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   Table of Contents - Current issue
Coverpage
March 2021
Volume 10 | Issue 3
Page Nos. 1077-1502

Online since Thursday, April 8, 2021

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EDITORIAL  

Health care of the elderly during Covid-19 pandemic—All a family physician should know Highly accessed article p. 1077
Kamal Bandhu Klanidhi, M Bhavesh, Piyush Ranjan, Avinash Chakrawarty, Shailendra S Bhadouria
DOI:10.4103/jfmpc.jfmpc_2200_20  
Elderly people account for more than 9% of the global population, and more than 6% of the Indian population. Covid-19 has badly affected the older population, identification of risk factors for severe disease and early intervention results in reduced mortality. Older adults may have a varied spectrum of presentation which ranges from mild to severe disease. Milder diseases are more in older adults without prior comorbidities whereas severity increases with increase in number of illness. Till date there is no definitive treatment and vaccines are also at different stages of trial only preventive methods and early detection of cases are important tools for fighting this pandemic. Dedicated centre's for elder care as well as trained geriatricians are very few in India. Prevention should be the most important strategy for older adults. Follow social distancing and maintain a distance of 1 meter from others even if you are healthy. Wash hands repeatedly with soap and water or use hand sanitizer and generous use of masks. Older adults should be encouraged to take their regular medication and the baseline disease should be under controlled. Frequent teleconsultation from the primary physician should be done repeatedly to identify the symptoms and also control of baseline disease. Considering Covid-19 increased mortality and severity in the older population we are providing practical suggestions for family physicians while managing elderly Covid patients.
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COMMENTARIES Top

Experience of setting up of Control room for COVID-19 at NCDC, New Delhi Highly accessed article p. 1082
Kanica Kaushal, Meera Dhuria, Warisha Mariam, SK Jain, Sujeet Singh, Suneela Garg, Arun Chauhan, Ram Singh
DOI:10.4103/jfmpc.jfmpc_1826_20  
Significant public health events of the 21st century include epidemic prone diseases such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza A (H1N1), Ebola virus disease, and coronavirus (SARS-COV-2). Preparedness as well as risk mitigation strategies play an integral role for the success of responses to such health emergencies. An extraordinary cluster of cases of respiratory disease of unknown cause triggered a series of events that constituted a public health risk across the globe through international spread from China and was declared a Public Health Emergency of International Concern (PHEIC) on 30 January, 2020 by the World Health Organization (WHO). To monitor implementation of activities in order to contain the local transmission of COVID-2019 in India, a control room was established at the National Centre for Disease Control (NCDC), New Delhi on 23rd January, 2020 under the Integrated Disease Surveillance Project (IDSP). The main objectives of the control room were to alleviate the concerns and address queries of passengers arriving from the affected countries and also to provide the general public information regarding the measures to be taken as well as the contact details of the respected district health authorities for further necessary action. A total of 183 hunting lines were established at the NCDC, Noida, TB Centre, and the National Health Authority (NHA) Hyderabad and Bengaluru by March 2020. A total of 79,013 calls, 1,04,779 emails, and 1,787 international calls were received w.e.f. 23 January to 30 March, 2020 at the NCDC control room. The NHA Bengaluru and Hyderabad Control room received 3,52,176 calls w.e.f. 15 March to 30 March and TB Noida control room received 55,018 calls w.e.f. 16 March to 30 March, 2020. This prompt action of the center to set up a control room at the NCDC gave the states enough grace period to train their staff and start their individual help lines for addressing people's queries and allay fears.
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Diploma in primary care psychiatry: Do primary care doctors need training in cannabis use disorder module? p. 1086
Erika Pahuja, KT Santosh, Nisha Harshitha, Barikar C Malathesh, Narayana Manjunatha, Arun Kandasamy, Channaveerachari Naveen Kumar, Suresh Bada Math
DOI:10.4103/jfmpc.jfmpc_2124_20  
Background: Cannabis is one of the most used illicit substances in India but is under-recognized and under-represented in clinical settings of India, especially at primary care. Patients usually do not seek treatment primarily for cannabis use, but it is identified on pro-active questioning by doctors. The aim is to study the clinical profiles of patients with cannabis use disorders (CUD) at primary care and to derive learning points from collaborative consultations to devise an optional module for CUD primarily for primary care doctors (PCDs). Methods: File review of general patients with cannabis use, identified by PCDs during collaborative video consultation module of Diploma in Primary Care Psychiatry, was performed, and their profile and management difficulties were assessed. Result: Twelve patients with a mean age of 31.25 ± 12.04 years were identified by PCDs over a year. All were males with psychosis being the most common comorbidity. None of the patients presented primarily for cannabis use disorder. Conclusion: Identifying cannabis use among patients visiting PCDs becomes all the more important as the use of cannabis is not usually revealed spontaneously unless specifically probed. This warrants establishing guidelines for CUD specifically for use of PCDs for identifying and managing CUD.
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REVIEW ARTICLES Top

Oral cancer management in the SARS-CoV-2 Pandemic—Indian scenario p. 1090
Karla M Carvalho, Ridhima B Gaunkar, Aradhana Nagarsekar
DOI:10.4103/jfmpc.jfmpc_1948_20  
The global burden of oral cancer rests on India's shoulders. Distant metastasis and extensive loco-regional spread result in a dismal 5-year prognosis. Tobacco chewing is the leading etiological factor. A lack of education among the masses combined with an inundated cancer care system account for high morbidity and mortality rates. The SARS-CoV-2 shows tropism for the oral mucosa. This viral tropism is thought to get augmented in oral cancer because of the upregulation of oral mucosal receptors and enzymes which enhance viral attachment and entry. The COVID-19 disease has caused a heavy blow to the cancer care sector in India because of paucity of COVID-19 centred health care regulations. This review highlights the need for the prompt creation of a national health policy which would prioritize and allow for the resumption of oral onco-surgical in light of COVID-19 pandemic.
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Epidemiological characteristics, reinfection possibilities and vaccine development of SARS CoV2: A global review Highly accessed article p. 1095
Ramakant Yadav, Prashant K Bajpai, Dhiraj K Srivastava, Raj Kumar
DOI:10.4103/jfmpc.jfmpc_2151_20  
According to the World Health Organization (WHO), there are 37,704,153 cases and 10,79,029 deaths due to COVID-19 till the 13th October 2020 in the world. Day by day, rise in the number of COVID-19 deaths has created great pressure on health facilities, governmental bodies, and health workers. There is a need for knowledge regarding lifecycle, transmission, and different strains of SARSCoV2, so that countries can stop the disease as early as possible. The present study was conducted to review various epidemiological aspects along with measures used in the containment and prevention of this new pandemic. The scientific literature database was searched using the terms: coronavirus, 2019-nCoV, SARSCoV2, and COVID-19. Articles with appropriate topics fulfilling the objective of the present work were included. The epidemiological characteristics regarding life-cycle, intermediate hosts, viability on various surfaces, strains, case fatality rate, and their implication to reduce the transmission of SARSCoV2 have been identified. According to Centers for Disease Control and Prevention, Atlanta (updated till October 05, 2020) people with recurrent or persistent positive COVID-19 tests in South Korea and USA did not show to have live virus in their bodies. As per WHO web-page information till 15 October 2020, there were 42 candidate vaccines in clinical evaluation and 156 vaccines are in preclinical evaluation phase. As the virus can easily be transmitted to the people either via droplets, fomites, and may be via the fecal–oral route, knowledge regarding the above-mentioned areas is needed for time to be prepared for the next waves of the COVID-19 pandemic.
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Immuno-inflammatory predictors of disease severity in COVID-19: A systematic review and meta-analysis p. 1102
Suchismita Panda, Rachita Nanda, Prasanta Kumar Tripathy, Manaswini Mangaraj
DOI:10.4103/jfmpc.jfmpc_2196_20  
Deregulated immune response and raised inflammation are the cardinal laboratory features in COVID-19 infection reflecting severity of condition. Detection of the markers will help in early diagnosis with timely therapeutic implementation and effective outcome. Observational studies have suggested alteration in these parameters with severity of the condition. This systematic review and meta-analysis was conducted to assess the relevance of the fact. Observational studies from databases were scrutinised and 3669 articles were identified. Further screening, based on the inclusion criteria a total of 19 articles with 3115 participants, were reviewed for meta-analysis using random effects model. Any data in median and interquartile range were converted to mean ± SD. There was a significant rise in total leukocyte count, C-reactive protein, ferritin, IL-6, IL-10, procalcitonin in severe cases but absolute lymphocyte count, CD4+ and CD8+ registered a fall in severe cases in comparison to non-severe group. Immune and inflammatory markers are significantly altered and related to severity of manifestation in COVID-19 infection.
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Critical interpretative synthesis of herd immunity for COVID-19 pandemic p. 1117
Suneela Garg, Meghachandra M Singh, Chetana Prakash Deshmukh, Nidhi Bhatnagar, Amod L Borle, Raman Kumar
DOI:10.4103/jfmpc.jfmpc_1127_20  
Introduction: Countries globally are evaluating the concept of herd immunity and its critical role in the control of pandemic. The current paper attempts to conduct a critical interpretative synthesis (CIS) on the role of herd immunity in current COVID-19 pandemic. Methods: CIS is tool for developing theoretical framework using interpretation drawn from relevant empirical and non-empirical sources. This review is done by formulating review question for literature search. Purposive sampling of literature was done followed by reciprocal translational analysis of extracted data. Results: Herd immunity is indirect protection from a contagious infectious disease when a population is immune either through vaccination or natural immunity developed through previous infection. The reproduction number for COVID-19 in India was found to be 2.56 and herd immunity threshold as 61%. Discussion: Exposing 71% young population in India to the SARS-CoV-2 infection can achieve herd immunity but with high morbidity as well as mortality. Vaccine are under process. Feco-oral transmission and reinfection of COVID 19 are major factors to develop or break the circle of herd immunity in community. “Immunity passport” can give false sense of security. Surveillance and seroprevalence studies assess immunity status, gradual exposure of infection to younger population and collaborative partnerships on organizations are few strategies to acquire herd immunity. Conclusion: Herd immunity is a measure for prevention and control of COVID-19 pandemic against the backdrop of mortality and morbidity. Vaccine can be boon but if herd immunity is to be acquired by natural infection then preparedness is necessary.
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Hydroxychloroquine: A review of its safety and efficacy in COVID-19 p. 1124
Rutu H Karia, Sanjana Nagraj, Ishita Gupta, Amit Barua, Nirmaljot Kaur, Harmandeep Singh
DOI:10.4103/jfmpc.jfmpc_1961_20  
SARS-CoV-2 is a novel virus that has infected millions of people across the world. Given the compelling need to develop a therapeutic strategy, hydroxychloroquine has been advocated as an effective drug for the infection. However, multiple clinical trials conducted using hydroxychloroquine have yielded contrasting results. An electronic search using the primary databases from WHO, PubMed and Google Scholar was performed that yielded 21 studies eligible for inclusion. Among a total of 1,350 patients who received hydroxychloroquine, 689 (51.04%) were females. The most commonly reported comorbidities include hypertension (15.18%), diabetes mellitus (8.44%) and pulmonary disease (8.96%). Of the hydroxychloroquine-treated patients, 70% were virologically cured compared to 12.5% of the control group (p = 0.001). A good clinical outcome with virological cure was reported in 973 patients (91%) within 10 days out of 1,061 hydroxychloroquine-treated patients. A total of 29 (65%) renal transplant recipients achieved complete recovery following hydroxychloroquine administration. A total of 37 (2.7%) patients reported QT prolongation. Hydroxychloroquine was found to reduce mortality in healthy, SARS-Cov-2 positive patients and improve clinical recovery in renal transplant recipients. However, a definitive conclusion regarding its effect on viral clearance can only be reached by conducting more clinical trials involving bigger and diverse samples.
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Coronavirus disease 2019 and the natural agents: Is there a role for the primary care? p. 1134
Manal O Alharthi, Raghad A Alasmari, Rahaf I Almatani, Rehab M Alharthi, Suha A Aljumaiei, Bashayr A Alkuhayli, Ahmed M Kabel
DOI:10.4103/jfmpc.jfmpc_2195_20  
Coronavirus disease 2019 (COVID-19) is a newly discovered RNA virus that belongs to corona virus group. It leads to an infectious state manifested as fever, loss of smell and taste sensations, cough, myalgia, fatigue and headache. The condition may become more serious as difficulty in breathing, chest pain and even death. Until successful vaccine is developed, complimentary and herbal medicine can be used as alternative prevention measure against COVID-19 in high-risk populations. This is because the none of the traditional agents used in the treatment protocols had proven effective results. In addition, recent studies reported that dietary supplements and herbal agents may have effective antioxidant and anti-inflammatory properties that may contribute efficiently to amelioration of the effects of COVID-19. This review sheds light on the possible role of the natural agents in the management of COVID-19 with reference to the role of the primary care in this issue.
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An update on the diagnostic biomarkers for asthma p. 1139
Rashmi Pandey, Ved Parkash, Surya Kant, Ajay K Verma, SN Sankhwar, Avinash Agrawal, Devendra Parmar, Sheetal Verma, Md Kaleem Ahmad
DOI:10.4103/jfmpc.jfmpc_2037_20  
Asthma is a respiratory disorder accounts for ~339 million cases per annum. The initial diagnosis of asthma relies on the symptomatic identification of characters, such as wheeze, shortness of breath, chest tightness, and cough. The presence of two or more of these symptoms may be considered as indicative of asthma. The asthma-diagnostic also involves spirometry test before and after inhaling a bronchodilator like albuterol. Because asthma pathophysiology involves participation of immune system, the cytokines play an important role. The review discusses various molecules that are or may be used as biomarkers for the asthma diagnosis.
