National Medical Journal of India

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    A 10-year experience of managing acute limb ischaemia in India.
    (2008-11) Turel, Mazda; Kumar, Prabhu Prem; Stephen, Edwin; Agarwal, Sunil
    Background. Acute limb ischaemia is threatening to both limb and life. There is little information about this disease entity from India. Methods. We did a retrospective analysis of the clinical profile of patients presenting with non-traumatic acute limb ischaemia to our department (a tertiary care centre in India) from January 1998 to December 2007. The demography, risk factors, time taken to present to the emergency from the onset of symptoms, time taken to administer the first dose of heparin upon arrival to the emergency, primary interventions and outcomes in terms of amputation rates and in-hospital mortality were studied. Results. The mean (SD) age of the 84 patients was 48.9 (14.3) years. Only one patient died (1.2%) and 24 patients had an amputation (28.6%). Among the predisposing risk factors a significant association was found between smoking and the rate of amputation. Early presentation to emergency and early administration of heparin was associated with lower amputation rates though this did not achieve statistical significance. Conclusion. Acute limb ischaemia is a catastrophic event. Smoking is a risk factor associated with poorer outcomes. Early arrival to the emergency and early administration of heparin was associated with lower amputation rates.
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    The 13C urea breath test to assess Helicobacter pylori infection in school children.
    (1997-03-01) Dore, S P; Krupadas, S; Borgonha, S; Kurpad, A V
    BACKGROUND: The 13C urea breath test was used in this study to establish it as a diagnostic tool as well as to assess the prevalence of Helicobactor pylori in a group of school children. METHODS AND RESULTS: In a group of 50 children studied, 82% were found to be positive for H. pylori by this test. The influence of diet in modifying the results of the test was also assessed. Relatively small errors were seen if adequate precautions were taken. CONCLUSION: Epidemiological studies are required to further quantify the magnitude of the prevalence of H. pylori in the Indian setting.
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    Abdominal radiograph: Archaic modality or still clinically relevant.
    (2008-11) Madhusudhan, K S; Sharma, Raju; Das, Chandan Jyoti
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    Absenteeism among nurses in a tertiary care hospital in India.
    (2010-05) Tripathi, Mamta; Mohan, U; Tripathi, Mukesh; Verma, R; Masih, L; Pandey, Hem Chandra
    Background. Absence due to sickness among nurses has not been studied in-depth in the Indian setting. Methods. We studied the sickness pattern among 385 nurses during one calendar year and retrospectively compared the absenteeism among nurses in different work areas of a tertiary care hospital. Results. Sickness leave was availed by 68.9% of nurses at least once during the year. Nurses in the ward area were significantly older (43[5.4] years of age) than those in operation theatres (38[6.2] years of age) and intensive care units (39[5.9] years of age). The average annual duration of absenteeism per nurse (index of severity) was 27.7 days/ person. The average sickness leave days/spell (index of duration) was 8.82 days/person. The annual inception rate of nonsickness leave (index of frequency) was 1.57 spells/person and for sickness leave was 1.27 spells/person. While nurses working in the ward area took the highest number of unplanned sickness leave (7.36 days/spell), the planned sickness leaves were highest (64.8 days/spell) among those in operation theatres. About half the episodes of sickness were related to diseases of the respiratory tract, digestive system, infections and injury. Planned sickness leave mainly constituted maternity leave related to childbearing and was highest among younger nurses in operation theatres and intensive care units. Conclusion. Unplanned leave demands greater administrative adjustments and substitution. Inappropriate substitution may compromise patient care and sharing of work by the staff present; it may increase the workload and absenteeism. Occupational welfare services at tertiary care hospitals should work towards decreasing absence due to sickness among nurses.
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    Absenteeism and under-achievement in final year medical students.
    (2003-01-29) Dhaliwal, Upreet
    BACKGROUND: Absenteeism among medical students has received little attention in the literature. The aim of this study was to determine the causes of absenteeism from didactic lectures in ophthalmology and its correlation with performance in formative assessment. METHODS: The attendance of 101 final year medical students for lectures in ophthalmology was studied in three parts: terms 1, 2 and 3. Based on the attendance in all three terms, students were divided into groups I to V, where group I students had good attendance in all three terms down to group V, with very poor attendance in one or more terms. The marks scored in the first, second and third terminal theory tests were tabulated separately. Results of the second and final professional examinations were assessed for the five groups of students. Students were asked to list the causes of absenteeism in a proforma. Data were analysed by regression analysis and Chi-square test. Significance was obtained at 5% level. RESULTS: In each formative assessment, higher attendance was associated with better marks (p < 0.0001). Illness, family commitment, teacher/topic, or lecture period spent in an extended clinical posting were cited as causes of absenteeism in 62.6% of instances. Six of the 10 students who failed the ophthalmology professional examination were in groups IV and V and had failed the second professional examination as well. They were designated low achievers, as were 3 students who made several attempts to pass the second professional examination and failed in ophthalmology despite a fair-good attendance. CONCLUSION: Learner absenteeism may contribute to low achievement. However, absenteeism may be symptomatic of low achievers. Low achievers or students with learning handicaps must be identified before admission or early in the medical course and encouraged to improve their performance and thereby enhance their self-esteem. A support group of family, peers, faculty and psychologists could help.
