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Volume-11 (2012);
Issue 4 (Oct-December)
Published on Jan 25, 2013
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2012;4:1
Review |
Zejdlova IA.
Strategy to Support Improvement of Healthcare Quality. |
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Abstract: One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. It is an emerging movement in health insurance (initially in Britain and United States). Providers under this arrangement are rewarded for meeting pre-established targets for delivery of healthcare services. This is a fundamental change from fee for service payment.Also known as "P4P" or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency. Disincentives, such as eliminating payments for negative consequences of care (medical errors) or increased costs, have also been proposed. In the developed nations, the rapidly aging population and rising health care costs have recently brought P4P to the forefront of health policy discussions. Pilot studies underway in several large healthcare systems have shown modest improvements in specific outcomes and increased efficiency, but no cost savings due to added administrative requirements. Statements by professional medical societies generally support incentive programs to increase the quality of health care, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens. This article serves as an introduction to pay for performance. We discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care area.
Key words: Pay for performance; Quality; Health care; Payment models; Quality indicators. |
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This Article |
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2012;4:2
Original Article |
Labrague LJ et al.
Future Educators’ Gender Norms, Sexuality, and Reproductive Health. |
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Abstract: This investigation explored gender-related norms, sexuality, and reproductive health among education students in a government university in Samar, Philippines. A descriptive-analytical design of study was adopted for this investigation and data were collected over a period of five months. Five hundred fifty (550) education students who were enrolled in the different year level completed the modified John Clelands’ Illustrative Questionnaire for Young People. Results indicated that 14.73% of the students reported having had early sexual experience where in 69.14 % had it unplanned. Among sexually active students, only 17.28% used contraception, with condoms and withdrawal as the most popular choices. Respondents were also found to have some misconceptions regarding HIV/AIDS and STI’s. Result also showed that dating was still acceptable, however, the idea of abortion and sexual coercion were considered wrong. No significant differences in the knowledge about HIV/AIDS and STI’s and gender norms were found across year level. Findings suggest a greater need for education, support and advocacy relative to sexuality so as to create a more positive school environment conducive for holistic growth and development of all students. Thus, school administrators should improve/enhance existing policies and programs relative to reproductive health among college students of the University such as health promotion activities, sexuality education, counseling and alike.
Key words: Sexuality; Reproductive health; Future educators; Gender norms. |
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This Article |
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2012;4-3
Original Article |
Ganguly E.
Supplementary Role of Health Metrics for Reducing Total Fertility Rate in a North-Indian State. |
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Abstract: Reducing Total Fertility Rate (TFR) amongst rural Indian couples from the current level is a significant challenge to the population control policies relying solely on the Government efforts. REACH strategy, based on health metrics, succeeded in lowering the TFR below replacement levels in a rural population of more than 300,000 in Rajasthan. The REACH strategy was first developed and demonstrated success in decreasing TFR in a pilot project by SHARE India in Medchal region of Andhra Pradesh utilizing designated workers, and was replicated in Rajgarh District of Rajasthan in cooperation with Bhoruka Charitable Trust (supervisor of ICDS and NRHM health workers in Rajgarh) using Government health workers. The success of the REACH strategy in both Rajasthan and previously in Andhra Pradesh holds promise as a tool to reduce TFR in other areas of rural India.
Key words: Total Fertility Rate; REACH Strategy; Health metrics; ICDS; Gender; Rajasthan; India |
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This Article |
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2012;4-4
Original Article |
Kundargi R, Guruprasad B, Shakuntala PN, Rathod R, Bhise R, Shobha K, Pallavi R, Umadevi, Bafna UD.
