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   2014| January-March  | Volume 3 | Issue 1  
    Online since April 9, 2014

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Knowledge, attitude and practices on malaria among the rural communities in Aliero, Northern Nigeria
Rupashree Singh, Jamila Musa, Sanjay Singh, Ukatu Victoria Ebere
January-March 2014, 3(1):39-44
DOI:10.4103/2249-4863.130271  PMID:24791235
Objective: Families' perceptions, beliefs, and attitudes about malaria causation, symptom identification, treatment of malaria, and prevention are often overlooked in malaria control efforts. This study was conducted to understand these issues, which can be an important step towards developing strategies, aimed at controlling malaria. Materials and Methods: A community based descriptive cross-sectional study in four villages: Danwarai, Gehuru, Jiga, and Kashin Zama of Aliero local government area in Kebbi Sate, in northern Nigeria. Two hundred household were randomly selected and interviewed using standardized questionnaire. Results: Knowledge of the role of mosquitoes in malaria transmission (11.8%) and cause of malaria (9.6%) was observed to be low among the study population. Comprehensive knowledge about malaria prevention measures was high (90%), but not reflecting in their practice (16%). They have good knowledge of mosquito behavior (breeding areas (64.5%), resting places (70%) and biting time (81%)). Seeking hospital care for a febrile child was a good practice (68.5%) observed. Attitudes regarding the "best antimalarial therapy" was limited (56.7%) to chloroquine. Conclusions: Misconceptions about malaria transmission and its cause still exist. Knowledge about preventive measures does not necessarily translate into improvement in practices. There is a need for targeted educational programs to increase the communities' efforts to develop desirable attitude and practices regarding malaria and their participation for malaria control.
  24 5,580 808
Protein energy malnutrition in India: The plight of our under five children
Dechenla Tshering Bhutia
January-March 2014, 3(1):63-67
DOI:10.4103/2249-4863.130279  PMID:24791240
Protein energy malnutrition (PEM) is a major public health problem in India. This affects the child at the most crucial period of time of development, which can lead to permanent impairment in later life. PEM is measured in terms of underweight (low weight for age), stunting (low height for age) and wasting (low weight for height). The prevalence of stunting among under five is 48% and wasting is 19.8% and with an underweight prevalence of 42.5%, it is the highest in the world. Undernutrition predisposes the child to infection and complements its effect in contributing to child mortality. Lalonde model (1974) is used to look into the various determinants of PEM in under five children and its interrelation in causation of PEM. The determinants of PEM are broadly classified under four distinct categories: Environmental factors including the physical and social environment, behavioral factors, health-care service related and biological factors. The socio-cultural factors play an important role wherein, it affects the attitude of the care giver in feeding and care practices. Faulty feeding practice in addition to poor nutritional status of the mother further worsens the situation. The vicious cycle of poor nutritional status of the mother leading to low birth weight child further exposes the child to susceptibility to infections which aggravates the situation. However, it is seen that percapita income of the family did not have much bearing on the poor nutritional status of the child rather lack of proper health-care services adversely contributed to poor nutritional status of the child. PEM is a critical problem with many determinants playing a role in causing this vicious cycle of undernutrition. With almost half of under five children undernourished in India, the Millennium Development Goal (MDG) of halving the prevalence of underweight by 2015 seems a distant dream.
