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Tuberculosis is known as one of the long-standing and dominating health problems affecting people and the extent further escalates in a developing country like India. A pre-evaluated feedback structured questionnaire was validated and adopted to get their quantitative data from 424 respondents. In the present study urban respondents (60.8%) gave affirmative responses regarding awareness of TB, especially with mobile media as their major source of information, followed by information from healthcare workers. Rural respondents were less expressed and deficient on knowledge of TB transmission and preventive methods. Prevention practices toward TB are claimed to be high in urban population because 79.48% believed that early diagnosis, prompt treatment and avoiding poor hygiene and crowded environment are effective strategies to cease the transmission of TB. Effective preventive and informative strategies should be employed in rural border areas to make up for the knowledge gap found among rural and urban populations in this study.
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Introduction: Mucormycosis is an exceptional but rising fungal infection correlated with the COVID-19 disease. COVID-19 positive patients exhibiting severe symptoms admitted in the ICU have an increased susceptibility to develop bacterial and fungal infection. We hereby report a case of oral mucormycosis that is seen in a patient in post COVID-19 infection. Case Presentation: A 65-year-old woman presented to our institution, with the chief complaint of ulceration in her right palate region for the past 7 days along with pyrexia and generalised malaise. The patient reported to have recovered from COVID-19 infection recently. She presented with medical history of diabetes and hypertension for past 8 years. Post recovery from COVID-19 infection the patient developed an ulcer in the hard palate. Treatment: Surgery was done under General anesthesia. Maxillectomy was done with aggressive debridement of necrotic tissue. Bilaterally periosteal flap was approximated and suture was placed. Conclusion: The extensive use of steroids and broad-spectrum antibiotics in COVID-19 treatment may raise the risk of fungal infections. Medical practitioners should be aware of the possibility of invasive secondary fungal infections in patients with COVID-19 infection.
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Pulmonary aspergillosis is a well-recognized fungal lung disease caused by the Aspergillus species (especially Aspergillus fumigatus). Allergic bronchopulmonary aspergillosis (ABPA) is milder form of pulmonary aspergillosis compared to other more invasive forms. However, if left untreated, ABPA can cause significant lung damage. We present the case of a 33-year-old man who came with complaints of shortness of breath, chest discomfort, and productive cough. The patient underwent High Resolution Computed Tomography (HRCT) scan of the chest which, suggested the diagnosis of ABPA with secondary tension pneumothorax.
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Background: Diabetes is highly prevalent and it is responsible for the increased financial burden on healthcare. Type II diabetes is a more prevalent form of diabetes. Uncontrolled and unsupervised type II diabetes may lead to various microvascular and macrovascular complications which are responsible for high morbidity and mortality. Diabetic nephropathy (DN) is a common complication characterized by the expansion of mesangial cells with thickening of the basement and nodular glomerulosis. TNF-alpha and IL-6 play an important role in causing detrimental changes leading to nephropathy. The study of the role of these inflammatory cytokines in patients with DN may help in the early diagnosis and management. Aims and Objectives: The objectives of this study were to compare the levels of proinflammatory cytokines, TNF-?, and IL-6 in the evolution of DN patients. Materials and Methods: The present study was conducted in the Department of Biochemistry, in collaboration with the Department of Medicine (Nephrology unit); Pt. B.D. Sharma, Post Graduate Institute of Medical Sciences, Rohtak after ethical clearance. Forty patients with DN (Stages 3, 4, and 5) and forty patients with diabetes mellitus without nephropathy were taken up for study after taking informed consent. Results: The mean serum TNF-? levels in cases was 33.05 ± 29.22 pg/mL and in controls was 17.67 ± 12.33 pg/mL. On the basis of unpaired t-test, the difference between the groups was statistically highly significant (P < 0.05). The mean serum interleukin-6 levels in cases was 24.92 ± 30.16 pg/mL (2.95–155.55 pg/mL) and in controls was 6.76 ± 5.82 pg/mL (2.22–35.42 pg/mL). On the basis of the t-test, the difference between the groups was statistically highly significant (P < 0.05). Conclusion: TNF-? and IL-6 may serve as potential biomarkers for patients with DN and also in the development of newer therapeutic modalities for the prevention and treatment of DN.
