Non-Hodgkin’s Lymphoma Masquerading as Submandibular Sialadenitis.

Non-Hodgkin’s lymphoma often presents outside the lymphoid system. Among the salivary glands, parotid is exclusively involved and it is extremely rare in submandibular gland. We report a case of non-Hodgkin’s lymphoma in submandibular gland, which was initially managed as a case of chronic submandibular sialadenitis, but later on confirmed as non-Hodgkin’s lymphoma after surgical excision and histopathological examination.

A Study of Social Status of People with Disabilities due to Leprosy in Desert Part of Rajasthan, India.

Leprosy is a stigmatized disease in our society. Ninety-eight disabled leprosy patients were studied in areas of Pokaran CHC and Ramdeora PHC of Jaisalmer district. About ninety-five per cent (94.6%) leprosy patients were found discarded by their life partners due to disabilities. A positive relationship was found between social stigma and deformity due to disease. IEC need to be done at community level also for changing attitude and behaviour towards leprosy patients.

A study of treatment seeking behaviour for malaria and its management in febrile children in rural part of desert, Rajasthan, India.

Background & objectives: For management of malaria, there is a need to give attention on specific group of people like children <5 yr of age in the community. They are unable to explain their feelings about severity of illness and effects of treatment on health and they are dependent on others for their health care, therefore, it is the mother who can seek, obtain, and use medication appropriately. This is directly linked to the level of education, socioeconomic status, timely decision, accessibility of health facility, correct use of drugs and their follow-up. The present study was undertaken with the aim to know the basis on which malaria was recognized and classified and exploring factors involved in the selection of different treatment options in the desert population of Rajasthan. Methods: Interview and observation techniques were used for data collection in 15 villages of Ramgarh PHC in Jaisalmer district of Rajasthan state, India. A total of 164 mothers were interviewed and observations were made by the investigators in the group discussions who utilized health facility for the febrile children <5 yr of age. Results: More than 93.3% mothers started taking care at home for their febrile children and watched for improvement on an average up to 72 h. When they thought there was no hope to manage the case at their level, they shifted their febrile children to the nearest health facility such as sub-centre/PHC/private health practitioner. Utilization of health facility was linked with the age of the child, with younger children (<24 months of age) being significantly more likely to be utilized nearby health facility than 24–59 months children. Children judged as severely ill by their mothers utilized health facility significantly more often than those not thought to be severely ill. Mothers from households where the household heads had a primary or secondary education were more likely to utilize health facility than those household heads having no education. Similarly, mothers from households with moderate or high income utilized health facility more frequently than those with low income. Interpretation & conclusion: The study revealed that mothers usually tried to manage febrile cases at their own level at home for children <5 yr of age. They had gone through different treatment options before utilizing health facilities. There was, on an average three days delay in seeking care in the remote villages of desert part of Rajasthan. To minimize the delay in diagnosis and treatment of malaria among the children <5 yr of age is an urgent need for intervening through IEC programme and trained volunteers for the management of malaria cases at village-level.

Major Depressive Disorder: Part-I: Personality and Phenomenology.

Objectives: To study the phenomenological variations in context of personality psychopathology in Major Depressive Disorder patients. Methods:36 indoor patients of psychiatry ward of tertiary level service out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR) . Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS)and Presumptive Stressful Life Event Scale(PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: Sociodemographic variables by enlarge didn’t make a difference in MADRS score. MADRS score was significantly higher with increasing episodes of illness. Personality disorder patients had significantly higher MADRS score than Double traits (t=3.47, df=27, p<0.01) and Single trait (t=4.056, df=23, p<0.001) personality psychopathology. Higher level of depression in Personality disorder patients in all components of depression like sadness, reduced sleep pessimistic and suicidal thought etc were reported. Presence of stress with personality psychopathology added greater severity to depression. Conclusion: Our study brings out constitutional vulnerability with adverse environmental conditions were associated with higher level of psychopathology.

Major Depressive Disorder: Part-II -Comorbid Anxiety Disorders.

