooth (DMFT) indices and treatment needs in 50 hemophiliac patients registered at Karnataka hemophilia society were evaluated along with an Oral health-related quality of life (OHR-QoL) questionnaire. They were matched with healthy controls of the same age and gender. The data was analyzed using t test and Chi square test. Results: The oral hygiene was fair in both hemophilic and healthy individuals with a mean value of 1.82 ± 0.79 and 1.83 ± 0.73, respectively. All the parameters such as OHIS, DMFT indices, and teatment needs were not statistically significant. The spontaneous oral bleeding was the only significant factor in OHR-Qol questionnaire. Conclusion: The present study concluded that oral hygiene, dental caries prevalence, and treatment needs were similar in both hemophiliac and control groups. With proper guidance, motivation, and preventive care by primary health care professionals, it was relatively easy for individuals with congenital blood disorder (CBD) to maintain oral health-related quality of life in Davangere population, Karnataka.
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Health care seeking behaviour among rural women in Telangana: A cross sectional study p. 4778
P Mani C. Reddy, T Rineetha, D Sreeharshika, Kishore Y Jothula
DOI:10.4103/jfmpc.jfmpc_489_20  
Background: The health of women is of particular concern because, in many societies, they are disadvantaged by discrimination rooted in sociocultural factors. Women need to breach many social barriers to empower and to get access for quality health care services. Health seeking behavior is one of the important determinants of women health. Objectives: To assess healthcare seeking behavior among rural women in Telangana. Methods: Cross-sectional study with sample size of 200 was conducted in three villages attached to a medical college. Women of aged 20 years and above were included in the study. Data was collected by predesigned pretested semi-structured questionnaire. Data was presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23. Results: Only 34.5% [95% CI: 27.9, 41.5] of the subjects seek medical care as soon as symptoms appear and 69% [95% CI: 62.1, 75.3] of the participants were aware of nearby functioning health centres. Majority (60.5%) of the subjects Visits qualified medical practitioner during illness. Conclusions: The present study found that there is still a need to create awareness about the importance of healthcare and available health centers as significant proportion of women population approached unqualified medical practitioners and seeking home remedies as first consultancy source for their health remedies.
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Prevalence and awareness of varicose veins among teachers in Abha, Saudi Arabia p. 4784
Abdullah Dalboh, Nawaf Amer Alshehri, Abdulmajeed Abdullah Alrafie, Khalid Ali Bakri
DOI:10.4103/jfmpc.jfmpc_490_20  
Background: Teachers, compelled by the nature of their profession, are required to stand for a significant amount of time. This prolonged standing, being one of the risk factors for venous insufficiency, puts them at risk to develop varicose veins. Hence, as there is a need to educate and sensitize the teachers. This study was carried out to investigate the prevalence and awareness regarding varicose veins in school teachers. Methods: A cross sectional, questionnaire based study was carried out on 391 school teachers of the Aseer region, KSA, after obtaining ethical committee clearance and informed consent. Questions included personal, occupational, and varicose vein based questions. Responses were collected and analyzed using SPSS version 25.0 software. Frequencies and percentages were calculated. Results: Forty two percent of the teachers were found to have varicose veins most of which were females. Around 62% of the teachers suffering from varicose veins were between 36 and 45 years of age. Participants who did regular exercises were less prone to varicose than irregularly exercising participants (P = 0.0001). No association was observed between smoking and varicose veins (odds ratio 0.15, 95% confidence interval 0.05–0.44). Conclusion: Due to high prevalence of varicose veins among teachers, it is necessary to spread awareness regarding varicose veins among them and sensitize them with the methods to prevent its formation.
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Examining tribal health inequalities around three forested sites in India: Results of a cross-sectional survey Highly accessed article p. 4788
Tanya Seshadri, Nandini Velho, Nityasri S Narasimhamurti, Prashanth N Srinivas
DOI:10.4103/jfmpc.jfmpc_508_20  
Background: The data available for the health of Scheduled Tribes (ST) in India are often coarse-scale snapshots at district and state levels and fine-scale comparison within and across site is often not possible. In this paper, we examine the health inequalities between the ST and non-ST populations in two forested sites and compare the healthcare parameters for ST populations across three forested sites. Methods: We conducted a cross-sectional household survey in three sites in and around three tiger reserves in Karnataka, Madhya Pradesh (MP) and Arunachal Pradesh (AP). In each site, multi-stage sampling and cluster analysis provided a representative sample of households across villages of 859 ST and non-ST households. We examined the sociodemographic and health-related information including self-reported illnesses and healthcare utilisation; from these, we explored the within-site health inequality patterns for the two sites and intersite differences among the ST households of the three sites. Results: In Karnataka, the ST and non-ST differences favoured the latter with regard to socio-economic characteristics with no difference in self-reported illness/injuries or healthcare utilisation. In MP, both groups were similar with regard to socio-economic characteristics and healthcare utilisation. AP ST households reported the highest healthcare utilisation, while MP ST households reported the lowest care seeking at hospitals and relied on home networks and health workers. High tobacco consumption was noted among ST groups in all the sites. Conclusions: The ST and non-ST inequality patterns at a fine-scale were different between Karnataka and MP. The absence of health inequalities in MP indicates a uniform socio-geographical disadvantage while poor healthcare utilisation by ST people in Karnataka indicates health inequities. The ST households of AP reported the highest utilisation while those of MP reported the lowest. Programmes addressing the health inequalities of STs need to consider site-specific assessments of socio-geographical and health system factors.
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Prevalence of internet addiction and its associated factors among medical students at Taiba University, Saudi Arabia p. 4797
Alshaima Mohammad A Kolaib, Abdullah Hasan H Alhazmi, Maisa Mohammad A Kulaib
DOI:10.4103/jfmpc.jfmpc_655_20  
Background: This study aimed to determine the prevalence of internet addiction and its associated factors among medical students at Taibah University in Madinah, KSA. Methods: This cross-sectional study was conducted among 426 medical students from Taibah University, KSA. The 20-item Internet Addiction Test (IAT) was used to measure internet addiction. Results: Most participants (40.8%) used the internet for 5–7 hours/day and mainly for social networking (88.5%) and for downloading media files. Approximately, 6% were classified as internet addicts and 42% had occasional problems. Internet addiction was correlated negatively with performance. Internet addiction was significantly higher among those who used the internet for more than 10 hours/day (P < 0.001), those who used the internet mostly for downloading media files (P = 0.005) and for social networking (P = 0.005). Conclusion: Internet addiction among medical students is relatively high. Preventative measures like awareness campaigns are recommended to minimize internet addiction among university students.
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Evaluation of Factors Affecting Awareness About Beta-Thalassemia in Western Rajasthan p. 4801
Mayank Kumar, Abhishek Purohit, Suman Pramanik, Shashikant Saini
DOI:10.4103/jfmpc.jfmpc_804_20  
Aims: To determine the factors influencing awareness about beta-thalassemia in the population. Settings and Design: A cross sectional study was conducted by the Department of Pathology, AIIMS, Jodhpur. Methods and Material: The study population included participants with medical as well as non-medical background, to ensure representation of all sections of the society. Data was collected in an objective survey form drafted in simple language. Statistical Analysis Used: The data was analysed using Microsoft Excel and Chi Square Test for Independence was performed. Results: The participants with a positive family history had significantly more knowledge compared to others, but even these participants didn't have complete knowledge about the disease. Age and gender had no significant impact on the results. The mode of occurrence of beta-thalassemia was known to less than half of the participants, with even less number being aware of the fact that diagnosis of beta-thalassemia can be made before birth. Participants with a medical background were aware that there were several forms of beta-thalassemia, but the knowledge about treatment options was limited. Conclusions: Various factors affect the awareness in the general population, which has an effect on the outcome of screening programmes. There is a need for successful implementation of a screening programme for beta-thalassemia in order to reduce the financial burden that it imposes on healthcare facilities and to lessen the emotional burden on relatives of patients with the disease.
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Flipped classroom versus traditional lecture in training undergraduates in pediatric epilepsy p. 4805
Vandana Arya, Virender Kumar Gehlawat, Radhamohan Rana, Jayashankar Kaushik
DOI:10.4103/jfmpc.jfmpc_816_20  
Introduction: Pedagogical constructs such as flipped classroom are used to engage students in the learning process by their active participation. The aim of the present study was to compare the two models of flipped classroom and traditional lecture in training undergraduates in pediatric epilepsy. Methods: The study was conducted among the 3rd-year undergraduate medical students. They were divided to either of Group I or II. Pediatric epilepsy was taught in two parts (clinical diagnosis and management). Group I received Part A as traditional lecture and Part B as the flipped classroom and the reverse for Group II. The difference in posttest and pretest scores was compared between two groups for each part. Results: There was a significant increase in posttest scores when compared to pretest scores in both the groups. Mean (standard deviation [SD]) difference in scores for epilepsy diagnosis was comparable in Group I (3.33 [2.3]) and Group II (2.46 [2.17]) (P = 0.16). Mean (SD) difference in scores for epilepsy management was significantly higher in Group I (3.41 [2.09]) when compared to Group II (1.30 [1.84]) (P < 0.01). Conclusion: Flipped classroom model resulted in better scores than the traditional teaching method for training undergraduates in the management of epilepsy in children. This teaching–learning method could be adopted in training of primary care physicians.
