Smartphone for retinal imaging – Case series in resource-limited rural settings

Purpose: There is a clinical need for a cost?effective, reliable, easy?to?use, and portable retinal photography. The use of smartphone fundus photography for documentation of retinal changes in resource?limited settings, where retinal imaging was not previously possible, is studied here. The introduction of smartphone?based retinal imaging has resulted in the increase in available technologies for fundus photography. On account of the cost, fundus cameras are not readily available in ophthalmic practice in developing countries. Because smartphones are readily available, easy to use, and also portable, they present a low?cost alternative method in resource?limited settings. The aim is to explore the use of smartphones (iphones) for retinal imaging in resource?limited settings. Methods: A smartphone (iphone) was used to acquire retinal images with the use of +20 D lens in patients with dilated pupils by activating the video mode of the camera. Results: Clear retinal images were obtained in different clinical conditions in adults and children, including branch retinal vein occlusion with fibro?vascular proliferation, choroidal neo?vascular membranes, presumed ocular toxoplasmosis, diabetic retinopathy, retinoblastoma, ocular albinism, and hypertensive retinopathy. Conclusion: New inexpensive, portable, easy?to?operate cameras have revolutionized retinal imaging and screening programs and play an innovative role in research, education, and information sharing

Comparative study to evaluate retinal changes using spectral-domain optical coherence tomography in diabetics without diabetic retinopathy

Purpose: To elucidate changes in the neuro?sensory retina at the macula, using spectral?domain optical coherence tomography (SD?OCT) in type 2 diabetics without clinical signs of diabetic retinopathy, and compare with healthy subjects. Methods: This was a cross?sectional observational study, conducted at a tertiary eye institute from November 2018 to March 2020. Type 2 diabetics visiting the outpatient department with normal fundus (without any clinical signs of diabetic retinopathy) were taken as Group 1, and healthy subjects as Group 2. Both underwent recording of visual acuity, intraocular pressure (non?contact tonometry), slit?lamp anterior segment examination, fundus examination using an indirect ophthalmoscope, and macular SD?OCT. SPSS (Statistical Package for Social Sciences) version 20 [IBM SPSS statistics (IBM corp. Armonk, NY, USA released 2011)] was used to perform the statistical analysis of the data entered in the excel sheet. Results: Our study included 440 eyes of 220 subjects, divided equally into two groups. The mean age of patients with diabetes was 58.09 ± 9.42 years, and of controls 57.25 ± 8.91 years. The mean BCVA in group 1 and group 2 was 0.36 ± 0.37 and 0.21 ± 0.24 logMAR, respectively. SD?OCT showed thinning in all areas in group 1 compared to group 2, but statistically significant thinning was seen only in the central subfield (P = 0.0001), temporal parafoveal (P = 0.0001), temporal perifoveal (P = 0.0005), and nasal perifoveal areas (P = 0.023) in group 1. There was a significant inter?eye difference noted between the right and left eyes in nasal and inferior parafovea only in group 1 (P = 0.03). No significant difference was noted between males and females. Conclusion: There was significant macular thinning in diabetics compared with controls, which denotes the occurrence of neuronal damage in these eyes before clinical evidence of diabetic retinopathy.

Cord Blood Lipid Profile In Preterm And Term Newborns: A Hospital Based Comparative Study From North Kanara Region Of India

