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   2019| October  | Volume 8 | Issue 10  
    Online since October 31, 2019

 
 
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REVIEW ARTICLES
Disaster and its impact on mental health: A narrative review
Nikunj Makwana
October 2019, 8(10):3090-3095
DOI:10.4103/jfmpc.jfmpc_893_19  PMID:31742125
The purpose of this study is to understand the linkages between disaster and its impact on mental health. To fulfil this objective, an attempt has been made to examine the existing qualitative literature on disaster and mental health. In this paper, disaster and mental health as a concept has been used in a holistic sense. Based on the review of literature, the following broad themes have been identified: natural disaster and its impact on mental health, man-made disaster and its effect on mental health, effects of industrial disaster on mental health. It examines the post-disaster behavioural and psychological symptoms associated with an impairment in functioning. By this review, various protective factors, including resilience and other coping strategies which amplified the individual's capacity while encountering negative situations, have been identified. The effectiveness of post-disaster intervention techniques is also highlighted. Better preparedness and community empowerment can improve the condition of the vulnerable population affected by the disaster. Thus, efforts should be given for holistic rehabilitation of the affected population.
  19 6,539 1,141
ORIGINAL ARTICLES
Levetiracetam versus phenytoin in children with status epilepticus
Gowhar Wani, Ayesha Imran, Neeraj Dhawan, Anumodhan Gupta, Javed I Giri
October 2019, 8(10):3367-3371
DOI:10.4103/jfmpc.jfmpc_750_19  PMID:31742170
Background: To compare the efficacy and safety of intravenous levetiracetam and phenytoin in status epilepticus. Methodology: A prospective, randomized controlled, nonblinded study was conducted in children 1 month to 12 years of age with active seizure and with status epilepticus. A total of 104 children were randomly allocated to either group 1 (levetiracetam) or group 2 (phenytoin) on the basis of computer-generated random number table. Children already on antiepileptic drugs, very sick children with shock, impending respiratory failure, or head injury, and children hypersensitive to phenytoin or levetiracetam were excluded. Data analysis was done by IBM SPSS statistics. Results: The mean age was 4.09 years with a male preponderance with the most common type of seizure being generalized type (74%). The seizures were controlled in all 104 patients initially within 40 min. Seizure control for 24 h was significantly better in group 1 (96%) when compared with group 2 (59.6%) (P = 0.0001). Minibolus of drug was given in 28.8% in group 1 and 46.2% in group 2 (P = 0.068).The seizure recurrence in groups 1 and 2 in the first hour was 1.9% and 5.8%, respectively (P = 0.61), whereas the recurrence between 1 and 24 h was significantly more in group 1 (34.6%) when compared with group 2 (3.8%) (P = 0.0001). The mean time to control seizure was comparable between both the groups (P = 0.71). There was no significant adverse effect in both the groups. Conclusion: Levetiracetam is more effective than phenytoin for seizure control for 24 h in children with status epilepticus, and it is safe and effective as a second-line therapy.
  4 1,906 255
Assessing knowledge on preventive colorectal cancer screening in Saudi Arabia: A cross-sectional study
Marwan Al-Hajeili, Hassan K Abdulwassi, Faisal Alshadadi, Lujain Alqurashi, Mohmmad Idriss, Lamis Halawani
October 2019, 8(10):3140-3146
DOI:10.4103/jfmpc.jfmpc_508_19  PMID:31742133
Context: According to the Saudi Cancer Registry's 2014 Cancer Incidence Report, colorectal cancer (CRC) is the leading form of malignant cancer among Saudi men and ranks third among women. Raising awareness about CRC risk factors could lead to a significant decline in incidence of disease. Aims: To assess CRC awareness and evaluate the main barriers that might prevent individuals' participation in screening. Settings and Design: A self-administered survey was conducted over two days as part of a CRC awareness campaign in Jeddah, Saudi Arabia in March, 2018. Methods and Materials: The survey addressed issues regarding knowledge of CRC and available screening methods. The survey also examined barriers that might make one reluctant to undergo preventative screening. Stata/SE 15.0 was used for all statistical analyses. Statistical Analyses: Continuous variables were described with frequencies and percentages. Stepwise linear regression models were constructed to predict CRC knowledge and barriers. Results: Out of 422 participants, 50.2% were men. Most respondents were between 15–35 years old (65.8%). Multivariate analysis revealed that gender was a significant predictor of CRC knowledge. Furthermore, the variables of education and family history of CRC significantly predicted subjects' awareness of colonoscopic screenings. The most common barriers for seeking screening included fear of the procedure, absence of clinical symptoms, and fear of the results. Conclusions: Our results highlight deficits in public CRC knowledge and their awareness of preventative measures. These shortcomings were found to be mainly related to education level. Specific barriers affecting screening decisions were also identified; intensive efforts on awareness to overcome these obstacles will be required.
  3 1,807 186
Role of epidemiological risk factors in improving the clinical diagnosis of streptococcal sore throat in pediatric clinical practice
Kapil Bhalla, Parveen Bhardwaj, Ashish Gupta, Shuchi Mehra, Deepak Nehra, Sanjiv Nanda
October 2019, 8(10):3130-3135
DOI:10.4103/jfmpc.jfmpc_495_19  PMID:31742131
Background and Aims: Antibiotics are frequently prescribed for sore throat in developing countries, that in turn leads to huge healthcare expenditure and their irrational use may lead to antimicrobial resistance in the community. The aim of this study is to investigate the effect of environmental factors on the frequency of occurrence of group A beta hemolytic streptococcus (GABHS) sore throat and to work out enhancing effect on the sensitivity and specificity and positive predictive value of the signs and symptoms of GABHS sore throat for facilitation of rational antibiotic use. Settings and Design: This was a prospective, cross sectional study conducted over period of one year in Pediatric Outpatient Department (OPD) of a Tertiary care teaching hospital. Methods: All the children between the age of 5 years and 15 years of age presenting in OPD with the signs and symptoms of sore throat were included in the study. Statistical Analysis Used: Statistical analysis was carried out by using Statistical Package for Social Sciences software and statistical tests of Pearson's Coefficient, Chi-square Test, Fischer's Test, Likelihood Ratio, Odds Ratio, and ROC Curve were applied. Results: Out of 225 children of the study group, 153 (68%) of the children were in the 5-10 years' age group. Positive throat swab culture was found to be positively associated with high grade fever, pain in throat while swallowing, severely enlarged tonsils, tender lymphadenopathy, poor housing condition, fuel used for cooking, and presence of smoker in house. Conclusions: The study stresses on the need of carefully evaluating children presenting with the symptoms of sore throat as majority of the cases may be viral and thus, self-limiting. Poor housing conditions and indoor pollution contribute to the increased prevalence of sore throat.
  3 1,200 176
Correlation of CD4 counts with oral and systemic manifestations in HIV patients
Puneeta Vohra, Kahamnuk Jamatia, B Subhada, Rahul Vinay Chandra Tiwari, M S Nabeel Althaf, Chayan Jain
October 2019, 8(10):3247-3252
DOI:10.4103/jfmpc.jfmpc_767_19  PMID:31742150
Aim: Aim of the study was to correlate CD4 counts with oral and systemic manifestations in HIV patients. Materials and Methods: Study population comprised of newly diagnosed 100 confirmed seropositive patients, before starting any antiretroviral therapy, were included. The oral lesions were diagnosed based on clinical manifestation using international criteria and CD4 count was determined within maximum 1 week of oral examination. Oral and systemic manifestations of HIV-positive patients were recorded and correlated with CD4 counts. Results: It was found that decrease in CD4 count is associated with a wide range of oral and systemic manifestations which can be used as prognostic marker for immune suppression in AIDS patient. Conclusion: Correlation of CD4 count with oral and systemic manifestation in HIV patient demonstrate the role of oral physician in identification, diagnosis, and treatment of HIV-associated lesions, providing proper guidance to the patient and allowing for an early diagnosis and treatment of the disease, which is fundamental for a successful management of the life conditions of HIV infected patients.
  3 1,848 312
Public's perception and satisfaction on the role and services provided by family physicians in Saudi Arabia: A cross-sectional study
Amnah Ali Abdulqader Elagi, Basem Amer Jaber, Almonther Hussain Ahmed Wassly, Ruba Mohammed Sallam Ahmed, Fatimah Ali Ahmed Bosily
October 2019, 8(10):3282-3286
DOI:10.4103/jfmpc.jfmpc_621_19  PMID:31742156
Background: Few studies have addressed the awareness of the family physicians' (FPs) role and its impact on the quality of primary healthcare. This study aims to explore public's perception and satisfaction on the role and services provided by FPs in the Kingdom of Saudi Arabia (KSA). Materials and Methods: An online survey was conducted using a convenience sample of 830 participants age 18 years and above from Jazan region, KSA. Statistical analysis was done using SPSS including descriptive studies and Chi-square or Fisher's exact test. Results: A total of 830 valid responses were analyzed, of which 55.1% were females. The median age of respondents was 32.5 years (range 18–75 years). Most of the respondents (90.2%) did not have a regular FP. A considerable proportion of the participants were aware of the principles (81.2%) and essential role of family medicine (73.3%), health conditions that FPs can treat (59.9%), and conditions they do not treat (n = 622, 74.9%). The majority agreed on the value of involving FPs in their care (76.7%), the priority of FPs in the action of health-seeking (58.9%), and the sufficiency of FPs' expertise (55.5%). However, only 28.3% had a positive experience with FPs. In addition, 59.8% preferred to first seek healthcare from specialists from other specialties. Conclusion: In general, participants in this study had good perception of the role of FPs as important components in the healthcare system. However, there may be some gaps in the physician–patient communication which may contribute to the dissatisfaction reported by most of the present sample.
  2 1,282 116
Will controlled release mebeverine be able to surpass placebo in treatment of diarrhoea predominant irritable bowel syndrome?
Dwaipayan Sarathi Chakraborty, Avijit Hazra, Amrita Sil, Shantasil Pain
October 2019, 8(10):3173-3178
DOI:10.4103/jfmpc.jfmpc_522_19  PMID:31742138
Background and Aims: Irritable bowel syndrome (IBS) is a chronic relapsing disorder characterized by abdominal pain-discomfort and altered bowel habits. The IBS-diarrhoea predominant subtype (IBS-D) is defined as >25% of bowel movements representing type 6 or 7 of the Bristol Stool Form Scale. Management of IBS-D is mainly symptomatic, including lifestyle modification. Due to absence of standard treatment, multiple drugs are used. A controlled release (CR) form of mebeverine, recommended for spasmodic gastrointestinal disorders (including IBS) has recently been introduced in Indian market. We have conducted a placebo-controlled double blind randomized controlled trial [CTRI/2018/03/012897] to evaluate the effectiveness and safety of this product. Methods: 40 patients of IBS-D were recruited from medicine out-patient department (OPD) of a tertiary care hospital and randomized to two parallel groups. One received mebeverine 200 mg CR tablets twice daily for 8 weeks, while other received matching placebo. Outcome parameters were number of bowel movements per day over past 7 days (NoBM7d), severity of abdominal cramps and IBS quality of life (IBSQoL) score. Medication adherence record and treatment emergent adverse events were captured. Results: Mebeverine group showed modest but statistically significant improvement in NoBM7d, cramps and IBSQoL from baseline to 4 and 8 weeks. The changes within the placebo group were not statistically significant. Also, the intergroup differences at both 4 and 8 weeks were not statistically significant. Adherence was better in mebeverine group and both interventions were well tolerated. Conclusions: Mebeverine 200 mg CR twice daily has modest effect in IBS-D and therefore will not be a good choice for patients with severe symptoms.
  2 2,438 168
General public knowledge and use of dietary supplements in Riyadh, Saudi Arabia
Hamad A Algaeed, Mohammed I AlJaber, Abdullah I Alwehaibi, Lubna I AlJaber, Abdulrahman M Arafah, Mohammed A Aloyayri, Omar A Binsebayel, Sultan A Alotaiq, Musaab A Alfozan, Ibrahim Bin Ahmed
October 2019, 8(10):3147-3154
DOI:10.4103/jfmpc.jfmpc_511_19  PMID:31742134
Context: Dietary supplements is a growing industry, pharmaceuticals are having several types of similar supplements and multivitamins as over-the-counter products, a complete diet is necessary for a healthy body which leads to the usage of supplements or multivitamins complementing diets as needed, therefore leading to its encouraged usage among the population worldwide. Aims: The study was aimed to determine the public's knowledge and their use of dietary supplements. Settings and Design: A cross-sectional study was conducted among the general public of Riyadh, Saudi Arabia. Methods and Materials: The sample consisted of 679 participants including 41% males and 59% females. The ethnicity of the participants is 100% Arabs. Statistical Analysis Used: SPSS. Results: The sociodemographic data showed there were more female participants than males (59.1% vs. 40.9%), most of our participants had at least bachelor degree (64.4%), most of our participants had normal BMI (62.3%). 88.5% had knowledge on supplements and only 11.5% stated they were not aware at all. Conclusions: Dietary supplements and multivitamins consumption is prevalent among Saudi Arabian population. Our study suggests the majority of consumers understand the supportive role of dietary supplements and are aware of risks and side effects.
