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   2014| July-September  | Volume 3 | Issue 3  
    Online since September 24, 2014

 
 
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ORIGINAL ARTICLES
Beliefs about medicines and self-reported adherence among patients with chronic illness: A study in Palestine
Raniah Majed Jamous, Waleed Mohamad Sweileh, Adham Saed El-Deen Abu Taha, Sa'ed Husni Zyoud
July-September 2014, 3(3):224-229
DOI:10.4103/2249-4863.141615  PMID:25374859
Background: Identifying factors associated with adherence is of great value in clinical practice. The objective of this study was to investigate medication adherence, beliefs about medicines held by people with chronic illness and whether beliefs influence medication adherence. Methods: The study was carried out at primary health care clinic of the Palestinian Medical Military Services in Nablus, Palestine. The beliefs about medicines questionnaire was used to assess beliefs and Morisky medication adherence scale was used to assess adherence. Results: A total of 187 patients were interviewed. Most participants (79.6%) agreed or strongly agreed that their medications were necessary for their current health. However, 58.2% of the participants were concerned about having to take their medicines on a regular basis and 57.8% were concerned about becoming dependent on their medicines. None of the demographic and clinical variables was significantly associated with medication adherence. However, multivariate analysis showed that patients who had higher beliefs about medication necessity had higher odds (1.107 [1.023-1.197]) of being adherent. On the other hand, patients who had higher concern beliefs had lower odds (0.908 [0.845-0.975]) of being adherent. Conclusions: Beliefs about medicines are a major contributing factor to medication adherence.
  12 2,893 512
EDITORIAL
Beyond controversies: Sexuality education for adolescents in India
Jagdish Khubchandani, Jeffrey Clark, Raman Kumar
July-September 2014, 3(3):175-179
DOI:10.4103/2249-4863.141588  PMID:25374847
Sexuality education for adolescents is one of the most controversial topics in the field of child health. In the past decade, policymakers in India have also struggled with the issue and there has been greater public discourse. However, policymaking and public discussions on adolescent sexuality education are frequently fueled by religious, social, and cultural values, while receiving scant scientific attention. To meet the needs of an expanding young population in India, scientific evidence for best practices must be kept at the core of policymaking in the context of sexuality education for adolescents.
  9 8,471 672
CASE REPORTS
Hashimoto's encephalitis: Unusual cause of reversible dementia
Kuljeet Singh Anand, Jyoti Garg, Rohit Verma, Anirban Chakraborty
July-September 2014, 3(3):284-286
DOI:10.4103/2249-4863.141650  PMID:25374873
Hashimoto's encephalopathy (HE) is a poorly understood and often misdiagnosed rare autoimmune disease with varied neurological and psychiatric features. The low prevalence and varied clinical features coupled with unclear pathogenesis and histopathologic characteristics have caused still doubts in any particular diagnostic criteria. Therefore, more case studies are needed to characterize the clinical, laboratory and imaging features and outcomes of HE patients. We describe a case of such a patient with HE presenting with dementia and focus on its early recognition as the cognitive changes are reversible.
  6 2,271 487
ORIGINAL ARTICLES
Attitudes toward euthanasia and related issues among physicians and patients in a multi-cultural society of Malaysia
Mohammad Yousuf Rathor, Mohammad Fauzi Abdul Rani, Mohammad Arif Shahar, Ab Rehman Jamalludin, Shahrin Tarmizi Bin Che Abdullah, Ahmad Marzuki Bin Omar, Azarisman Shah Bin Mohamad Shah
July-September 2014, 3(3):230-237
DOI:10.4103/2249-4863.141616  PMID:25374860
Introduction: Due to globalization and changes in the health care delivery system, there has been a gradual change in the attitude of the medical community as well as the lay public toward greater acceptance of euthanasia as an option for terminally ill and dying patients. Physicians in developing countries come across situations where such issues are raised with increasing frequency. As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues. Concomitantly, we wanted to ascertain the frequency of requests for assistance in active euthanasia. Materials and Methods: Questionnaire based survey among consenting patients and physicians. Results: The majority of our physicians and patients did not support active euthanasia or physician-assisted suicide (EAS), no matter what the circumstances may be P < 0.001. Both opposed to its legalization P < 0.001. Just 15% of physicians reported that they were asked by patients for assistance in dying. Both physicians 29.2% and patients 61.5% were in favor of withdrawing or withholding life-sustaining treatment to a patient with no chances of survival. Among patients no significant differences were observed for age, marital status, or underlying health status. Conclusions: A significant percentage of surveyed respondents were against EAS or its legalization. Patient views were primarily determined by religious beliefs rather than the disease severity. More debates on the matter are crucial in the ever-evolving world of clinical medicine.
