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Context: ?-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ?-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ?-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ?-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ?-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ?-thalassemia trait in cases of megaloblastic anemia.
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Background: As our age increases, different pathophysiological changes occur, which leads to geriatric syndromes in the elderly. Along with other bodily changes, psychological changes and dementia start emerging that affects day-to-day activities of the elderly people. These symptoms often get undetected due to lack of care or awareness among the geriatric population or their caregivers. Aim and Objectives: This study aims to measure the prevalence of psychiatric disorders and onset of dementia among the geriatric population in a rural area of West Bengal. Materials and Methods: An observational, descriptive, community-based, and cross-sectional study was conducted by interviewing persons aged 60 years and above residing in Banspole village during the months of April–May, 2022, using General Health Questionnaire-12 and dementia assessment by rapid test questionnaire. The data were analyzed with the Statistical Package for the Social Sciences. Results: A total of 104 respondents were interviewed (62.5% male and 37.5% female). Most commonly found comorbidity was hypertension (48.08%), followed by chronic obstructive pulmonary disease (26.92%) and hypothyroidism (25.97%). Significant psychological morbidity was found in 49 (47.11%) persons, whereas, different levels of dementia was found in 72 (69.23%) participants. Significant associations were found between psychiatric morbidity with age and socioeconomic status, and dementia with age and marital status. Significance level was at P < 0.05. Conclusion: As it can be seen that in psychiatric morbidity is present in almost half of the participants, and dementia in almost 70% participants, but most of the times, these get undetected or overlooked. Early detection and management are the need of the hour, as these conditions causes huge economic burden on the caregivers, as well as on the government concerned.
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COVID-19 has been labeled a serious public health emergency globally. Due to its high infectivity it has led to an increased burden to the Medical Fraternity as well as the Government. Therefore, the need for preparedness as well as conventional intervention strategies became integral during such health emergencies. To monitor the implementation of proper activities and to manage the patient load with adequate safety of the staff, COVID control rooms were established in the hospital premises. The main objective of the Control Room is risk mitigation, planning strategies, alleviating concerns and addressing issues associated with the health emergency across the hospital and further delegating the information to the higher authorities and the Ministry. Hereby in this review we have tried to summarize the administrative structure, functions and limitations of the 24x7 Control Room established in Tertiary Care Hospital, New Delhi.
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Background: IgA anti-tissue transglutaminase-2 antibody (anti-TG2Ab) deposits in intestinal and extraintestinal organs have been used to link the respective pathological changes in these organs with celiac disease (CeD). Aims: To know if parts of intestine other than the duodenum, such as esophagus, stomach, and colon, have any pathology related to potential CeD or have mucosal IgA anti-TG2 Ab deposits. Settings and Design: A prospective case–control study conducted from April 2018 to December 2019. Materials and Methods: Nine patients with potential CeD and 27 age- and gender-matched patients with irritable bowel syndrome were recruited as cases and controls, respectively. Mucosal biopsies were collected from esophagus, stomach, duodenum, and rectosigmoid regions, histological changes were evaluated, and IgA anti-TG2 Ab deposits were analyzed in these regions by two-color immunohistochemical staining. Statistics: Data were analyzed using statistical software Stata 14.0. Results: No distinct difference in mucosal lymphocytosis were identified between biopsies of patients with potential CeD and controls at the following sites: esophagus (11.1% vs 0%, P = 0.079), stomach (14.3% vs 7.7%, P = 0.590), and rectum (20% vs 0%, P = 0.067). Co-localized IgA anti-TG2Ab deposits were observed more in potential CeD than in controls at esophagus 22.2% (2/9) vs 0%, P = 0.012; stomach 66.7% (6/9) vs 11.5% (3/26), P < 0.001; and duodenum 66.7% (6/9) vs 0%, P < 0.001 but not at rectum 0% (0/4) vs 0% (0/25). Conclusion: Although histological changes are not distinct, a subset of subjects with potential CeD has pan-intestinal involvement other than in the duodenum.
