During a routine dissection in the Department of Anatomy of the Rural Medical College, Loni, we found a rare variation in branching pattern of the common carotid artery (CCA) and external carotid artery (ECA) bilaterally. The knowledge of possible anatomical variations of CCA and ECA are especially important in the surgeries of head, neck and face; and also for the radiologist to understand and interpret carotid system imaging when undertaking cerebral angiography. This case and the clinical significance of this variation are reported in this paper.
Common carotid artery; external carotid artery; superior thyroid artery,; linguo-facial trunk; ascending pharyngeal artery; occipital artery
Human resource capacity building is a key strategy in the design, delivery, sustainability and scale up HIV treatment and prevention programmes. The review aims to present human resource capacity building initiatives undertaken by the National AIDS Control Organisation (NACO) and to discuss the available opportunities in India.
There was minimal emphasis on human resource capacity building in National AIDS control programme (NACP)-I. The focus of capacity building in NACP-II was on strengthening the capacity of partners implementing various HIV/AIDS interventions. NACP-III (2007–2012) focussed on capacity building as a priority agenda. Other than short-term training programmes, NACP-III is strengthening the capacity of partners through the State Training and Resource Centre, Technical Support Unit, District AIDS Prevention Control Unit, Fellowship Programme and Network of Indian Institutions for HIV/AIDS Research.
Various opportunities to enhance and consolidate capacity building responses in HIV/AIDS in India may include mainstreaming of capacity building, appropriate management of knowledge and resources, effective delivery of training, measuring and documenting impact,accreditation of programmes and institutes,use of information technology, identifying and implementing innovations and working for sustainability.
Growing demand for capacity-building in HIV/AIDS needs substantial efforts to ensure that these are implemented effectively and efficiently. NACO had made significant strides in these regards, but at the same time there are arduous challenges like measuring impact, quality, documentation, operational research, and sustainability. NACO is formulating Phase-IV of NACP. This review will provide feedback to the NACO for strengthening its strategic document for human resource capacity building.
Human resource capacity building; NACO; HIV/AIDS
With the aid of internal tobacco industry documents, this paper provides a chronology of events documenting the role of the Philip Morris tobacco company in the 1993 litigation case against the Burswood International Resort Casino (BIRC). The paper also examines the implications of this case for the regulation of second hand smoke exposure.
A systematic keyword search and analysis of internal tobacco industry documents was conducted using documents available on the World Wide Web through the Master Settlement Agreement.
The industry documents provide comprehensive evidence that the Philip Morris tobacco company provided assistance to the BIRC in its defence against action by the Western Australian government. The Philip Morris tobacco company, along with others, sought to publicise and promote the outcome as a ‘landmark example’ to lobby against the implementation of indoor smoking bans.
Philip Morris' investment in the BIRC defence demonstrated the industry's recognition of the potential significance of the case beyond Western Australia. Involvement in the BIRC case assisted the wider tobacco industry by helping to prolong smoking at casinos and other Australian hospitality venues. The findings contribute to our understanding of the history of tobacco industry strategies implemented in Western Australia and internationally to slow tobacco control progress, and the preparedness of the tobacco industry to exploit favourable developments originating anywhere in the world.
Tobacco; tobacco industry; second hand smoke; Burswood Casino; policy
This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people.
A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement.
The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents.
The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.
Youth; tobacco; tobacco industry
A 25-year-old housewife presented with a burning sensation over both legs for the past 15 months, and fever with weight loss for the past six months. She had noticed a lump in her left breast one month ago. Examination revealed hyperaesthesia and allodynia over the lower limbs. Nerve conduction studies confirmed the presence of sensory neuropathy. Nerve biopsy was suggestive of a chronic axonopathy. Subsequently sputum as well as aspirate from the breast lump tested positive for acid fast bacilli. Treatment with anti-tubercular therapy resulted in full recovery. Peripheral neuropathy is a unique and unusual presentation of tuberculosis.
peripheral neuropathy; disseminated tuberculosis; sensory polyneuropathy
Medical schools have a major challenge in teaching students to choose and prescribe medicines safely and effectively. Problem-based learning based on national essential medicine lists and standard treatment guidelines has been strongly recommended to improve prescribing. In Nepal, pharmacology is taught during the first two years of the undergraduate medical course. At KIST Medical College, Lalitpur the Department of Clinical Pharmacology teaches students to use essential medicines rationally. Small group, activity-based learning is used during practical sessions. In this article the author lists the 10 basic competencies which students should have developed by the end of the pharmacology practical module and also describes a selection of activities with regard to a particular competency used during the practical module and an exercise used to assess these competencies during the practical examination.
