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Background: The role of BCG and MMR/Measles vaccination in reducing the burden of COVID-19 has been based on ecological data mostly. We planned this explorative pilot case-control study to understand the role of vaccination with Bacillus Calmette朑uerin (BCG) and measles administered as part of MMR vaccine on COVID 19. Methodology: A case-control study was conducted in AIIMS Patna during December 2020 and January 2021. A total of 100 COVID-19 patients confirmed by RT-PCR test were taken as cases, and for each case, age and gender-matched SARS-COV-2 negative individual was taken as control. A study tool containing a pre-tested semi-structured questionnaire was used. Results: The unadjusted odds of COVID-19 were found to be significantly higher among BCG vaccinated [1.88(1.03-4.4)] and MMR vaccinated individuals [5.06(2.34-10.90]. BCG vaccine was not found to have an independent effect on COVID-19 after adjusting for tobacco use, MMR vaccination status, unprotected contact with SARS-COV-2 positive patients, and co-morbidities. But Measles vaccine was found to independently increase the risk of COVID-19 [AOR: 4.505(1.8-11.3)]. Conclusion: BCG vaccination status was not found to be an independent predictor of COVID-19. Further studies with large sample size and better study design (cohort, randomized trials) need to be conducted.
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A 51-year-old Asian Indian male with right oculodermal melanocytosis presented with a blurred visual acuity of 20/40. Upon fundus examination, he was discovered to have two independent pigmented choroidal melanomas in the temporal juxtapapillary region and inferiorly, in the region of trace clinical sectoral choroidal melanocytosis. The patient underwent enucleation, and on histopathology the two tumors were found to be in the area of choroidal melanocytosis, in continuity with each other. Multifocal choroidal melanoma is an exceedingly rare diagnosis. Ocular melanocytosis is a known predisposing factor for both unifocal and multifocal melanomas. Lifelong monitoring for uveal melanomas must be done in all patients with ocular melanocytosis.
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Background: In India, teenage pregnancy is an important public-health problem, although the national policy of the Government of India advocates the minimum legal age of marriage for girls to be 18 years. Data of the National Family Health Survey (NFHS)-3 revealed that 16% of women, aged 15-19 years, have already started childbearing. Teenage pregnancies represent a high-risk group in reproductive terms because of the double burden of reproduction and growth. Complications of pregnancy and childbirth are the leading cause of mortality among girls aged 15-19 years in developing countries. Aim and objective of the study was to study the prevalence of teenage pregnancies and to study the clinic social impact of teenage pregnancies.Methods: The observational cross-sectional study was conducted in Government General Hospital, Guntur in the department of Obstetrics and Gynaecology over three Months from August to October 2018. All pregnant women coming to either OPD or directly to the labour room were included in the study group. History was taken and examination was done.Results: Among the 709 deliveries in the institute, 138 are teenage pregnancies contributing to 19.4%. Prevalence of anaemia in teenage mothers is as high as 63.7%, pregnancy induced hypertension contributing to 26.8% and abortions 9.4%. The neonatal outcome is poor in teenage mothers, low birth weight 20.2% contributing to the main morbidity.Conclusions: Teenage pregnancy is associated with an increased incidence of preeclampsia, eclampsia, preterm delivery, increased incidence of instrumental deliveries and lower segment caesarean sections due to cephalopelvic disproportion, neonatal complications, increased neonatal morbidity and mortality mainly due to low birth weight was noted in babies delivered to teenage mothers.
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Hypophysitis is classified into primary and secondary. Xanthomatous hypophysitis is one of the rare types of primary hypophysitis. A 55-year-old female presented with headache, vomiting, and blurring of vision. She also had endocrine dysfunction in the form of low serum T3, T4, and low cortisol levels. MRI scan showed a sellar expansile lesion suggestive of pituitary macroadenoma. Microscopy showed pituitary tissue replaced by inflammatory infiltrate made up of foamy histiocytes arranged in sheets along with lymphoplasmacytic infiltrate. Interspersed areas of fibrosis, hyalinization, few congested and sclerosed blood vessels were seen. Compressed residual pituitary tissue was identified at the periphery. Xanthomatous hypophysitis is a rare entity which can mimic as pituitary adenoma both clinically and radiologically. Accurate diagnosis at an early stage with postsurgical steroid therapy may help to prevent permanent pituitary damage.
