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   2019| June  | Volume 8 | Issue 6  
    Online since June 26, 2019

 
 
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REVIEW ARTICLES
Socioeconomic status scales-modified Kuppuswamy and Udai Pareekh's scale updated for 2019
Rabbanie Tariq Wani
June 2019, 8(6):1846-1849
DOI:10.4103/jfmpc.jfmpc_288_19  PMID:31334143
Socioeconomic status (SES) is one of the prime factors influencing the health status of a nation. It is the measure of the social standing of the individual or a family and has a wide impact on an individual/family's health, educational attainment, diet, lifestyle, etc., The per capita income of citizens is a major factor that decides the SES of the population. The affordability and utilization of the health facilities depend on the socioeconomic profile of the population. The periodic changes in the consumer price of goods globally as well as nationally due to inflation warrants that it is mandatory to constantly update the income-based socioeconomic scales so as the assessment is made correctly in practice. We are making an attempt to provide an updated Kuppuswamy and Udai Pareekh's socioeconomic scales for 2019.
  38 44,343 3,158
Telemedicine in India: Where do we stand?
Vinoth G Chellaiyan, AY Nirupama, Neha Taneja
June 2019, 8(6):1872-1876
DOI:10.4103/jfmpc.jfmpc_264_19  PMID:31334148
Telemedicine is considered to be the remote diagnosis and treatment of patients by means of telecommunications technology, thereby providing substantial healthcare to low income regions. Earliest published record of telemedicine is in the first half if the 20th century when ECG was transmitted over telephone lines. From then to today, telemedicine has come a long way in terms of both healthcare delivery and technology. A major role in this was played by NASA and ISRO. The setting up of the National Telemedicine Taskforce by the Health Ministry of India, in 2005, paved way for the success of various projects like the ICMR-AROGYASREE, NeHA and VRCs. Telemedicine also helps family physicians by giving them easy acess to speciality doctors and helping them in close monitoring of patients. Different types of telemedicine services like store and forward, real-time and remote or self-monitoring provides various educational, healthcare delivery and management, disease screening and disaster management services all over the globe. Even though telemedicine cannot be a solution to all the problems, it can surely help decrease the burden of the healthcare system to a large extent.
  26 9,545 1,009
COMMENTARIES
India's National Action Plan for antimicrobial resistance – An overview of the context, status, and way ahead
Jaya Ranjalkar, Sujith J Chandy
June 2019, 8(6):1828-1834
DOI:10.4103/jfmpc.jfmpc_275_19  PMID:31334140
Antimicrobial resistance (AMR) is a multifaceted complex problem with momentous consequences for individuals as well as health-care systems. Understanding the gravity of the problem, the World Health Assembly has adopted the Global Action Plan on AMR in the year 2015 as a part of the tripartite collaboration with World Health Organization, Food and Agricultural Organization, and World Organization for Animal Health. India's National Action Plan (NAP) for AMR was released in April 2017 by the Union Ministry of Health and Family Welfare. The objectives of the NAP include improving awareness, enhancing surveillance measures, strengthening infection prevention and control, research and development, promoting investments, and collaborative activities to control AMR. On the basis of the NAP, various states have begun the process of initiating their State Action Plans. The aim of this article is to highlight some of the main components of the NAP and to make family physicians, general practitioners, and other stakeholders aware of the issue of AMR and its factors and what can be done. The article also discusses some of the challenges in implementation of NAP such as varied perceptions about antibiotic use and AMR among key stakeholders, inappropriate antibiotic use owing to a number of reasons, lack of diagnostic facilities, widespread use of antibiotics in various sectors, environmental contamination because of pharmaceutical industry, agricultural and hospital waste, gaps in infection prevention and control, and difficulty in enforcing regulations. Similar to other low-middle income countries (LMICs), lack of sufficient finances remains a major challenge in NAP implementation in India as well. Overall, a strong political will, inter-sectoral co-ordination between public and private sectors and comprehensive strengthening of the healthcare systems are necessary to achieve the desired forward momentum.
  13 7,274 1,085
REVIEW ARTICLES
Integration of oral health into primary health care: A systematic review
Monika Prasad, C Manjunath, Archana Krishna Murthy, Aishwarya Sampath, Shefali Jaiswal, Ankit Mohapatra
June 2019, 8(6):1838-1845
DOI:10.4103/jfmpc.jfmpc_286_19  PMID:31334142
Integration of oral health into primary health care holds the key to affordable and accessible health care as oral health is still a neglected component in many countries. This review aims to determine integration of oral health into primary health care and provide an evidence-based synthesis on a primary oral healthcare approach. Searches were conducted in various databases like Biomed Central, MEDLINE, Cochrane databases, NCBI (PubMed), Sci-Hub, Google Scholar, and WHO sites. The studies included in this review are according to the following eligibility criteria: the articles in English language, the articles published from January 2000 to October 2018, and only full text article. The search yielded 500 articles. After removal of duplicates: 410 articles screened based on title and abstract, 100 full text articles were assessed for eligibility, and 30 full text articles were included. This review showed evidence how oral health is related to general health: focused on common risk factor approach and bidirectional relationship. There are various ways of integration, such as interprofessional education, interprofessional collaborative practice, closed-loop referral process, and various public and private partnerships, and at the same time, there are a lot of barriers in integration. Thus, the primary oral health care needs to be developed as an integral part of primary health care. Consequently, there is a need to increase finance, health care workforce, government support, and public–private partnership to achieve the goal of affordable and accessible health care, i.e. health for all.
  10 4,089 686
Role of microRNAs in stroke recovery
Agam Bansal, Rana Prathap, Samiksha Gupta, Aditi Chaurasia, Pooja Chaudhary
June 2019, 8(6):1850-1854
DOI:10.4103/jfmpc.jfmpc_296_19  PMID:31334144
Ischemic stroke is an important cause of morbidity and mortality across the globe. It is associated with physical, social, and economic disability. Immediately after the stroke, there is a critical period of spontaneous recovery during which there is maximal return to near normal. Following stroke, there is a period of neurogenesis, angiogenesis, axonal growth, and synaptic plasticity. There have been several studies focusing on neuroprotection and enhancing recovery following stroke. However, translation of these into clinical practice has been disappointing. The role of microRNAs in treatment of cancer has been well documented, but studying their role in stroke recovery has been minimal. MicroRNAs serve as critical mediators of recovery following stroke. In this review article, we discuss the role of microRNAs in stroke recovery.
  6 1,657 202
EDITORIAL
Designing primary healthcare systems for future in India
Pavitra Mohan, Himani Sethi, Kadarpeta Rahul Reddy, Maharaj K Bhan
June 2019, 8(6):1817-1820
DOI:10.4103/jfmpc.jfmpc_422_19  PMID:31334137
Changing epidemiology, rapid urbanization, and rising expectations of populations are creating new challenges and opportunities for India's primary healthcare system. A group of primary care experts, practitioners, and researchers got together to design key elements of primary healthcare models for the future that would address these challenges and make use of emergent opportunities in rural and urban India. Based on experiences and evidence from India and across the globe shared in the consultation, the article lays out a vision and components of India's primary healthcare for future. It provides answers to questions such as how will healthcare be financed and organized, what mechanisms will assure quality of services, who will provide primary healthcare, and what role will technology have. Finally, it provides an agenda for primary healthcare practitioners and researchers to translate this vision into action.
  5 3,020 397
REVIEW ARTICLES
Review on sodium-glucose cotransporter 2 inhibitor (SGLT2i) in diabetes mellitus and heart failure
Akshyaya Pradhan, Shweta Vohra, Pravesh Vishwakarma, Rishi Sethi
June 2019, 8(6):1855-1862
DOI:10.4103/jfmpc.jfmpc_232_19  PMID:31334145
SGLT-2 inhibitors are a novel class of anti-diabetic agents which act by inhibiting glucose reabsorption in proximal convoluted tubules of kidney. Apart from maintaining glucose homeostasis they exert a number of positive effects on the cardiovascular system like weight loss, decreasing blood pressure, preserving renal function, reducing triglycerides, natriuresis and improving endothelial dysfunction. In large clinical trials, all the three prototype agents – Empaglifozin, Canaglifozin and dapaglifozin have shown reductions in major adverse cardiovascular events including cardiovascular deaths, non fatal MI, stroke and heart failure (HF) hospitalizations. The reduction in heart failure hospitalization is a surprising finding and trials of these drug are now underway for HF also. More surprising is the fact that the benefits are comparable or even better that achieved by recently approved novel drugs for HF. In this review, we briefly discuss the pathophysiology of HF in diabetes, describe the prototype SGLT-2 molecules available, their data from large cardiovascular outcome trials till date and their role in current practice of diabetes management.
  5 3,585 1,751
ORIGINAL ARTICLES
Prevalence and correlates of depression among male medical students and interns in Albaha University, Saudi Arabia
Mohannad A Albajjar, Marwan A Bakarman
June 2019, 8(6):1889-1894
DOI:10.4103/jfmpc.jfmpc_323_19  PMID:31334151
Background: Depression in medical students and interns appear higher than the general population, with evidence of mental health deterioration over a period of medical training. Objectives: To estimate the prevalence and evaluate the predictors of depression among male medical students and interns, Albaha University, Saudi Arabia. Subjects and Methods: A cross-sectional analytic study was conducted which includes a representative stratified random sample with the proportional allocation of male medical students and interns, College of Medicine, Albaha University (2017–2018). A questionnaire included sociodemographic characteristics of the participants as well as a medical and family history of depression, medical or psychiatric illness, abuse or violence, and the major traumatic event was utilized. In addition, the validated reliable Arabic version of Becks Depression Inventory (BDI) questionnaire was used to screen for depression. Results: The study included 161 medical students and 21 interns. Their age ranged between 19 and 26 years with a mean of 22.03 ± 1.94 years. Majority of the participants (98.9%) were Saudis and singles (84.6%). The prevalence of depression, based on the BDI scale, was 53.8%; it was mild in 25.8% and severe or extreme in 4.4% of the participants. No factor was significantly associated with depression. However, severe or extreme depression was more reported among students/interns with a history of domestic abuse or violence and those who had a history of major trauma or psychiatric event, P < 0.001. Conclusion: Depression is a common problem among male medical students and interns in AlBaha University, with no difference according to demographics, smoking history, family history of depression, history of chronic medical or psychiatric illness, history of domestic/violence abuse, and history of major trauma or psychiatric event.
  4 4,224 198
Target organ damage in newly detected hypertensive patients
Divya Prakash
June 2019, 8(6):2042-2046
DOI:10.4103/jfmpc.jfmpc_231_19  PMID:31334177
Background: Hypertension (HTN) is difficult to diagnose since it is asymptomatic. Most of the patients with HTN are unaware of their disease, and hence a large number of these subjects have target organ damage (TOD) on their first arrival at hospital or clinic. Hence, early detection and treatment of TOD determines the cardiovascular prognosis in hypertensive patient and can retard or prevent further damage. Methods: An observational and cross-sectional study was carried out in a tertiary care hospital and clinical profile was collected. Newly detected hypertensive men and women were recruited from outpatient and inpatient departments of medicine based on a set of inclusion and exclusion criteria. The study was carried out over a duration of 18 months from March 2014 to August 2015. Results: A total of 150 participants were included in the study with a mean age of 51.64 ± 11.64 years. A total of 91 participants had presence of at least one TOD. In our study, retinopathy (20.67%), macroalbuminuria (MA) (44.67%), electrocardiographic left ventricular hypertrophy (LVH) (20.67%), echocardiographic LVH (29.33%), diastolic dysfunction (21.33%), and systolic dysfunction (3.33%) were particularly notable. Grade 3 retinopathy, microalbuminria, and diastolic dysfunction were associated with severity of HTN. Conclusion: We conclude that a strong relationship exists between HTN and TOD. The evidence for TOD was found to be greater than that expected in newly detected hypertensive patients. Hence, a tight control of blood pressure represents the first step in treating essential HTN, which not only keep the blood pressure under control and further steps to be taken to prevent or retard the onset/progression of TOD.
