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  Most popular articles (Since July 28, 2016)

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Diabetic retinopathy and its risk factors in patients with type 2 diabetes attending rural primary healthcare facilities in Tamil Nadu
Tony Fredrick, Prabhdeep Kaur, Manoj V Murhekar, Yuvaraj Jayaraman, K Kolandaswamy, Sudha Ramachandra Rao, Joseph K David
January-February 2016, 29(1):9-13
Background. India has a high burden of diabetic retinopathy ranging from 12.2% to 20.4% among patients with type 2 diabetes mellitus (T2DM). A T2DM management programme was initiated in the public sector in Tamil Nadu. We estimated the prevalence of diabetic retinopathy and its associated risk factors. Methods. We did a cross-sectional survey among patients with T2DM attending two primary health centres for treatment and follow-up in Kancheepuram, Tamil Nadu in January- March 2013. We did a questionnaire-based survey, and measured blood pressure and biochemical parameters (serum creatinine, plasma glucose, etc.) of the patients. We examined their eyes by direct and indirect ophthalmoscopy and defined diabetic retinopathy using a modified classification by Klein et al. We calculated the proportion and 95% CI for the prevalence and adjusted odds ratio (AOR) for risk factors associated with diabetic retinopathy. Results. Among the 270 patients, the mean (SD) age was 54.5 (10) years. The median duration of T2DM was 48 months. The prevalence of diabetic retinopathy was 29.6%. Overall, 65.9% of patients had hypertension, 14.4% had nephropathy (eGFR <60 mg/dl) and 67.4% had neuropathy. Among patients with comorbid conditions, 60%, 48%, 32%, and 3% were already diagnosed to have hypertension, neuropathy, retinopathy, and nephropathy, respectively. The risk factors for diabetic retinopathy were hypertension (AOR 3.2, 95% CI 1.7-6.3), duration of T2DM >5 years (AOR 6.5, 95% CI 3.6-11.7), poor glycaemic control (AOR 2.4, 95% CI 1.4-4.4), and nephropathy (AOR 2.3, 95% CI 1.1-4.6). Conclusions. There was a high burden of undetected retinopathy and other comorbid conditions among patients with T2DM. Early detection of comorbid conditions and glycaemic control can be improved by training care-providers and educating patients.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Post-earthquake Nepal: Acute-on-chronic problems
Buddha Basnyat
January-February 2016, 29(1):27-27
Full text not available  [PDF]  [PubMed]
  114 40,642 -
Guillain–Barré syndrome in a patient with neuropsychiatric systemic lupus erythematosus
GK Rajeshwari, CH Bangaru Rao, NV Sundarachary, SK Moula Ali, JS Kalyani, A Sridhar
January-February 2016, 29(1):14-17
Guillain-Barré syndrome is a rare manifestation of neuropsychiatric systemic lupus erythematosus (SLE). Clinical and electrophysiological features of Guillain-Barré syndrome in patients with SLE are different from those in patients without SLE. There is considerable variation in the management and prognosis. We present a patient with Guillain-Barrι syndrome and SLE and review the recent knowledge on the various manifestations of neuropsychiatric SLE.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  282 40,409 -
The revised guidelines of the Medical Council of India for academic promotions: Need for a rethink
Rakesh Aggarwal, Nithya Gogtay, Rajeev Kumar, Peush Sahni
January-February 2016, 29(1):1-5
Full text not available  [PDF]  [PubMed]
  167 40,515 -
Then and now: Teaching medicine at the patient's bedside
Sunil Pandya
January-February 2016, 29(1):28-29
Full text not available  [PDF]  [PubMed]
  115 40,563 -
Routine health check-ups: A boon or a burden?
