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Volume-10 (2011);
Issue 4 (October-December)
Published on Jan 15, 2012
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2011;4-1
Editorial |
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Sharma VM, Anupama N.
Management of Tuberculosis- The
Need to Enforce Proper Treatment Guidelines among Private
Practitioners in India.
Abstract:
Tuberculosis
continues to be a daunting challenge for our healthcare system. Even after
fifteen years of the much publicised Revised National Tuberculosis Control
Programme that envisages directly observed short course chemotherapy (DOTS), TB
continues to spread and drug resistant strains, MDR and XDR, are also
increasingly reported. More than 50% of TB patients seeking private health care,
but the level of awareness regarding treatment of TB among private practitioners
appears to be poor. All this call for an urgent revamp of TB control strategy in
India.
Key Words:
Tuberculosis, RNTCP; MDR tuberculosis. |
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2011;4-2
Original Article |
Khadse J, Bhardwaj SD, Ruikar M.
Assessment
of Knowledge and Practices of Referring Private Practitioners Regarding
Revised National Tuberculosis Control Programme in Nagpur City- A
Cross Sectional Study. |
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Abstract: Objectives:
To assess knowledge, diagnostic and treatment practices of the referring
private practitioners of Nagpur city regarding Revised National Tuberculosis
Control Programme (RNTCP). Methods:
The study involved interview of 103 Private Practitioners (PPs) of Nagpur
city. Knowledge of private practitioners was assessed based on questions
related to diagnosis, categorization, treatment regimens & follow
up. Practices of private practitioners were assessed based on which
investigations and treatment regimen they advise & whether they
offer supervised treatment. Their willingness to get involved in the
programme was also recorded. Results:
Only 49 (47.6%) private practitioners knew sputum smear examination
as primary tool of diagnosis of TB. Only half, 52 (50.5%) of the private
practitioners knew number of categories of tuberculosis correctly and
64 (62.1%) private practitioners did know how to categorize TB patients.
Chest X-ray and Mantoux test (38.5%) was mainly used by the PPs for
TB diagnosis. 42.7% of PPs were prescribing treatment for TB and among
them only 8 were prescribing as per RNTCP guidelines and just one provided
treatment under direct observation. Different combination of HRZE and
HRZES was prescribed for variable period ranges from 2-8 months. And
only 12 (11.6%) private practitioners expressed their willingness to
get involved in RNTCP for TB control. Conclusion:
There is lack of adequate knowledge, diagnostic and treatment practice
among PPs as per RNTCP guidelines and further encouragement is required
for their participation in the programme.
Key words: Private Practitioner; Tuberculosis; Knowledge; Practices; India |
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2011;4-3
Original Article |
Inamdar M, Piparsania S, Inamdar S, Singh K.
Exploring the Causes of Low Immunization Status in School Going Children. |
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Abstract: Background:
Although a definitive immunization program has been advocated for children
in our country, the immunization coverage is far from satisfactory.
There is paucity of survey studies related to immunization pattern. Objective:
This study has been undertaken to explore the social and attitudinal
factors with parents resulting into adverse immunization. Material and
Methods: The study was school based cross-sectional study conducted
in 50 schools of Indore district selected by random sampling from three
groups. Information was collected from parents by providing pre-tested
questionnaire. Result:
Association of parent’s literacy and socioeconomic status with successful
immunization could be established. Overall coverage rate with vaccines
was poor in school going girls as compared to the boys; proving thereby
that gender discrimination exists putting girls in disadvantageous position. Conclusion:
It can be expected that the immunization status of school children will
improve if identified risk factors such as parental education, socioeconomic
status, awareness status are improved and attitudinal gender discrimination
is curbed.
Key words: Immunization
status; Gender discrimination; Parental education; Adolescent immunization |
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This Article |
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2011;4-4
Original Article |
Pande A, Bhattacharyya M, Pain S, Ghosh B, Saha S, Ghosh A, Banerjee
A.
Anemia in Antiretroviral
Naïve HIV/AIDS Patients: A Study from Eastern India. |
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Abstract: Background: Hematological manifestations
are common throughout the course of HIV infection. Impact of anemia
is the most significant among them. The present study was undertaken
to evaluate the etiologies underlying anemia in HIV/AIDS. Methods This was a non randomized cross
sectional observational study conducted in a tertiary care hospital
of India over a period of 2 years. One hundred and fifty HIV patients
were screened. Thorough clinical and laboratory evaluation was done
in 50 randomly selected anemic cases. Results: Proper etiological diagnosis
could be reached in 46 patients. Among them correlation between Hb%
and CD4 count was statistically insignificant (p = 0.074, r = 0.47)
whereas it was significant with absolute lymphocyte and CD4 count (p
= 0.006, r = 0.41). There was better correlation of bone marrow iron
status with percent saturation of transferrin (p = 0.003, r = 0.54)
than with serum ferritin (p = 0.055, r = 0.09). Bone marrow iron status
did not have any relationship with CD4 count. Anemia of chronic disease
was the commonest etiology (37%) followed by HIV related myelodysplastic
syndrome (31%), iron deficiency anemia (13%), bone marrow suppression
due to direct involvement by some infective process (7%). Aplastic anemia,
multiple myeloma, Hodgkin’s disease, pure red cell aplasia, hemophagocytic
lymphohistiocytosis and vitamin B12 deficiency were detected in one
case (2%) each. Conclusions: Etiologies of anemia in HIV/AIDS
are multifactorial with anemia of chronic disease being the commonest.
