Insular carcinoma of thyroid--a case report.

Insular carcinoma of thyroid (ICT) is a rare tumor, which accounts for 4-6% of thyroid malignancies. ICT arising from follicular cells of thyroid shows a characteristic insular growth pattern characterized by solid nests of tumor cells separated by vessels. A 52-year-old female presented with a huge swelling in midline of the neck with retrosternal extension. The patient was euthyroid. Near total thyroidectomy was done. Grossly, the tumour was involving both the lobes and isthmus of thyroid. Microscopic examination revealed features of insular carcinoma. On immunohistochemistry, tumour cells were positive for thyroglobulin and negative for calcitonin.

A serological study of human toxocariasis in north India.

BACKGROUND: Human toxocariasis owing to lodgement of the larvae of Toxocara canis in different organs can result in serious clinical syndromes such as visceral larva migrans or ocular larva migrans. Detection of an antibody response to Toxocara canis excretory-secretory (TES) antigen in serum samples is sensitive and specific for diagnosis and epidemiological surveys. To assess the extent of this problem in northern India, we tested the antibody response to the TES antigen by ELISA technique in subjects residing in a rural area near Chandigarh and in patients attending Nehru hospital, Chandigarh and clinically suspected to have toxocariasis. METHODS: Serum samples were collected from 94 randomly selected subjects, residents of Kheri village, Ambala district, Haryana; 30 patients clinically suspected to have toxocariasis attending Nehru hospital, Chandigarh; 25 control patients and 15 normal healthy individuals. These were subjected to ELISA technique for detection of an antibody response to TES antigen usinga commercial kit (LMD Laboratories Inc. Ca. USA). All the samples were tested in duplicate and positive samples were tested by a different kit (Melotec Biotechnology, Spain). RESULTS: Of the 94 subjects residing in Kheri village and 30 clinically suspected toxocariasis patients, 6 (6.4%) and 7 (23.3%), respectively, were seropositive for anti-Toxocara antibody response. A history of pica and/or contact with puppies could not be obtained from all the subjects/patients, hence the exact mode of transmission could not be ascertained. However, 3 (3.2%), 2 (2.13%) and 1 (1.06%) seropositive subjects in Kheri village were in the age groups of 1-10, 11-20 and 21-30 years, respectively, while 4 (13.33%) and 3 (10%) seropositive patients who attended Nehru hospital, Chandigarh were in the age groups of 1-10 and 21-30 years, respectively. None of the control patients/healthy individuals were seropositive. CONCLUSION: A positive antibody response to TES antigen in 6.4% subjects residing in a rural area near Chandigarh and in 23.3% of patients clinically suspected to have toxocariasis indicates that human toxocariasis may be endemic in certain regions of northern India. A detailed epidemiological study is needed to determine the extent of this problem.

Animal bite management practices: a survey of health care providers in a community development block of Haryana.

It is seen that outcome of animal bites is influenced by various factors including the treatment procedures practiced by health care providers (HCPs). A cross sectional study of health care providers was conducted during May 2000 in PHC Kurali and Naraingarh town of community development block Naraingarh in district Ambala, Haryana. A total of forty-four HCPs were interviewed at their health facility. They were asked about the qualification and number of years in practice. Health care providers were assessed for their knowledge regarding history taking, immediate management of animal bite, post bite anti-rabies treatment, follow up advice and availability of vaccines. Pre-exposure prophylaxis was known to 18.8% of HCPs. Fifty-nine per cent of HCPs were confident in managing dog bites and 93.1% knew about tissue culture vaccine. Vaccine cost was the commonest barrier (38.8%) in the management of animal bites. This study shows a gross difference between awareness and actual practice of management of animal bites.

Adolescent behaviour regarding reproductive health.

A cross-sectional household survey was undertaken in rural areas of district Sirmaur, Himachal Pradesh, to assess the knowledge, beliefs and practices of adolescents about reproductive health. Six hundred and forty three unmarried adolescents aged 15-19 years were selected by 30-cluster sampling method from 2400 households. They were interviewed using a semi-structured schedule. Fifty-six per cent were girls. More girls (14%) were illiterate than boys (6%). Most of the boys (88%) and 58% girls knew that a female conceives through sexual intercourse. Seventy seven per cent girls and eighty seven per cent boys were aware of at least one contraceptive method. Majority of the girls (71%) and boys (82.5%) favoured termination of an unwanted pregnancy. About one-fourth respondents considered husband responsible for infertility and for sex of the baby. Boys considered night emission, poor body built and less growth of hair as reproductive health problems, whereas, girls were worried about menstruation and inadequate breast development. Almost 6% boys reported use of a contraceptive method indicating existence of pre-marital sexual activity. Knowledge on reproductive health is low and there is a big gap between actual and desired practices.

Effect of continuing training on knowledge and practices of traditional birth attendants about maternal and newborn care.