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Assessment of knowledge, attitudes, and practices toward COVID-19 virus among university students in Kurdistan region, Iraq: Online cross-sectional study p. 4809
Nawfal R Hussein, Ibrahim A Naqid, Karwan Jacksi, Basheer Ali Abdi
DOI:10.4103/jfmpc.jfmpc_870_20  
Background and Aim: The World Health Organization (WHO) declared the novel coronavirus infection COVID-19 as a pandemic on March 11, 2020. Adherence to infection control measures is potentially influenced by people's knowledge, attitudes, and practices (KAP) about the infection. This project was performed to assess the KAP toward COVID-19 of university students in Kurdistan Region, Iraq. Materials and Methods: An online cross-sectional study was performed in April 2020 to evaluate KAP about coronavirus infection among university students in Kurdistan Region, Iraq. A total of 1959 students were recruited in this study and ages ranged from 18 to 55 years old. Results: Among the respondents, 55.03% were female, 93.8% were from Duhok province, and the majority of participants (93.4%) were undergraduate students. The overall correct answer rate of the knowledge questions toward COVID-19 was 75.8% with an average score of 9.1 ± 2.1 SD out of 12. Participants showed better knowledge of infection prevention with around 86.2% correct answers, while the lowermost subscale scores were (67.7%) for questions toward the mode of the transmission of the infection. We found a significant difference in knowledge scores across genders, marital status, program of study, and among different colleges/institutes (P < 0.001). The majority of participants agreed that the local authority will control the infection successfully (69.8%) and showed confidence that the battle against the virus will be won by Kurdistan Regional Government (86.7%). The majority of the recruited sample (93.0%) had not been in any area with crowd and 57.3% used facemasks when leaving out, recently. Conclusion: Students demonstrated good knowledge, appropriate practice, and positive attitude about the infection. These findings indicated that local health education plans to improve people's knowledge about the infection are valuable in protecting the community. The results may be helpful in tailoring an educational program for better containment of the infection and halting the spread of the virus.
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Taking care experiences of improved comatose patients with traumatic brain injury and their families p. 4815
Nahid Dehghan Nayeri, Maryam Esmaeili, Zahra Farsi, Hadi Ahmadi Chenari
DOI:10.4103/jfmpc.jfmpc_878_20  
Introduction: The most prominent causes of coma are traumatic brain injuries (TBIs), which have high incidence. However, little research about the caring aspects of these patients has been done, and the notion of caring experiences is unknown. Therefore, this study was conducted to describe the care-taking experiences of coma patients and their families during and after treatment. Methods: This study is a qualitative content analysis. Participants in this study were improved TBI patients and their families. Participants were selected purposefully. The method of data collection was 16 interviews that were held with 14 of the participants. Data were analyzed using Elo and Kyngäs conventional content analysis guidelines with MAXQDA software, version 10. Results: The results showed four main themes and eight categories. Themes included “crisis,” “comprehensive support,” communication,” and “unprofessional care.” Conclusion: Patients and families experience a crisis during hospitalization and after discharge. Therefore, patients and families need psychological support. Informing families and communication decrease the conflicts between healthcare personnel and the family. Medical staff must be careful about their statements and behaviors during comatose patients' care because they understand the care process.
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Prevalence of oromucosal lesions in HIV positive patients receiving haart-A prospective clinical study p. 4821
Saritha Maloth, TR Shrinivas, B Pramod Krishna, PJ Nagarathna
DOI:10.4103/jfmpc.jfmpc_881_20  
Aim: To determine the preponderance of oral mucosal lesions and conditions in patients receiving highly active antiretroviral therapy (HAART) for Human Immunodeficiency virus (HIV). Material and Methods: Patient tested Seropositive for HIV and on HAART therapy were clinically examined to evaluate prevalence of oral lesions. Results: In the pool of 152 HIV positive patients in the study, age ranged from 7 to 71 years, 67 were males and 85 females. The duration of the HAART medication was 43 months. Oral lesion was present in 51.32% of patients related to infection. Oral lesions seen in descending order of frequency were periodontitis, mucosal hyperpigmentation, acute gingivitis, oral candidiasis, linear gingival erythema, stomatitis, and nonspecific ulcers. Totally, 48.68% of patients had no oral lesions. Conclusion: Majority of the HIV patients on HAART exhibited periodontitis (30.77%), mucosal hyperpigmentation (17.44%), gingivitis (10.77%), anemic stomatitis (11.28%), and other oral lesions accounted to 29.74% which may be attributed to Anti Retro Viral Therapy.
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Understanding the determinants of happiness through Gallup World Poll p. 4826
Vidushi Jaswal, Kamal Kishore, M Muniraju, Nidhi Jaswal, Rakesh Kapoor
DOI:10.4103/jfmpc.jfmpc_156_20  
Background: The idea of happiness is as old as civilization, but breakthrough is achieved only in 20th century. Happiness can be broadly segmented into biological and behavioural component. The sufferings from illnesses hamper happiness. Happiness correlates negatively with morbidity, mortality, stress and anxiety in contrast to a positive correlation with motivation, healthy behaviours and longevity. In this article, an attempt has been made to understand the relationship between happiness and its important contributory factors. Material and Methods: The current study used data from the Gallup World Poll available under license CC0. Data analysis was performed using R studio version 1.0.136. Initially, descriptive analysis in the form of mean (standard deviation), violin plot, correlation matrix, and scatter plots were reported. Subsequently, robust regression estimates along with bootstrap standard errors and confidence intervals were used to report inferential statistics. Results: Norway, with a happiness score of 7.537 ranked first followed by Denmark with a score of 7.522. Burundi with a score of 2.905 is at the bottom of ranking for happiness. Freedom (CI; 0.95-2.22) and Family (CI; 0.92 - 1.57) are the strongest predictors of happiness. The trust variable does not have a significant (CI; -0.27 – 1.94) relationship with happiness. Conclusions: The values and norms in society are changing at a fast pace. Therefore, the measures of happiness require consistent and innovative approaches to measure it.
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Effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension: Pretest–posttest study p. 4833
Sujitha Elavally, Muralidharan Thoddi Ramamurthy, Jeyagowri Subash, Ramesh Meleveedu, Munikumar Ramasamy Venkatasalu
DOI:10.4103/jfmpc.jfmpc_210_20  
Aim: To investigate the effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension. Background: Nurse-led interventions are emerging as cost-effective as well as clinically proven in chronic illness management. Hypertension, a leading long-term cardiovascular condition, has autonomic dysregulation and increased sympathetic tone as its pathophysiological background. Complementary interventions evidenced to interplay hypertension pathophysiology. Design: A pretest–posttest design. Materials and Methods: Uncomplicated primary hypertension outpatients were randomly assigned as study group (n = 173) and control group (n = 173) at a tertiary care hospital. Sociodemographic, clinical, and outcome variables [the baseline blood pressure and galvanic skin response (GSR)] were collected. Study group patients were given four teaching sessions of abdominal breathing-assisted relaxation facilitated by GSR biofeedback. Daily home practice was encouraged and monitored to measure the effects on blood pressure and GSR at the end of the 1st, 2nd, and 3rd month of intervention. Results: The study group participants showed significant decrease in mean (SD) systolic [140.77 (8.31) to 136.93 (7.96), F = 469.08] and diastolic blood pressure [88.24 (5.42) to 85.77 (4.66), F = 208.21]. In contrast, control group participants had a mild increase in the mean systolic (F = 6.02) and diastolic blood pressure (F = 4.70) values from pretest to posttests. GSR showed a significant increase from 559.63 (226.33) to 615.03 (232.24), (F = 80.21) from pretest to posttest III. Conclusions: Use of home-based biofeedback-centered behavioral interventions enabled BP reduction among hypertensive patients. Further studies should use biochemical markers of sympathetic nervous system activity to endorse this home-based chronic illness intervention.
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The impact of integration of a dental module into the existing integrated child development services scheme in Chennai, India p. 4841
N Divyalalitha, Sunayana Manipal, Rajmohan , VV Bharatwaj, D Prabu
DOI:10.4103/jfmpc.jfmpc_239_20  
Aim: The aim of this study was to assess the impact of reinforced oral health awareness program to the children, parents and Anganwadi workers on the oral hygiene and oral health status of the children in Anganwadi centers functioning under the Integrated Child Development Scheme (ICDS) services all around Chennai city, Tamil Nadu, India. Materials and Methods: This longitudinal study was conducted among 511 study participants. All the study participants, their parents and Anganwadi workers attended an oral health education program. Oral hygiene and the oral health status of the children were assessed using a debris and WHO Pro forma 2013 at the baseline and after 1 year. Follow-up debris score was collected after 3 weeks, 1, 3, and 6 months in all the 12 zones divided into three groups, i.e., Groups A, B, and C according to the re-intervention schedule. Results: A highly significant reduction in the debris scores of the study participants was observed between each follow-up data collection (P = 0.001) regardless of the groups. A significant reduction (P = 0.001) in terms of the prevalence of dental caries, filled with no caries, missing teeth, gingival bleeding, and oral mucosal lesions were observed in the children between the baseline and final assessment after 1 year. Conclusion: A definite paradigm shift was observed in the present study after incorporation of the dental module, which could be taken up as an example to include oral health education and oral health checkups to the existing ICDS scheme, which was lacking before.
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A comparative study of serum effusion albumin gradient and Light's criteria to differentiate exudative and transudative pleural effusion p. 4847
V Sandeesha, Ch V Ravi Kiran, P Ushakiran, Md D Sulemani, N Lakshmanakumar
DOI:10.4103/jfmpc.jfmpc_321_20  
Context: The incidence of pleural effusion is approximately one million per year. For diagnosing and treatment plan, pleural effusions have to be classified into transudate and exudate. If the diagnosis is not appropriate, it may result in severe complications. The established criterion for differentiating exudates from transudates is Light's criteria. But there were some false positive results in case of transudative effusions when Light's criteria were used. Aims: This study was done to determine the accuracy of serum effusion albumin gradient (SEAG) when compared to Light's criteria in differentiating transudates and exudates. Settings and Design: It is a prospective observational study. In the present study, the sample size is 66 patients, in whom the SEAG was used for the classification of pleural effusions with a cut-off value of 1.2 g/dl. Methods and Materials: All the blood samples were collected and biochemical parameters like total protein, albumin, and LDH were analyzed in both serum and pleural fluid using XL 640 fully automated random access analyzer. Statistical Analysis Used: Results were analyzed using SPSS software version 20. Results: 20 of 22 transudates and 41 of 44 exudates were classified correctly using SEAG. The diagnostic accuracy of SEAG (92.42%) is better than Light's criteria (87.87%) in differentiating both transudative and exudative effusions. Conclusions: The SEAG is superior to Light's criteria in identifying the transudative effusions. It is also observed that Light's criteria identified exudative effusions better than SEAG.