  6 3,952 492
Spectrum of hemoglobin variants in the population of northern region of West Bengal: An ethnogenetic proposition
Bidyut Krishna Goswami, Raghunath Pramanik, Sudipta Chakrabarty, Partha Pratim Pal, Sarama Banerjee, Arghya Bandyopadhyay
July-September 2014, 3(3):219-223
DOI:10.4103/2249-4863.141614  PMID:25374858
Context: The birth of transfusion-dependent states of hemoglobinopathies including thalassemias is preventable by population screening and genetic counseling. Magnitude is not addressed in the Northern Region of West Bengal where many ethnic variants inhabit. Aims and Objectives: The aim of the following study is to find out the burden of different entities of hemoglobinopathies, their correlation with ethnicity and the "at risk" groups. Subjects and Methods: A descriptive study was conducted from the Hematology Unit of North Bengal Medical College over 1 year on the subjects underwent screening for hemoglobinopathies for detection of abnormal hemoglobin (Hb) variants by "cation-exchange high-performance liquid chromatography" principle along with other relevant tests. Statistical Analysis: Data was analyzed by frequency distribution and Chi-square test assuming P value as 95% of the level of significance using the SPSS version 16 (SPSS Inc., Chicago, Illinois, U.S.A). Result: Abnormal Hb variant was 47.5% among 1872. Hb E trait (34.4%) was most common followed by Hb E disease (25.3%) and others. Hb E disorders (92.7%) were observed mostly among Rajbangsi population while E-β-thalassemias (40%) in the Muslims and a heterogeneous pattern noted among tribal and mongoloid. Conclusion: Hb E hemoglobinopathies was high among Rajbangsi and Muslims with identification of some other hemoglobinopathies involving tribal and mongoloid.
  5 2,444 309
Intimate partner violence and associated coping strategies among women in a primary care clinic in Port Harcourt, Nigeria
Kalamawei Itimi, Paul O Dienye, Precious K Gbeneol
July-September 2014, 3(3):193-198
DOI:10.4103/2249-4863.141601  PMID:25374852
Context: Intimate partner violence (IPV) is an important gender-based, social, and public health problem, affecting women globally. Aims: The aim was to report the prevalence of IPV and describe the coping strategies of the victims. Settings and Design: It was conducted in the general outpatient clinic of a tertiary care hospital using a cross-sectional design. Materials and Methods: A random sample of consenting women living in an intimate partnership for a minimum of 1 year were served with a three part structured questionnaire which sought information on sociodemographic characteristics, the experience of IPV and the Brief COPE Inventory. Statistical Analysis Used: SPSS version 17.0 software, Microsoft word and Excel were used in data handling and analysis. Means, percentages, standard deviations, and Chi-square were calculated. P < 0.05 was considered to be significant. Results: Of the 384 participants, 161 (41.9%) were physically abused. IPV was significantly common among women ≤40 years of age, married couples (78.5%), unemployed and in Christians. It was precipitated by argument with husband (19.25%) and financial demands (44.10%). The employed coping strategy with the highest score was religion. The least score was found in substance abuse. Conclusion: There was significantly high prevalence of domestic violence against women in this study. Hence, routine screening is advocated by family physicians to elicit abuse in order to avoid the more devastating psychological consequences after the incidence so as to institute appropriate treatment as multiple episodes of abuse appears to be cumulative in effect. The reason for violence mainly borders around the argument with husband and finance issues. The coping strategies utilized by the participants minimally involve substance abuse, but more of a religion.
  5 2,815 444
CASE REPORTS
Losartan-induced ischemic hepatocellular hepatotoxicity: A case report and literature review
Moh'd Z Al-Halawani, Mohammad Thawabi, Fady Asslo, Hamid Shaaban, Fayez Shamoon, Walid J Baddoura
July-September 2014, 3(3):272-274
DOI:10.4103/2249-4863.141635  PMID:25374869
With the increasing use of various medications and supplements nowadays, the incidence of abnormal liver function tests and frank hepatic injury is has been increasing. Medications are now considered one of the most common causes of acute hepatic failure in the United States. Losartan was the first angiotensin 1 (AT1) receptor blocker approved by FDA for the treatment of arterial hypertension. It is a well-tolerated medication with few significant adverse effects. However, losartan-related hepatotoxicity has been reported rarely. We report a case of acute hepatic injury in an adult patient treated with losartan as a monotherapy for arterial hypertension.