Seventy nine traditional birth attendants (TBAs) of Raipur Rani community development block, Haryana were interviewed to assess the effectiveness of continuing training in changing their knowledge and practices regarding maternal and newborn care. Seventy three percent of them reported participation in continuing training sessions. However, analysis of attendance register showed that only 35.4% had attended more than 50% sessions in year 1993. Most (83.5%) of the TBAs gave advice to pregnant women for increased food intake, 47% advised tetanus toxoid, 16.5% for more rest, and 31.6% for iron tablets. Many of them were aware of maternal complications i.e. anaemia (64.6%), oedema (26.6%), bleeding per veginum (39.2%), abnormal presentation (77.2%) and high fever (48.1%). Risks to newborn like low birth weight, fever, cough/rapid breathing and hypothermia were known to 20.2%, 31.6%, 17.7% and 1.3% of the TBAs respectively. Knowledge regarding causes of low birth weight baby like 'weak' mother, less diet in pregnancy, short birth interval and preterm delivery were reported by 69.6%, 63.3%, 12.6% and 3.8% respectively. About two fifth of TBAs advised referral to hospital in case of prolonged labour and 88.6% for very low birth weight babies. Disposable Dai Kit and weighing machine were available with 32% and 73% TBAs. Significantly higher proportion of TBAs participating in continuing training advised tetanus toxoid vaccination, appropriate feeding practices of the newborn, hospital referral in case of prolonged labour and were less inclined to advise injection to speed up labour. Therefore, efforts should be made to increase the attendance of TBAs in continuing training sessions so as to sustain modern maternal and newborn care practices acquired after initial training.

Community based study of reproductive tract infections among ever married women of reproductive age in a rural area of Haryana, India.

A community based study was carried out to estimate the load of reproductive tract infections (RTIs) among ever married rural women aged 15-44 years and utilisation of a mobile village based treatment facility by them, during 1997. Complete household survey was done in 10 randomly selected villages of Mahindergarh district in Haryana, India. A total of 2325 women were interviewed by auxiliary nurse midwives and were invited for medical examination in a health camp set-up in their village. Sixty-one percent (1415/2325) women reported symptoms of RTIs. Only 35% (812/2325) had their per-speculum examination done. Out of those examined, 32% (263/812) had vaginitis, 21% (175/812) had cervicits, and 19% (156/812) had pelvic inflammatory disease. Vaginal smear of those having discharge revealed that 48% (231/476) had bacterial vaginosis, 0.8% (4/476) had fungal infection 9% (44/496) had trichomonal infection and none was found to be having gonococcal infection. Tests for chlamydial infection could not be performed as the cost was not affordable. Eighty-nine percent of women who reported symptoms of RTIs had not consulted anyone for their problem prior to our village based camp. Only 42% symptomatic and 24% asymptomatics availed the services even in the village based camps. Study revealed high load of reproductive tract infections and low utilisation of treatment facility. In-depth studies are required to understand for high RTI morbidity load and low treatment seeking rate so as to design an appropriate RTI control programme.

Awareness of AIDS among school children in Haryana.

The study is aimed to assess the existing level of knowledge of school children of 9th and 10th classes about Acquired Immune Deficiency Syndrome (AIDS). Three high schools in an urban area and three in the villages of a district of North India were included in the study. A pretested closed-ended questionnaire was administered to 336 students available. Overall level of knowledge about AIDS was found to be high. However, there were significant differences in knowledge among rural-urban and male-female students. There were some misconceptions in knowledge regarding transmission, prognosis and prevention. Books and media were the most common sources of information. Most of the students wanted to learn more about AIDS. Since overall knowledge levels were high we conclude that AIDS education should concentrate on clarifying areas of misconceptions.

Nutritional status of children: validity of mid-upper arm circumference for screening undernutrition.

OBJECTIVES: To determine the nutritional status and validity of mid upper arm circumference (MAC) in diagnosing malnutrition among preschool children. DESIGN: Cross-sectional household survey. SETTING: 47 villages in District Ambala, Haryana. SUBJECTS: 3747 children aged less than six years. METHODOLOGY: Trained field workers recorded age, weight, length/ height and MAC of children. Prevalence of underweight, stunting, and wasting were calculated in reference to National Centre for Health Statistics (NCHS) standards. Sensitivity and specificity of MAC for detecting underweight, wasting and stunting among children aged 1 to 4 years were determined. RESULTS: At the cut-off level of < -2.00 SD of Z-scores, 48.8% children were stunted, 49.6% were underweight and 9.1% were wasted whereas 47.6% children had neither wasting nor stunting. Prevalence of severe stunting, underweight, and wasting (Z-score < -3 SD) was 18.1%, 11.5% and 0.6%, respectively. Undernutrition showed a significant rise after 12 months of age (p < 0.0001). Stunting and underweight were significantly more among girls compared to boys (p < 0.01) but wasting was not significantly different in them. Compared to the conventional MAC cut off levels of < 13.5 cm and < 12.5 cm, sensitivity and specificity in our setting were optimum at < 13.5 cm for detection of wasting and < 14.0 cm for diagnosis of underweight and stunting, and < 13.0 cm for detection of severe wasting and < 13.5 cm for diagnosis of severe underweight and severe stunting. CONCLUSIONS: Almost every second child was undernourished. Optimum cut off level of MAC in our setting were higher than the conventional cut off points for detection of undernutrition among children.