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  Most popular articles (Since February 12, 2014)

 
 
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ORIGINAL ARTICLES
A descriptive study to assess the knowledge and practice regarding menstrual hygiene among adolescent girls of Government School of Shimla, Himachal Pradesh
Anjali Mahajan, Kanica Kaushal
April-June 2017, 4(2):99-103
DOI:10.4103/cjhr.cjhr_103_16  
Introduction: Adolescent girls belong to vital age group, not only because they are the entrant population to motherhood but also because they are threshold between childhood and motherhood. The girls should be educated about significance of menstruation and development of secondary sexual characteristics, selection of sanitary menstrual absorbent and its proper disposal. Aims and Objectives: The objectives of the present study were to assess the existing knowledge and practice regarding menstrual hygiene among adolescent girls and to determine the co-relation of knowledge and practice score among the adolescent girls. Materials and Methods: The study conducted was a descriptive cross sectional study done on 100 adolescent girls from class 9th to 12th of Govt. Girls School in Shimla, Himachal Pradesh (Convenience sampling). Prior to the commencement of the study, they were explained the purpose and nature of the study. Information on demographic variables which include age, class, type of family, education of mother, family income, age of menarche were collected from the participants. Results: The data on knowledge scores revealed that 29% had adequate knowledge about menstrual hygiene, 71% had inadequate knowledge about menstrual hygiene. The data revealed on practice scores revealed that 19%, 69%, 12% samples had poor, fair and good score of practices regarding menstrual hygiene respectively. Knowledge and practice scores of participants shows positive correlation between the two scores (*P < 0.001). Conclusion: Lack of information about menstrual hygiene can be attributed to various factors which need to be studied separately. The above findings reinforce the need to encourage safe and hygienic practices among the adolescent girls and bring them out of traditional beliefs, misconceptions and restrictions regarding menstruation. The investigators improved the general awareness about cause of menstruation and the organs involved. Use of sanitary napkins was promoted and various schemes regarding menstrual health were briefed to the students. Early awareness can prevent students from suffering from the various reproductive tract infections.
  11,979 750 -
REVIEW ARTICLES
Oral manifestations of tuberculosis
Shekhar Kapoor, Sumir Gandhi, Nitasha Gandhi, Inderjot Singh
January-April 2014, 1(1):11-14
DOI:10.4103/2348-3334.126772  
Tuberculosis (TB) is still among the most life-threatening infectious diseases, resulting in high mortality in adults. A significant proportion of patients (15-25%) exist in whom the active TB infection is manifested in an extrapulmonary site. Healthcare workers, including dentists, are at the frontline and can make an important contribution to the control of this infectious epidemic. Oral TB has been considered to account for 0.1-5% of all TB infections. Nowadays, oral manifestations of TB are re-appearing alongside many forgotten extrapulmonary infections as a consequence of the outbreak and emergence of drug-resistant TB and of the emergence of acquired immune-deficiency syndrome.
  11,107 1,230 4
ORIGINAL ARTICLES
Study of histopathological patterns of endometrium in abnormal uterine bleeding
K Sajitha, Shetty K Padma, K Jayaprakash Shetty, HL KishanPrasad, Harish S Permi, Panna Hegde
April-June 2014, 1(2):76-81
DOI:10.4103/2348-3334.134265  
Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. The aim of the study was to analyze the histomorphological patterns of endometrium in patients presenting with AUB and also to determine the incidence of AUB in various age groups. Materials and Methods: This is a prospective study, conducted in the Department of Pathology, in a tertiary care teaching hospital, Mangalore from October 2011 till date. All cases of AUB with a probable endometrial cause were included in the study. Data was entered in Microsoft Excel and managed in Statistical Package for the Social Sciences (SPSS) version 16. Analysis was done in the form of percentages and proportions and represented as tables where necessary. Results: A total of 156 cases were analyzed. Patients' age ranged from 23-78 years. AUB was most prevalent in the perimenopausal age group. The most common presenting complaint was menorrhagia (47%). Endometrial hyperplasia was the most common histopathological finding and was seen in 25% patients, followed by secretory endometrium in 16.7% patients, and proliferative phase pattern and disordered proliferative endometrium were seen in 12.2% patients each. Malignancy was detected in 6.4% of cases and endometrial carcinoma was the most common lesion (4.5%). Conclusions: Histopathological evaluation of endometrial samples is especially indicated in women over the age of 35 years to rule out malignancy and preneoplasia. Among the patients with no organic pathology, normal physiological patterns with proliferative, secretory, and menstrual changes were observed. The most common endometrial pathology in this series was endometrial hyperplasia.
