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   2019| September-October  | Volume 32 | Issue 5  
    Online since September 23, 2020

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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
  5,933 542 3
High uptake of an innovative mobile phone application among community health workers in rural India: An implementation study
Pankaj Shah, Neha Madhiwala, Shobha Shah, Gayatri Desai, Kapilkumar Dave, Nishith Dholakia, Shivani Patel, Shrey Desai, Dhiren Modi
September-October 2019, 32(5):262-269
DOI:10.4103/0970-258X.295956  PMID:32985439
Background. We assessed the uptake, feasibility and effectiveness of an mHealth intervention in improving the performance of village-based frontline workers, called accredited social health activists (ASHAs), to increase the coverage of maternal, newborn and child health services in rural India. Methods. A new mobile phone application—Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO)—was implemented in all the 45 villages of two primary health centres in Jhagadia, Gujarat (population ~45 000), between August 2013 and February 2014 after training 45 ASHAs. After 9 months of implementation, 99 mothers of young infants between the ages of 1 and 4 months and 187 mothers of infants between the ages of 6 and 9 months were interviewed during the household survey to assess the coverage of maternal, newborn and child health services in the project and similar control villages. Fifteen ASHAs were purposively selected and interviewed. Results. The coverage of home-based newborn care (56% v. 10%), exclusive breastfeeding (44% v. 23%), care-seeking for maternal (77% v. 57%) and neonatal complications (78% v. 27%) and pneumonia (41% v. 24%) improved in the interventional area compared to the control area. The ASHAs logged into the mobile phone application on 88% of working days. Of a total of 10 774 forms required to be completed, the ASHAs completed 7710 forms. During the interviews, all ASHAs demonstrated sufficient competency to use ImTeCHO and expressed a high level of acceptability and utility of all components of the intervention. Conclusion. A high degree of acceptability, feasibility and effectiveness for the mHealth intervention among ASHAs was supported by its widespread use.
  3,446 423 1
Use of pornography in India: Need to explore its implications
Manoj Kumar Sharma, Girish N Rao, Vivek Benegal, K Thennarasu, Divya Oommen
September-October 2019, 32(5):282-284
DOI:10.4103/0970-258X.295968  PMID:32985442
Background. Internet use has increased access to online sexually explicit material. We explored the use of pornography in a community sample. Methods. In a house-to-house survey, 2525 individuals (1239 men; 1286 women) in the age group of 18–40 years were administered a schedule which included a screening tool for pornographic addiction along with a General Health Questionnaire. Results. Around 8.3% (229; 152 men [10.9%]; 77 women [5.6%]; p<0.001) acknowledged the use of pornography. It was more common among single and single parenting group samples. Pornographic addiction was 0.2% (5/2525; 0.3% men; 0.1% women). Sex had a significant association with age and pornography addiction. Conclusion. Our study documents the use of pornography in India. It suggests the need for in-depth studies.
  3,169 264 -
Severe maternal morbidity and maternal near miss in a tertiary hospital of Delhi
Pragti Chhabra, Kiran Guleria, Sanjiv Kumar Bhasin, Komal Kumari, Shalini Singh, Shveta Lukhmana
September-October 2019, 32(5):270-276
DOI:10.4103/0970-258X.295967  PMID:32985440
Background. In addition to maternal mortality, information on maternal near miss and severe maternal morbidity are important in maternal healthcare. We aimed to determine the incidence, causes and outcome of severe maternal morbidity and near miss, and the sociodemographic and obstetric factors associated with these at a tertiary care teaching hospital in Delhi. Methods. Women admitted with severe maternal morbidity and near miss, as defined by the WHO study group, were included in the study. The incidence ratio of near miss and severe morbidity in the hospital was determined, and a case–control study was conducted to study the factors associated with the occurrence of near miss. Information was obtained from hospital records and interviews, using a semi-structured open-ended questionnaire. Results. The incidence ratio of near miss was 6.85/ 1000, and severe morbidity was 11.38/1000 live births. Hypertensive disorders and haemorrhage were the common causes of cases of near miss and severe morbidity. Coagulation dysfunction (62%) was the most common organ dysfunction, followed by uterine dysfunction (22%). Older age (odds ratio [OR] 2.01, confidence interval [CI] 1.02–3.93), the absence of formal education (OR 2.05, CI 1.11–3.75), <18 years of age at marriage (OR 2.01, CI 1.21–3.32), lower income (OR 3.8, CI 1.88–7.64), gravida of four or more (OR 2.25, CI 1.21–4.17) and residence outside Delhi (OR 9.31, CI 4.36–19.90) were significant predictors of near miss. Sepsis, hypertensive disorders and haemorrhage were the most common underlying conditions in women who died. The foetal outcome was a live birth in 64% of near-miss cases and 62% among severe morbidity. Conclusions. The burden of severe maternal morbidity and near miss is high. These need to be identified and managed at the earliest.
