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   2017| May-August  | Volume 31 | Issue 2  
    Online since April 20, 2017

 
 
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ORIGINAL ARTICLES
Patient's satisfaction with care in a government health facility in North East India: A cross-sectional study
Bishwalata Rajkumari, Polly Nula
May-August 2017, 31(2):94-98
DOI:10.4103/jms.jms_81_16  
Background: The study of patient satisfaction with care received is of paramount importance in the context of providing quality patient care services. Objectives: This study planned to assess the satisfaction and associated factors among in-patients attending a tertiary care government health facility. Materials and Methods: A cross-sectional study was conducted among all eligible in-patients of a government health care facility in North East India during March and April 2015 using a semi-structured questionnaire assessing seven domains related to patient care services. Descriptive statistics such as mean, standard deviation, percentiles, and percentages were generated and Chi-square test was applied to look for association between the level of satisfaction and other variables such as income, gender, age, and department admitted. Ethical approval was obtained from the Institutional Ethics Committee. Results: A total of 751 patients were interviewed with males constituting 275 (36.6%). Almost one-third 244 (32.5%) of the patients were highly satisfied with the overall care received. Patient education domain was unsatisfactory for 185 (24.6%) of the patients. Patients admitted to surgery and allied departments showed a significantly higher satisfaction level (P < 0.001) with care received than those admitted in other departments. Conclusion: Although the satisfaction level of physician and nursing care domains were high management needs to improve on the comfort and cleanliness of the wards and quality of food service to bring an overall improvement in the quality of care provided and to augment patients' loyalty.
  6,565 598 2
REVIEW ARTICLES
Legal and ethical complexities in the examination of victims of sexual assault in India: A medical practitioner's perspective
Swapnil Sudhirkumar Agarwal, Lavlesh Kumar, Krishnadutt Harishankar Chavali
May-August 2017, 31(2):72-76
DOI:10.4103/0972-4958.204826  
Sexual assault causes tremendous physical and psychological trauma in women and children. Indian law recognizes sexual violence very seriously through various sections of the Indian Penal Code, yet the conviction rate is meager. It resulted in several amendments of Penal and Criminal Procedure Codes, Evidence Act along with Protection of Children from Sexual Offenses Act. These amendments intend to broaden the focus of medical examination from mere collection of evidence to a holistic approach for complete care and rehabilitation of victims.[1] However, these amendments have landed the medical practitioners as well as the victim in conflicts of ethical and legal issue such as mandatory reporting to police even when the victim is nonconsenting; mandatory examination, treatment and rehabilitation by any medical practitioner (government and private), and that too free of cost. The present article aims to highlight such conflicting legal and ethical issues for the medical practitioners who examine and treat such victims. All the relevant and pertinent statutory laws, guidelines, and regulations were studied together from the viewpoint of rights and duties of a medical practitioner. We intend the law makers to review the acts, codes, and guidelines for clarity, leaving no space for perplexity for medical practitioners and at the same time protecting the rights of victims of sexual assault.
  5,885 644 -
ORIGINAL ARTICLES
Diurnal variation of peak expiratory flow rate in healthy young adults: A gender-based study
Sunil Kumar Jena, Arati Mohanty, Rabi Narayan Mania, Ankita Pal
May-August 2017, 31(2):104-108
DOI:10.4103/jms.jms_50_16  
Background: Peak expiratory flow rate (PEFR) variability follows a diurnal rhythmic pattern in healthy people as well as in asthmatics. A number of studies are there on diurnal variation of PEFR in asthmatics. However, there are fewer studies on diurnal variation in PEFR in young adult male and female in Indian population. Objective: To find out diurnal PEFR variability in young male and female separately in Indian population. Materials and Methods: Sixty-three male and 40 female medical students of age 18–24 years were recruited for this study as the participants. After proper training, PEFR recording of the participants was taken at 6–7 am, 9–10 am, 1–2 pm, 5–6 pm, and 10–11 pm by Mini-Wright peak flow meter. Recording was done by students themselves in guidance of principal investigator. Data analysis was done by unpaired t-test and one-way ANOVA. Diurnal variation of each participant was calculated by two indices, i.e., amplitude percent mean (A%M) and standard deviation percent mean (SD%M). Results: There was a significant difference in PEFR at different time periods in both male and female (P = 0.000) which shows lowest at morning followed by progressive rise in day, highest at evening, and again fall at bedtime. A%M between male and female was found significant (P = 0.019), but SD%M between male and female was not significant (P = 0.105). Conclusion: Our study provides the reference data of diurnal variation of PEFR in male and female which further will be helpful in diagnosis and monitoring of bronchial asthma patients.
