Ethics of Managing an Adolescent Living with Disability.

An ethical challenge arose when the parents of an adolescent girl living with severe intellectual disability requested for a permanent surgical intervention (hysterectomy) that would cause cessation of menstruation and reduce the possibility of pregnancy following nonconsensual sex. The family background was rural with poor access to extended family/community support, financial and social welfare resources. The parental distress was real with the adolescent incompetent to give informed consent. Is a non-therapeutic hysterectomy in an adolescent living with severe intellectual disability ethical? Views of a pediatrician, adolescent specialist, nurse, and an ethicist referring to literature suggesting an approach to an ethical decision are discussed herein.

Perception of family medicine as the career option among young Indian graduates.

Aims and Objectives: 1. To estimate the number of graduates who had exposure to family medicine specialty. 2. To estimate the number of graduates who consider family medicine as the carrier option. 3. To compare the perception of family medicine as career option among the young graduates who had exposure to family medicine during their training or practice with no exposure. Materials and Methods: It is a cross-sectional, questionnaire-based study. The doctors graduated 2018 onwards were contacted through SIMSA (South Indian Medical Students Association) and WhatsApp groups (students doing the rural health service and intern WhatsApp). Subjects who consented for the study filled the google form. Filled Google forms were evaluated. Results: First choice of among the graduates is general medicine followed by general surgery and paediatrics. Family medicine is 4th in the order. There is overall a very positive perception about the family medicine among the respondents irrespective of exposure to family medicine. Majority of them feel that it gives good financial gain (55.55%), interesting (67.03%), work and family balance (75.55%), which contributes to individual and community health (84.07%) and essential part of healthcare system (83.33%). Graduates feel that career growth (26.66%) and academic growth (33.70%) are less and it is not popular (38.88%). If there is an opportunity, majority would choose family medicine (54.44%). Conclusions: Around 5.9% are open to choose family medicine as the career option. Medical graduates perceive family medicine subject to give them good work and family balance and the subject is essential part of healthcare system and contributes to the individual and community health, and at the same time, it may not give them great financial gain, academic and career growth.

Health for all in an unequal world: Obligations of global bioethics.

The theme of the joint 14th World Congress of Bioethics and 7th National Bioethics Conference Congress "Health for all in an unequal world: Obligations of global bioethics" is of critical relevance in the present global context. Although the world is better off in terms of improved health status of people by many measures than before, there exist colossal gaps across and within populations. Much needs to be done to respond to the lack of access to healthcare, poor quality of living and working conditions, and deteriorating quality of overall environment which affects more adversely the already deprived. We take this opportunity to make a few observations about the current status of affairs on this front, and offer brief analytical insights into the complex origins of the global health scenario characterised by disparities. We revisit the original conception of bioethics and suggest that it is well placed to respond to the current global crisis of inexorably widening disparities in health and wealth, and that global bioethics has an obligation to engage with this crisis.

On the integration of Ethics into the Physiology curriculum.

A one-day state-level workshop was organised in Karnataka to share the experience of a programme implemented earlier, in 2015-16, at St John's Medical College, Bengaluru that integrated the teaching of ethics into the physiology curriculum. The aim was to develop the programme further, list the challenges likely to be faced while scaling it up, and identify other colleges which could participate in the scaling up. Twenty-eight participants, representing 13 medical colleges, and five resource persons attended the workshop. There was a consensus that the integration of ethics into the physiology course was relevant and desirable, although the participants identified several critical challenges which might arise. These included the lack of institutional support, a possible lack of student "buy-in" since it was beyond the requirements of the examinations, and time constraints. Specific areas of integration were identified. Three medical colleges, including the host institution, opted to implement the programme and refine it further.

The burden of segregated respiratory diseases in India and the quality of care in these patients: Results from the Asia-Pacific Burden of Respiratory Diseases study.

BACKGROUND: Chronic respiratory diseases such as asthma, allergic rhinitis (AR), chronic obstructive pulmonary disease (COPD), and rhinosinusitis are becoming increasingly prevalent in the Asia-Pacific region. The Asia-Pacific Burden of Respiratory Diseases study examined the disease and economic burden of AR, asthma, COPD, and rhinosinusitis across the Asia-Pacific and more specifically India. OBJECTIVES: To estimate the proportion of adults receiving care for asthma, AR, COPD, and rhinosinusitis and assess the economic burden, both direct and indirect of these chronic respiratory disease. SUBJECTS AND METHODS: Consecutive participants aged ≥18 years with a primary diagnosis of asthma, AR, COPD, or rhinosinusitis were enrolled. Surveys comprising questions about respiratory disease symptoms, healthcare resource utilization, work productivity, and activity impairment were completed by treating physicians and participants during one study visit. Costs, indirect and direct, that contributed to treatment for each of the four respiratory diseases were calculated. RESULTS: A total of 1000 patients were enrolled. Asthma was the most frequent primary diagnosis followed by AR, COPD, and rhinosinusitis. A total of 335 (33.5%) patients were diagnosed with combinations of the four respiratory diseases; the most frequently diagnosed combinations were asthma/AR and rhinosinusitis/AR. Cough or coughing up sputum was the primary reason for the current visit by patients diagnosed with asthma and COPD while AR patients reported a watery, runny nose, and sneezing; patients with rhinosinusitis primarily reported a colored nasal discharge. The mean annual cost per patient was US$637 (SD 806). The most significant driver of direct costs was medications. The biggest cost component was productivity loss. CONCLUSIONS: Given the ongoing rapid urbanization of India, the frequency of respiratory diseases and their economic burden will continue to rise. Efforts are required to better understand the impact and devise strategies to appropriately allocate resources.

