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   2015| October-December  | Volume 2 | Issue 4  
    Online since September 18, 2015

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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
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.
  5,510 1,682 1
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
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.
  2,631 3,959 1
Morquio syndrome: A radiological diagnosis
Sadhanandham Shrinuvasan, Ranganathan Chidambaram
October-December 2015, 2(4):360-363
Mucopolysaccharidoses (MPS) are a family of inherited metabolic diseases that results from the deficiency of lysosomal enzymes involved in the degradation of the glycosaminoglycans (MPS). We report here a 7-year-old female child who presented with complaints of short stature, skeletal deformities, and difficulty in walking with normal intelligence. A clinical diagnosis with differential diagnosis of achondroplasia/rickets was considered. Skeletal survey showed radiological features characteristic of Morquio syndrome (MPS IV) which lead to diagnosis in this case.
  4,586 379 -
Knowledge, awareness, and utilization pattern of services under Janani Suraksha Yojana among beneficiaries in rural area of Himachal Pradesh
Prem Lal Chauhan, Dineshwar Dhadwal, Anjali Mahajan
October-December 2015, 2(4):324-328
Introduction: Safe motherhood is perceived as a human right, and the health sector is always encouraged to provide quality services to ensure the same. Government of India launched a scheme called Janani Suraksha Yojana (JSY) on April 11, 2005, under the flagship of National Rural Health Mission to reduce maternal and neonatal mortality, by promoting institutional deliveries for which financial incentives are provided to mothers delivering in the health facilities. Objective: To study the knowledge, awareness, and utilization pattern of services under JSY among the beneficiaries in rural area of Shimla, Himachal Pradesh, India. Materials and Methods: This cross-sectional study was conducted among the 78 JSY beneficiaries residing in the rural field practice area of Indira Gandhi Medical College Shimla, Himachal Pradesh, India. These beneficiaries were interviewed with pretested, predesigned, semi-structured close ended questionnaire by house-to-house visits, after obtaining informed consent. Results: Majority of the JSY beneficiaries (50; 64%) were in the age group of 20–25 years and 43 (55.1%) of them heard about the JSY scheme before the present pregnancy. Anganwadi workers 78 (100%) and female health workers (62; 79.5%) were the main sources of information. More than half of the study participants (44; 56%) had good knowledge about the scheme and 42 (53.85%) registered their name in health institution during thefirst trimester of last pregnancy. Forty-four (56.4%) beneficiaries had undergone three antenatal checkups and only 11 (14.1%) of them received three postnatal (PN) visits. All the beneficiaries received the JSY incentives 1-week the following delivery. Conclusions: Awareness regarding the JSY scheme, early antenatal registration, minimum three antenatal care visits, and three PN visits is still low among rural women which needs strengthening through intensification of IEC activities.
  3,360 943 -
Leuconostoc lactis: An unusual cause for bacteremia
Bichitrananda Swain, Kundan Kumar Sahu, Subhrajita Rout
October-December 2015, 2(4):367-369
Leuconostoc species, the common saprophytic bacteria are now emerging as one of the important opportunistic pathogens. There are different risk factors such as compromised immunity, use of vancomycin, parenteral nutrition, and contaminated surgical implanted devices to contribute the human infection. We here present one of the unusual fatal cases of bacteremia in a cancer patient who was infected with a vancomycin-resistant strain of L. lactis.