  2,291 403 1
Respectful maternity care: A national landscape review
Humaira Ansari, Rajiv Yeravdekar
September-October 2019, 32(5):290-293
DOI:10.4103/0970-258X.295957  PMID:32985445
Respectful maternity care is a fundamental right of every childbearing woman. It contributes to ensuring a positive outcome for mothers as well as newborns, and aims to address health inequalities. However, studies have reported a high prevalence of disrespect and abuse in India, and have shown that the quality of care has been overlooked at all levels including research, policy, programme and practice. The lack of respectful maternity care results in failure in accessing institutional services. Thus, it is essential to design context-specific and evidence-based interventions as well as formulate policies and programmes to reduce disrespectful maternity care.
  2,180 312 -
Prevalence and determinants of hookah use among college-going women of Delhi
Kritika Anand, Kanishka , Smridhi Marwah
September-October 2019, 32(5):277-281
DOI:10.4103/0970-258X.295963  PMID:32985441
Background. As governments across the world implement tobacco-control measures, the tobacco industry responds by coming up with new products such as hookah, which are more appealing and affordable for young people—especially women—their primary target group. We assessed the prevalence and determinants of tobacco use among undergraduate women students of the University of Delhi with special emphasis on hookah use. Methods. Using an anonymous self-administered questionnaire, we conducted a survey among the undergraduate women students of four colleges of the University of Delhi during March 2016. The tool was adapted from standard global surveys and had specific sections on tobacco use and patterns—use of shisha (hookah), smokeless tobacco as well as cessation and exposure to media and awareness about the harmful health effects of tobacco use. Point estimates along with 95% confidence intervals were estimated. Multivariate logistic regression was done to identify the determinants of current tobacco use and hookah use. Results. Of the 780 respondents (mean [SD] age 19.3 [1.08] years), 22.9% (20.1–26.0) used tobacco in any form, with hookah being the most prevalent form (20.3%). One-third of the respondents believed that hookah smoking was less harmful than cigarette smoking. The major determinants of hookah use were—attending a private school (1.84; 1.11–3.01) or all-women college (2.79; 1.80–4.33); tobacco use by friends (2.47; 1.61–3.77); belief that smoking is a sign of women empowerment (2.09; 1.05–4.1 7) and the belief that hookah smoking is less harmful than cigarette smoking (2.81; 1.92–4.13). Conclusions. High prevalence of hookah use among young girls and women calls for a comprehensive approach including legislative options as well as increasing awareness about tobacco-cessation programmes among them.
  1,695 218 -
Hyperthyroidism due to involvement of thyroid gland in disseminated tuberculosis: A rare entity
Anubhuti Singh, Kislay Kishore, Ajay Kumar Verma
September-October 2019, 32(5):285-287
DOI:10.4103/0970-258X.295953  PMID:32985443
Involvement of the thyroid gland with tuberculosis (TB) is unusual and is commonly associated with hypothyroidism. Involvement of the thyroid as a part of disseminated TB is even rarer. Dissemination is an indication of immunosuppression. We present a 16-year-old immunocompetent girl with disseminated TB involving the thyroid gland and the right radius bone with features of hyperthyroidism. The patient responded well to anti-TB treatment.
  1,687 154 -
Epidural blood patch for spontaneous intracranial hypotension
MC Rajesh, Mohan Leslie Noone, PS Harish Babu
September-October 2019, 32(5):288-289
DOI:10.4103/0970-258X.295965  PMID:32985444
A 32-year-old woman presented to the neurology department with complaints of holocranial headache of 1-month duration, which was getting worse on sitting up and standing. Headache was not relieved with analgesics but on lying down. A provisional diagnosis of spontaneous intracranial hypotension was considered, which was confirmed by the findings on magnetic resonance imaging. She was given an epidural blood patch, which relieved her symptoms.
  1,670 126 -
CIA, MoSSAD, NKGB and SURETE in medical research: The RAW truth
Sanjay A Pai, Sachi Sri Kantha
September-October 2019, 32(5):311-312
DOI:10.4103/0970-258X.295955  PMID:32985451
Background. We aimed to categorize the types of productivity among published scientists and correlate them with the Nobel Prize. Data source. Nobel Foundation website ( www.nobelprize.org/nobel_organizations/nobelfoundation/ ) and PubMed database. Inclusion criteria. Scientists born from 1867, the year in which Alfred Nobel patented dynamite to accumulate his fortune, which in turn led to the establishment of Nobel’s famous will in 1895. Design. Retrospective analysis of the Nobel awards since 1901. Results. We propose an eponymous formulation called Pai-Kan Footprints (PKF) each with an alphabet tag of a recognized gumshoe agency.
