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   Table of Contents - Current issue
January-April 2019
Volume 5 | Issue 1
Page Nos. 1-44

Online since Tuesday, April 30, 2019

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Psychogenic nonepileptic seizures (PNES): A review Highly accessed article p. 1
Neera Chaudhry, Kamakshi Dhamija, Vinod Puri
Psychogenic nonepileptic seizures (PNES) are observable abrupt paroxysmal changes in consciousness or behaviour that present similar to epileptic seizures but are not accompanied by the electrophysiological changes associated with epilepsy and there is a strong suspicion or positive evidence for existence of a psychogenic cause. There is no single feature that absolutely distinguishes true epileptic events from psychogenic nonepileptic seizures and hence there is considerable diagnostic uncertainty for the condition. This is well evidenced by the fact that there is an average delay of approximately 7 years before the right diagnosis of ‘psychogenic seizures’ is achieved. Hence, this leads to an enormous social and economic burden on the society with costs incurred upon ‘PNES’ approximating that of refractory epilepsy group. This review focusses on the salient clinical pointers to the condition along with possible diagnostic and treatment strategies.
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Barriers and Challenges in Seeking Healthcare by Pediatric Tuberculosis Patients Attending DOTS Centers in Urban Areas of Delhi p. 8
Sunita Dhaked, Nandini Sharma, K.K. Chopra, Ashwani Khanna
Background: Healthcare seeking by pediatric tuberculosis (TB) patients is complicated because of some factors such as lack of knowledge among family members, diagnostic difficulties, limited resources, and treatment challenges. Aims: The aim of this article is to identify the barriers and challenges related to seeking healthcare by pediatric TB patients. Settings and Design: It was a prospective observational study conducted from January 2015 to December 2015 at two chest clinics. Materials and Methods: A predesigned, pretested, and semi-structured questionnaire was used to interview caregivers of pediatric TB patients and followed up at two more occasions, that is, at the end of intensive and of continuation phase, to identify the challenges they were facing during treatment. Statistical Analysis: Data were analyzed using SPSS software version 17 (SPSS Inc., New Delhi, Delhi, India) and P value less than 0.05 was considered significant. Result: The lack of knowledge was a barrier to understand the disease, seeking care, and being compliant with treatment as nearly 40% (41.8%) did not know that TB is infectious and more than half (55.3%) did not know that TB can occur in any age group. Only 14.2% knew about vaccine for TB, but no one had knowledge about isoniazid prophylaxis. Reported challenges in treatment seeking were high transport cost, long distance for higher government facility (83.7%), and interference with daily routine (39.0%), and in-treatment compliance were heavy pill burden (80%), refusal of child to take medicines (41.8%), fear of side effects (71.6%), and difficulty in powdering the medicines (35.5%). Conclusion: Major barrier was lack of knowledge about childhood TB and major challenge was heavy pill burden, which affected the compliance.
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Health-Related Knowledge and Attitude Toward Common Cancers Among Slum Dwellers in Delhi p. 13
Damini Batra, Dhruv Ahuja, Malvika Sharma, Bratati Banerjee
Background: The dead weight of growing incidence and mortality of cancer is a cause of concern for increased economic burden in a developing country. Low awareness levels lead to late presentation and high mortality. Lack of awareness vitiates the screening and early detection measures. Hence, assessment of prevalent knowledge and attitude is cardinal to outline and implement health policies appropriately. Objectives: This study aimed to assess the knowledge and attitude regarding risk factors and early warning signs of common cancers, viz. oral, lung, breast, and cervix, among urban slum dwellers in New Delhi. Methods: This cross-sectional study was carried out in field practice area attached to the Department of Community Medicine, Maulana Azad Medical College, New Delhi, using a pretested semistructured questionnaire to evaluate the awareness levels in 100 study participants. Mean scores and proportions were calculated and Chi square was applied to test the difference in awareness levels across various sociodemographic variables. Results: Unsatisfactory mean scores were obtained, both for knowledge regarding warning signs (3.20 out of 6) and risk factors (5.67 out of 10). Knowledge regarding screening was also poor. Females were significantly more aware regarding passive smoking as a risk factor for future development of cancer (P = 0.012) and prevalence of some cancers (P = 0.010). Conclusion: Low mean scores for knowledge regarding warning signs and risk factors depict a general unawareness. Media advertising and education seemed to play a positive role as more participants were aware of signs of oral cancer and younger population was better acquainted with risk factors further emphasizing the need for health education. There is also a need to strengthen the screening activities.