For screening of iron deficiency in this group, percent saturation is
a better tool than serum ferritin. Absolute lymphocyte count can sometimes
be used as a surrogate marker of immunological status in antiretroviral
naïve HIV patients, particularly in resource poor areas.
Key words: HIV; AIDS; Anemia; MDS; India |
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2011;4-5
Original Article |
Nagaraj AKM, Mathew J, Nanjegowda RB, Majgi SM, Purushothama SM.
Psychiatric Morbidity Among Elderly People Living in Old Age Homes and
in the Community: A Comparative Study. |
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Abstract: Background:
Disorders such as depression, anxiety, cognitive and psychotic disorders
have a high prevalence among elderly. There is some preliminary evidence
that life in old age homes is perceived by inmates as more supportive,
though the issue is not well studied. Aim: This project is
directed towards studying and comparing the psychiatric morbidity and
quality of life of elderly people residing in two unique settings: community
and old age homes. Method: It is a cross-sectional study where
the elderly subjects, 50 each in both the groups, were selected by simple
random sampling technique and assessed on Mini Mental Status Examination
(MMSE), Informant Questionnaire on Cognitive Decline in Elderly (IQCODE),
Brief Psychiatric Rating Scale (BPRS) and Quality of life visual analogue
scale. Result: On comparison using suitable statistical analysis,
there was no significant difference in the total scores on MMSE, IQCODE
and quality of life scale across the groups. Depression was present
in 22% of people in the community and 36% of old age home inmates. Psychosis
was present in 26% of people in the community and 20% of old age home
inmates. Conclusion: The psychiatric morbidity is high in elderly
irrespective of the setting in which they live.
Key words: Elderly people; Old age homes; Psychiatric morbidity; Cognitive disturbances; Quality of life |
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This Article |
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2011;4-6
Original Article |
Amr MA, Balaha M, Al Moghannum M.
Postpartum
Mental Health among Young Women. |
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Context: Background:
A number of
studies have highlighted the physical health problems associated with
adolescent pregnancy in Saudi Arabia , However there were few studies
dealing with the postpartum psychiatric disorders .The study aims to
determine the prevalence of postpartum psychological distress and to
evaluate the associated risk factors in a sample of primigravid young
women in Al Ahsa region, Saudi Arabia. Methods: We assessed
the prevalence of postnatal mental health in 190 young mothers attending
the maternity hospital using general health questionnaire. We also
assessed the relationship between socio-demographic, psychiatric and
obstetric risk factors and the mental health. Results: The percent
of women with psychological distress was 35.2%. Significant risk of
psychological distress was associated with several socio-demographic,
psychiatric and obstetric risk factors. Only four items were found to
be significant predictors of postpartum psychological distress; low
family income, poor husband support, birth of female baby and gestational
diabetes. Conclusions: These results
highlighted importance of screening for psychological distress and
its associated risk factors in the implementation of proper perinatal
care for the pregnant Saudi adolescents.
Key words: Teenage pregnancy; Postnatal psychiatric disorders; Risk factors
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This Article |
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2011;4-7
Original Article |
Sinha RK, Pai MM, Vidyasagar MS, Vadhiraja BM.
Clinical Decision Support System for Oncologist: Perception, Expectations
and Implementation. |
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Abstract: Background:
Clinical Decision Support System is an integral application in modern
healthcare practice to assist the clinicians with patient information
and domain knowledge during patient care. Purpose:
Assessment of perception and Identification of expectation are the prerequisite
for the implementation of Clinical Decision Support System (CDSS).
Methodology: A descriptive study was conducted among the 100 Oncologists
of cancer hospitals and research centers of Southern India. A validated
survey questionnaire related to the perception and expectation towards
CDSS was provided to the participants and asked them to mark their response
on a 5-Point Likert Scale i.e. from Strongly Agree to Strongly Disagree.
The time motion study was also conducted to understand the issues related
to the access of patient information and domain knowledge. Result:
The Oncologist perception towards CDSS was found to be significant where
the Oncologists felt that the implementation of CDSS will decrease the
cost of healthcare and increase the productivity of the hospital. The
Oncologists expected that the system should have the features to automatically
capture the clinical knowledge, practice guidelines and updates related
to cancer care. The time motion study revealed that the Oncologists
spend their maximum time in documentation & retrieval of patient
information during patient care and evaluation because they largely
depend on printed text. A web enabled CDSS is developed, implemented,
and tested against the requirement of the Oncologists where the system
was found to be highly acceptable by the Oncologists. Conclusion:
The expectations of the end users should be fulfilled to make the CDSS
more acceptable and sustainable as the similar result had been observed
and found in the present research.
