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   2015| May-August  | Volume 1 | Issue 2  
    Online since June 1, 2015

 
 
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REVIEW ARTICLES
Management of Upper Gastrointestinal Bleed
V Jain, PN Agarwal, R Singh, A Mishra, A Chugh, M Meena
May-August 2015, 1(2):69-79
DOI:10.4103/2394-7438.157913  
Upper gastrointestinal bleed (UGIB) causes significant morbidity and mortality the world over. The two main causes have been due to increasing nonsteroidal anti-inflammatory drug use along with the high prevalence of Helicobacter pylori infection in patients with peptic ulcer and bleeding from gastroesophageal varices due to portal hypertension. Other causes of esophageal tears, gastrointestinal malignancy, and arteriovenous malformations also contribute to the morbidity and motality. Rapid assessment, resuscitation, and early endoscopy form the basis of early management of patients with severe bleeding. Risk stratification is based on clinical assessment and endoscopic findings. Early Upper gastrointestinal endoscopy (UGIE) (within 24 h of presentation) confirms the diagnosis and allows for targeted endoscopic treatment, which results in reduced morbidity, hospital stay, the risk of recurrent bleeding, and need for surgery. Despite successful endoscopic therapy, re-bleeding remains a risk and a second attempt at endoscopic therapy is recommended in most. Arteriography with embolization can serve as an extremely useful therapeutic option. Thanks to excellent medical and endoscopic control, surgery for UGIB is rarely required nowadays.
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Should Abnormal Vaginal Flora in 2 nd Trimester of Pregnancy be Treated to Prevent Preterm Labor
Gunjan Kumari, Anjali Tempe
May-August 2015, 1(2):64-68
DOI:10.4103/2394-7438.157912  
Screening and treatment of abnormal vaginal flora during pregnancy to prevent preterm labor is a matter of debate for practicing obstetrician and physician in a country where maternal health and its outcome is a big concern. The recent evidence suggests that infection may be implicated in a substantial proportion of cases of preterm delivery. Neonatal morbidity and mortality are primarily influenced by gestational age and less so by birth weight. Microbial flora normally present in the human vagina play a key role in preventing pathological organisms including those responsible for sexually transmitted diseases, yeast infections, bacterial vaginosis (BV), and urinary tract infection. The outcome gathered from various recent studies have been remarkably consistent and managed to support the hypothesis that antibiotic treatment before 20 weeks of gestation reduces the risk of preterm birth. It is concluded that screening for abnormal vaginal flora cannot be generalized, but it may be safely carried out in pregnant women who have a previous history of preterm labor. Antibiotics with lactobacillus treatment can eradicate abnormal vaginal flora in pregnancy, however, screening and treating all pregnant women with asymptomatic BV to prevent preterm birth and its consequences is not substantiated by evidence.
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EDITORIAL
Whither Medical Education and Healthcare?
Pawanindra Lal
May-August 2015, 1(2):59-63
DOI:10.4103/2394-7438.157911  
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ORIGINAL ARTICLES
Prevalence of Risk Factors for Noncommunicable Diseases in Working Population
Sumita Sandhu, Raman Chauhan, SR Mazta
May-August 2015, 1(2):101-104
DOI:10.4103/2394-7438.157926  
Objectives: Noncommunicable diseases (NCDs) are the leading causes of death globally, killing more people each year than all other causes combined. NCDs are caused to a large extent by four behavioral risk factors that are pervasive aspects of economic transition, rapid urbanization, and 21 st century lifestyles: Tobacco use, unhealthy diet, insufficient physical activity, and the harmful use of alcohol. The aim was to find out the prevalence of risk factors for NCDs in working population. Materials and Methods: A cross sectional study was conducted in working population aged 18 years and above in 10 public institutions. World Health Organization STEPS approach was used to find the prevalence of risk factors. The study sample was randomly selected by using random number generator. Results: A total of 350 participants were included in the study. The overall prevalence of tobacco use was 23.4%. The prevalence of alcohol consumption was 36%. Thirty three percent of the participants was consuming more than five servings of fruits and vegetables per day. Physical inactivity was seen in 51%. 33.1% of the participants were overweight, 6% were obese and 32.6%, 5.8% were hypertensive and diabetic, respectively. Conclusions: This study shows the high burden of risk factors for NCDs in the working population. Action should be oriented toward curbing the NCD risk factors and promoting healthier lifestyles to reduce NCD incidence rates and delay the age of NCD onset.
