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   2019| March  | Volume 8 | Issue 3  
    Online since March 27, 2019

 
 
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ORIGINAL ARTICLES
Clinicolaboratory profile of expanded dengue syndrome – Our experience in a teaching hospital
Bijaya Mohanty, Ashok Sunder, Saurabh Pathak
March 2019, 8(3):1022-1027
DOI:10.4103/jfmpc.jfmpc_12_19  PMID:31041245
Introduction: Classic dengue fever presentation has expanded its horizon by involving various organ systems and is named as expanded dengue syndrome. This changing presentation and rising burden across the globe may lead to delayed diagnosis and under reporting of this syndrome. Aim of Study: To analyze clinicolaboratory profile of patients with expanded dengue syndrome. Materials and Methods: About 520 cases of expanded dengue syndrome as per World Health Organization definition criteria 2012 were studied with their informed consent. Detailed history, thorough clinical examination, and relevant investigations were done. Their clinical and laboratory parameters were analyzed. Standard treatment guidelines were followed in all cases. Observation: About 301 patients were male and 219 were female with male-to-female ratio of 3:2. Their age varied from 12 to 76 years with the average age of 47.5 years. About 92% of cases presented with various gastro hepatic manifestations. The commonest gastrohepatic manifestation was transaminitis (57.5%) that is asymptomatic elevation of liver enzymes followed by acalculous cholecystitis (21%) and acute pancreatitis (13.9%). Twenty-nine patients presented with various neurological manifestations. Three patients presented with acute kidney injury and eight patients had coinfection with malaria. Fever with nausea and vomiting was the most common presentation. About 15% of patients presented with bleeding manifestations. About 40.6% of patients presenting as abdominal manifestations had platelet count <20,000/mm3 and needed platelet transfusion versus 9.8% with other system involvement (central nervous system, cardiovascular system (CVS), renal). Hepatomegaly was the most common ultrasonography (USG) finding being present in 57.5% of patients followed by acalculous cholecystitis in 21.3%. Total mortality was 1.9% in our series. We lost eight patients presenting with neurological manifestations and two patients with coinfection with malaria. Conclusion: Atypical presentations should prompt us to investigate for dengue especially during ongoing epidemics so that expanded dengue syndrome can be diagnosed and treated early.
  8,311 434 4
REVIEW ARTICLE
Pulse therapy: Opening new vistas in treatment of pemphigus
Subhasish Mustafi, Rupam Sinha, Samhita Hore, Suman Sen, Subhadeep Maity, Pritha Ghosh
March 2019, 8(3):793-798
DOI:10.4103/jfmpc.jfmpc_114_19  PMID:31041203
Pemphigus is comprised of a group of life-threatening autoimmune diseases that is characterized by circulating IgG antibodies targeting several types of keratinocyte antigens. After introduction of systemic steroids, survival has improved dramatically. However, mortality and morbidity were still very high due to side effects of steroids. Pulse therapy is defined as discontinuous/intermittent intravenous infusion of very high doses of corticosteroids along with certain immunosuppressive agents over a short period. This therapy was introduced to minimize the side effects of conventional corticosteroid therapy. The target is to achieve a faster response and stronger efficacy and to decrease the need for long-term use of systemic corticosteroids. As a result, this therapy has gained its popularity since three decades. The purpose of this article is to review the various available pulse therapy regimens with dosage, indications and contraindications and side effects.
  7,790 592 1
AFPI POSITION PAPER ON ROAD SAFETY AND PUBLIC HEALTH
Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India
Ranabir Pal, Amrita Ghosh, Raman Kumar, Sagar Galwankar, Swapan Kumar Paul, Shrayan Pal, Debashis Sinha, AK Jaiswal, Luis Rafael Moscote-Salazar, Amit Agrawal
March 2019, 8(3):775-783
DOI:10.4103/jfmpc.jfmpc_214_18  PMID:31041200
Roads are considered a sign of development bringing colossal benefits to community as socioeconomic and logistic facilitator. Yet, growth of road network has brought road crashes leading to civic pain from premature deaths of productive age group. In 2017, 16 citizens were killed and 53 injured every hour on Indian roads as per officially reported data, while a fair number go unreported. This is unacceptably high when compared with international standards. Risk correlates of road traffic injuries (RTIs) need to be redefined so as to form a continuum with other confounding factors that impact to take lives on road. Risk factors impacting RTIs vary from human components to the roles and responsibilities of healthcare stakeholders. We should have made roads safer for all citizens because a large percentage of population – children, pedestrians, cyclists, motorcyclists, and the elderly – are most vulnerable. A taskforce was set up by the Academy of Family Physicians of India to scientifically analyze the literature available to assess risks and put forward appropriate recommendations.
  7,329 621 9
ORIGINAL ARTICLES
Effect of DOTS on quality of life among tuberculosis patients: A follow-up study in a health district of Kolkata
Sitikantha Banerjee, Kajari Bandyopadhyay, Pranita Taraphdar, Aparajita Dasgupta
March 2019, 8(3):1070-1075
DOI:10.4103/jfmpc.jfmpc_347_18  PMID:31041253
Context and Aims: This study was carried out to assess quality of life (QoL) of tuberculosis patients receiving treatment from DOTS centres, to find out its change with treatment, and to ascertain its determinants. Materials and Methods: An institution based follow-up study was conducted in Bagbazar Urban Health District (UHD), Kolkata where all the tuberculosis patients registered within 1st 4 months of data collection were followed up for their current course of treatment. Quality of Life (QoL) was assessed using SF36v2 questionnaire at the start of treatment and after continuation phase (CP) (within 14 days). Statistical Analysis Used: General Linear Model was used to assess the predictors of change of QoL with treatment. Results: 61.4% and 16.4% patients were at the risk of depression at the start and end of their TB treatment respectively. Patient's per-capita monthly Income (PCI) and current smoking status interacted with time to predict trends in the Physical component scores. Similarly, PCI and educational status interacted with time to predict trends in the mental component scores. PCI and unemployment were found to be predictor of differences of Physical and mental component scores (between subject effects) respectively. Conclusions: QoL assessment in different stages of treatment should be incorporated in the ongoing RNTCP to make the programme more client-oriented and comprehensive, and to provide social support to those who need it most. Directly observed treatment should be supplemented with economic support, de-addiction campaign and Inter-personal counselling by the DOTS providers.
  7,628 283 2
Glomus tumor of the fingertips: A frequently missed diagnosis
John Ashutosh Santoshi, Vivek Kumar Kori, Ujjawal Khurana
March 2019, 8(3):904-908
DOI:10.4103/jfmpc.jfmpc_88_19  PMID:31041222
Background: Glomus tumors present as painful lesions, most commonly in the fingertips. These can present to outpatient clinics of multiple specialties. Materials and Methods: Retrospective review was performed of 37 patients diagnosed as having glomus tumor in the thumb or fingertips over a 10-year period. The data collected included demographics, presenting symptoms, duration, previous treatment history, physical examination, treatment, and recurrence. The data were presented by means of descriptive statistics. Results: The mean duration of symptoms before presentation was 3.8 years (range 2 to 12 years). The mean age at presentation was 38 years (range 16 to 62 years), and female to male ratio was 21:16. Twenty-two patients had left-hand involvement; thumb 8, index finger 5, middle finger 5, ring finger 14, and little finger 5. Clinical and radiological assessments were made preoperatively. At presentation, 18 cases had nail changes, whereas 19 had no obvious nail changes – out of these, 4 had pulp involvement. The lesion involved the subungual region in 33 cases. The mean size of the lesion was 3.8 mm (range 2 to 10 mm). Thirty-six patients were found to have histopathologically proven glomus tumors, whereas in one no specific lesion was found on histopathological examination; this patient returned with recurrence of symptoms at 2-month follow-up. There was no other patient experienced recurrence of symptoms. Conclusion: Early diagnosis of glomus tumors is important to avoid lengthy treatment delays, chronic pain, disuse syndromes, and psychiatric misdiagnoses.
  7,114 306 4
Impact assessment of India's Swachh Bharat Mission – Clean India Campaign on acute diarrheal disease outbreaks: Yes, there is a positive change
Giribabu Dandabathula, Pankaj Bhardwaj, Mithilesh Burra, Peddineni V. V. Prasada Rao, Srinivasa S Rao
March 2019, 8(3):1202-1208
DOI:10.4103/jfmpc.jfmpc_144_19  PMID:31041274
Background: Enough evidence exists to attribute the occurrence of diarrheal disease outbreaks due to open defecation practice and unsafe sanitation methods. Open defecation enables pathogens such as virus, bacteria, and protozoa to infect humans by means of fecal–oral transmission methods through contaminated fluids, water, and fomites. To curb the malefic effects of open defecation, the Indian government had initiated pro sanitation program namely Swachh Bharat Mission (SBM) in 2014. SBM became the world's largest toilet-building initiative. More than 95 million toilets have been built across rural and urban India since the launch of this mission. This articulation summarizes the trend analysis of acute diarrheal disease (ADD) outbreaks over a 9-year period with emphasis on changes due to the building of toilets under the clean India campaign. Methods: Weekly ADD outbreaks data from national-level Integrated Disease Surveillance Program between 2010 and 2018 were used for trend analysis along with the number of toilets constructed in rural areas under SBM from the year 2014. Results: ADD outbreaks were analyzed from 2010 to 2018. The number of ADD outbreaks per year during the past 2 years (i.e., 2017 and 2018) of SBM regime was lesser than in any year during the investigation period. Seasonal variations during the months of May, June, July, and August account for 55%–60% of ADD outbreaks in any of the years; but for 2018, the total outbreaks were 46%, which is significantly lower than that of regular range of outbreaks in the peak season. Conclusion: The recent pattern of ADD outbreaks exhibits a declining rate.
  5,926 420 10
The relationship between gender, age, anxiety, depression, and academic achievement among teenagers
Mahnaz F Khesht-Masjedi, Somayeh Shokrgozar, Elahe Abdollahi, Bahareh Habibi, Tahereh Asghari, Reyhaneh Saber Ofoghi, Sabra Pazhooman
March 2019, 8(3):799-804
DOI:10.4103/jfmpc.jfmpc_103_18  PMID:31041204
Background: Researchers have shown that the anxiety and depression have an important role in academic achievement. Objectives: This study is designed to identify the impact of anxiety and depression on academic achievement in students living in North of Iran. Patients and Methods: In this study 666 secondary school students (13–19 years old) were involved in North of Iran, were involved in this study. We used two instruments for data collection, The Beck Anxiety Inventory and The Beck Depression Inventory. Results: The results indicate that girls with 21.8% were more anxious than boys with 11.6% (F = 21.448, t = 5.420), while boys with 29.5% are more depressed than girls with 17.8% (F = 25.530, t = 4.847). Additionally, there were a significantly negative correlation between academic achievement with anxiety and depression. There was no statistically significant difference in the mean of anxiety and age between teenagers, but a significant depression level of respondents who are 18 and 19 years old was significantly different from other ages. Conclusions: It is recommended that along with academic performance, mental health be developed in school settings using support strategies such as educational guidance and counseling, teaching life skill programs, and psychotherapy. It was concluded that there is an urgent need to pay more attention to the anxiety and depression of adolescents in Iran. The findings of the study will be useful in assisting educators, counselors, and psychologists to develop strategies to enhance students' psychological well-being.
  5,384 698 4
Epidemiology of alcohol consumption in an urban area of Kancheepuram district, Tamil Nadu
V M. Anantha Eashwar, S Gopalakrishnan, R Umadevi, A Geetha
March 2019, 8(3):1098-1105
DOI:10.4103/jfmpc.jfmpc_390_18  PMID:31041257
Introduction: In India, the ever increasing production, promotion, distribution, and the easy availability and accessibility of alcohol together with the changing values in the society have resulted in alcohol consumption becoming one of the major public health problems. Aims: The study was undertaken to find out the prevalence of alcohol consumption and its epidemiological determinants in an urban area of Kancheepuram district, Tamil Nadu. Methodology: This descriptive cross-sectional study was done among adult males above 18 years of age in Anakaputhur area of Kancheepuram district, Tamil Nadu. Simple random sampling method was used to select the study participants to reach the required sample size of 400. Pretested structured questionnaire was used as study tool to collect data regarding alcohol consumption practices. Data were analyzed using SPSS version 22. Results: The prevalence of alcohol consumption among the study participants was found to be 39%. The major determinants of alcohol consumption which were found to be statistically significant were age less than 45 years, those belonging to a nuclear family, those who consume tobacco, consumption of alcohol by family members, those who did not receive advice regarding harmful effects of alcohol from family members, those having stigma of being a nondrinker among friends/peers and those having awareness of health problems caused due to alcohol consumption. Conclusion: This study shows that it is high time we change the approach of educating the public about the effects of alcohol consumption by intensive behavioral change continuum activities at a younger age group, coupled with encouraging refusal skills to overcome peer pressure.
  4,921 270 2
Outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study
Sourav Goswami, Anupriya Jha, Sarinkumar Puthenveettil Sivan, Dharampal Dambhare, Subodh Saran Gupta
March 2019, 8(3):1112-1116
DOI:10.4103/jfmpc.jfmpc_308_18  PMID:31041259
Introduction: Cholera, though a preventable and treatable disease, is still regarded as an important public health problem in developing countries including India. Migration, unhygienic living conditions, overcrowding, open field defecation, and ignorance about the spread of disease are the major reasons for the occurrence of cholera in the slum areas. Cholera was detected in the stool sample of a 3-year-old child from a slum area of urban Wardha, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic. Materials and Methods: This was a cross-sectional epidemiological study, where we have used pretested, predesigned epidemiological case sheets obtained from IDSP. A case definition was proposed before beginning the investigation. Linelisting, collection of stool and water samples, immediate referral, and treatment of the patients suffering from loose stool and/or vomiting were performed. A detailed epidemiological report was made with recommendations and plan of action that was forwarded to the district health system. Results: In all, 28 suspected cases of cholera were line listed. Among the affected population, more than half of the suspected cases were from the age group of 0–10 years of age. Males were more affected when compared with females. The overall attack rate was 27% and case fatality rate was 0%. There was positive history of travel in the index case. Two of the water samples were found to be unsatisfactory for drinking. Conclusion: The investigation report was soon developed and shared with the district health authorities, and recommendations were given to prevent such outbreaks in future.
  4,311 341 2
A pharmacoeconomic analysis to compare cost-effectiveness of metformin plus teneligliptin with metformin plus glimepiride in patients of type-2 diabetes mellitus
Tanya Tandon, Ashok K Dubey, Saurabh Srivastava, Sachin Manocha, Ekta Arora, Nazer Hasan
March 2019, 8(3):955-959
DOI:10.4103/jfmpc.jfmpc_22_19  PMID:31041232
Background: With the available evidence of early combined oral drug therapies being more effective in lowering blood glucose levels than maximal doses of a single drug, many clinicians are taking the aggressive approach of adding a sulfonylurea or a dipeptidyl peptidase-4 (DPP-4) inhibitor to metformin as the initial therapy in type 2 diabetes mellitus (T2DM). Pharmacotherapy for a chronic disease like diabetes has substantial economic implications for patients especially in a developing country like India. So it is important to scientifically evaluate the cost-effectiveness of these commonly practiced combination therapies in the management of T2DM. Materials and Methods: This was a prospective observational randomized comparative study conducted over 8 weeks on patients of T2DM who were prescribed either of the two therapies of metformin (500 mg) plus glimepiride (1 mg) or metformin (500 mg) plus teneligliptin (20 mg). Cost-effectiveness analysis was done by calculating the expense incurred on 0.1% reduction in HbA1 c and 1 mg/dl reduction in fasting plasma glucose (FPG)/post-prandial plasma glucose (PPG) levels after 8 weeks and compared for both the groups. The same was also evaluated for differences in BMI levels. Results: The cost-effectiveness for per unit reduction in HbA1c and FPG was significant in metformin plus glimepiride group as compared to the metformin plus teneligliptin group though it was comparable for both the groups for per unit PPG reduction. There was no significant change in BMI levels between the groups. Conclusion: Compared to metformin plus teneligliptin, metformin plus glimepiride is a significantly cost-effective therapy when used as an initial combination therapy in patients of T2DM in lowering HbA1c and FPG.
  3,855 498 1
A population-based study on tobacco consumption in urban slums: Its prevalence, pattern, and determinants
Amrita Sarkar, Debjit Roy, Arvind Nongpiur
March 2019, 8(3):892-898
DOI:10.4103/jfmpc.jfmpc_42_19  PMID:31041220
Background: India suffers from a huge burden of substance abuse and associated morbidity and mortality. Among all substance use, tobacco consumption is the most common and yet the most widely accepted one. This study aimed to estimate the prevalence of tobacco consumption, to find out the type of tobacco products used and to assess the factors influencing tobacco consumption in the slums of Shillong city. Materials and Methods: A cross-sectional, community-based study was carried out in 330 respondents aged 15 and above. Chi-square test was used to compare proportions, and Student's t-test was used to compare groups for continuous variables. Results: The prevalence of current tobacco consumption was found to be 73.9%, and the rate of quitting was found to be 4.3%. The prevalence of tobacco consumption was observed to be higher in males (52.4%) compared to 21.5% in females. Highly significant statistical association was observed between tobacco consumption and age, gender, and occupation. The statistical association between tobacco consumption and religion and education was found to be statistically significant. Ever use of tobacco in any form as well as smokeless form peaked in 24–34 years, while smoking was more prevalent among 15–24 year olds. The prevalence of smokeless tobacco was higher (47.5%) as compared to the prevalence of smoking (28.2%), closely followed by dual use (24.3%). The most popular smoked and smokeless forms were found to be cigarettes and khaini, respectively. Conclusions: Tobacco consumption was found to be highly prevalent and was much higher than the national average hinting toward its association with higher incidence of various malignancies in the region and calling for immediate action toward propelling its prevention and control by all stakeholders.