  4 1,957 377
ORIGINAL ARTICLES
Tracking the implementation to identify gaps in integrated disease surveillance program in a block of district Jhajjar (Haryana)
Arun Kumar, Manish Kumar Goel, Ram Bilas Jain, Pardeep Khanna
July-September 2014, 3(3):213-215
DOI:10.4103/2249-4863.141612  PMID:25374856
Context: To strengthen the surveillance system in India, Integrated Disease Surveillance Program (IDSP) was launched in 2004. The frequent occurrence of epidemics even after the launching of the IDSP was an indication toward inadequacy of the system. The responsibility for effective implementation of IDSP at the sub-center level lies with the health workers. Aims: The aim of the following study was to assess the knowledge and practice of health workers regarding IDSP and to assess the quality of IDSP reports at the sub-center level. Settings and Design: It was cross-sectional study carried out in the area under Community Health Center Dighal which is the rural field practice area attached to Post Graduate Institute of Medical Sciences, Rohtak in the State of Haryana, India. Subjects and Methods: All the 24 sub-centers in the area were visited and 46 health workers (22 male; 24 female) who met the inclusion criteria i.e. who had completed 1 year of their service or had been trained for IDSP, were included in the study. Data were collected on a self-designed, semi-structured and pre-tested schedule by interviewing the study subjects and observation of the records/reports. Statistical Analysis Used: Percentages and proportions. Results: Only 14/46 (~30%) of the workers could expand the abbreviation "IDSP" correctly. Only 4/46 (~9%) workers could narrate any of the trigger events and none could tell all the trigger events. Only at 12 such sub-centers, diagnoses were being written in their out-patient registers according to the defined syndromes. 43/46 (~93%) workers were not aware of the zero reporting. Conclusions: The surveillance system is much less alert and intense than the desired level and needs to be strengthened.
  4 1,831 255
Prevalence of folate, ferritin and cobalamin deficiencies amongst adolescent in India
Umesh Kapil, Ajeet Singh Bhadoria
July-September 2014, 3(3):247-249
DOI:10.4103/2249-4863.141619  PMID:25374863
Background: In India, 60-90% of adolescent suffer from anemia. Studies have documented folate, ferritin, and cobalamin deficiencies to be the major causes of nutritional anemia. However, limited data is available on the prevalence of folate, ferritin, and cobalamin deficiencies amongst adolescent from India. Objectives: The present study was carried out to find out the magnitude of folate, ferritin, and cobalamin deficiencies amongst adolescent of 11-18 years of age in National Capital Territory (NCT) of Delhi, India. Materials and Methods: A cross-sectional, school-based study was conducted in NCT of Delhi, India in the year 2010-2011. About 347 adolescent belonging to low- (LIG), middle- (MIG), and high-income groups (HIG) were selected using the probability proportionate to size (PPS) sampling methodology. Serum ferritin, serum folate, and serum cobalamin levels were determined by the enzyme-linked immunosorbent assay (ELISA) method, radioimmunoassay (RIA) method, and radioisotopic method, respectively. Hemoglobin (Hb) estimation was done by cyanmethemoglobin method in all the blood samples collected. Results: The prevalence of deficiency of ferritin in HIG, MIG, and LIG categories of adolescent was found to be 52.9, 67, and 58.8%, respectively. In the HIG, MIG, and LIG categories of adolescent, the prevalence of folate deficiency was 22.5, 40.4, and 52.2%, respectively. The prevalence of deficiency of cobalamin in HIG, MIG, and LIG categories of adolescent was 47.1, 80.7 and 87.5%, respectively. About 48, 66.1, and 68.4% of adolescent in the HIG, MIG, and LIG categories, respectively had Hb levels less than 12 g/dL and were found to be suffering from anemia. Conclusions: A high prevalence of anemia existed along with deficiency of ferritin, cobalamin, and folate amongst adolescent. The strategies for prevention of anemia amongst adolescent in India should also include cobalamin along with iron and folate supplementation for prevention and control of nutritional anemia. Primary care physicians should suspect all the three causes for anemia.