Competencies; Nepal; Pharmacology; Small groups
Diabetes prevalence is increasing worldwide. More than 800,000 Australians live with diabetes, and there are stark inequities in prevalence and clinical outcomes among Indigenous people and low socio-economic groups.
This paper focuses on food security issues experienced by low-income earners living with type 2 diabetes in Perth, Western Australia. The results presented here are part of a broader qualitative study exploring the impact of socioeconomic disadvantage on diabetes.
Data was collected through focus groups and semistructured interviews conducted from October 2008 to November 2009. The sample, comprising 38 participants ( Indigenous and non-Indigenous), was recruited from areas with high indices of socio-economic disadvantage in Perth. Deductive data analysis identified categories from an existing conceptual framework for the relationship between socio-economic position and diabetes health outcomes, while an inductive approach was adopted to identify new themes.
Participants had a good understanding of their dietary requirements. However, access to healthy food was not always realised, as many participants depended on others for food provision and meal preparation and had little control over their diets. Furthermore, the majority struggled to accommodate the price of healthy food within a limited budget.
In this study, low-income earners living with diabetes faced food security issues. Participants reported cost barriers, but also physical barriers relating to functional limitations and lack of transport. This study highlights that the socioeconomic circumstances in which vulnerable populations experience their disease need to be understood and addressed in order to reduce the inequities surrounding diabetes outcomes.
Diabetes; food security; access; disadvantage; low income; Indigenous health
General practitioners (GPs) are considered a trusted and reliable source of health-related information including nutritional advice. Preliminary investigation found that GPs wanted evidence-based nutrition resources that could be used within a 10 minute consultation.
The aim of the study was to identify and critically review current resources available to GPs that promote seafood consumption within a healthy diet, as a preventative or treatment measure for common lifestyle or medical conditions.
English language resources currently available to GPs in 2008 were sourced through multiple avenues including: individual organisations; medical service networks; health information services and internet search engines. Assessment included critical review of: format; appropriateness for target groups; reference to seafood and supporting evidence; credibility; readability; and suitability for use by practitioners in a short consultation.
One hundred and twenty resources were identified. The majority (88.4%, n=106) of identified resource were available Electronically. Just over half (57.5%, n=69) of the resources were targeted at specific audiences. All of the resources made reference to the health benefits of regular consumption of fish (100%, n=120), 22.5% (n=27) made reference to seafood in general and 5% (n=6) made reference to fish oil. Only 15% (n=18) of the identified resources were suitable for use with the general Australian population at or below the recommended reading level of Year Eight. The majority (87.5%, n=105) of the identified resources were associated with credible sources of information about the health benefits of regular consumption of seafood.
This study found that the majority of resources available to GPs were not suitable for use with the general Australian population at the recommended reading level of Year 8 or lower. Whilst it is acknowledged that written health information alone cannot change health behaviours, it can provide accurate information to assist in making changes to behaviours with support from appropriate health care professionals.
General Practitioners; nutrition education; seafood
There is good evidence that regular fish consumption can lead to a range of health benefits, and that there is high public awareness of this fact. In spite of this, Australians do not, on average, consume fish to recommended levels. An intervention is proposed, leveraging social media and mobile technology. This approach is justified on the basis of a precedence of similar initiatives and the calculation of a potential target group size of 2.8 million adult Australians.
Brief health interventions; chronic disease; fish; seafood; social media; mobile technology
Among the sexual minority groups, the Men who have Sex with Men (MSM) community is a large and scattered network. Sexual activity among MSM is frequent and often unplanned. STI and HIV are major medical problems faced by this vulnerable group. Stigma and discrimination towards this group result in poor access to preventive services that encourage condom and lubricant usage.