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Background: H1N1 or swine flu is a disease caused my influenza virus of family Orthomyxoviridae. Initial cases in India were seen in 2009 and ever since then it has been adding to the mortality rate over the years across various parts of the country. Dakshina Kannada district of Karnataka, India, had several cases of H1N1. But despite the efforts, the magnitude is rising inconspicuously. Aim & Objective: Assessment of H1N1 cases throughout Dakshina Kannada district from Jan 2011 to August 2017. Objectives: To observe the disease trend, its factors and provide certain recommendations to control the disease and promote Health. Material & Methods:H1N1 cases notified to District surveillance unit from all the Health collaborated settings over a period of six years from January 2011 to August 2017 were assessed to measure the burden of the disease across different age groups and Gender. Result: The study revealed a considerable increase in H1N1 cases compared to previous years with peak during monsoon and difference in risk among the gender. Conclusion: Vaccination of Health professionals, High alert for travelers, Pregnant women and individuals with co-morbid conditions is essential. Control of disease transmission with early diagnosis, isolation and treatment, effective vaccination to high risk individuals will be helpful to reduce disease burden
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A 20-year-old male presented with a gradually growing mass in the left lateral brow region for 2 years. On imaging, the mass appeared to arise from the lacrimal gland, was cystic, without any bony abnormality. With a diagnosis of dermoid cyst, an excision biopsy was performed. The histopathology revealed an epithelium-lined cyst, with the wall of the cyst comprising dermal adnexa and inflammatory cells. The wall also contained fragments of skeletal muscle, nerve bundles, adipose tissue, exocrine and secretory acini, few blood vessels with occasional hair shafts, with the lacrimal gland in the periphery of the tumor. There were no immature elements, atypia, and malignant cells, thus confirming the diagnosis of a mature cystic teratoma. Primary lacrimal gland teratoma is a rare diagnosis and its presentation in adults is extremely uncommon.
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Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.
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An 18-year-old female presented with rapidly progressive proptosis of the left eye for one month and grade II relative afferent pupillary defect. Orbital imaging showed a well-defined homogenous extraconal mass in close relation to the lateral rectus muscle and extending up to the superior orbital fissure, associated with bony erosion. An incisional biopsy was performed, with the histopathology demonstrating stellate to spindle-shaped tumor cells (fibroblasts) embedded in a richly myxoid matrix. A diagnosis of low-grade fibromyxoid sarcoma (LGFS) was made. The patient was treated by stereotactic external beam radiotherapy. Here, we report a case of LGFS which, to the best of our knowledge, is the first at an orbital location.
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Background: Juvenile is a boy who has not attained 16 yrs and a girl who has not attained 18 yrs. Any offence thefts/robbery, attempt to murder/murder, rape, addictions and any deviation from normal behavior like truancy, vandalism, immorality and ungovernability is termed as delinquency. According to National Crime Records Bureau (NCRB) (2016), Telangana is holding 16th rank and among the metropolitan cities, Hyderabad is contributing to 11th rank based on percentage share in India on Juvenile crime. The objective of the study was to study the factors influencing the juvenile delinquency.Methods: An institutional based cross-sectional study is carried out for a period of three months in the Government Juvenile homes of Hyderabad, Telangana. All the inmates of the male and female juvenile homes (n=200) available at the time of study who were willing to participate were interviewed. Those who were sick and not cooperative were excluded. A semi-structured questionnaire completed through interviews and studying the subjects’ records and ISRD3 questionnaire were used. Institutional ethical clearance was taken before starting the study.Results: 77.5% (155) were males and 22.5% (55) were females. 16.5% (33) were 6-10 yr age group and 83.5% (167) were above 11 yrs. The mean age (yrs) is 14.02±2.96. 18% (36) didn’t attend school and 82% (164) attended school. Age, sex, school attending and the time spent with the parents have shown significance (p<0.05) in the delinquency.Conclusions: The peer influence, smart phone usage, influence of movies and truancy from home also showed significance (p<0.05) in the delinquency.