  4 2,381 403
Dimensions of quality of antenatal care service at Suez, Egypt
Hanan Abbas Abdo Abdel Rahman El Gammal
July-September 2014, 3(3):238-242
DOI:10.4103/2249-4863.141617  PMID:25374861
Introduction: The 5 th millennium development goal aims at reducing maternal mortality by 75% by the year 2015. According to the World Health Organization, there was an estimated 358,000 maternal deaths globally in 2008. Developing countries accounted for 99% of these deaths of which three-fifths occurred in Sub-Saharan Africa. In primary health care (PHC), quality of antenatal care is fundamental and critically affects service continuity. Nevertheless, medical research ignores the issue and it is lacking scientific inquiry, particularly in Egypt. Aim of the Study: The aim of the following study is to assess the quality of antenatal care in urban Suez Governorate, Egypt. Materials and Methods: A cross-sectional primary health care center (PHCC) based study conducted at five PHCC in urban Suez, Egypt. The total sample size collected from clients, physicians and medical records. Parameters assessed auditing of medical records, assessing provider and pregnant women satisfaction. Results: Nearly 97% of respondents were satisfied about the quality of antenatal care, while provider's satisfaction was 61% and for file, auditing was 76.5 ° 5.6. Conclusion: The present study shows that client satisfaction, physicians' satisfaction and auditing of medical record represent an idea about opportunities for improvement.
  4 2,571 350
FAMILY MEDICINE EDUCATION
Role of family medicine education in India's step toward universal health coverage
Sajitha M.F. Rahman, Ruby P Angeline, Kirubah V David, Prince Christopher
July-September 2014, 3(3):180-182
DOI:10.4103/2249-4863.141594  PMID:25374848
India's commitment to universal health coverage has grown stronger with the submission of High Level Expert Group report by the Planning Commission in 2012. With this report comes the commitment to increase the primary health-care workforce to meet the population needs. However, the focus should not be just to increase the number of health workers, but to produce better health workers. Doctors, nurses and community health workers trained in primary and secondary health-care facilities can make a significant contribution in responding to the needs of the local community. The role of family medicine education is worth exploring in this context to equip the primary care health workers with the competencies of providing person-centered, comprehensive and continuous care.
  3 1,700 349
CASE REPORTS
Insulin injection site dystrophic calcification with fat necrosis: A case report of an uncommon adverse effect
Sharad Ramdas, Anita Ramdas, Moses Ambroise
July-September 2014, 3(3):269-271
DOI:10.4103/2249-4863.141633  PMID:25374868
We report a case of an uncommon adverse effect of insulin injection resulting in hard subcutaneous swelling in the lower abdomen of a 47-year-oldfemale with type 1 diabetes. Extensive dystrophic calcification and fat necrosis was revealed on histopathological examination.
  2 1,960 263
Diabetic tongue - Could it be a diagnostic criterion?
Nikhil N Bhandare, Mukundraj S Keny, Ramnath P Nevrekar, Padma N Bhandare
July-September 2014, 3(3):290-291
DOI:10.4103/2249-4863.141654  PMID:25374875
Diabetes mellitus (DM) is a common disease which usually manifests in the form of polyuria, polydipsia, weight loss, fatigue, weakness, blurry vision, frequent skin infections, and slow healing of skin lesions. Taste disturbances like ageusia, hypogeusia and dysgeusia have been associated with DM. The early diagnosis of DM based on these symptoms is very important to start treatment early and thereby prevent complications. We present an interesting case of a female presenting with altered taste as the first symptom of DM.
  2 1,738 350
ORIGINAL ARTICLES
Cardiovascular disease risk factor profiling of group C employees in Jipmer, Puducherry
K Aswin, Arun G Ghorpade, Sitanshu Sekhar Kar, Ganesh Kumar
July-September 2014, 3(3):255-259
DOI:10.4103/2249-4863.141624  PMID:25374865
Background: Settings-based approach for health promotion includes conducting risk factor surveillance as one of its component. It was aimed to estimate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A cross-sectional survey was conducted among 400 group C employees aged ≥20 years using the WHO "STEPwise approach to surveillance of non-communicable diseases" (STEPS) methodology. Standardized international protocols were used to measure behavioral risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist and hip circumferences, height, and blood pressure). Multivariate analysis was done to predict the factors, which carry independent risk of hypertension. Risk factor profiling of the staff was done using WHO/ISH risk prediction chart to calculate the 10-year risk of a fatal or non-fatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status, and presence or absence of diabetes mellitus. Results: Mean age in years was 40.9 (°10.4), and men constituted 81.3% of study population. Prevalence of major cardiovascular risk factors was as follows: Current smokers 12.3% men, regular alcohol intake 33.2% among men, overweight (≥23 kg/m 2 ) 74.5%, central obesity 78.7%, hypertension 38.8%, and history of diabetes mellitus 13.2%. Age, gender, physical inactivity, obesity, and family history of hypertension were found to be independently associated with hypertension. Four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee wellness program should be started in the institute to combat the burden of cardiovascular diseases.