Borderline Ovarian Malignancies : A Single Institute Retrospective Study. |
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Abstract: Background: Borderline ovarian tumors are histologically characterized as epithelial tumors with a stratified growth pattern but without destructive stromal invasion. Little is known about the histological subtypes and outcome, role of fertility sparing surgery and role of postoperative therapy in advanced stage in Indian scenario. While there is ample data in the world literature about this disease, prognosis in Indian patients is largely unknown due to dearth of studies in our setting. Objective: To study the demographic profile, clinical features, imaging, treatment and outcome of borderline ovarian tumors. Methods: This is a retrospective study of eighty seven patients with pathologically proven diagnosis of borderline ovarian tumor, diagnosed and treated from January 2006 to October 2011 at our institution. Most patients underwent surgical staging which incuded total abdominal hysterectomy and bilateral salphingo-oophorectomy, infracolic omentectomy, bilateral pelvic and para aortic lymphadenectomy. Young patients who had not completed their family underwent fertility sparing surgery. Patients with invasive metastatic implants received adjuvant chemotherapy. The outcome of these patients was correlated with stage, type of peritoneal implant, type of surgical procedure and with histological subtype. Results: At a median follow-up of 48 months, 100 percent survival was noted. One patient with stage III disease had recurrence. Conclusions: Borderline ovarian tumors occur at a younger age compared to invasive tumors. In patients with early stage disease who wish to preserve fertility, hysterectomy and contralateral oophorectomy are not necessary. Serous tumors occur at a younger age. They can be associated with invasive peritoneal implants and raised CA125 values. Majority of the serous tumors are bilateral and smaller in size compared to mucinous and endometroid tumors. Raised CA125 values did not correlate with the stage of disease. These patients have an excellent prognosis even in Indian scenario where majority of patients present with big ovarian masses.
Key words: Borderline ovarian tumor; Retrospective study; CA125 |
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This Article |
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2012;4-5
Original Article |
Bhise R, Purohit S, Lokanatha D, Jacob L, Suresh TM, Govind Babu K, Babu S, Lakshmaiah KC.
Chronic Myeloid Leukemia with Variant Chromosomal Translocations: Results of Treatment with Imatinib Mesylate. |
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Abstract: Objective: To evaluate the efficacy of imatinib in chronic myeloid leukemia patients with variant translocations. Methods: Forty eight chronic myeloid leukemia patients carrying variant translocations and treated with imatinib at our institute were considered for the study. Survival and response rates were evaluated. Results: The median follow up was 48 months(m). Forty three (89.58%) patients achieved complete hematologic response. Thirty one (64.58%) patients achieved complete cytogenetic response and 19(39.58%) achieved major molecular response anytime during their follow up period. Only 18.75% of the patients achieved complete cytogenetic response and major molecular response within the stipulated time frames.The estimated overall survival at 48 m median follow up was 81.2%.The progression free survival was also 81.2% and the event free survival was 79.1%.There was no significant survival difference between low vs intermediate and high risk sokal group. Conclusion: We report suboptimal responses to imatinib in chronic myeloid leukemia with variant translocations. Further studies with imatinib and the newer more active drugs dasatinib and nilotinib are justified.
Key words: Chronic myeloid leukemia; Imatinib; Variant translocation |
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This Article |
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2012;4-6
Original Article |
D'Silva SA, Pereira NR, Padmaja U.
Knowledge of Pharmacology of Analgesics Among Nurses in a Tertiary Centre. |
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Objectives: To evaluate the knowledge of nurses about the analgesics they administer in our hospital. Methodology: A total of 102 nurses completed the questionnaire which included 20 multiple choice questions based on the dosage forms, mechanism of action, route of administration, adverse effects of the commonly administered analgesics, the nurses’ educational qualifications and their working experience. Frequency, percentage, mean, Kruskal Wallis test and Mann Whitneys test were used to analyse data. Answers were given a score out of 20(100%). Results: The sample comprised of 17(16.6%) senior staff nurses, 38(37%) junior staff nurses and 47(46%) student nurses. Of the staff, 10.8 % were BSc and MSc nurses, 43.1 were GNM staff. The mean knowledge score of BSc & MSc staff was 12.18, GNM staff was 11.7 and of student nurses was 13.38. None of the groups scored more than 15, suggesting their knowledge was inadequate. There was a correlation between knowledge and experience in the staff nurses. Conclusion: The result of this study suggests that the knowledge of pharmacology of analgesics among nurses is inadequate, and thus supports the need for supplementary pharmacology education for nurses in clinical settings, focusing on common drugs they administer and help prevent medical errors.
Key words: Knowledge of Pharmacology; Nurses; Analgesics; Questionnaire study; Tertiary centre
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This Article |
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2012;4-7
Original Article |
Bhagya B, Sucharitha S, Avadhani R.
