bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of drug utilization pattern and pharmacoeconomic of antidiabetic drugs in patients attending a teaching hospital
Authors: M. Shanthi
Published: March 2018

Background: Drug utilization research establishes the current trend in the use of antidiabetic drugs including the new drug and to identify irrational prescription.Methods: A cross-sectional study was conducted for a period of one year (between August 2013 to August 2014) at outpatient department of Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari District, Tamil Nadu.Results: A total of 169 prescriptions were evaluated during the study period. Diabetes mellitus was predominant among the female population in this region. Demographic details of the patient included in the study were mean weight 67.56kg, mean height 155cm and average body mass index 27.82kg/m2. All the patients were diagnosed and were known case of type 2 diabetes mellitus. Systemic hypertension was the frequently encountered co-morbid conditions associated with this endocrine disorder. Metformin was the drug chosen for managing diabetes as monotherapy and 73% of the patients were on combination of antidiabetic drugs. Glimepiride with metformin was the combination therapy frequently prescribed during the study period. Pharmacoeconomic analysis identified that drugs prescribed by brand name were costlier compared to generic equivalent.Conclusions: Utilization of antidiabetic drug therapy in this region has shown a changing trend compared to the previous studies. There is a gradual increase in the prescription of metformin and dramatic increase in the use of newer drugs like pioglitazone, voglibose and sitagliptin. Pharmaeconomic analysis revealed that glibenclamide was least expensive while sitagliptin was most expensive in this study.
Comparative study of Alvarado score and RIPASA score in the diagnosis of acute appendicitis
Authors: Chavan Shahaji , Bhatnagar Shubhi , Bendre Mahendra , Sinha Nilesh
Published: March 2018

Background: Acute appendicitis despite being a common problem, remains a difficult diagnosis to establish. A delay to diagnose this condition as well as negative appendicectomies should be prevented. The above problems can be avoided by using scoring systems. This study aims to compare the efficacy of Alvarado score and RIPASA score in the diagnosis of acute appendicitis.Methods: In this study, 100 cases of appendicitis were admitted. Alvarado and RIPASA scores were applied to all patients. The scores were compared with post-operative histopathology findings.Results: Alvarado score was positive in 75% cases and RIPASA score was present in 90% cases. Histologically, appendicitis was present in 99% cases.Conclusions: RIPASA score is more efficient in diagnosing acute appendicitis compared to Alvarado score.
Incidental historiographic faux pas of venous air embolism in laparoscopy, reviewed critically: humanum est errare
Authors: Kumar Shiv , Sudrania Om P.
Published: March 2018

Historiographic antecedents about ambient air (AA) for embolism in operative laparoscopy (OL) are critically reviewed to decipher its representation; for its immense clinical and economic implications. Rumours of air embolism (AE) in beginning of twentieth century were based on rampant use of air tamponade in abdomen and chest for tuberculosis in absence of definitive treatment. News of AE in head, neck, dental and other open surgeries also compounded negative image of air for embolism. Resultant antiair heresy continued in medical press globally bereft of actual knowledge of etiopathophysiology of AE or gas embolism and biomechanics of pneumoperitoneum (PP). This incidental blemish was extended to OL also with divergent etiopathophysiology even when gas used was or is other than air, e.g., CO2, N2O, or O2, etc in PP and none of them are similar to each other in physical or chemical characters.
Threshing grain of mechanism from chaffy myth of air embolism in laparoscopy - lux et veritas
Authors: Kumar Shiv , Sudrania Om P.
Published: March 2018

Biomechanical processes involving exact mechanism of air embolism (AE) or gas embolism (GE) in pneumoperitoneum (PP) in operative laparoscopy (OL) causing morbidity and mortality lie in air lock (AL) or gas lock (GL) in right side of heart resulting in traffic jam (TJ) for blood flow in pulmonary tree (PT). This also leads to poorly understood cascade of immunopathological pulmonary reactions. These issues are critically reviewed and discussed to thresh the grain of mechanism from husk of myth of ghost of AE or GE in OL for its dreaded moribund complications. Physics of gas is defined with analysis that venous GE is not exclusive to ambient air (AA) in OL but occurs with CO2, N2O, O2 and other gases also. It is important since use of AA in OL is useful or ostensibly better than CO2 in situations like pregnancy, camps, cardiopulmonary cripples, cirrhotics, war fields, etc and economic needing no cylinders as AA is ubiquitous. Even when gas used was or is CO2 or O2 but blemish is labelled on air for embolism imprudently needing scientific scrutiny.
Evaluation of outcomes in elderly patients diagnosed with colorectal cancer
Authors: Lawrence Neil , Griffiths Joshua , Chapple Keith
Published: March 2018

