Journal of the Indian Medical Association最新文献

{"title":"Effect of antiretroviral therapy on pulmonary hypertension in HIV patients.","authors":"Jyotirmoy Pal,&nbsp;Kaushik Sen,&nbsp;Gauranga Sarkar,&nbsp;Anupam Mandal,&nbsp;Supratik Chakraborty,&nbsp;Animesh Deb","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pulmonary hypertension is an important cause of dyspnoea in human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) patients. The effect highly active antiretroviral therapy on pulmonary artery pressure has been an area of controversy. The purpose of this study was to evaluate the effect of antiretroviral therapy on pulmonary hypertension in HIV patients. This prospective cohort study was performed in a peripheral medical college of West Bengal with 88 patients from October 2008 to September 2011. By echocardiography, pulmonary artery pressure was recorded before initiation of antiretroviral therapy. After one year of antiretroviral therapy repeat echocardiography was done and pulmonary artery pressure was evaluated. The values were analysed. The present study showed that highly active antiretroviral therapy improves pulmonary artery pressure in HIV/AIDS patients if instituted at early stages (WHO classes I and II). However, at more advanced stages of pulmonary artery hypertension, it does not have any significant effect on reduction of the same. The present study documents that early detection of pulmonary artery hypertension in HIV/AIDS patients is essential and prompt institution of highly active antiretroviral therapy should be considered in them even when those patients do not fulfill the conventional criteria for initiation of this treatment.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"845-6, 849"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative results of treatment of open diaphyseal fractures of tibia by the use of commonly used external fixators.","authors":"Emdad Hossain,&nbsp;Neeraj Dugar,&nbsp;Anant Kumar Garg,&nbsp;Sanjay Kumar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The present study was being undertaken in retrospective and prospective basis to investigate the ultimate outcome of the procedure in type IIIA and type IIIB injuries. We have used simple AO type of external fixator and applied uniplanar double tube frame and unilateral biplanar frame. Frames were selected randomly; unilateral uniplanar frame in some patients having type IIIA wound and in some patients having type IIIB wound. Similarly, unilateral biplanar frames were used in some patients with observations have shown that these external fixators are simple, easy to apply, cost-effective and yield acceptably good results. Thus, the 'external fixator' application for the management of open fractures of tibia may give good results even to the poor patients and may be suitable for underdeveloped and developing countries. A study was undertaken by the committee on fracture and traumatic surgery of the American Academy of Orthopedic Surgeons to evaluate the efficacy and practicability of this method of treatment. The study was carried out in the department of orthopaedics, RG Kar Medical College & Hospital, Kolkata in retrospective and prospective basis since June, 2005. Forty-seven patients were selected from the outpatients department and emergency department having open fracture of shaft of the tibia with or without fracture of the fibula and were treated in the orthopaedic indoor department. The patients were followed up for 6 months to 2 years. Out of 47 cases, 2 patients could not be communicated for follow-up. Normal union could be seen in 25 patients followed by delayed union (n = 11) and malunion (n = 11). Joint shiffness was seen in 16 patients.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"830-2"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The concept of valgus under reduction in fixation of displaced trochanteric femoral fractures with sliding hip screw.","authors":"Abdul Latif,&nbsp;Kuladip Mukherjee,&nbsp;Amit Kumar Ranjan,&nbsp;Kiran Kumar Mukhopadhyay","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Sixty-six patients (male 30, female 36) with displaced trochanteric fractures (according to AO classification = A1.2, A1.3 A2 and A3 groups) have been studied during the period November 2011 to September 2013. Displaced stable fractures also have been included because in grossly osteoporotic elderly patients, this may lead to gross uncontrolled collapse and act like unstable fracture and it has fixation failure rate of 1-9%. Mean age of the patients was 8.5 years. DHS was used for the patients with intact lateral cortex and used DCS for the fractures with comminuted lateral cortex extending up to vastus ridge and also in A3 types. The screw placement was inferior to central in AP view, and central to posterior in lateral view. In AP view under reduction was done with slight lateralisation and upward displacement of distal fragment and fixed with DHS/DCS with affected limb in abduction 30 to 40 degree to achieve valgus angle of about 160-170. In lateral view neck shaft angle was maintained to 160-180 degree, on higher side, avoiding retroversion. All the parameters of fixation failure like varus displacement, retroversion, external rotation, medialisation, cut out, collapse and shortening of limb, pullout side plate and implant failure have been studied. Only the patients treated with valgus under-reduction have been included in this study. We conclude that under-reduction in valgus position gives excellent posteromedical stability as it provides controlled collapse as the calcar fragment is abutting against the medial femoral shaft (as in Weyne County reduction) and also prevents shortering by valgus reduction (Parker).