  3,874 316 1
Awareness and utilization of social welfare schemes by elderly persons residing in an urban resettlement colony of Delhi
Anil Kumar Goswami, S Ramadass, Mani Kalaivani, Baridalyne Nongkynrih, Shashi Kant, Sanjeev Kumar Gupta
March 2019, 8(3):960-965
DOI:10.4103/jfmpc.jfmpc_28_19  PMID:31041233
Background: Demographic transition increased the proportion of elderly in India. Elderly persons experience increased economic dependency for their day-to-day existence. The Government of India provides monetary benefit through social welfare schemes. Health outcomes of the elderly improve when they are economically independent. We aimed to assess the awareness and utilization of social welfare schemes among elderly persons in an urban resettlement colony of Delhi. Materials and Methods: This was a community-based cross-sectional study conducted from February to May 2018. Two specially recruited interviewers administered the self-developed semi-structured interview schedule. It consisted of sociodemographic data, awareness, and utilization of various schemes. Results: A total of 931 [416 (37.4%) males and 515 (55.3%) females] participants completed the interview. Of the total, 809 (86.9%) participants were aware of at least one social welfare scheme. Participants utilizing any of the social welfare schemes were 393 (42.2%). Females utilized the social welfare schemes almost twice as compared to males (AOR = 1.7, 95% CI: 1.1–2.6). Participants aged 75 years and above had four times higher utilization of social welfare schemes compared to 60–64 years age group (AOR = 3.9, 95% CI: 2.4–6.4). Conclusion: Although the awareness of social welfare schemes among elderly persons was good, their utilization has scope for significant improvement. Focus is needed on elderly males and among the younger elderly persons.
  3,798 270 1
Comparison of knowledge, attitude, and practices regarding needle-stick injury among health care providers
Anitha Madhavan, Anjana Asokan, Anu Vasudevan, Janeesh Maniyappan, K Veena
March 2019, 8(3):840-845
DOI:10.4103/jfmpc.jfmpc_103_19  PMID:31041211
Introduction: Needle-stick injury (NSI) is one of the most potential hazards for health care workers. They pose a significant risk of occupational transmission of blood-borne pathogens. The present study was done to determine the incidence of NSI among interns and nurses; their knowledge, attitude, and preventive strategies undertaken by the respondents after NSI. Materials and Methods: The cross-sectional study was done among interns and nurses in various departments of a tertiary care center in Kerala, India using a self-administered questionnaire. Results: The incidences of NSI among interns and nurses were 75.6% and 24.4%, respectively. The most common clinical activity leading to NSI among interns was blood withdrawal (42%) followed by recapping (29%). It was found that nurses had enough knowledge and followed better NSI practices and attitude than the interns. Conclusion: All the parameters analyzed were inadequate among the interns, indicating the need for continual awareness programs particularly during the preclinical years.
  3,549 414 -
Global epidemiology, risk factors, and histological types of ovarian cancers in Trinidad
Srikanth Umakanthan, Vijay K Chattu, Sherene Kalloo
March 2019, 8(3):1058-1064
DOI:10.4103/jfmpc.jfmpc_384_18  PMID:31041251
Background: Ovarian cancer is the seventh most common cancer in women in the world and Trinidad and Tobago is ranked 18th in the world with respect to the rate of occurrence. About 68% cases are diagnosed at a late stage, resulting in low survival rates. Since there is very scanty literature available on the epidemiology of ovarian cancer in the Caribbean region, this study was undertaken to assess the most common risk factors, presenting symptoms and common histological varieties in Trinidad. Methods: A hospital-based, cross-sectional study was designed, and all the 23 diagnosed ovarian cancer cases registered during 2015–2017 were considered. Information on sociodemographics, presenting symptoms, and histological type of cancers were collected after getting the ethical approval. Of the total 23 cases, 17 cases were included in this study after ensuring completeness of data as detailed analysis of patient data was done using Microsoft Excel. Results: The common risk factors identified were previous pregnancies, previous surgeries, and irregularities in the menstrual cycle. The commonest histological variety was granulosa tumors and the most common associated symptoms were irregular menses and abdominal pain in premenstrual women, and abdominal distention in postmenopausal women. Conclusions: It would greatly enhance the detection rate if screening and testing for the CA-125 gene were a mandatory practice, for any patient found with more than three risk factors. The public health authorities should identify the modifiable risk factors and implement cancer reduction and health promotion activities to reduce the mortality related to ovarian cancers.
  3,665 297 3
Effect of backpack loading on cervical and sagittal shoulder posture in standing and after dynamic activity in school going children
Nirav P Vaghela, Sanket K Parekh, Dixa Padsala, Dhruti Patel
March 2019, 8(3):1076-1081
DOI:10.4103/jfmpc.jfmpc_367_18  PMID:31041254
Background: Adolescent age group as school going children who experience a period of accelerated growth and development of skeletal and soft tissue. Any daily physical stresses external forces such as load carrying may also influence alignment of the human body. It is assumed that daily intermittent abnormal postural adaptations could result in pain and disability. Objectives: To know the effect of backpack loading on cervical and sagittal shoulder posture (SSP) in standing and after dynamic activity in school going children. Materials and Methods: The research project was conducted after getting clearance from Human Research Ethics Committee of the H M Patel Institution for Education and research center. Study was conducted on 160 school going children, and measurement were taken to know the loading over the cervical region along with their bagpacks were weighed. Results: Total 160 students were enrolled in the present study. Study found that average value of the subject's body weight was 34.83 kg, and subjects backpack weight was 6.42 kg that was equivalent to 18% of the subject's body weight. The mean value of cranio-vertebral angle (CVA) without school bag was 40.62. The mean values of cranio-horizontal angle (CHA) while standing with 18% of body weight and after dynamic activities with 18% of body weight were 24.51 ± 10.3 and 28.93 ± 4.34, respectively. The mean value of SSP without school bag was 39.39 ± 4.31, whereas the mean values of SSP while standing with 18% of body weight and after dynamic activities with 18% of body weight were 54.38 ± 21.19 and 77.62 ± 17.50, respectively. Conclusions: Study revealed that there is a significant reduction in the CVA (or increased forward head position), increase in CHA, and SSP were found while carrying a backpack weight 18% of body weight over both shoulders.
  3,571 372 5
Epidemiology and clinical outcomes of acute glomerulonephritis in a teaching hospital in North India
Kapil Bhalla, Ashish Gupta, Sanjiv Nanda, Shuchi Mehra
March 2019, 8(3):934-937
DOI:10.4103/jfmpc.jfmpc_57_19  PMID:31041228
Context: Acute glomerulonephritis (AGN) is a major cause of morbidity in developing countries like India. AGN includes both infectious and non infectious causes leading to immunological insult to the kidney. Aims: This study is an attempt to evaluate the clinical characteristics, complications and outcome of acute glomerulonephritis. Settings and Design: This hospital based descriptive study was conducted at a tertiary care hospital in North India. Materials and Methods: 50 children with AGN were recruited and analyzed over a period of one year. Detailed clinical examination and relevant laboratory investigations were done. Children were followed up for 6 months. Statistical Analysis Used: Data analysis was done using SPSS software and the results obtained are shown in the form of frequencies along with percentages. Results: 50 patients were enrolled in the study with male to female ratio of 1.72:1. Pharyngitis was the most common predisposing condition (70.2%). 22(40.4%) of patients had developed complications. Of this acute kidney injury with significant pulmonary edema was seen in 16 patients and 6 patients had encephalopathy with seizures. Two patients had to be managed with hemodialysis. 42 patients had positive CRP (>10) and ASO titres were >200 Todd units in all patients. At 6 months' majority of patients had complete clinical recovery with microscopic hematuria present only in 8 patients, persistent hypertension in 2 patients, 8 patients had proteinuria. These patients are being still followed up. Conclusions: Complications and morbidity is significantly high during the acute phase in AGN. Non infectious causes should also be kept in mind. This study highlights the complications requiring intensive care and need for long term follow up.
  3,420 366 2
CASE REPORTS
Lichen planus of lip – Report of a rare case with review of literature
Shamimul Hasan
March 2019, 8(3):1269-1275
DOI:10.4103/jfmpc.jfmpc_24_19  PMID:31041290
Lichen planus (LP) is a potentially malignant disorder with an immune-mediated etiopathogenesis. The condition frequently affects the skin, oral mucosa, skin appendages, and other mucous membranes. Oral lesions usually precede the onset of skin lesions and in majority of cases may only be presenting symptom. Isolated LP of the lip is rarely encountered in the clinical practice and is usually seen along with skin/other mucous membrane involvement. The clinical appearance poses diagnostic dilemmas and is often misinterpreted. This case report aims to highlight an interesting case of LP of the lower lip in a 50-year-old male patient. The patient presented with a diffuse erosive lesion on the lower lip bordered by white radiating striae on its inner aspect. Histopathological and immunofluorescent studies confirmed LP of the lip. Topical corticosteroids and Vaseline lip therapy were prescribed to the patient. There was considerable healing in the lip lesion during the follow-up period. However, recurrence was noted in the left buccal mucosa.
  3,377 273 6
ORIGINAL ARTICLES
A critical appraisal of the maternal and child health scenario in a metropolitan city in India with reference to achievements of millennium development goals
Anuradha Mohapatra, Mangala Gomare
March 2019, 8(3):995-1001
DOI:10.4103/jfmpc.jfmpc_379_18  PMID:31041240
Background: Post 2015, the Millennium Development Goals (MDGs) will undergo a transition to Sustainable Development Goals (SDGs). Therefore, it becomes necessary to assess the determinants influencing the present status of MDGs. This study was conducted to assess the progress, short comings related to the transition from MDGs to SDGs in a metropolitan city. It provides practical insights for extrapolating need based strategies related to the SDGs. Methods: Study was conducted in a metropolitan city, Mumbai. Situational analysis of the city was done using monthly and annual performance reports and key informant's interviews at city level. Qualitative analysis was done using thematic analysis. Results: The current infant mortality rate of Mumbai is 26.72 and under-five mortality rate is 38.7/1000 live births. The current MMR of mumbai is 88. The responses from the key informants' spanned three major themes: Concerns and challenges; Good practices and schemes in pipeline; and Opportunities envisioned. Eight major challenging areas were identified. Opportunities are sustainable models of public-private partnership; Involvement of NGOs and AYUSH practitioners; and IT sector involvement, HMIS, e- governance, and Corporate Social Responsibility (CSR). Conclusions: Significant progress has been made in the field of maternal and child health (MCH), and sustained efforts are required. Maternal mortality figures may be illusive because of the effect of migration and referral cases. Socio-demographic issues of development need to be addressed through governance. Mechanism for intersectoral coordination, IT support, surveillance, and tracking of pregnant mothers needs to be developed. The linkage of MCH services with developmental programs needed.
  3,321 311 5
Drivers and barriers for measles rubella vaccination campaign: A qualitative study
VK Krishnendhu, Leyanna Susan George
March 2019, 8(3):881-885
DOI:10.4103/jfmpc.jfmpc_73_19  PMID:31041218
Background: The measles-rubella (MR) vaccination campaign was launched in Kerala on 3rd October 2017 aiming to eliminate MR by 2020.The drive was carried out in schools, community centers, and medical institutions. The initial phase of the MR campaign met with many controversies that affected its coverage. Objectives: The objectives of the study were to analyze the drivers and barriers for acceptance of MR vaccination in the field area of a primary health center (PHC), which reported a low coverage (62%) during the initial phase of the campaign. Methods: A qualitative study consisting of key informant interviews of parents of vaccinated and unvaccinated children, medical officers of the PHC, Junior Public Health Nurse (JPHN), and Accredited Social Health Activist (ASHA) workers, and the principals of government and private schools where the campaign was conducted was also interviewed. Results: The major barrier to acceptance of MR campaign was the anti-vaccination propaganda in social media. The messages falsely linked fertility issues with the vaccine. The purpose of this campaign was not properly understood by the parents. The campaign was implemented within a short span of time resulting in coordination issues between the stakeholders. However, it was observed that religious affiliations played a major role in reducing coverage. The drivers to acceptance of MR vaccination campaign were the team effort of the healthcare providers who constantly motivated parents to vaccinate their children. Conclusion: Addressing the anti-vaccination propaganda has become the need of the hour. The inclusion of all stakeholders including religious leaders in the planning and implementation of the campaign is essential for its success.
  3,273 338 1
Scrub typhus: Overview of demographic variables, clinical profile, and diagnostic issues in the sub-Himalayan region of India and its comparison to other Indian and Asian studies
Monika Pathania, Amisha , Paras Malik, Vyas Kumar Rathaur
March 2019, 8(3):1189-1195
DOI:10.4103/jfmpc.jfmpc_124_19  PMID:31041272
Background: India is a tropical country with a high burden of febrile zoonotic/infectious illnesses, scrub typhus being such a cause with multiple epidemics reported from different regions of the country. Objective: This study was plotted to document the clinical and diagnostic manifestations, treatment, and outcomes of scrub typhus in the sub-Himalayan region of India and to compare the results with other Indian and Asian studies. Materials and Methods: This was a retrospective observational study involving collection of data for 54 IgM ELISA-confirmed in-patient cases of scrub typhus at a tertiary care institute in Uttarakhand, India, from their case records. Results: The majority of patients were from rural background. Housewives constituted 28 (51.85%) patients. The most common symptoms were due to involvement of gastrointestinal tract in the form of abdominal pain in 39 (72.22%) and vomiting in 29 (53.7%) patients. Central nervous system involvement in the form of altered sensorium in 14 (25.9%) patients and pulmonary involvement as cough in 28 (51.85%) patients was observed. An eschar was found in 7 (12.96%) patients and upper eyelid edema in 40 (74.07%) patients. The most common laboratory abnormality documented was elevation of liver transaminases (aspartate aminotransferase > alanine aminotransferase), 40 (74.07%), and blood urea levels, 47 (87.03%). There was no difference in the clinical presentation, severity, or mortality in pregnant females when compared with nonpregnant females. One (1.45% mortality) died in our study. Conclusion: Scrub typhus is an important cause of acute febrile illness with variable, often nonspecific and multisystem involvement. Early recognition and antibiotic administration are the key to reduce complications and mortality, especially for a primary care physician.
  3,153 320 -
Why human papilloma virus vaccination coverage is low among adolescents in the US? A study of barriers for vaccination uptake
Shyamkumar Sriram, Radhika Ranganathan
March 2019, 8(3):866-870
DOI:10.4103/jfmpc.jfmpc_107_19  PMID:31041215
Introduction: Cervical cancer and Human papillomavirus (HPV) affects women, men, and children of all races, ethnicities, and backgrounds. The objective of this study is to examine the association between adolescent (13–17 years) HPV vaccination uptake and the key factors influencing the uptake rates of HPV vaccination. Materials and Methods: The 2016 NIS-Teen data, an annual survey conducted by the CDC to monitor vaccination uptake in the United States is used for this study. Multivariable logistic regression model was used to estimate the relationship between various factors and HPV vaccine uptake. Results: Male adolescents were 0.26 times less likely to get the HPV vaccines; adolescents covered by private health insurance were 0.18 times less likely to get HPV vaccines; Hispanic adolescents were 1.47 times more likely, adolescents from other races including Asians were 1.75 times more likely to get vaccinated for HPV compared to non-Hispanic white adolescents. Adolescents from the low-income families were 1.21 times more likely to get vaccinated for HPV; adolescents from North-eastern regions of the United States were 1.62 times more likely to get vaccinated; adolescents who were not recommended for vaccination by the family physicians were 0.43 times less likely to get HPV vaccination; adolescents who did not have any safety concerns and concerns about side effects were 3.24 times more likely to get the HPV vaccine; adolescents from households that did have not orthodox religious beliefs were 13.67 times more likely to get vaccinated. Conclusions: Vaccination uptake rates are low for adolescents in the US and the results of this study identified important barriers which need to be addressed in order to improve vaccine uptake rates among the target groups which are less likely to get vaccinated. Also, knowing the sociodemographic and community level factors associated with HPV vaccination uptake status, health planners can better plan strategies to improve HPV vaccination in their local settings.
  2,950 393 8
Quality of life among people living with HIV/AIDS and its predictors: A cross-sectional study at ART center, Bagalkot, Karnataka
C Shriharsha, Sreevani Rentala
March 2019, 8(3):1011-1016
DOI:10.4103/jfmpc.jfmpc_411_18  PMID:31041243
Background: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) emerged as one of the most important public health issues of the late twentieth and early twenty- first centuries. Quality of life (QoL) of people living with HIV/AIDS (PLHIV) is affected by multiple variables including depression as a major predictor of QoL. Aims: To assess the QoL of PLHIV and its predictors. Settings and Design: This cross-sectional study included a sample of 450 PLHIV attending the ART center, District Government Hospital, Bagalkot. Methods and Materials: Data were collected using self-report method and Hospital's records. Tools used for data collection included sociodemographic questionnaire, WHOQOLHIV-BREF scale, and Centre for Epidemiologic Studies Depression Scale (CES-D Scale). Bivariate associations were observed through Pearson's correlations, analysis of variance (ANOVA), and t-tests. Multiple linear regression analysis was performed to find the significant predictors of QoL. Results: Findings revealed a significant negative correlation between the QoL and depression (r = –0.751, P < 0.001). A significant regression equation was found (F14, 435= 57.76, P < 0.001, adjusted R2 = 0.64) when all the variables are considered together for finding the significant predictors of the QoL. Male gender, being graduated, not knowing the mode of transmission have positively predicted the QoL. On the other hand, having primary education, being in nuclear family, having HIV-positive wife, having HIV-positive children, HIV infection through homosexual relationships, history of suicidal attempts, and history of alcohol intake negatively predicted the QoL of PLHIV. Depression was the strongest negative predictor of the QoL of PLHIV (β = –0.672, P < 0.001). Conclusions: Interventions aimed at management of depression among PLHIV attending the ART centers would result in enhancing their QoL.
  2,993 339 1
Patterns of geriatric anemia: A hospital-based observational study in North India
Dheeraj Sharma, Vikas Suri, Ashok K Pannu, Savita V Attri, Neelam Varma, Rakesh Kochhar, Subhash Varma, Savita Kumari
March 2019, 8(3):976-980
DOI:10.4103/jfmpc.jfmpc_450_18  PMID:31041236
Background: Geriatric anemia is a global health problem because of its high prevalence and associated significant morbidity and mortality. Aim: The objectives of this study were to estimate the pattern of anemia in the elderly patients and the underlying etiology of anemia. Research Design and Methods: This was a hospital-based prospective observational study, conducted in patients aged 60 years and above at PGIMER, Chandigarh, a tertiary care center of North India. Anemia is defined as hemoglobin level less than 13 g/dl in men and 12 g/dl in women. Results: Among the 105 older patients with anemia, the mean value of hemoglobin was 8.8 ± 2.3 g/dl. The etiological distribution of anemia was iron deficiency in 26 patients (24.8%), chronic disease in 24 patients (22.9%), hematological disorders in 21 (20%), chronic kidney disease in 13 (12.4%), multifactorial in 8 (7.6%), vitamin B12 deficiency in 2 (1.9%), folate deficiency in 1 (0.9%), and hypothyroidism in 1 patient (0.9%). No etiology could be found in 9 patients (8.6%). 57.6% of the iron-deficient patients had upper gastrointestinal lesions and 30.7% had a nutritional cause. Common chronic diseases causing anemia were malignancy (36.6%) and liver disease (29.1%). The myelodysplastic syndrome was the commonest hematological disorder. 53.35% of the patients had normocytic anemia, 40% had microcytic anemia, and 6.6% had macrocytic anemia. Conclusions: In most of the cases, anemia in the elderly had a treatable cause. Thus, a thorough investigation including gastrointestinal endoscopy is warranted. Unexplained progressive or unresponsive anemia requires bone marrow examination.
