Medicine and politics: How to negotiate the minefield? Amitav Banerjee Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):381-382

Fear and uncertainty around the Lancet's editorial Ishan Lamba Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):383-384

Is ankylosing spondylitis a risk factor for subclinical atherosclerosis? The debate is going on A K M Monwarul Islam, A K M Mohibullah Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):385-386

Study on surveillance of risk factors for noncommunicable diseases in local population Shiv Kumar, Remitha R Pillai, V Dwarakamai, N Sravanthy Reddy, Noyal Joseph Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):387-390 Context: Noncommunicable diseases (NCDs) are emerging as the major scope of death and disability worldwide, which is the result of demographic and epidemiological transition along with increase in risk factors resulting from social and economic changes. Aims: The present work was undertaken to study the prevalence of key risk factors for major NCDs in local population. Materials and Methods: This is a descriptive cross-sectional study conducted from November 2016 to April 2017 by utilizing the World Health Organization formulated STEPwise approach to Surveillance of NCD risk factors. Data were collected from 303 participants aged 25–64 years using structured data collection format which includes demographic details, physical measures, and behavioral measures. Results: The results of the present study shows that illiteracy, overweight, alcohol consumption, smoking/tobacco use, hypertension, physical inactivity, and unhealthy dietary habits are existing in the study population which acts as potential risk factors for the development of various NCDs. Conclusions: The study concludes that both behavioral and physiological risk factors for NCDs exist in the study population. The high prevalence of these risk factors predicts high chances of occurrence of NCDs such as cardiovascular diseases, cancer, and chronic respiratory diseases.

A study of response to concurrent chemoradiotherapy as primary mode of management for the patients with laryngeal and hypopharyngeal squamous cell carcinoma and correlation of human papillomavirus status Sajal Kumar Sarkar, Arunima Chaudhuri Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):391-397 Background: Successful outcome of concurrent chemotherapy and radiotherapy as organ-preserving protocol in the management of locally advanced laryngeal and hypopharyngeal carcinomas may be a better-accepted modality of management of patients for preservation of the unique functions of the vital organs of communication and deglutition. Aims: The aim of the study is to observe the role of concurrent chemotherapy and radiotherapy as organ-preserving protocol in the management of locally advanced laryngeal and hypopharyngeal carcinomas taking into account the status of human papillomavirus (HPV) in such cases with outcome in a population of Eastern India. Materials and Methods: This cross-sectional observational study was conducted on 73 individuals in Eastern India after taking institutional ethical clearance and informed consent of the individuals in a period of 1 year. Concurrent chemoradiation therapy (CCRT) was the primary mode of treatment. Results: About 49.3% of the patients were smokers and 53.4% were alcoholic. All the patients had squamous cell carcinoma. About 46.6% of the patients had positive HPV in tissue. About 47.9%, 34.2%, and 17.8% of the patients had complete, partial, and no response to the primary treatment after CCRT, respectively. For larynx proportion of complete response was significantly higher for HPV-positive cases (46.2%) as compared to HPV-negative case (19.2%) (P < 0.01). About 22.2% and 11.8% recurrence were found in the hypopharynx and larynx, respectively. Salvage surgery for primary site was performed for 78.4% in the hypopharynx and 56.3% for larynx. The organ was preserved for 29.8% for hypopharynx and 57.7% for larynx during the total follow-up period. Conclusions: HPV was found in tissue of laryngeal and hypopharyngeal squamous cell carcinoma. The response of advanced hypopharyngeal carcinoma to CCRT was the best mode of treatment, as far as the organ preservation was concerned, while the organ preservation rate for advanced laryngeal carcinoma treated with CCRT was found to be a better option of treatment.

A prospective study on causality assessment rating, mortality rate, and case fatality rate for adverse drug reactions among medical inpatients at the University of Benin Teaching Hospital, Nigeria Olumuyiwa John Fasipe, Peter Ehizokhale Akhideno, Ambrose Ohumagho Isah, Omagbemi Sampson Owhin Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):398-407 Background: An adverse drug reaction (ADR) is a special form of adverse drug event (ADE) in which a causative relationship can be shown or established and is attributable to the offending/precipitating medication. ADR causality assessment is used to determine the likelihood that a particular drug caused a suspected ADR. Causality assessment rating evaluates the relationship between drug treatment and the occurrence of an ADE. It is also used to evaluate, check, confirm, and ascertain that the particular treatment is the cause of an observed adverse event or not. Aim: This study was designed to evaluate the causality assessment rating, mortality rate, and case fatality rate for ADRs among adult medical inpatients in clinical practice setting with the goal of preventing them and improving their treatment outcome. Methods: The patients admitted to the adult medical wards of a Nigerian University Teaching Hospital over 9 months from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge. Results: Five hundred and seven patients were evaluated during the study, of which 269 (53.1%) of them were male and 238 (46.9%) were female. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the causality assessment rating for the observed ADRs was evaluated using both the World Health Organization (WHO) causality rating criteria and the Naranjo algorithm. Using the WHO causality rating criteria, certain cases were 10 (19.6%), probable cases were 17 (33.3%), and possible cases were 24 (47.1%). Using the Naranjo algorithm, definite cases were 9 (17.6%), probable cases were 19 (37.3%), and possible cases were 23 (45.1%). The number of patients admitted solely because of ADRs (ADR-out) was 18 (3.6%) patients, whereas those that experienced ADRs during admission (ADR-in) stood at 33 (6.5%) patients. Furthermore, the case fatality rate for ADRs was 7.8% (4/51), while the ADR-associated overall mortality rate was 0.8% (4/507). Conclusion: In this study, the two methods used to ascertain causality rate for ADRs caused by a suspected drug; both the WHO causality rating criteria and Naranjo algorithm, showed similar causality ratings, which strengthening the ascribed ADR causality rating. In addition, the mortality rate and case fatality rate for ADRs were significantly high among these adult medical inpatients.