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ORIGINAL ARTICLES Top

Exploring the perspective of nursing staff or caregivers on birthing positions in Central India p. 1149
Anita Yadav, Anusha Kamath, Shuchita Mundle, Jyoti Baghel, Charu Sharma, Avinash Prakash
DOI:10.4103/jfmpc.jfmpc_2066_20  
Introduction: Maternal birthing positions refer to the various physical postures a pregnant mother may assume at the time of delivery. The World Health Organisation recommends that woman should be given an opportunity to make a choice on the type of position to use during labour. Alternative birth positions are associated with lower incidence rates of performing episiotomy, less perineal tears and less use of instrumental deliveries. Nurses' perspective on women's positions has rarely been explored in India. Present study aims at assessing the knowledge regarding alternative birth positions among nursing officers. Materials and Methods: This cross-sectional observational study was conducted on 52 nursing officers who were posted in the labour room. A pretested questionnaire was administered to them. Data analysis was done using SPSS software version 22. Results: Majority (82.7%) of nursing officers felt that there is a need of giving a choice to the woman regarding alternate birth position. 76.9% of them were aware of position other than lithotomy. Around 48.1% would recommend squatting position to a woman in labour. Ease and convenience in conducting the delivery was the foremost reason chosen in advocating a birth position. Whereas overcrowding in the labour room, ignorance about alternate positions and difficulty in converting to instrumental delivery were cited as reasons of not recommending these positions. Conclusion: Educating nursing officers about emerging evidence regarding birthing positions will enable them to give accurate information to women.
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Public knowledge, attitudes, and practices toward COVID-19: An online cross-sectional study in the Union territory of Jammu and Kashmir p. 1155
Chandani Gupta, Riya Gupta, Rashmi Kumari, Rajiv Kumar Gupta, Preeti Bhagat, Mehak T Mir, Heena Nazir, Sunil Kumar Raina
DOI:10.4103/jfmpc.jfmpc_1332_20  
Background: COVID-19, since its emergence, has become a global health problem with countries adopting unprecedented measures to control the spread of this pandemic. Adherence of the populations to control measures is affected by their knowledge, attitude, and practices (KAP) towards the disease. It was with this aim that the present study was conducted among the residents of UT of J&K to assess their KAP toward COVID-19. Methodology: A cross-sectional online survey of 464 J&K residents was conducted between 1st May and 10th May 2020. Survey Monkey tool was used to develop a link and KAP questionnaire was used for data collection. The survey instrument consisted of demographic characteristics, 11 items on knowledge, 5 items on attitudes, and 7 items on practices. Data collected was represented in descriptive statistics, and one-way analysis of variance was the test of significance. Results: Mean knowledge, attitude, and practice scores were 7.69 ± 0.74, 4.70 ± 0.57, and 4.32 ± 0.68, respectively, among the respondents. Majority (99%) knew the sign and symptoms, mode of transmission of the disease and avoided attending large gatherings. Use of mask was almost universal and about 38% were taking supplements like vitamins or herbal medicines. Good knowledge, positive attitude, and appropriate practices among the respondents about COVID-19 suggest that community based health education programs play a key role in containment and mitigation of this disease. Conclusion: Sustained messaging and updates from the national and local health authorities on COVID-19 to the public are likely to help control the transmission of the disease.
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Knowledge and perception about bioethics: A comparative study of private and government medical college students of Karachi Pakistan p. 1161
Tabinda Ashfaq, Aiesha Ishaq, Faisal Shahzad, Fahad Saleem
DOI:10.4103/jfmpc.jfmpc_103_21  
Introduction: Ethics plays an elementary role in current medical practice. Recent advancement in medical technology and its implications have raised many ethical issues and dilemmas in clinical practice, requiring dire needs for incorporation of bioethics into medical curriculum. Aim: The objective of this study is to assess the base line knowledge and perception of medical students regarding bioethical issues in clinical practice based on exposure to formal bioethics teaching in their medical curriculum. Setting and design: This cross sectional study was conducted among medical students of a private and government medical college who were currently enrolled into third to fifth year MBBS. Methods and Material: A pretested questionnaire was used to collect data. A structured questionnaire consisting of 27 questions was used for this study. An Ethics Review Committee approval was taken. Analysis: Data analysis was done under SPSS version 17 and frequencies were calculated. Results: A total of 285 medical students, 145 from private and 140 from government medical college participated in this study. Private college medical students (57%) had slightly better knowledge of bioethics as compared to the government students 43%. Conclusion: The study clearly signifies the need of teaching bioethics in the both the medical colleges. Our findings provide strong evidence for major educational initiatives related to bioethics education in medical curriculum.
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Impact of nutritional education in malnourished elderly patients with the comparison of Mini nutritional assessment (MNA) score p. 1167
Megha S Karthikeyan, Priya Vijaykumar, Linqalla Chandana, Alex Baby Paul
DOI:10.4103/jfmpc.jfmpc_1363_20  
Introduction: Prevalnce of malnutrition is high in the elderly. Very few studies exists mentioning the prevalnce of malmutrtion in elderly. In india around 7.7% of the total population belong to elderly age group and in kerala older adults constitute 13% of its population. The health of the elderly contributes to the health status of the population. Malnutrition is commonly seen in elders. There are multiple factors contributing to malnutrtion in this age group. Material and Methods: A sample of 30 patients, 60 years and above fulfilling the inclusion criteria are enrolled in the study. Malnutrition was assessed by MNA score. The score ranges from 0 to 30 points. The score above 24 show patient that are healthy with no nutritional problem, scores within range 17-23.5 indicate patients vulnerable to malnutrition and score below 17 as malnourished. MNA scoring was repeated after 3 months giving the dietary education. Results: 29 patients were found to be at risk of malnutrition and 1 patient was found to be malnourished After 3 months of dietary intervention, 23 attained normal. Conclusion: MNA is a very accurate and effective tool for identifying malnutrition in elderly. Nutrition is an important area that need to be addressed in elder population.
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Coverage, utilization, and impact of Ayushman Bharat scheme among the rural field practice area of Saveetha Medical College and Hospital, Chennai p. 1171
Vishnu Priya Sriee GV, G Rakesh Maiya
DOI:10.4103/jfmpc.jfmpc_1789_20  
Introduction: Ayushman Bharat scheme, otherwise called as Pradhan Mantri Jan Arogya Yojana (PMJAY), is a National Health Protection Scheme introduced on 23 September 2018 by the government of India to aid the economically disadvantaged families. Aim: The study was initiated to estimate the coverage, utilization, and impact of Ayushman Bharat scheme in the rural field practice area of Saveetha Medical College and Hospital, Chennai. Settings and Design: This is the cross-sectional study conducted in the rural field practice area of Saveetha Medical College and Hospital, Chennai. Methods and Material: This cross-sectional study done among 300 households in Mappedu region of Thiruvallur district, Tamil Nadu. Simple random sampling was done to choose the study participants to reach the sample size of 300. Data was collected using semi-structured questionnaire. After the entry of data, the descriptive statistics was presented in frequency tables and graph. Result: The study found that out of 300 households only about 42.33% of the households were covered under Ayushman Bharat scheme. Among the households covered under Ayushman Bharat scheme, 47.24% households have availed Ayushman Bharat scheme in the past 1 year and only 10% of those availed the scheme has spent additional amount for health care. Around 39.88% of the households not having Ayushman Bharat scheme has faced financial burden because of health care expenditure. Conclusion: Creating awareness, appropriate governance, and working toward quality assurance, prompt referral pathways in both public and private healthcare providers can make Ayushman Bharat scheme effective.
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Dermatoglyphics and Cheiloscopy patterns in hypertensive and type 2 Diabetes mellitus patients: An observational study p. 1177
CD Mouneshkumar, Santosh Anand, RH Shilpa, Nazia Haidry, Pranay Kulkarni, Aastha , Aaysha Gupta
DOI:10.4103/jfmpc.jfmpc_1986_20  
Background: Essential hypertension is a type of hypertension which bears no etiological reasons. It is found to affect approximately 90 to 95 percent of hypertensive individuals. Similarly, type 2 diabetes or diabetes mellitus is a genetically determined systemic condition with a close relation to familial medical history. Both of these conditions or diseases are closely linked with the process of ageing among various other inherited and genetically determined factors. Importantly, a positive family history increases disease risk manifolds. As there is increased risk of hypertension and development of type 2 diabetes in individuals with family history because of genetic factors, the study of co-relation between dermatoglyphics and hypertension can aid in early identification of individuals with a genetic predisposition towards developing hypertension and type 2 diabetes. Aim: The aim and objectives were as follows: (1) Analyze dermatoglyphic finger patterns; (2) Analyze cheiloscopic patterns; (3) Comparison of cheiloscopic and dermatoglyphic patterns with hypertension and type 2 diabetes; and (4) to determine if dermatoglyphics and/or cheiloscopic patterns can be used as tool(s) for pre-identification of inherited diseases. Materials and Methods: Total 300 study participants age range above 40 years were selected after obtaining informed consent. Lip patterns were recorded using a dark-colored lipstick and a transparent cellophane tape while finger print patterns were recorded using stamp ink-pad and by applying uniform finger pressure on blank paper sheet. Results and Observations: Cheiloscopic patterns analysis showed that the branched, straight, intersected, reticular followed by undifferentiated patterns were present in decreasing frequency among male patients while among female patients, branched, intersected, straight and reticular patterns were observed. However, no undifferentiated pattern was observed in female subjects. These findings were consistent with both diabetic as well as hypertensive patients. On the other hand, finger pattern analysis showed that ulnar loop was most frequently observed in both male and female patients with either hypertension or type 2 diabetes. Also, this was followed in decreasing order by arch type pattern, radial loop pattern and whorl pattern in both genders. Conclusion: It can be surmised from the study that both the finger prints and lip patterns can be used to ascertain predisposition to type 2 diabetes and hypertension.
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Awareness of diabetic retinopathy among patients with type 2 diabetes mellitus in Qassim, Saudi Arabia p. 1183
Nayef F Alswaina
DOI:10.4103/jfmpc.jfmpc_2231_20  
Introduction: Diabetic retinopathy (DR) is a well-known complication of diabetes mellitus (DM) and a major cause of vision loss. Increased awareness of DR is crucial for the prevention and early diagnosis of the disease and preservation of vision. The objective of this study is to assess the level of DR awareness in the Qassim region among type 2 diabetic patients. Materials and Methods: A cross-sectional study was conducted among patients who visited diabetic clinics between January and March 2019 in the Qassim region, Saudi Arabia. This study used structured questionnaires to assess awareness and knowledge of DR. The patients were considered to have a good level of DR awareness if they answered more than 60% of the questions correctly. Results: A total of 307 patients with type 2 DM, 201 males (65.5%) and 106 females (34.5%), participated in the current study. The results revealed that 63.5% of the participating patients involved in this study had good knowledge about DR; 86% of the patients had knowledge about the correlation between retinopathy and DM, and 89.9% believed that DR can be prevented by good control of diabetes. Conclusion: The study showed that about two-thirds of the participants were aware of DR, and most of them had knowledge about the relationship between retinopathy and DM. Younger patients and the group with a higher level of education were found to be more aware of DR. Awareness of DR should be correlated with behavioral practices to improve a patient's compliance in attending annual eye examinations.
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Role of mini-invasive bridge plate in the complex femoral fracture in school going children: A prospective clinical study of 30 cases p. 1188
Amit Lakhani, SM Bhatnagar, Gobind Pratap Singh, Nikunj Gupta, Ena Sharma
DOI:10.4103/jfmpc.jfmpc_1210_20  
Objective: Pediatric femoral fracture including supracondylar and subtrochanteric fracture constitutes 1.6% of all paediatric fracture. Elastic nails remain the standard treatment of choice in a midshaft transverse femoral fracture in children weighing less than 45 kg. But in subtrochanteric and spiral femoral fracture, the failure rate of elastic nails are quite high. Hence, in accordance with AAOS guidelines, we treated complex femoral fracture in children with submuscular mini-invasive bridge plate because of its advantage of minimal incision, early union with proper alignment and lower failure. Material and Methods: We retrospectively reviewed 30 complex femur fracture in children treated with Submuscular bridge plate by mini-invasive approach. Patients were analysed according to their age, type of fracture, time of union in weeks, complication and results were evaluated with modified Flynn's criteria. Result: Out of 30 patients 28 were boys and 2 were females, with an average age of 11.5 years in which Spiral fracture (n = 12), subtrochanteric fracture (n = 9), Complex Shaft fracture (n = 10). All fracture united well on an average of 11 weeks. And 29 patients has excellent results and in 1 patient there is Acceptable result. The single complication was 3 mm limb lengthening but it didn't change gait of the patient. Conclusion: Mini invasive bridge plating is an easy and soft tissue preserving procedure for managing complex femoral fracture in children. It has shown promising results in achieving union without any major complication. We strongly recommend the SBP in a complex femoral fracture in children.
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Pattern of Tobacco consumption among urban slum population in Jammu region: A cross-sectional study p. 1193
Neha Choudhary, Sonika Sangra
DOI:10.4103/jfmpc.jfmpc_1428_20  
Introduction: Consumption of tobacco leads to a myriad of ill effects among the smokers as well as those in their proximity. The study related to tobacco consumption was conducted among individuals over 15 years of age, residing in urban slums. Objective: To assess the pattern of tobacco consumption in urban slum population, using WHO standardized questionnaire which is Global Tobacco Surveillance System (GTSS); questions related to tobacco from the surveys, which are the subset of GATS 2nd Edition key questions. Materials and Methods: The present study was observational cross-sectional in nature which was conducted over a period of 6 months i.e., from September 2019 to February 2020 in urban slums of Trikuta Nagar, urban health training centre which is a field practice area of Postgraduate Department of Community Medicine, GMC Jammu. The information about the tobacco consumption was gathered by interview sessions after taking consent from all the participants. Totally, 718 individuals were met, out of which, 539 were over 15 years of age and 510 agreed to participate in the study. Results: 36% (maximum) belonged to 36-45 year age group and lowest (3%) among individuals >66 years. 48% prevalence of active smoking; maximum indulgence (53%) observed in 36-55 year group. Highest exposure to passive smoking seen in 56-65 year group (75%). 45% prevalence of smokeless tobacco consumption, highest in 56-65 year group (72%), lowest in 15-25 year age group (17%). Conclusion: Regular conducting of IEC activities for generating awareness with the strict implementation of tobacco control measures by the government needs to be carried out as urban slum population is a vulnerable group and most susceptible to the vicious cycle of disease and poverty.