  2,925 382 1
Clinical characteristics and complications of skull base osteomyelitis: A 12-year study in a teaching hospital in South India
Sohini Das, Ramya Iyadurai, Karthik Gunasekaran, Reka Karuppusamy, Zacharia Mathew, Ebenezer Rajadurai, Ajoy O John, Sunithi Mani, Tina George
March 2019, 8(3):834-839
DOI:10.4103/jfmpc.jfmpc_62_19  PMID:31041210
Context: Skull base osteomyelitis (SBO) is an uncommon disease with substantial morbidity and mortality. Aims: The aim of this study is to characterize clinical features, outcomes, and complications of SBO. We also looked at differences in clinical profile in otogenic and non-otogenic SBO. Materials and Methods: This is a single-center retrospective observational study. Patients aged more than 15 years of age with clinical and radiological diagnosis of SBO admitted in general medicine department in a teaching hospital in South India from March 2006 to February 2018 were recruited. Results: A total of 41 patients with SBO were identified and included. Mean age was 56.9 ± 10.7 years. In all, 90% of patients (37/41) had diabetes mellitus and 29% (12/41) had recent head/neck surgery. Only 19% (8/41) needed ICU care, and mortality was 21% (9/41). Most common symptom was headache seen in 73% (30/41) of patients. Majority, 61% (25/41), had otogenic infections. Otogenic infections were associated with longer duration of diabetes mellitus (mean = 11.5 vs. 5 years, P = 0.01), higher creatinine levels (mean = 1.66 vs. 0.9 mg/dL, P = 0.014, odds ratio [OR] = 3.8), and higher incidence of cranial nerve palsy (92% vs. 56%; OR = 8.9) compared to non-otogenic SBO. Cranial nerve palsy (78%), meningitis (63%), and cerebral venous thrombosis (43%) were frequent complications of SBO in this study. The causative organisms for SBO in our cohort was bacterial in 60% (15/25) and fungal in 40% (10/25) of the patients. Surgical debridement for source control was done in 54% of patients (22/41) and was associated with survival at discharge (P = 0.001). Conclusions: Bacterial infections are the most common cause of SBO. Otogenic SBO is associated with longer duration of diabetes mellitus and higher incidence of cranial nerve palsy. Therapeutic surgical debridement plays an important role in treatment of SBO and is associated with improved survival.
  2,824 265 8
CASE REPORTS
Fabrication of ocular prosthesis with a digital customization technique – A case report
Rajat Lanzara, Ashish Thakur, M Viswambaran, Amit Khattak
March 2019, 8(3):1239-1242
DOI:10.4103/jfmpc.jfmpc_133_19  PMID:31041281
Loss of an eye can be caused by cancer, trauma, or congenital defects. A loss of eye creates functional, esthetic, and psychological lacunae in individual's personal and professional life. Rehabilitation of ocular defect can be done by a custom ocular prosthesis fabricated with heat cure polymethylmethacrylate. The custom-made prosthesis provides a better fit, is more comfortable to use and gives better cosmetic results than a stock prosthesis. The main objective of this article is to describe a new technique of customization using digital photograph of the patient's iris made using a digital camera to give excellent cosmetic results to the patient.
  2,677 367 2
COMMENTARY
Fixing accountabilities and finding solutions to tackle acute (communicable) diseases viewed as collateral damage due to errors of omission and commission in primary care
Sudip Bhattacharya, Amarjeet Singh
March 2019, 8(3):784-787
DOI:10.4103/jfmpc.jfmpc_45_19  PMID:31041201
  2,816 174 3
EDITORIAL
Physicians and healthcare professionals in the era of #Metoo
Jagdish Khubchandani, Raman Kumar, Sharon L Bowman
March 2019, 8(3):771-774
DOI:10.4103/jfmpc.jfmpc_228_19  PMID:31041199
Gender Based Violence is and has been a pervasive problem in our societies and communities. In recent times, there has been a renewed emphasis on the problem given the #MeToo movement and social activism. In this editorial, we discuss healthcare professions and gender-based violence in light of the #MeToo movement. Also, three major types of exchanges in the healthcare field have been described in relation to gender-based violence. Implications for practice and prevention of gender-based violence in healthcare systems worldwide have been discussed. Healthcare industry is one of the biggest and most prominent enterprises worldwide with lives at stake. Safety of providers and patients and violence free healthcare workplaces can significantly improve health outcomes. The #MeToo movement reminds us of our responsibilities and professional codes of conduct and demands that we always keep at the forefront—the rights of those we serve or interact with.
  2,538 295 1
ORIGINAL ARTICLES
Nutritional status of the student nurses of a tertiary health-care center – A mixed-method study
Rujuta Hadaye, Barsha Pathak, Sujata Lavangare
March 2019, 8(3):1028-1034
DOI:10.4103/jfmpc.jfmpc_314_18  PMID:31041246
Context: Nursing students are the future role model of health; so critical evaluation of their nutritional status is imperative for effective functioning of health sector. Aims: The aim is to assess the nutritional status of nursing students using basal metabolic index and exploring the causes of malnutrition along with uncovering the causes behind these causes of malnutrition. Setting and Design: Nutritional status of student's nurses was assessed by mixed-method study design in tertiary care center of Mumbai, India. Materials and Methods: The method is to use the census method for sampling 280 nursing students of a tertiary care center interviewed using a semistructured interview schedule. Focus group discussions were held with student nurses, which were selected through purposive sampling technique to interpret the instigator causes behind causes of malnutrition. Statistical Analysis: Descriptive statistics was applied on qualitative data. Conceptual model framed on themes and subthemes based upon the codes from qualitative data. Results: Students having BMI less than 18 and more than 24.9 were 189 and 11, respectively, out of 280 students. About 64.20% had acidity and 11.07% performed regular exercises evolving major themes: challenges, stress, attitude, knowledge, social barriers, and motivators. Conclusion: About 67.5% of nursing students had BMI less than 18. Inappropriate dietary pattern, frequent ailments, and improper personal habits ensued their malnourished status. Lack of proper knowledge on balanced diet, work place stress, and challenges such as financial constrain, peer pressure, and health ailments along with improper perception of body image of the student nurses are major triggering factors behind the causes of malnutrition.
  2,651 175 2
Biochemical markers and lipid profile in nonalcoholic fatty liver disease patients in the PERSIAN Guilan cohort study (PGCS), Iran
Roya Mansour-Ghanaei, Fariborz Mansour-Ghanaei, Mohammadreza Naghipour, Farahnaz Joukar
March 2019, 8(3):923-928
DOI:10.4103/jfmpc.jfmpc_243_18  PMID:31041226
Background and Aim: Nonalcoholic fatty liver disease (NAFLD) is a global epidemic that is often asymptomatic and silent, and progresses slowly. This study aimed to determine the biochemical markers and lipid profile among NAFLD patients and their possible relationship with degrees of fatty liver. Methods: This is analytical cross-sectional study, in which, 950 individuals referred to the PERSIAN Guilan cohort study were included through sequential sampling method. The demographic information and blood pressure of the subjects were taken and the blood sample was prepared to investigate the biochemical markers and lipid profile. Also, abdominal ultrasonography was performed to investigate NAFLD and its grades. For data analysis, independent sample t-test, one-way ANOVA, and logistic regression model were used, where P < 0.05 was considered significant. Results: The systolic blood pressure (SBP) (P < 0.001), diastolic blood pressure (DBP) (P < 0.001), hepatic enzymes (aspartate aminotransferase [AST], P < 0.001, alanine aminotransferase [ALT], P < 0.001; gamma-glutamyle transferase [GGT], P < 0.001; AST/ALT ratio, P < 0.001), lipid profile (triglyceride [TG], P < 0.001; total cholesterol [TC], P = 0.008; high density lipoprotein [HDL], P < 0.001; LDL-C/HDL-C (ratio), P = 0.003; TC/HDL-C (ratio), P < 0.001); and fasting blood sugar [FBS], P < 0.001 correlated with NAFLD. However, there was no relationship between age (P = 0.34), alkaline phosphatase [ALP] (P = 0.26) and low-density lipoprotein [LDL] (P = 0.72). Further, a significant relationship was observed between AST (P < 0.001), ALT (P < 0.001), and GGT (P = 0.004) and NAFLD degrees based on the ultrasonography. Conclusion: Biochemical markers and lipid profile are associated with NAFLD. Thus, it is recommended to investigate NAFLD in clinical settings in cases in which their changes are observed in patients through ultrasonography.
  2,492 298 9
Effectiveness of holistic group health promotion program on educational stress, anxiety, and depression among adolescent girls – A pilot study
Sreevani Rentala, Bobo Hi Po Lau, Rajashree Aladakatti, Sunanda Govinder Thimmajja
March 2019, 8(3):1082-1089
DOI:10.4103/jfmpc.jfmpc_378_18  PMID:31041255
Background: Academic stress is one of the major stresses among adolescents and it has been associated with poor mental health. Aim: Evaluate effectiveness of holistic intervention on educational stress among adolescent girls. Materials and Methods: Randomized controlled design was adopted and study was conducted at selected colleges of Dharwad city, India. 60 adolescent girls were randomly assigned to either experimental or control group. All subjects were initially assessed for educational stress, depression and anxiety. The experimental group subjects received 8 sessions of holistic intervention. No intervention was given to control group subjects. Post intervention assessments were done at the end of 1st, 2nd and 3rd months. Results: Experimental group subjects showed statistically significant decrease in educational stress, depression and anxiety over 3 months follow-up compared to control group subjects. Conclusion: This study provided evidence of integrating a holistic intervention in reducing stress.
  2,471 270 2
Assessment of general practitioners' needs and barriers in primary health care delivery in Asia Pacific region
Pratyush Kumar, Christopher Larrison, Shelly B Rodrigues, Thomas McKeithen
March 2019, 8(3):1106-1111
DOI:10.4103/jfmpc.jfmpc_46_19  PMID:31041258
Background: Primary health care is the key to achieve universal health coverage and health for all. The role of general practitioner is now more important than ever. Gaps exist between primary care doctors' needs and available resources. Primary care professionals everywhere in the world are expected to provide basic standard of care and fulfill the unmet needs of the population. “Needs assessment” is essential in order to develop plans that reflect clinical priorities, educational needs, patient-centered care, and effective and efficient utilization of resources. Materials and Methods: A blend of qualitative (28 in-depth interviews) and quantitative (315 survey respondents) research helped to identify the educational gaps of general practitioners in the Asia Pacific (APAC) countries. Our in-depth methodology assessed perceived needs in order to inform educational tactics that will engage physicians and drive changes in clinical practice. Barriers to change and best practices were identified so that those barriers may be addressed by the educational strategy. Results: Key findings include a strong need for education for chronic conditions such as mental illness, skin problems, diabetes, hypertension, and others. The majority of physicians indicated that they prefer education in all aspects of the disease, from screening and diagnosis to maintenance or referral. Most clinicians prefer live presentations and small groups over Internet-based formats. Sub-analysis based on demographic factors showed little differences in the perceived needs, but significant differences in barriers to best practices. Conclusion: “Needs assessment” gives an insight into barriers, interest, and necessity related to education and skills in primary care and the best ways to deliver it.
  2,472 207 3
Health-seeking behaviour among antenatal and postnatal rural women in Kancheepuram District of Tamil Nadu: A cross-sectional Study
S Gopalakrishnan, V M. Anantha Eashwar, M Muthulakshmi
March 2019, 8(3):1035-1042
DOI:10.4103/jfmpc.jfmpc_323_18  PMID:31041247
Introduction: Maternal morbidity and mortality is still a major public health challenge. Lack of proper birth plan and delay in identification of pregnancy complications is one of the major causes of maternal morbidities and deaths, especially in the rural areas. Aim: The study was conducted with the aim to evaluate the health-seeking behaviour for obstetric care services among the antenatal and postnatal mothers in a rural area of Tamil Nadu. Materials and Methods: This descriptive cross-sectional study was done among antenatal and postnatal mothers registered in the Rural Health Training Centre, in Sripuram area of Kancheepuram district, Tamil Nadu during 2017. About 150 antenatal and 150 postnatal mothers were selected by simple random sampling method. A pre-tested structured questionnaire was used to collect relevant data which was analysed using the SPSS version 22. Results: Only 21% of the study participants had adequate knowledge regarding the danger signs of pregnancy and the major determinants were maternal literacy and adequate prenatal care. Regarding the health-seeking behaviour, 62.3% of them preferred primary health centres as preferred place of delivery, 87.3% of them had received adequate prenatal care and it was found to have statistically significant association with adequate gestational weight gain, exclusive breastfeeding, proper weaning practices and consumption of iron and folic acid supplements. Conclusion: The study shows the need to provide health education regarding the danger signs of pregnancy and importance of adequate prenatal care to all pregnant women and expectant mothers, to make them aware of when and how to seek medical care, which in turn could reduce the overall maternal morbidity and mortality.
  2,409 266 2
Knowledge, awareness, and attitude among the employees in emergency ambulance services towards traumatic dental injuries
C Chrishantha Joybell, M Kawin Kumar, Balaji Ramraj
March 2019, 8(3):1043-1048
DOI:10.4103/jfmpc.jfmpc_343_18  PMID:31041248
Introduction: Traumatic dental injuries are the most frequently encountered dental emergencies. Psychologically a missing tooth in the front tooth region can be a cause of social embarassment for the child and may elevate the anxiety level in the parents. The prognosis of any road traffic accident (RTA) mainly depends on the employees in emergency ambulance services to prompt correct emergency measures. Aim of the Study: The purpose of this study was to evaluate the knowledge and the awareness level of the employees in emergency ambulance services regarding the management of dental trauma in patients who have sustained RTAs. Materials and Methods: In total, 100 healthcare workers in 108 emergency ambulance services were randomly evaluated using a self-structured questionnaire in and around Kancheepuram district of Tamil Nadu. Results: The overall knowledge of the personnel in 108 emergency ambulance services regarding management of traumatic injuries to the teeth was not satisfactory. Approximately, 86% of employees reported that no dental first aid is given for the patient who has sustained RTA. Conclusion: Dental trauma awareness program and first aid training will help in rebuilding the awareness and knowledge regarding the importance of management in a dental emergency.
  2,445 222 -
Tracking lipid profile and atherogenic indices in the prediabetics of Andaman Nicobar Islands: A retrospective hospital-based study
Montosh Chakraborty, Shivakrishna Gouroju, Prerna Singh, Pandurang V Thatkar, Debajit Bagchi
March 2019, 8(3):1117-1122
DOI:10.4103/jfmpc.jfmpc_332_18  PMID:31041260
Context: Cardio vascular disease (CVD) is the leading cause of mortality and morbidity in diabetes mellitus (DM) contributing to 65% of all deaths with diabetic complications. The most important cause of CVD is atherosclerosis, and dyslipidemia acts as a marker of developing atherosclerosis. The derangement of lipid profile and atherogenic indices start in the prediabetic state, much before the development of DM. Detection of the deranged lipid profile and atherogenic indices in the prediabetic state can help devise the aggressive treatment strategy right from this stage, so as to arrest the development of CVD as a complication of diabetes. Aims: To compare the lipid profile and atherogenic indices of prediabetics with controls and diabetics. Settings and Design: The electronic medical records of 239 subjects were reviewed retrospectively. Materials and Methods: About 187 cases consisting of 137 diabetics and 50 prediabetics were evaluated for serum fasting blood sugar, post prandial blood sugar, HbA1c, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDLc), and low-density lipoprotein cholesterol (LDLc). Atherogenic indices [TC/HDLc, LDLc/HDLc, (TC-HDLc)/HDLc, TG/HDLc] were also evaluated in the two groups. Rest 52 age- and sex-matched subjects were taken as controls. Statistical Analysis Used: The comparisons were evaluated using SPSS statistical package version 20. Results: TC, TG, LDLc, and the atherogenic indices were significantly increased in prediabetics as compared with controls. HDLc was significantly decreased in prediabetics. Conclusions: The altered lipid profile and atherogenic indices in prediabetics signify the increased susceptibility of prediabetics to CVD in the long run. Hence, we recommend screening of prediabetics for dyslipidemia to arrest the development of cardiovascular complications.
  2,339 237 2
Clinical spectrum of renal disease in hospitalized HIV/AIDS patients: A teaching hospital experience
Bhupendra Verma, Amrita Singh
March 2019, 8(3):886-891
DOI:10.4103/jfmpc.jfmpc_98_19  PMID:31041219
Background: Renal involvement in HIV patients is relatively common and quite broad. However, despite an increasingly large number of HIV patients in Asia, systematic studies of renal involvement are lacking. Objectives: The study was carried out to delineate the clinical spectrum of renal disease in HIV/AIDS patients hospitalised in a tertiary care centre. Patients and Methods: A total of 510 consecutive hospitalised HIV/AIDS with age >18years were included in the study. Detailed demographic, clinical and laboratory data including urinalysis was obtained from all participants. Results: Electrolyte disorders were seen in 71% of patients, with the most frequent being hyponatremia (61%). Acute renal failure was seen in 15.8% and CKD was found in 13% of HIV patients. Dipstick proteinuria of grade ≥1+ was seen in 147 patients (29% of total). CD4 count had a significant positive correlation with creatinine clearance, hyponatremia and total leukocyte count, and significant negative correlation with duration of disease and proteinuria. Conclusion: Electrolyte disorders and renal involvement are quite common in HIV/AIDS patients from India. Prompt diagnosis and management is required as their presence carry higher morbidity and mortality.
