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Volume-15 (2016);
No. 1 (January- March)
Published on May 30, 2016
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2016;1:1
Original Article |
Purohit BC.
Efficiency in Health Care Sector in Tamil Nadu (India): An Exploratory Analysis. |
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Abstract: Keeping in view the importance of efficiency in resource utilization in healthcare sector, we focus on efficiency of health care system at sub-state level (i.e., district level) in India using Tamil Nadu state and its district level data for 2012-13. It being an economically advanced state, in terms of Infant Mortality Rate (IMR) the state ranks second lowest among the Indian states. We explore the reasons for relative performance of different districts with Data Envelopment Analysis. We used IMR as output variables. Using Principal component analysis we tried a sub-set of variables which had low correlations. Thus three components with an Eigen value greater than one were used. These related to Total beds in ESI (Employees state Insurance scheme) hospitals, Population per doctor of PHPM (Public Health and Preventive Medicine) and Full Vaccination. The factor scores for these components were used for Data Envelopment Analysis (DEA). We have focused on CCR scores (or constant returns to scale technical efficiency, CRST score) and efficiency rankings based on these are discussed. Thus our results pertaining to district level health system efficiency for Tamil Nadu state indicate that some of the districts have low efficiency in utilization of inputs like doctors and beds. There are also other districts which need more of these inputs which may enhance their output and efficiency. Thus it suggests that that the lowest performance of Kancheepuram district, for instance, is mainly owing to low availability of these health inputs as well as partly due to less efficient utilisation of inputs. It is also inferred that higher efficiency of Chennai is due to better availability of hospital beds and doctors per population. Among the factors external to health system, the statistical significance of an improved source of drinking water indicates that supportive input of better potable water supply helps to improve in general health status and thus reduce inter-district disparities in health system efficiency. Overall, thus, there is a mix of both inefficiency and inadequacy of inputs which has increased the inter district disparities in health outcomes in the state.
Key words: Efficiency; healthcare system; district level; IMR. |
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2016;1:2
Original Article |
Kumar V, Deshmukh PR, Taywade M, Gupta SS.
Magnitude and Correlates of Low Birth Weight at Term in Rural Wardha, Central India. |
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Abstract: Introduction: Birth weight is one of the most important determinant of the neonatal and infant survival. The goal of reducing low birth weight incidence by at least one third between 2000 and 2010 was one of the major goals in ‘A World Fit for Children’. The prevention of low birth weight is a public health priority, particularly in developing countries with high magnitude. Knowledge regarding magnitude and correlates help prevent the condition. Hence, the present study was carried out to study the magnitude and the correlates of low birth weight. Methodology: Two hundred and six newborn babies were recruited on a birth cohort from two Primary Health Centres (PHC) of Wardha district to study growth in first year of life. Here, we present the baseline analysis of 172 children who were born full term to study the correlates of low birth weight babies born full term. The children were recruited within first week of their birth. Data was collected on socio-demographic profile, birth history, and maternal characteristics. Proportion of low birth weight was expressed in percentage along with 95% confidence interval. Univariate and multivariate logistic regression was used to study the correlates. Findings are expressed in odds ratios with their 95% confidence intervals. Results: The magnitude of low birth weight at term was found to be 33.1% (95% CI: 26.4%-40.4%). On univariate analysis, significant correlates of low birth weight were consumption of less than 50 iron-folic acid tables and being born to than mother. On multivariate analysis, the significant correlates were female sex of child (OR=2.856), being born to thin mother (OR=5.320), consumption of less than 50 tablets (OR=4.648), and complications of pregnancy (OR=2.917). Conclusions: The magnitude of low birth weight is very high and modifiable correlates of low birth weight are nutritional status of mother, lower consumption of IFA tablets and complications of pregnancy.
Key words: Low birth weight, infant survival, nutrition. |
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2016;1:3
Original Article |
Shandiz FH, Janghorban R, Azarkish F, Sedigh S.
Effect of Treatment Delay on Survival in Patients with Breast Cancer. |
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Abstract: Background: The effect of time interval from diagnosis to treatment on survival has remained controversial. The aim of this study was to assess treatment delay in Iranian breast cancer patients and to examine its impact on overall survival and disease free survival. Materials and Methods: A historical cohort study was undertaken on breast cancer patients who were diagnosed and treated in two university hospitals between 2003 and 2013. The impact of interval to treatment defined as the time between date of pathological diagnosis, usually via open biopsy, and the date of initial therapy, either surgical or systemic was measured on overall survival and disease free survival. Prognostic factors and outcomes of the patients were analyzed using log-rank test and Cox regression model. Results: The median and mean of interval to treatment were 15 and 25.98±42.31 SD days, respectively. There was no association between the interval to treatment after a diagnosis of breast cancer and overall survival or disease free survival. In univariate analyses, statistically significant predictor for overall survival was tumor stage but not in disease free survival. In multivariate analyses, the stage II [Hazard Ratio: 0.145, 95% CI: 0.04 to 0.49, P Value: 0.002] and III [Hazard Ratio: 0.227, 95% CI: 0.08 to 0.64, P Value: 0.005] Compared with the stage IV were significantly associated with increased overall survival. Conclusion: The study suggests that delay to treatment up to two weeks has no adverse effect on overall and disease free survival. It seems that when patients diagnosed with early stage could have a waiting time longer than two weeks.
