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   2020| April  | Volume 9 | Issue 4  
    Online since April 30, 2020

 
 
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INVITED EDITORIALS
Current perspective on pandemic of COVID-19 in the United States
Kamal Kant Sahu, Raman Kumar
April 2020, 9(4):1784-1791
DOI:10.4103/jfmpc.jfmpc_424_20  
Currently, the world is facing its 3rd coronavirus outbreak of the 21st century, which has turned to a pandemic recently. Starting on December 2019, coronavirus disease (COVID-19) was first detected in Wuhan City, Hubei province, China. As of 31st March, 2020, more than 900,000 COVID-19 cases have been reported across the globe involving more than 200 countries. The first case of the United States (US) was confirmed on 20th January, 2020 in a 35-year-old male who had a travel history to Wuhan, China, before returning to the U.S. Since then, the SARS-CoV-2 virus has spread to all the 50 states of US, with more cases being reported every day. New York, New Jersey, Michigan, and California are the worst-hit states. As COVID-19 is growing, every day has been marked by novel developments and updates. We hereby talk about how the U.S. is leading the multiagency effort to fight against this pandemic and the steps that have been taken so far.
  16 1,980 265
EDITORIAL
Fever, flu and family physicians during COVID 19 pandemic 2020 in India
Raman Kumar
April 2020, 9(4):1781-1783
DOI:10.4103/jfmpc.jfmpc_617_20  
Fevers - undifferentiated, often unacknowledged, is one of the largest morbidity afflicting in primary care settings and the overall healthcare ecosystem in India. FEVER is probably also the largest public health entity in terms of DALY - (Disability Adjusted Life Years) impacting the working population both in urban as well as rural areas; however, it remains unaddressed by public health programs, which are largely organized through vertical disease-focused national programs. The family physicians see a high volume of undifferentiated fevers throughout the year with seasonal and regional variations in India. Family doctors are not formally linked with the public health programs as India continues to march on selective primary care. Family physicians and medical officers are the most vulnerable for exposure to undifferentiated patient load. The first two health workers who died of COVID 19 in India (Indore) were practicing family physicians. Two mohalla clinic doctors tested positive in Delhi and two other general practitioners have been found to be infected in Mumbai. The media discussions have been on increasing capacity for critical care and the number of ventilators etc., It is also important for the governments to urgently review the functionality of PHCs, CHCs and district hospitals, and create a framework of partnership with standalone family physicians and general practitioners as well as nursing home, small hospitals to play a constructive role in managing the epidemic.
  6 2,209 386
REVIEW ARTICLES
Novel coronavirus: A capsule review for primary care and acute care physicians
Ankit Kumar Sahu, Jamshed Nayer, Praveen Aggarwal
April 2020, 9(4):1820-1824
DOI:10.4103/jfmpc.jfmpc_217_20  
Novel coronavirus (nCoV) is a new emerging infectious agent causing coronavirus disease 2019 (COVID-19). Since the reporting of early cases of COVID-19 from China on December 29, 2019 till March 15, 2020, it has affected 1,42,539 humans in 135 countries, including 82 cases in India. As it is a difficult task for first-contact physicians, i.e. primary care and acute care physicians, to comprehend the fast-growing knowledge about nCoV and apply for prevention and care of suspected cases of COVID-19, we have tried to provide an updated capsule review of nCoV infection and management of COVID-19. It includes the evidence-based information on epidemiological determinants (agent, host, and environment) of the disease, its clinical features, clinical and laboratory diagnosis, basic infection prevention and control measures, and clinical management of COVID-19 cases. This review also includes the succinct summary of World Health Organization and Center for Diseases Control and Prevention interim guidelines (as of March 15, 2020) on nCoV.
  3 1,631 200
INVITED EDITORIALS
Restricting rural-urban connect to combat infectious disease epidemic as India fights COVID-19
Surabhi Mishra, Archisman Mohapatra, Raman Kumar, Anjana Singh, Ajeet Singh Bhadoria, Ravi Kant
April 2020, 9(4):1792-1794
DOI:10.4103/jfmpc.jfmpc_451_20  
With declaration of 2019 novel coronavirus disease (COVID-19) as a pandemic on 11 March 2020 by World Health Organization, India came to alert for its being at next potential risk. It reached alert Level 2, i.e. local transmission for virus spread in early March 2020 and soon thereafter alert Level 3, i.e. community transmission. With on-going rise in COVID-19 cases in country, Government of India (GoI) has been taking multiple intense measures in coordination with the state governments, such as urban lockdown, active airport screening, quarantining, aggressive calls for 'work from home', public awareness, and active case detection with contact tracing in most places. Feedback from other countries exhibits COVID-19 transmission levels to have shown within country variations. With two-third of Indian population living in rural areas, present editorial hypothesizes that if India enters Level 3, rural hinterland would also be at risk importation (at least Level 1). Hence, we have to call for stringent containment on rural-urban and inter-state fringes. This along with other on-going measures can result in flattening curve and also in staggering 'lockdowns', and thus, helping sustain national economy.
  2 1,578 246
POSITION PAPERS
A Statement of Solidarity on COVID-19 Pandemic 2020 by the South Asian Family Physicians
Raman Kumar, Shehla Naseem, Jayantha Jayatissa, Chhabi Lal Adhikari, Tariq Aziz, Riaz Qureshi, Pratap Narayan Prasad, Sankha Randenikumara, Pratyush Kumar, Md Zakiur Rahman, Pramendra Prasad Gupta, Md Kabir Ahmed Khan, Marian Antoinette Perera, Vandana Boobna, Resmi S Kaimal, Mohan Kubendra, Sanjeeb Tiwari, Hina Jawaid, Shyamalee Samaranayaka, Marie Andrades, Kishore Purshottam Madhwani, Pragnesh R Shah
April 2020, 9(4):1795-1797
DOI:10.4103/jfmpc.jfmpc_619_20  
The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.
  2 1,621 251
REVIEW ARTICLES
Does temperature and humidity influence the spread of COVID-19?: A preliminary report
Sunil K Raina, Raman Kumar, Sakshi Bhota, Garima Gupta, Dinesh Kumar, Raman Chauhan, Praveen Kumar
April 2020, 9(4):1811-1814
DOI:10.4103/jfmpc.jfmpc_494_20  
Introduction: Climate change has been known to influence infectious diseases. The reason for this being the fact; disease agents and their vectors each have particular environments that are optimal for growth, survival, transport, and dissemination. Materials and Methods: The WHO's website was accessed to look for the Novel Coronavirus (COVID-19) situation dashboard and comprehensively study and assess the report. An attempt was made to look for countries, areas or territories with maximum and minimum number of cases of lab confirmed COVID cases. Further, we entered the words "Climate" in google for each of the aforementioned countries and searched for the results. A comparison was established by including countries from both the hemispheres (northern and southern). The preliminary analysis was based on the reports from countries with established testing facilities for COVID-19. Results: The report suggests that countries with higher number of cases are the countries with cold weather. These are also the countries with low humidity which could be favoring the transmission and survival of the SARS-COV-2. Conclusions: The results though preliminary point to a pattern which favors the hypothesis that the extensive spread of COVID-19 maybe limited by temperature and humidity.
  2 1,399 345
LETTERS TO EDITOR
COVID-19 – An avoidable epidemic: A family medicine practitioner's perspective
Pranay Tanwar, Meenakshi Mourya, Ritesh Kumar
April 2020, 9(4):2132-2133
DOI:10.4103/jfmpc.jfmpc_409_20  
  1 522 109
ORIGINAL ARTICLES
Oral hygiene negligence among institutionalized mentally disabled children in Mysore city—A call for attention
Darshana Bennadi, Vinayaka Konekeri, M Maurya, Veera Reddy, G Satish, C V. K Reddy
April 2020, 9(4):2045-2051
DOI:10.4103/jfmpc.jfmpc_720_19  
Background: Oral health is integral part of general health. In certain conditions especially among mentally disabled, oral health is neglected. Studies have shown that mentally disabled population has the risk of poor oral health. People with disabilities deserve the same opportunities for oral health and hygiene as those who are healthy, but sadly dental care is the most common unmet health care need of the disabled people. Methodology: This comparative, descriptive cross-sectional study was conducted among institutionalized mentally disabled and normal children of age group 6–13 years in Mysore city. Results: Majority of mentally disabled children, that is, 36.73% (n = 180), had poor oral hygiene when compared with normal children, that is, 9.18% (n = 45). This difference was statistically highly significant (P < 0.000). The significant differences in the gingival status and severity of mental disability were seen (P < 0.001). The result showed that the gingival health worsens with increase in the severity of mental disability. Conclusion: The present study showed the dental negligence among mentally disabled children where the parents, caretakers, and dentists are responsible. Oral health promotion programs should be conducted for special group children, their parents, as well as caretakers.
  1 759 133
Comparative evaluation of salivary immunoglobulin a levels between pedodontic subjects
Anju Jha, Rohit Singh, Sovendu Jha, Supriya Singh, Riddhi Chawla, Akanksha Prakash
April 2020, 9(4):2052-2055
DOI:10.4103/jfmpc.jfmpc_967_19  
Background and Aims: Host immune response is altered by a series of physiologic and pathologic factors like age, gender, inflammation, surgery, medication etc., The present study was conducted to evaluate differences in salivary IgA (S-IgA) levels among pedodontic subjects undergoing active orthodontic treatment with fixed and removable appliance. The levels of S- IgA were determined before 3 months and 6 months post active orthodontic treatment. Methods: A total of 40 healthy pedodontic subjects (aged 8-15 years) were recruited in the present study. They were equally divided into Group A (fixed orthodontic group) and Group B (removable orthodontic group) with 20 subjects each. 1.5 mL of saliva per subject was obtained before 3 and 6 months after treatment. Enzyme Linked Immunosorbent Assay (ELISA) technique was used for measurement of Salivary IgA levels. Results: Group A and B both showed significant rise in S-IgA levels 3 months and 6 months post active orthodontic treatment. Mean value of S-IgA 3 months post treatment in the saliva of children in group B and group A were (144.27 ± 5.32) and (164.0 ± 3.23) μg/ml respectively. While mean value of S-IgA after 6 months of treatment in group B and group A were (149.8 ± 6.02) and (166.4 ± 3.65) μg/ml respectively. Conclusion: Salivary Immunoglobulin A level values were significantly higher statistically in both group A and group B post active orthodontic treatment than before. The results however, showed that Group A (fixed orthodontic group) showed statistically significant higher levels of S-IgA than Group B (removable orthodontic group). Active orthodontic treatment triggered a stronger stimulus for oral secretory immunity, hence the increase in levels were detected. There is a significant positive correlation between S-IgA and active fixed as well as removable orthodontic treatment. Orthodontic treatment is hence a local immunogenic factor.
  1 550 76
Assessment of occupational hazards among dentists practicing in Mumbai
E Ramaswami, V Nimma, A Jakhete, AS Lingam, I Contractor, S Kadam
April 2020, 9(4):2016-2021
DOI:10.4103/jfmpc.jfmpc_1180_19  
Aim: To assess the awareness of various occupational hazards experienced and the preventive measures undertaken by the dentists in and around Mumbai. Methods: The present study was conducted using self-administered questionnaire, which was circulated to 200 dentists practicing in and around Mumbai. The questionnaire also included questions on personal information like age, gender, position (student or faculty), years of experience, and number of working hours per day. Those who completed the questionnaire form completely and willing to participate were only included in the study. The results were analyzed using SPSS version 22.0. Results: 23.5% of the participants had the dental working experience more than 10 years and 28.5% dentists worked for ≥8 h. 69% were general practitioners and 40% of the participants treat nearly 10 to 20 patients per day. 45% of them experienced needle stick injury in clinical practice. 1.5% of dentists in our study admitted receiving some litigation from their patients. Conclusion: The present study indicated that occupational hazards, awareness about biological hazards, and preventive measures observed by dentists in Mumbai are generally consistent with published guidelines for infection control and also in accordance with the previous research. The majority of the dental practitioners were suffering from pain in the muscles of neck or back. Regular training and workshops can help lower such problems.