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    Academic medicine and health improvements in India.
    (2005-03-29) Dandona, Lalit; Tandon, Nikhil; Sahni, Peush
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    Academic staff in our teaching hospitals.
    (1993-09-01) Pandya, S K
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    Access to condoms for female sex workers in Andhra Pradesh.
    (2006-11-09) Kumar, G Anil; Dandona, Rakhi; Gutierrez, Juan Pablo; McPherson, Sam; Bertozzi, Stefano M; Dandona, Lalit
    BACKGROUND: Condoms are an essential part of comprehensive HIV prevention and care programmes. We report the accessibility of male condoms for female sex workers (FSWs) and the associated characteristics that may play a major role in determining access to condoms for FSWs. METHODS: Confidential interviews of 6509 street- and home-based FSWs in 13 districts of the Indian state of Andhra Pradesh provided data on the number of paying clients and various aspects of access to free condoms and purchase of condoms. Access to condoms was defined as having ever obtained condoms either through free distribution or through purchase. Multivariate analyses were done separately for street- and home-based FSWs to describe correlates of their access to condoms. The requirement of condoms was assessed based on the number of paying clients during the past 15 days. RESULTS: Data on condom access were available for 6465 (99.3%) FSWs. A total of 2850 (44.1%; 95% CI: 36.2%-52.0%) reported accessing free condoms ever and 2336 (36.1%; 95% CI: 30.6%-41.6%) had purchased condoms ever (not mutually exclusive). The primary sources for condoms were non-governmental organization facilities (73.8%) and pharmacies (79.7%) for free and purchased condoms, respectively. A total of 3510 (54.3%; 95% CI: 48.5%-60.1%) FSWs reported no access to free or purchased condoms during the past 15 days, and this no access was significantly higher for those > 30 years of age, with no schooling, street-based FSWs, and with no participation in a FSW support group (p < 0.001 for each in univariate analysis). Participation in a FSW support group was the main predictor of access to free condoms for both types of FSWs during the past 15 days with multivariate analysis. Condom requirements during the past 15 days were met for 67.5% of FSWs who had accessed only free condoms and for 33.8% of those who had accessed only purchased condoms. CONCLUSIONS: One-fourth of FSWs had never accessed condoms, and a little over half of those who had ever accessed reported no access during the past 15 days. Condom requirements were not met for three-fifths of the FSWs. HIV prevention programmes need to Increase access to free condoms for FSWs in Andhra Pradesh as access to condoms is a necessary prerequisite for condom use.
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    Access to healthcare among the Empowered Action Group (EAG) states of India: Current status and impeding factors .
    (2016-09) Kumar, Virendra; Singh, Pushpendra
    Background. Access to healthcare is crucial for meeting the health needs of Indians. We explored factors impeding access to public sources of healthcare among the Empowered Action Group (EAG) states of India. We also examined the extent to which Indians depend on public and private sources of healthcare in the EAG states. Methods. Our study is based on the unit-level records of 9988 ailing persons, who were surveyed among the EAG states in the 71stround of the National Sample Survey (NSS), conducted during January–June 2014 on the theme ‘Social consumption: Health’. To analyse the socioeconomic factors, we did logistic regression using STATA version 12.0. Results. Despite a vast public health infrastructure in the EAG states, around three-fourths of inpatients are dependent on private sources of healthcare in both rural (70%) and urban (78%) areas. Poor quality and long waiting time in accessing healthcare from public health facilities remain big concerns for inpatients of the EAG states. Conclusion. To make public health services more accessible, there is a need to improve the quality of services, enlarge infrastructure to reduce waiting time, and enhance the physical reach to inpatients in the EAG states of India. Public health services will then be able to compete with those in the private sector. Natl Med J India 2016;29:267–73
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    Accreditation of public health education in India: Enhancing quality, competence and trust.
