Utilization of Reproductive and Child Health Services and Client Satisfaction from Urban Primary Health Centers by Recently Delivered Women Living in Urban Slums of Lucknow, India

Background: Due to rapid urbanization, there is an increase in population in slums often lacking access to basic health services. Objective: The purpose of this study was to assess the utilization of reproductive and child health services by recently delivered women and their children residing in catchment areas of urban PHCs, to evaluate their level of satisfaction and to determine the factors associated with utilization of these services by recently delivered women. Settings and Design: The study was conducted in the catchment areas of urban primary health centre of Lucknow. Methods and Material: A cross-sectional study was conducted among 320 women having children less than 24 months in the slums covered under selected U-PHCs, sampled through a multi-stage random sampling technique using a semi-structured questionnaire. Statistical analysis used: SPSS-26 and MedCalc software were used for data analysis. Results: Utilization of RCH services by recently delivered women from UPHC was 39%. About 24% of recently delivered women availed ANC services from UPHC and 56.7% utilized family planning services and 95.8% immunization services for children. Child care services for diarrhea and ARI were availed by 9.9 and 3.1% of women, respectively. Satisfaction regarding maternal care and immunization services was seen in 84 and 95.8% of women. Poor satisfaction regarding child care was seen in 56.5% of women. Conclusions: The utilization of RCH services was found to be poor in the study population. Most recently delivered women were satisfied with all services except child care.

Myeloid sarcoma presenting as nasopharyngeal mass: A rare clinicopathological scenario

Myeloid sarcoma (MS) is considered as an extramedullary manifestation of acute myeloid leukemia (AML) with or without concurrent AML. It can present at any age and any site, however, nasopharynx being an extremely rare site of manifestation. MS may precede AML by weeks, months or years, thereby necessitating an early diagnosis and timely intervention and treatment. We report a case of MS in a young female who presented with nasal obstruction and epistaxis for 3 months. The present case also highlights the significance of judicious use of immunohistochemistry panel while dealing with a hematolymphoid neoplasm devoid of expression of B-cell or T cell specific markers in head and neck region.

Depression, anxiety, and stress of first-year MBBS students of Kanpur during coronavirus disease 2019 pandemic

Background: Globally undergraduate medical students have a high prevalence of depression, anxiety, and stress. Few studies from different parts of India have reported the increased prevalence of depression, anxiety, and stress in MBBS students due to the coronavirus disease 2019 (COVID-19) pandemic. However, the causal relationship between COVID-19 and the deranged mental health of the students have not been established. Further, data from the Kanpur city of Uttar Pradesh are lacking regarding the impact of COVID-19 on the mental health of 1st-year MBBS students. Aims and Objectives: The aim of the study was to explore the impact of COVID-19 on depression, anxiety, and stress of MBBS students in their first professional year. Materials and Methods: The present cross-sectional study was conducted on undergraduate medical students of a Government Medical College in Kanpur, Uttar Pradesh, India. Seventy-two male and forty-six female students were involved in the study. Most of the students were 17–25 years old. An online Google form was used to know the score of depression, anxiety, and stress scale (DASS). The demographic profile of the participants was also assessed through an online survey using Google form. The Chi-square test was used for testing relationships between categorical variables wherever required and P ? 0.05 was considered significant. Results: The prevalence of depression, anxiety, and stress was 39%, 52%, and 37%. Gender, age, place of residence, mediation practice, and type of family had no relation with the DASS-21 score. Conclusion: First-year MBBS students of Kanpur have an almost similar prevalence of depression, anxiety, and stress as reported by the previous Indian studies during the pre-COVID-19 pandemic.

Obstructive Sleep Apnea with Insomnia Overlap: An Under-recognized Entity

Introduction: The association between obstructive sleep apnea (OSA) and insomnia is relatively common but is underrecognized. There are important diagnostic and therapeutic implications of comorbid OSA杋nsomnia overlap but there is no data available from India. Objectives: (1) To find out the prevalence of insomnia among patients with OSA; (2) To compare the demographic characteristics, Epworth sleepiness scale (ESS) scores and the presence of comorbidities among patients of OSA with insomnia vs OSA without insomnia. Materials and methods: It was a prospective observational study involving 250 patients with suspected OSA. A total of 189 patients had OSA based on type I polysomnography and were further analyzed. Insomnia was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Results: The prevalence of insomnia among OSA was 15.34% (29/189). Overlap was seen in 22.45 and 12.86% of women and men respectively among patients with OSA. The prevalence of overlap increased with decreasing severity of obesity and OSA. Those with OSA杋nsomnia overlap had significantly lower ESS scores as compared to OSA without insomnia (12.31 vs 15.24; p = 0.019). A total of 10.34% (3/29) of patients of overlap had depression whereas none from OSA alone had depression. Conclusion: There is a high prevalence of insomnia among patients with OSA (15.34%), similar to findings worldwide. Insomnia is more common among women with OSA. Overlap patients have lower ESS scores and are likely to be depressed.