Introduction: Background: Cardiovascular diseases are common cause of moertality in developed countries and also are rising trend in developing countries. It has its roots in adverse fetal environment; which lead to adult diseases like Coronary artery diseases in later life. The objective of this study was to compare & contrast the lipid profiles inAim: term and preterm neonates. a case-control study was conducted in departments of PediatricsMaterials and Methods: & Obstetrics of Karwar Institute of Medical Sciences, Karwar, Karnataka of India over a period of 10 months. 500 deliveries were recruited randomly which met the inclusion criteria after informed written consent; babies were divided into Comparison group 1 (Preterm gestation of <37weeks gestational age)& comparison group 2 (term gestation of >37 weeks gestational age). Cord blood lipd-profiles of these babies were compared & studied. Out of 500 babiesResults: studied, there were 197 preterm (<37weeks gestational age) & 409 term babies (>37 weeks gestational age) babies. The Mean gestational age was 39.55±1.11 weeks for term babies & 34.50 ± 2.77 weeks for preterm babies. The mean TC level (73.76±27.98 mg/dL) was higher in comparison group 1(preterms) compared to comparison group 2(term)babies(62.60 ± 34.20mg/dL) and this difference was statistically very significant(P=0.003). The mean low density lipoprotein(LDL) level (35.54 ± 20.96mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (27.89 ± 15.62 mg/dL) and this difference was statistically very significant(P=0.001). The mean very low density lipoprotein(VLDL) level (11.12 ± 5.13mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (8.68 ± 7.55 mg/dL) and this difference was statistically very significant(P=0.003).The mean Triglycerides(TGs) levels of comparison group 1(preterms) & comparison group 2(term)babies were comparable with no statistical significance(42.63 ± 25.80mg/dL of preterm babies ; 42.43 ± 28.10mg/dL of term babies; P=0.948). The mean High density lipoprotein(HDL) levels of comparison group 1(preterms comparison) & comparison group 2(term)babies were comparable with low statistical significance(26.37 ± 13.65mg/dLof reterm babies ; 24.78 ± 10.76mg/dL of term babies;P=0.218). Levels of most lipidConclusion: components were observed to be higher in preterm babies compared to term babies

Accuracy of HRCT thorax in diagnosing COVID-19 in suspected patients with initial negative RT-PCR: A Retrospective analysis of discordant cases.

Background: During the Covid -19 pandemic, there was a need to diagnose the infection at an earlier stage for better treatment and containment of the disease.The standard method of detection was by the real-time reverse-transcription polymerase chain reaction (RT-PCR) tests. However in some cases when the initial PCR tests was negative, HRCT thorax played an important role for earlier detection. Aim: To test the accuracy of HRCT thorax in diagnosing COVID-19 infection in suspected patients with initial negative RT-PCR. Materials and methods: Retrospective analysis of patients with a negative RT PCR but with clinical suspicion of COVID who were referred for HRCT thorax during the initial phase of the disease, were included in the study. HRCT thorax images were categorized as per CORADS scoring system. Those patients with score of 4 or 5 were subjected to repeat RT-PCR test and results were analysed. Results: Total of 52 (33 (63%) males and 19 (37%)females) patients in age group from 36-62yrs,who had clinical suspicion of COVID and underwent HRCT were included.The CT was performed within 10 days of the illness. All these patients had a negative RT-PCR result when CT was performed.22 patients had a CORADS score of 4 and 30 patients had a score of 5. Follow up RT-PCR done within a week after the CT came out to be positive in 45(82.3%) patients. In rest of the 7 (13.4%) patients it was negative. The sensitivity of CT came out to be 84.8% which was statistically significant. Conclusion: HRCT appears to be more accurate in detection of the disease whereas RT-PCR test may produce false-negative results in the initial phase of the disease.

NEGATIVE PRESSURE WOUND THERAPY (NPWT): OUR EXPERIENCE USING HOSPITAL WALL SUCTION

Study Design: Prospective case series Delayed wound healing is a significant concern, particularly in Introduction: complex wounds and the elderly with co-morbidities. It leads to pain, morbidity, prolonged treatment, and requires major reconstructive surgery, which imposes an enormous social and financial burden. Negative Pressure Wound Therapy (NPWT) was used to cover large wounds, decubitus ulcers, and open fractures that cannot be closed either primarily or secondarily and often require a complex reconstructive procedure to protect the injury. NPWT is an alternative method of wound management, which uses the negative pressure to prepare the wound for spontaneous healing or by lesser reconstructive options. We applied NPWT on pa Materials and Methodology: tients with open fractures, decubitus ulcers, neglected wounds, fasciotomies, and large wounds. Compared to the patented VAC system, ours include pre-sterilized PVA foam, cling drape (Surgiwear TM), nasogastric tube or an infant feeding tube, and a hospital wall suction. There Results: were three cases of soft tissue injury of the foot with wound defect, one case of fasciotomy for compartment syndrome, one case of the decubitus ulcer, one case of open fractures, and three cases of degloving injuries of the foot. In our study, the NPWT was changed every five days, the average number of NPWT changes was 3-4, length of time NPWT applied before the closure was 14-21 days. The most frequent coverage mode is Split Thickness Skin Graft obviating the need for more complex flaps and microvascular reconstructive procedures. Negative Conclusion: pressure therapy stabilizes the wound environment, reduces wound edema/bacterial load, improves tissue perfusion, and stimulates granulation tissue and angiogenesis. NPWT appears to be simple and more effective than conventional dressings for managing complex wounds, reducing wound volume, depth, treatment duration, and cost.