  16 7,101 1,067
Role of health education and self-action plan in improving the drug compliance in bronchial asthma
Gajanan S Gaude, Jyothi Hattiholi, Alisha Chaudhury
January-March 2014, 3(1):33-38
DOI:10.4103/2249-4863.130269  PMID:24791234
Background: Considering the prevalence and associated burden of disease due to bronchial asthma, it is mandatory to obtain an optimal control of the disease and to improve outcomes for these patients. But it has been observed that there is very poor adherence to the inhalational therapy which leads to the suboptimal control of the disease. Objectives of the Study: To study the adherence for aerosol therapy in bronchial asthma patients and to assess the impact of health education and self-action plan in improving the compliance to the therapy. Methodology: A prospective study was done in a total of 500 bronchial asthma patients over a period of 2 years. Once included in the study, the patients were followed-up for a total of 12 weeks for calculation of nonadherence to the aerosol therapy. In nonadherent patients, we employed various health education strategies to improve the compliance in these cases. Results: A total of 500 patients of bronchial asthma who were started on aerosol therapy over duration of 2 years were included in the study. At the end of 12 weeks, it was observed that, only 193 patients (38.6%) had regular compliance and 307 patients (61.4%) were noncompliant to aerosol therapy as prescribed for bronchial asthma. Factors that were associated with poor compliance were: Lower educational level status, poor socioeconomic status, cumbersome regimens, dislike of medication, and distant pharmacies. Nondrug factors that reduced the compliance were: Fears about side effects, anger about condition or its treatment, forgetfulness or complacency, and patient's ill attitudes toward health. After employing the various strategies for improving the compliance in these patients, the compliance increased in 176 patients (57.3%) among the earlier defaulted patients, while the remaining 131 patients (42.7%) were found to be noncompliant even after various educational techniques. Conclusion: Noncompliance in asthma management is a fact of life and no single compliance improving strategy probably will be as effective as a good physician-patient relationship. Optimal self-management allowing for optimization of asthma control by adjustment of medications may be conducted by either self-adjustment with the aid of a written action plan or by regular medical review. Individualized written action plans based on peak expiratory flow are equivalent to action plans based on symptoms.
  12 4,348 572
A critical appraisal of kuppuswamy's socioeconomic status scale in the present scenario
Rahul Sharma, Narinder K Saini
January-March 2014, 3(1):3-4
DOI:10.4103/2249-4863.130248  PMID:24791227
The socioeconomic status (SES) is widely recognized as one of the important factors affecting the health condition of an individual or a family. One of the scales widely used and quoted even today is the one developed by Kuppuswamy. The Kuppuswamy scale in its various forms has held steady over three decades now and is still widely used as a measure of socioeconomic status in the urban population. However, it is important to discuss the applicability in the changed modern scenario.
  10 4,043 782
Knowledge, attitude and practices towards medical research amongst the postgraduate students of pravara institute of medical sciences university of central India
Purushottam A Giri, Vidyadhar B Bangal, Deepak B Phalke
January-March 2014, 3(1):22-24
DOI:10.4103/2249-4863.130263  PMID:24791231
Background: Health research training is an essential component of medical education and a vital exercise to help develop physician research skills. Objectives: This study was carried out to assess the knowledge, attitude, and practices towards health research amongst the postgraduate students of Pravara Institute of Medical Sciences University of central India. Materials and Methods: A cross-sectional study was carried out from August to October 2012. A total of 116 postgraduate students were interviewed. Knowledge, attitude, and practices related to health research were assessed using a predesigned, pretested and validated questionnaire. Results were analyzed in the form of percentage and proportions whenever appropriate. Results: In present study, the concept of research hypothesis was known to only 18.9% of the postgraduate students, whereas 17.2 and 21.5% students knew the full form of MEDLARS and MEDLINE respectively. Majority (91.4%) students believed that patient outcome improves with continued medical research and 70.7% are willing to participate in workshop for research methodology. Lack of time due to vast curriculum of postgraduate subjects (59.5%), lack of research curriculum (25%), and inadequate facilities (25.8%) were stated as major obstacles for pursuing research. Conclusion: Postgraduate students have inadequate knowledge, but have positive attitudes towards health research. Postgraduate training and research facilities at the institution need to undergo major transformation in order to encourage meaningful research by postgraduate trainees.
