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   2014| April-June  | Volume 3 | Issue 2  
    Online since July 29, 2014

 
 
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ORIGINAL ARTICLES
Knowledge, attitude, and practices of breastfeeding and weaning among mothers of children up to 2 years old in a rural area in el-minia governorate, Egypt
Eman S Mohammed, Eman R Ghazawy, Eptesam E Hassan
April-June 2014, 3(2):136-140
DOI:10.4103/2249-4863.137639  PMID:25161971
Aim: Was to describe the knowledge, attitude, and actual practices of mothers in a rural area in Egypt regarding breastfeeding, complementary feeding and weaning and to explore the effect of educational background and age on these views. Materials and Methods: A community-based cross-sectional study was conducted on 307 rural mothers who have a youngest child aged 2 years or less. Mothers were selected using systematic random sampling. Results: All the studied mothers knew that breastfeeding is the best nutritional source for the baby. The majority of the mothers had good knowledge about the advantages of breastfeeding for child. As regards weaning, majority (92.5%) of the mothers defined weaning as breastfeeding cessation. Most of the mothers (94.8%) agreed that breastfeeding protect child from infection, 96.1% agreed that it is the healthiest for infant, 76.5% agreed that breast milk lead to loss of figure, and 83.4% agreed that breastfeeding should be avoided during mother's illness. About 84% initiated breastfeeding immediately after delivery, and 42.7% of the studied mothers offered pre-lacteal feeds to baby before lactation. About thirty quarters (74.2%) of mothers fed colostrum. Exclusive breast-feeding was found to be associated with mother's education (P < 0.0001) but not with mother's age at birth, mother's occupation, or place of birth. Conclusion: There is a need for health care system interventions, family interventions, and public health education campaigns to promote optimal BF practices, especially in less educated women.
  7,874 973 14
COMMENTARY
Health and beyond... strategies for a better India: Concept paper on primary health care in India
Soumyadeep Bhaumik
April-June 2014, 3(2):94-97
DOI:10.4103/2249-4863.137608  PMID:25161962
Background: India is one of the fastest growing economies of the world, and is posed to overtake China in terms of being the most populous nation of the world. The very essential components of primary health care - promotion of food supply, proper nutrition, safe water and basic sanitation and provision for quality health information concerning the prevailing health problems - is largely ignored. Access to healthcare services, provision of essential medicines and scarcity of doctors are other bottlenecks in the primary health care scenario. Complete absence of evidence-based guidelines on clinical scenarios and treatment plans in the primary health care sector, together with overburdening of the secondary and tertiary care sectors, has substantially lowered the quality of care in the nation. Aim: To discuss a strategy for a better primary healthcare model. Methods: This is a concept paper with an exploratory view of various problems and a suggested strategy to counter it. Results: This concept paper suggests a triad of strategies (technology, accountability and ink-blot strategy) that can be adapted to various problems in the primary healthcare scenario. Discussion: The concept paper is a preliminary document on a suggested model that needs to be worked out on a broader basis across all stakeholders with operational definitions, standards of procedure and protocols finalised.
  4,978 493 4
ORIGINAL ARTICLES
Awareness and practices of oral hygiene and its relation to sociodemographic factors among patients attending the general outpatient department in a tertiary care hospital of Kolkata, India
Bobby Paul, Mausumi Basu, Sinjita Dutta, Sita Chattopadhyay, Debasis Sinha, Raghunath Misra
April-June 2014, 3(2):107-111
DOI:10.4103/2249-4863.137611  PMID:25161965
Background: Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. Objective: The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD). Materials and Methods: A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, Kolkata, India, from 1 April to 30 April, 2013. The study tool was a pre-designed and pre-tested semi-structured schedule. Results: About 69.20% of the participants used a toothbrush with toothpaste as a method of cleaning their teeth; 35.71% brushed twice in a day; 33.03% brushed both in the morning and at bedtime; and 8.93% used mouthwash. About 40.62% visited the dentist during the last six months; among them 61.18% attended because of pain. Almost three-fourth of the participants knew that tooth decay and bad breath were the effects of not cleaning the teeth. It was known to 71.42, 63.39, 70.53, and 73.21% of the respondents, respectively, that excess sweet, cold drink, alcohol, and smoking/pan chewing were bad for dental health. Television was the source of knowledge to 57.14% of the participants and 35.71% acquired their knowledge from a dentist. Females, literates, urban residents, users of mouthwash, and regular visitors to the dentist had good oral hygiene practices. Conclusion: Oral health awareness and practices among the study population are poor and need to improve.
