Identifying the Potential Determinants of Tobacco Counseling Implementation among Oral Health Professionals of India: A Cross-Sectional Survey

ABSTRACT Objective: To identify the potential determinants of tobacco counseling implementation among oral health professionals in India. Material and Methods: A cross-sectional survey was carried out among the 298 dentists of Aligarh and Gwalior. The questionnaire used in the study had sections on dentists' sociodemographic data and a 35-item questionnaire to assess the potential determinants of tobacco cessation counseling. Descriptive statistics were carried out, and a Chi-square test was utilized to determine the association. P-value <0.05 was considered statistically significant. Results: Domains "knowledge", "Professional Responsibility and Identity", and "Remembrance, awareness, and judgment" showed a statistically significant correlation with most tobacco cessation counseling behaviors. In addition, undergraduate education received in Tobacco Cessation counseling, and Continuing education received in Tobacco Cessation counseling had significantly impacted the practice of tobacco cessation counseling (p=0.02 and 0.04, respectively). Conclusion: This study suggests that "Knowledge", "Professional Responsibility and Identity" and "Remembrance, awareness, and judgment" are the potential determinants that could be used to design effective strategies to enhance tobacco counseling among dentists in India.

Visual outcome after manual small-incision cataract surgery by viscoexpression technique

Purpose: Globally, cataracts have remained the major cause of blindness. Cataract accounts for 62.6% of blindness affecting 9� million people. The only treatment for cataracts is surgical removal of cataracts. The surgical procedures include phacoemulsification and extracapsular cataract extraction (ECCE). In India, there is a huge backlog of cataract patients. Phacoemulsification is preferred nowadays for early visual rehabilitation, but in developing countries like ours, where facilities are not widely available, small-incision cataract surgery (SICS) is a cost-effective alternative as no machine is required. Also, it provides early visual rehabilitation as it is sutureless when compared to ECCE. So, manual SICS has emerged as a substitute for phacoemulsification and ECCE. The aim of the study was to evaluate the visual acuity and surgically induced astigmatism in patients more than 40 years of age, undergoing manual SICS with nucleus management by viscoexpression technique. Methods: This was a prospective study that included 50 patients over the age of 40 years undergoing manual SICS at a tertiary health-care center in North India by viscoexpression technique. Only those patients whose functional visual disability could be attributed to cataracts were included in the study. Preoperative and postoperative astigmatism were analyzed in the first, fourth, and sixth weeks. Results: Fifty patients who were undergoing manual SICS were analyzed. Preoperative best-corrected visual acuity (BCVA) and astigmatism were compared to postoperative BCVA and astigmatism. Of 50 patients, 48 (96%) patients were able to gain good vision after 6 weeks. Conclusion: This study showed early visual rehabilitation with less surgically induced astigmatism following manual SICS by viscoexpression technique.

Investigation of Seroprevalence of Sars-Cov-2 IgG Antibodies Among Healthcare Workers in a Tertiary Care Centre in District Amritsar

Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe.Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV-2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1stand 2ndwave.Material & Methods:A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during JuneJuly2020 (1stwave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique.Results:Out of the 184 samples, 79 (42.9 %) were found to be seropositive. Higher seropositivity was seen i.e 60.8 % during the 2ndwave (April-May 2021 ) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8 % vz 34.7 %, lab technicians 72% vz 30.4 % and housekeeping staff 72.2 % vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5 % of vaccinated HCWs had demonstrable IgG antibodies.Conclusions:High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2ndwave concludes that increase in seroprevalence was attributable to natural infection.The vaccine’s immunological response was also highlighted in the study.

Correlation of C-Reactive Protein, Low Total Leucocyte Count and Platelet Count with Blood Culture in Neonates With Sepsis

Background: Neonatal sepsis is characterized by systemic signs and symptoms of generalised bacterial infection in the first four weeks of life. Early recognition and diagnosis of neonatal sepsis remains a challenge because of the variable and nonspecific clinical presentation. A combination of haematological and biochemical tests may provide a more rapid diagnosis of sepsis than blood culture which takes at least 24 to 48 hours for the results. Objectives: To study the correlation of parameters of sepsis screen with blood culture in neonates with clinical sepsis and or having significant risk factors for sepsis and To study the outcome of neonatal sepsis was our secondary aim.Material & Methods:The descriptive prospective study with cross sectional design was conducted on 100 neonates admitted with signs and symptoms of sepsis in the nursery ward and NICU of paediatric department of BebeNanki Hospital, GMC, Amritsar. Sepsis screen and blood culture (gold standard for neonatal sepsis diagnosis) and other relevant investigations were sent under strict aseptic conditions and treatment was started. S.CRP levels >1mg/dl, total leukocyte count < 5000 cells/cumm, platelets count < 1.5 lakhs/ µL were taken as positive significant (P <0.005) markers for neonatal sepsis. The data was tabulated and subjected to statistical analysis.Results:Positive CRP (>1mg/dl) were found to be highly significant (p<0.0001), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 93.33%,16.00%,76.92%,44.44% and 74.00% respectively. TLC <5000 were found to be significant (p<0.0001), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 65.33%,44.00%,77.78 %,29.73% and 60.00% respectively. Platelet count < 1.5 lakhs/ µL was found to be significant (p<0.0091), Sensitivity, Specificity, PPV, NPV and Diagnostic accuracy were 68.00%, 16.00%,70.83%,14.29% and 55.00% respectively.Conclusions:In developing countries like India, where blood culture investigations are limited, altered haematological parameters such as CRP, TLC, and Platelets counts can serve as quick, simple, economical methods to diagnose neonatal sepsis. Further studies with larger sample size are required to substantiate the results.

