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   Table of Contents - Current issue
Coverpage
November-December 2016
Volume 29 | Issue 6
Page Nos. 317-361

Online since Friday, March 17, 2017

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EDITORIAL  

The Mental Healthcare Bill 2016: Exotic in nature, quixotic in scope … but let's take the plunge, shall we? Highly accessed article p. 317
Nitin Gupta, Debasish Basu
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ORIGINAL ARTICLES Top

Effectiveness of symptom screening and incidence of tuberculosis among adults and children living with HIV infection in India Highly accessed article p. 321
C Padmapriyadarsini, PK Bhavani, L Sekar, Anandhachitra , M Selvaraj, N Poornagangadevi, SN Mothi, K Nandagopal, S Vennila, GK Priyadarshini, Mahesh Manisha, G Sanjeeva, Upasna Agarwal, E Suresh, BB Rewari, Soumya Swaminathan
Background. WHO recommends the use of a simplified symptom-based algorithm for screening for tuberculosis (TB) among people living with HIV (PLHIV). We assessed the feasibility and effectiveness of this algorithm and determined the prevalence and incidence of TB among PLHIV attending antiretroviral treatment (ART) centres in India. Methods. We did a prospective multicentric implementation research study in four states of India. To rule out TB, we administered the WHO symptom-screen algorithm to all PLHIV every month for 6 months. If they were found to be symptomatic any time during this period, they were referred for investigations for TB. A case of TB diagnosed during the first month of screening was taken as a prevalent case while those detected TB in the subsequent 5 months were considered cases of incident TB. We calculated the incidence rate using the person-years method. Results . Between May 2012 and October 2013, a total of 6099 adults and 1662 children living with HIV were screened for TB at the ART centres of four states. Of the 6099 adult PLHIV, 1815 (30%) had at least one symptom suggestive of TB, of whom only 634 (35%) were referred for investigations of TB. Of those referred, 97 (15%) PLHIV were diagnosed with TB. Overall, the prevalence of undiagnosed TB was 0.84 person-years and in the subsequent period, the incidence of TB was 2.4/100 person-years (95% CI 1.90-3.10). Among 1662 children, 434 (26%) had at least one symptom suggestive of TB. But only 57 (13%) children were referred for investigations of TB and 13 (23%) of them were diagnosed with TB. The prevalence of TB among children was 0.5% and its incidence among them was 2.7/100 person-years (95% CI 1.60-4.30). Conclusion. Prevalence and incidence of TB is high among PLHIV attending ART centres. This emphasizes the need to strengthen regular screening for symptoms of TB and further referral of those symptomatic for diagnosis of TB.
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Finger printing of counterfeit bevacizumab and identifying it before clinical use p. 326
Thirumurthy Velpandian, Madhu Nath, Moksha Laxmi, Nabanita Halder
Background. Bevacizumab is widely used for ophthalmic purposes. Recently, counterfeit bevacizumab has become a matter of concern. We analysed samples of suspected counterfeit formulations of bevacizumab and assessed the possibility of using simple tests in the clinic by ophthalmologists to prevent the use of counterfeit preparations in patients. Methods.We did a protein analysis using Bradford assay and SDS-PAGE to confirm the presence of bevacizumab in 16 samples - 6 suspected and 10 others. The samples were also subjected to physicochemical analysis such as osmolarity, chloride content and pH. The samples tested negative for protein were analysed by mass spectrometry to detect drugs used in place of bevacizumab. We standardized the method of frothing and precipitation analysis for identifying authentic samples of bevacizumab before their clinical use. Results. Five of the 16 samples tested were negative for the presence of bevacizumab. The physicochemical parameters also supported the protein analysis test. However, no ionizable organic compound (other drug[s]) was detected by mass spectrometry. Conclusion. Ophthalmic use of counterfeit bevacizumab can be prevented by simple methods such as the frothing and precipitation tests. These can identify the absence of an active drug.
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REVIEW ARTICLE Top

Pharmacotherapy of patients with stable bronchial asthma p. 330
Ashutosh Nath Aggarwal
Several reliever and controller medications are available for managing patients with stable asthma. Inhaled corticosteroids (ICS) are the mainstay of treatment, and can be combined with long-acting beta-agonists (LABA) for patients with moderate or severe disease. An ICS-LABA combination is best administered as a single inhaler used for both maintenance and emergency use. A stepwise approach to therapy has recently been proposed as part of Indian guidelines for management of asthma. Clinicians should advise proper use of inhaled medications, and step up or step down treatment based on adequacy of asthma control.
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SELECTED SUMMARIES Top

Exercise or surgery for meniscal tears: Do we have an answer? p. 338
Ravi Mittal
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Microcephaly not a reliable indicator of congenital Zika virus syndrome in infants p. 339
Reeta S Mani
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MEDICINE AND SOCIETY Top

Mobile health (mHealth) in mental health: Scope and applications in low-resource settings p. 341
Mamta Sood, Rakesh Kumar Chadda, Pushpendra Singh
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Workplace violence against resident doctors in a tertiary care hospital in Delhi p. 344
Tanu Anand, Shekhar Grover, Rajesh Kumar, Madhan Kumar, Gopal Krishna Ingle
Background. Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. Methods. This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. Results. Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. Conclusions. A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.
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SPEAKING FOR OURSELVES Top

Listening catalyses healing p. 349
Anna Tharyan, Jenifer Jeba, Ravi Livingstone, Reena George
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My first lesson in home obstetrics p. 351
Ratnakar Bhattacharyya
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LETTER FROM CHENNAI Top

The Tamil Nadu Medical Council Awards p. 352
MK Mani
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LETTER FROM GLASGOW Top

Lanarkshire Healthy Weight Strategy p. 353
Harpreet S Kohli
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BOOK REVIEWS Top

Advanced Therapies in Pediatric Endocrinology and Diabetology p. 355
Rajni Sharma
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The Gene. An intimate history p. 356
Sunil K Pandya
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NEWS FROM HERE AND THERE Top

News from here and there p. 359
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MASALA Top

Masala p. 361
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