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Background: The increase in worldwide life expectancy among the elderly is contributing to an increase in cognitive impairment (CI). A more complicated etiology makes CI an essential clinical concern for elderly patients with depression. Ageing populations as a result of demographic change have accelerated the development of certain geriatric conditions, including CI and depression. Aims and Objectives: The objective was to identify the prevalence and contributing factors of CI and depression in the elderly rural community. Materials and Methods: A descriptive, cross-sectional, and community-based study was conducted in rural field practice area of Medical College, Kolkata, among 133 geriatric people during time period of March–June, 2022. The prevalence of CI was measured using the Mini-Mental State Examination (MMSE) scale and depression was assessed using the geriatric depression scale. Data were analyzed in SPSS software version 16. Results: Mean age of the participants was 65.68 (±6.03) years. The prevalence of CI was 86.5%, with a mean MMSE score of 19.27 ± 4.34, and the depression was 77.5% and 7.07 ± 3.39. Conclusion: Almost two-third of the geriatric population is suffering from depression and CI. To handle the issue of CI, depression, and its resulting effects, new and modified geriatric health policies are very much needed.
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Background: A lot of comorbid conditions and health problems result from unhealthy dietary habit and sedentary lifestyle in all age group, but more among geriatric population. Due to progressive fragility, weakness, and comorbidities, there is gradual decrease in overall physical activity in elderly which again leads to different health problems and this vicious cycle is going on. There was scarcity of evidences related to dietary pattern and physical activity of elderly population particularly in West Bengal. Aim and Objectives: The present study was conducted for estimating the physical activity level of the study participants and to determine its relationship with the sociodemographic profile and dietary consumption pattern. Materials and Methods: Observational descriptive cross-sectional epidemiological study was conducted in Geriatric Outpatient Department of Medical College and Hospital, Kolkata, from August 1, 2022, to October 31, 2022, among 124 participants aged 60 years and above attended OPD in first 2 months of study period. IPAQ-SF questionnaire was used for assessment of physical activity. Analysis was done in Microsoft Excel and SPSS (version 20) software. Results: Larger proportion (52.4%) participants belonged to HEPA active (Category 3) according to physical activity status. Age of the participant, place of residence and socioeconomic status and consumption of green leafy vegetables, other vegetables, fruits, flesh food and egg, milk and milk products, and sugar and jaggery were significantly associated with physical activity. Conclusion: In the present study, significant proportion (32.3%) was minimally active which should be dealt properly. Physical activity should be promoted to all elder persons as a part of healthy lifestyle.
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Background: In addition to risk of developing different non-communicable diseases, chronic diseases, and disabilities with increases of age, elderly people are more likely to suffer from mental and psychological distress and sleep disturbances which are again very much related to other physical problems of elderly. However, these two issues are often neglected and also were not addressed by research work adequately. Aims and Objectives: In above backdrop, our present study was conducted to determine sleep pattern and perceived stress among elderly population and their relationship with sociodemographic parameters. Materials and Methods: An observational descriptive cross-sectional study was conducted in Geriatric Outpatient Department (OPD) of Medical College and Hospital, Kolkata, from August to October 2022, among 161 geriatric OPD patients. A semi-structured questionnaire was used for eliciting sociodemographic information. Pittsburgh Sleep Quality Index and perceived stress scale were used for assessing sleep quality and perceived stress of participants respectively. Data were analyzed in the Statistical Package for the Social Sciences (version 20). Results: About 41.2% participants suffered from poor sleep pattern. About 41.2% of geriatric participants had low level of stress and rest had moderate stress. Age and marital status were significantly associated with both sleep pattern and perceived stress. Socioeconomic status was related to sleep score, whereas perceived stress was associated with education of elderly participants. Conclusion: Poor quality of sleep and stress has an impact on other physical health problems of elderly such as diabetes, hypertension, and cardiovascular diseases. Hence, awareness generation among general population and provision of adequate management in elderly health clinics regarding these two issues is required.
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Mixed neuroendocrine non-neuroendocrine neoplasm (MiNeN) is a recently described entity of the esophagus in the latest (fifth) edition of WHO Classification of Digestive System Tumors. It is often a difficult pathological diagnosis, especially in small preoperative biopsies. We herein report a case of high-grade MiNeN of gastroesophageal junction diagnosed as a squamous cell carcinoma in preoperative biopsy and subsequently as a high-grade MiNeN in esophagogastrectomy specimen comprising areas of mucoepidermoid carcinoma and large-cell neuroendocrine carcinoma (NEC). This report accentuates the importance of deeper multisite preoperative biopsies as the management is completely different in a MiNeN from esophageal squamous cell carcinoma.
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Background: Child rearing practices are very important determinants of overall growth and development of child. As mother is primary caregiver of child, her knowledge regarding child rearing is very important. Unfortunately, till today, in India, teenage marriage and teenage pregnancy are very common. These adolescent mothers are not only underprepared physically and psychologically for giving birth and rearing a child successfully, but also it is assumed that have no proper knowledge. However, there was no sufficient research study for assessing knowledge regarding child rearing among teenage pregnant women in West Bengal, especially in rural area. Aims and Objectives: Assessing the knowledge regarding child rearing practice and its relationship with the determinants among teenage pregnant women in rural area of West Bengal. Materials and Methods: A descriptive community-based cross-sectional epidemiological study was conducted in rural field practice area of Medical College, Kolkata among 99 adolescent pregnant women during time period of July–December 2021. Data were analyzed in SPSS software version 20. Results: Mean age of the respondents was 17.60 (±1.23) years. Among the participants 58% being school dropout and 46% were homemaker. Maximum number of participants was married and got pregnant within age group of 15–17. Only 59.6% had good knowledge about child rearing. Number of child and perceived social pressure was statistically significant with the CRK score. Conclusions: The government should give more emphasis to improving maternal education and preventing teenage marriage and teenage pregnancy as a long-term strategy for improving child health.
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Background: H. pylori-associated gastritis in patients from the high-altitude area of Ladakh showed severe gastritis, mucosal nodularity, atrophy, and cancer in comparison to those from North India. This study served to analyze if differences in the H. pylori virulence genotypes decide the extent of gastric mucosal inflammation. Methods: Fifty gastric biopsies each from patients with H. pylori-associated gastritis from Ladakh and a tertiary care center in North India were included. The presence of H. pylori strain was confirmed with Warthin starry stain and polymerase chain amplification of the H. pylori-specific 16S rRNA. The cagA, vacA s1, s2, and m1, m2 alleles, and dupA virulence genotypes were studied in all archival samples, followed by their histological correlations. Results: cagA (P 0.009) and vacAs1 m1 (P 0.009) genes were distinctly more in H. pylori strains colonizing the biopsies of North Indian patients. In contrast, the cagA -ve vacAs2 m2 strains were significantly more in H. pylori strain colonizing the biopsies from Ladakhi patients. dupA genotype was almost similarly present in strains from both regions. Among these, only cagA and dupA virulence genes were associated with severe mucosal neutrophilic activity and deep infiltration of H. pylori strains in North Indian patients. Conclusions: Differences in virulence genotypes of H. pylori in gastric biopsies from North Indian and Ladakhi patients were found not significant in deciding the severity of H. pylori-associated gastritis.
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Background: COVID vaccines have been rolled out all over the world after emergency use authorization in the prevailing pandemic situation. However, hesitancy about its safety and efficacy exists among beneficiaries. Vaccine hesitancy can be a barrier to adequate immunization coverage. Aims and Objectives: This qualitative study was undertaken among health care workers in the rural field practice area of a tertiary care hospital, to find out their perceptions about COVID vaccines, and reasons behind hesitancy toward the same. Materials and Methods: Six focused group discussions (FGD) were held with the help of moderator. Each FGD had five members, so 30 members were included in the study. Health care workers included doctors, nurses, ANM/ASHAs, and other health care workers. Results: There were 17 males and 13 females. Doctors had a positive attitude toward vaccination, but other health care workers had mixed perception regarding vaccination. Most grass root level workers were sceptical about the efficacy of the vaccine. Conclusion: Mostly positive attitude toward COVID vaccines was observed in the present study. Hesitancy toward vaccines was observed in some health care workers, and it likely rooted from their inadequate knowledge about the vaccine.
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Jugular foramen schwannomas (JFS) are rare benign tumors located in the jugular foramen. They can present with various symptoms depending on the extent of involvement of the tumor such as hearing loss, tinnitus, headache, and ataxia. Surgical resection has been considered as the primary treatment option for JFS. Stereotactic radiosurgery (SRS) offers an equally good treatment in patients with small and residual tumors after surgery with the advantage of being non-invasive with minimal complication rates. Herein, we present a rare case of JFS treated by SRS in our institution.
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Climate change is possibly the most significant environmental challenge and possess serious threats to sustainable development in the world and more so in developing countries. Impact of climate change affects ecosystems, water resources, food and health. To adapt to the change and overcome the threats of climate change several climate-resilient agro-technologies have been introduced under the National Innovations on Climate Resilient Agriculture (NICRA) Project. The present study was conducted in Lakhimpur District of Assam to measure the extent of adoption of the climate-resilient agro-technologies introduced under the NICRA Project by the participant and non-participant farmers. A total of 160 farmers, 80 NICRA participant farmers and 80 non-participant farmers were interviewed. Findings revealed that the majority of the participant farmers (68.75 per cent) had a medium extent of adoption followed by 17.50 per cent with a low extent of adoption of climate-resilient agro-technologies. Only 13.75 per cent of the participant farmers were found to have a high level of adoption of climate-resilient agro-technologies. Among the non-participant farmers, majority of them (75.00 per cent) had a low extent of adoption followed by 17.50 per cent with a medium extent of adoption of climate-resilient agro-technologies. Only a very small proportion of them (7.50 per cent) had a high extent of adoption of climate-resilient agro-technologies.
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Background: The first-line treatment for locally advanced squamous cell carcinoma of head-and-neck cancer is concurrent chemoradiation, which is the standard of care. Concurrent chemoradiation improved locoregional control but little impact on distance metastases. Induction chemotherapy (IC) can reduce local disease and distance metastases. Objectives: The purpose of our study is to compare the outcome of disease and toxicity between IC followed by concurrent chemo-radiation and only concurrent chemoradiation in patients of locally advanced unresectable head-and-neck cancer. Materials and Methods: A total of 37 patients were included in IC followed by concurrent chemoradiotherapy group. IC was administered with injection paclitaxel, injection carboplatin, and injection 5-fluorouracil for three cycles. Thirty-six patients were included in Arm B, concurrent chemoradiation group. The total dose of radiation was given in both the Arms 66 Gy in 33 fractions, five fractions per week for 6.3 weeks with concurrent chemotherapy injection cisplatin 40 mg/m2 weekly. Results: Grade 4 skin reaction was 2 (7%) in Arm A and 1 (3.3%) in Arm B. Grade 3 febrile neutropenia was 1 (3.4%) in Arm A and no Grade 3 febrile neutropenia was seen in Arm B. Grade 3 thrombocytopenia was 1 (3.4%) in Arm A and 2 (6.6%) in Arm B. Complete response of disease after 6 months of completion of treatment was 19 (65.5%) in Arm A and 18 (60%) in Arm B. Conclusion: Our study showed no significant difference in disease response regarding locoregional disease control between two groups but distance recurrence can be reduced with IC with manageable toxicity.
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Clear cell sarcoma-like tumor of the gastrointestinal tract (CCSGT) is a rare, aggressive tumor with many histological mimickers. Herein, we have documented our experience of three cases of CCSGT and reviewed the literature. The index cases were identified in male patients in their twenties, one in jejunum and two in the distal colon. Histomorphological examination revealed the characteristic heterogeneous histomorphology with patchy immunohistochemical positivity with S100 protein and negative melanocytic markers. The fluorescence in-situ hybridization test showed translocation of the EWSR1 (22q12) gene in >80% tumor cells. While one of our patients died after 2 years with lung metastasis, the other two patients are still alive on 1.5 years and 3 months follow up, respectively. CCSGT is a rare malignant tumor of the gastrointestinal tract. Although characteristic morphology, use of a judicial panel of immunohistochemical stains, and translocation study for EWSR1 gene can establish the diagnosis, experience in adjuvant therapy is still limited.
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@#Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years followup, functional result was satisfactory.
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Background: Worldwide, leading cause of cancer mortality is lung cancer. Approximately 63,000/year new lung cancer cases reported in India. Around 80–85% of patients of lung cancer is non-small cell histology (non-small cell lung cancer) and over >90% of patients presented locally advanced and metastatic disease. Hence, in these patients, population curative treatment approach with radiotherapy (RT) and chemotherapy in most of the time is non-viable option yielding short survival and relatively poor prognosis. In majority of such cases, the only aim of treatment remains palliative, the main aim is to improve quality of life. Although there are other medical management of symptoms palliation, radiation therapy is the cheapest option, quite effective, time efficient, and well tolerated in providing relief from symptoms. The rate of palliation of symptoms is quite high for chest pain and hemoptysis at 60–80%, whereas cough and dyspnea are improved in only 50–70%. For intrathoracic disease with obstructive symptoms, 30 Gy/10# over 2 weeks are generally recommended. Patients with poor performance status, advanced age, and associated comorbidity at the time of diagnosis, for which daily RT over 2–3 weeks is logistically difficult, 1–2 fractions have been utilized with good results. There are multiple randomized trials showed that both short and long RT course were equally effective for symptoms control. Aims and Objectives: The aims of our study are to compare the outcome, symptom control and assess toxicity profile in locally advanced lung cancer patient with 17 Gy/2 fractions (8.5 Gy/fraction, × 2 fractions) only on Saturdays over 2 weeks versus 30 Gy/10 fractions (3 Gy/fraction) over 2 weeks and to compare quality of life. Materials and Methods: This study was a single-institutional, prospective, open-labeled, randomized controlled study. Eligible patients were age ≥18 years with histopathologically proven lung carcinoma which was inoperable Stage III or IV disease and too locally advanced to curative concurrent chemoradiation, pulmonary symptoms attributable to the primary tumor, Eastern Cooperative Oncology Group (ECOG) performance status ≤3, and adequate hematologic (hemoglobin >10 g/dl; absolute neutrophil count >1500; platelet count >100,000/ml; and hepatic and renal function calculated creatinine >60 ml/min). Patients with bleeding diathesis, emphysematous bullae, poor respiratory function or reserve, pregnancy, and ECOG performance status >3 were excluded from the study. Results: Age, stage, histopathology, and pre-treatment symptoms score between two groups were comparable and statistically not significant. Pain in chest due to lung cancer was decreased in both arms due to treatment (at treatment completion Arm A = 47.62 and Arm B = 38.09). However, at the 2nd follow-up, difference between two arms was statistically significant where Arm A = 27.78 and Arm B = 15.00; P = 0.005. Global health status of patients in this study was improved in both arms due to treatment. Physical functioning emotional functioning, role functioning, global health status, cognitive functioning, and social functioning were improved in both arms due to treatment and kept improving during follow-up, but difference between two arms was not significance. Conclusions: Although overall symptom palliation, toxicity profile, and quality of life parameters are almost equal in both arms, patients with short expected survival, 8.5 Gy × 2 fractions would be preferable, limiting the number of hospital visit to a minimum. On the other hand, 3 Gy × 10 fractions schedule can be chosen for those patients with longer expected survival and better ECOG status, due to prolong duration of palliative response.