  9 3,272 703
Study of prevalence of type 2 diabetes mellitus and hypertension in overweight and obese people
Abhijit Mandal
January-March 2014, 3(1):25-28
DOI:10.4103/2249-4863.130265  PMID:24791232
Context: In recent years, there has been a marked change in life-style of South Asian countries caused by economic growth, affluence, urbanization and dietary westernization. Few studies on the prevalence of obesity, hypertension and diabetes in the Indian population have been reported. However, there has been scarce literature on the study of prevalence of type 2 diabetes mellitus (DM) and Hypertension in overweight and obese people in India with criteria suggested by World Health Organization (WHO) for Asians. Information on such public health issues would provide evidence based data to develop guidelines and policies on this subject. Aim: The aim of this article is to determine the prevalence of hypertension and type 2 DM in overweight and obese people. Setting and Design: A cross-sectional study consisted of people selected from the out-patient department and indoors of a large defense hospital in a semi urban area of Assam. Materials and Methods: Patients with overweight and obesity, reporting for consultation and medical examination were taken into the study. The data collected was analyzed using the criteria for overweight, obesity, diabetes and hypertension defined by WHO, Joint National Committee VII and International Diabetes Federation, American Diabetes Association. A descriptive statistical analysis has been carried out in the study. Results: A total of 300 people were the subject population of this study. Among the subject population, there were 97 overweight and 203 obese. The 56 subjects were found to be diabetic. The prevalence of type 2 DM in overweight subjects was 15.5% and in obese was 20.2% and overall was 18.7%. Prevalence of hypertension in the overweight population was 8.2% and in obese was 22.2% and overall found to be 17.7%. Conclusions: The prevalence of type 2 DM, hypertension in the obese group of the study population were found to be 20.2%, 22.2% and in the overweight population were 15.5% and 8.2%, respectively. This indicates that the prevalence of type 2 DM and hypertension increases with increasing weight of the individuals. The prevalence of type 2 DM and hypertension were relatively higher compared with other studies in India and abroad.
  9 3,438 658
Patient Satisfaction and it's Relation to Diabetic Control in a Primary Care Setting
Abeer Al Shahrani, Muneera Baraja
January-March 2014, 3(1):5-11
DOI:10.4103/2249-4863.130254  PMID:24791228
Context: Patient satisfaction is of increasing importance and recognized as an important indicator for quality of care. It is influenced by the patients, physicians and practice's characteristics. The literature on diabetes has increasingly focused on the quality of care and its measurement. The relationship between the quality of diabetes care and patient satisfaction is poorly understood and it requires further elaboration. Aims: The aim of this study is to Identify the underlying factors influencing patient's satisfaction with the diabetes care, to assess whether comprehensive diabetes management that provided in diabetic clinic improves satisfaction and glycemic control. Settings and Design: Cross-sectional study Family Medicine and Diabetic Clinics at King Abdul-Aziz Medical City. Materials and Methods: A total of 230 type two diabetic patients attending their follow-up were requested to fill the questionnaire. The questionnaire identified patients, doctors and practice related factors. Statistical Analysis Used: SPSS 16 with appropriate statistical test. Results: The response rate was 85%. Mean hemoglobin A1c (HbA1c) level was 0.087 ± 0.020. Around half of the patients were having high satisfaction rate of (>60%). Doctor's communication ranked the highest satisfaction level among other factors. However, no association between satisfaction with other patient's characteristics and HbA1c. Conclusions: Physicians play a major role in promoting higher level of satisfaction by good communication with their patients. More efforts are needed to improve certain aspects of diabetic care such as: Patient's education and periodic physical examination. Although the present study did not show any association between satisfaction and important outcome like HbA1c, more studies are needed to explore such complex relationship. To obtain more significant results a bigger sample size might be needed.
  8 3,173 630
Scrub typhus complicated by acute respiratory distress syndrome and multiorgan failure; an unrecognized alarming entity in central India: A report of two cases
Amrish Saxena, Benjamine Khiangte, Iadarilang Tiewsoh
January-March 2014, 3(1):80-83
DOI:10.4103/2249-4863.130334  PMID:24791245
Scrub typhus is an acute infectious illness, distributed throughout the Asia Pacific rim. In India, it has been reported from northern, eastern, and southern India. However, cases of scrub typhus have not been well-documented from Vidarbha, an eastern region of Maharashtra state in central India. We report two cases of complicated scrub typhus from Vidarbha region. These cases admitted in unconscious state with 8-10 days history of fever, body ache, cough, and progressive breathlessness. The diagnosis in both cases was based on presence of eschar, a positive Weil-Felix test, and a positive rapid diagnostic test (immunochromatographic assay). Both cases were complicated by acute respiratory distress syndrome (ARDS) and multiorgan failure. Both of them presented in their 2 nd week of illness and died during the hospital course in spite of intensive supportive care. The main cause of mortality was delayed referral leading to delay in diagnosis and treatment.