  7,470 949 -
A study of stress, anxiety, and depression among postgraduate medical students
Anjali N Shete, KD Garkal
April-June 2015, 2(2):119-123
DOI:10.4103/2348-3334.153255  
Introduction: Medical education is highly challenging and often places heavy demands on the mental health of the students. Stress is an external constraint which upsets an individual both mentally and physically. The postgraduate students suffer from higher stress that definitely affects the mental wellbeing of these students. Study Design: It is a cross-sectional, observational study. Objectives: The objective of the present study was to explore the level of stress, anxiety and depression among the postgraduate medical students. The secondary objective was to find out the factors affecting the stress, anxiety and depression level in these students. Materials and Methods: Fifty post graduate medical students of Government Medical College were selected. Depression, anxiety and stress scale 42 questionnaires were given for assessment of stress level. A completed scale was taken for assessment from the students. Result: The mean depression score was 6.26 ± 6.00, the anxiety score was 10.34 ± 3.91 and the mean stress score was 15.30 ± 3.93. The present study showed mild anxiety level and moderate level of stress in postgraduate students. The study showed a difference in stress level when compared for age and gender, but it was not statistically significant. When the stress level was compared for clinical and non-clinical departments; the difference was statistically significant. Conclusion: The present study concluded that a high level of stress is seen in postgraduate medical students. The study further concluded that there are various factors which can affect the level of stress. These factors should be assessed separately for the further study.
  7,410 712 1
A hospital based study of rickettsial diseases evidenced by Weil Felix test in a tertiary care hospital
Uttam Udayan, Meena Dias, Santosh Machado
July-September 2014, 1(3):150-153
DOI:10.4103/2348-3334.138883  
Introduction: Rickettsial infections, one of the re-emerging diseases are increasingly underdiagnosed due to nonspecific symptoms, absence of reliable and affordable diagnostic test and contribute substantially to the acute febrile burden and preventive illness in many populations. A delay in diagnosis and therapy are associated with increased morbidity and mortality. Objectives: To determine and categorize rickettsial disease titers by Weil Felix test, and to know the frequency of rickettsial diseases in febrile patients presenting to a tertiary hospital. Materials and Methods: In a prospective study, a total of 100 samples were tested by Weil Felix test from patients with fever and results were analyzed. Results: Out of 100 samples 64 were positive. Male preponderance was seen. The most common clinical symptom were fever, rash followed by hepatomegaly and splenomegaly. One patient with a high titer of more than 1280 died of encephalitis. Conclusion: In the absence of availability of a good reliable serological or molecular evidence, Weil Felix test can be used in the laboratories mainly due to cost and technical aspects of other reliable tests for diagnosis.
  6,081 332 1
Psychometric properties of a questionnaire assessing nursing professionals' knowledge regarding etiology and prevention of viral hepatitis B and C
Anita Thakur, Deepak Sharma
April-June 2014, 1(2):87-90
DOI:10.4103/2348-3334.134267  
Background: Viral hepatitis B and C are a global public health problem. For better targeting their detection and prevention, nursing professionals' should have adequate knowledge and skills. Aims and Objectives: This study aimed at developing a "viral hepatitis questionnaire" and then validating it among nursing professionals' working in a Medical College of North India. Materials and Methods: A fifteen-item questionnaire was developed by the principal investigator. This was based on a systematic search in database namely "PubMed" "IndMed" "Directory of Open Access journals" and "Google scholar". It was then administered to 318 nursing professionals'. The psychometric properties of the questionnaire were assessed in terms of construct validity and reliability. Results: The average age of the study subjects was 23.4 years (SD = 17.2, range = 18 years-54 years). Sampling adequacy as measured by Kaiser-Meyer-Olkin (KMO) test was 0.82. This indicated relevance of the factorial model. Varimax rotation revealed that all items had achieved the required loading of 0.3. The internal consistency ranged from 0.81 to 0.87. The intra class correlation coefficient ranged from 0.67 to 0.71. Conclusion: " Viral hepatitis questionnaire" (VHQ) appears to be a reliable and valid measure of assessing nursing professionals' knowledge about viral hepatitis B and C. Its periodic use can serve the purpose of assessing nursing professionals' training needs. It is further recommended that it should be tested among nursing staff in different healthcare facilities of India, in order to assess its wider performance.
