Introduction: Knee osteoarthritis (KOA) is a chronic condition leading to pain, stiffness, and long-term disability. In the search of relief from symptoms, KOA patients visit various health agencies. This study was conducted to assess the treatment-seeking behavior of KOA patients in northern India.
Materials and methods: One hundred twenty-three KOA patients, who attended the outpatient department (OPD) of orthopedics of a premier institute of northern India during 2012–2014, were enrolled in the study. They were diagnosed KOA cases as per Kellgren–Lawrence radiological criteria by an orthopedic surgeon.
Results: Patients (58%) had sought treatment from other agencies before visiting the tertiary care hospital. Ninety eight (79%) had not visited any other health agency but had tried home remedies. Relatives (43%) were the most common source of referral for treatment. The consultation lag varied from 1 month to 3 years. Poor adherence to therapy results in worsening of their condition over time. Moreover, asking a patient who has not been accustomed to exercise, to do so involves a significant behavior change. Apart from this, good dialog in clinics has a major influence on the doctor and patient satisfaction. In the current study, 10% of the patients expressed their dissatisfaction regarding consultation. It is also a major determinant of treatment compliance.
Conclusion: Many factors affect the doctor–patient relationship, e.g., accessibility of doctors and their courtesy level help patients feel important and respected. Good hospitals adopt these strategies to keenly promote a patient-centered culture for better results.
How to cite this article:
Singla V, Ahuja CK, Singh T, Prabhakar N, Singh G, Kang M, Khandelwal N. Internal Audit of Factors Affecting Mean Glandular Dose of Mammography in a North Indian Cohort. J Postgrad Med Edu Res 2019; 53 (3):113-117.
Aim: Increasing use of screening mammography has led to the speculation of increased incidence of radiation-induced cancer of the glandular breast tissue. The present study aimed to estimate the mammographic mean glandular dose (MGD) in North Indian females and establish the various factors which affect the radiation dose and compare it with global results.
Materials and methods: Four hundred and ninety consecutive females referred for diagnostic and screening mammography were enrolled in the study over four months duration. Standard two mammographic views of bilateral breasts, viz., mediolateral oblique (MLO) and craniocaudal (CC) views were taken generating a total of 1960 views. The tube voltage (kV), current (mA) [available as automatic exposure controls (AEC)], and other variables such as compressed breast thickness (CBT), applied compression force (CF), and MGD per projection for each breast available as digital readouts were evaluated.
Results: The mean CBT was 5.1 ± 1.7 cm in CC views and 5.72 ± 1.8 cm in MLO views. The mean CF was 99.8 ± 35.9 N and 117.7 ± 36 N in CC and MLO views respectively. The average MGD per view in CC and MLO views was 1.11 ± 0.41 mGy and 1.27 ± 0.47 mGy respectively; and the mean MGD per woman for four views was 4.76 mGy. Mean glandular dose was found to be directly proportional to the CBT, which was seen to be inversely related to age.
Conclusion: The mean MGD per view in the present study was 1.19 mGy, which is lower than average global values and is well within the stipulated guidelines of 3 mGy set by the American College of Radiology (ACR).
Clinical significance: As there is a trend of rising incidence of breast cancer in younger women in India, this study might help to allay fears concerning radiation risk during mammography in the minds of patients, referring surgeons, gynecologists, technologists, and radiologists.
Background: An endodontic management of the primary teeth is important considering the various untoward consequences associated with its premature loss.
Aim: To compare the patient acceptability with manual and rotary methods of root canal instrumentation during pulpectomy.
Materials and methods: Pulpectomy treatment was carried out in 60 pulpally infected the primary teeth among children aged 4–7 years. Thirty teeth were instrumented with manual and rotary methods of root canal instrumentation. Patient acceptability during instrumentation was recorded by an independent evaluator using a modified patient acceptability scale.
Results: Children accept treatment readily with manual technique; however, no statistically significant difference was observed between manual and rotary techniques of root canal instrumentation.
Conclusion: Acceptability of root canal instrumentation in children is comparable with manual and rotary techniques.
Aim: To review the role of nonpneumatic antishock garment (NASG) as a temporary measure to stabilize patient in postpartum hemorrhage (PPH) while waiting for a more definitive treatment.
Background: Though several studies have suggested the efficacy of NASG as a temporary measure to resuscitate women with obstetric hemorrhage, its precise role remains to be delineated. In this review, we extensively review available evidence and current recommendations regarding the use of NASG in PPH.
Review results: Current review included several observational studies and one cluster randomized controlled trial (RCT). The results of this review suggest that the application of NASG significantly reduces the amount of obstetrical blood loss. However, with regard to reduction in maternal mortality and severe morbidity, the results are inconclusive with some studies showing significant reduction while others not.
Conclusion: Nonpneumatic antishock garment appears to a promising tool in reducing the maternal mortality and severe morbidity in PPH. In future, well-conducted randomized controlled trials employing appropriate sample size will further help in clarifying the role of NASG as a temporary measure to resuscitate women with PPH.
Clinical significance: Nonpneumatic antishock garment appears to be a promising device for resuscitation of women with PPH.
Brucellosis is a major cause of febrile illnesses in areas with high exposure to animals or unpasteurized milk and dairy products. It may manifest with multisystem clinical presentations. Our patient was a six-year-old boy who was presented in emergency room with a prolonged history (3 weeks) of high-grade fever with chills, not responding to antibiotics. Upon inquiry, the history revealed the use of unpasteurized goat milk and contact with goats at home. Upon investigation, serum antibodies for brucellosis were raised (1:640). He was started on combination therapy with rifampicin and doxycycline. He became afebrile within two days so was discharged home. We found that an ineffective history could lead to delay in diagnosis and management. Clinicians should have high index of suspicion for brucellosis in children.
Introduction: Methylene blue is a commonly available stain used to see through microscope. Methylene blue is added to bacteria on a glass slide and examined under the microscope. It has been used in the laboratory and clinical science as well as in deciphering any leakage and breach of mucosal barrier as a treatment modality in cyanide poisoning.
Case description: We report a 36-year-old male patient, a shopkeeper by occupation, who accidently had ingested methylene blue and noticed change in his urine color to green. The patient was evaluated and found to be hemodynamically stable with the normal renal, liver, and complete blood picture. The patient was observed for the next 2 days and the green urine color disappeared.
Conclusion: Though different urine colors are a clue to underlying pathologic and physiologic state, many a times, it can be a truly benign picture. Methylene blue is one such example.
“Let us assume that an investigator collected various demographic, clinical, psychiatric, and radiological characteristics of the study participants.” The investigator took adequate precautions to enter data in a structured format into a spreadsheet. However, before proceeding ahead, the investigator wanted to ensure that data are ready for analysis. In this context, the investigator reviewed the literature and came across the term “data cleaning.” The fellow colleagues advised him to approach a statistician for cleaning and analyses of the data. The investigator was in dilemma, whether to share the data with a statistician before or after cleaning. The investigator reviewed the literature and found some answers regarding the role and responsibilities of the investigator in data cleaning. However, the investigator still had the following questions for data cleaning.
• Is data cleaning practice a part of good clinical practice (GCP)?
• Is it the responsibility of a statistician to clean and code the data?
• Do data cleaning begin after data entry?
• How to deal with missing values at the data entry stage?
Clinicopathological Conference Report
Prof. Amanjit Bal,
Dr Aastha Takkar,
Prof. Vivek Gupta,
Dr Balamurugan ,
Prof. Ashish Bhalla,
Prof. Subhash Varma