‘Makkalai Thedi Maruthuvam’ scheme in Tamil Nadu: an intersectionality-based analysis of access to NCD care.

There are gross inequities in access to non-communicable disease (NCD) care in India. The Indian state of Tamil Nadu recently launched the “Medicine at people’s doorstep” (Makkalai Thedi Maruthuvam — MTM) scheme in which screening and medications for NCDs are delivered at people’s doorsteps. This is likely to improve geographical access to NCD services in the community. The objective of this study is to analyse the MTM scheme and recommend policy interventions for improved and equitable access to NCD services in the community. We analysed the MTM policy document using the intersectionality-based policy analysis framework. This analysis was supplemented further with literature review to enhance understanding of the various intersecting axes of inequities, such as gender discrimination, caste oppression, poverty, disabilities and geographical access barriers. The MTM policy document, while it removes the physical access barrier, does not frame the problem of NCDs from an intersectionality perspective. This can increase the chances of inequities in access to NCD services persisting despite this scheme. We also recommend interventions for the short, intermediate and long term to make NCD care more accessible. Creation of a gender, caste, class, geographical access, and disabilities disaggregated database of patients with NCDs, using this database for monitoring the delivery of MTM services, dynamic mapping of vulnerability of the target populations for delivery of MTM services and long term ongoing digital surveillance of factors inducing inequities to access of NCD services can all help reduce inequities in access to NCD care.

Clinical study of profile of retinal detachment in vasculitis and its management at tertiary eye care hospital

Purpose: The aim of the study was to understand the clinical profile and anatomical and visual outcome in Tractional/Combined (Tractional + Rhegmatogenous) Retinal Detachment due to vasculitis after surgical intervention. Methods: It was an interventional retrospective study of all cases who underwent surgery for RD with vasculitis at a single tertiary eye care center for over a period of 6 years. Patients with retinal detachment due to vasculitis were included in the study. All patients underwent the following surgical procedures: 240 belt buckle with three?port pars plana vitrectomy with membrane dissection and peeling with fluid gas exchange/with endolaser with silicon oil/C3 F8 gas injection. Results: In our study, 83.33% had preoperative vision of less than 6/60, whereas postoperatively 66.66% had vision of less than 6/60. Postoperatively 33.33% patients had vision better than 6/36. Of the six eyes operated for vasculitis with RD, retina was attached in five eyes following surgery. One patient had recurrent retinal detachment due to extensive proliferative vitreoretinopathy changes, and he was advised re?procedure but was lost for follow?up. The anatomical success was 83.33% on the first surgery. Conclusion: The overall anatomic success rate of retina reattachment surgery in vasculitis patient was good, and the visual outcome following the surgery can improve in majority of the cases. Hence, timely intervention is advocated.

Manual small-incision cataract surgery under topical anesthesia

Manual small-incision cataract surgery is one of the most common surgical procedures in ophthalmology. Most cataract surgeries are performed under local anaesthesia. Peribulbar or retrobulbar anaesthesia is commonly used to achieve analgesia and akinesia during surgery but it has various complications. Our aim was to study patient comfort and surgeon抯 perspective in terms of patient cooperation in MSICS under topical anaesthesia using only proparacaine 0.5% eye drops without any periocular block or intracameral drug. Also to popularise Topical MSICS similar to Topical Phacoemulsification. A prospective analytical study of 33 patients who underwent MSICS surgery from March 2022 to June 2022 using Topical proparacaine eye drops 0.5% was done and patient抯 comfort and surgeon抯 perspective in terms of patient cooperation was studied on a scale of 1-5. Out of 33 patients who underwent surgery, the average comfort score based on patient feedback was 3.45� 0.96 and average patient cooperation score based on surgeon assessment was 3.42 � 1.07 on a scale of 1-5. We concluded that MSICS using only topical proparacaine 0.5% eye drops, can provide sufficient patient comfort and can avoid complications related to peribulbar anaesthesia. Hence it can be used in large scale cataract surgeries and also provides economical utilisation of resources, lesser complications and early post operative recovery without compromising surgical outcome.

Impact of Autonomous Learning for Advanced Acquisition of Physiology (ALAAP) module among undergraduate health-care professional students

Objectives: The present study aims to document the effectiveness of self-directed activity-based Autonomous Learning for Advanced Acquisition of Physiology (ALAAP) module for endocrine learning among undergraduate physical therapy students. Materials and Methods: Fifty-five second semester students (28 males and 27 females) of the physical therapy course of a private healthcare university were recruited and the traditional didactic method of teaching-learning was compared with that of the newly developed ALAAP module. Results: The triad approach employed to compare the scores of pre-test and post-test after the ALAAP module intervention showed P < 0.001 and Hedges’ g effect size of 0.75 with a 95% CI of –3.41 to –1.5 implying the effectiveness of the module to be strong. Furthermore, the feedback obtained was favourable toward this module and showed that there was an increase in both the affective and cognitive domains of learning. Conclusion: ALAAP module for endocrine physiology is effective and positively targeted all types of learners. It helped their transition from pedagogy to andragogy type of deep learning. The group work done by the students as a part of this module instilled collaborative and cooperative learning in them.