  4,528 589 5
CLINICAL PRACTICE
Hypothyroidism in clinical practice
Faiza Qari
April-June 2014, 3(2):98-101
DOI:10.4103/2249-4863.137609  PMID:25161963
Background: Hypothyroidism is the most common endocrine disease that was seen in the clinical practice especially for family physicians. Methods: This review article covered the important practical clinical issues for managing overt hypothyroidism, subclinical hypothyroidism and hypothyroidism during pregnancy. Conclusions: The clinical issues were addressed by clinical scenario followed by questions and stressed on the important clinical points.
  4,222 744 2
ORIGINAL ARTICLES
Predictors of postpartum depression in the eastern province capital of Saudi Arabia
Lamia I Alasoom, Manal R Koura
April-June 2014, 3(2):146-150
DOI:10.4103/2249-4863.137654  PMID:25161973
Background and Objectives: Postpartum depression (PPD) is a major depressive episode that occurs four weeks after delivery. Its risk increases during the first ninety days after delivery and continues for almost two years. The aim of present study is to assess the prevalence of PPD and the associated risk factors in the Eastern Province capital of Saudi Arabia. Materials and Methods: A cross-sectional study was conducted in the five largest Primary Healthcare Centers of Dammam. Four hundred and fifty mothers - visiting the health centers for immunizing their children at age two to six months - were selected by proportionate allocation to the population served by each health center. The mothers were screened for PPD using the Edinburgh Postnatal Depression Scale and interviewed for the associated risk factors. Results: It was found that 17.8% of the women had PPD. Regression analysis revealed that the strongest predictor of PPD was a family history of depression, followed by non-supportive husband, lifetime history of depression, unwanted pregnancy, and stressful life events. It was recommended to screen all high-risk mothers for PPD, while visiting the Primary Care Well-Baby Clinics.
  4,374 590 17
Helicobacter pylori infection among patients with upper gastrointestinal symptoms: prevalence and relation to endoscopy diagnosis and histopathology
Roshana Shrestha, Kamal Koirala, KC Shiv Raj, Kabita Hada Batajoo
April-June 2014, 3(2):154-158
DOI:10.4103/2249-4863.137663  PMID:25161975
Aim: To determine the prevalence of H. pylori based on endoscopic biopsy and to investigate the association between H. pylori and endoscopy diagnosis and histopathological diagnosis. Materials and Methods: Over a period of two years, 228 endoscopic biopsies were included. Endoscopy diagnosis, histopathological diagnosis, and colonization with H. pylori were recorded and compared using appropriate statistical tests. Results: The overall prevalence of H. pylori was 68%; 69.6% in males and 66.7% in females. Duodenal and gastric ulcers were seen more in males (63.2% and 60%) compared with females (32.1% and 40%) (P < 0.001). The total rate of colonization of H. pylori in duodenal ulcer and gastric ulcer (85.7% and 84%, respectively) was significantly higher than those in gastritis, duodenitis, and gastric cancer (61.8%, 69.2%, and 60%, respectively) (P = 0.046). Histologically, chronic active gastritis and chronic follicular gastritis was significantly higher in duodenal ulcer and gastric ulcer (57.1%, 44% and 21%, 40%) in comparison to chronic persistent gastritis (21.4%, 16%) with P value < 0.001. Similarly, chronic active gastritis and chronic follicular gastritis had higher prevalence of H. pylori infection in comparison to chronic persistent gastritis (85.3%, 83.3% vs. 41.4%) with P value < 0.001. Conclusion: This study reveals that the overall prevalence of H. pylori infection is high in our setting with no significant difference in gender. Peptic ulcers were common in males. Those with peptic ulcers had higher rates of H. pylori colonization. Chronic active gastritis and chronic follicular gastritis were common histological findings in ulcerative diseases with significantly higher H. pylori positivity.
