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REVIEW ARTICLE
Telemedicine and virtual consultation: The Indian perspective
Navneet Ateriya, Ashish Saraf, Vikas Premlal Meshram, Puneet Setia
July-August 2018, 31(4):215-218
DOI:10.4103/0970-258X.258220  PMID:31134926
Telemedicine was considered futuristic and experimental some years ago, but it is a reality today. It is now emerging as an important tool for convenient as well as specialized healthcare, particularly for patients in remote locations with limited access to standardized healthcare services. However, there are multiple challenges to realizing its full potential. We focus on some key medicolegal and ethical issues such as doctor–patient relationship, informed consent, rights of the patient, malpractice, and principles of confidentiality relevant to the practice of telemedicine and virtual consultation. We explore the global as well as the Indian legal perspective pertaining to the application of telemedicine. The absence of specific laws for registration and practice of telemedicine and virtual consul-tation in India acts as a deterrent for medical practitioners to engage in its potential use. Hence, there is a need for specific legislation.
  20 16,611 2,029
Assessment of pain in the elderly: A literature review
Yoon-Sook Kim, Jae-Min Park, Yeon-Sil Moon, Seol-Heui Han
July-August 2017, 30(4):203-207
DOI:10.4103/0970-258X.218673  PMID:29162753
Background. Pain perception is highly subjective, and effective pain management can be challenging in the elderly. We aimed to identify a set of practical measures that could be used to assess pain in elderly patients with or without cognitive impairment, as the first step towards effectively managing their pain. Methods. We used the PRISMA guidelines for this literature review. Two reviewers independently assessed titles, abstracts and full-text articles, and a third reviewer resolved any disagreements. Results. A total of 11 285 abstracts and 103 full-text articles were assessed. Forty-one studies met the inclusion criteria. The Numeric Rating Scale, Visual Analogue Scale, Face Pain Scale and Verbal Descriptor Scale have proven valid in the elderly. The Abbey pain scale, Doloplus-2, Pain Assessment in Advanced Dementia scale, Pain Assessment Checklist for Seniors with Limited Ability to Communicate, Checklist of Nonverbal Pain Indicators, Pain Assessment for the Dementing Elderly rating tool and the Clinical Utility of the CNA Pain Assessment Tool are used in elderly patients with cognitive impairment. Conclusions. We identified a number of reliable and valid methods for pain assessment in the elderly. Elderly patients can receive treatment in a variety of settings, and frequently it is administered by a caregiver or family member, rather than a medical employee. The development of a pain assessment tool that is not subject to variations arising from differences in settings or caregivers is needed to assess pain accurately in elderly patients, and provide timely treatment. Natl Med J India 2017;30:203–7
  11 10,801 1,999
Eye donation and eye banking in India
Noopur Gupta, Praveen Vashist, Anita Ganger, Radhika Tandon, Sanjeev K Gupta
September-October 2018, 31(5):283-286
DOI:10.4103/0970-258X.261189  PMID:31267994
Corneal blindness is a priority condition under the National Programme for Control of Blindness and an important cause of avoidable blindness in India. A multipronged approach is needed to eliminate corneal blindness. Curable or treatable blindness requires a spectrum of care including medication, optical rehabilitation and corneal transplantation. Corneal transplantation is dependent on the availability of safe, donor eyes; however, there is scarcity of donor corneal tissues in India. To improve the eye banking system, the Government of India supports eye banks through recurring grants for operational costs and non-recurring grants for infrastructure costs. Strategic interventions by the government and non-governmental organizations include awareness by health promotion and education, community participation, sustainable source of donor cornea, quality medical standards, accreditation and endeavours to strengthen eye banking systems and procedures through training and research. A model eye banking system in India can be achieved only when it is linked with the targeted infrastructure proposed under ‘Vision 2020: Right to Sight- India’. Considering these targets, there is a requirement of at least 20 eye bank training centres, 200 eye banks with corneal transplant facility (collection of nearly 500 corneas per year) and 2000 eye donation centres in the country. This would become a reality if the Hospital Cornea Retrieval Programme is strengthened at all private and government hospitals, uniform medical standards are made mandatory for all eye banks and eye donation centres and the process of registration and eye donation is simplified to enhance community participation.