  2,344 205 1
Self-reported health problems, health care seeking behaviour and cost coping mechanism of older people: Implication for primary health care delivery in rural Bangladesh
Sheikh Jamal Hossain, Mt. Jannatul Ferdousi, Md. Abu Bakkar Siddique, S M. Mulk Uddin Tipu, Mohammad Abdul Qayyum, Mohammad Shawkatuzzaman Laskar
March 2019, 8(3):1209-1215
DOI:10.4103/jfmpc.jfmpc_162_18  PMID:31041275
Background: Optimum utilization of primary health care system by older people is a challenge for every low and middle income country. Little is known about self reported health problems, health care seeking behaviour and cost coping mechanism of older people in developing countries. Objectives: This study aimed to measure self-reported health problems, health care seeking behaviour and expenditure coping mechanism of older people, and to describe its implication for primary health care delivery in rural Bangladesh. Methodology: It was a cross sectional study. In total, 362 older people were enrolled who sought health care preceding the last month of the interview. Descriptive and bivariate data analysis along with proportion test (z test) was carried out. Results: The most frequent self-reported health problems were fever (43.8%) followed by physical pain (15.2%). More than half of the respondents (57.5%) had a second health problem. Only one third (33.8%) visited qualified health providers having minimum western health or medical training from government approved authority. More than half (54%) of the older people spent for health care out of pocket from their own. Only 2% older people sold their assets or took loans to meet their health care. 36% older people thought that they could afford to pay for health care in future. Conclusions: The findings of this study will help in developing primary health care policy for older people in rural Bangladesh and similar settings in South Asia.
  2,305 211 3
INVITED ARTICLE
Out-patient coverage: Private sector insurance in India
Ramandeep S Gambhir, Ravneet Malhi, Saru Khosla, Rina Singh, Arvind Bhardwaj, Mandeep Kumar
March 2019, 8(3):788-792
DOI:10.4103/jfmpc.jfmpc_101_19  PMID:31041202
Background: There has been a growth of 25% in the health insurance business in India during the last few years with the expansion of the private health insurance sector. The share of the private health insurance companies has increased considerably, despite the fact that from the patients' point of view, health insurance is not a good deal. Aim: To provide information and assess the current status of private sector insurance with regard to out-patient coverage in India. Materials and Methods: The present review was conducted after doing extensive literature search of peer review journals in Pubmed and various search engines like Google. Data of Indian private health insurance companies was also utilized. No limitation in terms of publication date and language was considered. The main focus of the present review would be on the private health insurance sector with a spotlight on the out-patient coverage and various obstacles faced by the private health insurance sector. Results: Out-patient (OPD) coverage is one of the important emerging trends in the private sector health insurance. OPD cover assists the insured to claim expenses other than that incurred during hospitalization. However, it is still not a full-fledged offering under health insurance and major insurance companies are providing this cover for an additional premium. Conclusion: Private is strongly being advocated and receiving growing consideration by our country's policy makers that can deal with alarming health care challenges in India. However, it is not the only option.
  2,185 321 3
ORIGINAL ARTICLES
Clinico-etiological profile of hyponatremia among elderly age group patients in a tertiary care hospital in Sikkim
Amit K Jain, Parvati Nandy
March 2019, 8(3):988-994
DOI:10.4103/jfmpc.jfmpc_32_19  PMID:31041239
Background: Hyponatremia is a common condition observed in hospitalized patients. The incidence is much more in the elderly patients owing to impaired ability to maintain water and electrolyte homeostasis. It is important to evaluate and understand the causes and patient characteristics in order to deliver precise management. Materials and Methods: Study was conducted at a teaching referral hospital in Sikkim and total of 100 elderly patients, diagnosed with hyponatremia, were enrolled in the study. Detailed medical history, clinical and laboratory examination were performed and data including treatment details were collected. Descriptive analysis was performed and results were correlated with patient characteristics. Results: Mean age of the patients was 73.87 ± 6.54 years with a male to female ratio of 1:0.96. About 81% of patients were symptomatic among which lethargy (50%), drowsiness (40%), and abnormal behavior (39%) were common symptoms. Most patients (51%) had profound hyponatremia and Syndrome of inappropriate antidiuretic hormone secretion (SIADH) (36%) and drugs (26%) were the most common cause of hyponatremia in this study. The common treatment given in this study was 0.9% NaCl (71%). Mortality of patients in this study was 20%. Conclusion: Clinicians need to be aware of the common occurrence of hyponatremia in the elderly, especially acutely sick elderly. A systematic approach to its diagnosis with the application of simple standardized diagnostic algorithms can significantly improve the assessment and management of hyponatremia as the outcome in profound hyponatremia is governed by etiology, and not by the serum sodium level.
  2,262 244 3
A comparative study of perception and practices regarding menstrual hygiene among adolescent girls in urban and rural areas of Jodhpur district, Rajasthan
Neha Choudhary, Manoj K Gupta
March 2019, 8(3):875-880
DOI:10.4103/jfmpc.jfmpc_69_19  PMID:31041217
Context: There are vast disparities of information gap between urban and rural adolescent girls in India, which do have an impact on the practices during menstruation. Aim: To assess and compare the knowledge, perceptions, and practices of adolescent girls regarding menstrual hygiene in rural and urban areas of Jodhpur. Settings and Design: It was a cross-sectional study, which was conducted on school going adolescent girls in urban and rural schools of Jodhpur. Materials and Methods: The sample size for the study was 450, which was divided into rural and urban adolescent girls. A self-administered questionnaire was used for data collection. Statistical Analysis Used: Data were analyzed using SPSS v. 16. Inferences were drawn using Chi-square test and t test. Results: The mean age of menarche was 13.41 ± 1.07 years. A significantly more number of girls from an urban area (56.2%) were using sanitary napkins during menstruation. Only around one-fourth of the girls in study area had ever been counseled for menstrual hygiene. Awareness about adolescent health clinic was significantly more among urban girls. Conclusion: Significant differences were observed among urban and rural adolescent girls in terms of knowledge, perception, and practices related to menstrual hygiene.
  2,178 307 3
Supraglottic airway devices in short gynecological procedures: A randomized, clinical study comparing the Baska® mask and I-Gel® device
Anurag Garg, NS Lamba, N S. Ajai Chandra, RK Singhal, Vishal Chaudhary
March 2019, 8(3):1134-1137
DOI:10.4103/jfmpc.jfmpc_359_18  PMID:31041263
Background: Supraglottic airway devices are used for anesthesia in elective surgical procedures circumventing the need for intubation. We investigated the efficacy and safety of Baska® mask in comparison to an I-Gel® device. Methods: In this cross-sectional, observational study, we randomized 100 female patients (age 18–45 years, American Society of Anaesthesiologists grade I or II) undergoing elective short gynecological procedures into two groups, to receive ventilation with either Baska mask® (group 1, n = 50) or an I-Gel® device (group 2, n = 50). We excluded patients with obesity, short neck, and known systemic and upper airway disorders. The primary outcome was the oropharyngeal airway seal pressure, and the secondary outcomes were the ease of insertion and the complication rate. The results were analyzed using Mann–Whitney U-test and Fisher's exact test, and correlation analysis was done by Spearman's correlation test. Results: A total of 56 patients underwent dilatation and curettage, whereas the remaining had hysteroscopy in the study. The airway seal pressure achieved was higher with Baska® mask than I-Gel® device (35.8 ± 10.3 and 26.9 ± 7.5 of cm H2O, respectively; P < 0.0001). The ease of insertion (P < 0.0001) was better in group 1 and the complication rates were similar in both the groups (P > 0.05). Conclusion: Baska® mask offers a superior airway seal pressure with minimum complications in comparison to an I-Gel® device. Further studies with a large number of patients in different surgical settings are required to confirm our findings.
  2,141 302 5
Recognizing missed opportunities to diagnose and treat iron deficiency anemia: A study based on prevalence of anemia among children in a teaching hospital
Dipshikha Maiti, Suchi Acharya, Surupa Basu
March 2019, 8(3):899-903
DOI:10.4103/jfmpc.jfmpc_81_19  PMID:31041221
Background: In developing world, anemia is a significant cause of mortality and morbidity in children under 5 years of age. Iron deficiency anemia (IDA) is a very important causative factor for childhood anemia. The aim of this study was to find the prevalence of anemia in different age group, sex, and its pattern of severity in hospitalized children. Materials and Methods: A cross-sectional study was carried out in a teaching hospital in Kolkata between April 2016 and September 2016. Children 1–168 months of age were included in the study. Results: Of 697 children, 296 (42.5%) had anemia as per the World Health Organization criteria. Males outnumbered the females with a ratio of 1.6:1. The median age of presentation was 29.6 months. The majority were from 1–5 years of age. About 73.3% of children had moderate anemia, whereas 21.3% had severe anemia and only 5% had mild anemia. The mean hemoglobin, mean mean corpuscular volume, mean mean corpuscular hemoglobin concentration, and mean red cell distribution width were 9.3 ± 1.4 g/dL, 73.6 ± 8.8 (fL), 32.2 ± 2.6, and 16.3 ± 3.4 (%), respectively. Microcytic hypochromic anemia (71.3%) was the most common morphological type in all age groups, whereas macrocytic anemia was the least common among them. Prevalence of IDA was 69%. IDA was documented in close to 80% of children with microcytic hypochromic anemia. Interestingly, IDA was also documented in almost half of the children with normocytic normochromic anemia. Conclusion: The high prevalence of IDA among these hospitalized children indicates the role of early screening for IDA in all children with anemia. This early diagnosis and prompt management can prevent the mortality and morbidity related to IDA.
  2,186 240 1
Cognitive-behavioral therapy for depression among menopausal woman: A randomized controlled trial
Nethravathi Venkataswamy Reddy, Dayananda Bittenahalli Omkarappa
March 2019, 8(3):1002-1006
DOI:10.4103/jfmpc.jfmpc_396_18  PMID:31041241
Context: Menopause is associated with high risk of depression among women. Studies have shown that group cognitive behavioral theory (CBT) is safe and effective treatment for depression among menopausal women; however, only limited studies are conducted in India. Aims: To examine the efficacy of group CBT for depression among menopausal woman. Settings and Design: A randomized, controlled trial design was adopted with longitudinal measurement of outcomes for 6 months. The study was conducted from January 2017 to November 2017 at selected Primary Health Centre (PHC) area, urban Bengaluru. Subject and Methods: Participants were 80 women from selected PHC areas, Bengaluru, India. The participants were randomly assigned to either the experimental or control group by computer-generated random numbers. The experimental group received six weekly group CBT sessions. Depression was evaluated for both groups at the baseline and at two follow-up assessments in the 1st and 6th month. Treatment effects of the group CBT were analyzed by repeated-measures analysis of variance. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences software package (Version 23). Results: The results showed that comparisons of depression scores between the two groups before initiating group CBT were not significant. Statistically significant reduction in depression scores were seen among experimental group compared to control group over the 6-month period. Conclusion: This study concluded that group CBT is effective for reducing depression among menopausal woman.
  2,145 214 -
Short-term pregnancy outcomes in patients chikungunya infection: An observational study
Suruchi Gupta, Nikhil Gupta
March 2019, 8(3):985-987
DOI:10.4103/jfmpc.jfmpc_274_18  PMID:31041238
Background: Maternal to fetal transmission of chikungunya infection is reported in various studies. However, there is no study from India that looked at the pregnancy outcomes in patients infected with chikungunya. Thus, we planned an observational study that looked at the short-term outcomes of chikungunya infection on pregnancy outcomes. Materials and Methods: It was an observational study conducted at a private clinic in New Delhi from August 2016 to October 2016. We recruited 150 consecutive pregnant females from the outpatient that were suspected chikungunya infection and subsequently tested positive for the same. Those patients who fulfill the inclusion and exclusion criteria would be followed till 10 days including the time till fever subsided. Pregnancy outcomes would be noted in these subjects based on history, examination, and investigations. Results: Out of 150 patients, 141 (94%) recovered completely within 10 days of onset of symptoms. Only nine patients had persistent arthralgias. In our study, mean age (years) ± std was 24.52 ± 3.765, mean period of gestation (months) ± std was 25.62 ± 13.475, and mean period of gestation at delivery (months) ± std was 36.36 ± 3.225. Most of our patients, 75 (50%) were in 2nd trimester, 24 (16%) were in first trimester, and 51 (34%) in third trimester. Pregnancy complications were seen in 30 (20%) patients. Preterm delivery (<36 weeks) were seen in 11 (7.33%), premature rupture of membranes were seen in 5 (3.33%), decreased fetal movements in 4 (2.67%), intrauterine deaths in 4 (2.67%), oligohydromnios in 3 (2%), and preterm labor pains 3 (2%). There were six patients who underwent delivery at term. In our study cohort, 30 (20%) developed adverse pregnancy outcomes which were maximum during third trimester –24/30 (80%). Conclusion: Chikungunya infection in pregnancy is associated with increased pregnancy morbidity and fetal mortality.
  2,174 170 2
Identifying and validating requirements of telemental health services for Iranian veterans
Reza Safdari, Maryam Ahmadi, Kambiz Bahaadinbeigy, Jebraeil Farzi, Tayebeh Noori, Esmaeil Mehraeen
March 2019, 8(3):1216-1221
DOI:10.4103/jfmpc.jfmpc_324_18  PMID:31041276
Background: The ability of timely access to mental health care is very important for combat veterans that are facing many barriers such as living in rural and remote areas and the lack of integration. Telemental health services improve the veterans' health situation by providing mental health care from a distance. We aimed to identify the telemental health service requirements for Iranian veterans and validate them from the perspective of the statistical population. Methods: This descriptive cross-sectional study was conducted in 2018. In the first phase, a review was conducted in relevant databases, such as PubMed, Scopus, Ovid, Ebsco, and Web of Science. In the second phase, veterans, mental health providers, and telemedicine experts were consulted to validating of the identified telemental health service requirements by a researcher-made questionnaire. Analysis of collecting data was done using SPSS software. Results: By full-text reviewing of 15 related articles, the identified elements were justified in 2 main categories and 24 subcategories including telemental health services (17 items) and telemental health requirements (7 items). According to the findings, the highest score was related to “save health-care costs” (4.47) and “reduce transportation-related problems” (4.47). Moreover, the “feasible alternative to face-to-face care” (2.22) obtained the lowest score from the perspective of the statistical population. Conclusion: Due to the importance of accessibility and patient-based mental health services, more studies are needed to investigate the point of views of patients and specialists to better understand the concerns and barriers to the implementation and use of telemental health services.
  2,132 155 -
Depression, anxiety, and bodily pain independently predict poor sleep quality among adult women attending a primary health center of Puducherry, India
Anindo Majumdar, S Ramya, Jayalakshmy Ramakrishnan
March 2019, 8(3):1182-1188
DOI:10.4103/jfmpc.jfmpc_118_19  PMID:31041271
Background: Sleep disorders and mental health problems are common diagnoses in primary care settings. The objective of this study was to estimate the magnitude of poor sleep, depression, and anxiety through opportunistic screening and to find out the independent predictors of poor sleep quality among female participants. Materials and Methods: A hospital-based study was conducted in the outpatient department (OPD) of an urban primary health center of Puducherry. Patients and accompanying healthy attendants ≥ 18 years of age who visited the OPD for any reason were included. Those with serious acute illness, previously diagnosed mental illness, pregnant women, and women in postpartum period (upto 6 weeks) were excluded. Systematic random sampling was used to select the participants. A semi-structured questionnaire was used to collect sociodemographic and clinical details along with the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale. Height and weight were also measured. Results: A total of 301 participants were recruited. Mean age of the participants was 49.4 (standard deviation 15.2) years. Magnitude of poor sleep (PSQI score > 5), abnormal anxiety, and abnormal depression were 118 (39.2%), 60 (19.9%), and 28 (9.3%) respectively. Multivariate logistic regression analysis showed that history of pain [odds ratio (OR) 3.2 (1.6–6.5), P = 0.001], abnormal anxiety [OR 2.5 (1.2–5.6), P = 0.021], and abnormal depression [OR 4.3 (1.4–13.2), P = 0.01] independently predicted poor sleep quality among females. Conclusion: OPD-based opportunistic screening for sleep and mental health problems should be routinely conducted by primary care and family physicians.
  2,081 178 1
First outbreak of dengue fever in East Sikkim in Northeastern part of India
Karma Doma Bhutia, Sangey Chhophel Lamtha
March 2019, 8(3):1007-1010
DOI:10.4103/jfmpc.jfmpc_397_18  PMID:31041242
Background: Dengue viruses, single-stranded positive polarity ribonucleic acid (RNA) viruses of the family Flaviviridae, are the most common cause of arboviral disease in the world and has turned this disease into a serious public health problem. Aims: To study retrospectively the incidence of laboratory confirmed dengue cases among the clinically suspected patients, the clinical profile of dengue-positive cases, and to co-relate with the environmental conditions. Materials and Methods: Five hundred and eighty blood sample was collected in the microbiology laboratory of district hospital Singtam, from clinically suspected cases of dengue infection, from 22nd August 2013 till 30th November 2013 for rapid dengue kit test initially followed by confirmation test by Immunoglobulin M (IgM) capture ELISA test. Conclusions: Fever with myalgia should be evaluated for Dengue fever (DF) in Sikkim, northeastern part of India. We also report the first outbreak of dengue fever in the east district (Singtam) of Sikkim.
  2,075 140 1
Awareness of disc herniation among general population in Aseer province, Saudi Arabia
Abdullah Khalid Alshehri, Turki Khalid Alshehri, Sultan Abdulrahman Alyali, Abdulrahman Abdulelah Alshahrani, Shaker H Alshehri
March 2019, 8(3):1159-1163
DOI:10.4103/jfmpc.jfmpc_462_18  PMID:31041267
Background: Herniated lumbar disc is a depositions of discs material (nucleus pulposus and annulus fibrosus) behind the intervertebral disk. Intervertebral disc connected the vertebral bodies together by pad of fibrocartilage. The major functions of intervertebral disc are mechanical, transferring load coming from the body weight and muscle contractions by spinal columns and letting the curving, flexion, and contortion. Aim: To assess the awareness of general population in Aseer region, southern of Saudi Arabia, regarding disc herniation and to identify the predictors for their awareness. Methodology: A descriptive cross-sectional approach was conducted through a questionnaire designed to examine the public herniated disc awareness and knowledge. The questionnaire given to individuals from general population visiting general public places in Aseer region. Content validity for the questionnaire was done as it was reviewed by three experts for any modification of corrections. Results: The study included 1,044 participants aged between 15 and 70 years with mean age of 36.3 ± 11.2 years old. The majority of respondents were males (62.4%) and Saudi (98.9%). About 71% of the participants were university graduated. Generally, only 9% of the study participants recorded good awareness level regarding all aspects of disc herniation. Conclusion: This study showed that awareness regarding disc herniation among the general population was very poor for all domains.