  4,365 574 7
Ankle and foot tuberculosis: A diagnostic dilemma
Biswaranjan Nayak, Rashmi Rani Dash, Kailash Chandra Mohapatra, Geetanjali Panda
April-June 2014, 3(2):129-131
DOI:10.4103/2249-4863.137629  PMID:25161969
Aim and Objective: To know the biological behavior of ankle and foot tuberculosis (AFTB) and to know the reasons for delay in diagnosis and treatment of AFTB in our population. Materials and Methods: Patients with non-healing ulcers/sinuses/swellings in the ankle and foot region are the subjects of present study. Detailed clinical history, physical examination and relevant investigations were done in all cases. Pus/wound discharge for acid fast bacillus (AFB) study and biopsy from wound margin/sinus tract was taken in all the cases. Results: During the period from July 2007-June 2012, 20 cases of AFTB were treated. Out of them five cases were difficult to diagnose and a mean period of 6 month to 5year was elapsed before final diagnosis was established. Out of these five cases - three cases were diabetic with ulcers and sinuses in the heel and ankle region. One case was wrongly diagnosed as angiodysplasia with A-V malformation of foot and diagnosis was delayed for 5 year. In one case of rheumatoid arthritis with abscess in ankle joint, the diagnosis was delayed for 1year. Conclusion: AFTB is very rare condition. AFTB is suspected in cases with long standing pain/swelling/discharging sinus in the foot and thorough investigations is must to differentiate from other foot diseases. Diagnosis is delayed due to lack of clinical suspicion and non-confirmatory biopsy reports. Early diagnosis and ATT for 9-18 months is must in all cases of AFTB to prevent joint involvement and other complications.
  3,602 422 13
Prevalence of risk factors for chronic non-communicable diseases using who steps approach in an adult population in Delhi
Ankur Garg, Tanu Anand, Urvi Sharma, Jugal Kishore, Mantosh Chakraborty, Prakash Chandra Ray, Gopal Krishna Ingle
April-June 2014, 3(2):112-118
DOI:10.4103/2249-4863.137617  PMID:25161966
Objective: The burden of non-communicable diseases (NCDs) is increasing worldwide largely due to prevalence of various risk factors, which can be controlled. Therefore, the present study was undertaken to measure the prevalence of major preventable risk factors for chronic non-communicable diseases in an urban resettlement colony of Delhi, using STEPS approach. Materials and Methods: A cross-sectional study, that included a random sample of 200 adults, was conducted. A study tool based on the WHO STEPS questionnaire for assessing non-communicable diseases and their risk factors was used. Fasting venous blood sample was collected to assess the lipid profile and fasting blood sugar. Anthropometric measurements of the participants were also taken. Data was analyzed using SPSS version 17. Results: Out of the 200 participants, 26% (n = 52) were consuming alcohol and 17% (n = 34) were smoking. Majority (77.5%) had a raised waist circumference, and more than two-thirds were either overweight or obese. Fasting blood sugar levels were found to be raised in 18% of the study population. More than third participants had raised systolic and diastolic blood pressures and abnormal lipid profiles. More males were found to be overweight in comparison to females (P < 0.01), but in contrast, obesity (P < 0.05) and raised waist circumference (P < 0.001) were more common in females. Tobacco use was more common in lower class (P < 0.05), whereas obesity was commoner in the upper socio-economic class (P < 0.05). Conclusions: Study showed a high burden of risk factors for NCDs in the study population, pointing towards changing disease epidemiology of non-communicable diseases in India.