  5,770 227 -
CASE REPORTS
Stroke after cold bath
Paulin S Benedict, Jeyaraj Durai Pandian
October-December 2014, 1(4):283-285
DOI:10.4103/2348-3334.143007  
Seasonal variation in stroke occurrence is well described. However, correlation between sudden cold water exposure and stroke is not documented in literature. We report two cases of ischemic stroke on sudden cold water exposure. Case 1: A 73-year-old male developed sudden left face, arm and leg weakness immediately after taking a dip in the holy waters of Amritsar Golden Temple, during peak winter. Case 2: A 48-year-old male developed right side weakness and fell in bathroom while taking bath in cold water at 6am. Studies show that both stroke and atrial fibrillation peak in winter. Pathophysiologically, sudden cold water exposure increases sympathetic tone, which is mediated by thermo-receptors, activated by the rapid fall in skin temperature. Superimposed on the hyper-dynamic circulatory situation during short-term cold water immersion, it induces a further increase in blood pressure. Cold water immersion or simply an exposure might increase the propensity for stroke, especially in high risk individuals.
  5,779 203 -
A rare case of male infertility: Sertoli only syndrome
Babulreddy Hanmayyagari, Mounika Guntaka, Srinagesh
January-March 2015, 2(1):64-67
DOI:10.4103/2348-3334.149350  
Sertoli cell-only syndrome (SCOS) is not an uncommon finding in testicular biopsies that are performed in patients with infertility. The salient histopathologic feature of SCOS is the absence of germ cells. Many of these patients have a normal karyotype and normal secondary male sexual characteristics, yet are infertile and azoospermic or severe oligozoospermic. This case report describes a 29-year-old male patient who presented with primary infertility, normal physical characteristics and hormonal profile with SCOS detected on testicular biopsy.
  5,548 326 2
ORIGINAL ARTICLES
Medical diagnostic laboratories provisioning of services in India
Rahi Jain, Bakul Rao
January-March 2015, 2(1):19-31
DOI:10.4103/2348-3334.149340  
Context: Diagnostic services have a very important role to play in medical decision-making, which have an impact on the nation's health status. The understanding of Indian diagnostic services provisioning has certain literature gaps. Aims: This study focused on understanding the functioning of provision of diagnostic services by Indian diagnostic laboratories. Materials and Methods: Exploratory field visits and literature review were used as tools to understand the Indian health system. Results: Indian diagnostic laboratory can be classified into various categories based on the type of services provided and governance. The difference in their financing, resources, quality assurance of services and patient access to services was found in these different laboratories. Conclusions: It was concluded from the study that patient's access to laboratory services is affected by the functioning of laboratories in terms of governance, financing, resources, quality assurance of services and patient services.
  4,975 406 2
Neonatal morbidity and mortality of sick newborns admitted in a teaching hospital of Uttarakhand
Ritu Rakholia, Vineeta Rawat, Mehar Bano, Gurpreet Singh
October-December 2014, 1(4):228-234
DOI:10.4103/2348-3334.142983  
Context: India accounts for 27.3% of total neonatal deaths in the world. This rate is highest in poor and marginalized areas like hilly regions of Uttarakhand that lack medical facilities. The newborns referred from here and admitted as outborn neonates contribute to the high neonatal mortality rate (NMR) of India. Aims : To study the demographic profile and morbidity-mortality pattern of neonates admitted in Sick Neonatal Care Unit (SNCU) and study the difference between inborn and outborn neonates. Study Design: Retrospective study of medical records for 1 year (2013-2014). Subjects and Methods: The age, sex, gestational age, and morbidity and mortality profile of all SNCU admissions in 1 year was determined, and the difference between inborn (those born in Teaching Hospital) and outborn (neonates delivered outside and referred) was calculated. Modifiable risk factors to reduce NMR in Uttarakhand were determined. Statistics: The data were analyzed using appropriate statistical tools in software Statistical Package for the Social Sciences (SPSS)-18. Results : Of the 721 neonates admitted, 63.25% neonates were males, and 53.54% were outborn and 46.46% inborn. Approximately, 60% were low birth weight and 50% preterm. Respiratory distress syndrome (RDS) (21.9%), sepsis (19%), perinatal asphyxia (16.37%), and jaundice (12.9%) were the chief morbidities. The chief causes of mortality were prematurity (25.6%), sepsis (21.6%), perinatal asphyxia (19.5%), and RDS (17.3%) with a statistically higher rate in the outborn in comparison with inborn. Total 20.5% neonates died due to poor outcome of outborn neonates. Conclusion: Huge burden of neonatal death among the outborn is due to preventable causes like asphyxia and infections in Uttarakhand. Health policies must ensure increased access to essential services to target sick neonates born here.