  2,015 182 1
Addressing research barriers and facilitators in medical residency
Satish Chandrasekhar Nair, Halah Ibrahim, Farida Almarzoqi, Aysha Alkhemeiri, Jayadevan Sreedharan
March 2019, 8(3):1145-1150
DOI:10.4103/jfmpc.jfmpc_38_19  PMID:31041265
Objective: To develop and implement an instrument to identify contributing factors and obstacles to resident research participation. Materials and Methods: Clinical Research Excellence Development in Innovation and Technology (CREDIT-20), a 20-point questionnaire, was developed through a four-stage methodology to measure opportunities and challenges to enhance participation of medical residents in research. The study was distributed to all medical residents at three Joint Commission–accredited academic medical centers in the emirate of Abu Dhabi between March 2017 and July 2018. Participant responses were analyzed and represented as mean ± standard error of mean, and subgroup analysis was conducted using Fisher's exact test. Results: In all, 314 of 380 residents completed the survey (83% response rate). Resident interest in research was high, with the majority of trainees responding that research will enhance their critical thinking (93%) and add to their knowledge of medicine (92%). Lack of protected time and lack of research methodology training were the most significant barriers. Over half of the residents cited the lack of a dedicated research budget as a program organization challenge. Age significantly correlated with resident perceptions of the benefits for conducting research, with trainees age 27 years or less indicating that they would be more likely to benefit from conducting research than their older counterparts (164 vs 128, P < 0.05). Conclusion: Improving research methodology training and dedicating structured-protected time for the scholarship are strategies to increase research output in international academic medical centers. The CREDIT-20 survey can identify specific barriers faced by trainees and assist medical educational leaders in implementing targeted interventions.
  1,973 207 3
Knowledge and awareness toward anterior cruciate ligament (ACL) injury among population of Aseer region, Saudi Arabia
Alsheri Shaker, Mohammed Sultan M. Alshehri, Fayez Saeed Alshehri, Mazen Mohammed Alshahrani, Meshary Safar Alshahrani, Omar Mohammed Alamri
March 2019, 8(3):812-817
DOI:10.4103/jfmpc.jfmpc_27_19  PMID:31041206
Purpose: The aim of this article is to determine the knowledge and awareness of population toward anterior cruciate ligament (ACL) injury in Aseer region, and to determine the extent of knowledge about what does a person with ACL injury suffer from, and thus investigate the main sources of information that public obtained their medical information about sport injury from. Materials and Methods: This is a cross-sectional study based on a questionnaire distributed to the participants either in malls, campuses, or campaigns and filled by them in Aseer region. A sample of 576 participants was successfully interviewed. Convenience sampling method was used. Results: Nearly all of the participants considered this injury as a multi-factorial incident resulting from a combination of any of the following risk factors: sports, high body weight, heavy housework, and car accidents. Regarding mechanisms responsible about occurrence of ACL injuries during playing sports, the majority (60.8%) proposed a combination of two or more incorrect technical movements: lack of self-protection awareness, insufficient preparation, and overload of exercise. Regarding the participant's information about methods that could decrease pain of ACL injury, about three quarters of all participants (72.2%) stated that resting could alleviate pain. Moreover, most of individuals with previous ACL injury confirmed this. In addition, those with pervious ACL injury supported the role of ice significantly more than the remainder (53.6% vs. 48.1%). Prescription pain medications were selected by 47.3% of all participants. In all, 53.8% of all participants considered Internet as a main source of information about ACL injury. Conclusion: Findings indicated reasonable awareness of the general population in Aseer region about the seriousness of ACL injury, but there was a lack of information about risk factors other than sports, that is, dangerous actions that increase incidence of ACL injuries and their characteristic symptoms.
  1,952 199 -
An association of Helicobacter pylori infection with endoscopic and histological findings in the Nepalese population
Amrendra Kumar Mandal, Paritosh Kafle, Pradeep Puri, Baikuntha Chaulagai, Jasdeep S Sidhu, Muhammad Hassan, Mukesh S Paudel, Rajan Kanth, Vijay Gayam
March 2019, 8(3):1227-1231
DOI:10.4103/jfmpc.jfmpc_82_19  PMID:31041278
Background: Helicobacter pylori (H. pylori) is one of the most common human infections worldwide particularly in the developing countries. We aimed to study an association of H. Pylori infection with endoscopic and histological findings in the Nepalese population. Materials and Methods: We conducted a study between Oct 2014 and Jan 2015 after meeting inclusion and exclusion criteria. Institutional Review Board approval was obtained from National Academy of Medical Sciences. Endoscopic findings and histopathological diagnosis were documented and data were analysed. Results: A total of 113 patients who had complete endoscopy were enrolled. The prevalence of H. pylori infections recorded was 27 (23.9%) patients. There were 17 (62%) male and 10 (37%) female infected with H. pylori (P = 0.33). All biopsied specimens were sent to pathology lab for examination. The most common endoscopic findings was erythematous antral gastritis (40.7%) followed by erosive gastritis 34 (30.1%), pangastritis 10 (8.8%), duodenal ulcer 13 (11.5%), gastric ulcer 9 (8%), erosive fundal gastritis 2 (1.8%), reflux esophagitis 10 (37%) (P < 0.04). Histology revealed that 23 (85.2%) patients had chronic active gastritis (CAG); (P < 0.001). Conclusions: Our study revealed that H. pylori infection is strongly associated with chronic active gastritis (CAG) and Reflux esophagitis in Nepalese adults.
  1,901 229 2
Treatment compliance among previously diagnosed type 2 diabetics in a rural area in Southern India
Satyajit Pattnaik, Samina Mustafa Ausvi, Akshay Salgar, Dhananjaya Sharma
March 2019, 8(3):919-922
DOI:10.4103/jfmpc.jfmpc_23_19  PMID:31041225
Background: Treatment adherence will help to achieve good glycemic control among diabetics and will lead to lesser complications associated with the disease. This study was carried out to determine the compliance to treatment among previously diagnosed diabetic patient and their level of glycemic control, in a rural area. Materials and Methods: This cross-sectional study was conducted among all previously diagnosed diabetics above 30 years, on treatment for more than 6 months. Nonadherence was defined as “missing more than 2 doses” in the last 15 days. Glycemic control was assessed by performing glycated hemoglobin (HbA1c). Results: Among 155 people interviewed, 140 (90.3%) were found to be compliant to the treatment. Treatment compliance was significantly associated with duration of Diabetes and age. However gender, literacy status, occupation, and socioeconomic status were not significantly associated with compliance. The most common reasons for noncompliance was the asymptomatic nature of the disease (60%) and the high cost of treatment (33.3%). Forty-two percent of participants were found to have poor glycemic control (HbA1c >8%). Conclusion: Treatment compliance was found to be good among diabetic patients. The treatment compliance increases with increase in the duration of the disease. Many have poor glycemic control, which is a matter of concern. They need more regular follow-up to adjust the treatment label for better glycemic control.
  1,940 190 2
Strategic implications of changing rule of halves in hypertension: A cross-sectional observational study
Rujuta Hadaye, Vishal Kale, Rukman M Manapurath
March 2019, 8(3):1049-1053
DOI:10.4103/jfmpc.jfmpc_356_18  PMID:31041249
Context: The burden of non-communicable diseases will sooner overwhelm the health system of the country and could curtail future economic development. Hypertension causes highest cardiovascular morbidities. To attain target Blood Pressure (BP), different strategies are required, which are area specific. The validity of rule of halves of hypertension in various settings needs to be studied for developing strategies for that particular geographical area. To utilize the resources in more efficient way, strategies need to differ in rural-urban and underserved- well-served areas. Aims: The present study aims at exploring whether the rule of halves holds good in the city of Mumbai as the findings of such research may have implications on strategies to control hypertension in communities. Hence, the objectives of this study are to ascertain the proportion of persons with hypertension with respect to the status of diagnosis, treatment, adequate treatment, and validate it with existing rule of halves. Setting and Design: Study was conducted in the urban field practice area of a teaching hospital and medical college of Mumbai that comprises 42 chawl (housing structures); study design- cross-sectional observational study. Materials and Methods: This observational cross-sectional study was conducted over a period of 18 months in the field practice area of a teaching hospital and medical college of Mumbai with a total population of 43,069. Sample size was 667. After ethical clearance, participants were interviewed using pretested semi-structured interview schedule that included socio-demographic factors, risk factor evaluation, clinical examination, and anthropometry. Subjects with diagnosed hypertension were questioned thoroughly about hypertension adherence. Statistical Analysis: Descriptive statistics was applied on quantitative data. Results: A total of 667 people from five chawls of age more than 35 years were included into the study. The mean age of study subjects was 50.84 ± 11.47 years. Out of total 667 respondents, 20.3% respondents were normotensive, 50.3% respondents were pre-hypertensive, 25.3% respondents were in stage 1 hypertension, and 4% respondents were in stage 2 hypertension. In contrary to the classical rule of halves, the present study shows only 31% of the diagnosed hypertensives are adequately treated. Conclusions: The strategies in the national programs are from the traditional understanding of rule of halves and emphasize increasing awareness and treatment. Family physician should actively involve in regular screening, treatment, and adherence of hypertension treatment. As a part of primary care, community participation is required for effectively achieving the target BP goal of the population.
  1,991 132 1
Validation of a questionnaire to identify noise-induced hearing loss among drivers
Manish K Manar, Sheo Prasad Shukla, Uday Mohan, Shivendra Kumar Singh, Veerendra Verma
March 2019, 8(3):1196-1201
DOI:10.4103/jfmpc.jfmpc_108_19  PMID:31041273
Objective: To assess the validity of a questionnaire (consisting of 10 items/questions) to identify hearing loss (HL) among three-wheeler tempo and noncommercial car drivers. Materials and Methods: This was a cross-sectional study conducted in an urban area of Lucknow city. Three-wheeler tempo drivers and noncommercial car drivers were assessed for HL by audiometry. A total of 300 subjects, who fulfilled the study criteria, were selected for the interview and health assessment. The pure tone audiometry was conducted after >12 hours of the last noise exposure to avoid temporary threshold shift. Results: The percentage of respondents aged between 31 and 40 years was 36%. The highest affirmative response item was “Do you have trouble hearing in noisy background?” constituting 68% and the lowest affirmative response item was “Do you have trouble understanding the speech of women and children?” constituting 33.7%. Kappa values showed that there was significantly (<0.05) mild agreement between most of the items and the gold standard for mid and high-frequency HL. The area under the curve for low, mid, and high frequency HL was 0.76% (95% CI = 0.68–0.84), 0.69 (95% CI = 0.73–0.75), and 0.67 (95% CI = 0.62–0.73), respectively. The sensitivity and specificity were reasonable for all the definition of HL at different cutoff scores. Conclusion: A self-reported questionnaire-based approach may be used for the assessment of HL especially when audiometry is not feasible.
  1,930 189 -
A lay epidemiological study on coexistent stress in hypertension: Its prevalence, risk factors, and implications in patients' lives
Amrita Sarkar, Debjit Roy, Meet M Chauhan, Prashant Dave, Naresh R Makwana, Dipesh V Parmar
March 2019, 8(3):966-971
DOI:10.4103/jfmpc.jfmpc_60_19  PMID:31041234
Introduction: Hypertension poses a global challenge in terms of morbidity and mortality. Worldwide prevalence of hypertension is over 40%. Management of hypertension targets blood pressure control to prevent disease complications. Though stress and hypertension are closely related, stress management is often overlooked in the treatment of hypertension. Aims: (1) To estimate the prevalence of stress in hypertensive patients and (2) to study the associated risk factors of stress and its implications in disease management. Materials and Methods: It was a hospital-based, cross-sectional study done in Western India for 1 year. Data were collected from 400 hypertensive patients attending the selected health institutions using a pretested questionnaire. Chi-square tests were done using Medcalc 10.4.8.0. Results: The prevalence of stress in hypertensive patients was found to be 84.3%. Only 2.4% of these patients sought help from any health professional for stress. The most common stressors found in the patients were financial dependence on others, living in rented house, having a daughter of marriageable age because of associated dowry, death of a loved one, sleep-related problem, and owing a debt among others. Significant statistical association (P < 0.05) of stress was observed with the type of family and socioeconomic status. A highly significant association (P < 0.001) of stress with religion and residential area (whether urban non-slum, slum, or rural) was observed. Stress in individuals leads to poorer compliance with treatment and blood pressure control. Conclusion: Coexistent stress should be diagnosed and managed in patients of hypertension for proper disease management and control.
  1,864 167 1
Musculoskeletal disorders and associated risk factors in coaching students: A cross-sectional study
John Ashutosh Santoshi, Siddharth Jain, Harshanand Janardhanrao Popalwar, Abhijit P Pakhare
March 2019, 8(3):929-933
DOI:10.4103/jfmpc.jfmpc_54_19  PMID:31041227
Background: Coaching institutes attract students aspiring for admission to professional courses and jobs. Physical stress during coaching includes poor study posture and sitting on chairs improperly in overcrowded classes for prolonged periods. Many students attending the coaching institutes report to outpatient clinics of multiple specialties with musculoskeletal disorders (MSD). Materials and Methods: We carried out a cross-sectional study of 500 coaching students. We ascertained the 12-month MSD (period prevalence) and last 7-day MSD (point prevalence) using the Nordic Musculoskeletal Questionnaire. The duration of attending classes, hours of daily study, and duration of sitting continuously at a stretch were also enquired. Results: A total of 488 responses were retrieved. Males and females accounted for 63.9% and 36.1%, respectively. The respondents' mean age was 18.6 ± 1.06 years; mean body mass index was 21.4; mean duration of attending classes was 15.6 ± 7.66 months; mean hours of daily study were 4.78 ± 1.71 hours; mean duration of sitting continuously at a stretch was 2.2 hours. The overall prevalence of MSD was 87.1%. The mean frequency of MSD per participant was 2.6. Most participants reported pain in the neck region and lower back (43%), followed by ankle/foot (36%), followed by upper back (32%), followed by shoulder (28%); knee, elbow, and wrist/hand were lesser than 20%, while hip/thigh pain was the least common symptom (8%). Conclusion: This study serves to sensitize the medical community to this largely under-reported problem in young individuals who are in the phase of life preparing for their future career while inadvertently risking their long-term health in the process.
  1,791 220 1
Awareness about first aid management of epistaxis among medical students in Kingdom of Saudi Arabia
Khalid Alyahya, Sara Alsaad, Sara Alsuliman, Nouf Alsuliman
March 2019, 8(3):914-918
DOI:10.4103/jfmpc.jfmpc_15_19  PMID:31041224
Background: Epistaxis is the bleeding from nose or nasal cavity and it is considered as one of the most common emergencies presenting in ear, nose, and throat department and accident and emergency department worldwide. Objective and Aim: The aim of this study was to assess and evaluate knowledge, attitude, and practice of first aid management of epistaxis among medical students in the Kingdom of Saudi Arabia. Materials and Methods: A cross-sectional community-based studies were collected using electronic questionnaire distributed among medical students all over the Kingdom of Saudi Arabia. The study was conducted between September and January 2018. Results: Data were collected from 300 medical students from all over the Kingdom of Saudi Arabia using questionnaires, which were filled electronically. Majority of the respondents were females (75.7%), whereas 24.3% of the respondents were males. Most of the participants were from fourth and fifth year with 25.0 and 24.3%, respectively. 39.7% of the participants responded that fingernail trauma as the commonest cause of the epistaxis, followed by bleeding disorder in 17.3%. 64% of the respondents think that epistaxis is an emergency condition that requires early intervention. 71% of the respondents demonstrated the correct position as first aid measure of epistaxis and only 41.3% of respondents demonstrated the correct site for pinching the nose. The main source of the respondent's knowledge regarding first aid management of epistaxis was self-taught (53.67%) followed by medical books (23.33%). Conclusion: Medical students in Saudi Arabia have an adequate knowledge about epistaxis and first aid measure that can be used to manage epistaxis.
  1,822 188 2
Knowledge, attitude, and believes of epilepsy in local communities of Saudi Arabia
Abdulrahman M Alshahrani, Aslam Pathan, Judan Fahad Alruwais, Ali Mohammed Alduhayshi
March 2019, 8(3):1065-1069
DOI:10.4103/jfmpc.jfmpc_425_18  PMID:31041252
Aim of the Study: To assess public knowledge, attitude, and believes toward the epilepsy among local community populations in Shaqra Area, Kingdom of Saudi Arabia. Methods: An organized 14 questionnaire was prepared to analyze public knowledge attitudes and believes about epilepsy. Study was conducted randomly in common public places in Shaqra City, Saudi Arabia, during the months of April and May 2016. Sample size includes 155 males and 130 females from Shaqra City of Saudi Arabia. Results: The study analyzed the 285 local public including 155 male and 130 female contributors. About 68.38% male contributors and 63.07% female contributors studied Diploma or Bachelor education program. Female contributors (71.53%) were aware about epilepsy as compared with male contributors (58.70%). Maximum number of female contributors (82.30%) believes that epilepsy is treated by medication as compared with male contributors (58.70%). Conclusion: The knowledge, awareness, and attitudes of the epilepsy are found to be much improved in local community of Saudi Arabia. In the modern era, people assume that epilepsy is still due to evil spirit. Many contributors think there should be restrictions on driving and getting jobs in epilepsy patient. Public awareness and educational campaigns should be included in modern methods of education to develop well-knowledged community, which will improve the quality of life of epileptic patients.
  1,811 175 4
Knowledge and behaviors related to dietary salt and sources of dietary sodium in north India
Prashanth Aparna, Harshal Ramesh Salve, Krishnan Anand, Lakshmy Ramakrishnan, Sanjeev Kumar Gupta, Baridalyne Nongkynrih
March 2019, 8(3):846-852
DOI:10.4103/jfmpc.jfmpc_49_19  PMID:31041212
Sodium, an element needed for the normal human physiology is known to be associated with high blood pressure and other consequences if consumed in excess. The assessment of knowledge and behavior related to sodium that is consumed in the form of salt plays an important role in the control of cardiovascular diseases. To control the intake of sodium, dietary sources of sodium need to be identified. To address this, a community-based cross-sectional study was conducted among women aged 20 to 59 years in north India, where knowledge, attitude, and behavior questionnaire given by the World Health Organization and 24-h dietary recall were used. The mean age of the participants was 34.5 years, and the majority of them were homemakers. Approximately, 80% of the participants believed that high salt diet causes serious health problems, and only 5% of the participants were aware of the existence of a recommendation for daily salt intake. Less than 20% of the participants took measures to control their salt intake. Vegetable-based dishes were found to be the major contributors to the daily salt intake followed by pulse-based and cereal-based dishes. This is because of the high quantity in which they are consumed. Food cooked at home contributed to 90% of the daily salt intake. To control the salt intake, we should cut- down the discretionary salt use. Dietary advice should be customized to the individual, and the family physician plays an important role in this. Behavioral change is the need of the hour to control the epidemic of non-communicable diseases.