  4 1,994 266
Evaluation of cholinesterase and lipid profile levels in chronic pesticide exposed persons
Usha Kiran Pothu, Anil Kumar Thammisetty, Lakshmana Kumar Nelakuditi
June 2019, 8(6):2073-2078
DOI:10.4103/jfmpc.jfmpc_239_19  PMID:31334182
Background: Agriculture being the predominant occupation in India with rampant usage of pesticides to meet its enormous population needs. This pesticide abuse is taking a toll on the health of the persons involved in this work. Objectives: To evaluate pesticide exposure by assessing serum cholinesterase levels, and comparing them with the serum lipid profile levels which assumes the cardiovascular risk status. Study Design: It is a cross-sectional comparative study involving around 283 agricultural farm workers in Rajamahendravaram, Andhra Pradesh. The study period was for about 3 months during pesticide spraying season. Materials and Methods: All the blood samples were collected and analysed for biochemical parameters like plasma glucose, blood urea, serum creatinine, and lipid profile and serum cholinesterase levels using XL 640 fully automated random access analyser. Statistical Analysis Used: Results were analysed using SPSS software version 20. Results: The study group was classified into two groups based on serum cholinesterase levels. It was observed that there were significant alterations in lipid profile levels in the study group with decreased cholinesterase levels when compared to those of normal cholinesterase levels. There was significant negative correlation between cholinesterase levels and non-HDL cholesterol and total cholesterol/HDL ratio. Conclusion: This study implicates that the pesticides have an adverse health effect with regard to cardiovascular risk status.
  4 1,190 163
Prevalence of influenza and pneumococcal vaccine uptake in Saudi type 2 diabetic individuals
Yousef A Almusalam, Medhat K Ghorab, Saleh L Alanezi
June 2019, 8(6):2112-2119
DOI:10.4103/jfmpc.jfmpc_265_19  PMID:31334189
Introduction: Individuals with diabetes are at particularly at high risk for many of the negative health consequences associated with influenza and pneumococcal infections. This study aimed to determine the prevalence of influenza and pneumococcal vaccination among a population of type 2 diabetic patients in Saudi Arabia and to determine the factors associated with vaccine uptake. Methods: A cross-sectional survey was conducted among patients with type 2 diabetes at Security Forces Hospital, Riyadh in Saudi Arabia. The survey asked basic demographic questions as well as questions about awareness, vaccination status, and beliefs about the influenza and pneumococcal vaccines. Results: From a total number of 422 responses, 360 participants were ultimately included in the final sample. The overall prevalence of influenza and pneumococcal vaccination in this population were 47.8% and 2.8%, respectively. In general, there was a very low awareness of the pneumococcal vaccine. Older individuals, unmarried individuals, those with less education, and those living with certain chronic conditions were less likely to have gotten the influenza vaccine. Beliefs in the importance of vaccination for people with diabetes, the efficacy of the influenza vaccine, and not being worried about the side effect of the vaccine were strongly associated with having received the vaccine. Conclusions: Attention should be given to increasing awareness of the pneumococcal vaccine among people living with diabetes. Particular consideration should also be paid to increasing access and awareness to both vaccines among those groups that have the lowest prevalence of vaccination and may be at the highest risk for the negative consequences associated with these infections. Finally, education interventions should be used to increase the understanding of the safety and efficacy of the influenza vaccine.
  4 1,485 181
Asian BMI criteria are better than WHO criteria in predicting Hypertension: A cross-sectional study from rural India
Madhur Verma, Meena Rajput, Kamal Kishore, Soundappan Kathirvel
June 2019, 8(6):2095-2100
DOI:10.4103/jfmpc.jfmpc_257_19  PMID:31334186
Background: International Obesity Task Force proposed lower body mass index (BMI) cut-off values for defining overweight and obesity in Asian population. However, there is an absence of unanimity regarding the definition of overweight and obesity that is confusing while estimating disease burden, resource allocation, and priority setting. Therefore, the primary aim of the study was to assess the prevalence of overweight and obesity and its predictors as per different criteria (WHO criteria, Modified Asian criteria of BMI classification and BF% estimation by bioelectric impedance analysis technique). The secondary aim was to assess the concordance of overweight and obesity as diagnosed using these three methods. Methodology: A community-based cross-sectional study was conducted in a rural area of Rohtak, north India over a period of 1 year with a sample size of 1080. Anthropometric measurements including height, weight, blood pressure, body fat % analysis were recorded using standard protocols. Results: The prevalence of overweight and obesity were observed to be 49.62% (N = 536) as per the modified criteria for the Asian Indians (BMI ≥23 kg/m2) and 34.62% (N = 374) according to WHO criteria (BMI ≥25 kg/m2). A total of 18.3% of the study population were hypertensive. Modified criteria of BMI classification for Asian Indians had high sensitivity (67%) as compared to WHO criteria (55%) in predicting, diagnosing hypertension, and resembled sensitivity estimate obtained through direct body fat percentage estimation (69%). Conclusion: Modified criteria of overweight and obesity classification are better in terms of reducing comorbid dysmetabolic conditions, as exemplified by hypertension.
  3 15,880 855
A cross-sectional study to screen community health volunteers for hip/knee-osteoarthritis and osteoporosis
Chinmay N Gokhale, Sophie S Simon, Rujuta S Hadaye, Sujata R Lavangare
June 2019, 8(6):2101-2105
DOI:10.4103/jfmpc.jfmpc_261_19  PMID:31334187
Context: Osteoarthritis (OA) is a degenerative disease mainly affecting hip and knee joints, and osteoporosis is characterized by diminution of bone mass. Both these diseases have a substantial economic impact on society. Community health volunteers (CHVs) being peripheral health workers are prone to such diseases owing to their sociodemographic and occupational profile. Aim: This study was conducted to estimate the proportion of hip/knee OA and osteoporosis among CHVs and understand determinants of their current bone health status. Materials and Methods: Screening for OA was done using a tool adopted from a previous study after obtaining due permissions. Weight, height, blood pressure, and bone mineral density of all participants were recorded. Statistical tests such as Chi-square and multiple logistic regression were used for analysis of data. Results: Out of 80 participants, 50 (62.5%) had increased body mass index (overweight + obese), 10 (12.5%) were hypertensive, 14 (17.5%) CHVs screened positive for hip OA, and 29 (36.3%) were positive for knee OA. Hip OA was associated with advancing age, parity, and obesity. Knee OA was associated with age and exercise. In total, 16.3% subjects were found to have osteoporosis and 61.2% had osteopenia. Conclusions: This study showed that a remarkable proportion of CHVs had bone and joint problems. CHVs must, therefore, receive preventive measures such as health education and screening for these diseases.
  3 1,125 138
Mortality and morbidity associated with acute poisoning cases in north-east India: A retrospective study
Rakesh Sharma, Neelanjana , Nandita Rawat, Nalini Panwar
June 2019, 8(6):2068-2072
DOI:10.4103/jfmpc.jfmpc_237_19  PMID:31334181
Poisoning is a leading cause of morbidity and mortality in India and also a major health problem worldwide. Majority of the studies shows that insecticides and pesticides compounds are the most widely used agents for poisoning. Materials and Methods: A retrospective study was conducted to explore the hospital records of patients with acute poisoning cases. A structured proforma used to collect data regarding patients' demographic information, incidence of poisoning, cause and type of poisoning, clinical presentation of patient, treatment, and prognosis. Data were analyzed with descriptive and inferential statistics. Results: A total 505 patient files with poisoning cases were admitted at emergency department. The mean age of the patients was 28.43 ± 14 years (range 1–84 years). In gender-wise ratio, male patients (59%) were higher than the females (39%). The occurrence of poisoning was high 209 (41.38%) in young adult with age of 21–30 years. The causes of poisoning were suicide in 63.96% of cases. In majority, 310 (61.38%) patients consumed insecticides or pesticides. About 51.1% patients were treated at locally available medical facilities and 48.9% cases were brought to tertiary care center directly for the treatment. About 258 (51.08%) patients treated with gastric lavage, and for 9 (1.8%) patients endotracheal intubation was performed. The average stay in the hospital was 12.53 ± 7.53 days and mortality was 42 (8.31%). Conclusion: This study highlights that the incidence of poisoning and its morbidity and mortality can be reduced by development and implementation of effective intervention at primary level by health care providers and strategies on preventive aspect.
  3 1,803 209
Pattern of alcohol consumption and its associated morbidity among alcohol consumers in an urban area of Tamil Nadu
V M. Anantha Eashwar, S Gopalakrishnan, R Umadevi, A Geetha
June 2019, 8(6):2029-2035
DOI:10.4103/jfmpc.jfmpc_226_19  PMID:31334175
Introduction: In India, though the prevalence of alcohol consumption is low, nearly half of the alcoholic consumers fall into the category of hazardous drinking. There have been rapid changes in the trends and pattern of alcohol use in India. Aims: The study was carried to find out the pattern of alcohol consumption, associated morbidities, and its association with related factors in an urban area of Tamil Nadu. Materials and Methods: This is a descriptive cross-sectional study done among adult males >18 years of age in Kancheepuram district Tamil Nadu. Among the 400 study participants selected by simple random sampling, 156 were found to be alcohol consumers. A pre-tested structured questionnaire and Alcohol Use Disorders Identification Test (AUDIT) was used to identify the pattern of alcohol consumption and the associated health morbidities. Data analysis was done using SPSS version 22. Results: It was found that 67% of alcohol consumers had a problematic drinking pattern with 52.5% having a hazardous/harmful drinking pattern and 14.7% were found to be dependent alcoholics. The associated factors of problem drinking among the alcohol consumers were illiteracy, having a history of tobacco use, being unmarried/divorced and consuming alcohol in wine shops. The health morbidities that were found to be associated with alcohol consumption were hypertension, gastritis/peptic ulcer disease, and psychiatric illnesses. Conclusion: More than half of the alcohol consumers had a problematic drinking pattern, which is an alarming public health problem. All the current drinkers in a community have to be screened for problematic drinking pattern and it has to be supplemented with referral services, health promotion, behavioral change communication to the alcohol consumer, and his family members.
  3 2,293 221
Study of role of serum amyloid A (SAA) as a marker of disease activity in juvenile idiopathic arthritis
Sharad Dev, Anup Singh
June 2019, 8(6):2129-2133
DOI:10.4103/jfmpc.jfmpc_339_19  PMID:31334192
Background: Role of serum amyloid A (SAA) protein as a biomarker for the disease activity in juvenile idiopathic arthritis (JIA) has not been explored. This study was done to find its role as marker of disease activity in JIA. Methods: A case–control study with 50 newly diagnosed cases of JIA of all subtypes and 40 healthy controls was done. Serum amyloid A (SAA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured in both patients and healthy controls. Quantitative measurement of SAA level was measured by using standard human SAA enzyme-linked immunosorbent assay (ELISA). Disease activity was assessed clinically and by ultrasonography (USG) score determined by examining eight large joints (bilateral elbow, wrist, knee, ankle). Serum SAA levels were found significantly higher in JIA patients as compared with healthy controls (P < 0.001). Significant positive correlations were found between SAA with presence of active joints (r = 0.64, P < 0.001), ESR (r = 0.39, P < 0.05), and CRP (r = 0.36, P < 0.05). However, significant correlations was not found between ESR and the presence of active joints (r = 0.21, P = 0.225) and between CRP and the presence of active joints (r = 0.034, P = 0.855). The mean USG score of patients with increased SAA level was significantly higher than that of patients with normal SAA level (P < 0.05). Conclusion: A significant increase in SAA levels was found in JIA patients with strong positive correlation between SAA level and JIA disease activity. The study discerned SAA to be a more sensitive laboratory marker than ESR and CRP for evaluating the presence of active joints.
