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Liver transplant scene in india
AS Soin, S Thiagarajan
January-April 2016, 2(1):6-11
Over the last 17 years, liver transplant in India has evolved from a rarity to a common procedure available along the length and breadth of the country with survival data comparable to the best centres in the world. India is now in the forefront of Living donor liver transplant (LDLT) in the world, led by the team of the principal author. LDLT is possible for all types of recipients and indications with 95% success, with low incidence of vascular complications and biliary complications. While Deceased donor liver transplants (DDLTs) have picked up steam in Southern India, there is still a large gap between demand and supply of organs. LDLT is essential to bridge this gap and continues to be the main curative option for the majority of patients in India suffering from end-stage liver disease and Hepato cellular carcinoma (HCC) confined to the liver.
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Food safety in India: An unfinished agenda
Charu Kohli, Suneela Garg
September-December 2015, 1(3):131-135
Food safety refers to all those hazards which make the food unsafe to health. The unsafe food creates a vicious cycle of disease and malnutrition which affect all age groups but in particular children, the elderly, and the sick. Foodborne diseases are important hidden causes of morbidity. This article has been written with an objective to assess the current status of food safety and related issues in India and the measures to improve the same. Though most of the foodborne diseases are sporadic and often not reported in India, a nationwide study reported an alarming 13.2% prevalence at the household level. Currently, the mainstay for food safety in India is a legislative approach. The Indian food industry is regulated by the number of legislations covering sanitation, licensing, and permits. Food Safety and Standards Authority of India established by the Government of India develop the standards for food and regulate and monitor the manufacture, processing, storage, distribution, sale, and import of food so as to ensure the availability of safe and wholesome food for human consumption. The literature review shows that the consumer awareness is not very good in India in relation to food safety. There is a need to initiate the public health surveillance for food safety and foodborne diseases. Legislations related to food safety should be enforced strictly. The consumer awareness should be an important part of all initiatives.
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Organ donation and transplantation: An updated overview
Anika Sulania, Sandeep Sachdeva, Diwakar Jha, Gurmeet Kaur, Ruchi Sachdeva
January-April 2016, 2(1):18-27
This article reviews and describes the theoretical concept of organ donation (OD) and transplantation, historical milestones, need, shortage, status of global activities, health system capacity, survival outcome, and update on legislative environment in India, Central/State contribution and Nongovernment Organizations actively involved in OD.
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Hamartoma of parapharyngeal space: A rare case report
Swati Tandon, Ravi Meher, Anoop Raj, Chandala Chitguppi
January-April 2016, 2(1):51-53
A hamartoma is a tumor-like lesion made up of tissues indigenous to the part but lacks the true growth potential of a true neoplasm. Hamartomas are rare in head and neck region. Since they are often asymptomatic, they are easily missed during routine examination. To the best of our knowledge, lymphangiomatous hamartoma of parapharyngeal space has not been reported in medical literature so far. We report a rare case of lymphangiomatous hamartoma of parapharyngeal space in an 8-year-old child managed by surgery.
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Dengue presenting as hemorrhagic acute disseminated encephalomyelitis
Richa Dewan, Subramanian Anuradha, Prayas Sethi, Pranav Ish
January-April 2016, 2(1):54-56
Dengue fever over the recent years has gained attention of not only the health care professionals and researchers, but also public at large and it is a major seasonal health care problem in the tropics and the developing countries. Mortality due to complications such as hemorrhage and shock is well-known and is a major concern for the physician. Neurological manifesations include myelitis and encephalitis have started to gain attention as they present with high mortality and morbidity. We report a case of dengue fever with predominant neurological manifestations of acute disseminated encephalomyelitis (ADEM). The patient presented with fever, vomiting, and altered sensorium of recent onset. On evaluation, the patient was positive for dengue serology and magnetic resonance imaging picture suggested ADEM.