  1 708 101
The influence of tobacco consumption on periodontal health: A stratified analysis based on type of tobacco use
Anusha Yaragani, K VR Sushuma, Vineeth Guduri, S S. Manikanta Kumar Thirumalasetty, Gautam Vishnubhotla, Pradeep Kandikatla, Viswa Chaitanya Chandu
April 2020, 9(4):2061-2066
DOI:10.4103/jfmpc.jfmpc_1071_19  
Introduction: Though the negative influence of tobacco consumption on the periodontal status of an individual is established, the magnitude of this association based on the type of tobacco used is seldom investigated. Aim: The aim of this study is to check the differences in the periodontal status of individuals based on their current tobacco consumption status and type of tobacco consumption. Materials and Methods: This study was conducted among subjects attending a teaching dental institution in Andhra Pradesh. Subjects were divided into three groups based on their current tobacco consumption status. The following parameters were recorded after examination by two calibrated investigators: number of sites with bleeding on probing; number of teeth with periodontal pockets; number of teeth with clinical attachment loss of ≥5 mm; number of teeth lost. SPSS version 20 software was used to analyze the data. Results: While current users demonstrated poor periodontal status than the former and nonusers, there was a significant difference in periodontal health between former users and nonusers in all the study parameters except the mean number of teeth lost. Among current users, the mean percentage of sites with bleeding and attachment loss >5 mm were found to be least among smokers compared to tobacco chewers and those who consume both smoke and smokeless forms of tobacco. Conclusion: The study confirms the negative influence of tobacco consumption on periodontal health and also establishes the increased destruction of clinical attachment levels among tobacco chewers compared to smokers.
  1 718 118
Human papillomavirus and its vaccination: Knowledge and attitudes among female university students in Saudi Arabia
Tahani Altamimi
April 2020, 9(4):1849-1855
DOI:10.4103/jfmpc.jfmpc_1205_19  
Context: College students worldwide have low levels of knowledge on human papillomavirus (HPV)-related diseases, highlighting the lack of awareness about HPV infection. To date, no study has examined the level of knowledge of cervical cancer and the HPV vaccine in the northern region of Saudi Arabia. Aim: This study aimed to assess the level of knowledge of cervical cancer and its risk factors, as well as HPV vaccine acceptance among female students in Saudi Arabia enrolled in health colleges. Methods: A descriptive cross-sectional survey was conducted using a valid and reliable self-administered questionnaire. The questionnaire was completed by 966 female students enrolled at the University of Hail, northern region of Saudi Arabia, with a response rate of 83.5%. The main outcome measure was the identification of the knowledge gap pertaining to HPV infection and its prophylactic vaccine. Results: The findings highlighted a lack of knowledge about cervical cancer, Pap smears, and HPV vaccine among most female university students. The knowledge score positively correlated to the duration of education. Students enrolled in applied medical science and medical colleges showed significantly higher knowledge scores, as did students in their senior academic years. Vaccine uptake barriers included concerns about its side effects and a lack of information. Conclusions: Our findings can be used to formulate effective future awareness programs in the northern region of Saudi Arabia. A larger number of educational programs are required to enlighten Saudi women about cervical cancer and its prophylactic vaccine, including the benefits of screening programs and prevention strategies.
  1 1,203 202
A clinical study of the association and risk factors for lower limb neuropathy in patients with diabetic retinopathy
Devika Joshi, Mansur Ali Khan, Anirudh Singh
April 2020, 9(4):1891-1895
DOI:10.4103/jfmpc.jfmpc_231_20  
Purpose: Association of peripheral neuropathy with diabetic retinopathy is known but the relationship of preclinical neuropathy with various grades of retinopathy is not well documented. This study evaluated the association of preclinical peripheral neuropathy using nerve conduction studies with various grades of retinopathy. Methods: Cases of diabetic retinopathy of various grades but asymptomatic for peripheral neuropathy underwent nerve conduction studies of the lower limbs using Caldwell machine and Sierra wave software. The risk factors for retinopathy and association of neuropathy with various grades of retinopathy were analyzed by bivariate and multivariate regression analysis. Results: The overall prevalence of neuropathy was 75.6% (sensory 58.54% and combined motor and sensory 17.1%) with increase in prevalence with increase in severity of retinopathy. Duration was positively associated with neuropathy (OR = 1.13, 95% CI = 1.02–1.24; P = 0.012); moderate nonproliferative diabetic retinopathy (NPDR) (OR = 5.60, P = 0.002), severe and very severe NPDR (OR = 5.8, P = 0.041), and PDR (OR = 16.05, P = 0.000) were significantly at higher risk for having neuropathy as compared to mild NPDR. Conclusion: Duration and severity of retinopathy are important risk factors for peripheral neuropathy. There is a high prevalence of peripheral neuropathy among diabetics with retinopathy especially with severe grades, when neuropathy is diagnosed using nerve conduction studies.
  1 618 105
Effectiveness of oral exercise on oral function among the elderly
B Thanga Raj, B Sreelekha, A Manjula
April 2020, 9(4):1896-1903
DOI:10.4103/jfmpc.jfmpc_899_19  
Purpose: To evaluate the effectiveness of oral exercise on oral function among the elderly at a selected old age home in Chennai. Research Design: The present study adopted a one-group pretest and posttest (preexperimental) design. Methods: Participants received intervention "oral exercise" which comprised of exercises for expression muscles (orbicularis oculi, buccinator and orbicularis oris), tongue, salivary glands, and swallowing. The pre- and posttests included assessment of oral function (dry mouth symptoms, amount of salivary pH, salivary secretion, size of mouth opening, halitosis, and oral motor function) using summated xerostomia inventory, spitting into a measuring container for 10 min, pH meter, Vernier caliper, organoleptic test, and Sunnybrook facial grading system, respectively. Results: Using nonprobability convenience sampling technique, a total of 48 older people living in an old age home who met the inclusion and dental screening criteria were recruited. There was a statistically considerable difference noted in the mean scores of the dry mouth symptoms (t = 11.88), amount of salivary secretions (t = 17.05), salivary pH (t = 8.68), size of mouth opening (t = 14.76), halitosis (t = 13.13), and oral motor function (t = 11.52) at P < .001 before and after oral exercise among the elderly. Conclusion: Oral exercise as a self-regulating intervention can efficiently promote oral health of older people.
  1 769 139
Oral health care system analysis: A case study from India
Venkitachalam Ramanarayanan, Chandrashekar Janakiram, Joe Joseph, K Krishnakumar
April 2020, 9(4):1950-1957
DOI:10.4103/jfmpc.jfmpc_1191_19  
Objectives: The health system of Kerala, India has won many accolades in having health indicators comparable to developed countries. But oral health has not received its due importance at the policy level. With the burden of oral diseases on the rise in the state, a critical introspection of the existing system is warranted. The objective of this review was to assess the oral health care system in Kerala to provide policy solutions. Methods: This study adopted a mixed methodological approach that gathered information from the primary and secondary sources, which included health facility surveys, key informant interviews, review of published literature, and websites of governmental and non-governmental bodies. The WHO framework of health system building blocks was adapted for the assessment. Results: A review of epidemiological studies conducted in Kerala suggests that the prevalence of oral diseases is high with the prevalence of dental caries at the age of 12 years ranging from 37-69%. The state has a dentist population ratio of 1:2200 which is well within the prescribed ratio by WHO (1:7500). Only 2% of dentists in Kerala work with government sector catering to 0.6 million of the approximately 33.4 million population. This point to the absence of oral care in first contact levels like primary health centers. Service delivery is chiefly through the private sector and payment for dental care is predominantly through out-of-pocket expenditure. Conclusion: Despite having the best health indicators, the oral health system of Kerala is deficient in many aspects. Reorientation of oral health services is required to combat the burden of diseases.
  1 2,116 236
REVIEW ARTICLES
Non-Hodgkin's lymphoma: A review
Rohit Singh, Shabana Shaik, Bhupender Singh Negi, Jagadish Prasad Rajguru, Pankaj Bajirao Patil, Anuj Singh Parihar, Uma Sharma
April 2020, 9(4):1834-1840
DOI:10.4103/jfmpc.jfmpc_1037_19  
Lymphomas constitute the third most common neoplasm in head and neck region arising from the lymphoreticular system. Malignant lymphomas are divided into Hodgkin's disease and non-Hodgkin's lymphoma (NHL). NHL comprises approximately 5% of head and neck malignancies and displays a wide range of appearances comparable with Hodgkin's disease. Hodgkin's and non-Hodgkin's lymphomas are seen in the head and neck region, but extranodal disease, with or without lymph node involvement, is more common among NHL patients. Extranodal involvement includes the areas such as Waldeyer's ring (i.e., the tonsils, pharynx, and base of the tongue), salivary glands, orbit, paranasal sinuses, and thyroid glands. There are several classification systems for categorizing NHL out of which WHO classification for lymphoid neoplasms is mostly followed. This review describes the pathogenesis of NHL and explains some of the important NHL (Marginal zone B-cell Lymphoma, follicular lymphoma, mantle cell lymphoma).
  1 3,415 770
Coronavirus: An emergency for healthcare professionals
Sumit Verma, SM Manjunath, Ettishree , Atul Singh, Madhulika Srivastava, Kajal Kiran Sahoo, S Vinuta, Ujwal Singh
April 2020, 9(4):1815-1819
DOI:10.4103/jfmpc.jfmpc_462_20  
Coronavirus infection is a transmissible disease. It was first described in China in December, 2019. It has been said to have a person-to-person transmission after prolonged and unprotected exposure. Patients with a potential SARS-CoV-2 exposure present with symptoms of low-grade pyrexia, dry cough, or shortness of breath. People with these symptoms should contact health-care providers before seeking medical intervention so that appropriate preventive actions may be implemented. Health-care facilities should rapidly isolate suspected individuals and notify local health departments for support involved in performing laboratory tests and efforts in containment. The present article describes the nature of virus, method of detection, and its mode of transmission.
  1 888 172
CASE REPORTS
Systemic lupus erythematosus-myositis overlap syndrome with lupus nephritis
Biswajit Dey, Vandana Rapahel, Yookarin Khonglah, Md Jamil
April 2020, 9(4):2104-2106
DOI:10.4103/jfmpc.jfmpc_186_20  
Systemic lupus erythematosus-myositis overlap syndrome is rare with prognostic implications. Reports suggest that systemic lupus erythematosus-myositis overlap syndrome with lupus nephritis has a variable clinical outcome. We report a case of systemic lupus erythematosus-myositis overlap syndrome with lupus nephritis in a 28-year-old female, who presented with facial puffiness, proximal muscle weakness, and proteinuria.
  - 523 81
Cerebral venous sinus thrombosis–A primer for emergency physician
Subhankar Chatterjee, Chandra Bhushan Sharma, Rishi Tuhin Guria, Souvik Dubey, Carl J Lavie
April 2020, 9(4):2107-2110
DOI:10.4103/jfmpc.jfmpc_192_20  
Cerebral venous sinus thrombosis (CVT) is notoriously known for its varied presentations and extremely high risk of mortality, if remains undetected and untreated. On the other hand, life can be saved with full functional recovery if CVT can be identified with high index of clinical suspicion with supportive imaging and treatment with appropriate anticoagulation. It is important for clinicians to be meticulous to screen for both the potential reversible and heritable causes of CVT so that appropriate measures can be taken to prevent such catastrophe. Here we report a case of CVT involving right sigmoid and transverse sinuses presenting with acute onset left sided hemiplegic without antecedent headache or seizures. Patient was successfully treated with anticoagulants with nearly full functional recovery. Multiple predisposing factors were identified. As per our knowledge, this is the first case of CVT with underlying conglomeration of multiple acquired (lactation, folate deficiency, hyperhomocysteinemia, depot medroxyprogesterone acetate injection) and hereditary risk factors (deficiency of protein C, protein S and antithrombin-III) in a single patient.
  - 659 104
Multiple radiolucencies in the mandible: A diagnostic dilemma
Susmitha Madishetti, Prabhat K Tiwari, Ramen Sinha, Uday K Uppada, Sameer Banavath, Rahul V. C Tiwari
April 2020, 9(4):2111-2113
DOI:10.4103/jfmpc.jfmpc_1204_19  
Diagnosis and treatment planning of maxillofacial pathologies is an art. It requires careful evaluation and correlation of clinical presentation and radiologic investigations. When the pathology concerned is an intraosseous lesion, the radiographic findings assume a significantly more important role. While carrying out the radiographic assessment, we rely on typical findings regarding the number, location, and appearance of radiolucent areas which point towards certain types of pathologies. Whenever these findings are atypical or at variance with the clinical presentation, it creates a diagnostic dilemma for the clinician. We report a case of a 34-year-old man who presented with a simple clinical history but multiple radiolucencies on the radiograph.