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Changing trend in the pattern of ocular diseases in patients attending ophthalmology department of a teaching institute in North India during COVID-19 pandemic p. 1197
Hina Kauser, Taskin Khan
DOI:10.4103/jfmpc.jfmpc_1554_20  
Purpose: The objective of this study is to report the changing trend in ocular diseases during COVID-19 pandemic. Methods: A retrospective review of patients attending the ophthalmology department of a teaching institute was conducted. We studied the 3 months of the COVID period from April 2020 to June 2020. For comparison, we took the corresponding period of April 2019 to June 2019. Data were collected from the medical record section of the Hospital. Results: Overall, 876 patients presented during the 2020 period compared to 7,242 patients in the 2019 period. Percentage of female patients decreased from 53.1% to 49.1% in the 2020 period (P = 0.0251). There is significant decrease in pediatric group in the 2020 period (P < 0.0001). In the 2019 period, refractive errors was the most common (57.6%) followed by cataract (12.29%), allergic conjunctivitis (3.82%), diabetic retinopathy (3.37%). While in the 2020 period refractive errors, constitute 22.37%, followed by allergic conjunctivitis (8.56%), scleritis/episcleritis (7.19%), dry eyes (7.08%), infective conjunctivitis 6.85%), anterior uveitis (6.74%). In the 2020 period, there was significant decrease (P < 0.00001) in the percentage of refractive errors, cataract and diabetic retinopathy, and significant increase in painful symptomatic conditions. The features of ocular trauma in the two study periods were also quite different. Conclusion: There is significant decrease in patients of curable/avoidable blindness. We should be ready for the increase burden of curable/avoidable blindness and should plan various strategies to overcome the potential backlog of blindness.
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Prevalence of self-medication and its associated factors among students of an engineering college in Chennai p. 1204
Sushil A Chakravarthy, G Rakesh Maiya
DOI:10.4103/jfmpc.jfmpc_1654_20  
Context: Self-medication in healthcare is becoming an increasingly important area. However, risks such as misdiagnosis, inappropriate drug dosage, extended time of use, drug interactions and polypharmacy are also associated with it. Aims: The present cross-sectional study aims to study the prevalence of self-medication and its associated factors among engineering students. Setting and Design: The present cross-sectional study was conducted in an engineering college in Chennai. Materials and Methods: A total of 199 participants were studied. A pretested semi-structured questionnaire including general information and specific questions regarding the prevalence of self-medication and its associated factors was given to the study participants and were instructed to fill them. Statistical Analysis Used: Data were recorded and analysed in the excel spreadsheet using SPSS software version 16 and Chi-square test was used to perform interferential statistical analysis. Results: 199 engineering students were studied, ranging from 1st year to 4th year between the age group of 17–25 years. From the data collected, 154 (77.4%) participants said they had been on self-medications before and 45 (22.6%) participants said they have never been on self-medication. Conclusions: From this study we come to a conclusion that the prevalence of self-medication among the engineering students in sub-urban Chennai is high that is 77.4%. The parameters frequently linked with self-medication are the type of illness and the easy access to drugs. Since self-medication is at an alarming rate, the need of the hour is to educate the youth to ensure healthy practice.
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Assessment of osteoporosis knowledge among adult Saudi females attending the family medicine department at Security Forces Hospital, Riyadh, Saudi Arabia p. 1209
Ghada M Alqahtani, Abdullah M Alghamdi
DOI:10.4103/jfmpc.jfmpc_1810_20  
Background: Osteoporosis is a skeletal disorder characterized by loss of bone mineral density, deterioration of bone structure, bone fragility, and it is associated with high risk of fractures. The prevalence of osteoporosis among Saudis is estimated to be 34% in females and 30.7% in males. The aim of this study was to know the level of knowledge about osteoporosis among Saudi females at Security Forces Hospital, Riyadh, Saudi Arabia. Materials and Methods: This was a descriptive and analytical cross-sectional study conducted between January 2019 and January 2020. We used the osteoporosis knowledge assessment tool (OKAT) for data collection. The survey assessed the understanding of symptoms and fracture risk, risk factors, treatment availability and preventive factors for osteoporosis. Results: The overall knowledge of our 376 participants was good with a mean score of (66%). Participants had more knowledge about the symptoms and fracture risk and the preventive factors such as physical activity and diet compared to the other subscales of the OKAT. There was a significant difference between the knowledge of younger and older females (>40 yrs.), where younger females had lower scores on the OKAT. Conclusion: This study showed that knowledge about osteoporosis was good among females attending the family medicine clinics in Riyadh, Saudi Arabia. However, younger females were less knowledgeable, which means that more effort should be made to increase the awareness about osteoporosis especially among the younger females.
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Risk factors of placenta previa with maternal and neonatal outcome at Dongola/Sudan p. 1215
Nahid A Salim, Ismail Satti
DOI:10.4103/jfmpc.jfmpc_2111_20  
Background: Placenta previa is a major cause of hemorrhage affecting 0.4–0.5% of all pregnancy's early detection of cases and senior input will significantly reduce maternal and fetal morbidity and mortality. Objectives: The aim of the study is to determine risk factors, fetal and maternal outcome in pregnancy complicated by placenta previa. Method: This is descriptive cross-sectional study in women diagnosed with placenta previa at Dongola maternity hospital, Sudan from December 2018 to June 2019. Results: There were 3,674 deliveries and 52 cases of placenta previa during the study period with prevalence of 1.4%. The average age of the patients was 34.8 years and most of them were above 35 years (53.8%), and (63.5%) were para 3 and more. Other identified risk factors included previous cesarean section (69.1%), previous uterine evacuation (13.5%), and assisted reproductive technique (5.8%). Maternal complications were hemorrhage needing blood transfusion (40.4%), cesarean hysterectomy (21.2%), and bladder injury (3.8%), but (34.6%) were with good outcome and no maternal death. NICU admission with RDS (25%), prematurity (25%), and death (5.8%) were the fetal complications, while in (44.2%) fetal outcome was good. Conclusion: The most identifiable risk factors for placenta previa were previous uterine scars, advanced maternal age, and multiparity. And it is associated with adverse maternal and fetal outcomes.
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Knowledge and attitude of Attention-Deficit and Hyperactivity Disorder (ADHD) among male primary school teachers, in Riyadh City, Saudi Arabia p. 1218
Fahad Alanazi, Yousef Al Turki
DOI:10.4103/jfmpc.jfmpc_2194_20  
Objective: The aim of this study was to explore teachers' knowledge about the ADHD, its origin, causes, and identify the main demographic variables affecting their knowledge. Methods: The study was conducted among male school teachers of ten government primary schools that are found in different regions of Riyadh city, the Kingdom of Saudi Arabia. We used a stratified random sampling technique to collect our sample with inclusion criteria of being male teachers who currently working in male government primary school and are directly involved on teaching of students. Data analysis was performed using SPSS software statistical program version 21. Results: We received 400 response for our questionnaire, mostly younger than 40 years old. Most of teachers in this sample had a bachelor's degree, only 6% had diploma while 8% had a higher degree, while most of them had experience more than 5 years in teaching (74.2%). only 8%of teachers admitted that they had not heard about ADHD before. 78% of teachers had read about ADHD at least once before. This knowledge was more from reading books (32.8%) followed by reading internet websites (28.7%), TV/Media (14.6%) while magazine and social media represent (23.9%). Most of the teachers showed that they had attended courses/training about ADHD (76.7%) however only 40.4% of them thought that they had the enough information about the disease. 51.5% of teachers showed that they had already asked before to assess a child who was suspected to have ADHD and 65.3% had taught a child with the disease. Conclusion: From the results of this study, it is concluded that the knowledge regarding ADHD among elementary school teachers is suboptimal. Some teachers had misunderstanding about ADHD symptoms and general information, which indicated the further needing for courses to enhance this knowledge.
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The moderating effect of financial stress and autism severity on development of depression among parents and caregivers of Autistic children in Taif, Saudi Arabia p. 1227
Mohammed Saeed Alshahrani, Hasaan Algashmari
DOI:10.4103/jfmpc.jfmpc_2203_20  
Background: Autistic spectrum disorder (ASD) is a common problem in the Kingdom of Saudi Arabia. However, little research explored the extent of anxiety and depressive disorders in parents of children with ASD. Method: Descriptive questionnaire-based cross-sectional survey of a sample of parents of children with ASD who attended Prince Mohammed Bin Salman Autistic Centre, Ministry of defense, Taif city. Results: The study included (n = 50) parents. The prevalence of mild depression was 30%, whereas the prevalence of moderately severe depression was 68%. Increased ASD severity level was associated with a significant impact on the PHQ-9 total score (level II was 1.293 times level I to have an increased PHQ-9 score, and level III was 1.530 times level I to have an increased PHQ-9 score). Economic status did not significantly alter depressive symptoms. Discussion and Conclusion: ASD diagnosis in Saudi children is associated with high parental depressive prevalence. However, this result could be bidirectional. Stigma, future-related worry, and stress could mediate parental depressive symptoms. Our findings in Saudi parents of children with ASD corroborate the established association between parental depressive symptoms and ASD severity. Our results corroborated previous findings that neither parental gender nor child gender exert any substantial effect on predictability of depressive symptoms among parents of children with ASD. Comprehensive therapeutic packages for children with ASD should include treatment of emotional problems arising out of carer burden among their parents. Screening for parental emotional problems should be routine in autism treatment facilities.
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Prevalence of home related injuries among children under 5 years old and practice of mothers toward first aid in Buraidah, Qassim p. 1234
Soad Abdulrhman Al-Bshri, Saulat Jahan
DOI:10.4103/jfmpc.jfmpc_2265_20  
Background: Unintentional injuries are reported to be the most common mechanism of childhood injuries; large proportion of these occur in or around home. Quick response and appropriate first aid is vital in saving life and preventing negative outcomes. Objectives: The aim of this study was to determine prevalence of home injuries among children five years old and younger and to explore their mothers' knowledge, attitude and practice toward first aid. Methods: A cross-sectional study was conducted among 250 mothers attending well baby clinics at primary health care centers (PHCC) in Buraidah city. The survey was conducted from February to June 2020. Simple random sampling was used to select PHCCs and systematic random sampling was used for participant selection. A self-administered, semi-structured questionnaire was used to collect data. Results: A history of home-related injury to the youngest child was reported by 114 (46.3%) mothers. The common home injuries were falls (50%), cut wounds (15.2%) and burns (10.7%). Among less than one-year age, injuries were more prevalent among males (41.4%) as compared to females (27.6%). Majority (58.2%) of mothers had fair knowledge about first aid. Internet websites (53.6%) followed by social media (47.6%) were the main sources of their knowledge. Mothers showed appropriate practice in dealing with suspected fracture (85.9%) and foreign body ingestion (80%) while burn (55.5%) and choking (43.2%) had the lowest appropriate practice. Conclusion: Home injuries are common among children. However, mothers' knowledge and practice of first aid is inadequate. To reduce the injuries' related morbidity and mortality, increasing awareness and organizing first aid training courses are recommended.
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Prevalence of tuberculosis and diabetes comorbidity in patients attending secondary healthcare hospital in south India: A retrospective study p. 1241
Dillieswary Ragouraman, Raman P Priyadharsini, C Venkatesh
DOI:10.4103/jfmpc.jfmpc_1984_20  
Background and Objectives: Tuberculosis, a communicable disease and diabetes, a non-communicable disease together has a bidirectional relationship toward each other withsignificant morbidity and delayed treatment outcome. Therefore, there is a need to identify the prevalence of both these diseases in a community. A retrospective study was planned to identify the prevalence of both diseases among the patients attending secondary hospitals for 3 years. Methods: The study was conducted in the chest diseases department in a secondary care hospital after obtaining approval from the institute ethics committee and RNTCP. The retrospective data in the hospital register was used to identify various parameters. The data for basic demographic characteristics, number of new cases, previously treated cases, pulmonary/extrapulmonary cases, drug resistance cases, and DM/TB cases were entered in Microsoft excel and were analyzed. Results: The prevalence of TB among the patients attending the chest diseases department was 2.9%, 2.5%, and 3% for the years 2016, 2017, and 2018, respectively. The prevalence of DM/TB ranged between 8.5–11%, which is a lesser range when compared with many other studies. Interpretations and Conclusion: There was no significant difference in the prevalence between the years. The screening of one disease in the presence of the other can reduce the prevalence and improve the prognosis.
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Effects of nationwide COVID-19 lockdown on lifestyle and diet: An Indian survey Highly accessed article p. 1246
Birgurman Singh, Srishti Jain, Ashu Rastogi
DOI:10.4103/jfmpc.jfmpc_2046_20  
Aims, Settings, and Design: The COVID-19 pandemic has forced upon sudden lifestyle changes because of nationwide lockdowns mandating isolation at home, affecting daily habits and lifestyle changes. The present study was conducted with an aim to assess these changes brought about because of COVID-19 lockdown restrictions. Methods: The web-survey aimed to understand the immediate impact of the COVID-19 lockdown on people by using a structured questionnaire collecting demographic, lifestyle, and dietary information. The survey was disseminated online among the literate, urban, adult population with internet access. Results: Of the 1,200 people who received the survey, a total of 1,008 respondents participated in the study, aged between 18 and 81 years (Median- 24). An increase in daily screen time has been observed in 56.7% of the population. A decrease in work-related stress was observed in 43% of the population, sleep pattern improved in 36.7% people, and 27.1% of the inactive population showed increased physical activity. A significant decrease in the proportion of people consuming junk food (73.8%), alcohol (27.6%), and smoking (8.1%) was observed. Conclusions: The present web-based survey study suggests a significant change in the lifestyle and dietary patterns of people brought about because of the COVID-19 lockdown most highly seen as a major increase in screen usage and a decrease in junk food consumption.
