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Background: Nearly one third of people who suffer major psychiatric disorders end up with a long- term disability and dependency. They are most likely to be non-adherent to medication due to various reasons including lack of knowledge or insight about their illness and treatment which in turn leads to exacerbation of their illness, reduce treatment effectiveness, or make them less responsive to subsequent treatment, multiple hospitalizations and poor quality of life. Materials and methods: A cross sectional study was carried out in outpatients attending the Psychiatry OPD using the consecutive sampling technique. Subjects meeting the ICD-10 Diagnostic criteria for psychiatric disorders, age 18 year and above, subjects willing to participate in the study were included. A structured proforma, the Drug attitude inventory and the WHO-QOL-BREF questionnaires were used for assessment. Results: Mean age of subjects = 38.07 + 11.07 years. Mean medication cost = Rs. 917.82 + 397.89. 87 subjects participated in the study and of them 48% were adherent to medication and 52% were non-adherent. 56% of males and 43% females were adherent to medication. There was significant association between the occupation and the type of family of the subjects and medication adherence (p<0.05). Majority of patients with medication non-adherence were seen in schizophrenia, delusional disorder, bipolar disorder, generalized anxiety disorder, obsessive-compulsive disorder and substance related disorder. Majority (44.5%) of them reported fear of side effects, followed by stopping the medication when feeling better (35.5%) as the reasons for non-adherence followed by cost, embarrassment, etc. There was significant association between the psychological and social quality of life and medication adherence (p<0.05). Conclusions: This study implicates the importance of psycho education about the diagnosis, prognosis, need for medication and the expected adverse effects which should be clearly explained to the patient. The therapeutic alliance is the most effective component in helping the patient maintain medication adherence and subsequently better quality of life.
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The genus Corynebacterium is composed of Gram-positive, aerobic, non-motile, non-spore-forming bacilli that are widely distributed throughout the environment. They are usually found as commensals on the skin and are often considered as mere contaminants when isolated from clinical samples. We describe a patient with skin and soft-tissue infections due to Corynebacterium striatum following exploratory laparotomy identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. The clinical importance and pathogenic potential of Corynebacterium species, especially C. striatum, cannot be underestimated. This report is a reminder to physicians of the possible pathogenicity of non-diphtherial Corynebacteria.
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Background: Antenatal care (ANC) services are considered to be the crucial element in the primary health care delivery system of a country. World Health Organization (WHO) estimates suggested that almost all of the maternal deaths (99%) and child deaths (98%) occurred in developing countries. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality antenatal care. The objectives of the present study were conducted in rural parts of district Amroha, Uttar Pradesh for assessing the patterns of utilization of the ANC services and to ascertain the factors influencing utilization of ANC services.Methods: The present study was a cross sectional in nature. Recently delivered women were selected as study subject. A multi-stage stratified sampling design with random approaches had been used. Total 360 subjects included in the study.Results: Respondents age, education, occupation, socio economic status, family type and family size were the factors that influenced the utilization of the ANC services. With 100% ANC registration, sub centre was the most preferred place for registration. 76.9% of woman received more than 3 ANC visits. 315 (87.5%) and (71.9%) respondents received 2 doses to TT vaccine and more than 100 IFA tablets respectively.Conclusions: Utilization of ANC services are on rise in rural parts of Amroha, Uttar Pradesh. Still significant proportions of women are doesn’t return to health facility after the ANC registration. Intensification of efforts is needed to cater this left out group through improving community awareness and motivation.
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Background: Developing countries are riddled with poorhealth care infrastructure especially for pregnant women andchildren. Lack of access to quality health care was leading tohigh maternal mortality as well as maternal morbidity. Althoughsituation improved dramatically with the launch of conditionalcash transfer schemes. Prioritizing institutional deliveries overhome deliveries along with other added measures has helpedin changing scenario in short span of time.Objectives: Study was done for assessing the factors thatinfluence women’s decisions regarding their place of delivery,exploring the preferential place for delivery and Contribution ofskilled birth attendant in home deliveries.Methods: The present study was a cross sectional studyconducted in the rural area of Amroha district for a period ofone year from July 2015 to June 2016. Recently deliveredwomen (RDW) were selected as study subject. A multi-stagestratified sampling design with random approaches had beenused. Total 360 respondents participated in the study.Results: Respondents age, education, occupation, socioeconomic status, family type and family size were the factorsthat influenced the place of delivery. The institution was thepreferred place for delivery. Out of total 360 respondents,deliveries conducted in the institution and home were286(79.4%) & 74(20.6%) respectively. SBA attendance at thetime of delivery was impressively low. Just 1 (1.3%) deliverywas conducted by SBA.Conclusion: Institutional births are on rise in rural parts ofAmroha, Uttar Pradesh. Still Significant proportions of birthsare taking place at home despite the government led cashincentive and the other support provided by the healthcareproviders.
