S Gopalakrishnan

Standard treatment guidelines in primary healthcare practice

In India, healthcare delivery is implemented at primary, secondary and tertiary levels. Of these, primary health care is the essential health care and is the first point of care for the public across the country. The primary health care system caters to nearly 70% of the population by treating about 90% of the common and locally prevailing problems. One of the integral elements of primary health care is provision of essential medicines, which should be available at all times in adequate amounts in appropriate dosage forms and at an affordable cost. It has an important bearing on the medical, economical and social outcomes of the healthcare delivery system. This situation mandates the need for rational use of medicines by standardizing the treatment of commonly occurring illness at the primary health care level. Standard Treatment Guidelines (STGs) have been in vogue in India only since recent times and is gaining popularity among practitioners. STGs have many advantages for the patients, healthcare providers, drug manufacturers and marketing agencies, and above all, the policy makers and the legislative system of the country. The drawback in STGs lies in the difficulties in implementation on a large scale. With due efforts to prioritize the health needs, comprehensive coverage of national health programs involving all the stakeholders including professional organizations, undergraduate medical curriculum planners and medical practitioners, STGs can be implemented effectively and thereby we can ensure a quality health care at the primary care level at an affordable cost as part of the now redefined Universal Health Coverage. This article is intended as a guide to understand the concept of STGs, prepared with the aim of capacity building for medical professionals in rationally treating patients in their day-to-day clinical practice.

An orthopedic-, surgical-, and epidemiological-based investigation of leprosy, in the Tamil Nadu state of India.

No other research paper has ever been written about leprosy in this manner. The orthopedic and surgical implications, as well as the functional debility caused by the disease, have not been previously explained by past research as they have in such a comprehensive manner in this paper. The results of this study have regional and global implications as they pertain to disease pathology, risk factor recognition/disease prevention, and treatment. This paper is a unique, in that it also serves as a combination of a review of the current medical literature, as well as an epidemiological survey of the disease in a region of the world which has never been researched in the past. Clinical data points to the possibility of a new strain of the disease. This information is of significance because it effects prevention and improved treatment of the disease, which leads to devastating sequela. This was a cross-sectional study involving subjects diagnosed with leprosy in the Chengalpet region of the Kancheepuram District, of the Tamil Nadu state of India. The study was performed at the Tamil Nadu Medical College Teaching Hospital and Research Center. This study included various physical examinations, observation and survey of lesions, questionnaires in regard the debilitating orthopedic and medical effects of the disease, as well as treatment options.

Evaluation of inter-arm difference in blood pressure as predictor of vascular diseases among urban adults in Kancheepuram District of Tamil Nadu

Introduction: An “Inter-Arm Difference” (IAD) in blood pressure (BP) is defined as a variation in systolic BP of >10 mmHg. Various studies conducted in different population show that there are wide variations in the prevalence of IAD, which ranges from 5% to 46%. The aim of this study is to evaluate the prevalence of IAD in BP among adults and its association with risk factors. Methods: This community-based cross-sectional study was carried out among urban adults in Kancheepuram district. The study sample size of 1634 was calculated, and simple random sampling method was used. Data analysis was performed using SPSS software version 16. Prevalence of IAD in BP was calculated using percentages, and statistical significance was tested to look for an association. Results: This study shows that 26.2% were at moderate risk for vascular events with IAD in systolic BP of 10–15 mmHg and 17.3% were at high risk with IAD >15 mmHg. About 14.2% had diastolic BP difference of 10–15 mmHg indicative of moderate risk and 6.1% had a difference of >15 mmHg indicative of high risk for vascular events. The statistical significant association was found between IAD in systolic BP and risk factors such as hypertension, smoking, alcoholism, and between IAD in diastolic BP with overweight/obesity (P < 0.05). Conclusion: This study outcome shows that the prevalence of IAD in BP is on the higher side. Hence, specific guidelines should be brought in to practice for measuring BP in both arms to detect IAD in every health-care settings.

Socio-demographic and obstetric risk factors of anaemia among pregnant women in rural Tamil Nadu

Background: Anaemia in pregnant women remains one of the most intractable public health problems in developing countries because of various socio-cultural factors like illiteracy, poverty, lack of awareness, cultural and religious taboos, poor dietary habits, and high prevalence of parasitic infestation. The study was aimed at determining the factors associated with anaemia among rural pregnant women in the field practice area of our medical college in Tamil Nadu. Methods: This is a community based cross sectional study among 270 pregnant women registered at our rural health training centre. Ethical approval and informed consent were obtained prior to the data collection. A pilot tested structured interview schedule was used to elicit questions related to socio-demographic and obstetric factors and hemoglobin levels were recorded from their mother child protection card. Various factors associated with anaemic status of the pregnant mothers were analysed using chi square for significance at 95% confidence interval. Results: Among the study participants, 41.5% were found to be anaemic. Passive smoking [kitchen smoke, cigarette/beedi smoke] (p<0.004 and X 2 -8.2), dietary habits (p<0.009 and X 2 -6.8), irregular iron folic acid tablet consumption (p<0.0001 and X 2 -59.1) and deworming (p<0.0001 and X 2 -12.4) were found to be significantly associated with anaemia. Conclusions: Anaemia is a social problem, wherein the knowledge and attitudes of the pregnant women deeply influence the disease burden. The results suggest that pregnant women and their family members should be educated to understand the importance of anaemia and its associated risk factors.