  5,426 213 -
Scope of integrated teaching in a medical college: A study from South India
T Muthukumar, Rajesh Kumar Konduru, M Manikandan, Johny Asir, Nayyar Iqbal, Joy Bazroy, Anil J Purty, Zile Singh
May-August 2017, 31(2):127-130
DOI:10.4103/jms.jms_98_16  
Background: Medical schools all over India mainly have lectures as the most widely used teaching and learning methods. Current medical education imparts knowledge in a disjointed manner and does not allow students to develop the skills to perceive the patient as a whole. There is a need to teach the students by correlating the various subjects to create interest and promote active learning. Aim: This study was conducted to find out the scope of integrated teaching in the undergraduate medical curriculum. Setting and Design: A cross-sectional study was conducted in a medical college in the coastal region of South India. Methodology: Objectives that are to be achieved by the end of the integrated teaching were clearly drafted, a detailed lesson plan was drafted and was circulated among the faculty and students, and it was decided that the integrated teaching would be conducted in coordination between Department of General Medicine, Department of Microbiology, and Department of Community Medicine. Statistical Analysis: Collected data were entered into MS Excel, and analysis was done using SPSS software. The students' feedback of the session was assessed using Likert scale. Results and Conclusion: The pre- and post-test scores showed that there was statistically extremely significant increase in the knowledge. Overall, 56.7% (38) students gave a feedback of very good for the integrated teaching on a whole. This method is an improvisation in the teaching methods to meet the expectations of the students and to improve the quality of teaching and has the ability to make the teaching–learning process more effective.
  3,915 396 -
Adherence for medication among self-reporting rural elderly with diabetes and hypertension
Parveen Singh, Rajiv Kumar Gupta, Rayaz Jan, Sunil Kumar Raina
May-August 2017, 31(2):86-89
DOI:10.4103/jms.jms_48_16  
Background: Elderly population (age group with >60 years of age) is usually beset with multiple morbidities. Many medications (drugs) are generally prescribed for the management and care of such morbidities. For majority, consumption of such medications on a regular basis is not an easy option, therefore giving rise to nonadherence for medications. The study was conducted with the objective to assess adherence to medication for hypertension and Type 2 diabetes mellitus (T2DM) among rural elderly. Materials and Methods: A cross-sectional observational study was conducted among all rural elderly (more than 60 years of age) being managed for hypertension and type 2 diabetes, using a pretested and semi-structured questionnaire. Results: The number of female elderly was more than the male. Nearly 56% of the elderly with hypertension were not taking regular medication, whereas the comparative figure was 50% for elderly with T2DM. Compliance of treatment in geriatrics with both hypertension and diabetes in relation to the genders was found to be nonsignificant (P> 0.05). The main reasons identified for this were costs of medications, adverse events of drugs, fear of addiction, and declining memory. Conclusions: Nonadherence to medication among the elderly for hypertension and T2DM in this rural study was not uncommon.
  2,833 397 1
LETTERS TO EDITOR
Tramadol for maintenance in poppy husk dependence
Abinav Tewari, Siddharth Sarkar
May-August 2017, 31(2):136-137
DOI:10.4103/0972-4958.204830  
  2,871 169 1
REVIEW ARTICLES
Sofosbuvir: Arrival of a paradigm shift in the management of hepatitis C in India
KNM Singh, SK Kamat, A Shukla
May-August 2017, 31(2):77-85
DOI:10.4103/jms.jms_68_16  
More than 185 million people in the world are affected by hepatitis C, with India having a huge patient load of about 18 million cases. The association of various complications and hepatocellular carcinoma risk with hepatitis C makes it a dangerous health issue. In the early 90s, due to lack of choice for hepatitis C treatment, pegylated interferon (peg-IFN) and ribavirin (RBV) were the widely used agents, but they have low efficacy and multiple side effects. Last decade saw the development of direct-acting antiviral (DAA) agents, including the hepatitis C-specific drug sofosbuvir (SOF). Multiple clinical trials were carried out testing SOF which showed it has excellent efficacy and low side effects. This ultimately led to the approval of SOF in the USA for hepatitis C treatment, in combination with RBV and/or peg-IFN as well as with other newer DAAs. India considered the excellent efficacy and tolerability profile of SOF in the international trials and gave it a marketing approval in early 2015, with a waiver of the national clinical trial data. This has come as a major boost to the millions of hepatitis C patients in the country. However, the exorbitant cost remains a deterrent for its universal use, especially in developing countries like India. The literature search was performed across various databases such as PubMed, EMBASE, and Google Scholar for articles.