</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"833-4"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single long midline incision versus two small incision techniques in treatment of Schatzker type V and type VI tibial plateau fractures--a comparative study.","authors":"Ananda Mandal,&nbsp;Prasenjit Dutta,&nbsp;Partha Sarathi Sarkar,&nbsp;Utpal Bandyopadhyay,&nbsp;Sabyasachi Santra","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Tibial plateau fractures had been treated with single long midline incision technique traditionally. But recently two-incision technique is becoming popular Tibial plateau fractures are generally classified according to the method developed by Schatzker. Schatzker types V and VI fractures are high-energy fractures often accompanied by other injuries and complications, such as postoperative inflammation, wound problems and infections. It was a prospective randomised study where 56 patients with Schatzker types V and VI were included in the study group. Alternatively all were allocated in the two groups ie, two small incision and one midline incision. Two incision was better than single midline incision in terms of posteromedial collapse, postoperative infection, skin necrosis. Operative fixation of complex fractures of the tibial plateau remains quite difficult and is associated with postoperative functional limitations in a large percentage of patients. Dual plating through an anterolateral and posteromedial approach is recommended in fractures complicated by a significantly displaced posteromedial fragment or depression of the medial articular surface.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"804-5"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness regarding otitis media in patients belonging to rural population of Raichur district, Karnataka.","authors":"B H Shrikrishna,&nbsp;A C Jyothi,&nbsp;G Sanjay,&nbsp;Samson G Sandeep,&nbsp;V Chaitanya","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The objective of this study was to assess awareness regarding otitis media in patients of rural parts of Raichur district, Karnataka. Patients of otitis media attending village health check-up camps conducted by our department were given questionnaire to assess the awareness regarding otitis media. Association between sociodemographic parameters and awareness were studied using Chi-square test. Age group of 10-30 years was the most affected. More than half of the patients had ear discharge of 5 to 15 years duration. Over 50% of the population showed ignorance with regard to the risk factors for otitis media. Earache was either disregarded (32%) or treated with home remedies by most, (63%) while a doctor's opinion was often sought for ear discharge (60%). Lack of awareness about otitis media contributes to its' high prevalence in this South Indian district. Health education is essential to reduce the disease burden.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"817-20"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of asthma management practices among general practitioners and physicians in and around Pune city.","authors":"M S Barthwal,&nbsp;Manoj P Pethe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since significant number of cases of bronchial asthma are first seen by general practitioners (GPs) and physicians, the present study was undertaken to assess the asthma management practices among GPs and physicians in and around Pune city of Maharashtra. It was a prospective study in which 40 GPs and 30 physicians were personally administered a questionnaire dealing with use of diagnostic methods and management plan in chronic asthma. Spirometry was used for diagnosis by 16 physicians (53.3%) and 7 GPs (17.5%) and peak flow meter by 1 GP (2.5%) and 5 physicians (16.6%). Nine GPs (22.5%) and 12 physicians (40%) preferred inhalation therapy solely. Twenty-six GPs (65%) and 20 physicians (66.6%) preferred combination of inhalation and oral therapy. Thirty-two GPs (80%) and 11 physicians (36.6%) were using inhaled short acting beta2-agonists on regular basis. Thirty-seven GPs (92.5%) and 25 physicians (83.3%) were prescribing inhaled and oral bronchodilators together. Twenty-nine physicians (96.6%) and 12 GPs (30%) were prescribing inhaled corticosteroids on regular basis. Twenty-two GPs (55%) and 12 physicians (40%) were prescribing inhaled and oral steroids concurrently. Twenty-two GPs (55%) were prescribing inhaled and oral steroids as on required basis. Thirty-two GPs (80%) and 20 physicians (66.6%) did not explain the importance of inhaled steroids to their patients. Single dose dry powder inhaler was prescribed by 24 GPs (60%) and 27 physicians (90%), metered dose inhaler was prescribed by 9 GPs (22.5%) and 12 physicians (40%). Spacer was prescribed by 4 GPs (10%) and 6 physicians (20%). Inhalation technique for metered dose inhaler was incorrect in 22 GPs (61.2%) and 6 physicians (20%) and for single dose dry powder inhaler it was incorrect in 15 GPs (35%) and 2 physicians (6.6%). None of the GPs and only 5 physicians (16.6%) were monitoring their patients as per GINA guidelines. Four GPs (10%) and 7 physicians (23.3%) delivered asthma education in the form of only verbal communication. Overall management skills of physicians were better than GPs. However, they need to be educated about more frequent use of spirometry or peak flow meter in confirmation of diagnosis, increasing use of inhalation therapy, emphasising the role of inhaled steroids to patients and providing optimal asthma education to all patients. There is an urgent need to educate GPs in almost all aspects of asthma management.