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   2018| January-February  | Volume 31 | Issue 1  
    Online since October 15, 2018

 
 
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SPEAKING FOR MYSELF
What’s wrong with doctors’ handwriting?
Santosh K Chaturvedi
January-February 2018, 31(1):47-48
DOI:10.4103/0970-258X.243417  PMID:30348927
  34,582 506 -
Why we don’t get doctors for rural medical service in India?
Kanjaksha Ghosh
January-February 2018, 31(1):44-46
DOI:10.4103/0970-258X.243416  PMID:30348926
  6,371 297 -
SELECTED SUMMARIES
Prophylactic platelet transfusion in dengue: Blanket of false comfort?
Ashish Sharma, Mohammad Ali
January-February 2018, 31(1):24-25
DOI:10.4103/0970-258X.243409  PMID:30348919
  4,482 407 -
EDITORIAL
Medical Council of India’s Amended Qualifications for Indian Medical Teachers: Well intended, yet half-hearted
Sunita V.S. Bandewar, Amita Aggarwal, Rajeev Kumar, Rakesh Aggarwal, Peush Sahni, Sanjay A Pai
January-February 2018, 31(1):1-4
DOI:10.4103/0970-258X.243404  PMID:30348911
  3,312 630 1
ORIGINAL ARTICLES
Rapid antigen diagnostic testing for the diagnosis of group A beta-haemolytic streptococci pharyngitis
S Balasubramanian, Sumanth Amperayani, K Dhanalakshmi, S Senthilnathan, Vaishnavi Chandramohan
January-February 2018, 31(1):8-10
DOI:10.4103/0970-258X.243433  PMID:30348914
Background. It is difficult to make a diagnosis of group A beta-haemolytic streptococci (GABHS) pharyngitis solely on clinical findings. The McIssac scoring system has been recommended as a reliable clinical tool for diagnosis. The rapid antigen detection test (RADT) has been shown to considerably increase the number of patients who are appropriately treated for streptococcal pharyngitis, compared with the use of traditional throat cultures. It also reduces the time to start treatment. We evaluated the diagnostic utility of RADT in comparison with throat swab culture. Methods. Using the McIssac scoring system, RADT and throat swab cultures in those with a McIssac score of 3 or more, we evaluated 165 children (aged 2–15 years) with a clinical diagnosis of pharyngitis. Results. GABHS pharyngitis was confirmed in 41 (24.8%) by throat swab culture and RADT was positive in 39(23.6%). Only in 2 (4.9%) children, RADT was negative but throat swab was positive. The sensitivity of RADT was 89.7% and specificity was 98.4% with a positive predictive value of 94.6%, negative predictive value of 96.9% and diagnostic accuracy of 96.4%. Conclusion. RADT performed was observed to have high sensitivity and sensitivity for the diagnosis of GABHS pharyngitis in contrast to an earlier report from India. Our observations suggest that using RADT as a point-of-care test is reliable and cost-effective and needs to be propagated in Indian settings where facilities for throat swab culture are not routinely available and also because clinical diagnosis based on scoring systems are comparatively less reliable.
  3,113 652 -
SHORT REPORTS
Prevalence of risk factors for non-communicable diseases in a rural tribal population of Mokokchung, Nagaland, India
Aonungdok Tushi, Sudha Ramachandra Rao, Kamaraj Pattabi, Prabhdeep Kaur
January-February 2018, 31(1):11-14
DOI:10.4103/0970-258X.243405  PMID:30348915
Background Non-communicable diseases (NCDs) are the leading cause of mortality in India. The northeastern part of India has a high burden of NCDs. However, data on the prevalence of risk factors for NCDs in the rural tribal population of Nagaland are limited. We estimated the prevalence and awareness level of risk factors for NCDs in the rural population of Mokokchung district, Nagaland. Methods In a cross-sectional survey, we selected 472 subjects aged 25–64 years, stratified by age and sex, in 20 villages, using a cluster sampling technique. The WHO STEPS tools were used to collect data on behavioural risk factors, and anthropometric, blood pressure and capillary glucose measurements. The proportion of subjects with each NCD risk factor was determined overall and in various age and sex subgroups. Results The 472 subjects had a median age of 44.5 years, 92 (19.5%) reported current smoking and 75 (15.9%) reported current alcohol use. Among 236 males, 90 (38.1 %) were current smokers and 65 (27.5%) were current alcohol users, whereas of the 236 females, only 2 (0.8%) and 10 (4.2%) were current smokers and current alcohol users, respectively. The use of smokeless tobacco was common among both males (139/236; 58.9%) and females (117/ 236; 49.6%). Inadequate intake of fruits and vegetables was reported by 189 (80.1%) males and 221 (93.6%) females. Insufficient physical activity was observed only among 16 (3.4%) participants. Prevalence of hypertension and a body mass index of 23.0–27.49 kg/m2 was 43.2% and 32.4%, respectively. Conclusions We observed a high prevalence of behavioural risk factors for NCDs and of hypertension in rural tribal people in Nagaland. The primary healthcare system needs to be strengthened in this area to improve detection and management of hypertension. Mass and print media campaigns and provision of cessation services may also be helpful.
  2,962 574 5
ORIGINAL ARTICLES
Evaluation of a novel flushing protocol for a peripherally inserted central catheter (PICC) in the neurological intensive care unit: A prospective randomized study
Fan Liu, Tianzhi Liao, Qiong Wang, Yan Tao
January-February 2018, 31(1):5-7
DOI:10.4103/0970-258X.243419  PMID:30348912
Background Peripherally inserted central catheters (PICCs) are increasingly used in critical care units. Venous arterial blood management protection (VAMP) for PICCs could decrease the rate of blockage of PICCs. We investigated whether a novel flushing method for PICCs could decrease the risk of venous thromboembolism (VT) and catheter-associated bloodstream infections (CABSIs) compared to the traditional flushing method. Methods In this prospective randomized study, we evaluated 360 patients with PICCs who were admitted to our neurological intensive care unit from March 2012 to February 201 4. The patients were randomized into the experimental group (n= 186) and the control group (n= 174). The VAMP-system flushing method was used in the experimental group whereas in the control group the PICCs were flushed with a 10 ml syringe of saline. Baseline clinical information, blockage rate of PICCs, occurrence of VT and CABSIs and average time for flushing (seconds per flushing time) were compared and analysed. Results The occurrence of CABSIs and average time for flushing were statistically lower in the experimental group. The rate of blockage of PICCs, proportion of male subjects, age of subjects, APACHE II score and length of stay in hospital showed no significant differences between the two groups. Conclusion This study showed that the VAMP-system flushing method is simple to use and may be more beneficial for patients with a PICC; it may also lower the risk of CABSIs.
  2,737 765 2
SHORT REPORTS
Leptospirosis following heavy rains in 2017 in Mumbai: Report of large-scale community chemoprophylaxis
Avinash Supe, Mini Khetarpal, Shantaram Naik, Padmaja Keskar
January-February 2018, 31(1):19-21
DOI:10.4103/0970-258X.243407  PMID:30348917
Background Globally, cities get flooded due to heavy rains. As the incidence of leptospirosis increases after such flooding in Mumbai, community chemoprophylaxis to selected individuals was a consensus recommendation by experts. Methods We surveyed a total of 1 499 293 houses in severely affected areas of Mumbai (where there was waterlogging or high incidence of leptospirosis in the past) as well as in all slum areas. A total of 6 714 210 people (>50% of the population) were screened. A total of 156 934 adults, 4465 children, 359 pregnant women and 4957 high-risk adults were given prophylaxis with doxycycline or azithromycin by paramedical staff (n = 9526) under the supervision of medical staff. Social media and newspaper advertisements were used to create public awareness. Results Compared with previous floods, there were reduced number of cases of leptospirosis due to community chemoprophylaxis (432 confirmed cases in 2005 v. 128 [59 confirmed] in 2017). Conclusions Selective, time-bound chemoprophylaxis following floods is likely to reduce the incidence of leptospirosis, as well as associated morbidity and mortality.
  2,106 328 3
Frontline use of bevacizumab in ovarian cancer: Experience from India
Richa Vatsa, Lalit Kumar, Sunesh Kumar, Kallol Kumar Roy, Neeta Singh, Jyoti Meena
January-February 2018, 31(1):15-18
DOI:10.4103/0970-258X.243406  PMID:30348916
Background Ovarian cancer is the second most common gynaecological malignancy in India. Despite relatively high response rates to first-line carboplatin and paclitaxel-based chemotherapy in epithelial ovarian cancer (EOC), the majority of patients experience multiple relapses and finally become resistant. Vascular endothelial growth factor (VEGF) promotes progression of ovarian cancer. Bevacizumab, a recombinant humanized monoclonal antibody directed against VEGF-A is an anti-angiogenesis agent. Data on the use of bevacizumab for EOC from India are not available. We, therefore, studied the use of bevacizumab in ovarian cancer. Methods In this prospective, non-randomized study, 10 patients who received bevacizumab were compared with 20 age- and stage-matched controls. After maximal surgical debulking, patients in the bevacizumab arm received bevacizumab 15 mg/kg i.v. on day 1 every 3 weeks followed by paclitaxel and carboplatin from cycle 1. After 6 cycles, bevacizumab was continued for 1 year. Controls received paclitaxel 1 75 mg/m2 and carboplatin only for 4–8 cycles. The outcome measures were adverse effects and progression-free survival. Results Haematological toxicity (i.e. neutropenia, thrombocytopenia and anaemia) was similar in both arms. Hypertension (40% v. 10%, p = 0.04) and bleeding-related complications (50% v. 0%, p = 0.002) were more in the bevacizumab arm. However, gastrointestinal (GI) perforations were not increased. The median progression-free survival was similar in both arms; 26 months versus 21 months (p = 0.57). Conclusion In this small group of patients, addition of bevacizumab increased the toxicity of chemotherapy.
  1,877 378 2
CORRESPONDENCE
Effect of moxifloxacin on QTc interval in adults with pulmonary tuberculosis
Dina Nair, Banurekha Velayutham, Makeshkumar Marimuthu, Poorana Ganga Devi Navaneethapandian, Ponnuraja Chinnaiyan, Mohammed Shaheed Jawahar, Soumya Swaminathan
January-February 2018, 31(1):58-59
DOI:10.4103/0970-258X.243427  PMID:30348931
  1,968 238 -
MEDICINE AND SOCIETY
Patient safety at a public hospital in southern India: A hospital administration perspective using a mixed methods approach
Laxmitej Wundavalli, SG Bulkapuram, NL Bhaskar, N Satyanarayana
January-February 2018, 31(1):39-43
DOI:10.4103/0970-258X.243415  PMID:30348925
Background Patient safety cannot be considered in isolation when organizational factors, both active and latent, influence patient outcomes. Methods We did a cross-sectional mixed methods study using a convergent parallel design at a tertiary care public sector hospital in Hyderabad, Telangana (i) to qualitatively investigate the nature and determinants of patient safety incidents occurring in the hospital; (ii) to quantify the perception of hospital staff regarding factors affecting patient safety from an organizational perspective; and (iii) to triangulate the results to highlight areas in need of improvement. Results The most common factors affecting patient safety were situational factors, working conditions and latent organizational factors including communication systems. Despite the relatively poor knowledge of paramedical staff regarding patient safety incidents, they perceived innovation and flexibility, outward focus, reflexivity, quality, pressure to produce, performance feedback and effort to be significantly higher compared to the heads of departments and clinical faculty. The strength of the dimensions: integration, involvement, training, welfare, supervisory support in the hospital was weak as perceived by all categories of staff. Conclusion There is a need to build team work, improve trust and communication between various departments, invest more in training, and provide supervisory support along with structural and process improvements in issues such as drug procurement and developing patient-friendly physical environment.
  1,839 289 1
SELECTED SUMMARIES
Aspirin for pregnancies at high risk for preterm pre-eclampsia
Aparna K Sharma, Neerja Bhatla
January-February 2018, 31(1):26-27
DOI:10.4103/0970-258X.243410  PMID:30348920
  1,641 286 -
MEDICINE AND SOCIETY
Coping with diabetes as an everyday experience: A study from urban Chennai
D Arutselvi
January-February 2018, 31(1):35-38
DOI:10.4103/0970-258X.243414  PMID:30348924
The day-to-day experience of dealing with chronic diseases such as diabetes affects the behaviour and social roles of individuals. The action that individuals seek to redress their suffering is determined by their socioeconomic context and responsiveness of health services. I explored the everyday experience and coping among individuals living with type 2 diabetes. This qualitative study captures the process of coping at the individual, family and healthcare services levels. I conducted in-depth interviews among people with diabetes using a semi-structured interview schedule. Informed consent was taken from the study participants. Narratives of two women belonging to different socioeconomic strata, provide the contrast in how they cope with diabetes in their everyday life in terms of diet, exercise, medication and health-seeking behaviour. This study provides insights into the complexities involved in dealing with diabetes. It highlights how social determinants play a critical role in coping with daily living, health and illness.
  1,387 238 -
MEDICAL EDUCATION
Students’ perception of lacunae in medical education in India, and suggestions for reforms
Vaishali Adlakha, Tanvi Jha, Pallavi Sahoo, Aishwarya Muralidharan, Damodar Bachani
January-February 2018, 31(1):29-31
DOI:10.4103/0970-258X.243412  PMID:30348922
Background The methods of classroom and clinical teaching in the MBBS course in India have not seen major modifications or innovations in recent decades, leading to dissatisfaction among students. Lack of conclusive data in this regard and absence of a mechanism for students’ feedback are also areas of concern. We aimed to assess the satisfaction levels and identify lacunae in undergraduate medical education in India. Methods We used an 8-item questionnaire to identify lacunae in medical education. A total of 336 undergraduate medical students from second and third professional years and interns of Delhi voluntarily participated in the study. Data were analysed using SPSS 17 version. Results Eighty-one per cent of students were not satisfied with teaching methods due to lack of coordination between different departments and lack of problem-based learning. Sixty-five per cent of students did not find the classroom environment conducive to learning due to large sizes of teaching batches and inadequate maintenance of infrastructure. Eighty-six per cent of students were not satisfied with learning experience during clinical postings attributing it to ‘doctors being too busy to teach in clinics’. Conclusion There is dissatisfaction among students indicating their desire for improved methods in medical education. Suggestions include short-term reforms such as encouraging interdepartmental planning and introducing problem-based learning, coupled with long-term measures such as improving infrastructure.
  1,134 231 1
LETTER FROM GANIYARI
Letter from Ganiyari
Puja Chebrolu, Priyank Jain
January-February 2018, 31(1):51-52
DOI:10.4103/0970-258X.243420  PMID:30348929
  1,108 115 -
SELECTED SUMMARIES
Does vitamin A supplementation decrease the risk of progression of tuberculosis among household contacts?
D Vignesh, Harshal Ramesh Salve
January-February 2018, 31(1):27-28
DOI:10.4103/0970-258X.243411  PMID:30348921
  881 177 1
CLINICAL CASE REPORT
Incidentally detected right aortic arch with mirror image branching in a patient with rheumatic calcific mitral valve disease
Krishna Kumar Mohanan Nair, Sanjay Ganapathi, Sonali Inamdar, Arun Gopalakrishnan, Tirur Raman Kapilamoorthy, Ajitkumar Valaparambil
January-February 2018, 31(1):22-23
DOI:10.4103/0970-258X.243408  PMID:30348918
An isolated right-sided aortic arch with no congenital heart disease is extremely rare. We report an adult woman with longstanding rheumatic heart disease causing severe calcific mitral stenosis, moderate mitral regurgitation and moderate pulmonary hypertension, for which she underwent mitral valve replacement and tricuspid annuloplasty. On preoperative work-up, she was detected to have a right-sided aortic arch with mirror image branching along with a ductal dimple. However, there were no associated congenital cardiac defects.
  806 172 -
LETTER FROM MUMBAI
Letter from Mumbai
Sunil Pandya
January-February 2018, 31(1):49-51
DOI:10.4103/0970-258X.243418  PMID:30348928
  743 159 -
BOOK REVIEWS
Known Unknowns of Everyday Radiology Practice
Anju Garg
January-February 2018, 31(1):54-54
DOI:10.4103/0970-258X.243422  
  736 161 1
IMAGES IN MEDICINE
Tracheomalacia with tracheal bronchus
Sudipta Mohakud, Lipsa Priyadarshini
January-February 2018, 31(1):57-57
DOI:10.4103/0970-258X.243426  PMID:30348930
  695 161 -
MEDICAL EDUCATION
Predictive utility of performance of students of dentistry in the first periodic assessment
Shivasakthy Manivasakan
January-February 2018, 31(1):32-34
DOI:10.4103/0970-258X.243413  PMID:30348923
Background Predicting students who need extra support academically may help initiate early remedial measures. We assessed the predictive utility of the first periodic assessment as a tool to identify students who need additional curricular support in the first year of Bachelor of Dental Surgery (BDS) course. Methods We retrospectively compared the performance of two batches of BDS students in the first periodic assessment and final university examination. The students were divided into three groups on the basis of their ranks in the first periodic assessment as high, middle and low achievers. We assessed the tendency of the students to be in the same group in the university examination. Results Though the performance of all the three groups improved significantly from the first periodic assessment to the final university examination, 73% of low achievers and 80.6% of high achievers stayed in the same group in both examinations. All those who failed in the final university examination were from the low achiever group. Conclusion Performance of students in the first periodic assessment is a valid tool to identify students who need additional curricular support.
  720 127 -
BOOK REVIEWS
Complications after Gastrointestinal Surgery
Venkatramani Sitaram
January-February 2018, 31(1):54-55
DOI:10.4103/0970-258X.243423  
  689 118 -
CORRESPONDENCE
Vaccine recommendation requires more transparency in India
Yogesh Jain
January-February 2018, 31(1):59-59
DOI:10.4103/0970-258X.243428  PMID:30348932
  684 118 -
ERRATUM
Erratum: Students' perceptions of gaps in teaching communication skills and behavioural sciences in undergraduate dental education

January-February 2018, 31(1):7-7
DOI:10.4103/0970-258X.243432  PMID:30348913
  597 149 -
BOOK REVIEWS
Rational Emotive Behaviour Therapy Integrated
M Manjula
January-February 2018, 31(1):53-53
DOI:10.4103/0970-258X.243421  
  626 111 -
Adult Health and Human Capital: Impact of birth weight and childhood growth
Ramesh Agarwal
January-February 2018, 31(1):55-56
DOI:10.4103/0970-258X.243424  
  426 83 -
NEWS FROM HERE AND THERE
News from here and there
PM Nischal
January-February 2018, 31(1):60-61
DOI:10.4103/0970-258X.243429  
  360 104 -