Bianca Honnekeri, Aniruddha Vyas, Disha Lokhandwala, Avani Vaishnav, Aditi Vaishnav, Mayank Singhal, Parag Barwad, Gopi Krishna Panicker, Yash Lokhandwala
January-February 2016, 29(1):18-21
Healthcare provider institutions in India now offer structured health check-up 'packages' for routine screening of common diseases. While some tests included within their ambit are in keeping with international and Indian recommendations, some are entirely unwarranted. Unnecessary and inappropriate screening tests may cause more harm than benefit. Besides financial and resource burden, there may be over-diagnosis and over-treatment, psychological distress due to false-positive test results, harm from invasive follow-up tests, and false reassurance due to false-negative test results. Clinicians must ensure a net benefit from tests and interventions in order to efficiently deliver preventive services. We reviewed current screening guidelines for cardiovascular disease and common cancers, and surveyed multiple 'packages' provided at 8 centres in Mumbai, India. We put forth our recommendations for routine health screening in asymptomatic adults in India.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Vivek Arya
January-February 2016, 29(1):59-59
Full text not available  [PDF]  [PubMed]
  59 40,521 -
Elimination of lymphatic filariasis
SB Gogia, Sathi , Sangtin
January-February 2016, 29(1):37-37
Full text not available  [PDF]  [PubMed]
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The art of letting go and the mandate of going further
Timothy S Laux
January-February 2016, 29(1):30-31
Full text not available  [PDF]  [PubMed]
  124 40,366 -
Sharing Clinical Trial Data: A Proposal from the International Committee of Medical Journal Editors
Darren B Taichman, Joyce Backus, Christopher Baethge, Howard Bauchner, Peter W de Leeuw, Jeffrey M Drazen, John Fletcher, Frank A Frizelle, Trish Groves, Abraham Haileamlak, Astrid James, Christine Laine, Larry Peiperl, Anja Pinborg, Peush Sahni, Sinan Wu
January-February 2016, 29(1):6-8
Full text not available  [PDF]  [PubMed]
  121 40,359 -
News from here and there
Sanjay A Pai
January-February 2016, 29(1):57-58
Full text not available  [PDF]  [PubMed]
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Cytomegaloviral retinitis
Koushik Tripathy, Pradeep Venkatesh, Rohan Chawla
January-February 2016, 29(1):35-35
Full text not available  [PDF]  [PubMed]
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Metachronous second primary of the oesophagus detected by FDG-PET/CT in a patient with follicular variant of papillary thyroid carcinoma
Sandip Basu, Rohit Ranade
January-February 2016, 29(1):36-36
Full text not available  [PDF]  [PubMed]
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Myelopathy complicating congenital atlanto-axial dislocation (A study of 28 cases)
NH Wadia
January-February 2016, 29(1):38-56
  244 39,879 -
Knowledge, attitude and behaviour of the general population towards organ donation: An Indian perspective
Poreddi Vijayalakshmi, TS Sunitha, Sailaxmi Gandhi, Rohini Thimmaiah, Suresh Bada Math
September-October 2016, 29(5):257-261
Background. The rate of organ donation in India is low and research on organ donation among the general population is limited. We assessed the knowledge, attitude and willingness to donate organs among the general population. Methods. We carried out a cross-sectional descriptive study among 193 randomly selected relatives of patients (not of those seeking organ donation) attending the outpatient department at a tertiary care centre. We used a structured questionnaire to collect data through face-to-face interviews. Results. We found that 52.8% of the participants had adequate knowledge and 67% had a positive attitude towards organ donation. While 181 (93.8%) participants were aware of and 147 (76.2%) supported organ donation, only 120 (62.2%) were willing to donate organs after death. Further, there were significant associations between age, gender, education, economic status and background of the participants with their intention to donate organs. Conclusion. Our study advocates for public education programmes to increase awareness among the general population about the legislation related to organ donation.
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Dengue virus infection
C Santosh Kumar, SK Sharma
March-April 2016, 29(2):61-63
Full text not available  [PDF]  [PubMed]
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Access to healthcare among the Empowered Action Group (EAG) states of India: Current status and impeding factors
Virendra Kumar, Pushpendra Singh
September-October 2016, 29(5):267-273
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 71st round 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.