  - 1,201 121
Management of nonhealing venous ulcer in systemic sclerosis with leech therapy—A case report
Pooja Sharma, Divya Kajaria
April 2020, 9(4):2114-2118
DOI:10.4103/jfmpc.jfmpc_1184_19  
Systemic sclerosis (SSc) is a rare disease characterized by autoimmune pathogenesis, alterations to the vascular system, and fibrosis of the skin and internal organs. Nonhealing venous ulcers are quite common in SSc patients. A 32 years old female was brought with a foul-smelling ulcer with purulent discharge which was not healed despite using the allopathic treatment for 2 months. Even with treatment, it got worsened so the fear of amputation of leg enforced her to take Ayurvedic consultation. After 1 month of treatment with leech therapy along with Ayurvedic medicines and 3 months of follow-up, the wound got healed. It is concluded that leech therapy with Ayurvedic medicines is highly effective for the management of nonhealing venous ulcers.
  - 663 87
Bacteremia because of Streptococcus pseudoporcinus in a Syphilis-HIV co-infected patient: A case report
Kavita Gupta, Monalisa Mohanty, Sutapa Rath
April 2020, 9(4):2119-2120
DOI:10.4103/jfmpc.jfmpc_663_19  
A 43 year old male patient came to the emergency department with complaints of severe breathlessness and pedal edema with on & off fever since 15 days. The patient also gave history of sexual exposures with multiple partners. ECHO revealed moderate LV dysfunction, severe aortic regurgitation (AR), trivial mitral regurgitation (MR) with mild pulmonary edema. The patient was diagnosed as a case of severe Aortic regurgitation with atrial fibrillation. The patient was found sero-positive for HIV and Syphilis. His blood cultures obtained prior to initiation of antibiotics showed growth of small 0.5-1mm in diameter, β- hemolytic colonies on blood agar The isolate was identified to be Streptococcus pseudoporcinous by VITEK2 Compact system and was sensitive to vancomycin, linezolid, penicillin, cotrimoxazole and ciprofloxacin. Streptococcus pseudoporcinus is usually found as colonizer of female genital tract has been rarely associated with bacteremia. In the present report the patient possibly has acquired the infection from female genital tract because of his abnormal sexual behaviour. Association of Streptococcus pseudoporcinus with increased numbers of sexual partners and sexually transmitted infections suggests that further studies of this organism are warranted.
  - 463 64
Diagnosis and treatment considerations of atypical oral pain in tuberous sclerosis
Lata Goyal, Padmanidhi Agarwal, Gosla S Reddy, Kanav Jain
April 2020, 9(4):2121-2124
DOI:10.4103/jfmpc.jfmpc_1213_19  
Diagnosis and management of non-specific, atypical, and non-dental pain are challenging. We hereby report a case of a 23-year-old female who presented with a complaint of intermittent dull ache over her lower front anterior teeth with no radiographic findings. She was diagnosed after history, imaging, and neurology consultation and treated conservatively with complete remission of symptoms. Proper history and counseling are mandatory for all patients. It is important to recognize patients with underlying neurological conditions and take adequate interdepartmental consultation before labeling complaints psychogenic or carrying out unwarranted dental treatment.
  - 650 82
Improvement of patient satisfaction by root cause analysis in health care services for urban slum community in North India
Har Ashish Jindal, MV Saraswathy, Atul Gupta, JS Thakur
April 2020, 9(4):2125-2128
DOI:10.4103/jfmpc.jfmpc_915_19  
Universal health care (UHC) endorses availability and access to health care services for a wider population with equity and quality in a way that protects them from financial hardship while availing the services. This case study shares the experience of a health facility in a resource constraint setting catering to the health needs of a migrant residing in an urban slum of north India. Out-of-pocket expenditure is one of the major reasons for nonachievement of UHC. "Root cause analysis" revealed the challenges for patient satisfaction in the academic outpatient clinic (OPD). Inadequate availability of laboratory investigations at health facilities poses hindrances during health service delivery and achievement of UHC. It was found that one of the major reasons for patient's dissatisfaction were out of pocket expenditure at private facilities and loss their daily wage to get access to the investigations. Problem-solving techniques were utilized to improve patient satisfaction and make the health system sensitive to the migrant urban poor population. The use of "plan do study act cycle (PDSA)" technique for improvement of the health system with collaboration, advocacy, and feedback analysis with the government hospital helped improve health care access for the people with poor purchasing power. Feedback analysis of the established system helped in the sustainability and feasibility of the system for the smooth functioning of the referral system. Root cause analysis, health advocacy, and collaboration has helped making a model for improvement of access to health care services and patient satisfaction in an urban slum population. which maybe replication in a resource constraint setting.
  - 900 98
Amitraz poisoning: Early gastric lavage can prevent life-threatening complications
Pratti Madhuri, Anirudh Mukherjee, Sukdev Manna, Minakshi Dhar
April 2020, 9(4):2129-2131
DOI:10.4103/jfmpc.jfmpc_1268_19  
Amitraz is a worldwide available pesticide of formamidine chemical family, proven to have reversible toxic effects on both animals and humans. Upon intoxication by ingestion, inhalation, or dermal route, it can cause various central nervous system (CNS), CVS, respiratory and gastrointestinal effects, some of which may be life threatening. Because of lack of specific antidote patients are usually managed with supportive and symptomatic management. We describe a case of 36-year-old female patient who presented to us with alleged history of 120 ml amitraz ingestion. She was given early gastric lavage with activated charcoal at emergency along with supportive and symptomatic management. She developed mild CNS depression, bradycardia, miosis, and fluctuating blood pressure. She was managed in intensive care unit and was kept under close hemodynamic monitoring. Her clinical course during hospital stay was uneventful and was successfully discharged without any residual deficits. According to previously published data, this amount of amitraz intoxication could have caused more serious clinical manifestations. This disproportionately less severe clinical manifestation in our patient is attributed to early gastric lavage. Ominous of reducing amitraz-related health hazards lies in the hands of primary health care physicians and regulatory bodies of government.
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HEALTH POLICY
Advocacy to act – Family medicine in health policy: A decade-long journey of the academy of family physicians of India
Raman Kumar
April 2020, 9(4):1805-1810
DOI:10.4103/jfmpc.jfmpc_289_20  
The 'Academy of Family Physicians of India (AFPI)', is a non-profit organisation registered in New Delhi with a membership base, spread over all India. AFPI is working towards the establishment of a distinct academic discipline 'family medicine' for doctors pursuing primary care vocation within the mainstream medical education system in India. AFPI adopted a multi-pronged approach engaging political leadership, bureaucracy, higher judiciary and other stakeholders. In 2018, a public interest litigation was filed in the Supreme Court of India. In pursuance to the Supreme Court of India order, AFPI approached the ministry as well as the Medical Council of India. In 2018 we had received written assurance from the Prime Minister's Office - PMO that the family medicine discipline will be addressed in the NMC bill. Earlier family medicine was mentioned only as part of the National Health Policies (NHP 2002 and NHP 2017) and finally, it has become part of the act, the National Medical Commission Act 2019.
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LETTERS TO EDITOR
COVID 19: Are we fighting with the monster?
Alok Singh
April 2020, 9(4):2134-2135
DOI:10.4103/jfmpc.jfmpc_492_20  
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In reply to article "A cross-sectional study of epidemiological factors related to road traffic accidents in a metropolitan city"
Chitta Ranjan Mohanty, Mantu Jain, Rakesh Vadakkethil Radhakrishnan, Bhavna Sriramka
April 2020, 9(4):2136-2136
DOI:10.4103/jfmpc.jfmpc_323_20  
  - 382 65
Salutogenesis and Yoga – Are they similar?
Reena Doomra, Anjana Goyal
April 2020, 9(4):2137-2138
DOI:10.4103/jfmpc.jfmpc_184_20  
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"Selfie test": The proposal of a new clinical test for diagnosing De Quervain's tenosynovitis at primary care level
Ganesh S Dharmshaktu
April 2020, 9(4):2139-2140
DOI:10.4103/jfmpc.jfmpc_241_20  
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Hot-iron branding for musculoskeletal pain: A tribal ritual dying a slow death as primary healthcare system flourish
Ganesh S Dharmshaktu
April 2020, 9(4):2141-2142
DOI:10.4103/jfmpc.jfmpc_337_20  
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Cephalosporin's induced hepatic enzyme derangement - An educational report
Pugazhenthan Thangaraju, Shoban Babu Varthya, Meenalotchini Prakash Guruthalingam, Sajitha Venkatesan
April 2020, 9(4):2143-2145
DOI:10.4103/jfmpc.jfmpc_1133_19  
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Named terminologies of patient-centered – A focus respective to stigmatized disease
Pugazhenthan Thangaraju, Shoban Babu Varthya, Sajitha Venkatesan
April 2020, 9(4):2146-2147
DOI:10.4103/jfmpc.jfmpc_7_20  
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ORIGINAL ARTICLES
Facial measurements: A guide for vertical dimension
Dharmendra K Singh, Sambit Subhas, Arya Gupta, Mritunjay Kesari, Ashish Kumar, Lakshmikant Nayak
April 2020, 9(4):2056-2060
DOI:10.4103/jfmpc.jfmpc_968_19  
Background: Leonardo de Vinci contributed several observations and drawings on facial proportion and the lower one third of the face. Many facial and body measurements to determine vertical dimension at occlusion. These facial measurements can be implemented in construction of complete denture patients. Aim: This study aims to correlate the vertical dimension at occlusion to 13 anthropometric measurements. Then correlating, which measurement is more accurate to the vertical dimension at occlusion.Methodology: 20 male and female subjects were selected. Vertical dimension at occlusion and 12 anthropometric parameters were measured. Results and Conclusion: Twice the length of the eye and distance between the tip of the thumb and tip of the index finger is closest to the vertical dimension at occlusion in male patients and that vertical distance from the pupil to corner of the mouth, vertical height of the ear is closest to the vertical dimension at occlusion in female patients.
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Assessment of basal implants in compromised ridges
M Anuradha, Harsha V Babaji, Neel V Hiremath, VA Usha, Arunoday Kumar, Tanya Nandkeoliar, Sankalp Verma
April 2020, 9(4):2067-2070
DOI:10.4103/jfmpc.jfmpc_1149_19  
Aim: The aim of the present study was to evaluate clinically, radiographically, and functionally the outcomes of immediately loaded basal implants when placed in patients with compromised bone/alveolar ridges. Materials and Methods: A total of 18 systemically healthy (9 male and 9 female) subjects with compromised bone with poor quantity or quality were included in the study. A total number of 57 implants was placed, out of which 26 implants were placed in maxilla and 31 implants in mandible. There were 6 patients in which single implants were placed and in rest of the 12 patients, multiple implants were placed, out of which full mouth rehabilitation was done in one patient. In 10 patients, implants were placed immediately in fresh extraction socket and in 7 patients, implants were placed in healed edentulous site. In all the patients, loading was done immediately within 72 h of implant placement. All patients were evaluated for primary and secondary stability, pain, periimplant bone levels using IOPA with grid and CBCT, bleeding, suppuration, sulcular bleeding index, prosthetic complications, and patient satisfaction at specified time intervals. Result: All the values obtained during the study were expressed in the form of mean, standard deviation, and standard error of the mean. The parameters were compared between groups using Paired t-test for intragroup comparison at a similar time, i.e., baseline, 1 month, and 3 months. The data collected was comprehensively analyzed using SPSS software. All implants were successful, with no incidence of infection, nil mobility at the end of the study period of 6 months. Conclusion: Thus, it can be concluded from the present study, that Basal implants can play a vital role in the rehabilitation of patients, where compromised quality and/or quantity of bone is present and additional augmentation procedures would be required for the placement of conventional root form implants.