A randomized crossover study to determine bioequivalence of generic and brand name nevirapine, zidovudine, and lamivudine in HIV-negative women in India.

Low-cost generic antiretroviral drugs are available in resource-limited settings for treatment of HIV infections. However, few bioequivalence data in specific populations in which these generics are likely to be used are available. We conducted a randomized crossover bioequivalence study of generic and brand name formulations of nevirapine, zidovudine, and lamivudine in HIV-negative Indian women using US Food and Drug Administration (FDA) criteria. Subjects took single doses of all formulations separated by a 14-day washout period. Plasma concentrations were measured over 96 hours during each study period. Average bioequivalence was determined using natural log-transformed maximum concentration (C(max)) and area-under-the-concentration-time curve (AUC) mean ratio data. Fifteen Indian women were enrolled. The 90% confidence intervals for nevirapine (14 subjects) and lamivudine (15 subjects) C(max), AUC from 0 to the last measurable time point (AUC(0-t)), and AUC from 0 to infinity (AUC(0-infinity)) mean ratios and zidovudine (15 subjects) AUC(0-t) and AUC(0-infinity) mean ratios were all within 0.80 to 1.25. However, the 90% confidence interval for zidovudine C(max) mean ratio was 0.70 to 1.46. Generic and brand name nevirapine and lamivudine met FDA average bioequivalence criteria. Lack of average bioequivalence for zidovudine was found for C(max) but is not expected to be clinically significant, because the total AUC values were similar between formulations.

Physicians must not help parents decide the gender of their unborn child: the case against preconception gender selection.

India has amongst the worst gender ratios in the world. Preconception gender selection can aggravate this situation. This procedure is costly and has a moderate success rate. No moral theory supports this procedure. It demeans human beings and commodifies gender. The medical profession should not invest resources in this procedure and the government should ban the import of this technology.

Urinary IgG antibody capture particles adherence test for detecting HIV antibodies: a preliminary report.

It is known that antibodies to HIV are secreted in urine and saliva. IgG antibody capture particle adherence test (GACPAT) has been shown to provide accurate results for antibodies in urine. The aim of the study was to study the sensitivity and specificity of this test in our settings. 114 urine samples were collected from both HIV positive and HIV negative patients and were analysed using GACPAT. The test has a sensitivity of 92.3% and specificity of 100%. We feel that this test has a definite role in our country especially for surveillance purposes.

Changing pattern of antibiotic sensitivity of Salmonella typhi.

BACKGROUND: The emergence of multidrug-resistant Salmonella typhi led to the use of quinolones as the first-line drug in the treatment of adult patients with typhoid fever. However, over the last few years there has been an impression that patients on ciprofloxacin tended to take longer to defervesce. We studied the response and antibiotic sensitivity patterns during 2 time periods to assess the changes that may have occurred. METHODS: A retrospective analysis was done of blood culture-positive patients with Salmonella typhi infection during 1991 and 1996-97. The mode of presentation treatment history, antibiotic sensitivity pattern, antibiotics administered, response to therapy and the complications that ensued were studied. RESULTS: In vitro sensitivity to ciprofloxacin was found to be 100% in both the study groups. It was found that a greater number of patients were sensitive to ampicillin (80%), chloramphenicol (80%) and co-trimoxazole (80%) during 1996-97 as compared to 1991, when sensitivity to ampicillin was 63%, chloramphenicol 65% and co-trimoxazole 65%. The mean (SD) defervescence period in 1991 was 6 (2.3) days and in 1996-97 was 6 (2) days (p > 0.05). CONCLUSION: In vitro sensitivity of Salmonella typhi to ciprofloxacin remains 100%. There was an increase in the sensitivity to ampicillin, chloramphenicol and co-trimoxazole which have been rarely used over the past few years. There was no significant difference in the time taken to defervesce between the two study periods.

Teaching medical ethics in a medical college in India.

To the best of our knowledge, medical ethics is not taught as a separate subject in Indian medical colleges. St John's Medical College has a programme for teaching medical ethics to its undergraduate students. We describe here the structure of our programme, the syllabus and the teaching methodology. We feel that we have an effective way of teaching medical ethics at our medical college and would encourage other medical colleges to introduce the subject in their curriculum.

Cryptococcal meningitis in AIDS--need for early diagnosis.

Cryptococcal meningitis is the most common opportunistic fungal infection in patients with Acquired Immunodeficiency Syndrome (AIDS) contributing to the increased morbidity and mortality. This important infection in AIDS seems to be under diagnosed in India. We discuss the clinical features, laboratory diagnosis and therapy of seven cases of cryptococcal meningitis detected in our hospital. Diagnosis was established in all cases by identification of the fungus in cerebrospinal fluid (CSF) by India Ink preparation and positive fungal culture in CSF and/or Blood. Six patients were treated with Amphotericin B and Flucytosine. Two were cured and have not relapsed on suppressive therapy. Two died during treatment. Two were lost to follow up. All the three patients who died had positive fungal culture in blood and CSF. Presence of Cryptococcemia in Cryptococcal meningitis is an indicator of poor prognosis. A high index of clinical suspicion and routine mycological surveillance essential to identify this infection.