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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 5 | Issue 1
Page Nos. 1-73

Online since Thursday, July 4, 2019

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EDITORIAL  

Climate change: A global emergency, let's save our planet p. 1
Vikas Bhatia, Raviraj Uttamrao Kamble
DOI:10.4103/IJCFM.IJCFM_48_19  
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PERSPECTIVE Top

Prevalence of polypharmacy: Comparing the status of Indian states p. 4
Priya Sharma, NL Gupta, HS Chauhan
DOI:10.4103/IJCFM.IJCFM_10_19  
Introduction: The word “poly” is Greek and means many or much. However, the term polypharmacy has been given definitions connected both to the use of more than a certain number of drugs concomitantly and to the clinical appropriateness of drug use. Polypharmacy is the use of multiple medications by a patient, generally older adults (those aged 60 or over 65 years). More specifically, it is often defined as the use of 5 or more regular medications. It sometimes alternatively refers to purportedly excessive or unnecessary prescriptions. The term polypharmacy lacks a universally consistent definition with an increasing share of population in this age group, it is natural to expect an increase in the problems associated with them as well. Health problems are supposed to be the major concern of this section of the society, and it is reported that use of medications has increased significantly among the elderly in the last decade. Objective: The objective of this study is to assess the prevalence of polypharmacy among elderly patients in different Indian states, to make a comparison, and also to study the patterns of polypharmacy and its associated aspects. Materials and Methods: Literature review comprising of original articles, reviews, and case studies was studied to identify articles which correspond to research done on polypharmacy in various different ways published between the years 2010 and 2018. As the review focuses on the geriatric population, so considerable data were searched and collected for the use of medication in geriatrics to assess what makes them prone to polypharmacy, what pattern of polypharmacy they follow, and how they are affected by the consequences. Results: Uttaranchal, Karnataka, and Telangana reported a higher level of polypharmacy with 93.14%, 84.6%, and 82.8%, respectively, whereas Andaman and Nicobar Islands (2%) and West Bengal (5.82%) showed the lowest polypharmacy. Conclusion: Overall comparisons made show that there are more studies needed to assess the level of polypharmacy and ways and measures should be incorporated by the government in states showing high polypharmacy.
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REVIEW ARTICLES Top

Operational issues and lessons learned during National Iron Plus Initiative documentation in Eastern India p. 10
Vikas Bhatia, Swayam P Parida, Preetam B Mahajan, Sasmita Pradhan
DOI:10.4103/IJCFM.IJCFM_2_19  
Anaemia is a condition in which red blood cells have fewer haemoglobin molecules than normal, or fewer red blood cells overall, and thus less ability to carry oxygen to tissues in the body. Nutritional anaemia is a major public health problem in India and is primarily due to iron deficiency. Symptoms of iron deficiency anaemia are primarily non specific and become apparent when there is severe anaemia. The National Iron Plus Initiative (NIPI) is the most ambitious and comprehensive anaemia control programme in the world. The process documentation team conducted 170 interviews in March, April and May 2016 among officials and frontline workers at state, district, block, sector/cluster and field levels and among NIPI beneficiaries in Odisha. To achieve variation in responses and to get full set of information on how NIPI was being implemented, process documentation and survey data were collected in four districts of Odisha– Keonjhar, Jagatsinghpur, Bhadrak and Kalahandi. This review will give an overview about the operational issues encountered during the National Iron Plus Initiative documentation in Odisha.
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Decoding mystery disease “litchi as idiopathic triggering cause of hypoglycemia-induced (LITCHI) encephalitic syndrome” – Are the evidence of association adequate? p. 16
Vineet Kumar Pathak, Kapil Yadav, Jitendra Majhi
DOI:10.4103/IJCFM.IJCFM_19_19  
There has been an increase in reports of outbreak of encephalopathy in children presenting with a syndrome of sudden onset of high fever and altered sensorium in and around the peak of Indian summer months in geographical regions that flourish in Litchi plantation. In the light of the increased mortality and morbidity due to the mystery disease and the speculations surrounding litchi consumptions, a study was conducted in the litchi production hub of Muzaffarpur district Bihar in India by the NCDC in technical collaboration with US CDC. The variables that were significantly associated were litchi consumption (OR: 9.6 [3.8-24.1]), visiting a fruit orchard (OR: 6 [2.7-13.4]), and absence of an evening meal (OR: 2.2 [1.2-4.3]) in the 24-h preceding illness onset. The recommendations that have been advocated are to avoid eating unripe litchi or its seed and always preferring fresh and ripe ones, children should not to go to sleep without a proper dinner meal during the litchi season and cases of altered sensorium should be always be checked for blood glucose levels and prompt correction should be done if levels suggest hypoglycemia in hospitals.
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CME Top