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Study of bodyweight and eating attitude among female university members in the Kingdom of Saudi Arabia: A comparison between different methods of weight assessment
Rania Naguib, Marwa M. R Tawfik, Sukainah A Alsubaiei, Altaf M Almoallem, Dana M Alajlouni, Tahani A Alruwaili, Wd S Sendy, Zainab Al Habib
April 2020, 9(4):2071-2078
DOI:10.4103/jfmpc.jfmpc_1058_19  
Background: The economic transition in Saudi Arabia imposed negative consequences leading to an increase in the prevalence of obesity and its sequelae. Despite the commitment of high authorities in KSA to combat obesity, so far 25% of Saudis are still obese. The association between obesity, disordered eating attitude, and body image needs to be addressed. Aim: To explore the relationship between obesity, eating attitude, and body image satisfaction among students and employees at Princess Nourah University (PNU) and to compare the different modalities of assessing body weight. Methods: A cross-sectional study using a convenient sampling technique comprised of 550 participants. Obesity was assessed by anthropometric measurements and body composition monitor (BF511). Eating attitude test (EAT26) was used to determine eating attitude while body image satisfaction score was determined using body shape questionnaire (BSQ). Results: Around 382 (69.5%) students and 168 employees participated in the study. Obesity was significantly higher among employees (48.2%) vs students (27.7%) (P < 0.001). Body fat composition showed significant positive correlations ranging from weak-to-moderate (0.13 to 0.44) with other body measurements for students and employees. The disordered eating attitude was maximized among obese compared to other BMI groups (P < 0.05). Percentage of disordered eating attitude score correlated positively with BMI: 35.2% vs 52.3% among underweight and obese, respectively (P = 0.001). There was no statistical difference in eating attitudes between students and employees. BSQ score correlates positively with BMI (P < 0.001), it was 36.73 ± 18.68 vs 57.92 ± 18.50 for underweight and obese, respectively. The effect of BMI on body image score was 19.1%. Discussion and Conclusion: Obesity remains a significant health problem among Saudi females. Increased BMI is associated with increased disordered food attitude and the effect of BMI on body image score was minimal.
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Knowledge and attitudes toward vaccination among Saudi medical students
Layla M Mjrby, Angham A Sahli, Zahra M Alsrori, Fatimah H Kamili, Halimah A Althurwi, Amal A Zalah, Hadeel M Alharbi, Hesham M Alharbi
April 2020, 9(4):2079-2084
DOI:10.4103/jfmpc.jfmpc_1061_19  
Background: Studies have identified health care providers as an important determinant of vaccination acceptance. However, knowledge and attitudes toward vaccination have not been sufficiently studied in Saudi Arabia, especially among medical students. Therefore, we conducted this study to explore vaccination knowledge and attitudes among medical students at a large Saudi university. Methods: A cross-sectional survey was conducted on 182 Saudi medical students between February 2019 and May 2019. Participants were invited to fill out a self-administered questionnaire assessing knowledge and attitudes toward vaccination. The statistical analysis included descriptive analysis, Chi-square test, independent samples t-test, and analysis of variance (ANOVA). The relationship between knowledge and attitudes was assessed using Pearson's correlation test. Results: A total of 182 respondents completed the questionnaires, giving a response rate of 91%. The study included male (52.7%) and female (47.3%) students from study years 2, 3, 4, 5, and 6. The overall mean knowledge score was under average (3.05/9, SD = 1.86) and the respondents showed generally moderate attitudes toward vaccination (Mean = 30.60/45, SD = 6.07). While, there was no sex difference in both the scores on knowledge and attitudes domains, the year of study was significantly associated with the mean knowledge score (F = 6.48, P < 0.01) and attitudes score (F = 7.12, P < 0.01). As predicted, there was a significant linear relationship between vaccination knowledge and attitudes (r = 0.71, P < 0.01). Conclusion: The study revealed generally moderate attitudes of Saudi medical students toward vaccination. However, several knowledge gaps were detected. The implications of the current findings are discussed.
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Diabetes-care practices and related awareness amongst type-2 diabetes patients attending diabetes OPD at a tertiary care hospital in southwestern Saudi Arabia
Ali Al Bshabshe, Mohammad Tauheed Ahmad, Ohood A. Ayed Assiri, Abeer A Assery, Ghaida A Aljadhaa, Sameera A Al Aslai, Zainab S Alamri, Muhammad Abid Khan, Lobna S Asiri
April 2020, 9(4):2085-2091
DOI:10.4103/jfmpc.jfmpc_1120_19  
Background: Diabetes is the most prevalent disease in Saudi Arabia having vast health and economic implications. Hence, it is important that all measures must be undertaken to prevent and control the disease. Objectives: This study was performed to assess the diabetes-care practice and related awareness of patients of type 2 diabetes attending the outpatient department of a diabetes care center at a tertiary care hospital in southwestern Saudi Arabia. Methods: A descriptive cross-sectional approach was used wherein patients attending the outpatient department of the diabetes treatment center of a tertiary hospital in the southern region of the Kingdom of Saudi Arabia were surveyed, using a predesigned pretested questionnaire covering the study variables. Results: The study included 287 individuals with type 2 diabetes in the age range 25 years to 90 years (mean age = 55.5 years). Around 57% of the participants were females while the rest were males. Conclusion: The present study showed that awareness about diabetic complications among the study population is good, especially among young educated patients who adhere to regular medical follow-up. Attending physicians were a major source of awareness for the patients.
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Prevalence and predictors of using complementary and alternative medicine among diabetic patients in Taif city, Saudi Arabia
Rehab I Abdullah, Ahmad Aman Allah, Ali S Mubarak, Rayan I Abdullah, Sarah H Alzhrani, Maram H Alsufyani, Salman J. A Alharthi, Reham O. H Althomali
April 2020, 9(4):2092-2098
DOI:10.4103/jfmpc.jfmpc_1222_19  
Background: Saudi Arabia has the second-highest rate of diabetes in the Middle East. Herbal treatment is the most used complementary and alternative therapy among Saudi diabetic patients. Little is known about the use of complementary and alternative medicine among diabetic patients who reside in Taif city. Method: This study evaluated the magnitude and correlates of complementary and alternative medicine (CAM) use among diabetic patients attending diabetic clinics and primary healthcare in two governmental hospitals, namely, Prince Mansour Military Hospital (PMMH) and National Gourd Hospital (NGH) in Taif city. Results: CAM prevalence was 33.7%, of whom 87.3% did not consult a doctor before use and 43.2% had more than one source of information while 62.7% used more than one CAM method. Around 49.2% reported that it is very useful, and 72.9% did not notice any side effect from its use. In addition, 47.5% would recommend CAM to other diabetic patients. All (100%) reported using bitter apple, 66.1% reported using cinnamon, 55.1% used ginger, 35.6% took fenugreek, and 21.2% reported using Garlic as an only CAM. Female gender, family history, diabetic complications, and longer duration of diabetes were associated with the increased use of CAM. Discussion and Conclusion: CAM use by diabetic patients in Taif is prevalent. Health education and the safe use of CAM is much needed. Appropriate efforts from the government to integrate CAM into conventional diabetes treatment should be considered.
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Reasons for recurrent visits of emergency department by pediatric asthmatic patients in Al-Qassim Region
Mohammad A Alhasoon, Abdualziz N Alharbi, Waleed S Almohamadi, Abdulrahman M Alsobiay, Hudeban A AlArmani, Abdullah M Alrehaili, Huthayfah A Alamer, Abdullah S Alsoghair, Aeshah M Alrasheedi
April 2020, 9(4):2099-2103
DOI:10.4103/jfmpc.jfmpc_966_19  
Introduction: Bronchial asthma has been the subject of controversy for several decades. The Global Initiative for Asthma (GINA) describes asthma as "a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation." Although not strictly a definition, this description captures the essential features for clinical purposes. Bronchial asthma is defined as a chronic lung disease characterized by airway obstruction, inflammation and hyper-responsiveness that leads to symptoms like wheezing, coughing, chest tightening and shortness of breath especially at night or in the morning. It is one of the most common medical emergency conditions in the pediatrics all over the world. The primary care provider is the cornerstone of this study; his/her awareness about reasons of recurrent visits of emergency department by pediatric asthmatic patients would help to reduce the frequency of ED visits, which lead to minimizing the load on hospitals by addressing patient's concerns, correcting some misconceptions, and improving the patients' and their parents' knowledge and awareness. Aim: This study aims to identify the predictors associated with frequent visits to the ED among asthmatic children at main governmental hospitals in Al-Qassim Region. Materials and Methods: This is a cross-sectional study conducted at three different emergency departments in Qassim region such as Maternity and Children Hospital in Buraidah, King Saud Hospital in Unayzah, and Alrass General Hospital. A validated interview questionnaire was used which includes general demographic characteristics, whether the caregiver has been educated about asthma as a disease, about the use of medicines and inhalers, about the management of symptoms, reasons for using the ED for asthma care, prescription received during the ED visit, and referral from ED. Results: Children with less than 3 visits to ED for the last 6 months were 70.3% while those with 3 or more visits were 29.7%. Nearly all patients (88.3%) had already been diagnosed with asthma with their attending physician. The most commonly known medication was beta-agonist (62%) while the most common reason for ED visit was "to obtain oxygen" and "to obtain a bronchodilator." The prevalence of ED referral to PHC was low (9.7%). Based on the adjusted regression model, we observed that medication used (AOR = 1.760, P = 0.046) and referral from ED (AOR = 3.711, P < 0.001) were the significant factors being associated with 3 or more visits to ED. Conclusion: Recurrent ED visitation of children with asthma was moderately low. Furthermore, medication used and referral from ED were identified as the predictors being associated with recurrent visits to ED. Further research is needed in order to validate the predictors being associated with recurrent ED visitation of asthmatic children in our region.
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Risk factors for undernutrition in under-five children living in a migrant populated area of South Delhi
Deepti Dabar, Vikas Yadav, Akhil D Goel, Abha Mangal, Pankaj Prasad, Mahendra Singh
April 2020, 9(4):2022-2027
DOI:10.4103/jfmpc.jfmpc_1185_19  
Introduction: Undernutrition is continuing to be a major public health problem in India. Moreover, India houses more than 30% of the world's stunted children aged under 5 years. There was a paucity of a community-based cross-sectional study on the nutrition of children aged under 5 years in urban Delhi. Therefore, we conducted this study to assess the prevalence of undernutrition and their associated factors in children aged under 5 years in urban South Delhi. Materials and Methods: A cross-sectional community-based study was conducted in the Mehrauli area of South Delhi with a semi-structured questionnaire. Systematic random sampling without replacement was implemented. Informed written consent was sought from the parents of participants. Questions were asked regarding demography and sociocultural factors of the participants. Anthropometry measurements were obtained. Underweight and stunting were defined using WHO child growth standards 2006. Results: A total of 520 participants in 695 houses were contacted and interviewed. Prevalence of underweight and stunting were 34.0% and 42.6%, respectively. Sociocultural factors, associated with underweight and stunting, found in current study were fathers' education (with both, P value < 0.05), mothers' education (with both, P value < 0.05), poverty status (with both, P value <0.05), overcrowding (stunting only, P value <0.05), fathers' alcohol abuse (with both, P value < 0.05) and exclusive breastfeeding for 6 months (stunting only, P value <0.05). Conclusions: There was a very high prevalence of underweight (34.0%) and stunting (42.6%) in children under 5 years age in Mehrauli.
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Mindful awareness for female dental students through yoga, motivational video, and a combination of two on stress reduction
Manju Singh, Sridhar Kannan, Manu Dhillon, Dhirja Goel, Anju Jha, Amit Kumar
April 2020, 9(4):2028-2032
DOI:10.4103/jfmpc.jfmpc_1187_19  
Objective: Assessment of the potential effect of yoga, motivational videos, and a combination of two on stress reduction in female dental students. Methods: The current study design is a nonrandomized trial carried out among female dental students (n = 120). The selected subjects were allocated into three groups, namely, group A: yoga group assigned under a professional yoga instructor, group B: motivational video group, and group C: a combination of two (A and B) involving yoga sessions and motivational videos; following which formative examinations were carried out at 6 weeks which were referred to as stressor 1 and those carried out at 12 weeks were referred to as stressor 2. Using Spielberger's State-Trait Anxiety Inventory for Adults (STAI-A) recordings were measured at baseline, stressor 1, and stressor 2. Results: There was a significant decrease in trait anxiety scores at both stressors in all the groups with a significant reduction in depression score from stressor 1 to 2 in group 1 and group 3 subjects. The significant decrease occurred in STAI-A scores in group 1 and group 3 subjects at both stressors (P < 0.001) with no change observed in group 2 subjects. Conclusion: The present study is one of a kind and positively correlates yoga and motivational videos with stress reduction. Both of these interventions proved to be beneficiary for physical as well as mental health of study subjects.