  9 9,722 888
MEDICINE AND SOCIETY
Influenza A (H1N1) in India: Changing epidemiology and its implications
Sanket Vasant Kulkarni, Jai P Narain, Sunil Gupta, Akshay C Dhariwal, Sujeet Kumar Singh, C Raina Macintyre
March-April 2019, 32(2):107-108
DOI:10.4103/0970-258X.253355  PMID:31939410
  7 14,490 486
Pattern and profile of children using substances in India: Insights and recommendations
Anju Dhawan, Raman Deep Pattanayak, Anita Chopra, VK Tikoo, Rajesh Kumar
July-August 2017, 30(4):224-229
DOI:10.4103/0970-258X.218679  PMID:29162759
India has one of the largest proportion of children and adolescents in the world, but the threat posed by child substance use remains under-researched. Only recently a large study, the first of its kind in India, was carried out with a sample of nearly 4000 children using substances (school-going, out-of-school as well as street children) across more than a hundred cities/towns. We discuss (i) the existing knowledge on the prevalence of child substance abuse in India; (ii) perspectives and insights gained from the recent nation-wide study on its pattern and profile; and (iii) recommendations for substance use prevention and treatment among children in the Indian context. A multipronged approach involving all stakeholders is required to address the issues of prevention and treatment.
  6 15,057 1,130
ORIGINAL ARTICLES
Footwear in the causation and prevention of foot ulcers in diabetes mellitus
Ramaswamy Premkumar, Pitchaimuthu Rajan, Jeeva Rima, Joseph Richard
September-October 2017, 30(5):255-261
DOI:10.4103/0970-258X.234391  PMID:29916424
Background. Inappropriate footwear may be a major cause of foot ulceration among patients with diabetic neuropathy in India. No study has specifically examined the types of footwear or its components in patients with diabetes mellitus and their role in causing foot ulcers. We analysed the role of commonly used footwear in India in inducing first foot ulcers (FFU) in people with diabetes. Methods. Of 4800 patients with diabetes attending our centre over 1 year, 301 had FFU from different causes. Sixty-six patients with diabetic neuro-/vasculopathy presenting with ulcers due to footwear were included as cases. An equal number of patients with diabetes but without foot ulcers were enrolled as controls. Cases and controls were matched demographically and clinically for type of diabetes, metabolic control, duration of diabetes, comorbid conditions and foot neurovascular status. We did a detailed foot examination for neurological, vascular and wound status. We also evaluated the footwear in both groups. Results. In one-fifth of 335 limbs (301 patients), the primary cause for the FFU was use of inappropriate footwear. The patients used seven different models of footwear, six of which were found to be inappropriate. The straps of footwear caused over 50% of ulcers. Another one-third were due to penetration of sharp objects through the outer sole of footwear; among these cases, 1 3.6% of ulcers were caused by not using soft inner soles. Conclusions. The use of softer insole is least effective in preventing foot ulcers. Similarly, straps contribute to a higher percentage of foot ulcers. Foot ulcers can be prevented by a combination of soft insole, with midsole and hard outsole with proper back counter and adjustable front and back straps.
  6 5,996 730
Status and trend of acute encephalitis syndrome and Japanese encephalitis in Bihar, India
Praveen Kumar, PM Pisudde, PP Sarthi, MP Sharma, VR Keshri
November-December 2017, 30(6):317-320
DOI:10.4103/0970-258X.239070  PMID:30117441
Background. Acute encephalitis syndrome (AES) is a clinical condition, of which the most common cause is Japanese encephalitis (JE). Though there is deficiency of data on AES and JE from Bihar, the state ranks third in the reporting of JE cases after Uttar Pradesh and Assam. We aimed to assess the status and trends of AES and JE cases in Bihar and to know the status of the disease in the districts. Methods. We collected monthly epidemiological data for AES and JE for the period 2009–2014. Results. A total of 4400 cases (733 cases/year) with an average case fatality rate (CFR) of 30% for AES for the entire study period. A total of 396 cases of JE were reported with approximately 14% CFR. The disease peaks were during the start and end of the Indian summer and monsoon months for AES and JE, respectively. Districts such as Patna, Jehanabad, Nawada, Gaya and East Champaran reported the maximum number of AES and JE cases with annual incidence rates of 4.7–25.0 and 0.546–1.78 per 100 000 population, respectively. Conclusion. Since 2009, the incidence of AES and JE cases has been increasing in Bihar.