Oral leukoplakia: Management protocol for primary health-care providers and family physicians p. 19
Ashok Kumar Jena, Jitendra Sharan, Swapnil Ghodke, V Anusuya, Uday Hemant Barhate
DOI:10.4103/IJCFM.IJCFM_9_19  
Oral cancer is very common in India. Most of the oral cancers develop on a potentially malignant (precancerous) lesion. Leukoplakia is the most common precancerous lesion in the oral cavity. The malignant transformation rate of oral leukoplakia is very high. There is no marker to distinguish those lesions that may transform to frank cancer from those that may not. Thus, early identification of oral leukoplakia and its proper treatment is important for best prognosis. This article highlights on the diagnosis and treatment protocol for oral leukoplakia.
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MEDICAL EDUCATION Top

Understanding the patterns of technology and internet use for academics by undergraduate medical students in a teaching hospital of North India p. 24
Sneha Mohan, Sumit Malhotra
DOI:10.4103/IJCFM.IJCFM_8_19  
Background: E-learning or computer-based learning has been incorporated into medical education in many countries. Readiness to utilize this medium merits exploration in the Indian context. Therefore, we aimed at assessing the current patterns of technology and internet use by undergraduate medical students in a tertiary care teaching hospital, focusing on their use for academics and their views on e-learning. Materials and Methods: This cross-sectional study was conducted using a self-administered questionnaire among undergraduate medical students in the first 4 years of the study. The data generated were entered into Microsoft Excel and analyzed using SPSS version 22. Descriptive analysis and comparison of proportions were done using Chi-square test. Results: A total of 212 students responded, with a mean (±standard deviation) age of 20 years (±1.54) and 70.3% of males. There was universal access to technological devices with complete internet access. Internet was used primarily for entertainment (99.1%) and WhatsApp (97.2%), with 86.8% use in academics. Most students accessed the internet multiple times each day. Majority of the students (90.6%) used social networking sites and were open to using it for academics. Reliability of the material found online was a concern (83.5%), and most (63.2%) were interested in further training. Only a quarter of the students had utilized medical e-learning material online, and a majority (77.4%) were willing to incorporate it into the curriculum feeling that it would benefit them (64.6%). Conclusions: Incorporating e-learning tools into the medical curriculum needs to be considered for undergraduate medical studies, owing to its availability and readiness for utilization.
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ORIGINAL ARTICLES Top