  7 2,957 369
Informed consent: Corner stone in ethical medical and dental practice
Heena Kakar, Ramandeep Singh Gambhir, Simarpreet Singh, Amarinder Kaur, Tarun Nanda
January-March 2014, 3(1):68-71
DOI:10.4103/2249-4863.130284  PMID:24791241
Progress in health care technologies has enabled patients to be better informed about all aspects of health care. Patients' informed consent is a legal regulation and a moral principle which represents patients' rights to take part in the clinical decisions concerning their treatment. With increasing awareness among the patients, the concept of informed consent is also evolving in developing countries like India. It is important for the medical and dental practitioners to have a written and signed informed consent from their patients before performing any invasive or irreversible procedures. Informed consent is also needed when providing medical care to children, foreign patients, and incorporating images of the patients while conducting medical and dental research. The present review addresses some of the vital issues regarding informed consent when providing medical and dental care with current review of the literature.
  7 3,539 635
Anemia among hospitalized children at a multispecialty hospital, Bangalore (Karnataka), India
Firdos Saba, Siddaraju Poornima, Pishey Ashwathnarayan Rao Balaji, Smitha Ranoji Rao Varne, Krishnamurthy Jayashree
January-March 2014, 3(1):48-53
DOI:10.4103/2249-4863.130275  PMID:24791237
Background: Due to the limited availability of data related to anemia in hospitalized children, this research was conducted to study the occurrence, morphological patterns, distribution in different age groups, sex, and severity of anemia among children aged 6 months-12 years. Setting: Inpatients in department of pediatrics at a multispecialty hospital, Bangalore. Study Design: Descriptive cross sectional study from Oct, 2011 to Sep, 2012. Materials and Methods: Ethical clearance was obtained from the ethical committee of the hospital as per 1964 Declaration of Helsinki. Unrestricted random sampling method was used to select the study group consisting of 882 children between the age of 6 months and 12 years. After obtaining the consent, data were obtained and statistically analyzed using statistical tools like mean, median, standard deviation, and Chi-square test. Results: Out of 882 children selected, 642 (72.79%) were anemic, out of which a majority of 629 (98%) children suffered from nonhemoglobinopathies and a meagre 13 (2%) suffered from hemoglobinopathies. Children in the age group of 6 months-1 year were most affected with nonhemoglobinopathies (33%). Moderate degree of anemia (hemoglobin = 7-9.9 g/dL) was the commonest grade of anemia (80%), while microcytic hypochromic anemia was commonest morphological type of anemia (48%). Among hemoglobinopathies, thalassemia major was the most common (69%, that is 9 out of 13 patients). Conclusion: The occurrence of anemia among children aged between 6 months and 12 years is high and nonhemoglobinopathies predominate over the hemoglobinopathies.
  5 2,641 393
Fulminant guillain-barré syndrome with myocarditis
Ajay Mishra, Nikhil Dave, Manan Mehta
January-March 2014, 3(1):84-85
DOI:10.4103/2249-4863.130335  PMID:24791246
Guillain-Barré syndrome (GBS) represents a diverse spectrum of diseases, with variable pathophysiological mechanisms, clinical manifestation, presentation pattern, and degree of severity. We report a rare case of fatal fulminant GBS complicated with myocarditis during the course of illness.
  4 2,124 341
A study on mental disorders: 5-year retrospective study
Thalappillil Mathew Celine, Jimmy Antony
January-March 2014, 3(1):12-16
DOI:10.4103/2249-4863.130260  PMID:24791229
Background: "Mental disorder" is the most common used term in the modern life and the main reason behind this may be the mechanical way of life or stress and strain among youth. Aim: To find the pattern of mental disorders of hospitalized patients in a medical college hospital from 1 st April 2005 to 31 st March 2010. Settings and Design: A retrospective study conducted among the patients admitted with mental disorders in a medical college hospital from 1 st April 2005 to 31 st March 2010. Materials and Methods: Data collected from the registers maintained in the medical records department. Statistical Analysis: Z test is used for the comparison of proportions. Results: A total of 7908 mental disorder cases reported in the medical college hospital, 5564 (70.36%) were males and 2344 (29.64%) were females. Most cases occurred in the age group of 30-44 years. Mental disorder was more among females than males in 0-29 years and ≥ 60 years, but in 30-59 years males were more. In each year, mental disorders were reported more in males than females. Of the cases, most of them were mood disorders. Mental and behavioral disorders due to psychoactive substance use were more among males but schizophrenia, delusional disorders, mood disorders, stress-related disorders, mental retardation, and so on were more among females. Conclusion: Mood disorder was the most occurred mental disorder and the next leading mental disorder was mental and behavioral disorders due to psychoactive substance use. Counseling can be helpful for preventing most of the mental disorders. Improve the mental health care facilities will be the solution for controlling the mental disorders.