A cross-sectional, community-based study of 309 MSM was carried out in the Davangere district between December 2008 and February 2010. Participants were identified in three stages: cruising venue identification and mapping; determining eligibility and willingness to participate; and recruitment to the study. Consecutive sampling was used to recruit the participants with the help of a snowball technique, obtaining informed and written consent.
Of the participants 79.61% and 88.03% reported inconsistent use of condom and lubricant during the three months prior to the interview, respectively. In multivariate analysis, middle socioeconomic class, sex in a public place and increased frequency of sex were significantly associated with inconsistent condom use. Whereas, practising both types of anal sex (receptive and insertive), not using a condom during the last sexual encounter and increased frequency of sex were significantly associated with inconsistent lubricant use.
Many social and behavioural factors are involved in the inconsistent use of condom and lubricant among MSM. Preventive programmes must identify these factors in order to target consistent condom and lubricant use among the MSM community.
Inconsistent condom use; Men who have Sex with Men; Human Immunodeficiency Virus; Sexual risk behaviour
Telepathology has grown immensely due to rapid advances in information and technology. It has a wide variety of applications especially in the developing world, namely for remote primary diagnosis, specialist referrals, secondary opinions, remote teachings and in research. Basic infrastructure and skilled and experienced staff are the prerequisites for its successful implementation.
Socio-economic differences in developing nations result in a chaotic scenario so that, the advanced areas have expertise, while rural and remote areas remain deprived. Telepathology has the potential to bridge this gap.
This article discusses how successful use of the internet for telepathology is bridging this gap in developing nations and thereby contributing positively to effective healthcare. Possible constraints to telepathology and some solutions to overcome them are also discussed.
Internet; Healthcare; Telepathology; Telereporting; Developing nations
Sexual Assault (SA) is a major public health and pervasive social problem that transcends socio-cultural bounds; with myriad bio-psychosocial effects on victims/survivors and the wider community. Indeed, survivors of SA suffer the effects of assault for a lifetime. A key aspect for practitioners working with individuals, families and communities affected by SA is to understand the background, nature and extent of the problem; as well as important medicolegal considerations and support services.
Sexual assault; rape; counselling
Nocardia brasiliensis is a rare human pathogen that is usually associated with localised cutaneous infections. We report a case of primary cutaneous Nocardia brasiliensis infection causing delayed wound healing that developed after ovarian cystectomy in an otherwise healthy 32-year-old woman. The patient was initially treated with cotrimoxazole, however due to intolerance intravenous amikacin was given and gradually the wound healed. The diagnosis was confirmed by demonstrating the causative organism in exudates, and cultures. Early diagnosis as well as early institution of chemotherapy is effective in most patients, and antimicrobial susceptibility testing of the isolate should be performed to identify the best treatment options.
Nocardia brasiliensis; immunocompetent; cutaneous Nocardiosis; ovarian cystectomy
It is well-known that sexual dysfunction can result from many classes of drugs including sedatives, anti-hypertensives and anti-depressants. Untreated sexual dysfunction can lead to patient distress.
A 64-year-old man with a history of a left cerebrovascular accident participated in a qualitative research study on sex after stroke. He had been experiencing sexual dysfunction for four years.
Discussions with the patient were difficult due to his expressive dysphasia. The researcher asked him to re-visit his general practitioner (GP) who reviewed his medications and changed the prescribed sleeping tablet. Sexual function returned within a week. This case report highlights the contribution of medication to sexual dysfunction and the need for doctors to initiate conversations about sexual concerns.
Sexual dysfunction; doctor-patient communication; stroke; sleeping tablets; expressive dysphasia
Cancer often has a profound and enduring impact on sexuality, affecting both patients and their partners. Most healthcare professionals in cancer and palliative care are struggling to address intimate issues with the patients in their care.
Study 1: An Australian study using semi-structured interviews and documentary data analysis.
Study 2: Building on this Australian study, using a hermeneutic phenomenological approach, data were collected in the Netherlands through interviewing 15 cancer patients, 13 partners and 20 healthcare professionals working in cancer and palliative care. The hermeneutic analysis was supported by ATLAS.ti and enhanced by peer debriefing and expert consultation.
For patients and partners a person-oriented approach is a prerequisite for discussing the whole of their experience regarding the impact of cancer treatment on their sexuality and intimacy. Not all healthcare professionals are willing or capable of adopting such a person-oriented approach.