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Prevalence and determinants of depression among elderly persons in a rural community from northern India
Priyamadhaba Behera, Pratap Sharan, Ashwani Kumar Mishra, Baridalyne Nongkynrih, Shashi Kant, Sanjeev Kumar Gupta
May-June 2016, 29(3):129-135
Background. Globally, more than 350 million people of all ages suffer from depression. Elderly persons are more vulnerable to depression. We conducted this study to estimate the prevalence of depression, and to study the association of depression with sociodemographic and clinical variables among elderly persons in a rural community. Methods. We conducted a community-based cross-sectional study among 395 randomly selected elderly persons aged 60 years and above in a rural area of Ballabgarh, Haryana, India. The participants were screened by using the Geriatric Depression Scale, and diagnosis was confirmed by the Mini International Neuropsychiatric Interview. Multivariate analysis was done for independent predictors of depression. Results. The prevalence of depression was 11.4% (95% CI 8.6%-14.9%). Living in a nuclear family (adjusted odds ratio [AOR] 8.98, 95% CI 3.40-23.71), lack of physical activity (AOR 4.95, 95% CI 2.00-12.27), whole-time involvement in household work (AOR 4.47, 95% CI 1.18-16.93), presence of two or more chronic diseases (AOR 4.45, 95% CI 1.60-12.35), having no role in family decision-making (AOR 2.77, 95% CI 1.19-6.42), sleep problems in past one year (AOR 2.97, 95% CI 1.32-6.69) and bilateral hearing impairment (AOR 4.00, 95% CI 1.80-8.88) were factors associated with depression in elderly persons. Conclusions. Depression is common among elderly persons in rural areas. Individuals providing healthcare to elderly persons need to be trained to identify depression and take appropriate action; elderly persons with chronic diseases and hearing impairment deserve special attention.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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High direct costs of medical care in patients with Type 1 diabetes attending a referral clinic in a government-funded hospital in Northern India
Kishore K Katam, Vijayalakshmi Bhatia, Preeti Dabadghao, Eesh Bhatia
March-April 2016, 29(2):64-67
Background. There is little information regarding costs of managing type 1 diabetes mellitus (T1DM) from low- and middle-income countries. We estimated direct costs of T1DM in patients attending a referral diabetes clinic in a governmentfunded hospital in northern India. Methods. We prospectively enrolled 88 consecutive T1DM patients (mean [SD] age 15.3 [8] years) with age at onset <18 years presenting to the endocrine clinic of our institution. Data on direct costs were collected for a 12 months-6 months retrospectively followed by 6 months prospectively. Results. Patients belonged predominantly (77%) to the middle socioeconomic strata (SES); 81% had no access to government subsidy or health insurance. The mean direct cost per patient-year of T1DM was `27 915 (inter-quartile range [IQR] `19 852-32 856), which was 18.6% (7.1%-30.1%) of the total family income. A greater proportion of income was spent by families of lower compared to middle SES (32.6% v. 6.6%, p<0.001). The mean out-of-pocket payment for diabetes care ranged from 2% to 100% (mean 87%) of the total costs. The largest expenditure was on home blood glucose monitoring (40%) and insulin (39.5%). On multivariate analysis, total direct cost was associated with annual family income (β=0.223, p=0.033), frequency of home blood glucose monitoring (β=0.249, p=0.016) and use of analogue insulin (β=0.225, p=0.016). Conclusions. Direct costs of T1DM were high; in proportion to their income the costs were greater in the lower SES. The largest expenditure was on home blood glucose monitoring and insulin. Support for insulin and glucose testing strips for T1DM care is urgently required.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Salt Reduction at a Population Level: To do or not to do?