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Cardiovascular disease risk assessment and treatment among person with type 2 diabetes mellitus at the primary care level in rural central India
Shilpa Gaidhane, Nazli Khatib, Quazi Syed Zahiruddin, Anand Bang, Sonali Choudhari, Abhay Gaidhane
April 2020, 9(4):2033-2039
DOI:10.4103/jfmpc.jfmpc_1192_19  
Introduction: Despite evidence in support of assessment and treatment of risk factors to prevent cardiovascular disease (CVD) among people with type 2 diabetes mellitus (T2DM), studies have shown gaps in practises at the primary care level. The study was undertaken to find out the prevalence and management of risk factors for CVD in patients with T2DM from rural area India. Methodology: A crosssectional study was conducted in a tertiary care hospital in rural India. Around 192 persons with T2DM over 35 years of age were interviewed and examined using a structured questionnaire to determine the presence of CVD risk factors, previous assessment and management of these risk factors. Results: The mean age was 58.91 (SD 11.30) years. Tobacco use and harmful consumption of alcohol were reported by 67.7% and 27%, respectively. Nearly 43.8% were doing moderateintensity physical activity, 2.1% were consuming more than 6 servings of green leafy vegetables/fruits per week, 22.9% were overweight and 5.2% were obese. A family history of CVD was present in 12.5%. About 75% of participants were having one or more risk factors for CVD, and a comprehensive CVD risk assessment was done by 15%. The most commonly assessed risk factor was blood pressure (84.3%) and blood sugar (40%). Around 30% were advised for weight reduction and 23.4% were advised to quit tobacco. Dietary counseling and diet plan were prepared for 17 (8.9%) participants. Conclusion: Nearly threefourths were receiving treatment for hypertension. The majority of people with T2DM in rural areas had one or more CVD risk factors; however, very few were assessed and treated for CVD risk factors at the primary care level. Patient education and training of the diabetes care providers at the primary care level may be useful for comprehensive CVD risk assessment and treatment to prevent CVD complications in patients of T2DM.
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Dengue awareness and its determinants among urban adults of Rohtak, Haryana
Neelam Kumar, Seema Verma, Shiba , Priyanka Choudhary, Komal Singhania, Mukesh Kumar
April 2020, 9(4):2040-2044
DOI:10.4103/jfmpc.jfmpc_1203_19  
Context: Despite so many efforts to control dengue, the disease has a huge impact on the health, well-being, and economy of the population. The key success to control dengue depends not only on services provided by health authorities but also on the awareness of the community about preventing practices and their health-seeking behavior. Hence, the present study was conducted to assess the awareness regarding dengue and its determinants among urban adult population of Rohtak. Aims: To assess the awareness regarding dengue and its determinants among urban adult population of Rohtak. Settings and Design: A cross-sectional study. Methods and Materials: Data were collected using a pretested, semi-structured interview schedule from 210 participants which included information on the demographic profile of the subject, awareness about the symptoms, transmission, vector behavior in terms of biting time and breeding places, preventive measures and treatment of dengue fever, and responsibility of vector control. Cumulative awareness was calculated on the basis of correct answers provided. Statistical Analysis Used: Categorical data were presented as a percentage. Pearson's Chi-square test was used to evaluate differences between groups for categorical variables. Results: The level of awareness was better among males (statistically significant). The difference in the level of awareness with respect to education, occupation, and the socioeconomic class was found highly statistically significant. Conclusions: Awareness regarding dengue and its preventive measures were specifically low in women; mostly housewives, in participants of the lower socioeconomic group, and those who were illiterate.
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Epidemiological investigation of an outbreak of Acute Viral Hepatitis A and E in a semi-urban locality in Chandigarh, North Indian Union Territory, 2016–17
Ankita Kankaria, Madhu Gupta, M D Abu Bashar, Shuchi Aggarwal, Sathiabalan Murugan, Chering Bhag, Sunil Kumar, Krishna Chaudhary, Kawaljeet S Sandha, Ruby Jain
April 2020, 9(4):1856-1867
DOI:10.4103/jfmpc.jfmpc_1244_19  
Context: During ongoing passive surveillance in Burail, Chandigarh an unexpected rise in number of acute viral hepatitis (AVH) was reported during December 2016. Aims: An outbreak of AVH was investigated in an urbanized village, Burail, in Chandigarh, India with an objective of describing its epidemiological features. Settings and Design: A house-to-house survey was conducted in Burail (population 51,958). Subjects and Methods: WHO's standard case definition for AVH was used to identify cases. Suspected cases were tested for hepatitis A virus (HAV) and E virus (HEV) using enzyme-linked immunosorbent assay. Drinking water samples were tested for fecal contamination. Control measures were implemented to contain the outbreak. Statistical Analysis Used: Descriptive analysis was done as per time, person, and place. Results: Out of 141 confirmed cases of AVH, 85.1% were positive for HEV, 12.8% for HAV, and 2.1% for both HAV and HEV. The attack rate was 27.1 per 10,000 in a population. Males were affected more than females (P < 0.05). One of the areas reported a leakage in drinking water pipeline and had highest attack rate (36.8/10000 population). Drinking water samples were found negative for contamination. Around 27% of confirmed cases reported history of taking food from local vendors in Burail 2–6 weeks prior to the onset of symptoms. Conclusion: This study described the epidemiological features of dual hepatitis outbreak due to HAV and HEV from Chandigarh, Union Territory, north India.
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The prevalence of partial edentulism and complete edentulism among adults and above population of Riyadh city in Saudi Arabia
Saleh M Almusallam, Mohammed A AlRafee
April 2020, 9(4):1868-1872
DOI:10.4103/jfmpc.jfmpc_1209_19  
Objectives: The present study was conducted to investigate the prevalence of complete edentulism and partial edentulism among adults and above population in Riyadh city, in relation to gender, age, and education level. Baseline information related to edentulism will help us take action to promote oral health. Methods: A cross-sectional stratified cluster study was carried out in 2018–2019 in several dental care centers across Riyadh city. A total of 618 subjects aged 35–74 years were selected through convenient sampling and information related to edentulism was gathered followed by clinical examination. Results: Of the total sample, 349 (56.5%) were males and 261 (43.5%) were females. In the overall assessment of edentulism, it was found that the majority of the subjects 426 (69%) had one or more teeth missing. Among these subjects, there was (2.6%) who were completely edentulous, which represented (1.8%) of the total sample. Conclusion: A high percentage of adult patients have missing teeth and complete edentulism was found mostly in elderly people. Frequenting a dental center had an inverse relation with edentulism.
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Correlation and prognostic significance of serum amylase, serum lipase, and plasma cholinesterase in acute organophosphorus poisoning
Ajit Dungdung, Abhinav Kumar, Bindey Kumar, Mukul Preetam, Ruth K Tara, Md K Saba
April 2020, 9(4):1873-1877
DOI:10.4103/jfmpc.jfmpc_205_20  
Background: Organophosphorus (OP) are substances that are originally produced by the reaction of alcohols and phosphoric acid. These OP compounds are the main components of herbicides, pesticides, and insecticides. These are easily available in developing country like India; there is lack of awareness about these chemicals which results in high morbidity and mortality. Aims and Objectives: To estimate levels of amylase, lipase, plasma cholinesterase in acute OP poisoning. To assess severity of OP poisoning by using plasma cholinesterase levels and correlating it with other two markers. Predicting the severity of acute OP poisoning by using these biochemical markers. Materials and Methods: A hospital-based observational study was conducted on 100 subjects who were clinically diagnosed of acute OP poisoning. Subjects of either gender of all age-groups were included in the study. On admission, plasma cholinesterase, serum amylase, and serum lipase were measured. Based on plasma cholinesterase activity at the time of admission, subjects were divided into three groups. Group I-having 20-50% of plasma cholinesterase activity; Group II-10-20% of plasma cholinesterase activity; and Group III <10% of plasma cholinesterase activity. Results: Among 100 patients it was seen that serum amylase and serum lipase were negatively correlated with plasma cholinesterase levels and it was statistically significant. It was seen that serum amylase had the highest diagnostic accuracy for assessing severity of poisoning, 10 deaths were there in which 6 had <10% of plasma cholinesterase activity, 8 out of these 10 patients had elevated amylase level. Conclusion: OP poisoning is associated with elevated amylase level. Serum amylase, lipase can be used as an additional prognostic indicator along with plasma cholinesterase levels. Serum amylase could be considered as a better predictor of severity than lipase.
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Perception of general pediatricians in Riyadh towards vaccination of patients with congenital heart diseases
Mohammed Omar Alfakhri, Meshal Fahad Alhajji, Abdulrahman Mohammed Alyani, Yahya Zohair Murad, Abdulrahman Eissa Alghannam, Alwaleed Hamad Alqahtani
April 2020, 9(4):1878-1884
DOI:10.4103/jfmpc.jfmpc_1175_19  
Background: Congenital heart defected (CHD) children are often predisposed to numerous conditions ranging from arrythmias, infections, to heart failure. Proper implementation of vaccination plan and multidisciplinary acts are mandatory for maintaining such cases to reduce the mortality and morbidity. Furthermore, CHD are also at risk of vaccine adverse reaction and several blooddisseminated pathogens infections, and at risk of death if such events where to occur. Perception and Interpretation of the knowledge and experience of general pediatricians towards vaccination of patients with congenital heart diseases is a crucial element to understand, and to improve healthcare practice in Riyadh, Saudi Arabia. Aims: To clarify, our aim is to investigate views of different pediatricians in vaccination plans, to perceive junior and senior pediatricians, and to identify extra vaccines given to children with a congenital heart defect. Settings and Design: This study is a cross-sectional study that includes the distribution of 246 questionnaires through personal interview focusing on pediatric cardiologists and general pediatricians with varying years of practice and degrees. Study was conducted by six medical interns: Mohammed O. Alfakhri, Meshal F. Alhajji, Abdulrahman M. Alyani, Yahya Z. Murad, Abdulrahman E. Alghannam, Alwaleed H. Algahtani, in six different teritiary hospitals, King Abdulaziz Medical City (KAMC), King Fahad Medical City (KFMC), King Faisal Specialist Hospital (KFSH), King Salman Hospital, and Alyamamah Hospital, in Riyadh, Saudi Arabia. Methods and Material: Data was collected through a convenient sampling technique and was analyzed using SPSS (version 20) and rearranged to observe the most frequent information obtained from the questionnaire. Statistical Analysis Used: Categorical study was described in frequencies and bar charts. Chi-Square test of significance was used after the data entry to assess the significance of the values obtained. Results and Conclusions: There was no significant difference between the six hospitals. In the following study, 81.7% of the participants believe that patients with congenital heart diseases are combined immunodeficient, and 84.6% agreed on giving special\extra vaccine with no preference over live and\or killed vaccine. On top of that, participants believe that the extra vaccines given to congenital heart disease patients with combined immunodeficiency are meningococcal and pneumococcal vaccines, and the special vaccine given to them are respiratory syncytial virus (RSV) and influenza vaccine. To conclude, congenitally heart defected children are widespread worldwide. Children suffering from the disease are having a serious problem that affects their lives from its earliest. For that, our research mainly focuses on improving their lives by trying to reduce the effect of several other preventable diseases using vaccines as and when they need. Several other studies believed in giving extra/special vaccines that vary depending on the location of the study. However, in Riyadh, we found that most pediatricians agree on giving extra vaccines as meningococcal and pneumococcal, and RSV and influenza as special vaccines to children with congenital heart defects.
  - 690 105
Prevalence of obesity among hypertensive patients in Primary Care Clinic, Security Forces Hospital, Riyadh, Saudi Arabia 2017–2018: A prospective cross-sectional study
Eman A AlMarri, Jamal Al-Hamad
April 2020, 9(4):1885-1890
DOI:10.4103/jfmpc.jfmpc_1190_19  
Background: Saudi Arabians suffer from overweight and obesity which contribute significantly to the poor control of hypertension (HTN). Aim: To compare the percentage of HTN between obese and nonobese hypertensive patients who visit Primary Care Center in Security Forces Hospital (SFH), Riyadh, Saudi Arabia between (December-February) 2017–2018 and to calculate and compare the percentage of a number of antihypertensive medication usage in groups with different body mass index (BMI). Methods: This study was a prospective cross-sectional study which included all hypertensive patients on medication or patients with (BP >140/90) who attended the Primary Care Center in Security Forces Hospital (SFH), Riyadh, Saudi Arabia between (December-February) 2017–2018. Data were extracted from the computerized medical records database at the hospital. According to the practice followed at the hospital, the diagnosis of obesity was achieved based on a calculation of body mass ≥30. Results: About 56.1% of participants were females and 43.9% were males, the most prevalent age group of obese students (55.2%) was above 55 years. We also found that 2.1% of students were normal in weight whereas 1.3% of patients were underweight. A significant correlation with weight (89.02 ± 19.765) and BMI (34.742 ± 6.3818) was also noted (P value <0.001). Conclusion: This study revealed that most of the HTN patients in the SFH, Riyadh, Saudi Arabia, suffer from overweight and obesity that could contribute significantly to the incidence of HTN.
