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   2017| July-August  | Volume 30 | Issue 4  
    Online since November 17, 2017

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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.
  8,470 846 3
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
  6,240 1,394 6
Population-based estimate of urinary stones from Ballabgarh, northern India
Ayush Lohiya, Shashi Kant, Arti Kapil, Sanjeev Kumar Gupta, Puneet Misra, Sanjay K Rai
July-August 2017, 30(4):198-200
DOI:10.4103/0970-258X.218671  PMID:29162751
Background. Stones in the urinary tract are a common condition but there is paucity of data on their population-based estimates in India. We describe our findings of the burden of urinary stones during a cross-sectional study with another primary goal. Methods. We conducted the study at Ballabgarh Health and Demographic Surveillance System, Haryana, among residents aged 18 years or above. We used simple random sampling to enrol participants. Self-reported history of urinary stones was elicited through an interview schedule. Results of the descriptive analysis were described as proportions with 95% confidence intervals (CI) or as mean wherever applicable. Bivariate analysis was done using t-test and chi-square test as applicable. Results. The response rate for our study was 86.6%; lifetime prevalence (95% CI) of urinary stones was 7.9% (5.7, 10.8). In a majority of participants, urinary stones were diagnosed at an age of 20–40 years (55.9%), mostly by an ultrasonography examination (94.1%). Conclusions. A high burden of urinary stones is indicated in the working-age population in northern India at the community level. Untreated urinary stones can lead to an acute emergency (colic) or may have long-term adverse consequences, e.g. hydronephrosis, which have implications for the healthcare delivery system.
  3,306 472 1
Psychometric validation of a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test in patients in northern India
Ashutosh N Aggarwal, Isak Lallawmkima, Debasish Basu
July-August 2017, 30(4):193-197
DOI:10.4103/0970-258X.218670  PMID:29162750
Background. We aimed to validate a Hindi version of a chronic obstructive pulmonary disease (COPD) assessment test (CAT) for assessing the health status of patients in northern India. Methods. Of the 178 patients studied, 171 with COPD self-completed CAT twice at a 4-week interval. The patients also self-completed the Hindi versions of the abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref) and St George’s Respiratory Questionnaire (SGRQ) at the initial assessment. Baseline clinical details and spirometric data were recorded. Acceptability, validity, internal consistency, test–retest reproducibility and responsiveness were assessed using standard tools. Results. The study population of 178 had 167 (93.8%) males and 1 59 (89.3%) smokers. One hundred and twenty- seven (71.3%) patients completed the second assessment, of whom the condition of 19 had worsened. Each of the eight CAT items correlated strongly with the total CAT score (Pearson coefficients 0.59–0.73). The total CAT score correlated well with the dyspnoea grade, SGRQ domain scores and the physical domain score of WHOQOL-Bref. Cronbach’s alpha coefficient had a high value of 0.83. The intraclass correlation coefficient for 101 patients with stable disease between the two assessments was high (0.83), but the effect size in the 19 patients who recovered from an exacerbation was moderate (0.45). Conclusion. The Hindi version of CAT has good validity and reliability and can be used to quantify the health impact of COPD among patients in northern India.
  2,585 484 -
Theorizing medical practice for India
KS Jacob
July-August 2017, 30(4):183-186
DOI:10.4103/0970-258X.218668  PMID:29162748
  2,302 726 3
Public health challenges for the 21st century: Convergence of demography, economics, environment and biology: Nalanda distinguished lecture
K M Venkat Narayan
July-August 2017, 30(4):219-223
DOI:10.4103/0970-258X.218678  PMID:29162758
The rapidly changing and interdependent world under the mega-force of globalization presents unique challenges and opportunities for public health. Focusing on the example of type 2 diabetes, I argue that an appreciation for the evolution of demographic and economic contexts is essential to appropriately address today's dynamic and complex health challenges. For the vast majority of the past 2000 years, India and China were the world's largest economies until the rise of western European nations in the 18th century and later the USA. In the case of India, inflation-adjusted per capita income remained flat between 1700 and 1950, while in the same period that of the UK grew more than 7-fold, although the population of the UK relatively grew 3-times faster than that of India in the same period. This 250-year gap in industrial and economic development may be central to understanding the large burden of diabetes among individuals of Indian descent, and should be taken into account in a wider context to understand the divergence in health development between India and parts of the world which benefited from early industrial progress and accompanying improvements in food supply, hygiene and living conditions. Lessons from high-income countries support a strong emphasis on public health to achieve important populationwide health gains, and offer insights into the broader determinants of health such as economic and food security, equity, urban infrastructure, health-promoting environments, and access to high-quality health systems. Critical to contemporary public health is also strong data systems and evidence-based decision-making.
