Perianal complications in puerperium and associated risk factors

Introduction: Puerperium is defined as the period of about 6 weeks after childbirth during which the mother's reproductive organs return to their original nonpregnant condition. Perianal problems, including constipation, hemorrhoids, and fissure, are among the most common digestive complications among women in puerperium, observed in about 30 to 50 percent of women. Considering this great prevalence and the paucity of similar research in this aspect in an Indian population, the present study was done to assess the prevalence of perianal problems seen in puerperium and the risk factors associated with it. Methods: This was a prospective observational cohort study done over the span of 3 years on 902 puerperal women. A self-structured questionnaire covered detailed history and per-rectal and proctoscopy examination. Patients were followed up telephonically for regression of perianal problems post management. Results: The total prevalence of all the perianal problems in puerperium encountered in the present study, out of 902 subjects, was 36.3% (327 subjects). The perianal problems encountered were fissure in 185 patients (20.5%) followed by hemorrhoids in 110 patients (12.2%), perianal episiotomy infections in 25 patients (2.8%), and perineal tears in 7 patients (0.8%). On comparative analysis, positive family history, macrosomia, past history of perianal diseases, and second stage of labour > 50 minutes showed a higher prevalence in the perianal disease group as compared with the healthy group. Out of these, positive family history of perianal diseases (p= 0.015) and past history of perianal diseases (p= 0.016) were statistically significant. The percentage of multipara with hemorrhoids was more when compared to primipara (p= 0.01), patients who had a past history of any perianal disease have a higher chance of hemorrhoids during puerperium (p= 0.00). Patients with constipation in pregnancy have higher chance of hemorrhoids in pregnancy (p= 0.00). Patients who had a past history of any perianal disease had higher chance of fissure during puerperium (p= 0.00). A total of 27.74% of the study subjects with macrosomic babies had fissure in their puerperal period which on comparison with patients with non macrosomic babies was only 19.22%, which was statistically significant (p= 0.02). Conclusion: Constipation, hemorrhoids, and anal fissures are the most common perianal problems in postpartum period causing significant reduction in the quality of life of those afflicted with them. (AU)

Assessing The Anxiety Levels Among Mbbs Students During Covid-19 Lockdown

Introduction: The outbreak of COVID-19, which started in China in December 2019, has spread around the entire world. Due to the COVID-19 pandemic, lockdowns have been implemented in numerous countries around the world. On 23 March 2020, India went into Nation-wide lockdown. Schools, Colleges & Universities were closed nationwide. The disruption in academics, daily routines and isolation had a deeply negative impact on students, making them extremely vulnerable to mental health issues like mood and anxiety disorders and depression. The main aim of this study is toAim: assess the level of anxiety among MBBS students during the COVID-19 lockdown. A cross-sectionalMethodology: online survey was conducted on 632 MBBS Students. A survey invitation through Google Forms was sent to students via WhatsApp & was assured regarding the confidentiality of their responses. Anxiety levels were assessed using Zung's self-rating anxiety scale (SAS). Results: Out of 632 Students, 24.07% of students experienced mild to moderate levels of Anxiety, 6.48% of students experienced Marked to Severe Levels of Anxiety and 0.92% of Students experienced Extreme levels of Anxiety. Gender wise nearly 46.54% of female students and 16% of male students experienced different levels of anxiety. Academic Year wise 57.13% 1st MBBS, 7.69% 2nd MBBS, 11.53% Final MBBS Part 1 & 53.56% Final MBBS Part 2 students experienced different levels of anxiety. Gender, Academic Year wereConclusion: significantly associated with anxiety levels. Predominant stressors were online learning & uncertainty related to their academic performance.