Background: Colorectal cancer in the elderly carries a high morbidity and mortality. The National Bowel Cancer Audit Programme is a high-quality audit incorporating all UK colorectal cancer patients. Author analysed this database to investigate the local outcomes for this high-risk group.Methods: Data (mode of presentation, presence of metastatic disease, treatment surgery, colonic stent or conservative and WHO performance status) was collected on all patients aged 85 years or over diagnosed with colorectal cancer at a large tertiary referral centre over a 5-year period. Ninety day and 2 year-mortality was obtained for all patients.Results: Ninety patients (45 male, 45 female, median age 88.9 range 85.0-97.9 years) were included (47 emergency presentation, 43 elective presentation). A 18 of 47 patients underwent emergency surgery. A 90-day and 2-year mortality in this group was 17% and 69% respectively. 29 of 47 patients presenting as an emergency had non-operative treatment (2-year mortality 87%). Two years mortality for patients undergoing emergency surgery was 100% if aged above 90 years or if distant metastases were present. Eleven of 43 patients presenting electively underwent surgery. 90-day and 2-year mortality for this group was 18% and 0% respectively. Two years mortality for those presenting electively and undergoing non-operative treatment was 62%.Conclusions: Decision making must be very carefully considered in patients aged over 85 years as the presence of metastases, poor WHO performance status or age over 90 carries with it a significant risk of mortality at both 90 days and 2 years following diagnosis.
A retrospective study of clinical efficacy of serum lipase/amylase ratio in predicting etiology of acute pancreatitis
Authors: C. Harish Kumar , G. S. Mridul
Published: March 2018

Background: The serum lipase/amylase (L/A) ratio had been proposed to distinguish the etiology of pancreatitis, the efficacy to predict the etiology of acute pancreatitis is assessed in our study as it may need different therapeutic approaches.Methods: From January 2017 to December 2017, 54 patients with acute pancreatitis were included 48 (88.9%) men and 6 (11.1%) women with a mean age of 39.2 years, ranging from 18 to 90 years. They were divided into 2 subgroups as alcohol (n=27), nonalcoholic (n=27), and their serum L/A ratio level were compared with a mean age 39.42±9.9 years in alcoholic group versus 39.04 ± 7.7 years in nonalcoholic group.Results: Male predominance in alcoholic and nonalcoholic group and all female patients (100%) etiology is nonalcoholic. The elevation of serum amylase level in nonalcoholic group on average is 600 versus in alcoholic group 512 and serum lipase level average in nonalcoholic group 766 versus in alcohol group 629. Instead, the serum L/A ratio showed no significant changes among each group. In this study, the alcoholic acute pancreatitis is more severe than nonalcoholic pancreatitis. There was also no statistically significant (p=0.90) difference in serum L/A ratio in alcoholic and nonalcoholic pancreatitis.Conclusions: The serum amylase and lipase concentrations are not able to establish etiology acute pancreatitis as assessed by imaging techniques. The L/A ratio is not a good predictive factor in distinguishing acute episode of alcoholic and non-alcoholic acute pancreatitis.
Evaluation of the use of subcutaneous drains to prevent wound complications in abdominal surgeries
Authors: Manoharan G. V. , Sivakumar T. , Kumar M. Ashok
Published: March 2018

Background: Wound complications like surgical site infections (SSI) and wound dehiscence are common following abdominal surgery for peritonitis. Drains have been used to remove collections from the early days of surgery. The use of drains to remove subcutaneous collections to prevent wound complications needs to be studied.Methods: Sixty patients who underwent surgery for peritonitis were selected for the study. 30 patients underwent conventional abdominal wall closure while the other 30 had suction drains inserted in the subcutaneous tissue. Wounds were observed for complications and time for healing.Results: The incidence of SSI was significantly less in Group A (23%) than in Group B (60%). Similarly, wound dehiscence occurred in 43% of SSI cases in Group A as against 89% of SSI cases in Group B, the difference of which was statistically significant. The mean duration of hospital stay was significantly less when subcutaneous suction drain was placed (9 days).Conclusions: Subcutaneous suction drainage tube is an effective method of abdominal wall closure in cases of peritonitis when compared to conventional primary skin closure as it significantly reduces the incidence of SSI, wound dehiscence, wound secondary suturing and duration of hospital stay.
Clinical study of peripheral arterial occlusive disease of lower extremities
Authors: C. Prasad , K. Santosh Nayak
Published: March 2018

Background: Peripheral arterial occlusive disease or commonly known as peripheral arterial disease (PAD) comprises those entities which result in obstruction to blood flow in the arteries, exclusive of the coronary and intracranial vessels and the term is usually applied to disease involving the arteries of lower extremity. Peripheral arterial disease is an important manifestation of atherosclerosis involving the arteries of legs. Vascular surgeons continue to encounter complications of atherosclerosis as their most common clinical challenge. Objective of this study was to know the various etiologies and different clinical presentation of Peripheral arterial occlusive disease.Methods: This was a cross sectional observational study of 50 cases diagnosed with Peripheral Arterial disease of the lower extremities, done during the period from January 2013 to June 2014 among the Patients with Peripheral Arterial disease of the lower extremities admitted to surgical wards of SCBMCH, Cuttack.Results: All the cases in the present study fall under the category of chronic lower limb ischemia and no cases of acute limb ischemia. Majority of the cases in atherosclerosis were above the age of 50 years, while in the TAO group majority belong to the age group between 31 to 50 years. TAO was usually limited to the distal part of the limb. All patients with TAO had a history of smoking and 61% of atherosclerotic patients gave history of smoking.Conclusions: TAO and Atherosclerosis are the etiologies for ischemia in these cases, with atherosclerosis being more common of the two. TAO presented at a younger age group whereas atherosclerosis presented in the older age group.
Serum iron and serum ferritin levels in cholelithiasis: a randomized study
Authors: Arora Bhavinder Kumar , Yadav Anuj Kumar
Published: March 2018