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A survey of multivitamin supplement knowledge, attitude, and use in the urban community of Bikaner, Rajasthan
Savita Saini, Najmul Hasan
October-December 2015, 2(4):329-332
Background and Objective: Over the last two decades, there has been a trend for people to supplement their nutritional intake with dietary supplements including multivitamins, which are also commonly prescribed as a concomitant medication. We conducted a community-based survey in an urban population to assess consumers' knowledge, practices, and attitudes regarding multivitamin supplements. Materials and Methods: A cross-sectional questionnaire-based survey was conducted from November 2013 to April 2014 among 500 participants residing in urban areas of Bikaner (Rajasthan). The data were collected in a predesigned questionnaire after obtaining written informed consent from each participant. Results: The survey results showed that the taking of multivitamin supplements is quite prevalent (64.2%) in the community of urban areas of Bikaner. Physicians were found to be the most common source of information regarding multivitamins; however, consumers do get the information from the internet, newspaper, and relatives also. Multiple reasons were quoted for the practice of multivitamins such as maintenance of general health, compensation for the deficiencies, etc. The majority of the respondents were unaware of the correct indications for use of vitamin supplements and had little knowledge of harmful effects. Conclusion: This survey in an urban population highlights that the multivitamin supplements are commonly taken on a daily basis. Most consumers are unaware of any possible side-effects or drug-supplement interactions. There is a continuing need to adopt certain educational interventions for physicians to update and disseminate knowledge of vitamin supplements to their patients and also to increase awareness regarding their correct usage.
  2,692 353 1
Nonoperative management of adult femoral shaft fracture using the principle of controlled collapse in mission hospital in Central India
Deeptiman James
October-December 2015, 2(4):379-382
Operative as well as non operative treatment methods have been described for management of femoral shaft fracture in adults. Non operative management of adult femoral shaft fracture is uncommon as operative management has better functional outcome. This report highlights the use of non operative method, described more than 60 years ago, to successfully manage adult femoral shaft fracture in a mission hospital located in a resource limited part of the country.
  2,713 170 -
Kluver-Bucy syndrome: A morbid consequences of post herpes simplex encephalitis
Ajay Halder, Uday Sankar Mandal, Subrata Halder, Abhinanda Biswas
October-December 2015, 2(4):373-375
Kluver-Bucy syndrome (KBS) is a neuropsychiatric behavioral disorder that is most commonly associated with damage to both of the anterior temporal lobes of the brain. Most commonly it is due to infection of herpes simplex encephalitis (HSE). Although computed tomography (CT), magnetic resonance imaging (MRI) and electroencephalography (EEG) suggest the injury to the temporal region of brain, the definitive diagnosis is only established by the finding of the viral antigen in brain. Previously viral antigen is obtained by biopsy, currently it is demonstrated by the polymerase chain reaction technique. As we all know, it is a very rare disorder and most of the literature relates to animal models rather than human cases. We here describe an important human case of KBS following HSE.
  2,631 202 -
Aerobic bacteriology of burn wound infections
Sarita Otta, Jayant Kumar Dash, Bichitrananda Swain
October-December 2015, 2(4):337-341
Introduction: Burn wound infections are important cause of mortality, morbidity and prolonged hospitalization in burn patients as the causative agent is generally a multidrug resistant organism. The pattern of microbial flora infecting burn wound varies according to geographical pattern as well as with duration of hospital stay. Objective: The present study aims to identify the causative agents of burn wound infections in our hospital, to assess the change in pattern of flora in accordance to duration of wound as well as to determine the sensitivity pattern of isolates. Materials and Methods: Wound swabs from 52 patients admitted in Burn unit of IMS and SUM Hospital, Bhubaneswar were collected every 5th day during their hospital stays and were cultured. The results were interpreted according to the standard methods and antibiotic susceptibility pattern was noted. Results: The most common organism isolated was Staphylococcus aureus, that is, 20 (47.6%) while Klebsiella spp. 12 (28.6%) was the most common Gram-negative isolate. The commonest organism isolated in the 1st week of hospital stay was S. aureus (15.4%), but it was Acinetobacter spp. (22.2%) in 2nd week and coagulase negative Staphylococcus in 3rd week of hospital stay S. aureus was mostly sensitive to levofloxacin (77.8%) and netilmycin (98%). Conclusion: The pattern of bacterial flora changes according to duration of hospital stay. Effective strict isolation techniques and infection control are thus needed to decrease the occurrence of burn wound infection.