  2 2,025 405
Tobacco smoking status as assessed by oral questionnaire results 30% under-reporting by adult males in rural India: A confirmatory comparison by exhaled breath carbon monoxide analysis
Pradeep Aggarwal, Saurabh Varshney, Sunil D Kandpal, Divya Gupta
July-September 2014, 3(3):199-203
DOI:10.4103/2249-4863.141606  PMID:25374853
Background: The authenticity and true status of tobacco use, especially in the form of smoking among the patient clientele is always a matter of concern for their physicians. Objectives: The purpose of this study was to assess the authenticity of self-reported habit of tobacco smoking among a population sample of male respondents in rural India. Methods: Respondents were asked to complete oral questionnaires that assessed their status of tobacco smoking (if any) as well as duration of tobacco smoking, type of tobacco smoking, and frequency of tobacco smoking. Subsequently, exhaled breath carbon monoxide analysis was performed to detect their amounts of exhaled carbon monoxide. Results: In 175 respondents, the Smoke Check color indicators were significantly different (P < 0.0001) in the respondents who were diagnosed smokers per oral questionnaires (n = 92) versus diagnosed nonsmokers per oral questionnaires (n = 83). The probability statistics of authenticity of oral questionnaires for assessing smoking status showed that self-reporting was only 75% sensitive and 76% specific with 80% positive predictive value and 70% negative predictive value. Conclusion: True status of tobacco smoking with exhaled breath carbon monoxide analysis can be an easy clinical maneuver with community health screening and health promotion implications among patient populations in rural India.
  2 2,174 284
Therapeutic-diagnostic evaluation of chronic cough amongst adults: causes, symptoms and management at the primary care level, Malaysia
Yogarabindranath Swarna Nantha
July-September 2014, 3(3):207-212
DOI:10.4103/2249-4863.141611  PMID:25374855
Background: Patients presenting with chronic cough pose a common diagnostic dilemma during routine consultations at public primary care clinics in Malaysia. To date, there has been little attempt at designing a standardized model or algorithm to facilitate an accurate diagnosis of chronic cough. This study proposes a clinical method to detect the causes of chronic cough in a primary care setting in Malaysia. Materials and Methods: A total of 117 patients aged above 18 at an urban primary care clinic were tracked over a span of 5 months to diagnose the cause of chronic cough. A therapeutic-diagnostic method was employed to help identify the causes of chronic cough. Subsequently, the demographic details of patients, the prevalence of the different causes of chronic cough and the relationship between history and diagnosis were analyzed statistically. Results: Chronic cough had a slightly higher male preponderance (51.3% vs. 48.7%). Patients within the 'above 60' age category had the highest frequency of chronic cough. The most common cause of chronic cough was post-infectious cough (n = 42, 35.9%), followed closely by angiotensin-converting enzyme-inhibitor related cough (n = 14, 12%). Majority of patients had the symptom of phlegm production (n = 41, 54%). 33 patients (29.2%) had recent upper respiratory tract infection (<2 weeks ago) prior to the diagnosis of chronic cough. There were poor association between symptoms and the various entities comprising chronic cough. The exceptions were the following associations: (1) Bronchial asthma and itchiness of throat (P = 0021), (2) gastroesophageal reflux disease and heartburn (P < 0.001), (3) upper airway cough syndrome and running nose (P = 0.016) and (4) pulmonary tuberculosis and absence of weight loss (P = 0.004). Conclusion: This study demonstrates that the effectiveness of a therapeutic-diagnostic technique in the diagnosis of chronic cough. Consistent with previous studies, there was poor association between most symptoms and the causes of chronic cough. A study involving a larger primary care population is required to confirm the findings found in this analysis.
  2 2,000 335
CASE REPORTS
Primary hypoparathyroidism presenting with new adult onset seizures in family practice
R.H. Prince Christopher, Kirubah V David, Ruby Angeline Pricilla
July-September 2014, 3(3):266-268
DOI:10.4103/2249-4863.141629  PMID:25374867
Hypoparathyroidism commonly presents with paresthesias, fatigue, anxiety, muscle cramps and infrequently with seizures due to hypocalcaemia. Here, we present a case of 27-year-old adult female presenting with new onset convulsions who was subsequently diagnosed to have primary (congenital) hypoparathyroidism.