  1,702 245 1
CASE REPORTS
Acute parvovirus B19 infection presenting as rheumatoid arthritis mimic
Vijay Alexander, Sohini Das, Austin Saju Mangan, Ramya Iyadurai
March 2019, 8(3):1257-1259
DOI:10.4103/jfmpc.jfmpc_25_19  PMID:31041286
Acute parvovirus B19 infection can cause acute symmetric polyarthritis indistinguishable from polyarticular rheumatoid arthritis. Most cases of acute arthritis due to parvovirus B19 are self-limiting and resolve with symptomatic treatment. We present a 65-year-old lady from Southern India who presented with history of fever and joint pain for 10 days. Clinical examination revealed symmetric inflammatory arthritis involving the appendicular skeleton with predominant involvement of bilateral metacarpophalageal joints. Laboratory investigations revealed elevated inflammatory markers with negative serology for rheumatoid arthritis. Parvovirus B19 IgM antibody tested positive. She was initiated on nonsteroidal anti-inflammatory drugs with which her symptoms resolved completely.
  1,745 199 -
ORIGINAL ARTICLES
Examining oral hygiene status and care needs of deaf and blind 6–12 years old exceptional school children in Kermanshah in 2015
Fatemeh Rezaei, Arkiya Mardani, Amir Hossein Moradi, Nafiseh Nikkerdar
March 2019, 8(3):871-874
DOI:10.4103/jfmpc.jfmpc_225_17  PMID:31041216
Introduction: Controlling and preventing oral diseases of patients with mental and physical disabilities had become one of the most important topics within the realm of dentistry researches. The main objective of this study was to examine oral hygiene and care needs of deaf and blind 6–12 years old exceptional school children in Kermanshah in 2015. Materials and Methods: Oral hygiene of 51 deaf and blind 6–12 years old exceptional school children in Kermanshah in 2015 was examined in this study; indicators which underwent assessment included DMFT/decay, missing, falling, teeth (dmft), Gingival Index (GI), Plaque Index (PI), brushing, and flossing; the amount of used Unmet Treatment Need (UTN) was measured using DMFT/dmft index, and collected data were analyzed using SPSS, version 18. Findings: The mean and standard deviation of GI and PI of the 51 deaf and blind students examined turned out to be 1.39 ± 0.30 and 0.86 ± 0.15, respectively; DMFT, dmft, and UTN of the blind students were 1.31 ± 1.20, 2.81 ± 2.81, and 0.76 ± 0.34, respectively; these values turned out to be 1.81 ± 2.16, 2.08 ± 3.48, and 0.85 ± 0.31, respectively, in case of deaf students. According to the results of this study, 18.7% of blind students and 27% of deaf students brushed their teeth once on a daily basis. Conclusion: Based on the results of this study, the incidence and severity of dental caries, particularly in primary teeth, were high among these children (mean: 2.06) and a large number of their teeth needed treatment (UTN: 1.18). In comparison to their peers, these group of children had lower state of oral health; therefore, a systematic, long-term is definitely required for the improvement of oral hygiene of studied patients.
  1,749 187 -
Coping mechanism used by homemakers in Kumaon region (Uttarakhand, India) to deal with stress in their day-to-day life
Hariom Kumar Solanki, Amandeep Kaur, Mrinmay Das, Sadhana Awasthi, Shreyance Jain
March 2019, 8(3):1138-1144
DOI:10.4103/jfmpc.jfmpc_362_18  PMID:31041264
Context: Chronic stress, if not appropriately addressed, can cause a variety of mental health disorders. In patriarchal societies like India, little is known about the coping mechanisms used by homemakers to deal with stress in their lives. Aim: To identify usual coping mechanisms used by the homemakers residing in Kumaon region, India, to deal with stress in their day-to-day lives. Settings and Design: This is a population-based, cross sectional study done in the urban field practice area of a teaching tertiary care health facility in the Kumaon region of Uttarakhand, India. Materials and Methods: A total of 324 ever-married, apparently healthy homemakers age 18–59 years residing in the area for at least 6 months were interviewed. Systematic random sampling along with population proportionate to size method was used to recruit study participants. Pretested, semi-structured questionnaire was used to elicit information on coping mechanisms used by the study participants. Standardized questionnaires were used to determine possible depressive or anxiety disorders. Statistical Analysis: Data were entered in Microsoft Excel Sheet followed by analysis in SPSS and Epi Info. Chi-square test, Chi-square for trend, and Fisher's exact test were used. Results: Multiple ways including praying, watching TV, taking care of children, and talking to family and friends were identified as the usual coping mechanism used by study participants. Coping mechanism varied with the mental health status and other sociodemographic characteristics of the study participants. Conclusion: Coping strategy was predominantly “emotion-based” in the study population. Understanding of usual coping mechanism used by women may help counselors and clinicians in fine-tuning their therapeutic approach as per needs and preferences of such women.
  1,793 131 -
Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India
Vikas Pandey, Mallangoud Patil, Ruchir Patel, Alisha Chaubal, Meghraj Ingle, Akash Shukla
March 2019, 8(3):818-822
DOI:10.4103/jfmpc.jfmpc_414_18  PMID:31041207
Background: Splenic vein thrombosis (SVT) is most commonly caused by acute and chronic pancreatitis (CP). Variceal gastrointestinal (GI) bleeding is a potentially life-threatening event in such patients. The aim of this study was to determine the prevalence of SVT in CP patients and the risk of variceal GI bleeding. Materials and Methods: A total of 187 consecutive patients with a diagnosis of CP were assessed for the presence of SVT at the gastroenterology department of a tertiary care hospital. Thirty seven patients had evidence of SVT. Patients with portal vein thrombosis or cirrhosis were excluded. Potential factors associated with SVT were assessed. Results: Of the 187 CP patients assessed, 37 patients (19.8%) (male 33; female 4; mean age 41.9 years) had evidence of SVT. Among patients with SVT, most common etiology of CP was alcohol abuse (70.3%). Seven patients (18.9%) with SVT presented with clinically significant upper GI bleeding. The source of GI bleeding was gastric varices in three patients (8.1%) and non-variceal source in four patients (10.8%). All three patients with gastric varices were managed by splenectomy. There were no new variceal bleeding episodes in other 33 patients (89.2%) during mean follow-up of 16.4 months. On comparison of patients with and without SVT, the factors associated with significantly higher incidence of SVT were smoking (P = 0.019, odds ratio 3.021, 95% confidence interval 1.195–7.633) and presence of pseudocyst (P = 0.008, odds ratio 3.743, 95% confidence interval 1.403–9.983). Complete resolution of SVT was seen in three patients (8.1%) after resolution of underlying pseudocyst. Conclusion: SVT is a common complication of CP, particularly in patients with pseudocysts and history of smoking. Most patients remain asymptomatic and the risk of variceal bleeding is low. Splenectomy is the treatment of choice in patients with variceal bleeding. Conservative approach is preferred in other patients. Resolution of pseudocysts may lead to resolution of SVT in some patients.
  1,731 188 4
Prayers and beliefs among relatives of children admitted in pediatrics wards
Archana S Nimbalkar, Bhavdeep M Mungala, Ankush K Khanna, Karamchand H Patil, Somashekhar M Nimbalkar
March 2019, 8(3):1123-1128
DOI:10.4103/jfmpc.jfmpc_333_18  PMID:31041261
Context: Spirituality/Religion is important to many parents and they may call upon God to make the child healthier and normal. Aims: We surveyed parents/relatives of children admitted to in-patient services for their praying practices and beliefs thereof. Settings and Design: Cross-sectional survey in 150 parents/relatives of patients admitted to pediatric ward, pediatric intensive care (PICU) unit, and neonatal intensive care unit (NICU) (50 each). Materials and Methods: We collected demographic, praying practices' information and asked them to fill a Prayer Questionnaire Score Chart which classified the individual's religiosity. Statistical Analysis Used: Descriptive statistics, Chi-square test, independent t-test, and one-way ANOVA were used for analysis. Results: Hindus constituted 126 (84%) participants. In 118 (78.67%) cases, mothers responded to survey. Average time of prayer in PICU (159 min) was more than NICU (109 min) and pediatric ward (114 min). Average frequency of prayer before admission (10.49) was less significant than frequency of prayer after admission (13.64) (P value < 0.001). Most of the people, 91 (60.67%), prayed by standing near statues of God or praying silently while recalling God's images. Almost all people, 149 (99.33%), believed that both medical care and prayer were required for recovery of patient. According to patient's relatives, average 52% recovery of patient was due to medicine. Conclusions: Prayer was an integral component of parents/relatives' daily spiritual/religious ritual that was directed toward the admitted child's recovery. Statistically significant increase in frequency of praying after admission indicates the importance of prayers and spirituality in their minds as a part of treatment.
  1,753 137 -
Parent's knowledge, attitude, and practice about children car seats at Unaizah city, KSA
Ghadah A AlSallum, Alshamoos A Alwassel, Abdullah M Alshushan, Abdulrahman K Abaalkhail, Mohammad A Alhasoon, Abdullah S Aldamigh
March 2019, 8(3):805-811
DOI:10.4103/jfmpc.jfmpc_75_19  PMID:31041205
Background: Motor vehicle collision (MVC) is a major cause of death in children worldwide. Using children car seats will stabilize them during accidents and decrease the morbidity and mortality from MVC dramatically. There is no study in Saudi Arabia about car seat use and relationship between using it and children morbidity and mortality following a car accident. Objectives: To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA, to assess the level of awareness regarding the children car safety system, to determine the parent level of education, socioeconomic status, and other factors affecting their behavior regarding car seats, to determine the prevalence of car seat use among parents in Unaizah city, and to assess the effectiveness of car seat policies on parents' behavior. Design: Cross-sectional study. Settings: Public and private pediatric clinics at Unaizah city in Qassim region. Materials and Methods: The study was conducted from May to June 2018, among parents with child ≤7 years old. Anyone who could not complete the questionnaire for any reason was excluded from our study. SPSS version 20 has been used to analyze all data. Main Outcome Measures: To assess knowledge, attitude, and practice of children car seats among parents at Unaizah city, KSA. Sample Size: 350. Results: There were 350 participants who were included in this study of which females were dominant 77.1%. The age range of parents was 25–35 years old. Most of them complied with the seatbelt policy (56.7%). Among these numbers, 130 participants use a seatbelt for security reason while others were to protect from irregularities. More parents do not put baby seat in the car (57.3%) while 57 participants use child seat every time the child rides in the car. Conclusion: The overall knowledge, attitude, and practices toward children car safety seat in this study was relatively low. This signifies the need of parents to step up their awareness to safe guard their children while on the road. Limitations: Small sample size and limited to pediatrics clinics visitors.
  1,645 206 -
A time–motion analysis of the mothers staying in the neonatal care unit
Vallaree A Morgaonkar, Dharti S Patel, Dipen V Patel, Ajay G Phatak, Somashekhar M Nimbalkar
March 2019, 8(3):1129-1133
DOI:10.4103/jfmpc.jfmpc_348_18  PMID:31041262
Context: In addition to various barriers studied for kangaroo mother care (KMC), time opportunities for better implementation of KMC need to be studied. Aim: Time–motion analysis of the mother's daily activities was carried out to identify scope to improve KMC. Settings and Design: This is a 24-h recall-based questionnaire study. Mothers were interviewed whose newborns were admitted at a tertiary and secondary care neonatal care unit of western India over a period of 9 months from November 2015 to July 2016. Materials and Methods: Mothers were approached when the preterm neonate and mother dyad was eligible for KMC, that is, when mothers were physically healthy and newborns were physiologically stable. A total of 60 mothers were enrolled in the study. Mothers' daily activities were noted, and time spent in each activity was charted for 3 consecutive days. Missed time opportunities which could be used to increase daily KMC hours were studied. Statistical Analysis Used: To compare quantitative variables, two-sample unpaired t-test and one-way analysis of variance were used. Results: The average time of activities which consumed most was 8.24 h for sleep/rest, 3.46 h for meals/snacks, 4.89 h for breastfeeding, and a daily average of only 1.4 h was used for KMC. A quite a significant proportion, that is, 3.89 h, was spent for meeting relatives which could be used for KMC as well without affecting social meetings. Conclusion: Time–motion analysis was helpful to find out weak links in KMC implementation. Providing family-centered environment in terms of implementing KMC during meeting hours with family may augment KMC hours.
  1,708 133 -
An investigation into the effects of psychological consultation on the sense of satisfaction of the infertile women referring to the infertility centers of Tabriz
Mohammad Islami Vaghar
March 2019, 8(3):1170-1175
DOI:10.4103/jfmpc.jfmpc_16_19  PMID:31041269
Background and Aim: Infertility is a major crisis in life which causes mental stress. Studies have shown that infertility can negatively influence the sense of satisfaction. The effect of infertility on marital and sexual functioning, health related quality of life (QOL), and the acceptability of the treatment modalities is poorly researched area in Iran. The present study is aimed to investigate the effects of psychological consultation on the sense of satisfaction of the infertile women. Methods: In an experimental study, 90 women referred to the Alzahra Educational and Medical Center and Tabriz Madar Clinic were randomly divided into case and control groups. First, The Personal Information Questionnaire and the Temporal Satisfaction with Life Questionnaire were used to collect information about the samples. The samples of the case group received a 90-minute psychological consultation once a week for 8 weeks. Second, both groups completed the same questionnaires two weeks after the end of consultation sessions. Accordingly, the rate of life satisfaction in the past, present and future was compared, using T-Test, paired T-Test and Chi-Square Tests. Results: The results showed there was a significant difference between the case and control groups in terms of past, present and future life (P < 0.05). The rate of life satisfaction in the case group increased after the psychological consultation sessions. In other words, the behavioral, cognitive and emotional consultation can decrease the negative aspects of infertility. Conclusion: According to the results, an increase in the satisfaction of infertile women in the case group before and after psychological consultation in comparison with control group was significant. Moreover, psychological consultation increased the life satisfaction in infertile women.
  1,659 138 1
Frequency of dyslipidemia in migraineurs in comparison to control group
Farhad Assarzadegan, Seyedeh Parya Hosseinpanahi, Omid Hesami, Behnam Mansouri, Behnam Safarpour Lima
March 2019, 8(3):950-954
DOI:10.4103/jfmpc.jfmpc_9_19  PMID:31041231
Background: Migraine is a common disease with neurovascular nature, which is commonly prevalent in the general population. Due to the significant prevalence of migraine and its long-term complications, it is necessary to pay attention to its exacerbating factors. Therefore, the aim of this study was to evaluate the frequency distribution of dyslipidemia in patients with migraine compared with control group. Materials and Methods: This is a case–control study, in which 50 patients with migraine (with aura and without aura) were confirmed by the criteria of International Headache Society. Migraineurs and control group (n = 50) were selected from among patients who referred to the Neurology Clinic of Imam Hossein Hospital. The levels of total cholesterol, triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were measured in both the groups. SPSS software (version 21) was used to analyze the data. Results: The findings showed that among migraineurs, 21 patients (42%) revealed high levels of cholesterol and 22 revealed high levels of LDL (44%); whereas among subjects without migraine, 12 subjects (24%) exhibited high levels of cholesterol and 12 (24%) high levels of LDL, where a significant correlation between the two groups was achieved. Conclusion: The present results showed that migraine is associated with higher level of cholesterol and LDL when compared with the control group, where a significant relationship was found.
  1,646 130 -
CASE REPORTS
Ectodermal dysplasia: Report of two cases in a family and literature review
Vani Chappidi, Dheeraj Voulligonda, Bharadwaj Bhogavaram, P Krishnanjaneya Reddy
March 2019, 8(3):1263-1265
DOI:10.4103/jfmpc.jfmpc_48_19  PMID:31041288
Ectodermal dysplasia (ED) is a inherited genetic disorder with manifestations of abnormalities in more than one ectodermal derivatives like skin, hair, nails, exocrine glands and teeth. There are more than 150 different variants of ED described in literature. The condition is thought to occur in approximately 1 in every 100,000 live births. It mainly manifests in two types i.e. Hypohidrotic (Anhidrotic) type and Hydrotic type depending on degree of sweat gland function. This report presents two cases within a family, a 4 year old boy and a 6 year old girl with typical features of Hypohidrotic Hereditary ED i.e, hypodontia, hypohidrosis and hypotrichosis.
  1,610 164 -
Congenital heart disease in harlequin ichthyosis: Case series
Bhupendra Verma, Abhishek Abhinay, Anand Mohan, Amrita Singh
March 2019, 8(3):1266-1268
DOI:10.4103/jfmpc.jfmpc_61_19  PMID:31041289
Harlequin ichthyosis (HI) is the most severe form of congenital ichthyosis and inherited in an autosomal recessive manner. The disease is marked by severe thickened and scaly skin on the entire body. It is a lethal disease, but patients can rarely survive for several months or years with treatment. We present here seven cases of HI, where cardiac evaluation was done by echocardiography. To our knowledge, this is the first study to report associated cardiac abnormalities in such patients.