  6 6,422 800
CLINICAL CASE REPORT
Systemic thrombosis due to pulmonary tuberculosis
Sameer Bansal, Ketaki Utpat, Jyotsna M Joshi
July-August 2017, 30(4):201-202
DOI:10.4103/0970-258X.218672  PMID:29162752
Pulmonary tuberculosis (TB) is an established cause of venous thrombosis. A few instances have been described with arterial thrombosis as well. It has been speculated that TB causes systemic hypercoagulability, which may lead to venous thrombosis. This may be the presenting phenomenon, may occur shortly after diagnosis of TB, or even after starting antitubercular therapy. We describe a patient of pulmonary TB, who presented with pulmonary thromboembolism, with both arterial as well as venous thrombosis, which resolved on antitubercular therapy.
  5 2,799 510
ORIGINAL ARTICLES
Mapping of health research funding in India
Lalit Dandona, Rakhi Dandona, G Anil Kumar, Krycia Cowling, Pritty Titus, Vishwa Mohan Katoch, Soumya Swaminathan
November-December 2017, 30(6):309-316
DOI:10.4103/0970-258X.239069  PMID:30117440
Background. We aimed to estimate the total annual funding available for health research in India. We also examined the trends of funding for health research since 2001 by major national and international agencies. Methods. We did a retrospective survey of 1150 health research institutions in India to estimate the quantum of funding over 5 years. We explored the Prowess database for industry spending on health research and development and gathered data from key funding agencies. All amounts were converted to 2015 constant US$. Results. The total health research funding available in India in 2011–12 was US$ 1.42 billion, 0.09% of the gross domestic product (GDP) including only 0.02% from public sources. The average annual increase of funding over the previous 5 years (2007–08 to 2011–12) was 8.8%. 95% of this funding was from Indian sources, including 79% by the Indian pharmaceutical industry. Of the total funding, only 3.2% was available for public health research. From 2006–10 to 2011–15 the funding for health research in India by the three major international agencies cumulatively decreased by 40.8%. The non-industry funding for non-communicable diseases doubled from 2007–08 to 2011–12, but the funding for some of the leading causes of disease burden, including neonatal disorders, cardiovascular disease, chronic respiratory disease, mental health, musculoskeletal disorders and injuries was substantially lower than their contribution to the disease burden. Conclusion. The total funding available for health research in India is lower than previous estimates, and only a miniscule proportion is available for public health research. The non industry funding for health research in India, which is predominantly from public resources, is extremely small, and had considerable mismatches with the major causes of disease burden. The magnitude of public funding for health research and its appropriate allocation should be addressed at the highest policy level.