  - 678 104
Evaluation of the frequency of resistance to 2 drugs (Isoniazid and Rifampin) by molecular investigation and it's risk factors in new cases of smear positive pulmonary tuberculosis in health centers under the cover of Jundishapur University of Medical Sciences in 2017
Shokrollah Salmanzadeh, Masoumeh Karamian, Seyed Mohammad Alavi, Roohangiz Nashibi
April 2020, 9(4):1958-1962
DOI:10.4103/jfmpc.jfmpc_983_19  
Introduction: Despite the great efforts to control tuberculosis (TB), the disease is still one of the major health challenges throughout the world. The basic treatment for TB is drug therapy. Currently, the main anti-tuberculosis drugs with major use in the treatment and control of the disease are isoniazid, rifampin, pyrazinamide, ethambutol, and streptomycin. One of the serious crises in controlling TB epidemic is diagnosis and treatment of patients with Multidrug Resistant Tuberculosis (MDR-TB MDR). The purpose of the study was to examine and evaluate the resistance of mycobacterium TB strains isolated from specimens of newly diagnosed smear positive pulmonary TB to isoniazid and rifampin using molecular methods and their risk factors. Methods: Sputum samples of newly diagnosed smear positive pulmonary TB patients were prepared, collected, and sent to Reference Laboratory in Ahvaz. DNA of mycobacterium tuberculosis was prepared from the samples using Qiagen kit according to the instructions of the manufacturing company. Isoniazid resistance was evaluated using specific primers for inhA and KatG genes. Rifampin resistance was evaluated using MAS-PCR method with three specific alleles of rpobB codons and codons 516, 526 and 531. Results: Mycobacterium tuberculosis resistance to Isoniazid was 7.3%, to Rifampin 5.5% and to both drugs 1.8%. In our study, there were no association between drug resistance and gender, age, prison history, smoking, drug use, underlying disease, occupation, and HIV. Conclusion: According our findings that include prevalence of 7.3% Isoniazide resistance, 5.5% Rifampin resistance and 1.8% to both drugs, evaluating all newly diagnosed patients for resistance to standard anti-tuberculosis treatment seems rational.
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Prevalence of myocardial bridge in angiographic population—A study from rural part of western India
Sunil K Karna, Mahendra Chourasiya, Rohan P Parikh, Tanvi Chaudhari, Utsav Patel
April 2020, 9(4):1963-1966
DOI:10.4103/jfmpc.jfmpc_1075_19  
Introduction: Intramural course of coronary artery is known as myocardial bridge (MB). Its prevalence is highly variable. Very few studies have been conducted in India, mostly from southern state and that too covering urban population. There are no studies from western India. In this study we aimed to estimate the prevalence of MB in coronary angiogram from rural part of western India. Methods and Results: A total of 4,438 patients underwent coronary angiography for various indications during the study period of 69 months. Mean age of the study population was 53.6 ± 11.2 years. MB was found in 212 (4.77%) of patients, predominantly in males. Unstable angina was the most common presentation among males (28.7%), whereas chronic stable angina was being the most common presentation among females (22.6%). Majority of MBs were seen in left anterior descending artery in its mid part (61%). Mean diameter compression of the affected segment was 32.6% ± 11.8%, with no significant difference seen among males and females or between mid and distal left anterior descending artery. Conclusion: Our study showed the prevalence of MB similar to other Indian studies. Left anterior descending artery was most common artery involved. Mean compression was not statistically significant among either sex.
  - 649 82
Identifying health priorities among workers from occupational health clinic visit records: Experience from automobile industry in India
Melur Sukumar Gautham, Banavaram Anniappan Arvind, Kupatira Kowshik, Banandur S Pradeep, Gopalkrishna Gururaj
April 2020, 9(4):1967-1973
DOI:10.4103/jfmpc.jfmpc_1107_19  
Context: Occupational health surveillance in India, focused on notifiable diseases, relies heavily on periodic medical examination, and isolated surveys. The opportunities to identify changes in morbidity patterns utilizing data available in workplace on-site clinics is less explored in India context. Aims: Present paper describes longitudinal assessment of morbidity patterns and trends among employees seeking care in occupation health clinic (OHC). The study also intends to explore associations between work department, clinic visits and morbidity pattern. Materials and Methods: Record-based analysis was undertaken on data available (for the period 2010-2014) from two OHCs in a leading automobile industry in India. The doctor, examining every employee, documented the provisional diagnosis in specific software which in turn provides summary diagnosis based on affected body organ system as per ICD-10 categories. This information was used to assess the morbidity pattern and trend among workers. Chi-square test of significance and Extended Mantel-Haenszel chi square test was used assess the association and its linear trend. Results: Respiratory, musculoskeletal and digestive system related diseases were the top three reasons for employees visit to OHC. The nature of morbidity varied across different departments in the industry. There was a significant increase in proportion of employees visiting OHC during 2010-2014. Conclusion: A clinic visit record, with its own strengths and limitations, provides information on morbidity pattern and its trends among workers. Such information will help plan, implement and evaluate health preventive, promotive, and curative services.
  - 627 74
Effect of depression on attentional network system among rheumatoid arthritis patients—A cross-sectional study
Neha Chaurasia, Indramani L Singh, Tara Singh, Trayambak Tiwari, Anup Singh
April 2020, 9(4):1974-1980
DOI:10.4103/jfmpc.jfmpc_1161_19  
Rheumatoid arthritis (RA) is a chronic, painful and debilitating musculoskeletal condition with depression being its common co-morbidity. It is associated with symptoms of fatigue, pain, and sleep disturbances that can overlap with or mimic symptoms of depression. It may occur with at least mild severity is up to 42% of RA patients. Basically, depression refers to a constellation of experience including not only mood but also physical, mental and behavioral experiences. The fact that rates of depression are higher in samples of patients with RA than in the normal population is well documented. The present study was conducted in order to examine the effect of depression on attentional functioning with diagnosed RA patients. Twenty RA patients out of which 10 patients with depression and 10 patients without depression participated in the study. The Beck Depression Inventory was administered for the assessment of depression and the attentional network task was used to measure the attentional performance of the RA patients. Results revealed that there was a significant difference in depressive symptoms among RA patients on accuracy and reaction time (P < 0.01) and orienting effect (P < 0.05). The findings would also imply intervention and rehabilitation of depression among RA patients.
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Perception and simplified question for assessing problems sleeping among university students at a primary care unit
Varisara Luvira, Nisachon Butsathon, Pat Nonjui, Phahurat Deenok, Wilawan Aunruean
April 2020, 9(4):1981-1985
DOI:10.4103/jfmpc.jfmpc_1206_19  
Introduction: Students entering university undergo various lifestyle changes, many of which may affect their sleeping habits. This study aimed to evaluate 1) individual perception of the problems sleeping, 2) "actual" problems sleeping as detected using a simplified questionnaire, 3) the relationship between individual perceptions and actual problems sleeping, and 4) the factors affecting the problems sleeping. Methods and Material: This was a descriptive study of 240 university students who attended the "123 Primary Care Unit" for no sleep-related problems between March and June 2019. The tool was a self-response questionnaire that assessed the respondent's demographic data and sleep patterns over the past year. All parameters and problems sleeping were analyzed for their association. Results: Most of the students (51.3%) perceived themselves as having problems sleeping. Actual problems sleeping was found in 174 (72.5%) students. Individual perception was significantly related to the presence of all four of the problems sleeping assessed, which included difficulty in initiating sleep, waking up at night and being unable fall back to sleep, the need for daytime napping, and the feeling that one is sleep deprived (P < 0.05). Conclusions: This study provides a simplified method for assessing problems sleeping among university students at a primary care facility. Most of the students had problems sleeping and accurate perceptions of those problems sleeping, but the problems sleeping were often ignored. Further improvements to the system for screening and treating problems sleeping are required.
  - 520 76
Relationship between nutritional habits and school performance among primary school students in Asser Region
Youssef Alqahtani, Ohood A. A Assiri, Nouf S. S Al-Shahrani, Noha S. S Alyazidi, Malak S. H Alshahrani
April 2020, 9(4):1986-1990
DOI:10.4103/jfmpc.jfmpc_885_19  
Background: Healthy nutrition is a necessary for people mental health, because of that nutritional habits effect on school performance. So, a high sugar intake, fat, and fast food meals have a strong relationship with low academic performance and lot of diseases like metabolic disease in other researches of pediatric age group. Aim: To assess nutritional habits and its relation with school performance among primary school students in Aseer region, Saudi Arabia. Methods: A cross-sectional study was conducted in targeting parents of primary school children in Aseer region. Data were collected using pre-structured online questionnaire. Questionnaire was available online using social media programs to be answered by students' mothers. Residence was initial question to confirm residency at Aseer region. Results: A total sample of 357 respondents with their children ages ranged from 6- to 18-year-old and 62.7% of their children were females. Exact 81% of the students had 3 meals daily and 88% had their breakfast before going to school. About 75% of the sampled mothers reported excellent grade for their student school performance. Also, significant association of school performance with breakfast intake and fast food was recorded. Conclusions: In conclusion, the study revealed that the students had an averaged eating habits regarding meals number specially breakfast and contents. Fast food was recorded among two thirds of the students which is negative finding. Also, school performance was very good and significantly associated with eating habits specially breakfast intake and fast food frequency.
  - 891 129
Social determinants in access to tobacco prevention and cessation support services among migrant construction workers in Urban Chennai, India
Sree Sucharitha Tirukkovalluri, Balaji Arumugam, N Gunasekharan, E Suganya, T Akhshaya Ponsuba, S Divyadharshini
April 2020, 9(4):1991-1998
DOI:10.4103/jfmpc.jfmpc_1072_19  
Context: In spite of the high burden of tobacco consumption among migrants, disparities in the awareness of tobacco-related harms, health-seeking behaviors, and intention to switch to lower risk alternatives remain understudied area. Aims: Assess the social determinants in access to tobacco prevention and cessation support services among migrant construction workers in urban Chennai, India. Settings and Designs: A community-based, cross-sectional study design. Materials and Methods: A questionnaire adapted from GATS survey was used among migrants working across 13 construction sites of Chennai during May–September 2019. A counseling session was provided for the migrant workers who were willing to quit. Statistical Analysis Used: Data entered in MS Excel was analyzed using SPSS and multivariate analysis was performed. Results: Among 345 migrants, 338 (98%) were currently using tobacco and smokeless tobacco (57.4%) consumers. In spite of awareness (84.6%) about tobacco ill-effects on health, only 48% care providers enquired of the tobacco use in the previous one year. Pictorial health warnings were seen by 315 migrants (91.3%) in the past one month, but only 110 migrants (34.9%) considered quitting. The majority (341 migrants, 98.4%) have not heard of the lower risk alternatives such as nicotine gums and lozenges and only 89 migrants (26.33%) agreed to try lower risk alternatives for tobacco on trial basis. Migrant construction workers who were using tobacco less than 5 years (P = 0.001) were more likely to try lower risk alternatives. Conclusions: Reappraising social determinants in access to tobacco prevention and cessation support services to migrant construction workers may be a promising strategy to reduce health harms of tobacco intake.