  1,577 127 1
ORIGINAL ARTICLES
Is maternal health services utilization predict the contraceptives adoption in extended postpartum period: A community-based cross-sectional study done in urban slums of Western Gujarat
Mubashshera Firdous Khan, Ilesh S Kotecha
March 2019, 8(3):1164-1169
DOI:10.4103/jfmpc.jfmpc_122_19  PMID:31041268
Background: Family planning (FP) programme has been integrated since long with MCH programme in order to reduce maternal and child mortality. The period of pregnancy, delivery, and postnatal period is very crucial to sensitize the women to adopt contraceptive practice because during this time they are in constant contact with health provider and more receptive to advice. The present study is designed in this context to see whether the utilization of maternal health services have any impact on adoption of modern contraceptives in extended postpartum period. Materials and Methods: Community-based cross-sectional study was done in urban slum of Jamnagar, Gujarat, for 1 year in 2016. Two-stage sampling methodology was used; in first stage, 30 Anganwadi centres (AWC) was chosen by systemic random sampling and in second stage from each AWC, 8 women in extended postpartum period were included. Study included total 240 women. Sampling was done at household level. Descriptive statistics for sociodemographic factors and reproductive characteristics were done. Chi-square test was used to find association between different variables. Result: Prevalence of using modern contraceptive was only 24.6%. The most preferred choice was barrier method (35.5%), followed by sterilization (27.1%), Intrauterine device (IUD) (25.04%), and OCP (12%). Around 57% women had taken ≥4 health center visit during their last pregnancy and 7.5% had never visited or consulted. 12% women were delivered at home. Majority of the participants (63.5%) were not paid visit by health worker, only 15% were provided with adequate postnatal visit and 21% had inadequate visit during their immediate postpartum period. A statistical association was found between usage of contraceptive with health center visit during ANC, postnatal visit by HW, parity and age of women in extended postpartum period. Conclusion: There is need to improve the quality of maternal health services to increase the utilization of FP services.
  1,524 167 1
CASE REPORTS
Visual loss and optic neuropathy associated with Wernicke's encephalopathy in hyperemesis gravidarum
Naseem Palakkuzhiyil, Sherinas Rehiman, P P. Baby Manoj, Shahul Hameed, NA Uvais
March 2019, 8(3):1243-1245
DOI:10.4103/jfmpc.jfmpc_121_19  PMID:31041282
Wernicke's encephalopathy (WE) is a potentially fatal neuropsychiatric syndrome precipitated by thiamine deficiency due to a variety of causes such as chronic severe alcoholism, starvation, and prolonged intravenous feeding. WE has also been observed rarely in the clinical setting of hyperemesis gravidarum. Here, we report the case of a 34-year-old pregnant woman who presented with reduced vision, gaze-evoked nystagmus, and postural imbalance preceded by 2 weeks of hyperemesis. Fundus examination showed features consistent with papillitis. Magnetic resonance imaging (MRI) showed T2WI, FLAIR, and diffusion-weighted imaging MR images showing hyperintensity in dorsomedial thalami and periaqueductal grey matter with diffusion restriction. She was diagnosed with WE based on history, clinical examination findings, and MRI findings and was treated with injectable thiamine. She showed marked improvement in vision and nystagmus within 3 days. Our case is a rare presentation of WE in a pregnant woman with hyperemesis gravidarum.
  1,535 139 1
ORIGINAL ARTICLES
Beneficial effects of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in celiac disease patients
Dayanand Hota, Kapil Bhalla, Sanjiv Nanda, Ashish Gupta, Shuchi Mehra
March 2019, 8(3):823-827
DOI:10.4103/jfmpc.jfmpc_56_19  PMID:31041208
Context: In the resource poor country like India it is difficult to get HLA screening and EMA testing in patients with celiac disease in small centres. Aims: To study the effect of gluten free diet on IgA tissue transglutaminase levels and various growth parameters in patients with celiac disease. Settings and Design: This was a prospective study conducted in the department of paediatrics of a tertiary referral hospital in north India in 3 stages viz. on presentation, after 3 months and 6 months of initial presentation. Materials and Methods: 392 patients with symptoms suggestive of celiac disease were screened for IgA tTG levels more than 10 folds of upper limit of normal. 50 cases (who followed up for 6 months regularly) were enrolled in the study. Spectrum of various growth and clinical parameters were also studied. Statistical analysis used: Statistical analysis was performed by the SPSS version 20.0. Data were checked for normality before statistical analysis. p value less than 0.05 was considered statistically significant. Results: 50 cases were enrolled in study. After initiation of gluten free diet, improvements were seen in various growth factors like height (12.71%) and weight (3.47 cm) after 6 months. Serum tTG(IgA) levels decreased to 94.88±55.35 U/mL from baseline level of 202±83.96 U/mL after 6 months. Conclusions: Gluten free diet has major role in improvement in growth parameters as well as anemia. So, early detection of celiac disease is an important step in prevention of morbidity associated with this chronic disease.
  1,500 157 -
A study of comparing two cognitive-behavioral workshop for college students: Sleep, wakefulness program and perseverance program
Mohammad Hasan Ehrampoush, Seyed Ziaeddin Tabei, Seyed Saeed Mazloomy Mahmoodabad, Hossein Fallahzadeh, Mohammad Nami, Elnaz Khayer, Seyede Zahra Ghaemi, Mahtab Matin, Forouhari Sedighe
March 2019, 8(3):1222-1226
DOI:10.4103/jfmpc.jfmpc_130_19  PMID:31041277
Introduction and Aim: Researchers and specialists believe that health maintenance and improvement through university students, as a part of society, play a crucial role in community configuration which should not be ignored. Since there was a few studies in these fields, researchers have sought to explore how mentioned workshops is related to cognitive emotion regulation, anxiety, depression, and sleep quality for the student volunteers of Shiraz University of Medical Sciences. Materials and Methods: In a randomized controlled trial, 152 students were allocated into the 3 equal groups (study1: “perseverance workshop” study2:”sleep and wakefulness workshop” and control group). Data collection instruments were the Granovsky cognitive emotion regulation scale, the Beck depression and anxiety inventories and Pittsburgh sleep Quality Index (PSQI-P) Questionnaire. Results: The results of comparing the anxiety and depression between groups showed that there was a decreasing and significant trend in the two intervention groups, before and after the two workshops (P < 0.001). For PSQ analysis, within-group comparisons in those who have participated sleep and wakefulness workshop showed that the change trend was significant and in linear form. In addition, to compare those who have participated in perseverance workshop with the control group, there was a significant difference between the pretest and posttest results in the Cognitive Emotion Regulation subgroups. Conclusion: It can be said that the implementation of the workshops could improve the emotional state of the participants in comparison to the control group.
  1,488 166 1
Smoking cessation education and training in obstetrics and gynecology residency programs in the United States
Liz Nims, Timothy R Jordan, James H Price, Joseph A Dake, Jagdish Khubchandani
March 2019, 8(3):1151-1158
DOI:10.4103/jfmpc.jfmpc_451_18  PMID:31041266
Background: OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. Methods: The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. Results: The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. Conclusion: Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.
  1,523 127 -
CASE REPORTS
Double outlet right ventricle and aortopulmonary window in a neonate with Bohring-Opitz (Oberklaid-Danks) syndrome: First case report
Bhupendra Verma, Abhishek Abhinay, Amrita Singh, Manu Kumar
March 2019, 8(3):1279-1281
DOI:10.4103/jfmpc.jfmpc_74_19  PMID:31041292
Bohring-Opitz syndrome (BOS) is a rare, sporadic genetic disorder, characterized by feeding difficulties, developmental delay, flexion abnormalities, dysmorphic facial features and typical body posture (BOS posture). This syndrome is diagnosed on the basis of distinctive clinical features with or without confirmation by genetic studies. Cardiac abnormalities are seen in almost half of the patients, but are nonspecific. We present a case of a 3-week-old male baby with BOS who was referred to our hospital with congestive heart failure, seizures and failure to thrive. He was diagnosed to have double outlet right ventricle and aortopulmonary window (DORV and APW). To our knowledge, this is the first case of Bohring-Opitz Syndrome ever reported with such clinical presentation.
  1,494 131 -
Cryptococcus gattii meningitis in a diabetic adult in South India
Mithilesh Kumar Jha, Aroop Mohanty, Pratima Gupta
March 2019, 8(3):1253-1256
DOI:10.4103/jfmpc.jfmpc_66_19  PMID:31041285
Cryptococcosis is the opportunistic infection usually seen in immunocompromised individuals. Among human immunodeficiency virus (HIV)–seropositive participants, cryptococcal meningitis is the second most common cause of opportunistic neuro-infection, but at times, it occurs in non-HIV patients who are immunodeficient due to other reasons like chronic glucocorticoid use, organ transplantation, malignancy, and sarcoidosis and has rarely been described in diabetic patients. We present a fatal case of Cryptococcus gattii meningitis in a 56-year-old HIV-negative male patient with diabetes mellitus.
  1,503 118 1
ORIGINAL ARTICLES
An audit of cerebral venous thrombosis associated with pregnancy and puerperium in teaching hospital in North Eastern India
Nalini Sharma, Shri Ram Sharma, Masaraf Hussain
March 2019, 8(3):1054-1057
DOI:10.4103/jfmpc.jfmpc_366_18  PMID:31041250
Background and Purpose: Cerebral venous thrombosis (CVT) is characterized by its clinical pleomorphism and pathogenetic variability. We studied 87 patients with CVT associated with pregnancy, and puerperium to find clinical profile, neuroradiological presentation and prognosis. Methods: A retrospective analysis was conducted based on clinical records at our institute between June 2008 and June 2018 without any personally identifying information. The diagnosis of CVT was confirmed by magnetic resonance imaging, angiography, or neuropathological study. Results: Among 87 patients, there were 82 of CVT associated with puerperium and 5 during pregnancy. Fifty-five women were multiparous. Cesarean delivery, hypertension, and anemia were strongly and significantly associated with CVT. Final outcome was considered good with anticoagulation; mortality rate was 10.34%. Conclusion: CVT associated with pregnancy, and puerperium is not an uncommon entity and has acute onset and a better prognosis. Pregnancy-related hypertension and Cesarean delivery and anemia are important risk factors for CVT. Further studies are needed to evaluate the need for therapeutic strategies for patients with CVT during pregnancy and puerperium.
  1,474 143 1
Microbiological evaluation of clinically suspected cases of tubercular lymphadenopathy by cytology, culture, and smear microscopy – A hospital-based study from Northern India
Kamla Kant, Chandra Prakash Baveja, Jyoti Sarkar, Deepak Juyal
March 2019, 8(3):828-833
DOI:10.4103/jfmpc.jfmpc_20_19  PMID:31041209
Introduction: Over the past few years, the incidence of extrapulmonary tuberculosis (EPTB), particularly of tubercular lymphadenitis (TBLN), is on the rise. TBLN, which contributes to 20–40% of EPTB cases, often poses a diagnostic and therapeutic challenge for clinicians more so in resource-constrained settings where laboratory confirmation is not available. In this study, we aimed to study if fine-needle aspiration cytology (FNAC) combined with Ziehl–Neelsen (ZN) staining and mycobacterial culture could improve the diagnostic accuracy in patients clinically suspected of TBLN. Materials and Methods: This cross-sectional study involved 120 patients (>12 years of age), clinically suspected of peripheral TBLN. Direct examination of the samples with ZN staining and culture on Lowenstein–Jensen (LJ) slants and Bactec MGIT 960 vials (MGIT 960 medium) was performed on previously collected fine-needle aspirates. Results: Out of total 120 patients included in study, 43.3% were males and 56.7% were females. Maximum numbers of cases were observed in age group 13–21 (56%). On ZN staining, 21.7% samples were found positive, whereas FNAC findings were suggestive of tuberculosis (TB) in 455 patients. Culture on LJ media showed 33.3% samples to be positive, whereas Bactec MGIT 960 system showed positivity of 35%. Out of 54 samples suggestive of TB on FNAC, only 30 (55.6%) were found positive on Bactec culture. Also out of 66 samples which were not suggestive of TB in FNAC, 12 (18.2%) were found positive in Bactec culture. Conclusion: Accurate diagnosis of TBLN requires a multifaceted approach involving microbiology, pathology, radiology, and clinical presentation of the disease. FNAC and ZN staining along with the culture can result in better diagnostic yield and will be helpful in reducing the burden of TB.
  1,447 150 2
CASE REPORTS
Gingival metastasis of adenocarcinoma with an unknown occult primary
Rashmi Naik, KR Chatura, B R. Ahmed Mujib, Smitha Veerappa, Shalini Gopal
March 2019, 8(3):1246-1249
DOI:10.4103/jfmpc.jfmpc_132_19  PMID:31041283
Metastatic dissemination to the oral cavity is extremely rare and constitutes about 1%–2.1% of all oral malignancies. The very first sign of the metastasis into the oral cavity indicates an occult malignancy in the distant site. It gives the evidence of widespread disease with an average survival rate of less than 7 months. Adenocarcinomas account for up to 60% of all metastatic neoplasms of unknown primary origin. Here, we report a case of metastatic adenocarcinoma of unknown primary origin in a 60-year-old male patient in the upper and lower gingiva without involvement of the underlying bone which is a very rare case reported in the literature till date.
  1,489 100 -
ORIGINAL ARTICLES
Audit of diabetes mellitus among patients attending an employee health clinic at a tertiary care centre in Riyadh, Saudi Arabia
Almas S Al Mutairi, Abdulaziz Al Dheshe, Abdullah Al Gahtani, Faisal Al Mutairi, Mooj Al Ghofaili, Sara Al Sawayyed, Humariya Heena
March 2019, 8(3):972-975
DOI:10.4103/jfmpc.jfmpc_182_18  PMID:31041235
Purpose: To assess the clinical practices in the management of patients with type 2 diabetes mellitus (T2DM) as a basis for establishing a guideline that focuses on risk factors and complications. Methods: We conducted a retrospective audit of the medical records of 450 patients (aged 20–65 years) diagnosed with T2DM attending an employee health clinic at King Fahad Medical City, Riyadh (Saudi Arabia) during the period from 1 January to 1 July 2016. All patients requiring emergency treatment were excluded. A checklist of demographic variables, co-morbidities, clinical examinations, and laboratory investigations was used for collecting data. Results: In total, 303 (67.3%) were women and 312 (69.3%) were Saudis. Forty-five (10%) patients were not receiving current treatment for diabetes and body mass index was not calculated for 117 (26%). Retinal and neurological examinations were not performed in 363 (80.7%) and 109 (24.2%) patients, respectively. Cardiovascular and peripheral vascular system examinations were not conducted for 112 (24.9%) and 114 (25.3%) patients, respectively. For laboratory investigations, 2-h glucose tolerance tests and vitamin B12 tests were not performed for 473 (97.1%) and 436 (96.9%) patients, respectively. Moreover, TSH/T4 and eGFR tests were not performed for 220 (48.9%) and 135 patients (30%), respectively. Conclusions: We concluded that current clinical practice for management of T2DM patients is not comprehensive and that the quality of healthcare should be improved with continuous checking of patient records.
  1,440 120 -
CASE REPORTS
Shigella flexneri associated reactive arthritis - GI transmitted or sexually transmitted?
Nidhi Kaeley, Manish Kumar, Bharat B Bhardwaj, Vempalli Nagasubramanyam
March 2019, 8(3):1250-1252
DOI:10.4103/jfmpc.jfmpc_30_19  PMID:31041284
The pathogenic association of reactive arthritis with human immunodeficiency virus (HIV) needs more attention. In this case report we described a case of 22 year old male patient suffering from severe HIV infection. He presented with the complaints of left knee joint pain associated with swelling and tenderness. He also developed keratotic papules on palms and soles and polycyclic erosions on the glans penis. He was diagnosed as a case of reactive arthritis with HIV infection. The patient was treated with sulfasalazine and anti retroviral therapy. We, hereby discuss the underlying pathogenesis and treatment modalities in patients of reactive arthritis with underlying HIV infection. The treatment of reactive arthritis with HIV is a challenge due to limited options of immunosupressive agents.
  1,436 108 2
ORIGINAL ARTICLES
Expenditure on health care, tobacco, and alcohol: Evidence from household surveys in rural Puducherry
Surendran Venkataraman, Suguna Anbazhagan, Surekha Anbazhagan
March 2019, 8(3):909-913
DOI:10.4103/jfmpc.jfmpc_91_19  PMID:31041223
Background: Healthcare expenditures exacerbate poverty, with about 39 million people falling into poverty every year because of such expenditures. Tobacco and alcohol consumption in addition to harmful health impact have economic consequences at household level. Aim: To evaluate healthcare, alcohol, and tobacco expenditures among households in rural Puducherry and their impact on household expenditure patterns. Materials and Methods: A community-based cross-sectional analytical study was conducted in selected villages within 5 km of a medical college hospital in Puducherry from September 2016 to June 2017. Sociodemographic details and various household expenditures were obtained from 817 households with 3459 individuals. Data were analyzed using STATA (v14). Results: Higher mean percentage of health expenditure was found among households with low socioeconomic status [17.7 (95% confidence interval (CI): 14–21.3)] and no health insurance schemes [13.4 (95% CI: 11.1–15.7)]. Households with low socioeconomic status [13.1 (95% CI: 7.5–18.7)] had higher tobacco–alcohol expenditure. Increased health expenditure among households was positively correlated with loan (rs = 0.48). Increased alcohol–tobacco expenditure among households was negatively correlated with food (rs= −0.52) and education (rs= −0.70) expenditure. Conclusion: Healthcare and alcohol–tobacco expenditure individually contributed to one-tenth of the household budget. Spending on healthcare, alcohol, and tobacco created significant negative influence on investment in human capital development.
  1,408 130 -
Teaching children about hygiene: A primary prevention experience in Portugal
Ana N Barata, Tiago Maricoto
March 2019, 8(3):1017-1021
DOI:10.4103/jfmpc.jfmpc_428_18  PMID:31041244
Background: Children's knowledge on hygiene is often considered to be provided by parents or schools. It is something with a direct impact on health and linked with socio-cultural factors. Primary care plays a vital role in health education and promotion, so focusing on hygiene habits is part of primary prevention. Objectives: Improving the knowledge on hygiene and promoting healthy behaviors in students from the 4th to the 6th grade. Materials and Methods: Longitudinal, prospective study. Hygiene habits were assessed through a questionnaire, followed by a brief health education session organized by healthcare professionals at schools. Hygiene habits were then reassessed using the original questionnaire. Results: A total of 812 questionnaires (354 in the pre-session phase and 458 in the post-session phase) were collected, filled in by students with ages ranging between 8 and 16 (average, 10.8), being 52% boys. There were significant increases in the score in both genders, but this increase was slightly higher for boys, with an average increase of 0.98 points (P < 0.05, independent samples t test). The 9 year old group (in the first evaluation; 10 years old post-talk) had the highest increase in score, with an average increase of 1.33 points in the questionnaire. Conclusion: Interventions conducted by healthcare professionals at schools have a positive effect for health education. The resulting scores revealed an improvement regarding hygiene habits namely in younger students. This may suggest that interventions on hygiene habits should take place at younger ages, so to have a greater impact in behavioral change.