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Background: Anemia is a major public health problem especially in adolescent age group because of its intergenerational impact. The Ministry of Health and Family Welfare, India launched the weekly iron and folic acid supplementation programme for adolescent girls and boys. The objectives of the study were to study the awareness of the weekly iron and folic acid supplementation in preventing anemia in the study subjects; to assess the implementation of the weekly iron and folic acid supplementation in government schools and anganwadi centres.Methods: A cross-sectional study was carried out in the 4 government schools and 11 anganwadi centres of the urban field practising area of a tertiary health care centre, Osmania Medical College, Hyderabad. All the students who were present at the time of study, the teachers and anganwadi workers, who gave consent were included. The study was carried out for a period of 3 months (August to October, 2018) using a pretested schedule.Results: A total of 313 students, 21 teachers and 10 anganwadi workers had participated in the study. Among school students, only 15% had awareness of anemia. Girls had better knowledge than boys (p<0.05). The benefits of iron folic acid tablets were known to 17% students and 67% teachers. Most commonly side effects were nausea, vomiting and stomach pain. Irregular supply of tablets and poor maintainence of records was seen.Conclusions: The supply and distribution of tablets was found to be not in accordance with the guidelines of the programme.There is need of regular orientation to the teachers and anganwadi workers and nutrition education meetings for behaviour change communication to the parents.
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Background: Tuberculosis is a major public health problem and is among top ten causes of deaths worldwide. People with diabetes are three times at higher risk of getting infected with tuberculosis. Globally 10.4 million TB cases exists of them 10% are linked to diabetes. In India 13% of Tuberculosis cases were diabetic. DM has been reported to modify the clinical features of TB. The objectives were to study the prevalence of diabetes mellitus among adult tuberculosis patients registered in DOTS centre in tertiary health care centre, Hyderabad and to study the clinical profile of tuberculosis in study subjects.Methods: A cross sectional study was conducted in 4 DOTS centres under tertiary health care facility, Hyderabad. Sample size 200 was calculated using formula 4PQ/L2. Study subjects were registered adult tuberculosis patients attending DOTS centre and undergoing anti tuberculosis treatment. Data from study subjects was obtained by interview method using semi structured questionnaire consisting of socio-demographic parameters and clinical parameters.Results: Out of 200 patients, the prevalence of DM was found to be 18% (n=36). Increasing age (p<0.000), male sex (p=0.04), low BMI (p=0.02), family history of TB (p=0.017), Sputum positive severity (p=0.0008) are significantly associated with DM-TB comorbidity and clinical manifestations like bilateral involvement (p=0.151), multi lobes (p=0.243), other associated lung diseases (p=0.154), treatment category (p=0.8203) are not significantly associated with DM-TB comorbidity.Conclusions: Bidirectional screening of TB and DM will detect early and prevent complications of comorbiditiy.
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Due to the expansion of human population, threat for existence of all wild animals is gradually increasing. They are driven to exist in smaller areas and in the worst case scenario extinction. Zoos are being encouraged to improve the animal’s physical and social surroundings. In this study, the modern naturalistic enrichment introduced to large felids tiger, lion and leopard at Gandhi Zoological Park, Gwalior, Madhya Pradesh, was studied. The study has envisaged evaluating if the modern naturalistic enclosures could increase activity levels and how the felids opted to these enclosure. The enclosures were divided into menageries and natural enrichment, which had a varying degree of opportunities for the animals to climb, hide and rest above ground level. The environmental enrichment effects on the proportion of time spent engaging in active behaviors and stereotypic pacing in the large felids were compared and recorded using instantaneous scan sampling. The results of this study revealed clearly that large felids kept in more natural and complex enclosures performed less stereotypic pacing (unnatural behavior), and more exploratory (natural) behaviour than those housed in less natural enclosures reducing the stress level in captive tigers will enhance the animals’ overall physical and psychological well being, which will in turn increase the success of captive breeding programs. Furthermore, these results suggest that captive tigers should be housed in large enclosures containing natural substrate and vegetation, water pools, ample shade, a variety of resting locations and enrichment items
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Introduction: The nail disorders comprise approximately10% of all dermatological conditions. The nail unit mayreflect dermatological disorder by its own and may showspecific changes that are markers for a wide range of systemicdisorders. Consequently, no physical examination is completewithout a study of the nails. Study objective is to recordthe clinical spectrum of nail disorders including congenital,developmental, infectious, neoplastic, degenerative,dermatologic and systemic diseases.Material and methods: A total of 157 patients with nailchanges were studied over a period of 18 months. Allcases were evaluated with detailed history and thoroughexamination. Investigations like potassium hydroxide mount,fungal culture, random blood sugar, skin biopsy, longitudinalnail biopsy were performed as per requirement.Results: The age group of patients ranged from 1-86 years.Majority were seen between 31 and 40 years (22.30%). Maleto female ratio was 0.8:1. Finger nails were predominantlyaffected in 56.70%. Nail changes associated with dermatoseswere observed in 45.85%. Nail changes without associateddermatoses were observed in 33.75%, amongst which,onychomycosis (45.29%) was the commonest. Of theclinically diagnosed cases of onychomycosis, 54.3% werepotassium hydroxide mount positive and 51.43% were culturepositive. Most common fungal isolates detected on culturewere dermatophytes (34.29%).Conclusions: Psoriasis (41.66%) was the most commondermatoses associated with nail changes. Distal lateralsubungual type of onychomycosis was the commonest causeof nail changes without associated dermatoses. Amongdermatophytes, Trichophyton rubrum (66.67%) was the mostcommon isolate in culture.
