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Volume-12 (2013);
No. 4 (Oct-Dec)
Published on Feb 20, 2014
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2013;4:1
Original Article |
Malviya A, Dixit S, Bhagwat AK, Bansal SB, Khatri AK.
Assessment of Functioning of Village Health and Sanitation Committees (VHSCs) of Indore District |
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Abstract: Background: The NRHM framework of implementation mentions provision of Village Health and Sanitation Committee (VHSC) in each revenue village that has to be formed within the overall framework of Panchayati Raj Institution (PRI). Objective: To review the current status of formation, Training and functioning of Village Health and Sanitation Committee (VHSCs) in Indore district and mechanism of utilization of untied funds in these VHSCs. Materials and Methods: A Cross Sectional study was carried out in 32 villages, of four blocks of Indore district. Different stakeholders of VHSCs of these 32 villages were included purposively as study subjects. Data was collected using predesigned, pretested semi structured questionnaires and Checklist. 133 interviews of different stakeholders and 32 record reviews were carried out. The quantitative data collected by Interviews and record reviews was analyzed by SPSS software and qualitative data was analyzed manually using qualifier. Results: Significant association between knowledge and awareness about any aspect of VHSC and type of stakeholder has been observed. Panchayati Raj Institution (PRI) members and Self Help Group (SHG) members have been found to be totally ignorant about many aspects of VHSC. No formal training has ever been imparted to the members of VHSCs regarding functioning of VHSC at village level. None of the functionary found aware of village health plan. Conclusion: The efficiency and impact of VHSCs have been found to be very limited.
Key words: Village Health and Sanitation Committee; Accredited Social Health Activists; Panchayati Raj Institution; Self Help Group. |
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2013;4:2
Original Article |
Muruganandham R, Ingole A, Murugan V, Dongre AR.
An Approach of Initiating Geriatric Screening OPD at the Rural Health Training Centre of SMVMCH, Pondicherry. |
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Abstract: Objectives: To study the common chronic health problems among the elderly patients attending in recently initiated geriatric screening OPD at the RHTC. Material and Methods: Since one year, screening OPD has been started at RHTC of SMVMCH, for old patients (>60 years), twice a week. A team of trained medical interns, a post-graduate, a faculty in Community Medicine and a counselor screen and counsel the elderly patients for common medical and mental health problems. The screening tool is structured and has been adopted for patients of geriatric OPD at RHTC. The screening tool consist of General Health Questionnaire (GHQ-5), Psychosis screening, Alzheimer’s disease (AD8) questionnaire and checklist of common medical conditions. Patients were screened for early detection of health problems followed by counseling them/their caregivers and referral to specialty OPD for further care. Results: Total 512 elderly patients were screened over 4 months period from the start of geriatric OPD. Out of them, 276 (54%) and 117 (23%) were between the age group of 60-65 years and 66-70 years respectively. Among them 387 (75%) were below poverty line and 68 (13.3%) were having some kind of health insurance. GHQ score indicates that 255 (50%) patients had a score more than one and it was significantly higher among females compared to males. About 76 (16.8%) elderly had a score of > 1 for psychosis, out of which only 12 (14%) were referred to the higher centre. AD8 score shows 204 (40%) patients attended the clinic having a score more than 1 and it is significantly higher among females compared to males. Counseling for caregivers was given only in 13 (6%) of the patients with high AD8 score. Common chronic conditions present among them were joint pains (310, 60%), visual disturbances (247, 48%), hearing difficulty (120, 23.4%) and hypertension (107, 21%). Conclusion: The proportion of people with AD8 score more than 1 is high and most common chronic condition seen is joint pain. The action component of the clinic such as referral of dementia patients, psychosis patients and counseling of their care-givers need to be strengthened.
Key words: Screening; Counseling; Geriatric; Care-givers; Psychosis; Dementia; Alzheimer’s disease |
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2013;4:3
Original Article |
Nagaraja V, Raval J, Eslick GD, Denniss AR.
Approaches for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis |
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Abstract: Introduction: Retrograde transfemoral and antegrade transapical approaches are mostly used for transcatheter aortic valve replacement. This meta-analysis is designed to assess the performance of the transfemoral and transapical approach. Methods: A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data was abstracted from each study and used to calculate a pooled odd ratio (OR) and 95% confidence interval (95% CI). Results: Only 14 studies comprising of 6965 patients met full criteria for analysis.