  4 3,085 424
Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of Eastern India
Somenath Sarkar, Arnab Sarkar, Revanta Saha, Tanusree Sarkar
January-March 2014, 3(1):29-32
DOI:10.4103/2249-4863.130267  PMID:24791233
Context: Psoriasis has an impact on psychology of the patients. There is a dearth of studies regarding this field in eastern India. Aims and Objectives: The primary objective of this study is to evaluate the psychiatric morbidity in psoriasis and secondary objective is to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger. Settings and Design: Institutional based case control study. Materials and Methods: Forty-eight patients of psoriasis and equal number of healthy controls were included in the study. Self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both groups. Statistical Analysis Used: "MedCalc version" (by Acacialaan 22, B-8400, Ostend, Belgium) was used as statistical software. Chi-square test was used as a test of significance. Results: The SRQ assessed psychiatric morbidity in the study group was 62.5%, compared with 18.5% in the control group. This difference was statistically significant (P < 0.001). Guttate psoriasis had maximum association with psychiatric morbidity (100%), followed by plaque type (63.6%) and palmoplantar type (42.8%). According to the skindex, the most common psychiatric morbidity in psoriasis patients was anger (58.3%), followed by discomfort (52.08%), social problem (52.08%), cognitive impairment (50%), embarrassment (50%), physical limitation (47.91%), fear (47.91%) and depression (43.75%). The skindex observed psychiatric morbidity among the case and control group was statistically significant for all the parameters (P < 0.0001). Conclusion: Psoriasis has a high degree of psychiatric morbidity and the extent of this co-morbidity is even greater than hitherto thought of.
  3 2,690 381
Preventing coronary heart disease risk of slum dwelling residents in India
Lipi Dhar
January-March 2014, 3(1):58-62
DOI:10.4103/2249-4863.130278  PMID:24791239
Coronary heart disease (CHD) is the top cause of mortality and morbidity in India. People in slums are generally at a higher risk for CHD than Indians living in more affluent areas mostly because of the higher prevalence of major CHD risk factors such as uncontrolled hypertension and tobacco use amongst them. Knowing their CHD risk perceptions and bringing them into line with the actual CHD risk is a prerequisite for effective CHD risk management. Consequently, there is need to develop tailored interventions focusing medication management and tobacco cessation to reduce growing CHD epidemic among slum dwellers and long-term CHD burden in India.
  3 2,308 255
Self‑ear‑cleaning among educated young adults in Nigeria
Adedayo Olugbenga Olaosun
January-March 2014, 3(1):17-21
DOI:10.4103/2249-4863.130262  PMID:24791230
Context: Self-ear-cleaning has been reported to be common from several hospital-based studies and it has been associated with some diseases of the ear. Aims: To determine community-based prevalence of self-ear-cleaning and its sociodemographic correlates among educated young adults in Nigeria. Settings and Design: A cross-sectional survey conducted in a National Youth Service Corps camp in Nigeria. Subjects and Methods: Semistructured questionnaires were administered on a randomly selected sample of 1280 respondents. The outcome variable was self-ear-cleaning. Independent variables were sociodemographic variables, materials used and ear-cleaning habits. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS) version 15 was utilized for univariate, bivariate, and multiple logistic regression analysis. Results: There were 1012 respondents (M: F = 1.05:1). Mean age was 25.3 (standard deviation, 2.34). Prevalence of self-ear-cleaning was 93.4%. Mean age at first cleaning was 7.6 years. Cotton buds were the most frequently used objects (in 85.1%). Prevalence was high irrespective of sociodemographic class, significantly higher among females (c 2 = 4.549, P = 0.033), those who believed the habit was beneficial (c 2 = 114.185, P < 0.001) and those whose parents and siblings practiced the habit. Significant predictive factors were self-ear-cleaning in respondent's father [odds ratio (OR) P = 0.011) and owning cotton buds (OR = 0.192, P = 0.007). Conclusions: Self-ear-cleaning is almost universal. Most of the population is, therefore, at risk of possible harmful effects. Also, medical advice against self-ear-cleaning is not widely known. Rather, the erroneous perception that self-ear-cleaning is beneficial is common. Collaborative health education efforts targeted at families and schools and campaigns and advocacy for legislation regulating the sale of cotton buds are recommended.
