What brings people to government urban primary care facilities? A community-based study from Delhi, India

Introduction: Mohalla or Community Clinics of Delhi, India, provides free primary care services to the general population, with special focus on the underserved and marginalized. This study was conducted to analyze the perception and experience of target beneficiaries and to understand and document the determinants of people visiting these clinics. Material and Methods: A community-based study was conducted from October 2019 to April 2020. A semi-structured questionnaire was used for data collection. Correlation and comparative analysis were used. Thirty-seven Mohalla Clinics and their catchment areas were visited. A total of 391 respondents (including 35 health staff and 356 community members) were included. Results: Proximity of clinics, waiting times, age, perceived quality of treatment, and cleanliness at facilities were the factors that influenced the usage of clinics. Lack of first-aid facilities and long waiting time (at a few facilities) were identified challenges. There is a need for wider publicity and awareness about the clinics and regular analysis of data to determine an appropriate mid-course action to further increase utilization. Conclusion: Community Clinics of Delhi, India, have brought people back to government primary healthcare (PHC) facilities. The popularity of these clinics has encouraged a number of Indian states to set up similar facilities. The factors behind their success need to be studied in detail to derive lessons for making urban PHC accessible in other low- and middle-income countries.

Evaluation of Bilateral Ureteral Urinary Jet Flows for Patency of Uretero- Vesical Junctions by Color Flow Imaging

Background: Ureters are meant to transport urine from the pelvis to the urinary bladder in the form of urinary jet. This is continuous process with intermittent release of urine at uretero-vesical junction. This is regulated by autonomous nervous system. The urine coming to urinary bladder can be seen by color flow imaging (CFI) .This also reflects the patency of the ureter without any obstruction in the pathway. Methods: The size of the population was 30 patients (20 males and 10 females). In this study, the Color Doppler ultrasound was used to evaluate the ureteral jets flow in 10 healthy patients and 20 patients with obstructive uropathy. A probability sampling method was employed while collecting samples. Results: In the right ureteral-vesical junction there was complete absence of detectable jets in 5 patients, 6 patients had weak flow of jet and 19 patients had normal flow of jet. Similarly, in the left ureteral-vesical junction there was complete absence of detectable jet in 3 patients, 12 patients had weak flow and 15 patients had normal flow. Conclusions: The color Doppler evaluation of the ureteral jets is a valid method of evaluating ureteral and renal calculi obstruction and could be a first line of investigation to detect ureteric obstruction in patients with obstructive uropathy.

MRI Spectrum of Symptomatic and Non –Symptomatic Tarlov Cyst: Series of Seven Cases in Orthopaedic Management Point of View

Tarlov cysts are perineural cysts and are usually found in sacral region. The dorsal nerve root is encased in this type of the cyst. These may or may not be with any of the symptomatology. The entity is infrequently found as an incidental finding. These are cerebrospinal fluid (CSF) filled sacs which are diagnosed on cross sectional imaging modalities especially in magnetic resonance imaging (MRI). Tarlov cysts can cause different type of myelopathies as per their location and size. Methods: We present a series of seven cases where these perineural cysts were found during the routine imaging of lumbosacral spine. All these patients had undergone Magnetic Resonance Imaging (MRI) of lumbosacral spine for backache or some other pelvic complaints. In one case Computerized Tomography (CT) Myelography also helped in diagnosis and related bone remodeling.MR myelography adds to the delineation of CSF wrapping around the spinal cord. Results: Three patients were found to be symptomatic and the intensity of complaints corresponded to the size and location of the cysts. In our three cases, the etiopathogenesis also corresponded to the underlying development of these entities. Four patients were asymptomatic as the size of these cysts were small and not contributing to the complaints of the patient. Conclusion: MRI is the best modality to diagnose these perineural cysts which are responsible for different types of myelopathies .T2WI sequences in non contrast MRI studies are the best in delineating the size, shape, outline and location of these cysts. This also further elaborates their extension to the surrounding regions.MR myelography is adjuvant to more morphological features of these cysts.

Importance of Hoffa’s Pad Sign in MRI evaluation of various knee pathologies: a study conducted at SGT Hospital of SGT University of Gurugram Haryana

Hoffa’s fat pad is intracapsular and extra synovial structure present behind the patella and Infrapatellar tendon. This is delineated nicely in magnetic resonance imaging(MRI) by which it has become a modality of choice for its evaluation .The evaluation is by disruption of the outline of this region due to injury or other underlying pathologies .The indirect signs of this fat pad corresponds to the grading of associated trauma or underlying disease. Methods: We had conducted the MRI knee studies of fifty three patients which included both the genders from March 2018 to July 2018 .They all were having complaints of knee pain because of different aetiologies This cross sectional study included from 7-70 years of age group and patients were evaluated for the characteristics of Hoffa’s pad in MRI .The morphological characters of the region were studied and correlated in relation to the corresponding pathology. Results: There was excellent delineation and intensity relationship of HFP in various MRI sequences. The most vulnerable group to the changes was in 21- 30 years age group .The trivial trauma was the most common cause. The left knee was affected more than the right. Conclusion: Hoffa’s fat pad sign is an excellent indicator in various knee pathologies during MR evaluation. This also helps to know the involvement of the associated surrounding structures .MRI evaluation is very helpful in the decision making for the line of management.

Atypical iliac unicameral bone cyst – An incidental finding in MRI.

is no expansion of the bone with unicameral bone cysts but in our present case there was expansion making it atypical presentation. We present a 22-year male who underwent MRI for Lumbosacral spine for his vague low backache symptoms. There was incidental finding of bony lesion in left iliac bone which turned out to be simple bone cyst. The study of Lumbosacral spine was unremarkable.

Mature Ethmoid Sinus Osteoma - Incidental finding in CT.

Paranasal osteomas are not uncommon to be found as an incidental finding in routine radiological examinations. Many a times, this entity is found while undergoing computerized tomography (CT) for some other reason. Sometimes, patient comes with vague complaints not related to this finding but indirectly is responsible for few of these symptoms. We present a case of 18-years old male who presented with the complaint of vague headache of about one year duration. He underwent CT examination and was found to be having slightly uncommon mature type of ethmoid osteomas in addition to pan sinusitis.