  2 1,420 160
Prevalence of type 2 diabetes and their complications among home health care patients at Al-Kharj military industries corporation hospital
Mohammed Albarakat, Ali Guzu
October 2019, 8(10):3303-3312
DOI:10.4103/jfmpc.jfmpc_634_19  PMID:31742160
Introduction: The diabetes mellitus type 2 is a result of hyperglycemia due to insulin resistance caused by insufficient secretion of insulin from the beta cells of pancreas. The detection and controlling of diabetes mellitus type 2 (DMT2) at primary health-care centers in Saudi Arabia is well justified and widely practiced. The knowledge and awareness of DMT2 patients should be increased through the determination of its prevalence which may decrease the rates of comorbidities. Methods: A questionnaire of 159 patients registered at Home Care Center at Family and Community Medicine Department, Al-Kharj Military Industries Corporation Hospital, Saudi Arabia was used. Hemoglobin A1C (HbA1C) percentage and blood pressure were measured for all participants. Statistical analysis was performed for all data. Results: A total of 36.5% of cases were males and 63.5% were females with a mean age of 77.6 years. 94.3% of participants had DMT2 where 3.8% had type 1. 74.2% of cases experienced only one to two complications other than diabetes where 20.8% had more than three diseases. 47.2% of cases had HbA1C% <7.5% where 29 cases had HbA1C% ranged from 7.5% to 8% and about 32.8% of patients had poor glycemic control with HbA1C >8%. 81.1% of cases had hypertension, while 25.8% suffered from Stroke complication, 8.8% of patients had a congestive cardiac failure, 7.5% had ischemic heart disease, and 6.3% suffered from chronic kidney disease. The treatment goals, HbA1C 7.5--8%, have been achieved for about 64% of DMT2 patients where 51 patients still had uncontrolled DMT2 with HbA1C >8%. Conclusion: Despite the majority of cases had good glycemic control, more attention should be paid to those over 65 years as they commonly had more morbidities that definitely affect their treatment regimes. Patients should be involved in different home health care programs to increase their awareness and knowledge of the possible risk factors and diabetes comorbidities.
  2 2,467 181
Knowledge, attitude, and practice regarding prosthodontic rehabilitation and factors affecting the patients visiting private clinics in Riyadh, Saudi Arabia: A cross-sectional study
Mansour K. A. Assery
October 2019, 8(10):3362-3366
DOI:10.4103/jfmpc.jfmpc_686_19  PMID:31742169
Background: Prosthodontic rehabilitation maintains the esthetics, functional support, and the masticatory function of the oral cavity. The main aim of the present study was to explore the knowledge, attitude, and practice towards prosthodontic rehabilitation and factors affecting the KAP of patients. Materials and Methods: The present research is a cross-sectional descriptive questionnaire study conducted among the patients visiting private hospitals in Riyadh City, Saudi Arabia. The city was divided into five directions; south, north, east, west, and central. From each direction, one hospital was included randomly with more than 50 patients in OPD per day. The interview was conducted among 121 patients from each hospital which made the sample size of 605. Results: Among all study participants in the present study, majority (252 [41.67%]) of them were more than 50 years of age. Female study participants (318 [52.57%]) were more than (287 [47.43%]) the male participants. It was reported that 458 (75.70%) of the study participants have missing teeth ranging from 6 to 10. The main reason reported for absence of prosthesis was money constraints among the 121 (38.90%) study participants. Inadequate knowledge regarding prosthodontic rehabilitation was significantly associated (P-value ≤ 0.05*) with attitude and practice of the study participants. Conclusion: It was concluded that financial constraints were the major factors for not availing prosthodontic rehabilitation. Moreover, inadequate knowledge regarding prosthodontic rehabilitation significantly affects the attitude and practice of the study participants.
  2 921 103
REVIEW ARTICLES
Capacity and confidence building for general practitioners on optimum insulin use
Sanjay Kalra, Prasun Deb, Kalyan K Gangopadhyay, Sunil Gupta, Abhay Ahluwalia
October 2019, 8(10):3096-3107
DOI:10.4103/jfmpc.jfmpc_635_19  PMID:31742126
Type 2 diabetes is characterised by a progressive decline in insulin secretion, and sooner or later patients require insulin therapy. However, physicians are reluctant to initiate insulin therapy because of perceived inadequacy in managing insulin therapy, cost and lack of benefits. Experts from across the country met at a workshop during 12th National Insulin Summit which was held in September at Hyderabad and came up with key recommendations to build capacity and confidence in general practitioners for insulin usage. Barriers can be overcome through self-education and training; effective patient education; imparting coping skill training to patients; and bridging gaps to improve adherence. Moreover, optimum insulinization requires knowledge about the available options for initiation and intensification of insulin therapy; various insulin regimens; dosing and titration; and choosing effective and simple insulin therapy as per patient characteristics. Hence, the objective of this review article is to help build capacity and confidence among general practitioners on optimising insulin therapy.
  2 2,640 221
Association of leukemia and mitochondrial diseases—A review
Ashwani Sachdeva, Jagadish Prasad Rajguru, Kanwardeep Sohi, Swati Saggar Sachdeva, Kirandeep Kaur, Rani Devi, Vivek Rana
October 2019, 8(10):3120-3124
DOI:10.4103/jfmpc.jfmpc_679_19  PMID:31742129
Mitochondria play an important role in various metabolic pathways like oxidative phosphorylation free radical generation and apoptosis. Defects in mitochondrial function are responsible for a number of heterogenous clinical presentations along with development and progression of cancer. Decrease in cellular energy (ATP) production because of impaired oxidative phosphorylation is the most important cause for these underlying disorders. The present review article aims to provide current understanding of mitochondrial genetics and biology and relates the mt-DNA alterations in leukemia patients.
  2 1,279 161
A notorious vector-borne disease: Dengue fever, its evolution as public health threat
Vineet K Pathak, M Mohan
October 2019, 8(10):3125-3129
DOI:10.4103/jfmpc.jfmpc_716_19  PMID:31742130
Dengue fever, the most notorious of vector borne diseases is under global resurgence. Incidence has increased 30 fold with global expansion. It is thus imperative to review the origin, history and current epidemiology of dengue, its transmission, factors responsible for resurgence, surveillance and the treatment options available. India being hyperendemic, national level comprehensive studies to estimate the true burden of dengue along with its geographical mapping is the need of the hour. Through integrated and combined efforts from various sectors and policy makers, prevention of dengue must be identified and intensified to control further disease transmission as there is no specific antiviral treatment or vaccine against dengue is available in India.
  2 5,710 283
CASE REPORTS
Hepatotoxicity and neurotoxicity of Fipronil poisoning in human: A case report
Smitesh Gutta, John D Prasad, Karthik Gunasekaran, Ramya Iyadurai
October 2019, 8(10):3437-3439
DOI:10.4103/jfmpc.jfmpc_486_19  PMID:31742187
Fipronil is an N-phenylprazole insecticide which is commonly used pesticide in south India. In animals it has been described to cause toxic manifestations mainly in the Gastro-intestinal (GI) and Central nervous system (CNS) and less commonly in kidney and liver. The available medical literature about toxic effects of Fipronil consumption in humans has been very little and mostly limited to acute GI and neurological manifestation mostly lasting for less than three days. We report the case of a 32-year-old gentleman who had consumed Fipronil (5%) in an attempt of deliberate self-harm. The patient had neurotoxicity features in the form of seizures and decreased sensorium requiring intensive medical care with mechanical ventilation and also had hepatotoxicity. Both hepatotoxicity and neurotoxicity lasted for nearly three weeks. The patient improved with supportive therapy and gradually overcame both the toxicities.
  1 2,525 175
A transdisciplinary approach for treatment of class III malocclusion
Shalu Jain, Sumit Aggarwal, Tanvi Mahajan, Sameep Singh, Vishwas Bansal, Abhishek Singh
October 2019, 8(10):3412-3415
DOI:10.4103/jfmpc.jfmpc_601_19  PMID:31742179
The main aim of orthodontic treatment is to achieve most stable, functional, and esthetic outcome either by conventional, interdisciplinary, or surgical protocol. Treatment modalities differ for growing and nongrowing patients. In nongrowing patients with moderate to severe dental and skeletal deformities, interdisciplinary treatment combined approach is required with orthodontics and orthognathic surgery. Case discussed here is of class III skeletal bases with orthognathic maxilla and prognathic mandible having anterior crossbite with a horizontal growth pattern treated by transdisciplinary approach with combination of orthodontics, orthognathic surgery, and prosthetic approach to get best achievable results of skeletal class III malocclusion.
  1 1,212 219
A coinfection of severe leptospirosis and scrub typhus in Indian Himalayas
Vibha Mehta, Ankith Bhasi, Prasan Kumar Panda, Pratima Gupta
October 2019, 8(10):3416-3418
DOI:10.4103/jfmpc.jfmpc_614_19  PMID:31742180
Scrub typhus and leptospirosis are zoonosis and systemic febrile illnesses with diverse, nonspecific clinical manifestations, and shared risk factors for coinfection. Diagnosis of the coinfection is dependent on laboratory serological tests, which are under used. A coinfection from Uttarakhand Himalayan region is not yet reported. A 25-year-old man from altitude of 2126 feet above sea level presented with fever, myalgia, jaundice, oliguria, mental confusion, and tender hepatomegaly. Investigations revealed leukocytosis, thrombocytopenia, impaired liver function tests, renal dysfunction with neurological involvement. Leptospira immunoglobulin IgM enzyme linked immunosorbent assay (ELISA) and scrub typhus immunochromatography test were positive. This coinfection is first to be documented in this holy Indian Himalayas. Clinical suspicion, early laboratory diagnosis, and early treatment could prevent complications and fatal outcomes. Coinfection of this type may be considered when there is persistence of fever and a treatment response to doxycycline.
  1 1,185 128
Granuloma annulare: A rare dermatological manifestation of diabetes mellitus
Prabhat Agrawal, Nikhil Pursnani, Roshmy Jose, Maaz Farooqui
October 2019, 8(10):3419-3421
DOI:10.4103/jfmpc.jfmpc_616_19  PMID:31742181
Granuloma annulare (GA) is usually a self-limited, benign granulomatous disease of the dermis and subcutaneous tissue. It's generalized or disseminated form is associated with underlying diabetes mellitus and at times it precedes the sign and symptoms of diabetes mellitus. We are reporting a case of a 56-year-old female, who is a known case of type 2 diabetes mellitus she presented to us with symmetric lesions on her trunk, arms, and legs. On further evaluation by the dermatologists, it was established to be lesions of GA. This case has been reported to highlight the incidence and the importance of recognition of this common but rarely diagnosed condition.
  1 946 97
Post-vaccinial encephalomyelitis – Probable acute disseminated encephalomyelitis (ADEM) -: A case report
Manish Kumar, Sangita Kamath, Ashok Sunder
October 2019, 8(10):3425-3427
DOI:10.4103/jfmpc.jfmpc_651_19  PMID:31742183
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease that typically occurs following a viral infection or vaccination. The incidence of ADEM following vaccination has fallen since the introduction of non-neural rabies vaccine and very few cases have been reported due to pure chick embryo derived rabies vaccine (PCERV). Here we are reporting a rare case of probable post vaccinial ADEM.
  1 1,539 145
EDITORIAL
Healing the heart of healthcare: Leaving no one behind: Impact of 15th World Rural Health Conference New Delhi
Raman Kumar, Pratyush Kumar
October 2019, 8(10):3077-3082
DOI:10.4103/jfmpc.jfmpc_868_19  PMID:31742122
More than a 1,000 delegates from 40 countries participated in the 15th WONCA World Rural Health Conference held at India Habitat Centre, New Delhi, from 26-29th April, 2018. The theme of this conference was “Healing the Heart of Healthcare - Leaving no one behind”. The conference was organized by the Academy of Family Physicians of India in association with WoRSA - WONCA Rural South Asia. WONCA is the World Organization of Family Doctors. The conference aspired to bring rural healthcare on global agenda. SDG 3 though focuses on healthcare; however rural healthcare hasn't been emphasized enough. The conference was formally endorsed by the National Health Mission (NHM) under Ministry of Health and Family Welfare (MOHFW) and the Niti Ayog – the National Policy Commission under Government of India. An extensive scientific program with 13 keynote speakers, 250 oral presentations, 85 e-posters, 60 workshops, 26 Ideathon presentations, 20 panel discussions and 10 symposiums spread over 8 parallel meeting rooms, ran over 4 days, kept the delegates engaged throughout. A national consultation on strengthening rural health care witnessed rural health experts from across the world deliberating on rural health challenges and solutions. Niti Ayog – the policy commission the highest policy making body in India cohosted a national consultation on strengthening rural healthcare in India, during this conference. The conference brought together stakeholders of rural health and primary health care, to address current and future challenges in rural health. The conference culminated with the unanimous adoption of the Delhi Declaration, calling for people living in rural and isolated parts of the country to be given special priority if nations are to achieve universal health coverage. The Declaration identifies six areas as priorities to achieve “Health For All Rural People”: equity and access to care, rural proofing of policy, health system development, developing and educating a workforce fit for purpose, realigning the research and people and communities. Delhi declaration was also featured acknowledged by the World Health Organization at its website as an positive outcome.