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Background: Diffuse parenchymal lung diseases (DPLDs) have gone through various changes in nomenclature and classification since they were first described in 1868. Increasing knowledge about their etiopathogenesis has since led to several reclassifications and changes in the nomenclature. This has had a major impact on the prevalence of each interstitial lung disease (ILD) reported by the different registries worldwide. In this study, we attempted to describe the distribution of the different DPLDs in our population and reported changes in prevalence due to changing diagnostic criteria for the disease. Materials and methods: We analyzed retrospective data of 434 patients. For the initial 75 patients, ATS/ERS guidelines published in 2002 were followed in the diagnosis of the ILD (group I). In the later part of the study (359 patients), the diagnosis was based on the computed tomography (CT) patterns defined by ATS/ERS/JPS/ALAT statement on diagnosis of idiopathic pulmonary fibrosis (IPF) and updated 2013 ATS/ERS guidelines (group II). Results: Of the 75 patients in group I, IPF was the most common diagnosis (52%) made at that time, followed by sarcoidosis and connective tissue-related ILD (CTD-ILD) with 12% each. Group II had 359 patients, with IPF again being the most commonly diagnosed ILD with 21.3%. This was followed by CTD-ILD (18.6%), sarcoid (14.7%), and idiopathic nonspecific interstitial pneumonitis (iNSIP; 13.3%). The changing guidelines have an impact on reporting of different DPLD by our multidisciplinary teamover a period of time. Though IPF was the most commonest DPLD reported among both the groups, the diagnosis of IPF had fallen by more than half in the second group. It was paralleled by an increase in the diagnosis of iNSIP and chronic hypersensitivity pneumonitis. These reported changes in the prevalence of DPLDs may reflect the better-defined criteria in the latest guidelines and a better understanding of the fibrotic ILDs other than IPF by the multidisciplinary team. Conclusions: The frequency of diagnosis of the different DPLDs has changed, following the publication of several guidelines in the last decade. It has recognized newer entities with greater clarity, such as idiopathic NSIP and interstitial pneumonia with autoimmune features.
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BACKGROUND The Covid-19 pandemic has posed a challenge to organizing a safe clinical assessment for postgraduate degree candidates completing the residency programmes in various specialties. Although minimizing the risk of Covid-19 transmission is a priority, fulfilling the objectives of the assessment is equally important. METHODS We conducted this study in the Department of Internal Medicine at our institute. Instead of physically examining patients, case scenarios that included history, clinical and investigational data of the cardiovascular system (CVS) were presented to the candidates. Performance was scored by both the conventional and the CVS objective-structured clinical examination (CVS-OSCE) method and compared. RESULTS Clinical assessment examination of 27 candidates for the degree of Doctor of Medicine showed that the median cumulative score gained in narrating and analysing various differential diagnoses was lower compared to the mean cumulative score gained in arriving at a single correct diagnosis (50% [interquartile range—IQR 39%–64%] v. 79% [IQR 64%–100%], p<0.01). Most of the candidates agreed that case scenarios were good alternatives to the conventional physical examination amidst the pandemic. CONCLUSION CVS-OSCE-based assessment using structured case scenarios is a feasible and effective alternative for clinical skill assessment in high-stake examinations.
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Tamil Nadu is one of the states in India, where the diabetic retinopathy (DR) project was implemented in the Tirunelveli District. Aravind Eye Hospital, Tirunelveli was the mentoring institution and ophthalmology department of Tirunelveli Medical College and Hospital (TVMCH) was the implementing partner. The objective of the project was to develop a district level model for building capacity at the government health system for effective screening, diagnosis and management (primary to tertiary) of diabetic retinopathy. The DR screening, counseling, referral and follow-up tasks were included in the scope of Non- Communicable Disease (NCD) nurses at the respective Community Health Centres and Primary Health Centres using the tele-medicine platform. During the project period (December 2016 to June 2019), 8,574 people with diabetes were registered at the 18 CHCs/PHCs. 6,462 (75.4% of those registered) were screened by NCD staff. The government has agreed to scale up services in 3 more districts.