  3 1,378 181
An open-label, randomized, 10 weeks prospective study on the efficacy of vitamin D (daily low dose and weekly high dose) in vitamin D deficient patients
Vikram Singh, Arup K Misra, Mridu Singh, Naresh K Midha, Bharat Kumar, Sneha Ambwani, Gopal K Bohra, Pramod K Sharma
June 2019, 8(6):1958-1963
DOI:10.4103/jfmpc.jfmpc_272_19  PMID:31334162
Background: Vitamin D is an important vitamin required to maintain normal skeletal as well as nonskeletal functions. The daily supplementation of vitamin D not only have poor adherence to the regimen but also of doubtful efficacy in deficient patients. Objectives: The aim of this study was to compare the effect of oral high-dose vitamin D regimens (60,000 IU weekly) and daily low-dose vitamin D regimen of 1000 IU in mitigating symptoms and increase in serum levels of vitamin D in patients with hypovitaminosis D. Materials and Methods: A total of 90 patients aged 18–60 years with vitamin D deficiency (serum levels < 30 ng/mL) were enrolled. A total of 38 subjects received 60,000 IU of vitamin D weekly with 500 mg/day calcium and 40 subjects received a dose of 1000 IU of vitamin D daily with 500 mg/day calcium for 10 weeks. Baseline and follow-up total serum vitamin D levels and improvement in symptoms were measured within and between groups. Results: For high-dose vitamin D (60,000 IU weekly), the increase in mean serum vitamin D levels from baseline was 28.33 ng/mL over 10 weeks' treatment period; whereas for the low-dose group (1000 IU daily) the mean increment in serum vitamin D was 6.79 ng/mL for the same period. The mean difference in increase in serum vitamin D between two groups was highly significant (P < 0.001). In both the groups, decrease in myalgia as evaluated on visual analog scale was observed after 10 weeks. Conclusions: High-dose vitamin D (60,000 IU weekly) regimen rapidly normalized 25(OH) D levels and ensure symptomatic relief earlier than daily dosing of 1000 IU vitamin D for same duration.
  3 7,944 291
Screen time usage among preschoolers aged 2-6 in rural Western India: A cross-sectional study
Rutvi R Shah, Nisha M Fahey, Apurv V Soni, Ajay G Phatak, Somashekhar M Nimbalkar
June 2019, 8(6):1999-2002
DOI:10.4103/jfmpc.jfmpc_206_19  PMID:31334169
Aims: We have evaluated screen time usage among preschool-aged (≤6 years) children in rural Western India. In addition, we have evaluated various lifestyle factors and their impact on the screen time of these children. Materials and Methods: English-medium schools in the locality were chosen based on convenience. A self-report survey requesting family information and screen usage information was distributed to the parents. Daily screen time was categorized as a three-category variable. Ordered logistic regression with multivariable regression was performed to examine the association of risk factors with screen time. Results: Average screen time among the 379 (208 males, 171 female) children amounted to 2.7 hours (SD: 1.7), with average daily television screen time of 1.6 hours (SD: 1.1). Most children (87.2%) started screen use by the age of 3. Only 65 (17.2%) participants met AAP recommendation. Households with three devices and smartphone usage by mothers increased the odds of screen time by 60% and two-folds, respectively. Compared to weekdays, children had increased screen time exposure (3.5 vs 2.7 hours, P < 0.001), outdoor activity time (2.3 vs 1.6, P < 0.001), and reading hours (1.2 vs 1.1, P = 0.03) on weekends. No association was observed between screen time and mother's occupation. Conclusions: More than 80% of children exceeded the advised screen time with television and smartphone being the major contributors. This issue has to be dealt with at both individual and societal levels. Increased awareness about the high prevalence of inappropriate use of screen time use within the Indian context is needed to inspire attention and interventions for this emerging public health problem in India.
  3 3,173 364
CASE REPORTS
Hemp seed pill may improve chronic constipation of the elderly and reduce the burden of helpers
Koh Iwasaki, Shin Takayama
June 2019, 8(6):2150-2150
DOI:10.4103/jfmpc.jfmpc_384_19  PMID:31334198
Traditional Chinese medicine Hemp seed pill (麻子仁丸) could improve chronic constipation of elderly in the difficult case.
  2 1,619 201
COMMENTARIES
Utility of FRAX (fracture risk assessment tool) in primary care and family practice setting in India
Kripa Elizabeth Cherian, Nitin Kapoor, Thomas Vizhalil Paul
June 2019, 8(6):1824-1827
DOI:10.4103/jfmpc.jfmpc_385_19  PMID:31334139
The prevalence of osteoporosis in postmenopausal women is about 35 to 50% and the mortality associated with hip fractures is about 20%. Despite these figures, osteoporosis continues to be under diagnosed in the primary care setting. One of the reasons for this is attributed to the poor availability of DXA (Dual Energy X-ray Absorptiometry) scanners in rural areas. The fracture risk assessment tool (FRAX) is an online web-based tool that takes into account multiple factors that help in predicting the 10-year risk of developing hip or major osteoporotic fractures. The tool was developed and validated in independent cohorts. The advantages of using the FRAX tool are that, it is inexpensive, easily available, and does not need the technical expertise that is required in the use of a DXA scanner. Besides these merits, it is a tool that is easy to use for the rural health care worker as well as the family physician in identifying those subjects at risk for developing osteoporotic fractures. These benefits make it a suitable fracture prediction tool in the primary care setting in India.
  2 2,048 294
ORIGINAL ARTICLES
Assessment of family physicians' awareness and knowledge of familial hypercholesterolemia in governmental hospitals in Riyadh, Saudi Arabia
Maha Mohammed Arnous, Abdullah Mohammed Alghamdi, Medhat A Ghoraba
June 2019, 8(6):1981-1986
DOI:10.4103/jfmpc.jfmpc_285_19  PMID:31334166
Background: Familial Hypercholesterolemia (FH) is an inherited and complex multifactorial disease that can lead to early onset of coronary artery disease (CAD). Diagnosis, treatment, and management of FH require a well-trained physician with high awareness of the disease and different risk factors to avoid complications. Materials and Methods: This cross-sectional study evaluated family physicians' awareness and knowledge of FH using self-administered questionnaires in governmental hospitals in Riyadh, Saudi Arabia, during 2018. Results: A total of 225 family physicians completed the questionnaire, with a response rate of 58.4%. The mean age of respondents was 31.3 years and more than 59.1% were men. Although 72.4% of physicians rated their familiarity with FH as average and above, 48.4% of all participants had poor FH knowledge, while only 51.6% had acceptable FH knowledge. About 65.8% of physicians reported that they routinely take a detailed family history, perform a physical examination, and screen close relatives. Awareness of various clinical algorithms for diagnosis of patients with FH was very low at 52.0%. The mean FH knowledge and familiarity scores were significantly higher (P < 0.001) among participants who were older, had higher training levels, or longer years in practice. Conclusions: The current study revealed significant deficits in FH familiarity, awareness, knowledge, and practice among Saudi physicians. FH educational programs directed at all physicians involved in FH patients' management are necessary to improve physicians' knowledge of all aspects of FH management, including the importance of a mechanism for identifying people at risk for a genetic condition by a process of systematic family tracing.
  2 1,194 120
Attitude and knowledge about foot care among diabetic patients in Riyadh, Saudi Arabia
Zainab J Alshammari, Leila A Alsaid, PJ Parameaswari, Abrar A Alzahrani
June 2019, 8(6):2089-2094
DOI:10.4103/jfmpc.jfmpc_248_19  PMID:31334185
Introduction: Saudi Arabia ranks second as the highest country with the highest prevalence of diabetes mellitus (DM) in the Middle East and seventh in the world. Knowledge, attitude, and good practice for foot care are essential in the management and prevention of diabetic foot ulcers. Objective: This study was conducted to determine the knowledge, attitude, and practice to diabetic foot care among patients attending a diabetic clinic in Riyadh, Saudi Arabia. Materials and Methods: We conducted a descriptive cross-sectional study of all the patients with Type 1 and Type 2 diabetes aged ≥15 years seen at a diabetic clinic of King Saud Medical City in Riyadh, Saudi Arabia. A structured questionnaire on knowledge, attitude, and practices was used to collect the data. Results: In total, 368 diabetic patients were surveyed, comprising 111 (30.2%) males and 257 (69.8%) females. About 282 (76.6%) patients had good knowledge of diabetic foot and foot ulcers. Only 41 (11.1) patients have attended a class on diabetic foot care, and 81 (22.0%) received education on diabetic foot care from a doctor and 38 (10.3%) from a nurse. Majority of them washed their feet daily (98.4%), 59.8% inspects shoes before wearing them, but less than half of the patients (47.6%) actually self-inspect their foot daily. Being married, having a secondary and university level of education, and being a government employee had significantly better knowledge of diabetic foot compared with their counterparts. There were no significant differences in the attitude toward diabetic foot and diabetic foot care across age groups. Patients with longer duration of diabetes (>5 years) significantly had better practice of diabetic foot care. Conclusion: This study revealed a high percentage of the surveyed population with good knowledge and good practice of diabetic foot care, however with a poor attitude toward foot care. There were very few patients who received formal education on diabetic foot and diabetic foot care. There is a need for awareness program for these patients not only to improve their knowledge and practices, but also to motivate patients to have a positive attitude toward diabetic foot care.
  2 2,044 352
Cryptococcal meningitis: An under-reported disease from the hills of Uttarakhand: A hospital-based cross-sectional study
Aroop Mohanty, Mohit Bhatia, Ankita Kabi, Kuhu Chatterjee, Neelam Kaistha, Balram Ji Omar, Puneet K Gupta, Pratima Gupta
June 2019, 8(6):2008-2011
DOI:10.4103/jfmpc.jfmpc_216_19  PMID:31334171
Background: Cryptococcal meningitis is a fatal opportunistic neuroinfection and an AIDS defining illness. It can also occur in non-HIV patients who are immunodefecient due to chronic glucocorticoid use, organ transplantation, malignancy and sarcodiosis. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital from July to December 2018. CSF samples of 364 patients were received by Microbiology laboratory during this period for the purpose of aerobic bacterial, fungal and TB culture, respectively. All samples were subjected to examination by direct wet mount, Gram stain and India ink preparation. Ziehl Neelsen staining, solid culture for Mycobacterium tuberculosis on Lowenstein Jensen medium and Gene Xpert was also performed on all CSF samples. These samples were further subjected to fungal culture on Sabouraud's dextrose agar. Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS) was used for identifying all bacterial (except M. tuberculosis) and fungal isolates. Results: Out of 364 CSF samples received, 288 were sterile after 48 hours of aerobic incubation. Bacterial isolates, M. tuberculosis and Cryptococcus spp. were obtained in culture from 51, 21 and 4 samples, respectively. The prevalence of cryptococcal meningitis in our study was 1.09% (4/364). Cryptococcus neoformans var grubii was the most common isolate (2/4; 50%) followed by Cryptococcus neoformans var neoformans (1/4; 25%) and Cryptococcus neoformans var gattii (1/4; 25%), respectively. Conclusion: Cryptococcal meningitis is a rapidly fatal condition which requires a high index of suspicion and calls for a collective effort from family physicians and diagnosticians alike. This disease is under-reported from Uttarakhand and therefore calls for further research from this region.
  2 1,482 175
Relationships between nutrition-related knowledge, attitude, and self-efficacy among adolescents: A community-based survey
Shantanu Sharma, Faiyaz Akhtar, Rajesh Kumar Singh, Sunil Mehra
June 2019, 8(6):2012-2016
DOI:10.4103/jfmpc.jfmpc_217_19  PMID:31334172
Introduction: Millions of adolescents are facing the burden of malnutrition in India, and the sociocultural context of nutrition poses challenges while addressing this burden. This study aimed to assess: (a) the determinants of knowledge, attitude, and self-efficacy scores and (b) the relationships between nutrition-related knowledge, attitude, and self-efficacy scores among adolescents in India. Methods: The community-based study was conducted among adolescents across three rural and three urban districts in India. This observational study employed a self-administered structured questionnaire containing information on demography, nutrition-related knowledge, attitude, and dietary self-efficacy. Differences in knowledge, attitude, and self-efficacy scores between sociodemographic variables were assessed using the t-test. Regression analysis was used to determine relationships between knowledge, attitude, and self-efficacy scores. Results: A total of 985 adolescents (44.5%) from rural areas and 1225 (55.5%) from urban slums participated. There were significant differences in knowledge, and self-efficacy scores between rural, urban inhabitants (P < 0.001), and adolescents with different grades of education (P < 0.001 for knowledge and P = 0.01 for self-efficacy). There were significant differences in knowledge and attitude scores among adolescents from non-backward and backward classes (P < 0.001 for knowledge and P = 0.02 for attitude) and those who were vegetarians and non-vegetarians (P = 0.002 for knowledge and P < 0.001 for attitude). The study demonstrated significant relationships between knowledge, attitude, and self-efficacy scores (P < 0.001). Conclusion: Nutrition-related knowledge, attitude, and self-efficacy scores are determinants of dietary behavior and are inter-related. Community-based interventions targeting to improve the nutritional status of adolescents should focus on improving self-efficacy besides the other two determinants.