Giant non-functioning adrenocortical carcinoma: an unusual tumour presentation

Adrenocortical carcinoma is a rare tumour with incidence of 1 per million all over the world. Age distribution is bimodal with peaks occurring at 5-20 years and 40-50 years. Tumours greater than 9 cm commonly involve inferior vena cava (IVC) or right side of heart. 80 percent of the carcinomas are functional. We describe a case report of a rare tumour of a non-functioning adrenocortical carcinoma in a 40 year old female having incidence of 0.5/million world over with no extra-adrenal spread at presentation without IVC or right heart involvement in spite of having a large size of 12 cm. Patient underwent successful surgical extirpation with adjuvant radiotherapy with regular follow ups and disease free survival since the surgery. It is imperative to determine hormone levels in symptomatic and asymptomatic patients with adrenal masses. The possibility of adrenocortical carcinoma should not be ruled out in a functioning/non-functioning tumour. All solid incidentalomas on computed tomography (CT)/magnetic resonance imaging (MRI) greater than 5 cm in size should be removed surgically with adjuvant therapy consideration after histopathological reporting.

Marginalizing health: employing an equity and intersectionality frame / Marginalizando a saúde: empregando uma abordagem de equidade e interseccionalidade

ABSTRACT The understanding that the drivers of inequities are multiple and intersecting is critical for health policy formulation and implementation. An intersectionality analysis reveals these relationships and allows a nuanced grasp of how health inequities are framed and understood. Using global statistics and other examples, the paper argues the significance of an intersectionality analysis in unravelling the disproportionate impact of inequity and the implications for the health and lives of persons experiencing these multiple discriminations. Attention to this, challenges the assumption of homogeneity and helps to visibilize lived realities. A few examples of acts of resistance are cited by the authors that have attempted to amplify the voices and knowledge of those whose realities are otherwise invisibilized by prevailing inequities, policies and discourses. 'Marginalizing' health thus implies an intersectional understanding of inequity as well as challenging and changing prevailing socio-political structures.

RESUMO O entendimento de que os fatores motivadores das desigualdades são múltiplos e se cruzam é fundamental para a formulação e para a implementação de políticas de saúde. Uma análise de interseccionalidade revela essas relações e permite uma compreensão diferenciada de como as iniquidades em saúde são estruturadas e compreendidas. Usando estatísticas globais e outros exemplos, o artigo argumenta a importância de uma análise de interseccionalidade para desvendar o impacto desproporcional da desigualdade e as implicações para a saúde e a vida das pessoas que sofrem essas múltiplas discriminações. Essa abordagem desafia o pressuposto de homogeneidade e ajuda a visibilizar as realidades vividas. Alguns exemplos de atos de resistência são citados pelos autores que tentaram ampliar as vozes e o conhecimento daqueles cujas realidades são, de outro modo, invisibilizadas pelas iniquidades, políticas e discursos predominantes. A 'marginalização' da saúde implica, portanto, um entendimento interseccional da desigualdade, assim como em enfrentar e mudar as estruturas sociopolíticas predominantes.

'Marginalizing' health: employing an equity and intersectionality frame / 'Marginalizando' a saúde: empregando uma abordagem de equidade e interseccionalidade

ABSTRACT The understanding that the drivers of inequities are multiple and intersecting is critical for health policy formulation and implementation. An intersectionality analysis reveals these relationships and allows a nuanced grasp of how health inequities are framed and understood. Using global statistics and other examples, the paper argues the significance of an intersectionality analysis in unravelling the disproportionate impact of inequity and the implications for the health and lives of persons experiencing these multiple discriminations. Attention to this, challenges the assumption of homogeneity and helps to visibilize lived realities. A few examples of acts of resistance are cited by the authors that have attempted to amplify the voices and knowledge of those whose realities are otherwise invisibilized by prevailing inequities, policies and discourses. 'Marginalizing' health thus implies an intersectional understanding of inequity as well as challenging and changing prevailing socio-political structures.

RESUMO O entendimento de que os fatores motivadores das desigualdades são múltiplos e se cruzam é fundamental para a formulação e para a implementação de políticas de saúde. Uma análise de interseccionalidade revela essas relações e permite uma compreensão diferenciada de como as iniquidades em saúde são estruturadas e compreendidas. Usando estatísticas globais e outros exemplos, o artigo argumenta a importância de uma análise de interseccionalidade para desvendar o impacto desproporcional da desigualdade e as implicações para a saúde e a vida das pessoas que sofrem essas múltiplas discriminações. Essa abordagem desafia o pressuposto de homogeneidade e ajuda a visibilizar as realidades vividas. Alguns exemplos de atos de resistência são citados pelos autores que tentaram ampliar as vozes e o conhecimento daqueles cujas realidades são, de outro modo, invisibilizadas pelas iniquidades, políticas e discursos predominantes. A 'marginalização' da saúde implica, portanto, um entendimento interseccional da desigualdade, assim como em enfrentar e mudar as estruturas sociopolíticas predominantes.