Effect of information, education, and communication activity on health literacy of smoking and alcohol among school-going adolescents in Delhi p. 28
Srishti Yadav, Anita Khokhar
DOI:10.4103/IJCFM.IJCFM_23_19  
Background: Noncommunicable diseases (NCDs)/lifestyle diseases account for a major cause of deaths every year. Risk factors such as smoking and alcohol consumption contributing to the development of lifestyle diseases were more prevalent in the developed countries decades back, but millions of productive years of life are lost due to NCDs in India too. Objective: This study was conducted to assess the health literacy of school-going adolescents regarding harmful effects of smoking and alcohol consumption and assess the improvement in their knowledge after different information, education, and communication (IEC) activities. Methods: It was a school-based interventional study conducted among students of class 6, 7, and 8. Assessment of health literacy of risk factors – smoking and alcohol use in lifestyle diseases was done by self-administered questionnaire among school-going adolescents. Intervention in the form of IEC was done three times, and the postintervention data were collected 2 weeks after the first and 3 months after the last intervention. Responses were scored and categorized as satisfactory and unsatisfactory. Results: There were a higher proportion of students with satisfactory level of knowledge of smoking and alcohol use effects in both the schools after 3 months of educational intervention, although the result was statistically significant for School 2 only where intervention was given by didactic lectures (P < 0.05). Conclusions: There was an improvement in scores of students in both the schools after 2 weeks and 3 months of educational intervention, though the results were statistically significant for 3 months only (P < 0.05).
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They do not just drive when they are driving: Distracted driving practices among professional vehicle drivers in South India p. 34
Rizwan Suliankatchi Abdulkader, Chittibabu Madhan, Kathiresan Jeyashree
DOI:10.4103/IJCFM.IJCFM_29_19  
Background: Driving is a complex task, requiring coordination between multiple mental and physical faculties. Distractions lead to delayed recognition of information needed to drive safely. It is essential to understand distracted driving practices to regulate them and reduce crash risk. This study aims to identify common distractors among professional vehicle drivers in South India. Methodology: A questionnaire-based cross-sectional study was conducted on professional drivers of three-and four-wheeled vehicles. Epicollect 5, a mobile-based data collection tool, was used for data collection and entry. Results: Among 82 male professional drivers (57.3% car, 35.4% bus/lorry), with a mean (standard deviation) age of 38.4 (10.6) years, all reported being distracted by at least one of the listed distractors. Mobile phone usage and cognitive distractions were reported by 75.6% and 79.3%, respectively. Younger drivers (P = 0.005) and those with less than a decade of driving experience (P = 0.038) were more likely to use mobiles while driving. Drivers reporting cognitive distractions were more likely to have met with an accident than those who did not (44.6% vs. 23.5%). Conclusions: Distracted driving is common among professional drivers. Cognitive distractions are as common as distractions due to mobile phones. Sensitization of drivers and strict enforcement of legislation are recommended.
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Nutritional assessment among children (1–5 years of age) using various anthropometric indices in a rural area of Haryana, India p. 39
Vikas Gupta, Suraj Chawla, Debjyoti Mohapatra
DOI:10.4103/IJCFM.IJCFM_14_19  
Background: Global Nutrition Targets 2025 specified a set of six global nutrition targets, and one aim is to achieve a 40% reduction in the number of children under 5 years of age who are stunted. National data on underweight provided under National Family Health Survey-4 (NFHS-4) (2015–2016) revealed an underweight prevalence rate around 35.7% as compared to NFHS-3 where it was 42.5%, which reflects only 6.8% reduction in underweight over a decade. Methods: This cross-sectional study was conducted in the rural area of Rohtak district during October 2014 to September 2015 among children who were 1–5 years of age. The anthropometric measurement and nutritional status categorization among children were done using the WHO guidelines. Results: A total of 600 children participated in the study. Around 41.3% of the study participants had stunting as their nutritional status, while taking composite index of anthropometric failure (CIAF) for nutritional status into consideration, nearly 54.4% of the participants were undernourished. Stunting and underweight were more prevalent among girls. Conclusions: Composite anthropometric index provides the actual prevalence or proportion of undernourished children in a community, so the policies should be based on the basis of CIAF so to reduce the prevalence of undernutrition in the community more effectively.
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Mental health, functional ability, and health-related quality of life in elderly patients attending a tertiary hospital of Patna p. 44
Sudeep Kumar, Pragya Kumar, Shamshad Ahmad, Anup Kumar
DOI:10.4103/IJCFM.IJCFM_1_19  
Background: With changing socioeconomic, demographic, and development scenario, there is a cultural shift in looking after the elderly population which may lead to depression in this age group. Materials and Methods: The study was a hospital-based cross-sectional study conducted in the orthopedic department of a tertiary care setting on 157 elderly individuals. This study was conducted with objectives to estimate the proportion of depression using the Geriatric Depression Scale Short Form (GDS-SF) questionnaire along with its associated factors in geriatric population coming to the orthopedic department of the institute. The study tools were GDS-SF, Katz Index of Independence in activities of daily living (ADL), the Lawton instrumental ADL, and health-related quality of life by the Centers for Disease Control. Results: The proportion of depressed individuals was 70/157 (44.6%) using GDS as a tool. The maximum number was in the age group of 60–74 years. Women outnumbered men (51.3% vs. 38.31%) for depression. The depression using GDS score was more prevalent in rural elderly, illiterate, and elderly who were economically dependent on their children and who belonged to lower middle socioeconomic status. Approximately 98% of the study participants were found to be independent using ADL. Approximately 60% males and 68% females were dependent for the instrumental ADL using Lawton score. Most of the study participants had arthritis as a major impairment sharing almost equal proportion among males and females. Conclusion: The current study concludes that there is a very high proportion of elderly subjects who are experiencing depression using the GDS-SF tool. There should be regular screening for this disease in this age group even in a tertiary care setting.