  3,274 567 4
Non-traumatic ileal perforation: A retrospective study
Gurjit Singh, Bharat Bhushan Dogra, Neha Jindal, Santhosh Rejintal
April-June 2014, 3(2):132-135
DOI:10.4103/2249-4863.137633  PMID:25161970
Objective: To determine clinical features, operative findings and post-operative complications in patients operated for non-traumatic ileal perforation and to discuss the role of typhoid vaccination. Materials and Methods: A retrospective study was carried out from 2009-2010. Seven patients were admitted through casualty as cases of acute abdomen. Underlying conditions were typhoid ulcers (4 patients) and non-specific etiology (3 patients). Diagnosis was made on clinical grounds, laboratory investigations, radiology and operative findings. Exploratory laporotomy was done. Different variables studied post-operatively were wound infection, residual abscess, recurrence and delayed post-operative complications. Results: Tenderness, distension and rigidity were found in maximum patients. Gases under diaphragm and air fluid levels were common radiological findings. However, widal test and blood culture for S. typhi was positive in four patients. Six patients had single perforation and one patient had two perforations, all being on antimesentric border of ileum. Maximum patients had peritoneal collection of less than 1000 ml. In five patients simple closure of perforation was done and in remaining two resection with end to side ileotransverse anatomosis was required. Wound infection and residual intraabdominal abscess were found in one patient each. Conclusion: Management criteria remain same in typhoid and non-specific perforations. Commonest cause of ileal perforation is typhoid fever in our country, so immunization against typhoid beyond 18 years of age is recommended.
  3,430 316 2
Provider's constraints and difficulties in primary health care system
Pawan Kumar, Abdul Majeed Khan, Deep Inder, Anu
April-June 2014, 3(2):102-106
DOI:10.4103/2249-4863.137610  PMID:25161964
Background: The contractualization of human resource in recent years has resulted into various human resource management issues. Objective: To explore the administrative and management issues of contractual model of human resource under primary health care system in Delhi. Materials and Methods: Comparative study was conducted on randomly selected sample of 333, comprised of Medical Officers, ANMs, Pharmacist and Laboratory Assistants and Technicians, both regular and contractual cadre. The data was collected using the semi-structured interview schedule and thematic content analysis was done. Results: The five major themes emerged in the analysis; these are (i) physical infrastructure, (ii) organization's working environment, (iii) privileges of staff, (iv) discontentment, (v) human resource development. Comparative analysis of themes between regular and contractual staff revealed significant differences in factors which are embedded into the organization's culture. Element of discontentment is high amongst contractual staff particularly for discrimination in job, undermining of authority, patient care relationship and privileges provided to regular staff. This reflects the area of dissatisfaction which varies between regular and contractual staff in the organization. Conclusion: If primary health care system fails to address genuine constraints of human resources of both regular and contractual cadre and perception of discrimination persists, it is bound to result into poor motivation for good performance in the system of health care. So, adopting good practices in human resource management keeping regular and contractual employees grievances at forefront are urgently needed to ensure the availability of adequately trained and motivated personnel's in health facilities.
  2,698 376 2
CASE REPORTS
Metastatic prostate cancer to the duodenum: A rare case
Dharmesh H Kaswala, Nitin Patel, Sana Jadallah, Weizheng Wang
April-June 2014, 3(2):166-168
DOI:10.4103/2249-4863.137668  PMID:25161979
Prostate cancer is the third most common cancer in man. About 1 in 6 males developed prostate cancer and 1 in 35 males die of this disease. Prostate cancer behavior ranges from microscopic tumors to aggressive cancer with metastatic potential. While metastasis to bone is relatively common, prostate cancer rarely metastasizes to the cecum, pituitary gland, small bowel, maxillary sinus and skin. Our case report presents a rare presentation of metastatic prostate cancer to the duodenum. Our search of the literature found only 2 cases of prostate metastases to duodenum published from 1966 to the present. To our knowledge this is the third case of metastatic prostate cancer presenting with duodenal metastasis. Although it is rare but in symptomatic patients small intestine metastasis should not be ignored with advanced prostate cancer. The case demonstrates a novel presentation of a common malignancy, and should raise awareness in clinicians and radiologists that prostate cancer can present with distant metastases in absence of any local lymphadenopathy.
