Community based sensitization to address maternal and child health problems in tribal population of India

Background: India fights with substantial maternal and child health (MCH) concerns, accounting about one quarter of the global burden of maternal and childhood mortality.The current study was tried to assess the impact of community partnerships between medical students, community stakeholders (TBAs and local tribal girls) and general community members on their awareness levels about MCH care and services. Methods:a community-based pilot interventional study was conducted at one of the rural blocks of Maharashtra state of India. Of 120, sixty (50%) first year undergraduate MBBS medical students (intervention group) posted at two months rural healthcare training programme’ participated in preparing MCH related health education material (HEM) in local language. Similarly local tribal girls, TBAs and general community people were trained about MCH and their knowledge levels were assessed. Results:Pre and post training assessment scores of participants (students, TBAs, tribal girls and general people) indicated significant (p<0.05) differences in their knowledge about MCH. The used approach of community collaborations in this study upgraded the knowledge of stakeholders (TBAs, tribal girls) and common tribal peopleabout basic aspects of MCH and associated welfare schemes. The study also reported positive attitudes of all participants about an intervention. Conclusions:Productive and synergistic community partnerships can be created among health care providers, community health workers and other stakeholders to ensure commitment and engagement towards positive health.

Diagnosis and Management of Acquired Aplastic Anemia: Consensus Statement of Indian Academy of Pediatrics

Justification: In India, there is a lack of uniformity of treatment strategies for aplastic anemia (AA), and many children are managed only with supportive care due to non-availability of hematopoietic stem cell transplantation (HSCT). Process: Eminent national faculty members were invited to participate in the process of forming a consensus statement in Hyderabad in July, 2016. Draft guidelines were circulated to all members, and comments received in a online meeting in October, 2020 were incorporated into the final draft. These were approved by all experts. Objective: To facilitate appropriate management of children with acquired aplastic anemia. Recommendations: Key recommendations are: i) A bone marrow biopsy is must to make a diagnosis of AA; ii) Rule out inherited bone marrow failure syndromes (IBMFS), connective tissue disorders, viral infections, paroxysmal nocturnal hemoglobinuria (PNH), drug or heavy metal induced marrow suppression in all cases of AA; iii) Conservative approach to transfusions should be followed, with a target to keep hemoglobin >6 g/dL in children with no co-morbidities; iv) HLA-matched sibling donor HSCT is the preferred choice of treatment for newly diagnosed very severe/ severe AA; v) In absence of HLA-matched family donor, a matched unrelated donor (MUD) transplant or immunosuppressive therapy (IST) should be considered as alternate choice based on physician expertise; vi) Fludarabine, cyclophosphamide and anti-thymocyte globulin (ATG) based conditioning with cyclosporine and methotrexate as graft versus host disease (GvHD) prophylaxis is the preferred regimen; vii) Horse ATG and cyclosporine are the recommended drugs for IST. One should wait for 3-6 months for the response assessment and consideration of next line therapy.

A Prospective Study on Association of Social Anxiety in Patients Suffering from Various Clinical Presentations of Acne Vulgaris

Background: Acne vulgaris is a common illness of adolescence. During adolescence, the importance of body image and the cosmetic problems that this illness may cause, it is important that the level of social anxiety should be studied in acne patients. Methods: 100 acne vulgaris cases were included in this study. This study conducted in the department of Psychiatry in Ananta Institute of Medical Sciences and Research Centre. The duration of study over a period of six month. Results: This study showed that amongst acne patients having social anxiety majority had acne lesions localized on face (36,7%), almost all had clinically very severe (100%) acne and none of them subjectively perceived their acne lesions as mild. Conclusions: This study concludes that, clinician's evaluation is objective and more precise and valuable, but the self-perception of a patient has a greater effect on his/her psychological condition.

How Stigma and Discrimination are Perceived by Rural or Urban Patients Suffering from Schizophrenia? An Exploratory Cross – Sectional Study fromWestern India

Background: Stigma is conceptualized as an attribute which is deeply discrediting and makes the person carrying it different from other and of a less desirable kind. Current study aimed to describe the nature and direction of experienced stigma; and discrimination reported by people with schizophrenia. Methods: One hundred and fifty patients diagnosed with Schizophrenia were selected from the Out Patient service of Psychiatry Department of a medical college general hospital. The experiences of stigma and discrimination were assessed using a semi-structured instrument developed by national working group for India by the world psychiatric association steering committee. Results: Differences were seen between rural and urban respondents. Patients from rural background more often reported these experiences: society treats differently, ridiculing by others, offensive comments, hiding from relatives, rejecting attitude of peoples around, attribution of supernatural cause as most common source of stigma, social exploitation, not fully accepted in the family, pushed into unacceptable social situation and sexual harassment. Reported narratives provided the direct view of these patients. Conclusions: Stigma experience is pervasive: it deeply affects the social, occupational and emotional wellbeing of patients with schizophrenia and should be included in clinical management. Effective anti-stigma intervention should target on improving attitudes and the condition for social integration in the community, empowering people with schizophrenia to challenge self-stigmatization and discrimination behavior towards them.

Biological therapy for pediatric malignancy: current perspectives.

Biologicals are defined as agents that are either uniquely or partially tumor-specific. Great expectations were raised by the success in agents that target a specific genetic translocation: all-trans retinoic acid, targeting the chronic myeloid leukemia retinoic acid receptor in acute promyelocytic leukemia and imatinib, a small molecule targeting the BCR-ABL translocation in chronic myeloid leukemia (CML). Thus far, the search for similar "druggable" genetic targets in pediatric cancers has not yet resulted in such dramatic results. The rarity of pediatric cancer as well as ethical considerations necessitate that the agents for testing be carefully and rigorously selected. Biologicals present an additional challenge, as they often do not lend themselves to in vitro testing. Early approaches to specific targeting of solid tumors utilized monoclonal antibodies. The microenvironment provides an interesting new biological approach to treating tumors and alteration of the host immune response provides another avenue. Biological agents are a step forward in supportive care to reduce the hematological toxicity of high-dose chemotherapy and to manage the frequent infectious complications.

Recent advances in management of acute myeloid leukemia (AML).

Acute myeloid leukemia (AML) is the most common childhood malignancy. AML has therapeutically been difficult to treat. In 2001, the World Health Organization (WHO), in conjunction with the Society for Hematopathology and the European Association of Hematopathology, published a new classification for myeloid neoplasms. A number of chromosomal abnormalities are used to predict outcome and stratify therapeutic risk groups in children with AML. Recently, alterations in receptor tyrosine kinases, tyrosine phosphatases and in oncogenes such as RAS have been implicated in the pathogenesis of AML. This article aims to review the recent development in diagnosis, treatment and monitoring of AML. Better understanding of the molecular pathogenesis of AML has led to the development of target-specific therapies. Some of the new classes of drugs include monoclonal antibody directed against the CD33 antigen, farnesyltransferase inhibitors (FTI), and FMSlike tyrosine kinase 3 (FLT3) inhibitors. The role of allogenic SCT, particularly whether it should be done during first CR or reserved for second remission, remains the most controversial issue in pediatric AML. There is a need of collaboration with international pediatric cooperative oncology groups and definitive clinical trials in order to establish use of these newer molecules in pediatric populations.