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  Most popular articles (Since July 28, 2016)

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Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu
Tony Fredrick, Prabhdeep Kaur, Manoj V Murhekar, Yuvaraj Jayaraman, K Kolandaswamy, Sudha Ramachandra Rao, Joseph K David
January-February 2016, 29(1):9-13
Background. India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. Methods. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January- March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Results. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR <60 mg/dl) and 67.4% had neuropathy. Among patients with comorbid conditions, 60%, 48%, 32%, and 3% were already diagnosed to have hypertension, neuropathy, retinopathy, and nephropathy, respectively. The risk factors for diabetic retinopathy were hypertension (AOR 3.2, 95% CI 1.7-6.3), duration of T2DM >5 years (AOR 6.5, 95% CI 3.6-11.7), poor glycaemic control (AOR 2.4, 95% CI 1.4-4.4), and nephropathy (AOR 2.3, 95% CI 1.1-4.6). Conclusions. There was a high burden of undetected retinopathy and other comorbid conditions among patients with T2DM. Early detection of comorbid conditions and glycaemic control can be improved by training care-providers and educating patients.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Guillain–Barré syndrome in a patient with neuropsychiatric systemic lupus erythematosus
GK Rajeshwari, CH Bangaru Rao, NV Sundarachary, SK Moula Ali, JS Kalyani, A Sridhar
January-February 2016, 29(1):14-17
Guillain-Barré syndrome is a rare manifestation of neuropsychiatric systemic lupus erythematosus (SLE). Clinical and electrophysiological features of Guillain-Barré syndrome in patients with SLE are different from those in patients without SLE. There is considerable variation in the management and prognosis. We present a patient with Guillain-Barrι syndrome and SLE and review the recent knowledge on the various manifestations of neuropsychiatric SLE.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Routine health check-ups: A boon or a burden?
Bianca Honnekeri, Aniruddha Vyas, Disha Lokhandwala, Avani Vaishnav, Aditi Vaishnav, Mayank Singhal, Parag Barwad, Gopi Krishna Panicker, Yash Lokhandwala
January-February 2016, 29(1):18-21
Healthcare provider institutions in India now offer structured health check-up 'packages' for routine screening of common diseases. While some tests included within their ambit are in keeping with international and Indian recommendations, some are entirely unwarranted. Unnecessary and inappropriate screening tests may cause more harm than benefit. Besides financial and resource burden, there may be over-diagnosis and over-treatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Clinicians must ensure a net benefit from tests and interventions in order to efficiently deliver preventive services. We reviewed current screening guidelines for cardiovascular disease and common cancers, and surveyed multiple 'packages' provided at 8 centres in Mumbai, India. We put forth our recommendations for routine health screening in asymptomatic adults in India.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Elimination of lymphatic filariasis
SB Gogia, Sathi , Sangtin
January-February 2016, 29(1):37-37
Full text not available  [PDF]  [PubMed]
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The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink
Rakesh Aggarwal, Nithya Gogtay, Rajeev Kumar, Peush Sahni
January-February 2016, 29(1):1-5
Full text not available  [PDF]  [PubMed]
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Post-earthquake Nepal: Acute-on-chronic problems
Buddha Basnyat
January-February 2016, 29(1):27-27
Full text not available  [PDF]  [PubMed]
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Then and now: Teaching medicine at the patient's bedside
Sunil Pandya
January-February 2016, 29(1):28-29
Full text not available  [PDF]  [PubMed]
  809 40,699 -
News from here and there
Sanjay A Pai
January-February 2016, 29(1):57-58
Full text not available  [PDF]  [PubMed]
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The art of letting go and the mandate of going further
Timothy S Laux
January-February 2016, 29(1):30-31
Full text not available  [PDF]  [PubMed]
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Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors
Darren B Taichman, Joyce Backus, Christopher Baethge, Howard Bauchner, Peter W de Leeuw, Jeffrey M Drazen, John Fletcher, Frank A Frizelle, Trish Groves, Abraham Haileamlak, Astrid James, Christine Laine, Larry Peiperl, Anja Pinborg, Peush Sahni, Sinan Wu
January-February 2016, 29(1):6-8
Full text not available  [PDF]  [PubMed]
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Cytomegaloviral retinitis
Koushik Tripathy, Pradeep Venkatesh, Rohan Chawla
January-February 2016, 29(1):35-35
Full text not available  [PDF]  [PubMed]
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Metachronous second primary of the oesophagus detected by FDG-PET/CT in a patient with follicular variant of papillary thyroid carcinoma
Sandip Basu, Rohit Ranade
January-February 2016, 29(1):36-36
Full text not available  [PDF]  [PubMed]
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Vivek Arya
January-February 2016, 29(1):59-59
Full text not available  [PDF]  [PubMed]
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Myelopathy complicating congenital atlanto-axial dislocation (A study of 28 cases)
NH Wadia
January-February 2016, 29(1):38-56
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Incidents of violence against doctors in India: Can these be prevented?