  1 1,848 144
LETTERS TO EDITOR
Level of cervical cancer awareness among hospital visitors
Ritika Agarwal, Meeta Sharma
October 2019, 8(10):3452-3453
DOI:10.4103/jfmpc.jfmpc_780_19  PMID:31742192
  1 882 78
ORIGINAL ARTICLES
A study of the status of provision of sterilisation services in India
Surya Bali, Kriti Yadav, Yash Alok
October 2019, 8(10):3297-3302
DOI:10.4103/jfmpc.jfmpc_627_19  PMID:31742159
Context: India has the second-largest population in the world with a significant growth rate that adversely affects the quality of life (QoL). Sterilisation is one of the main methods of female contraception in the country. Meeting the sterilisation services' numerical demand and quality requirements have remained a challenge. Aims: This study was done to assess the infrastructural component of the sterilisation services provided by the static centres. Settings and Design: This was a descriptive cross-sectional facility-based study conducted from September to December 2017. It involved 30 facilities (10 district hospitals and 20 community health centres [CHCs]) from 10 divisions of the state of Madhya Pradesh. Methods and Materials: The data were collected using a pre-tested and pre-structured questionnaire, which was uploaded on the Ona platform. Statistical Analysis Used: Data analysis was performed using SPSS version 21. Results: Only 11 of the 30 facilities had proper waiting areas for the patients. Approximately, only 63% of the facilities had proper toilets, 50% had display of the contraceptives, and 43% had a complaint/suggestion box. In terms of the availability of equipment, only 43% of the facilities had a table with the Trendelenburg facility. Conclusions: The main limitations in the infrastructure of the facilities were general cleanliness; availability of proper waiting and post-operative areas; and the lack of equipment, record keeping, and supervision. To accomplish the provision of quality sterilisation services, policy-makers and programme managers need to pay attention to and address these limitations.
  1 1,628 110
Prevalence of hypothyroidism among chronic kidney disease patients in security force hospital (SFH) in Saudi Arabia
Faisal Alshammari, Sultan Alhazaa, Abdullah Althemery, Fahad Alsabaan, Abdulelah AlGosaibi, Manal Alshammari, Ali Aldabies, Mohammad Alfifi
October 2019, 8(10):3313-3317
DOI:10.4103/jfmpc.jfmpc_641_19  PMID:31742161
Introduction: Impairment in kidney function leads to disturbed thyroid physiology. All levels of the hypothalamic-pituitary-thyroid axis may be involved, including alterations in hormone production, distribution, and excretion, and even CKD progress with hypothyroidism. Aim of Work: To assess the prevalence of hypothyroidism among chronic kidney disease patients. Materials and Methods: A cross-sectional analysis was conducted in the nephrology department of security forces hospital from January 2015 to February 2018. Biochemical tests (includes blood urea, serum creatinine, PTH, total T4, TSH) were carried out to all participants. Results: Out of 255 CKD patients in the present study, 166 patients had no hypothyroidism, 43 had subclinical hypothyroidism, and 46 had hypothyroidism. The percentage of hypothyroidism among CKD patients was 34.9%, including dialysis patients and 17.66% after exclusion. Out of 24 peritoneal dialysis patients in the current study (P = 0.03), 7 had subclinical hypothyroidism and another 7 had hypothyroidism. In addition, out of 139 hemodialysis patients (P = 0.02), 20 patients had subclinical hypothyroidism and 18 had hypothyroidism. The majority (67.36%) of CKD patients were in CKD stage 5 and had no hypothyroidism (45.10%). Only 29 (11.37%) patients in CKD stage 5 had hypothyroidism and 28 (10.89%) patients had subclinical hypothyroidism. T4 was higher in nondialysis patients, whereas TSH and PTH were higher in dialysis patients. Conclusion: The prevalence of hypothyroidism among chronic kidney disease patients was high and increased with the decrease in estimated GFR.
  1 1,438 194
Study of antibiotic efficacy of topical vancomycin powder in treatment of infected mandibular fractures and soft tissue surgical site infections
Geeta Singh, Deepak Passi, Deepti Daga, Abhigyan Manas, U Vignesh, Sujay Milind Bhave
October 2019, 8(10):3340-3344
DOI:10.4103/jfmpc.jfmpc_661_19  PMID:31742165
Aims and Objective: To study the antibiotic efficacy of topical vancomycin in infected mandibular fracture treatment and its effect in preventing surgical site infections. Materials and Methods: The study comprised of 100 subjects of infected mandibular fractures requiring open reduction and internal fixation, randomly categorized into two equal groups of 50 each, that is, vancomycin group (N = 50) treated for infected mandibular fractures with topical vancomycin powder used as adjunct and non-vancomycin group (N = 50). Clinical parameters like hospital stay, postoperative infections, postoperative fever, abnormal swelling, purulent discharge, and fistula formation at surgical site and radiographic healing was evaluated and compared between the groups. Results: Mean age of vancomycin group and non-vancomycin group was 32.5 and 33.2 years, respectively. Demographic factors of the patients like age, sex, and hospital stay (3 ± 0.5 days) did not show significant difference between two groups. Vancomycin group shows 1 hyperthermia, 2 abnormal swelling and discharge, whereas non-vancomycin group shows 6 hyperthermia, 5 postoperative abnormal swelling and discharge with statistically significant (P < 0.05). Culture sensitivity of discharged fluid shows staphylococcal + MRSA infection in two patients in vancomycin group and eight patients in non-vancomycin group. Bony healing in vancomycin group shows one patient had non-union and one had graft rejection, whereas five patients had non-union and graft rejection in non- vancomycin group. The comparative results were statistically significant (P < 0.05). Conclusion: From the result of our study we can conclude that routine use of vancomycin powder in surgical site as a surgical adjunct reduces the incidence of infections at surgical site when it is applied in addition to standard antibiotic prophylaxis. Topical application into a surgical wound also reduces the risk associated with parenteral administration of vancomycin.
  1 1,516 191
The diagnostic precision of apparent diffusion coefficient (ADC) in grading of malignant endometrial lesions compared with histopathological findings
Mohammad M Gharibvand, Azar Ahmadzadeh, Fariba Asadi, Zahra Fazelinejad
October 2019, 8(10):3372-3378
DOI:10.4103/jfmpc.jfmpc_142_19  PMID:31742171
Objective: The present study aimed to extract apparent diffusion coefficient (ADC) values from the diffusion-weighted imaging (DWI) sequence of endometrial lesions and compare them with tissue specimen results in order to determine the precision of ADC values in grading of malignant endometrial lesions. Methods: The present prospective study was conducted on 22 patients complaining of abnormal vaginal bleeding or evidence for endometrial thickening or masses detected using the ultrasound. Sampling was performed for pathological examination. MRI T2W+DWI+T1W+Post Contrast T1W were performed for patients. The statistical analysis was performed in SPSS 20 and MedCalc. Results: In this study, although the mean ADC value was lower in patients with endometrial cancer than those with benign endometrial lesions, the difference was not significant (0.86 ± 0.2 mm2/sec versus 1.33 ± 0.53 mm2/sec; P = 0.13). Using the cutoff point of 0.53, the sensitivity and specificity of ADC value for differentiating benign and malignant lesions, respectively, equaled 90.91 and 9.09, with an equal positive and negative predictive value of 50%. In patients with endometrioid adenocarcinoma, mean ADC value was 0.93 ± 0.15 in FIGO Grade I, and 0.76 ± 0.165 in FIGO Grade II. Based on the statistical test, no significant difference existed between the two groups in terms of ADC values. Conclusion: Results indicate that the use of a DWI sequence (ADC values) can prevent invasive measures in the diagnosis of benign endometrial lesions and the identification of malignant lesions with a high precision in many patients having accompanying diseases or other cases for which invasive measures cannot be used. Also, there is no significant difference in the mean ADC values between G1 and G2 of endometrioid carcinoma.
  1 1,136 130
Epidemiological profile of tuberculosis patients in Delhi, India: A retrospective data analysis from the directly observed treatment short-course (DOTS) center
Priyanka Sharma, Madhur Verma, Meenakshi Bhilwar, Himanshu Shekhar, Neelam Roy, Anita Verma, Geeta Pardeshi
October 2019, 8(10):3388-3392
DOI:10.4103/jfmpc.jfmpc_409_19  PMID:31742174
Background: Tuberculosis (TB) has been a public health menace for decades. India harbors its highest burden globally. The present study was conducted to study the epidemiological profile of patients taking treatment from a directly observed treatment short-course (DOTS) center in Delhi, India. Method: Retrospective analysis of past 1-year treatment records of a total of 227 patients undergoing treatment in DOTS since June 2014–2015 was undertaken. Socio-demographic information, data related to disease status, and HIV testing were collected and analyzed. Results: The majority of cases were new (77.1%) and pulmonary TB (69.2%). The highest disease burden was found in the 20–60 year age group (72.2%) and males (58.6%). Genitourinary TB was present only among females. None of the patients was HIV positive. A significant association was found between the age group of 20–60 years and relapse and loss to follow-up cases (P < 0.05). Conclusions: A higher proportion of adult males aged 20–60 years constituted the majority of patients treated in the DOTS center. Focussed interventions can be designed for this age group in future public health policies to reduce disease burden in the total population. Further research is required to be undertaken in exploring reasons for higher prevalence among males and productive age group and role of age, gender in disease causation
  1 1,069 122
Systemic inflammation in patients of chronic obstructive pulmonary disease with metabolic syndrome
Sufia Naseem, Ummul Baneen
October 2019, 8(10):3393-3398
DOI:10.4103/jfmpc.jfmpc_482_19  PMID:31742175
Context: India has 18% of the global population and an increasing burden of chronic respiratory diseases. The prevalence of Metabolic syndrome (MS) was found to be as high as 39.7% among Indian population. Metabolic syndrome is found to be more common in Chronic Obstructive Pulmonary Disease (COPD) when compared to the general population. This study was done to assess the prevalence of metabolic syndrome in COPD and the association of systemic inflammation in COPD patients with metabolic syndrome. Methodology: This study enrolled 150 consecutive consenting patients of stable COPD attending the outpatient pulmonology department. Detailed history, clinical examination, spirometry, and relevant routine laboratory investigations including complete blood count, fasting blood sugar, and lipid profile were done. In addition, hsCRP, Serum lactate and Vitamin D level was assessed in all patients. Diagnosis of COPD and Metabolic syndrome was done according to GOLD guidelines, 2018 and the International Diabetes Federation criteria respectively. Result: The prevalence of metabolic syndrome was found to be 27.3% in our COPD patients. The frequency of metabolic syndrome in GOLD stage I, II, III, and IV was 75%, 32%, 17%, and 13.5%, respectively. Logistic regression analysis showed a significant relationship of blood leucocyte count (OR = 0.342, CI = 0.171-0.686), hs-CRP (OR = 0.020, CI = 0.003-0.122), pack years (OR = 1.083, CI = 1.026-1.14) and vitamin D levels (OR = 1.219, CI = 1.093-1.359) with metabolic syndrome in COPD patients. Conclusion: Metabolic syndrome is a co-morbidity that is very often overlooked in patients of COPD. Systemic inflammation which is a common characteristic of both COPD and Metabolic syndrome has been found to be an important contributor towards cardiovascular morbidity and mortality.
  1 1,401 187
Study on the perception of Swachh Bharat Abhiyan and attitude towards cleanliness among the residents of urban Jodhpur
Praveen Suthar, Nitin Kumar Joshi, Vibha Joshi
October 2019, 8(10):3136-3139
DOI:10.4103/jfmpc.jfmpc_502_19  PMID:31742132
Context: Swachh Bharat Abhiyan (SBA) is an ambitious project and has been successful in bringing a difference at the facility and infrastructure level, and the objectives of this programme can be achieved if people are aware of this mission and basic sanitation and waste management practices. Aims: To assess awareness and perception of SBA and attitude towards cleanliness among the residents of urban Jodhpur. Settings and Design: A cross-sectional survey was done in the largest mixed-income housing society of Jodhpur. Methods and Materials: A semi-structured questionnaire was designed for data collection. Sample size was 400. Participants aged above 18 years were included in the study. Statistical Analysis Used: Descriptive and inferential statistical analysis was done using Epi Info Version 7.1. The data were evaluated using Chi-square test and P < 0.05 was considered statistically significant. Results: Mean age of female participants were 30.02 ± 11.34 years and male participants were 34.92 ± 13.10 years. Mean perception about SBA for being able to communicate the importance of cleanliness was 4.8, i.e. lying between strongly agree and agree. No significant association was observed between educational status and attitude towards cleanliness (P < 0.005). A significant association was seen between gender and knowledge about SBA in terms of correctly mentioning the duration of the SBA programme (P > 0.005). Conclusions: Existing knowledge about SBA and perception towards cleanliness among participants were positive but still there is need of programmes and strategies that help in bringing positive behaviour among group of people who are reluctant towards adopting proper cleanliness, sanitation and hygiene practices.
  1 4,519 328
Comparison of the subgingival temperature of smokers and nonsmokers in healthy and diseased sites of gingiva in association with sublingual body temperature
Dhirendra K Singh, Gunjan Kumar
October 2019, 8(10):3166-3172
DOI:10.4103/jfmpc.jfmpc_516_19  PMID:31742137
Background: To compare the subgingival temperature in healthy and diseased sites of gingiva in smokers and non-smokers using a modified digital thermometer. To also find whether subgingival temperature measurements can be used as reliable indicator of periodontal disease activity. Materials and Methods: Participants for this study comprised 50 males, 25 smokers and 25 non-smokers with mild to moderate periodontitis, aged 25-40 years and had four maxillary incisor teeth (12, 11, 21, 22) intact. For each participant, six sites around each tooth were examined. Hence, a total of 24 sites for each participant were examined. The clinical parameters used were probing pocket depth and gingival bleeding index. Results: Sublingual and subgingival temperature was found to be warmer in smokers compared to non-smokers. Subgingival temperature was more in diseased sites than healthy sites in both smokers and non-smokers. The mean temperature differential of diseased sites in smokers was more compared to non-smokers. Mean probing pocket depth was higher in smokers, but bleeding sites were less. Conclusion: Subgingival temperature measurement was found to be a good indicator of periodontal disease activity.