Key words: Breast cancer, Treatment delay, Survival |
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2016;1:4
Original Article |
Kumar VA, Kalaiselvan G, Dongre AR.
Prevalence of Tuberculosis among Household Contacts in Pondicherry: Active Case Finding Among New Smear Positive Cases. |
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Abstract: Introduction: The risk of transmission from the index case to its contacts is more in case of smear
positive Pulmonary Tuberculosis cases. Any delay in diagnosis and treatment increases the risk of disease
transmission to their contacts. Contact screening is important for early detection of transmission of infection.
Thus, active case finding of TB is needed to identify the case yield among household contacts. This study will
yield the burden of Tuberculosis among the household contact. Objective: To identify the TB suspect and
estimate the prevalence of TB among household contacts. Material and Methods: A community based two stage cross sectional study was
done in 472 households of 157 ‘Index cases’ registered in the State Tuberculosis Unit, Puducherry. The study
duration was one year and eight months. Data was entered and analyzed by using Epi_Info (Version 3.4.3)
software package. Results: A total of 96 (20.3%) symptomatic was found from the 472 households contacts
who participated in this study. Out of 90 symptomatics, 70 (72.9%) were symptomatic within two months of visit
and 26 (27.1%) were found to have symptoms after eight months. The overall prevalence of tuberculosis in
symptomatic household contacts was 4.3% and all tuberculosis confirmed cases were found at the end of in second
month only. Conclusion: Considering the prevalence tuberculosis among the symptomatic of household contact
to be 4.3%, their investigation to rule out TB in earlier stages is a need. It may help prevent further spread of
M. tuberculosis infection in the local community.
Key words: Active case finding, Household contacts, Tuberculosis. |
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2016;1:5
Original Article |
Shkurat T, Savikina K, Lomteva S, Sagamonova K, Shestel A, Prokofev V, Sherchkova T, Shimanskaya E, Derevyanchuk E, Aleksandrova A.
The Intensity of Free Radical Processes and the Testosterone and Estradiol Levels in Seminal Fluid of Men with Different Types of Pathospermia - Personalized Approach. |
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Abstract: Background: We studied the intensity of free-radical processes and the testosterone and estradiol levels in
seminal fluid of men with normospermia, asthenozoospermia, oligozoospermia, oligoasthenozoospermia, teratozoospermia.
Results: An increased ability to generate reactive oxygen species in seminal fluid in patients with
oligozoospermia was determined. Increased levels of testosterone and estradiol in semen were noted in pathospermia
associated with reduced sperm motility. A positive correlation was found between the free-radical processes
intensity and testosterone levels increase, and high correlation (r = 0.8) between the testosterone and estradiol
levels in seminal fluid in patients with oligozoospermia was marked. Conclusion: The prooxidant and
antioxidant processes conjugacy violation occurs in one of the pathospermia types - asthenozoospermia, which
is reflected in the absence of all studied parameters correlation in the seminal fluid.
Key words: Reactive oxygen species (ROS), Luminol-dependent chemiluminescence, Semen, Estradiol, Testosterone, Oxidative stress, Spermatogenesis. |
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2011;1:6
Original Article |
Omuta GED..
The Quality of Healthcare Service Delivery in Nigeria: An Assessment of the Availability of Some Basic Medical Devices/Equipment in the Primary Health Care Centres in Delta State. |
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Abstract: Background: Ordinarily, accessibility implies locational proximity. However, this study limits its use to the quality of what is accessed. There is, therefore, service-delivery inaccessibility, when health care seekers can only access poor quality service, because of the poor quality of the equipment at the disposal of primary health care centres. Service-delivery equipment are, therefore, surrogate indicators of the quality of the health care services that are geographically accessible. Methodology: Both qualitative and quantitative approaches of investigation were deployed, using structured questionnaires and focus group discussions/key informant interviews, respectively. It covered nine local government areas, three each from the senatorial districts. The paper discusses three basic medical devices/equipment that determine the quality of services delivered by PHCs, namely available and functioning general purpose equipment; most commonly used methods of sterilization; and availability of different types of laboratory tests. The quantitative data were cleaned up, processed and analysed, using the SPSS 10.0. Results: There were variations in the availability of devices and equipment. Syringes/needles and stethoscopes were available in more than three-quarters of the centres, while less than ten (10) per cent had microscopes. About 15 per cent of the centres either had no methods of sterilization at all or used ‘inappropriate’ ones. In spite of the prevalence of malaria, only 28.89 per centres could test for the parasite. Conclusion: The quality of services were perceived as poor because the basic medical devices and equipment were either lacking or inadequate. Policy implication is that government should increase resource allocation to the PHC subsector to procure the basic facilities for efficient service delivery.