Our experience with Radio - Pathological diagnosis of liver lesions in a tertiary health care centre.

Introduction: The diagnosis of space occupying lesions of liver is always a challenge especially when the lesions are multifocal in location. Imaging modalities, serum markers and pathological investigations will definitely help in arriving at a specific diagnosis for appropriate patient management and prognosis. Aim: The aim of the current study is to know the importance of various imaging modalities in diagnosing the space occupying lesions of liver and to find an association of Radiological with Pathological diagnosis and serum markers. Materials and methods: This retrospective study was performed over period of one year. Clinically suspicious cases for malignancy were assessed by the imaging modalities such as Ultrasonography (USG), Computed Tomography (CT) or Magnetic Resonance Imaging(MRI). Further Radiologically confirmed cases were subjected for Fine needle aspiration (FNA)/biopsy under the USG guidance, while serum markers were retrieved from laboratory investigation archives. Association of Radiological and Pathological diagnosis with serum markers was performed and analyzed. Results: The study was conducted on 70 cases of hepatic lesion. Male to female ratio was 1.5:1 with mean age of 54.47±1.5. Most of cases were diagnosed with MDCT scan. About 95.7% cases were malignancy of which 13.4% were HCC. Among malignant cases, metastatic lesions were more prevalent which were mostly adenocarcinoma. Radiological and pathological diagnosis found to have significant association, only few cases showed the discrepancies. Serum AFP was found to have high levels in 7 cases of HCC, while other 2 HCC cases and metastatic lesions were within normal range. Conclusion: The diagnostic accuracy of hepatic lesion enhances with utility of radiological patterns in conjunction with pathological diagnosis and serum markers. Association of radiological and pathological findings found to have statically significant value in the current study.

A retrospective study on the prevalence of urinary tract infections in a tertiary care hospital in Sangareddy district of South India

Background: Urinary tract infections (UTI) affect the portion of the urinary tract including kidneys, ureters, bladder, and urethra, and are among the commonly acquired nosocomial infections. Diagnosis based on the culture and sensitivity profile of the organism is highly beneficial for appropriate antimicrobial therapy of the individual.Methods: A retrospective study of culture isolates obtained from urine samples from different departments of a tertiary care hospital was performed in the period January 2018 to March 2020 in the district of Sangareddy, Telangana, India.Results: A total 204 samples of 1886 exhibited significant growth of organisms i.e., ≥105 colony-forming units of bacteria per millilitre (CFU mL-1). The most common pathogen isolated was Escherichia coli (47.05%), followed by Klebsiella pneumoniae (15.68%), Staphylococcus aureus (10.78%), Pseudomonas aeruginosa (10.78%), Enterobacter spp. (7.84%) and, Candida albicans (7.84%). The presence of Gram-negative organisms was found to be more than Gram-positive organisms among the samples cultured. Resistance was found to be more towards Amoxicillin (57.14%), followed by oxacillin (34%), cefotaxime (23.62%), clarithromycin (12.08%), erythromycin (12.08%), azithromycin (9.34%), linezolid (3.84%) and vancomycin (2.19%).Conclusions: Increasing levels of antimicrobial resistance by uropathogens emphasize the importance of therapy based on the culture and sensitivity of the organisms. Many uropathogens exhibit multi-drugs resistance. Regular surveillance and monitoring are useful in controlling the increasing resistance.

Implementation of Radiotherapy and Overcoming the Treatment Breaks in COVID-19 Crisis