  1 1,294 128
VEGF-A and cardiac autonomic function in newly diagnosed type 2 diabetes mellitus: A cross-sectional study at a tertiary care center
Suresh Ravichandran, Shival Srivastav, Prathamesh Haridas Kamble, Shailja Chambial, Ravindra Shukla, Praveen Sharma, Rajesh Kumar Sharma
October 2019, 8(10):3185-3190
DOI:10.4103/jfmpc.jfmpc_537_19  PMID:31742140
Introduction: Cardiac autonomic neuropathy (CAN) is a key complication of type 2 diabetes mellitus (Ty2DM). Vascular endothelial-derived growth factor (VEGF-A) plays a key role in diabetic macrovascular and microvascular complications. It is shown to be elevated in diabetic neuropathy and has the potential to serve as a biomarker in Ty2DM. We evaluated VEGF-A levels and cardiac autonomic function in newly diagnosed Ty2DM patients. Materials and Methods: Forty-four newly diagnosed patients (with symptoms within 1 year from the date of recruitment) were included in the study. Cardiac autonomic function was assessed using heart rate variability (HRV) and Ewing's battery tests. Ewing's scores were computed and tabulated. VEGF-A levels were estimated using enzyme-linked immunosorbent assay (ELISA). Results: The patients demonstrated normal responses to the reactivity tests. Ewing's scores were 0 (0-0) and 0 (0-0) for sympathetic and parasympathetic parameters, respectively. The autonomic tone was impaired as assessed by HRV parameters. VEGF-A levels were elevated (308.3 ± 167.2 pg/mL) when compared with the previous literature. Discussion: Impaired tone with normal reactivity was suggestive of early stage of autonomic neuropathy. Elevated VEGF-A levels may be attributed to a protective action of the factor seen in early stages of neuropathy in Ty2DM. Serial VEGF-A estimation in large cohorts of newly diagnosed diabetics may validate it as a biomarker in CAN seen in Ty2DM.
  1 1,055 130
Prevalence of multidrug resistance tuberculosis in adult patients in India: A systematic review and meta-analysis
Jaykaran Charan, Nitish Tank, Tea Reljic, Surjit Singh, Pankaj Bhardwaj, Rimplejeet Kaur, Jagdish P Goyal, Ambuj Kumar
October 2019, 8(10):3191-3201
DOI:10.4103/jfmpc.jfmpc_542_19  PMID:31742141
Background: Multidrug resistance tuberculosis (MDR-TB) is an important public health problem for India but there is a paucity of data related to the prevalence of MDR-TB in India. This systematic review and meta-analysis was designed to synthesize evidence regarding the prevalence of MDR-TB in adult patients in India. Methods: PubMed and Google Scholar were searched to find different observational studies reporting MDR-TB prevalence in India. Data related to MDR-TB prevalence were pooled for the analysis. PubMed was searched by using different MeSH words. Prevalence was reported with 95% confidence interval (CI). A separate analysis was done for new cases and previously treated cases. Random effect model was used and heterogeneity was assessed by I2 and Cochran Q test. Results: MDR-TB prevalence in new cases were 3% (95% CI 2%-5%, I2 = 95.3%). There was difference in prevalence between different methods of measurement of MDR-TB and study designs. MDR-TB prevalence in previously treated cases was found to be 35% (95% CI 29%-41%, I2 = 98.7%). Results vary with the method of measurement as well as the study design. Conclusion: MDR-TB prevalence in previously treated patients was found higher compared to the reported values in national surveys. There is a need for large scale cross-sectional study to verify the findings observed in this review.
  1 3,865 282
A population-based cross-sectional study to determine the practices of breastfeeding among the lactating mothers of Patiala city
Avneet Randhawa, Neha Chaudhary, BS Gill, Amarjit Singh, Vibhor Garg, RS Balgir
October 2019, 8(10):3207-3213
DOI:10.4103/jfmpc.jfmpc_549_19  PMID:31742143
Introduction: The present study was undertaken to study the breastfeeding practices and the influence of literacy and prevailing cultural factors on different aspects of breastfeeding. Materials and Methods: A community-based cross-sectional study was conducted at Badungar, a semi-urban area in Patiala city including a total of 370 mothers. Mothers were interviewed using pre-formed, semi-structured Performa. The participant's demographic information, awareness and practices regarding breastfeeding were recorded by paying house to house visits. Data were analyzed using SPSS ver. 21. Results: Only 27.30% of the mothers knew that breastfeeding should be initiated within 1 hour of birth. A total of 51.62% mothers considered prelacteal feed to be the right practice while 55.95% considered colostrum bad for the baby. Only 53.78% of the lactating mothers knew the correct meaning of exclusive breastfeeding. Only 24.86% mothers started breastfeeding within an hour after birth. Colostrum was not given by 57.29% of the lactating mothers while Prelacteal feeds were given by 50.81% mothers. Exclusive breastfeeding till 6 months was given by 45.67% mothers. A significant association was observed in high mother's education, high socio-economic status, nuclear status of family, history of antenatal care registration, and hospital delivery with exclusive breastfeeding (P < 0.01). Conclusion: Study concluded that breastfeeding practices were not optimum; hence promotion of knowledge regarding the right practices of breastfeeding and focus on the factors affecting them is highly warranted in this area.
  1 2,227 239
Views of physicians on the establishment of a department of family medicine in South India: A qualitative study
Sajitha M. F. Rahman, Evelyn Vingilis, Saadia Hameed
October 2019, 8(10):3214-3219
DOI:10.4103/jfmpc.jfmpc_551_19  PMID:31742144
Objective: To explore the experiences and perceptions of physicians involved in establishing a department of Family Medicine in South India. Methods: In this study, descriptive qualitative methodology was used. Nine family physicians and one community medicine physician were interviewed. The data were subjected to thematic analysis. Findings: The establishment of a department of Family Medicine in South India in response to the local health-care demands needed support from the institution, visionary leaders and alumni of the institution. The key challenges perceived were lack of mentorship, lack of identity and misunderstanding of the work of family physicians. Conclusion: This study replicates earlier studies on the role of local health-care needs and visionary leaders in striving towards family medicine-based clinical services that further evolved into training and research opportunities in family medicine. The study identified the challenges and supportive forces behind the initiation of a department of Family Medicine and the role of family physicians in strengthening primary health care.
  1 905 82
Job satisfaction among health care providers: A cross-sectional study in public health facilities of Punjab, India
Tarundeep Singh, Manmeet Kaur, Madhur Verma, Rajesh Kumar
October 2019, 8(10):3268-3275
DOI:10.4103/jfmpc.jfmpc_600_19  PMID:31742154
Introduction: Job satisfaction is a multidimensional response to work and workplace environment. It depends on many factors, and affects the behavior of employees that, in turn, affects organizational functioning. The aim of the study was to measure job satisfaction among different categories of healthcare providers from the Punjab government health services and to determine the factors that affect job satisfaction the most. Methodology: The study was conducted between September 2015 and February 2016 and included 462 participants working under the Punjab Government health services. Multi-stage random sampling was used, and participants were interviewed telephonically. The study instrument comprised the sociodemographic data and questions from Job Satisfaction Scale (JSS). Results: Three-fourth of the respondents (75.3%) were dissatisfied by their working conditions, followed by fringe benefits facet (34%), promotion facet (25.4%), and contingent rewards facet (23.7%). But they felt satisfied concerning relations with their coworkers (97%), nature of their work (93.3%), supervision (91.2%) and communication facet (80.6). Ambivalence was seen in a range of 2.8% (coworkers facet) to 54.8% (contingent rewards facet). Conclusion: Job satisfaction affects future career goals, social relationships, and personal health. An extremely demanding workplace can make workers susceptible to feelings of uncertainty and low self-esteem. It is recommended to beef up the policies related to healthcare providers and their working conditions regularly. Job responsibilities should have a scope of change to avoid monotony and loss of interest. A conducive working ecosystem can have a positive effect on the evolving health system of a country.
  1 5,946 534
Immune status against diphtheria in healthy adults
Jesheera M Kutty, Bijayraj RajanBabu, Sohanlal Thiruvoth
October 2019, 8(10):3253-3257
DOI:10.4103/jfmpc.jfmpc_589_19  PMID:31742151
Outbreaks of diphtheria continue to occur in Kerala with an age shift to older population. Antibody seroprevalence studies are essential to understand the immune status of the community and to develop an effective immunization strategy. Aim: To assess the necessity of diphtheria vaccination among adults. Settings and Design: Cross-sectional study, among 152 healthy adults (>18 years).Methods and Materials: Diphtheria IgG antibody detection was performed by using ELISA technique. Results: Out of 152 study population, 14 (9.2%) individuals had very low antibody levels, requiring basic immunization, 123 (80.9%) needed booster vaccination, 12 (7.9%) would need a booster dose in 5 years and 3 (2%) would need a booster dose in 7 years to maintain adequate antibody levels. Out of the total, 131 (86.2%) individuals had completed childhood immunization and 21 (13.8%) had incomplete or no immunization during childhood. In the population who had completed childhood immunization, 4 (3%) had very low antibody levels requiring basic immunization and 113 (86%) had antibody levels needing booster vaccine soon, with the remaining 14 (10.6%) individuals requiring a booster vaccine after 5 years and 7 years. In the partially immunized/unimmunized population, 10 (47.6%) had antibody levels requiring basic immunization and another 10 (47.6%) had antibody levels low enough to warrant a booster vaccine. Conclusions: Majority of the subjects who had completed childhood immunization showed an inadequate immunity against diphtheria during adulthood. This indicates waning immunity against diphtheria. Hence, modifying the present diphtheria vaccination strategy to include booster doses during adulthood is essential. Context: Even in developed countries where nearly 100% universal immunization is achieved, diphtheria outbreaks are known to occur. Several seroprevalence studies have been conducted in those regions to determine whether those populations have adequate levels of antibodies against diphtheria. In India, sporadic outbreaks occur, and an increasing number of diphtheria cases are being reported over the last few years. Large outbreaks in Kerala 2016 were about 533 cases. Recent outbreaks in 2019, in Trivandrum, about 175 cases were suspected and 19 cases were confirmed in laboratory. However, Indian studies to determine whether the adult population has adequate protective antibody levels are lacking. Knowing the immune status of the population and devising an appropriate strategies to prevent outbreaks of diphtheria are the integral parts of primary care. These concerns are the basis and evaluation of the seroprevalence of IgG antibody levels against diphtheria antitoxin among healthy adults in our region in this study.
  1 1,151 110
REVIEW ARTICLES
Interventions in management of dental fluorosis, an endemic disease: A systematic review
Nor Syakirah Binti Shahroom, Geo Mani, Mahesh Ramakrishnan
October 2019, 8(10):3108-3113
DOI:10.4103/jfmpc.jfmpc_648_19  PMID:31742127
Objective: Mottling and pitting of enamel due to excess fluoride consumption may affect one's self-esteem due to unaesthetic appearance and also in turn can affect the quality of life. This present study was conducted to assess various treatment approaches available for patients with dental fluorosis. Materials and Methods: Literatures were searched from August 1998 to August 2019 for articles in the management of dental fluorosis. The databases used were National Center for Biotechnology Information (NCBI) and Google Scholar. In NCBI, the filters were modified to randomized controlled trial, clinical trial, human trial, and free full-text articles. The following queries were used in order to search for the article: treatment for dental fluorosis, intervention of dental fluorosis, and management of dental fluorosis. Results: All the five studies selected after screening were randomized controlled trials. Total number of patients included in this study were 304 with the mean age of 17.7 years old. They were treated with microabrasion, bleaching, resin infiltration or combination of microabrasion with bleaching, and resin infiltration with bleaching. Microabrasion resulted in less esthetic improvement compared with bleaching. Meanwhile, resin infiltration showed a greater improvement in esthetics in comparison to bleaching. Resin infiltration with additional infiltration time and combination of resin infiltration with bleaching are the best treatment options. Conclusion: Based on this systematic review, resin infiltration with increased infiltration time is the best treatment approach in treating dental fluorosis.
  1 4,820 830
CASE REPORTS
Generalized seizure following lignocaine administration: Case report and literature review
Jaspreet K Boparai, Deepti Chopra, Sandeep K Pandey, Bharti Bhandari
October 2019, 8(10):3440-3442
DOI:10.4103/jfmpc.jfmpc_552_19  PMID:31742188
Local anaesthetics (LAs) are considered the most effective drugs for prevention and management of pain associated with dental procedures. Lignocaine is the most preferred LA worldwide. Adverse drug reactions reported with lignocaine use are usually mild, however severe complications have been encountered. This article reports a case of lignocaine-induced seizure in a child. We also reviewed similar cases encountered over the last 10 years. The possible explanations could be placement of the needle in a small vein or hypersensitivity to lignocaine. We hereby reinforce the fact that seemingly safe LA's can cause life-threatening complications and rapid identification of clinical symptoms can drastically change the clinical course. Hence it is vital that primary care physicians and other healthcare professionals should to be aware, alert and be able to diagnose and manage these reactions immediately.