  2 1,627 189
Association between vitamin D and hypertension in people coming for health check up to a tertiary care centre in South India
Rose Mary J. Vatakencherry, L Saraswathy
June 2019, 8(6):2061-2067
DOI:10.4103/jfmpc.jfmpc_236_19  PMID:31334180
Introduction: Vitamin D has many effects apart from its role in calcium metabolism and bone health. Vitamin D is derived from endogenous ultraviolet-B induced vitamin D synthesis in the skin, and the current high prevalence of vitamin D deficiency in India, can be attributed to lifestyle related low sunlight exposure. Identification of the vitamin D receptor (VDR) in almost all human cells, suggests a role in extra skeletal diseases. Studies have shown that vitamin D deficiency is an independent risk factor for hypertension. Aim: To evaluate the association between vitamin D and hypertension in people coming for health check up to a tertiary care center in South India. Materials and Methods: Study was carried out as a cross sectional study in a tertiary care hospital in South India. Participants (520) were both males and females (337 males and 183 females), between the age group of 20-60 years attending the comprehensive health check up clinic of our hospital. Statistical Analysis: Statistical analysis was done using IBM SPSS statistics 20.0. Results: Severe vitamin D deficiency was highly prevalent in people with hypertension than in people without hypertension (P value <0.001). Conclusion: Since India is a tropical country, till recently it was believed that vitamin D deficiency and its ill effects are uncommon. But it was found that, vitamin D deficiency was highly prevalent in people with hypertension in South India, emphasizing the need of early vitamin D supplementation. Therefore, to reduce cardiovascular morbidity, early identification of vitamin D deficiency and appropriate vitamin D supplementation may be of primary importance in population, especially like ours, having high prevalence.
  2 2,192 274
Prevalence of Metabolic syndrome among adults in a teaching hospital in Kochi, Central Kerala: A cross-sectional study
Rose Mary J Vatakencherry, L Saraswathy
June 2019, 8(6):2079-2083
DOI:10.4103/jfmpc.jfmpc_241_19  PMID:31334183
Background: Metabolic syndrome is an aggregation of conditions that together increase the risk of cardiovascular disease in individuals, which would not otherwise be recognized to be at risk. Metabolic syndrome increases the risk of developing diabetes mellitus and chronic kidney disease and is associated with a number of other disorders. Objective: To find the prevalence of Metabolic syndrome in people attending tertiary care center in Kochi, Kerala. Materials and Methods: A total of 520 participants attending the comprehensive health checkup clinic of a teaching hospital in Kochi, Kerala, India, for a period of three months were enrolled in the cross-sectional study. Waist circumference, weight, and height were measured and blood was withdrawn for investigations. Results: About 76% (395) of participants met the NCEP: ATP III criteria for Metabolic syndrome. Prevalence of Metabolic syndrome among males was 80.4% and among females was 67.8% (P-value < 0.001). Conclusion: Metabolic syndrome was highly prevalent in our population.
  2 1,387 181
Presenile cataract and its risk factors: A case control study
Gopal K Das, Krutika Boriwal, Pragti Chhabra, Pramod K Sahu, Sabitabh Kumar, Nitish Kumar
June 2019, 8(6):2120-2123
DOI:10.4103/jfmpc.jfmpc_267_19  PMID:31334190
Purpose: Early onset opacification of the lens (cataract) has been observed to be on the rise globally. This study was conducted to determine the various types of presenile cataract and to determine the probable risk factors associated with the occurrence of presenile cataract. Materials and Methods: Patients in the age group of 18–40 years attending the Out-Patient Clinic of the Ophthalmology Department who were found to have presenile cataract were recruited as cases. An equal number of consecutive patients of the same age group were included in the control group. Those who gave consent to participate in the study were interviewed through a preformed questionnaire and underwent a complete ocular examination and set of blood investigations. The type of cataract was noted, data obtained were compiled, and examination and investigations done were documented and analyzed using frequency distribution and Chi-squared test. Results: In total, 90 cases and 90 controls that fulfilled the inclusion criteria were recruited. Most common type of cataract was found to be posterior subcapsular cataract. Presenile cataract was observed to be significantly associated with tobacco intake (P = 0.035), hypercholesterolemia (P = 0.002), fuel exposure (P = 0.004), and lower socioeconomic status (P = <0.001). Conclusions: Tobacco chewing, hypercholesterolemia, and excessive fuel exposure are risk factors for early development of cataract.
  2 3,170 299
COMMENTARIES
Maathru Samman Pants: An initiative towards “Respectful Maternity Care”
B Venkatashiva Reddy
June 2019, 8(6):1821-1823
DOI:10.4103/jfmpc.jfmpc_326_19  PMID:31334138
Respectful maternity care is the new approach under National Health Mission providing services towards improved satisfaction of pregnant women while in the health facility. Maathru Samman Pants is a new transformational initiative respecting both the psychological and physiological concerns of the pregnant woman and her family during labor. Maathru Samman Pant is a pant with vulval opening which is appropriate in size to perform procedures like per vaginal examination, episiotomy, forceps, ventouse application, bladder catheterization, and delivery of baby and placenta with flap on the front and the back for privacy in various positions. This short communication outlines the background, features, benefits, and future directions of Maathru Samman Pants. I emphasize the need for dignified obstetric care, ensuring that all women receive high-quality, equitable, and respectful maternity care in all health facilities. To the present published literature, Maathru Samman Pants is the first of its kind in India for pregnant woman in normal labor. Innovation is vital to address patient needs in present tumultuous environment. Respectful maternity care standards need to be the designed in continuum with patient's perspectives. Therefore, I call on health system across various states to introduce Maathru Samman Pants, like Andhra Pradesh, thereby ensuring the respect of women's basic human right of dignity which is beyond the prevention of mortality and morbidity. The implications of this innovation (Maathru Samman Pants) should not be limited to India only; rather, it should be contemplated by the other health facilities worldwide.
  1 1,276 197
ORIGINAL ARTICLES
Difficulties in conducting clinical research among healthcare practitioners in Saudi Arabia: A cross-sectional survey
Sultan Al Dalbhi, Abdulaziz Alodhayani, Yasser Alghamdi, Salma Alrasheed, Alyah Alshehri, Noura Alotaibi
June 2019, 8(6):1877-1883
DOI:10.4103/jfmpc.jfmpc_317_19  PMID:31334149
Background: Research activity represents an important process conducted to address an issue in a precise and systematic manner. Data of this kind regarding the methodological difficulties encountered by healthcare practitioners in conducting clinical research in Saudi Arabia are scarce. This study aims to assess the methodological difficulties encountered by healthcare practitioners in conducting clinical research in Saudi Arabia. Materials and Methods: This cross-sectional survey was conducted among healthcare practitioners who conducted or who were involved in research in Saudi Arabia from June 2018 through August 2018. Data were collected through SurveyMonkey, using a modified version of a questionnaire from a previous similar study. Results: Overall, 236 respondents participated in the study, more than half, that is, 131 (55.50%) had conducted research as principal investigators, 41 (17.40%) had never attended a research workshop, and 57 (24.20%) were members of research committees. Respondents identified “formulating the research title” and “cooperation between research partners” as the easiest research steps by 58 (24.58%) for each. “Receiving funds and financial resources to complete the research project” ranked the highest difficult step by 124 (52.54%) of the respondents. Attending >2 clinical research workshops was significantly associated with lower methodological difficulty scores. Specifically, those who attended scored 35.28 ± 12.86, while those who did not scored 42.34 ± 12.64, with a highly statistically significant difference (P = 0.001). Conclusion: These findings show that securing funding and finding an available biostatistician contributed greatly to the methodological difficulties of conducting clinical research. The difficulty score decreased significantly with increasing the number of clinical research workshops attended by the researchers.
  1 1,345 200
Perception and convenience of caring for children with autism spectrum disorder among family medicine residents in Riyadh 2018
Maha S Alshammari, Ayman A. M. Afify, Osama Abdelhay
June 2019, 8(6):1902-1907
DOI:10.4103/jfmpc.jfmpc_328_19  PMID:31334153
Background: Autism spectrum disorder (ASD) is a group of childhood pervasive neurodevelopmental disorders characterized predominantly by persistent moderate to severe impairment in social skills, communication, and associated with restricted repetitive or stereotyped behaviors. Early diagnosis of this disorder is paramount, which then allows for a timely intervention to facilitate a positive prognosis. To the best of our knowledge, there is no study that has investigated the perception of ASD among family medicine residents in Saudi Arabia. Objective: To determine the level of awareness of childhood autism among family medicine residents in Riyadh. Settings and Design: A cross-sectional study was conducted in nine teaching primary healthcare centers in Riyadh. Materials and Methods: The questionnaire was adopted from Unigwe et al. study and distributed to 344 available physicians, of which 277 were received back completed. Results: Only 28 physicians (10.1%) answered positively if they had previously attended any ASD workshops or conferences. In addition, only 29 participants (10.5%) correctly answered 50% or more questions. The question that yielded the lowest scoring was “Recognizing the signs and symptoms of autism in individuals with good language and no apparent intellectual difficulties”, while the question with the highest scoring was “Identifying stress in the parents and carers of my patients with autism.” The regression analysis showed no association between the scores and the physicians' characteristics. Conclusions: The results show a low awareness level and moderate to low level of confidence in the physicians ability to recognize, identify, or communicate in regards to ASD. We recommend integrating lectures and clinical exposure of ASD to the residency training program curriculum.
  1 1,668 200
Awareness of asthma and its management in primary school teachers in Eastern Province
Zahra Nizar Alkhamis, Sarah Alawi Hashim
June 2019, 8(6):1908-1913
DOI:10.4103/jfmpc.jfmpc_358_19  PMID:31334154
Introduction: Asthma is one of the most common chronic respiratory disease affecting young children. It is estimated that 14% of the world's children have had asthmatic symptoms, according to the International Study of Asthma and Allergies in Childhood (ISAAC). Schools represent “home” for most children as they spend about a third of their waking hours in school each weekday. Also, schools are significant sources of exposure to asthma-triggering allergens. Therefore, school personnel, including teachers, face all the issues of asthma management that the family meets at home. The aim of this study is to assess the levels of knowledge about asthma and its management among primary school teachers in Eastern Province; Saudi Arabia. Methods: 396 primary school teachers answered an electronic questionnaire about asthma. This questionnaire contained different questions which assessed teacher's knowledge about symptoms of asthma, and its management. Also, the survey can determine the teacher's attitude and practice regarding asthmatic students. Results: Overall, 59.6% of teachers had a high level of asthma knowledge as they were able to answer ≥75% of the knowledge questions correctly. Teachers' level of asthma knowledge was not significantly associated with age, but significantly associated with years of teaching experience, educational level and contact with an asthmatic individual. Most of the respondents were at a high level of awareness concerning asthma symptoms, triggering and treatment (73.2%, 60.9%, 60.7%), respectively, while only 19.4% had high knowledge level about sport and asthma. Conclusions: The primary school teachers are not well informed about asthma and its management. Future educational efforts should seek to provide teachers with accurate information about asthma with particular concern for sport and asthma. This will have a significant impact on the management of this chronic respiratory disorder.
  1 1,564 198
Changing trends of prosthetic rehabilitation of partially edentulous patients visiting a tertiary care dental hospital
Marwa E. I. Elagra, Abdulhadi I. A. Alhayek, Bashayir F. M. Al-Mutairi, Noora A Aljohar, Reem A Aladwani
June 2019, 8(6):1914-1918
DOI:10.4103/jfmpc.jfmpc_360_19  PMID:31334155
Introduction: The choice of prosthetic replacement is largely determined by the patient's choice and economic status, available technology and expertise, as well as the number of missing teeth. The aim of this study was to identify the trend in prosthetic replacement, in partially edentulous patients treated at Riyadh Elm University (REU) hospitals, as well as to investigate the factors that might influence the prosthetic choice. Methods: The records from Dentoplus digital system of all partially edentulous patients who had a prosthetic replacement at REU 2013, until June 2018, were screened and analyzed using Statistical software SPSS version 25. Chi-square and Fisher exact tests were performed. Alpha level was set at ≤0.05. Results: 6,340 patients received implants, removable or fixed prosthesis. Majority of the patients were females (60%). RPDs were the highest placed restorations (69%). Students (73%) placed most RPDs. Implants significantly increased through the years by almost (30%) (P-value = 0.00). Among FPDs, metal-ceramics were the highest restorations (74%), with a significant increase of all-ceramic restorations through years (P-value = 0.00). Moreover, FPDs were significantly the highest restorations among young-adult and middle-aged patients (P-value = 0.00). Conclusion: There was a clear change in prosthetic rehabilitation trends over the past few years. Although removable partial dentures continued to play a major role in prosthetic teeth replacement, the use of dental implants showed a steady increase every year. Students' requirements and level of experience, along with the patient age, had an influence in the prosthetic choice.
