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   Table of Contents - Current issue
January-June 2018
Volume 5 | Issue 1
Page Nos. 1-40

Online since Friday, June 29, 2018

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Cost-Effective breast cancer care in India p. 1
Selvi Radhakrishna
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Use of simulation for undergraduate medical education p. 3
Dinker Pai
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Modification of antiretroviral therapy regimen: Incidence and predictors in two major HIV/AIDS treatment centers in the Southwest Region of Cameroon p. 7
Elvis Tajoache Amin, Roland C Ngu, Martin H Abanda, Belmond T Kika, Tatiana N Mvilongo, Peter N Fon
Background: The effectiveness of the first regimen of antiretroviral therapy (ART) is a major key to long-term success and sustainability of HIV treatment program. Aims: The objectives of this study were to determine the incidence rate, reasons, and factors associated with modification of initial ART regimen. Methods: A total of 502 patient files were reviewed. Modification of ART regimen was defined as either substitution or switch of a single drug in the regimen. Results: The total duration of follow-up was 629.8 person-years (PYs) over a median follow-up period of 37 months. About 92 (18.2%) of patients had their initial ART regimen modified, with a resulting incidence rate of modification at 14.6/100 PYs. Drug unavailability 49 (53.3%), drug toxicity 16 (17.4%), treatment failure 10 (10.9%), nonadherence 7 (7.6%), and concomitant condition 7 (7.6%) were common reasons for ART modifications. In the adjusted multivariate Cox proportional hazard model, the type of initial ART regimen (zidovudine/lamivudine (3TC)/efavirenz vs. tenofovir/3TC/nevirapine (NVP), aHR 4.78, 95% confidence interval [CI] [1.42, 16.12], P = 0.012), and duration on regimen (≤1 year vs. >3 years, aHR 4.11, 95% CI [1.02–9.22], P = 0.0001) were significantly associated with modification of initial ART regimen. Conclusion: Our findings indicate that the incidence rate of initial ART regimen modification was high. Hence, implementing better health systems to ensure a steady supply of drugs as well as early HIV diagnosis and ART initiation will reduce the rate of regimen change.
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Reliability and validity of the CONFbal scale in patients with hemiparesis following stroke p. 14
Raja Regan, G Kaleeswari, R Sowmya, Anushaw Sneha Bharkavi, S Karthik, P Gomathi
Background: The 10-item CONFbal scale is a measure used to assess balance confidence in geriatric population. However, its measurement properties have not been studied in the poststroke population. Objectives: The objective of this study was to assess the reliability and validity of the CONFbal scale in poststroke patients. Methods: We did a cross-sectional study of 80 poststroke patients with hemiparesis attending the Neurology Outpatient Department, PSG Hospitals, Coimbatore. Participants completed the CONFbal scale and the activities-specific balance confidence (ABC) scale in a random order to assess balance confidence. Results: The Cronbach's alpha for CONFbal scale was 0.894, which showed that the items of the scale were internally consistent. The Pearson correlation coefficient (r) for CONFbal and ABC scales was −0.702, which showed that there was a moderate association between the two scales. Conclusion: The CONFbal scale is a reliable and valid scale to assess balance confidence in poststroke patients.
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Practice of early initiation of breastfeeding among postnatal mothers in a tertiary hospital in South India p. 18
Reema Alen Babu, Anish Keepanasseril, K Kanimozhi
Background: Early initiation of breastfeeding (EIBF) has significant health benefits, but the practice of this in many parts of the world is far beyond the optimal period of initiation. Hence, we planned to assess the time of initiation of breastfeeding among postnatal mothers and to identify the factors associated with practice of early initiation in a tertiary hospital setting. Methods: The study was carried out among 216 postnatal mothers who delivered term healthy babies. All the mother–infant dyads enrolled were interviewed within 6 h postpartum. Data were collected using a structured interview. An in-depth interview of 35 staff nurses, who worked in the labor rooms and postpartum wards, was carried out after 3 months of initial data collection, to assess the factors responsible for delayed breastfeeding. Results: One hundred and twenty-six (58%) mothers were primiparous and 97 (44.9%) had secondary level of education. The median time of initiation of breastfeeding was 94 min (interquartile range 48–126 min). The time of rooming-in and the mother's knowledge on early breastfeeding initiation were found to be associated with the time of initiation of breastfeeding. Conclusion: EIBF was extremely low in the study setting, which is alarming and suggests an immediate need for the change of existing hospital policy.