  4,340 855 1
Prevalence of hypertension in type-2 diabetes mellitus
K Venugopal, MZ Mohammed
October-December 2014, 1(4):223-227
DOI:10.4103/2348-3334.142981  
Aims and Objectives: 1 To study the prevalence of hypertension in Type-2 diabetic patients. 2 To study the association with hypertension and diabetic complications. Materials and Methods: A total of 250 diabetic patients coming to Vijayanagara Institute of Medical Sciences Hospital and College, Bellary were studied and evaluated for blood pressure (BP), and macrovascular and microvascular complication. Study Design: A cross-sectional study. Sample Size: 250. Inclusion Criteria: All Type-2 diabetic patients who are on treatment for diabetes. Exclusion Criteria: a. Newly diagnosed diabetes, b. Seriously ill patients, c. Refused to be a part of the study, d. Pregnancy, e. Type-1 diabetes mellitus. Results and Conclusion: Prevalence of hypertension noted in 64 (25.6%) patients. BP was normal in 55 (22%), 131 (52.4%) patients were prehypertensive, 45 (18%) patients were in stage-1 hypertension, and 19 (7.6%) had stage-2 hypertension. Macrovascular complications noted in 120 (48%) and microvascular complications noted in 60 (24%) patients.
  3,482 1,301 2
BRIEF COMMUNICATION
Modifications in the Revised National Tuberculosis Control Program to achieve universal access to tuberculosis care
Saurabh Ram Bihari Lal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
January-April 2014, 1(1):45-47
DOI:10.4103/2348-3334.126791  
Global Tuberculosis Report - 2012, released by the World Health Organization (WHO) has revealed that in the year 2011 alone, 11.7 million new cases of tuberculosis (TB) have been reported worldwide, of which India contributed to almost one-quarter of the cases. Considering the global distribution, magnitude of the problem, serious impact on the quality of life, and high mortality rates; TB in today's world is the biggest public health disease of an infectious nature. Revised National Tuberculosis Control Program (RNTCP) has been geographically scaled-up and updated on multiple fronts based on the epidemiology of disease, infield practical experience, WHO's recommendations, and the successful implementation of different strategies in high burden countries. Refinement in the program has been observed in different fields such as diagnostics, treatment, involvement of medical college and private sector, along with some innovative measures. To conclude, strengthening of the RNTCP program has been planned in a comprehensive manner and due attention has been given to encourage and actively involve all the stakeholders so that global vision to achieve universal access to TB care can be accomplished.
  4,103 667 -
ORIGINAL ARTICLES
Effect of free maternal health services on maternal mortality: An experience from Niger Delta, Nigeria
Samuel O Azubuike, Ngozi O Odagwe
October-December 2015, 2(4):309-315
DOI:10.4103/2348-3334.165738  
Background: Free maternal health care was launched by Delta State Government in 2007. This development was laudable as poverty has been identified as a big hindrance to accessing health care services among mothers in rural communities. There was need, however, to ascertain the effectiveness of this program. Aim: The study aimed at determining maternal mortality rate (MMR) from 2005 to 2009, its correlates, obstetric cause of death and to evaluate the effect of free maternal care on MMR. Methodology: MMRs were computed based on all maternal deaths and live births available in summary health report of Ika South local government area from 2005 to 2009. Correlational analysis was done to determine the correlates of MMRs. Statistical Package for Social Sciences (SPSS) version 16 (USA, 2007) was used in the analysis. Results: There was a reduction in MMR from 932/100,000 in 2005 to 604/100,000 in 2009. This reduction negatively correlated (r =−;0.74, P = 0.15) with an increase in antenatal care registration within the period. The gradual increase in proportion of child delivery in health facilities from 59% in 2007 to 74.6% (2288/3065) in 2009 negatively correlated (r =−;0.5, P = 0.4) with a reduction in MMR from 836/100,000 to 604/100,000. The number of skilled staff employed increased by 36.4% (51/140) since 2005 and negatively correlated (r =−;0.34, P = 0.56) with MMR reduction of 328/100,000 since that period, with the employment of nurses being the stronger correlate (r =−;0.48, P = 0.41). Hemorrhage (44%) was the leading obstetric cause of death. Conclusion: The study showed that MMR has been on a gradual downward trend since the introduction of free maternal health services in Delta State, Nigeria.