Prevalence and Pattern of Consanguineous Marriages Among Different Communities in Mangalore. |
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Abstract: Introduction: Consanguineous marriages are a common practice in the Middle East, Asian and African populations. Many studies have stated an association between first cousin marriages and the incidence of autosomal recessive diseases and congenital malformations. High frequency of consanguinity is reported by researchers among South India. The objectives of this study were to determine the prevalence and type of consanguineous marriages among the different communities of Mangalore. Methods: This study was conducted on 1164 married women in Mangalore to investigate the prevalence and type of consanguineous marriages. All the women were interviewed personally using a structured questionnaire. Family pedigree was constructed to study the type of consanguineous marriages. Data analysis was done by SPSS Win 13.0. Results: A low percentage of consanguinity (6.53%) was observed with a mean inbreeding coefficient of 0.0339. Frequency of consanguinity between religions was highly significant. Of these the most frequent were first cousin marriages (43.42%). Within Hindu religion the highest rate of consanguinity was among the Billavas (47.62%) of which the most frequent were distant relative marriages (75%) followed by second cousin marriages (57.14%). There was no significant difference in the frequency distribution of the types of consanguinity between the religions and also between the different groups among Hindus. Conclusion: The frequency of consanguinity was found to be low in Mangalore. The findings contradict with the earlier reports of high prevalence of consanguineous marriages in South India. Increased female education, increased socio-economic status and decrease in parental decisions in marriages may be the reasons.
Key words: Consanguineous marriages; Coefficient of inbreeding; Prevalence; Religion |
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This Article |
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2012;4-8
Original Article |
Ganu SS, Panhale V.
Effect of Obesity on Arch Index in Young Adults. |
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Abstract: Background: Excessive increases in weight bearing forces caused by obesity may negatively affect the lower limbs and feet but minimal research has examined the long-term loading effects of obesity on the musculoskeletal system, particularly in reference to the feet. Objectives: The purpose of the study was to investigate the effect of obesity on medial longitudinal arch of foot in young adults. Method: 60 subjects, 30 obese & 30 non obese were assessed for height & weight using standard technique. Radiographic images under static condition were used for calculating the arch index. Result: The arch index of obese subjects was significantly lower than the non obese subjects & there is a negative correlation between the BMI & the arch index. Conclusion: These results suggests that obesity lowers the medial longitudinal arch of foot.
Key words: Obesity; Medial longitudinal arch; Arch index. |
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This Article |
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2012;4-9
Short Review |
Guru Prasad B, Kundargi R, Purohit S, Bhise R, Shety R, Lakshmaiah KC.
Systemic Therapy in Endometrial Cancer: Recent Advances. |
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Abstract: Endometrial cancer is a chemosensitive disease. Studies have established a clear benefit of chemotherapy in advanced stages and trials are ongoing to define its role in early stages as well. As more molecular pathways are being elucidated there is increasing role for targeted agents and future looks quite promising. We did an extensive search both online and offline for all the relevant articles including chemotherapy and targeted therapy for endometrial cancer.
Key words: Chemotherapy; Endometrial cancer; Hormonal therapy; Targeted therapy. |
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This Article |
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2012;4-10
Case Report |
Gupta R, Gupta AK, Shankar A, Bansal S, Bhattacharya A, Bal A.
Insular Carcinoma of Thyroid Presenting as a Giant Skull Lesion: A Dilemma in Treatment. |
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Abstract: Thyroid surgeons are becoming increasingly more aware of a histologically distinct subset of thyroid carcinoma whose classification falls between well-differentiated and anaplastic carcinomas with respect to both cell differentiation and clinical behavior. This subtype of tumors has been categorized as poorly differentiated or insular carcinoma, based on its characteristic cell groupings. Although the differentiation of insular carcinoma from other thyroid carcinomas has important prognostic and therapeutic significance, relatively little about insular carcinoma has been published in the otolaryngology literature. In this article, we discuss a case of insular carcinoma of thyroid presenting with concurrent distant metastasis to skull, lung, ribs, and inguinal region with review of the literature. We conclude that insular thyroid carcinoma warrants aggressive management with total thyroidectomy and excision of accessible giant lesion followed by radioactive iodine ablation of any remaining thyroid tissue.