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Anemia among pregnant women attending antenatal clinic at a secondary health care facility in district Faridabad, Haryana p. 51
Shashi Kant, Sumit Malhotra, Partha Haldar, Ravneet Kaur, Rakesh Kumar
DOI:10.4103/IJCFM.IJCFM_7_19  
Background: India confronts a high burden of anemia among pregnant women, that contributes to significant morbidity and mortality for mother and child. Anemia Mukt Bharat strategy launched by Government of India envisages provision of variety of facility-based interventions for management of anemia in pregnancy. Secondary care hospitals prescribe injectable iron treatment for moderate anemia and blood transfusion services for severe anemia. Objective: To estimate the magnitude and severity of anemia among pregnant women when they presented themselves for the first time at the antenatal care clinic of a secondary care hospital so as to forecast adequate supplies of medicines for managing anemia. Materials and Methods: This was a descriptive study using routinely maintained hospital clinical records during the years 2013–2015. It was conducted in a subdistrict hospital, Ballabhgarh in Faridabad district of Haryana state. Hemoglobin (Hb) level was routinely measured at first visit for all pregnant women using BC-3000 plus autohematology analyzer. Anemia in pregnancy was considered when Hb concentration was <11.0 g/dL. Results: The Hb level at first visit was available for 13,467 women during the study period. The mean Hb level (standard deviation) was 9.3 g/dL (1.3). The proportion of anemic pregnant women was 91.3% (95% confidence interval [CI]: 90.8, 91.7). The most common category of anemia was moderate anemia 62.5% (95% CI: 61.6, 63.2). Conclusion: We found a very high prevalence of anemia in pregnant women presenting to a secondary care setting of a North Indian hospital during their first visit to the facility during the antenatal period.
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Effectiveness of daily directly observed treatment, short-course regimen among patients registered for treatment at an urban primary health center in Bengaluru p. 56
Huluvadi Shivalingaiah Anwith, Sreerama Reddy Kaushik, Ramanathan Thenambigai, M Madhusudan, Dandiganahalli Shivaram Priyanka, Nagaraj Deepthi, PS Karishma
DOI:10.4103/IJCFM.IJCFM_4_19  
Background: Tuberculosis (TB) is a major public health problem in India with high morbidity and mortality. As per the World Health Organization guidelines, the Revised National Tuberculosis Control Program introduced daily directly observed treatment, short-course (DOTS) regimen with a fixed-dose combination with weight bands. This study was undertaken to compare the effectiveness of daily DOTS regimen with intermittent regimen and to assess the proportion of adverse drug reactions in both groups. Materials and Methods: A descriptive study was conducted at a peripheral health institute under one of the TB Units in South Bengaluru. Participants registered for treatment during the third and fourth quarter of 2017 were selected using continuous sampling. Data were collected by case record analysis, structured interviews, and telephonic follow-up. Results: The study included 81 participants, with the mean age of 40 ± 16.1 years. Majority of the study participants 55 (67.9%) were male, and majority (38 [46.9%]) belonged to the upper-lower class. Forty-two (51.8%) of the study participants were on intermittent regimen, and 39 (48.1%) were on daily DOTS regimen. There was 100% sputum conversion at the end of treatment under both treatment regimens. A total of 36 (85.7%) participants under intermittent regimen and nine (23%) under daily regimen developed one or the other adverse drug reactions. The treatment success for participants under intermittent regimen was 38 (90.47%) and that for daily regimen was 35 (89.74%). However, there was no statistically significant difference between the two groups. Conclusion: Both daily and intermittent DOTS regimens are equally effective in TB treatment, but adverse drug reactions were more common with the intermittent regimen.
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A community-based study on awareness of cancer and anticipated barriers in seeking help p. 61
Deepak Sharma, Naveen Krishan Goel, Munish Kumar Sharma, Dinesh Kumar Walia, Sonia Puri
DOI:10.4103/IJCFM.IJCFM_34_19  
Introduction: Cancer is a leading public health problem worldwide. Contributing factors include lack of awareness regarding cancer and improper help seeking behavior. Objective: To assess the awareness regarding early warning signs of cancer, its risk factors and anticipated barriers in seeking help. Methodology: A community-based cross-sectional study was conducted among 470 study participants. Trained workers administered a standardized tool to respondents after obtaining their informed consent. Epi Info software for windows version 7.2 was used for the analysis. Results: Overall, merely 7.7% (36/470) of the study respondents were aware of all the nine warning signs of cancer. The most commonly known early warning sign of cancer was “unexplained swelling” (58.3%). Further, although majority knew that cigarette smoking is a risk factor for cancer (90.4%), very few were aware about the role of inadequate physical activity (9.3%) and diet devoid of adequate amounts of fruits and vegetables (11.9%). There were few anticipated barriers in seeking help such as embarrassment (13.2%) and difficult to interact with a doctor (7.9%). Conclusion: There was inadequate awareness about cancer but a favorable help-seeking behavior. It is, therefore, recommended that health-care professionals should scale up efforts for disseminating information regarding cancer among the people.
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CASE REPORT Top