    (2013-11) SHARMA, KAVYA; ZODPEY, SANJAY; ZAHIRUDDIN, QUAZI SYED; GAIDHANE, ABHAY
    With an increase in the number of institutes offering public health education, there is a need for discussion on future directions and challenges. The World Health Report 2006 identified the need to improve the quality of public health education. There are various mechanisms and bodies that look after accreditation issues in several countries. The Council on Education for Public Health in the USA assists in the accreditation of schools of public health, as well as public health programmes. The Australian Network of Academic Public Health Institutions is actively engaged in discussions to improve the quality of its programme and institutions. In Europe, the European Agency for Accreditation in Public Health Education is responsible for accreditation. The South-East Asia Public Health Education Institutes Network facilitates accreditation of public health education in the region. In India, public health education varies across institutes. India needs an accreditation system to ensure that public health education is of the desired quality. Certain initiatives, such as conferences, consultation and the Calcutta Declaration, have been taken in the past two decades. However, the ideas mooted have yet to be translated into reality. The broad framework for accreditation may entail an institutional self-assessment against set standards, preparation of a database, cataloguing, and site visits by a peer team. There is a need for an apical body with all stakeholders participating in the process. Accreditation has specific benefits, but there are critical challenges as well. For example, the autonomy of the institutions needs to be protected, the accreditation bodies should exhibit professionalism and substantial financial resources are required. Before tackling specific criteria for accreditation, it is necessary to define a collective vision for schools of public health in India.
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    Accuracy of Xpert® MTB/RIF in diagnosing extrapulmonary tuberculosis in Indian children
    (All India Institute of Medical Sciences, 2022-12) SHAH, IRA; BHAMRE, RASIKA; SHETTY, NAMAN S
    BACKGROUND Diagnosing extrapulmonary tuberculosis (EPTB) can be challenging because of a variety of presentations. We assessed the accuracy of the Xpert MTB/RIF assay in diagnosing EPTB in children. METHODS Of the 255 children diagnosed to have tuberculosis (TB) who underwent testing by the Xpert MTB/ RIF assay at the TB clinic from December 2014 to April 2017, 182 had EPTB and were included in the study. The diagnostic accuracy, specificity and sensitivity of the Xpert assay were calculated with Mycobacterium growth indicator tube (MGIT) as a reference standard. RESULTS Lymph node TB was present in 58 (32%) children, 37 (20%) had neurological TB, 36 (20%) had bone TB, 31 (17%) had pleural TB, 15 (8%) had abdominal TB, 2 (1%) had abscess, 2 (1%) had congenital TB and disseminated TB was seen in 1 (0.4%) child. Xpert MTB/RIF assay was positive in 84 (46.2%) patients. The sensitivity and specificity of the Xpert MTB/RIF assay were 72% and 72.04%, respectively. Compared to MGIT, a kappa coefficient of 0.44 shows moderate agreement between the Xpert assay and MGIT. The sensitivity of Xpert MTB/RIF assay in abdominal TB, bone TB, lymph node TB, neurological TB and pleural TB was 50% (15%–85%), 72.7% (15.9%– 86.9%), 80.8% (62.1%–91.5%), 75% (50.5%–90%) and 25% (4.6%–70%), respectively. The specificity of abdominal TB, bone TB, lymph node TB, neurological TB and pleural TB was 83.3% (43.7%–97%), 69.2% (42.4%– 87.3%), 55.2% (37.6%–71.6%), 85% (64%–94.8%) and 82.6% (62.9%–93%), respectively. Forty-seven (26%) patients had drug-resistant TB (DR-TB), of which 15 (8%) were rifampicin-resistant (RR), 2 (1%) were polyresistant, 14 (8%) had multi-DR (MDR), 15 (8%) had pre-extremely DR (XDR) and 1 (1%) had XDR-TB. Of the 15 patients with MDR-TB, Xpert MTB/RIF assay detected only 10 (71%) as RR (p=0.06). Of the 15 pre-XDR cases, Xpert MTB/RIF detected only 8 (53%) as RR (p=0.02). CONCLUSION Xpert MTB/RIF assay is useful in the diagnosis of EPTB. It shows good concordance with MGIT. However, it may be negative in patients with DR-TB.
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    Acetylator status, drug metabolism and disease.
    (2003-01-29) Pande, J N; Pande, A; Singh, S P N
    Acetylation polymorphism, although discovered 40 years ago, still holds interest not only because many drugs and carcinogens are metabolized by acetylation in the liver but also because advances have been made in the understanding of the molecular genetics of acetylation. It is this genetic variation of drug metabolism that is one of the causes of inter-individual variation of the effect of a drug. Acetylation polymorphism relates to the metabolism of a number of arylamine and hydrazine drugs and carcinogens by cytosolic N-acetyltransferase--NAT2. In humans, 2 genes--NAT1 and NAT2--are responsible for the N-acetyltransferase activity. Studies have revealed several allelic variants of both NAT1 and NAT2. It has been suggested that some of these variants modify the individual susceptibility to disease.