  1 1,716 199
Implementation of principles of pharmacoeconomics and pharmacovigilance to achieve optimal financial and therapeutic benefits through WHO - Essential medicine policy and adoption of NLEM-Based hospital formulary policy
Suresh Saravdekar, Vijay K Shukla, Omprakash P Upadhya, Madhukar Rai, Kiran Giri
June 2019, 8(6):1987-1993
DOI:10.4103/jfmpc.jfmpc_287_19  PMID:31334167
Context: WHO in its development of the roadmap on access to medicines and vaccines 2019–2023 has emphasized that the greatest challenge in achieving Universal Health Coverage (UHC) stem from persistent barriers to accessing health services and to accessing affordable and quality assured health products. In this context, WHO introduced the concept of essential medicines in 1977, and since then, this concept, has been revised every 2 years and is accepted by many countries as guideline to develop National Drug Policy. The concept emphasizes that all aspects of drug management, including procurement, storage, distribution, and use, are easier if fewer essential medicines/items must be dealt with. Essential Medicines are those that satisfy the priority healthcare needs of the population. Aims: During 2017-18, based on the principles of Essential Medicines Concept, we decided to develop and implement “Quality Procurement Management Policies'(QPMP) at Sir Sundar Lal Hospital, at Varanasi. The Pharmaco-econmics and Pharmacovigilance tools are also used to further maximize financial and therapeutic benefits. Materials and Methods: This is evidence based, an observational, and retrospective study. Initially, the analysis of current data on sales of antibiotics during November 2017, December 2017, and January 2018, the procurement practices, selection of medicines, and pattern of use was studied and based on these findings reforms were designed and implemented through the Hospital Formulary Committee. Results: This study revealed that- By the application of QPMP, both the Cost and Quality factors of Medication Management can be dealt with very effectively. And it is possible to make available Quality Assured Medicines at most economic prices, resulting in substantial savings. This study has further, shown that the confidence of physicians also improved as quality assured medicines are provided. Conclusion: The study at Sir Sundar Lal Hospital is thus worth emulating and shown that a doable roadmap with signposts at each and every turn can be designed and can be effectively implemented so that the goal of UHC can be achieved.
  1 1,552 178
Knowledge, attitude, and practice of first aid among the commercial drivers in the Kumaon region of India
Sadhana Awasthi, Gaihemlung Pamei, Hariom K Solanki, Amandeep Kaur, Maneesh Bhatt
June 2019, 8(6):1994-1998
DOI:10.4103/jfmpc.jfmpc_295_19  PMID:31334168
Background: First aid assistance is one of the important life-saving skills. According to World Health Organization, over 50 million people are injured or disabled and over 1.2 million people die following Road Traffic Accident (RTA) every year. Providing the basic care until emergency medical services arrive is the essence of first aid, which will prevent a number of RTA-related mortality and morbidity. Aim: To assess the knowledge, attitude, and practice regarding first aid among the commercial vehicle drivers operating in and from Haldwani. Method: This was a cross-sectional study conducted among the commercial drivers operating in and from Haldwani Block of Uttarakhand, from November 2018 to January 2019. Participants were selected using consecutive sampling technique. The questionnaire used for data collection was semistructured and pretested. Results: All participants were male with the mean age (standard deviation) of 40.4 (8.7) years. Overall 96.4% and 81.7% had heard about first aid and the “Good Samaritan” law. Among participants, 96% knew that first aid should be provided immediately and 90.5% were willing to be trained in first aid. First aid kit was available in 84.9% of the vehicles. In total, 211 (91%) participants had attended RTA victim/s in the past, and 192 (91%) of them provided assistance to RTA victims. Conclusions: Although the study showed a positive attitude toward giving first aid to RTA victims, the knowledge and practice of first aid was not universal.
  1 2,159 217
Assessment of diabetic patients' adherence to insulin injections on basal-bolus regimen in diabetic care center in Saudi Arabia 2018: Cross sectional survey
Khalid A Alsayed, Medhat Khalifa Ghoraba
June 2019, 8(6):1964-1970
DOI:10.4103/jfmpc.jfmpc_276_19  PMID:31334163
Background: Since insulin became a focal point of diabetes management, several studies have been carried out to monitor and improve patient outcomes. Adherence insulin therapy is an important part of diabetes management. Aim: This study reviews the responses of patients being managed in a diabetic care setting in monitoring their adherence to basal bolus insulin therapy. Method: A pre-validated questionnaire containing 18 questions was administered to patients in the diabetic care unit of the Security Forces Hospital, Riyadh, Saudi Arabia. Results: The levels of adherence with basal bolus insulin therapy was 61.9%. There is no considerable difference in adherence levels of male and female respondents with 31.62% and 31.58% respectively. The younger age groups (14-29) had the highest adherence levels at 65.75%. Higher levels of patient literacy and the location also have a positive relationship with adherence. Conclusion: To improve adherence levels, dosing should be made with consideration for patient convenience, and patients should be encouraged to build positive psychological relationships. Further studies should look to studying outcomes of therapy, and markers should be developed to monitor patient progress on therapy regimen regularly. The aspect of short clinic visits is another major consideration that needs to be look into properly to understand and monitor patients' proper adherence toward the basal bolus insulin.
  1 1,834 181
Pattern and determinants of soil-transmitted helminthiasis in a rural area of Haryana: A school-based study
Rohit Dhaka, Ramesh Verma, Raj Kumar, Vinod Chayal, Kapil Bhalla, Ranvir Singh, Ginni Agrawal, Gopal Kumar
June 2019, 8(6):1971-1975
DOI:10.4103/jfmpc.jfmpc_278_19  PMID:31334164
Background: In the world, helminthiasis is the major public health problem in school-age children. More than 60 million school-age children live in intensively transmitted areas and they need immediate treatment and preventive interventions. Methodology: The study was conducted in the rural government schools of Block Beri, District Jhajjar (Haryana), India, and the study was descriptive and cross-sectional in design. The study recruited 300 school-going children in the age group of 6–10 years. Results: In this study, the mean age of subjects was 7.68 ± 1.467 years and prevalence of soil-transmitted helminths was 28.7%. The association between practice of hand washing and practice of washing fruits and vegetables with helminthic children were found statistically significant. Conclusion and Recommendation: Impart health education among community through primary care physician about wash hands before eating food and after defecation, washed thoroughly raw and uncooked food before eating.
  1 1,745 203
The effect of smartphone usage at bedtime on sleep quality among Saudi non- medical staff at King Saud University Medical City
Fahdah A Alshobaili, Nada A AlYousefi
June 2019, 8(6):1953-1957
DOI:10.4103/jfmpc.jfmpc_269_19  PMID:31334161
Objective: This study's main objectives are to examine the prevalence of smartphone usage at bedtime and its effect on sleep quality among Saudi non-medical staff working in King Saud University medical city in Riyadh, Saudi Arabia. Methods: This cross-sectional study was carried out over the period from January 2016 to July 2016 A sample of 435 Saudi adults aged 21 years and above working in King Saud University Medical City in Riyadh, Saudi Arabia participated in a self-reported Arabic questionnaire about bedtime usage of smartphone and sleep quality. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using odds ratio. Results: More than 98% of the respondents owned a smartphone, and nine out of ten use their smartphones at bedtime. Social media was the most used service among participants. An increase in bedtime smartphone use specially more than 60 minutes makes participants at great risk of having poor sleep quality. Conclusion: our findings suggest that employees who use their smartphones more at bedtime have more risk of being poor sleepers. More attention should be drawn to the misuse of smartphones and its effect sleep quality, health and productivity of adults.
  1 8,539 527
Factors associated with delayed diagnosis of migraine: A hospital-based cross-sectional study
Nirendra Kumar Rai, Ritwa Bitswa, Ruchi Singh, Abhijit P Pakhre, Daya Shankar Parauha
June 2019, 8(6):1925-1930
DOI:10.4103/jfmpc.jfmpc_376_19  PMID:31334157
Context: Migraine is common debilitating disorders, affecting 10 to 20% of the world's population. However, proper diagnosis is delayed due to many factors. Aims: To determine various factors associated with delayed diagnosis of migraine. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: Patients attending Neurology OPD of AIIMS Bhopal and satisfying diagnostic criteria of the International Headache Society (ICHD-3β) for migraine were selected for study. MIDAS, MINI, and ROME-III were used. First diagnosis was considered as “Appropriate” if patients were previously diagnosed as “migraine” or getting treatment for it; otherwise labeled as “Inappropriate.” Statistical Analysis: Associations were tested by Chi-square, t-test, or Mann-Whitney test. Logistic regression analysis was used for identifying independent factors associated with inappropriate diagnosis. Results: Hundred patients (female = 77) of migraine were included. Mean age (SD) was 32.42 (10.74). Diagnosis was “inappropriate” in 65 patients. Number of inappropriate diagnosis/appropriate diagnosis was 10/40 (25%) by neurologists; 35/39 (89.3%) by physicians; 18/18 (100%) by ophthalmologists. Factors associated with “Inappropriate Diagnosis” were “Neurologist vs Other Doctors” {10 (25%) vs 55 (91.7%), P < 0.001}; throbbing vs other types of headache {51 (60.7%) vs 14 (87%), P = 0.047}; and temporal vs other sites {9 (42.9%) vs 56 (70.9%), P = 0.017}. Patients with “Inappropriate Diagnosis” had to expend more money {7000 (4,500; 12,500) vs 4000 (1000, 6000), P < 0.01; median (interquartile range) all in INR}. Other clinical parameters including vertigo, cervical pain, anxiety, depression, and functional gastrointestinal symptoms were not associated with delayed diagnosis. Conclusion: Delayed diagnosis and misdiagnosis is very frequent in migraine, leading to financial burden to patients. Management of common disorders like migraine should be addressed in undergraduate medical teaching curriculum.
  1 1,246 131
Pattern and determinants of contraceptive usage among women of reproductive age in the United Arab Emirates
Mahera Abdulrahman, Halah Mohammed Farajallah, Mahra Nooruddin Kazim, Fatema Ebrahim AlHammadi, Amani Salem AlZubaidi, Frederick Robert Carrick
June 2019, 8(6):1931-1940
DOI:10.4103/jfmpc.jfmpc_390_19  PMID:31334158
Introduction: Women in the UAE and Muslim countries are a largely understudied population with significant disparities in knowledge to most basic health concerns and family planning. Our objective was to identify UAE contraceptive knowledge similarities and variances to other world regions, and to inform efforts to improve contraceptive care at Arab world and Muslim countries. Methods: Structured questionnaire consisting of socio-demographic characteristics, knowledge, beliefs and attitudes related to contraception methods. Results: The use of effective contraception methods was associated with higher educational levels of UAE national women who desired to conceive. These women had knowledge of contraception that was associated with an identified impact of their spouse on their choice of contraception. Religion plays an essential role in knowledge on the risk of contraception and safe type of contraceptive methods in the UAE. Statistically significant predictors of having knowledge on different methods of contraception were nationality, P < 0.002; education level, P < 0.03; number of marriages P < 0.002; monthly income, P < 0.04; and the number of children, P < 0.015. Conclusions: Our results demonstrate that higher education and communication of the benefits and risks of different types of contraceptive methods are needed to improve the use of contraception in the UAE population. We recommend additional training in this area for healthcare providers. The involvement of the spouse in the mutual understanding of contraception and its choice coupled with third party insurance coverage may decrease knowledge and utilization gaps further assisting in providing a best contraceptive method.