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Introduction: Uterine tumors resembling ovarian sex cord tumor (UTROSCT) are a unique group of neoplasms with diverse morphology and immunophenotypic characteristics, coexpressing sex cord, epithelial, and smooth-muscle markers. To date, less than 100 cases have been reported and there is paucity of data concerning their clinical behavior. Materials and Methods: All cases of uterine body tumors diagnosed over a period of two and a half years (2016-2018) were retrieved. Histopathological features were reviewed and extended panel of immunohistochemistry was performed to identify cases of UTROSCTs. Results: Six cases of UTROSCTs were identified with a median age of 46.5 years. Four of them presented with menorrhagia, while two with postmenopausal bleeding including one with a history of carcinoma breast. Three of these cases were initially misdiagnosed as endometrial stromal sarcoma and adenocarcinomas. They all underwent hysterectomy with bilateral salpingo-oophorectomy. Conclusion: It is considered a tumor with low malignant potential; however, one out of six cases (16.7%) in our study showed metastasis, within 1 year of diagnosis. It is important to recognize this entity as it mimics a wide range of both benign and malignant tumors. Molecular pathogenesis and exact management protocols remain elusive due to rarity,hence, multi-institutional studies are warranted.
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Abstract Objective: To analyze two techniques of papaverine application, topical spray on the harvested left internal mammary artery (LIMA) and perivascular injection, to find out their ability to improve LIMA flow. Methods: Forty patients were randomized into two groups. In Group 1, papaverine was sprayed on the harvested pedunculated LIMA. In Group 2, papaverine was delivered into the perivascular plane. Drug dosage was the same for both groups. LIMA flow was measured 20 minutes after applying papaverine. Blood flow was recorded for 20 seconds and flow per minute was calculated. The systemic mean pressures were maintained at 70 mmHg during blood collection. The data collected was statistically evaluated and interpreted. Results: The LIMA blood flow before papaverine application in the Group 1 was 51.9±13.40 ml/min and in Group 2 it was 55.1±15.70 ml/min. Statistically, LIMA flows were identical in both groups before papaverine application. The LIMA blood flow, post papaverine application, in Group 1 was 87.20±13.46 ml/min and in Group 2 it was 104.7±20.19 ml/min. The Group 2 flows were statistically higher than Group 1 flows. Conclusion: Papaverine delivery to LIMA by the perivascular injection method provided statistically significant higher flows when compared to the topical spray method. Hence, the perivascular delivery of papaverine is more efficient than the spray method in improving LIMA blood flow.
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Humans , Mammary Arteries , Papaverine , Vasodilator Agents , InjectionsABSTRACT
Introduction: Different patterns of activities were reported due to different cultural attitudes of the individuals. Socio-economic status should be taken into consideration when exploring the effect of socio-economic status on health over the life course. Available literature brings out limited studies on socio-economic status and its association with physical activity. In view of above, present study was undertaken to determine an association between selected demographic variables, BMI and physical activity, among older adults, in south India. Materials and Methods: Present study is a community based cross-sectional study, undertaken among older adults (> 55 years and above). Purposive sampling method was used to select the study subjects. A total of 63 older adults were included in the study. The study was conducted over a period of one and half years from 01 January 2018 to 30 June 2019, in selected urban and semi-urban areas in Dakshina Kannada district, Karnataka (India). Results: The study comprised of a total of 63 older adults which included 32 (50.79%) males while remaining 31(49.20%) were females. The physical activity levels were found to be highest (33.33%) in 55-60 years age group while these were lowest (0.00%) in 75 years and above, age group. The association between physical activity and age, was found to be statistically significant. (p value= 0.015) Discussion: In our study, out of 21 older adults from middle SES class 13 (61.90%) were found to be having low physical activity, while in lower SES group out of 21 subjects 9 (42.85%) were found to be having high physical activity levels. However, the subjects from upper SES group, revealed low levels of physical activity as only 02(09.52%) out of 21 subjects showed high levels of physical activity. Conclusion: Present study brings out significant association between physical activity and BMI, while no association was observed between socio-economic status and physical activity. Further, low levels of physical activity were observed across all SES groups,
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Background: Oral submucous fibrosis (OSMF), a well-recognized oral potentially malignant disorder, results due to increased collagen production and reduced collagen degradation. Aims and Objectives: To qualitatively compare the staining properties of collagen in OSMF using two special stains based on their birefringent property using polarizing microscopy. The study also assessed the distribution and orientation of collagen fibers in different grades of OSMF. Materials and Methods: A total of 73 subjects with different clinical and histopathological staging of OSMF comprised the study population. Histopathological examination was done using hematoxylin and eosin stain, Van Gieson and picrosirius red. Collagen fibers were analyzed for polarization colors, distribution, and orientation. Results: Picrosirius red stained both thick and thin collagen fibers. Irrespective of the histopathological grades reddish orange and yellowish orange were the most predominant colors. Parallel arrangement of fibers was observed when stained with Van Gieson but picrosirius red stained sections showed a majority of parallel type I fibers with perpendicular type III fibers which increased with advancement in the histopathological grade. Yellowish orange and greenish yellow fibers were predominant in the lamina propria, while reddish orange fibers were predominant in the submucosa. Conclusion: Picrosirius red was found to be a better stain. Histopathological grading and polarization colors showed no association with each other. Collagen fibers were more thickly and tightly packed in the submucosa indicating that the process of fibrosis began there. The increase in perpendicular type III fibers with advancing histopathological grades suggested their role in fibrosis.