  2,724 215 5
ORIGINAL ARTICLES
Effect of long-term transfusion therapy on the glycometabolic status and pancreatic beta cell function in patients with beta Thalassemia major
Kamalakshi G Bhat, Prakash K Periasamy
April-June 2014, 3(2):119-123
DOI:10.4103/2249-4863.137621  PMID:25161967
Background: Diabetes mellitus is a major complication of iron overload in patients with beta thalassemia major. Design: This is a descriptive study conducted in a Tertiary Care Teaching Hospital to analyze beta cell function and insulin resistance, and their relation to iron overload status in beta thalassemia major. Fasting glucose, two-hour post load glucose, fasting insulin, alanine amino transaminase (ALT), and ferritin were used as outcome measures. The homeostatic model assessment (HOMA model) was used to calculate the beta cell function and insulin resistance index. Results: Of the 30 cases, 20% had impaired fasting glucose, 3.3% had impaired glucose tolerance, and none had diabetes. Fasting glucose was not significant between the cases and controls (P = 0.113). Fasting insulin (P = 0.001), ferritin (P = 0.001), and ALT (P = 0.001) levels were significantly high in the cases. Insulin resistance index was significantly higher in the cases (P = 0.001) as also the beta cell function (P = 0.001). With increase in age and the number of units transfused there is a decline in beta cell function, fasting insulin, and insulin resistance after attaining the maximum level. This suggests that initial insulin resistance is followed by insulin depletion due to loss of beta cell function, leading to diabetes mellitus. Conclusion: Impaired glucose tolerance (IGT) and insulin resistance precede the onset of insulin-dependent diabetes and adequate chelation therapy is essential for delaying the onset or for prevention of diabetes.
  2,460 409 6
Effect of safe water on arsenicosis: A follow-up study
Kunal K Majumdar, Aloke Ghose, Nilima Ghose, Anirban Biswas, DN Guha Mazumder
April-June 2014, 3(2):124-128
DOI:10.4103/2249-4863.137626  PMID:25161968
Background: Arsenic pollution in groundwater, used for drinking purposes, has been envisaged as a problem of global concern. Treatment options for the management symptoms of chronic arsenicosis are limited. Mitigation option available for dealing with the health problem of ground water arsenic contamination rests mainly on supply of arsenic safe water in arsenic-endemic region of Indo-Bangladesh subcontinent. Limited information is available regarding the long-term effect of chronic arsenic toxicity after stoppage of consumption of arsenic-containing water. Objective: The current study was, therefore, done to assess, objectively, the effect of drinking arsenic safe water (<50 μg/L) on disease manifestation of arsenicosis. Results: Manifestations of various skin lesions and systemic diseases associated with chronic arsenic exposure were ascertained initially by carrying on baseline study on 208 participants in Nadia (Cohort-I, with skin lesion and Cohort-II, without skin lesion) using a scoring system, as developed by us, and compared objectively at the end of each year for 3 year follow-up period. All the participants who had arsenic contaminated drinking water source in their houses were supplied with arsenic removal filters for getting arsenic-free water during the follow-up period. In participants belonging to Cohort-I, the skin score was found to improve significantly at the end of each year, and it was found to be reduced significantly from 2.17 ± 1.09 to 1.23 ± 1.17; P < 0.001 at the end of 3 year's intervention study indicating beneficial effect of safe water on skin lesions. The systemic disease symptom score was also found to improve, but less significantly, at the end of 3 years in both the cohorts. Most important observation during the follow-up study was persistence of severe symptoms of chronic lung disease and severe skin lesion including Bowen's disease in spite of taking arsenic-safe water. Further, death could not be prevented to occur because of lung cancer and severe lung disease. Conclusion: It is, therefore, an urgent need to make arrangement for availability of safe water source among the arsenic-affected people in the district. Many of the people in the affected villages are not aware of contamination of their home tube wells with arsenic. Awareness generation and motivation of the people for testing their drinking water sources for arsenic and environmental interventions like rain water harvesting, ground water recharge, and restricting excessive use of ground water for domestic and agricultural purposes are also important to prevent further exposure of arsenic to these people.