Vulval carcinoma at the site of recent Bartholin gland excision: a rare case report

Around 2-7% of all vulvar cancers are represented by primary carcinomas of Bartholin gland. Here we are presenting such a rare case of carcinoma of Bartholin gland. 45/F P2L2 presented in our OPD with non-healing lesion in vulva for 2 months. She had history of Bartholin’s cyst excision (elsewhere), 2 months back (the exact time since when she is having the non-healing lesion in vulva). Diagnostic biopsy revealed it to be vulval squamous cell carcinoma. She was given two cycles of Neo adjuvant chemotherapy (Inj. Paclitaxel and Carboplatin). In view of better response to the treatment patient was planned for surgery. Patient underwent wide local excision with bilateral inguinofemoral lymphadenectomy. Although the majority of vulvar lesions are benign, especially in women younger than 50 years of age, any solid mass should be carefully evaluated for malignancy. Preferably biopsy of Bartholin gland should be considered if the patient is more than 40 years of age and should be mandatory in a menopausal woman.

Surgical management of a case of recurrent carcinoma cervix: a case report

Worldwide cervical cancer is the fourth most common cancers among females. Pelvic recurrence, distant metastases, or a combination of both can occur in patients of carcinoma cervix. A 42-year-old P2L2 with a history of carcinoma cervix stage 3-b came to our OPD for routine follow up. Two year back she was managed with chemoradiation for her primary carcinoma which had parametrium extension. There was a 1 × 1 cm lesion on the anterior vaginal wall which was diagnosed to be cervical recurrence. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Patient is disease free till now. Treatment decisions should be individualised based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment.

Ogilvie’s Syndrome – A Post-Operative Emergency in a Case of Carcinoma Rectum

Acute colonic pseudo obstruction or Ogilvie’s syndrome is a rare entity that is characterized by acute dilatation of the colon without any mechanical obstruction. It is usually associated with medical disease or surgery and rarely occurs spontaneously. If not diagnosed early, Ogilvie’s syndrome may cause bowel ischemia and perforation. Its early diagnosis and prompt treatment are the keystones to avoid any subsequent fatal complications. We report a case of acute intestinal pseudo obstruction causing post-operative wound dehiscence in a patient who underwent colostomy reversal following a Hartman’s procedure for a rectal carcinoma. We also review the clinical characteristics, diagnostic methods, and management of Ogilvie’s syndrome with reference to literature.

Laparoscopic Radical Hysterectomy for Early Stage Cervical Cancers – A Single Team Experience

Current evidence on the efficacy and safety of Laparoscopic Radical Hysterectomy for early stage cervical cancer is adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit. This study aims to present our single unit experience of Laparoscopic Radical Hysterectomy performed for early stage cervical cancers. Methods: 74 laparoscopic radical hysterectomies performed for early stage cervical cancers from 2012 to 2017 were reviewed. Results: Key efficacyoutcomes evaluated were completing the procedure without conversion to open surgery ( conversion rate – 3/74),the mean operating time (144 mts), intra operative complications ( rectal injury 2/74, primary hemorrhage 1/74), post operative complications ( ureteric fistula 2/74, vescico vaginal fistula 1/74 , port site hernia 1/74), number of LN removed ( mean - 14 LN on each side), recovery time (6 hrs on average ) and length of hospital stay (average – 5days); lone term outcomes viz recurrence rate and % year survival are under study. Conclusion: Our initial experience indicate that laparoscopic radical hysterectomy is safe ,feasible and effective with low morbidity and with comparable outcome to open approach; It does not compromise oncological radicality of resection; short term results are promising; long term results are awaited.

Modified ovarian response prediction index: a novel index for ovarian response prediction in GnRH agonist cycles

Background: Evaluation of the ovarian reserve is necessary to achieve an appropriate controlled ovarian stimulation (COS). This can be done by correctly predicting the ovarian response. The objective of this study was to derive a simple index by combining the above parameters which will be helpful determining ovarian response.Methods: This retrospective analysis was performed at Guru hospital, Madurai, involving 162 patients between July 2016 and July 2018. Inclusion criteria was all patients attending for their first ICSI (intracytoplasmic sperm injection) cycle between the above period, GnRH agonist protocol as the method of ovarian stimulation, no history of any previous ovarian surgery, presence of both ovaries and no evidence of any obvious endocrine disorders. We calculated MORPI values by multiplying the AMH (ng/ml) level by the number of antral follicles (2-9 mm), and the result was divided by the age (years) of the patient and the day- 3 serum FSH level.Results: At a cut-off value of 35 (AUC-0.952) for collection of ≥ 4 oocytes and 140 (AUC-0.952) for collection of ≥ 15 oocytes, MORPI was found to have optimum sensitivity and specificity under ROC curve analysis.Conclusions: MORPI is a simple, precise and cost effective index to predict a low ovarian response, the collection of >4 MII oocytes and an excessive ovarian response in infertile women. This index also has a good ability to predict the clinical pregnancy rate. This might be used to improve the cost-benefit ratio of ovarian stimulation regimens.