  5 4,008 1,471
SHORT REPORTS
Prevalence of risk factors for non-communicable diseases in a rural tribal population of Mokokchung, Nagaland, India
Aonungdok Tushi, Sudha Ramachandra Rao, Kamaraj Pattabi, Prabhdeep Kaur
January-February 2018, 31(1):11-14
DOI:10.4103/0970-258X.243405  PMID:30348915
Background Non-communicable diseases (NCDs) are the leading cause of mortality in India. The northeastern part of India has a high burden of NCDs. However, data on the prevalence of risk factors for NCDs in the rural tribal population of Nagaland are limited. We estimated the prevalence and awareness level of risk factors for NCDs in the rural population of Mokokchung district, Nagaland. Methods In a cross-sectional survey, we selected 472 subjects aged 25–64 years, stratified by age and sex, in 20 villages, using a cluster sampling technique. The WHO STEPS tools were used to collect data on behavioural risk factors, and anthropometric, blood pressure and capillary glucose measurements. The proportion of subjects with each NCD risk factor was determined overall and in various age and sex subgroups. Results The 472 subjects had a median age of 44.5 years, 92 (19.5%) reported current smoking and 75 (15.9%) reported current alcohol use. Among 236 males, 90 (38.1 %) were current smokers and 65 (27.5%) were current alcohol users, whereas of the 236 females, only 2 (0.8%) and 10 (4.2%) were current smokers and current alcohol users, respectively. The use of smokeless tobacco was common among both males (139/236; 58.9%) and females (117/ 236; 49.6%). Inadequate intake of fruits and vegetables was reported by 189 (80.1%) males and 221 (93.6%) females. Insufficient physical activity was observed only among 16 (3.4%) participants. Prevalence of hypertension and a body mass index of 23.0–27.49 kg/m2 was 43.2% and 32.4%, respectively. Conclusions We observed a high prevalence of behavioural risk factors for NCDs and of hypertension in rural tribal people in Nagaland. The primary healthcare system needs to be strengthened in this area to improve detection and management of hypertension. Mass and print media campaigns and provision of cessation services may also be helpful.
  5 3,543 622
EDITORIAL
Theorizing medical practice for India
KS Jacob
July-August 2017, 30(4):183-186
DOI:10.4103/0970-258X.218668  PMID:29162748
  4 2,920 772
ORIGINAL ARTICLES
Sleep patterns, hygiene and daytime sleepiness among adolescent school-goers in three districts of Tamil Nadu: A descriptive study
Gowtham Murugesan, Logamani Karthigeyan, Praveen Kumar Selvagandhi, Vijayaprasad Gopichandran
July-August 2018, 31(4):196-200
DOI:10.4103/0970-258X.258216  PMID:31134922
Background. Sleep is important for the growth, development and good health of adolescents. We assessed sleep patterns, hygiene and daytime sleepiness among school-going adolescents in 3 districts of Tamil Nadu. Methods. We conducted a cross-sectional survey among 538 school-going adolescents between the ages of 10 and 17 years, from 8 schools in 3 districts of Thiruvallur, Thiruppur and Namakkal selected through multistage sampling. A questionnaire with items focusing on demographic details, sleep patterns, sleep hygiene behaviour and daytime sleepiness was given to the students for self-administration after obtaining informed consent from their parents and school authorities. Results. Over 64% of adolescents sleep <8 hours at night with 5.6% sleeping <6 hours. About 48% of adolescents suffered from prolonged sleep-onset latency and about 43% had interrupted sleep. Over 64% of adolescents watched television (TV) in bed and >23% reported use of mobile phone in bed. About 64% of adolescents had at least one form of poor sleep hygiene behaviour. Decreasing age (0.7; 95% CI 0.582–0.843), studying while lying in bed (1.72; 95% CI 1.009–2.942), greater time gap between dinner and bedtime (0.795; 95% CI 0.650–0.972), staying awake late in the night and chatting on mobile phone (2.24; 95% CI 1.266–3.978) and watching TV (3.41; 95% CI 2.037– 5.722) significantly influenced excessive daytime sleepiness. Conclusion. A large proportion of adolescent students have abnormal sleep patterns and sleep hygiene behaviours. There is a need for concerted sleep-related education at the school level.