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Autopsy study of spectrum of lung lesions in Tertiary care hospital p. 1251
Parth Rajendragiri Goswami, Alpeshpuri P Goswami, Abhijit S Khandkar
DOI:10.4103/jfmpc.jfmpc_2115_20  
Background: Inflammation, Infections, occupational diseases and neoplastic lesions are common in lungs. In Autopsy internal organs including lungs are studied to decide cause of death and figure out prevalence of various lung lesions. So, prophylactic prevention plan can be prepared for prevention of various lung lesions induced mortality and reducing need for invasive biopsy as well. Aim & objective: To find out frequency of various lung lesions in relation to age and sex and analyze histopathological spectrum of lung lesions. Material & Methods: Non interventional, record based cross sectional, retrospective autopsy study was done on 139 cases of lung autopsy samples at department of pathology of tertiary care hospital, Bhavnagar, Gujarat for 2 years on samples received from January 2016 to January 2018. Lungs were fixed in 10% formalin & processed. Paraffin wax embedding was done & sections stained with H&E stain. Gross and microscopic examination of samples done and diagnosis was done. All findings were recorded and tabulated. Conclusion: Pneumonia is most common observed pathological lung lesion in our study which suggest that infections of lungs are common cause for mortality. Therefore, we suggest effective implementation of measures to prevent hospital acquired pneumonia may reduce mortality. Smoking was associated in nearly 70% patients. Autopsy study of such lung lesions can provide vision to plan preventive strategy to reduce mortality due to lung pathology.
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Unengaged head in primigravidae, mode of delivery and outcome (a case-control study) in Dongola—Sudan (2019) p. 1254
Nahid Abdalla Salim, Ismail Satti, Abdalhafeez Osman Mahmoud
DOI:10.4103/jfmpc.jfmpc_2134_20  
Background: Child birth is difficult period and associated with strenuous stress for the birth attendants as well, the parturient ladies, especially in primigravidae whose pelvis has not been tested. Methods: A prospective case-control study at Dongola maternity hospital. To assess mode of delivery and outcome in primigravidae with unengaged head. The study included 248 primigravidae at term, singleton, and in labor, divided into case and control groups equally, unengaged and engaged head. Results: The overall results among both case and control group revealed no difference in mode of delivery, vaginal delivery was (77.4%) and (83.9%), respectively. The significant findings were: head position as it was in the case group 24.2% O.A, 58.1% O.T, and 17.7% O.P. The corresponding figures in control group were 29%, 64.5%, and 6.5%. The difference was significant (P = 0.024). 91.9% of the case group augmented and 77.4% in the control group (P = 0.002). The most interesting significant difference was body mass index. in the control group 3.2% had a BMI of <20 kg/m2, 50% had a BMI 20–25 kg/m2, 16.8% had a BMI 25–30 kg/m2, and 30% had a BMI >30 kg/m2. In the cases, group were 3.7%, 31%, 25.3%, and 40% sequentially with significant difference (P = 0.011). Conclusion: With good conduction of labor, there were no difference in mode of delivery and outcome in primigravidae with unengaged fetal heads.
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Clinico-epidemiological profile of Influenza A H1N1 cases at a tertiary care institute of Uttarakhand p. 1258
Ajay K Pandita, Dimple Raina, Tanya Arora, Puneet Ohri
DOI:10.4103/jfmpc.jfmpc_1134_20  
Introduction: The swine (H1N1) virus responsible for worldwide pandemics since 2009 is now causing seasonal epidemics. Since then alarming spikes of swine flu cases have been reported from Uttarakhand every year. There are limited studies conducted in this Himalayan belt to evaluate the clinical and epidemiological profile of the patients admitted in tertiary care hospitals. Aims & Objectives: This study aims to summarize the clinical and epidemiological attributes of swine flu and to approximate the burden of Influenza A H1N1 (Swine Flu) cases in this Himalayan belt. Material and Methods: Clinical and epidemiological characteristics of influenza A H1N1 cases from October 2018 to April 2019 were retrospectively and descriptively analyzed using data from the Medical Records Section and the isolation ward at Shri Guru Ram Rai Institute of Medical and Health Sciences; Shri Mahant Indiresh hospital. Results: A total of 1126 (51.6%) patients were tested of which 30% (338) patients were found to be H1N1 positive. Maximum cases and positivity were detected in the months of January (26.4%), February (50.3%), and March (14.8%), and the patients in the age groups of 41–50 (21.9%) and 51–60 years (19.3%) accounted for majority of the cases. The most common symptoms were fever (85.8%), cough (82.2%), sore throat (82%), and breathlessness (71.3%). A case fatality ratio of 10.9% was observed. A significant statistical association (p value < 0.00001) was reported between co-morbid conditions and death. Conclusion: According to the results of this study, close caution should be exercised in case of patients infected with H1N1 particularly those with co-morbidities.
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Clinical profile of patients with rolandic epilepsy at a clinic in rural Maharashtra p. 1263
Sunil Sable, Rachna Sable, Parag Tamhankar, Vasundhara Tamhankar
DOI:10.4103/jfmpc.jfmpc_1355_20  
Purpose: To describe the seizure pattern, treatment strategies and outcome in a series of children with Rolandic seizures or childhood epilepsy with centrotemporal spikes. Materials and Methods: Patients were defined as Rolandic epilepsy if on electroencephalographic studies high voltage spike and waves were seen in centrotemporal areas, could be followed by slow waves, often activated on sleep and could shift from one side to other or be secondarily generalized. Typical (TRS) or benign were those with normal intellect. Atypical rolandic seizures (ARS) were those associated with neuroregression of language and cognitive milestones. Patients were treated with antiepileptic drugs if more than one episode occurred or the first episode was generalized status epilepticus. Results: Thirty-three patients were included over the period of eight years (2012-2020). There was male preponderance (21 males versus 12 females). Four patients (12.12%) later evolved into Landau Kleffner syndrome (ARS group). The mean age of onset of epilepsy in the TRS group (29 patients) was 7.2 (+/-2.2) with the youngest patient being 4 years and the eldest being 12 years. In the ARS group the mean age of onset was 5 yrs. (+/-1.41). In the TRS group, 23 (79.31%) patients were managed on monotherapy AED. Seventeen patients (58.62%) responded (remission) to carbamazepine monotherapy alone. Six patients (20.68%) could afford oxcarbazepine monotherapy and went in remission with this therapy. In the ARS group all patients required three drugs (valproate, clobazam and levetiracetam). By the end of the study period, 23/33 (75.75%) patients remained seizure free. Conclusions: Most patients with rolandic seizures have excellent prognosis being seizure free around puberty. The neurological outcome in most patients was normal.
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Impact of structured educational interventions on the prevention of pressure ulcers in immobile orthopedic patients in India: A pragmatic randomized controlled trial p. 1267
Soundappan Kathirvel, Sukhpal Kaur, Mandeep Singh Dhillon, Amarjeet Singh
DOI:10.4103/jfmpc.jfmpc_1436_20  
Background: Pressure ulcer (PU) is one of the common, neglected and avoidable complications among bedridden patients. Despite the potential to reduce PU incidence, the evidence on the effect of patient/caregiver education is low. This pragmatic randomized controlled trial (CTRI/2011/07/001862) compared the impact of two structured educational interventions to patients and caregivers on prevention of PU in immobile orthopaedic patients. Methodology: Ninety-two orthopedically immobile patients (Braden score ≤12 or stage I PU) and their caregivers were (block) randomized into two equal groups. One group was offered Prevention Package 1 (PP1), i.e., self-instruction manual (SIM), one to one training and counselling on PU care practices. The second group (PP2) was given SIM only. Patients were followed equally at the hospital and home after discharge. Intention to treat analysis was conducted. Results: The cumulative incidence of PU was 8.7% in PP1 and 21.7% in PP2 for the entire study period. PU incidence rate in PP1 and PP2 was 0.9 and 2.41 per 1000 person-days, respectively. Incidence rate ratio was 2.67 (95% CI: 0.89, 8.02, p-0.04). The Kaplan-Meier survival curves of PP1 and PP2 were statistically significantly different (p-0.043). PP1 also showed statistically significant improvement in knowledge on the prevention and management of PU compared to PP2 at post-intervention (p < 0.001). Conclusion: Individualized, structured education of patients and caregiver is effective in improving the knowledge and preventing the PU in immobile orthopaedic patients. A comprehensive approach involving hospital administrators, health care professionals, patients and caregivers may be further researched upon for a sustainable reduction in PU.
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Determinants of smoking cessation counseling favorable practice for primary care physicians: A cross-sectional study from Palestine Highly accessed article p. 1275
Beesan Maraqa, Zaher Nazzal, Jurouh Jabareen, Kamal Al-Shakhrah
DOI:10.4103/jfmpc.jfmpc_1456_20  
Background: Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants. Methods: Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah. Results: 295 physicians were enrolled in the study with an 86% response rate. 75.5% (n = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31–41%). Attitude is the main predictor of favorable practice (P value = 0.002, adjusted OR = 1.1). Conclusion: Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.
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A qualitative study on attitude towards smoking, quitting and tobacco control policies among current smokers of different socio-economic status p. 1282
Lalitha Rani Chellappa, Arthi Balasubramaniam, Meignana Arumugham Indiran, Pradeep Kumar Rathinavelu
DOI:10.4103/jfmpc.jfmpc_1628_20  
Introduction: Tobacco consumed as smoke and smokeless forms is an important preventable public health issue projected to be the single largest cause of mortality worldwide. The aim of the study was to qualitatively assess the attitudes towards smoking, quitting and tobacco control policies among current smokers of different socio-economic status. Materials and Methods: An in-depth interview for 10 current smokers and a focus group discussion comprising of 10 current smokers was conducted with a guide and moderator which was audio recorded. About 6, 8 and 6 subjects from white collar, blue collar, and black collar employee status participated in the study. Their tobacco consumption and dependence using the Fagerstrom Test for Nicotine Dependence scale (FTNDS) was assessed. Results: About 50% of the participants had low; 30% had moderate and 20% had high nicotine dependency. Most of the participants started smoking by peer influence and continued as it made them to socialize. Relapses during their quit attempt was mainly due to work stress. Participants heard about the control of tobacco act but were unsure of the features in it. They perceived that no changes will happen if government bans production and selling of tobacco products. Also anti-tobacco commercials in social media will have no use. Nicotine replacement therapy may help in quitting the habit. Conclusion: The study concluded that people in low socio-economic status had high nicotine dependency with inadequate knowledge on tobacco control policies. They strongly believe that an individual's self-restrain only can succeed him in quitting the habit.
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Comparative study on fasting and postprandial lipid profile in type 2 diabetes mellitus p. 1288
Jasmeen Chahal, Sunita Gupta, Sumit Pal Singh Chawla, Harpreet Grewal
DOI:10.4103/jfmpc.jfmpc_1632_20  
Context: Postprandial dyslipidemia plays a vital role in the pathogenesis of atherosclerosis and possible macrovascular complications in type 2 diabetes mellitus (DM). Aims: To assess and compare the fasting and postprandial lipid profiles in type 2 DM patients. Settings and Design: This case-control study was conducted in the Medicine department of a tertiary care teaching hospital. Methods and Materials: The study included 100 subjects; 50 type 2 diabetic patients and 50 healthy age- and gender-matched controls. Fasting and postprandial lipid levels were estimated in all the subjects and compared. Statistical Analysis Used: The Student's t-test and the analysis of variance (ANOVA) test were used for comparison between two and more than two groups, respectively, for normally distributed data. Results: Mean total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), and very low density lipoprotein (VLDL) levels were significantly higher and high density lipoprotein (HDL) level was significantly lower in the diabetics in comparison to the controls in both fasting (200.82, 172.59, 126.20, 37.63, and 40.74 mg/dL in diabetics versus 179.90, 98.03, 109.54, 19.60, and 50.46 mg/dL in controls) and postprandial states (223.75, 232.99, 139.19, 46.52, and 40.54 mg/dL in diabetics versus 185.36, 102.20, 110.36, 20.24, and 48.96 mg/dL in controls). The mean postprandial TC and TG levels (223.75, 232.99 mg/dL) in diabetics were significantly higher when compared to their fasting values (200.82, 172.59 mg/dL) in these patients. Conclusions: Type 2 DM patients show significant postprandial lipid abnormalities particularly postprandial hypertriglyceridemia. Raised postprandial lipid parameters highlight that estimating lipids in the postprandial state is equally important as is estimation of lipids in the fasting state in type 2 DM.
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Prevalence of erectile dysfunction and associated factors among males visiting family medicine clinics in a Tertiary Care Hospital in Karachi, Pakistan p. 1294
Rabeeya Saeed, Faridah Amin, Noureen Durrani, Syed M Ali. Saif, Muhammad Talha Zafar
DOI:10.4103/jfmpc.jfmpc_1871_20  
Background: The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it. Methods: The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017–January 2018. A total of 450 males participated in this study with the age range of 24–77 years. More than half of the participants were graduates or above. Results: On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74–10.89), alcohol use (aOR = 5.23, 95% CI: 1.45–18.84), diabetes (aOR = 6.61, 95% CI: 3.27–13.36), and current smoking (OR = 2.41, 95% CI: 1.35–4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13–0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17–0.96) than illiterate when model was adjusted for other covariates. Conclusion: Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.