Coexistence of both Brenner tumor and cystadenofibroma of ovary in a postmenopausal woman: a rare case

Brenner tumor, and cystadeno fibroma of ovary are rare varieties of ovarian tumor, characterized by presence of solid components. There are very rare instances where both Brenner tumor and cystadenofibroma coexist in a single patient. A 48-year P1L1, postmenopusal woman presented at Guru hospital, Madurai, with chief complaints of on and off postmenopausal bleeding for 6 months. On ultrasonography there were two simple cysts of ovary measuring 6x 6 cm on left side and 4x4 cm on right side. She was managed with total laparoscopic hysterectomy and bilateral salpingoophorectomy.  Intraoperatively there was a right ovarian mass of 6x6 cm size and a left ovarian mass of 4x4 cm size. Left ovarian mass reported as benign cystadenofibroma while the right ovarian mass was reported to be brenners tumor on histopathology. As the preoperative imaging are not completely relied for diagnosing these tumors, awareness of the surgeons of these entities is particularly important. The prognosis of both of these tumors is excellent with suitable treatment. They have a very low recurrence risk on compete removal through surgery.

Churg Strauss Syndrome — A Rare Case Report.

A 25 year old male was diagnosed as a case of churg strauss syndrome (allergic granulomatosis and angitis) with history of loose motion, generalized weakness, blanch able erythematous rash on trunk seen along with severe joint tenderness was diagnosed on postmortem autopsy .The aim of this case report is the possibility of churg strauss syndrome in the patient presenting with loose motion and skin rash.

Extramedullary Plasmacytoma of Breast.

Solitary plasmacytomas are more frequent in males than females. We are describing a solitary extramedullary plasmacytoma of the breast in a 50 year old woman on fine needle aspiration cytology and confirmed on histology. During 6 months of fallow up, no other involvement was detected in the bone marrow or in any other site. Extramedullary plasmacytoma occur in lymph node, lung, thyroid, gastrointestinal tract testis, and skin. Extramedullary plasmacytoma of breast is a rare lesion. Especially those are not associated with multipal myeloma. Most reported cases represent secondary involvement or initial manifestation of the multipal myeloma.

Synovial Cyst with Fungal Granuloma.

Synovial cysts are frequently seen and are most commonly seen at the back of the knee where it is known as popliteal cyst. But synovial cyst with fungal granuloma is rather rare. This case report illustrates an occurrence of synovial cyst with fungal granuloma, in a 40 years old male at the dorsal aspect of the right ankle joint. Clinical examination revealed lesion about 4x4x4cms in size over the dorsal aspect of the right ankle joint. Simple excision of the lesion was done with the clinical diagnosis of lipoma. Microscopic examination revealed synovial lining hyperplasia and subintimal tissue showed granulomatous reaction with foreign body giant cells and black colored fungal colonies. Patients did not attend further, so follow up was not available.

Lung function changes in young obese women – A harbinger for graver outcomes.

Obesity is a global health hazard. As standards of living are continuing to rise, weight gain and obesity are posing a growing threat to health in countries all over the world. These obese individuals are at increased risk of morbidity and mortality because of its relationship with various metabolic disorders. It is also known to cause alterations in pulmonary functions, so the present study was planned to assess the effect of obesity on pulmonary function tests in young adult females of 18 to 25 years. Based on body mass index (BMI) participants were divided in to two groups. Both groups were age and physical activity matched. Pulmonary function tests were recorded using computerized spirometry. Results when analyzed statistically using students “t” test showed that there was a significant decrease in expiratory reserve volume in obese individuals compared to controls. Other tests were not significant. This result shows that obesity has an impact on respiratory functions even in younger age group hence we have to safeguard against the hazards of obesity by taking corrective steps through our health programs.

Study of placenta in sickle cell disorders.

Remarkable changes are seen on gross and microscopic examination of placenta of patients with sickle cell disorders, hence the present study was undertaken to find out the pathological changes seen in the placenta of sickle cell disorder patients, as compared to control and to study the effect of maternal sickling on the fetus. It includes total 73 cases, of which 10 were of control group and 63 were from patients with sickle cell disorders, which included 47 sickle cell trait (AS) and 16 sickle cell disease (SS) patients. In group II, 9 (14.28%) patients with SS pattern developed complications during pregnancy, in the form of vaso-occlusive and hemolytic crises. Pregnancy induced hypertension was seen in 4 (25%) out of 16 SS and 11 (23.40%) of the 47 AS patients. Urinary tract infection (UTI) was seen in 6 (37.5%) out of 16 SS and 8 (17.02%) out of 47 AS patients. Placentae in sickle cell disorders showed pathological changes in the form of infarction, calcification, sickled red blood cells and hemorrhage in intervillous spaces, increased syncytial knots, fibrinoid necrosis, stromal fibrosis, hyalinised villi and compensatory proliferation of trophoblastic cells.