  2,275 373 8
EDITORIAL
Helicopter dropping of 50 free allopathic medicines; prescribed by homoeopathic doctors at ground: Sorry this is not universal health coverage
Raman Kumar
April-June 2014, 3(2):91-93
DOI:10.4103/2249-4863.137603  PMID:25161961
The provision of Universal Health Coverage (UHC) is being discussed in India. Crippled by the charges of corruption and unethical practice by media and public at large, medical professionals are largely unaware, disinterested, isolated and edged out from this debate. The traditional general practitioner is a dying breed and deficiency of doctors willing to work in community settings is rampant. Is UHC model proposed in present form good for an ordinary Indian citizen? This editorial looks into the underlying politics of health care in India in the past and how this ongoing debate could impact the future of primary care and health care of people in India.
  2,311 291 -
LETTERS TO EDITOR
Do not miss scrub typhus as a cause of multiorgan dysfunction in primary care practice
Arjun Khanna, JC Suri, Animesh Ray, Harish Kumar
April-June 2014, 3(2):170-171
DOI:10.4103/2249-4863.137671  PMID:25161981
  2,301 239 -
Overuse of various radiological and pathological investigations: Should we be safe or sorry?
Mitesh Kumar
April-June 2014, 3(2):171-172
DOI:10.4103/2249-4863.137672  PMID:25161982
  2,194 214 2
ORIGINAL ARTICLES
A qualitative study on working experience of rural doctors in malappuram district of Kerala, India
Vinod Vallikunnu, S Ganesh Kumar, Sonali Sarkar, Sitanshu Sekhar Kar, KT Harichandrakumar
April-June 2014, 3(2):141-145
DOI:10.4103/2249-4863.137643  PMID:25161972
Background: Improving the working conditions of rural doctors is an important issue to increase the quality of health services to target groups. Objectives: To assess the working experience of rural doctors at primary health care level. Materials and Methods: This qualitative study was conducted among 30 medical officers from 21 primary health centers in Malappuram district of Kerala, India. In-depth interview was conducted, and content analysis was performed with the identification of themes based on the responses obtained. Results: There were 19 males and 11 females belonged to 25 to 55 years age group. About 70% (21) of them were graduates with MBBS qualification, and the rest were postgraduates. About 2/3 rd of them (20) had experience of less than 5 years. They expressed difficulty in managing the work in stipulated time period. However, this had never affected their OP management in anyway. They told that higher authorities were supportive, but they faced some opposition from the public in implementation of national program. Few opined that the training received was grossly insufficient in running the administrative affairs of the health center. Most of them satisfied with physical infrastructure, but manpower including medical officers and supporting staff were not sufficient. Some opined that the age of retirement is too early and should be increased. They participated in Continuing Medical Education, but expressed that it's content should suit to primary health care level. Conclusion: This study highlighted their concern to patient care and time, field work, administrative work, infrastructure, professional development, and future prospects. Further large scale evaluation studies will explore the situational analysis of it.
