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   2017| May-June  | Volume 30 | Issue 3  
    Online since September 20, 2017

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Quota in specialty and super-specialty courses: What does the judiciary say?
Mukul Chandra Kapoor, Shubhendu Anand
May-June 2017, 30(3):159-160
Reservations in super-specialty courses have been controversial for decades. A number of practising doctors, medical students and others in society have wanted to do away with reservations in specialty and super-specialty courses, while there are others in favour of persisting with reservations. Article 15 (4) of the Constitution of India states that nothing shall prevent the State from making any special provision for the advancement of any socially and educationally backward classes of citizens or for the Scheduled Castes/Tribes. However, Article 14 of the Indian Constitution should also be considered. The judiciary, particularly, the Supreme Court of India, in its judgments has strived to strike a balance between the two constitutional provisions. The Supreme Court, on various occasions, has observed that reservations in super-specialty courses should be done away with, as such reservations would be detrimental to the advancement of medical science and research and will also not serve national interest. We present the observations of the Supreme Court of India through its various judgments, with a focus on the recent case of Dr Sandeep versus Union of India, where the honourable court stated that the government should do away with reservations in super-specialty courses.
  6,601 266 -
Prevalence of disability in Tamil Nadu, India
Banurekha Velayutham, Boopathi Kangusamy, Sanjay Mehendale
May-June 2017, 30(3):125-130
Background. Information on disability is essential for the government to formulate policies, allocate adequate resources and implement appropriate programmes. We aimed to estimate the prevalence of disability and describe the types of disability by gender, age and geographical regions in Tamil Nadu, India. Methods. We analysed the 2011 Census cross-sectional survey data of Tamil Nadu. Age-adjusted disability rates and disability rates per 100 000 population were calculated. Results. There were 1 179 963 disabled individuals in Tamil Nadu in 2011, a disability rate of 1635 per 100 000 population. Disability in movement, hearing and sight individually accounted for 24%, 19% and 11% of the total disability, respectively. Sixteen districts had disability rates above the state average. As age advanced, disability rates increased; the highest disability rate of 2533 per 100 000 was among people aged 60 years and above. The disability rates were higher in males compared to females (1819 v. 1451 per 100 000). Rural areas had higher disability areas compared to urban (1670 v. 1599 per 100 000). Currently married, working populations and literate populations had lower disability rates. Disability rate in the Scheduled Castes was higher at 1763 per 100 000 compared to the Scheduled Tribes and other social groups. Multiple disability was high in the age groups 0–19 years and 60 years and above. Conclusion. Physical or mental disability was observed in 1.6% of the population of Tamil Nadu. Research is warranted to identify underlying causes and interventions to reduce the burden of disability in the state.
  6,130 665 -
Suicide in india: Part perceptions, partial insights, and inadequate solutions
KS Jacob
May-June 2017, 30(3):155-158
Suicide is a complex phenomenon, often linked to environment. Despite the identification of many social, cultural, economic and political correlates and risk factors, psychiatry continues to argue for curative solutions based on the reductionistic biomedical model, rather than support public health measures to manage the larger sociocultural, economic and political context. While psychiatry and curative medicine help many people, survival of the human body is best explained by the materialist explanation that locates the variation in health and longevity to tangible resources. There is no single, simple or straightforward solution to reducing population suicide rates; specific mental health interventions are unlikely to impact secular trends in the rates of suicide.
  2,693 361 -
Venous thromboembolism due to hyperhomocysteinaemia and tuberculosis
Ankush Chaudhary, Unnati Desai, Jyotsna M Joshi
May-June 2017, 30(3):139-141
An 18-year-old male presented to our hospital with complaints of episodic abdominal pain, dry cough and right pleuritic chest pain. He was diagnosed as a case of right tuberculous pleural effusion on the basis of the pleural fluid Genexpert report of Mycobacterium tuberculosis detected sensitive to rifampicin and was started on antituberculous therapy. Forty-five days later, he presented with acute onset breathlessness, swelling of the right leg, streaky haemoptysis and a fresh left-sided pleural effusion. Evaluation revealed venous thromboembolism (right lower lobar segment pulmonary embolism with right leg deep vein thrombosis). Workup for malignancy was negative. However, he had vitamin B12 deficiency with increased homocysteine levels and heterozygous mutation of the MTHFR gene at A1298C. He was treated with optimal anticoagulation, vitamin B12 supplementation and antitubercular treatment. This is a rare combination of events perhaps related to the MTHFR gene mutation.