  1 1,422 198
An unusual case of primary human immunodeficiency virus infection presenting as mononucleosis-like syndrome and acute aseptic meningoencephalitis. Report of a case and review of the literature
Marcelo Corti, Leonardo Gilardi
July-September 2014, 3(3):279-280
DOI:10.4103/2249-4863.141643  PMID:25374871
Clinical presentation of primary human immunodeficiency virus (HIV) infection includes a wide spectrum of manifestations from asymptomatic infection to a symptomatic and severe illness. Central nervous system involvement should be always considered as a severe clinical form of primary HIV infection. Physicians should be aware to the broad clinical spectrum of primary HIV infection. We report a case of a female with diagnosis of mononucleosis-like syndrome and acute aseptic meningoencephalitis during primary HIV infection.
  1 1,623 216
ORIGINAL ARTICLES
Beers criteria-based assessment of medication use in hospitalized elderly patients in Southern Brazil
Carla de Oliveira Alves, Fabiana Schuelter-Trevisol, Daisson Jose Trevisol
July-September 2014, 3(3):260-265
DOI:10.4103/2249-4863.141628  PMID:25374866
Background: Population aging has evolved gradually. Polypharmacy to control disease associated with age-related physiological changes increases the risk of adverse drug reactions, including drug interactions among the elderly population. Objective: This study was intended to assess the medications used by the elderly population, aiming at identifying the potentially inappropriate medications according to the Beers Criteria. Materials and Methods: We conducted a cross-sectional study on medical records to assess the use of medications by elderly patients admitted to the Hospital Nossa Senhora da Conceição in 2011. The variables included gender, age, reasons for admission, comorbidities, and medications used by the elderly patients. Results: In total, we reviewed 440 medical records. Patients were predominantly male (51.6%). The total number of medications used was 5904, with an average of 13.4 per person. The three most commonly used drugs were dipyrone, omeprazole, and metoclopramide. The most frequently used drugs according to the Anatomical Therapeutic Chemical Classification (ATC) system were those of the alimentary tract and metabolism, nervous system, and cardiovascular system. Of the 255 types of drugs used, 42 (16.4%) were included in the Beers list, and the three most often used were metoclopramide, ketoprofen, and aspirin. Conclusion: The number of medications used per patient was substantial, and potentially inappropriate medications according to the Beers Criteria were significant as well.
  1 2,362 493
Study of drug utilization pattern for acute exacerbation of chronic obstructive pulmonary disease in patients attending a government hospital in Kerala, India
Sajesh Kalkandi Veettil, Kingston Rajiah, Suresh Kumar
July-September 2014, 3(3):250-254
DOI:10.4103/2249-4863.141622  PMID:25374864
Objective: Drug utilization studies are powerful exploratory tools to ascertain the role of drugs in society. This study was conducted to establish the drug utilization pattern and the common adverse drug reactions for the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) in one of the government hospitals in Kerala, India. Methods: This was a prospective observational study aimed at recognizing the drug utilization pattern for the treatment of acute exacerbation of COPD for 7-day under nonexperimental settings. All information significant to the study was collected from the case records and discussions conducted with the inpatients and bystanders during ward rounds, with the support of a physician. Moreover, daily follow-ups were conducted to assemble data on amendment in therapy, add-on therapy, and clinical improvement until the patient was discharged from the hospital or to an upper limit of 7-day, whichever is earlier. Results: All the patients in this study received combination therapy. Among the inhalational β-agonists, salbutamol accounted for 74% use. Parenteral steroids were used in 78% of the patients and all of them received hydrocortisone. Steroid inhalers were used only in 25% of the patients. Anticholinergics were used in 77.5% of patients. Antibiotics were used in 86.7% patients. The main adverse effects noted were dry mouth (15%) and bad taste (10%) and these adverse effects were highly correlated with the use of anticholinergics (P < 0.05). Conclusions: Despite the use of drugs according to the availability and physician's preference, it was found in the analysis that majority were in accordance with Global Initiative for Chronic Obstructive Lung Disease criteria recommendations.
  1 1,925 417
CASE REPORTS
Dysmorphism in one of a set of male twins; Could they have been identical twins? A diagnostic dilemma
Aliyu Ibrahim
July-September 2014, 3(3):281-283
DOI:10.4103/2249-4863.141646  PMID:25374872
Twinning occurs worldwide, but Nigerian women of the southwest extraction record one of the highest rates in the world. Among the notable risk factors for fraternal twinning is advanced maternal age, which is also an independent risk factor for Down syndrome. Even as morphological characteristics can easily be applied to distinguish identical from fraternal twins, in cases of an associated dysmorphism, in any member of the couplet, it becomes a difficult tool to use, as has been observed in the case of a set of twins who were of the same sex, blood group, hemoglobin genotype, and shared the same placenta.