Key words: Basic medical devices and equipment; primary health care; increased resource allocation |
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2016;1:7
Original Article |
Kamath BJ, Reddy B, Jayasheelan N, Reddy R.
The Thomas Splint: A Modification and Extension of its Uses in Clinical Orthopaedics. |
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Abstract: Sir Hugh Owen Thomas descended from a long line of Welsh bone-setters. He stressed on the importance of rest in treatment and was responsible for many landmark contributions in the field of orthopaedics. He is especially celebrated for his design and use of splints; the famous Thomas knee splint is still in wide use in emergency departments and Orthopaedic units in hospitals worldwide. Many a time’s assessment of fracture reduction becomes difficult as the Thomas splint obstructs the view. We tried to reduce these problems by modifying the Thomas splint into a radiolucent one by using nylon. This radiolucent splint not only allows repeated radiography to provides clear image without any superimposition but more importantly these repeated radiographs do not cause any pain and discomfort to the patient.
Key words: Thomas splint, Sir Hugh Owen Thomas |
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2016;1:8
Original Article |
Quadros LS, Jaison J, Bhat N, Prasanna LC, Bhat KMR, Kalthur SG.
Auriculotemporal Nerve – A Study on its Roots. |
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Abstract: Auriculotemporal nerve (ATN) is a branch of the posterior division of mandibular nerve. It presents two roots at its origin, which encircle the middle meningeal artery. In the present study of thirty hemi-sections of head and neck the roots of the ATN and its relation with middle meningeal artery (MMA) were observed and photographed. The number of roots in these thirty specimens were as follows: Single root – was observed in four specimens, two roots – were observed in twenty two specimens, three roots – were observed in three specimens and five roots – were observed in a single specimen. Since the infratemporal region is filled with the temporomandibular joint (TMJ), the muscles of mastication, important blood vessels and nerves, the variations described in the present study, may enlighten the surgeon towards the possible entrapment of the nerve roots due to the pressure exerted due to dislocation of TMJ or due to hypertrophic masticatory muscles.
Key words: Auriculotemporal nerve, infra temporal fossa, mandibular nerve, middle meningeal artery. |
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2016;1:9
Case Report |
Abhinita P, Kumar N, Rao MKG, Nayak SB, Swamy RS, Aithal AP.
High Origin of Superficial Ulnar Artery Associated with Absence of Palmaris Longus Muscle- A Rare Concurrent Anatomical Variation. |
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Abstract: Superficial ulnar artery is one among the rare variant form of ulnar artery. The overall incidence of superficial ulnar artery is reported to be 0.7% - 9.4%. The occurrence of superficial ulnar artery is also said to be associated with the absence of palmaris longus muscle as an uncommon variation. We report here such a concurrent unilateral case of higher origin of superficial ulnar artery from brachial artery at mid arm level associated with the absence of palmaris longus muscle in a male cadaver. Knowledge of atypical superficial course of ulnar artery might be useful for cannulation but such a course is also prone to injuries leading to bleeding and ischemia. Therefore, it is important for radiologists, surgeons and phlebotomists to check for the persistence of superficial ulnar artery before performing any interventional procedures in the upper limb.
Key words: Superficial ulnar artery, palmaris longus, high origin, brachial artery |
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2016;1:10
Case Report |
Mahajan D, Shirazi N, Ahmad S, Kumar S, Harsh M.
Pulmonary Cystic Echinococcosis Presenting as Refractory Lung Abscess in a 14 Year Old Child. |
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Abstract: The prevalence of hydatid disease in North India is higher than it is actually diagnosed and reported. It manifests as a wide variety of symptoms due to different organs affected by the disease. We describe a young girl with clinical and radiological features of suppurative lung abscess subjected to lobectomy due to lack of response to appropriate antibiotic therapy. Surgery was curative as histopathology of the resected specimen clinched the diagnosis of pulmonary cystic hydatid.
Key words: Lung abscess, echinococcosis, pulmonary cystic hydatid |
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2016;1:11
Case Report |
Kumar P, Alam P, Chakravarthy S, Allada R.