  1,837 2,895 -
Factors affecting utilization of medical diagnostic equipment: A study at a tertiary healthcare setup of Chandigarh
Poonam Chaudhary, Pankaj Kaul
October-December 2015, 2(4):316-323
DOI:10.4103/2348-3334.165741  
Context: A quality patient diagnosis and clinical management are largely depending upon the availability of reliable medical diagnostic equipment. However, in Indian scenario, the lack of preventive maintenance, nonavailability of technology and spare parts, and nonavailability of required funds for maintenance are mainly responsible for the failure of equipment maintenance, and hence, their proper utilization. Aims: This study was focused to find out the deficiency in the utilization coefficient (UC) of medical diagnostic equipment and the various factors causing the under-utilization of these equipment. Materials and Methods: This study was conducted in a tertiary health care setup at Chandigarh. Approximately, 30 medical diagnostic equipment were studied for their UC and simultaneously a perception based analysis was conducted, where the faculty and staff members concerned with the administrative matters and use of that particular medical diagnostic equipment were concerned. Factors such as low accessibility, obsolescence, break-down, affordability, availability of trained manpower, nonavailability of consumables and spares, maintenance delays, limited working hours, and restricted availability were taken into account. Results: On an average, 23% of these medical diagnostic equipment were not adequately utilized due to one reason or the other. Conclusions: It was concluded that the most crucial factors affecting the utilization of medical diagnostic equipment as per the perception of the respondents were obsolescence, nonavailability of spares, and maintenance delays.
  3,542 1,024 -
Anatomy of maxillary sinus and its ostium: A radiological study using computed tomography
Anne D Souza, KV Rajagopal, Vrinda Hari Ankolekar, Antony Sylvan D Souza, Sushma R Kotian
January-March 2016, 3(1):37-40
DOI:10.4103/2348-3334.172397  
Background: Interventions involving the middle meatus are commonly performed because the majority of the paranasal sinuses open into the osteomeatal complex. Therefore, the aim of the present study was to locate the level of maxillary sinus ostium (MSO), to measure the distances between MSO and different anatomical landmarks, to measure the different dimensions of maxillary sinus and to compare the morphology of maxillary sinus between the right and the left sides. Materials and Methods: The study involved 50 computed tomography (CT) images of normal paranasal sinus anatomy in coronal and sagittal planes from the Department of Radiodiagnosis. The location of the sinus ostium (upper, middle, or lower third) was observed. Perpendicular distance from the sinus ostium to the lower border of inferior turbinate and hard palate were measured. The maximum vertical, transverse, and antero-posterior diameters of the maxillary sinus were measured. Results: Of 50 CT images, the MSO was located in the upper third in 40 cases while in 10 it was located in the middle third. The most common location of MSO was in the upper third. The dimensions of the maxillary sinus indicated bilateral symmetry. Conclusion: The dimensions of the maxillary sinus indicated bilateral symmetry, and there were no significant gender differences when compared. However, the distances of the MSO from the major anatomical landmarks were significantly different between males and females which are seldom reported earlier. This knowledge about the variations in the lateral wall of the nasal cavity is crucial during the endoscopic interventions and for functional endoscopic sinus surgeries.