AP Jose, D Prabhakaran
September-October 2016, 29(5):253-256
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Autologous stem cell transplantation for multiple myeloma: Long-term results
Lalit Kumar, Rakesh Reddy Boya, Rohit Pai, P Harish, Anjali Mookerjee, B Sainath, Mukesh Bhimrao Patekar, Ranjit Kumar Sahoo, Prabhat Singh Malik, OD Sharma, Ritu Gupta
July-August 2016, 29(4):192-199
Background. Survival of myeloma patients has improved considerably in the past decade. However, limited data are available on their long-term outcome. We analysed the data of 225 consecutive patients who underwent autologous stem cell transplantation (ASCT) at our centre. Methods. Between April 1990 and December 2013, a total of 225 patients with multiple myeloma (median age 53 years, range 27-67 years, 69.3% men) underwent ASCT. High-dose melphalan 200 mg/m2 was used for conditioning. Before transplant, the patients received induction therapy with novel agents (thalidomide and dexamethasone, or lenalidomide and dexamethasone, or bortezomib and dexamethasone); or vincristine, doxorubicin, dexamethasone; or alkylating agents (vincristine, melphalan, cyclophosphamide and prednisolone; or melphalan and prednisolone). The response to transplant was evaluated using the European Bone Marrow Transplant criteria, and an intention-to-treat analysis was done. Results. Four-fifths (79.6%) of our patients had Durie Salmon Stage (DSS) IIIA and nearly a quarter (24%) of them had International Stage III disease. Before the transplant, 80.4% of patients had chemosensitive disease. The median interval from diagnosis to transplant was 10 months (range 2-128 months). Following ASCT, 197 (87.5%) patients responded. Complete response was obtained in 54.7%, very good partial response in 19% and partial response in 13.8%. At a median follow-up of 90 months (range 18-266 months), the median progression-free survival (PFS) and overall survival (OS) were 32 and 85.5 months, respectively. The estimated PFS and OS at 10 years were 29.7% and 43.6%, respectively. On multivariate analysis, the presence of extramedullary disease (HR 3.05, p < 0.001), and ISS III (HR 0.50, p < 0.02) predicted inferior OS. Extramedullary disease at diagnosis (HR 1.585, p < 0.03), and more than one regimen pre- transplant (HR 0.53, p < 0.02) predicted an inferior PFS. Complete response was a predictor of superior OS and PFS (p < 0.001). Conclusion. Complete response following ASCT is associated with good long-term outcome. Alternative treatment strategies are needed to improve results in patients who fail to achieve CR post-transplant and in those with high-risk disease.
[ABSTRACT]   Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
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Estimating the burden of 'weighing less': A systematic review and meta-analysis of low birth-weight in India
Meenakshi Bhilwar, Ravi Prakash Upadhyay, Kapil Yadav, Rakesh Kumar, Palanivel Chinnakali, Smita Sinha, Shashi Kant
March-April 2016, 29(2):73-81
Background. The National Family Health Survey-3 (NFHS- 3; 2005-06) reports that the prevalence of low birth-weight babies is 22% in India. This old figure is probably an underestimate as this nationwide survey acquired information on birth-weight of only 34% of babies. We aimed to make a fresh estimate of the proportion of low birth-weight babies. Methods. A systematic search was done through PubMed, Google Scholar, Cochrane Library, Medline, IndMed, Embase, WHO and Biomed Central databases. Studies published from 2004 to 2014 were included. Study quality was assessed using the adapted Mirza and Jenkins checklist. An 'adjustment' of 24% was applied to the published estimates where data were collected through records or through a combination of records and anthropometry. The adjustment was done to account for the heaping of birth-weight data at 2500 g. Metaanalysis using both random and fixed effects model was done to derive an estimate. Results. Nineteen studies with 44 133 subjects were included in the review. The pooled estimate for the prevalence of low birth-weight was 27% (95% CI 24%-30%) and the 'adjusted' pooled prevalence was 31% (95% CI 28%-33%). The prevalence in urban and rural areas was 30% (95% CI 23%- 38%) and 26% (95% CI 22%-30%), respectively. Regionwise estimates revealed that the prevalence at 33% was comparatively higher in eastern regions (95% CI 29%-37%). Conclusion. The pooled prevalence of low birth-weight is higher than that reported by NFHS-3. Updated estimates should be used to guide future interventions and policies.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Nutritional status and intellectual development in children: A community-based study from rural Southern India
Amita Jacob, Leah Thomas, Kezia Stephen, Sam Marconi, J Noel, KS Jacob, Jasmin prasad
March-April 2016, 29(2):82-84