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Prevalence and predictors of exclusive breastfeeding in urban slums, Bihar p. 1301
Shahwar Kazmi, Robert Akparibo, Danish Ahmed, Nafis Faizi
DOI:10.4103/jfmpc.jfmpc_2000_20  
Objective: Various socio-cultural factors influence infant feeding practices and thus early childhood nutrition and child survival in India. This study aimed to examine the prevalence of exclusive breastfeeding, its promoters and barriers in urban slums of Bihar, India. Methods: We conducted a community based cross-sectional survey involving 297 mothers living in slum settlements in Bihar. Data were collected using structured questionnaire on exclusive breastfeeding practices, and the factors that could influence this. Descriptive analysis was done to estimate the prevalence of exclusive breastfeeding and regression model was performed to identify the predictors of exclusive breastfeeding. Results: Only 23% of mothers initiate breastfeeding within 1 hour of delivery and 27.6% mothers practise exclusive breastfeeding up to six months. Mother's education was found to be associated with duration of exclusive breastfeeding (OR 11, 95% CI 2-59). Term babies were more likely to be breastfed exclusively for six months than pre-term babies (OR 8.6, 95% CI 1.6-47.6). Antenatal care visits and completing immunization were significantly associated with duration of exclusive breastfeeding (P < 0.001). The majority of mothers acquire exclusive breastfeeding knowledge through television/radio (OR 68, 95% CI 5.5-832.5) and newspaper advertisements (OR 14, 95% CI 2.6-76). Conclusion: Prevalence of exclusive breastfeeding up to six months of age and early initiation of breastfeeding remains low in slums of Bihar. Exclusive breastfeeding and early initiation of breastfeeding rates could be improved by educating and counselling mothers during health facility contacts by primary care providers.
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A study to assess the socio-demographic factor and knowledge, attitude, and practice of family planning methods in Lohpeeta migrants tribe located in Shivpuri central India p. 1308
Rajesh K Ahirwar, Sanjeev Kumar, Shubhanshu Gupta, Anjana Niranjan, Kshatrapal Prajapati, Shailendra Rawal
DOI:10.4103/jfmpc.jfmpc_2075_20  
Background: Even though India was the first country in the whole world to introduce the national family planning policy, the acceptance rate of contraceptive methods has been unsatisfactory to date. Many women in their fertility period, who were ready to control their fertility and limit the number of unwanted children, were not aware of different methods of contraceptives available and their proper use and other benefits. Aim and Objective: 1. To assess the socio-demographic status of the study participants. 2. To assess the knowledge, attitude, and practice of contraceptive methods in Lohpeeta mobile tribe located in Shivpuri, central India. Methods: The present study was an observational cross-sectional survey conducted from 1st December 2019 to 28th February 2020 in Lohpeeta mobile tribe located in Shivpuri local; nonrandom convenience sampling method was used after applying the inclusion and exclusion criteria, so the total sample size was 209. Data were collected by a principal investigator with a predesigned, pretested, questionnaire by conducting face-to-face interview with the participants. Firstly, the data was administered in an excel sheet then it was analyzed and presented in the form of percentage, and a Chi-square test was applied to assess the level of significance. Result: The most common age group of participants was 18–30 year (37.3%) and most were married (97.6%); we found that the knowledge and attitude toward contraceptives of participants was very poor, most 185 (88.5%) of the participants had never used any contraceptive method and only a few participants were using it occasionally, and none of the participants were using any contraceptive methods regularly. Conclusion: The knowledge, attitude, and compliance towards contraceptives were poor in this group, we need to focus on this type of migrant population to increase their awareness and change their attitude towards contraceptives, so that they can use it without any fear.
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Universal Health Insurance coverage and utilization among women in urban slum of Rajnandgaon, Chhattisgarh p. 1313
Harshal Gajanan Mendhe, Rohit David, Daneshwar Singh, Kiran G Makade
DOI:10.4103/jfmpc.jfmpc_2226_20  
Background: Universal Health Coverage refers to health care system that provides health care and financial protection to all the citizen. Rashtriya Swasthya Bima Yojna as National Health Insurance Scheme initiated in Chhattisgarh State in 2009 for below poverty line families. Second scheme is Mukhyamantri Swasthya Bima Yojna initiated in 2012, which covers non below poverty line families. Objectives: To assess socio demographic factors among women residing in slum of Rajnandgaon, to find their universal health insurance coverage under RSBY/ MSBY and to assess the extent of concerned treatment under RSBY/MSBY. Methods: It was a community based cross sectional study, conducted in the urban slum area of Rajnandgaon amongst 188 women above 18 years of age who were hospitalized 6 months prior to the study using snow ball technique as a sampling method. They were interviewed using semi structured questionnaires by the investigator with the help of anganwadi worker. Result: 77.65% respondents/study subjects were enrolled under the universal health insurance (RSBY card/ MSBY card). Subjects belonging to Lower socio-economic status and having BPL card were enrolled under scheme more than upper socio-economic group. Out of 146 smart card holders, a mere 1.36% subjects incurred catastrophic OOPE. Out of 42 respondents not having smart card, 40.47% subjects incurred catastrophic OOPE Conclusion: The RSBY card reduced the inpatient OOPE. RSBY card prevented catastrophic OOP in most of the respondent. RSBY has made health services accessible to all sections of community at minimal cost.
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Association of Paternal Individual Deprivation Measure with General Anthropometric Data and Dental Caries among 12 to 15 year old school going children, in Tiruvallur District - A cross sectional study p. 1320
M Sasikala, D Prabu, Sunayana Manipal, VV Bharathwaj, M Rajmohan
DOI:10.4103/jfmpc.jfmpc_118_20  
Aim: To determine General anthropometric data and dental caries and their association of paternal Individual Deprivation Measure among 12- to 15-year-old school going children in Tiruvallur District. Methods and Material: The Anthropometric data such as Body mass index, Skin fold thickness and mid arm circumference was assessed. The study was also conducted to assess children's paternal deprivation using individual deprivation index (IDM). Paternal deprivation was calculated using Individual deprivation index which comprises of 15 dimensions. Pilot study was done to calculate sample size which is found to be 800. Results: Dimension of paternal individual deprivation measure in parent Education, Housing, toileting, family planning, problem in visiting doctor between Government and Private School children was significant with P value of 0.0005. Interpretation of Paternal individual deprivation measure was found to be significant among Government and private school children. There was no association of individual deprivation measure with dental caries, but there was an association of Individual paternal deprivation measure with one of the anthropometric measure was mid arm circumference. In paternal deprivation index 21.8% of the children's parent were not deprived, 45.8% were somewhat deprived, 22.6% were deprived, 7.3% were very deprived, 2.6 were extremely deprived among school children.
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A study on anemia and its risk factors among pregnant women attending antenatal clinic of a rural medical college of West Bengal p. 1327
Anuradha Sinha, Moumita Adhikary, Jyoti P Phukan, Sonal Kedia, Tirthankar Sinha
DOI:10.4103/jfmpc.jfmpc_1588_20  
Background: Anemia is the commonest nutritional deficiency disorder in the world, particularly in developing countries. Though anemia is easily treatable and largely preventable disease if timely detected, it still continues to be significantly prevalent among pregnant women. Aim: The aim of this study was to measure the extent of anemia in pregnancy and to assess the association of risk factors with anemia. Study Design: Hospital-based cross-sectional descriptive study. Materials and Methods: A total of 200 women were selected among pregnant women attending antenatal clinic. Sampling was done by selecting every fifth woman visiting antenatal clinic within the duration of two months on alternate days. Data were collected using a predesigned, pretested semi-structured schedule. Hemoglobin concentrations were also recorded for each patient. Data were analyzed using Chi-square test and 'T' test of significance. A value of P < 0.05 was considered significant. Results: We found overall prevalence of anemia to be 90% among pregnant women. Most of the anemic patients (60.5%) belong to moderate severity according to the World Health Organization classification. Three factors namely socioeconomic status, gravida and time of 1st antenatal visit were significantly associated with prevalence of anemia in pregnancy (P < 0.05). Conclusion: In this study, a high prevalence of anemia was found in pregnant women. Low socioeconomic status, multigravida and delayed visit to antenatal clinic were significantly associated with anemia in pregnancy. So, awareness and education programs should be generated to make people come to know about anemia, its complications during pregnancy and ways to prevent it.
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Comparing topical administration of lidocaine alone and in combination with alfentanil in children undergoing bronchoscopy p. 1332
Alireza Takzare, Parastou Ariana, Bita Malekianzadeh, Mehrdad Goudarzi, Ebrahim Espahbodi
DOI:10.4103/jfmpc.jfmpc_1719_20  
Introduction: Airway surgery and endoscopy in pediatric patients are always associated with challenges in anesthesia management. Deep anesthesia is required for preventing patient bucking during the procedure but patient breath should be maintained; in this regard, a combination of general and topical anesthesia can be beneficial. There is also evidence of the peripheral effects of opioids. The main objective of this study is to compare using lidocaine topically alone and combined with alfentanil opioids with respect to the central effects of opioids. Methods: In this study, 40 ASA class I and II children, aged 1–6 years, who were candidates for flexible diagnostic bronchoscopy were divided into two groups through block randomization using the random number table after obtaining parents' consent in complete health conditions. In this clinical trial, for collecting the data a special data collection form was used at the bedside of patients undergoing bronchoscopy at Pediatric Medical Center in 2017. Data including demographic information (age, weight, gender), duration of anesthesia, blood pressure before and after drug administration, duration of bronchoscopy, and recovery time were recorded in a form. Findings: In terms of demographic variables, there were not any significant differences between the two studied groups, indicating that the groups were matched and randomized appropriately. Although there were not any significant differences between the two groups of using lidocaine alone and in combination with alfentanil in other variables, in the recovery time a significant difference was observed between the two groups, with a mean of 13.05 min in the lidocaine group and 18.75 min in the lidocaine combined with alfentanil group. Conclusion: Topical administration of opioid with lidocaine through bronchoscopy had no impact on blood pressure, heart rate, anesthesia duration, and the frequency of perioperative complications.
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Impact of the COVID-19 pandemic on rural obstetrics practices in New Mexico p. 1336
Colleen E Sells, Aurora M Maes, Rachel A Fleddermann, Eliana L Otero-Bell, Rebecca S Hartley
DOI:10.4103/jfmpc.jfmpc_1940_20  
Context: During pregnancy, the immune system is altered, putting women at increased risk of complications from respiratory viruses. There is limited information about the effects of COVID-19 on pregnant women and obstetrics programs, particularly in rural regions. Aims: Most published reports have been from large urban hospitals. This study sought to gain insight into how the COVID-19 pandemic is impacting rural obstetrics programs. Materials and Methods: This qualitative study surveyed participants who worked in rural obstetrics programs in New Mexico using a free response questionnaire. Results: The pandemic has changed the obstetrics experience in rural New Mexico by impacting the relationship between patients and providers and altering the family-centered model of birth. Difficulties unique to rural obstetrics included lack of transportation, limited hospital rooms and limited staff, including OB providers, nurses and housekeeping. Wellness has been impacted for providers, manifested in increased anxiety, stress and burnout. Patients reported increased anxiety, decreased family support, and potential disruptions in maternal-infant bonding. Conclusions: Rural hospitals and clinics in New Mexico and across the United States operate with challenges at baseline, with many clinics across the nation closing, leading to increasing shortages of healthcare services in rural areas. This study showed that COVID-19 has increased the challenges that rural obstetrics providers face, altering the way they practice and creating uncertainty for the future due to potentially permanent changes to their practice. Future research will explore the lasting effects of the pandemic on rural obstetrics providers specifically, and rural hospitals generally.
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Gliomas - An experience based on molecular markers p. 1341
Susmita Sarma, Yookarin Khonglah, Jaya Mishra, Arindom Kakati, Pranjal Phukan
DOI:10.4103/jfmpc.jfmpc_1963_20  
Background: Gliomas account for 45% of all intracranial tumors. Newer technologies have allowed deeper genetic and epigenetic analysis leading to the discovery of IDH (Isocitrate dehydrogenase) mutations and their association with ATRX (alpha-thalassemia/mental retardation syndrome X-linked) and p53, for better diagnosis and prognosis. In this study, we analysed their expression and correlated with various clinicopathological parameters. A follow up to prognosticate gliomas based on the molecular findings is also attempted. Materials and Method: During last 5 years both retrospective and prospective cases were included in the study. Immunohistochemistry for IDH1, ATRX, and p53 was done and reported based on intensity and percentage of tumor cells expressing the markers. Results: A total of 53 cases of gliomas were included, excluding primary glioblastomas and ependymomas. The patient's age ranged from 10 to 53 years. The male to female ratio was 1.3:1. IDH1 positivity was seen in 88% of diffuse astrocytoma, 80% of anaplastic astrocytoma, 90% of oligodendroglioma, 60% of anaplastic oligodendroglioma, and 54% of glioblastoma. A significant association was seen between positive IDH1 expression and low-grade gliomas (p = 0.028). A combined analysis of expression of IDH1 and ATRX versus IDH1, ATRX, and p53 with WHO grade showed a statistically significant association. A follow-up of 32 patients was available. Out of 24 IDH1+ (positive) cases, 22 patients had a median survival of 21.5 months (92%). Out of 8 IDH1- (negative) cases, 5 had a median survival of 15.8 months (62%). Conclusion: Gliomas expressing IDH1 mutation show improved survival of patients. Combined analysis of IDH1, ATRX, and p53 has diagnostic and prognostic significance. For routine cases of gliomas, a combination of IDH1 and ATRX are sufficient; however, the use of p53 is recommended for further prognostication and for possible targeted therapy in the future.