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Qualitative Assessment of Accredited Social Health Activists (ASHA) Regarding their roles and responsibilities and factors influencing their performance in selected villages of Wardha p. 21
Ishita Guha, Abhishek V Raut, Chetna H Maliye, Ashok M Mehendale, Bishan S Garg
Background: The National Rural Health Mission has introduced village-level female community health worker, accredited social health activist (ASHA) who acts as an interface between the community and the public health system. The is study was conducted to assess the awareness and perceptions of ASHA regarding their roles and responsibilities in health-care system and factors affecting their performance in delivering health-care services. Methodology: A qualitative study was conducted in seven selected villages under Talegaon Primary Health Centers, Wardha district, Maharashtra, which is also field practice area of a medical college. Nonprobability sampling (purposive sampling) was done. In-depth interviews were conducted on ASHAs (n = 7) of those selected villages till saturation of data. Data were analyzed using the thematic framework approach. Results: ASHAs perception regarding their job responsibilities appeared to be incomplete. They had good awareness regarding their roles and responsibilities as a link worker. They were found to be mostly interested in higher incentive performances. ASHAs clarity regarding their roles and responsibilities as facilitator, social activist, and service provider was found to be somewhat compromised. They were ignorant about their roles and responsibilities under various newly launched national programs. The positive factors influencing ASHAs performances were regular supervision of their performances and appraisal by higher authority and support from community, family, and good relations with coworkers and staff. Challenges faced by most of the ASHAs were more workload, poor orientation to program, lack of quality training, and inadequate and delayed monetary incentives. Conclusion: Good quality training with regular refresher training sessions and regularization of incentives are required to motivate them ASHAs.
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Macrophage activation syndrome complicating adult-onset still's disease: A diagnostic challenge p. 27
Vijesh Vijayan Sobha, Maya Gopalakrishnan, Suryanarayana Bettadpura Shamanna
We report the case of a young man who presented with high-spiking fever, erosive arthritis, and generalized lymphadenopathy. He was diagnosed as adult-onset Still's disease (AOSD), and his clinical course was complicated by reactive macrophage activation syndrome (MAS). The sudden precipitous drop in leukocyte and platelet counts proved a valuable clue to the diagnosis of MAS in the setting of AOSD. The new American College of Rheumatology/European League Against Rheumatism classification criteria for reactive MAS complicating systemic juvenile idiopathic arthritis were applied in this patient. When MAS is associated with AOSD, treatment could be challenging. We managed this patient successfully with a combination of systemic corticosteroids and cyclosporine in the acute phase.
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Pneumorrhachis in a patient with stable bronchial asthma p. 31
Madhusmita Mohanty Mohapatra, Manju Rajaram, Dharm Prakash Dwebedi, Govindraj Vishnukanth
The presence of air in the spinal canal, called pneumorrhachis, is an important radiographic finding. Pneumorrhachis is usually asymptomatic and resolves spontaneously. Sometimes, neurological complications might develop. We report a case of pneumorrhachis occurring in an adolescent male with stable bronchial asthma who presented with pneumomediastinum and subcutaneous emphysema without a pneumothorax.
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Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor p. 34
Keerthana Kothandaraman, PV Midhuna, Dilip Kumar Maurya, Anish Keepanasseril
Laparoelytrotomy refers to the inadvertent delivery of the fetus through transverse incision over the vagina during a cesarean section. It is found to be associated with increased risk of maternal morbidity. Being an unintended, complication of cesarean section in advanced labor; it can be avoided by proper planning of the uterine incision. We report a case of inadvertent laparoelytrotomy during cesarean section for cephalopelvic disproportion in the second stage.
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Consumer awareness and status of food labeling in selected supermarkets of Puducherry: An exploratory study p. 36
Sejal Jain, R Gomathi, Sitanshu Sekhar Kar
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