  2,367 394 -
Caregiver perceptions on intensive care: A qualitative study from southern India
Shuba Kumar, Jony Christina, Anna Revathi Jagadish, John Victor Peter, Kurien Thomas, Thambu David Sudarsanam
May-June 2017, 30(3):131-135
Background. Admission of a patient to an intensive care unit (ICU) can result in tremendous stress to family caregivers not only because of the need to provide physical and emotional support to the sick relative, but also due to the burden of decision-making on behalf of the critically ill person. We enquired about family caregivers' perspectives on intensive care, the challenges they faced with decision-making and their perceptions on the nature of their interactions with healthcare providers. Methods. We used maximum variation sampling and enrolled 20 consenting caregivers for semi-structured interviews. Each interview, based on an interview guide, took 30–40 minutes and was conducted in a private place within the hospital premises. All interviews were recorded, transcribed verbatim and entered into a qualitative software (NVivo) for analysis. Results. The three emergent themes of analysis were (i) understanding about ICU, (ii) decision-making concerning ongoing treatment; and (iii) relationship with healthcare-providers. Some respondents saw the intensive care as an expensive facility for seriously ill patients while others were not so clear. The family's relationship with the patient and their financial status were seen as important deciding factors in continuing treatment. Decision-making was a complex and emotional issue and doctors were held in awe and seen as the main deciding authority. The importance of doctors being compassionate and communicative was stressed. Conclusion. Our study highlights the problems faced by family caregivers and of the need to improve their satisfaction through clear and simple communication strategies.
  2,251 455 -
Physician burnout: Can we prevent or reduce it?
Vijay Krishnan, Siddharth Sarkar
May-June 2017, 30(3):149-150
  1,623 396 -
Renal failure deaths in india: Crying for attention
Atul V Mulay
May-June 2017, 30(3):148-149
  1,806 205 -
Influence of age and gender on the function of postganglionic sympathetic sudomotor axons
Kedar Mal, Hulegar A Abhishekh, Mahavir Prasad Chawla, Trichur R Raju, Talakad N Sathyaprabha
May-June 2017, 30(3):136-138
Background. The quantitative sudomotor axon reflex test (QSART) is an autonomic function test to evaluate the function of postganglionic sympathetic sudomotor axons. The QSART is used for research and in clinical assessment of various neurological diseases, but few studies have assessed the influence of age, gender and reported a normative range. We assessed the influence of age and gender on QSART parameters. Methods. We recruited 61 healthy volunteers (41 men and 20 women) after obtaining written informed consent. The QSART was recorded as per standard protocol after iontophoretic stimulation (using acetylcholine) for 5 minutes. We analysed the sweat response to obtain total sweat production, rate of sweat production and latency time from the start of stimulation to sweat response. We assessed these parameters in the right medial forearm, right proximal leg, right distal leg and right proximal foot. Results. Men had significantly higher evoked sweat volume and sweat latency period compared to women. A positive correlation was observed between age and evoked total sweat volume. An inverse correlation was noted between age and evoked sweat latency period. Conclusion. Postganglionic sudomotor function increased significantly with age. Men had significantly higher sweat volume suggesting sympathetic predominance. These results might help establish normative data for the Indian population.
  1,518 293 -
Non-adherence to CML therapy and its clinical implications in India
Hari Menon
May-June 2017, 30(3):142-147
Clinical trials have shown that early and deeper cytogenetic/ molecular responses to tyrosine kinase inhibitors (TKIs) help in achieving improved long-term outcomes including lower rates of disease progression in chronic myeloid leukaemia (CML). However, the level of molecular responses achieved with TKI therapy in patients with CML is variable and this could be explained by differences in adherence to CML therapy. A systematic literature review of CML studies reporting adherence to BCR–ABL inhibitors from the USA, Asia and Europe (19 articles: 9 retrospective, 4 prospective, rest cross-sectional) showed that average adherence varies from 19% to 100% of the proportion of prescribed drug taken. Some factors that contribute to non-adherence include patient attitudes, adverse events associated with therapy, treatment complexities and socioeconomic issues. This article focuses on the problem of non-adherence to therapy in CML, especially from an Indian perspective, and offers suggestions for its mitigation.