  - 664 85
Awareness about breast cancer in males in urban area of Delhi
Anjana Goyal, Jigyasa Gupta, Anushka Choudhary, Kadambari Harit, Kaja Sai Ragesvari, Ishu Gupta
April 2020, 9(4):1999-2001
DOI:10.4103/jfmpc.jfmpc_1098_19  
Background: Breast cancer in males is still an issue that is not known to majority of the population across the globe. People in general are not aware that breast cancer can occur in males too as increasing campaigns are done to raise awareness in females. Objective: To assess the level of awareness of male breast cancer (MBC) in males of urban population residing in the Soami Nagar colony, Panchsheel, New Delhi. Methodology: A cross sectional survey was conducted through a self-administered questionnaire to know the awareness of the occurrence of MBC, its diagnosis and criticality. Results: It was found that only 19% of men were aware of the fact that breast cancer can occur in males as well and remaining 81% were ignorant. Conclusion: Because a whopping 81% of the surveyed population did not know that breast cancer could even occur in males, they were made aware about all the symptoms to look for and not to ignore any sort of bulge/lumps/knots that they may feel in their breast region or under the armpits. Findings of this study would serve as a baseline to focus on making people aware of this life threatening problem. Increased awareness of MBC would help males to discuss the problem in initial phase and reach out to primary health care physicians for early diagnosis and treatment.
  - 605 87
Comparative evaluation of bite force in paediatric patients
Rohit Singh, Supriya Singh, Anju Jha, Sovendu Jha, Ajit Kumar Singh, Shashi Kumar
April 2020, 9(4):2002-2005
DOI:10.4103/jfmpc.jfmpc_1135_19  
Aim: The present study aimed at analysing the probable effects of full mouth oral rehabilitation on bite forces at their maximum extent in young paediatric patients with primary as well as mixed dentitions. Methodology: The present study is one of a kind and explores the maximum bite forces in young children. A statistically significant number of children (n = 30) with a mean age of 6.54 years. About 44.75% were boys and 55.25% were girls. The maximum voluntary bite force was assessed for each participant immediately before treatment and 1 month (3–5 weeks) following completion of the needful dental treatment. The difference in bite force magnitude before and after dental treatment was analysed statistically. In addition, the correlations of key variables including, age, height, weight, BMI, gender and caries severity or dental status with maximum bite force were statistically analysed. Results: The mean maximum bite force for the total sample (n = 30) prior to treatment was found to be 167.83 N (SD = 65.20). The mean bite force in the male subgroup was 175.39 N (SD = 64.69) while for the females the mean bite force was equal to 166.29 N (SD = 68.93). Following comprehensive dental treatment, the recorded mean maximum bite force for the children (n = 30) who attended the post-treatment review appointment was 182.60 N (SD = 68.58). Conclusion: The essential factors such as the extent of dental caries, their severity, presence of clinical signs and symptoms has a negative impact on maximum bite force.
  - 650 112
A comparative study of sleep quality in different phases of the medical course: A study from Haryana (North India)
Shilpi Gupta, Anu Bhardwaj, Anuradha Nadda, Angad Gill, Anshu Mittal, Sachin Gupta
April 2020, 9(4):2006-2010
DOI:10.4103/jfmpc.jfmpc_1137_19  
Background: Inadequate sleep quality is a crucial problem in today's hectic lifestyle. Sleep is known to facilitate cognitive skills, aid memory, and is important for physical, emotional and intellectual health. Objectives: To determine the sleep quality of the medical undergraduate students and to explore differences in various phases of medical curriculum. Material and Methods: Sleep quality was assessed in 400 medical students in various phases of the medical course using the Pittsburgh Sleep Quality Index (PSQI). Chi square test was used for comparisons of the all seven components of PSQI and sleep quality for different study year, whereas ANOVA was used for comparison of the components and global score. Results: Of the total, 25.3% of the participants classified their sleep quality as either very or fairly bad, and 31.1% reported taking more than 30 min to fall asleep. The average hours slept per night was 7.1 ± 1.21. Of the total, 8.4% of the participants reported using sleep medication at least once a week. Subjective sleep quality and sleep duration were found to be significantly different among the four groups. Conclusion: Poor subjective sleep quality was high for students in all class years of the undergraduate medical course. The comparison across the various phases of the course showed that first years reported worse sleep quality than did those in other class years.
  - 535 93
Comparative evaluation of fracture resistance of simulated immature teeth and its effect on single visit apexification versus complete obturation using MTA and biodentine
Pawan Darak, Manoj Likhitkar, Shachi Goenka, Abhinav Kumar, Priyanka Madale, Ashwini Kelode
April 2020, 9(4):2011-2015
DOI:10.4103/jfmpc.jfmpc_1145_19  
Aim and Objectives: This study sought to evaluate and compare the fractured resistance of simulated immature teeth and the effect of single visit apexification versus complete obturation using MTA and biodentine. Material and Methodology: Forty-five freshly extracted sound maxillary central incisors with single canal were selected. The apical 5 mm of each sample was then sectioned to simulate Cvek's stage 3 root development access cavity preparation, followed by preparation using peeso reamers. Irrigation was carried out followed by randomization of samples. Obturation was performed using different materials. Fracture resistance was checked under universal testing machine, by recording the ultimate load to fracture in Newtons. Statistical Analysis: Statistical analysis was performed using SPSS 20.0 Software. One-way analysis of variance followed by pair wise comparison of the groups was performed using Tukey's post-hoc test. The significance level was set at P < 0.05. Results: All the experimental groups showed statistically higher value of fracture resistance than the control groups. Group I (entire canal obturated with MTA) reported highest value of fracture resistance followed by group III (entire canal obturated with biodentine), group II, and group IV. Conclusion: In apexification cases, reinforcing the immature teeth with bioceramic materials such as MTA and biodentine is advantageous. Clinical Significance: Clinically in patients, high success rate of apexification can be achieved with complete MTA obturation as compared to MTA and biodentine apical plug and gutta percha obturation.
  - 1,018 189
The perception of Swachh Bharat Abhiyaan and attitude towards cleanliness among dental students of Kanpur city: A cross-sectional study
Rahul Srivastava, Devina Pradhan, Lokesh Sharma, Omveer Singh, Shruti Gupta, Shekhar Mukherjee
April 2020, 9(4):1904-1909
DOI:10.4103/jfmpc.jfmpc_93_20  
Background: The Swachh Bharat Abhiyan (SBA) is the most significant cleanliness campaign by the Government of India. Youth are the strong pillars of the development of any country. There is a need to bring a big change to the youth about the cleanliness drive. This study aims to assess the perception of SBA and attitude towards cleanliness among dental students of Kanpur city. Materials and Methods: This study is a descriptive, cross-sectional survey, which comprised of 390 undergraduate and postgraduate students. A pretested, self-administered, close-ended questionnaire consisting of 11 questions were included to evaluate the perceptions and attitudes regarding SBA among the dental students. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.). Categorical data were compared using the Chi-square test. All values were considered statistically significant for a value of P ≤ 0.05. Results: The results of the study revealed that there is a positive attitude among study participants towards cleanliness, but efforts are still required to emphasize the importance of cleanliness among the many inhabitants. To implement SBA effectively, it is important to highlight the urgent need for public awareness. Conclusion: This study found that the majority of the participants was having positive attitude and perception towards SBA, yet initiatives and approaches are still needed to help bring positive actions among those who are reluctant to follow proper cleanliness, sanitation, and hygiene practices.
  - 767 103
Effectiveness of a community health worker (CHW) training in monitoring and care of patients with chronic obstructive pulmonary disease (COPD) in rural Gujarat, India
Ashish V Gupta, Ajay G Phatak, Meha U Patel, Neha Das, Nirav P Vaghela, Harihara Prakash, Shyamsudar J Raithatha
April 2020, 9(4):1910-1914
DOI:10.4103/jfmpc.jfmpc_1193_19  
Context: Chronic obstructive pulmonary disease (COPD) is the second leading contributor to the disease burden of India. The current COPD burden cannot be managed effectively just through a physician-based approach. In a primary care setting, community health workers (CHWs) can play an effective role in making COPD care accessible and effective. Aim: Findings of an assessment of a training program for CHWs on COPD have been reported here. Methods: 90 CHWs working as a part of a noncommunicable disease prevention and care program in a rural primary care setting were exposed to a series of five training sessions. The sessions were designed and administered jointly by a team of public health experts and physiotherapists in the year 2017–18. Topics covered were basic clinical aspects of COPD, monitoring a patient with COPD, and basic aspects of pulmonary rehabilitation. The assessment comprised 12 MCQs and short questions, 7 video exercises, 2 case vignettes, and 5 skill assessments through objectively structured clinical examination (OSCE). Statistical Analysis: Mean percentage scores were calculated for each domain of assessment to make it comparable. Results: 70 CHWs with a mean age of 42.2 years completed all the training and underwent the assessment. Mean percentage score (SD) for knowledge was 62% (16.3). In OSCE assessment, scores were best in sputum clearance technique demonstration (92.1%) and the least in dyspnea relieving positions (59.2%). The CHWs had difficulties in identifying signs of respiratory distress (score - 55.1%). No statistically significant association was observed between performance scores and their sociodemographic profile. Conclusion: The results were encouraging and the program may be pilot tested in a government setting particularly using the health and wellness centers (HWC) platform.
  - 781 107
Detection of Red complex bacteria, P. gingivalis, T. denticola and T. forsythia in infected root canals and their association with clinical signs and symptoms
Sonia Tiwari, Sudhanshu Saxena, Aarti Kumari, Silpi Chatterjee, Adreet Hazra, Alok Ratan Choudhary
April 2020, 9(4):1915-1920
DOI:10.4103/jfmpc.jfmpc_1177_19  
Aim: This study aimed to investigate the association between endodontic clinical signs and symptoms and the presence of Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia employing polymerase chain reaction (PCR). Materials and Methods: Microbial samples were obtained from 60 cases with necrotic pulp with primary teeth infections. DNA extracted from samples were analyzed for endodontic pathogens by using species-specific primers. Results: P. gingivalis/T. denticola were detected in 15 symptomatic teeth associated with periapical lesions. T. forsythia/T. denticola were found in 16 symptomatic teeth associated with pain and swelling. P. gingivalis was detected in 9 teeth which were associated with pain, 2 with tenderness on percussion, and 15 with periapical lesions. Statistically significant associations were found between T. forsythia as well as T. denticola in relation to clinical findings of pain and swelling. (P < 0.05). Red complex bacteria showed no statistical significant association with the presence of signs and symptoms. Conclusion: Prevalence of P. gingivalis, T. denticola, and T. forsythia suggested association of these bacteria with symptomatic infected pulp and periradicular diseases.
  - 780 98
Assessment of adherence and factors contributing to non-adherence among patients on anti-retroviral therapy in a tertiary care hospital: A cross sectional study
Rujuta S Hadaye, Vyankat B Jambhale, Shruti Shastri
April 2020, 9(4):1921-1926
DOI:10.4103/jfmpc.jfmpc_1138_19  
Background: For the successful treatment of human immunodeficiency virus (HIV), it is important that drugs should be taken regularly. Non-adherence not only increases chances of failure of treatment but also leads to the development of resistance to drugs and hence more focus has been given to adherence in the treatment protocol of HIV. Objectives: To determine the level of adherence, its determinants, and to ascertain reasons for non-adherence of antiretroviral therapy (ART) in patients with HIV/acquired immunodeficiency syndrome (AIDS). Methods: A cross-sectional study conducted at an adult ART clinic over a period of one year. The sample size was 320. A systematic random sampling technique was used. Semi-structured Adult AIDS Clinical Trials Group questionnaire was used. Beck Depression Inventory (BDI-II) for current depression and self-report of four days recall method and multi-method approach were used for adherence measurement. Results: The mean age of respondents was 37.26 ± 8.3 years. About 60.3% were males, 34.1% females, and 5.6% were transgenders (TGs). High adherence was found in 87.2% by self-report and 72.5% by multi-method approach. History of opportunistic infection and depression were found to be the best predictors of adherence. Reasons for short term non-adherence were found to be simply forgot to take medications, being away from home, busy with other things, and ran out of pills. Reasons for long-term non-adherence were financial difficulty, side-effects, and shift to alternate therapy. Conclusions: Significant non-adherence to ART necessitates addressing adherence issues in pre-ART counseling, the involvement of family and social support.