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Purpose: Refractory or recurrent vitreous seeds account for a large proportion of failure of eye salvage in retinoblastoma. The purpose of this study is to evaluate the efficacy of periocular topotecan (POT) in the management of vitreous seeds in retinoblastoma. Methods: Retrospective, interventional study of patients with retinoblastoma with vitreous seeds who received POT concurrent with intravenous chemotherapy (IVC). Results: Thirty-eight eyes of 35 patients received POT. Five eyes (13%) belonged to International Classification of Retinoblastoma group C, 23 eyes (61%) belonged to group D, and 10 eyes (26%) belonged to group E. Primary treatment included IVC with a combination of carboplatin, etoposide, and vincristine for a mean of 6 cycles (median 6; range 6–9). Concurrent to IVC from the fourth cycle onward, all patients received POT. Focal vitreous seeds were present in 20 eyes (53%) which received a mean of 3 injections (median 3; range 1–7). Diffuse vitreous seeds were present in 18 eyes (47%) which received a mean of 4 injections (median 5; range 1–7). At a mean follow-up of 8.5 months (median 5 months; range 1–15 months), regression of focal and diffuse vitreous seeds was achieved in 16 eyes (80%) and 8 eyes (44%), respectively. In all, 24 eyes (63%) had complete remission of vitreous seeds with POT given concurrently with IVC. Eye salvage was possible in 19 eyes (95%) with focal vitreous seeds and 12 eyes (68%) with diffuse VS. Enucleation was necessary for persistent vitreous seeds and viable tumor in five eyes (13%), viable tumor alone in one eye (0.02%), and recurrent vitreous seeds in one eye (0.02%). None of the patients developed systemic metastasis. Conclusion: POT administered concurrent with IVC is safe and effective in the initial management of vitreous seeds.
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Purpose: Comparison of outcomes of localized eyelid sebaceous carcinoma (American Joint Committee on Cancer (AJCC) 8th edition categories T1, T2, T3) following initial management with posterior lamellar resection (PLR) versus (vs) lumpectomy (nonposterior lamellar resection, non-PLR). Methods: This was a retrospective, comparative, interventional case series. Of 54 patients, 26 were managed by PLR and 28 by nonPLR. The main outcome measures were vision loss, orbital exenteration, lymph node metastasis, and remote metastasis were the main outcome measures. Results: A comparison of PLR vs nonPLR revealed no difference in mean age at presentation (70 vs 72 years), race (Caucasian 100% vs nonCaucasian 93%), gender (female 54% vs male 71%), entering mean visual acuity (20/30 vs 20/50), or corneal involvement (23% vs 11%). There was significant difference in clinical features with PLR demonstrating greater mean basal diameter (21 mm vs 12 mm, P = 0.004), and positive margins were seen more frequently in PLR (69% vs 46%). There was significantly less number of surgical procedures in PLR to achieve complete tumor control (1.7 vs 2.5, P = 0.001). Outcomes at mean 55 months follow-up revealed significantly better control with PLR (vs nonPLR) with fewer orbital exenterations (15% vs 43%, P = 0.038), fewer lymph node, and systemic metastases (0% vs 39%, P < 0.001). There was no significant difference in final mean visual acuity (20/60 vs 20/200). Conclusion: For eyelid sebaceous carcinoma, the initial management is critical to the patient's outcome. PLR demonstrates superior outcomes with regard to preservation of visual acuity and avoidance of exenterations, lymph node metastases, and systemic metastases compared to patients managed with other techniques.
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A 42-year-old Asian Indian male with a history of conjunctival melanoma in the left eye presented with a recurrent tumor in the upper tarsal conjunctiva. The tumor was completely excised under margin control, followed by two-staged eyelid reconstruction. During the second stage of the eyelid reconstruction, a brown-colored discharge was noted at the punctum, which on cytology was confirmatory of melanoma. Left dacryocystectomy with en bloc nasolacrimal duct (NLD) excision was performed. Histopathology demonstrated infiltration of the NLD by the tumor with no presence of melanoma in the lacrimal sac. Lacrimal oncorrhea is a term used to describe tumor spread by free-floating cells in the tear film. All conjunctival tumors carry a risk of tumor spread by oncorrhea.