Prevalence and Epidemiological Profile of COVID-19 Infection Detected Through RT-PCR AmongPatients of Various Districts of Punjab, India

Background: The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge for healthcare systems worldwide. Earlier to SARS-CoV pandemic, coronaviruses were only thought to cause mild, self-limiting upper respiratory tract infections in humans. COVID 19 presents across a spectrum of symptoms. WHO recommends detection of unique sequences of virus RNA by Nucleic Acid Amplification Test (NAAT) such as real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). The aim of this cross sectional study was analysis and confirmation of Nasopharyngeal/oropharyngeal swab specimen by real-time reverse transcription polymerase chain reaction (RT-PCR).Material & Methods:This was a cross-sectional retrospective study that reviewed records of samples collected from June 2021 to March 2022. Nasopharyngeal/oropharyngeal swab specimen were collected from suspected COVID-19 subjects of various districts of Punjab and referred to Viral Research Diagnostic Laboratory [VRDL], Government Medical College [GMC], Amritsar for laboratory analysis and confirmation by real-time reverse transcription polymerase chain reaction (RT-PCR).Results:During the present study, a total of 11,27,005 samples were analyzed from June 2021 to March 2022 for SARS-CoV-2 detection by ICMR approved COVID-19 RT-PCR kits. Out of total 11,27,005 cases, 24,466 cases (2.17%) were found to be SARS-CoV-2 positive while 11,02,539 cases (97.83%) were SARS-CoV-2 negative.Conclusions:Ever since the COVID-19 global pandemic emerged, the developing countries are facing challenges regarding its diagnosis. Isolation of the infected person will eventually decrease the Reproduction number i.e Ro which will further interrupt the transmission cycle leading to decrease in community spread.

Spatial Epidemiology of COPD in Delhi, India

Introduction?Chronic obstructive pulmonary disease (COPD) and bronchial asthma are the most common chronic respiratory illnesses. COPD is one of the three most common causes of death worldwide. The main burden of mortality from COPD is seen in Latin America, sub-Saharan Africa, India, China, and South-East Asia. Absence of true prevalence values and mortality burden hinder planning and operationalization of public health interventions for prevention, control, and treatment of the disease. Further, the aggregated value of prevalence estimates calculated for a whole city or a larger geographical area does not provide the location of patients and presence of locally prevalent risk factors. The objective of this study was to understand the spatial distribution of COPD in a large, highly polluted city of a developing country. Materials and Methods?A cross-sectional community-based study was conducted in the National Capital Territory of Delhi (NCTD). All surveyed households were geocoded. GOLD screening criteria and pulmonary function tests using portable digital spirometer were used for diagnosis of COPD. Results?Results are presented as a series of maps depicting spatial epidemiology. Overall prevalence rate was 9.8/1,000 population. Highest prevalence was seen in industrial area. Most of the spatial hotspots were seen in industrial and slum areas. Similarly, Kernel density was also highest in industrial area. Conclusion?In the city of NCTD, we found the COPD being distributed in all types of habitations but spatial distribution helped us understand clustering of cases and compare prevalence rates in subunits of residential clusters within a metropolitan city.

Preoperative Factors Affecting the Outcome of Single Stage Hypospadias Repair- An Observational Study

Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP and Mathieu抯 repair. Results: Overall operative success rate observed in the study was 41 (85.41%) patients. In 7 (14.58%) patients urethrocutaneous fistula as a major complication occurred which included 1 patient in Group A and 2 patients with Distal Penile Hypospadias (DPH), 2 patients with Mid Penile Hypospadias (MPH) and 2 patients with Proximal Penile Hypospadias (PPH) in Group B. In 2 (4.16%) patients, mild meatal stenosis was noted which settled with meatal dilatation. Urethrocutaneous fistula (UCF) disappeared in 2 (4.16%) patients on follow up with regular urethral dilatation. Conclusion: MAGPI is the ideal procedure for glanular/coronal hypospadias. For distal penile hypospadias, TIP alone or combined TIP and Mathieu抯 repair gives equally good results. Preoperative testosterone therapy reduces the incidence of complications in a single stage hypospadias repair.