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Carbapenem Resistance Patterns in General Intensive Care Unit of a Tertiary Care Hospital in India
Deepak K Tempe, Jyotsna Agarwal, Kapil Chaudhary, Parin Lalwani, Madhu Sudan Tudu, Upendra Hansdah, Bibhavati Mishra
May-August 2015, 1(2):85-91
DOI:10.4103/2394-7438.157918  
Aim: Carbapenems are one of the last resort drugs against drug-resistant organisms and carbapenem resistance (CR) is increasingly being reported. The present study evaluated the CR pattern in general Intensive Care Unit (ICU) of a tertiary care hospital in India. Materials and Methods: This was a retrospective analysis of data collected from May 2011 to January 2012 of 40 patients admitted in the general ICU with a stay of more than a week. The clinical and demographic data, Sequential Organ Failure Assessment (SOFA) score, need for mechanical ventilation, antibiotic sensitivity reports, and outcome were assessed. The results were statistically analyzed using Student's t-test, Mann-Whitney U-test, Chi-square test, and Fisher's exact test, where appropriate. P < 0.05 was considered statistically significant. Results: Acinetobacter baumanii was the most common organism in tracheal samples, Pseudomonas aeruginosa in blood samples and Escherichia coli in urine samples. CR in fresh episodes was seen maximally with Acinetobacter baumanii (79%) and Pseudomonas aeruginosa (70%). Meropenem resistance (MR) was more common than imipenem resistance in CR organisms. High sensitivity among CR organisms was observed to tigecycline and colistin, and among carbapenem sensitive organisms to tigecycline, piperacillin-tazobactam combination, and levofloxacin. CR was prevalent with age >50 years (P = 0.002), ICU stay of >15 days (P = 0.002), mechanical ventilation (P = 0.003), and ventilation >10 days (P = 0.008). Mortality was more common among mechanically ventilated patients (P = 0.002) and those with higher SOFA scores on admission (P = 0.012). Conclusion: Carbapenem resistance is high in microbiological cultures of ICU patients with a stay for over a week. Acinetobacter baumanii and Pseudomonas aeruginosa were the most common CR organisms. MR was more common than imipenem resistance.
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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
DOI:10.4103/2394-7438.157923  
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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A Community-based Study to Estimate the Prevalence and Determinants of Hypertension in a Rural Area of Puducherry
Saurabh RamBihariLal Shrivastava, Arun Gangadhar Ghorpade, Prateek Saurabh Shrivastava
May-August 2015, 1(2):92-95
DOI:10.4103/2394-7438.157921  
Objectives: The objective was to estimate the prevalence of hypertension and its determinants in a rural setting of Puducherry. Materials and Methods: A community-based study for the duration of 2 years (March 2012-February 2014) was conducted among persons aged 25 years and above, residing in two villages of Puducherry. Single-stage cluster random sampling was employed and subjects were enrolled based on the fulfillment of inclusion criteria. Institutional Ethics Committee permission was obtained prior to the start of the study. SPSS version 16 was used for statistical analysis. Chi-square and unpaired t-tests were employed to study the association between risk factors and hypertension. Results: The prevalence of hypertension in the study population was 24.7%, with higher prevalence being observed in males (28.7%) than females (21.0%). The statistical analysis revealed a significant association between reduced physical activity/week, addiction to smoking and alcohol, abdominal obesity, high salt intake, and presence of hypertension. Conclusion: The prevalence of hypertension was higher in the study subjects residing in rural areas of Puducherry. However, the positive association between the common lifestyle related parameters and presence of hypertension suggest that there is a significant scope to create awareness about these risk factors among the rural population.
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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
DOI:10.4103/2394-7438.157914  
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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CASE REPORTS
A Case Report of Staphylococcus aureus Induced Cutaneous Botryomycosis in a Patient with Acquired Immune Deficiency Syndrome
Kalidas Rit, Rajdeep Saha, Parthasarathi Chakrabarty
May-August 2015, 1(2):108-110
DOI:10.4103/2394-7438.157929  
Botryomycosis is a rare bacterial infection that can involve the skin and viscera. It is multifocal in development, characterized by granulomatous bacterial infection. The organisms form granules, which are composed of bacterial masses that are adhered to each other. Here, we describe one unusual case of culture proved Staphylococcus aureus induced botryomycosis in patients with the acquired immune deficiency syndrome who was successfully treated.
  1,420 15 -
LETTERS TO THE EDITOR
Establishing Financial Control in Health Care Settings: Need and Tools
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-August 2015, 1(2):114-114
DOI:10.4103/2394-7438.157936  
  1,394 14 -
CASE REPORTS
Entanglement of Nasogastric Tube and Nasopharyngeal Temperature Probe During Surgery
Preranna Bagharwal, Kapil Chaudhary, Rajeev Uppal, Chandni Maheshwari
May-August 2015, 1(2):105-107
DOI:10.4103/2394-7438.157927  
Nasogastric tube (NGT) insertion and nasopharyngeal temperature probe (NTP) insertion are routine procedures in patients scheduled for gastric pull or colonic pull surgeries for corrosive esophageal strictures. Although intra-gastric and intra-esophgeal knotting of NGT is described in the literature, there is no report of entanglement of NTP with the NGT in a knot in the nasopharynx. We report entanglement of NGT and NTP in a 17-year-old female scheduled for gastric pull-up surgery and discuss the possible causes and preventive measures. The preventive measures discussed may improve patient safety and quality of care by preventing misplacements of NGT and NTP which can cause such entanglement.
  1,052 15 -
INTERESTING IMAGE
Echocardiographic Features of Refractory Right Ventricular Failure Treated with Atrial Septostomy-Following Mitral Valve Replacement
Vishnu Datt, Deepak K Tempe, Shailendra Motwani
May-August 2015, 1(2):111-112
DOI:10.4103/2394-7438.157930  
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LETTERS TO THE EDITOR
Health Strategy Evaluation: An Overview
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-August 2015, 1(2):113-113
DOI:10.4103/2394-7438.157934  
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