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Superior ophthalmic vein (SOV) thrombosis is an uncommon orbital pathology that can present with sudden onset proptosis, conjunctival injection, and visual disturbance. SOV thrombosis is frequently secondary to a cavernous sinus pathology. A 32-year-old female with a known history of autoimmune hemolytic anemia presented with sudden painful proptosis left eye, and on imaging, she was found to have SOV thrombosis without cavernous sinus involvement. She was diagnosed with unilateral isolated SOV thrombosis and was managed conservatively. A careful history and clinical evaluation can help diagnose such rare disorders and initiate appropriate therapy.
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BACKGROUND: Bilateral superficial cervical plexus block (BSCPB) provides good postoperative analgesia, but its effect on anesthetic consumption is unknown. This study evaluated the effects of BSCPB on sevoflurane consumption during thyroid surgery. METHODS: Fifty patients were randomly allocated into groups A and B of 25 each in this prospective double-blind study. Group A received BSCPB with 20 ml 0.25% bupivacaine, whereas group B received 20 ml saline immediately before entropy-guided general anesthesia. Intraoperative hemodynamic parameters, end-tidal sevoflurane concentration, minimum alveolar concentration, and sevoflurane consumption were recorded. Postoperative pain was assessed using a visual analog scale, and the time of the first request for analgesia was noted. All side effects were recorded. RESULTS: Demographics were comparable. Mean sevoflurane consumption [for 30 min: group A = 7.2 (1.1) ml, group B = 8.8 (2.0) ml, P = 0.001; for 60 min: group A = 13.5 (1.7) ml, group B = 16.5 (3.9) ml, P = 0.002] and mean end-tidal sevoflurane concentration [for 30 min: group A = 1.2% (0.2%), group B = 1.4% (0.2%), P = 0.008; for 60 min: group A = 1.2% (0.1%), group B = 1.4% (0.2%), P = 0.010] were significantly lower in group A. Patients in group A had a longer duration of analgesia [361.6 (79.5) min vs. 151.0 (60.2) min, P < 0.001] compared to those in group B. CONCLUSIONS: Preinduction BSCPB during thyroid surgery significantly reduced sevoflurane consumption and increased the duration of postoperative analgesia.
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Humans , Analgesia , Anesthesia, General , Bupivacaine , Cervical Plexus Block , Cervical Plexus , Demography , Double-Blind Method , Entropy , Hemodynamics , Nerve Block , Pain, Postoperative , Prospective Studies , Thyroid Gland , Thyroidectomy , Visual Analog ScaleABSTRACT
Abstract Background: Trauma information systems are needed to improve decision making and to identify potential areas of intervention. Objective: To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. Methods: The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. Results: A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound. Conclusion: Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.
Resumen Introducción: Los sistemas de información en trauma son requeridos para mejorar la toma de decisiones e identificar potenciales áreas de intervención. Objetivo: Describir el primer año de experiencia del registro de trauma en dos centros de referencia de trauma del suroccidente Colombiano. Métodos: Estudio realizado en dos centros de referencia de Cali. Se incluyeron pacientes con trauma o lesiones externas entre el 1-Ene y el 31-Dic-2012. Se recolectó información demográfica, relacionada con mecanismos de trauma, severidad (ISS) y mortalidad. Se presenta un análisis descriptivo. Resultados: Se registraron 17,431 pacientes. El 67.8% de los pacientes eran de género masculino con edad promedio de 30 (±20) años. Las lesiones laborales fueron causa de consulta a urgencias en un 28.2%, y las caídas el mecanismo de trauma más frecuente (37.3%). Los pacientes con ISS ≥15 en su mayoría se encontraban en el rango de edad de 18-35 años (6.4%). El 28% de los pacientes que sufrieron lesión por arma de fuego presentaron un ISS ≥15. El 2.5% de los pacientes murieron y aquellos pacientes con ISS ≥15 y lesión por arma de fuego presentaron mortalidad del 54%. Conclusión: una vez se logró implementar el registro de trauma en dos instituciones en Cali, se identificó que la principal causa de ingreso fue secundaria a caídas y las lesiones laborales. Los pacientes más severamente comprometidos están en el rango de población entre 18 a 35 años. La mayor mortalidad se presentó secundario a lesiones de causa externa por arma de fuego.