Objective: To demonstrate that Anxiety Disorder comorbidity is reflection of underlying common risk factors (Anxiety proneness) in Major Depressive Disorder patients and may not be a separate disorder. We hypothesized that “Anxious personality traits or disorders under stress take the form of state that is Anxiety Disorders”. Methods:36 indoor patients of psychiatry ward of tertiary level services, out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR). Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS) and Presumptive Stressful Life Event Scale (PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: High level of co-existence of Anxiety disorder 29(80.5%) in the study sample, 11 patients (30.55%) of Major Depressive Disorder had personality disorder level of psychopathology and 18(50%) patient of Major Depressive Disorder had double or more personality traits psychopathology and there were 7(19.45%) patients of Major Depressive Disorder had only single trait personality psychopathology. Conclusion: This work support the gene environmental diathesis where vulnerable person under stress develop Axis I disorder which are considered currently as co morbid disorders.

Obstructing mass lesion of epiglottis: it can be tubercular.

We report a case of 60-year old male who had difficulty in breathing as well as in swallowing. On examination, he was found to be having proliferative growth of epiglottis and right aryepiglottic fold mimicking neoplasm. So emergency tracheostomy was performed and biopsy taken. He was found to be having asymptomatic miliary mottling on routine x-ray chest PA view. Further on HRCT, it turned out to be lesion suggesting tubercular etiology. Histopathology (epiglottic biopsy) report confirmed the whole process as tubercular. The patient recovered promptly in due course with anti-tubercular treatment. Point remains to be seen that if we can avoid tracheostomy and its complications in such cases.

Endo-DCR: is it an end of the road for external DCR?

Endo-DCR is a safe, quick, less traumatic, with minimal blood loss and post-operative discomfort and last but not the least, avoids external scar. It has high success rate in both primary and secondary cases. Fifty two cases of chronic dacryocystitis were treated by the endoscopic technique including 33 females and 19 males in mean age group 35.8 year, 29 left eye and 23 right eye with 8 patients cannulated with nasolacrimal tube with very good results and few complications.

Sociocultural factors and malaria in the desert part of Rajasthan, India.

BACKGROUND & OBJECTIVES: Malaria is a new emerging problem of Indian Thar Desert. The study was attempted to find out some sociocultural factors associated with malaria transmission in this region and to supplement social solutions to ongoing malaria control efforts in the desert part of Rajasthan. METHODS: Interview technique was used for data collection on pre-tested schedules. In all 30 households (15 from low socioeconomic group and the same number of households from the high socioeconomic group) in a village were selected following systematic random sampling technique. A total of 450 respondents were selected randomly in 15 villages of Jaisalmer district, Rajasthan. RESULTS: One-third of the respondents had neither taken treatment for malaria nor took part in the vector control operations because they did not consider mosquito bites to be harmful and took malaria as a mild disease. Outdoor sleeping habits, sharing bed with children, uneasy and suffocation feeling in using mosquito bednets or any other protective device also contributed to the spread of malaria in the study villages. INTERPRETATION & CONCLUSION: Community should be educated as a whole particularly the low socioeconomic group of people to bring changes in their beliefs, sociocultural and health practices to protect themselves from mosquito bites by using bednets, repellents and other devices, such as wire mesh screening of house doors and windows.

Treatment seeking behaviour of malaria patients in desert part of Rajasthan, India.

Malaria remains to be the most important cause of morbidity and mortality in India and in many other tropical countries with approximately 2 to 3 million new cases arising every year. In spite of arid conditions prevailing in desert part of Rajasthan, malaria is a major public health problem. A longitudinal study on social determinants of malaria has been undertaken in different villages of Ramgarh PHC of Jaisalmer district, Rajasthan. The study aims to know treatment seeking behabiour of malaria patients in the desert communities which is significantly different than the non-desert part of India. Out of 60 villages, 12 villages and 573 malaria patients were selected randomly. Interview technique was used for data collection. Information was recorded on pre-tested schedules. Self diagnosis 423 (73.8%) was more common among the respondents and 443 (77.3%) had taken treatment at home with local herbal remedies as the first treatment action. Desert population was not used to laboratory test for the malaria diagnosis. Symptoms based treatment was practised. They used private and government health facilities for the treatment of malaria. Self diagnosis for malaria was common but practised more by the poorer households. A large part of the population did not complete the full course of malaria treatment as a result drug resistance was more common. They did not use the government health facility as a first step of malaria treatment. There is need for health education with campaign emphasizing the role of mosquitoes in malaria transmission and the need for prompt medical intervention. The use of Government health services for the diagnosis and treatment of malaria by the poor should be encouraged through appropriate information, education and communication (IEC) which on the long run will be more cost effective for desert population under the national malaria control programme.