Background: The role of iron in the pathogenesis of gallstone disease has not been well established so far. Iron deficiency has been shown to alter the activity of several hepatic enzymes, leading to increased cholesterol saturation of bile in gall bladder and hence promoting cholesterol crystallization.Serum iron, total iron binding capacity and transferrin saturation are not good indicators of iron status in individuals. In infection free situation, serum ferritin is an ideal indicator for diagnosis of iron deficiency.Methods: The study was conducted as a prospective study in the department of Surgery. The study population was divided into two groups; Case group with 200 patients with gallstone disease and control group with 50 patients without gallstone disease. Serum iron and ferritin contents of both groups will be analyzed and compared with each other.Results: In this study the gallstones are more prevalent in female population than males in ratio of 5.4:1. Serum iron in males was low in 41.93% not comparable 20.8% of control suggesting that low serum iron is not associated with Cholelithiasis in male. In males, serum ferritin was low in 64.5% of cases and 16.66% of controls. Serum ferritin levels were normal in 35.50% of cases and 66.66% of controls and above normal in 16.66% of controls suggesting that low serum ferritin is associated with gall stones in males. In this study, low serum iron was seen in 23.07% of females comparable to 23% low serum iron in control females and low ferritin was seen in 35.50% of female cases as compare to 15.38% of controls.Conclusions: It was concluded that a low body store of serum iron is a risk factor for cholelithiasis in females and serum iron, serum ferritin may be used as marker of iron store so that low serum iron status could be diagnosed at early stage.
Study of the degree of gall bladder wall thickness and its impact on outcomes following laparoscopic cholecystectomy in JSS Hospital
Authors: B. J. Sharath Chandra , Bose Rahul
Published: March 2018

Background: Elective laparoscopic cholecystectomy (LC) is presently the gold standard for management of symptomatic gall stone disease, replacing open cholecystectomy. The objective of this study was to measure gall bladder wall thickness preoperatively on ultrasound in patients with symptomatic gallstone disease and to establish its role as a prognostic indicator for complications during or following laparoscopic cholecystectomy.Methods: Gall bladder wall thickness was measured by ultrasonography in 151 patients who presented with Gallstone disease and underwent laparoscopic cholecystectomy for gallstone disease in the JSS Hospital in the given time period. They were then divided into 4 groups depending upon the wall thickness. Normal (upto 2 mm), mildly thickened (>2 to 4 mm), moderately thickened (>4 to 6mm), severely thickened (>6 mm). The incidence of intra and post-operative complications were monitored and compared between the four groups.Results: The incidence of complications was found to be significantly higher in patients with mildly and moderately thickened gall bladder walls (53.1% and 83.3% respectively) as compared to gall bladders with normal wall thickness (10.5%). Average postoperative length of stay in hospital was significantly higher in patients with thickened walls as compared to patients with normal thickness.Conclusions: With wall thickness of greater than 2 mm, the complication and conversion rates are extremely high. An increase in the thickness of the gall bladder wall leads to an increased risk of complications and conversions as well as an increased length of stay in hospital post operatively. Patients with thickened gall bladder walls accounted for only 30% of the study population but they experienced the maximum number of complications (72.5%) and conversions to open (71.4%).
Complex anal fistulae management by combined technique approach: an experience
Authors: M. E. Shaileshkumar , P. T. Sushanth
Published: March 2018

Background: The aim of this study is to evaluate our experience in the management of complex anal fistulae by combined technique approach. Ideal surgical treatment for complex anal fistula should aim to eradicate the source of infection and promote healing of the tract, while preserving the sphincters and the mechanism of anal continence. Even with the evolving newer techniques complex anal fistulae have higher rates of recurrence and functional disability as anal incontinence. The requirement of multiple surgeries for recurrence and the newer techniques like anal fistula plug are expensive and will become a burden for patients living in developing countries like ours. Thus, apart from Ligation of Intersphincteric fistula tract, the use of cutting seton is the main surgical method practiced here. This article focuses on the approach to the complex anal fistula management through evidence-based treatment strategies.Methods: Author conducted a prospective study of 35 complex anal fistulae patients undergoing combined technique approach with cutting Seton, Ligation of Intersphincteric Fistula tract and fistulotomy. Results: All patients recovered well with no complications in postoperative period. After 2 years of follow up patients are recurrence free and only 2 patients had partial incontinence with improving trend.Conclusions: The use of cutting Seton in high anal fistula is an effective technique. LIFT technique is good for Transphincteric tracts without previous scarring; it can be easily learned and applied. We can conclude that combined technique was an effective procedure and valid alternative for complex anal fistula management.
A comparative study of single layer closure versus conventional layered closure of laparotomy wounds
Authors: Bande Akash , Saxena Divish , B. Nichkaode Prabhat , Akhtar Murtaza
Published: March 2018