The mean duration of hospitalisation and procedure duration were similar among the 2 cohorts. The 30 days mortality (OR: 0.70, 95% CI: 0.531-0.921), the need for haemodialysis (OR: 0.29, 95% CI: 0.157-0.525) and one year mortality (OR: 0.72, 95% CI: 0.564-0.927) were lower in the transfemoral cohort. The frequency of stroke at 30 days and new pacemaker insertion were comparable. However, the prevalence of vascular complication (OR: 2.88, 95% CI: 1.821-4.563) was higher in the transfemoral group. The incidence of aortic regurgitation (OR: 1.25, 95% CI: 0.844-1.855), valve embolization (OR: 2.00, 95% CI: 0.622-6.448), major bleeding incidence rates (OR:0.77, 95% CI: 0.488-1.225), coronary obstruction (OR:0.74, 95% CI:0.234-2.311), myocardial infarction (OR: 0.75, 95% CI: 0.28-2.00), conversion to open cardiac surgery (OR: 0.29, 95% CI: 0.062-1.343) and successful implantation (OR: 0.67, 95% CI: 0.394-1.149) were comparable in the two cohorts. Conclusions: In the absence of a randomized controlled study, the ability to discriminate true differences is challenging. Even though the complications rate was much lower in transfemoral group as compared to transapical group, the current literature does not support a clear superiority of one approach to TAVR over the other.
Key words: Transcatheter aortic valve replacement; Access approaches; Transfemoral; Transapical; Aortic stenosis |
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2013;4:4
Original Article |
Balgir RS.
A Cross-Sectional Study of Hemoglobin Disorders in Pregnant Women Attending Two Urban Hospitals in Eastern Coast of Odisha, India. |
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Abstract: Pregnant women are an important segment of the society. They bear the children and provide nourishment to them during the period of gestation of nine months. The health of a mother reflects the health of a child. No such study of prevalence of hemoglobinopathy in pregnant women from India is available. The study objectives were: to find the prevalence (genetic burden) of hemoglobin disorders in pregnant women belonging to urban setting; identify the communities at risk, and to determine the hematological profile of native pregnant women of coastal Odisha. A cross-sectional study of pregnant women visiting for antenatal care at two urban hospitals, Bhubaneswar and Berhampur in Coastal Odisha was investigated. A total of 178 pregnant women attending antenatal care check up at two urban hospitals in coastal Odisha were studied. Appropriate statistical tools were used for analysis of data. High prevalence of 13.5% for hemoglobin disorders was observed in urban pregnant women visiting two major hospitals in coastal Odisha. Mild to moderate anemia was recorded. Reduced values of hematological indices in women afflicted with hemoglobin disorders than the normal controls were noted. Major hemoglobinopathies detected were: β-thalassemia trait (5.6%), sickle cell trait (5.6%), hemoglobin E trait (1.1%), sickle cell-E-disease (0.6%), and hemoglobin H disease (0.6%). Mandatory awareness, comprehensive clinical management, and genetic/marriage counseling are highly essential to ameliorate the sufferings of afflicted pregnant women of coastal Odisha.
Key words: Pregnant women; Hemoglobin disorders; Hemolytic anemia; Community health; Urban population; Coastal Odisha. |
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2013;4:5
Original Article |
Balgir RS.
Red Cell Genetic Markers in Malarial Susceptibility and Selective Advantage Hypothesis.
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Abstract: Malaria is still a serious public health challenge in many parts of the world including India. Human genetic susceptibility to malaria varies from individual to individual depending upon the genetic constitution and from region to region based on geo-ecological and climatic conditions. In the present study, intravenous 334 random blood samples of unrelated adult individuals belonging to Mongoloid ethnic stock were taken after informed consent from the endemic localities of Arunachal Pradesh, Assam and Nagaland to find out the relationship between the abnormal hemoglobin and G6PD enzyme deficiency, and susceptibility to malaria. Abnormal hemoglobin E and G6PD enzyme deficiency seem to interact with malarial parasite in such a way that they probably provide decreased susceptibility or inhibitory effect or increased resistance. Genetic alterations in human genome are maintained in the specific population by natural selection to protect the host against the malarial infection. These findings are consistent with those studies which support the notion of selective genetic advantage hypothesis against the malaria infection.
Key words: Red cell genetic markers; Hemoglobin E; G6PD deficiency; Malaria susceptibility;
Natural selection; North-Eastern India. |
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2013;4:6
Original Article |
Kamath BJ, Vardhan H, Jayasheelan N, Mahale A, Kumar A.
Optimisation of Surgical Results in de-Quervain’s Disease. |
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Abstract: Background: De Quervain’s disease poses more problems with respect to management thanthe diagnosis. Surgery is resorted to when the conservative methods fail. There are known complications of the surgical intervention.Surgeon contemplating the surgery should be aware of these and make every attempt to optimize the results and avoid the above mentioned complication.
Methods: Sixty symptomatic wrists in 57 individuals suffering from de Quervain’s disease who needed surgery were studied preoperatively with ultrasound. Number of tendons and the sub septae identified in the ultrasound examination preoperativelywere confirmed on the table during the surgery. The release was brought about under local anesthesia, with magnification taking care to avoid injury to the cephalic vein and superficial branch of radial nerve, not to violate the anterior margin of the sheath, thus preventing complications.A negative post release finkelstein test was ensured before the wound closure. Results: All 60 patients who underwent release for de Quervain’s disease were symptom free,satisfied and fully functional. Conclusions: De-Quervain's disease not relieved by conservative methods needs surgical release under local anesthesia with a transverse incision with Preoperative ultrasound examination for the number of tendons and subseptae. Avoiding the violation of the volar aspect of the sheath, loupe magnification, tourniquet and post release Finkelstein’s test before wound closure, will ensure optimal results.
Key words: De Quervain’s tenosynovitis; Ultrasonography; Loupe; Finkelstien’s test.
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This Article |
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2013;4:7
Original Article |
Salati SA, Rather AA.
Adult Umbilical Disorders in Surgical Practice – An Experience from Kashmir. |
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Abstract: Umbilical disorders form an important part of general surgical practice. The disorders may be congenital or acquired and manifest in both genders and affects all age groups. This article analyses the profile of adult umbilical disorders as seen in a surgical division of a medical college in Kashmir valley over a period of two years.
Key words: Umbilicus; Hernia; Pilonidal sinus; Granuloma; Endometriosis; Lipoma; Sebaceous cyst |
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2013;4:8
Short Report |
Nalini PR, Thirunavukarasu MR, Dongre AR.
Reports of Child Abuse in India from Scientific Journals and Newspapers - An Exploratory Study. |
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Abstract: Background: Child abuse is a state of emotional, physical, economic and sexual maltreatment meted out to a person below the age of eighteen and is a globally prevalent phenomenon. A total of 33,098 cases of crimes against children were reported in India during 2011 as compared to 26,694 cases during 2010, suggesting a recent increase of 24 percent. Objectives: To explore the contents of the published articles/reports on child abuse in India from scientific journals and newspapers identifying areas and gaps for further research and program development. Material and Methods: Published articles in scientific journals during the years 2007-2012 with free access and online versions of English newspapers (2007-2012) in India were searched using the search engines such as ‘PubMed’ and ‘Google’. The key words used were ‘child abuse in (on, about) India. First two researchers independently reviewed the content of articles/newspaper reports and decided the categories emerging from the articles and reports. Later on, the quantification of these categories was done by identifying the number of times it was reported in the reports. Results: The nature and extent of reporting child abuse in scientific journal is different from that of newspapers. In Journals, our search provided us with 9 articles, of which prevalence studies were predominant (4) followed by case reports (3) and Knowledge, Attitude, Practice studies (2). The studies were mostly conducted in the hospital setting. We obtained 38 reports from newspapers. Child abuse was found more among girls. Among type of abuse, sexual abuse was more common (84.2%). About 52.6% of the abusers were members known to the victim. The maximum cases were reported from West India especially in Goa, followed by South region. Most reports reported legal action on accused. Little was reported on what happened to a victim, indicators of abuse and settings of the abuse. The motives and consequences of the abuses were not mentioned explicitly. Conclusions: The articles were more focused on prevalence of child abuse in hospital settings. As per newspaper reports, female child abuse (sexual abuse) by a known person to family was reported more. It was found more in West part of India. Recommendations: More research/reporting is required to study the extent of problem in different settings of India, settings of abuse, quality of life of victims, parental/community education on indicators of abuse and development of support program to victim.
Key words: Child Abuse; Journals; Newspapers; India |
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2013;4:9
Short Report |
Kakunje A, Puthran S, Shihabuddeen ITM, Chandran MVV.
‘Gas Syndrome’ - A Culture Bound Syndrome. |
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Abstract: Culture refers to the shared patterns of feelings, beliefs and behaviour that reflect in the way of living in a society. Culture uniquely influence the role functioning or psychosoical wellbeing of people living in a given society by exerting influence on their mind by their traditional health beliefs. Cultural factors influence understanding, presentation, diagnosis, management, course and outcome of many diseases, especially psychiatric disorders. Culture-bound syndromes seem to be episodic, dramatic and discrete patterns of behavioral reactions specific to a particular community that articulate both personal predicament and public concerns. Every culture provides explanations and causal attributions for somatic symptoms. One of the common complaints of persons coming to medical attention is ‘Gas’ or similar terminologies like ‘vayu’ etc. People attribute varied symptoms from abdominal discomfort, chest pain, headache, joint pains, back pain, somatic complaints to ‘Gas’. ‘Gas’ is reported to be the cause for the distress and the primary duty of the treating clinician is to relieve them of the gas. The problem of troubling Gas or vayu has been influencing Indian culture/tradition since ancient days. We do see a significant proportion of patients visiting varied specialists attributing all their problems to Gas. 'Gas Syndrome’ is proposed as a culture bound syndrome.