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Estimation of cardiovascular risk in a rural population of Lucknow district using WHO/ISH risk prediction charts p. 4853
Trideep J Deori, Monika Agarwal, Jamal Masood, Sugandhi Sharma, Arshi Ansari
DOI:10.4103/jfmpc.jfmpc_646_20  
Context: Cardiovascular diseases (CVDs) are the number one cause of death globally, with low- and middle-income countries being affected disproportionately. By 2020, it is projected that there will be 25 million deaths from CVD worldwide, 19 million of which would be from middle- and low-income countries. Aims: The aim of this study was to estimate the 10-year risk of cardiovascular events among adults aged ≥40 years in a rural population of Lucknow district using the World Health Organization (WHO)/International Society of Hypertension (ISH) risk prediction charts for SEAR-D region. Settings and Design: This was a community based cross-sectional study, conducted from September 2017 to August 2018, in the rural areas of Lucknow district. Methods and Material: This study was conducted on 397 subjects aged ≥40 years. The two sets of the WHO/ISH risk prediction charts, with and without cholesterol, for WHO SEAR-D region were used in the study. Statistical analysis used: SPSS, version 23 was used for data analysis. Results: Using the risk assessment tools, with and without cholesterol, 78.5 and 76.8%, respectively, of the study population were in the 10-year cardiovascular risk category of <10% risk, while 11.2 and 10.4%, respectively, were in the category of ≥20% risk. Risk categories were found to be concordant in 86.3% of the population. Conclusions: The WHO/ISH risk prediction charts can be used at low-cost resource setting as a tool to predict CVD risk among asymptomatic individuals, thus, helping in early detection and prevention of CVDs in resource-scarce settings.
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Status of maternal health care services: An assessment study in slums of Kolkata p. 4861
Sayanti Bandyopadhyay, Dipak Pal, Aparajita Dasgupta, Mousumi Datta, Bobby Paul
DOI:10.4103/jfmpc.jfmpc_688_20  
Background and Aims: Mothers constitute an important and priority group in any community due to their high pregnancy related morbidities and mortality. The prevention of pregnancy related complications was possible with proper utilisation of maternal health care services. This study was conducted with the aim of assessing the utilisation of maternal health care services among mothers with younger child aged ≤3 years in slums of Kolkata, West Bengal and to find out the factors associated with it. Methodology: It was a community-based, observational study with cross-sectional design conducted in slums of Kolkata from June 2017 to May 2018. 30 slums [under Kolkata municipal corporation] were selected by cluster sampling technique using probability proportionate to size method. 10 mothers were selected from each slum and a total of 300 mothers were selected for the study. A pre-designed, pre-tested, structured schedule was used for data collection. Results: The mean age of the mothers was 23.83 (±3.64) years with the age ranging from 18 to 35 years. 75.7% mothers were registered in 1st trimester of pregnancy and 100% mothers received ≥4 antenatal check-ups. But only 78% mothers consumed ≥100 IFA tablets and only 23.3% mothers consumed ≥360 calcium tablets in antenatal period. 80.3% of the mothers had unsatisfactory utilisation of maternal health care services. Unsatisfactory utilisation of maternal care services was significantly associated with the younger age of the mothers, a smaller number of pregnancies and teenage marriage. Conclusion: Utilisation maternal health care services was not satisfactory among mothers in slums of Kolkata. Awareness generation and behaviour change communication among mothers is necessary for proper utilisation of the services.
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Gaps in facilities available at community health Centers/Rural Hospitals as per Indian public health standards – Study from Western Maharashtra p. 4869
Supriya S Patil, Rajesh A Gaikwad, Tanvi N Deshpande, SR Patil, PM Durgawale
DOI:10.4103/jfmpc.jfmpc_717_20  
Background: The launch of the National Rural Health Mission (NRHM) gives us the opportunity to review the functioning and bring up the Community Health Centers (CHC) services to the level of Indian Public Health Standards and thus improve the lives of citizens. Objectives: Assessment of the gaps in the facilities available at Community health centers/Rural hospitals as per Indian Public health standards. Methods: Facility based cross-sectional study was conducted in the Satara district of Maharashtra. Results: This study in the majority showed that the gap in the delivery of healthcare according to IPHS. It was observed that the Funded CHCs had a better quality of services than the non-funded CHCs. The non-funded CHCs lacked essential emergency services. Along with ANC care, newborn care in the first few minutes of life is very crucial, but very little priority was given to the newborn care as those services were not as per norms. Specialists as well as paramedical and other support staff are deficient in both funded and non funded CHCs/rural hospitals (RHs). Conclusion: Standards were greatly influenced by funds delivered by IPHS itself. A staffing pattern is one of the important pillars in delivering various health services. A better salary, working place with continuous water supply, electricity, and cleanliness will improve the staffing pattern. Therefore, competent manpower and well-built infrastructure will help in the standard delivery of healthcare at CHC/RH and will thus serve the purpose of dispensing basic health services to every individual in the remotest areas.
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Circulating adropin and vascular endothelial growth factor receptor-2 levels in age-related macular degeneration and T2DM patients—A cross-sectional study p. 4875
Areekulangara Neethu, Kuppuswami Jayashree, Gandhipuram Periyasamy Senthilkumar, K Ramesh Babu, Mehalingam Vadivelan
DOI:10.4103/jfmpc.jfmpc_813_20  
Background: Macular drusen formation and angiogenesis are the two chief processes associated with age-related macular degeneration. Adropin and vascular endothelial growth factor receptor-2 (VEGFR-2) may be involved in these pathologies. By altering lipid metabolism, adropin may contribute in the early stages of age-related macular degeneration (AMD). VEGFR-2 may participate in the later form of AMD, by promoting angiogenesis. This study compared the circulatory levels of adropin and VEGFR-2 in AMD and patients without AMD and assessed their association with disease severity, to understand their possible role in AMD. Objectives: This study aimed to assess and compare the serum levels of adropin and VEGFR-2 in patients with AMD and type 2 diabetes patients without AMD, and, to investigate the correlation between these two parameters with disease severity. Methods: Our study involves two groups of 39 each. Group A (age-related macular degeneration) and Group B (diabetes patients without age-related macular degeneration). Routine parameters fasting blood sugar (FBS), lipid profile, and liver function tests (LFT) were estimated by using autoanalyzer. Serum adropin and VEGFR-2 were assessed by ELISA. Results: Among the basic parameters, systolic blood pressure and fasting blood glucose alone were significantly different across the groups. We did not find significant alterations in adropin and VEGFR-2 levels between the study groups. Our lipid profile parameters (triglycerides and total cholesterol) have significant positive association. VEGFR-2 showed a positive correlation with the severity of AMD. Adropin did not exhibit any correlation with disease severity and with VEGFR-2. Conclusion: We could not find any observable alterations of statistical significance, in adropin and VEGFR-2 levels. VEGFR-2's correlation with disease severity could be important. Adropin might have subtler roles in AMD, though not evident from our study, and requires a deeper observation at the molecular level to elucidate its function.
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Early detection of renal disease among truck drivers through organized screening p. 4880
Rama Ravi, Georgi Abraham, Rajalakshmi Ravi, Milly Mathews, Rajeevalochana Partasarathy
DOI:10.4103/jfmpc.jfmpc_903_20  
Background: Trucking industry is the backbone of trade and economy and in India, truck drivers are occupationally faced with various challenges. Several risk factors including stress and abnormal lifestyle predisposes this group to non-communicable disease and chronic kidney disease (CKD) is one of the major threats. This study was carried out to evaluate the prevalence and risk factors of chronic kidney disease. Methods: The present cross-sectional study was carried out as a population-based screening programme among 3,200 truck drivers in Tamil Nadu for a period of 1 year in 2018. A structured proforma was used to obtain information regarding the diabetic and hypertensive status. Body mass index was calculated and blood pressure was measured using standard equipments. Urine dipstick method was used to detect the presence of albumin and glucose in the urine. Results: The mean age of the participants was 40.3 years. Overweight and obesity was seen in 49.9% of the participants, while elevated blood pressure was observed in 41.1%. About 12.4% of the participants were known hypertensives on medications. Albuminuria was present in 19.7% of the participants. Albuminuria was significantly associated with elevated blood pressure, high body mass index and elevated random blood sugars (P < 0.0001). In 83.7% of the participants, random blood sugar was elevated beyond 200 mg/dl. Conclusion: The screening programme can be enhanced when coupled with an awareness campaign, with due focus on culturally relevant information delivered by trained health educators in the native language, so as to bring about adequate education through effective communication.
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Motivating factors associated with choosing orthodontics for future prospects among newly passed out dental professionals in Maharashtra, India p. 4885
Prachi Dave, Ruchiketan S Gute, Truppti P Sonone, Aniket Gupta, Rucha Bhatkhande Kulkarni, Vasu Kumar
DOI:10.4103/jfmpc.jfmpc_1155_19  
Background: Choosing postgraduate subject as a future career is always tricky but there are factors associated which persuade the dental undergrads to choose the particular postgraduate course and orthodontics is one of them. Hence, the aim of present study was to determine motivating factors associated with choosing orthodontics for future prospects among newly passed out undergraduate dental professionals. Materials and Methods: This was a cross-sectional descriptive questionnaire study. The present study is conducted among the freshly pass out dental professionals who had started their setup. The study was conducted in October–November 2019. The study was conducted among three cities of Maharashtra. Convenient sampling was used to select the samples. A close ended questionnaire was prepared. Results: Majority of study participants {64 (45.39%)} belonged to age group 26–28 years. Females respondents {82 (58.15%)} were more than male study participants. Majority of dental professionals {71 (50.35%)} choose orthodontics dentofacial orthopedics as the specialty for future prospect. Most common reasons {16 (22.57%)} to choose orthodontics for future prospect by majority of respondents was “Can earn more money.” Age was significantly (P = 005*) associated with money as reason to choose orthodontic as future prospect. Gender was significantly associated with family pressure (P = 0.01*) and love, interest, and passion for orthodontics (P = 0.01*). Conclusion: It was concluded that majority of dental professionals choose orthodontic as their preferred choice. Main reason for choosing orthodontics was monetary benefits followed by the reason that finds orthodontics intellectually and clinically challenging.