Use of microalgal biomass as functional ingredient for preparation of cereal based extrudates: impact of processing on amino acid concentrations and colour degradation kinetics

Abstract Suitability of developing Spirulina incorporated cereal based low cost nutritious extrudates was analysed against extrusion processing parameters. Most significant extrusion processing parameters considered for present study were feed moisture (20-25%), die temperature (100-120 °C) and screw speed (50-100 rpm). Different extrusion conditions were used to obtain most acceptable rice: Spirulina blend extrudates. In present study before extrusion processing different additives (citric acid and sodium bicarbonate) were added in rice: Spirulina blend and checked its effect on colour degradation kinetics at varied packaging and storage conditions. Higher screw speed (100 rpm) indicating less residence time of feed material inside the barrel resulted in higher colour retention of rice: Spirulina (97:03) blend extrudates. Kinetics for rice: Spirulina (97:03) blend extrudates indicates faster rate of colour degradation in terms of lightness (half-life of 4 days) when packed in metalized polyethylene at 50°C with 65% relative humidity. Increased concentration of Spirulina (1-3%) in raw formulations resulted in increase in concentration of all amino acids. Impact of extrusion processing has shown non-significant (p ≤ 0.05) effect on amino acid concentrations of rice: Spirulina blend extrudates. Also, all the spirulina added samples showed good consumer acceptability with the score of 6.7

Assessment of colistin resistance in Gram negative bacteria from clinical samples in resource-limited settings

Objective: To find a proper method to assess colistin resistance in multidrug resistant Gram negative bacteria (MDR-GNB) on a routine basis in resource limited settings. Methods: Clinical samples were processed. MDR-GNB were identified and were examined for colistin resistance by colistin broth elution method, colistin agar method, and colistin disk elution screening method. Broth microdilution method was used the gold standard. Results: A total of 10 235 clinical samples were processed, in which 857 (8.4%) MDR-GNB were identified. The very significant errors, categorical agreement, major errors, positive predictive values, negative predictive values, specificity and sensitivity of all the phenotypic methods were 5.5%, 0%, 94.4%, 100%, 99.6%, 100% and 94.4%, respectively for the detection of colistin resistance. The colistin elution screening method was cheap and easy to perform with similar results to broth microdilution method. Conclusions: All the evaluation methods for colistin resistance showed similar results. So the laboratories can choose any method for detection of colistin resistance. However, we recommend colistin disk elution screening method because, it is easy and cheap and can be performed in limited resources.

Oral Health Consequences of Use of Smokeless Tobacco in North India: A Cross-Sectional Survey

ABSTRACT Objective: To evaluate the effects of commonly used smokeless tobacco forms on oral health at habitual placement sites of smokeless tobacco compared to non-placement sites among the North Indian population. Material and Methods: This cross-sectional study was conducted among 542 individuals using smokeless tobacco recruited from the outpatient wing of the Dental College. Subjects completed a questionnaire and received an oral examination. Periodontal pocket depth, gingival index, plaque index, gingival recession, and oral mucosal changes were assessed. Kendal's Tau test, paired t-test, and chi-square test were carried out to compare different variables among placement and non-placement sites. Results: Most of the subjects were male, reporting an average of 11.26 years of SLT use. Clinical inflammation of gingiva was significantly greater (p=0.01) at placement-sites (1.64 ± 0.53) of SLT in comparison to non-placement-sites (1.40 ± 0.41). The difference in the GR and PPD at placement and non-placement-sites was also statistically significant with p=0.002 and p=0.001, respectively. Clinically, the majority of subjects had mucosal changes at the placement sites, and a statistically significant association (p=0.034) was observed between the duration of the use of smokeless tobacco and the mucosal changes. Conclusion: Smokeless tobacco use predisposes to increased risk of periodontal diseases and oral mucosal changes at the placement sites in an individual due to the local irritant effect.

Surgical management of plexiform ameloblastoma presenting as exophytic growth ­ A rare entity

Ameloblastoma is locally aggressive neoplasm of odontogenic origin comprising about 1% among tumours and cysts that usually occurs in the vicinity of the mandibular molars or ramus of the mandible. Predominantly occurring in third to fifth decade, with no gender propensity. Inadequate treatment may lead to recurrence in certain cases. Even though benign in growth, they are locally aggressive and can occasionally metastasize. Of them, a unique exophytic presentation of plexiform ameloblastoma in a 22-year-old male patient is documented as follows.