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Are numbers deceptive? Is death auditing a solution for death analysis, among the COVID-19 deceased?: A study from a dedicated COVID-19 hospital in Faridabad, Haryana p. 1347
Pooja Goyal, Ruchi Arora Sachdeva, Lokesh Parashar, Asit Kumar Sikary, Aamir Tarique
DOI:10.4103/jfmpc.jfmpc_2063_20  
Background: COVID-19 pandemic has havocked the entire world and India has not been spared. The focus is not only on the containment but on the reduction in mortality also. The objective of the study was to know the trend of COVID-19 deaths in a 510-bedded dedicated COVID-19 hospital and to determine the cause of death and various factors associated with these deaths. Method: A descriptive study was conducted in a COVID-dedicated hospital setting to analyze deaths occurring during April--July, 2020 using a standard death audit proforma. Results: A total number of 95 COVID-19 patients died in ICU. The mortality rate among ICU patients varied from 24.6% to 52.9%. Most of the cases were referred from other hospitals. About 64% of the deceased was admitted in severe condition and 34% of cases were referred on ventilator support. The week-wise trend revealed a positive association between the number of deaths and the number of referred cases as well as the number of patients received on ventilator support and in severe condition. About one-third of cases were late in seeking treatment at health centers with the same weekly trend. Being unaware of the condition (1%) and the stigma associated with the disease (32%) were the reasons behind it. Common direct causes of death were pneumonia (73%), pneumonia complicated with sepsis (16%), and acute respiratory disease syndrome (ARDS) (7%). Conclusion: High case fatality rate in the ICU of a referral COVID-dedicated hospital is mainly because of the admission of patients in severe conditions.
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Knowledge, attitudes and behaviour towards oral hygiene of transgenders in Bhubaneswar during COVID-19 p. 1353
Gunjan Kumar, Alok K Sethi, Anandamoy Bagchi, Shilpa Rai, Prathisha Tamilselvan
DOI:10.4103/jfmpc.jfmpc_2215_20  
Introduction: Reducing harmful oral hygiene practices can minimize the negative impacts of periodontal diseases. Transgenders are among the most vulnerable groups. Knowledge of their oral hygiene awareness, attitude and behaviour shall help in improving their oral health and also in planning oral health strategies specific to this group. Aim: To explore the oral hygiene-related knowledge, attitude and practices of transgenders residing in the Bhubaneswar during COVID-19. Methodology: A cross-sectional study was conducted among the transgenders residing in Bhubaneswar using a self-structured questionnaire containing questions on knowledge, attitude and practices related to oral hygiene. Mann–Whitney U test was applied to find any significant differences between different variables in groups. Results: A total of 205 transgenders participated in the study. Around 43.9% of the transgenders in rural areas felt they had bad breath and there was no statistically significant difference between the two groups. Majority of the participants in the rural areas did not know how to describe the health of their teeth and gums while 43% of the participants in the urban areas felt their oral health was good. There was statistically significant difference between the two groups in the type of material used for cleaning teeth [p = 0.020]. There was statistically significant difference between the two groups in terms of brushing their teeth everyday [p = 0.005, duration of brushing [p = 0.052], tools used for cleaning teeth [p = 0.023] and method employed to control mouth odour. Conclusion: The information presented in this study adds onto our understanding of the oral hygiene related behaviour among the transgenders.
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Sensitivity towards patient's presence to avoid violent situations in hospitals: An observatory study p. 1359
Nandini Lakshmikantha, B Shivananda Nayak, Mohan Kashinkunti, Shivalingappa B Javali, Sananda Mukherjee
DOI:10.4103/jfmpc.jfmpc_842_20  
Context: The process of communication includes intense observation based on which opinions are formed or situations are created. A patient whose is in state of panic due to the health conditions feels neglected and becomes skeptical about the treatment hi/she is going to receive. Aims: The aim of the study is to understand the need for being sensitive towards patient's presence while communicating. Settings and Design: It was conducted in the outpatient wing of clinics at three different cities of Karnataka using a Sequential Observatory Study design. Materials and Methods: Based on the results obtained from the pilot study a final schedule was prepared and sent to people using google drive during the month of Dec 2019. Out of 200 filled forms only 55 patients/relatives were qualified for analysis. SPSS version 17.0 software, Microsoft word and Excel were used in data handling and analysis. Textual analysis was used for presenting interview data. Results: The qualitative analysis of the questionnaires found four emerging themes that disturbed the patients psychologically and such situations could lead to violence. The results prove that patients/relatives observe both verbal and nonverbal communication in the hospital from the time of their entry to exit. Conclusion: The communication intended or unintended made some impact on the perceptions of the patients about the way they are going to be treated. This indicates that the workforce should be conscious of their behaviour.
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Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan p. 1364
Khuld Nihan, Aamir Makda, Huzaifah Salat, Munawar Khursheed, Jabeen Fayyaz, Uzma Rahim Khan
DOI:10.4103/jfmpc.jfmpc_1691_20  
Introduction: UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it. Objective: This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims. Methods: A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0. Results: HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals. Conclusion: Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.
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Overview of e-Health initiatives in Rajasthan: An exploratory study p. 1369
Nitin Kumar Joshi, Pankaj Bhardwaj, Praveen Suthar, Yogesh Kumar Jain, Vibha Joshi, Kuldeep Singh
DOI:10.4103/jfmpc.jfmpc_1989_20  
Background: Government of Rajasthan has undertaken a series of e-Health initiatives, especially under various programs of National Health Mission in the past few years. There is a paucity of studies which document and provide appraisal of these initiatives in Rajasthan. Aim: To document ongoing e-Health Initiatives based on technologies and approaches used, coverage by the region and population, services provided and scope. Materials and Methods: Primary data collection in form of key-informant interviews while secondary data collection in form of internet-based search of peer and non-peer reviewed literature was conducted to achieve the study objectives. Appropriate documents, records, and reports were reviewed to ensure that all necessary information was obtained. Results: A total of 13 e-Health initiatives were included in the study. The e-Health programs were classified with the use of WHO's classification of Digital Health Interventions v1.0. Most of the initiatives perceived in the study were found to be beneficial to the community, covering the entire population targeted. Supporting agencies, technologies used, and challenges faced during the implementation were identified and documented. Lack of trained manpower, technical and software glitches and deficiency of awareness activities were few obstacles that were found consistent across all user groups. Conclusions: The overview from this study augmented the knowledge about further scopes and sustainability of these initiatives. Deploying dedicated professionals may improve the functioning of these initiatives. Since e-Health interventions significantly influence healthcare systems, further scale-up of such studies with appropriate evaluation should be planned to guide policy decisions.
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Self-care practice and its predictors amongst Type-2 Diabetes Mellitus patients in the outpatient department of a tertiary hospital of Kolkata, Eastern India - A cross-sectional study p. 1377
Jayeeta Burman, Aritra Bhattacharya, Amitabha Chattopdhyay, Indira Dey, Sembagamuthu Sembiah, Rudresh Negi
DOI:10.4103/jfmpc.jfmpc_2070_20  
Purpose: The purpose of this study is to find out the pattern and factors associated with self-care practices among diabetic patients as self-care was considered imperative for the control of disease and enhancement of patient's quality of life. Methods: This is a cross-sectional clinic-based observational study conducted among the type 2 diabetes mellitus patients who came for follow up to the outpatient department of a tertiary hospital of Kolkata from September to December 2019. Self-care practice assessed using questions adapted from the “Summary Diabetes Self-Care Activities Questionnaire” by face-to-face interview. Logistic regression used to find out the predictors of self-care practice. Results: Self-care practice was unsatisfactory among 67.5% of the patients. Near half (56%) of the patients had mild to moderate distress and about 18% were severely distressed. Self-care practice was significantly associated with the educational level, family history, presence of hypertension, advice given regarding self-care activities, and diabetes distress levels of the participants. Conclusions: Primary care physicians should be encouraged to give practical aspects of self-care practices and counseling regarding diabetes distress. To perform self-care practices adequate, support from the family level and community level is imperative.
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Anxiety, depression and quality of life (QOL) related to COVID-19 among frontline health care professionals: A multicentric cross-sectional survey Highly accessed article p. 1383
Suresh K Sharma, Shiv K Mudgal, Kalpana Thakur, Aashish Parihar, Digpal Singh Chundawat, Jaydeep Joshi
DOI:10.4103/jfmpc.jfmpc_2129_20  
Background: During this pandemic everyone is facing the wrath of this novel coronavirus but nurses who are meticulously working in closed contact with diseased are at more risk for developing anxiety, depression and compromised quality of life. This study was conducted with an intent to identify anxiety, depression and quality of life and its predictors among nurses who are actively involved in caring of COVID-19 patients. Methods: A cross-sectional online survey was carried out among nurses who were actively involved in COVID-19 duties at government tertiary health care institutes of India and data was collection through convenience sampling. Standardized tools (HADS, WHOQOL-BREF) were preferred for the assessment of participants' anxiety, depression and quality of life. Multivariate regression analysis was used to identify predictors for anxiety and depression. Results: Of 354 nurses, 12.1% were suffering from anxiety while 14.7% had depression. Mean score for physical, psychological, social and environmental domains were 14.75 ± 1.86, 14.92 ± 2.46, 15.21 ± 3.01, and 14.48 ± 2.38 respectively. Nurses' education was a significant predictor for anxiety (odds ratio [OR] = -0.262, 95% CI: -0.510- -0.014, and P value = 0.038). Similarly for depression, designation of nurses acts as a contributing factor (odds ratio [OR] = 0.287, 95% CI: 0.016- 0.557, and P value = 0.038). Conclusion: Nurses are providing their services beyond boundaries so that we can overcome with hard time of COVID-19 pandemic. Although less but still nurses are suffering from anxiety and depression which need to be addressed to protect and enhance their mental well-being.
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Opinion of primary care physicians regarding prescription of generic drugs: A Cross-sectional study p. 1390
Jaykaran Charan, Deepak Saxena, Mayur Chaudhri, Siddhartha Dutta, Rimple Jeet Kaur, Pankaj Bhardwaj
DOI:10.4103/jfmpc.jfmpc_2157_20  
Background: Generics are low-cost alternatives of the existing approved branded drugs. The aim of this work was to study knowledge and perception about generic drugs among the doctors practicing in government and private healthcare sectors. Methods: A cross-sectional study was conducted with a prevalidated questionnaire. Physicians working in government and private healthcare sectors were asked to fill the survey form after obtaining written informed consent. Descriptive analysis was used. Results: Of 240, 11.6% of primary care physicians could identify all the correct statements regarding generic drugs and 57% physicians agreed or strongly agreed that doctors should prescribe only generic drugs. Substandard quality (24.4%) and less effectiveness (35.6%) of generics was cited major reason for low use. Majority (76.1%) believed that patients will accept substitution of branded with generics but 21% either did not or rarely inform patients regarding generics. Only 11.7% considered generics has low efficacy as compared to branded drugs but majority (57.4%) denied the interchangeability of generics. Majority were aware about the Jan Aushadhi scheme (79.3%) and Indian Medical Council Act (Professional conduct, Etiquette and Ethics) (76.8%). For personal use, 45.6% preferred generics. Around 44% agreed/strongly agreed for pharmacist's right to substitute branded drugs with generics but private practicing physicians opted against it. Conclusion: Knowledge and acceptance of generic drugs is still low amongst the doctors. Efforts need to be done increase the awareness and acceptability.
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A longitudinal study to evaluate the bleeding pattern of patients on low dose aspirin therapy following dental extraction p. 1399
VS Sunu, A Roshni, M Ummar, Sachin A Aslam, Rakesh B Nair, Tom Thomas
DOI:10.4103/jfmpc.jfmpc_312_20  
Background and Aims: Antiplatelet dugs are often interrupted preceding invasive dental extraction because of concern of bleeding complications. The fear of uncontrolled bleeding often prompts medical and dental practitioners to stop aspirin intake for 7 to 10 days before any surgical procedure, which puts the patient at risk from adverse thrombotic events. The aim of the study conducted was to evaluate the bleeding pattern after routine dental extraction among patients on low dose long term aspirin therapy. Methods: A total of 104 subjects in the age group of 30-65 years, who continued to have aspirin intake during extraction were included in the study. Dental extraction was performed without stopping aspirin therapy under local anesthesia. The post-operative blood loss was quantified by weighing the gauze pre and post operatively and adding total volume of fluid in the suction jar. Results: Of these 104 patients treated, 87% of patients had mild bleeding (<20 ml) and 13% of patients had moderate bleeding (20-30 ml). The total study population showed a mean blood loss of 16.15 ± 3.5 ml. Conclusion: Within in the limitations, our study concluded that the routine dental extraction in patients under low dose aspirin therapy did not cause clinically significant post extraction hemorrhage. Aspirin intake can be continued during routine dental extraction as post extraction bleeding encountered will be negligible.
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Antimicrobial resistance (AMR) at the community level: An urban and rural case study from Karnataka p. 1404
Swathi S Balachandra, Prathamesh S Sawant, Poorva G Huilgol, T Vithya, GS Kumar, Ramakrishna Prasad
DOI:10.4103/jfmpc.jfmpc_888_20  
Context: The emergence of antimicrobial resistance (AMR) is a major public health crisis in India and globally. While national guidelines exist, the sources of data which form the basis of these guidelines are limited to a few well-established tertiary care centres. There is inadequate literature on AMR and antibiotic mismatch from India at community level and even less literature on AMR patterns from rural India. Aims: The aims of this study were as follows: 1) to describe the patterns of AMR at an urban tertiary care hospital and a rural 100 bedded hospital; 2) to compare and contrast the AMR patterns noted with published ICMR guidelines; 3) to examine the issue of AMR and antibiotic mismatch; and 4) to identify local factors influencing drug-bug mismatch at the local level. Settings and Design: The data were obtained from two independently conceived projects (Site 1: Urban tertiary care hospital, Site 2: Rural 100-bedded hospital). Methods and Materials: Local antibiograms were made, and the antibiotic resistance patterns were compared between the urban and rural sites and with data published in the 2017 ICMR national guideline for AMR. Statistical Analysis Used: Descriptive statistics including means and medians were used. Results: Our data reveal: a) a significant mismatch between sensitivity patterns and antibiotics prescribed; b) The national guidelines fail to capture the local picture of AMR, highlighting the need for local data; and c) challenges with data collection/retrieval, access and accuracy of diagnostic tools, administrative issues, and lack of local expertise limit antimicrobial stewardship efforts. Conclusions: Our study finds the burden of AMR high in both rural and urban sites, reinforcing that AMR burden cannot be ignored in rural settings. It also highlights that national data obtained from tertiary care settings fail to capture the local picture, highlighting the need for local data. Mechanisms of linking rural practices, primary health centres, and small hospitals with a common microbiology laboratory and shared data platforms will facilitate antibiotic stewardship at the community level.