  1,419 116 2
Evaluation of transcranial Doppler abnormalities in children with sickle cell disease in El-Obeid Specialized Children's Hospital
Walaa Ismail Musa Ismail, Mustafa Elnour, Alam Eldin Musa Mustafa
March 2019, 8(3):1176-1181
DOI:10.4103/jfmpc.jfmpc_112_19  PMID:31041270
Objectives: This study aims to evaluate transcranial Doppler abnormalities in children with sickle cell disease (SCD) in a specialized children's hospital in El-Obeid. Materials and Methods: This is a cross-sectional study done on 119 patients (2–18 years of age were included) who attended the sickle cell clinic in a specialized children's hospital in El-Obeid from December 2016 to February 2017; when patients do not have recent stroke symptoms, blood flow velocities were measured in both proximal internal carotid and middle cerebral arteries (MCAs) using non-imaging Doppler method, and time average mean velocities were recorded along with hemoglobin concentration and of the patients. Results: None of the study population had MCA velocity higher than 200 cm/s; also no high conditional velocity (170–199 cm/s) was recorded, so no patient was at high risk to develop stroke. About 20.1% of patients showed low velocities in one or both MCAs; 4.2% had abnormal MCAs' interhemispheric ratio; 4.2% of study population showed absent flow in one of their MCAs, reflecting previous occlusion. About 4.2% had poor temporal window. It was difficult to measure the velocity in one of the four vessels in 5.9% of the patient due to uncooperativeness. There was statistically significant relationship between hemoglobin concentration and blood velocity in the left MCA. Conclusion: Despite the international recommendations, using transcranial Doppler ultrasonography (TCD) as a stroke screening tool in children with SCD in Sudan is still not a well-known practice. Successful strategies to improve TCD screening rates must be encouraged in all healthcare institutions.
  1,386 140 -
Morbidity pattern and healthcare seeking behavior among the elderly in an urban settlement of Bhubaneswar, Odisha
Avinandan Sarkar, Ipsa Mohapatra, Rabindra N Rout, Bhaskar Thakur
March 2019, 8(3):944-949
DOI:10.4103/jfmpc.jfmpc_8_19  PMID:31041230
Background: Population aging is inevitable. Old age is marked with health problems because of aging process, long-term chronic illnesses, also associated with social and mental problems. Objectives: To determine the pattern of physical morbidities in geriatric population and to study the utilization of health services among them. Methods: A cross-sectional study was undertaken from April to September 2017, among 270 consenting elderly people, residing in urban slums under field practice area of a medical college, using a structured interview schedule. Results: Among the 270 elderly, 36.30% were males, 80% belonged to nuclear families. A total of 262 reported of some morbidity, 61.85% had hypertension, 45.19% had diabetes, 37.78% had acid peptic disease, and 51.08% reported to have 1--3 morbidities. Majority (41.85%) of them had visited a physician on an average of 4--6 times in the preceding year. A total of 84.81% went to the urban health center, whereas 24.81% to a government hospital for treatment. Reasons cited for preference of health facility were “free consultation” and “nearby location” (85.19%). A total of 90.74% received allopathic medicines. Conclusion: Prevalence of morbidity was found to be high, which can be attributed to their compromised living conditions. Health-seeking behavior was found to be good.
  1,365 157 1
Young, obese, and underweight patients show up inadequately at scheduled appointments: Findings from a record-based study on diabetic, hypertensive diabetic, and hypertensive patients attending a primary care clinic of Puducherry
Anindo Majumdar, Arun Mitra, S Parthibane, G Revadi
March 2019, 8(3):1090-1097
DOI:10.4103/jfmpc.jfmpc_387_18  PMID:31041256
Background: One key barrier to proper management of common cardio-metabolic conditions such as diabetes and hypertension in primary care is inadequate adherence to treatment, which, in many cases, results from inadequate follow-up at scheduled appointments. In addition to provider and health system level factors, individual patient level factors are also associated with attendance at follow-up appointments. Objective: To document the association of diabetic, hypertensive diabetic, and hypertensive patient's demographic and clinical factors with showing up inadequately at scheduled appointments. Methods: A record-based retrospective follow-up study was conducted in an urban primary health center of Puducherry from January to March 2015. Registered diabetic, hypertensive diabetic, and hypertensive patients who made at least one visit between July and December 2014 were included. Data on demographic factors, clinical factors, and dates of visits to the clinic were collected from case records of patients and were entered in EpiData entry version 3.1. Analysis was performed using R statistical package. Results: Out of 366 patients, 79% were females and 70.2% were aged >50 years. It was found that 183 (50%) were diabetic, 266 (72.7%) were hypertensive, and 115 (31.4%) were hypertensive diabetic. Out of 366 patients, all the five follow-up visits were attended by 185 (50.6%) patients, and “adequate follow-up” was found in 123 (33.6%) patients. Young, underweight, and obese patients were more likely to have inadequate follow-up. Conclusion: Family physicians should give special attention to these groups in their routine practice along with providing targeted health education and implementing full proof mechanisms to track them.
  1,368 120 2
Histological spectrum of renal disease in HIV/AIDS patients with significant proteinuria: An Indian perspective
Bhupendra Verma, Amrita Singh
March 2019, 8(3):860-865
DOI:10.4103/jfmpc.jfmpc_104_19  PMID:31041214
Background: Chronic kidney disease (CKD) has become epidemic in HIV/AIDS patients across Western and Eastern countries. HIV-associated nephropathy (HIVAN) has been consistently reported in studies from North America, Europe and African countries. However, studies from Asian countries are very sparse and differ strikingly in histological spectrum of renal disease, particularly in presence of HIVAN. Objectives: The study was carried out to in a teaching hospital from India to delineate the histological spectrum of renal disease and detect presence HIVAN in those with significant proteinuria (≥1gm/day). Patients and Methods: Urine analysis was done in 510 consecutive hospitalised HIV/AIDS patients after screening 640 such patients with age >18years. Patients with dipstick proteinuria ≥1+ were subjected to 24-hour urinary protein estimation. Renal biopsy was done in 10 patients with proteinuria ≥1gm/day. Results: Dipstick proteinuria ≥1+ was present in 29% patients. In patients undergoing kidney biopsy, the most frequent glomerular lesion was mesangial proliferative glomerulonephritis (30%) followed by HIVAN (20%). Tubulo-interstitial lesions were seen in 60% of biopsies. Pooled analysis of all the available kidney biopsy series from India revealed prevalence of HIVAN to be 16.5%. Conclusion: Contrary to the popular belief, HIVAN appears to be a common entity in this part of world too. High degree of clinical suspicion is required as diagnosis of HIVAN caries higher morbidity and mortality. Moreover, an early diagnosis and timely management can improve prognosis in such patients.
  1,321 157 -
CASE REPORTS
An uncommon cause of dysphagia
Manickavasagam Senthilraja, Remya Rajan, Nitin Kapoor, Thomas Vizhalil Paul, Kripa Elizabeth Cherian
March 2019, 8(3):1282-1283
DOI:10.4103/jfmpc.jfmpc_2_19  PMID:31041293
Lingual thyroid is an abnormal mass of ectopic thyroid tissue seen in the base of tongue caused due to aberrant embryological development. It is often asymptomatic but may cause local symptoms, such as dysphagia, dysphonia, and upper airway obstruction. In this case, we report a 13-year-old girl who presented with dysphagia and breathing difficulty. Local examination revealed thyroid tissue in the posterior aspect of the tongue. Thyroid scintigraphy showed abnormal tracer uptake at base of tongue. Hormonal test showed subclinical hypothyroidism. She was treated with Levothyroxine.
  1,314 119 -
ORIGINAL ARTICLES
Safety of food served in Mid-Day Meal program: An in-depth study in upper primary schools of Kolkata
Sembagamuthu Sembiah, Jayeeta Burman, Aparajita Dasgupta, Bobby Paul
March 2019, 8(3):938-943
DOI:10.4103/jfmpc.jfmpc_59_19  PMID:31041229
Introduction: The Mid-Day Meal (MDM) program is the world's biggest supplementary school lunch program and is being implemented all over India for primary and upper primary school students. To continue a healthy program, personal hygiene of food handlers and beneficiaries should be well maintained. Objective: This study aims at examining the status of food safety measures including personal hygiene of food handlers and beneficiaries of MDM. Methodology: An institution-based observational study with cross-sectional design was conducted in upper primary schools (government, government-aided school) in Kolkata over a period of 2 years from November 2016 to October 2018. A sample of 52 schools from a total of 515 schools were then selected by simple random sampling. Analyses were conducted using SPSS software (SPSS Inc., released 2007 SPSS for Windows, version 16.0). Results: Among 52 schools, 53.8% were government-aided schools and 46.2% were government schools. There were significant differences in cleaning practice by cook-cum-helper (CCH) (χ2 = 4.4, df = 1, P = 0.036), personal hygiene of CCH (χ2 = 19.01, df = 1, P = 0.000) and beneficiaries (χ2 = 9.3, df = 1, P = 0.002), practice during serving (χ2 = 4.4, df = 1, P = 0.036), and use and storage of oils and condiments in MDM (χ2 = 27.7, df = 1, P = 0.000) between government and government-aided schools. Conclusion: School authority should be concerned about maintaining proper hygiene. Adequate facilities and training program must be arranged for CCH to provide a healthy meal.
  1,257 135 -
CASE REPORTS
Recurrent episodes of pneumonia in a toddler: Don't forget chronic granulomatous disease
Alkesh Kumar Khurana, Abhishek Goyal, Ujjawal Khurana, Bhavna Dhingra
March 2019, 8(3):1260-1262
DOI:10.4103/jfmpc.jfmpc_29_19  PMID:31041287
A 4-year-old boy presented with community acquired pneumonia, hepatosplenomegaly and bilateral cervical lymphadenopathy. The peripheral blood film showed significant monocytosis and bone marrow examination revealed multiple histiocytic granulomas. Presence of CD 68 positive granulomas supported by cytological findings enabled us to make a diagnosis of chronic granulomatous disease.
  1,275 113 -
Congenital dilatation of the nasolacrimal sac (Dacryocystocele): Case report
Sakiyeva Kanshaiym, Mohamed H. Naser El-Din, Ibrahim A Abdelazim, Mohamed E S. Hamed, Tatyana Starchenko
March 2019, 8(3):1284-1286
DOI:10.4103/jfmpc.jfmpc_17_19  PMID:31041294
Congenital dacryocystoceles are usually diagnosed in the third trimester by parental ultrasound as a cystic lesion adjacent to the medial and inferior aspects of the fetal orbit. A considerable number of dacryocystocele are bilateral and resolve spontaneously in utero and/or immediately after delivery. Persistent dacryocystoceles need ophthalmological consultation to avoid the possible potential complications. This case report represents a case of congenital dacryocystocele diagnosed by antenatal 2D and 3D ultrasounds, which disappeared spontaneously 2 days after birth. To highlight that, the diagnosis of congenital dacryocystoceles is important to avoid additional postnatal diagnostic techniques and to manage the potential postnatal complications.
  1,169 100 -
Abdelazim and Shikanova suggested protocol of Ain Shams and West Kazakhstan Universities for management of delayed-interval delivery of the second twin: Case report
Ibrahim A Abdelazim, Svetlana Shikanova
March 2019, 8(3):1276-1278
DOI:10.4103/jfmpc.jfmpc_5_19  PMID:31041291
Background: The incidence of multiple gestations increased after the assisted reproductive techniques. Preterm labor and preterm premature rupture of fetal membranes are the most common complications of multiple gestations. Traditionally, if one fetus is delivered preterm in twin pregnancies, the situation is managed by delivery of the second fetus. Recently, there are reported cases of delayed-interval delivery (DID) of the second twin, with good outcome without established protocol for management of such cases. This report presents the protocol suggested by Abdelazim and Shikanova for the management of DID of the remaining second twin. Conclusion: The birth weight and the survival rate increased after Abdelazim and Shikanova suggested protocol for management of DID of the remaining second twin without any maternal risks or complications. DID should be done in tertiary centers after informing the parents about the possible risks of keeping the live second twin in the hostile intrauterine environment.
  1,154 108 2
ORIGINAL ARTICLES
Factors affecting accurate parents' perception of ideal weight of preschool age children in Abha City, KSA
Saleh M Alqahtani
March 2019, 8(3):981-984
DOI:10.4103/jfmpc.jfmpc_1_19  PMID:31041237
Background: Obesity as a significant health problem among children worldwide can have major adverse effects on children life. Awareness of parents about childhood obesity and ideal weight in children is crucial. Objectives: To identify the factors affecting the parental perception about ideal weight for their preschool children. Methods: A cross-sectional study was carried out including a representative sample of the parents of healthy children attending sevenprimary health care centers (PHCCs) in Abha city, KSA. All parents who have a child aged 12–70 month were included. The parents were interviewed through structured questionnaire inquiring about factors that could impact the parents' perception regarding the ideal weight for their children. Saudi body mass index chart was used to classify children into ideal, overweight or failure to thrive. SPSS version 25 was used for data analysis. Results: Out of 385 children aged 12–70 month, the overall overweight/obesity amounted to 8.6% (33/385). Overall, accurate parental perception was observed among slightly more than half of parents. Parents whose children were ≤24 months were more likely to perceive accurately their weight compared with those whose children were older (61.3% vs 49.1%). The difference was statistically significant, P = 0.032. Conclusion: Approaching half of parents have inaccurate perception of their children's weight, particularly their older children. Encouragement of parents to follow their children's weight through percentile charts at primary care centers is needed.
  1,145 102 -
CASE REPORTS
Dhoti cancer revisited
Manojit Midya, Deepti Sukheeja, Jagdeep Rao, Gautam Prakash
March 2019, 8(3):1235-1238
DOI:10.4103/jfmpc.jfmpc_113_19  PMID:31041280
Dhoti is traditional Indian dresses worn by males in the Indian subcontinent to cover the lower parts of the body. The term Dhoti cancer was first used by Khanolkar and Suryabhai in 1945. It is a type of waistline SCC reported in Indian males wearing dhoti. Only a handful of cases are reported in English literature. This case is remarkable due to its rare site of presentation, simultaneous presence of carcinoma and suspicious acanthosis on both side of waist in the same patient. Any hypo pigmented patch and acanthosis on the waist area in a dhoti clad man should be viewed with suspicion and continuous surveillance is needed thereof.
  1,129 110 -
ORIGINAL ARTICLES
Identification of alcohol problem among long route bus drivers and staffs of Dharan, eastern Nepal: Assessing from the CAGE and DSM-IV tools
Ashok K Yadav, BK Rai, SR Niraula, A Yadav, R Bhandari, V Shrivastav
March 2019, 8(3):853-859
DOI:10.4103/jfmpc.jfmpc_301_17  PMID:31041213
Background: Alcohol use remains a major cause of preventable death worldwide occurring prematurely. Despite its global burden, alcohol still is a legal drug. Various studies have also shown that factors like education, occupation, influence from films and family, for stress relief, pleasure during alcohol use, better self-esteem, and occupational boredom are associated with alcohol use. The consumption of alcohol, even in relatively small amounts, increases the risk of being involved in a crash for motorists and pedestrians. It is also associated with impaired judgments and so is often linked to road traffic accident. Objectives: To assess the prevalence, type of alcohol use, and the associated factors for the initiation of alcohol use among bus drivers and staffs of long route bus of Dharan. To assess the knowledge, attitude, and practice regarding alcohol use for their willingness to quit it with medical help. Materials and Methods: The cross-sectional survey was conducted in 250 long route drivers and staffs in Dharan Bus Park in 2016 with the help of a self-designed questionnaire in Nepali language. The sample size was preliminarily estimated on the basis of the prevalence of alcohol use. The “Alcohol consumer” refers to drivers who used alcohol at least once in the previous year. Results: Alcohol dependency among Hindu was found to be significantly more than other religious group. The prevalence of alcohol consumption was found to be 78%. About 51% drivers are likely to have alcohol problems, 39% are alcohol abuser, and 45% are alcohol dependent. Conclusion: Drinking and driving increase the vulnerability to injury and death on the road. The study creates awareness among drivers about the harmful use of alcohol and psychosocial consequences.
  1,092 123 1
CASE REPORTS
Increased household exposure to respiratory pathogens in HIV exposed uninfected children due to maternal HIV
Tila Khan, Ranjan S Das, Sangeeta D Bhattacharya
March 2019, 8(3):1232-1234
DOI:10.4103/jfmpc.jfmpc_111_19  PMID:31041279
Little is known about household exposures to respiratory pathogens in HIV-exposed uninfected children (HEU) in Indian families. This case series investigates the nasopharyngeal carriage of Streptococcus pneumoniae, Staphylococcus aureus, and respiratory viruses at multiple points in three mother child pairs: (1) an HIV-infected child and mother, (2) an HEU child and HIV-infected mother, and (3) an HIV-unexposed uninfected (HUU) child and mother. Nasopharyngeal carriage densities of Streptococcus pneumoniae and Staphylococcus aureus were higher in mothers and children living in HIV-affected households, regardless of the child's HIV status. Maternal HIV and ART status impact these household exposures.
  1,094 107 -
LETTERS TO EDITOR
Medical education in India: Looking beyond doctor: Population ratio
SS Prakash
March 2019, 8(3):1290-1291
DOI:10.4103/jfmpc.jfmpc_85_19  PMID:31041296
  1,076 114 -
CASE REPORTS
A rare cause of nodular skin lesions with fever in an immunocompetent individual
Subodh Kumar Mahto, Afroz Jamal, Pankaj Kumar Gupta, Pritam Majumdar, Vijeta Grewal, Nagina Agarwal
March 2019, 8(3):1287-1289
DOI:10.4103/jfmpc.jfmpc_26_19  PMID:31041295
Histoplasmosis is a fungal disease caused by the dimorphic fungus Histoplasma capsulatum. It is endemic to many parts of the world but is rarely seen in India. The fungus usually affects the immunocompromised patients and is rarely reported in immunocompetent hosts. We hereby report a case of the nodular skin lesion with fever lesion that finally turned out to have cutaneous histoplasmosis, from a non-endemic region of northern India and that too in an immunocompetent.
  1,036 96 -
LETTERS TO EDITOR
A rare case of quadriparesis
Himmatrao Saluba Bawaskar, Pramodini Himmatrao Bawaksar
March 2019, 8(3):1292-1292
DOI:10.4103/jfmpc.jfmpc_87_19  PMID:31041297
  854 83 -
ERRATUM
Erratum: Prevalence and associated factors of burnout among family medicine residents in Al Madina, Saudi Arabia

March 2019, 8(3):1293-1293
DOI:10.4103/2249-4863.256944  PMID:31041298
  838 79 -
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