  1,402 380 -
Construct validity and predictive utility of internal assessment in undergraduate medical education
Dinesh K Badyal, Sheena Singh, Tejinder Singh
May-June 2017, 30(3):151-154
Background. Internal assessment is a partial requirement of all medical college examinations in India. It can help teachers provide remedial action and guide learning. But its utility and acceptability is doubted because, with no external control, internal assessment is considered prone to misuse. It is therefore not used as a tool for learning. There is no study on the validity of internal assessment from India. Methods. We use multiple methods and multiple teachers to assess students and our records are well maintained. We analysed the internal assessment scores at our institute. We correlated the internal assessment marks with the university marks obtained by students in one of the subjects in each of the four professional examinations. Results. There was a positive correlation of university marks with internal assessment marks. The r values ranged from +0.426 to +0.685 and were statistically significant (p<0.01). The percentage of internal assessment marks was higher than the university percentage in all professional examinations except the first. Conclusions. Internal assessment marks correlate well with marks in university examinations. This provides evidence for construct validity and predictive utility of internal assessment. Internal assessment can predict performance at summative examinations and allow remedial action.
  1,458 277 -
Data sharing Statements for Clinical Trials: A requirement of the International Committee of Medical Journal Editors
Darren B Taichman, Peush Sahni, Anja Pinborg, Larry Peiperl, Christine Laine, Astrid James, Sung-Tae Hong, Abraham Haileamlak, Laragh Gollogly, Fiona Godlee, Frank A Frizelle, Fernando Florenzano, Jeffrey M Drazen, Howard Bauchner, Christopher Baethge, Joyce Backus
May-June 2017, 30(3):121-124
  1,208 307 -
Manual of ICU Procedures
PK Verma
May-June 2017, 30(3):173-173
  1,144 199 -
Efforts of a healthcare institution in central India to reduce carbon footprints
Dev Narang, Rahul Narang
May-June 2017, 30(3):178-179
  1,161 141 -
Chandrakant gokuldas saraiya (22 october 1916–14 march 2017)
Sunil K Pandya
May-June 2017, 30(3):167-168
  1,159 106 -
The Miracle-worker
Prabha Desikan
May-June 2017, 30(3):161-162
  950 136 -
Medical Practice Management: An update
AC Anand
May-June 2017, 30(3):163-166
  893 148 -
Ectopia lentis and blue sclera in hyperhomocysteinaemia
Anubha Rathi, Brijesh Takkar, Shorya Azad
May-June 2017, 30(3):176-176
  861 156 -
Demons: Our changing attitudes to alcohol, tobacco and drugs
Pallavi Rajhans, Ravindra Rao
May-June 2017, 30(3):174-175
  810 100 -
Letter from Mumbai
SK Pandya
May-June 2017, 30(3):169-171
  782 109 -
First instar larva of Oestrus ovis: 'Caught in action'
Pratibha Kale, Nitin Gupta, Nishant Verma, Bijay Ranjan Mirdha, Neha Midha, Sudarshan Khokhar
May-June 2017, 30(3):177-177
  728 158 -

May-June 2017, 30(3):183-183
  705 93 -

May-June 2017, 30(3):150-150
  568 83 -
Ethical Issues in Pediatric Organ Transplantation
Olinda Timms
May-June 2017, 30(3):172-172
  556 82 -
Vivek Arya
May-June 2017, 30(3):182-182
  541 91 -
Understanding Clinical Data Analysis
Deepak Chawla
May-June 2017, 30(3):175-175
  531 98 -
News from here and there

May-June 2017, 30(3):180-181
  547 77 -
Pancreas and Biliary Disease: A point of care clinical guide
Pramod Garg
May-June 2017, 30(3):173-173
  528 80 -
MK Singh
May-June 2017, 30(3):172-173
  533 65 -