Introduction: Tackling of; the patients who had defaultedfor radiation therapy due to implementation of lockdownfollowing COVID-19 outbreak, new patients presenting toout-patient department(OPD) and continuing Radiotherapytreatment without postponing during this health crisis ischallenging. Study objective was to evaluate the outcomesof hypofractionated radiation therapy in the COVID-19 eraand to provide guidance on measures for preparedness in theDepartment of Radiation Oncology to continue the treatmentand tackling treatment breaks.Material and Methods: Patients reporting to the OPD,patients who defaulted for treatment during lockdown phaseand newly diagnosed patients awaiting treatment wereincluded in the study. Hypofractionated schedules were usedfor treatment to reduce the overall treatment time and durationof hospital stayResults: Clinical response evaluation was done at the end of 1month by RECIST criteria. In Head and neck cancer patients60%, 26% and 13.3% of the patients showed CompleteResponse (CR), Partial response (PR) and Progressive diseaserespectively in primary disease and 46%, 40%, 13.3% of thepatients showed CR, PR and progressive disease respectivelyin nodal disease. Among Cervical cancer patients: 75% and25% of the patients showed CR and PR respectively. All Breastcancer patient were disease free at the time of assessment.Conclusion: Hypofractionated radiotherapy schedules to beused wherever feasible reducing the overall treatment timeand the exposure of Cancer patients to COVID-19 and viraltransmission can be mitigated with best clinical practice ofsanitization, wearing masks, Face shield, PPE and Socialdistancing.

Gaint cell tumour of phalynx: have you seen it?

Giant cell tumors are rarely seen in the foot. Only 1-2% cases of GCT occur in the foot. They can cause a significant amount of pain and deformity due to their aggressive and recurrent nature whenever it occurs in foot. We present an unusual case of a giant cell tumor of proximal phalynx of middle toe of left foot. 26 year old male came with complaints of pain and swelling over the middle toe of left foot since 6 months. Clinical and radiological features showed features consistent with GCT. Foot Function Index revealed a) Pain scale: 29 / 50 = 58%, b) Disability scale: 56 / 90 = 62%, c) Activity limitation scale: 8 / 30 = 27%. Authors performed enbloc resection with ray amputation of 3rd toe. Histopathological examination of excised specimen revealed classic findings of mononuclear cells with interspersed fibro-collagenous strands and numerous multinucleated osteoclast-like giant cells which confirmed our diagnosis. Patient was serially followed up and at 6 months followup, there were no signs of recurrence with markedly improved foot function index.

Hyperphosphatemic tumoral calcinosis: a rare differential of periarticular swelling

Tumour calcinosis is a rare clinical and histopathological syndrome characterised by deposition of calcium deposits in different periarticular soft tissue regions of the body. It mainly manifest in childhood/ adolescence as a painless, firm to hard tumour like mass around the joints. Most common regions involved: Shoulder, elbow and hip. An 18 year old male patient presented to the opd with a history of pain and swelling over his left hip since 2 months. On examination, there was a diffuse tender swelling over the left greater trochanter, skin over the swelling was normal with no discharge, no dilated/ engorged veins. Range of motion of left hip was normal, no limb length discrepancies. X-ray: Showed a well define calcified mass over the greater trochanter with no osseous involvement. MRI revealed an encapsulated hypointense mass present posterior to the greater trochanter, mostly in the muscular plane. Lab findings revealed mild hyperphosphetemia. An aspirate from the swelling showed casseousmaterial. En mass removal was done and sent for biopsy. Biopsy showed features suggestive of tumoral calcinosis. Tumoral calcinosis is a distinct clinico-radiopathological entity characterised by soft tissue periarticular calcinosis which mimics a true neoplasm, associated with elevated levels of serum phosphate. It is an extremely rare condition which is seen in the adolescence and requires more studies regarding the surgical and medical management of the same.

Is there a need for antibiotic cover in clean surgery like laparoscopic cholecystectomy: a prospective study

Background: Even with a low post-operative infection complication rate in elective laparoscopic cholecystectomy (LC), most surgeons use prophylactic antibiotics out of habit. This prospective study was done to analyze the need for such prophylaxis in cases of elective LC.Methods: 135 successive patients undergoing elective LC were included in the study. Patients were randomized into 3 groups. Group A (n=45) cases received 3 doses of injection ceftriaxone in the post op period, group B (n=48) cases received a single dose of injection ceftriaxone at the time of induction of anesthesia, and group C (n=42) cases did not receive any antibiotic pre or post operatively. Post-operative infectious complications between three groups were compared.Results: There was no significant difference in surgical site infection rates between the groups for variables such as age, sex, body mass index, duration of symptoms, duration of surgery and hospital stay. Intraoperative spillage of bile [6.7% (A): 4.6% (B): 5.2% (C)] did not increase infectious complications.Conclusions: Routine use of prophylactic antibiotic in a clean, uncomplicated cases of laparoscopic cholecystectomy is not required. One dose of ceftriaxone at the time of induction or 3 doses of injection ceftriaxone post operatively following elective LC even in the urban Indian setting should be abandoned as it neither reduces the rate of surgical site infection but also contributes to adverse reactions, drug resistance, and unnecessary financial burden.

Assessment and accreditation of a medical college by national assessment and accreditation council: an overview

Accreditation affirms provision of quality education, thus determines its graduate attributes. WFME, WHO and various bodies have been striving to ensure credibility of educational institutions through accreditation. NAAC is an Indian accrediting body providing framework for quality assurance to higher education institutions. Being an autonomous body under UGC, it sets a standard of excellence to which they are bound to adhere. This article provides details regarding an insight into NAAC, its vision, objectives, core values and the process of accreditation. The details regarding various criteria, components, allotment of weightage to each of them are detailed in the manuscript. The requirements and needs towards preparedness for this accreditation process are simplified to make the readers to understand easily thus providing a bird抯 eye view of entire process.

Evaluation of admission serum magnesium levels in patients with septic shock and its correlation with outcome

Background: Admission hypomagnesemia has been linked with an increased risk of septic shock. The purpose of this study was to evaluate admission serum magnesium levels in patients with septic shock and to determine its correlation with the outcomes.Methods: It was a prospective observational study. Total 50 patients fitting the Sepsis-3 definition between time period of June 2017 to November 2018 were included in the study. Patients with suspected infection were identified at the bedside with qSOFA. Admission serum magnesium levels was measured for all patients included. APACHE II scores were calculated at the end of 24 hours after admission. Routine standard of care treatment was provided to all patients. The patients were monitored for organ dysfunctions based on daily SOFA scores, ventilator free days, vasopressors free days, dialysis free days, length of intensive care unit stay, length of hospital stay. The data was analysed using Statistical Package for Social Sciences for MS Windows.Results: In this study hypomagnesemia was prevalent in 18%, normomagnesemia in 62% and hypermagnesemia in 20% of total included patients. The mean vasopressor free days in Hypomagnesemia group (7.11�.79 days) were higher than those in normomagnesemic patients (5.06�51 days) and hypermagnesemia patients (1.70�09 days). Out of total 50 patients 18 died and 32 recovered. 11 patients out of 32 who recovered had abnormal admission serum magnesium levels whereas 8 pts out of 18 who died had abnormal admission serum magnesium levels. SOFA score in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients was statistically significant.Conclusions: Author did not find any statistically significant correlation between admission magnesium levels in septic shock patients and outcomes although SOFA score was higher in hypomagnesemic patients admitted with septic shock compared with those of normomagnesemic and hypermagnesemic patients. Serum magnesium may not truly reflect body抯 magnesium status. RBC magnesium may need to be studied to see whether it is a more reliable biomarker.

Blunt abdominal trauma: the experience in rural India and review of literature

Background: Blunt Abdominal trauma is one of the most common injuries caused due to road traffic accidents. The rapid increase in number of motor vehicles and its aftermath has caused rapid increase in number of victims due to blunt abdominal trauma. As the care of patients with blunt abdominal injuries is largely a surgical responsibility and abdominal injuries involving major hemorrhage from solid viscera constitute surgical emergencies. Abdominal blunt traumas represent a real diagnostic and therapeutic challenge to even a most experienced surgeon, thereby representing importance of its study. Early diagnosis and effective management help in decreasing mortality in blunt abdominal trauma.Methods: Prospective study of 50 patients admitted to the institute with history of Blunt Abdominal Trauma. After initial resuscitation of the patients, thorough assessments for injuries were carried out in all the patients. Documentation of patients, which included identification, history, clinical findings, diagnostic test, operative findings, operative procedures and complications during the stay in the hospital were all recorded on a Performa specially prepared. The management was decided depending upon history, clinical examination and investigations.Results: Males were predominantly affected, and most cases were between the age group of 21-40 years (76%). Majority of the patients (90%) presented with the complaint of abdominal pain followed by abdominal distension (56%). 36(60%) patients were managed conservatively while operative interventions were required in 24(40%) patients. The common surgeries performed in the patients included splenectomy, primary closure of perforation and resection and anastomosis of bowel. Majority of the patients (80%) were discharged within 20 days of admission. The mortality in present study was 13.3%.Conclusions: Blunt Abdominal Trauma is one of the important causes of morbidity and mortality in young adults. Immediate resuscitative measures, management of associated injuries and appropriate operative intervention are important parts of management of such cases.

Prevalence of oral potentially malignant disorders associated with habits in Puducherry - a Cross-sectional study

Tobacco and betel quid are the most common cause of oral cancer in India. Very often oral cancers are preceded by a visible oral precursor lesion called as potentially malignant disorder (PMD). Aim: The aim of this study was to assess the prevalence of oral PMDs associated with habits in urban and rural areas of Puducherry Union territory, India. Methods: A cross-sectional descriptive study in urban and rural areas of Puducherry was conducted. The study group comprised of 450 patients with positive history of oral habits. A standard structured questionnaire was designed to record information about demographic details, socioeconomic status, type, duration and frequency of habits followed by clinical oral examination by single trained and calibrated examiner to detect the presence of PMD. Statistical analysis used: EpiData software (version 3.1). Descriptive statistics were presented for all variables. Pearson's Chi-Square test and adjusted odds ratio (ORs) with 95% confidence interval (CI) were calculated to estimate the suspected risk factors for PMD by using multivariate logistic regression analysis. P-value of ≤ 0.05 was considered to be statistically significant. Results: Prevalence of habit associated oral PMD was 64.2%. Females were more prone to develop PMDs (68.3%) as compared to males (62.8%). PMD was more common in the age group of 51-60 years (69.2%). Smoking with alcohol consumption was the most common oral habit. Habits, socio-economic status and diet were significantly associated with development of oral PMDs in our study population. Multivariate logistic regression analysis showed that chronic betel quid chewing and smoking were significant risk factors for PMD. Increased frequency of vegetable consumption reduced the risk of PMD. Conclusions: Oral PMD were observed in more than half of the subjects with oral habits in Puducherry. Clearly, there is an increased risk of PMD with increased duration of tobacco and betel quid use in this region. Patients and public need to be educated regarding PMD and encouraged to quit habits so as to prevent high risk population from developing cancer

Immunological alterations in tuberculosis associated immune reconstitution inflammatory syndrome in HIV infected patients

The tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) frequently complicates the course of HIV/AIDS and HIV-TB treatment and its immunological mechanisms are poorly understood. Here, we investigated T-cells frequencies, their secreted chemokines and cytokines. In this prospective case-control study, HIV/AIDS and HIV-TB patients during treatment with highly active antiretroviral treatment (HAART) and anti-TB treatment were followed for TB-IRIS development. Age, gender and BMI-matched patients without IRIS constituted as “Controls” (non-IRIS). Activation and proliferation were assessed in CD4 and CD8 cell compartments. CCR4, CCR6 and T-reg cells were also analysed in PBMCs. Cytokines (IL-2, IL-4, IL-10, IFN-γ and TGF-β1) and chemokines (IP-10, MCP-1, MIG and RANTES) were measured in culture supernatants. Of 560 enrolled HIV/AIDS patients, TB-IRIS developed in 50 (8.9%) patients (25-paradoxical and 25-unmasking) at a median interval of 35-days (IQR, 24-78). After ART therapy, CD8+ T-cell proportion decreased in both paradoxical and unmasking-TB-IRIS as compared to non-IRIS. Simultaneously, activation of CD4+ T-cells was observed in unmasking TB-IRIS only. Similarly, CD161+ T-cells, Th17-cells and inflammatory cytokines like IFN-γ, IP-10 and MIG elevated in both TB-IRIS subgroups as compared to non-IRIS.In conclusion, during HAART treatment the dominance of pro-inflammatory cells and cytokines in TB-IRIS patients favours the development of IRIS event. On the other hand, in non-IRIS patients relative increase of anti-inflammatory cells and cytokines prevents the development of IRIS event.

A Case Of Multiple Self-Inflicted Cuts To The Neck And Wrist Presenting With Airway Compromise And Catastrophic Hemorrhage

Cut-throat injuries are seen commonly, however, the reporting in the medical literature is not so common. Due to the close proximity of the vital structures in the neck, there is a high risk of compromise to the airway. Transection of just the ulnar artery in itself is sufficient to cause death within a period of 6 hours. Here, we report the case of a 22-year-old male patient with a history of a self-inflicted wound on the anterior aspect of the neck which was associated with bleeding and respiratory distress and multiple incised wounds over the left wrist. The patient was then taken up in the OT for wound exploration and suturing by an ENT surgeon. Simultaneously Radial and Ulnar artery repair, with the repair of multiple flexor tendons of the left forearm was done by a vascular surgeon and a plastic surgeon, respectively

Assessment of knowledge and health care seeking behaviour for menstrual health among adolescent school girls in urban slums of Bengaluru: a cross sectional study

Background: Adolescent girls are often less informed and less comfortable in accessing reproductive health care and information. Due to taboos and socio-cultural restrictions associated with menstruation and its issues, a culture of silence surrounds it. Every stage of women’s life influences next stage, thus present menstrual health will help the girls to have good reproductive, sexual and maternal health later. Good knowledge and better health care seeking behaviour will help in managing menstruation hygienically and with dignity. Hence the present study was undertaken with the objectives, to assess knowledge about menstruation and to determine health care seeking behaviour for menstrual health among adolescent girls in urban slums.Methods: A cross sectional study was conducted to assess knowledge about menstruation and determine health seeking behaviour for menstrual health among 150 adolescent school girls. Multi stage random sampling with probability proportionate to size sampling technique was used. A pre-tested, semi-structured questionnaire was self administered to assess socio-demographic factors, knowledge and health care seeking behaviour for menstrual health.Results: Among 150 adolescent girls, 102(68.0%) of them had good knowledge. Among girls who had excessive bleeding and irregular menses only half of them sought medical treatment (p<0.05) and though 59.5% had more than one symptoms in a cycle, only 37.3% sought treatment.Conclusions: Health care seeking behaviour for menstrual health among adolescent girls was marginally low, only 34(37.4%) sought treatment.

Comparing infrastructure of anganwadi centres under integrated child development services of urban and rural Bangalore: a cross sectional study

Background: Anganwadi centres under integrated child development services is the largest Project in India to improve not only child health but reproductive, maternal and adolescent health. The aim of the present study is to compare the infrastructure of urban and rural anganwadi which is one of the basic need to provide quality services.Methods: A total of 30 anganwadi centres are involved in our study in which 20 are from rural and 10 are from urban field practice area of Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore. This study employed interview method with anganwadi worker’s and observation of anganwadi centre using pre-designed, semi structured questionnaire and checklist.Results: 85% of rural and 60% urban anganwadi centres have their own buildings to carry out the services. 20% of rural anganwadi centres lack fixed name boards compared to urban anganwadi centres. 55% of rural anganwadi centres and 90% of urban anganwadi centres lack separate storage for raw food materials. 15% of rural anganwadi centres lack functional toilet facility. 40% of rural anganwadi centres lack functional weighing machine.Conclusions: Anganwadi centres are remote contact point of health care system within the community. The infrastructure of anganwadi centre such as type of building, space for cooking and activities, availability of functional equipments ensure the quality service deliveries which in turn are enhanced by timely supervision from higher authorities.

Etiological spectrum and short term outcome of acute kidney injury in children: a prospective study

Background: Acute Kidney Injury is a common condition in critically ill children, and it is independently associated with increased mortality. Etiology of AKI in admitted patients is multi factorial. The present study was conducted to determine possible etiologies and to know short term outcome.Methods: A prospective case series study was conducted in our PICU from Nov 2014 to October 2015. The cases fulfilling criteria as AKI, as per definition were included in study. The urine output was monitored, base line blood urea and serum creatinine was estimated at admission and on alternate days till recovery. Investigations were done to know exact etiology of prerenal, renal or post renal AKI. Cases were managed accordingly and short term outcome was noted.Results: Out of 150 cases studied, 87(58%) were boys and 63(42%) were girls.' Ninety three cases (62%) had oliguria and remaining patients had non-oliguric AKI. Majority of cases in the study belonged to prerenal AKI, followed by renal and post renal AKI. Amongst 150 cases,136 children managed conservatively,11 cases required hemodialysis and 3 cases peritoneal dialysis. In our study, 16 cases succumbed with mortality of 10.66%.Conclusion: AKI is common associated condition in children admitted to PICU. AKI is commonly seen with acute gastroenteritis with severe dehydration, sepsis, glomerulonephritis and dengue shock syndrome. Most of these conditions are easily preventable. Early and effective management of hypovolemic shock and sepsis is also crucial in prevention of AKI.