Ultra Sound Evaluation of Asymptomatic Gall Bladder Perforation. |
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Abstract: Gall bladder perforation is a rare, fatal and life threatening complication of acute cholecystitis. A definitive diagnosis is uncommon before surgery due to which the morbidity and mortality associated with this condition is high. The delay in the diagnosis is attributed to the fact that most patients present with the same symptoms which can range from an acute generalized peritonitis to benign non-specific abdominal symptoms. We report a case of asymptomatic GB perforation which was confirmed on surgery.
Key words: Gall bladder, perforation, peritonitis |
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2016;1:12
Case Report |
Bist SS, Luthra M, Agarwal V, Bharti B.
Isolated Lacrimal Gland Tuberculosis: A Rare Clinical Entity in a Young Child. |
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Abstract: Discharging sinus in upper eyelid is one of rare manifestations of tuberculosis. The present report describes the youngest case of tubercular dacryoadenitis in an otherwise healthy child. A 4 year old male patient presented with discharging sinus in upper eyelid that developed after a spontaneously burst abscess in upper eyelid. Pus culture was sterile and the child did not improve with antibiotics. The child subsequently developed superotemporal orbital swelling and along with discharging sinus. Debridement and curettage of the necrotic tissue and sequestrum were done, histopathology showed the chronic granulomatous inflammation consistent with tuberculosis. The patient was managed with anti-tubercular therapy for 6 months. Atypical presentations of tuberculosis like discharging sinus in eyelid pose a difficult problem in diagnosis particularly in a young child. Spread of tubercular bacilli to the lacrimal gland is more commonly hematogenous or may occur directly from conjunctival tuberculosis and rarely from direct inoculation during trauma. This case report presents unusual development of tuberculosis with no other local or systemic focus of tubercular infection and any direct trauma. Tuberculosis should be kept as a possible differential diagnosis in cases of painless lid swelling, especially in a country like India where tuberculosis is endemic.
Key words: Tuberculosis, lacrimal gland, granuloma |
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2016;1:13
Case Report |
Mohanty RK, Sahoo SP, Sahoo UC, Paikray S, Behera K.
The Effectiveness of a Hip Abduction Orthosis for Perthes Disease. |
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Abstract: Perthes disease is a rare childhood disorder of femoral head affecting 5-10 per 100,000 children. Prognostic factors remain uncertain after age five which requires careful evaluation of subject, planning for treatment always associated with a slow recovery. Orthoses are provided as a conservative treatment to reduce weight bearing stress across hip joint, maintenance of joint congruity, allowing safe and pain free ambulation for school growing children by keeping the limb in abduction and internal rotation. Though there are different number of orthoses used earlier, the present literature does not provide sufficient evidence to support its use in Perthes disease. We report a case of 8 years old active school going subject with Perthes disease of right hip who was fitted with an ambulatory trilateral hip abduction orthosis and assessed by radiographic examination with satisfactory result.
Key words: Abduction, Ambulatory, Orthosis, Perthes disease |
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2016;1:14
Case Report |
Alam P, Kumar P, Chakravarthy S.
Ultra Sound Evaluation of Choledochal Cyst With Portal Hypertension. |
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Abstract: Choledochal cyst is an uncommon congenital cystic dilatation of the bile duct. The underlying etiology is believed to be an anomalous junction of the pancreatic duct and common bile duct (CBD) that allows free reflux of pancreatic enzymes into the CBD, weakening its wall. Portal hypertension is a rare complication of choledochal cyst. We report a case of choledochal cyst with portal hypertension confirmed by surgery.
Key words: Choledochal cyst, Portal hypertension |
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2016;1:15
Case Report |
Sumalatha S, D Souza AS, Bhat KMR, Ankolekar VH, Kotian SR.
Variation in the Branching Pattern of the Superficial Palmar Arch. |
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Abstract: In this article we describe a rare variation in the superficial palmar arch (SPA) encountered during routine cadaveric dissection. SPA was formed by the superficial branches of ulnar and radial arteries which provided a proper digital branch to the ulnar side of the little finger and three common palmar digital branches to the medial four digits. Additionally a first common digital artery was seen to emerge from the radial side of SPA which further divided into the arteria princeps pollicis and arteria radialis indicis. We also found a small communicating branch between the arteria princeps pollicis and the radial artery in the anatomical snuff box. Such arterial variations in the palm due to alteration in the developmental sequence remains a crucial issue in the reconstructive hand surgeries, especially while dealing with the innovative microsurgical procedures, where these varied patterns act as pivotal points around which successful results of various advanced surgical procedures revolve.
Key words: Superficial palmar arch, Radial artery, Ulnar artery, Common digital artery, communicating branch |
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