  1,823 244 1
Aarskog–Scott syndrome: A perspective on growth and the influence of growth hormone therapy: Case-based review of literature
Babulreddy Hanmayyagari, Mounika Guntaka, Jayanthy Ramesh
October-December 2015, 2(4):356-359
Aarskog–Scott syndrome is an X-linked inherited disease characterized by short stature, facial abnormalities, skeletal, and genital anomalies. Although ophthalmic, dental, and cardiac defects are rarely seen. The present case report is of a 10-year-old boy with Aarskog syndrome who born with third degree of consanguineous marriage, delivered by caesarean section. The boy had triangular facies, maxillary hypoplasia, short neck, hypoplastic ear lobes, drooping shoulders, clinodactyly, single palmar crease, shawl scrotum. The patient was on growth hormone (GH) therapy and responding well. Along with GH therapy, the patient was on rehabilitation program and his family was undergoing genetic counseling.
  1,747 180 -
Chiari Type II malformation: Prenatal sonographic findings
Sadhanandham Shrinuvasan, Ranganathan Chidambaram
October-December 2015, 2(4):383-385
Chiari malformations (CM) are a group of defects associated with the congenital caudal displacement of the cerebellum and brainstem. A thorough understanding of the sonographic findings is necessary for the diagnosis of CM in the developing fetus. Here, we present the classical imaging findings of CM Type II detected in a 25-year-old primigravida at 26 weeks of gestation by routine sonographic screening.
  1,625 119 -
Human immunodeficiency virus infection and acquired immune deficiency syndrome vulnerability of men who have sex with men in a border area of West Bengal, India
Dibakar Haldar, Amiya Kumar Dwari, Abhik Sinha, Dipendra Narayan Goswami, Sukamal Bisoi, Nabanita Bhattacharya, Kanti Bhushan Choudhury
October-December 2015, 2(4):349-355
Background: Studying level of living, awareness about sexually transmitted infections (STIs) including human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) and sex behavior of men who have sex with men (MSMs) is prerequisite for control of increasing AIDS among them in India. Objective: To assess sociodemographics, awareness about STIs including AIDS, and find out the pattern of high risk sex behavior of MSM. Methodology: Cross-sectional survey was undertaken in May, 2012 among MSMs catered by T I program via Nongovernmental Organization "Madhya Banglar Sangram" in Murshidabad District. 62 MSMs were included from five cruising spots sampled randomly out of fourteen such. Information was collected via interview and focused group discussions (FGD) using questionnaire and FGD guide. Blood samples were examined for VDRL reactivity. Results: Median age was 25 years and sexual debut at 13.67 ± 4.29 years. 87% respondents were residing in parental house, 20% was married, 40% had low education, 80.33% had additional jobs but 54% reported poor income. About 56% respondents knew "what is AIDS" and its spread via anal sex, mother to child transmission, needle sharing, sex worker, and blood transfusion reported by 52.46, 50.82, 47.54, 45.90, and 34.43%, respectively. More than 2/3rd, about 40 and 34.43% MSMs played "anal and oral receptive," "anal insertive" and "oral insertive" role. About 33% used condom regularly. Majority knew main symptoms of STIs. About 2/3rd reported discrimination by neighbors. Blood examination showed 6.45% VDRL reactivity. Conclusion: Reducing vulnerability of MSMs to HIV/AIDS requires holistic programs.
  1,597 114 -
Oral hygiene practices and its relationship with periodontal status among police personnel of Bhopal city, Central India: An epidemiological study
Aishwarya Singh, Ajay Bhambal, Sudhanshu Saxena, Vidhatri Tiwari, Utkarsh Tiwari, Ratika Shrivastava
October-December 2015, 2(4):342-348
Background: To assess the oral hygiene practices, oral health awareness, and oral health status of police personnel in Bhopal city and to suggest measures to improve the present oral health status. Materials and Methods: The cross-sectional study was conducted on 781 subjects, mean aged 40.5 years, who were selected by simple random sampling. Type-III examination of the subjects was conducted and along with questionnaire, community periodontal index (CPI), loss of attachment index and decayed, missing, filled teeth (DMFT) data was recorded on modified W.H.O format 1997. A value of P ≤ 0.05 was considered statistically significant. Results: Awareness related to oral health diseases, its cause, and prevention was low among police personnel. DMFT was significantly lower among this group. CPI score 2 was highest among the majority of subjects. Subjects brushing twice daily had significantly healthy periodontium than those brushing once daily. Conclusion: Most of the police personnel lack oral health awareness and suffer from periodontal diseases. Awareness should be created to maintain good oral hygiene, regular dental checkup and refrain from smoking among police personnel.