Dermatologic clue to renal cell carcinoma: a case report

Visceral malignancies often present as cutaneous lesion and are an important clue towards the diagnosis. Authors report a case of a 64 years old male, who presented to us with right hemiparesis and multiple purple-red skin lesions. Systematic evaluation, thorough history and histological examination of the skin lesion showing the characteristic lesion lead to a final diagnosis of Renal Cell Carcinoma. Although in the history and physical examination there was no sign of Renal Cell Carcinoma, but eventually the case turned out to be an extensively spread cancer. This kind of Cutaneous lesions in a case of RCC is a rare phenomenon and has not been frequently mentioned in the previous literature, thus this case reminds us about the importance of a detailed clinical look out in each and every patient and various clues to make a correct and timely diagnosis of systemic diseases. The list of visceral malignancies causing cutaneous metastasis is quite long and requires a battery of test to diagnose the same.

Microbiological profile and antibiotic susceptibility of scleral buckle infections in North India

Purpose: The aim of this article to study causative organisms for scleral buckle (SB) infections in North India. Methods: A retrospective review of records was done for all patients who have undergone SB removal at our institute between January 2009 and December 2017. The records were analyzed for etiological agent of the infected buckle and its antibiotic sensitivity. Results: A total of 43 samples were analyzed and a positive culture was noted in 35 (81.40%) cases. The buckle infection rate at our institute was noted to be 2.53%. The commonest organism causing SB infections was Staphylococcus – 15 (42.6%) cases, followed by Pseudomonas – 6 (17.14%) cases and Fungi – 6 (17.14%) cases. The median interval between retinal detachment surgery and buckle explantation was 3 years. Conclusion: A large variety of organisms may cause SB infections. The commonest organism found to cause buckle infections in our study was Staphylococcus sp.

Evaluation of the effect and safety of dexmedetomidine as an additive to local anesthesia in peribulbar block for vitreoretinal surgery

Purpose: We conducted a prospective, randomized study to evaluate the efficacy of dexmedetomidine as an additive to peribulbar block for vitreoretinal surgery in terms of onset time of block, hemodynamic stability profile, patient comfort, and surgeon satisfaction. Methods: One hundred patients of American Society of Anesthesiologists grade 1 and 2 scheduled for vitreoretinal surgery were randomly assigned into two groups: control group (n = 50) received lignocaine bupivacaine block, and Dex group (n = 50) received lignocaine bupivacaine plus 20 ?g dexmedetomidine peribulbar block. Information regarding time for onset of block, hemodynamic data, visual analog scale for pain, sedation levels, total duration of surgery, and surgeon satisfaction levels were collected. Results: All the demographic characteristics including age, gender, American Society of Anesthesiologists grade, onset of anesthesia, and duration of surgery were comparable in both groups. At the baseline, there was no statistically significant difference in heart rate, mean arterial pressure, diastolic blood pressure, and respiratory rate between the two groups, with a difference noted in systolic blood pressure at the baseline. There was significant difference noted in the systolic blood pressure and mean arterial pressure at different time intervals with a decreasing trend as time progressed. The mean sedation score was significantly higher in the Dex group than that in the control group. The surgeon satisfaction was higher in the Dex group than that in the control group. Conclusion: Dexmedetomidine is a useful and safe drug in combination with lignocaine bupivacaine in peribulbar for vitreoretinal surgery as it maintains hemodynamic stability and provides sedation, which enables full cooperation and potentially better operating conditions.

Rebound inflammation after an intravitreal injection in Vogt朘oyanagi朒arada syndrome

A 43-year-old male with chronic Vogt朘oyanagi朒arada syndrome (VKH) presented with subfoveal choroidal neovascular membrane (CNVM) in the right eye with no evidence of active inflammation. He underwent intravitreal bevacizumab and dexamethasone injections. Postinjection he developed fresh keratic precipitates and exudative retinal detachment (RD). He received two more bevacizumab injections with oral corticosteroids and immunosuppressants causing resolution of exudative RD with scarred CNVM. We report this case to highlight that intravitreal injection may act as a trigger for rebound inflammation in VKH patients and may require anti-inflammatory drugs to be started even in the absence of an active inflammation.