Neeraj Nagpal
March-April 2017, 30(2):97-100
Violence against doctors is on the rise all over the world. However, India has a unique problem. Meagre government spending on healthcare has resulted in poor infrastructure and human resource crunch in government hospitals. Hence, people are forced to seek private healthcare. Small and medium private healthcare establishments, which provide the bulk of healthcare services, are isolated, disorganized and vulnerable to violence. Violence against health service providers is only a manifestation of this malady. The Prevention of Violence Against Medicare Persons and Institutions Acts, which have been notified in 19 states in the past 10 years, have failed to address the issue. To prevent violence against doctors, government spending on healthcare must be increased and the Indian Penal Code should be changed to provide for a tougher penalty that could act as a deterrent to violence against doctors.
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The point system of the Dental Council of India for publications by faculty
Thorakkal Shamim
September-October 2016, 29(5):312-312
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Cavitatory tuberculosis in complex cyanotic heart disease
Parth Gada, Ira Shah
May-June 2016, 29(3):181-181
Full text not available  [PDF]  [PubMed]
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Scrub typhus: A prospective, observational study during an outbreak in Rajasthan, India
Rajendra Prasad Takhar, Moti Lal Bunkar, Savita Arya, Nitin Mirdha, Arif Mohd
March-April 2017, 30(2):69-72
Background. Scrub typhus, a potentially fatal rickettsial infection, is common in India. It usually presents with acute febrile illness along with multi-organ involvement caused by Orientia tsutsugamushi. As there was an outbreak of scrub typhus in the Hadoti region of Rajasthan and there is a paucity of data from this region, we studied this entity to describe the diverse epidemiological, clinico-radiological, laboratory parameters and outcome profile of patients with scrub typhus in a tertiary care hospital. Methods. In this descriptive study, we included all patients with an acute febrile illness diagnosed as scrub typhus by positive IgM antibodies against O. tsutsugamushi, over a period of 4 months (July to October 2014). All relevant data were recorded and analysed. Results. A total of 66 (24 males/42 females) patients were enrolled. Fever was the most common presenting symptom (100%), and in 67% its duration was for 7–14 days. Other symptoms were breathlessness (66.7%), haemoptysis (63.6%), oliguria (51.5%) and altered mental status (39.4%). The pathognomonic features such as eschar (12%) and lymphadenopathy (18%) were not so common. The commonest radiological observation was consistent with acute respiratory distress syndrome. Complications noted were respiratory (69.7%), renal (51.5%) and hepatic dysfunction (48.5%). The overall mortality rate was 21.2%. Conclusions. Scrub typhus has emerged as an important cause of febrile illness in the Hadoti region and can present with varying clinical manifestations with or without eschar. A high index of suspicion, early diagnosis and prompt intervention may help in reducing the mortality.
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What’s wrong with doctors’ handwriting?
Santosh K Chaturvedi
January-February 2018, 31(1):47-48
DOI:10.4103/0970-258X.243417  PMID:30348927
  6,106 188 -
Knowledge, attitude and behaviour of the general population towards organ donation: An Indian perspective
Poreddi Vijayalakshmi, TS Sunitha, Sailaxmi Gandhi, Rohini Thimmaiah, Suresh Bada Math
September-October 2016, 29(5):257-261
Background. The rate of organ donation in India is low and research on organ donation among the general population is limited. We assessed the knowledge, attitude and willingness to donate organs among the general population. Methods. We carried out a cross-sectional descriptive study among 193 randomly selected relatives of patients (not of those seeking organ donation) attending the outpatient department at a tertiary care centre. We used a structured questionnaire to collect data through face-to-face interviews. Results. We found that 52.8% of the participants had adequate knowledge and 67% had a positive attitude towards organ donation. While 181 (93.8%) participants were aware of and 147 (76.2%) supported organ donation, only 120 (62.2%) were willing to donate organs after death. Further, there were significant associations between age, gender, education, economic status and background of the participants with their intention to donate organs. Conclusion. Our study advocates for public education programmes to increase awareness among the general population about the legislation related to organ donation.