  1,484 162 -
An anatomical study of pterygoalar bar and its clinical relevance
Neeru Goyal, Anjali Jain
October-December 2015, 2(4):333-336
Objectives: Pterygoalar ligament extends from the root of lateral pterygoid plate to the under surface of greater wing of sphenoid. The ligament may ossify partly or completely leading to the formation of bony bar. Complete or incomplete pterygoalar bar may act as an obstacle for approaching retro-and para-paharyngeal spaces for various surgical procedures. Methods: A total of 55 dried adult skulls and 20 sphenoid bones were observed for the presence of complete or incomplete ossification of the pterygoalar ligament. Results: Totally, 17 bones (22.67%) showed partial ossification of the pterygoalar ligament. Complete ossification was not observed in any of the cases. Bilateral incomplete pterygoalar bar was seen in six skulls. Unilateral incomplete pterygoalar bar was seen in 11 cases (5 left and 6 right sides). Conclusions: Knowledge of complete or partial ossification of the various ligaments in the region is important for anesthetists, surgeons and dentists. Being closely related to foramen ovale, such ossified bars of bone may cause entrapment neuropathy of mandibular nerve and its branches.
  1,402 173 -
Rare presentation of sacrococcygeal teratoma in a prepubertal girl
Minakshi Bhosale, Dasmit Singh, Amit Gupta
October-December 2015, 2(4):364-366
Eighty-five percent of sacrococcygeal teratomas, the most common neonatal tumor present in infancy with externally visible swelling. Because of associated risk of malignancy, which increases exponentially with age, majority of the tumors undergo operative intervention. Hence, presentation in an adult that too of a benign mass is extremely rare, with less than 10 reported cases in world literature. We report case of a 9-year-old girl who presented with swelling in the gluteal cleft. Excision of the swelling along with the coccyx was done. Benign cystic sacrococcygeal teratoma was diagnosed on histopathological evaluation of the excised tumor mass. This case is reported for a very unusual presentation of sacrococcygeal teratoma and also brings forth the difficulties encountered during excision of the tumor.
  1,441 123 -
Testicular abscess as an unusual presentation of Salmonella typhi
Sophia Garg, Francis Katumalla, Amit Tuli, Kim Mammen
October-December 2015, 2(4):376-378
Salmonella is a large genus of Gram-negative bacilli within the family Enterobacteriaceae. It commonly causes infection involving the intestine as well as extraintestinal organs such as meninges, lungs, urinary tract, bones, and vessels, however, it rarely involves the genitalia. Review of literature shows only a few case reports of bacteriologically proven testicular abscess, most commonly due to nontyphoidal Salmonella. We report a case of a 68-year-old gentleman with testicular abscess due to Salmonella typhi with no systemic signs and symptoms.
  1,396 115 -
Primary extracranial sino-nasal tract meningioma in a child: A rare lesion with diagnostic pitfall
Adhikari Anindya, Jain Parul, Mandal Palash Kumar, Basu Nandita
October-December 2015, 2(4):370-372
Extracranial meningiomas are rare in children and are frequently misdiagnosed. We report a case of primary extracranial meningioma of the nasal cavity in a 2-year-old child who presented with a recurrent, gradually increasing swelling over the nasal bridge. Computed tomography scan revealed a mass protruding through a rent in the nasal bridge. Fine-needle aspiration cytology showed features suggestive of a benign mesenchymal neoplasm. Histologically, a diagnosis of meningothelial meningioma was made which was confirmed by immunohistochemistry. The neoplastic cells were strongly positive for vimentin and epithelial membrane antigen, weakly positive for S-100 and negative for neuron specific enolase, and glial fibrillary acidic protein. The case is documented for the rarity of its occurrence and varied prognosis.
  1,147 115 -
Opportunistic infections in relation to CD4 counts in human immunodeficiency virus seropositive patients in a tertiary care hospital in North India: Erratum

October-December 2015, 2(4):386-386
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