  - 1,122 108
Skin metastasis from squamous cell carcinoma of the cervix to the lower extremities: Case report and review of the literature
Sumayyah I Alrefaie, Hussein M Alshamrani, Mohammed H Abduljabbar, Jehad O Hariri
October 2019, 8(10):3443-3446
DOI:10.4103/jfmpc.jfmpc_541_19  PMID:31742189
Squamous cell carcinoma of cervix commonly metastasizes to the lymph nodes of the pelvis and skin metastasis is a rare presentation even in the late stages of cervical cancer. We report here the first case of cervical cancer with skin metastasis in Saudi Arabia in a 69-year-old female that preceded the diagnosis of cervical carcinoma. Microscopic examination of the skin lesion revealed poorly differentiated squamous cell carcinoma. The patient was in stage IVB based on the International Federation of Gynecology and Obstetrics (FIGO) staging system. Due to her late presentation and advanced stage, the decision was to place the patient on palliative therapy. Later, the patient passed away due to the progression of her disease. The case reported in this paper emphasizes the need for a complete clinical assessment to rule out metastatic disease from cases with known cervical cancer and include skin examination in their follow-up.
  - 1,062 119
Teratoid Wilms' tumor of kidney with neural tissue predominant: Case report with review of literature
Santosh G Rathod, Mahesh U Garje, Vinayagapandian Sakthivel, Priyanka P Dhaimbekar
October 2019, 8(10):3447-3449
DOI:10.4103/jfmpc.jfmpc_558_19  PMID:31742190
Wilms' tumor is most common pediatric renal tumor. Teratoid Wilms' tumor is a variant of Wilms' tumor, in which heterologous tissue predominates. Most commonly, epithelial and mesenchymal tissue present as heterologous component. Biological behavior of this tumor is very different from usual Wilms' tumor. They do not respond to chemotherapy and radiotherapy. We are presenting another case of teratoid Wilms' tumor in a 4-year female child with a review of literature.
  - 895 87
A clinical dilemma in an unconscious patient
Suman K Panda, Hari Mohan P. Sinha, Binita Panigrahi, Satish K Prasad
October 2019, 8(10):3428-3430
DOI:10.4103/jfmpc.jfmpc_672_19  PMID:31742184
Snake bite is a major life-threatening emergency seen more commonly in rural tropical countries. In general, about 70% of the bites are nonpoisonous, 15% are dry bites, and only 15% cause envenomation. Venom is the saliva of snake ejected during biting, from the poison apparatus (the modified parotid glands). It can be neurotoxic, vasculotoxic, or myotoxic in its action. The polyvalent antisnake venom is effective against most common poisonous snakes. Prompt diagnosis and timely administration of the polyvalent antisnake venom can reduce mortality and morbidity to a great extent. We present a case which was brought to the emergency department of without any previous forthcoming history of snakebite, with symptom such as abdominal pain, chest pain, vomiting, and respiratory distress followed by loss of consciousness. The patient was timely resuscitated and with prompt use of polyvalent ASV and neostigmine the patient recovered without any neurological symptoms within a week.
  - 1,088 100
Hyperglycemia-induced posterior reversible encephalopathy syndrome: A rare cause of reversible blindness
Nishanth Dev, Rahul Kumar, Priyadarshi Kumar, Ashok Kumawat
October 2019, 8(10):3431-3433
DOI:10.4103/jfmpc.jfmpc_695_19  PMID:31742185
Posterior reversible encephalopathy syndrome (PRES) is an amalgam of clinical and radiological entities, which is reversible if diagnosed and treated promptly. It is characterized by varying neurological manifestation of seizure, headache, visual loss with typical magnetic resonance imaging findings of symmetric distribution of changes involving the parietooccipital lobes, which reflects vasogenic edema. The common causes include hypertension, renal failure, eclampsia, preeclampsia, sepsis, diabetic ketoacidosis, sepsis, cytotoxic drugs, and autoimmune disorders. Although it has been reported in association with diabetic ketoacidosis in few cases, its association with hyperglycemia in the absence of any other clinical or metabolic derangements is extremely rare. We report here a case of reversible blindness caused by hyperglycemia-induced PRES in a 21-year-old female.
  - 1,393 132
Chest pain and exercise induced left bundle branch block – A clinical dilemma
Surender Deora, Jai Bharat Sharma, Rahul Choudhary, Atul Kaushik
October 2019, 8(10):3434-3436
DOI:10.4103/jfmpc.jfmpc_747_19  PMID:31742186
Exercise-induced left bundle branch block is a rare electrocardiographic phenomenon. We present two patients with angina pectoris who developed left bundle branch block on ECG during treadmill test. The first patient had non-obstructive coronary arteries with slow flow and is a rarely reported entity. The second patient had typical chest pain with single vessel Coronary Artery Disease. Left bundle branch block occurred in stage I of Treadmill Testing and persisted for approximately 4 hours and then reverted spontaneously. These two interesting cases of this rare phenomenon are presented here with review of relevant literature.
  - 1,862 144
Recurrent cerebral venous sinus thrombosis in a young man- A case report of JAK2-negative polycythemia vera
Akanksha Singh, Subodh Kumar Mahto, Jyotsana Prasad, Suman Sharma, Ashwani Kumar Malhotra
October 2019, 8(10):3422-3424
DOI:10.4103/jfmpc.jfmpc_628_19  PMID:31742182
Polycythemia vera (PV) is a myeloproliferative disorder most commonly associated with JAK2V617F mutation. Cerebral venous sinus thrombosis (CVST) has a wide range of etiologies and PV is one of them. CVST associated with PV has a poor prognosis. Some patients with classical PV lack JAK2V617F mutation and the molecular basis of JAK2V617F-negative PV is not known. We hereby report a case of a young man who presented with headache, vomiting and altered sensorium and was found to have recurrent CSVT. The patient had primary polycythemia and was subsequently diagnosed to have JAK2-negative PV.
  - 1,108 118
An unusual case of pulmonary arterio-venous fistula (PAVF)
Ajay Kumar Jha, Ashok Sunder
October 2019, 8(10):3408-3411
DOI:10.4103/jfmpc.jfmpc_580_19  PMID:31742178
Pulmonary Arteriovenous Fistula (PAVF) is an abnormal communication between the pulmonary veins and pulmonary arteries. Most individuals may have the condition since birth (congenital occurrence), but it can also be an acquired condition. Most individuals with Pulmonary Arteriovenous Fistula also have a hereditary haemorrhagic telangiectasia. The common signs and symptoms of Pulmonary Arteriovenous Fistula are shortness of breath, haemoptysis, chest pain, dizziness, and syncope. Pulmonary Arteriovenous Fistula is treated with embolization and surgery. PAVF are more common in females than males. Complete evaluation of medical history along with a thorough physical examination required to diagnose PAVF. The CT scan is more sensitive than a chest x-ray in establishing a diagnosis. However pulmonary angiography is the gold standard. Many clinical conditions may have similar signs and symptoms. PAVF is associated with variety of complications, some of which may be life-threatening. These may include: Stroke, bleeding in the lung and brain abscess. Typically, individuals with mild conditions presenting no symptoms may not require any treatment. The treatment of Pulmonary Arteriovenous Fistula may include: Embolization and surgery (the later may be required in a cases not responding to embolization). During surgery, the abnormal vessels are removed along with surrounding lung tissue. We report a rare case of large right pulmonary arterio-venous fistula (PAVF) which was misdiagnosed as mass lung in a 30-year-old lady who presented with generalized seizures due to secondary polycythemia, right sided hemiparesis, central cyanosis and clubbing. She had hypoxemia while breathing ambient air and little improvement with 100% oxygen. Diagnosis was clinched by pulmonary CT angiography which revealed a large PAVF.
  - 1,051 132
COMMENTARY
Role of social marketing in promoting primary care to succeed in current era
Arti Gupta, Navya Krishna Naidu, Rakesh Kakkar
October 2019, 8(10):3086-3089
DOI:10.4103/jfmpc.jfmpc_514_19  PMID:31742124
Social marketing has expanded its purview in the modern era aiming at a behavioral change of target audience on a large scale. Public health practitioners now admit the value of community-based approaches to social change. Three main patterns of health education materials are social marketing communication material, information and education communication (IEC) material, and behavior change communication (BCC) material. Social marketing is a strategy based on marketing principles of selling products. The communication material suggests that the healthcare option for a particular disease is the best solution, and therefore choice or critical thinking is not necessary. IEC strategy attempts at informing people and increasing their knowledge about a disease, having them use it as a basis for action. BCC strategy promotes individual change leading to healthy community behavior. Social marketing communication material for communities should be creative, innovative, original, with clear messages in English and other local languages, reproducible, acceptable, and reflective. Primary care requires customizing health education material using translatable strategies based on social marketing to change health-care patient behavior for wellbeing. The concept of social marketing should be emphasized in early medical education. In the present times, doctors and medical students should be informed about different communication strategies to transform communication material into program tools to achieve health.
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EVIDENCE BASED SUMMARY
Camel milk for reduction of diabetes risk: Are we heading toward the right direction?
Komal Shah, Sandul Yasobant, Deepak Saxena
October 2019, 8(10):3083-3085
DOI:10.4103/jfmpc.jfmpc_501_19  PMID:31742123
Diabetes is emerging as an important public health problem in India imparting huge burden on healthcare economics. Recently a milk packaging company has introduced camel milk product with its potential use in reducing risk of diabetes. In this study, we had evaluated the available evidences and found that though camel milk may have some benefits for the patients with type 1 diabetes, its efficacy for improving glycemic profile of type 2 diabetes is highly controversial and further evidences in the form of randomized controlled trials are needed to substantiate the effect.
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LETTERS TO EDITOR
Doctor! Thou shall abide by amended Hippocratic oath
Ganesh S Dharmshaktu, Tanuja Pangtey
October 2019, 8(10):3450-3451
DOI:10.4103/jfmpc.jfmpc_763_19  PMID:31742191
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Chloroquine induced utricaria—A detailed history helps
Pugazhenthan Thangaraju, Sajitha Venkatesan, Meenalotchini Prakash
October 2019, 8(10):3454-3455
DOI:10.4103/jfmpc.jfmpc_712_19  PMID:31742193
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Lord Mountbatten's last supper to public health's last rites – The trajectory of medicine
Jayanta Bhattacharya
October 2019, 8(10):3456-3456
DOI:10.4103/jfmpc.jfmpc_744_19  PMID:31742194
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ORIGINAL ARTICLES
Flexible nasopharyngolaryngoscopy: Evaluation and appraisal of its effectiveness and diagnostic yield, The Nigerian experience
Shuaib Kayode Aremu
October 2019, 8(10):3399-3403
DOI:10.4103/jfmpc.jfmpc_489_19  PMID:31742176
Background: Fiber-optic nasopahryngolaryngoscopy is a visual examination of the larynx and its related structures. It is an effective procedure for ascertaining the causes of laryngeal disorders, pain in the throat, and difficulty in swallowing and hence should be used in all ENT clinics routinely. This study established the diagnostic effectiveness of fiber-optic nasoparyngolaryngoscopy in our clinics in Federal Teaching Hospital Ido-Ekiti, Ekiti State, Nigeria. It also analyzed the indications, findings, and the role it played in the management of the patients. Materials and Methods: This was a one-year (May 2015 to April 2019) prospective study involving 100 patients who had nasolaryngoscopy procedures done in the ear, nose, and throat (ENT) surgery clinics of Federal Teaching Hospital Ido-Ekiti, Ekiti State, Nigeria. A structured proforma was designed for the study. The data collected included the biodata (age and sex), presenting symptoms/indications for the procedure and findings at nasopharyngolaryngoscopy. These were entered into SPSS version 24 computer software and analyzed descriptively. Results: A total of 100 patients had the procedure during the study period. The mean age and standard deviation of respondents were 47.3 ± 16.4 years with more than half (71.0%) being females. The male to female ratio was 1:2.4. Majority of the patients were in the age range of 60 years and above (28.0%) while the minority were less than 20 years (6.0%). Conclusion: This study substantiates the contention that flexible nasopharyngolaryngoscopy is a very effective diagnostic tool for the patients presenting with upper airway related symptoms.
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Addressing the relationship between paratracheal air cyst and Paranchymal lung disease in thoracic CT-scan in patients referring to Golestan Hospital of Ahvaz
Vina Goudarzi, Mohammad Momeni, Mohammad Ghasem Hanafi, Azim Motamedfar
October 2019, 8(10):3404-3407
DOI:10.4103/jfmpc.jfmpc_491_19  PMID:31742177
Background and Aims: Gas accumulation around the tracheamay is observed in neck and thoracic CT scans making the radiologist suspect whether these symptoms are associated with a pathologic process. This study was designed to evaluate the prevalence of partharesal cysts and their association with lung disease. Methods: The results of 400 patients evaluated for thoracic routine were analyzed for presence of paratracheal cysts. The location of cysts, size, shape and their relationship with the trachea were studied. The patients' results were compared with and without paratracheal cysts. The collected data were analyzed using SPSS software version 22. Results: Paratracheal cysts were found in 30 patients (7.5%) including 12 males and 18 females (P = 0.07). The age range was between 3 to 78 years old and the mean ages in patients with and without paratracheal cysts were 54 and 38 years, respectively (P < 0.0001). More than 60% of patients had cysts associated with the trachea. The mean AP level in patients with paratracheal cysts was significantly higher (P = 0.04). In addition, it was observed that the incidence of paratracheal cysts in patients with lung disease and especially COPD patients was higher (P < 0.0001). Conclusion: In general, the results of this study showed that paratracheal cysts had a high prevalence and had a significant correlation with the presence of COPD. It was also observed that the incidence of these cysts increases in older people, which indicates that paratracheal cysts have an acquired mechanism.