  - 512 79
A prospective study on bacteriological profile and antibiogram of postoperative wound infections in a tertiary care hospital in Western Rajasthan
Himanshu Narula, Gaurav Chikara, Pratima Gupta
April 2020, 9(4):1927-1934
DOI:10.4103/jfmpc.jfmpc_1154_19  
Background: Surgical site infections (SSI) are one of the most common hospital-acquired infections worldwide. SSI are known to increase morbidity, mortality, length of stay in hospital as well as the cost of treatment to the patients. The incidence varies from 1% to 20% among developed countries to as high as 40% in developing world. Aims: To find the incidence and risk factors, bacteriological profile, and antibiogram for SSI in General Surgery department of a tertiary care hospital in Western Rajasthan. Methods: Culture and sensitivity of wounds of all the clinically suspected cases of SSI were taken. Bacterial identification and antimicrobial susceptibility were performed according to standard CLSI guidelines. Statistical analysis was done using Microsoft Excel, SPSS 13 software. Results: Among total 609 patients, 102 were clinically suspected SSI and 88 were culture positive. Incidence of SSI was 14.45%. The most common organism was Staphylococcus aureus followed by Klebsiella pneumoniae. Most of the Gram-positive isolates were resistant to penicillin and cephalosporin antibiotics and were moderately susceptible to fluoroquinolones and aminoglycosides. Gram-negative isolates were resistant to beta-lactam and beta-lactam/beta-lactamase inhibitor combination also but were susceptible to fluoroquinolones, aminoglycosides, and carbapenems. Conclusion: High incidence rate of SSI in our setup emphasizes the need of quality surgical care which takes into consideration all the three important factors, i.e. host, environmental, and microorganism characteristics before doing any surgery. Increasing resistance to commonly used antibiotics warrants the judicious use of antibiotics and establishment of antibiotic policy in the hospital.
  - 1,153 160
A cross-sectional study of awareness and practices regarding thalassemia among parents of thalassemic children
Ankur Jain, Shafali Singla, Samridhi Lakhanpal, Ira Jain
April 2020, 9(4):1935-1938
DOI:10.4103/jfmpc.jfmpc_1035_19  
Background: This cross-sectional study was carried out in thalassemia ward of Rajindra Hospital, Patiala, among the parents of thalassemic children to determine awareness about side effects and complications of blood transfusion therapy, other treatment options, nature of disease, and food practices of transfusion-dependent patients. The study was carried out using a predesigned questionnaire and 118 parents participated in the study. About 50.84% patients belonged to the Sikh community, 45.76% patients practiced Hindu religion, and only 3.38% of the patients were Muslim. This study shows that 87.29% parents do not know how the disease is spread. About 55.93% have no knowledge about iron-containing food should not be included in the diet of transfusion-dependent patients. About 86.44% parents believed they had no role in transmission of the disease to their child, 79.66% parents do not understand the importance of screening before marriage, and 95.76% parents do not know about alternative treatment options. This study wants to shine light about the inadequate and superficial knowledge of thalassemia among general public and how awareness of the disease will bring down the incidence rates. Aims: The main objective of the study is to determine the degree of awareness of the disease, their knowledge of complications of blood transfusion therapy, and other treatment options among the parents of the children with thalassemia who are currently on blood transfusion therapy. Subjects and Methods: This cross-sectional study was conducted in thalassemia ward of Rajindra Hospital, Patiala from June 2018 to November 2018. After informed verbal consent was ensured, parents of the patients were interviewed using a questionnaire as the patients received blood transfusion. Questions include prevention, progression, cause, and spread, of the disease. The questions also include side effects and complications of blood transfusion therapy and other treatment options available. Statistics Used: Continuous variables were summarized as mean and standard deviation and categorical variables as proportion (%). Percentage and frequency was used wherever applicable. Results: Parents of about 118 patients were interviewed out of which 74.57% parents were illiterate and only 25.42% were literate. About 50.84% of the patients were Sikh, 45.76% were Hindu, and only 3.38% patients were Muslims. About 71.19% of the parents had no knowledge about the prevention of the disease, and 87.29% of the parents did not know mechanism of spread. Despite having transfusion-dependent children, only 44.07% of the parents restricted iron-containing food from the diet of their children. About 72.05% of the patients have inadequate information about risk of hepatitis B, hepatitis C, and HIV due to blood transfusions and only 21.29% of the patients understand the importance of hepatitis B vaccine. Conclusion: Awareness among both literate and illiterate parents was inadequate and sensitization among general public and parents of thalasemmic children should be initiated.
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Evaluation of hand hygiene compliance over the years, in an intensive care unit of a north Delhi hospital preparing for accreditation: A 3-year study
Tanisha Bharara, Renu Gur, Shalini Duggal, Vandana Chugh
April 2020, 9(4):1939-1943
DOI:10.4103/jfmpc.jfmpc_1050_19  
Introduction: World Health Organization (WHO) initiated a global movement to achieve universal health coverage (UHC). Hand hygiene (HH) is critical for achieving UHC as it is a practical and evidence-based approach with a gaugeable impact on the quality of care and patient safety in healthcare. Material and Methods: A cross-sectional observational study was conducted in an intensive care unit of a government hospital spanning a period of 3 years. WHO single-observer direct observation technique was used and HH compliance was noted. The results were compared over the years since the hospital was preparing to undergo a National Accreditation Board for Hospitals and Healthcare (NABH) assessment. Results: The overall compliance significantly increased over the years (P < 0.0001). HH compliance for hand rub (HR) and hand wash (HW) was compared among doctors, nurses, and ICU technicians, respectively. HR compliance remained more or less the same over the years (P = 0.4738) while HW compliance significantly improved (P < 0.0001). Conclusions: This is one of the first studies from our country evaluating HH compliance over the years in a healthcare setup undergoing accreditation. During the course of the study, we observed a significant increase in HH compliance. This can be attributed to the unflinching support of our hospital's administration and relentless efforts of our infection control team. This is our first step initiative towards improving HH and thus preventing healthcare-associated infections (HCAIs) in our setup.
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Correlation of pharmacy students' knowledge, attitude, and practices with their oral health status in Salem city—A cross-sectional survey
Priya Deepa Lakshmi K, C Bharath, S Venkatalakshmi, N Saravanan
April 2020, 9(4):1944-1949
DOI:10.4103/jfmpc.jfmpc_1172_19  
Background: Pharmacy is the health profession that links the health sciences with the basic sciences also contributes in health maintenance and promotion for the population. Objectives: The primary objective was to assess knowledge, attitude, and practice (KAP) among pharmacy students in Salem toward oral health. Secondary objectives are to correlate KAP with their oral health status. Methods: A descriptive cross-sectional study was carried out using self-administered 16-item pretested and pre-validated questionnaire and oral health status data were collected using the WHO oral health assessment form (1997) targeting pharmacy students Vinayaka Missions College of pharmacy. Six, four, and six questions were used to assess pharmacy students' knowledge, attitude, and practice, respectively. Data analysis was done using SPSS version 20.0 to perform the Chi-square test, Mann-Whitney, Kruskal-Wallis, Spearman's correlation, and linear regression analysis. Results: 386 participated in the survey (263 males and 123 females). The highest mean for knowledge was among 17–21 years of age group students (18.07 ± 3.07) and this was statistically significant when compared to another age group (P < 0.05). The gender difference was seen with males having a significantly (P < 0.001) more positive mean ± SD oral health KAP compared to their female counterparts. KAP scores upon correlation revealed a positive relationship between knowledge-attitude (r = 0.015), knowledge-practice (r = 0.016), and attitude-practice (r = 0.069). Conclusion: Results of this study suggest that oral health KAP of students is inadequate and needs to be improved as they play an important role in the patients' counseling toward oral care.
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POSITION PAPERS
Ensuring continuity of care by small family practices and clinics in the primary care setting during COVID 19 pandemic 2020 - A position paper by the Academy of Family Physicians of India
Raman Kumar, Vandana Boobna, Mohan Kubendra, Resmi S Kaimal, Jachin Velavan, Sreenivas Venkapalli
April 2020, 9(4):1798-1800
DOI:10.4103/jfmpc.jfmpc_620_20  
The world is passing through a global pandemic of COVID 19. The number of positive cases has crossed over twenty thousand as of April 2020. Like everyone else, it is indeed a very challenging situation for family physicians and primary care providers as most of the guidelines presently have focused on screening, quarantine, isolation, and hospital-based management. Limited information or clarity is available on running small private clinics during pandemic times. The key concern is professional obligation versus risks of community transmission. Family physicians see routine flu-like illnesses throughout the year with seasonal variation within their practices. This document is intended to develop consensus and standard practices for the family physicians and other primary care providers during the pandemic, ensuring optimal continuity of care. This document was reviewed by the national executive of the Academy of Family Physicians of India and approved for dissemination among members. However, due to the dynamic status of the pandemic, all practitioners are advised to closely follow the instructions, guidelines, and advisories of national, state and local health authorities as well.
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Framework for development of urgent care services towards strengthening primary healthcare in India – Joint position paper by the Academy of Family Physician of India and the Academic College of Emergency Experts
Pritam Roy, Raman Kumar, Praveen Aggarwal, Rajeshwari S Vhora, Manish Gupta, Vandana Boobna, Ramkumar Gupta, Sukrit Kumar
April 2020, 9(4):1801-1804
DOI:10.4103/jfmpc.jfmpc_286_20  
Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India.
  - 767 84
REVIEW ARTICLES
The epidemiology of edentulism and the associated factors: A literature Review
Mohammed A Al-Rafee
April 2020, 9(4):1841-1843
DOI:10.4103/jfmpc.jfmpc_1181_19  
Considering the advancement of curative and preventive dentistry, edentulism is still a challenging problem for healthcare providers all over the world. Dental caries and periodontal diseases are the main causative factors to teeth loss and eventually, if untreated, lead to edentulism. The socioeconomical factors also contribute to the edentulism as it has an association with education and income status. This literature review will put some highlights in the epidemiology and etiology of edentulism, its prevalence, and the association with the social-economical factors.
  - 1,795 281
Factors affecting supportive needs in hemodialysis patients: A literature review
Attieh Nikkhah, Shohreh Kolagari, Mahnaz Modanloo
April 2020, 9(4):1844-1848
DOI:10.4103/jfmpc.jfmpc_984_19  
Background: Explaining the factors affecting supportive needs of patients under hemodialysis seems to be essential to supply their needs. Also, it can help healthcare providers to make favorite decisions about care planning to improve the patients' quality of life. Objective: This study was conducted to determine the factors affecting supportive needs in hemodialysis patients using a literature review. Methods: This literature review was carried out in PubMed, MEDLINE, SCOPUS, SID, Magiran, and Iranmedex. Data based were searched from 2000 to 2018 using the keywords of "Need", "Supportive Need", and "Hemodialysis". In a total of 239 full texts of published articles, 12 such relevant articles were selected. Results: The finding showed that the factors affecting the supportive need of patients can be categorised into two: internal and external factors. Internal factors consist of patient-related factors, disease-related factors, and treatment-related factors. External factors consist of personal living circumstances, health system-related factors and socioeconomic factors. Conclusion: By explaining the factors affecting supportive need in hemodialysis patients, it may help clinicians and researchers to identify the patients' need, developing an appropriate questionnaire, and implementing suitable intervention. As a result, it can improve their quality of life.
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A review of genetics of nasal development and morphological variation
Prateek Gupta, Tulika Tripathi, Navneet Singh, Neha Bhutiani, Priyank Rai, Ram Gopal
April 2020, 9(4):1825-1833
DOI:10.4103/jfmpc.jfmpc_1265_19  
The nose is central in the determination of facial esthetics. The variations in its structural characteristics greatly influence the ultimate dentoskeletal positioning at the end of an orthodontic therapy. A careful insight into its developmental etiology will greatly aid the health care professional in identifying patient's real concern about the facial appearance. This in turn will aid in the fabrication of a better treatment plan regarding the end placement goals for the teeth and jaws in all the three dimensions of space. However, this important structure is often missed as a part of the diagnostic and treatment planning regime owing to the lack of meticulous understanding of its developmental etiology by the orthodontists. The development of the nose in the embryo occurs in pre skeletal and skeletal phases by a well-coordinated and regulated interaction of multiple signaling cascades with the crucial importance of each factor in the entire mechanism. The five key factors, which control frontonasal development are sonic hedgehog (SHH), fibroblast growth factors (FGF), transforming growth factor β (TGFβ), wingless (WNT) proteins, and bone morphogenetic protein (BMP). The recent evidence suggests the association of various nasal dimensions and their related syndromes with multiple genes. The revelation of nasal genetic makeup in totality will aid in ascertaining the direction of growth, which will govern our orthodontic treatment results and will also act as a harbinger for potential genetic editing and tissue engineering. This article describes at length the morphological and genetic aspect of nasal growth and development in light of the gender and racial variability along with the emphasis on the importance of knowing these nasal features with regard to diagnosis and treatment planning in orthodontics.
  - 1,104 197
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