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   2018| September-October  | Volume 11 | Issue 5  
    Online since September 5, 2018

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Quality of service and associated factors in neonatal intensive care unit at Debre Berhan Referral hospital, Debre Berhan Ethiopia: A cross sectional study
Wassie Negash Mekonnen, Alemnesh Mekuanint Desalegn
September-October 2018, 11(5):412-419
Background: Neonatal Intensive Care Units (NICUs) are important units to maintain the health of newborns in hospitals. However, there are complaints about the quality of care in the NICU. Objective: The aim of this study was to assess the quality of services and associated factors in the NICU at Debre Berhan Referral Hospital. Materials and Methods: We conducted a cross-sectional study from January to June 2017 on a sample of 129 neonates. The data were collected through 5-point Likert scale questionnaire and observation and analyzed using SPSS version 20. In the meantime, bivariate and multivariate logistic regression was computed. We considered the level P < 0.05 statistically significant. Results: The maternal mean satisfaction score in the NICU was 77%. Majority (89%) of the respondents were satisfied with compassionate care and 85.5% with cleanliness of the compound. Half of the respondents, i.e., 53.5%, were dissatisfied with waiting time for card and test results. Equipment and drugs were not fulfilled in the NICU ward. The odds ratio of maternal satisfaction was higher among mothers who were satisfied with complaint procedures (adjusted odds ratio [AOR] = 13.8, 95% confidential interval [CI]: 4.48–42.38), those who were allowed to have visitors (AOR = 17.04, 95% CI: 2.83–102.4), and those who were satisfied with functionality and cleanness of toilet (AOR = 9.59, 95% CI: 1.19–76.87). Conclusions and Recommendations: The over all levels of maternal satisfaction were suboptimal. Mothers were highly satisfied with medication availability and cleanness of the hospital compound. Being satisfied with complaint procedure, allowed to have visitors, and satisfied with functionality and cleanness of toilet were the independent predictors.
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Prevalence and risk factors of hypertension among women in a rural community of Maharashtra
Maj Rekha Sharma, Ravikant Nair, Raj Kumar, Dashrath Basannar
September-October 2018, 11(5):400-405
Background: There are very few epidemiological studies on the prevalence of hypertension and its risk factors among women in the rural population. This cross-sectional study was carried out to determine the same in a rural community. This study was carried out in a rural population of Maharashtra in a rural field practice area of a Medical college with which the author is affiliated. The present study is thus a novel effort to measure the burden related to hypertension and related sociodemographic factors in a rural setting among women aged >30 years. Materials and Methods: A random sample of 220 women of 30 years and above were selected from a rural area. The study participants were selected using simple random sampling technique using lottery method. Numbers were allotted to every individual. All the women were then listed. This became the sampling frame. An individual was taken as the sampling unit. The pre-tested pro forma was used to collect the data by trained doctors. Results: Maximum participants in the study were from age group 30–39 years (33.6%), followed by 40–49 years (23.2%). Mean and standard deviation (SD) of age among study participants was found to be 47.7 ± 13.4 years. A total of 155 (70.5%) of the study participants used tobacco in one or the other smokeless form. About 29.5% of the study participants never used tobacco in the lifetime. The most common form of smokeless tobacco consumption was Mishri (71.6%) followed by tobacco which was used by 27% of the participants. Supari was also consumed by few of the participants. About 51.4% of the participants consumed >5 g (World Health Organization recommended level) of salt per day. All the participants consumed extra salt in the form of pickle/papad/table salt over and above that consumed in meals. About 8.2% of the study participants were found to be underweight while 21.2% were overweight. 3.2% of the study participants were in Grade I obesity and only one (0.4%) was in morbid obesity category. 70% of the study participants who had waist-hip ratio ≤ 0.85, whereas 30% of them had ratio > 0.85. Nearly 52% of the study participants gave a positive family history of hypertension among first-degree relatives. Only 22 (68.7%) of those participants diagnosed with hypertension were taking antihypertensive drugs and nearly half of these participants 12 (54.5%) were taking regular medication. 34.1% of participants had systolic blood pressure (BP) >140 than mmHg (isolated systolic hypertension) while 37.2% had diastolic BP >90 mmHg (isolated diastolic hypertension). The mean systolic BP calculated was 130 mmHg with SD 20.7 with 95% confidence interval (CI) of mean to be 127.5–132.8 mmHg, whereas diastolic BP was 83 mmHg with SD 11.1 with 95% CI of mean to be 81.7–84.6 mmHg. The overall prevalence of hypertension among the study participants was calculated to be 23.6% with 95% CI to be 18.2–26.8 mmHg. Conclusion: Prevalence of systolic hypertension in rural community was 34.1% and of diastolic hypertension 37.2% with an overall prevalence of 23.6%. Significant associations were found between the presence of hypertension and various sociodemographic variables using Chi-square test. Furthermore, there was a significant association between hypertension and consumption of smokeless tobacco, low physical activity level.