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INTRODUCTION: The recommended technique of sentinel lymph node biopsy (SLNB) in breast cancer is a combination of blue dye and radiotracer. In the Indian scenario, SLNB is still not routinely practiced due to lack of nuclear medicine facilities and unavailability of isosulfan blue or patent blue violet (PBV). This study was conducted for optimizing SLN identification techniques by comparing the identification rate using PBV and methylene blue (MB) in combination with radiotracer. MATERIALS AND METHODS: Single-blinded two-arm parallel design randomized control trial was conducted at an apex teaching and research medical institute in India. Patients with axillary LN–negative breast cancer were included. Blue dye and radio tracer were injected preoperatively, and SLNB was performed using a combination technique. Frozen section was performed. Demographic, clinical, radiological, operative, and histopathological data were recorded. Descriptive statistics were used to represent patient characteristics. Baseline characteristics for entire cohort and between groups were compared using Student's t-test for quantitative variables and Chi-square test for qualitative variables. RESULTS: A total of 119 patients were randomized for mapping with MB and 118 patients with PBV between 2011 and 2015. SLN was identified in 116 patients with MB and 115 with PBV. SLN identification proportions were 97.4% (MB) and 96.6% (PBV). In patients undergoing axillary lymph node dissection, concordance with SLNB was 98.5% and 96.61% in MB and PBV, respectively. False-negative proportion for MB was 2.56% and 7.69% for PBV, respectively. The cost of MB is about INR 15 per ~10-mL vial. The cost of PBV is approximately ~$91 per ampoule (equivalent to approximately INR 8190). CONCLUSION: SLNB using MB can be recommended as the technique of choice in low-resource settings.
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Background: Present study is aimed to note the prevalence of femoral hernia and trend of disease in two genders and different age groups in patients from Bundelkhand region. Methods: This observational study was carried out on 42 patients of femoral hernia belonging from Bundelkhand region of India. Patients were classified into groups based on their genders, age, laterality and types of femoral hernia. All the findings were tabulated and inferences were drawn followed by statistical comparison using chi-square test with p value <0.05 considered as significant. Results: Highest prevalence of femoral hernia was noted in >60 years age group. Females show a higher preponderance for femoral hernia as compared to males. Prevalence of hernia was higher on right side as compared to left side. Recurrent femoral hernia showed very small preponderance.Conclusion: Such studies are needed to be conducted in all geographical regions with as much possible number of observations. Results of present study might be helpful for future studies in estimating femoral hernia prevalence in population as a whole.
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Background & objectives: Biopsy of palpable breast masses can be performed manually by palpation guidance or under imaging guidance. Based on retrospective studies, image guided biopsy is considered more accurate than palpation guided breast biopsy; however, these techniques have not been compared prospectively. We conducted this prospective study to verify the superiority and determine the size of beneficial effect of image guided biopsy over palpation guided biopsy. Methods: Over a period of 18 months, 36 patients each with palpable breast masses were randomized into palpation guided and image guided breast biopsy arms. Ultrasound was used for image guidance in 33 patients and mammographic (stereotactic) guidance in three patients. All biopsies were performed using 14 gauge automated core biopsy needles. Inconclusive, suspicious or imaging-histologic discordant biopsies were repeated. Results: Malignancy was found in 30 of 36 women in palpation guided biopsy arm and 27 of 36 women in image guided biopsy arm. Palpation guided biopsy had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 46.7, 100, 100, 27.3 per cent, respectively, for diagnosing breast cancer. Nineteen of 36 women (52.8%) required repeat biopsy because of inadequate samples (7 of 19), suspicious findings (2 of 19) or imaging-histologic discordance (10 of 19). On repeat biopsy, malignancy was found in all cases of imaging-histologic discordance. Image guided biopsy had 96.3 per cent sensitivity and 100 per cent specificity. There was no case of inadequate sample or imaging-histologic discordance with image guided biopsy. Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.