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"840-4"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High tibial osteotomy--an effective treatment option for osteo-arthritis.","authors":"Kuladip Mukherjee,&nbsp;Abdul Latif,&nbsp;Amit Kumar Ranjan,&nbsp;Neeraj Dugar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Most patients of symptomatic osteo-arthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment osteo-arthrosis of the knee. Between 2007 and 2012 we performed closing wedge osteotomy in 44 knees in 42 patients. Of the 10 patients who had bilateral symptomatic disease, 2 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Pre-operative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA) rating scale. At a minimum follow-up of 6 months (range 0.6-5 years) 6-10 degrees of valgus correction at the site of osteotomy was maintained. The visual analogue scale (VAS) score improved from mean of 5.77 to 1.5. Approximately 19 satisfied with this operation. The JOA score mean 55 (range 45-61) improved to 86.18 (range 82 to 89). The activity of daily living (ADL) like rising from chair, going upstair and downstair, improved in all patients. Walking distance improved in all patients. No patient was lost any pre-operative knee function. Closing wedge high tibial osteotomy performed by our technique can be undertaken in any set-up with moderate facilities. Operation related complications are minimal and avoidable. Closed wedge osteotomy is least likely to interfere with replacement surgery if it becomes necessary.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"801-3"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular health among healthy population of Northeast region of India: a cross-sectional study comparing urban-tribal difference.","authors":"Soma Saha,&nbsp;Kinnari Gupta,&nbsp;Soumitra Kumar","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiovascular disease is the leading cause of adult mortality in India but data on the prevalence of cardiovascular risk factors are scarce, especially from North-east region of India. This study aims to assess the prevalence and the urban/tribal gradient of cardiovascular disease risk factors among healthy population of Tripura. A cross-sectional study was carried out among 238 healthy individuals (140 urban and 98 tribal) in one urban and five tribal areas of Tripura. Data was collected on sociodemographic profile, medical history, anthropometry, dietary patterns and addiction. Fasting blood samples were collected for biochemical analysis. Prevalence of cardiovascular disease risk factors and short-term cardiovascular disease risk score was calculated. The association of independent variables with 10-year cardiovascular disease risk score were examined by using multiple regression model. Prevalence of obesity, hypertension, diabetes, dyslipidaemia, metabolic syndrome and short-term cardiovascular disease risk score were higher in urban group. Urban people had higher salt, calories and fat intake. No difference was found in the addiction patterns of tobacco and alcohol but frequency and quantity being higher in tribal area. Dyslipidaemia and alcohol consumption showed significant positive association with 10-year cardiovascular disease risk score in both groups. While the non-sedentary lifestyle and dietary habits (low salt, low fat, carbohydrate predominant) of tribal population need to be promoted as a whole across the nation, they need to be protected from the adverse effects of rampant prevalence of tobacco and alcohol addiction among them. Urban population need to be extricated from adverse effects of sedentary lifestyle, modern food habits (high salt, high fat) and tobacco-alcohol addiction.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"810-4, 816"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute intermittent porphyria in pregnancy: a case report and review of literature.","authors":"Uma Pandey,&nbsp;V K Dixit","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The porphyrias are a group of rare metabolic disorders, each arising from a predominantly hereditary catalytic dysfunction of one of the eight enzymes in the porphyrin-haem biosynthetic pathway. Acute intermittent porphyria is the commonest type of porphyria worldwide. The disease is more common in women than men. It is therefore important for the obstetricians to know about this entity as many women present with abdominal pain during pregnancy. This case shows that if acute intermittent porphyria is properly treated in a mother there is normal maternal and foetal outcome. A case of acute intermittent porphyria known before pregnancy has been reported in a patient who had three spontaneous abortions in the past, she was delivered by elective caesarean section. The pathogenesis of the disease, its' symptoms, diagnosis, therapeutic approach both during and out of pregnancy have been also discussed.</p>","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 12","pages":"850-1"},"PeriodicalIF":0.0,"publicationDate":"2013-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32611626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel insulin delivery systems.","authors":"K K Gangopadhyay,&nbsp;B Ghosh Dastidar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17244,"journal":{"name":"Journal of the Indian Medical Association","volume":"111 11","pages":"755-60"},"PeriodicalIF":0.0,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32456870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}