  - 1,267 158
Johnson-McMillin microtia syndrome: New additional family
Nagwa Abdel-Meguid, Ola Hosny Gebril, Ehab Ragaa Abdelraouf, Mohammed Akmal Shafie, Mohammed Bahgat
July-September 2014, 3(3):275-278
DOI:10.4103/2249-4863.141639  PMID:25374870
Microtia is a congenital anomaly that is found with different prevalence among various populations. The exact etiology of ear anomalies is still unknown. We describe a new additional family with this rare disorder; Johnson-McMillin syndrome (JMS) where mother, son, and distant grandmother have multiple features of JMS in the form of microtia, facial asymmetry, ear malformation, hearing defect, and hypotrichosis. Variable presentations in this family could be referred to phenotype variation supporting an autosomal dominant pattern of inheritance. We observed that the mother was very sad and suffered from feelings of guilt. We found that she had isolated herself from family and community out of fear of being stigmatized and hurt. We concluded that the occurrence of microtia is of public health importance, adhering to traditional marriage customs in Egypt increases women's risk of giving birth to a disabled child, yet the mothers are blamed and shamed for their children's birth defects by their husbands, families, and communities, while the fathers are not stigmatized.
  - 1,788 229
Sudden cardiac death, aborted, in healthy 34-year-old Male
Hitesh Shah
July-September 2014, 3(3):287-289
DOI:10.4103/2249-4863.141652  PMID:25374874
A 34-year-old male, non-hypertensive, non-diabetic, had a sudden onset of cardiac arrest, he was revived and then referred to a cardiologist at an advanced center for further care. His 2D echo revealed hypertrophic obstructive cardiomyopathy, all the other investigations were normal. His father was also found to have a similar condition however the father was asymptomatic. The patient underwent an automated implantable cardioverter-defibrillator implantation and was advised the necessary precautions and care.
  - 1,222 158
COMMENTARY
Why genetically modified food need reconsideration before consumption?
Alka Grover, Nida Ashhar, Pranav Patni
July-September 2014, 3(3):188-190
PMID:25374850
  - 2,079 427
Food for thought
Ranabir Pal, Surajit Ghatak
July-September 2014, 3(3):191-192
PMID:25374851
  - 951 173
FAMILY MEDICINE EDUCATION
Can credit systems help in family medicine training in developing countries? An innovative concept
J Beulah Raji, Jachin Velavan, Sahaya Anbarasi, Liz Grant
July-September 2014, 3(3):183-187
DOI:10.4103/2249-4863.141596  PMID:25374849
There is irrefutable evidence that health systems perform best when supported by a Family Physician network. Training a critical mass of highly skilled Family Physicians can help developing countries to reach their Millennium Development Goals and deliver comprehensive patient-centered health care to their population. The challenge in developing countries is the need to rapidly train these Family Physicians in large numbers, while also ensuring the quality of the learning, and assuring the quality of training. The experience of Christian Medical College (CMC), Vellore, India and other global examples confirm the fact that training large numbers is possible through well-designed blended learning programs. The question then arises as to how these programs can be standardized. Globally, the concept of the "credit system" has become the watch-word for many training programs seeking standardization. This article explores the possibility of introducing incremental academic certifications using credit systems as a method to standardize these blended learning programs, gives a glimpse at the innovation that CMC, Vellore is piloting in this regard partnering with the University of Edinburgh and analyses the possible benefits and pitfalls of such an approach.