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Number needed to screen to prevent progression of liver fibrosis to cirrhosis at primary health centers: An experience from Delhi p. 1412
Bharathnag Nagappa, Archana Ramalingam, Aayushi Rastogi, Shantanu Dubey, Sherin Sarah Thomas, Ekta Gupta, Shiv Kumar Sarin
DOI:10.4103/jfmpc.jfmpc_1441_20  
Background: Early diagnosis has been a bottleneck in the care of chronic liver disease patients and can be addressed by Community-based screening for liver fibrosis using non-invasive diagnostic techniques. Objectives: The study aimed to determine the prevalence of liver fibrosis and the number needed to screen (NNS) to prevent the progression of fibrosis, among adults visiting urban Primary Health Centres (PHC). Methods: A facility-based cross-sectional study was conducted from May 2018 to April 2019 in 72 randomly chosen PHCs using a mobile screening van. A pre-tested questionnaire was used to collect relevant history from adult patients and patient attenders. A venous blood sample was collected for biochemical markers and Transient Elastography was also done to measure Liver stiffness (LSM). LSM ≥6.0 kPa was taken as the cut-off for detecting liver fibrosis. Lifestyle modifications and alcohol cessations were considered as interventions for non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease (ALD) respectively, to calculate NNS. Results: 7624 participants were recruited in the study with a mean age of 46 ± 12 years. Around 35.5% of participants had liver fibrosis and 3% had cirrhosis. Nearly 4% had ALD and 30% had NAFLD. NNS for preventing progression of fibrosis for ALD and NAFLD was 12 and 29 respectively. NNS was least among obese, diabetes and hypertensive participants. Conclusion: One-third of adults visiting urban PHCs had significant liver fibrosis. Low NNS to prevent the progression of fibrosis to cirrhosis among alcohol users and other high-risk groups, substantiates the need for screening among these groups.
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Retrospective sequential trend analysis of neoplasms reported in a tertiary care hospital of district Etawah, Uttar Pradesh p. 1419
Sushil K Shukla, Divyta Sachan, Prashant K Bajpai, Dhiraj K Srivastava, Manoj K Verma, Tanya Agarwal
DOI:10.4103/jfmpc.jfmpc_1468_20  
Introduction: An estimated 2.25 million new cancer cases with 7 lakh cancer deaths were reported, according to GLOBOCAN 2018 in India. There is a steady rise in cancer cases, but trends and patterns vary within the state depending on the geographic region. Objectives: To study the proportion and site-wise distribution of neoplasm reported at a tertiary care hospital in district Etawah, Uttar Pradesh, India. Material and Methods: A record based retrospective study was conducted at a tertiary care hospital in district Etawah, Uttar Pradesh. Total four years (from 2015 to 2018) hospital-based retrospective data were collected from the Medical Record Department. Identification and distribution of malignant neoplasm were done according to the WHO ICD-10 classification. Results: Total cases diagnosed with malignancy from January 2015 to December 2018 were 3614. Cancer cases reported over the years was 932 (25.8%) in 2015, 1031 (28.5%) cases in 2016, 897 (24.8%) in 2017 and 754 (20.9%) in 2018. It was found that breast carcinoma (24.0%) accounted for the maximum number of cases diagnosed, followed by lung carcinoma (10.9%), cervical cancer (8.7%), gall bladder carcinoma (8%), and oral cavity cancer (7.9%). Conclusion: The present study reveals that the malignancy of the breast is most common, followed by malignancies of lung, cervix, and gall bladder among the patients who were seeking care in a tertiary care hospital of the district Etawah Uttar Pradesh, India.
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The impact of the English medical curriculum on medical history taking from Arabic speaking patients by medical students Highly accessed article p. 1425
Muhannad A Alnahdi, Abdullah Alhaider, Fahad Bahanan, Ahmed Aldubaikhi, Abdulrahman Aljehani, Aamir Omair, Meshal Alaqeel
DOI:10.4103/jfmpc.jfmpc_1946_20  
Introduction: Medical education in Saudi medical colleges is delivered to students through a completely English language curriculum, whereas the practice that students face in the hospital is generally conducted in Arabic language settings. We suggest that the linguistic gap between the adopted medical curriculum and actual practice could influence students' confidence and level of difficulty in history taking in Arabic. The study aimed to identify the effects of learning history taking in the English language on applying it in the medical student's native language. Methods: This cross-sectional design study was held in the College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS). The targeted sample size was 377 medical students from the fourth to the sixth year, and stratified random sampling was used. The questionnaire used was self-developed, validated, and pilot tested in other medical colleges. The questionnaire asked about students' confidence, the difficulty of Arabic history taking, and suggested strategies to improve the current curriculum. Results: The response rate was 290 participants (76.9%), males were 205 (71%), and 136 (47%) were in the fourth year. Agreement on feeling confident while taking history taking in Arabic was 98 (33.8%), 102 (35.2%) were neutral, and 90 (31%) disagreed. Moreover, 138 (47.6%) of students preferred training for Objective Structured Clinical Examination (OSCE) in Arabic more than English, 86 (29.7%) were neutral, while 66 (22.8%) disagreed. The mean level of difficulty was 2.1 ± 0.7 (range 1- 5). Additionally, 198 (68%) of students suggested adding short Arabic history courses. Conclusion: Students considered history taking in Arabic as easy, even though they were not completely confident. Further efforts are needed to uplift students' of confidence to optimal levels. Advances in Knowledge: Communication is the cornerstone of medical education as well as clinical practice. The study explores the impact of instruction language on the physician-patient communication dynamic, providing better infrastructure for evidence-based educational practice. Application to Patient Care: This study gives insight into the students' level of preparation to practice in their local community and language. Furthermore, the study addresses strategies to enhance students communication skills and alleviate linguistic barriers in the physician-patient encounter.
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A prospective cohort study of patients presenting to the emergency department with upper gastrointestinal bleeding p. 1431
Vrinda Shenoy, Sarina Shah, Sathish Kumar, Deepu David, Karthik Gunasekaran, G Priya, Bagyalakshmi Selvaraj, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/jfmpc.jfmpc_1996_20  
Background: Upper gastrointestinal (UGI) bleeding is a common presentation to the Emergency Department (ED), and is associated with re-bleeding and significant mortality. Although several studies have described etiology and outcome of UGI bleeding, few have been done in the EDs. Materials and Methods: This prospective observational cohort study included all patients presenting with hematemesis or melena, between June 2016 and January 2017 to the ED. Demographic data, risk factors, endoscopy findings and prognosticating scores were noted. Patients were followed up through telephonic communication after 3 months to assess re-bleeding rate and mortality. Results: The study cohort included 210 patients with a male predominance (76.2%). The mean (SD) age was 51 (16.8) years. They presented with either hematemesis (33.8%), melena (28.6%), or both (37.6%). One third (35.7%) had variceal bleed, 21% had peptic ulcer disease (PUD), and 43.3%bled due to other etiology. UGI scopy was performed in 85.2% of patients with banding (25.1%) and sclerotherapy (14%) being the most frequently performed procedures. Endoscopic intervention was not required in 58.6%of patients. Packed red cells were transfused in 46.7% patients. The 48-h re-bleed rate among variceal bleeders was 5.3% and 11.4% among peptic ulcer bleeders. The 3-month re-bleeding rate was 42.9% and the 3-month mortality rate was 17.5% among the variceal bleeders and the same was 5.6% and 2.8%, respectively, among the peptic ulcer bleeders. The overall mortality was 12.4%. Conclusions: Variceal bleeding and PUD were the predominant causes of UGI bleeding. Overall, a quarter of our patients had a re-bleed within 3 months, with majority being variceal bleeds.
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Rare but not Abdicated: Status of Haemophilia in foothills of Himalaya, Uttarakhand: A cross-sectional study p. 1437
Vyas K Rathaur, NK V. Vigneshwar, Ayesha Imran, Monika Pathania, Sonam Agrawal, Swathi Chacham, Prashant K Verma, Nowneet K Bhat
DOI:10.4103/jfmpc.jfmpc_1613_20  
Background: Haemophilia is one of the bleeding disorders, which is inherited, in an xlinked recessive pattern. The diagnosis is by estimation of factor levels of 8 and 9. Timebound treatment for people living with Haemophilia (PWH) is factor replacement during bleeding manifestation. The prevalence of Haemophilia was mostly underestimated, and it is more so in hilly terrains like the state of Uttarakhand. Materials and Method: This is a crosssectional study by compiling the data of PWH visiting the tertiary care centre for Haemophilia in Uttarakhand. We collected data from the patients with bleeding disorder reporting to the Haemophilia centre from July 2017 to December 2018. In this manuscript, we try to describe the pattern of Haemophilia and the degree of severity and incidence of inhibitors among the sample population of PWH who represent the population of Uttarakhand. The magnitude of problems faced by PWH from this hilly terrain to assess basic treatment in case of emergency is also being depicted. Result: We reported Haemophilia A contributing about 80% of the PWH in our centre. Average distance a PWH has to travel to obtain treatment was about 131.5 km (SD ± 83.7 km). Incidence of inhibitors was about 5%. Conclusion: We infer from our study that Hemophilia A is more common than Hemophilia B. Through this manuscript we hope to spread awareness of the Haemophilia care that is ongoing, the role of prophylaxis therapy and the future role of primary care physicians that may change the care of PWH in future.
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Exploratory study on the operational issues faced in collection, transportation, and laboratory testing related to COVID-19 in remote areas of selected EAG states of North East and East India p. 1443
Forhad Akhtar Zaman, Sumit Aggarwal, Ranabir Pal, Prabir Kumar Chatterjee, K Asha Kiran, Srikanta Panda, Utpal Sharma, Tridibes Bhattacharya
DOI:10.4103/jfmpc.jfmpc_2130_20  
Background: COVID-19 ongoing pandemic has proved beyond doubt that all countries in the world from high income to low- and middle-income countries were unprepared with under-diagnosed and underreported losses of precious human lives on already overstretched healthcare delivery infrastructure. Thus, the urgent need of the hour is to understand and identify the operational issues and challenges encountered in the sample collection process and also at the testing labs in order to respond at the earliest. This early and effective response will help not only to address the identified issues in the whole chain of sample collecting to test result communication but also it will help to improve the functioning of the entire system involved in this process. Objectives: The present study was undertaken to identify the issues faced during various steps involved in laboratory testing as part of the COVID-19 control activities in selected remote districts of North East and East India. Further, perceived adequacy of human resources, equipment, diagnostic kits, and other essential consumables including PPEs vis-a-vis the load of samples received from the catchment areas of the testing laboratories were also explored. Methods: The study was a qualitative research using in-depth interview method to collect and collate the data from the chain of personnel involved in sample collection, storage, transportation, and testing by recorded telephonic interview by state-level collaborators as per the study protocol. The respondents were recruited from randomly selected sites of remote districts for sample collection, storage, transportation, and dedicated testing labs in six states of North East and Eastern India. The study findings were analyzed by two-dimensional scaling and hierarchical cluster analysis to get the collective picture involving transcription, preliminary data scrutiny, content analysis, and interpretation of the verbal IDI; classified and summarized by triangulation; free listing and pile sorting of suggestions. Results: The entire laboratory testing related human resources has been working on war-footing round-the-clock to fulfil the expectation of the stakeholders and maintaining high quality despite the ever-increasing load of sample testing in both the public and private sectors. The findings indicated that the healthcare workers from all levels of laboratory diagnosis have taken it as a challenge to control the pandemic even with limitations of logistics to capacity building. Positive suggestions to improve laboratory services were to increase human resources, infrastructure, IT with the robust mechanism of monitoring and supervision. Conclusions: Upgradation of laboratory capacities and expertise in public health has become one of the points of concern to contain the COVID-19 pandemic of the new millennium.
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Seroprevalence of anti-SARS-CoV-2 of IgG antibody by ELISA: Community-based, cross-sectional study from urban area of Malegaon, Maharashtra p. 1453
Pallavi Saple, Shriram Gosavi, Tushar Pawar, Govind Chaudhari, Hitesh Mahale, Pradeep Deshmukh, Ashish Kurundkar, Sarang Pedgaonkar, Sapana Thakare
DOI:10.4103/jfmpc.jfmpc_2191_20  
Background: Given the high incidence of asymptomatic or subclinical SARS-CoV-2 infection, reported cases likely underestimate the overall prevalence and infectivity of COVID-19. Serological test for IgG can provide a better measure of disease activity by identifying asymptomatic or subclinical infection. This study was conducted to estimate the seroprevalence of SARS-CoV-2 infection and to the determinants of SARS-CoV-2 infection in the hotspot area of COVID-19. Method: It was a community-based, cross-sectional study using multistage sampling with a sample size of 360. After informed consent, the demographic information, past history of SARI/ILI, contact, COVID-19 status were collected. The blood samples were taken from one family member for anti-SARS-CoV-2 IgG antibody by ELISA testing kit. Results: Majority of the study subjects had no history of SARI (86%) or any contact with COVID-19 case (98%). Overall seroprevalence of anti-SARS-CoV-2 of IgG antibody was 40% (95% CI 35–45%), infection fatality rate (IFR) was 0.7%. Seroprevalence varied significantly depending on religious background; with Muslims (53%) seroprevalence compared to other religious groups. Seroprevalence of homemaker/unemployed (49%) and laborer (55%) was significantly higher compared to business (30%) and service occupation (21%). Subjects with overcrowding conditions and poor ventilation was significantly associated with higher seroprevalence with odds ratio of 2.5 and 2.3, respectively. Conclusion: The antibody testing detects a large number of asymptomatic cases or previously infected cases which would have been missed by clinical history. Thus, the number of undiagnosed cases was found significantly higher even with rigorous implementation of lockdown.