Study on Demographic Correlates of Corneal Ulcer among Patients Attending the Tertiary Care Hospital of Jharkhand

Introduction: Corneal ulcer is one of the important causesfor ocular morbidity in India. Early presentation with promptdiagnosis and treatment result in good visual rehabilitation.Aim: The aim of this study was to assess the etiology ofcorneal ulcer among patients attending the tertiary careteaching hospital of Jharkhand.Material and Methods: This was a prospective observationalhospital-based study conducted at the Department ofOphthalmology, at a tertiary care hospital, in Jharkhand.Data related to socioeconomic status, predisposing factor,and course of disease was collected. Results were analyzedon the basis of history, slit lamp examination, and appropriatelaboratory investigation.Result: During the study period of one year, 1013 patientswith the clinical diagnosis of corneal ulceration wereevaluated, mean age of the patient was 53 years and majorityof patients of infectious keratitis were in between 46 and 60(45%) age group. Incidence in male was higher than (59%)that of female. The left eye was more commonly involved(53%) as compared to the right eye (47%). Farmers (47%)followed by Industrial worker (27%) were most commonoccupation involved. Incidence of fungal keratitis (42%) washigher than bacterial (31%) and viral (11%).Conclusion: Proper diagnosis and management of cornealulcer is very much necessary among exposed population.Incidence of fungal corneal ulcer is very high amongagriculture and industrial workers and lack of awareness andpoor treatment leads to corneal blindness. Use of protectiveeye wear, masks and face shields may play a key role inprevention of the disease

Incidence and Prognostic Factors for Visual Outcome in Patients Having Cataract Surgery with Traumatic Cataract Visiting Tertiary Care Centre, Jharkhand

Introduction: Ocular trauma is one of the common causes ofvisual morbidity. This study aims to investigate the incidenceand prognostic factors for visual outcome in patients withtraumatic cataract following cataract surgery.Material and methods: This prospective hospital-basedstudy was performed in a tertiary care centre of Jharkhandbetween February 2019 to February 2020. All patientswho underwent cataract surgery with or without primaryintraocular lens implantation with traumatic cataract wereevaluated. Age, sex, preoperative vision, postoperative visionat 3 – 6 months, Injury type, wound location and posteriorsegment involvement responsible for poor visual outcomewere assessed.Results: Forty seven eyes of 47 patients were studied whichincluded 42 males and 5 females. In 32 patients right eye andin 15 patients left eye was involved. The preoperative visualacuity in all 47 eyes was less than 6/60. The postoperativevisual acuity in 25 eyes was 6/6 – 6/18, 14 eyes had visualacuity of 6/24 – 6/60 and 8 eyes had visual acuity less than6/60. Corneal opacity and posterior segment involvementwere the main causes of poor visual acuity.Conclusion: The prognostic factors like initial visual acuity,injury type, wound location and posterior segment involvementplayed a vital role in achieving final visual acuity. Our studyalso shows that satisfactory visual results can be achieved inthe absence of posterior segment involvement and cornealscar not obscuring the visual axis.

Large retroperitoneal dermoid cyst in a 55 year old lady: a rare case report

Retroperitoneal cysts are usually rare asymptomatic lesions but may present with unspecific symptoms depending on the size, location and complications such as hemorrhage, infection, or rupture. A 55-year-old lady presented with complaints of non-obstructed umbilical hernia. CT scan of abdomen and pelvis was done suggestive of a large cystic non-enhancing thin walled lesion of size 27×15 cm in right lumbar region. Intraoperatively, there was a large mesenteric cyst from retroperitoneum of size 25×15 cm, extending from right iliac fossa up to right hypochondrium. A confirmatory diagnosis of dermoid cyst was made following histopathology. Retroperitoneum is a rare site for dermoid cyst. Retroperitoneal cysts which develop within the retroperitoneal space are rare intra-abdominal tumours with an incidence of 1 per 1,40,000. The incidence of recurrence for retroperitoneal cysts is higher than with other forms of cysts because their proximity to major blood vessels and other organs makes them difficult to completely excise. Surgical resection is indicated to establish a diagnosis and prevent eventual complications. Complete excision of tumour is necessary due to the risk of malignancy. After complete surgical resection the 5 years survival rate is nearly 100%.