Background: The goal of wound closure after laparotomy is to restore the function of the abdominal wall. The techniques for closure of anterior abdominal wall includes either layered closure, modified Smead-Jones technique, mass closure or retention suture or combination of above mentioned techniques. The studies which compared the continuous and interrupted suture techniques have concluded that enmass continuous sutures have an advantage of holding the fascia together. The present study tries to compare the two techniques i.e. single layer closure (mass closure) and layered closure in patients undergoing laparotomy by midline incision in tertiary care hospital.Methods: 97 patients undergoing either emergency or elective midline laparotomy were included in the study, where in 64 patients laparotomy closure was done in single layer using polypropylene 1-0 and in 33 patients by layered closure where peritoneum was closed with polygalactin 2-0 and linea alba by polypropylene 1-0. Patients were allocated two groups as per convenience of operating surgeon without using any method of randomization.Results: The single layer closure technique required statistically significant less closure time of 18.2±3.2 minutes as compared to conventional layered closure 26.4±4 minutes time of (p <0.001). Also, the incidence of postoperative complications was found to be comparatively less (17.18%) in single layer closure group as compared to complications (42.42%) in layered closure group.Conclusions: Single layer closure technique continues to be better than conventional layered closure technique of laparotomy wounds in terms of operative time and post-operative complications.
Plastibell circumcision in neonates and infants at tertiary care centre
Authors: Shinde Nandkishor D. , Moinuddin Mohammad , Danish A. N. M. Owais
Published: March 2018

Background: Circumcision is the most common surgical procedure in children worldwide. The aim of this study was to study the safety and complication of Plastibell circumcision in neonates and infants.Methods: This prospective study of 420 male children less than 1 years who underwent Plastibell circumcision for religious or cultural indication in the Department of Surgery at KBN Institute of Medical Sciences, Kalaburagi, during February 2016 to January 2018. Children were divided into two groups; neonates (0 to 4 weeks) and infants (5 weeks to1 year). Parents were given specific instructions on care of the device on discharge and followed up on day 3 and on day of separation of the Plastibell.Results: During the study period, 420 cases of Plastibell circumcision fulfilling the inclusion criteria were included and analyzed. Out of the total cases, 120 (28.57%) were neonates, whereas the remaining 300 (71.42%) were infants. Mean surgical time was 4±2 minutes. The mean number of days for Plastibell to separate was 6.2 days, Plastibell ring separation in neonates earlier (3 days to 7 days) as compared to infants (5 days to 12 days). Out of the total 420 cases 65 (15.47%) cases developed minor complications. In neonates, out of 120 cases only 05 (4.16%) developed complications. In infants, out of 300 cases, 60 (20%) developed complications.Conclusions: Neonates had shorter time for the Plastibell to separate and with fewer complications than infants. Though complications were present, they were few and could be managed easily. Plastibell circumcision is safe in neonates and infants.
Retroactive analytical study by one surgeon using air in operative laparoscopy - exitus acta probat
Authors: Sudrania Om P. , Kumar Shiv
Published: March 2018

Background: This is a retroactive analysis that presents and discusses practical issues relating to ambient air (AA) in operative laparoscopy (OL) and Author used AA perforce in OL with good result after using CO2.Methods: Patient pool from North Eastern India and adjoining countries is presented with use of AA in OL. Technique was verses needle first in majority cases irrespective of their American Society of Anesthesiologists (ASA) status or previous abdominal surgery.Results: A total 233 procedures carried out unselectively are presented with results from ASA Grades I to V, along with surgical difficulties and complications observed. There was no mortality, no clinical evidence of embolism or wound infection.Conclusions: This first study of use of AA in OL analyses that it is safe, useful sans side effects of CO2. Gas embolism (GE), CO2 embolism, air embolism(AE) are interchangeably used. The mechanism of death in GE or AE is gas lock or air lock and traffic jam in right heart and pulmonary tree (PT) along with ill understood PT immunopathological events.
Primary intradural neuroendocrine tumour of spine: a rare pathology
Authors: Gupta Vipin K. , Latawa Archit , Kalra Gagan , Radotra Bishan D.
Published: March 2018

Neuroendocrine tumour in central nervous system is a very rare pathology. We hereby report a primary intradural neuroendocrine tumour, second to the only other case reported in literature till now as per the best of our knowledge. The tumour was completely intradural, spanning across five segments in the lumbar spine and no primary tumour could be detected elsewhere in body. The patient underwent surgery followed by radiotherapy and showed symptomatic relief.  This case report focusses on compiling the available literature on spinal carcinoids (both primary and metastatic) and discussing the relevant investigations and available treatment options for the same.
Metastatic Squamous cell carcinoma of small bowel with occult primary presented as small bowel obstruction
Authors: M. Sridhar Reddy , M. Naresh , Rath Alok
Published: March 2018