  3,926 437 3
Citrobacter as a uropathogen, its prevalence and antibiotics susceptibility pattern
Hiba Sami, Asfia Sultan, Meher Rizvi, Fatima Khan, Shariq Ahmad, Indu Shukla, Haris M Khan
January-March 2017, 4(1):23-26
DOI:10.4103/2348-3334.196037  
Introduction: Urinary tract infection (UTI) continues to be the most common infection diagnosed in outpatients as well as in hospitalized patients. Citrobacter spp. is an emerging urinary pathogen. The present study assessed the prevalence and antibiotic sensitivity pattern of Citrobacter spp. in patients admitted to or attending outpatient departments with Complain of UTI in a tertiary care hospital. Materials and Methods: A total of 36,250 urine samples were included in the study. UTI was confirmed in 7099 samples. Of these 246 (3.46%) had UTI due to Citrobacter spp. Identification was by conventional biochemical methods. Antimicrobial susceptibility testing was performed using Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standards Institute M2-A9. Multidrug-resistant (MDR) was defined as resistance to more than two groups of drugs. Extended spectrum beta-lactamase (ESBL), AmpC, and metallo beta-lactamase (MBL) were detected by phenotypic methods. Results: Females predominated in the study 193 (78.4%) with 53 (21.5%) males. Most of the isolates were in the age group 21-30 and 31-40. 49 (19.9%) patients were inpatients, and 197 (80.08%) were outpatients. Aminoglycosides had a better spectrum of antimicrobial sensitivity (70.2%) with 85.2% isolates sensitive to amikacin. Fluoroquinolones had a poor activity against Citrobacter (46% sensitive). Ureidopenicillins had poor efficacy (15.4%). Out of the 246 strains, 129 (52.4%) were MDR, 61 (24.7%) of which were ESBL producers and 65 (26.4%) were AmpC producers. Most of the ESBL producing strains were isolated from inpatients. No MBL were identified in this study. Conclusion: Citrobacter though not uncommon isolate is posing a problem due to its MDR character. Infection control practices should be observed strictly, and any type of unnecessary instrumentation should be avoided.
  4,061 250 1
Clostridium difficile associated diarrhea - 'suspect, inspect, treat, and prevent'
Shivani Tyagi, Aroma Oberoi
October-December 2014, 1(4):219-222
DOI:10.4103/2348-3334.142980  
Context: Clostridium difficile is a fastidious, gram-positive, spore-forming bacterium responsible for infectious diarrhea and pseudomembranous colitis associated with significant morbidity and mortality. Only toxigenic strains produce disease in humans. Pathogenicity is dependent on the presence of diarrhea-producing toxins, named toxin A (TcdA) and toxin B (TcdB). Risk factors include depletion of protective gut flora by antibiotics and diminished immune response to C. difficile due to age and medical co morbidities; and increased use of proton-pump inhibitors (PPI). Treatment includes the stoppage of inciting antibiotics if possible, to allow regeneration of the normal gut microflora, and starting an antibiotic with activity against C. difficile. A good clinical suspicion in patient with co morbidities developing diarrhea during hospital stay can help reduce the burden of this treatable morbid infection. Our aim of doing this study was to determine the prevalence of this infection in our tertiary care hospital, so as to monitor its burden in future. Aims: To determine the prevalence of this infection in our tertiary care hospital. Settings and Design: A retrospective study was conducted in the department of Microbiology in a tertiary care hospital in North India. Materials and Methods: A total of 195 stool samples received over a period of 2 years were included in the study. An enzyme immunoassay was performed for the qualitative determination of toxins A and B from Clostridium difficile in stool samples. Results: A total of 13 (6.67%) stool samples out of 195 samples processed were positive for the presence of Clostridium difficile toxins A/B. Conclusions: CDI has become a global public health challenge today. Various studies show a prevalence rate between 11% - 22%. Lower prevalence rate revealed from our study (6.7%), makes it imperative to maintain a strict surveillance in our patients to ensure opportune detection and treatment
  1,732 2,541 -
SHORT COMMUNICATION
Iodine deficiency disorders: Public health measures to mitigate the global burden
Saurabh Ram Bihari Lal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
April-June 2014, 1(2):119-122
DOI:10.4103/2348-3334.134280  
Iodine is an essential micronutrient required for the synthesis of the hormones - thyroxine and triiodothyronine. Iodine insufficiency is prevalent throughout the world, and is rated as one of the most significant public health concern in more than 125 countries. An optimal intake of dietary iodine during pregnancy, lactation and early childhood period is crucial for ensuring proper development of the brain of the fetus/newborn. During the course of implementation of the strategy of universal administration of the iodized salt, a wide gamut of challenges has been identified. In order to combat the same and simultaneously enhance the coverage of universal administration of the iodized salt, many measures have been proposed, namely formulating clear plan with time-based targets; encouraging coordination amongst all stakeholders; strengthening of the existing infrastructure; and increasing consumer awareness and demand for adequately iodized salt. To conclude, iodine has a crucial role in ensuring the normal growth and development of the child. However, to expand the coverage of the universal iodized salt to the vulnerable population, sustained political commitment and transparent monitoring and evaluation mechanism is the need of the hour.