Pathology of Hepato-renal Disorder due to Non-infectious Etiology in Swine

An investigation was carried out during the period from the month of April 2017 to March 2018 to study the non-infectious pathological conditions of liver and kidneys of pigs in and around Guwahati city. A total of 29 cases of non-infectious pathological condition of the liver and kidneys were recorded out of 53 necropsied pigs. The samples were collected for both histopathology as well as for bacterial isolation. Gross and histopathological studies revealed variable histopathological changes such as congestion, haemorrhage, fatty changes and necrosis (Centrilobular and panlobular) in the liver. Kidneys showed haemorrhages, nephrosis, fatty changes, necrosis, atrophy of glomeruli

Inverse Anton syndrome: A case report

@#This a case report on a rare case of denial of visual perception termed as inverse Anton syndrome. It is a rare extension of perception without awareness in which, specific brain lesions affected a patient’s visual abilities. A 66-year-old Malay gentleman presented with sudden onset of the painless bilateral total loss of vision with expressive aphasia for 2 days. His visual acuity was 6/12 in the right eye and 6/48 in the left eye. However, he was insistent that he could not see but did not request any form of assistance for his blindness. He also had neurological signs suggestive of parietal lobe syndrome. Brain imaging showed subacute left middle cerebral artery territorial infarct with no occipital lobe involvement. The denial of visual perception by this patient may be explained by a disconnection of parietal lobe attentional systems from visual perception

'Need of the Hour': Early Diagnosis and Management of Multidrug Resistant Tuberculosis of the Spine: An Analysis of 30 Patients from a “High Multidrug Resistant Tuberculosis Burden” Country

STUDY DESIGN: Retrospective study. PURPOSE: To report the prevalence of patients with multidrug-resistant (MDR) tubercular spondylodiscitis and their outcomes. Additionally, to assess the role of Xpert MTB/RIF assay in early detection of MDR tuberculosis. OVERVIEW OF LITERATURE: MDR tuberculosis is increasing globally. The World Health Organization (WHO) has strongly recommended Xpert MTB/RIF assay for early detection of tuberculosis. METHODS: From 2006 to 2015, a retrospective study was conducted on patients treated for MDR tuberculosis of the spine. Only patients whose diagnosis was confirmed using either culture and/or the Xpert MTB/RIF assay were included. Diagnostic method, treatment regimen, time taken to initiate second-line antituberculosis treatment (ATT), drug-related complications, and cost of medications were analyzed. All patients with MDR were treated according to the WHO recommendations for 2 years. The outcome parameters analyzed included clinical, biochemical, and radiological criteria to assess healing status. RESULTS: From 2006 to 2015, a total of 730 patients were treated for tubercular spondylodiscitis. Of those, 36 had MDR tubercular spondylitis (prevalence, 4.9%), and three had extremely drug resistant tubercular spondylitis (prevalence, 0.4%). In this study, 30 patients, with a mean age of 29 years and a mean post-treatment follow-up of 24 months, were enrolled. The majority (77%) had secondary MDR, 17 (56%) underwent surgery, and 26 (87%) completed treatment for 2 years and were healed. Drug-related complications (33%) included ototoxicity, hypothyroidism, and hyperpigmentation of the skin. The average time taken for initiation of second line ATT for MDR patients with Xpert MTB/RIF assay as the diagnostic tool was 18 days, when compared to patients for whom the assay was not available which was 243 days. CONCLUSIONS: The prevalence of MDR tubercular spondylodiscitis was 4.9%. In total, 87% of patients were healed with adequate treatment. The sensitivity and specificity of the Xpert MTB/RIF assay to detect MDR was 100% and 92.3%, respectively.

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.