  4 3,823 701
SHORT REPORT
A comparative study of the informed consent process with or without audiovisual recording
BH Figer, M Chaturvedi, SJ Thaker, NJ Gogtay, UM Thatte
September-October 2017, 30(5):262-265
DOI:10.4103/0970-258X.234392  PMID:29916425
Background. The Central Standard Drugs Control Organization (CDSCO) issued an administrative order in November 201 3 mandating audiovisual (AV) recording of the informed consent process for all regulatory studies. At this point, a phase 2/3 trial ongoing at our centre had recruited 45 participants using the written, informed consent process. Another 40 participants were recruited after the order and underwent AV recording of the consent process. We assessed the difference in participants’ understanding between the two consenting processes as the trial fortuitously had both forms of consent. Methods. A 16-item questionnaire with six domains (purpose, study procedures, risks, benefits, payment for participation, and rights and confidentiality) was designed and validated. It was administered to the participants after approval of the institutional ethics committee and written informed consent. Answers given were matched with a template of model answers. The responses were scored as fully correct (3), partially correct (2), ‘don't remember’ (1 ), and incorrect (0) with a total possible score of 48. Between-group analysis was done for total scores and domain-specific scores. Domain-wise analysis was done for the proportion of all categories of responses. The impact of potential confounders on participants’ understanding was also factored in. Results. A total of 38 respondents—21 in the AV consent group and 1 7 in the written consent group—agreed to participate. The total mean (SD) score of the AV consent group was significantly higher (40.3 [5.9]) compared to that of the written consent group (34.8 [7.94]; p = 0.01). Between the groups the score was significant in the domains of rights and confidentiality (p = 0.01). The proportion of participants who gave fully correct answers was statistically significant in the domain of purpose (p = 0.04). The time elapsed between the original consent and this study showed a weak inverse correlation (ρ = -0.3, p = 0.01). Conclusion. AV recording of the informed consent process in a clinical trial appears to improve the understanding of participants relative to the written informed consent alone.
  4 1,931 286
CLINICAL CASE REPORT
Terbinafine-induced liver injury
Madhu Kaushal, Priyanka Tolani, Navneet Kumar, Shiwani Sharma
November-December 2017, 30(6):321-323
DOI:10.4103/0970-258X.239071  PMID:30117442
Terbinafine is a common antifungal agent with few reports of liver injury. We present a 64-year-old man who developed terbinafine-induced liver injury. Drug-induced liver injury is an important cause of morbidity and an early diagnosis may prevent progression to severe and chronic forms of liver injury including fulminant hepatic failure.
  3 2,891 443
CLINICAL CASE REPORTS
Tacrolimus-associated mania with psychotic symptoms in a child after renal transplant
Prashant Gupta, Jawahar Singh, Ananya Mahapatra, Pratap Sharan
September-October 2018, 31(5):281-282
DOI:10.4103/0970-258X.261183  PMID:31267993
Tacrolimus is one of the mainstays for post-transplant immunosuppression. A variety of neuropsychiatric adverse effects have been reported above the levels of its therapeutic use. Manic symptoms associated with its use have been rarely reported. We report possibly the first such case in a child post-renal transplantation and discuss the potential neuro-immunological basis of these symptoms.
  3 1,568 420
EDITORIAL
Graduate Medical Education Regulations 2019: Competency-driven contextual curriculum
Avinash Supe
September-October 2019, 32(5):257-261
DOI:10.4103/0970-258X.295962  PMID:32985438
  3 5,928 542
Rheumatic heart disease in India: Declining, but not fast enough
Ganesan Karthikeyan
September-October 2017, 30(5):247-248
DOI:10.4103/0970-258X.234389  PMID:29916422
  3 3,141 542
EDITORIALS
Antimicrobial Resistance: Threat, consequences and options
Rajesh Bhatia
May-June 2018, 31(3):133-135
DOI:10.4103/0970-258X.255752  PMID:31044757
  3 2,001 283
EVERYDAY PRACTICE
Heatstroke: Causes, consequences and clinical guidelines
Yogesh Jain, R Srivatsan, Antony Kollannur, Anand Zachariah
July-August 2018, 31(4):224-227
DOI:10.4103/0970-258X.258224  PMID:31134930
  3 4,459 723
MEDICAL EDUCATION
Medical students’ perception of the educational environment in a tertiary care teaching hospital in India
Anandhi Amaranathan, Kadambari Dharanipragada, Subitha Lakshminarayanan
July-August 2018, 31(4):231-236
DOI:10.4103/0970-258X.258226  PMID:31134932