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Comparison of central venous catheter in brachiocephalic vein and internal jugular vein for the incidence of complications in patients undergoing radiology
Azim Motamedfar, Mohammad M Gharibvand, Asadollah Jalil
October 2019, 8(10):3379-3382
DOI:10.4103/jfmpc.jfmpc_205_19  PMID:31742172
Introduction: Central venous catheter (CVC) is an essential part of modern medical care that delivers the drugs, intravenous fluids, and intravenous feeding to the vein. So far, limited studies have been carried out on the brachiocephalic vein (BCV) in adults. This study aimed to compare the CVC in the internal jugular vein (IJV) and BCV in order to ease of access and incidence of complication such as infectious and mechanical complications. Materials and Methods: This clinical trial was performed on 52 patients who underwent BCV and the IJV catheterization. The patients were compared in two groups of IJV and BCV in order to facilitate catheterization and measure the success rate and catheterization-induced complications. The difference between the two groups was analyzed by Independent t-test and Chi-square tests. Results: Overall, 52 patients underwent intravenous catheterization. The success rate of catheterization in the first attempt was 100%. The problems of catheterization procedure in the IJV group (11.5%) were greater than the BCV group (6.6%). There was no significant difference between the two groups regarding the duration of catheterization, pneumothorax, emphysema, hematoma, arterial puncture, infection, and complete thrombosis, whereas the partial thrombosis in the IJV group (30.76%) was significantly (P < 0.05) greater than the BCV group (23.07%). Conclusion: Catheterization in both brachiocephalic and the IJV is an appropriate, highly efficient, stable, and safe procedure and ultrasound-guided catheterization is very reliable and safe method.
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Awareness of carpal tunnel syndrome among adult population of Al Majmaah city, Saudi Arabia, 2018–2019
Yousef Mohammed Y. Alyousef, Fahad Mohammed Y. Alyousef, Saleh Khalaf M. Almaymoni, Mohammed Abdallah Hazizi, Mohammed Khalaf M. Almaymoni, Abdulrahman Mohammed Y. Alyousef, Osama Abdullah Hazazi, Ahmad Abdulrahman M. Bayamin
October 2019, 8(10):3383-3387
DOI:10.4103/jfmpc.jfmpc_400_18  PMID:31742173
Background: Due to the lack of data and studies concerning about measurement of population awareness about carpal tunnel syndrome (CTS) in Al Majmaah city, this study aims at determining the level of population awareness among Al Majmaah adult population in Saudi Arabia. Aims: To study the awareness of CTS among adult population in Al Majmaah city, Saudi Arabia, and to estimate the overall prevalence of CTS. In addition, to look for the relationship between CTS and chronic disease. Materials and Methods: In this cross-sectional study, 386 individuals were covered, both males and females in the targeted areas. A standardized questionnaire was used to cover 11 different aspects concerning CTS. SPSS package was used to analyze the data collected from the sample. Results: The result of scoring system shows that 54 of participants (14.0%) have CTS. Approximately, 30% of them are thought that the main symptom is pain in wrist. However, 26.7% think that tingling and numbness in fingers is the main manifestation. The most causes that population think that leads to the CTS are trauma, repeated hand physical activities such as using computer, taping, and wrist fracture or dislocation by 33.8%, 29.1%, and 21.4% respectively. There is relationship between patients who had chronic diseases and CTS [sig = 0.000]. CTS cause a strong effect on social life by 79.01% of participant though that CTS could affect patient sleep and job performance. Conclusion: The awareness of community was sufficient among adult population in Al Majmaah city, and the prevalence of CTS is 14%.
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Does aging have an impact on hemoglobin? Study in elderly population at rural teaching hospital
Nitin Raisinghani, Sunil Kumar, Sourya Acharya, Aditi Gadegone, Vinay Pai
October 2019, 8(10):3345-3349
DOI:10.4103/jfmpc.jfmpc_668_19  PMID:31742166
Background: The prevalence of anemia increases with age. Some serious underlying conditions may lead to anemia in the old age. The present study was undertaken to detect and do morphological typing of anemia and further delineate etiological factors in elderly patients. Methods: In this hospital-based prevalence study carried out a tertiary care center over one and half years, a total of 90 patients were fully evaluated for etiology and typing of anemia in elderly (>60 years age) patients. Details of other significant medical and surgical history were noted. Laboratory investigations were conducted, which included complete hemogram, peripheral blood smear, reticulocyte count, erythrocyte sedimentation rate estimation, serum urea, serum creatinine and serum lactate dehydrogenase, bone marrow examination (with Prussian blue marrow iron staining), serum iron and serum total iron-binding capacity, serum ferritin, and stool and urine examination. Results: The mean hemoglobin as per age was 60–64 years- 5.95 gm%, 65–69 years - 6.7 gm%, 70–74 years - 6.58 gm%, and 75–79 years - 6.87 gm%. The difference not being significant (p = 0.33). Morphologically, 53 patients (24 males and 29 females) had microcytic anemia, 27 (17 males and 10 females) had normocytic anemia, and 10 (8 males and 2 females) had macrocytic anemia. Anemia of chronic disease (ACD) was the most common occurrence (50, 55.56%), followed by iron deficiency anemia (IDA) (27, 30%), macrocytic anemia (9, 10%), and others 4 (4.44%). The cause of anemia was found in 10 out of 27 (37.03%) patients in the IDA group, 28 out of 50 (56%) in the ACD group, whereas the etiology was discernible in only one out of nine cases (11.1%) of macrocytic anemias. Conclusion: There was no significant difference observed in the mean hemoglobin levels as the age increased. Morphologically, the majority of the patients had microcytic anemia, followed by normocytic anemia. A population-based study is recommended for further assessment of the prevalence and causes of anemias in asymptomatic elderly subjects.
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Perceptions and preferences regarding sex and contraception, amongst adolescents
Vineet Kaur Ahuja, Siriesha Patnaik, Gurchandandeep , Yogita Lugani, Nidhi Sharma, Sandeep Goyal, Gunbir Singh
October 2019, 8(10):3350-3355
DOI:10.4103/jfmpc.jfmpc_676_19  PMID:31742167
Introduction: Conceptually and by the outlook, the reproductive and sexual health needs of adolescents differ from those of adults. Adolescent girls are coerced into unwanted sex or marriage, putting them at risk of unwanted pregnancies, unsafe abortions, sexually transmitted infections (STIs) including HIV, and dangerous childbirth. A majority of young people do not have correct information on the use of contraceptives or the prevention of pregnancy and STIs, and youth-friendly reproductive health services are not readily available. Materials and Methods: A community-based cross-sectional study conducted among school-going 500 adolescent girls in the field practice area of Urban Health Training Centre, Tripuri, of Government Medical College, Patiala (Punjab). A survey with semi-structured, self-administered, and pretested questionnaire was conducted to collect the information on demographic characteristics, and knowledge and perceptions about safe sex. Results: Only 39.71% of girls were aware that the legal age of marriage of girls in India is 18 years. About 22% of girls said that they would prefer to have pre-marital sex and majority, out of them, belonged to nuclear families. Around 38.4% of girls knew that condom is the safest contraceptive method but a preferred choice of contraceptive method among the girls for condoms (24.40%), oral pills (20.20%), and emergency pill (19.60%). Conclusion: Choice of the method with lower levels of knowledge regarding STIs and 22% preferring premarital sex may expose them to higher risks. Increasing trends of pre-marital sex with lower levels of awareness about contraception and STIs is very detrimental.
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Correlation of follicle-stimulating hormone receptor gene Asn 680 Ser (rs6166) polymorphism with female infertility
Sangeeta Rai, Ashish , Preeti Kumari, Anup Singh, Royana Singh
October 2019, 8(10):3356-3361
DOI:10.4103/jfmpc.jfmpc_685_19  PMID:31742168
Background and Aims: Female infertility is a complex multifactorial, and polygenic disease associated with genetic factors plays an essential role in its formation and follicle development, oocyte maturation, and steroidogenesis regulation in the ovary. The aim here is too study the genetic association between follicle-stimulating hormone receptor (FSHR) Asn680Ser; (rs6166) gene polymorphism with female Infertility in our population. Methods: In this prospective case-control study, we enrolled 106 infertile and 164 unrelated healthy control individuals. Genomic DNA was extracted from the 5 ml of venous blood using the modified salting-out method. A polymerase chain reaction-amplified exon 10 of FSHR and purified PCR products were sequenced on an ABI 3730XL DNA sequencer. The data were analyzed statistically. Results: We found that the presence of rare allele ”G” and heterozygous and common homozygous genotypes significantly increased the risk of female infertility. No significant change in the FSHR 191756 G >A genotype frequency was observed, regardless of chromosomal integrity. The genotype frequency distribution of locus 680 was consistent with the Hardy–Weinberg Equilibrium (HWE) in both groups (P > 0.05). Conclusion: No significant differences were found in allelic variants frequency and genotype distribution between each category of subjects when analyzing the FSHR SNPs in the exonic region (P value >0.05). FSHR Asn680Ser polymorphisms and female infertility (P > 0.05). Variations in FSHR gene have an essential influence on ovarian function and can account for several defects of female fertility. FSHR Asn680Ser (rs6166) gene polymorphism is associated with female infertility and can be used as a relevant molecular biomarker to identify the risk of infertility in our population. This finding can be important for disease pathogenesis.
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Preparedness against self-infection and importation of Malaria - An airport survey among Saudis traveling to endemic countries
Hanin Saleh AlOwaini, Rizwan Suliankatchi Abdulkader, Qusay Fahad Almahmoud, Abdulaziz Eyad Alqudaimi, Raneem Saied Al-Ghamdi, Wateen Ahmed Alhamoud, Hasan Keriri
October 2019, 8(10):3318-3324
DOI:10.4103/jfmpc.jfmpc_649_19  PMID:31742162
Background: Infected travelers returning from malaria endemic countries pose the threat of local outbreaks in nonendemic countries. Such outbreaks are becoming potential public health threats with increasing volume of international travels. Aims: This study aimed to assess the knowledge, attitude, and practices toward malaria, its prevention and treatment among Saudi air travelers visiting malaria-endemic countries. Methods: A cross-sectional survey was conducted among Saudi passengers who were waiting at the departure gates of the King Khalid International Airport, Riyadh to travel to five chosen malaria-endemic countries. Knowledge, attitude, practice, and health-seeking behavior for malaria were assessed using a self-administered questionnaire. Factors associated with favorable responses were identified by statistical tests. Results: Among 531 travelers, adequate knowledge, favorable attitude, and healthy practices pertaining to malaria were present in 42.7%, 80.2%, and 55.7%, respectively. Traveling to India, age >=30 years, tourists and traveling businessmen, previous visit to same country or region, seeking malaria-specific advice were significantly associated with adequate knowledge. Only 11.3% had sought pretravel health advice on malaria. Lack of knowledge about the existence and importance of pretravel consultation was the common reason for not seeking advice. Conclusion: Knowledge about malaria and practice of preventive measures were suboptimal among Saudi travelers. Public awareness about travel consultation and chemoprophylaxis should be a part of malaria elimination and prevention efforts. Primary care physicians should take into account the level of knowledge among prospective travelers and provide opportunistic travel health services or refer them appropriately.
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Relationship between the nutritional status and antimicrobial protein levels with the periodontal condition in untreated head and neck cancer patients
Anu Anna John, Naresh C Kumar, V Ranganath, Subramaniam M Rao, Abhilasha S Patil, Puneet N Jumani
October 2019, 8(10):3325-3333
DOI:10.4103/jfmpc.jfmpc_658_19  PMID:31742163
Background: Chronic periodontitis might be associated with oral premalignant lesions, tongue cancers, and other oral neoplasms, which is a foremost public health problem throughout the world. The nutritional status of the patient with cancer becomes very important for tolerating the treatment course as most of the newly diagnosed patients with head and neck cancer are malnourished before treatment begins. Antimicrobial proteins are also essential contributors to maintaining the balance between health and disease in this complex environment. Therefore the aim of this study was to determine whether an association exists between the measures of nutritional status and the levels of antimicrobial proteins with the periodontal condition in newly diagnosed, untreated head and neck cancer patients. Materials and Methods: A total of 50 patients newly diagnosed with head and neck carcinoma were included. Saliva and plasma samples were collected, together with clinical periodontal recordings. Nutritional status parameters consisted of body mass index, serum albumin, hemoglobin, and total lymphocyte count. Cystatin C and lysozyme were the antimicrobial proteins. Results: A logistic regression model showed that periodontal parameters were inversely related to their nutritional status; however, antimicrobial protein levels showed to be directly related to periodontal condition. Conclusion: This study suggests an association between periodontal disease, nutritional status parameters, and antimicrobial protein levels.