Background. There is a dearth of recent data on the relationship between nutritional status and intellectual development among children in India. To determine whether such a relationship exists, we studied children in a rural area of Tamil Nadu. Methods. We stratified villages in Kaniyambadi block, Tamil Nadu, and recruited consecutive children who satisfied the study criteria. We assessed nutritional status by measuring height and weight and recording chronological age, and calculated indices weight-for-age, height-for-age, weight-forheight and their Z scores. We assessed intellectual development using the Indian adaptation of the Vineland Social Maturity Scale. We used a case-control framework to determine the relationship and logistic regression to adjust for common confounders. Results. We recruited 114 children between the ages of 12 and 72 months. Z score means (weight-for-age -1.36; height-for-age -1.42; weight-for-height -0.78) were much less than 0 and indicate undernutrition. Z score standard deviations (weight-for-age 1.04; height-for-age 1.18; weightfor- height 1.06) were within the WHO recommended range for good quality of nutrition data suggesting reduced measurement errors and incorrect reporting of age. The frequency distributions of population Z scores suggest high undernutrition, wasting and medium stunting. A tenth of the population (9.6%) had values to suggest borderline/below average intelligence (social quotient <89). Lower height-forage, height-for-age Z score and weight-for-height Z score were significantly associated with a lower social quotient. These relationships remained statistically significant after adjusting for sex and socioeconomic status using logistic regression. Conclusion. Chronic undernutrition, wasting and stunting and their association with lower intellectual development demand an urgent re-assessment of national food policies and programmes.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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Hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: A single institution Indian experience
SP Somashekhar, G Prasanna, Rajshekhar Jaka, Amit Rauthan, HS Murthy, Sunil Karanth
September-October 2016, 29(5):262-266
Background. Cytoreductive surgery followed by hyper- thermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients. Methods. In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naïve or previously treated by surgery and systemic chemotherapy. They underwent cytoreductive surgery followed by HIPEC using a hyperthermia pump, with the temperature at 42 °C for 30-90 minutes. The chemotherapy regimen was based on the primary malignancy. Perioperative outcome data were collected and analysed. We also analysed the short-term oncological outcomes. Results. Our patients included those with peritoneum confined ovarian carcinoma (32, 57.1%), colorectal carcinoma (9, 16.1%), pseudomyxoma peritonei (7, 12.5%), meso- thelioma (2, 3.6%), gastric carcinoma (2, 3.6%) and others (4, 7.1%). The median duration of surgery including HIPEC was 9 hours and the median hospital stay was 12 days. The median time for gastrointestinal recovery was 5 days. One-fifth of patients (11, 19.7%) required an extended stay in the inten- sive care unit. The most common grades 3 and 4 complications were hypocalcaemia 32.1%, hypokalaemia 32.1%, anaemia 21.4% and thrombocytopenia 7.1%. Major morbidity requiring surgical intervention occurred in 8.9% of patients. The 60-day operative mortality was 1.8%. At a median follow-up of 16 months, 7.1% developed peritoneal recurrence, 8.9% had systemic recurrence and 7.1% succumbed to the disease. Patients with platinum-resistant ovarian carcinomas had more peritoneal recurrence (3.6%). Conclusion. In patients with PSM, surgical cytoreduction and HIPEC is feasible and potentially beneficial. It can be done with low mortality and acceptable morbidity. It requires a dedicated team of surgeons, anaesthetists and intensivists and proper infrastructure.
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Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis
Smruti B Vaishnav, Bhalendu Vaishnav, Kailas N Desai, Nitin S Raithatha, Neeta S Bose
March-April 2016, 29(2):68-72
Background. There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. Methods. We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality. Results. Of the 6708 obstetric admissions studied, 1112 were of critically ill (16.5%) patients and 200 (17%) of these required mechanical ventilation. Over three-fourths (77%) of patients were from rural areas, 83.5% were referred and 97% had inadequate antenatal care. Severe pregnancy-induced hypertension/eclampsia, massive haemorrhage and sepsis were the common obstetric complications. Pulmonary oedema (32.5%), acute respiratory distress syndrome (ARDS, 14%) and acute lung injury (22.5%) were the three most common indications for mechanical ventilation. In 26% of patients, mechanical ventilation was initiated early based on a worsening cardiorespiratory profile. A sequential organ failure assessment score of >5 on admission and delay in treatment resulted in multi-organ failure and worsening outcome. The maternal mortality ratio was 32.5%, incidence of multi-organ dysfunction syndrome was 71%, and pregnancy loss was 43.5%. The odds ratio for maternal mortality in patients ventilated early was 0.39 as against 5 in those with ARDS. Conclusions. Inadequate antenatal care, delayed referral practices, pregnancy-induced hypertension, obstetric haemorrhage and sepsis remain the major causes of complications in obstetric patients from rural areas. The common indications for mechanical ventilation were pulmonary oedema, ARDS and acute lung injury. Early initiation of mechanical ventilation upon detection of imminent
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
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