Background. The educational environment perceived by students has an impact on satisfaction with the course of study and academic achievement. We aimed to analyse the perceptions of medical students about their learning environment and to provide feedback to stakeholders involved in curriculum planning and execution. Methods. We did a cross-sectional descriptive study at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. The DREEM inventory was administered to the undergraduate students of all semesters (n = 452). Students’ perceptions of learning, perception about teachers, academic self-perceptions, perceptions of atmosphere and their social self-perceptions were measured. The scores obtained were expressed as mean (standard deviation) and analysed using t-test and 1-way ANOVA (with post-hoc comparison using Tukey test). The difference between semesters and gender was also analysed. Results. The mean (SD) global score was 122.06 (22.27), out of a maximum possible score of 200. Our students opined that teachers were knowledgeable, with this component scoring the maximum of 3.32 and, at the same time, they felt that teaching overemphasizes factual learning (1.41). Only 6 items scored <2. ‘Students’ perception of atmosphere’ scored high among other domains (30 of 48, 62.5%). The mean global score of preclinical students (125.35 [20.43]) was better than clinical students (119.13 [23.44]; p = 0.003). Conclusion. Although the global score is more positive, we identified a few areas of concern such as overemphasis on factual learning, authoritarian teachers, the not-so-helpful existing learning strategies, vast curriculum (inability to memorize all), lack of supporting system for stressed out students and the boredom they felt in the course. These vital areas should be addressed by the stakeholders for the betterment of learning in the institute.
  3 2,128 282
MEDICINE AND SOCIETY
Intraocular use of bevacizumab in India: An issue resolved?
Atul Kumar, Koushik Tripathy, Rohan Chawla
November-December 2017, 30(6):345-347
DOI:10.4103/0970-258X.239079  PMID:30117450
Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF), which has been approved for intravenous use in certain cancers. There is evidence of its efficacy and safety as an intravitreal drug compared with ranibizumab and aflibercept. We have, in our practice, found it to be a cost-effective treatment option for ocular diseases, which could save a large amount of public money used in various national health insurance systems. An alert issued by the Drug Controller General of India led to a virtual ban on its intraocular use in India. However, pro-active advocacy and leadership by national ophthalmological societies helped to resolve the issue quickly.
  3 5,244 339
Clinical research training and capacity building for prevention and control of non-communicable diseases: A programme in India
Viswanathan Mohan, O Dale Williams, Sundarapandi Chella, Ranjit Unnikrishnan, Ranjit Mohan Anjana, Sudha Vidyasagar, Prasanta Kumar Bhattacharya, Nayanjeet Chaudhury, Anand Krishnan, Stephanie Garcia, Cora E Lewis, Myron Gross, Rajendra Pradeepa
November-December 2017, 30(6):340-344
DOI:10.4103/0970-258X.239078  PMID:30117449
Background. Non-communicable diseases (NCDs)—a term which includes diabetes, cardiovascular disease, cancers, chronic respiratory diseases, and mental illness—are now the major cause of death in India and pose healthcare and economic challenges. There is an urgent need for enhanced clinical research training and capacity building for NCD prevention and control in India. Methods. We describe a multi-pronged approach funded in part by the US National Institutes of Health Fogarty International Center, which was initiated in 2001, to train Indian present and future scientists/doctors in NCD prevention and control. The approaches used were annual national seminars, intensive training courses, in-house workshops, short-term training sessions in the USA and monthly video conferences. Results. During 2001–2016, a total of 3650 undergraduate, postgraduate and faculty from medical colleges and institutes from almost all states in India and several neighbouring countries participated in seminars and other capacity-building workshops held at the Madras Diabetes Research Foundation, Chennai and at six other medical colleges; 883 delegates participated in the in-house workshops, 463 in the intensive interactive sessions; 244 in workshops on advanced techniques in genomics; and 37 in short-term training sessions held in the USA. Conclusion. Through this unique capacity-building programme, more than 5000 individuals representing faculty and students from various medical colleges and research institutes across, and beyond, India, underwent training in the prevention and control of NCDs.