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Tuberculosis of the Gallbladder: A Case Report and Review
Anurag Mishra, Prateek Gupta, Nidhi Verma, Surekha Yadav
January-April 2017, 3(1):45-47
Gallbladder tuberculosis (GBTB) is an exceedingly rare finding presenting as calculous or acalculous cholecystitis. A correct, preoperative diagnosis of GBTB is difficult, and the literature review highlights the fact that most cases are diagnosed postcholecystectomy or at postmortem. We present a case of a 26-year-old woman who underwent laparoscopic cholecystectomy with preoperative diagnosis of cholelithiasis. GBTB was diagnosed by the histological examination. Routine histopathological examination of all cholecystectomy specimens should, therefore, be a standard practice.
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Cognitive Improvement After Endovascular Treatment in a Case of Intracranial Dural Fistula With Concomitant Dementia
Marco Zenteno, Angel Lee, Guru D Satyarthee, Gabriel Pinilla, Amit Agrawal, Luis R Moscote-Salazar
January-April 2018, 4(1):32-37
Dural fistulas associated with dementia are rarely reported and, among these, intracranial dural fistulas constitute an infrequent etiology. Moreover, dementia associated with dural fistulas occurs due to venous hypertension leading to ischemic neuronal dysfunction. This case report describes a male patient exhibiting unusual features of dementia with a concomitant dural fistula compromising the superior sagittal sinus. The fistula was completely occluded via endovascular embolization. Two months after the interventional therapy, clinical assessment revealed complete improvement of executive functions. Afterward, the patient returned to his daily activities without impairment.
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Communications Skills Training – A Missing Link in Medical Education Curriculum
Indu Arneja, Pawanindra Lal
September-December 2017, 3(3):117-119
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From rote to reasoning: The paradigm shift required in medical entrance examination and beyond!
Pawanindra Lal
January-April 2016, 2(1):1-5
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Role of Public Health Laws in the Advancement of Right to Health on an International Scale
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-August 2017, 3(2):107-108
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Reinforcing the Need to Invest in Health Related Research and Development Activities
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
May-August 2017, 3(2):108-109
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Salient Features Regarding Medicolegal Certificate
Anil Aggrawal
January-April 2015, 1(1):45-51
General duty doctors in all major hospitals -Govt and Private-are often unclear regarding when to label a case as medicolegal. This paper attempts to give general guidelines to doctors regarding this problem.
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Inhalational Therapy for Airway Disease Among Adult Patients: Compliance is a Major Challenge Toward Effective Management
Ruchi Sachdeva, Santwana Mehar, Sandeep Sachdeva
May-August 2015, 1(2):80-84
Objective: To determine proportion of correct inhalation technique amongst patients with asthma and chronic obstructive pulmonary disease. Methodology: A cross-sectional study involving 100 known subjects of either disease condition using inhaler device for atleast one-year reporting at chest OPD of government hospital were interviewed using pre-tested semi-structured interview schedule and inhalation technique determined by standard observation checklist. Each step was given a score of 'one' if undertaken by patient and 'zero' in case of non-compliance. Results: There were 62% male patients; 27% were illiterate; 92% were married; 32% were current smokers; average age was 50.3 (±14.5) years; 55% and 45% had asthma and COPD respectively; 60% were on MDI device and 40% were using DPI; 23% reported co-morbid (HT/DM) condition and 27% reported occupational dust exposure while more than one-third (36%) reported hospitalization during last one-year due to disease condition. Inspite of clinical requirement, 45% were not taking inhaler therapy regularly and reasons elicited were lack of knowledge (32%), casual attitude (07%), financial constraints (04%) and stigma (01%). On a positive note, patients undertaking regular visit to doctors were also taking inhaler regularly (P < 0.05). However, these positive practices did not translate into satisfactory inhaler performance. Majority (93%) of patients were not taking inhaler as per standard procedure i.e., only three were found undertaking all the 13-steps for MDI while four were following all the 8-steps for DPI use. Mean score (steps undertaken) for MDI user was 6.71 (±3.3) with a range of 0-13 points and 4.4 (±2.4) with a range of 0-8 score for DPI user. On further evaluation, satisfactory performance (minimum essential steps) with regard to either inhaler device was demonstrated by 25% patients only and found to be statistically associated with those not reporting any co-morbidity (P = 0.02). Conclusion: Proper training and compliance could improve inhalation technique.