Eagle syndrome or foreign body throat? p. 66
Michael Sze Liang Wong, Bakri Adzreil, Narayanan Prepageran
DOI:10.4103/IJCFM.IJCFM_20_19  
Eagle syndrome is a rare condition caused by an elongated styloid process or abnormal calcification of the stylohyoid ligament complex. Patients typically present with recurrent throat pain, neck or facial pain, sensation of foreign body in the throat, or even dysphagia. The finding of an elongated styloid process is usually incidental, with patients having no related symptoms. Only patients with symptoms are diagnosed with Eagle syndrome. This condition may be difficult to diagnose due to its rarity and the nonspecific nature of signs and symptoms. Diagnosis is mainly by clinical assessment and confirmation with radiological evidence. We present a unique case of eagle syndrome in a patient who complained of acute neck pain after eating fish.
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RESIDENT CORNER Top

Clinical correlates and profile of patients on antiretroviral therapy: A hospital-based cross-sectional study from a tertiary care institution of North India p. 69
Soumya Swaroop Sahoo, Pardeep Khanna, Ramesh Verma, Madhur Verma
DOI:10.4103/IJCFM.IJCFM_38_19  
Introduction: HIV/AIDS as a global pandemic has affected each and every region of the world. The HIV epidemic is dynamic in nature with relation to temporal changes, geographic distribution, and modes of transmission. India, though in the declining phase, is still confronting with the varied nature of the spread of the disease. Materials and Methods: This hospital-based cross-sectional study was conducted among four hundred people living with HIV/AIDS (PLHIV) attending the antiretroviral therapy (ART) center of a tertiary care institute of North India. Data were collected from the patients using a predesigned pretested questionnaire maintaining confidentiality. The data were analyzed using simple proportion and percentages. Results: The mean age of the study participants was 32.8 ± 7.4 years. The mean duration of ART intake was 24.5 ± 14.4 months. There was a significant improvement in clinical staging and CD4 count with ART intake among PLHIV. The most prevalent possible route of transmission was found to be heterosexual (85.5%) route. Conclusion: The spread among the population, particularly in the younger age group, reinforces the fact that preventive strategies need to be initiated within the target population at an early stage. Health education and social campaigns are the mainstays for “getting to zero” target.
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