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   Table of Contents - Current issue
April-June 2021
Volume 17 | Issue 2
Page Nos. 49-80

Online since Friday, October 22, 2021

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Ageism in time of COVID-19 p. 49
Venugopalan Gunasekaran
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Spectrum of skin diseases in the elderly age group: A hospital-based study p. 51
Mriganka Mehra, Nitin Mishra, Pratik Gahalaut, Madhur Kant Rastogi, Neni Agarwal
Background: The increasing average lifespan has led to an increase in an elderly patient encountered in day-to-day practice. Despite this, there is a lack of statistical data about dermatosis in the elderly. Objectives: This study has been performed with the objectives of studying the spectrum of skin diseases in the elderly and study associations of these with various demographic characteristics such as age, gender, and residence with clinical diagnosis. Methodology: This was a cross-sectional study based in a tertiary care teaching hospital, which included patients aged 60 years and above, presenting to the outpatient department of dermatology. Results: A total of 440 patients were enrolled. The mean age was 65.92 years, with maximum belonging to the 60–69 years' age group (73%) and a male preponderance (1.97:1). The most common systemic ailment was diabetes mellitus (18.2%). The most common physiological change was wrinkling (92.3%). Among pathological conditions, infections were the most common group (51.3%). Fungal infections were seen in 24.1% and leprosy in 6.8% of patients. Wrinkling, neoplasia, and nail changes were significantly higher in males. Metabolic dermatosis was significantly higher in diabetics. Generalized pruritus, neoplasia, and pigmentary disorders were significantly more common in urban residents, whereas infections were significantly higher in rural residents. Conclusion: The most common physiologic finding among the elderly was wrinkles while the most common dermatosis were infections. Dermatosis in the elderly has atypical presentations due to an interplay of physiological and pathological factors. With increasing average lifespan, dermatological demands of the aged are growing. Thus, it is important to study the problems of the aged individuals, so proper dermatological care can be provided to them.
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Association of caregiver distress with behavioral and psychological symptoms of dementia-A cross-sectional correlational study from South India p. 56
Sripathi Santhosh Goud, Vishal Indla, Manjiri Deshpande, Indla Ramasubba Reddy
Abstract Context: Non-cognitive symptoms of dementia, also known as behavioural and psychological symptoms of dementia (BPSD) are a less researched topic in developing countries like India. These symptoms not only affect the ability to sustain daily activities and reduce the quality of life but also increase morbidity and mortality in patients with dementia. Aims: The study aimed to assess the prevalence of BPSD and various correlates associated with the severity of BPSD and caregiver distress. Subjects and Methods: It was a cross-sectional, correlational study done on 80 consecutive patients and their caregivers attending the memory clinic of Indlas VIMHANS Hospital, Vijayawada. A semi-structured proforma to collect socio-demographic data, Mini-Mental Status Examination (MMSE), The Neuropsychiatric Inventory-Questionnaire (NPI-Q), and Everyday Abilities Scale for India (EASI) were used in the study. Descriptive and inferential statistical analyses were done to find the correlation between different study variables. Results: BPSD were reported in all the dementia patients. Night-time behaviour disturbances (100%), hallucinations (86.25%), irritability (76.25%), delusions (75%), and agitation (76.25%) were more commonly reported BPSD. There was a positive correlation between BPSD severity and caregiver distress on- hallucinations (r=0.661, P<0.001) delusions (r=0.840, P <0.001), agitation (r=0.823, P<0.001), depression (r=0.947, P<0.001), anxiety (r=0.971, P=0.038), disinhibition (r=0.917, P<0.001), irritability (r=0.875, P<0.001), night-time behaviour disturbances (r=0.451, P<0.001), and appetite abnormality (r=0.683, P<0.001) items. On Pearson correlation care giver distress was significantly associated with – age of the patient (r=0.325, P=0.003), MMSE score (r= -0.461, P<0.001), BPSD severity (r=0.780, P<0.001) and EASI score (r=0.475, P<0.001). Severity of BPSD showed significant correlation with- age of the patient (r=0.267, P=0.017), MMSE score (r= -0.269, P=0.016) and EASI score (r=0.356, P<0.001). Conclusion: BPSD are universal in dementia and they impact the quality of the life of the patients and the caregivers. Improvement in BPSD may reduce caregiver distress and improve the quality of care received by patients.