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Spectrum of Dermatological Manifestations in Patients with Chronic Kidney Failure
Sneha Ghunawat, Krishna Deb Barman, Rashmi Sarkar, Vijay Kumar Garg, Ravi S Alhawat
May-August 2015, 1(2):96-100
Objectives: Skin acts as the diagnostic window to many internal organs including the renal system. Subtle changes in the skin may act as clues to the underlying renal pathology. The present study was undertaken to evaluate and compare the cutaneous manifestations among the spectrum of renal failure including post-transplant patients. Materials and Methods: Hundred patients with chronic kidney disease including post-transplant patients were recruited in the bring highlighted line here. In the study conducted at Department Detailed cutaneous examination was performed and findings were recorded and compared among the study groups. Results: Total 61% patients had cutaneous manifestations and 40% had more than one finding. The most common cutaneous finding was xerosis noted in 53%, followed by pruritus in 42%, pallor 37%, pigmentation 34%, and cutaneous infections in 33%. Nail involvement was noted in 43%. The most common nail finding was half and half nail seen in 30%, followed by brittle nails in 20%, beau's line 18%, and leukonychia 16%. The prevalence of skin findings was significantly more among the patients with end stage renal disease and those undergoing dialysis. The post-transplant group showed increased prevalence of infections. Conclusions: Dermatological manifestations increase with duration and severity of renal disease. Though renal transplantation and hemodialysis reverse the metabolic derangement in these patients, they predispose to a number of cutaneous complications.
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Mass drug administration program against lymphatic filariasis: Are we on the path to success? experience from Solapur District, Maharashtra
Malangori Abdulgani Parande, Manjunath Shashikant Kamble, Vinay S Tapare
September-December 2015, 1(3):151-156
Background: Rate of coverage and consumption is the most crucial factor in the success of MDA program against lymphatic filariasis. The roles of the drug distributors and other health workers cannot be ignored in order to achieve success in MDA coverage and compliance. Materials and Methods: This was a cross-sectional study conducted in Solapur district in January 2015. A sample of 672 participants from four clusters was selected through multistage cluster sampling and interviewed using pretested and prestructured questionnaire. Additionally, MDA drug distributors were also interviewed to understand some of the operational issues encountered in MDA program. Results: The average coverage of MDA in Solapur district was 63.7%, the compliance rate was 75.5%, and effective coverage rate was 48.1%. The important reason for higher rate of noncompliance was unsupervised treatment by the drug distributor, beneficiaries were on empty stomach at the time of distribution of drugs, not received the drugs and not available at the time of drug distributor's visit and in urban area was lack of knowledge about the disease. The important reasons for noncompliance quoted by drug distributors were inadequate training of drug distributor, fear of side effects in beneficiaries, and the empty stomach at the time of drug distributor's visit. The majority of health personnel (69.7%) suggested Booth activity as an ideal method for MDA that is planned on a holiday, and more extensive training well before the planned MDA activity.