Key words: Insular carcinoma; Thyroid; Metastasis; Treatment |
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This Article |
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2012;4-11
Case Report |
Kabdwal N, Bhagat S, Varshney S, Bist SS, Mishra S, Singh B.
Aggressive Fibromatosis in Neck. |
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Abstract: Aggressive fibromatosis (AF) is a locally aggressive infiltrative low-grade benign tumor that accounts for approximately less than 3% of all soft tissue tumors. In the head and neck region this tumor tends to be more aggressive and associated with significant morbidity. Aggressive surgery is a viable management option and may be successfully used as a single modality treatment, or in combination with radiotherapy. We report a rare case of AF in a 38 year old female, who presented with a painless mass over the left supraclavicular fossa, extending inferiorly into the thoracic inlet, which was excised successfully in toto with the help of cardiothoracic vascular surgeon (CTVS).
Key words: Aggressive fibromatosis; Supraclavicular fossa; Benign tumor |
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This Article |
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2012;4-12
Case Report |
Patil SR, Kshirsagar AY, Ghorpade MV, Shinde RV.
Cellulitis Due to Salmonella infantis. |
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Abstract: Bacteria of the genus Salmonella are highly adapted for the growth in both humans and animals and cause a wide spectrum of disease. The growth of Serotypes S. typhi and S. paratyphi is restricted to human hosts, in whom these organisms cause enteric (typhoid) fever. The remaining Serotypes (non typhoidal Salmonella or NTS) can colonize the gastrointestinal tracts of the broad range of animals, including mammals, reptiles, birds and insects. The usual clinical presentation of non-typhoidal salmonellae (NTS) infection is self limited gastroenteritis; however bacteremia and focal extra intestinal infection may occur. However salmonella localization to the skin presenting as cutaneous ulceration is regarded as a rare event. Rates of morbidity and mortality associated with NTS are highest among the elderly, infants, and immunocompromised individuals, including those with hemoglobinopathies, HIV infection, or infections that cause blockade of the reticuloendothelial system. We isolated S.infantis in 50 years old man with left leg cellulitis. The serotype was confirmed at Central Research Institute, Kasauli.
Key words: Salmonella infantis; Cutaneous infection. |
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This Article |
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2012;4-13
Case Report |
Varshney S, Bhagat S, Bist SS, Mishra S, Shirazi N, Agarwal V, Kabdwal N.
Nodular Fasciitis of Neck in Childhood. |
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Abstract: Nodular fasciitis, is a benign, pseudo sarcomatous proliferative lesion of the soft tissue, which is frequently misinterpreted as sarcoma, both clinically and microscopically. It is a reactive lesion composed of fibroblasts/myofibroblasts and most commonly found in extremities and trunk. NF has been described in the head and neck region in 10-20% of cases. Many pathologists do not consider NF in the differential diagnosis of soft tissue masses arising in the Head neck region. NF that occurs in otherwise healthy individuals usually presents with a history of rapid growth, and is commonly found in the upper extremities and on the chest and trunk. The importance of otolaryngologists being aware of the existence of this entity in this area of the body is stressed. It has a confirmed perfectly benign clinical course, and simple excision, as tissue-sparing as possible, is the treatment of choice. A case of NF over the neck in a 05-year-old female not associated with trauma who presented with a localized mass over her left neck is presented.
Key words: Benign; Neck; Nodular fasciitis; Paediatric. |
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2012;4-14
Case Report |
Shakuntala PN, Ashmita D, Shubha RR, Usha R.
Reproductive Wastage in Recurrent Partial Hydatidiform Mole: A Clinical Dilemma. |
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Abstract: Recurrent partial Hydatidiform mole is an extremely rare clinical entity which represent a part of the gestational trophoblatic neoplasia spectrum. Since the first case was reported by Honore. LM in 1987 about eight cases of , recurrent partial moles have been reported in the English medical literature. Present two cases are the 9th and 10th case with recurrent partial moles to be described. We have discussed the aetiology, environmental factors, dietary habits , clinicopathologic features, the clinical dielemmas faced by us while counselling, follow up and pregnancy outcome in women presenting with two and three recurrent partial moles respectively. We have also reviewed the literature.