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Clinical and sociodemographic profiles of persons with spinal cord injury p. 4890
Berigai P Nirmala, Pallerla Srikanth, Janardhana , MN Vranda, TR Kanmani, Meeka Khanna
DOI:10.4103/jfmpc.jfmpc_427_20  
Aim: To collect and correlate the sociodemographic and clinical details of persons with spinal cord injury who were admitted to the Department of Neurological Rehabilitation. Objectives: To assess the sociodemographic characteristics and collect the clinical profiles of persons with spinal cord injury and to correlate their sociodemographic and clinical details. Materials and Methods: A retrospective file review was done over a period of 2 years from January 2017 to December 2018 to study patients with spinal cord injury who were admitted to the Neurological Rehabilitation ward of NIMHANS, Bengaluru, Karnataka, India. Results: A total of 60 patients were admitted with spinal cord injury. The mean age was 32.39 years and majority of the patients were young married males. Most of them belong to the low socioeconomic status and are housewives and daily wage laborers. Falls and road traffic accidents are the causes for the injury. Anxiety and depression are high among traumatic spinal cord injury patients. Conclusion: This information may contribute to prevent SCI and to improve the quality of life of patients with SCI. It has implications for the primary care physicians who are at first contact to identify and refer them for specialized super speciality district hospitals for further treatment as they pose a great threat to public health and their proportions are increasing. It is imperative that trauma care is included in graduate medical training as well to facilitate early intervention after initial screening.
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Prevalence of painful diabetic peripheral neuropathy and its impact on quality of life among diabetic patients in Western region, Saudi Arabia p. 4897
Maram Hassan AlSufyani, Abdullah M Alzahrani, Ahmed Aman Allah, Rehab Ismail Abdullah, Sara Hasan Alzhrani, Adel Ali Alsaab
DOI:10.4103/jfmpc.jfmpc_488_20  
Background: Diabetic neuropathy is the most common long-term complications of diabetes, frequently presenting as painful diabetic peripheral neuropathy (PDPN), which can significantly impair patients' quality of life (QOL). This study set to estimate the prevalence of PNPD and health-related quality of life (HRQoL) in the setting of primary health care in Saudi Arabia. Methods: This study was conducted in primary health-care centers affiliated with the National Guard Health Affairs in Western Saudi Arabia. Arabic version of the Douleur Neuropathique 4 questionnaire was administered on diabetic patients to screen for neuropathic pain and short-form 12 questionnaire to assess HRQoL. Results: The study screened (n = 349) Type 2 diabetic patients. The prevalence of PDPN was 33.2%. PDRN was more likely to affect females (adjusted odds ratio [“AOR”] =1.96, P = 0.024), and those living with diabetes for over 15 years (AOR = 2.26, P = 0.039), and those on insulin treatment (AOR: 2.33, P = 0.010) alone or in combination (AOR = 1.78, P = 0.034). Both physical and mental components (MCs) of QOL scores were significantly higher in diabetic patients without PDPN compared to those with it; 49.57 ± 9.31 versus 40.77 ± 8.14 for physical component QOL and 51.72 ± 9.36 versus 44.35 ± 8.12 for MC QOL, P < 0.001. Discussion and Conclusion: Painful peripheral neuropathy is relatively common among type 2 diabetic patients in Western Saudi Arabia and impacts both physical and MCs of the QOL of affected patients.
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Prevalence of COVID-19-related anxiety among healthcare workers: A cross-sectional study p. 4904
Esra H Alzaid, Safa S Alsaad, Nariman Alshakhis, Doaa Albagshi, Rania Albesher, Mahdi Aloqaili
DOI:10.4103/jfmpc.jfmpc_674_20  
Introduction: COVID-19 was labeled as a pandemic in March 2020. Healthcare workers (HCW) are confronting great mental stressors in coping with the crisis. In Saudi Arabia, research on the psychological effect of COVID-19 on HCW is lacking. Aim: To evaluate COVID-19 psychological impact on HCW and determine anxiety predictors to identify high-risk individuals. Materials and Methods: A descriptive cross-sectional study was conducted on HCW in First Health Cluster Institutes in Eastern Province. An English self-administered questionnaire was adopted from similar research done in China. The original questionnaires were modified to meet the objectives of our study and suit Saudi sociodemographic differences. Generalized anxiety disorder-7 scale was incorporated to be the main tool for assessing the psychological impact. Results: One-third of HCW were classified as having anxiety disorder. In univariate analyses, the age group in years (P = 0.026), gender (P = 0.001), nationality (P = 0.033), and living with family (P = 0.007) significantly influenced anxiety disorder. However, in the multivariate regression model, gender (P = 0.004), living with family (P = 0.021), family history of COVID-19 (P = 0.022), and been suspected or confirmed with COVID-19 infection (P = 0.018) remained statistically significant when compared to anxiety disorder. Conclusion: During early COVID-19 pandemic, anxiety disorder among HCW was noticeable. Being a female, living with family members, and having a family history of COVID-19 increased the risk for anxiety disorder.
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Ectopic pregnancies: Catch them early, treat them wisely! p. 4911
Beena Kingsbury, Dibu Sam, R Jeyasudha, Elsy Thomas, Grace Rebekah, Jessie Lionel
DOI:10.4103/jfmpc.jfmpc_684_20  
Introduction: Ectopic pregnancy (EP) is a common condition encountered in Obstetrics and Gynecology. Different management protocols are currently available for haemodymanically stable patients but definitive recommendations is yet to be established, especially in developing countries with limited resources. Aim: To determine the outcome of EP in patients who are haemodynamically stable and to evaluate the factors that would predict success of specific management protocols in them. Methodology: Haemodynamically stable patients with HCG levels <1500 mIU/ml were recruited for expectant management, 1500–5000 mIU/ml were given MTX and those with >5000 mIU/ml were managed surgically. Results: The overall success rate for expectant management was 92.7% and that with MTX was 80%. Baseline HCG values was found to be the only significant factor for predictor of success of treatment in the expectant group (P 0.05). The size of mass seen on USG did not have a significant correlation with beta HCG values (P 0.257). Conclusion: Of all the predictors for success of treatment that have been studied, the initial HCG value alone remains of paramount importance. Women with initial values of HCG <1500 mIU/ml can be offered expectant management, with a much better assurance of success for those with values <1000 mIU/ml. Those with values <5000 mIU/ml can be given MTX, with single dose being sufficient most often for <3000 mIU/ml. The presence of fluid restricted to the pelvis on USG can be managed non-surgically. One should not opt for surgical management only on the basis of size of the adnexal mass on USG.
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Clinical efficacy of amino bisphosphonate on periodontal disease status in postmenopausal women: Randomized double-blind placebo-controlled trial p. 4919
Shikha Gupta, Setu Mathur, Anjali Kapoor, Sharmistha Vijay, Rohit K Khatri, Rashi Srivastava
DOI:10.4103/jfmpc.jfmpc_724_20  
Objectives: Osteoporosis is a common skeletal disorder affecting postmenopausal women. Data suggest that postmenopausal women are at increased risk of periodontal diseases. Amino bisphosphonates are potent inhibitors of bone resorption and effectively used in the treatment of osteoporosis. Preliminary data indicate that there is a potential role for bisphosphonates in the management of periodontitis. Hence, this randomized placebo-controlled trial was designed to investigate the clinical efficacy of amino bisphosphonate on periodontal disease status among postmenopausal women. Materials and Methods: Thirty patients were randomly allocated to two treatment groups: Group A, which received scaling and root debridement and 70 mg weekly single oral dose of alendronate drug, and Group B, which received scaling and root debridement and placebo drug for 6 months. Clinical periodontal measurements were carried out for all patients at the baseline and 6 months later. Mandibular bone mineral density (BMD) was measured using a dual energy X-ray absorptiometer at the beginning of the study and the end of 6 months. Results: A weekly single oral dose of 70 mg alendronate was well-tolerated. The intragroup comparison showed significant improvement in periodontal parameters in both groups. The intergroup comparison showed a significant increase in BMD after 6 months in Group A when compared with Group B (P = 0.0179). Conclusion: Single oral dose of 70 mg alendronate per week is well-tolerable, gastro-intestinally safe, and improves the clinical outcome of nonsurgical periodontal therapy.
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The gap between ultrasonography and computed tomography in measuring the size of urinary calculi p. 4925
Ahmed Eid Alahmadi, Fawaz Mobasher Aljuhani, Sultan Abdulwadoud Alshoabi, Khalid M Aloufi, Walaa M Alsharif, Abdulrahman M Alamri
DOI:10.4103/jfmpc.jfmpc_742_20  
Objective: Due to a lack of studies regarding the need for computed tomography (CT) in measuring the size of each urinary calculus before surgery, this study was conducted to elucidate the difference between ultrasonography (US) and CT in measuring the size of urinary stones. Methods: A retrospective review of 100 stones from 83 patients. Each urinary stone was measured using both US and CT; both measurements were then compared. Results: Of 83 patients, the mean age was 39.29 ± 23.76 years; 47 (56.62%) were male and 36 (43.37%) were female. Most of the urinary stones were <10 mm (50.0%) followed by 11–20 mm (42.0%), (P < 0.001). A cross-tabulation test revealed strong compatibility between US and CT in measuring the size of urinary stones (73.7% in stones <10 mm, 66.7% in stones 11–20 mm and 50% in stones >21 mm), (P < 0.001). Spearman's rho correlation test revealed strong compatibility between stone diameters measured by US and CT (r = 0.755), (P = 0 < 0.001). T-test for equality of means revealed no significant difference in the measured size using US and CT (mean = 11.80 ± 5.83 vs. 11.65 ± 6.59, respectively), mean difference = 0.15, and P = 0.865, 95% confidence interval: -1.584–1.884. Conclusion: No significant difference in measuring the size of urinary stones using US and CT. However, US may slightly overestimate small stones in some cases.