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Online course in geriatrics for final-year medical students p. 62
Arun N Bhatt, Gayatri Ganesh, Prabha Adhikari, Alka Ganesh
Background: The new competency-based MBBS undergraduate curriculum articulates 24 competencies in geriatrics. Acknowledging the dearth of faculty in the country, a group of geriatricians developed and conducted an online modular course for final-year medical students. Methods: This 6-week online course included 13 modules and the study materials were developed through a two-stage vetting process. The course was advertised to potential students through social media and was delivered over Google classroom platform. Students' learning was assessed by multiple-choice questions (MCQs), and the course was evaluated with comparison of pretest and posttest, feedbacks from students with both structured and open-ended questionnaires. Results: Out of 200 eligible students from 38 medical colleges who applied, 142 students joined the course. Out of 142 students joined, 98 (69%) completed the course with 80% attendance; 91 (64.1%) secured scores above 50%; and 46 (32.4%) secured scores above 80% in MCQ test. Posttest scores were significantly higher than pretest scores (P < 0.001) with medium Cohen's effect size. Median scores of feedbacks on 20-point Likert scale for all modules were 15 or 16. Content analysis of qualitative feedback showed appreciation for the structure and content of the course, praise for the expertise and commitment of the faculty in delivering it effectively, scope for further improvement, and positive change in attitude toward discipline of geriatrics. Conclusions: This endeavor shows that short online course will be helpful for motivated medical students to expand their knowledge in geriatrics.
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Knowledge, attitudes, and practices among older adults of Urban Rajasthan toward COVID-19: A cross-sectional survey p. 67
Laxmi Kant Goyal, Dharmesh Kumar Sharma, Dileep Wadhwani, Sunny Singhal, Arvind Mathur
Introduction: With no effective treatment in sight, preventive measures are the only effective way to fight coronavirus. As older adults are highly vulnerable in this pandemic, it is essential to understand and identify gaps in their knowledge, attitudes, and practices (KAP) regarding COVID-19 to address them. The study aimed to assess KAP among older adults of urban Rajasthan toward COVID-19 infection and its vaccination. Materials and Methods: The online cross-sectional survey was conducted in June 2021 using a questionnaire with close-ended questions on COVID-19 infection and vaccination with a convenience sample of 100 older adults above 60 years residing in Rajasthan. The questionnaire was developed and validated using Google Forms and circulated via social media. Results: The mean age of the participants was 68.2 years. Seventy-four were male and 72 had educational qualification graduate and above. They demonstrated a moderate level of KAP toward the coronavirus infection. However, <5% had completely correct score on either knowledge, attitude, or practices. Knowledge, attitude and practices of subjects regarding vaccination were good. 97% of the participants received at least one dose and 95% agreeing to recommend it to others too. However, only 36% knew that vaccine does not decrease immunity. Conclusion: Although older adults had reasonably good KAP relating to coronavirus infection and its vaccination, there are still some misconceptions and malpractices. Further, information, education, and communication activity can promote their positive attitude toward preventive measures into good practice of self-imposed lockdown.
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Ageing agony: Rape against elderly women p. 73
Mamta Patel
Introduction: Rape is a type of sexual assault and brutal, demeaning, cruel act perpetrated without concern. Despite extensive research on rape, especially in India, there exists an important gap in knowledge around elderly victims. The rapist has been considered by many clinicians as the victim of uncontrollable urges or the recipient of a disordered personality. Objective: The objective of this study was to examine the situation during the commission of the crime and what was the relationship between the victim and the offender in committing the heinous crime. Methods: In this research, data were obtained from print media and electronic media from 2004 to 2018. A total number of 49 cases were found reported during this period of work. This study is based on quantitative findings using the unobtrusive method of content analysis. The elderly women aged 60 and above were taken for the study. Results: The results show that cruelty was involved in more than one-fourth of the cases. In most of the cases, victims were targeted as they were alone in their homes. In some cases, the offenders were found in a state of inebriation at the time of the crime. The crime was committed mostly by the impulsive type rapist. Conclusions: The findings challenge the social norms and have implications for future research, policy, and practice.
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A case report of coinfection of cytomegalovirus colitis and tuberculosis of the intestine in an older patient with heterozygous beta-thalassemia-induced immunodeficiency p. 78
Sunny Singhal, Gaurav Desai, Aparajit Ballav Dey
While thalassemia major is a known immunodeficient state, reports of thalassemia minor presenting with immunodeficiency are rare. We present a 66-year-old male with acute abdomen, hemorrhagic colitis, and septic shock. He was diagnosed with coinfection of intestinal tuberculosis and cytomegalovirus colitis secondary to an immunodeficient state due to heterozygous beta-thalassemia.
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