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Assessment of pain in the elderly: A literature review
Yoon-Sook Kim, Jae-Min Park, Yeon-Sil Moon, Seol-Heui Han
July-August 2017, 30(4):203-207
DOI:10.4103/0970-258X.218673  PMID:29162753
Background. Pain perception is highly subjective, and effective pain management can be challenging in the elderly. We aimed to identify a set of practical measures that could be used to assess pain in elderly patients with or without cognitive impairment, as the first step towards effectively managing their pain. Methods. We used the PRISMA guidelines for this literature review. Two reviewers independently assessed titles, abstracts and full-text articles, and a third reviewer resolved any disagreements. Results. A total of 11 285 abstracts and 103 full-text articles were assessed. Forty-one studies met the inclusion criteria. The Numeric Rating Scale, Visual Analogue Scale, Face Pain Scale and Verbal Descriptor Scale have proven valid in the elderly. The Abbey pain scale, Doloplus-2, Pain Assessment in Advanced Dementia scale, Pain Assessment Checklist for Seniors with Limited Ability to Communicate, Checklist of Nonverbal Pain Indicators, Pain Assessment for the Dementing Elderly rating tool and the Clinical Utility of the CNA Pain Assessment Tool are used in elderly patients with cognitive impairment. Conclusions. We identified a number of reliable and valid methods for pain assessment in the elderly. Elderly patients can receive treatment in a variety of settings, and frequently it is administered by a caregiver or family member, rather than a medical employee. The development of a pain assessment tool that is not subject to variations arising from differences in settings or caregivers is needed to assess pain accurately in elderly patients, and provide timely treatment. Natl Med J India 2017;30:203–7
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Pattern and profile of children using substances in India: Insights and recommendations
Anju Dhawan, Raman Deep Pattanayak, Anita Chopra, VK Tikoo, Rajesh Kumar
July-August 2017, 30(4):224-229
DOI:10.4103/0970-258X.218679  PMID:29162759
India has one of the largest proportion of children and adolescents in the world, but the threat posed by child substance use remains under-researched. Only recently a large study, the first of its kind in India, was carried out with a sample of nearly 4000 children using substances (school-going, out-of-school as well as street children) across more than a hundred cities/towns. We discuss (i) the existing knowledge on the prevalence of child substance abuse in India; (ii) perspectives and insights gained from the recent nation-wide study on its pattern and profile; and (iii) recommendations for substance use prevention and treatment among children in the Indian context. A multipronged approach involving all stakeholders is required to address the issues of prevention and treatment.
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Access to healthcare among the Empowered Action Group (EAG) states of India: Current status and impeding factors
Virendra Kumar, Pushpendra Singh
September-October 2016, 29(5):267-273
Background. Access to healthcare is crucial for meeting the health needs of Indians. We explored factors impeding access to public sources of healthcare among the Empowered Action Group (EAG) states of India. We also examined the extent to which Indians depend on public and private sources of healthcare in the EAG states. Methods. Our study is based on the unit-level records of 9988 ailing persons, who were surveyed among the EAG states in the 71st round of the National Sample Survey (NSS), conducted during January-June 2014 on the theme 'Social consumption: Health'. To analyse the socioeconomic factors, we did logistic regression using STATA version 12.0. Results. Despite a vast public health infrastructure in the EAG states, around three-fourths of inpatients are dependent on private sources of healthcare in both rural (70%) and urban (78%) areas. Poor quality and long waiting time in accessing healthcare from public health facilities remain big concerns for inpatients of the EAG states. Conclusion. To make public health services more accessible, there is a need to improve the quality of services, enlarge infrastructure to reduce waiting time, and enhance the physical reach to inpatients in the EAG states of India. Public health services will then be able to compete with those in the private sector.
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Quota in specialty and super-specialty courses: What does the judiciary say?
Mukul Chandra Kapoor, Shubhendu Anand
May-June 2017, 30(3):159-160
Reservations in super-specialty courses have been controversial for decades. A number of practising doctors, medical students and others in society have wanted to do away with reservations in specialty and super-specialty courses, while there are others in favour of persisting with reservations. Article 15 (4) of the Constitution of India states that nothing shall prevent the State from making any special provision for the advancement of any socially and educationally backward classes of citizens or for the Scheduled Castes/Tribes. However, Article 14 of the Indian Constitution should also be considered. The judiciary, particularly, the Supreme Court of India, in its judgments has strived to strike a balance between the two constitutional provisions. The Supreme Court, on various occasions, has observed that reservations in super-specialty courses should be done away with, as such reservations would be detrimental to the advancement of medical science and research and will also not serve national interest. We present the observations of the Supreme Court of India through its various judgments, with a focus on the recent case of Dr Sandeep versus Union of India, where the honourable court stated that the government should do away with reservations in super-specialty courses.
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Status and trend of acute encephalitis syndrome and Japanese encephalitis in Bihar, India
Praveen Kumar, PM Pisudde, PP Sarthi, MP Sharma, VR Keshri
November-December 2017, 30(6):317-320
DOI:10.4103/0970-258X.239070  PMID:30117441
Background. Acute encephalitis syndrome (AES) is a clinical condition, of which the most common cause is Japanese encephalitis (JE). Though there is deficiency of data on AES and JE from Bihar, the state ranks third in the reporting of JE cases after Uttar Pradesh and Assam. We aimed to assess the status and trends of AES and JE cases in Bihar and to know the status of the disease in the districts. Methods. We collected monthly epidemiological data for AES and JE for the period 2009–2014. Results. A total of 4400 cases (733 cases/year) with an average case fatality rate (CFR) of 30% for AES for the entire study period. A total of 396 cases of JE were reported with approximately 14% CFR. The disease peaks were during the start and end of the Indian summer and monsoon months for AES and JE, respectively. Districts such as Patna, Jehanabad, Nawada, Gaya and East Champaran reported the maximum number of AES and JE cases with annual incidence rates of 4.7–25.0 and 0.546–1.78 per 100 000 population, respectively. Conclusion. Since 2009, the incidence of AES and JE cases has been increasing in Bihar.
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