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Massive splenomegaly associated with multiple splenunculi in B-Thalassemia major
Rahul Gupta, Jhankar Mittal, Nilima Soni
September-October 2018, 11(5):433-435
A 4-year-old male child with β-thalassemia major presented with massive splenomegaly and hepatomegaly along with increasing transfusion requirements (700 ml/kg/last year). Splenectomy was performed; the meticulous search revealed two small splenunculi embedded in the greater omentum near the splenic hilum, which was removed. Histopathological examination confirmed splenunculi. It is important to remove splenunculi during splenectomy for hematological disorders because failure to remove them may result in the nonresolution of the condition as they take over the function of the original spleen.
  1 4,815 208
Pleural effusion in silicosis: A rare case report
Pragyan Rout, Garima Markam
September-October 2018, 11(5):436-438
Silicosis is a diffuse pulmonary interstitial disease characterized by a fibrotic response in lung parenchyma caused by continual inhalation of crystalline silica (SiO2). Pleural effusion is an extremely rare presentation of silicosis. To the best of our knowledge, there have been only few cases of silicosis with pleural effusion reported in medical literature. Herein, we describe a case of a 60-year-old male, who presented with shortness of breath for 5 years. He was a nonsmoker. He had a history of exposure to mineral dusts for 25 years. Chest X-ray showed left-sided pleural effusion and bilateral reticulonodular opacities. High-resolution computed tomography thorax showed the presence of bilateral pleural effusion (left >right) with left-sided pleural thickening, bilateral septal thickening, and bilateral randomly distributed nodules, and also bilateral segmental consolidation with air bronchogram. The patient had undergone extensive workup and was diagnosed with silicosis.
  1 2,612 198
Undifferentiated/Anaplastic thyroid carcinoma: A cytological case report
Sunil Yogiraj Swami, Arun D Chopwad, Arvind G Valand
September-October 2018, 11(5):449-451
Undifferentiated thyroid carcinoma is a relatively uncommon highly malignant tumor originating from the follicular cells of thyroid gland having poor prognosis. It accounts for 2%–5% of all thyroid carcinomas and patients typically present with a rapidly growing anterior neck mass with aggressive symptoms. A 70-year-old female presented with diffuse neck swelling measuring 6 cm × 5 cm for 1-month duration which was associated with mild dyspnea. Fine needle aspiration cytology (FNAC) from the swelling revealed a cellular smear comprising of highly pleomorphic follicular epithelial cells arranged in clusters and singly scattered with a background of bizarre tumor giant cells and inflammatory cells.
  1 3,839 200
Tracheal buckling: A bizarre but normal finding in chest radiograph of a sick preterm infant
G Sandhya Krishnan, M Gomez Joseph, Victor Samuel Rajadurai, Suresh Chandran
September-October 2018, 11(5):427-429
Lateral deviation or buckling of the tracheal air column just above the thoracic inlet is infrequently observed on frontal chest X-rays of infants and young children. Tracheal buckling can cause unnecessary concern and alarm to neonatal and pediatric intensivists when dealing with critically ill infants. We report a case of preterm female infant, who was born at 25 weeks of gestation and required intubation at birth and surfactant administration. She was extubated to continuous positive airway pressure support at 5 h of life. On day 24 of life, she had increasing respiratory distress and X-ray of the chest was done. The X-ray showed a significant right lateral deviation of the trachea, raising the concern of mediastinal mass effect or right upper lobe collapse to the attending neonatologist. However, the radiologist diagnosed the lateral deviation of the trachea as benign tracheal buckling. The infant was intubated and ventilated. Two weeks later, a postextubation chest X-ray showed normal trachea.