  3 1,633 259
REVIEW ARTICLE
Psychosocial aspects of colour vision deficiency: Implications for a career in medicine
Subho Chakrabarti
March-April 2018, 31(2):86-96
DOI:10.4103/0970-258X.253167  PMID:30829224
Colour vision deficiency (CVD) is a common problem and persons with CVD experience difficulties in daily life, early learning and development, education, choice of careers and work performance. Medical professionals with CVD also report difficulties in everyday tasks, training in medicine and performance of medical duties. However, because of limited evidence, the real impact of CVD on the lives of medical professionals is unclear, especially regarding the practice of medicine by doctors. The nature and severity of CVD, awareness of its impact, personal circumstances and the ability to cope with the deficiency are the major factors that determine the impact of CVD. However, there is a paucity of methodologically sound research on social and psychological aspects of CVD. Currently, early detection, enhancing awareness and offering support are the only proven ways of helping medical professionals with CVD. With the growing emphasis on equality and inclusivity of those with deficiencies, it is desirable to strike a balance between concerns about patient care and the rights of medical professionals with CVD to pursue their careers. Therefore, any future research also needs to focus on psychological aspects of CVD while exploring its impact on a career in medicine.
  3 3,278 442
SHORT REPORTS
Leptospirosis following heavy rains in 2017 in Mumbai: Report of large-scale community chemoprophylaxis
Avinash Supe, Mini Khetarpal, Shantaram Naik, Padmaja Keskar
January-February 2018, 31(1):19-21
DOI:10.4103/0970-258X.243407  PMID:30348917
Background Globally, cities get flooded due to heavy rains. As the incidence of leptospirosis increases after such flooding in Mumbai, community chemoprophylaxis to selected individuals was a consensus recommendation by experts. Methods We surveyed a total of 1 499 293 houses in severely affected areas of Mumbai (where there was waterlogging or high incidence of leptospirosis in the past) as well as in all slum areas. A total of 6 714 210 people (>50% of the population) were screened. A total of 156 934 adults, 4465 children, 359 pregnant women and 4957 high-risk adults were given prophylaxis with doxycycline or azithromycin by paramedical staff (n = 9526) under the supervision of medical staff. Social media and newspaper advertisements were used to create public awareness. Results Compared with previous floods, there were reduced number of cases of leptospirosis due to community chemoprophylaxis (432 confirmed cases in 2005 v. 128 [59 confirmed] in 2017). Conclusions Selective, time-bound chemoprophylaxis following floods is likely to reduce the incidence of leptospirosis, as well as associated morbidity and mortality.
  3 2,475 367
MEDICAL EDUCATION
Low-fidelity simulation to enhance understanding of infection control among undergraduate medical students
Suman P Singh, Chirag M Modi, Chirag P Patel, Ajay G Pathak
July-August 2017, 30(4):215-218
DOI:10.4103/0970-258X.218677  PMID:29162757
Background. Developing economies are stressing institutional care for better health outcomes but its advantages are dampened by healthcare-associated infections (HAIs). Besides other undesired complications, the economic cost of HAIs is enormous. Developing countries have higher HAI rates compared with Europe or the USA. The knowledge and practice of infection control is poor among medical students. Based on introspection of ‘Infection Control Module’ for undergraduates introduced in 2012, we tested emotional sensitization using low-fidelity techniques to enhance its effectiveness. Methods. All medical undergraduate students in their second year (n=102) were randomly divided into three groups using balanced randomization (two test and one control). Test groups were made to realize the emotional, social and financial consequences of HAI on patients and their families through low-fidelity simulation in the form of case discussions and video demonstrations. Pre- and postintervention empathy scores were calculated using Toronto empathy questionnaire (TEQ) for all the 102 students. Postintervention, all students were subjected to an infection control module and knowledge test. Perceptions of the intervention groups were recorded. Descriptive statistics and ANOVA were applied for data analysis. Results. Of the 102 students, 93 (91.1%) participated in the study. There was no significant difference in the pre-test TEQ score (p=0.87) but there was a significant difference in the post-test TEQ (p = 0.026) and knowledge test score (p = 0.016) among the groups. Both the simulation exercises were well appreciated by the students. Conclusion. Emotional sensitization using low-fidelity simulation served as a catalyst in understanding infection control among medical undergraduate students.
  2 1,672 259
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