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A 19-year-old girl presented with a lump in her right breast and with a history of surgery for the similar complaint 3 years back. Ultrasound was suggestive of benign solitary lesion of size 16 cm × 10 cm. Core biopsy was suggestive of phyllodes tumor, and the histopathology report of previous surgery was also suggestive of phyllodes tumor. Wide excision of the tumor and reconstruction was done with batwing mastopexy and with a slight modification of the described technique so that to avoid contralateral reduction mammoplasty in a young unmarried girl. Postoperative histopathology was suggestive of fibroadenoma measuring 15 cm × 8 cm with all margins free of tumor, and it is probably one of the biggest fibroadenomas reported so far. On follow-up, no significant disparity noted between the appearances of both breasts
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Background: To improve coverage of key child health community practices, Home Based Infant Care (HBNC+) was implemented with support of Norway India Partnership Initiative (NIPI) in 4 States of Rajasthan, Madhya Pradesh, Bihar and Odisha. The innovation aimed at improving coverage of key child health interventions through home visits by community health worker, Accredited Social Health Activist (ASHA). Aims & Objective: This paper elucidates the results from the assessment of implementation in intervention versus control districts of Rajasthan. Material & Methods: A cross-sectional intervention-control design with a sample size of 3211 mothers of children in age group 0 to 23 months was adopted. Results: 85 percent of the children (aged 3-23 months) received at least one infant care home visit in the intervention districts in comparison to 32 percent in control. Significant improvements were found in terms of exclusive breastfeeding, weighing and Iron Folic Acid (IFA) consumption and availability of ORS and Iron Syrup in intervention districts. 15 percent additional children had weight plotted in growth charts and 24 percent more consumed IFA syrup bi-weekly in intervention districts. Conclusion: Home visits in infancy is a scalable model and can lead to improvement of community child health practices.
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Background: Brain metastases are the most common intracranial malignancy in adults and their management poses a significant healthcare problem. Of the various options available, whole brain radiotherapy (WBRT) remains the mainstay of treatment. Nonetheless, there is a need to develop fractionation schedules for best symptom palliation and prolonged survival. This prospective study aims to compare treatment outcome in terms of overall survival in two different WBRT schedules and determine the prognostic factors affecting this outcome.Methods: Sixty previously untreated patients with symptomatic brain metastases were randomized in two arms of 30 patients each to receive WBRT. Arm A patients received 30Gy in 10 fractions (long-course) and arm B received 20Gy in 5 fractions (short-course). All patients were assessed during and after completion of WBRT at 1, 3, 6, 9 and 12 months.Results: At 12 months post WBRT, the objective response rate i.e. complete and partial response (CR+PR) was 6.67% in arm A and 13.34% in arm B (p=0.96). Both WBRT regimens showed similar survival (p=0.65). On multivariate linear regression analysis, age ≤65 years, Karnofsky performance score (KPS) ≥70 and lack of extra-cranial metastases were significantly associated with improved survival at the end of 12 months post WBRT. EORTC QLQ-C30 showed similar improvement in quality of life in both the arms (p=0.86).Conclusions: This study suggests comparable results in the two fractionation schedules. Therefore, short-course WBRT may be used as a more convenient option in favour of shorter hospital stay and lesser burden on RT machines.