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A Study on Knowledge and Preventive Practices about Mosquito Borne Diseases in Delhi
Charu Kohli, Rajesh Kumar, Gajendra S Meena, Mongjam M Singh, Gopal K Ingle
January-April 2015, 1(1):16-19
Background: Mosquito-borne diseases constitute an important cause of morbidity and mortality, especially in India. Assessment of knowledge and practices of community about prevention of mosquito borne diseases is important for designing community-based interventions. Therefore, the study was carried out to assess such information. Materials and Methods: A community-based cross-sectional study was conducted among 350 adults selected by systematic sampling method in a rural and urban area in Delhi. Data was collected using pretested semi-structured questionnaire after taking written informed consent. Data was analyzed using SPSS version 17. Chi-square and Fisher's Exact test was used for qualitative variables to find association and P <</i> 0.05 was considered significant. Results: One hundred and forty-two (67.6%) subjects in rural and 89 (63.6%) in the urban area were able to name at least one mosquito borne disease. Only small number of participants (from rural 28.1% and urban 18.6% areas) was aware of "fever with chills and rigor" as a symptom of malaria. Television was most common source of information in both rural and urban areas. Desert coolers were reported to be cleaned regularly in a week in 86.4% houses in a rural area, and 88.4% houses in the urban area. Potential breeding sites were significantly more in urban (n = 34, 24.3%) than rural (n = 13, 6.2%) houses (P = 0.01). Similarly actual breeding of mosquitoes was found significantly more in urban houses (n = 29, 20.7%) than rural houses (n = 14, 6.7%), which was statistically significant (P = 0.01). Knowledge about mosquito borne diseases was significantly associated with education status of the participants. Conclusion and Recommendation: Level of awareness was good; however mosquito breeding was occurring more in urban areas, which demands innovative mass media techniques to convey health messages to the public for prevention and control of mosquito borne diseases.
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Comparative Analysis of Study Design and Statistical Test Utilization in Indian Journal of Community Medicine, Indian Journal of Public Health and Bulletin of the World Health Organization
Sandeep Sachdeva, Nidhi Dwivedi
May-August 2017, 3(2):73-78
Objective: To analyze study topic, study design, usage of statistical test, and other selected document parameters in published original research articles. Materials and Methods: Three journals (1) Indian Journal of Community Medicine (IJCM), (2) Indian Journal of Public Health (IJPH), and (3) Bulletin of World Health Organization (WHO) were reviewed and all original research article published during three years, that is, January 2014 to December 2016, were considered, and selected document parameters were recorded using checklist. During this period, IJCM released volumes 39 to 41, IJPH released 58 to 60, and WHO released 92 to 94. Results: A total of 318 original articles were reviewed with the contribution of 28.9% in IJCM, 27.6% in IJPH, and 43.3% in WHO bulletin. Out of all the publications, highest (46.5%) original article belonged to research domain category-I [communicable, maternal and child health (MCH)] followed by 104 (32.7%) category-II (noncommunicable diseases) and 66 (20.8%) by category-III (health system, medical education, and environment). Overall 79.2% original articles were cross-sectional in study design followed by cohort (15.4%), intervention/experimental study (3.4%), and case-control (1.8%). Average number of authors per article in WHO bulletin was 8.1 [95% confidence interval (CI): 7.1–9.0] followed by IJCM 4.2 (95% CI: 3.8–4.6), and IJPH (3.84, 95% CI: 3.49–4.19). There were 95 (29.9%) articles where-in all the authors were from a single institution, whereas in 223 (70.1%) articles, co-authors were from different institutions. It was also found that most (80.1%) of the study papers did not contain any background statement regarding statistical sample size estimation; 239 (75.2%) articles used statistical software; majority had utilized SPSS (61.08%), followed by STATA (19.24%), SAS (8.76%), R-software (5.45%), EPI-info (3.76%), and EXCEL (1.25%); nearly 210 (66%) original research articles utilized at least one of the inferential statistics (basic, advance, and survival analytical methods). Higher proportion of advance (60.2%) inferential statistical test and survival analysis (92.3%) were used in Bulletin of WHO; 82% of references used were within 10 years of publications of articles in WHO while this figure was 66% for ICJM and 63% for IJPH. Conclusion: This study provides an objective snapshot of national and international public health journal that may aid researcher for better comprehension, situational, and trend analysis as well as assist them in their future research endeavor.