  1 1,699 383
Factors influencing the choice of otolaryngology (ORL) head and neck surgery as a future specialty for Saudi medical students
Abdullah A Alamri, Khalid A Alshehri, Ahmed A Alharbi, Abdulmajeed F Alahmari, Talal A Alkhatib, Mazin A Merdad, Hani Z Marzoukib
June 2019, 8(6):1941-1946
DOI:10.4103/jfmpc.jfmpc_414_19  PMID:31334159
Aim: To find out the factors and causes that motivate medical students to choose ear, nose, and throat (ORL head and neck surgery) as a specialty in Saudi Arabian medical universities. Materials and Methods: A cross-sectional study was conducted at Kingdom of Saudi Arabia by distributing a self-administered questionnaire to 1,516 medical students across all medical universities. Chi-squared test and logistic regression analyses were used to examine the association between the participants' choices and factors motivating their choice of specialty. Results: ORL head and neck surgery was chosen as a future specialty by 27% of the participants. Of these, 52% chose lifestyle as the most influential factor determining their choice of specialty. Further analysis of participant preferences revealed that 87.6% listed flexibility within medicine as their main reason for choosing a specialty, followed by reasonable hours of practice in 86%, while 15.9% considered a strong mentor relationship to be important. Students from King Abdulaziz University more frequently chose ORL head and neck, along with those from the eastern kingdom compared with other areas. Student preference for ORL head and neck did not vary significantly with gender, age, or duration of clinical rounds. Conclusion: Approximately 27% of students chose ORL head and neck, with lifestyle being the most influential factor, followed by flexibility within medicine. Among students who chose ORL head and neck, the highest percentage was from King Abdulaziz University.
  1 1,171 121
Prevalence and determinants of menstrual disorders and napkin usage among women in India using DLHS-4 data
Nitika , Pallavi Lohani
June 2019, 8(6):2106-2111
DOI:10.4103/jfmpc.jfmpc_262_19  PMID:31334188
Introduction: Menstrual disorders and hygiene practices during the menstruation significantly affect the health of reproductive age-group women. Methods: The data from nationally representative survey, DLHS-4, was used. The outcome assessed were menstrual disorders and napkin usage. The predictor variables were socio-demographic characteristics such as age group, caste, religion, marital status, and education status; reproductive characteristics such as outcome of pregnancy, condom use, IUCD usage, and vaginal discharge. The descriptive analysis and logistic regression analysis were done on 1,70,632 women. Results: The most common problems experienced by women were pain (5.4%), irregular periods (4.2%), followed by frequent period, prolonged bleeding, no period, scanty bleeding, excessive bleeding, and intermenstrual bleeding. A large proportion (37%) women were using cloth during menstruation. The factors significantly associated with menstrual problems were age, 36-40 years (OR 1.26, P value <0.001), marriage before 18 years (OR 1.16, P value <0.001), no education (OR 1.24 P value <0.001), BPL card holders (OR 1.14, P value <0.001), non-users of sanitary napkin (OR 1.09, P value <0.001). The socio-demographic factors significantly associated with napkin usage were women with secondary education and higher (OR 3.52, P value <0.001), toilet use - using flush toilet (OR 1.97, P value <0.001), not possessing BPL card (OR 1.42, P value <0.001), marriage after the age of 18 years (OR 1.35, P value <0.001). The reproductive characteristics significantly associated with menstrual problems were history of spontaneous abortion (OR 1.79, P value <0.001), history of induced abortion (OR 2.29, P value <0.001), women never used condoms (OR 1.09, P value <0.001), ever used IUCD (OR 1.11, P value <0.001), history of abnormal vaginal discharge during last three months (OR 5.32, P value <0.001). Conclusion: The use of sanitary napkin should be promoted as it promotes dignity, and equality of women, apart from the public health aspect.
  1 1,429 132
Analysis of food frequency and acquired dietary allowance (ADA) in relation to dental caries and dental erosion affecting dental postgraduate students of Sawangi: A cross-sectional survey
Sourav Sen, Shravani Deolia, Kumar Gaurav Chhabra, Rakashree Chakraborty, Chaya Chhabra, Anushree Rathi
June 2019, 8(6):2084-2088
DOI:10.4103/jfmpc.jfmpc_242_19  PMID:31334184
Background: The development and integrity of the oral cavity and the progression of oral diseases may be affected by the nutritional status and diet of the person. The most ubiquitous oral diseases are found to be dental caries and periodontal diseases in the world. Therefore, the aim of the present study was to assess the correlation between food frequency with nutrient adequacy ratio (NAR), NAR with dental caries, and dental erosion. Materials and Methods: This study was conducted among dental postgraduate (PG) students. A self-administered questionnaire was developed with consisted food frequency, acquired dietary allowance, Decayed, Missing Filled teeth (DMFT) index, and tooth wear index. Correlation was assessed between food frequency and NAR, NAR with dental caries and dental erosion. Results: Out of 123 PGs 100 PGs participated in the study making response rate 81%. Consumption of chapatti, pulses vegetables white rice, sugar, milk and milk products, and acidic food is on the daily basis mostly and it was statistically significant (P < 0.05). A statistically significant difference (P < 0.05) was also seen between frequency of consuming food items in decreasing order is fats, legumes, roots and tubers, fruits, meat and meat products, fried foods, vitamin and mineral supplements those who eat daily and never. Conclusion: The significant association between food frequency and nutrient adequacy ratio might be helpful assessing nutritional values. The high use of acidic beverages is a serious threat to the health of the oral cavity.
  1 10,278 219
Prevalence patterns and profile of adolescent tobacco users findings from a youth survey: A cross-sectional study
Avinash Janeswar, Gunjan Kumar, Sloka Kanungo, Arpita Singh, Goutham Bala Subramanya, Kunal Jha
June 2019, 8(6):2017-2022
DOI:10.4103/jfmpc.jfmpc_219_19  PMID:31334173
Aim: To assess the prevalence of smoking and smokeless tobacco use among 16--19-year-old government and private college student of Bhubaneswar city. Materials and Methods: A cross-sectional descriptive study was designed and data on tobacco usage was collected from 906 students aged 16--19-year old government and private college students of Bhubaneswar city using modified youth tobacco survey (YTS) closed-ended questionnaire. Data was analyzed using descriptive statistics and Chi-square tests were used to determine the significant differences in the variables of interest. Results: Out of 906 study subjects, mean age of initiation of use of tobacco product was found to be 14.8 among males and 15.3 among females. The responses of study subjects upon there believe that tobacco companies try to lure young people to use tobacco products, 54.7% males, 45.3% females reported as yes. 63 (9.9%) of students from private college reported using smokeless tobacco whereas 27 (10%) of students from government college used chewing tobacco. The results were statistically significant. A total of 84 (16.9%) males followed by 18 (4.4%) females reported to have ever tried smoking. The results were statistically significant. Conclusion: It was encouraging to find that during the period of the survey, majority of students did not use tobacco of any form. Regular and systematic education programs catering to teachers, children, and also their parents should be undertaken. Enabling teachers to educate the young impressionable minds regarding lifestyle disorders should be a cornerstone activity in preventing the establishment of lifestyle disorders like tobacco and alcohol use within the community.
  1 2,150 237
Central hemodynamics and arterial stiffness by oscillometric pulse-wave analysis in treated Gujarati euglycemic hypertensives: A case-control study
Jayesh D Solanki, Hemant B Mehta, Sunil J Panjwani, Hirava B Munshi, Chinmay J Shah
June 2019, 8(6):2047-2054
DOI:10.4103/jfmpc.jfmpc_233_19  PMID:31334178
Introduction: Hypertension is the most prevalent noncommunicable disorder, studied in terms of brachial blood pressure. Direct parameters like central hemodynamics and arterial stiffness, though superior, are not studied much. The same can be studied by pulse-wave analysis (PWA) and we did that in euglycemic treated hypertensives. Materials and Methods: A case-control study was conducted in 258 treated euglycemic hypertensives and 258 matched controls. Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Parameters were further analyzed for the effect of gender, physical activity, body mass index (BMI) (cutoff 23), blood pressure control, and duration (cutoff 5 years). Multiple linear regressions were used to find significant predictors. P < 0.05 was taken as statistically significant. Results: Cases had significantly higher brachial arterial parameters (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse-wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) compared to age, gender, and BMI-matched controls. In the case group, female gender, BMI ≥ 23, and uncontrolled blood pressure were significant factors affecting results. Heart rate and pulse pressure were major predictors of study parameters. Central pressure parameters were not predicted significantly by corresponding brachial pressure parameters. Conclusion: PWA revealed the adverse profile of arterial stiffness and central hemodynamics in treated Gujarati hypertensives, associated with female gender, BMI, and blood pressure control, predicted mainly by heart rate and pulse pressure, independent of brachial blood pressure. It indicates both potential and further study of these parameters.
  1 1,074 113
REVIEW ARTICLES
Communication strategies for improving public awareness on appropriate antibiotic use: Bridging a vital gap for action on antibiotic resistance
Philip Mathew, Satya Sivaraman, Sujith Chandy
June 2019, 8(6):1867-1871
DOI:10.4103/jfmpc.jfmpc_263_19  PMID:31334147
Antimicrobial resistance (AMR) is now a global public health issue and is projected to affect the longevity of people and increase health expenditure of countries. Its impact is going to be higher in low-middle income countries as the healthcare systems are suboptimal and ill-equipped to deal with the issue. As antibiotic misuse is the primary driver for AMR, there is an acute need to create awareness among general public regarding antibiotic misuse. This calls for a comprehensive communication strategy, which takes into account the various drivers of AMR and the solutions associated with it. In the short term, the focus of communication strategies can be on raising awareness in specific interest groups. It can help in channeling limited resources to achieve specific objectives for raising awareness among these groups, thereby improving the chances of behavior change. The general public can be targeted at a later stage or as a second phase with definite strategies and messages. But, it is erroneous to assume that a higher level of awareness will translate into a positive change in behavior. We propose that behavior change is the final fruit of a long and dynamic process. This process should rest on four pillars: adequate awareness, robust regulatory environment, emotional or material incentives, and an enabling social structure. Unless all these domains are satisfactorily addressed, the communication strategy will not be able to bring about a discernible change in behavior in terms of antibiotic use.
  1 1,638 240
CASE REPORTS
Prenatal diagnosis of single umbilical artery complicated by intrauterine growth retardation and preterm labor: Case report
Ibrahim A Abdelazim, Mohannad Abu-Faza, Mohamed E. S. Hamed, Osama O Amer, Svetlana Shikanova, Gulmira Zhurabekova
June 2019, 8(6):2151-2154
DOI:10.4103/jfmpc.jfmpc_394_19  PMID:31334199
Fetuses with single umbilical artery (SUA) at great risk of intrauterine growth retardation (IUGR), intrauterine fetal death (IUFD) and prematurity. A 24-years-old woman, 28 weeks' gestation, presented to the Ahmadi hospital, Kuwait, with history of preterm premature rupture of fetal membranes (PPROM). After exclusion of the PPROM, the ultrasound scan of the studied woman showed; asymmetrical IUGR with SUA. The diagnosis of SUA confirmed by the color flow Doppler. She delivered spontaneously at 36 weeks+2, and a cut section in the umbilical cord done to confirm the diagnosis of SUA. The congenital and chromosomal abnormalities of the studied neonate excluded after normal pelvi-abdominal, brain ultrasound and normal karyotyping (46, xx); respectively. The prenatal diagnosed SUA in the studied cases associated with IUGR, preterm labor (PTL) and small for gestational age (SGA). SUA can be considered a marker of diagnosable congenital fetal malformation (CFM) and aneuploidy.
  - 1,632 166
An unusual case of urinothorax after percutaneous nephrostolithotomy
Diana Dregoesc, Rachel Kelley, David Lick
June 2019, 8(6):2155-2157
DOI:10.4103/jfmpc.jfmpc_28_17  PMID:31334200
We present here a case of severe dyspnea after a percutaneous nephrostolithotomy, which resulted from an urinothorax, an uncommon complication of posturological procedures. Chest X-ray indicated a significant left pleural effusion, and a diagnosis was confirmed by the pleural fluid analysis. Chest tube placement did not improve the patient's clinical status; retrograde pyelogram was performed, and a stent was placed in the left ureter orifice where a narrowing was discovered. Correcting the cause of the urinothorax is the key in such cases of severe pleural effusions as seen in our case.