Key words: Recurrent Partial Hydatidiform moles; Dietary habits; Pregnancy outcome. |
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This Article |
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2012;4-15
Case Report |
Raina R, Kaushik M, Mahajan SK, Raghav S, Sharathbabu NM.
A Case of Multiple Sclerosis Presenting as Eight and Half Syndrome. |
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Abstract: Multiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination, gliosis (scarring), and neuronal loss; the course can be relapsing-remitting or progressive. Manifestations of MS vary from a benign illness to a rapidly evolving and incapacitating disease requiring profound lifestyle adjustments. We report a 24 year old female who presented with right internuclear ophthalmoplegia with right lower motor neuron facial nerve palsy which is called eight and half syndrome. The etiology in our patient was multiple sclerosis which was confirmed by radio-imaging studies. Patient improved on pulse therapy of methyl prednisolone and tapering dose of steroids.
Key words: Eight and half syndrome; Multiple sclerosis; Fifteen and half syndrome. |
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This Article |
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2012;4-16
Case Report |
Shilpa MN, Patil MA, Sunila S, Chandrashekhar AP.
An Unusual Tumor at an Unusual Site - A Leiomyoma Masquerading as a Urethral Polyp. |
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Abstract: Polyps and papillomas encompass the most common benign tumors of the urethra.Leiomyoma of urethra is a rare clinical entity which can be diagnosed only with histopathological examination and only around 35 such cases have been reported worldwide.
Key words: Leiomyoma; Urethral Polyp. |
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This Article |
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2012;4-17
Case Report |
Kumar S, Diwan S, Chandek S, Nitey PO, Kakani A.
Subdural Hematoma in Grave’s Disease Induced Thrombocytopenia. |
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Abstract: Subdural hematoma (SDH) usually occurs secondary to trauma, in bleeding disorders it may occur spontaneously. It is a rare complication of immune thrombocytopenia. Here we report a case of 45 yrs female presenting with presenting with complaints of headache, palpitation and menorrhagia and later diagnosed to be a case of graves disease with thrombocytopenia with sub dural hematoma. No such case reports are available in literature.
Key words: Subdural hematoma; Thrombocytopenia; Hyperthyroidism; Graves disease. |
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This Article |
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2012;4-18
Case Report |
Challa VR, Swamyvelu K, Amirtham U, Rangappa P, Goud BYG.
Epitheloid Variant of Angiomyolipoma in a Patient with Tuberous Sclerosis. |
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Abstract: Epitheloid angiomyolipoma of kidney is a type of Perivascular endothelial cell derived tumor with an aggressive behaviour with specific pathological, immunohistochemistrical and genetic characteristics. They can occur in a pure form or in assosciation with classical angiomyolipoma. It can be assosciated with tuberous sclerosis in 50% of cases. Our case is a possible case of tuberous sclerosis with epitheloid angiomyolipoma, hepatic angiomyolipoma and lymphangioleiomyomatosis with normal MRI brain and no cutaneous features. Radical nephrectomy with biopsy of hepatic lesion was performed. Histopathological examination revealed epitheloid variant with features of angiomyolipoma. It is six months post surgery and patient is doing well with no evidence of recurrence. Epitheloid angiomyolipoma is a rare malignancy with only 120 cases reported in literature.
Key words: Epitheloid angiomyolipoma; Tuberous sclerosis; Hepatic angiomyolpoma;
Pulmonary lymphangioleiomyomatosis. |
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This Article |
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2012;4-19
Case Report |
Sharma VM, Anupama N, Pradeepa N, Harsha DS, Simon RA, Basavaraj S.
Intracardiac Calcification - An Interesting Chest X-ray Report. |
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Abstract: We report a case of chest X-ray finding of mitral annular calcification. Mitral annular calcification is a degenerative process involving the fibrous annulus of the mitral valve. It is generally an incidental finding associated with aging and atherosclerosis. It may lead to significant mitral regurgitation and can rarely cause symptomatic mitral stenosis. In addition, mitral annulus calcification may be associated with atrial fibrillation and cardiac arrhythmia. Calcification of mitral annulus in the chest X-ray generally follows the C-shape of the mitral annulus. Confirmation is by echocardiography. Symptomatic cases require repair by surgery.
Key words: Mitral annulus; Intra cardiac calcification. |
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