  2 2,598 393
Unfamiliar manifestations of anti-tubercular therapy
Ramesh Aggarwal, Shridhar Dwivedi, Meenakshi Aggarwal
January-March 2014, 3(1):72-73
DOI:10.4103/2249-4863.130327  PMID:24791242
Cutaneous drug reactions are frequent in hospitalized patients and vary from simple manifestations like rash and erythema to severe life threatening conditions like angio-oedema, erythroderma, Stevens-Johnson syndrome and toxic epidermal necrolysis. However drug eruptions with antitubercular drugs are largely unknown except few case reports. We highlight here one similar case which presented with pleomorphic cutaneous manifestations after taking anti tubercular therapy and closely mimicked vasculitis. But when the offending drugs were stopped the lesions disappeared and the patient improved.
  1 1,786 290
Why family medicine is a good career choice for indian medical graduates?
Raman Kumar
January-March 2014, 3(1):1-2
DOI:10.4103/2249-4863.130242  PMID:24791226
Internationally family medicine has evolved as an independent academic discipline of medical science and speciality vocational training for community based primary care physicians. India has a long tradition of family practice however due to various regulatory barriers family medicine did not optimally develop in mainstream medical education system for many decades. Recently, there is growing interest in this concept in India and family medicine is emerging as a viable career option for medical graduates in India.
  1 2,926 488
Epidemiological correlates of cataract cases in tertiary health care center in rural area of Maharashtra
Shubhada Sunil Avachat, Vaishali Phalke, Suchit Kambale
January-March 2014, 3(1):45-47
DOI:10.4103/2249-4863.130273  PMID:24791236
Background: The most recent estimates from World Health Organization (WHO) reveal that 47.8% of global blindness is due to cataract. Cataract has been documented to be the most significant cause of bilateral blindness in India. The most recent estimates from WHO reveal that 47.8% of global blindness is due to cataract and in south Asia region which includes India, 51% of blindness is due to cataract. In India cataract is the principal cause of blindness accounting for 62.6% cases of blindness. The key to the success of the Global Vision 2020: The right to sight initiative is a special effort to tackle cataract blindness which includes estimation of magnitude of the problem and understanding factors associated with it. Therefore, a study was conducted in the hospital to estimate the magnitude of cataract and study various epidemiological factors associated with it. Materials and Methods: A cross-sectional study was conducted in a tertiary health center in rural area. Total 746 patients who availed services from ophthalmology department during study period were included in the study and relevant data was collected from them. Data analysis was done by percentages, proportions, and tests of significance (Chi-square test). Results: Out of 746 patients, 400 (53.6%) were suffering from cataract. Senile cataract was the most common cause (54%). Fifty-five percent patients were in the age group of 60-80 years and majority of them were from low socioeconomic strata. Conclusion: The prevalence of cataract in a medical college hospital in rural area was 53.6%. Age, sex, and educational status were significantly associated with cataract.