  3,633 448 -
ORIGINAL ARTICLES
Role of discharge planning and other determinants in total discharge time at a large tertiary care hospital
Shweta Mehta, Jayesh Nair, Sunil Rao, Kasturi Shukla
January-March 2015, 2(1):46-50
DOI:10.4103/2348-3334.149345  
Introduction: Discharge time, a crucial quality indicator, is dependent on several other factors like clearance time and patient-related issues. The present study analyzes these determinants and presents measures to control the discharge time. Materials and Methods: This cross-sectional study was conducted during May-June 2013 at a large multispecialty hospital. During initial 15 days, that is, the pilot study, data was collected across various steps where time was consumed during discharge process and initiatives were taken to increase the number of planned discharges. For the main study, discharges were classified as planned/unplanned and patients as insured and uninsured. Results of pilot study and main study were compared. We computed one-sample t-test on overall discharge time, clearance time, and independent sample t-test on discharge time consumed for types of discharges. All results with P < 0.05 were considered statistically significant. Results: Out of 105 discharges, 75 were included wherein mean discharge time of 177.6 (± 613) min was significantly lower than the mean time of 285.42 (±105.46) min taken for 35 discharges during pilot study (P < 0.01). Mean discharge time of 572 (±1378.4) min for the 14 insured patients was significantly higher (P < 0.0001) than the 61 uninsured patients where discharge time was 88 (±84.7) min. Mean discharge time for planned discharges (n = 18) was 85 (±87.9) min that was significantly lower than unplanned discharges (n = 57) with a mean of 524 (±1446.6) min (P < 0.01). ther patient-related factors like, delay in bill payment, request for discounts further increased the discharge time. Conclusion: Planning the discharges reduced the total time of discharge process substantially. Discharge time was substantially high for insured patients that need to be controlled. Departmental clearance and patient-related factors also impact the discharge time.
  3,625 400 2
LETTER TO EDITOR
Blood-filled blister in the oral cavity: Angina bullosa hemorrhagica
Naveen Kumar Kansal
April-June 2014, 1(2):130-131
DOI:10.4103/2348-3334.134284  
  3,667 227 -
ORIGINAL ARTICLES
A comparative study of pulse oximetry with the conventional pulp testing methods to assess vitality in immature and mature permanent maxillary incisors
Shini Susan Samuel, Abi M Thomas, Namita Singh
October-December 2014, 1(4):235-240
DOI:10.4103/2348-3334.142985  
Context: Subjective pulp tests are not reliable, particularly in children. It is important for dentists to understand the various pulp testing methods that are available in order to make an accurate diagnosis of the state of dental pulp in children. Aims: To assess pulp vitality and compare the reliability of pulse oximetry with the conventional pulp tests (electric pulp test and cold test) in immature and mature permanent maxillary incisors. Subjects and Methods: Sixty selected children aged 7-18 years with normal permanent maxillary central and lateral incisors were categorized into Group I (mature teeth) and Group II (immature teeth). Thirty endodontically treated permanent maxillary incisors were used as the negative control. Statistical Analysis Used: The sensitivity, specificity, positive predictive value, and negative predictive value were calculated and the results were analyzed. Results: The specificity for the pulse oximetry test, cold test, and electric pulp test in Group I (mature teeth) was 100%. The specificity for the pulse oximetry and cold test in Group II was 100% and 80% for electric pulp test. Conclusions: For an accurate pulpal diagnosis in children, one should not rely on one pulp test alone. In young children, pulse oximetry method was found to be as accurate as cold test but large variations were seen in electric pulp test.
