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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 9 | Issue 2
Page Nos. 47-87

Online since Friday, June 11, 2021

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EDITORIAL  

Tuberculosis elimination in India by 2025: Dream or reality? p. 47
Rashmi Sharma, Pradeep Kumar
DOI:10.4103/mjhs.mjhs_34_21  
Tuberculosis is probably the oldest disease known to humankind. Globally, efforts are being made to eliminate the disease by 2030, while the Government of India has committed to achieve this in 2025 (5 years before). A critical evaluation has been made of the strategic plan outlining various activities to attain this goal.
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ORIGINAL ARTICLES Top

Knowledge, attitude, and practices on sanitation, water, and hygiene among mothers of under five children in rural area: A cross-sectional study p. 51
Sushma Katkuri
DOI:10.4103/mjhs.mjhs_34_20  
Background: Simple practices such as appropriate washing of the hands, supply as well as use of clean water, excreta disposal in a scientific manner, sanitary latrine use, persona hygiene, etc., help to maintain health and promote the quality of life by preventing a number of diseases. Objective: The objective of this study is to study knowledge, attitude, and practices on sanitation, water and hygiene among mothers of under five children in rural area. Materials and Methods: A community-based cross-sectional study was carried out among 347 mothers of under five children in villages around the Rural Health Training Center. Data were collected in semistructured questionnaire where the information was obtained by face-to-face interview. Results: Majority mothers belonged to 21–30 years (87.3%); educated up to intermediate level (69.7%); were home makers (77.5%) and majority (94.5%) belonged to lower class of socioeconomic status. 43.8% used boiling method to purify water at household level. For the baby food, 31.1% were using boiled water. Majority (84.7%) had adequate knowledge on hand-washing. 71.5% told that hand washing is necessary to keep oneself away from the diseases. 97.1% were washing their hands after defecation and 85.9% expressed the need of soap for hand washing. 33.7% told that flies over food are the cause of worm infections. For diarrhea, 44.4% told that unhygienic food is the cause of diarrhea. 87.1% used dumping for disposal of waste water from kitchen and general household; 82.7% were dumping solid waste. Using the sanitary latrine was seen in 83.3%. Conclusion: It was observed that the knowledge on purification of water was poor. Second, very few people use boiled water for preparing baby's food. The knowledge about washing of hands after defecation was good.
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Clinical profile, management, and postoperative complications among patients with trigeminal neuralgia at a tertiary care hospital p. 56
Rajesh R Raykar, Sibhi Ganapathy
DOI:10.4103/mjhs.mjhs_35_20  
Background: There is no clarity in diagnostic criteria of trigeminal neuralgia, and hence, the diagnosis is difficult and often delayed. Therefore, the patient has to visit many clinics before the final and correct diagnosis is established. Trigeminal neuralgia is not harmful, but it definitely affects the quality of life. It may become nonresponsive to treatment. Objective: To study clinical profile, management, and postoperative complications among patients with trigeminal neuralgia. Methods: The present study was designed as a retrospective study for which the case records of patients as having trigeminal neuralgia kept with Medical Records Department, of a tertiary care hospital were studied and the patients were called for follow-up during the study period of July 2012 to December 2015 in the present study. Sixty-five patients who responded to follow-up call during the study period were included in the present study. Results: Majority belonged to 41–50 years (36.9%). Males (75.4%) were more than females (24.6%). Male-to-female ratio was 3.1:1. Both sides were equally affected. Pain distribution was commonly seen (38.5%) in V2+V3. Most common precipitating factor was cold (33.8%). 13.8% had hyperesthesia and 12.3% had hypoesthesia. Majority (83.1%) were directly operated for microvascular decompression. Trigeminal neuralgia was due to vascular compression (83.1%). The most common microvascular relationship was with superior cerebellar artery (50.8%). Only five patients had postoperative complications. Conclusion: Males were affected more than females. V2+V3 was common site of pain distribution. Cold was found to precipitate trigeminal neuralgia. The most common microvascular relationship was with superior cerebellar artery. Thus, trigeminal neuralgia has varied presentation, and hence, care needs to be taken in the diagnosis and management.
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Knowledge, attitude, and practices toward COVID-19 of people staying in night shelters during lockdown in Kakinada, Andhra Pradesh p. 61
Jeevanapriya Pala, Goru Krishna Babu, K Babji
DOI:10.4103/mjhs.mjhs_3_21  