A review of adolescent reproductive and sexual health program implemented in Sonitpur District, Assam Sukhmeet Minhas, Rajesh Kunwar, Harinder Sekhon Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):408-414 Context: Adolescent Reproductive and Sexual Health Programme has been widely conducted some time now, but it requires improvement for creating a more supportive environment, generating requisite level of awareness among adolescents, organizing better services, improving the capacity of service providers, and monitoring service provision and utilization. Aims: This study aimed to review the current implementation status of the programme in Sonitpur district of Assam and develop a proposal to improve the programme coverage. Settings and Design: Evaluation of various program indicators was carried out in the district by using secondary data available and interview of all stakeholders. Subjects and Methods: A review of the current implementation status was done by a review of programme indicators; interviewing the staff affiliated with the District Health Office and identifying geographic areas or population groups requiring a high focus. Results: There was a lack of awareness on the part of target population, inadequacy of staff especially grassroot workers, and insufficient advertisement and promotion by the authorities. Limitations of program implementation that came to light included sporadic implementation, lack of motivation at the level of staff for outreach activities to areas that do not have proper connectivity, limited information and awareness of population in certain blocks due to geographical remoteness, and lack of political will and commitment. Conclusions: Improvements in health-care facilities aimed specifically at adolescent population have been introduced relatively recently. There are barriers that hamper the implementation of programme on ground. It is important to address the limitations by better political will, intersectoral co-ordination, and interpersonal communication.

Profile of firecracker injuries of the eye during Diwali: A tertiary eye-care center study Chandana Chakraborti, Swati Majumdar, Shreya Gayen Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):415-418 Aims and Objectives: The aim was to study the demographic pattern, clinical features, management, and prognosis of the patients with firecracker-related ocular injuries during Diwali. Materials and Methods: This institution-based prospective study was done in 30 patients who attended eye emergency and outpatient department (OPD) of Calcutta National Medical College and Hospital, West Bengal, during the period of 1 week of Diwali in 2016 and 2017. The parameters studied were the age and sex of the patients, type of firework (crackers and sparklers), eye involved, severity of injury with respect to active and passive participants, management, severity of injury, and visual outcome with respect to type of firecrackers. Results: A total of 30 patients attended eye OPD and emergency during our study period, of which 23 (76.7%) were male and 7 (23.3%) were female. All of them were in the pediatric age group (1–15). All patients were examined on the day of injury. Patients between 6 and 10 years of age were most commonly affected. Four cases (13.3%) were open-globe injuries and 26 (86.7%) cases were closed-globe injuries. Visual acuity varied from 6/9 to no perception of light. The most common firework involved was the crackers. Conclusions: Careless and indiscriminate use of firecrackers may sometimes lead to serious ocular damage. In India, use of fireworks is quite common during various festivals, particularly during Diwali, thus fireworks-related ocular injuries are important causes of blindness. This prospective study revealed the presentation and outcome of ocular injuries due to firecrackers in this area of mixed culture during this festive week.

Epidemiological and clinical features of scrub typhus in Odisha, Eastern India Palash Das, Divya Singh, Mirabai Das, Rajesh Kumar Nayak, Nirmal Kumar Mohakud Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):419-423 Introduction: Scrub typhus is a mite-borne bacterial infection of humans caused by Orientia tsutsugamushi that presents with prolonged fever unless suspected early. The aim of this study was to characterize the epidemiological factors and clinical clues in this region for early diagnosis. Materials and Methods: This study was a retrospective, observational study conducted in all diagnosed scrub typhus cases admitted to the pediatric ward of a tertiary care hospital in-between January 1, 2015 and December 31, 2016. One hundred and one patients admitted with IgM positive for scrub typhus over 2-year period were analyzed for the epidemiological factors and clinical features. Results: Male:female ratio is 1.4:1. The mean age of the patients in our cohort was 4.83 years, ranging from 0.25 to 14 years. Majority (79.2%) was from the rural area. Fever was present in all cases and about 81.19% of children presented with fever for >7 days. Other findings were hepatosplenomegaly (55.45%), respiratory problems (47.54%), abdominal symptoms (40.59%), eschar (26.74%), rashes (15.84%), altered behavior (9.9%) and lymphadenopathy (2.97%) of cases studied. Thrombocytopenia, elevated liver enzymes, and raised C-reactive protein (CRP) were found characteristically. Defervescence after starting doxycycline was within 3.26 ± 2.26 days. Conclusions: Scrub typhus can present in various ways but mostly with prolonged fever. Hepatosplenomegaly, eschar, third spacing, raised CRP, and thrombocytopenia are important clues for early clinical diagnosis. Increased awareness and heightened suspicion, especially in the light of increasing number of patients are required for timely treatment and prevention of complications.

Epidemiological and clinical features of scrub typhus Viroj Wiwanitkit Medical Journal of Dr. D.Y. Patil Vidyapeeth 2019 12(5):424-425