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Cross sectional study on Kashmiri tribal population: Their demo-economic status and behavioural risk factors p. 4929
Mohd Ashraf Ganie, Arif Habib, Sheikh Abid Ali, Aafia Rashid, Rabiya Rashid, Anjum Fazili
DOI:10.4103/jfmpc.jfmpc_745_20  
Background: The demographic particulars of Gujar-Bakarwals are mostly dominant on mountainous regions of Kashmir Valley. Their housing, sanitation, health care facilities are very low sub-standard than other sections of population. Behavioral risk factors including tobacco use and skipping meals are prevalent. Objective: The present study focuses on the socio-economic and demographic profile among the tribal population of Kashmir; their major risk factors of some non-communicable diseases. Methods: The study is community based cross sectional survey undertaken in selected districts of Jammu and Kashmir. Results: Around 94.3% of the tribal population fell under low income groups with an annual income of Rs. <25000 per year. Only 37.1% subjects were educated. 61.0% of tribal subjects lack access to pure drinking water and proper sanitation. Interestingly, 63–66% of the population was younger with a high prevalence of smoking among both males and females (33.3% males and 7.3%, respectively). Among non-communicable diseases, diabetes was less prevalent whereas a comparatively higher prevalence of hypertension, dyslipidemia, thyroid dysfunction, and vitamin D deficiency was present with significant associations with the risk factors. Conclusions: There is widespread poverty, illiteracy, and lack of basic amenities among the tribal people which makes it imperative to address these concerns to improve the socioeconomic disparities and health indices of the marginalized population. Smoking and inadequate consumption of meals was prevalent. There is an urgent need to address behavioral risk factors such as smoking and skipping meals through primary prevention.
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Staphylococcus aureus including MRSA nasal carriage among hospital exposed and unexposed medical students p. 4936
Shraddha Sharma, Shekhar Pal, Vikrant Negi, Deepak Juyal, Munesh Sharma, Rajat Prakash
DOI:10.4103/jfmpc.jfmpc_820_20  
Introduction: Staphylococcus aureus is one of the most common human pathogen causing a wide range of infections. It is estimated that S.aureus colonizes the anterior nares in approximately 31% of the general population at any given time. The incidence of community acquired & hospital acquired S. aureus has been increasing over the past few decades, predominantly due to continuous upsurge in the drug resistant isolates. Moreover, globally the incidence of methicillin resistant S.aureus (MRSA) is progressively increasing. Hence, it would be imperative to screen all healthcare workers, interns and admitted patients for MRSA carriage and to treat all those who are found positive for the same. With the above background, the current study was undertaken to investigate the carrier rate of S. aureus (including MRSA) among hospital unexposed & exposed medical students. Methods: A total of 181 medical students of Veer Chandra Singh Garhwali Government Institute of Medical Sciences & Research, Srinagar Garhwal, Uttarakhand. Study participants were broadly divided into two groups: hospital exposed group (n=107) and hospital unexposed group (n=74). Nasal swabs were obtained & cultured for the detection of S. aureus. Congo red agar and 0.1% Crystal Violet Assay were performed to observe the ability to form in vitro biofilm by S. aureus. Results: Out of total 181 medical students 29.28% were found to be healthy carrier of S. aureus. Among the hospital exposed group 37.38% and among hospital unexposed group 17.57% were found to be healthy carrier of S. aureus. Only one student (hospital exposed group) was found to be positive for MRSA. Beta-lactamase production was noted in 90.57% strains of S. aureus while the significant rate of slime layer production was observed in 73.58% of strains. Conclusion: Prevalence of S. aureus nasal carriage increases with the duration of exposure to the hospital environment. The nasal carriage of S. aureus in medical students indicate the potential danger of dissemination of S. aureus including MRSA from them to the hospitalized patients which in turn complicates the treatment of same.
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Emotional intelligence and perceived stress among undergraduate students of arts and science colleges in Puducherry, India: A cross-sectional study p. 4942
Arunima Sen, Mahalakshmy Thulasingam, Jeby Jose Olickal, Arpita Sen, A Kalaiselvy, Preeti Kandasamy
DOI:10.4103/jfmpc.jfmpc_823_20  
Background: The concept of emotional intelligence has gained great popularity in the last few decades. With significant rise in stress and other emotional disturbances among students, it becomes necessary to determine whether high emotional intelligence could help manage perceived stress better. This study aims to assess emotional intelligence and perceived stress among undergraduate students of Arts and Science colleges, to determine the association of emotional intelligence with perceived stress, academic performance, and selected socio-demographic factors. Methods and Material: Using multistage sampling, 720 students aged 18 years and above were selected from four colleges in Puducherry. Emotional intelligence and perceived stress were assessed using standard self-administered questionnaires “The Schutte Self-Report Emotional Intelligence Test (SEIT)” and “Perceived Stress Scale (PSS-14),” respectively. Results: The median (IQR) Emotional Intelligence score and Perceived Stress score were 127 (114–137) and 43 (39–47), respectively. The study was not able to establish a significant association between emotional intelligence and perceived stress. A weak significant correlation existed between emotional intelligence and academic performance. Multiple variable analysis revealed gender, year of study, volunteering with youth organizations, and mother's occupation to be significantly associated with emotional intelligence (p < 0.05). Conclusions: Women, final year students and those who volunteered with youth organizations had higher emotional intelligence. Children of mothers who were employed in knowledge-intensive occupations were more emotionally intelligent. Academic performance had a weak positive significant correlation with emotional intelligence.
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Parental perceptions of child's healthy diet: Evidence from a rapidly developing country p. 4949
Mohamed A Hendaus, Walid El Ansari, Samar Magboul, Ola AlHalabi, Maram Sati, Hebat Kamal, Ahmed H Alhammadi
DOI:10.4103/jfmpc.jfmpc_1252_19  
Background: There are no studies in Qatar or in the Middle East to investigate parental perception of healthy diet in childhood. Purpose: To investigate parental perception of childhood healthy diet in the State of Qatar. Methods: Cross-sectional prospective study at Hamad Medical Corporation, State of Qatar. Parents of children <14 years old were invited to complete a questionnaire. Results: A total of 398 parents agreed to participate, while 22 parents refused (response rate 94%). About 80% of parents were between 20 and 39 years of age, and 77% were females. Around 230 (58%) parents had ≥1 housemaid to help with housework, including food preparation. Whilst 151 children (37%) fell into the overweight and obese category, only 68 parents (17%) perceived that their child was in this category. Less than half the participants (n = 179, 45%) stated that childhood weight should be monitored prior to 5 years of age, while around 35% stated the same, but for children ages 5–14 years. Most participants (n = 324, 81%) agreed that parental eating habits could influence childhood weight. In terms of food preparation at home, mothers cooked almost 50% of the times, housemaids 30%, followed by grandmothers (16.6%), and fathers (3.4%). When asked about the frequency of school meals being prepared at home, 237 parents (60%) prepared their children's lunch box only 1-2 times per week. Moreover, 63% of parents chose the quality of food based on nutritional values, while 44% and 35% chose it based on safety and taste, respectively. When queried about whether the child's pediatrician or the primary care physician counsel families regarding childhood healthy diet, 187 families (47%) had not received counseling by their children's health care providers. Most families agreed that healthy diets lead to better school performance (n = 372, 94%) and better physical activity quality (n = 379, 96%). Compared to families living in the rural areas, parents living in the capital Doha had better insights that healthy diets result in better in school performance (p = 0.032). Conclusion: Parental perception is an important target for public health interventions. Within the current sample, families were aware of the positive impact of healthy diet on overall wellbeing. Qatar is a well-resourced country and it would be cost effective to train and professionally develop pediatricians and primary care physicians to be more proactive in tackling childhood obesity.
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Health insurance coverage and its impact on out-of-pocket expenditures at a public sector hospital in Kerala, India p. 4956
Ravindran Harish, Ranjana S Suresh, S Rameesa, PM Laiveishiwo, Prosper Singh Loktongbam, KC Prajitha, Mathew J Valamparampil
DOI:10.4103/jfmpc.jfmpc_665_20  
Background: Health insurance coverage ensures protection from catastrophic health-care expenditure, especially to the underprivileged sections of society. Health insurance schemes such as Ayushman Bharat are coming up in addition to the existing schemes such as Rashtriya Swasthya Bima Yojana in India. The objectives are to find the health insurance coverage and its impact on out-of-pocket (OOP) expenditure for public sector tertiary health-care hospitalization. Methods: A cross-sectional study was conducted at a tertiary care hospital in Kerala. Insurance coverage was assessed among patients seeking inpatient care in various medical and surgical departments. OOP expenses incurred for those receiving and not receiving insurance coverage were compared. In addition, factors influencing enrolment and availing of insurance schemes were determined. Results: The coverage of health insurance was found to be 74%. Awareness campaigns and activities of local self-government (LSG) departments were the important reasons for enrolment and availing, respectively. Significantly lower OOP expenditures occurred in insured persons with regard to expenses incurred for treatment procedures (P = 0.019), investigations (P = 0.004), and medicines (P = 0.001). Among the enrolled patients, 45% expressed dissatisfaction regarding available services. Conclusion: A quarter of patients still remain out of insurance coverage. All patients are incurring OOP expenditures, though the insured patients have significantly lower OOP expenses. The role of primary care providers and LSG is pivotal in creating awareness and ensuring enrolment. Availing services depend on the availability of resources at the respective institution. Improvements in enrolment and use of health insurance should ultimately result in improved patient satisfaction.