  2,714 315 -
ORIGINAL ARTICLES
Determinants of utilization of assisted reproductive technology services in Ilorin, Nigeria
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Kabir Adekunle Durowade, Hadijat Olaide Raji, Sekinat Titilayo Raji, Sikiru Abayomi Biliaminu, Salaudeen Adekunle Ganiyu
May-August 2017, 31(2):109-113
DOI:10.4103/jms.jms_59_16  
Background: Infertility is the most important reproductive health and social issue confronting married couples in developing countries. Assisted Reproductive Technology (ART) offer a chance at parenthood to couples, who until recently would have had no hope of having a “biologically related” child. Aims and Objectives: This study aimed at determining the factors influencing the utilization of ART services at a public health facility in Ilorin, Nigeria. Materials and Methods: A cross-sectional descriptive study of consecutively consenting infertile couples seen at the ART unit of the Department of Obstetrics and Gynaecology, University of Ilorin Teaching Hospital, Ilorin, between January 1, 2012, and December 31, 2015. Results: The patients aged 22–52 years with a mean age of 36.1 ± 6.6 years and mean duration of infertility of 7.3 ± 5.8 years. Majority (87.3%) was aware of ART services; only a few (15.6%) had ever used it. Most (63.3%) were of the opinion that ART is financially accessible. Reasons for nonutilization of ART were high cost (44.3%) and nonavailability (29.4%). Measures to enhance the utilization of ART were cost reduction (61.2%) and awareness creation (27.2%). Knowledge on ART practices showed that 56.7% were aware that the procedure could fail and 35.1% knew that it could address male infertility. Female partner age and parity had a significant influence on awareness and utilization of ART services. Conclusion: Awareness of ART services is high; however, utilization is abysmally low. Efforts should be made to make the procedure more affordable and accessible to the masses.
  2,725 245 1
Profile of acute ST-elevation myocardial infarction patients with hyponatremia
Konsam Biona Devi, Keisham Jaya Chanu, Ratan Ram, Gopinath Narayanaswamy, Ksh Birendra Singh, Dhanaraj Singh Chongtham
May-August 2017, 31(2):119-122
DOI:10.4103/jms.jms_83_15  
Context: In acute ST-elevation myocardial infarction (STEMI), hyponatremia occurs due to neurohormonal activation. Magnitude of this neurohormonal change is related to the severity of myocardial damage. Aims: This study aimed to document the profile of STEMI with hyponatremia and to evaluate the correlation of hyponatremia with Killip class, creatine kinase-muscle brain (CK-MB) level, and degree of ST-elevation. Settings and Design: A longitudinal study was conducted in a tertiary care teaching hospital, Imphal. Patients and Methods: The study included 100 patients with STEMI. Killip class was ascertained on admission. Serum sodium level was estimated on admission, after 24 h, 48 h, and 72 h. CK-MB level was estimated, and the degree of ST-elevation was measured. Statistical Analysis: Statistical Package for the Social Sciences (SPSS 16.0 version) and Student's t-test, Chi-square test, and Fisher's exact test were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Hyponatremia was observed in 44% of the patients. There was no significant relation of hyponatremia with comorbidities such as hypertension, diabetes mellitus, and dyslipidemia. Hyponatremia was associated with Killip III and IV (P = 0.00), higher CK-MB level (P = 0.010), and higher degree of ST-elevation (P = 0.002). Out of six in-hospital deaths, four had hyponatremia. Conclusion: Since hyponatremia was found to be associated with higher Killip class, elevated CK-MB level, and greater degree of ST-segment elevation, it can be speculated that hyponatremia in STEMI patients can be a predictor of poor outcome. Therefore, serum sodium levels can serve as a simple marker to identify patients at high risk.
  2,629 198 2
Effect of palonosetron pretreatment to attenuate the pain caused by propofol injection
Takhelmayum Hemjit Singh, Ningthoujam Anita Devi, Thanigai Arasu, Gojendra Rajkumar, Longjam Eshori Devi, Nongthombam Ratan Singh
May-August 2017, 31(2):90-93
DOI:10.4103/0972-4958.204817  
Objective: Propofol is the induction agent of choice in modern anesthetic practice because of its rapid onset, short duration of action, easy titration, and favorable side effect profile. Pain on injection of anesthetic is an important source of patient dissatisfaction and is a recognized adverse effect of propofol. We compared the effects of pretreatment of palonosetron and saline (placebo) in ameliorating propofol injection pain. Materials and Methods: Sixty adult patients of either sex (18–50 years, American Society of Anesthesiologists I and II) were randomized into two equal groups (n = 30) to receive either 1.5 ml of intravenous saline (placebo) or 1.5 ml of 75 mg palonosetron to compare the pain relieving effects of the drugs during propofol injection before the patients had lost consciousness. The propofol injection pain was assessed according to McCririck and Hunter scale. Results: The palonosetron group had significantly (P < 0.05) more patients (86.67%) without propofol injection pain as compared with the saline group (56.67%). Conclusion: Pretreatment with palonosetron with venous occlusion for 1 min can effectively reduce the incidence of propofol injection pain.
  2,449 293 -
A comparative study of the antiemetic effect of intravenous palonosetron with granisetron for the prevention of postoperative nausea and vomiting following laparoscopic cholecystectomy under general anesthesia
Priyadarshini Sharma Monohar, Longjam Eshori, Lairenlakpam Deban Singh, Nongthombam Ratan Singh, Gojendra Rajkumar, Sofia Haobam
May-August 2017, 31(2):114-118
DOI:10.4103/0972-4958.204818  
Background: Postoperative nausea and vomiting (PONV) is commonly experienced unpleasant complications of general anesthesia following laparoscopic cholecystectomy (LC). The present study was undertaken to compare the efficacy of palonosetron with granisetron in the prevention of PONV following LC under general anesthesia (GA). Materials and Methods: In a randomized, double-blinded study, after Ethical Committee approval, 100 adult patients aged 18–65 years, American Society of Anesthesiologists I/II undergoing elective LC under GA during a 2-year period in a Tertiary Care Hospital in Imphal were assigned into one of two groups. Group P (n = 50) received palonosetron 0.075 mg intravenous (IV) and Group G (n= 50) received granisetron 40 μg/kg body weight in 4 ml NS (0.9% normal saline added to get desired volume), 10 min before induction of anesthesia. Standardized anesthetic technique was used, and data were collected for PONV in postanesthesia care unit for 0–2 h and in the postoperative ward for 2–48 h. Results: The incidence of early PONV (0–2 h) was 28% in Group P (palonosetron) and 32% in Group G (granisetron), whereas the incidence of late PONV (2–48 h) was 18% in Group P and 32% in Group G. However, palonosetron had lesser delayed onset nausea (2–48 h) compared to granisetron (P = 0.037). Common side effects observed in the two groups were similar with no statistically significant difference between the groups. Conclusion: Prophylactic IV palonosetron was as effective as granisetron in preventing early (0–2 h) PONV. However, palonosetron was significantly better in the prevention of late onset nausea (2–48 h) in patients undergoing LC under GA without any major adverse effects.
  2,495 213 2
Efficacy of pretreatment with intravenous paracetamol and lidocaine on rocuronium injection pain: A randomized, double-blinded, placebo-controlled study
Maharabam Binarani, Yumnam Arunkumar Singh, Deban Singh Lairenlakpam, Sinam Manichandra Singh, Longjam Eshori, Neetu Sinam
May-August 2017, 31(2):99-103
DOI:10.4103/0972-4958.204828  
Background: Pain and withdrawal movement during rocuronium injection are common. The present study was conducted to compare the effect of paracetamol and lidocaine in ameliorating rocuronium injection pain and withdrawal movements. Materials and Methods: With approval of the Institutional Ethics Committee, 135 adult patients of both sexes aged 18–65 years with American Society of Anesthesiologists I or II, undergoing general anesthesia, were recruited to this randomized, double-blinded, placebo-controlled study, and patients were randomly divided into three equal groups. A rubber tourniquet was applied to the arm with intravenous line to occlude the venous drainage. Then, one of the pretreatment solutions was given, Group P received 50 mg paracetamol, Group L received 40 mg lidocaine, and Group S received 5 ml normal saline. After 2-min, tourniquet was released, and subparalyzing dose of rocuronium bromide 0.06 mg/kg was given and pain assessed using a 4-point verbal rating scale. Anesthesia was induced using 2.5% thiopentone sodium, followed by giving the remainder of calculated dose of rocuronium. During and after injection of rocuronium, withdrawal movements were observed and graded on a 4-point scale. Results: The incidence of pain on injection of subparalyzing dose of rocuronium in paracetamol, lidocaine and saline groups was 35.5%, 20%, and 55.5%, respectively (P < 0.05). The incidence of withdrawal movements while giving the bolus dose of rocuronium in paracetamol, lidocaine, and saline was 35.6%, 28.8%, and 59.9%, respectively (P < 0.05). Conclusion: Both paracetamol and lidocaine were effective in reducing rocuronium injection pain and withdrawal movements, but lidocaine is more effective than paracetamol.
  2,398 151 -
Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain
Feiga Luckson Gangmei, Longjam Eshori, Sanasam Sarat Singh, Nongthombam Ratan Singh, Mohan Thapa, Sagar Debbarman
May-August 2017, 31(2):123-126
DOI:10.4103/0972-4958.204820  
Background: Propofol injection pain is one of the significant drawbacks to its use as an intravenous (IV) anesthetic induction agent so this study has been undertaken to compare the efficacy of IV acetaminophen and lidocaine on propofol injection pain. Materials and Methods: After obtaining Institutional Ethical Committee approval, ninety adult patients of ages 18–60 years of both sexes and American Society of Anaesthesiologist I and II who underwent elective surgery from September 2013 to September 2015 in the Tertiary Care Hospital, Imphal, were randomly allocated to one of the three groups to receive 10 ml saline (Group 1), 40 mg lidocaine (loxicard) in 10 ml saline (Group 2) and acetaminophen 100 mg (10 ml) (Group 3) to compare the pain efficacy during propofol injection into the large dorsal vein on the left hand. Pain was assessed with a verbal rating scale. Results: It was observed that the number of patients experiencing pain was 20 (66.67%), i.e., mild: moderate: severe - 11 (36.67%): 6 (20%): 3 (10%) in Group 1, in Group 2 the incidence was 2 (6.67%) i.e., mild: moderate: severe - 2 (6.67%): 0: 0, and in Group 3 it was 6 (20%) i.e., mild: moderate: severe - 5 (16.67%): 1 (3.33%): 0, respectively (P < 0.001). Conclusion: IV acetaminophen and lidocaine could significantly reduce pain during propofol injection with a significant P< 0.001.
  1,968 141 -
GUEST EDITORIAL
Frailty syndrome in older adults
Taruni Ngangbam
May-August 2017, 31(2):71-71
DOI:10.4103/jms.jms_24_17  
  1,740 299 -
LETTERS TO EDITOR
Iatrogenic hepatitis - A term medical personnel are reluctant to use
Immad Arif, Salman Assad
May-August 2017, 31(2):134-135
DOI:10.4103/0972-4958.204825  
  1,779 88 -
CASE REPORT
Lingual thyroid: A rare anomaly
Banyameen Iqbal, Iqra Mushtaq
May-August 2017, 31(2):131-133
DOI:10.4103/0972-4958.204829  
Lingual thyroid (LT) is a rare developmental anomaly originating from aberrant embryogenesis during the passage of the thyroid gland through the neck. LT has an incidence of one in 3,000, with an overall prevalence of one in 100,000. Female to male ratio ranges from 4:1 to 7:1. Clinical presentation is varying, more related to oropharyngeal obstruction, causing mild to severe dysphagia and/or upper airway obstruction, dysphonia, and sleep apnea. Up to 70% of patients with LT have hypothyroidism. Surgery is the treatment of choice in symptomatic cases. We, hereby, report a case of a 16-year-old girl who presented with a midline swelling at the base of the tongue, was hypothyroid, and on oral thyroxine. The swelling was surgically removed and was diagnosed to be LT. The significance of reporting this case is that it should be recognized and treated at the earliest because of the ill effects of hypothyroidism associated with it.
  1,725 90 -
LETTERS TO EDITOR
Recommending global public health strategies to counter the impact of climate change on health
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
May-August 2017, 31(2):138-139
DOI:10.4103/0972-4958.204821  
  1,286 85 1
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