  1 1,077 18
Prevalence of Obesity and Overweight Among Second Year Students in a Malaysian Medical University and Their knowledge and Perception of Obesity
Lakshmi Sivashunmugam, Reshma M Ansari
September-December 2017, 3(3):140-145
Introduction: Obesity is a lifestyle disease that has been significantly increasing in the recent years. Body mass index (BMI) is recommended by the WHO to classify obesity and is used as a tool to identify patients or individuals at risk for adverse health outcomes. Waist circumference (WC) is also an important risk factor for lifestyle diseases and it can also be used to measure body fat distribution. Our study, therefore aims to determine the prevalence of overweight and obesity among the preclinical students in a Malaysian medical university, correlate the relationship of BMI and WC and evaluate the knowledge and perception of obesity of obese and overweight students. Method: A descriptive cross sectional study was performed involving 93 second year medical students. The BMI and WC were recorded of all the participants. The obese and overweight participants were identified and asked to answer a close-ended self-administered questionnaire. Results: Out of 93 students who participated in the study, 23 (25%) were overweight and 21 (22%) were obese. Pearson correlation analysis between BMI and WC values showed that the two variables strongly correlate with each other. The questionnaire identified gaps in the knowledge of the students and poor perception among overweight students. Conclusion: Hence, our study concludes that the prevalence of obese and overweight individuals is on the rise and there a gap in the knowledge. Based on our study results it is recommended that appropriate measures are taken to address the issue.
  1 1,626 16
Medical Students’ Opinion and Perception of the Education Environment in a Medical College of Delhi, India
Sandeep Sachdeva, Nidhi Dwivedi
January-April 2018, 4(1):18-25
Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India. Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2nd, 3rd, and 4th year) were considered in the present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were males; 94 (80.3%) passed their 12th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4th year) vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12th class, native place, current residence, supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring strengthening were listed including social and leisure time student involvement.
  1 1,500 8
Monitoring of Intracranial Pressure in Patients with Severe Traumatic Brain Injury: Review
Alexis R Narvaez-Rojas, Joulem Mo-Carrascal, Johana Maraby, Guru D Satyarthee, Samer Hoz, Andrei F Joaquim, Luis R Moscote-Salazar
May-August 2018, 4(2):63-67
Traumatic brain injury is a very heterogeneous entity that emerges over time. The neuromonitoring is critical for the prevention of secondary alterations, such as ischemia and hypoxia, which appear days after a primary injury. Neurosurgeons must understand that the phenomena are secondary to the primary lesion. Advances in multimodal neuromonitoring techniques have allowed evaluation of brain metabolism as well as other physiological parameters, including intracranial pressure, cerebral perfusion pressure, cerebral blood flow, brain temperature, blood pressure, and partial pressure of oxygen in brain tissue.
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Apixaban: An oral anticoagulant having unique mechanism of action with better safety and efficacy profile
ZA Fazeel
May-August 2016, 2(2):63-68
Anticoagulants are routinely used in stroke, embolism, infarct, etc. Blood clotting profile in such patients needs to be monitored frequently. Anticoagulants which can be administered orally such as warfarin and dicoumarol are preferred in such patients. Injectable anticoagulants such as heparin are prescribed when anticoagulation therapy is required for short duration. Absence of oral form of heparin makes it impractical for long-term use. Currently, warfarin and coumarone derivatives are the best available oral anticoagulants in market. They act by inhibiting decarboxylation of blood clotting factors II, VII, IX, and X. Pharmacological response of warfarin and dicoumarol needs to be monitored by frequent assessments of prothrombin time (PT) and international normalized ratio (INR). There is a need for a drug which can overcome these limitations. Apixaban is an oral anticoagulant which acts by inhibiting factor Xa. It does not require laboratory monitoring of PT and INR. Hence, it overcomes the limitations of heparin and warfarin. It acts by selectively inhibiting the activated factor Xa in a reversible manner. Apixaban has an oral bioavailability of ~50%. It is administered as twice daily dose. It is excreted in urine and feces. Apixaban is useful in atrial fibrillation, venous thromboembolism, and pulmonary embolism. Bleeding is the major side effect of apixaban. It has been found that apixaban has superiority over warfarin and aspirin in terms of efficacy and safety. Further studies are required to monitor and assess the pharmacokinetics, efficacy, adverse effects, and drug interaction data in many populations and sub-populations throughout the world.
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* Source: CrossRef