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Postoperative operative inflammation following cataract surgery is common occurrence may be due to severalsurgery-dependent factors such as surgical trauma, intraocular lens type, and due to various physical, chemicaland biological agents introduced during surgery and also on patient-dependent factors such as history ofinflammatory disease and degree of iris pigmentation. Anti-inflammatory agents are routinely prescribedfollowing cataract extraction surgery to resolve signs and symptoms of inflammation more rapidly and toimprove patient comfort. For the treatment of postoperative ocular inflammation and pain the most widelyprescribed topical corticosteroid is betamethasone 0.1%, and Difluprednate ophthalmic emulsion 0.05% astrong topical steroid. Hence, this study was to compare the efficacy and safety of topical corticosteroidsDifluprednate 0.05% and betamethasone 0.1%, in managing inflammation and pain following post cataractextraction surgery. In a total 100 patients were randomized into two groups Group –A (50 patients) prescribingtopical Difluprednate emulsion 0.05% and Group-B (50 patients) prescribing betamethasone phosphate 0.1%.in our observation after 15 days no pain in group-A, after 30 days no one are having corneal oedema in groupA. Difluprednate emulsion 0.05% drug was efficient in the reduction of anterior chamber cells and flare withbetamethasone phosphate 0.1% being more rapid. Based on our findings and previous study results,Difluprednate emulsion 0.05% can be used in post-operative management post cataract surgery, however,further clinical trials with long follow- up periods are required.
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Corneal injuries remain an important cause of avoidable and, predominantly, monocular visual morbidity, themain strategy to prevent these injuries has been to educate people to identify high-risk situations and to takecorrect action to avoid danger. Present study conducted in the department of ophthalmology of Raichur instituteof Medical sciences teaching Hospital, with 49 patients of ocular trauma above 14 years of either sex wassubjected to slit lamp examination to ensure the cornea is involved the etiology of the injury was noted. Then thepattern of the corneal injury was studied under the slit lamp examination. The Prevalence of corneal blindnesswas 10.20% (5) were had corneal blindness in both eyes and 24.49% (12) were had corneal blindness in one eyein Raichur. The majority of corneal injuries are avoidable. Eye health promotion strategies are warranted toraise awareness about the causes and prevention of corneal blindness.
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Purpose: Prevalence, diagnosis and treatment of refractive error is relativity simple and easiest way to reduceimpaired vision, population-based data in children are not sufficiently available for India. In view of importance of detecting the refractive error in children an effort is going to be made in this study. To find out the extentof problem of refractive errors among children in Raichur.Materials and Methods: the prospective study was conducted with 100 number 10-15 years children from theRaichur. All the children were examined with visual acuity by snellen’s chart, Examination of anterior andposterior segment, Retinoscope, trail set and cycloplegic refraction followed by subjective correction will bedone.Results: The prevalence of Refractive error in the 10-15 years children was found to be 11%, higher in 15 years(3%), more in girls (6%) and in urban area children had more prevalence (7%). Myopia was the commonest typeof refractive error in this study which constitutes 55%, Astigmatism 27% and 18% of hypermetropia was seen inthe 10-15yrs children.Conclusion: Most of the children are unaware of Refractive error, so screening of children is very important.Parents have to take the responsibility of this screening for vision error and they should monitor the their visionvial watching tv, reading books. The screening system should be yearly at least 3 time a year to every childespecially 14-15 years student.
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Purpose: This study is being taken for comparing the efficacy and complications encountered between subtenonanaesthesia and peribulbar anaesthesia in manual small incision cataract surgery in RIMS teaching hospitalRaichur.Materials and Methods: This comparative study was done on 50 patients (group 1 subtenon anaesthesia (n=25)and group 2 peribulbar anaesthesia (n=25)) with senile cataractwith visual acuity CF/HMundergoing lens extraction by manual small incision cataract surgery with posterior chamber intra ocular lens implantation atinthe Department of Ophthalmology, RIMS teaching hospital Raichur.Results: 56% Subtenon’s anaesthesia group patients, and 32% Peribulbar anaesthesia group patients had nopain, when it compared it is statistically significant (0.048), 20% Subtenon’s anaesthesia group patients, and64% Peribulbar anaesthesia group patients had no grade 0, when it compared it is statistically significant(0.004), and 20% Subtenon’s anaesthesia group patients, and 64% Peribulbar anaesthesia group patients had nograde 0, when it compared it is statistically significant (0.004).Conclusion: Subtenon’s anaesthesia is a safe and effective substitute for preibulbar anaesthesia in Manualsmallincision cataract surgery.
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While lasers have been used for many years for the treatment of glaucoma, proper indications and use of the procedures need to be considered before their application. This review summarizes the important laser procedures in Glaucoma.