  - 878 99
A rarer association of eosinophilic fasciitis
U Namita, S Rajesh, C Vidya
June 2019, 8(6):2158-2160
DOI:10.4103/jfmpc.jfmpc_281_19  PMID:31334201
Eosinophilic fasciitis (EF, also called Shulman syndrome) is a rare connective tissue disorder with poorly understood pathogenesis and unknown etiology. EF is characterized initially by limb or trunk erythema and edema and later by collagenous thickening of the subcutaneous fascia. Here, we present the case of a 16-year-old boy who presented with typical clinical features of EF with a history of typical trigger factor – preceding strenuous physical activity and had a rarer atypical association of hypercalcemia and raised angiotensin converting enzyme (ACE) levels.
  - 1,177 125
Challenging neurological presentations of varicella virus infections in Sudan: Clinical features, imaging and recommendations
Muaz A. M. Elsayed, Omer Aladil, Sara M Elsadig, Mohamed H Ahmed, Suzan I Noori
June 2019, 8(6):2161-2164
DOI:10.4103/jfmpc.jfmpc_183_19  PMID:31334202
Consequences of varicella zoster infection reflect a wide range of minor to serious complications involving the central nervous system. This is a case series with challenging presentations, imaging features and favorable outcome. For example, the cases presented with clinical features that resemble Brown Sequard Syndrome, transverse myelitis manner and multiple sclerosis and cognitive decline. We recommend adequate history taking, clinical examination and use of available investigation. Early treatment is likely to prevent any disabling neurological damage.
  - 967 106
An innovative modified feeding appliance for an infant with cleft lip and cleft palate: A case report
BH Naveen, Raghavendra S Prasad, KR Kashinath, Shylesh Kumar, SD Kalavathi, Narendra Laishram
June 2019, 8(6):2134-2136
DOI:10.4103/jfmpc.jfmpc_327_19  PMID:31334193
Cleft lip and palate is one of the most common craniofacial anomalies of humans. A child born with cleft lip and palate may experience difficulties while feeding due to lack of seal of the oral cavity due to incomplete facial and palatal structures. Difficulty in feeding leads to inadequate nutrition and affects the health of the infant. Feeding difficulties should be assessed and intervened as early as possible, as they are an important aspect of the multidisciplinary team approach in the management of cleft lip and palate. Feeding appliance is a favorable feeding option in these infants as it creates a separation between oral and nasal cavities and thus helps in creating a negative intraoral pressure during suckling. This case report represents a fabrication of feeding appliance for a 2-day-old neonate born with cleft lip and palate, using copper wire as a retainer for the appliance.
  - 2,633 336
Leukocytoclastic vasculitis: An uncommon adverse effect of a common drug
Ankita Sheoran, Subodh Kumar Mahto, Pooja Verma, Gwenette A War, Nagina Agarwal, Anu Singh
June 2019, 8(6):2137-2139
DOI:10.4103/jfmpc.jfmpc_338_19  PMID:31334194
A hypertensive elderly male on amlodipine presented with a palpable purpuric rash on both legs followed by shoulder, buttocks, and back with foot ulcer, which was found to be leukocytoclastic vasculitis on skin biopsy. The patient recovered completely on discontinuation of amlodipine and short-term steroid.
  - 1,164 146
”Two third tumor”: A case report and its differential diagnosis
Rakashree Chakraborty, Sourav Sen, Kriti Goyal, Divya Pandya
June 2019, 8(6):2140-2143
DOI:10.4103/jfmpc.jfmpc_351_19  PMID:31334195
Adenamatoid odontogenic tumor (AOT) is an odontogenic tumor with a prevalence of 2.2–7.1%. AOT is a benign, noninvasive, and progressive lesion which is also known as “a two third tumor.” As the name suggests the tumor occurs in the maxilla in two third of cases. It occurs in young patients in two third of cases and associated with missing or unerupted teeth in two third of cases. Two third cases are associated with the maxillary canine. Characterized by slow growing, gradually enlarging, painless swelling associated with missing teeth. We report a case of a male patient of age 22 years, with characteristic findings. AOT resembles different odontogenic cysts and tumors which may include dentigerous cyst, globulomaxillary cyst, ameloblastoma, and other entities, hence must be well differentiated. Conservative surgical enucleation is the treatment of choice. Recurrence rate for AOT is 0.2%. Prognosis is excellent when completely removed in toto.
  - 1,891 199
Diagnosis of tubo-ovarian filariasis with retroperitoneal extension: A radiological challenge
Somen Chakravarthy, Rohit Chakravarty
June 2019, 8(6):2144-2146
DOI:10.4103/jfmpc.jfmpc_368_19  PMID:31334196
The purpose of this report is to describe a very rare case of bilateral tubo-ovarian filariasis with retroperitoneal extension in a 20-year-old female patient. The patient complained of low-grade fever with whitish cloudy urine. Computerized tomography imaging revealed hypodense cystic abdominopelvic masses with nonenhancing septations involving the retroperitoneum and ultrasound showing the characteristic “dancing larvae sign” suggesting filariasis.
  - 965 90
Successful management of severe preeclampsia major complications: Case report
Svetlana Shikanova, Bakyt Karimova, Mukhit Sarsembayev, Ibrahim A Abdelazim, Tatyana Starchenko, Mariya Bekzhanova
June 2019, 8(6):2147-2149
DOI:10.4103/jfmpc.jfmpc_377_19  PMID:31334197
Severe preeclampsia (PE) have considerable adverse outcome especially in low-resource countries. A 21-year-old pregnant woman with severe PE and intrauterine fetal death, delivered by cesarean section (CS). The CS complicated by atonic postpartum hemorrhage (PPH). She was transferred by the air ambulance to the tertiary center of West Kazakhstan University-intensive care unit, once she developed anuria. She was carefully monitored after exclusion of maternal sepsis and HELLP (hemolysis, elevated liver enzymes and low platelet) syndrome and she developed postpartum eclampsia and right partial lobe intracranial hemorrhage (ICH). She was managed by multi-disciplinary team with proper and clear management plan and discharged from the hospital on the 20th postpartum day in good general condition. The complications of severe PE need clear multi-disciplinary team management plan to avoid the adverse outcome of the severe PE.
  - 1,200 191
COMMENTARIES
NHS vs Modicare: The Indian Healthcare v2.0. Are we ready to build the healthier India that we envisage?
Suvansh R Nirula, Mayuresh Naik, Srishti R Gupta
June 2019, 8(6):1835-1837
DOI:10.4103/jfmpc.jfmpc_309_19  PMID:31334141
The National Health Services (NHS – UK) is a government-run organisation that provides free healthcare to everyone, irrespective of their ability to afford healthcare. Even though the NHS has its fair share of shortcomings, it has been one of the best healthcare systems of the world. India dreams of replicating the model of health services in some of the developed countries, the prime example being of the NHS in the United Kingdom (UK). We have a vision to take the public expenditure of healthcare to 2.5% of GDP by 2025 and launch India's very own “NHS” model or “Modicare” – which includes the newly formed Nation Health Protection Scheme (NHPS) 2018 as a part of the Ayushman Bharat programme. There are a lot of challenges in the path to achieve this dream here in India. The population of this nation deserves a budget that focuses on healthcare more than defence.
  - 1,816 241
LETTERS TO EDITOR
Comprehensive primary health care, not any vertical program needed for UHC
Jayanta Bhattacharya
June 2019, 8(6):2165-2165
DOI:10.4103/jfmpc.jfmpc_361_19  PMID:31334203
  - 914 79
Mental health conditions and the risk of road traffic accidents
NA Uvais
June 2019, 8(6):2166-2167
DOI:10.4103/jfmpc.jfmpc_256_19  PMID:31334204
  - 882 112
ORIGINAL ARTICLES
An audit of the appointment booking system and patient waiting time in an ultrasound unit in Nigeria: A need to eliminate congestion in our public hospitals
Akintunde O Akintomide, Ofonime N Ukweh, Samuel A Efanga
June 2019, 8(6):2055-2060
DOI:10.4103/jfmpc.jfmpc_235_19  PMID:31334179
Background: Congestion of patient waiting areas at commencement of work is the usual scenario in Nigeria's public hospitals. This strains the personnel and facilities. Patients are dissatisfied and lose faith in the system. This study aims to audit the booking system, patient waiting time, and causes of congestion in an ultrasound unit. Materials and Methods: This is a prospective, descriptive study involving 350 patients referred from general outpatient and specialist clinics to the ultrasound unit, twice weekly for 6 weeks. Patients were grouped into two: those with scheduled appointments and the unbooked. The time of scheduled appointment and arrival in the unit and the time of commencement and conclusion of the examination were recorded. Results: Three hundred and eighteen patients had scheduled appointments, while 32 were unbooked. Half of the later were emergencies and the other half were walk-ins. There was no consistency in number of slots and block size. Large blocks of over 20 patients were observed on 33.3% of the days and 51.26% of the patients were given 8:00 am appointments. The average patient waiting time is 132.11 minutes but range from 62 to 220 minutes daily. The radiologists resumed work between 8:17 and 9:29 am each scan day. The average waiting time is shorter for patients who arrived after 11:00 am. Conclusion: Ineffective booking of appointments and Sonologist's tardiness are major predisposition to congestion. Appointments in small blocks at 30 minutes intervals will eliminate congestion, reduce patient waiting time, and improve satisfaction. Point-of-care ultrasound should be introduced in outpatient clinics.
  - 1,731 174
Factors influencing anxiety levels in children undergoing dental treatment in an undergraduate clinic
Shreya Kothari, Deepa Gurunathan
June 2019, 8(6):2036-2041
DOI:10.4103/jfmpc.jfmpc_229_19  PMID:31334176
Introduction: Dental anxiety is a kind of fear exerted due to threatening stimuli. Assessing a child's dental anxiety level is very important to perform a particular treatment. The aim of this study is to examine the various factors that determine the anxiety levels in children and evaluate their anxiety levels. Materials and Methods: A total of 50 children participated in the survey conducted. Each participant had fulfilled the inclusion and exclusion criteria to answer the questionnaire. It included questions regarding their habits, fears, and dental visit experience. Evaluation of their anxiety levels was done using the facial image scale (FIS) and the modified dental anxiety scale and was correlated with various factors using the Statistical Package for Social Science Software. Results: Female children are more anxious than male children toward dental treatment. About 38% were anxious and 16% refused while undergoing radiographic examination and showed significant anxiety levels (P = 0.012). About 16% of the population were highly uncooperative and were necessary to implement behavioral shaping techniques on them. It influences the FIS anxiety score before initiation of the treatment (P = 0.003). About 48% of children had maintained a good rapport with the dentist and showed strong significance with the child's anxiety (P = 0.025). Conclusion: Gender and behavior of the child while diagnosis and radiographic examination, implementation of behavioral shaping techniques, and rapport developed between child and dentist are all influencing factors of dental anxiety. The number of visits to the dental clinic, socioeconomic status, kind of amount of consumption of sugars, and type of treatment being done do not contribute to a child's anxiety level.
  - 2,867 325
Auditory effect of noise exposures among commercial and non-commercial light motor vehicle drivers: A comparative cross-sectional study in Lucknow city
Manish K Manar, Veerendra Verma, Uday Mohan, Sheo P Shukla, Shivendra K Singh
June 2019, 8(6):2023-2028
DOI:10.4103/jfmpc.jfmpc_220_19  PMID:31334174
Context: Noise-induced hearing loss, one of the most common and preventable occupational hazard, occurs due to repeated and continuous exposure of loud noise, A single exposure of an impulse of noise at the level of 130--140 dB or long and repeated exposures to loud sounds to an average level of 85 dB or higher for an 8-h period can cause permanent loss of hearing. Aims: To study and compare hearing loss over different audiometric frequencies among autorickshaw and non-commercial institutional personal car drivers. Settings and Design: This was a cross-sectional comparative study conducted at a tertiary medical college, located in Lucknow during October 2017–November 2018. Methods and Materials: The sample size was calculated using EpiInfo7. We took a sample size of 300 drivers, out of which 150 three-wheeler autorickshaw drivers (Tempo), that is, group I and 150 non-commercial car drivers, that is, group II were selected. Statistical Analysis Used: For statistical analysis, “Chi-square test of independence” and student's t-tests were used. Results: The mean age at which drivers in group I and group II started work was 23.91 ± 7.63 years an d 23.60 ± 5.58 years, respectively. The mean hearing loss in Group I was 21.15 ± 8.65 dB and in group II it was 13.34 ± 5.79 dB. Conclusions: Autorickshaw drivers who were exposed to louder noise, that is, autorickshaw drivers in group I had more sensory neural hearing loss than the non-commercial car drivers, that is, group II.