  1 2,719 416
Clinical profile of cerebral malaria at a secondary care hospital
Jency Maria Koshy, Jacob Koshy
January-March 2014, 3(1):54-57
DOI:10.4103/2249-4863.130276  PMID:24791238
Introduction: Cerebral malaria (CM) is one of the most common causes for non-traumatic encephalopathy in the world. It affects both the urban and rural population. It is a challenge to treat these patients in a resource limited setting; where majority of these cases present. Materials and Methods: This was a prospective study carried out from September 2005 to December 2006 at Jiwan Jyoti Christian Hospital in Eastern Uttar Pradesh in India. This is a secondary level care with limited resources. We studied the clinical profile, treatment and outcome of all the patients above the age of 14 years diagnosed with CM. Results: There were a total of 53 patients with CM of which 38 (71.7%) of them were females. Among them, 35 (66%) patients were less than 30 years of age. The clinical features noted were seizure (39.62%), anemia (84.9%), icterus (16.98%), hypotension (13.2%), bleeding (3.7%), hepatomegaly (5.66%), splenomegaly (5.66%), non-cardiogenic pulmonary edema (16.98%) and renal dysfunction (37.36%). Co-infection with Plasmodium vivax was present in 13 (24.53%) of them. Treatment received included artesunin compounds or quinine. Median time of defervescence was 2 (interquartile range1-3). Complete recovery was achieved in 43 (81%) of them. Two (3.7%) of them died. Conclusion: CM, once considered to be a fatal disease has shown remarkable improvement in the outcome with the wide availability of artesunin and quinine components. To combat the malaria burden, physicians in resource limited setting should be well trained to manage these patients especially in the endemic areas. The key to management is early diagnosis and initiation of treatment based on a high index of suspicion. Anticipation and early recognition of the various complications are crucial.
  1 1,988 302
Mononucleosis-like drug rash: An interesting case presentation
Reshma T Vishnani, Ram H Malkani, Afsha A Topal, HG Desai
January-March 2014, 3(1):74-76
DOI:10.4103/2249-4863.130329  PMID:24791243
Dapsone hypersensitivity syndrome (DHS) is a rare adverse effect of the commonly prescribed drug dapsone. We present a case of a 35-year-old male who was referred to us from the gastroenterologist with complaints of rash, nausea, vomiting, and jaundice since 2 days with a provisional differential diagnosis of infectious mononucleosis or viral exanthema. On enquiry patient gave history of taking dapsone a week prior for refractory urticaria. After thorough investigations we diagnosed him with DHS. This syndrome occurs in a relatively small proportion of patients, but it is associated with considerable morbidity and mortality. The reason for presenting this case is to remind physicians of the unpredictability and potential severity of this reaction which makes it a major concern in clinical practice.
  - 1,766 294
Alopecia universalis, renal stones, and hyperuricemia: A familial or an unfamiliar association
Kalachand Jana, Arun Shivajirao Bade, Sachin Kumar Jain, Ramesh Aggarwal, Aditya Dutta
January-March 2014, 3(1):77-79
DOI:10.4103/2249-4863.130331  PMID:24791244
Alopecia Universalis is an autoimmune disorder which sometimes may be associated with other autoimmune diseases like vitiligo, atopic dermatitis and endocrine disorders like hypothyroidism. In less than 2% of cases it may be associated with nephrotic syndrome although the underlying etiology has not been reported. We report here one similar case that had alopecia universalis beginning at the age of 17 years and simultaneously developed hyperuricemia. His son also developed alopecia universalis and renal stones at an early age of 10 years. The case represents one of the rare forms of alopecia namely alopecia universalis in two generations of the same family. Apart from this the case highlights the presence of renal stones probably due to hyperuricemia in both the generations which invokes a need to investigate any association of hyperuricemia with alopecia universalis.
  - 2,061 275
Recurrent pneumothorax in a young female with pulmonary lymphangiomyomatosis: A case report and overview of literature
Vishakha V Jain, OP Gupta, Sumedh Jajoo, Benjamin Khiangate
January-March 2014, 3(1):86-88
DOI:10.4103/2249-4863.130336  PMID:24791247
Lymphangiomyomatosis (LAM) is a rare cystic interstitial lung disease that exclusively affects women of child bearing age and is associated with vascular proliferation of smooth muscle cells in the lung. We report a case of young female with pulmonary LAM presenting with recurrent pneumothorax.
  - 2,623 259
Responding to domestic violence in clinical practice: Are we equipped enough?
John Jacob, Baren Minz, PS Rakesh, Immanuel Rajamani
January-March 2014, 3(1):89-90
DOI:10.4103/2249-4863.130337  PMID:24791248
  - 1,481 223
India and end of life discussions: A comment on end of life discussion in an academic family health team in Kingston, Ontario, Canada
Sunil Kumar Raina, Kanica Kaushal
January-March 2014, 3(1):90-90
DOI:10.4103/2249-4863.130338  PMID:24791249
  - 1,445 207