A Study On Analgesic Effect Of Hemidesmus Indicus

BACKGROUND : Hemidesmus indicus is one such important herb popularly known as Indian sarasaparilla It is said to possess analgesic effect AIM:The present study investigates the analgesic activity of the crude extract of Hemidesmus indicus METHODS: Analgesic effect was evaluated using Eddys hot plate and Tail clio method in mice . Institutional animal ethical clearance was obtained RESULTS: The analgesic effect was seen following oral administration of aqueous and ethanolic extract of Hemidesmusindicus, shown prolongation of reaction time and reduction in the number of attempts to dislodge the tail clip by mice. The hot plate method showed a statistically significant prolongation in the reaction time. The effects of both aqueous and ethanolic extract of Hemidesmus indicus are comparable with that of diclofenac sodium

Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.

Bilaspur sterilisation deaths: evidence of oppressive population control policy.

The recent tragic and completely avoidable deaths of 13 women1 and the critical condition of many more following laparoscopic sterilisation in Bilaspur, Chhattisgarh, signals that nothing has really changed in India’s family planning programme over the past several decades. The manner in which the surgeries were performed, in complete violation of all standard operating procedures and ethical norms, amounts to grave violation of the very basic health rights of the affected women. In addition, it points to the callous and biased attitudes towards poor women that persist among health functionaries and policy-makers, and the tenacious hold of the “targets” approach in the family planning programme despite statements to the contrary.

Evaluation and Comparison of the Biopathology of Collagen and Inflammation in the Extracellular Matrix of Oral Epithelial Dysplasias and Inflammatory Fibrous Hyperplasia Using Picrosirius Red Stain and Polarising Microscopy: A Preliminary Study

BACKGROUND: The role of tumour inflammation and the dysplastic epithelial-stromal interactions on the nature of collagen fibres in the extracellular matrix of dysplastic epithelium is not fully understood. The present study was aimed to evaluate and compare the inflammation and pathological stromal collagen (loosely packed thin disorganized collagen) present in mild, moderate and severe epithelial dysplasias with that of inflammatory fibrous hyperplasias. The basement membrane intactness of epithelial dysplasias was also evaluated to determine if dysplastic epithelial mesenchymal interaction has any role in the integrity of stromal collagen in epithelial dysplasia. METHODS: Oral epithelial dysplasias, inflammatory fibrous hyperplasia and normal oral mucosal samples were used for the study. Packing, thickness and orientation of collagen fibres in mild, moderate and severe grades of oral epithelial dysplasias (n = 24), inflammatory fibrous hyperplasia (n = 8) and normal oral mucosal samples (n = 8) were analysed based on the polarisation of collagen fibres in picrosirius red polarising stain under polarising microscope. RESULTS: All the grades of epithelial dysplasias showed greenish yellow birefringence confirming the presence of loosely arranged pathological collagen in the presence of moderate inflammation. All the cases of inflammatory fibrous hyperplasia showed red polarisation hue and moderate inflammation. A statistically significant difference was found in the packing and orientation of collagen when epithelial dysplasias and inflammatory fibrous hyperplasia were compared (P < 0.01). When the intactness of basement membrane integrity was compared in all the groups of epithelial dysplasia, a statistically significant result was obtained (P < 0.05). CONCLUSIONS: Presence of significant amount of loosely packed thin disoriented collagen even in mild epithelial dysplasia suggests that tumourigenic factors are released to connective tissue stroma much earlier than expected. Hence we suggest considering the integrity of extracellular matrix collagen, intactness of basement membrane and inflammation associated with dysplasia along with the anaplasia of epithelial cells in the microscopic assessment of dysplastic epithelium.

ICMR programme on Antibiotic Stewardship, Prevention of Infection & Control (ASPIC).

Antimicrobial resistance and hospital infections have increased alarmingly in India. Antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections. For this to succeed, it is important to bring on board the various stakeholders in hospitals, especially the clinical pharmacologists. The discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care. Clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting. The ASPIC programme was initiated by the Indian Council of Medical Research (ICMR) in response to the above need and was designed to bring together faculty from clinical pharmacology, microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices. This programme involves the participation of 20 centres per year throughout the country which come together for a training workshop. Topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres. It is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance.