A Scoping Review of Research on Comprehensive Primary Health Care (CPHC) in India

Background: The current situation of Comprehensive Primary Healthcare (CPHC) in India with reference to its characteristics is lesser known. Objectives: 1. To explore various characteristics of research based on CPHC in India. 2. To identify gaps in research on CPHC. Materials and Methods: A broad search strategy was developed to obtain articles on CPHC from PubMed and Google scholar. Out of 218 articles, 17 were explored for objectives, key findings. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) was used. Results: Most were on reproductive and child health, non-communicable diseases, and utilization & gaps in services. Only 1 study was Randomized controlled trial, followed by mixed method (n=2). Fourteen studies focussed on current situation of CPHC and none on service delivery of CPHC. Conclusion: Limited studies have been conducted on CPHC in India. Significant number of research are needed for strengthening primary health care.

Clinicopathological spectrum of anterior mediastinal lesions with special reference to the role of cytology in diagnosis: A cross-sectional study

Background: Anterior mediastinal tumors comprise only 3% of all chest tumours. They are often of diagnostic challenge to both clinicians and histopathologists owing to their wide variety of clinical presentations and diversity in histomorphological appearance respectively. Hence, there is a need for elaborated studies to make the pathologists and clinicians aware of their diversity. Aim and Objectives: The present study was aimed to evaluate the diverse spectrum of clinical presentations and histomorphological appearances of anterior mediastinal lesions. In addition, cytological and radiological interpretations were correlated with histological diagnosis to assess their comparative role in diagnosis. Materials and Methods: It was a descriptive observational cross-sectional study. Patients diagnosed with anterior mediastinal mass on chest computed tomography (CT) scan were included in this study. Demographic details including clinical presentations and radiological interpretations were recorded. Patients underwent both CT guided Fine needle aspiration cytology (FNAC) and needle core/excisional biopsy. Histological diagnosis was correlated with radiological and cytological interpretations. Results: Of 659 patients presented with chest tumours, 19 were detected as having anterior mediastinal mass on chest CT scan indicating the prevalence of 2.88%. The most common presenting symptom was respiratory distress (73.68%), followed by chest pain (36.84%), superior vena cava syndrome (26.32%) and Myasthenic features (5.26%). About 50% of malignant tumours occurred at the 2nd decade of life. Thymic epithelial neoplasms comprise the major tumour type in this study (52.63%) followed by germ cell tumors (15.79%) and lymphomas (10.53%). Cytology was found to be more effective compared to radiology in diagnosis. Conclusion: Anterior mediastinal tumors are extremely heterogeneous in clinical presentation and histomorphological appearance. CT-guided FNAC can play an important role in their diagnosis along with radiology and histology.

Prevalence of Under Nutrition and Its Risk Factors among Children below Two Years of Age in a Tertiary Health Centre in West Bengal

Background: Malnutrition in under five children is prevalent widely. It affects growth as well as development; also causes higher morbidity and mortality among children significantly. This public health problem is multi-factorial. Aim and Objectives: This study was conducted to estimate the prevalence of under nutrition and its risk factors among children up to 2 years of age attending a tertiary health care institution of Kolkata. Material and methods: This cross-sectional study was conducted among children aged 0 � 23 months, attending the Immunization clinic of CMSDH, Kolkata, during December, 2019 朖anuary, 2020. Data were collected by interviewing the accompanying caregivers, anthropometric measurements of the study subjects and review of records. Results: Among 135 children studied, the prevalence of stunting was 14.1% (5.8% severely stunted), underweight was 9.7% (3.8% severely underweight), wasting was 18.5% (8.1% were SAM).Younger age group (0-6 months),boys and children having inappropriate feeding for age were at increased risk of under nutrition. Children having working mothers, birth spacing of <3 years, LBW and delayed initiation of breastfeeding (>1hour) were at higher risk of stunting and underweight. Incorrect age of introduction of complementary feeding had higher risk of wasting. Conclusion: Several risk factors for malnutrition were found which are amenable to prevention.

A study to assess the quality of life (QOL) of patients suffering from tinea corporis attending dermatology OPD of a tertiary care centre of Eastern India

Background: A huge number of patients in our country are affected by Tinea Corporis (TC). The number of patients affected by dermatophytosis has increased by a large extent in the last 4 to 5 years. The quality of life in TC patients can be affected by various factors including the disease morbidity, duration of disease, social & demographic factors. Aims and Objectives: The aim of the study is to find out the effect of TC on the quality of life of the affected patients & along with that to assess whether there is some association of this effect on quality of life with some demographic & clinical factors. Methods: The effect on quality of life of 328 patients affected by TC who attended the Dermatology outpatient’s department of NRS Medical College was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Results: 12 (3.658 %) of the patients had an extremely large effect on quality of life. There was a very large effect on the QOL of 121 (36.890 %) patients. There was moderate effect on 134 (40.853 %) of the patients. There was a small effect on 59 (17.987 %) of the patients. 2 (0.609 %) patients had no effect on their QOL. Duration of disease & body surface area involved have significant impacts on QOL. Conclusion: The quality of life is adversely affected by TC. Early detection & treatment of the disease is very important. Steps must be taken to increase awareness about the disease among the general population.

FLI1 and MIC2 expression in precursor B-lymphoblastic leukemia with Burkitt-like morphology and extensive extramedullary involvement: A diagnostic challenge in pediatric small round cell tumor

Pediatric small round cell tumors (PSRCTs) constitute a large proportion of childhood malignancies with overlapping diagnostic and clinical features but radically different therapies. Here, we report a case of 16-year-old male child presenting with diffuse abdominal and mediastinal mass, axillary lymphadenopathy, and pleural effusion. Bone marrow aspirate showed near total replacement by small round malignant cells. The bone marrow biopsy showed interstitial infiltration by malignant cells, which were CD45? CD3? CD20? MIC2+ FLI1+ and diagnosis of Ewing's sarcoma was established. In contrast, flowcytometric immunophenotyping of the bone marrow aspirate showed CD45? cells, which were CD19+ cytCD79a+ CD10+ CD81+ CD38+ HLA-DR+ CD22+ CD20? consistent with B-cell acute lymphoblastic leukemia (B-ALL). The extended immunostaining panel on bone marrow biopsy also showed positivity for cytCD79a, CD10, CD19, and BCL-2, whereas fluorescent in-situ hybridization for EWSR1 gene rearrangement was negative. Thus, a final diagnosis of CD45? FLI1+ MIC2+ B-ALL was established. Rare cases of CD45? B-ALL with immunoreactivity for MIC2 and Friend leukemia virus integration 1 (FLI1) have posed a diagnostic challenge for PSRCTs in the recent past. This case report highlights the role of multimodality approach in establishing a correct diagnosis in CD45? PSRCTs to ensure definitive therapy and better clinical outcome.

DDT & deltamethrin resistance status of known Japanese encephalitis vectors in Assam, India.

Background & objective: Japanese encephalitis (JE) outbreaks are common in Assam, northeastern State of India. Information on resistance in known JE vectors in the affected area is important for effective control measures. This study was undertaken to determine the species abundance of JE vectors endemic to Sibsagar district of Assam, and their susceptibility against DDT and deltamethrin. Methods: Adult mosquitoes were collected using CDC light trap and aspirators from human dwellings from 13 endemic villages falling under three Primary Health Centres. Collected mosquitoes were identified and unfed female mosquitoes were used for DDT and deltamethrin sensitivity bioassay. The bioassay was performed following WHO protocol using standard susceptibility test kit. Knockdown time (KDT) was monitored at every 10 minutes intervals, whereas mortalities were recorded 24 h post-exposure. Vector density and resistance status were mapped using geographic information system (GIS) technique. Results: A total of 7655 mosquitoes were sampled under three genera, i.e. Anopheles, Culex and Mansonia, and nine species, the JE vector Cx. vishnui group (31.78%) was the most predominant species, followed by Ma. uniformis (16.81%) and Ma. indiana (16.45%). All vector species were suspected to be resistant to DDT and sensitive to deltamethrin, except Ma. indiana, which was suspected to deltamethrin resistant. The KDT50 and KDT95 values of vector mosquitoes for DDT were significantly higher as compared to deltamethrin. The probit model used to estimate KDT50 and KDT95 values did not display normal distribution of percentage knockdown with time for all the vectors tested for DDT and deltamethrin, except for Ma. indiana for deltamethrin assay and Cx. gelidus for the DDT assay. Interpretation & conclusion: Differences in insecticide resistance status were observed between insecticides and vector species. The results of this study provided baseline data on insecticide resistance in known JE vectors of Sibsagar, Assam. The maps generated may allow better communication in control operations and comparison of changes in susceptibility status of these vectors over time.

Electrocardiogram assessment in non-anaesthetized clinically healthy agouti (Dasyprocta primnolopha, Wagler 1831) / Avaliação do eletrocardiograma em cutias (Dasyprocta primnolopha, Wagler 1831) não-anestesiadas clinicamente saudáveis

The agouti is one of the most intensely hunted species throughout the Amazon and the semiarid regions of north-eastern Brazil. Considering the current tendency of wild animal management in captivity, the objective of this study was to determine heart reference values for agouti raised in captivity, based on electrocardiographic assessments (ECG). Adult agouti were selected without clinical signs of heart disease (n=30). The animals were restrained physically and then the ECG was performed. Standardized measurements were taken to establish the statistical analysis of the data. Analysis of the QRS complex showed values compatible with previous reports in peer animals and the limited data available for other wild and exotic species, except for the T wave that showed similar amplitude to the R wave in all the animals studied. The data obtained provided the first reference values for ECG tracings in agouti, contributing to a better understanding of heart electrophysiology in identifying myocardial pathology in these animals.

A cutia é uma das espécies mais intensamente caçados em toda a Amazônia e as regiões semi-áridas do nordeste do Brasil. Considerando-se a tendência atual no manejo de animais silvestres em cativeiro, o objetivo deste estudo foi determinar os valores de referência para o coração cutia criadas em cativeiro, com base em avaliações do eletrocardiograma (ECG). Foram selecionadas cutias adultas e sem sinais clínicos de doença cardíaca (n=30). Os animais foram contidos fisicamente e, em seguida, o ECG foi realizado. Medições padronizadas foram tomadas para estabelecer a análise estatística dos dados. Análise do complexo QRS apresentou valores compatíveis com os relatórios pregressos em animais animais de companhia, assim como para os poucos dados disponíveis para outras espécies selvagens e exóticas, com exceção da onda T, que mostrou amplitude semelhante à onda R em todos os animais estudados. Os dados obtidos permitiram a aquisição dos primeiros valores de referência para os traçados de ECG em cutias, contribuindo para uma melhor compreensão eletrofisiologia cardíaca, na identificação de miocardiopatia nesses animais.

Reexpansion pulmonary edema in children / Edema pulmonar de reexpansion en ninos / Edema pulmonar de reexpansao em criancas

OBJECTIVE To present a case of a patient with clinical and radiological features of reexpansion pulmonary edema, a rare and potentially fatal disease. CASE DESCRIPTION An 11-year-old boy presenting fever, clinical signs and radiological features of large pleural effusion initially treated as a parapneumonic process. Due to clinical deterioration he underwent tube thoracostomy, with evacuation of 3,000 mL of fluid; he shortly presented acute respiratory insufficiency and needed mechanical ventilation. He had an atypical evolution (extubated twice with no satisfactory response). Computerized tomography findings matched those of reexpansion edema. He recovered satisfactorily after intensive care, and pleural tuberculosis was diagnosed afterwards. COMMENTS Despite its rareness in the pediatric population (only five case reports gathered), the knowledge of this pathology and its prevention is very important, due to high mortality rates. It is recommended, among other measures, slow evacuation of the pleural effusion, not removing more than 1,500 mL of fluid at once. .

OBJETIVO Relatar caso de paciente con cuadro clínico y radiológico de edema pulmonar de reexpansión, patología rara y potencialmente fatal. DESCRIPCIÓN DEL CASO Niño de 11 años con fiebre y cuadro clínico-radiológico de derrame pleural voluminoso, inicialmente tratado como parapneumónico. Después de la compensación clínica, se realizó drenaje torácico, con salida de 3000mL de líquido. Evolucionó rápidamente con insuficiencia respiratoria aguda, necesitando ventilación mecánica. Tuvo dos extubaciones mal sucedidas y, debido a la evolución atípica, se realizó tomografía computadorizada, cuyos hallazgos fueron compatibles con edema de reexpansión. Después de soporte intensivo, evolucionó satisfactoriamente y, posteriormente, se diagnosticó tuberculosis pleural. COMENTARIOS Es importante el conocimiento de la patología, aunque sea rara en la población pediátrica (encontrados solamente cinco casos descriptos), para prevención, una vez que la tasa de mortalidad es muy alta. Se recomienda, entre otras medidas, que el vaciamiento de un derrame pleural sea lento y que el volumen total retirado no sobrepase 1500mL. .

OBJETIVO Relatar caso de paciente com quadro clínico e radiológico de edema pulmonar de reexpansão, patologia rara e potencialmente fatal. DESCRIÇÃO DO CASO Menino de 11 anos com febre e quadro clínico-radiológico de derrame pleural volumoso, inicialmente tratado como parapneumônico. Após descompensação clínica, realizou-se drenagem torácica, com saída de 3.000mL de líquido. Evoluiu rapidamente com insuficiência respiratória aguda, necessitando de ventilação mecânica. Teve duas extubações malsucedidas e, devido à evolução atípica, realizou-se tomografia computadorizada, cujos achados foram compatíveis com edema de reexpansão. Após suporte intensivo, evoluiu satisfatoriamente e, posteriormente, foi diagnosticado com tuberculose pleural. COMENTÁRIOS É importante o conhecimento da patologia, ainda que seja rara na população pediátrica (encontrados apenas cinco casos descritos), para prevenção, visto que a taxa de mortalidade é muito alta. Recomenda-se, entre outras medidas, que o esvaziamento de um derrame pleural seja lento e que o volume total retirado não ultrapasse 1.500mL. .

Evento com aparente risco de morte recorrente como manifestação inicial de síndrome miastênica congênita / Recurrent apparent life-threatening event as the first manifestation of congenital myasthenia / Evento con aparente riesgo de muerte recurrente como manifestación inicial de síndrome miasténico congénito

OBJETIVO: Alertar os pediatras sobre a necessidade de investigar criteriosamente a etiologia de eventos com aparente risco de morte recorrente. Não foram encontrados relatos associando tais eventos à miastenia congênita. DESCRIÇÃO DO CASO: Lactente de sete meses apresentando história de eventos com aparente risco de morte recorrente foi internado para investigação. Durante a internação, apresentou cianose e dispneia progressiva, com necessidade de ventilação mecânica por três dias. Após a melhora clínica, e tendo sido descartadas as hipóteses de doença do refluxo gastroesofágico e aspiração pulmonar como desencadeantes, notou-se ptose palpebral bilateral, hipotonia apendicular e choro fraco, que conduziram à suspeita clínica de miastenia congênita. Após confirmação do diagnóstico, foi mantido tratamento ambulatorial com piridostigmina, com recuperação nutricional e neurológica, sem novos eventos com aparente risco de morte nos três anos seguintes. COMENTÁRIOS: A investigação minuciosa das causas de eventos com aparente risco de morte pode levar a diagnósticos menos frequentes que exigem tratamento específico, como a miastenia congênita.

OBJECTIVE: To alert pediatricians about the importance of a careful investigation on recurrent apparent life-threatening events. Reports of the association of these events with congenital myasthenic syndromes were not found. CASE DESCRIPTION: A seven-month-old infant with recurrent apparent life-threatening events was admitted for investigation. During hospital stay, she presented cyanosis and respiratory failure, requiring mechanical ventilation for three days. After clinical improvement, hypotheses of gastroesophageal reflux and pulmonary aspiration were ruled out. The presence of eyelid ptosis, general hypotonia and weak crying led to the suspicion of congenital myasthenia, which was confirmed. Treatment with oral piridostigmine led to neurological and nutritional normalization, without any other apparent life-threatening event during the next three years. COMMENTS: The careful etiological investigation of apparent life-threatening events may lead to rare diagnosis that requires specific treatments, such as congenital myasthenia.

OBJETIVO: Alertar a los pediatras sobre la necesidad de investigar criteriosamente la etiología de eventos con aparente riesgo de muerte recurrente. No se encontraron relatos asociando tales eventos a la miastenia congénita. DESCRIPCIÓN DEL CASO: Lactante de siete meses presentando historia de eventos con aparente riesgo de muerte recurrente fue internado para investigación. Durante la internación, presentó cianosis y disnea progresiva, con necesidad de ventilación mecánica por tres días. Después de la mejora clínica, y habiendo sido rechazadas las hipótesis de enfermedad del reflujo gastroesofágico y aspiración pulmonar como desencadenantes, se notó ptosis palpebral bilateral, hipotonía apendicular y lloro débil, que condujeron a la sospecha clínica de miastenia congénita. Después de la confirmación del diagnóstico, se mantuvo el tratamiento ambulatorial con piridostigmina, con recuperación nutricional y neurológica, sin nuevos eventos con aparente riesgo de muerte en los tres años siguientes. COMENTARIOS: La investigación minuciosa de las causas de eventos con aparente riesgo de muerte puede llevar a diagnósticos menos frecuentes que exigen tratamiento específico, como la miastenia congénita.

Thoracic and heart biometrics of non-anesthetized agouti (Dasyprocta primnolopha Wagler, 1831) measured on radiographic images / Biometria torácica e cardíaca de cutias não anestesiadas (Dasyprocta primnolopha Wagler, 1831) mensuradas em imagens radiográficas

The agouti is a species intensively hunted throughout the Amazon and the semi-arid regions of northeastern Brazil. Considering the current trend in conservation management of wild species, the aim of this study was to determine the morphometric reference to the heart of agouti raised in captivity, based on thoracic and cardiac measurements in these animals. Thirty adult agoutis, 1 to 3 years of age, without clinical signs of cardiac disease were selected. The animals were physically restrained and radiographies in laterolateral (LL) and ventrodorsal (VD) recumbence were produced. The following measures were taken: the apicobasilar length of the heart (at the most cranial height of the Carina region to the heart apex) (AB), maximum width of the heart perpendicular to AB (CD), heart inclination angle (AIC), trachea inclination angle (AIT), distance from the right heart wall (DPTd), distance from the left heart wall (DPTe) and vertical depth of the thorax, and the ventral face of the vertebral column to the dorsal border of the sternum at the level of the trachea bifurcation (H). The ratios between AB/CD, AB/H and CD/H were also analyzed. To calculate the vertebral heart scale (VHS), the AB and CD measurements were laid over the thoracic vertebra starting at T4. Radiographic evaluation showed values consistent with those reported in small animals and some wild and exotic species. The main biometric values in the chest cavity and heart of agouti are arranged as follows: (1) The ratios between AB/H ratio and CD/H were not sensitive for identifying heart increases (p>0.05), while the ratio AB/CD was more sensitive in this identification (p<0.05); (2) AIC: 21.2±6.4º (mean between male and famale); (3) AIT for males and females: 9.93±3.23° and 8.4±3.94°; (4) DPTd and DPTe for males: 0.97±0.40cm and 0.7±0.30cm; (5) DPTd and DPTe for females: 1.12±0.42cm and 01.02±0.43cm; (6) VHS for males and females: 7.75±0.48v e 7.61±0.34v; (7) The caudal vena cava (CVC) was visualized dorsal-cranially and located right of the midline. The data obtained allowed the acquisition of the first reference values for biometry of the heart of agoutis, contributing to better understanding of cardiac morphology and identification of cardiomyopathy in these animals.

A cutia é uma espécie intensamente caçada em toda a Amazônia e nas regiões semi-áridas do Nordeste do Brasil. Considerando a tendência atual em gestão de conservação das espécies selvagens, o objetivo deste estudo foi determinar referências morfométricas para o coração de cutia criadas em cativeiro, com base em medições torácicas e cardíacas desses animais. Foram selecionados 30 cutias adultas, sem sinais clínicos de doença cardíaca, com idade entre 1 a 3 anos. Os animais foram contidos fisicamente e realizadas projeções radiográficas laterolaterais e (LL) e ventrodorsais (VD). As seguintes medidas foram tomadas: O comprimento apicobasilar do coração (na altura mais cranial da região carina até o ápice do coração) (AB); a largura máxima coração perpendicular a AB (CD); o ângulo de inclinação do cardíaca (AIC); ângulo de inclinação da traquéia (AIT); a distância a partir da parede direita do coração (DPTd); a distância a partir da parede esquerda do coração (DPTe) e profundidade vertical do tórax, da face ventral da coluna vertebral até à borda dorsal do esterno, no nível da bifurcação da traqueia (H). As relações entre AB/CD, AB/H e CD/H também foram analisadas. Para calcular o "vertebral heart scale" (VHS), as medidas AB e CD foram colocadas sob as vértebras torácicas a partir de T4. A avaliação radiográfica demonstrou valores consistentes com aqueles relatados em pequenos animais e algumas espécies selvagens e exóticos. Os principais valores biométricos mensurados na cavidade torácica e cardíaca da cutia, estão dispostas da seguinte forma: (1) As relações entre AB/H e CD/H não foram sensíveis para identificar aumento do coração (p> 0,05), enquanto a proporção AB/CD foi mais sensível nesta identificação (p <0,05); (2) AIC: 21,2 ± 6.4º (média entre machos e fêmeas); (3) AIT para machos e fêmeas: 9.93 ± 3.23° and 8.4±3.94°; (4) DPTd e DPTe para os machos: 0,97 ± 0,40 cm e 0,7 ± 0,30, (5) DPTd e DPTe para as fêmeas: 1,12 ± 0,42 e 01,02 ± 0,43; (6) VHS para machos e fêmeas: 7.75±0.48v e 7.61±0.34v; (7) A veia cava caudal (CVC) foi visualizada dorso-cranialmente e localizada à direita da linha média. Os dados obtidos permitiram a obtenção dos primeiros valores de referência para a biometria do coração de cutias, contribuindo para uma maior compreensão da morfologia cardíaca e identificação de cardiomiopatia nestes animais.

Evento com aparente risco de morte: uma revisão / Apparent life-threatening event: a review / Evento con aparente riesgo de muerte (alte): una revisión

OBJETIVO: Realizar uma revisão crítica reunindo informações disponíveis a respeito dos eventos com aparente risco de morte. FONTES DE DADOS: Revisão bibliográfica dos artigos (em português, inglês e espanhol) obtidos dos bancos de dados eletrônicos Medline, Lilacs e SciELO, utilizando as palavras-chave: eventos com aparente risco de morte, evento com aparente risco de vida infantil, lactente, apneia, monitorização e cianose. SÍNTESE DOS DADOS: Os eventos com aparente risco de mortesão súbitos e caracterizados por uma combinação de apneia, alteração na coloração da pele e tônus muscular, com inúmeras causas subjacentes. Sua incidência verdadeira é desconhecida e a faixa etária mais acometida é de 11 a 12 semanas. Não há correlação entre o evento com aparente risco de morte e a síndrome da morte súbita do lactente, embora já tenham sido consideradas manifestações da mesma doença. Muitas vezes, o lactente tem aparência saudável ao ser avaliado pelo pediatra após apresentar eventos com aparente risco de morte, porém, isso não afasta a possibilidade de existir uma doença grave associada ao evento, que deve ser investigada e tratada. Quando não são encontradas as causas, o evento é idiopático, geralmente com boa evolução. CONCLUSÕES: É necessário investigar os lactentes levados ao pronto-socorro após apresentarem eventos com aparente risco de morte, devido ao risco de sequelas e mortalidade. Não há uma padronização das condutas a serem realizadas diante de um lactente com aparência saudável que tenha evento com aparente risco de morte, mas recomenda-se que o paciente seja internado e a causa do evento, investigada. A observação e o monitoramento em ambiente hospitalar devem ocorrer no mínimo 24 horas após o evento.

OBJECTIVE: To perform a critical review by gathering all the available information about apparent life-threatening events. DATA SOURCES: Bibliographic review of the articles published in Portuguese, English and Spanish from the electronic databases Medline, Lilacs and SciELO, using the key-words: apparent life-threatening events, apparent life-threatening event, infant, apnea, monitoring, and cyanosis. DATA SYNTHESIS: Apparent life-threatening events define sudden events with, a combination of apnea, color change, and marked change in the muscle tone, that have various underlying causes. The real incidence remains unknown, and it affects infants from 11 to 12 weeks of age. There is no association between apparent life-threatening events and sudden infant death syndrome. There are many possible causes for the events, and they must be investigated even in apparently healthy infants, because the presence of a severe underlying disease associated with the event is possible. If the cause of the apparent life-threatening events is found, it must be treated properly. If there is no explainable cause, the event is considered idiopathic and generally has a benign course. CONCLUSIONS: It is necessary to investigate all the infants taken to the pediatric emergency unit after experiencing an apparent life-threatening event, since there is the risk of morbidity caused by an underlying disease or the event itself, as well as subsequent mortality. Consensus guidelines about the investigation in apparently healthy infants who experienced apparent life-threatening events are not available. Most authors recommend that careful observation and hospital monitoring should be performed for at least for 24 hours after the event.

OBJETIVO: Realizar una revisión crítica, reuniendo las informaciones disponibles respecto a los Eventos con Aparente Riesgo de Muerte (ALTE - Apparent life-threatening event). FUENTES DE DATOS: Revisión bibliográfica de los artículos (en portugués, inglés y español) obtenidos de las bases de datos electrónicas MEDLINE, LILACS y SCIELO, utilizándose las palabras clave ALTE, evento con aparente riesgo de vida infantil, lactante, apnea, monitorización y cianosis. SÍNTESIS DE LOS DATOS: Los ALTE (apparent life-threatening event) son eventos súbitos y caracterizados por una combinación de apnea, alteración en la coloración de la piel y tono muscular, con innúmeras causas subyacentes. Su incidencia verdadera es desconocida y la franja de edad más acometida es de 11 a 12 semanas. No hay correlación entre ALTE y SIDS (Síndrome de la Muerte Súbita del Lactante), aunque ya hayan sido consideradas manifestaciones de la misma enfermedad. Muchas veces, el lactante tiene apariencia sana al ser evaluado por el pediatra después de presentar ALTE, pero eso no aleja la posibilidad de que exista una enfermedad grave asociada al evento, la cual se debe investigar y tratar. Cuando no se encuentran causas, el evento es idiopático, generalmente con buena evolución. CONCLUSIONES: Es necesario investigar los lactantes llevados a la emergencia después de presentar ALTE, por riesgo de secuelas y de mortalidad. No hay una estandarización de las conductas a tomar frente a un lactante con apariencia sana que presentó ALTE, pero se recomienda que se interne el paciente y se investigue la causa del evento. La observación y monitoración en ambiente hospitalaria debe ocurrir por un mínimo de 24 horas después del evento.

Anatomical and radiographic appearance of the capuchin monkey thoracic cavity (Cebus apella) / Aparência anatômica e radiográfica da cavidade torácica do macaco-prego (Cebus apella)

The capuchin monkey is widespread both north and south of the Legal Amazon and in the Brazilian cerrado. Ten clinically healthy capuchin monkeys were submitted to an anatomical and radiographic study of their thoracic cavities. The radiographic evaluation allowed the description of biometric values associated with the cardiac silhouette and thoracic structures. Application of the VHS (vertebral heart size) method showed positive correlation (P<0.05) with depth of the thoracic cavity, as well as between the body length of vertebrae T3, T4, T5 and T6 and the cardiac length and width. The lung fields showed a diffuse interstitial pattern, more visible in the caudal lung lobes and a bronchial pattern in the middle and cranial lung lobes. The radiographic examination allowed preliminary inferences to be made concerning the syntopy of the thoracic structures and modification of the pulmonary patterns and cardiac anatomy for the capuchin monkey.

O macaco-prego é muito comum tanto no norte, quanto no sul da Amazônia Legal e no cerrado brasileiro. Dez macacos-prego clinicamente saudáveis foram submetidos a um estudo anatômico e radiográfico de suas cavidades torácicas. A avaliação radiográfica permitiu a descrição de valores biométricos associados à silhueta cardíaca e estruturas torácicas. A aplicação do método de VHS (vertebral heart size) demonstrou correlação positiva (P <0,05) com a profundidade da cavidade torácica, assim como entre o comprimento do corpo de vértebras T3, T4, T5 e T6 e do comprimento e largura cardíaca. Os campos pulmonares apresentaram padrão intersticial difuso, mais visível nos lobos pulmonares caudais e um padrão brônquial em lobo pulmonar médio e cranial. O exame radiográfico permitiu inferências preliminares a serem realizadas no âmbito da sintopia das estruturas torácicas e de modificação dos padrões pulmonares e anatomia cardíaca para o macaco-prego.

An experience with 156 patients attending a newly organized pain and palliative care clinic in a tertiary hospital.

Context: Pain and palliative care clinic (PCC). Aims: The primary object of this study was to enumerate the demographic characteristics of patients attending a newly organized PCC. The secondary purpose was to detect symptom prevalence and frequency of different cancers in these patients. Settings and Design: Prospective cross-sectional descriptive study. Materials and Methods: A prospective cross-sectional descriptive study was done on patients referred to the PCC of a tertiary hospital in North India. Comprehensive details of all patients were recorded systematically on the first visit on a proforma specially prepared for the newly established palliative care clinic. Statistical Analysis Used: The descriptive statistics of palliative care data was presented in terms of frequencies and percentages (%) for categorical variables. Results: The data collected at our PCC showed that out of 156 patients, 87 were males and 69 were females. Patients of all ages varying from 6 to 85 years were seen. Most patients (82.1%) lived with their families, and 28 (17.1%) patients lived alone and had no financial support. The most common primary diagnoses were head and neck cancers (38.5%), carcinoma cervix (15.4%), breast cancer (10.3%), colorectal cancer (6.4%), and lung cancer (4.5%). Frequency of seven most common symptoms was pain (100%), insomnia (64.1%), loss of appetite (34.6%), nausea (32.7%), vomiting (32.1%), constipation (31.4%) and sore mouth (28.8%). Conclusions: Population-based studies determine the actual magnitude of sufferers and suffering and show that palliative care services should be included as an essential component in a tertiary care hospital. The objective should be to reach out to the patient and help in improving the patent's quality of life in every way possible.

Field evaluation of repellency of a polyherbal essential oil against blackflies and its dermal toxicity using rat model

In the present study we have evaluated the repellent activity of mixture of Curcuma longa, Zanthoxylum limonella and Pogostemon heyneanus essential oils in 1:1:2 ratio at 5%, 10% and 20% concentration against blackflies in northeastern India. Initially the essential oil mixture tested here has been found effective against Aedes albopictus mosquitoes. The average protection recorded in 20% concentration (170.56±4.0; 95% CI = 162.09-179.02) was higher as compared to other two concentrations (F = 90.2; p<0.0001; df = 53). Percentage repellency and repellency index was found to be higher in 20% concentration (p<0.017). No appreciable clinical and behavioral signs were observed in the acute dermal toxicity using rat model. No changes were observed in biochemical profiles of treatment group animals. Similarly, no prominent lesions were observed in vital organs of treatment in both the sexes. The study concludes that tested repellent is safe for use and has multi-insects repellent property.

Infantile Hypertrophic Pyloric Stenosis - Experiences of 77 Cases.

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants which needs surgical treatment. The aim of this study was to review the management of IHPS in our hospital to compare with other developed centers. This is a prospective analytical study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to October 2010. Total 77 patients were treated by Ramstedt's pyloromyotomy after proper diagnosis and resuscitation. The male to female ratio was 10:1. Most of the patients presented to us within 40 days of age (90%).Younger one was 15 days and elder one was 69 days. In all cases diagnosis were done on clinical basis. The diagnosis is confirmed by barium meal x-ray in 71 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There was moderate to severe dehydration in more than 60% cases. 71 cases were operated under general anesthesia and 06 cases were operated with local anesthesia. There was one postoperative death on 4th post-operative day. Oral feeding started after 8 to 10 hours postoperatively in all cases. Mucosal perforation occurred in 1 case and that was recognized and treated conservatively without any ill effect. Superficial wound infection encountered in 3 cases. Early diagnosis, preoperative correction of dehydration and electrolyte imbalance and experiences of surgeons play important role for management of IHPS.

Malaria situation in forest-fringed villages of Sonitpur district (Assam), India bordering Arunachal Pradesh during an outbreak.

BACKGROUND & OBJECTIVES: Epidemiological and entomological studies were undertaken in forest-fringed villages in Sonitpur district (Assam) bordering Arunachal Pradesh, India to assess the malaria situation. Blood smears (thick and thin) were collected from the fever cases through door-to-door survey. Both the blood smears stained with Giemsa were used for malaria parasite detection. Slide positivity rate (SPR) was recorded as 39.1% with predominance of Plasmodium falciparum (97.1%) infections. Children between 5 and 14 yr showed higher rates of infection. METHODS & RESULTS: Over all malaria prevalence was higher among the males (SPR 43.2%) than in females (SPR 34.5%). Adult mosquito collection was made using CDC miniature light-traps from dusk-to-dawn. Per-trap night density of mosquitoes in human dwellings and cattlesheds were 289 and 925, respectively. Anopheles minimus and An. dirus, the major vectors of malaria in Northeastern region of India formed 33.2% of the total vectors recorded. An. dirus could be recorded only from human dwellings. The results showed high malaria risk in the study villages. INTERPRETATION & CONCLUSION: High vector density with high parity rate, poor socio-economic conditions, lack of awareness, poor sanitation and congenial atmosphere for mosquito proliferation are aggravating the malaria situation in the study area.

A study on the effects of diclofenac sodium and etoricoxib in the treatment of osteoarthritis.

Diclofenac sodium, a non-selective cyclo-oxygenase inhibitor and etoricoxib, a selective cyclo-oxygenase-2 inhibitor have been widely used in treatment of patients with osteo-arthritis. Five hundred and eighty-five patients with uncomplicated knee osteo-arthritis were randomly allocated into 3 equal groups and received either diclofenac sodium, etoricoxib or placebo in a double-blind manner. The response in both the drug groups was comparable and much more than placebo group. The study shows that etoricoxib provides better clinical efficacy and gastro-intestinal tolerability in osteo-arthritis in comparison to diclofenac sodium presumably due to the selective inhibition of cyclo-oxygenase-2 by etoricoxib.