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Undiagnosed elevated blood pressure and its life style related risk factors among adults: Cross sectional survey p. 4962
C Vasantha Kalyani, Anissa A Mirza, Suresh K Sharma, Vartika Saxena, Kusum K Rohilla, Senkadhirdasan Dakshinamurthy
DOI:10.4103/jfmpc.jfmpc_679_20  
Background: Globally, high blood pressure (BP) is a main health problem among adult population. High BP is considered as a major risk factor which may lead to many cardiovascular diseases. Globally, it is also the leading cause of death. According to the American Heart Association, a BP of 120/80 mm of Hg is a normal range but when the systolic blood pressure ≥130 and diastolic blood pressure ≥80, it is always labeled as hypertension. Objectives: In the present study, the researchers wanted to identify the prevalence of undiagnosed elevated blood pressure in the adult population of Uttarakhand, India and also try to explore its lifestyle-related risk factors. Methods: This study was an exploratory survey with a cross-sectional design. Data were collected from 440 participants by using the cluster sampling technique. Results: The male:female ratio among participants was 1:4 and most of the participants were aged 25–30 years. The study found that the prevalence of high blood pressure was 26%, in which marginal elevated BP prevalence was 16%, hypertension stage I was 7%, and hypertension Stage II was 3% which is significantly higher in number at a young age. Lifestyle-related risk factors showed a significant association of hypertensive status with gender, consumption of balanced diet, and personal habits. This increases the chances of elevated blood pressure in young adults. Conclusion: All health professionals must be sensitized for elevated blood pressure problems among the young adult populations. Elevated blood pressure should be considered as a warning alarm at an early age when prescribing any medication and during any invasive procedure. Awareness should be created among public regarding elevated blood pressure issues at a younger age and motivate people to adopt a healthy and stress-free lifestyle.
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Hand hygiene knowledge, attitude, practice and hand microflora analysis of staff nurses in a rural tertiary care hospital p. 4969
Deepak , Sameer Singh Faujdar, Satish Kumar, Priya Mehrishi, Seema Solanki, Amisha Sharma, Suman Verma
DOI:10.4103/jfmpc.jfmpc_773_20  
Introduction: Hand hygiene play crucial role in infectious control. The present research is on accessing Knowledge, attitude, and practice of nursing staff regarding hand washing. Human hands are covered with several commensal and pathogenic microorganism. Pathogenic bacterial species especially Staphylococcus species are the most common to participate in nosocomial infections. Methods: Total 300 hand swab samples were taken from 150 nursing staffs followed by filling the questionnaire form. Standard culture media (Blood agar and MacConkey agar) were used to isolate the microorganisms. Microbial identification was done by using standard biochemical tests. Results: Our study concluded that over all staff members had moderate knowledge and attitude regarding hand washing. Coagulase-negative Staphylococcus isolates were the most dominant bacteria. Occurrence of Staphylococcus aureus was relatively less. Conclusions: Creating awareness and education regarding hand hygiene would definitely increase the attitude and practice of health care workers to minimizing the nosocomial infection.
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Clinicoepidemiological profile of trauma patients admitting to the emergency department of a tertiary care hospital in eastern India p. 4974
Mantu Jain, Rakesh Vadakkethil Radhakrishnan, Chitta Ranjan Mohanty, Sudarshan Behera, Arvind Kumar Singh, Soumya Swaroop Sahoo, Satyabrata Guru, Sadananda Barik
DOI:10.4103/jfmpc.jfmpc_621_20  
Context: Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement. Aims: To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India. Settings and Design: A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department. Methods and Material: Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded. Statistical Analysis Used: Statistical analysis was done by R version 3.6.1. Results: Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15). Conclusions: The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.
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A study to assess undernutrition and its sociodemographic correlates in under-five children in urban and rural areas of Rishikesh, Uttarakhand p. 4980
Abu Rehan, Surekha Kishore, Mahendra Singh, Bhavna Jain, Navuluri Kranthi K. Reddy, Deepak Kumar, Preeti Usha, Rukhsar Parveen
DOI:10.4103/jfmpc.jfmpc_663_20  
Context: Nutrition is one of the most important factors that affect a child's health. It plays a vital role in the prevention and control of disease morbidity and mortality. It is a major public health problem in a developing country like India. Aims: To assess undernutrition in under-five children and various sociodemographic factors affecting it. Settings and Design: A community-based cross-sectional study was conducted among under-five children of rural and urban Rishikesh. A total sample size of 400 under-five children was taken. Multistage sampling was done to select the areas and systematic random sampling was done for selection of households. Subject and Methods: A predesigned, pretested, and semistructured questionnaire was used to collect information on the sociodemographic characteristics and status of undernutrition in study participants. Statistical Analysis Used: Data was entered into excel sheets and analyzed using SPSS version 23 utilizing appropriate statistical methods. Results: The prevalence of underweight was 37.3%, stunting 43.3% and wasting 24.5%. Underweight (40.5% v/s 35.0%), stunting (46.5% v/s 40.0%), and wasting (27.0% v/s 22.0%) was more prevalent in urban areas as compared to rural areas. Sociodemographic factors such as religion, caste, parental education, father's occupation, and family size emerged as significant predictors of under nutrition. Conclusion: Undernutrition in under-five children was quite high. Since childhood malnutrition is multifactorial, there is no single cause big enough to blame but a multifaceted approach is required to combat malnutrition.
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Vitamin B12 deficiency in children from Northern India: Time to reconsider nutritional handicaps p. 4985
Swati Umasanker, Rahul Bhakat, Sonalika Mehta, Vyas Kumar Rathaur, Prashant Kumar Verma, NK Bhat, Manisha Naithani, Swathi Chacham
DOI:10.4103/jfmpc.jfmpc_712_20  
Background and Aims: Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile. Setting and Design: This prospective analytical study was conducted in a tertiary level care institute in Northern India. Materials and Methods: Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done. Statistics: For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests. Results: A total of 111 children were included. 64.8% (n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair (p 0.056) and knuckle pigmentation (p 0.027). Younger children had more weight loss (p 0.001), knuckle pigmentation (p 0.019) and hypotonia (p 0.045). One fifth of children presented with neurological manifestations. Conclusions: Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [<6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.
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Utility of nested polymerase chain reaction for fungus in detecting clinically suspected patients of invasive fungal infections and its clinical correlation and comparison with fungal culture p. 4992
Vibhu Ranjan Khare, Munesh Kumar Gupta, Nilesh Kumar, Ranjan Bhattnagar, Ragini Tilak, Kailash Kumar, Chandan Kumar, Anurag Rana
DOI:10.4103/jfmpc.jfmpc_775_20  
Aims and Objectives: The aim and objective of this study is to detect invasive fungal infections (IFIs) early and with more sensitivity by the nested polymerase chain reaction (PCR) for fungus as compared to fungal culture in clinically suspected patients and also explore its correlation in reference to age, duration of symptoms, immunocompromised status, and other risk factors predisposing to IFIs. Materials and Methods: In this cross-sectional study, 50 suspected patients admitted in medical acute care unit/intensive care unit (ACU/ICU) of Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India, comprised the study. All cases were selected based on the predefined inclusion and exclusion criteria. A detailed history, clinical examination, and all required investigations were done in all suspected patients. Blood samples were taken for nested-PCR for fungus and culture. Nested PCR was performed on extracted DNA form samples collected from all participants under the study. Results: Our study comprised of 50 suspected immunocompromised patients of IFIs. Among the participants under the study, the most common risk factor was diabetes mellitus (28% cases). Nearly two-thirds (60%) of the cases were 50 years or more. Around 70% of the cases had a history of illness more than 2 weeks. Nested PCR for fungus came out to be positive in 21/50 patients (42%); however, fungal culture was positive in none. Among the admitted patient in ACU/ICU, 75% were neutropenic. Conclusions: IFIs are more common in immunocompromised individuals, patients with comorbidities, long history of symptoms, and elderly population. Nested PCR for fungus has a high sensitivity (as compared to the fungal culture), and also they are rapid in giving the results. Thus, nested PCR for fungus can be used in a cost-effective manner for the early and reliable diagnosis of clinically suspected IFIs.
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The first state-level public health program for obstructive airway disease in India: An early field-level evaluation p. 4998
Soumya Gopakumar, Mathew J Valamparampil, MS Manu, Sanjeev Nair, R Kamala, A Raj Atulya, Bipin K Gopal, Veena Babu, K Vijayakumar
DOI:10.4103/jfmpc.jfmpc_216_20  
Background: Chronic obstructive pulmonary disease (COPD) is the second leading cause of mortality in India; however, there are no programs for COPD in India at primary care level. Kerala became the first state in India to implement a program at primary care for COPD, called the Step Wise Approach to Airway Syndrome program. Objective: The objective of the study was to evaluate and document the implementation status of a program for obstructive airway disease (OAD) in Trivandrum district of Kerala state in India and compare the treatment characteristics of patients with OAD seeking care from the centers implementing and not implementing this program for OADs. Methods: A cross-sectional study was done as early evaluation of a program for OAD implemented in Kerala state, India, from October 2018 to February 2019. Results: A reflection of the health-seeking behavior due to better facilities at the FHCs. There was no difference in the hospital visits or emergency department visits between the two groups. However, there was a statistically significant difference in the average number of visits per patient to health center for taking injectable drugs and visits for nebulization. Forty-nine (94%) of the COPD and 36 (100%) of the asthma patients underwent spirometry from implementing center itself. A higher proportion of patients receiving care from implementing centers (30.9%) never had to buy inhalers from outside. Conclusion: This is the first time that a public health programme for chronic respiratory disease management at primary care level was evaluated in India. The study has provided valuable insights on the need for strengthening the training for health care providers as well as patient education in bringing about a change in patient attitudes.