Background: Coronavirus disease-2019 (COVID-19) has emerged as a serious public health problem worldwide. Appropriate knowledge, attitude, and practices like wearing a mask always and in a proper manner, following social distancing and handwashing frequently are some measures required to protect oneself from COVID-19. Government of India and State Governments have created the lot of awareness. Objectives: To assess and determine the factors responsible for knowledge, attitude, and practices of people staying in night shelters toward COVID-19 in Kakinada. Materials and Methods: A cross-sectional study was conducted among 131 members staying in night shelters. The present study was carried out using the semi-structured questionnaire. Study participants were contacted and interviewed to assess the knowledge, attitude, and practices. Results: Majority were males (89.3%); 40.4% were married; 63.4% were from rural areas; 70.9% were migrant laborer; 55.7% were Hindu; 41.2% belonged to backward class; 37.4% were educated up to primary class; and 67.2% had income <400 INR per day. Mean knowledge, attitude, and practice scores were 7.4 ± 2.78, 6.36 ± 2.59, and 4.36 ± 1.43, respectively. Multiple linear regression analysis showed that age group >50 years (vs. <50 years), location urban (vs. rural), marital status married (vs. separate, others), education primary (vs. illiterate, secondary, inter) were significantly associated with high knowledge score (P < 0.05). Age group <50 years, gender female (vs. males), and education illiterate (vs. primary and secondary) were significantly associated with positive attitude toward COVID-19 (P < 0.05). There was no statistically significant correlation between practice and the sociodemographic variable. Conclusion: The overall knowledge, attitude among night shelters in Kakinada was just above average but with poor practices.
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The knowledge and practices toward neonatal care among primipara mothers in Dehradun, Uttarakhand: A correlation study p. 67
Anjali Mall, Bijaya Mohanta, Shatrughan Pareek
DOI:10.4103/mjhs.mjhs_1_21  
Background and Objective: Proper care of the newborn babies form the foundation of the subsequent life not only in terms of longevity or survival but also in terms of qualitative outcome without any physical and mental disabilities. A study was done to evaluate the knowledge and practice regarding neonatal care among primipara mothers in Dehradun, Uttarakhand. Methodology: A nonexperimental descriptive research approach was applied for the study. The patients were 155 primipara mothers, selected by nonprobability purposive sampling technique. Sociodemographic proforma, self-structured questionnaire, and practice checklist were used to collect data regarding neonatal care among primipara mothers. Results: The study communicated that out of 155 samples that mostly (76.1%) had average knowledge level. Moreover, practices of the mothers illustrated that the majority of participants (87.09%) hadpoor practice, whereas only 12.90% hadgood practice. Furthermore, a significant moderate positive correlation (P = 0.0001) was highlighted between knowledge scores and practices scores regarding neonatal care among primipara mothers. In addition, Chi-square value showed that no association found between knowledge score when scored a significant association was reported between knowledge score of primipara mothers with their age and education. Furthermore, practice scores of primipara mothers were significantly associated with the religion. Conclusion: Findings emphasis the need of educational/teaching programs and awareness campaigns, which in turn may enhance the overall knowledge and practice regarding neonatal care. These initiatives may be significant in declining neonatal morbidity and mortality.
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Awareness about new guidelines of national tuberculosis elimination program among medical college faculty p. 72
Prashant R Kokiwar, N Asritha, N Ganesh, N Neelima Reddy, NU Dakshayani, N Nikitha, P Naresh, K Snigdha, B Naila, N Vyshnavi, P Nikhil, P Saikrishna, P Sukanya, P Mounika
DOI:10.4103/mjhs.mjhs_1_20  
Background: Physicians and faculty working in Medical Colleges play a major role in tuberculosis (TB) control. Their knowledge, attitude, and practices can affect the treatment and care of TB patients significantly. Objectives: The objectives were to assess the awareness about new guidelines of National TB Elimination Program (NTEP) among medical college faculty. Methods: A cross-sectional study was carried out among 95 faculties. They were given anonymous self-administered questionnaire with 23 questions. One mark was given for each correct answer. We classified correct knowledge as score >10 and poor knowledge as score <10. Yates-corrected Chi-square was used to study the association between variables and outcomes. P 0.05 was considered as statistically significant. Results: Questions about case detection rate, cure rate, incentives to private practitioner, bedaquiline, and follow-up of patients after completion of treatment were very poorly answered (<10 persons had correct knowledge). Only 17 could answer about the fixed-dose combinations, 10 about 99 Directly Observed Treatment Short-Course (DOTS) chemotherapy, and 13 about the choice of treatment in HIV-TB. Best answered questions were about the drugs used in each DOTS category, categories of DOTS, what are multidrug-resistant TB, extensive drug-resistant TB, and definition of presumptive case of TB. Overall, 58 faculties (61.1%) had poor knowledge with a score <11. The remaining 37 (38.9%) had correct knowledge with a score 11 or more. Correct knowledge was not found to be associated with age, sex, and designation but was associated with professional experience, with higher experience being associated with poor knowledge (P < 0.05). Conclusion: Majority of the faculty in the studied medical colleges had poor knowledge about new updates/guidelines in the NTEP. Professional experience was found to be significantly associated with the correct knowledge on recent updates in NTEP.
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CASE REPORTS Top

Lessons from a battle-front: When and where to “scoop and scoot”? p. 77
Shibu Sasidharan, BL Lahareesh, Harpreet Singh Dhillon
DOI:10.4103/mjhs.mjhs_6_21  
There has been game-changing advances in battlefield medicine. Improved training and expertise has enabled emergency medical personnel to provide advanced levels of care at the scene of trauma. It is better to “scoop and run” than “stay and play”. Current data relates to the urban environment where transport times to trauma centres are short and where it appears better to simply rapidly transport the patient to hospital than attempt major interventions at the scene. There may be more need for advanced techniques in the rural environment or where transport times are prolonged and certainly a need for more studies into subsets of patients who may benefit from interventions in the field. This report examines how time and early response is crucial in saving lives and decreasing morbidity. This article also gives insight into the to-do list for paramedics and doctors before and during causality transfers.
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Asymptomatic diffuse cerebritis presenting as middle cerebral artery infarct: A case report and review of literature p. 81
Sibhi Ganapathy, J Adesh, Pratham Bysani, Jay Pandya, Rajesh R Raykar
DOI:10.4103/mjhs.mjhs_33_20  
Diffuse cerebritis is a devastating disease presenting with features of raised intracranial tension, deficits, and features of meningeal and neural irritation. The most common feature is seizures which may persist despite normal antiepileptic medication. We present a patient with diffuse cerebritis who presented as a subacute middle cerebral artery (MCA) territory infarct without any symptoms of meningeal irritation or infection. The patient once admitted deteriorated with pupillary asymmetry and loss of consciousness. A computerized tomography scan revealed a massive increase in cerebral edema of the infarcted brain with midline shift and mass effect. In view of the serious threat to life, a decompressive craniectomy was done. Once the dura was opened, pus was seen subpially oozing into the subdural space. This was sampled for analysis and the scalp flap was closed with a drain. The patient improved well post surgically and was gradually extubated. His pus was found to grow Klebsiella pneumoniae sensitive to amikacin and gentamicin. A prolonged course of antibiotics was started. An angiogram done to determine the cause of the infarct showed only distal MCA branches (M4) occluded. The patient later deteriorated with venous thrombosis and succumbed to his illness later. We present a discussion on the etiology of the patient's condition and possible treatment options when faced with such situations.
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Allergic bronchopulmonary aspergillosis misdiagnosed as pneumonia p. 85
Tarun Kumar Suvvari, Haider Shaik, Bhargav Prasad Bathula, Lakshmi Venkata Simhachalam Kutikuppala, Sumanth Tangudu
DOI:10.4103/mjhs.mjhs_16_21  
Allergic bronchopulmonary aspergillosis (ABPA) is a fungal infection of lung predisposing in long-standing bronchial asthma and cystic fibrosis patients. Due to its similar clinical and radiological findings of other pulmonary diseases such as pulmonary tuberculosis and pneumonia, ABPA is commonly misdiagnosed. The usage of anti-tubercular drugs for ABPA is exploited due to misdiagnosis. We illustrate a case of ABPA, which was misdiagnosed to be pneumonia.
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