  1 5,609 234
Do research workshops lead to research: Or is it like lecturing birds how to fly?
Amitav Banerjee
September-October 2018, 11(5):383-384
  1 3,010 315
India's national health protection scheme: A preview
Reema Mukherjee, Manisha Arora
September-October 2018, 11(5):385-388
India has recently announced the “Ayushman Bharat–National Health Protection Scheme (AB-NHPS),” one of the largest government health insurance schemes in the world. The scheme aims to provide quality health care to the poor and vulnerable families, a step forward toward the government's commitment on universal health care. The beneficiary households under the AB-NHPS will be based on the deprivation and occupation status of the family, drawn from the Socioeconomic and Caste Census database. The scheme will take care of all the secondary health care and most of the tertiary health care procedures. The road map envisaged for the implementation of the scheme consists of number of challenges such as funding, acceptance by the states, exclusion of primary health care, and outpatient expenditure from the scheme. We conclude that successful implementation of the said scheme will require robust planning, stringent regulations, simplified processes, and continuous monitoring using advanced technological E-health platforms.
  1 4,834 501
Primary pleomorphic adenoma of the parapharyngeal space
Shreeya Taresh Indulkar, Manisha Khare, Yasmeen Khatib, Yogita Mangaldas Talpade
September-October 2018, 11(5):420-422
Parapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all head-and-neck neoplasms. Most of them are benign and originate in the salivary glands. Pleomorphic adenoma is the most common benign salivary gland tumor originating from PPS. We report a case of a 32-year-old patient presented with the complaints of a snoring, excessive daytime sleepiness, and painless parapharyngeal mass from 3 to 4 years. As PPS tumors are difficult to diagnose early due to their complex anatomy and vague presentation, histopathological examination remains the gold standard for final diagnosis.
  - 2,254 172
Anesthetic management of a patient of multinodular goiter with retrosternal extension presenting with obstructive sleep apnea for total thyroidectomy
Vidhu Bhatnagar, Abhijit A Karmarkar, Vibhu P S. Raghuvanshi
September-October 2018, 11(5):423-426
Multinodular goiter (MNG), one of the disorders of the thyroid gland, is often detected as a mass in the neck, but sometimes produces pressure symptoms. We present successful anesthetic management of a case of an obese woman having MNG with retrosternal extension, in the setting of severe OSA, planned for total thyroidectomy. The complicated presentation of the disorder, with challenging airway management during the peri-operative period and a positive outcome is a reason for sharing this experience.
  - 3,589 230
Very rare childhood tumor: Giant cell fibroblastoma
Aditya Pratap Singh, Arun Kumar Gupta, Maryem Ansari, Sunil Kumar Mehra, Dinesh Kumar Barolia
September-October 2018, 11(5):452-454
Giant cell fibroblastoma (GCF) is an intermediate grade, soft-tissue tumor of childhood with a high incidence of local recurrence. GCF merits attentive interpretation as they have been misdiagnosed as sarcoma in the past leading to erroneous remedies. Here, we are reporting the case of GCF in 13-month-old boy who presented with a painless swelling over the left gluteal region for the past 3 months.
  - 2,288 176
Congenital infiltrating lipomatosis of the face
Nikhil Nair, Anupama Ramachandran
September-October 2018, 11(5):439-443
Congenital unilateral facial enlargement can be attributed to a host of clinical conditions ranging from lipomatosis, lymphangioma, and vascular malformations to congenital overgrowth syndromes. Congenital infiltrating lipomatosis of the face (CILF) is one among them and is considered as a variant of benign lipomatosis. The exact etiology and pathogenesis are not known. It is characterized by proliferation and infiltration of adipocytes into adjacent muscles and soft tissues along with hypertrophy of underlying bones. Radiological imaging plays a central role in diagnosis as it enables accurate identification of CILF. Magnetic resonance imaging demonstrates the fatty nature of the disease, and computed tomography demonstrates the osseous abnormalities. In this case report, we discuss the case of an 8-year-old female child who presented with facial hemihypertrophy and how the rare diagnosis of CILF was clinched at imaging. The utility of radiological imaging in differentiation of CILF from its close differentials is also discussed.
  - 2,046 145
Pregnancy-associated hyperkeratosis of nipple/areola
Pratiksha Sonkusale, Sumit Kar, Nidhi Yadav, Pooja Bonde
September-October 2018, 11(5):444-446
Hyperkeratosis of nipple is uncommon, benign, asymptomatic, acquired condition of unknown pathogenesis. Most cases are bilateral, although unilateral cases had been reported. Breastfeeding is usually not affected. Physiologic changes of the nipple and areola during pregnancy include enlargement, hyperpigmentation, secondary areolae, erectile nipples, prominence of veins, striae, and enlargement of the Montgomery glands or tubercles (hypertrophied sebaceous glands). Women with unilateral primary hyperkeratosis of the nipple and/or areola may have bilateral disease during pregnancy (secondary hyperkeratosis of the nipple and/or areola). Pregnancy may also produce thicker, darker lesions. Here, we report a case of pregnancy-associated hyperkeratosis of nipple in a primigravida. We counseled her about benign nature of the condition and treated her with topical steroids and moisturizers.
  - 3,621 222
Isoniazid-induced acute pancreatitis in a child with tuberculous meningitis
Himali Meshram, Ira Shah
September-October 2018, 11(5):447-448
Drug-related acute pancreatitis is uncommon in children and is mostly caused due to valproic acid, l-asparaginase, prednisone, and 6-mercaptopurine. Anti-tuberculous drugs causing pancreatitis are rare. We present a 3-year-old girl with tuberculous meningitis who developed isoniazid (INH)-induced pancreatitis. She has persistent vomiting in spite of omission of steroids and ultrasound showed bulky pancreas with high serum amylase. Her vomiting subsided with the omission of INH.
  - 2,450 169
Acute acalculous cholecystitis after transurethral resection of the prostate
Saman Farshid, Melina Eghbal, Behzad Abyar, Sina Dindarian, Sedra Mohammadi
September-October 2018, 11(5):430-432
A 61-year-old man presented with a history of 4-month progressive hematuria, frequency, urgency, urinary straining, and terminal dripping, and he was treated with transurethral resection of the prostate in Imam Khomeini Educational Hospital, Urmia, Iran, in August 2016. Four days later, he developed fever, abdominal tenderness, abnormal liver function, and loss of consciousness. Computed tomography scan showed all classical findings suggestive of acute acalculous cholecystitis (AAC). Laparoscopic cholecystectomy was performed. The result showed a distended gallbladder with thickened walls. As the patient presented in this report had no risk factors for acalculous cholecystitis, physicians should be aware of the possibility of AAC as a life-threatening event after transurethral resection of prostate.
  - 2,166 160
Failure to attain set targets for non-communicable diseases: World health organization
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-October 2018, 11(5):455-456
  - 1,518 145
Diagnostic dilemma of severe excruciating low backache in pediatric patient following spinal anesthesia
Sushama Raghunath Tandale, Kalpana V Kelkar, Shriaunsh R Abhade, Vaijayanti N Gadre
September-October 2018, 11(5):456-457
  - 1,532 164
Life satisfaction and correlates among working women of a tertiary care health sector: A cross-sectional study from Delhi, India
Mamta Parashar, Mitasha Singh, Panna Lal
September-October 2018, 11(5):406-411
Background: The dual role of women at home and workplace negatively impacts their quality of life. The health-care system demands quality services and urbanization and globalization have increased the demands of every individual to lead a satisfactory life. Objective: The aim of this study is to find the correlates of life satisfaction (LS) among working women of the health sector. Methodology: A descriptive cross-sectional study was conducted among female staff in the campus of a tertiary care center of New Delhi for 6 months (2011–2012). A sample of 345 women was selected with equal representation from all the departments of the institution. All participants were asked to complete modified pretested semi-structured LS scale by Alam and Srivastava. Results: The prevalence of overall satisfaction among working females in our study was 39.3%. Females were highly satisfied with their job, but satisfaction level in health and the economic domain was low. Age, type of occupation, mode of transport, family type, and income as compared to the husband's income were the significant correlates of satisfaction level in different domains. Conclusions: Satisfaction among workers that to females in the health sector is proportional to job profile which comes at the cost of their personal needs. These tentative conclusions demand further investigations determining causality of the observed associations. It is high time to make our workplace environment worker-friendly to increase the output.
  - 4,416 264
Amalgamating psychiatric services with polyclinic in a multispecialty service hospital
Rajiv Kumar Saini, Jyotindu Debnath, Sunil Aggarwal, Suprakash Chaudhury
September-October 2018, 11(5):389-394
Background: Provision of multitude of medical services under one roof is a norm in modern hospitals. However, in many service hospitals, psychiatric services are still confined within the premises of psychiatric wards. Due to the social stigma attached to psychiatric care many psychiatric patients avoid visiting the psychiatric ward for mental health care. The main objective of this study was to improve attendance in the psychiatric outpatient department (OPD) by making it accessible and acceptable for the clientele in a busy multispecialty service hospital. Materials and Methods: This retrospective study was carried out from January 1, 2009, to December 31, 2010. During the 1st year of the study (i.e., 2009), psychiatry OPD services continued in the psychiatry ward. From January 1, 2010, psychiatric OPD was shifted to polyclinic with a new name as “Department of behavioral sciences and deaddiction.” The data for the year 2009 and 2010 were compared using the Chi-square test. Results: There was a significant rise in the total number of new OPD patients from 522 to 1779 (P < 0.05) in 2010. Among various age groups, in 41–50 years of age group (144 [27.6%] vs. 574 [32.26%], P < 0.05) and those above 70 years (12 [2.29%] vs. 96 [5.39%], P < 0.05) the rise was highly significant. There was a significant increase in the number of patients with substance abuse (38 [7.27%] vs. 188 [10.56%], P < 0.05) and childhood and adolescent psychiatric disorders (42 [8.04%] vs. 213 [11.97%], P < 0.05). Conclusion: Amalgamation of psychiatric OPD services with other specialist OPD services in service hospital resulted in better utilization of psychiatric services.
  - 2,537 207
Constraint-Induced movement therapy is a potential treatment for improving upper limb function in stroke patients
Sajid Ali, Maryam Shabir, Muhammad Mustafa Qamar, Ayesha Basharat, Javid Ali, Waqas Ahmad
September-October 2018, 11(5):395-399
Introduction/Background: Task-oriented training is a therapeutic approach based on the system theory of motor control. Constraint-induced movement therapy improves upper extremity function in stroke by increasing the use of their affected upper limb. The aim of this study is to compare the different types of goal setting, one is task-oriented and other is constrained-induced movement therapy in stroke rehabilitation. Constrained-induced movement therapy goal setting combined with a task-oriented approach to improve upper limb function in subacute stroke patients. Materials and Methods: This was a randomized clinical trial study, conducted in Lahore in which 40 stroke patients had participated, randomly assigned into two groups. Group A comprised task-oriented movement therapy and Group B comprised constraint-induced movement therapy. The measurement was taken at baseline, after 1 and 2 months. Results: The baseline readings were the same. Constrained-induced movement therapy showed a significant improvement in grip, grasp, pinch, and gross motor activities VS task-oriented movement therapy (<0.05). Conclusions: This study concluded that constrained-induced movement therapy is a potential treatment for upgrading motor limit of upper limb and activities of step-by-step living in patients with stroke.
  - 3,490 415