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Prevalence of short sleep duration and effect of co-morbid medical conditions – A cross-sectional study in Saudi Arabia
Kholoud A Althakafi, Abdulaziz A Alrashed, Khalid I Aljammaz, Ihdaa J Abdulwahab, Raghad Hamza, Asalah F Hamad, Khalid S Alhejaili
October 2019, 8(10):3334-3339
DOI:10.4103/jfmpc.jfmpc_660_19  PMID:31742164
Background: Sleep is crucial to human's health and essential for a person's wellbeing. It is involved in multiple physiological mechanisms, such as metabolism, appetite regulation, immune and hormone function, and cardiovascular systems. The National Sleep Foundation recommends 7–9 h of sleep each night for adults. Short (<7 h) and long (<9 h) sleep duration has been reported to be associated with increased risk of morbidity and mortality. Aim: 1) To assess the prevalence of short sleep durations among Saudi adult population. 2) To examine comorbid medical condition's association with short sleep duration. Methods: A nation-wide quantitative cross-sectional study using an online self-administered constructed questionnaire during the period from August to October 2018 was conducted. The questionnaire included demographic characters, such as age, gender, education level, height, and weight. As well as some of the participants' habits such as consuming coffee and/or tea, smoking status, and other habits known to be associated with shorter sleep hours. The questionnaire also included self-reported duration of sleep and history of diagnosed medical illnesses. Results: The study included 805 adult Saudi participants with ages ranging from 15- to 60-year old and mean age of 21.8 ± 10.7-year old. About 63% of the participants were females. It was established that almost half 49.6% of the participants sleep for <7 h daily, and 39.3% of them sleep for 7–9 h. Conclusion: About half of Saudi adults do not get enough hours of sleep. Especially, people who are married, above 30-year old, students or tea drinkers (P < 0.05): furthermore, people with medical comorbidities such as anxiety, depression, and insomnia had a higher association with short sleep duration. Last, sleep deprivation adversely affects the physical wellbeing and quality of life of participants, demonstrated in bad mood, somnolence, and tiredness during the day time.
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Use of reteplase for thrombolysis in patients with massive pulmonary embolism diagnosed by bedside transthoracic echocardiography: A retrospective study of safety and efficacy
Bhupendra Verma, Avinash K Singh
October 2019, 8(10):3155-3159
DOI:10.4103/jfmpc.jfmpc_512_19  PMID:31742135
Background: Pulmonary embolism (PE) is a lethal clinical condition requiring immediate systemic thrombolysis to decrease mortality. Reteplase has been extensively used in acute myocardial infarction but studies in massive PE are rare. We have presented here efficacy and safety of reteplase in patients with high risk PE diagnosed on basis of bedside transthoracic echocardiography. Methods: This was retrospective study including 20 patients of massive PE undergoing thrombolysis with reteplase. Bedside TTE was used to evaluate presence of RV dysfunction and thrombi in these patients with hemodynamic compromise. Safety and efficacy outcomes were analysed till three months of follow up. Results: 12 patients (60%) included in the study were males and mean age was 41 ± 19 years. The dyspnoea, chest pain and haemoptysis improved in all patients after thrombolysis. At discharge, RV dilatation normalised, systolic pulmonary artery pressure decreased, systolic blood pressure significantly increased and hypoxemia had completely corrected. Two patients had minor self-limiting bleeding episodes in form of mild haematuria and oral bleeding. During the follow up period of 3 months all patients were clinically stable and there were no bleeding episodes or death. Moreover, there was no recurrence of PE and/or DVT. Conclusion: Reteplase is highly efficacious in massive pulmonary embolism and results in rapid clinical improvement. Moreover, it can be safely used without increased risk of significant bleeding or mortality. Although limited by retrospective nature, reteplase appears to be an attractive option for massive PE but large prospective studies are further required.
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Preparing career development model of Iranian nurses using Delphi technique
Zeinab Rahimi, Sanaz Aazami, Mosayeb Mozafari
October 2019, 8(10):3160-3165
DOI:10.4103/jfmpc.jfmpc_513_19  PMID:31742136
Introduction: Nowadays, nurses play a key role in all health-care systems in the world. To improve the professional conditions and increase the quality of care, nurses' career development should be fulfilled in a specific and targeted way. The aim of this study was to investigate the factors affecting career development of nurses in Iran. Method: This prospective study was conducted using Delphi technique in three stages with the presence of 60 nurses and nursing faculty members. In the first round, four questions were used to assess the participants' perspective career development, how to evaluate it, its effective factors and suggestions to design a career development model. In the second and third rounds, to collect participants' opinion and create consensus, a researcher-made questionnaire based on the results obtained during the first round was used. Results: According to the results, 25 effective factors were extracted and classified into 6 categories of professional development, increasing organizational influence, individual development, specialization, improvement of career dignity, and psychological acceptance. The nurses' career development model was also developed and validated with the results. Conclusion: According to the obtained results, it can be concluded that career development in the nursing area is achieved by realizing six factors of professional development, specialization, increasing organizational influence, individual development, psychological acceptance, improvement of career dignity, and psychological acceptance.
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Noncompliance of the postexposure prophylactic vaccination following animal bites reporting to a rural primary health center
B Gadapani, S Rahini, Rukman M Manapurath
October 2019, 8(10):3258-3262
DOI:10.4103/jfmpc.jfmpc_592_19  PMID:31742152
Context: Man lives in close harmony with animals and so the chances of injuries and diseases contracted from them. Effective preventive measure such as vaccination is to be ensured following harmful bites resulting in Rabies. Aim: The aim is to assess the proportion of rabid animal bite cases and non-compliance of post exposure prophylaxis vaccination following bites, reporting to a rural primary health care centre. Setting and Design: This is a retrospective cross sectional study from records of animal bite cases attending a rural primary health centre from January 2017 to December 2017. Materials and Methods: A pre-designed case record form was used to estimate the proportion of animal bite cases leading to Rabies and Non-compliance of post exposure prophylaxis attending the health centre. Statistical Analysis: Data analysis was done in SPSS 2016. Chi square was used to find the significance. Results: Around 448 animal bites were found over a span of one year, out of which 222 (49.5%) were found to be rabid animal bites. 46.65% (209) were dog bites and 2.9% (13) were cat bites. Statistical significance (P < 0.05) was seen between age and compliance of vaccination following dog bites. 1.14% of the study subjects who had completed the 5 dose post prophylaxis vaccination belonged to the elderly age group. Among the cat bite cases, 2 of the study subjects had received 1 dose of PEP with anti-rabies vaccine. Conclusion: Only 1.14% of the study subjects had taken the complete dose of PEP. This suggests the lack of awareness among public and lack of services and supervision for rabid animal bites in rural areas. It is the duty of every physician to counsel people, co-ordinate with veterinary physician and maintain proper records so as to ensure completion of PEP to prevent rabies related deaths in humans.
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Comparing the attitude of doctors and nurses toward factor of collaborative relationships
Lari Mahboube, Elnaz Talebi, Pejman Porouhan, Rohangiz J Orak, Mansoure A Farahani
October 2019, 8(10):3263-3267
DOI:10.4103/jfmpc.jfmpc_596_19  PMID:31742153
Background and Objectives: Effective relationship and collaboration between doctors and nurses is considered the main factor in achieving positive medical results, which is the most important goal of the healthcare system. This study aims to compare attitude of doctors and nurses toward factors associated with doctor-nurse collaboration, including shared education and teamwork, caring as opposed to curing, physician's dominance, and nurses' autonomy. Methods: In this cross sectional, descriptive-comparative study, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration was used to assess doctor–nurse collaboration in four domains, including shared education and teamwork, caring as opposed to curing, physician's dominance, and nurses' autonomy. To this end, descriptive (mean, standard deviation) and inferential statistics including independent t test, Chi-square, and variance analysis were used. Results: According to the results obtained, compared to doctors, nurses showed a more positive attitude toward shared education and teamwork, caring as opposed to curing, and physicians' dominance, but there was no significant difference between the two groups in nurses' autonomy. Conclusion: With regard to doctor-nurse collaboration, it is essential that doctors and nurses be acculturated in the course of their academic education. Moreover, policies to change pattern of professional relationships from hierarchical to complementary can be effective in enhancing professional autonomy of nurses and reducing impaired professional interactions.
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Diagnosis of obstructive sleep apnea in women: Is there any difference?- Experience from a tertiary care hospital of North India
Zia Hashim, Alok Nath, Mansi Gupta, Ajmal Khan, Ravi Mishra, Shivani Srivastava, Surya Kant Tripathi
October 2019, 8(10):3276-3281
DOI:10.4103/jfmpc.jfmpc_609_19  PMID:31742155
Context: Obstructive sleep apnea (OSA) considered classically to be a male-dominant disease, may have significant gender-based differences in clinical presentation and diagnosis. Aims: To evaluate gender-based differences in the clinical profile and polysomnographic features of Indian patients with OSA. Settings and Design: A prospective observational study was conducted over a period of 12 months involving adult ambulatory patients, referred for evaluation of OSA. Methods and Materials: Enrolled patients underwent detailed clinical evaluation followed by supervised polysomnography. Sleep studies were manually validated and analyzed. Statistical Analysis Used: Continuous variables were compared using two-tailed independent- sample t-test. For the univariate analysis, the Chi-square test was used. Results: Out of 150 enrolled patients, 94 (62.7%) were males (male-to-female: 1.7:1; age: 51.85 ± 12.60 years; BMI: 32.09 ± 5.53 kg/m2). Most common presenting features were excessive daytime somnolence, snoring, and easy fatiguability. Women with OSA were older than men. Insomnia and anxiety were significantly higher among females. Parameters defining sleep architecture were similar in both groups. Although obstructive apneas and hypopneas were similar, mean apnea hypopnea index was significantly higher (P < 0.05) in males compared to females with higher titratable continuous positive airway pressure. Conclusions: There are gender-specific differences in the clinical presentation of OSA due to various anatomical, physiological, and psychosocial factors. Their potential influence on the clinical features, natural history, and implications on treatment need further evaluation on a larger scale.
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The level of knowledge and attitude on insulin therapy in patients with diabetes mellitus in a teaching hospital of Southern India
Suniram Priscilla, S Malarvizhi, Ashok K Das, Vasanthi Natarajan
October 2019, 8(10):3287-3291
DOI:10.4103/jfmpc.jfmpc_622_19  PMID:31742157
Aim of the Study: To assess the level of knowledge and attitude on insulin therapy in patients with diabetes mellitus in a teaching hospital. Objectives: 1. To assess the level of knowledge and attitude on insulin therapy among patients with diabetes mellitus. 2. To find out the association between the knowledge and attitude on insulin therapy with the selected study variables. Materials and Methods: This is a nonexperimental, cross-sectional study. A total of 100 participants were recruited from the outpatients and inpatients attending the department of general medicine and general surgery. Adult male and female with diabetes mellitus receiving insulin injection and willing to participate in the study were included in the study. The data was collected using 20 structured questionnaires to assess the level of knowledge and modified 4 point Likert scale was used, which contains 10 statements to assess the level of attitude on insulin therapy by interview method. Results: It was observed from the results that the level of knowledge among the study participants was as follows: 4% of them had adequate knowledge, 44% had moderately adequate knowledge, and more than half (52%) of them had inadequate knowledge. The level of attitude among the study participants (27%) with diabetes mellitus had favorable attitude, more than half (69%) had moderately favorable attitude, and 4% had unfavorable attitude on insulin therapy. It is observed that there is no statistically significant correlation (r) =0.038, P = 0.707 between the level of knowledge and attitude on insulin therapy among patients with diabetes mellitus. Conclusion: This study showed that there was inadequate knowledge and unfavorable attitude among the diabetic patients regarding insulin therapy. The people with diabetes should receive ongoing need-based quality diabetic education by using innovative methods that is tailored to their needs, delivered by skilled healthcare providers.
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Restricting high-end antibiotics usage - challenge accepted!
J Jayalakshmi, MS Priyadharshini
October 2019, 8(10):3292-3296
DOI:10.4103/jfmpc.jfmpc_626_19  PMID:31742158
Objectives: Antimicrobial resistance (AMR) leads to increased morbidity, mortality, and healthcare expenditure. The rate of development of AMR is accelerated by the use and misuse of antimicrobials. Preauthorization and restricted use of high-end antibiotics are the key modalities of antimicrobial stewardship. Hence, choosing the right antibiotics is the key to better clinical outcomes and preventing resistance in hospitals as well as communities. The present study was done to assess the judicious usage of high-end antibiotics among inpatients treated at our hospital. Materials and Methods: A prospective observational study was conducted on high-end antibiotic usage using a structured proforma among inpatients treated at our hospital for a 3 month period. Department wise educational intervention was done and feedbacks were provided, after which reassessment was done. Results and Analysis: Meropenem was the most commonly used high-end antibiotics. After the feedback and intervention, there was 51.2% reduction in the unjustified antibiotic usage. The appropriateness of the usage increased from 77% observed during preintervention to 88% postintervention. Conclusion: The increasing compliance of judicious usage of high-end antibiotics needs to be sustained. Therefore, continuous strengthening of antimicrobial stewardship practices are crucial.