Metastatic lesions in the small bowel are more common than primary lesions and account for 0.5% of all small intestinal malignancies. Most common is malignant melanoma followed by adenocarcinoma from pancreas, colon or stomach; and squamous cell carcinoma from lung, cervix, esophagus, skin, penis, ovary, pancreas and gallbladder. Gastrointestinal involvement as a manifestation of metastatic squamous cell carcinoma with unknown primary is relatively uncommon with very few being reported in the literature. The most common presenting symptom of small bowel lesions is subacute or acute obstruction and less commonly, bowel perforation, abdominal pain or hemorrhage. It is a diagnosis which dawns upon after the surgery when histopathology proves the same and therefore a thorough workup to establish the primary starts after the bailout procedure. Its clinical course is aggressive, characterized by a short preclinical history, resistance to chemotherapy, and overall dismal prognosis with a median life expectancy of 6 to 9 months as it represents a disseminated disease.
Giant juvenile fibroadenoma: a case report
Authors: Pareek Prashant , Pareek Priyanka
Published: March 2018

Breast Lumps are not a common occurrence in paediatric patients. When encountered, they call for a thorough workup and meticulous treatment plan. Like in adults, fibroadenomas can be seen in children. These are termed 'juvenile fibroadenomas'. When these are larger than 5cm or weigh more than 500gm, they can be called 'giant juvenile fibroadenomas'. These comprise 1-8% of breast lumps in adolescent population. We report here a case of a 10 years old girl who presented with a rapidly growing unilateral breast lump which provided a diagnostic dielemma but was diagnosed as giant juvenile fibroadenoma on histopathology performed post excision. She was successfully treated surgically by removing the entire well-defined lump intact after raising overlying breast flaps. The post-operative period was uneventful. The patient shows no signs of recurrence or co-morbidity even now at follow up OPD visits.
A rare case report of solitary intramuscular cysticercosis of right forearm involving the extensor muscle group
Authors: Kumar Vinod , Reyaz Mushir , Gupta Shankar Kumar , Kumar Pawan
Published: March 2018

Cysticercosis is an infection with the larval form of the Taenia solium that commonly involves the central nervous system. Isolated muscular involvement is rare with only a handful of cases reported in the literature. We present a case of isolated cysticercosis of the extensor muscles of the forearm that presented a diagnostic challenge. High resolution ultrasound of the forearm helped in the diagnosis and the patient was managed successfully on anti-helminths and anti-inflammatory medications.
Palatability of micro-encapsulated iron pyrophosphate (Ferfer®)
Authors: Siddiqui Anum Sohail , Ashraf Tazeen , Imran Uzma
Published: March 2018

Background: Iron deficiency is the leading cause of anemia globally and affects 20% of world adult population. The general practice for replacement of iron reserves is oral supplementation. However, the success of this strategy solely depends on drug adherence and compliance. Where many other factors contribute to compliance, the role of taste of the medicine can also not be neglected. The aim of this study is to evaluate the palatability of micro-encapsulated iron pyrophosphate (Ferfer) and compare its taste with previously taken other oral forms of iron supplements.

Methods: The study was conducted with 231 female participants of age more than 18 years. Participants had taken one sachet of micro-encapsulated iron pyrophosphate (Ferfer) for the purpose of taste. Questionnaire based on their previous experience of iron supplements and palatability of Ferfer was asked by participants based on 0-10 mm visual analogue scale and 5 point Likert scale evaluating responses at 0 minute, 5 minute, and at 10 minute. Data was analyzed by using SPSS version 23.

Results: The women previously taking some others oral form of iron supplementation scored their supplements, a mean taste score is 2.92±2.44 on the VAS. However, micro-encapsulated iron pyrophosphate (Ferfer) received a mean score of 7.66±1.32 immediately after taking it and a score of 7.96±1.37 after 5 minutes on the 0-10 mm VAS. 81.4% patients will recommend their doctors to prescribe FERFER to them in future.

Conclusions: Enhanced palatability of micro-encapsulated iron pyrophosphate sachets have resulted in increased compliance to the supplementation regimen among the participants.
Sexual behavioural correlates of herpes simplex virus type 2 infections among pregnant women in South-western Nigeria
Authors: Anaedobe Chinenye G. , Ajani Tinuade A.
Published: March 2018

Background: Herpes simplex virus type 2 (HSV-2) is the most common cause of genital ulcer disease. It leads to lifelong latent infection and this raises concerns among women of reproductive age, considering the risk of neonatal transmission. This study was undertaken to identify the sexual behavioural correlates of HSV-2 infection as well as negative pregnancy outcomes.Methods: The cross-sectional study was conducted between March and August 2013, in the antenatal clinic of the University College Hospital Ibadan. A total of 270 pregnant women aged 20 to 44 years were enrolled and their serum samples were tested for HSV-2 IgG using type specific third generation ELISA (DIAPRO Milano Italy). Pretested validated questionnaire were used to obtain bio-data, sexual behaviour and obstetrics history of the participants. Data analyses was done using SPSS version 20.Results: The seroprevalence of HSV-2 type specific IgG was 33.3% (90/270). Logistic regression analysis showed that multiple lifetime sexual partners, early age at sexual debut, previous history of sexually transmitted infections (STIs) and having spouses whose work keep them away from home, were independent risk factors for HSV-2 infection. Obstetrics complications such as intrauterine foetal death, congenital malformations and spontaneous abortion were also strongly associated.Conclusions: The predictors of HSV-2 infection in this study may be important in selecting candidates for screening tests and developing strategies towards effective health promotion campaign.
Prevalence and determinants of excessive daytime sleepiness among resident doctors at a tertiary care institution in India
Authors: H. S. Siddalingaiah , Mastin David F. , Moore Bruce D. , Bryson W. Jeff , D. Chandrakala , Singh Amarjeet
Published: March 2018