Knowledge and attitude towards Tuberculosis amongsandstone quarry workers in desert parts of Rajasthan.

Aim: The present study was conducted to test the knowledge and attitude of sand-stone quarry workers of Jodhpur on tuberculosis. Material and Methods: Nineteen sand-stone quarry sites were selected randomly in Jodhpur district from which 376 quarry workers were interviewed who consented to participate in the study. Results: Their literacy rate was 28.5%. More than half (50.5%) had heard about tuberculosis from neighbours followed by friends (42.6%) and family members (37.2%). Only 1.6% knew that tuberculosis was caused by germs and 45.2% respondents had misconception that TB was a hereditary disease. Literates were more aware than illiterates about symptoms of tuberculosis. Only 6.9% knew about the need of treatment for 6-8 months and 0.8% knew about the use of BCG vaccine for prevention of tuberculosis. Tendency to discriminate TB patients was evident as 72.6% respondents opined to isolate TB patients from the family and 80.6% opined to avoid sharing food with these patients. Conclusion: Extensive health education directed towards bringing a change in attitude among sandstone quarry workers is needed to create awareness and remove myths about tuberculosis in such groups of people in the community.

Study of social determinants of malaria in desert part of Rajasthan, India.

BACKGROUND & OBJECTIVES: A longitudinal study on social determinants of malaria has been undertaken in different villages of Ramgarh PHC of Jaisalmer district, Rajasthan. The study aims to determine social determinants of malaria as applicable to existing cast groups of desert part of Rajasthan. METHODS: Out of 940 households in five villages, 150 households of Rajput community (forward community) and Meghwal community (backward community) were selected at random to study whether due to different behaviour of existing caste groups, transmission of malaria and its intensity also vary or not. RESULTS: It was found that magnitude of malaria was three times more in the Meghwal community as compared to Rajput community. In-migration of natives importing malaria was found to be prominent cause of more malaria incidence in the backward community. INTERPRETATION & CONCLUSION: An intervention policy aiming to study existing status of knowledge among different caste groups of desert areas could lead to a substantial control over in-migration as well as further transmission of disease in the desert part of Rajasthan.

Tubercular Osteomyelitis of Mandible.

Tubercular osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections and neoplastic diseases involving the mandible. We report a case of tubercular osteomyelitis of mandible in an old chronic smoker woman initially suspected of neoplasia, proved later on as primary tubercular osteomyelitis in absence of a primary focus.

Fatal pyothorax: a rare complication of retropharyngeal abscess.

Fatal pyothorax following a massive acute retropharyngeal abscess in an adult is reported. Acute non-tuberculous retropharyngeal abscess usually develops following a penetrating injury due to a foreign body or endoscopy. Microbial isolates are mixed and consists of aerobic and anaerobic organisms. It may lead on to mediastinitis since there is a potential communication between the two spaces. Immediate cervical, pleural and mediastinal surgical drainage along with appropriate antibiotics can be life saving.

A profile of renal/renovascular abnormalities in patients of hypertension.