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Lacunae in Forensic Handwriting Examination: Scope for Exploitation p. 19
V. P. Varshney, Mona Bedi
The process of forensic handwriting examination consists of two steps: the first step is the objective phase of the process and requires correct ocular observation to make a note of similarities and dissimilarities in the two samples of writing; the second step is subjective phase and depends on proper evaluation of what is observed based on expert’s belief, assumption and experience. The second phase, because of its subjective nature, can also be exploited by dishonest expert resulting in conflicting evidence. This scenario is obviously disruptive for justice, and generally weakens the credibility of this type of evidence.
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Ampullary Neuroendocrine Tumor With Multiple Gastrointestinal Stromal Tumors in a Patient with Von Recklinghausen’s Disease Patient: A Case Report p. 24
Rakesh Kumar Gupta, Utpal Anand, Kunal Parasar, Mamta Kumari, Punam Prasad Bhadani
Von Recklinghausen’s disease (VRD) is a hereditary disease that occurs because of mutation in NF1 gene located on chromosome 17. About 25% of VRD patients are reported to suffer from gastrointestinal lesions varying from hyperplasia of the gut neural tissue, endocrine tumors of the duodenum and the periampullary region, and gastrointestinal stromal tumors. Herein, we describe a case of ampullary neuroendocrine tumor with unique histology and immunohistochemistry in a 35-year-old male patient with VRD, detailed review of literature.
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Speech Induced Primary Focal Lingual Dystonia p. 29
Neera Chaudhry, Laxmikant Joshi, Kamakshi Dhamija, Geeta Anjum Khwaja
Isolated lingual dystonia is a rare form of focal dystonia. Speech-induced primary lingual dystonia is rarer still, with only eight cases reported worldwide till date. It is a challenge to differentiate it from psychogenic dystonia. This has therapeutic implications as directed speech therapy is an important modality of treatment in speech-induced primary lingual dystonia. We report one such case from our clinical practice.
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Severe Complicated Plasmodium vivax Malaria: A Case Report p. 31
Kanishka Kumar, Mitesh Thakkar, Harshad Rajge, Ahmed Khan
Complicated malaria as defined by the World Health Organization was always understood to be caused by Plasmodium falciparum. Reports of Plasmodium vivax causing complicated cases have been emerging. This is to report one such case that was complicated by myocarditis and acute respiratory distress syndrome.
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Postpartum Seizure Due to Neurocysticercosis: A Case of Diagnostic Dilemma p. 33
Lalit Gupta, Bhavna Gupta
Seizure in early postoperative period in a postpartum female always poses diagnostic dilemma for both the anesthetist and the surgeon. We are reporting a 30-year-old primigravida with unremarkable history, except for few readings of high blood pressure during antenatal period who developed convulsions within 1 hour of delivery performed by lower segment cesarean section under spinal anesthesia. All relevant causes of postpartum seizure were ruled out and surprisingly magnetic resonance imaging of brain revealed cerebral neurocysticercosis; appropriate management and timely intervention resulted in uneventful recovery. The clinical manifestations of neurocysticercosis are variable and depend on the number, size, and location of cysts and the immune response of the host.
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Successful Pregnancy Outcome in Eisenmenger Syndrome: A Case Report p. 36
Urvashi Chhikara, Latika Sahu, Asmita Rathore, Preeti Singh
In patient with Eisenmenger syndrome, raised pulmonary artery pressure with decreased systemic resistance increases maternal and fetal mortality. Multidisciplinary approach is needed for the management of these patients. This case report shows successful feto-maternal outcome in a patient with Eisenmenger syndrome.
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Rationale for Programmatic Assessment in Medical Education and Overcoming the Anticipated Challenges During Its Implementation Highly accessed article p. 39
Saurabh R Shrivastava, Prateek S Shrivastava
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Faculty Development Programs in Medical Education: Need and Points to Ponder for Its Successful Organization p. 41
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
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Challenges Associated With the Introduction of E-learning in Medical Education and Strategies to Counter Them p. 43
Saurabh R Shrivastava, Prateek S Shrivastava
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