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Clinicoepidemiology of benign paroxysmal positional vertigo in Nigerian
Waheed Atilade Adegbiji, Toye Gabriel Olajide, Olawale Olubi, Oyebanji Anthony Olajuyin, Adebayo AbdulAkeem Aluko
October 2019, 8(10):3220-3224
DOI:10.4103/jfmpc.jfmpc_555_19  PMID:31742145
Objective: Benign paroxysmal positional vertigo (BPPV) is poorly reported in developing countries. This study aimed at determining the prevalence, aetiology, and comorbid illnesses of benign paroxysmal positional vertigo in our center. Materials and Methods: This was a prevalence hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo (BPPV). Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike maneuver and supine roll test was performed on all patients to diagnose posterior, lateral or anterior canal benign paroxysmal positional vertigo. All the data obtained were collated and analyzed by using SPSS version 16.0. Results: Prevalence was 1.9%. Peak prevalence of 37.0% was at age group 41–50 years. Male accounted for 46.1% with male to female ratio of 1:1.2. Benign paroxysmal positional vertigo accounted for 62.3% urban dwellers, 33.1% postsecondary education, 39.6% Civil servant and 33.8% married. There were 99.4% unilateral and 64.3% right benign paroxysmal positional vertigo. Idiopathic was 70.1% while trauma, migraine, and inner ear disorder were 20.8%, 7.1%, and 1.9%, respectively. Benign paroxysmal positional vertigo was 66.2% posterior semicircular canal followed by 24.7% lateral semicircular canal and 0.6% anterior semicircular canal. Commonly associated comorbid illnesses were visual disorder, hypertension, arthritis, and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6%, respectively. Conclusion: Benign paroxysmal positional vertigo is common otologic disorder. It is associated with significant comorbid illnesses. Early detection will reduce morbidity and mortality. Improvement in the level of health care at primary level and health education to create awareness among the populace is to be encouraged.
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Knowledge, attitude, and practice toward regenerative endodontics and factors affecting its practice among dental practitioners in Ajmer city: A cross-sectional study
Akshay Raj Goyal, Rahul Puri Goswami, Sai Kumar Ganapathy, Rashmi Ojha, Kanica Singhal, Yuvika Ahluwalia
October 2019, 8(10):3225-3229
DOI:10.4103/jfmpc.jfmpc_560_19  PMID:31742146
Background: Regenerative methods, which regenerate the damaged structures, are one of the treatment methods in endodntics. This conservative approach helps to generate cells that may produce the lost structure. Thus, the aim of this study was to explore the knowledge, attitude, and practice among dental practitioners toward regenerative endodontics and factors affecting their knowledge, attitude, and practice. Materials and Methods: It was a cross-sectional questionnaire study conducted in the month of June–August 2018 in Ajmer city. Permission to conduct the study was obtained from JLN Medical College and Hospital, Department of Dentistry. A total of 100 clinics were visited and face-to-face interview schedule was conducted. A total of 123 dental practitioners were interviewed. A 26 item questionnaire was generated to measure knowledge, attitude, and practice of dental professionals regarding regenerative endodontics. Results: 63% of study participants had poor knowledge scores. Majority of study participants 83 (67%) had poor attitude scores. On applying Pearson's correlation, it was determined that the knowledge regarding regenerative endodontics was significantly (P ≤ 0.001) ** correlated to the attitude among study participants. On applying Chi-square test, it was assessed that the knowledge and practice among study participants were significantly (P = 0.041*) and (P = 0.001**) associated with gender of study participants. Conclusion: From above results, it is concluded that study participants have poor knowledge, attitude, and practice regarding regenerative endodontics. The knowledge regarding regenerative endodontics was significantly associated with the attitude of study participants. Participants with Masters of Dental Surgery (MDS) degree had a significant effect on the knowledge regarding the regenerative endodontics. Endodontic specialty has a significant effect on the attitude of study subjects.
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Testing of a dental student-administered multidisciplinary health promotion program
Ankur Sharma, Meena Jain, Shilpi Singh, Nisha Rani Yadav, Puneet Chahar, Akanksha Monga, Vishal Jain
October 2019, 8(10):3230-3235
DOI:10.4103/jfmpc.jfmpc_563_19  PMID:31742147
Background: A multidisciplinary approach involving healthcare students for health promotion has been recommended. With this view, the primary phase of the integrated health promotion program (IHPP) was designed and pilot tested. Methods: A pre-post-intervention study was conducted among 55 housewives of two self-help groups in India. The intervention consisted of a motivational interview, interactive session with a nutritionist, group discussion, personal hygiene training, and an illustrative reinforcement leaflet. Interventions were provided by trained dental students. The evaluation was based on outcomes from six tools specifically tailored for the program. These were the health self-regulation self-efficacy scale (HSSS), visual analogue scale (VAS) for self-health perception, oral health knowledge and attitude questionnaire, motivational interview, group discussion, and personal hygiene demonstration test. Results: Statistically significant change in mean pre- and postprogram scores in HSSS (P < 0.001), its two components, metacognitive component, action component, as well as VAS (P = 0.001) indicated a change in health-related perceptions in the participants. Mean oral health knowledge score (6.1), as well as attitude score (3.8), was fair. Most of the participants were able to demonstrate personal hygiene and tooth brushing correctly; take collective decisions about their health, plan changes in their diet, and resolve upon bringing about healthy changes in their lifestyle. Conclusion: The program evaluation indicated successful intervention and may be replicated in a larger population. Healthcare student population may be used in developing countries to bring about an attitude change in the underprivileged population through an IHPP.
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The tribal community's perception on tuberculosis: A community based qualitative study in Tamil Nadu, India
Alex Joseph, Anil Kumar Indira Krishnan, Aiswarya Anilkumar
October 2019, 8(10):3236-3241
DOI:10.4103/jfmpc.jfmpc_565_19  PMID:31742148
Background and Objective: Tuberculosis is a highly contagious bacterial infection. It is a major public health issue with India being the highest prevalent country in the world. The nation has a large and heterogeneous tribal population of approximately 104 million people which accounts for 8.6% of the total population. This study focuses on assessing the tuberculosis scenario amongst the tribal population their perceptions on risk factors of TB, general health problems, health seeking behavior, and challenges faced by them. Methods: The study was conducted using in-depth interviews and focus group discussions in the three sampled study districts namely Nilgiris, Namakkal, and Villipuram of Tamil Nadu, India. A thematic analysis was performed to identify the major emerging themes. Following thematic analysis, an interventional strategy for improving the overall knowledge and awareness among the community health education was imparted. Results: The conducted in-depth interviews and focus group discussions identified major themes that emerged from the codes which included stigma and discrimination, association with HIV, detection of symptoms, health seeking behavior, knowledge and awareness of TB, acculturation, treatment adherence and lack of lab facility. Conclusion: This qualitative study has captured the overall perception towards tuberculosis from the tribal community as a whole as well as from the health workers. The tribal community stigmatized and discriminated people suffering from TB which had an impact on the health seeking behavior as well as on the treatment adherence. The primary care providers were aware of the situation of TB in tribes but were poorly equipped. Primary healthcare providers should in fact, have a crucial role in identification of at-risk subjects, for prompt referrals, and delivery of treatment services.
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Research to policy on defining accessibility of public health facilities to ensure universal health coverage
Banuru M Prasad, Jhimly Baruah, Padam Khanna
October 2019, 8(10):3242-3246
DOI:10.4103/jfmpc.jfmpc_577_19  PMID:31742149
Background: The mandate to ensure the availability of doctors under Universal Health Coverage has been one of the most difficult issues to address in India. It is believed that the geographic location of health facilities has influenced the availability of doctors in rural areas, which may have resulted in long-standing vacancies. There was a need to classify facilities based on location and access, to propose policies and strategies. The classification was arrived through a consultative process, which led to ambiguity. Aim: The aim of this study is to develop a criteria to identify health facilities based on location considering accessibility indicators. Settings and Design: A cross-sectional operational research was conducted during 2010–2011 to collect data for public-health facilities above subcenters and below district hospitals across India. Materials and Methods: Data was collected for geographic, environmental, housing, and vacancy status of doctors; for which scores were assigned for each health facility. Results: A total of 20,528 (76%) were included for analysis out of 26,876 health facilities. Following application of criteria, 3,011 (11%) facilities were identified as eligible; of these, 1%, 3%, and 7% facilities were identified as inaccessible, most-difficult, and difficult facilities, respectively. The consultative meetings with state governments resulted in agreement on the criteria adopted. Conclusion: The study demonstrated more robust criteria to define access to health care facilities by applying composite scoring methods, which was validated through a consultative process with key stakeholders. The study results were applied to incentivize doctors serving in difficult areas in a move to address human resource gaps in rural areas and ensure universal health coverage.
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Training and mentorship of medical officers to improve MCH care in public health facilities: Lessons learned from eastern Uttar Pradesh
Harish Chandra Tiwari, Reena Srivastav, Saim Mohd Khan
October 2019, 8(10):3202-3206
DOI:10.4103/jfmpc.jfmpc_543_19  PMID:31742142
Introduction: To improve the quality of MCH services in high priority districts of eastern Uttar Pradesh, Regional Resource Training Center (RRTC) has been established in BRD Medical College Gorakhpur. Medical College faculties empanelled at RRTC Gorakhpur carried out the training and mentoring of medical officers of public health facilities. Aims and Objectives: To study the role of training and mentoring of medical officers in terms of quality improvements of MCH services at public health facilities. Materials and Methods: The present study was carried out in women hospitals of seven districts and one of their respective CHCs of eastern Uttar Pradesh from December 2017 to October 2018. Data was collected by direct observation and review of records of OPD/IPD, labor room, operation theaters, blood bank, and blood storage facilities by mentoring team. Findings of these observations were recorded in predesigned 50 point quality assurance, and facility score was calculated. Technical score was calculated from data collected during one-to-one interaction of mentor and mentees in a predesigned and tested proforma. Result: Technical scores of medical officers showed marked improvement after mentoring visits in majority of facilities. Mentoring visits build the confidence of medical officers to deal with the complications like severe anemia, eclampsia, and postpartum hemorrhage as per latest guidelines and protocol. It also helped in the initiation and augmentation of LSCS at certain facilities. Technical scores at few facilities showed little improvement (DWH Sant Kabir Nagar, CHC Colonelganj). Mentoring visit also helped in overall facility improvement at these centers. Conclusions: The whole training and mentorship program was found effective to improve the knowledge and skills of the medical officer with few exceptions of opposition/resistance. It was found useful in overall facility improvement up to some extent.
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A body shape index in a small sample of Saudi adults with type 2 diabetes
Faisal Khalid A. Zakri, Hassan Ali Abd El-Wahid, Mubarack Sani, Mohamed Salih Mahfouz
October 2019, 8(10):3179-3184
DOI:10.4103/jfmpc.jfmpc_532_19  PMID:31742139
Context: Overweight and obesity are assessed clinically using the body mass index (BMI), but the index is criticized as a crude measure of relative fat-muscle composition. The recently introduced a body shape index (ABSI) is an independent and more accurate predictor of mortality than other anthropometric measures. Aims: Describe ABSI in relation to other clinical and cardiometabolic risk factors in Saudi patients with type 2 diabetes. Settings and Design: Cross-sectional, armed forces diabetes clinic. Materials and Methods: Demographic and clinical data were obtained from randomly sampled patients with type 2 diabetes. Statistical Analysis: The t test, analysis of variance, or Chi-square test as appropriate, and contingency table analysis. Results: The 120 patients with type 2 diabetes (60 males, 60 females) had a mean (SD) age of 52.5 (9.3) years and BMI of 31.8 (5.5). Comparisons of ABSI and ABSI mortality risk categories with clinical and cardiovascular risk factors were statistically nonsignificant. Patients with below-average BMI (z < 0) (n = 33) were more likely to have above-average ABSI (z > 0) (27.5%) than a below-average ABSI z score (17.5%). Conclusion: These data provide a baseline assessment useful in further studies using larger datasets to confirm whether the ABSI can prove to be clinically useful and serve as a better predictor of mortality risk in the Saudi population. These local data should be of interest to the primary care practitioner who may be thinking of applying these new measures in their primary care practice.
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REVIEW ARTICLES
Health-promoting school in India: Approaches and challenges
Yogesh K Jain, Nitin K Joshi, Pankaj Bhardwaj, Praveen Suthar
October 2019, 8(10):3114-3119
DOI:10.4103/jfmpc.jfmpc_673_19  PMID:31742128
Interventions early in life are the need of the hour when it comes to controlling the rising incidence of communicable and non-communicable diseases (NCDs) globally. WHO has issued guidelines towards health promotional initiatives at schools as a part of Global School Health Initiative, and the Government of India has directed many policies and programs to integrate health deep within the school activities. School Health Promotion is an international need with programmes implementing across continents due to numerous documented benefits, to not just the individuals but to the community and country as a whole. Simple teachings like hand hygiene have shown to reduce the incidence diarrhea by more than 50% amongst children (a major cause of mortality in India), thus raising an urgent need of developing a model for health promotion at schools that is replicable, sustainable, and can be modified to the local needs as well. Though the existent programmes have a few documented challenges, a multisectorial involvement of government agencies, educational boards, and health sector along with the school is the way forward to address those challenges and covert the theory of health promoting schools (HPS) into a well-established fact. It presents a scope for the various established and newly emerging Schools of Public Health in the country to come forward and collaborate with these multiple sectors. These collaborations can be the only way to ensure sustainability and incorporation of health promotion into the core academic structure of schools in a diverse and highly populous country like India.
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