Infant and young child feeding practices of mothers attending immunisation clinic at a tertiary care hospital of Lucknow

Background: Adequate infant and young child feeding (IYCF) practices are essential to ensure optimal survival, health, growth, development and overall nutritional status of children. Objective: The objective of the present study was to assess the IYCF practices among mothers with children aged 0-23 months attending immunisation clinic at a tertiary care hospital of Lucknow, capital of Uttar Pradesh. Materials and methods: A hospital based cross-sectional study was conducted at immunisation clinic, King George’s Medical University from January 2015 to September 2015. Systematic random sampling was used and a total of 240 mothers with children 0-23 months old attending immunisation clinic were interviewed with the help of pre-designed, pre-tested and semi-structured questionnaire. Results: Breastfeeding (BF) was initiated within one hour of birth in 18.3% of children. Early initiation of BF was significantly associated with educational and socioeconomic status of mother and type of delivery. Pre-lacteal feeds were given to 23.4% of the children, children born at government health facility and with birth order ≤2 received pre-lacteal feeds more often. Colostrum was given by 67.9% of the mothers. Children born at private institutions or home were more likely to receive colostrum (p< 0.05). The prevalence of exclusive breastfeeding for at least 6 months was 53.8%. It was higher in children belonging to low socioeconomic group (p< 0.05). Complementary feeding was initiated at 6 months in 32.8% of children. Children of mothers belonging to upper socioeconomic Shukla M, Tyagi S, Agarwal M. Infant and young child feeding practices of mothers attending immunisation clinic at a tertiary care hospital of Lucknow. IAIM, 2016; 3(1): 58-66. Page 59 class, nuclear family and delivered at government institution through normal delivery were more likely to be started on timely complementary feeding (p<0.05). Conclusion: The study revealed that inadequate IYCF practices are still quite prevalent in the community and therefore emphasis should be given to IYCF education sessions.

Immunohistochemical expression of Bcl‑2 in oral epithelial dysplasia and oral squamous cell carcinoma.

BACKGROUND: The B cell lymphoma‑2 gene is a proto‑oncogene whose protein product inhibits apoptosis. Its role is associated with keeping cells alive, but not by stimulating them to proliferation, as other proto‑oncogenes do. Increased expression of protein product of Bcl‑2 gene appears in the early phase of carcinogenesis leading to apoptosis impairment and in consequence to the progression of neoplastic changes. OBJECTIVE: To evaluate and compare the expression of Bcl‑2 protein in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Sixty cases of formalin‑fixed paraffin‑embedded archival specimens comprising of 30 cases of leukoplakia with oral epithelial dysplasia and 30 cases of OSCC were taken for immunohistochemical analysis using monoclonal antibody against anti‑human Bcl‑2 oncoprotein. RESULTS: Immunostaining for Bcl‑2 protein was identified in basal and parabasal layers as granular cytoplasmic staining in oral epithelial dysplasia. In OSCC, Bcl‑2 immunoreactivity was most prominent in the peripheral cells of the infiltrating tumor islands which diminished toward the center in well‑differentiated and moderately differentiated OSCC, whereas stronger and more diffuse expression of Bcl‑2 oncoprotein was seen in poorly differentiated OSCC. Overall positivity of 26.7% (8/30) was observed in oral epithelial dysplasia and 30% (9/30) in OSCC in this study. INTERPRETATION AND CONCLUSION: Altered expression of Bcl‑2 oncoprotein may be an early molecular event which leads to prolonged cell survival, increased chances of accumulation of genetic alterations, and subsequent increase in malignant transformation potential.

Detection of dengue virus 4 from central India.

Background & objectives: Dengue is an important arboviral disease. All four dengue virus serotypes are reported to be circulating in India. It is also known that different serotypes, genotypes and clades of genotype determine outbreak severity. Dengue affected children are known to have serious disease outcome. We carried out this study to give reliable diagnosis of dengue infection in children and to detect circulating serotype in central India. Methods: Samples collected from paediatric patients suspected to have dengue fever were subjected to IgM and IgG ELISA to determine dengue virus infection. Samples collected within 0-5 days of onset of illness and positive by IgM ELISA were tested by nested reverse transcription polymerase chain reaction (nRT-PCR). The PCR products were sequenced and analyzed. Results: Of the 89 samples tested, 18 and 7 were positive for dengue IgM and IgG, respectively. Dengue activity was observed in both Jabalpur city and adjoining rural settings. One sample found positive by nRT-PCR was further sequenced to confirm dengue virus 4 as aetiological agent. Interpretation & conclusions: Our findings demonstrated dengue virus infection in children and adolescent in central India. Because of continuous changing epidemiology, it is important to monitor dengue virus activity at both serological and molecular level in this part of the country for better patient care and management.

Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India.

Background: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.

Deferasirox: Oral, once daily iron chelator - An expert opinion.

Iron overload is a serious and potentially fatal condition that results from multiple blood transfusions required over a long period of time to treat certain types of anemias such as, that caused by β-thalassemia, sickle cell disease and myelodysplastic syndrome. Deferoxamine, which has been used since four decades as an iron chelator has limited efficacy due to its demanding therapeutic regimen, leading to poor compliance. Deferasirox, once daily oral iron chelator provides an effective alternative to Deferoxamine in the treatment of transfusional hemosiderosis. In this review, the role of Deferasirox as an ideal iron chelator has been discussed. Pubmed searches on Deferasirox were carried out for the same. Several studies demonstrated the safety and efficacy of Deferasirox in reducing iron burden in iron-overloaded patients with β-thalassemia, sickle cell anemia and myelodysplastic anemia. Thus, convenient, effective and tolerable chelation therapy with oral Deferasirox is likely to be a significant development in the treatment of transfusional iron overload, due to its ability to provide constant chelation coverage and the potential to improve compliance.

Advances in management of thalassemia.

Thalassemias represent the most common single-gene disorder causing a major public health problem in India. Thalassemia and hemoglobinopathies probably developed over 7000 years ago as a defense against malaria. In simple terms, thalassemia is caused by a mutation in either the â-globin chain or the á-globin chain which combine equally in red cells to form hemoglobin. These mutations lead to varying degree of anemia resulting into thalassemia minor, intermedia or major. Present write up relates to advances in the management of â-thalassemia major.

Hyponatremia and hypernatremia: disorders of water balance.

Total body water and tonicity is tightly regulated by renal action of antidiuretic hormone (ADH), reninangiotensin-aldosterone system, norepinephrine and by the thirst mechanism. Abnormalities in water balance are manifested as sodium disturbances--hyponatremia and hypernatremia. Hyponatremia ([Na+ < 136 meq/ l]) is a common abnormality in hospitalized patients and is associated with increased morbidity and mortality. A common cause of hyponatremia is impaired renal water excretion either due to low extracellular fluid volume or inappropriate secretion of ADH. Clinical assessment of total body water and urine studies help in determining cause and guiding treatment of hyponatremia. Acute and severe hyponatremia cause neurological symptoms necessitating rapid correction with hypertonic saline. Careful administration and monitoring of serum [Na+] is required to avoid overcorrection and complication of osmotic demyelination. Vasopressin receptor antagonists are being evaluated in management of euvolemic and hypervolemic hyponatremia. Hypematremia ([Na+] > 145 meq/l) is caused by primary water deficit (with or without Na+ loss) and commonly occurs from inadequate access to water or impaired thirst mechanism. Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications from hypernatremia or its correction. Frequent monitoring of [Na+] is of paramount importance in the treatment of sodium disorders that overcomes the limitations of prediction equations.

Management of dentoalveolar injuries in children: a case report.

Children aged 6-15 years old experience more injuries to their teeth and the injuries sustained are more serious as evidenced by a higher percentage of luxations, avulsions, fractures and dislocations. The mandible is the most frequently fractured facial bone and mandibular alveolar injuries have been reported to range between 8.1-50.6%. Those with mandibular or midface fractures have a higher incidence of associated chest, extremity, abdomen and cervical spine injuries. The growing patient with facial injuries presents the clinician with a series of thought-provoking circumstances. Dentoalveolar and mandibular injuries are especially important to understand because of the potential complications related to tooth eruption, alveolar development, occlusion and facial growth. However, the principles involved in the treatment for children need to be modified by certain anatomical, physiological and psychological factors specifically related to childhood. This case report documents the trauma, management and follow-up care of an 11-year-old boy who sustained undisplaced infraorbital, nasal fractures and mandibular dentoalveolar fracture along with other associated injuries of the extremities.

Clinical applications of molecular haematology: JAK2 in myeloproliferative disorders.

Molecular markers are helpful in diagnosis, prognosis and management of haematological malignancies. Recently, a single point mutation in the Janus Kinase 2 (JAK2) gene in the Philadelphia-negative myeloproliferative disorders, including polycythemia vera (over 95%), essential thrombocythemia (50%) and primary myelofibrosis (50%) was identified by several groups. This mutation is now considered to have a fundamental role in the pathogenesis of these disorders. A PCR-based test from peripheral blood has become available in India to detect this mutation. Present article discusses the basic aspects of this mutation and its value in diagnosing, prognosticating and treating patients of suspected chronic myeloproliferative disorders.