  2,037 290 -
Prostate cancer in primary care, Port Harcourt, Nigeria
Andrew Bock-Oruma, S Oghu Iboh, Dan-Jumbo Prince
April-June 2014, 3(2):151-153
DOI:10.4103/2249-4863.137659  PMID:25161974
Context: Prostate cancer (PC) is under-researched in primary care settings in the developing world, and diagnostic modalities available to the primary care physician could limit the making of the diagnosis, thus affecting the prevalence. Aims: This study aims to determine the prevalence of prostate cancer in patients that presented with LUTS to a family medicine clinic, using the screening tools (DRE and PSA) available in the facility. Settings and Design: A cross-sectional study of middle-aged and elderly men that presented to the Family Medicine Clinic, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria, with LUTS. Materials and Methods: Consenting and eligible males that presented to the Family Medicine Clinic with LUTS were assessed for prostate cancer using the PSA and digital rectal examination (DRE) between October 2010 and April 2012. Data were entered and analyzed using the statistical package for the social sciences (SPSS) version 16.0. Association between the variables was compared using chi-Square test with statistical significance set at P < 0.05. Results: Two hundred and ninety subjects participated in the study; the mean age of the subjects was 62.50 ± 11.66 years with an age range of 40 to 100 years. The prevalence for DRE-detected abnormal prostate was 13%, suggestive of PC. One hundred and sixty-one (55.5%) of the subjects had their PSA done and results retrieved, with 51.6% of them having PSA values within the normal range of 0-4 ng/ml, and 48.4% had PSA values outside the normal limits. An association of PSA and DRE gave 24.2% prevalence for probable PC and a significant association between elevated PSA and DRE. Conclusion: The diagnostic modality in study is inconclusive, but it offers the family physician the opportunity of improving the quality of life of the patient that presented to him with PC by initiating early referral for secondary care.
  1,842 477 2
CASE REPORTS
Psychogenic hiccup in children and adolescents: A case series
Aseem Mehra, BN Subodh, Siddharth Sarkar
April-June 2014, 3(2):161-163
DOI:10.4103/2249-4863.137666  PMID:25161977
Hiccups can be due to organic diseases or psychogenic causes. Psychogenic hiccup in children is an understudied area. We report a series of four cases presenting with psychogenic hiccups to the Psychiatry Outpatient Clinic of a tertiary care hospital in North India. The cases were aged 11 to 13 years; three of them were males and one female. Three of the patients belonged to a rural background and all of them were from Hindu nuclear families. The duration of hiccups for which treatment was sought ranged from three to fourteen months. The most common gains seen in two of the patients were, lesser scolding from the parents and getting eatables of their choice. The patients were managed by counseling and psychoeducation about the problem and cutting down the secondary gain. Techniques of suggestion and double bind were tried. Two of the patients had improved on the day detailed assessments were done, and all of the patients had improved on follow up. Psychogenic hiccups in children and in the adolescent age group can be effectively managed by using non-pharmacological methods and appropriate education of the parents.
  2,018 274 1
Dengue fever with rectus sheath hematoma: A case report
Anurag Sharma, Sonia Bhatia, Rajendra Pratap Singh, Gaurav Malik
April-June 2014, 3(2):159-160
DOI:10.4103/2249-4863.137665  PMID:25161976
Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH) is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an uncommon cause of acute abdominal pain. It is accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear.
  2,012 258 4
LETTERS TO EDITOR
Tuberculosis is protean
Ibrahim Aliyu
April-June 2014, 3(2):169-170
DOI:10.4103/2249-4863.137670  PMID:25161980
  1,786 182 -
CASE REPORTS
Idiopathic multiple aneurysm of external carotid artery
Saravanan Balachandran, Rathinavel Subrammaniyan, Ashok Kumar, Lakshmi Dharan
April-June 2014, 3(2):164-165
DOI:10.4103/2249-4863.137667  PMID:25161978
Aneurysms of external carotid artery are rare. Treatments for these are undertaken for the prevention of complications like hemorrhage or rupture, and embolism. We present a 71-year-old male with idiopathic multiple aneurysm for the past 34 years on conservative management and regular follow up for the past 4 years. This case was discussed for the rarity of idiopathic multiple aneurysm of the external carotid artery and the need for individualized treatment protocol to be followed as in this case, only watchful observation considering the age and patient compliance. In this world of evolving surgical techniques and newer treatment modalities, conservative treatment still has a role to play. Primary care physicians at the community level have a major role in following these patients and referring them as and when the need arises.
  1,481 168 -
LETTERS TO EDITOR
More reasons for more primary care
Kieran Walsh
April-June 2014, 3(2):172-173
DOI:10.4103/2249-4863.137673  PMID:25161983
  1,166 181 -
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