  - 1,041 99
Pattern of ocular morbidities: A cross-sectional study on school-going children in Shillong city
Amrita Sarkar, Gajendra Kumar Medhi, Himashree Bhattacharyya, Star Pala, Sandhyamoni Gogoi
June 2019, 8(6):2124-2128
DOI:10.4103/jfmpc.jfmpc_268_19  PMID:31334191
Introduction: India is plagued by ocular morbidities in school-children. However, there exists paucity of studies, school health check-ups, and health education in the north-eastern region. This study aimed at estimating the prevalence and pattern of various ocular morbidities in school-going children of Shillong. Methodology: It was a school-based cross-sectional study done in Shillong, Meghalaya among 540 school-going children from class VI to X. Data were analyzed using SPSS version 23. Results: The most common ocular morbidity was refractive error (57.4%) followed by vitamin A deficiency (38.1%), color blindness (3.1%), nevus (3%), manifest squint (2.2%), ptosis (2.2%), conjunctivitis (0.9%), stye (0.4%), etc., There was statistically significant association (P = 0.0192) among the variations of presence of ocular morbidities in the various age groups, among students attending Government or Private schools (P = 0.0430), and socio-economic status (P = 0.012). The prevalence of ocular morbidities was found to have highly significant association with the educational status of both the father (P = 0.0001) and mother (P = 0.001). In addition, the occupational status of the father (P = 0.0472) and the mother (P = 0.0251) were significantly associated with the prevalence too. Conclusion: The prevalence of ocular morbidities was found to be much higher than in other places of the country, which may be because of environmental factors and lifestyle combined with a lack of awareness and timely diagnosis and an absence of robust school health program. A regular screening along with specific health education campaigns can go a long way in decreasing the same.
  - 1,489 168
Effects of liraglutide addition to multiple diabetes regimens on weight and risk of hypoglycemia for a cohort with type 2 diabetes followed in primary care clinics in Saudi Arabia
Yasser A Albarkah, Ayla M Tourkmani, Abdulaziz M Bin Rsheed, Turki J Al Harbi, Yasser A Ebeid, Reuof A Bushnag
June 2019, 8(6):1919-1924
DOI:10.4103/jfmpc.jfmpc_372_19  PMID:31334156
Context: Available therapies for type 2 diabetes mellitus (T2DM) do not adequately control glycemia in the long term as they do not address the issue of declining beta cell function and do not impact positively on weight or cardiovascular concerns associated with the disease. Aims: To measure changes in hemoglobin A1c, weight, and hypoglycemia after the addition of liraglutide to 3 therapeutic regimens of patients with T2DM. Settings and Design: An observational cohort study that was implemented in Al-Wazarat Health Center in Riyadh, Saudi Arabia. Methods and Materials: The study included 38 T2DM patients who were screened for initiation of liraglutide in combination with their treatment regimens; sulphonylurea, sulphonylurea with basal insulin (glargine), and multiple daily injections of insulin. The cohort was followed for 12 months, and the liraglutide was started with 0.6 mg dose that escalated to 1.2 and 1.8 mg. Glycemic level and weight were measured 3 times, whereas hypoglycemia was measured 2 times. Statistical Analysis Used: Quantitative continuous paired data were compared using a paired t-test and the nonparametric Wilcoxon signed rank test. Results: There was a statistically significant reduction of hemoglobin A1c with 1.2 mg dose (mean difference = 0.84%, P = 0.003). There were no statistically significant differences regarding the effect of liraglutide in addition to the 3 treatment regimens on patients' weight (P = 0.08, 0.472, 0.08, respectively). Regarding hypoglycemia, liraglutide has showed minimal effect. Conclusions: Sustained effect of liraglutide on glycemic control in patients with T2DM without any major hypoglycemic episodes.
  - 1,059 160
Coverage survey of Measles-Rubella mass vaccination campaign in a rural area in Tamil Nadu
Priyadharshini , Aliya Jasmine
June 2019, 8(6):1884-1888
DOI:10.4103/jfmpc.jfmpc_319_19  PMID:31334150
Background: In Tamil Nadu, where health indicators are above the national average and routine immunization coverage is >95%, the tepid response to Measles-Rubella (MR) mass vaccination campaign was unexpected. Several parents refused MR vaccine for their children, due to false news claiming inefficiency and adverse effects due to the vaccine. Aim: This study was conducted to assess the Measles-Rubella (MR) mass vaccination coverage and to know the motivating factors and barriers for vaccination. Methods: A cross-sectional study was conducted in a rural area immediately following the mass vaccination campaign. Using a pre-tested structured questionnaire, data was collected on awareness of MR vaccination campaign, MR vaccination status, motivating factors and reasons for non-acceptance of the vaccine. Results: Vaccine coverage among the 616 children surveyed was 80.2%. Factors that motivated acceptance of vaccine among the immunized participants were easy access to immunization (85%), support and motivation from school teachers (41.1%) and community level health workers (25.5%). Barriers reported among the unimmunized participants were rumours of adverse effects (47.5%), fear of adverse effects (53.3%), and no faith in immunization (18.9%). Risk factors for vaccine refusal included female child (OR = 1.7, 95%CI = 1.1-2.6), Children not attending school (OR = 3.32, 95%CI = 2.1-5.1), Mothers with higher education (OR = 4.3, 95%CI = 1.2-15.2). Conclusion: An effective communication strategy addressing the needs and concerns of the public/parents should be in place and started early on before initiation of the mass vaccination programme.
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The public perception of and attitude toward primary healthcare centers in comparison to other specialties among the Saudi community
Mai Abdulaziz Aldhamadi, Fayez Abdullah Alzahrani
June 2019, 8(6):1895-1901
DOI:10.4103/jfmpc.jfmpc_325_19  PMID:31334152
Objectives: The purpose of this study is to explore the community's perceptions and knowledge of and attitudes toward Primary Healthcare Centers (PHCs) and Primary Healthcare Providers (PHPs) and the PHCs' services in the Eastern Province of Saudi Arabia, and to discover some of the reasons behind not attending the PHCs as the first choice to address a medical issue. Methods: A cross-sectional study was done in Dammam and Al-Khobar cities, Saudi Arabia. 382 Saudi subjects were surveyed. Data was collected via a digital mobile-based survey and entered by the data collectors. SPSS version 25 was used to analyze the data. Results: Only 54% of the study population agreed to attend the PHCs as their first choice to address a medical issue. 72.3% of the respondents deemed the Emergency Department (ED) as a more important healthcare provider than a PHC. Conclusion: Acceptable perceptions, knowledge, and attitudes about PHCs and its services were noticed among the Saudi community in general. Public awareness campaigns are recommended to optimize full utilization of the PHCs' services.
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Computed tomography-based age estimation of illiac crests calcification in 10-29 year-old individuals
Masoome Norouzi, Mohammad Q Hanafi, Mohammad M Gharibvand
June 2019, 8(6):1947-1952
DOI:10.4103/jfmpc.jfmpc_465_18  PMID:31334160
Introduction: Estimating the age of the ossification of the iliac crest may help determine the legal age. For this purpose, both anthropological and radiological methods (conventional radiography, ultrasound, Tomography, and MRI) have been used to study different systems. Objectives: The present study aimed to to evaluate the iliac crest apophysis for age estimation through multidetector computed tomography (MDCT) in 10- to 29-year-old individuals. Materials and Methods: This retrospective study was carried out on 10- to 29-year-old individuals who underwent pelvic CT examinations for different reasons in Imam Khomeini and Golestan hospitals of Ahwaz during 2016–2018. The CT examinations of the iliac crest apophysis of 531 patients (267 females and 264 males) were evaluated based on the Kreitner's four-stage system. Results: According to the Kreitner's four-stage system, the minimum age for both sides of the pelvis at stage 2 for girls and boys was 12 years and 13 years, respectively. However, at stage 3, the minimum age for girls and boys was 15 and 17 years, respectively. Accordingly, stage 4 was first observed in boys at age 17 on both sides of the pelvis. In contrast, it appeared in girls at the age of 20 on the right side. Conclusion: Along with the findings of other studies, the results showed that multidetector computed tomography (MDCT) is recommended for iliac crest in retrospective cases (where pelvic CT scans already exist), and it may be considered as a supportive method for age-estimation purposes. Moreover, when CT images are used along with other age estimation methods, they provide physicians with valuable supplementary information.
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Effect of socioeconomic status on dental caries during pregnancy
Wasim I Kamate, Nupura Vibhute, Rajendra Baad, Uzma Belgaumi, Vidya Kadashetti, Sushma Bommanavar
June 2019, 8(6):1976-1980
DOI:10.4103/jfmpc.jfmpc_283_19  PMID:31334165
Background and Objective: It is generally agreed that people with low socioeconomic status have a significantly worse oral and general health compared to people with higher socioeconomic status. The aim of the study was to find out the role of socioeconomic status of pregnant women on their oral health by evaluating the dental caries risk factor, the salivary Streptococcus mutans count and DMFT index. Materials and Methods: A total of 50 first time pregnant women were randomly sampled and were divided into different socioeconomic strata following the Kuppuswamy socioeconomic status scale. DMFT index and microbiological assessment of dental caries risk factor parameter, the salivary Streptococcus mutans colony forming units, were carried out during the three trimesters and postpartum period. The observations were compared with 50 non-pregnant women of same age group. Results: Of the randomly sampled subjects, majority of the pregnant women (28/50) of the study group were of middle/lower middle class, 11 pregnant women were of upper middle class, and 11 were of the lower/upper lower class. When followed in their three trimesters and postpartum period, statistically significant increase in the salivary Streptococcus mutans colony forming units was noted in 2nd trimester, 3rd trimester and postpartum period (P value < 0.05) of all pregnant women. Comparison of the caries risk factor between the pregnant women of three socioeconomic strata, however, revealed that no particular class was at a higher risk for dental caries. Conclusion: This study gives an insight into the possible changing trends towards awareness for oral hygiene in various socioeconomic strata of pregnant women.
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An investigation into the effect of gabapentin capsules on the reduction of nausea and vomiting after chemotherapy in cancerous patients under platinum-based treatment
Maziar Hasanzadeh Kiani, Ali Akbar Shayesteh, Ahmad Ahmadzadeh
June 2019, 8(6):2003-2007
DOI:10.4103/jfmpc.jfmpc_212_18  PMID:31334170
Introduction and Objective: Chemotherapy-induced nausea and vomiting (CINV) is a condition that occur in most patients. This study aimed to investigate the effect of gabapentin capsules on the reduction of chemotherapy-induced nausea and vomiting in patients admitted in the hematological ward for adult patients with platinum-based treatment. Materials and Methods: The present study was a randomized clinical trial, which consisted of a control group and an experimental one. The study population consisted of 126 women and men with colonic and gastric cancer who were admitted to Ahwaz Shafa Hospital of adult hematology ward. Of these, 120 subjects were eligible to enter the study. Immediately after chemotherapy, gabapentin capsules were taken. Up to 72 hours later, nausea and vomiting were compared. Descriptive statistics was used to investigate the demographic characteristics. Paired t-test, independent t-test and ANOVA were used to compare the results. Results: The results showed that most of the patients had gastric cancer in the experimental (70%) and control group (66.66%). The results also showed that chemotherapy-induced nausea and vomiting in gabapentin recipient group was different from the placebo group. Accordingly, chemotherapy induced nausea and vomiting in gabapentin group was lower than the placebo group. Conclusion: Post-operative nausea and vomiting is an unpleasant experience. Today, the patients find it worse than pain, and they believe it is hard to afford the cost of treatment. Gabapentin seems to be a good drug for reducing nausea and vomiting.
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REVIEW ARTICLES
Leprosy–A raging persistent enigma
Abhiruchi Galhotra, Sunil Kumar Panigrahi, Anjali Pal
June 2019, 8(6):1863-1866
DOI:10.4103/jfmpc.jfmpc_245_19  PMID:31334146
Leprosy or Hansen's disease despite having achieved the elimination target across the world, the decrease in detection of new cases has almost stagnated for the last 10 years. Southeast Asia is having the highest prevalence of leprosy among all regions in the world. The review focuses on the programmatic laggards' post-achievement of elimination target in India, the most significant contributors to leprosy caseload in the world, and a way forward.
  - 2,191 226
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