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Clinical and biochemical profile of scrub typhus patients at a tertiary care hospital in Northern India p. 1459
Sudhir K Verma, Kamlesh K Gupta, Rajesh K Arya, Vivek Kumar, D Himanshu Reddy, Shyam C Chaudhary, Satyendra K Sonkar, Satish Kumar, Neeraj Verma, Deepak Sharma
DOI:10.4103/jfmpc.jfmpc_1162_20  
Background: Scrub typhus is a neglected rickettsial disease in India. Every year, we are facing outbreaks of Scrub typhus after Monsoon season. Patients present with a wide clinical spectrum ranging from pyrexia of unknown origin to multiple organ dysfunction. Some of these clinical features overlap with presentation of other tropical infections prevalent in Indian subcontinent, which leads to diagnostic dilemma and delay in diagnosis. Hence, we planned this study to know the demographic, clinical and biochemical profile of scrub typhus patients. Methods: This was an observational study conducted in department of Medicine, King George's Medical University Lucknow, India a leading tertiary care hospital of Northern India. All scrub typhus patients were evaluated by detailed history, examination and laboratory tests. Results: We enrolled 52 patients in our study. The mean age of the patients was 35.17 ± 16.90 years with majority (82.7%) of patients from rural background. All the patients had fever with an average duration of 9.6 ± 2 days. Most of the patients developed hepatitis (69.2%) followed by acute encephalitis syndrome (47%), acute kidney injury (23.1%) and acute respiratory failure (19.2%). Eschar was found in 11 patients (21.2%). Conclusion: Scrub typhus is often misdiagnosed or diagnosed late due to its wide clinical spectrum overlapping with clinical presentation of other commonly prevalent tropical diseases. One should always consider the differential diagnosis of scrub typhus while evaluating a young febrile patient of rural background, with features of single or multiple organ dysfunction and laboratory findings of leucocytosis, thrombocytopenia and elevation of transaminases.
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Relationship between shortage of basic life needs and quality of life of medical students in Yemen: A study utilizing validity and reliability of WHOQOL-BREF questionnaire p. 1466
Adam S Obad, Fareeha K Abdulwali, Hussein A H Alaidroos, Abdulrahman A BaAbbad, Mohammed A Al-Gunaid, Mohammed O S Al Ghurabi, Ahmed A Bawazir, Zain A A BaFadhl, Zahran A A Baqashmer, Mohammad Abrar Shareef
DOI:10.4103/jfmpc.jfmpc_935_20  
Purpose: This study examines quality of life of medical students in Yemen by evaluating validity and reliability of the World Health Organization Quality of Life questionnaire (WHOQOL) and assessing potential influencing factors. Methods: This is a single-centered cross-sectional study conducted in Hadramout University College of Medicine, Mukalla, Yemen during the academic year of 2019. The WHOQOL questionnaire was distributed among medical students. For validity, item discriminate validity and confirmatory factor analysis were assessed and for reliability, Cronbach's α test was examined. Independent sample t-test and one-way Analysis of Variance (ANOVA) were used to examine the academic level, gender, academic performance, and basic life necessities including water, electricity supply, sewage treatment and type of residence. Results: A total of 495 medical students have responded to this questionnaire which has demonstrated an adequate validity and good reliability. The mean score for students' self-rating of their quality of life in the major domains was found to be in a descending order (Mean ± SD): psychological health (55.18 ± 17.84), environmental (52.14 + 17.60), physical health (48.15 + 14.73) and social relations (45.09 ± 20.81). Demographics and basic life needs exhibit relationship with Quality of Life among medical students. Conclusion: The WHOQOL-BREF is a valid and reliable tool among medical students in Hadramout University. Demographics and basic life needs seem to impact Yemeni medical students' Quality of Life. Wellness and mentoring programs should be considered to ameliorate effects related to deteriorating medical students' Quality of Life in Hadramout University.
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Clinico-radiological profile of COVID-19 in Kashmiri population: A descriptive study p. 1473
Mir Shahnawaz, Abdul H Wani, Shivani Upadhyay, Sasmita Pattnaik, Hena Mustafa, Aaliya- Mohi-Ud-Din- Azad, Syed Suraiya Arjumand Farooq, Waseem Nabi, Yasir Hassan, Nayeem U Din Wani, Bikram S Datta, Naveed N Shah, Inaamul Haq, Khurshid A Dar
DOI:10.4103/jfmpc.jfmpc_1178_20  
Aim: The purpose of our study was to assess the presentation of COVID-19 disease in terms of clinical and radiological features in our population. Methods: 64 RT-PCR documented COVID-19 patients were included in the study. Clinical, biochemical, and radiological data were collected and analyzed retrospectively from last week of March to 30th April 2020. Results: Out of the 64 patients, 38 (59.4%) were males, 44 (68.7%) had a history of contact with COVID-19 positive patient. 26.6%patients were in the age group of 21–30 years. 53.1% patients were asymptomatic while as cough and fever were the most common symptoms in 21.8 and 20.3% patients, respectively. Anosmia was present in four patients. Hypertension and hypothyroidism were the most common comorbid illnesses among the study population in 9.4% patients each. Lymphopenia was present in 38% of patients CRP was increased in 83% patients, LDH in 90.2%, and ferritin in 51.5% of patients. 17 (26.6%) patients had bilateral disease in CT. RUL was the most common lobe involved in 18 (28.1%) patients. GGO and consolidation were seen in 22 (34.45) and 13 (20.3%) patients, respectively. Vessel enlargement was observed in 11 (17.2%) patients. All five lobes were involved in 9 (14.1%) patients. Five patients developed severe disease with respiratory comprise; two of them eventually died. Conclusion: The clinical and radiological characteristics of COVID-19 patients vary among different populations. Although there are no radiological features which seems to be characteristic of COVID-19, but CT helps in evaluation of the patients as many asymptomatic ones have some radiological findings suggestive of viral pneumonia.
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Seroprevalence of anti-SARS-CoV-2 antibodies in Indore, Madhya Pradesh: a community-based cross-sectional study, August 2020 p. 1479
Salil Sakalle, Satish Saroshe, Harish Shukla, Anita Mutha, Ameya Vaze, Arpit Arora, Aditya Athotra, Sudarshan Ramaswamy, Arania Jain, Meera Dhuria, Anil D Patil, Arvind Rai, Suneela Garg, Sudhir K Jain, Jyoti Bindal, Sujeet K Singh
DOI:10.4103/jfmpc.jfmpc_2015_20  
Background: In India, laboratory diagnosis of SARS – CoV-2 infection has been mostly based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Studies have shown that Viral titres peak within the first week of symptoms but may decline later hampering RT-PCR-based diagnostic strategies. Exact estimate is difficult under high-risk screening strategy with evidences of having large number of asymptomatic cases. This has prompted a call for adoption of antibody testing as potential source of data. Materials and Methods: A cross-sectional study with a sample size of 7000 was conducted for 15 days including all the 85 wards under Indore Municipal Corporation. Stratified Random Sampling was used to collect the samples. Trained teams collected basic sociodemographic information and serum samples which were tested for the presence of specific antibodies to COVID-19 using ICMR-Kavach IgG ELISA kits. The data collected was compiled and analysed using appropriate statistical software. Results: Overall weighted seroprevalence of the study population was found to be 7.75%. The prevalence in males and females was comparable (7.91% vs 7.57%). Highest seropositivity (10.04%) was seen among individuals aged more than 60 years. Total number of infections in the population were estimated to be 2,03,160. Overall Case Infection Ratio was found to be 27.43. Conclusion: The current seroprevalence study provides information on proportion of the population exposed, but the correlation between presence and absence of antibodies is not a marker of total or partial immunity. It must also be noted that more than 90 percent of the population is still susceptible for COVID-19 infection. Hence, non-pharmaceutical interventions like respiratory hygiene, physical distancing, hand sanitization, usage of personal protective equipment such as masks and implementation of public health measures need to be continued.
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Challenges and difficulties in research facing by Saudi board postgraduate residents in Aseer region p. 1485
Amal Abdulkhalig Alhefzi, Safar A Alsaleem, Razan Suliman Al Humayed, Mohamme Ali Mosfer Al Khathami, Ali Ahmed Ali Alwalan, Wael Saad Saaed Al Mufarrih, Mohammed Awadh Mohammed Alqarni, Bassam Mousa Khalawy Mokali, Bassam Mohammad Maghram Assiri
DOI:10.4103/jfmpc.jfmpc_1721_20  
Introduction: Research in health care system plays an important role in advancement and development of medicine and is essential in identifying the most optimal management. Progression in medicine depends upon the training and performance of researchers in health science. Training in research activity is an important aspect of post graduate training and has been recognized as one of its key components. It enhances learning and critical thinking of the resident. Methods: A purposely constructed questionnaire was used to gather the data, questionnaire was composed on demographic items, items related to the problems/difficulties regarding research, items related to specialty selection. Questionnaire was composed of by the panel of experts including subject (research faculty of the college) specialist, English language expert, family physician. Results: Mean ± S.D of age = 29.2 ± 8.6. 62.0% of the respondents were belongs to the age group of 25-30 years old, 22.% belongs to the 31-35 years old. 44.1% were female while 55.9% were male. Only 13.0% of the respondents finished the residency program (17.1% in R1, 25.7% in R2, 21.6% in R3, 13.6% in R4 while 2.5% in R5 and 6.7% as an adhoc). 51.6% have experience of healthcare from 1 to 3 years. 31.3% respondents participated in the research as a co-author while 26.3% participated in a research as principal investigator. Conclusion: To conclude, it is necessary to guide the students to conduct studies and keep them motivated. It is also important to reward them so keep their interest intact in research. In this view involving students in research committee and providing them a platform for presentation are very good methods to keep them motivated.
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CASE REPORTS Top

Primary to tertiary COVID-19 transmission in a hospital – A cluster outbreak analysis p. 1489
M Aishwarya, Mahendra Singh, Prasan K Panda
DOI:10.4103/jfmpc.jfmpc_2104_20  
The recent pandemic of SARS COV-2, a novel coronavirus requires research into understanding of its transmission dynamics and clinical presentations to help in understanding the spread of the disease, how to prevent it not only locally but also for national policy formulations. In this study, we described the transmission dynamics and clinical presentations of a cluster outbreak of SARS COV-2 in a tertiary level hospital. We also calculated the secondary attack rate for the primary, secondary, and tertiary transmissions. We conclude that symptomatic COVID-19 are primary and secondary contacts rather than tertiary contacts, hence, former to be quarantined. However, tertiary transmission is causing more COVID-19 compared to other transmissions in a hospital outbreak without further transmissibility. And overall secondary attack rate is very low in a hospital outbreak.
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Abdelazim equation: For 24-h urine protein from spot urine sample in preeclampsia p. 1493
Ibrahim A Abdelazim
DOI:10.4103/jfmpc.jfmpc_2112_20  
Measurement of 24-h urine protein (UP) is the standard method for detection of proteinuria in preeclampsia (PE). A 24-h urine sampling is time-consuming, inconvenient, and delays the diagnosis of PE. A 29-year-old woman, previous cesarean section (CS), pregnant 37 weeks'+2 days, mild PE, and another 31-year-old woman, primipara, pregnant 34 weeks'+4 days, severe PE, were admitted for control of blood pressure and termination of pregnancy. Studied women were subjected to fetal well-being assessment, routine antenatal, and laboratory investigations to exclude chronic renal diseases, and for 24-h urine sampling. A spot mid-stream urine sample was obtained shortly before the 24-h urine sampling to measure the protein/creatinine (P/C) ratio. The first studied woman had normal serum creatinine and blood urea, 688 mg protein/24-h urine, 86 mg/dL spot UP, 178 mg/dL spot urine creatinine, and 0.48 P/C ratio. The second studied woman had also normal serum creatinine and blood urea, 1199 mg protein/24-h urine, 147 mg/dL spot UP, 133 mg/dL spot urine creatinine, and 1.11 spot P/C ratio. The spot urine sample was suggested by the National Kidney Foundation to detect and monitor proteinuria in adults. Moreover, the 24-h UP can be calculated from the following equation: 24-h UP in g = P/C ratio × 0.81 + 0.3 (Abdelazim equation) without 24-h urine sampling. This report suggests the use of Abdelazim equation (24-h UP in g = P/C ratio × 0.81 + 0.3) for detection of 24-h UP from spot urine sample in PE without 24-h urine sampling.
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Symptomatic reinfection with COVID-19: A first from Western India Highly accessed article p. 1496
Tanisha Vora, Pragnesh Vora, Falguni Vora, Kamal Sharma, Hardik D Desai
DOI:10.4103/jfmpc.jfmpc_2002_20  
The reinfection of recovered COVID-19 patient is one of the major concerns worldwide. Here we report a case of previously recovered patient from Covid-19 who presented with symptomatic reinfection beyond 3 months. We report a case of 58 year old female patient who after presenting with symptomatic episode of RT-PCR confirmed COVID-19 in April 2020, presented with a new symptomatic infection by SARS-CoV-2 four months later. These 2 episodes of infection were caused by different sources as evident from her epidemiological correlates. This is the first epidemiologically, RAT, RT-PCR and antibody confirmed COVID-19 case of re-infection of SARS CoV-2 reported from Western India.
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Viral genome sequencing for Defining Re-infection with COVID-19 Highly accessed article p. 1499
Velmurugan Anbu Ananthan
DOI:10.4103/jfmpc.jfmpc_2410_20  
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Risk factor profile of our society is different p. 1501
Harish Gupta, Nitu Nigam
DOI:10.4103/jfmpc.jfmpc_1933_20  
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