  2,362 346 1
ESPAC-4 trial: A summary
Rajneesh Kumar Singh
July-August 2017, 30(4):208-209
  2,362 305 -
Role of synaptophysin in the intraoperative assessment of quadrantic innervation of the proximal doughnut in Hirschsprung disease
Lokendra Yadav, MK Babu, Kanishka Das, Suravi Mohanty, P Divya, Gowri Shankar, Usha Kini
July-August 2017, 30(4):187-192
DOI:10.4103/0970-258X.218669  PMID:29162749
Background. Symptoms may persist in a retained aganglionic segment of the colon after corrective (pull-through) surgery in Hirschsprung disease (HD). Thus, it is important to assess the proximal doughnut for innervation abnormalities intraoperatively by frozen sections stained with conventional haematoxylin and eosin stain and supported by rapid acetylcholinesterase (AChE) histochemistry. When the doughnut is proximal to the sigmoid colon, AChE is not useful and requires ratification by yet another rapid technique and hence this study. Methods. Two pathologists independently evaluated fresh doughnuts from the proximal bowel clinically assumed to be of normal innervation intraoperatively and chosen for anastomosis in patients with HD along with controls using AChE and synaptophysin (SY) immunohistochemistry. Results. From 38 patients with HD, 28 doughnuts (63.7%) showed normal innervation with intense SY activity in the mucosa, the muscularis and the ganglion cells. The circumferential aganglionic doughnuts (abnormal innervation) (n= 6, 13.6%) showed neither SY-positive fibres in the mucosa nor in the muscularis. The abnormal transition zone doughnuts (n=10, 22.7%) showed involvement of three quadrants of the doughnut in one, two quadrants in three and one quadrant in six with decreased SY-positive fibres in the muscularis and scattered ganglion cells with a statistically significant measure of agreement of (κ=0.973) between the two. Conclusion. The pattern, intensity and distribution of SY-positive fibres in the muscularis propria of the doughnut of the proximal bowel chosen intraoperatively for anastomosis in HD can identify sectors with abnormal innervation allowing the surgeon to seek normal innervation status more proximally to avoid complications.
  2,087 549 -
Systemic thrombosis due to pulmonary tuberculosis
Sameer Bansal, Ketaki Utpat, Jyotsna M Joshi
July-August 2017, 30(4):201-202
DOI:10.4103/0970-258X.218672  PMID:29162752
Pulmonary tuberculosis (TB) is an established cause of venous thrombosis. A few instances have been described with arterial thrombosis as well. It has been speculated that TB causes systemic hypercoagulability, which may lead to venous thrombosis. This may be the presenting phenomenon, may occur shortly after diagnosis of TB, or even after starting antitubercular therapy. We describe a patient of pulmonary TB, who presented with pulmonary thromboembolism, with both arterial as well as venous thrombosis, which resolved on antitubercular therapy.