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Workplace based potentially malignant oral lesions screening among tobacco consuming migrant construction site workers in Chennai, South India: A pilot study p. 5004
Sree S Tirukkovalluri, CP Luck, R L. S. Makesh, PT Akhshaya, A Radhakrishnan, RC Karthick, Balaji Arumugam, N Gunasekaran, Sudhanshu R Patwardhan
DOI:10.4103/jfmpc.jfmpc_687_20  
Context: Vulnerable population groups such as migrant workers are identified as emerging high-risk groups for oral cancer owing to the high prevalence of smokeless tobacco consumption. Premature deaths due to oral cancer can be prevented by screening the population with high tobacco consumption practices and detecting early reversible stages of oral mucosal cavity lesions and facilitating linkages for further care. Aim: To assess prevalence of potentially malignant oral mucosal cavity lesions among tobacco consuming migrant construction workers in sub-urban Chennai, India. Settings and Designs: A workplace based cross-sectional study design. Materials and Methods: A cross-sectional study was conducted at workplaces i.e., construction sites for screening potentially malignant oral mucosal cavity lesions among migrant workers across 23 construction sites of Chennai during September 2019 - February 2020. An onsite, group health education session was provided about the harms of tobacco use to the migrants. Statistical Analysis Used: Data entered in MS Excel was analysed using SPSS and multivariate analysis was performed. Results: Among 640 migrants included in the study, 411 (64.2%) were less than 30 years of age, 623 (97.4%) were from north-eastern states of India such as West Bengal, Bihar, Rajasthan, Uttar Pradesh, Jharkhand. A considerable size (272, 42.5%) could not read or write and 355 (55.4%) earn a monthly income of less than ten thousand rupees. Current tobacco users were 619 (96.7%), smokeless tobacco users (463, 72.34%), smokers (206, 32.2%) and dual users (52,8.12%). Inflammatory mucosal lesions in the oral cavity were 70.97% and more among smokeless tobacco users comparable to 22.58% among tobacco smokers and was significantly associated with up to 20 years of tobacco consumption. Conclusions: Prevalence of Potentially malignant oral lesions among smokeless tobacco using interstate migrant construction site workers is very high and need urgent interventions.
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Intraocular pressure and tear production changes in pregnant women at term pregnancy and immediate post-partum: A pilot study p. 5010
Shrinkhal , Ajai Agrawal, Anupama Bahadur, Anupam Singh, Sanjeev K Mittal, Mood Mahesh, Raghavendra R Mareguddi, Namrata Modi, Ramanuj Samanta
DOI:10.4103/jfmpc.jfmpc_795_20  
Aim: To study the intraocular pressure (IOP) and tear production changes in uncomplicated pregnant women at term pregnancy and immediate postpartum. Materials and methods: The patients admitted in the Department of Obstetrics and Gynaecology for delivery were included in the study. A total of 106 participants who were at term uncomplicated pregnancy were selected according to the inclusion and exclusion criteria. They were subjected to type 1 Schirmer's testing and intraocular pressure measurement by Perkin's tonometer before and after delivery. Result: There was no significant pre- and postdelivery IOP difference between the different age groups (<30 and ≥30 years), mode of delivery, and parity. There was a statistically significant (P < 0.001) increase in mean tear production (Schirmer's test) after delivery, irrespective of age group, mode of delivery, and gravida status. However, no significant intergroup difference was observed. Conclusion: There was no significant change in IOP before and after delivery in uncomplicated pregnancies. However, a statistically significant increase in tear production was observed in the immediate postpartum period.
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The pattern of iron deficiency with and without anemia among medical college girl students in high altitude southern Saudi Arabia p. 5018
Husain Y Alkhaldy, Rawan A Hadi, Khalid A Alghamdi, Saleh M Alqahtani, Ibraheem Sultan H Al Jabbar, Ibrahim S Al Ghamdi, Omayma Saad E Bakheet, Rayyh A M Saleh, Shehata F Shehata, Shahid Aziz
DOI:10.4103/jfmpc.jfmpc_730_20  
Introduction: The prevalence of iron deficiency, latent and symptomatic, is heterogeneous worldwide. In this study, we aim to explore the prevalence of iron deficiency, with and without anemia, among medical college females at the high Altitude Aseer region of Southwestern Saudi Arabia. Methodology: 200 female medical students were randomly sampled, between the ages of 19 and 27 years. Blood samples were collected for complete blood count (CBC) values and serum ferritin determination. Questionnaires were completed in order to collect demographics, medical history, and socioeconomic information of the participants. Results: Prevalence of overall iron deficiency was high (63%, serum ferritin <20 μg/L, 52.5%, ferritin <15 μg/L). Anemia, adjusted for high altitude (defined as less than 13 g/dL was present in 41 participants (20.5%) and 12 (6.5%) have Hb <12 g/dL. Iron-deficiency anemia (Hb <13 g/dL and serum ferritin <15 μg/L) was present in 35 (17.5%). Personal and family history of anemia and poor animal product containing meals were positively correlated with the presence of iron deficiency state. Neither symptoms of anemia, nor the presence of menorrhagia correlate with the presence of iron deficiency anemia. Conclusion: Iron deficiency with and without anemia is a very common and condition in young females' population at high altitude. Implementing a lab method to screen for anemia on vulnerable populations is needed. Frequently asymptomatic, the primary care providers should maintain a high degree of suspicion in order to initiate screening for iron status.
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Comparing the performance of two social risk screening tools in a vulnerable subpopulation p. 5026
Cara C Lewis, Robert Wellman, Salene M W Jones, Callie Walsh-Bailey, Ella Thompson, Alphonse Derus, Andrea Paolino, John Steiner, Emilia H De Marchis, Laura M Gottlieb, Adam L Sharp
DOI:10.4103/jfmpc.jfmpc_650_20  
Background: Research shows the profound impact of social factors on health, lead many healths systems to incorporate social risk screening. To help healthcare systems select among various screening tools we compared two tools, the Your Current Life Situation (YCLS) and the Accountable Health Communities (AHC) Screening tools, on key psychometric properties. Method: Kaiser Permanente Southern California subsidized exchange members (n = 1008) were randomly invited to complete a survey containing either the YCLS or the AHC tool, as well as other measures related to care experience and health. Healthcare use was measured through the electronic health record. Agreement between the AHC and YCLS was assessed using adjusted kappas for six domains (food – worry, food – pay, insecure housing, housing quality, transportation, utilities). To assess predictive validity, items on the AHC and YCLS were compared to self-rated health and receipt of a flu shot. Results: Responders (n = 450) and non-responders (n = 558) significantly differed on sex, language, and depression (P < 0.05) but not anxiety, race/ethnicity, or healthcare use. Agreement between the AHC and YCLS tools was substantial on all items (kappas > 0.60) except for housing quality (kappa 0.52). Four out of six screening questions on the AHC tool and four out of seven on the YCLS tool were associated with self-rated health (P < 0.03). No social needs were associated with flu shot receipt except utilities on the AHC tool (P = 0.028). Conclusion: In this sample, the AHC and YCLS tools are similar in their ability to screen for social risks. Differences observed likely stem from the timeframe and wording of the questions, which can be used to guide selection in healthcare systems.
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Risk factors of colorectal cancer among Saudi Population: Case-control study p. 5035
Mansour Z Alqahtani, Ashry G Mohammed, Awad S Alsamghan, Rishi K Bharti, Abdullah A Alsharm, Mohammed T Alshahrani, Mohammed A Alzahrani, Adil Ali N. Ayed, Mohammed Abadi Alsaleem, Eisa Y Ghazwani
DOI:10.4103/jfmpc.jfmpc_895_20  
Background: Colorectal cancer (CRC) incidence and related mortalities have been steadily increasing in KSA over the past 20 years. CRC in the Kingdom of Saudi Arabia (KSA) population presents in younger ages and in more advanced disease states as compared to other countries. This study was aimed to determine factors (demographic, habitual, environmental, nutritional, and genetic) associated with CRC in Riyadh, KSA. Materials and Methods: A matched case-control study conducted in the major hospitals in Riyadh (King Khalid university Hospital, King Faisal Specialist Hospital, Riyadh Military Hospital, Security Force Hospital, King Fahd Medical City). Here most of CRC cases are managed. The cases (n = 121) group included all recently diagnosed and pathologically confirmed Saudi cases of CRC identified during the period 1st of January 2017 till 31st of December 2018 who agreed to participate and fulfilled the inclusion criteria. A similar number of controls attending the study settings were selected consecutively from the clinics where cases were managed and matched on a 1:1 basis with cases based on age (+/-3 years) and gender. Data were collected using a structured questionnaire. Conditional logistic regression models were fitted to determine factors associated with risk of CRC. Result: This study included similar number of males and females in both groups: males 69 (57%) and females 52 (43%) in each group (Chi-square test P = 1.0). The mean (S.D) age in the cases group was 53.6 (S.D = 12.9) and 53.3 (S.D = 12.9) in the controls group (Student test P = 0.86). In the final multivariate conditional logistic regression model, variables independently associated with risk of colorectal cancer were body mass index (OR = 0.93; 95% CI 0.87–0.98; P = 0.011) employment status (inverse relation: OR = 0.33; 95% CI 0.14–0.77; P = 0.010), colon polyps (OR = 4.09; 95% CI 1.06–15.82; P = 0.041), and constipation (OR = 4.98; 95% CI 1.91–15.99; P = 0.001). Conclusion: Factors associated with CRC in the major referral hospitals in KSA were colon polyps, chronic constipation, and unemployment. These factors should be considered when screening for patients at risk for CRC.
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Adherence of heart failure patients to heart failure medications and its determinants in the Aseer region, Southern Saudi Arabia p. 5041
Hazim Saeed M. Raffaa, Bandar A Alasmari, Safar A Abadi, Metrek Ali Al Metrek, Hatim Saeed Raffaa, Hassan Zaher M. Al Qarni, Razan S Alhumayed, Fares Hamdi Al Hamad, Fayi Mohammed Almakhluti, Hassan Mohammed Al Mani, Faisal Mohammed Al Halafi, Malak Abdullah Assiri, Sameer Marei Al Qahtani
DOI:10.4103/jfmpc.jfmpc_904_20  
Background: Heart failure is a complex clinical syndrome of cardiovascular disease. Heart failure occurs when the heart muscle is weakened and cannot pump enough blood to meet the body's needs for blood and oxygen. It is characterised by several attacks of dyspnoea, chest pain, orthopnea and pulmonary or systemic congestion. The heart inability to fulfill the demands of the body further failure of heart to pump the blood with normal efficiency. Lack of patients' adherence to their treatment may affect their clinical compensation. Aim: To assess the extent of assessing the level and predictors of medication adherence among patients with heart failure in the Aseer region. Methodology: A descriptive cross-sectional approach was used for targeting all registered heart failure patients attending the cardio clinic and chronic diseases clinic in Aseer region hospitals. Data were collected using a direct interview questionnaire that was developed by the researchers with the help of experts. Questionnaire included the patients' sociodemographic data, co-morbidities, disease-related data and drugs. Results: The study included 151 patients diagnosed with heart failure. About 66% of the patients were above the age of 60 years and 62.3% were males. Exact of 47% of the cases had the disease for less than 3 years and 43.7% of the patients had the treatment for more than 3 years. About 49% of the patients forget to have their medication at least once while 34.4% had problems remembering to take your medication. Totally, more than half of the patients had poor medication adherence and only 7.3% had a high adherence rate. Conclusions and Recommendations: In conclusion, the adherence rate for the patients' medication was poor due to forgetting to have the medications. Poor adherence was related more with single patients who are not working with poor income.