  1,261 195 1
Can we stop imatinib?
Deepam Pushpam, Lalit Kumar
September-October 2019, 32(5):296-297
DOI:10.4103/0970-258X.295954  PMID:32985447
  1,267 171 -
Pigmented squamous cell carcinoma of the conjunctiva
KR Sheera, Abraham Kurian
September-October 2019, 32(5):316-316
DOI:10.4103/0970-258X.295964  PMID:32985454
  806 105 -
Cash transfer interventions in tuberculosis treatment outcomes
Raghavan Parthasarathy, Sumit Malhotra
September-October 2019, 32(5):294-295
DOI:10.4103/0970-258X.295960  PMID:32985446
  706 120 -
Secondary hospital rotation of postgraduate trainees: A pilot study
Punitha Victor, Gina Chandy, Krupa George, Anand Zachariah
September-October 2019, 32(5):303-307
DOI:10.4103/0970-258X.295959  PMID:32985449
Background. Postgraduate (PG) training in general medicine requires reorientation to meet the healthcare needs of India. In this pilot study, we designed a secondary hospital (SH) posting for medicine PGs to sensitize them to the practice of medicine and challenges in a rural SH setting. Methods. PG trainees in general medicine were sent for a 2-week rotation to select SHs. A faculty coordinator from the teaching hospital facilitated the programme. The SH faculty used qualitative tools to assess the performance of the trainees. The trainees also evaluated the programme using open- and close-ended questionnaires. Results: Eighteen PG trainees in general medicine were posted to six rural SHs. Data analysis showed that the training exposure provided sensitization to the challenges of medical practice in such settings and the need to be multicompetent. Seventeen (94%) trainees felt that they gained insight into the issues that are specific for practice at an SH and >80% expressed confidence about the knowledge and skills gained during that exposure to enhance medical practice in a resource-limited setting. They were also sensitized to various issues of secondary care including skills of multi-competence, the ability to handle a wide variety of cases with limited investigations, a cost-effective approach, decision-making on referrals, procedural competence and flexibility to adapt to new situations. Conclusion. A short SH posting can positively sensitize PGs to the practice of medicine and challenges in secondary care settings.
  685 104 -
Tuberculosis masquerading as a retroperitoneal pseudotumour
Ravi Kumar Bokarvadia, B Mahadevan, Mayank Jain, R Ravi, Sameer Paghadar, S.N.K. Chenduran, Jayanthi Venkataraman
September-October 2019, 32(5):317-317
DOI:10.4103/0970-258X.295961  PMID:32985455
  634 115 -
Changes in clivus after radiotherapy in patients with nasopharynx cancer
Yasemin Benderli Cihan
September-October 2019, 32(5):318-318
DOI:10.4103/0970-258X.295966  PMID:32985456
  621 109 -
The cultures of academic medicine in India
KS Jacob
September-October 2019, 32(5):308-310
DOI:10.4103/0970-258X.295958  PMID:32985450
  596 97 1
Iatrogenic aggravation of anxiety and neurosis
Sunil K Pandya
September-October 2019, 32(5):314-315
DOI:10.4103/0970-258X.295970  PMID:32985453
  527 79 -
Mastery avoidance: An overlooked aspect of medical students' motivation
Nir Madjar, Yaacov G Bachner, Talma Kushnir
September-October 2019, 32(5):298-302
DOI:10.4103/0970-258X.296240  PMID:32985448
Background. Previous research on medical students’ motivation mostly overlooked an important concept, namely, mastery-avoidance goals. The mastery-avoidance goal is defined as engaging in a task to avoid losing knowledge or skills that have already been acquired. We aimed to explore the role of mastery-avoidance goals in changes occurring in low frustration tolerance (LFT) levels over a span of one academic year. This approach enables us to understand which type of motivational orientation is expected to explain most adaptive educational outcomes. Methods. First year medical students (n = 241) participating in a physician–patient communication course completed the surveys of motivational orientations and LFT at the beginning and at the end of the academic year. A confirmatory factor analysis supported the construct validity of the motivational orientations structure. Results. Cross-lagged analysis using structural equation modelling revealed that the mastery-approach goal was negatively related to the progression of LFT while mastery-avoidance goal was positively related. Conclusions. The findings suggest that what matters is not merely the level of motivation, but rather the type of motivational orientations that students pursue. Encouraging students to improve their current skills, while discouraging competitiveness and reducing fear of losing competence, may enhance the effectiveness of medical training programmes.
  508 89 -
News from here and there

September-October 2019, 32(5):319-320
DOI:10.4103/0970-258X.295971  PMID:32985457
  490 76 -
Letter from London
Anna Ruddock
September-October 2019, 32(5):313-313
DOI:10.4103/0970-258X.295969  PMID:32985452
  476 89 -