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LETTERS TO EDITOR
Hospitalized patients with severe and non-severe pandemic influenza A (H1N1)
Viroj Wiwanitkit
July-September 2014, 3(3):292-292
DOI:10.4103/2249-4863.141655  PMID:25374876
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Referral letter and reply form
Beuy Joob, Viroj Wiwanitkit
July-September 2014, 3(3):292-293
DOI:10.4103/2249-4863.141657  PMID:25374877
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Community-based rehabilitation is an option to address challenges of disabilities in India
Ram Lakhan
July-September 2014, 3(3):293-293
DOI:10.4103/2249-4863.141659  PMID:25374878
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ORIGINAL ARTICLES
Knowledge of common problems of newborn among primi mothers admitted in a selected hospital for safe confinement
KC Leena, Deepthi A Koshy, Denna Thankachen, Deepa Thomas, Deepa R Varghese, Delcy S Fernandes
July-September 2014, 3(3):204-206
DOI:10.4103/2249-4863.141609  PMID:25374854
Background: Among the almost 3.9 million newborn deaths that occur worldwide, about 30% occur in India. Children are our future and utmost precious resources. After birth the health of the child depends upon the health care practice adopted by the family, especially by the mothers. Information about neonatal problems and newborn care practices will help in reducing mortality and morbidity during the neonatal period. This study was conducted to identify the knowledge of primi mothers with regard to the common problems of normal neonates. Materials and Methods: This descriptive study was carried out among the mothers of neonates in the Maternity Unit of a Medical College Hospital in Mangalore. A pretested structured knowledge questionnaire was used to collect information from 60 primi mothers, who were admitted for safe confinement for a one-month period. Results: The findings of the study show that the majority, that is, 27 (45%) of the primi mothers had a good knowledge of all the areas such as vomiting, regurgitation, diaper rash, umbilical cord infection, fever, constipation, and diarrhea. About 20 (33.3%) had very good knowledge and about 13 (21.67%) had an average level of knowledge on the common problems of newborns. Knowledge about vomiting was average among 34 (56.67%), poor in 21 (35%), and good in five (8.33%). Knowledge about diaper rash was average among 36 (60%), good among 21 (35%), and poor among three (5%). Knowledge on umbilical cord infection was average in 29 (48.33%), good in 27 (45%), and poor in 4 (6.67%). Knowledge on fever was good in 38 (63.33%), average in 19 (31.66%), and poor in three (5%). Knowledge on constipation and diarrhea were average in 38 (63.34%), good in 11 (18.33%), and poor in 11 (18.33%). No association was found between the knowledge of primi mothers and selected baseline variables, such as, age, education, religion, occupation, type of family or area of dwelling. Conclusion: The study concludes that there is a need to provide adequate information to first-time mothers about common newborn problems and this will help mothers care for their newborns better.
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Data entry skills in a computer-based spread sheet amongst postgraduate medical students: A simulation based descriptive assessment
Amir Maroof Khan, Dheeraj Shah, Pranab Chatterjee
July-September 2014, 3(3):216-218
DOI:10.4103/2249-4863.141613  PMID:25374857
Background: In India, research work in the form of a thesis is a mandatory requirement for the postgraduate (PG) medical students. Data entry in a computer-based spread sheet is one of the important basic skills for research, which has not yet been studied. This study was conducted to assess the data entry skills of the 2 nd year PG medical students of a medical college of North India. Materials and Methods: A cross-sectional, descriptive study was conducted among 111 second year PG students by using four simulated filled case record forms and a computer-based spread sheet in which data entry was to be carried out. Results: On a scale of 0-10, only 17.1% of the students scored more than seven. The specific sub-skills that were found to be lacking in more than half of the respondents were as follows: Inappropriate coding (93.7%), long variable names (51.4%), coding not being done for all the variables (76.6%), missing values entered in a non-uniform manner (84.7%) and two variables entered in the same column in the case of blood pressure reading (80.2%). Conclusion: PG medical students were not found to be proficient in data entry skill and this can act as a barrier to do research. This being a first of its kind study in India, more research is needed to understand this issue and then include this yet neglected aspect in teaching research methodology to the medical students.
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Radiation safety of women of the reproductive age: Evaluation of the role of referring physicians
AO Akintomide, AA Ikpeme
July-September 2014, 3(3):243-246
DOI:10.4103/2249-4863.141618  PMID:25374862
Background: Women between 12 and 50 years are in the reproductive age. The likelihood of or actual presence of pregnancy should be ruled out before they are exposed to medical ionizing radiation. Fetal exposure to ionizing radiation can either induce malformation (teratogenic) or cancer. They should be exposed only when it is safe for the fetus or when the benefit far outweighs the risk in urgent medical conditions. The radiation dose in medical imaging is generally below the threshold to induce malformation (100 mGy) in the fetus, but there is indeed no safe level as the risk of cancer induction later in life can occur at any dose. The referring physician must obtain the last menstrual period (LMP) and sometimes carry out pregnancy test before sending their patients for examinations using ionizing radiation. However, there are circumstances in which these rules are waived. Objective: The purpose of the study is to evaluate the role of the referring physician in the radiation protection of the fetus using the LMP. Subjects and Methods: This is a prospective study over a 2-month period. All the request forms of menstruating women aged 12-50 years sent for conventional radiography are included in the study. Results: One percent provided the LMP in the request forms. 0.6% (one) of our subjects was sure she is pregnant, but 13.7% (25) had an overdue menstruation. Conclusion: The level of compliance of the physicians with the referral guidelines for women of reproductive age is poor.
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