  3,408 479 1
Topical anesthetic versus lidocaine infiltration in arteriovenous fistula cannulation
Anisha George, Pratish George, Deepak Masih, Nina Philip, David Shelly, Jasmin Das, Timothy Rajamanickam
April-June 2014, 1(2):95-98
DOI:10.4103/2348-3334.134269  
Background: End stage renal disease (ESRD) patients on maintenance hemodialysis undergo arterio-venous fistula (AVF) cannulation prior to each hemodialysis session for blood access. Prior to cannulation lidocaine infiltration is done, which is often perceived as painful. Eutectic mixture of local anesthetic (EMLA) has been found to significantly reduce pain associated with radial artery cannulation compared with lidocaine infiltration. Aims: To evaluate the efficacy of EMLA compared to infiltration of lidocaine in hemodialysis patients for AVF cannulation. Materials and Methods: A single-centre, crossover study of patients with an AVF on regular maintenance hemodialysis was performed in the dialysis unit of a tertiary care teaching hospital. The site of AVF, number of attempts for AVF cannulation and cannula insertion time were recorded. The patients were asked about the acceptability of application of the anesthetic, delay between anesthetic and cannulation and to score the pain on cannulation. Results: Fifty patients were included in the study. With the visual analog scale, pain score on infiltration was 4.8. Pain score on cannulation after topical application was 2.9 and after infiltration, 2.0. The number of attempts for cannulation and the cannula insertion time were similar. Anesthesia was more stressful in the injectable group rather than the topical group (P < 0.001). Delay between anesthetic and cannulation was unacceptable in the topical group (P < 0.001). Patient compliance was better during infiltration compared to topical (P < 0.005). Mean pain score during infiltration of anesthetic was significantly higher than cannulation pain after either anesthetic, although pain on cannulation was higher in the topical group (P < 0.001). Conclusions: EMLA offers a suitable alternative to lidocaine infiltration for patients using AVF for blood access.
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REVIEW ARTICLE
Anemia: An approach to evaluation, 2014
Philip Kuriakose
April-June 2015, 2(2):95-99
DOI:10.4103/2348-3334.153250  
Anemia is very commonly encountered in general clinical practice among all age groups. The more commonly used way to classify anemia has been to categorize it as being microcytic (mean corpuscular volume [MCV] <80 fL), normocytic (MCV 80-100 fL), or macrocytic (MCV >100 fL), which in turn allows for a more practical way to attempt to come up with a cause for any decrease in hemoglobin. Microcytic anemias are usually due to iron deficiency (in turn, a result of a number of different etiologies ranging from decreased intake, malabsorption, or blood loss), hemoglobinopathies (thalassemic syndromes), and some cases of severe anemia resulting from chronic disease. Normocytic anemia is often a result of anemia of chronic disease, hemolysis, or secondary to bone marrow failure. Macrocytic anemias are frequently caused by deficiencies of folic acid and/or Vitamin B12, exposure to toxic agents like drugs that interfere with DNA metabolism and alcohol, as also bone marrow failure states, such as from myelodysplastic syndrome. A comprehensive history, physical examination, and directed laboratory evaluation will help to identify a specific cause for anemia.
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CASE REPORTS
Silent bowel perforation with per anal protrusion of ventriculoperitoneal shunt
Sarvpreet Singh Grewal, Sukhdeep Singh Jhawar, Bharat Gupta, Nandini K Bedi
April-June 2014, 1(2):113-115
DOI:10.4103/2348-3334.134278  
Ventriculoperitoneal (VP) shunt used in the treatment for hydrocephalus is associated with several complications. Visceral/bowel perforation is an unusual but serious complication of VP shunt. A silent protrusion of distal end of VP shunt per anus is reported in an 8-month-old male child. Patient underwent right VP shunt at the age of 6 months for congenital hydrocephalous. Patient was afebrile and had no signs of peritonitis or meningitis. Exploratory laparotomy was done where shunt was found to penetrate antimesenteric border of sigmoid colon. Shunt was removed and patient is doing well at 6 months follow-up without revision of VP shunt. Etiopathogenesis and management issues are discussed with relevant review of literature.
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REVIEW ARTICLES
Antimicrobial stewardship: Strategies for a global response
Jenny Grunwald, John Zervos, Marcus Zervos, Indira Brar
January-April 2014, 1(1):4-10
DOI:10.4103/2348-3334.126771  
The increasing antimicrobial resistance worldwide, combined with dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health and safety of patients. To combat this hazard, antimicrobial stewardship programs (ASPs) have emerged. Antimicrobial stewardship programs prevent or slow the emergence of antimicrobial resistance by coordinated interventions designed to optimize antimicrobial use to achieve the best clinical outcomes and limiting selective pressures that drive the emergence of resistance. This also reduces excessive costs attributable to suboptimal antimicrobial use. Even though an ideal effective ASP should incorporate more than one element simultaneously, it also requires a multidisciplinary team, which should include an infectious diseases physician, a clinical pharmacist with infectious diseases training, infection control professionals, hospital epidemiologist, a clinical microbiologist and an information specialist. However, for antimicrobial stewardship (AMS) programs to be successful, they must address the specific needs of individual institutions, must be built on available resources, the limitations and advantages of each institution, and the available staffing and technological infrastructure.
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