Key words: Perception; Expectation; Clinical Decision Support System; Oncology; Oncologist |
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This Article |
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2011;4-8
Case Report |
Mardi K, Kaushal V.
Primary
Transitional Cell Carcinoma of the Fallopian Tube. |
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Abstract: Primary carcinoma of the fallopian
tube is a rare entity that accounts for 0.2-0.5% of all gynecologic
malignancies, and most are discovered during or after surgery. Primary
transitional cell carcinoma of the fallopian tube is an extremely rare
tumor that is reported only occasionally in the worldwide literature.
As primary transitional cell carcinoma (TCC) of the fallopian tube is
so rare, the clinicopathologic characteristics are as yet unknown. The
authors recently experienced a case of primary transitional cell carcinoma
arising in the left fallopian tube and thus report the clinical features,
management, and also a review of the past pertinent literature. A 52 years old
woman presenting with lower abdominal pain was found to have a left
adnexal mass. Exploratory laparotomy revealed a mass arising from the
left fallopian tube with the histologic features of transitional cell
carcinoma.
Key words: Transitional cell
carcinoma; Fallopian tube |
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2011;4-9
case Report |
Sufi AR, Singh T.
Granulocytic
Sarcoma as the First Sign of Acute Leukemia
in Childhood. |
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Abstract: DAcute myeloid leukemia (AML) may rarely involve the orbit as
a solid tumor termed granulocytic sarcoma. This report describes the case of a child who presented with rapidly progressive
unilateral proptosis and was diagnosed as rhabdomyosarcoma. However subsequent examination of the peripheral blood film
revealed AML. Thus proptosis may present as the initial manifestation of AML.
Key words: Granulocytic sarcoma; Acute myeloid leukemia; Proptosis. |
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This Article |
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2011;4-10
Case Report |
Chauhan AK, Kaur P, Singh G, Mathur SK.
Tracheal Carcinoma. |
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Abstract: Background: Adenoid cystic carcinoma of the trachea is a rare primary tracheal malignancy.
Obstructive symptoms such as dyspnoea, hoarseness of voice, dysphasia
are commonly seen symptoms. Combined modality treatments including surgery
and radiation therapy are considered as optimal treatment for these
tumours. A case of adenoid cystic carcinoma in a 35 years old male patient
who was treated successfully by surgical excision and external beam
radiation therapy is presented.
Key words: Adenoid cystic carcinoma;
Tracheal tumours; Radiotherapy |
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2011;4-11
Case Report |
Patil RN, Bafna UD, Pallavi VR, Rathod PS.
Successful
Intra-peritoneal Antibiotic Therapy for Primary Abdominal Nocardiosis
in an Immunocompetent Young Female Masquerading as Carcinoma Ovary. |
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Abstract: Nocardiosis
is a common opportunistic infection in the immunocompromised and in
patients with chronic debilitating diseases,e.g continuous ambulatory
peritoneal dialysis (CAPD) patients. Primary abdominal nocardiosis is
rare and is indeed a very rare infection in immunocompetent persons.
Only two cases have been reported in immunocompetent patients so far
and this may be third case to the best of our knowledge and first in
India. About 11 cases have been reported in CAPD patients and AIDS patients.We
report a case of Nocardiosis in an immunocompetent young female who
presented with an abdomino-pelvic mass masquerading as carcinoma ovary.After
initial resistance to various antibiotics, she responded to intraperitoneal
and oral linezolid and oral ciprofloxacin.
Key words: Nocardiosis; CAPD
patients, Trimethoprim-sulfamethoxazole (TMP-SMX); Amikacin; Intraperitoneal. |
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2011;4-12
Case Report |
Kumar S, Sharath Babu NM, Kaushik M, Verma BS, Kaushal SS.
Explosive
Pleuritis. |
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Abstract: Pleural effusions associated
with pneumonia (parapneumonic effusions) are one of the most common
causes of exudative pleural effusions in the world. Approximately 20
to 40% of patients hospitalized with pneumonia will have an accompanying
pleural effusion. The term 'Explosive pleuritis' was originally described by Braman
and Donat in 1986 as pleural effusions developing within
hours of admission. We report a 38 years old male patient with minimal
pleural effusion which progressed rapidly within one day to involve
almost whole of the hemithorax. There were multiple loculations on ultrasonography
of thorax. Pleural fluid was sero-sanguinous and revealed gram positive
diplococcic. The patient improved with antibiotics and pigtail catheter
drainage.
Key words: Explosive pleuritis; Hemithorax; Loculated; Pigtail catheter. |
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