A complementary team approach, with clearly defined roles for different team members and clear referral pathways, is required to enhance communication about sexuality and intimacy in cancer and palliative care. This approach, that includes the acknowledgement of the importance of patients' and partners' sexuality and intimacy by all team members, is captured in the Stepped Skills model that was developed as an outcome of the Dutch study.
Sexuality; intimacy; cancer care; palliative care; communication; hermeneutics; Stepped Skills
Most studies address medical treatment of infertility and psychosocial outcomes caused by infertility-related stress, but few studies examine the infertility's impact on sexuality.
A literature review was conducted to answer the questions: 1) How is sexual self concept impacted in infertile individuals and their partners? 2) Does infertility have a negative impact on sexual relationships? 3) Is sexual function affected by infertility? In answering these questions, we may develop a better understanding of sexuality in the context of infertility, and thus better inform infertility management. Ultimately the aim is to improve the quality of life for infertile couples.
A literature search was conducted for publications from 1990 to 2011 via the electronic databases PubMed, PsycInfo and Scopus, which focused on sexuality in infertile subjects or couples.
In this review, all studies were descriptive quantitative studies which mapped the different aspects of sexuality in the context of infertility. The results suggested that infertility and its treatment approaches for fertilisation could lead to changes in sexual self-esteem, sexual relationship and sexual function.
The literature substantiated that many infertile subjects experienced trouble in various aspects of sexuality. However, further research should examine the reciprocal relations between sexual self concept, sexual relationship and sexual function in the context of infertility. How these changes affect the partners of infertile subjects should also be addressed.
Infertility; sexuality; IVF; Assisted Reproduction Technology (ART)
Medical journals published in South Asia and other developing regions encounter many challenges. Often authors do not perceive that they have received a fair deal from the journals. In this article the author puts forward a few suggestions to strengthen medical journals in South Asia and also other developing regions.
Authors; developing countries; medical journals; South Asia
Aspergillus spp. often colonise the respiratory tract of critically ill patients in intensive care units and subsequently cause invasive disease. The risk of developing invasive disease is more in immunocompromised patients. Here we report a case of fatal invasive pulmonary aspergillosis caused by Aspergillus versicolor in a post-operative patient on mechanical ventilation, who did not respond to intravenous itraconazole. We then discuss the challenges involved in the accurate diagnosis of this condition and appropriate management.
Aspergillosis; Aspergillus versicolor; itraconazole; ventilator
This multimedia project was as a beer commercial, a lad’s night in, an environment that can be used to target the relevant audience. The goal was to deploy a familiar atmosphere and recognisable characters whilst delivering a serious message with humour in a very short space of time.
Video; technology; condoms; advertisement; youth
Knowledge regarding nutrient foramina of bones is useful in surgical procedures such as microvascular bone transfer in order to preserve the circulation. The objective of the present study was to study the morphology and topography of nutrient foramina and to determine the foraminal index of the lower limb long bones to provide detailed data on such features.
The study comprised examination of 206 lower limb long bones which included femora, tibiae and fibulae. The nutrient foramina were identified analysed macroscopically and the foramen index calculated. Each bone was divided into five parts and topographical analysis was performed on each section.
Femora had single nutrient foramen in 47.7% of the cases, double foramen in 44.2% of the cases, triple in 3.5% of the cases and an absence of foramen in 4.6%. In the case of tibiae, 98.6% showed single foramen and in 1.4% of the cases, the foramen was absent. With respect to fibulae, 90.2% had single foramen and foramen was absent in 9.8%. The mean foraminal index was 38.9 for the femora, 32.5 for tibiae and 49.2 for fibulae. The majority (51.3%) of the foramina in the femora were located at the 2/5th part, 98.3% of the tibiae foramina at the 2/5th part and 60% of the fibulae at the 3/5th part.
The study provides information on the morphology and topography of nutrient foramina in lower limb long bones. The double foramina were more common in femur and rare in the tibia and fibula. The foramina of the femur and tibia were commonly observed at their upper part, whereas in the fibula they were present on the lower part. This knowledge of the nutrient foramina has to be kept in mind during surgical procedures.
Foraminal index; long bones; morphology; nutrient foramen; topography