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Background: The body mass index (BMI) is used in a wide variety of contexts as a simple method to assess how much an individual's body weight departs from what is normal or desirable for a person of his or her height. An increase in body fat is generally associated with increased risk of metabolic diseases such as type 2 diabetes mellitus, hypertension and dyslipidaemia. Methods: The study conducted on the undergraduate medical students was a cross-sectional analytical study. The BMI was calculated using the formula, BMI = Body Mass (kg)/Height (m2). The blood pressure (systolic and diastolic), blood sugar levels (fasting blood sugar) and fasting lipid levels were measured for the overweight and obese groups. Results: A total of 305 students participated in the study. The mean BMI was 21.47 with a standard deviation of 3.42. 218 (71.47%), were in the healthy, 26 (8.52%) were in the overweight and 6 (1.96%) were in the obese categories. 16 (61.5%) of the overweight subjects were prehypertensives. 4 (66.7%) of the obese subjects were hypertensives. 2 (7.69%) out of the 26 overweight subjects were in prediabetic stage. 22 (84.61%) of the overweight and 5 (83.33%) of the obese subjects had dyslipidaemias. Conclusions: The prevalence of being overweight and obese among undergraduate medical students is a matter of serious concern. This reflects on the students’ poor dietary habits and inadequate physical activity. A serious approach to reduce body weight through dietary modifications and regular physical activity is the need of the hour.
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Background There are many techniques being followed in marital or couples therapy for the resolution of marital discord. In the particular module of Conjoint collaborative therapy where joint sessions with the couple run concurrently with individual sessions for each partner, an additional issue crops up which may influence the outcome independently of the marital therapy: resolution of individual psychopathology may have beneficial effects in strengthening the marriage, but may also have the opposite effect. Individual ego strengthening may disturb the homeostasis which has kept the dysfunctional marriage together. Objective: To study individual ego strengthening as a dynamic factor that influences the course and outcome of marital therapy. Discussion: It may be that many marriages which are held together because of the pressures from without rather than the desire from within may find the dynamics changed by therapy. If the individual sessions are going well, it may be that the benefits there may outpace those in the joint sessions or the progress in the relationship. Conclusion: With the resolution of individual crisis, one or both partners may no longer be willing to carry the relationship forward and a separation is the result. The individual may benefit from the ego strengthening, but it proves deleterious for the relationship. This paper explores the dynamics that may be involved in this event.
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BACKGROUND: Peritonitis secondary to gut perforation is still one of the commonest surgical emergencies in India and is associated with high morbidity and mortality. The present study examines the aetiology and outcome of peritonitis cases operated on in our surgical unit, and compares our findings with those of previous studies performed between 1981 and 1991. METHOD: A retrospective study of 260 peritonitis patients operated on in a single surgical unit from 1995 to 2006 was done and data involving clinical presentation, operative findings and post-operative course were studied and analysed. RESULTS: Causes of peritonitis were small bowel perforation (96 ileal, 17 jejunal), peptic perforation (45 duodenal, 16 gastric), appendicular perforation (36), primary peritonitis (8), and others (42). The incidence of major complications was 25% (burst-11%, leak-5%, intraabdominal abscess-5%, multi-organ failure-6.5%). The overall mortality was 10%. High mortality was observed in jejunal, gall bladder and liver abscess perforation cases (> 20%). Histopathological evaluation (143 specimens) revealed tuberculosis in 42 (mostly small bowel), malignancy in 8, and inflammation in the rest. Comparisons with a similar study carried out in the same unit and published in 1995 revealed similar demographic features and mortality, but a change in the most common cause (peptic ulcer perforation to small bowel perforation), and an increased performance of enterostomy compared with primary repair in small bowel perforation and a decrease in the leak rate (13% to 4%). CONCLUSION: Small bowel perforation is the commonest form of perforation and the mortality rate associated with peritonitis remains unchanged.
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Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , India , Intestinal Perforation/complications , Male , Middle Aged , Peritonitis/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
Primary mesenteric fibromatosis is a rare condition. The aggressive nature of these tumors and the potential for major morbidity secondary to resection makes it a challenging disease for the surgeon. We report a case of mesenteric fibromatosis with involvement of small bowel.