Background: Modern socio-occupational settings, especially medical settings, often involve shift work, long work hours, and concomitant maladaptive sleep habits. These factors may result in daytime sleepiness, an increase in the prevalence of sleep disorders, and/or an exacerbation of existing sleep disorders in the contemporary workforce. Aim was to measure the prevalence and determinants of excessive daytime sleepiness (EDS) among medical residents at a Tertiary Care Institution in India.Methods: A cross-sectional study was designed and a list of all enrolled medical residents was obtained (N=430). The eligible subjects (N=428) were interviewed and administered the study instruments. The information on socio-demographics and sleep-related factors were collected using the sleep assessment proforma. The Epworth sleepiness scale (ESS) was used to measure excessive daytime sleepiness (EDS) and the sleep hygiene index (SHI) was used to measure sleep hygiene. Data were analyzed with appropriate statistical methods.Results: A total of 350 residents responded (82%). The prevalence of EDS and Maladaptive sleep hygiene were 47.4% and 85.5% respectively. A positive association was found between EDS and weekly work hours, SHI score, sleep duration, sleep quality, midnight awakenings, clinical stream, and rotating shift work. Coffee intake and smoking within 4 hours of bedtime, restless legs and allergies had weak association with EDS.Conclusions: EDS and unhygienic sleep were highly prevalent among resident doctors. The factors associated with EDS were mainly related to work, sleep quantity, sleep quality and sleep hygiene which are amenable to suitable modifications by behavioural change communications, awareness programs and by administrative actions.
A study on role of sputum conversion rate in management of tuberculosis in South Indian population
Authors: Bineni Chandrasekhar , Yarasani Pradeep , Ravi Prabhu G.
Published: March 2018

Background: Directly observed treatment short course (DOTS) is the currently recommended control strategy for tuberculosis. Even after intensive phase of directly observed treatment short course, there is delayed sputum smear conversion in some patients due to multiple factors. The present study was undertaken to study the role of sputum conversion in management of tuberculosis.Methods: A total of 229 patients with smear positive Tuberculosis cases of both Category-I and Category-II from DOTS centre in tuberculosis, S.V.R.R. Government General Hospital, Tirupati, A.P were enrolled and registered for the present study. Consent was taken from the patients to study the role of Sputum conversion rate importance in management of Tuberculosis in South Indian population.Results: The sputum conversion rate has been found to be higher in Category I (93.2%) compared to that of Category II (80.8%) and the difference is also found to be statistically significant. The sputum conversion rate has been found to be higher in those who were one + initial grade of sputum 96.1% followed by scanty grading 93.3%.Conclusions: The present study suggests that special attention should be given to patients enrolled for DOTS II regimen to improve sputum conversion rate in management of tuberculosis.
Evaluation of level of satisfaction among indoor patients attending in a tertiary care hospital of Rajnandgaon (C.G.), India
Authors: Verma Nirmal , Kamble Nitin , Bhawnani Dhiraj , Makade Kiran , Dengani Monika , Kaushik Tarun
Published: March 2018

Background: Patient expression is an important source of information in screening for problems and developing an effective plan of action for quality improvement in health care organizations. Assessing satisfaction has been mandatory for quality control of any hospital, which has resulted in an increasing number of projects devoted to the concept of satisfaction and determinant of patient satisfaction.Methods: The present Cross sectional Observational Hospital based study was conducted in Government Medical College Hospital, Rajnandgaon (C.G.) India during April 2016 to September 2016. A sample of 200 patients was taken who were admitted in different Indoor Patients Department of Clinical departments. Patients were selected according to inclusion and exclusion criteria. The information from the patients on various aspects of patient’s satisfaction like admission procedure, communication with staff, physical care, test and operation help availability, cleanliness, privacy related issues and overall satisfaction was obtained by interview with patients based on the semi structured questionnaire proforma.Results: In the present study, among IPD patient Male: Female ratio was 3:2 approx. Helpfulness of person at registration desk was ranked very good by 93% subject. Wheelchair was available for most of the patients (95%) but its availability when needed was ranked very good by 76% patients only. Majority of patient were satisfied with the behavior of the lab technician (89%), availability of lab results on given time (81%).Conclusions: This study shows that patients admitted in the various wards of hospital were satisfied with the quality of professional services by doctors, nursing and paramedical staff but problem lies with the availability of basic amenities. Overall present study shows that assessing satisfaction of patients is simple, easy and cost effective way for evaluating the hospital services.
Awareness of ASHA workers of low endemic area regarding malaria: a qualitative analysis
Authors: Pathak Nidhi , Baliga Sulakshana S. , Walvekar Padmaja R.
Published: March 2018

Background: Under the community-based approach, Accredited Social Health Activist (ASHA) is designated to address early detection, management and prevention of malaria at the community level. Majority of ASHAs in high risk areas are aptly trained for these tasks but ASHAs in many low endemic areas are insufficiently trained and hence may lack awareness about malaria and its prevention and surveillance. New operational guidelines for malaria elimination by Govt. of India has tasked ASHAs of category 1 areas like Belagavi for passive case detection and contact tracing apart from spreading health awareness about its prevention. Good knowledge and practices regarding malaria among ASHA workers is thus pertinent for efficient case detection and surveillance at grass root levels. The objective of the study was to assess the awareness of ASHA workers regarding malaria.Methods: A qualitative study was conducted from January to June 2017 using eight focus group discussions among 50 ASHA workers of rural area of Belagavi selected by purposive sampling. The responses were open ended and were recorded in same sequential manner after being translated to English from local language. Each interview transcript was read several times, and meaning units were extracted independently.Results: Findings revealed that majority of them had poor knowledge regarding collection of blood smears and none of them were aware about anti-malarials. Only half of ASHA workers were aware of vector control activities, very few were aware about anti-larval activities while less than half were aware about source reduction activities.Conclusions: The discussions highlighted a need for refresher training for effective capacity building of grassroot health workers especially in low endemic area.
Knowledge, attitude and practices about cervical cancer among rural married women: a cross sectional study
Authors: Ramaiah Radha , Jayarama Srividya
Published: March 2018

Background: Cervical cancer is the third most common cancer among women and the fourth leading cause of cancer deaths in females worldwide. The objectives of the study were to assess the level of knowledge, attitude and practice related to cervical cancer and its screening among women of reproductive age group in a rural area of Karnataka and to find the association between socio-demographic characters and knowledge, attitude and practice related to cervical cancer.Methods: A community based cross sectional study was conducted among 200 married women of reproductive age group residing in Javarnahalli, a rural field practice area of AIMS, Karnataka. Data was collected using predesigned, pretested structured questionnaire. The questionnaire consisted of four parts to gather information regarding socio-demographic characteristics of participants, knowledge, attitude and practice regarding cervical cancer and its screening. Institutional ethical committee approval and informed consent from study participants were taken.Results: 64% study participants were not aware of the early symptoms of cervical cancer. Around 34.5% had heard of cervical cancer screening. 76.2% women were willing to screened if offered free of cost. But only 9.5% women had ever been screened for cervical cancer.Conclusions: Strategic communication targeting eligible women, universal availability of screening facilities in public health facilities may increase the uptake of cervical screening.
Compliance of anti-rabies vaccine among dog bite victims in an urban slum of Chennai: a cross sectional study
Authors: R. Shivasakthimani , Chellaiyan D. Vinoth Gnana , G. Ravivarman , R. Murali
Published: March 2018

Background: Among infectious disease, rabies has the highest case fatality rate. The major problem of rabies is attributable to its dog-mediated transmission which is an impending threat to more than 3.3 billion people. Poor compliance of vaccine increases the mortality rate due to rabies. The present study attempts to ascertain pattern of dog bite and compliance to post exposure prophylaxis.Methods: This cross sectional study was carried out in Primary Health Centre in an urban slum of Chennai in Tamil Nadu. The study included 301 dog bite victims residing in urban slum with wound categories II & III (as per WHO). A pretested, semi-structured questionnaire was used for data collection. Data was analysed with SPSS-IBM (version 21.0). Chi-square test was applied.Results: Mean (SD) age of study participants was 28 (±16.3) years. Males were 176 (58.5%) and females were 125 (41.5%). Among the bites, pet dog bites were 140 (46.5%), and stray dog bites were 161 (53.5%). Majority of the bites 161 (53.5%) were unprovoked, category II bites were 216 (28.2%).Compliance up to 3 dose was found in 213(70.8%). Association was found between site of the dog bite and compliance of anti- rabies vaccine (p=0.021).Conclusions: Despite the availability of costless vaccines in public health care system, the compliance rate is only moderate. Health education about the vaccination after dog bite needs to be imparted among the community to reduce the rabies related mortality rate.
A study of treatment outcome of paediatric tuberculosis patients in an urban city of central India
Authors: Joshi Sheloj
Published: March 2018

Background: It is an established fact that healthy children build healthy nation. Proper management of Paediatric Tuberculosis is very essential for the control of tuberculosis as children also act as a source of infection within a community. The objective of the study was to determine the treatment outcome of paediatric TB patients registered under RNTCP in Bhopal city and to determine the relationship of socio-demographic profile and other selected factors with treatment outcome in Paediatric TB patients registered under RNTCP in Bhopal city.Methods: In this longitudinal study, data of all the paediatric TB patients (0 to 14 years of age group) diagnosed as TB and registered under R.N.T.C.P and fulfilling inclusion criteria during January 2013 to June 2013 were collected after obtaining informed consent from parents/guardians by using a structured questionnaire during their visit to designated microscopic centre (DMC) cum DOTS centre. The data was analysed on statistical software SPSS VS.20.Results: In our study 93.33% of paediatric patients were treatment completed, 4.84% were declared cure and 0.60% patients each were transferred out, declared treatment failure and died respectively. Educational status of mothers of paediatric patients (X2=40.569 and p=0.019, df=24), BCG vaccination (X2=11.299 and p=0.023, df=4) and nutritional status of children (X2=26.342 and p=0.049, df=16) are significantly associated with treatment outcome.Conclusions: Majority of paediatric patients were declared cured or treatment completed depending upon the result of sputum examination. In our study educational status of mothers of paediatric patients, BCG vaccination and nutritional status of children are significantly associated with treatment outcome. No association of treatment outcome was found with other selected factors such as age, gender, religion, type of family and socio economic status of paediatric patients.
Health insurance coverage and healthcare expenditure pattern in rural Mandya, Karnataka
Authors: B. R. Harish , Siddalingappa Hugara , J. Bharath
Published: March 2018

Background: Poverty and ill-health go hand in hand.In developing countries, high out of pocket payment, absence of risk pooling mechanism in health financing systems, and high level of poverty are said to result in catastrophic health expenditure.Health insurance (HI) is the need of the hour in the absence of Universal Health Coverage. Hence this study was undertaken to assess the health insurance coverage among people of rural field practice area of Mandya Institute of Medical Sciences, Mandya and to describe the health care expenditure pattern in the study population.Methods: Study design was based on community based cross sectional study. Study area was at rural field practice area of Mandya Institute of Medical Sciences, which comprises of 11 villages. Study population: Permanent residents of villages in the study area. Study period was on 4 months (August 2016–November 2016). Sample size: 264 households. Sampling method: Multistage sampling. Method of data collection: Personal interview of patients/head of the family of patients admitted to a hopital during study period using semi structured questionnaire.Results: 58.0% of the households in study area had some form of health insurance coverage. Among the covered households only 40.50% were having whole family coverage. Individual level HI coverage was 48.8%. Out of pocket (OOP) expenditure for inpatient care contributed to 83.81% of the health care expenditure.Conclusions: HI coverage is higher than national average. But health care expenditure is largely borne out of pocket.
A study on knowledge, attitude and practice regarding organ donation and transplantation among final year health science students in Bengaluru, Karnataka, India
Authors: S. G. Meghana , Subramanian Mangala , Atmakuri Sri Aditya , S. Tarun , Bera Priyadarshini , J. Nelson
Published: March 2018

Background: Organ transplantation is the most preferred modality for all end-stage organ diseases. Pre-requisites for the success of transplantation program include awareness, positive attitude of people towards the practice of organ donation. This study was carried out to assess the knowledge of organ donation among the final year medical, dental, nursing students and to study the attitude, religious beliefs of the health care professionals regarding organ donation and transplantation, to find out the effect of motivation, towards organ donation.Methods: A comparative, cross-Sectional study was conducted on 150 final year Medical, Dental and Nursing students of Vydehi Institute of Medical Sciences and Research Centre, Bengaluru over a period of 2 months. A questionnaire containing 3 sections of multiple choice questions was prepared and the knowledge, religious beliefs, attitude and practice on organ donation and transplantation was assessed. The data obtained was entered into SPSS Version 21.0. The qualitative variables were expressed as frequencies and percentages; quantitative variables as mean and standard deviation.Results: Out of the 150 participants, the mean knowledge score of Medical students was higher than that of Dental and Nursing students (p<0.01) and so was the mean belief score (p<0.05). The study motivated 34 (22.6%) students in total, who pledged their organs with the Zonal Co-ordination Committee of Karnataka.Conclusions: 33 (66%) of medical students who have significantly better knowledge have pledged their organs. This highlights importance of educating the society to bring a positive change in their thoughts, beliefs and practices towards organ donation and transplantation.
Evaluation of dog anti rabies vaccination centres and post exposure prophylaxis against rabies centres in an urban area
Authors: Chauhan Rambadan P.
Published: March 2018

Background: In spite of availability of vaccine, many rabies cases continue to occur. Is this due to the improper functioning of vaccination centres? Objective of the study was to evaluate the performance of dog anti rabies vaccination centres, for vaccination of pet dogs (DARVCs) and post exposure prophylaxis against rabies (PtEPAR) centres for humans for suspected rabies exposure in an urban area.Methods: The study was carried out during 1989-90, by way of observations, interviews and analysis of records maintained at various institutes. For observations procedures like dog licensing, dog vaccination, dog catching in fields, keeping them in kennels and their destruction, human post exposure prophylaxis against rabies viz. history taking by a physician, his advice to patients, procedure of vaccination and local wound care.Results: All (9) MCGB (Municipal Corporation of greater Bombay) run DARVCs and one (25%) DAHD (district animal husbandry department, Bombay suburbs) run DARVC had unsatisfactory services. Three (75%) DAHD run DARVCs and all three voluntary organizations run DARVCs (100%) had satisfactory services. The practices at PtEPAR centres and the knowledge of the doctors appointed there were dismally poor for post exposure prophylaxis against rabies. Only 2 (5.88%) PtEPAR centres were fit to provide PtEPAR services.Conclusions: Significant findings included poor dog anti-rabies vaccination services involving negligible number of dogs every year, dismally poor performances by the human post exposure prophylaxis against rabies centres, lack of pre-exposure prophylaxis to high risk individuals, ignorance on the part of physicians and pathologists regarding availability of rabies diagnostic services in this urban area, poor surveillance by public health department and lack of co-ordination among various institutes.