After a thorough dinical examination and laboratory investigations, ultrasonography (USG) followed by minute sequence urography (MSU) and aortography and/or selective renal angiography were done in 108 patients, clinically suspected of having renal hypertension of which 32 patients (29.6%) were found to be positive for renal/renovascular disease. Out of 82 patients, who were only young hypertensives, a definite diagnosis of renal/renovascular disease could be made in only 15 cases (18.3%), whereas the pick up rate increased to 65.4% in the rest of the 26 patients who had some other clinical criteria besides hypertension and it further increased up to 92.3% (out of these 26 patients) who had 2 or more than 2 clinical criteria of selection of patients besides hypertension. USG was useful in diagnosing renal parenchymal disease/ suggesting renal abnormalities in 30 cases and MSU was able to detect renal changes in 31 patients. Aortography and/or selective renal angiography could make a definite diagnosis of renovascular disease in 17 cases and renal agenesis in one case.

Gallstone expectoration following laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is the treatment of choice for uncomplicated gallstone disease. Laparoscopic cholecystectomy may result in lost (spilled) gallstones. Such stones may precipitate various infective intra-abdominal complications. An unusual case of spilled gallstones eroding the diaphragm and eventually being expectorated out 12 months after laparoscopic cholecystectomy is reported.

Myringoplasty for chronic otitis media.

METHODS: 25 children in the age group of 8-14 years suffering from chronic suppurative otitis media were taken up for myringoplasty using onlay technique under general anaesthesia. RESULTS: All selected cases had a central type of dry perforation, good cochlear reserve and healthy middle ear mucosa. Cases having enlarged adenoids, infection in nose or throat, any traumatic perforation or previous attempt at closure were excluded from the study. It was found that there was 76% take up of graft after two months who also had improvement in hearing. CONCLUSION: We conclude that myringoplasty stands a good chance in children.

Bilateral choanal atresia--respiratory emergency in a neonate.

Bilateral choanal atresia is potentially a fatal respiratory emergency in a newborn. A 2-day-old full term male infant was presented with history of attacks of cyanosis, difficulty in suckling and respiration. On examination cyclical change of body colour, ie, alternating cyanosis and normal colour was observed. CT scan of the base of the skull revealed bilateral choanal atresia. The patient underwent choanal canalisation operation by transnasal route using Lichtwitz trocar and cannula with controlled force.

Malaria outbreak in the Indira Gandhi Nahar Pariyojna command area in Jaisalmer district, Thar Desert, India.

A focal outbreak of malaria occurred in the villages situated close to the main Indira Gandhi canal near Ramgarh in Jaisalmer district, western Rajasthan. Stagnation of water over a month's period in the main canal as well as long standing rain water in the form of expansive lakes near these villages formed vast breeding grounds for the vectors like Anopheles culicifacies, along with A. stephensi already breeding in the 'tanka' and 'beri' in the epidemichit villages. Rapid mass blood surveys along with other entomological and parasitological investigations were conducted in four of the ten affected villages, viz., Seuva, Raghwa, Raimala and Sadhna. A total of 992 specimens belonging to four vector species were sampled, namely, A. stephensi (47.4%), A. culicifacies (41.0%), A. subpictus (11.2%) and A. annularis (0.4%). Epidemiologically, about one-fourth of the examined persons were positive (SPR 25.5%), although Plasmodium falciparum dominated the parasitaemia (49.5%). Available data are indicative of changed malariological scenario in the Indira Gandhi Nahar Pariyojna command area, where epidemics are regular features every year.

Urodynamic profile after Wertheim's hysterectomy.

Wertheim 's hysterectomy is likely to cause damage to innervation and anatomical support of the lower urinary tract. Urodynamic assessment was done in twenty patients of histopathologically proven cancer cervix who were about to undergo Wertheim's hysterectomy. The study was performed preoperatively, in the immediate postoperative period and six weeks after surgery. Urodynamic study included uroflowmetry, cystometry and urethral pressure profile. Urinary symptoms were also corelated with the urodynamic profile. It was concluded that the bladder was hypertonic in the immediate postoperative period and urethral closure pressures were low. Some regeneration of damaged nerve fibres was found to occur during the 6-8 weeks after surgery resulting in some improvement in sensory and motor functions of the bladder Post operatively continuous catheter drainage appeared to be the most important part of management of hypertonic bladder and the duration was individualised on the basis of urodynamic investigations.