Issue: Vol 2, Issue 4, Oct-Dec, 2012 :


Year : 2012 – Volume: 2 Issue: 4


Review Article

Unrelenting burden of anaemia in India: Highlighting possible prevention strategies

Ravi Prakash Upadhyay, Palanivel C and Vaman Kulkarni

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The paper highlights the extent of the problem of anaemia, its associated causes along with the consequent effects on the overall health of the people as well as on the productivity of the nation. Different interventions implemented on country level scale as well as future lines of actions have been delineated. Anaemia is widely prevalent in India with over half of women and one-fourth of men suffer from anaemia. Anaemia directly causes 20 per cent of maternal deaths and indirectly accounts for another 20 per cent of maternal deaths. Nearly 79% of children aged 6–59 months are anemic. The estimated Disability Adjusted Life Years (DALYs) per 100,000 were 450 for the year 2004. A multi-intervention approach is needed encompassing adequate nutritional intake through dietary supplementation, food fortification and dietary modification, along with reduction of concurrent infection. There should be strengthening of Vitamin and Mineral Nutrition Information System (VMNIS) supported with firm political commitment. Keywords: Anaemia, Burden, Prevention, India

Page No: 1-6 | Full Text


Original Research Article

Self medication pattern in rural areas in Pune, India

Yogendra Keche, Radha Yegnanarayan, Shraddha Bhoyar, Rashi Agrawal, Roshani Chavan and Priyanka Mahendrakar

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Objective: This study was carried to analyze the self medication pattern in rural areas of Pune. Method: Semi-structured questionnaire was used for collection of data. Information about age, sex, name of the self medication, diagnosis for the use of self medication, source of information about the self medication and adverse effects reported to self medications was collected. Results: NSAIDs (33.33), antibiotics (10.32), vitamins (14.08) and GIT ailment drugs (13.61) are most commonly used as self medication in rural areas. Other drugs that self medicated are: drugs for upper respiratory tract infection, antibiotics, antihypertensives, anticonvulsants and diuretics. Information about the self medication was predominantly obtained from previous prescription of doctors (64.32%) and from chemists (23%). Antibiotics like macrolides, fluoroquinolones, cephalosporins, antihelminthics, and furazolidine were taken as self medication in rural areas. 50% of antibiotics used as self medication was associated with development of ADRs. The adverse effects reported with antibiotics self medication were: vomiting, hyperacidity, gastrointestinal discomfort. 21.13% of persons reported adverse effects with NSAIDs self medication. Adverse effects reported with analgesic use in this study were: hyperacidity, skin rashes, nausea. Conclusions: NSAIDs, antibiotics, vitamins and GIT ailment drugs are commonly self medicated in rural areas of Pune. The self medication of antibiotics is disturbing, as these are liable for drug resistance and severe ADRs and hence should be taken under supervision only. Pharmacists, key person in rural areas, can provide information about adverse effects of self medicated drugs and also can guide about proper precautions to be taken for self medication. Keywords: ADRs to self medication, Antibiotic self medication, NSAIDs self medication

Page No: 7-11 | Full Text


Original Research Article

An assessment of QOL and its determining factors of post menopausal women in a rural area of West Bengal, India: A multivariate analysis

Dr. Sudeshna Ray and Professor Aparajita Dasgupta

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Objective: The aim was to assess QOL and its determining factors among postmenopausal women of a rural area of West- Bengal in India. Methods: This cross-sectional study was conducted among 315 postmenopausal women and the data were collected using the modified menopause quality of life questionnaire of Hilditch. (Hilditch MENQOL). Results: Out of the 315 women who have been interviewed 243 (77%) had poor quality of life. Multivariate analysis revealed that poor QOL was more among those who did not live with their own children [AOR (95% C.I.) 4.26 (2.1–8.6)], did not undertake regular exercise, [AOR (95% C.I.) 2.88 (1.38–6.03)], were literate [AOR (95% C.I.) 2.5 (1.13–4.8)], were monetarily dependent on their children [AOR (95% C.I.) 2.5 (1.32–4.88)], not living under one roof with children [AOR (95% C.I.) 4.26 (2.1–8.6)] and had attained menopause >5 years. [AOR (95% C.I.) 4.82 (2.47–9.41)]. Conclusion: Different stakeholders are required to mobilize the post-menopausal women through IEC activities to cope up with the stress of the post-menopausal phase and acquire a better quality of life beyond their reproductive age. Keywords: Post-Menopausal Women, Quality of Life, Determinants of QOL, Multivariate analysis

Page No: 12-19 | Full Text


Original Research Article

Brain natriuretic peptide (BNP): A diagnostic marker in congestive heart failure-induced acute dyspnea

Sheikh Ishaq, Sheikh Afaq, Harnam Kaur, Neeru Bhaskar, Qazi Najeeb and Rajesh Pandey

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Heart failure (HF) is a clinical syndrome that occurs in patients who because of an inherited or acquired abnormality of cardiac structure and/or function develop a constellation of clinical symptoms (dyspnea and fatigue) and signs (edema and rales) that lead to frequent hospitalizations, a poor quality of life, and a shortened life expectancy. 1 Acute dyspnea is a common clinical finding with which the patient is admitted in the emergency department. A rapid and accurate investigation of acute dyspnea is vital since treatment of dyspnea can differ markedly depending on the initial clinical impression. However, the rapid and accurate differentiation of heart failure from other causes of dyspnea remains a clinical challenge. After evaluating patient’s symptoms, conducting a physical examination, and performing electrocardiography (ECG) and chest radiography, the clinician is often left with considerable diagnostic uncertainty, which results in misdiagnosis and delays the initiation of appropriate therapy. Distinguishing between cardiac and non-cardiac causes of dyspnea is often challenging. Therefore, an assay with high sensitivity and high negative predictive value would be useful both in detecting dyspnea due to heart failure and in ruling out the diagnosis in patients with confounding co-morbid conditions.

Page No: 20-23 | Full Text


Original Research Article

Effect of literacy on family planning practices among married women in rural south India

Rizwan S A., Ankita Kankaria, Ronald K. Roy, Ravi P. Upadhyay, Palanivel C., Vinoth Gnana Chellaiyan and Surendra Babu D.

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Background and Aim: Few studies in India have tried to examine the role of female literacy on contraception usage. This study aimed to determine family planning related knowledge and practices and their association with female literacy. Materials and methods: Facility based cross-sectional study was done among married women aged 15–45 years attending outpatient department of three primary health centres in rural Tamilnadu. Data were collected using pretested semistructured questionnaire by a convenience sampling technique. To assess family planning related knowledge, a composite score was calculated and final score was categorised into satisfactory and unsatisfactory. Results: A total of 100 women participated. Fifty nine percent had satisfactory Family Planning related Knowledge and practices (FPK). Contraception prevalence rate for modern methods was 60%. Eighty percent had ever undergone abortions and among them, one fifth had undergone uncertified abortions.With increase in the literacy status, proportion having satisfactory family planning related knowledge increased (p < 0.001) and the parity decreased (p < 0.001). More literate women were using contraception, had undergone sterilization, had undergone certified abortions and had less male child preference compared to illiterate women. Conclusion: This study offers evidence that promotion of female literacy could be considered a strategy for promoting contraceptive usage and addressing population growth in India. Keywords: Family planning, Contraception, Female literacy, Facility based study, India Author’s contributions: RSA, RKR conceived the idea, prepared the protocol, developed

Page No: 24-27 | Full Text


Original Research Article

Lipid profile and lipoprotein(a) in chronic renal failure patients with and without hemodialysis

Hariom Sharma, Tejas J. Shah, Jignesh H. Gorasia and Dipika P. Baria

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Objectives: Chronic renal failure (CRF) is complicated by characteristic dyslipidemias. CRF patients on hemodialysis have abnormalities in lipid profile and have a high incidence of cardiovascular diseases. Lipoprotein(a) [Lp(a)] is now considered as a novel cardiovascular risk factor and its level is increased in CRF patients with and without hemodialysis. We sought to evaluate the pattern of lipid profile including Lp(a) level in CRF patients with and without hemodialysis. Methodology: Study were divided into 3 groups, Group-I: healthy controls (30), Group-II: CRF patients who never undergone hemodialysis (30) and Group-III: CRF patients on hemodialysis for more than 6 months (30). We obtained serum samples from patients in the morning after an overnight fast and were analysed for total cholesterol (TC), triglycerides (TGs), HDL, LDL, Lp(a) using standard colorimetric assays on fully automated analyzer. VLDL concentration was calculated using Friedewald’s Formula. Results: Among the various parameters tested triglyceride and VLDL levels were significantly higher in group-II and III as compared to controls (p<0.01). HDL levels were significantly lower in group-II and III as compared to control (p<0.05). HDL level was found reduced in group-III as compared to Group-II (p<0.01). There was no significant change (p>0.05) observed in total cholesterol and LDL levels in between healthy controls and CRF patients with & without hemodialysis. Lp(a) levels were significantly higher in group-II and III as compared to controls (p<0.01) but the difference between Lp(a) levels in group-II and III was found insignificant (p>0.05). There was no significant difference (p>0.05) observed between Lp(a) levels and lipid profile in male and female patients in control group and in CRF patients with and without hemodialysis. Conclusions: This study demonstrated that CRF patients with and without hemodialysis are at greater risk of development of dyslipidemias, characterized by hypertriglyceridemia, elevated VLDL and Lp(a) levels and decreased HDL levels. Total cholesterol and LDL cholesterol levels remain normal or decreased in these patients. Both male and female patients of CRF with and without hemodialysis have dyslipidemias without any discrimination of sex and it is not attenuated by the hemodialysis process. Keywords: Chronic renal failure, Lipid profile, Lipoprotein(a), Hemodialysis

Page No: 28-31 | Full Text


Original Research Article

Diagnostic value of the commercial MycoDotTM test in the diagnosis of active pulmonary tuberculosis in Nepalese population

Anil Chander and Chandrika Devi Shrestha

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Background: A rapid, technically non-demanding and inexpensive diagnostic test is needed to improve the early detection and better management of active pulmonary tuberculosis especially in resource limited areas. Objective: To assess the diagnostic value and usefulness of the commercially available MycoDotTM (DynaGen Inc., Cambridge, MA, USA) in the diagnosis of active pulmonary tuberculosis in Nepalese population. Materials and Methods: A prospective study was done from January 2008 to August 2008 on a group of 120 sputum smear positive adult patient group aged 17 to 78 years, confirmed cases of active pulmonary tuberculosis (with TB) were enrolled and sera samples collected from them. The second group comprised of 105 healthy controls with no history of pulmonary tuberculosis (without TB) and sera samples collected from them. The MycoDotTM serologic test was done on the sera samples collected from both the study groups according to the manufacturer’s instructions. Results: Of the sera collected from 120 sputum smear positive cases (with TB group), 48 sera specimens were MycoDotTM test positive (sensitivity = 40%; 95% CI 31.68–48.94). Healthy controls (without-TB group) – 8 sera samples were found to be positive by the MycoDotTM test and the remaining 97 sera samples tested negative by this serologic test (specificity = 92.38%; 95% CI 85.68–96.09). The value for % false positive was 7.61% and for % false negative was 60%. The positive predictive value and the negative predictive value was 85.71% (95% CI 73.22–93.20) and 57.4% (95% CI 49.56–64.88), respectively. Conclusion: The MycoDotTM test with its rapidity (completed within 20 min), easy – to – perform format and no expensive instrumentation required – had high specificity but a relatively low sensitivity in the study group subjects and thus could be used only as an additional test in the diagnosis of active pulmonary tuberculosis and to be interpreted judiciously alongwith clinical findings. Keywords: Immunodiagnosis, MycoDotTM test, Sensitivity, Specificity, Pulmonary tuberculosis

Page No: 32-36 | Full Text


Original Research Article

Study of effect of smoking on blood pressure in normotensive men

Jayakumar Jeganathan and Nithyananda Chowta

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Study of effect of smoking on blood pressure in normotensive men. Introduction: Though smoking has been conclusively found to cause significant cardiovascular morbidity, the literature on the topic of effect of smoking on blood pressure seem to show contradictory results. Objective: The aim of this study was to find out the effect of smoking on blood pressure. Methodology: A total of 2190 workers in a factory in south India were examined. A detailed history and examination was done on all the subjects. After six months, the same subjects were examined again. The statistical analysis applied in our study design was analysis of Co-variance [ANCOVA or ANOCOVA]. Results: In the age group of 20 to 40 years, the systolic and diastolic blood pressure was highest in the heavy smokers. In the 41 to 60 year group also the systolic blood pressure was highest in the heavy smokers, but the diastolic blood pressure was highest in the non-smokers. Blood pressure was found to be high in those who consumed alcohol and lower in those who engaged in sports. Conclusions: From this study we concluded that there was a rise in systolic blood pressure in smokers as compared to non-smokers. Blood pressure was also high in those who consumed alcohol and lower in those who engaged in sports. Keywords: Blood Pressure, Smoking, cigarette, Male, Adult

Page No: 43-46 | Full Text