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CASE REPORTS Top

Insulin autoimmune syndrome: A rare cause of hypoglycemia p. 5046
Tejas M Maheshwari, Anurag Sharma, Bhagwani Bai Maheshwari
DOI:10.4103/jfmpc.jfmpc_319_20  
Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycemia. It is due to autoantibodies to endogenous insulin in person who has never been sensitized to insulin by injections. IAS is a third leading cause of spontaneous hypoglycemia in Japan and it is increasingly being recognized worldwide in non-Asian population. However, we report a case of IAS in Asian male. A certain class of medication called sulfhydryl compounds have been shown to sometimes cause IAS. Recently a compound called alpha lipoic acid (ALA) has been associated with an increased risk of developing IAS. ALA is sometimes used for dieting purposes. We report a case of 36-year-old Indian male presented with symptoms of dizziness and feeling of hunger with sweating, noted to have low blood sugars on multiple occasions. There is a definite history of ALA compound intake as dietary supplements with multivitamins. Subsequently, he was diagnosed as a case of recurrent hypoglycemia from IAS due to ALA intake and managed accordingly.
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Bilateral limb gangrene in an HIV patient due to vasculopathy: Managing the dual challenge of psychosocial issues and an uncommon medical condition p. 5049
Mudit Kotwal, KK Gupta, Ahmad Ozair, Virendra Atam
DOI:10.4103/jfmpc.jfmpc_605_20  
Patients with human immunodeficiency virus (HIV) have been reported to experience a spectrum of homeostatic dysregulation and resulting manifestations in their vascular system. This may be due to either disruption in the coagulation-anticoagulation pathways or due to damage to vessels from either HIV or other opportunistic infections. However, gangrene in an HIV-infected patient is an uncommon phenomenon. We herein report a case of a 30-year-old female, who had been taking antiretrovirals irregularly for 10 years, developing bilateral limb gangrene during her hospitalization for cryptococcal meningitis. Unfortunately, her condition continued to deteriorate and her attendants took her from the hospital against medical advice, with her death soon after. We illustrate how several biopsychosocial factors came together here to result in poor outcomes. To note, peripheral arterial disease (PAD) in HIV can rapidly lead to critical limb ischemia, resulting in limb gangrene. Aggravating risk factors for the same include smoking, poor glycemic control, and/or low CD4 T-cell count (<200 cells/mm3). General practitioners should be aware that HIV patients are far more prone to PAD than the normal population. Early recognition of at-risk patients, both medically and psychosocially, by family physicians is thus critical.
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Multi-organ dysfunction following honeybee bite—A rare entity p. 5052
Satish Kumar Prasad, Sameer Kumar Mehta, Bhagyalakshmi Satyanarayan, Suman Kumar Panda
DOI:10.4103/jfmpc.jfmpc_629_20  
Honeybee bites have been known to cause localized allergic reactions and anaphylaxis but systemic toxic reactions leading to multiorgan dysfunction is very rare. Serious complications like acute renal failure, acute myocardial infarction (Kounis syndrome) and even death have been reported as the complication of honeybee bite. Herein, we report a case of multiorgan dysfunction following honeybee bite, which was complicated with acute kidney injury, thrombocytopenia, bradycardia, keratitis, and deranged liver function along with localized allergic reaction and pain.
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Primary echinococcal cyst in Trapezius muscle: An unusual intermuscular hydatidosis and review of literature p. 5055
Satya P Meena, Ratan Raj, Ashok Puranik, Prathyusha V Kompally
DOI:10.4103/jfmpc.jfmpc_899_20  
The primary hydatid disease in musculoskeletal position is not common, but maybe present in endemic areas. The human being is always an accidental host. We reported a 30 years adult male patient with trapezius muscle primary hydatidosis. He admitted with a complaint of large swelling right upper back for 2 years. The clinical diagnosis was a lipoma, but ultrasound suggested cystic changes in soft tissue tumor or lipoma and FNAC was inconclusive. Finally, the MRI report revealed hydatid cyst disease and diagnosis become clear with intraoperative findings as well as histopathology reports. We are reporting this case to show the very rare location of primary echinococcal cyst in trapezius muscle and challenging approach to diagnose this case with basic investigation.
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Atypical case presentations of Streptococcus pneumoniae from level 1 trauma centre in India -A case series p. 5058
Aishwarya Govindaswamy, Sushma Sagar, Vivek Trikha, Samarth Mittal, Rajesh Malhotra, Purva Mathur
DOI:10.4103/jfmpc.jfmpc_529_20  
Streptococcus pneumoniae is a rare cause of appendicitis, skin soft tissue, and bloodstream infections. The clinical significance of its isolation from samples of skin or soft tissues and pus from the appendix is poorly understood. Invasive pneumococcal disease (IPD) continues to be a problem in India, associated with a high case fatality rate despite treatment facilities available in the hospital settings. In the present study, we report three adult cases, one presented as acute appendicitis, the other had skin and soft tissue infection, and third presented with bloodstream infection caused by Streptococcus pneumoniae from our level 1 trauma center. The patients with acute appendicitis and soft tissue infection recovered when treated with appropriate antimicrobial therapy, however, the one with pneumococcal sepsis could not be revived.
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Candida tropicalis in the tropics: A rare fungal cause of perinephric abscess p. 5062
Vanya Singh, Aroop Mohanty, Tushar Aditya Narain, Neelam Kaistha, Pratima Gupta, Anshu
DOI:10.4103/jfmpc.jfmpc_784_20  
Perinephric and renal abscess are very rare entities with insidious presentation and pose a great diagnostic challenge, common etiology being bacterial. Only less than 30 cases of fungal etiology have been reported in literature. Herein, we report first case of fungal perinephric abscess caused by Candida tropicalis in a young diabetic female who presented with right flank pain and vomiting. Diagnosis made by CT imaging and culture of USG guided aspiration of perinephric abscess revealed growth of Candida tropicalis. Candida tropicalis perinephric abscess requires a very high index of suspicion for diagnosis. Associated high morbidity and mortality rates are likely due to misdiagnosis, therefore fungal perinephric and renal abscess must be kept as differential diagnosis in cases of fever with abdominal pain. Prompt diagnosis and early treatment are important for better outcome. Imaging and microbiological investigations are required for diagnosis, and drainage is indicated for successful therapy.
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CASE SERIES Top

Pediatric skin diseases in primary care: Diagnostic dilemmas a primary physician may face p. 5066
Navina P Chandy, Resmi S Kaimal
DOI:10.4103/jfmpc.jfmpc_761_20  
Dermatology is an area that appears at the top of general practitioners (GPs)' educational needs. Our curriculum in undergraduate classes is inadequate to equip us for the real clinical scenarios. Pediatric skin conditions pose a special dilemma to primary care practitioners. On the one hand, dermatologic problems are so common in childhood that the primary care physician is forced to become involved with many of them. On the other hand, the scope of dermatologic conditions found in children is so broad as to be beyond the skills of most primary care physicians. The secret to managing dermatologic problems in children within a primary care setting is to recognize that a relatively small group of conditions encompass the vast majority of reasons for which a primary care physician will be consulted. By recognizing those conditions and becoming expert in the treatment of these well-defined areas, the primary care physician can manage these better. Diagnosing pediatric skin conditions and recognizing the importance of early referral of the cases that fall outside one's expertise is an important measure of the primary care physician's competence as seen by patients and their families. In this article, I would like to highlight few pediatric dermatological cases that came to our family medicine clinic, where correct diagnosis and treatment led to good outcomes.
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LETTERS TO EDITOR Top

COVID-19 should not be taken lightly — Mitigation at the end of the lockdown p. 5070
Shrayan Pal
DOI:10.4103/jfmpc.jfmpc_1095_20  
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“Review” a core pillar of urgent care provision in primary care p. 5072
Moien A B Khan
DOI:10.4103/jfmpc.jfmpc_894_20  
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Immune response in SARS-CoV-2 p. 5074
Antonio Luis Aguilar-Shea, Cristina Gallardo Mayo
DOI:10.4103/jfmpc.jfmpc_1539_20  
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“COVID Vaccine” is not the excuse to delay adaptation to the “New-Normal” p. 5076
Kartik Deshmukh, Arjun Khanna, Deepak Talwar
DOI:10.4103/jfmpc.jfmpc_1079_20  
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Relationship between ankle Brachial Index and Pattern of Coronary Artery Disease: An observational study p. 5079
Elizabeth Pushpa Rani, Lakshmi Ramamoorthy, Santhosh Satheesh
DOI:10.4103/jfmpc.jfmpc_647_20  
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Dietary counseling: A requisite in geriatric prosthodontics p. 5081
Kamal Shigli, Sushma S Nayak, Kavitha Menon, Vasanti L Jirge, Sivaranjani Gali, Mansi Patil, Tejas Limaye, Anand Ambali
DOI:10.4103/jfmpc.jfmpc_815_20  
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COVID: We need citizen's charter for common folks p. 5083
Ranabir Pal
DOI:10.4103/jfmpc.jfmpc_1125_20  
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ERRATUM Top

Erratum: Association between mid-upper arm circumference and body mass index in pregnant women to assess their nutritional status p. 5085

DOI:10.4103/2249-4863.296375  
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