  1,996 444 4
Integrating medical biostatistics into postgraduate medical curriculum
Tatjana M Ille, Ramprasad Muthukrishnan, Mihailo E Ille
July-August 2017, 30(4):212-214
DOI:10.4103/0970-258X.218676  PMID:29162756
Background. Knowledge of biostatistics is important for a health professional to understand research methods, analyse new information presented in scientific journals and to assess its relevance for their clinical practice. Methods. We discuss the implementation of biostatistics in medical curricula, give perspectives on medical education in India, and narrate our own experience of integration of biostatistics into the medical curriculum. Results. Biostatistics is still not a part of all postgraduate curricula in spite of its growing importance for all medical practitioners in the 21st century. Conclusion. The need for a reliable tool in research and evidence-based medicine is recognized in most postgraduate medical curricula in developed countries to improve teaching–learning outcomes.
  1,743 267 -
Autonomy for Medical Institutes in India: A view from history
Shirish N Kavadi
July-August 2017, 30(4):230-234
DOI:10.4103/0970-258X.218680  PMID:29162760
  1,618 239 -
Extensive commotio retinae involving peripheral retina
Koushik Tripathy, Rohan Chawla
July-August 2017, 30(4):242-242
DOI:10.4103/0970-258X.218686  PMID:29162764
  1,287 219 1
Low-fidelity simulation to enhance understanding of infection control among undergraduate medical students
Suman P Singh, Chirag M Modi, Chirag P Patel, Ajay G Pathak
July-August 2017, 30(4):215-218
DOI:10.4103/0970-258X.218677  PMID:29162757
Background. Developing economies are stressing institutional care for better health outcomes but its advantages are dampened by healthcare-associated infections (HAIs). Besides other undesired complications, the economic cost of HAIs is enormous. Developing countries have higher HAI rates compared with Europe or the USA. The knowledge and practice of infection control is poor among medical students. Based on introspection of ‘Infection Control Module’ for undergraduates introduced in 2012, we tested emotional sensitization using low-fidelity techniques to enhance its effectiveness. Methods. All medical undergraduate students in their second year (n=102) were randomly divided into three groups using balanced randomization (two test and one control). Test groups were made to realize the emotional, social and financial consequences of HAI on patients and their families through low-fidelity simulation in the form of case discussions and video demonstrations. Pre- and postintervention empathy scores were calculated using Toronto empathy questionnaire (TEQ) for all the 102 students. Postintervention, all students were subjected to an infection control module and knowledge test. Perceptions of the intervention groups were recorded. Descriptive statistics and ANOVA were applied for data analysis. Results. Of the 102 students, 93 (91.1%) participated in the study. There was no significant difference in the pre-test TEQ score (p=0.87) but there was a significant difference in the post-test TEQ (p = 0.026) and knowledge test score (p = 0.016) among the groups. Both the simulation exercises were well appreciated by the students. Conclusion. Emotional sensitization using low-fidelity simulation served as a catalyst in understanding infection control among medical undergraduate students.
  1,014 190 -
Letter from Chennai
MK Mani
July-August 2017, 30(4):236-237
DOI:10.4103/0970-258X.218682  PMID:29162762
  780 163 -
Incidental cytodiagnosis of microfilaria from subcutaneous nodule
T Santosh, Hemlata Panwar, Amit Bugalia, Vandita Yogendra Singh, Nighat Hussain
July-August 2017, 30(4):241-241
DOI:10.4103/0970-258X.218685  PMID:29162763
  657 154 -
Standardized patient method in tuberculosis research
G Angeline Grace, D Bella Devaleenal
July-August 2017, 30(4):210-211
  642 165 -
A Passion Named Life: Memoirs of a physician
Sunil Pandya
July-August 2017, 30(4):238-240
  636 135 -
Letter from Glasgow
HS Kohli
July-August 2017, 30(4):235-235
DOI:10.4103/0970-258X.218681  PMID:29162761
  659 108 -
Vivek Arya
July-August 2017, 30(4):245-245
DOI:10.4103/0970-258X.218688  PMID:29162765
  596 123 -
Talking Sense about Medicine
Sanjay Pai
July-August 2017, 30(4):238-238
  469 115 -
News from here and there

July-August 2017, 30(4):243-244
  395 80 -