Key words: Gas; Syndrome; Culture |
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2013;4:10
Case Report |
Sudhakar S, Geethika V, Ramaswamy P, Kumar PK, Sreenivasulu P.
A Rare Presentation of Odontogenic Keratocyst Mimicking an Antral Polyp. |
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Abstract: Maxillary sinus harbours many pathological lesions. Many of those presents as a sinonasal mass and are rarely symptomatic. These masses are usually an antral polyp, mucoceles or mucous retention cysts. Odontogenic keratocyst, a benign odontogenic lesion presenting within the maxillary sinus is a rare entity. We present a case of odontogenic keratocyst of the maxillary sinus in a 35 years old female.
Key words: Keratocyst; Maxillary sinus |
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2013;4:11
Case Report |
Vijayaraju D, Ramkumar S, Subramanian SR.
Prallethrin Poisoning Presenting as Status Epilepticus. |
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Abstract: Mosquito repellents contain pyrethroid derivatives, as the active ingredient. Data regarding human toxicity following oral intake is limited. This is a case report of an individual who presented with neurotoxicity following oral ingestion of prallethrin (2.4% w/w) of a higher concentration present in formulations commercially available than previously. A 22 year old male presented to the emergency Room (ER) in status epilepticus. He was managed in the Intensive Care Unit (ICU). No cause for his status could be determined after all laboratory investigations. A review of history with the patient revealed that he had ingested a bottle of liquid mosquito repellent (45 ml). The patient has had no further symptoms on follow up and has been off anti epileptics. Pyrethroid containing mosquito repellents act on neuronal sodium channels causing hyperexcitiability. With no known specific antidotes, symptomatic treatment is the main stay of management.
Key words: Pyrethroids; Status Epilepticus; Sodium Channel |
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2013;4:12
Case Report |
Sailaja S, Rathod PS, Umadevi K, Shruti S, Bafna UD.
Preoperative Surprise of a Mass per Abdomen Mimicking Ovarian Neoplasm in a 50 Years Old Woman. |
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Abstract: We report a large cystic tumour of about 40cms size in a perimenopusal woman mimicking ovarian tumour, with peroperative surprise of finding it as degenerated fibroid arising from fundus of the uterus.
Key words: Ovarian neoplasm; Leiomyomata uteri; Degenerated. |
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2013;4:13
Case Report |
Kumar S, Babu SNM, Mahajan SK, Kaushik M, Verma BS, Kaushal SS.
Himalayan P waves in COPD - A Rare Feature. |
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Abstract: Himalayan or giant P-waves (amplitude =5 mm) are often known to be classically associated with congenital heart diseases with right to left shunt like tricuspid atresia, Ebstein anomaly, combined tricuspid and pulmonic stenosis, etc, where they indicate a dilated right atrium and tend to be persistent. These type P waves are rarely seen in chronic obstructive pulmonary disease (COPD) and in this condition it may be due to structural right atrial changes or hypoxemia or combination of both. Here we report a case of COPD with Himalayan P waves which is a rare entity.
Key words: Himalayan P waves; Giant; Chronic obstructive pulmonary disease. |
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2013;4-14
Case Report |
Lal B, Minhas RS, Sharma DR, Kumar S.
Scrub Typhus Presenting as Acute Mastoiditis. |
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Abstract: Scrub typhus, a zoonosis, is known to present with varied clinical presentation. We present a case of acute mastoiditis who did not respond to conventional antibiotic therapy. The detailed repeat clinical examination revealed lymphadenopathy with eschar and IgM antibodies for scrub typhus by ELISA were positive. Patient had dramatic response to doxycycline therapy.
Key words: Ear disease; Rickettsial disease; Himachal Pradesh. |
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2013;4:15
Case Report |
Sailaja S, Umadevi K, Rathod PS, Shruti S, Bafna UD.
Spontaneous Eviceration of an Incisional Hernia Presenting One Year After Primary Surgery. |
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Abstract: Spontaneous eviceration is a rare complication associated with incisional hernia which demands an emergency surgery. A few cases have been reported on this. We report a spontaneous evisceration of bowel with strangulation which was managed by bowel resection and anastomosis and anatomical repair of incisional hernia.
Key words: Incisional hernia; Spontaneous rupture; Bowel resection |
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2013;4:16
Letter |
Danasekaran R, Mani G, Annadurai K.
Mercury Free Healthcare by 2020: Time for Action. |
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Abstract: Urgent steps are needed to realise the goals of mercury free healthcare by 2020.
Key words: Mercury; Thermometer; Sphygmomanometer; Dental amalgam. |
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