Dynamics of Selected Trace Minerals during Estrus Induction in Anestrus Sahiwal Cattle

The present study evaluated the effect of circulatory trace mineral profiles on fertility response during estrus induction by progesterone based therapy in acyclic Sahiwal cattle. Sahiwal cows and post-pubertal heifers (n=25 each) with true anestrus condition (acyclicity confirmed ultrasonographically) were subjected to CIDR-based protocol (intravaginal CIDR application for 7 days, 500 IU eCG at CIDR removal, followed by estrus observation and AI). In heifers, additionally an injection of 5.0 mg estradiol valerate at CIDR insertion was given. Blood samples on days 0 (before CIDR application), 3, 5, 7 and 9 were collected. Almost similar estrus induction (68% vs. 64%) and subsequent conception rates (41.2% vs. 50%) during the first induced estrus were recorded in cows and heifers, respectively. During the course of treatment, significant (P<0.05) variation in plasma copper and zinc concentrations was recorded both in cows and heifers. Contrarily, manganese concentrations varied significantly (P<0.05) in cows only. However, iron profiles remained uniform during the course of treatment. Significantly (P<0.05) higher pre-treatment plasma concentrations of copper, zinc and manganese was recorded in those cows and heifers in which estrus was induced, compared to those in which estrus induction failed to occur. No significant difference (P>0.05) was recorded for iron concentration vis-à-vis estrus induction response. Hence, it is indicated that circulatory copper, zinc and manganese profiles influence the reproductives energy in acyclic animals and their suboptimal profiles may reduce the efficacy of estrus induction protocols in Sahiwal cattle.

Immunological alterations in tuberculosis associated immune reconstitution inflammatory syndrome in HIV infected patients

The tuberculosis associated immune reconstitution inflammatory syndrome (TB-IRIS) frequently complicates the course of HIV/AIDS and HIV-TB treatment and its immunological mechanisms are poorly understood. Here, we investigated T-cells frequencies, their secreted chemokines and cytokines. In this prospective case-control study, HIV/AIDS and HIV-TB patients during treatment with highly active antiretroviral treatment (HAART) and anti-TB treatment were followed for TB-IRIS development. Age, gender and BMI-matched patients without IRIS constituted as “Controls” (non-IRIS). Activation and proliferation were assessed in CD4 and CD8 cell compartments. CCR4, CCR6 and T-reg cells were also analysed in PBMCs. Cytokines (IL-2, IL-4, IL-10, IFN-γ and TGF-β1) and chemokines (IP-10, MCP-1, MIG and RANTES) were measured in culture supernatants. Of 560 enrolled HIV/AIDS patients, TB-IRIS developed in 50 (8.9%) patients (25-paradoxical and 25-unmasking) at a median interval of 35-days (IQR, 24-78). After ART therapy, CD8+ T-cell proportion decreased in both paradoxical and unmasking-TB-IRIS as compared to non-IRIS. Simultaneously, activation of CD4+ T-cells was observed in unmasking TB-IRIS only. Similarly, CD161+ T-cells, Th17-cells and inflammatory cytokines like IFN-γ, IP-10 and MIG elevated in both TB-IRIS subgroups as compared to non-IRIS.In conclusion, during HAART treatment the dominance of pro-inflammatory cells and cytokines in TB-IRIS patients favours the development of IRIS event. On the other hand, in non-IRIS patients relative increase of anti-inflammatory cells and cytokines prevents the development of IRIS event.

Synergistic effect of metformin and fenugreek on the lipid profile of type-II diabetic patients

Background: Fenugreek is a traditional herb which has great relevance in the world since time immemorial due to its multifarious uses. Besides being a rich source of nutrition, it also finds place in the cure of certain pathological conditions. One of its highly beneficial effects is have been observed on the lipid profile of the hyperlipidemic patient. This study was thus undertaken to see the hypolipidemic effect of fenugreek seeds in patients of Type 2 Diabetes Mellitus (DM) as add-on therapy with metformin.Methods: An open-labelled comparative study of 12 weeks duration was conducted on patients (randomly divided in 2 groups of 30 each) of Type 2 DM. Group 1 was given metformin 500 mg twice a day while group 2 was given 500 mg of metformin along with fenugreek seed powder capsule, 1gm thrice a day. Evaluation for fasting lipid profile estimation was done at the beginning and at the end of the study. Student’s t-test (paired and unpaired) was applied for statistical analysis.Results: After 12 weeks of treatment, there was significant improvement in the lipid profile of both the groups. However, group 2, that received fenugreek along with metformin showed statistically greater improvement as compared to group 1 which received only metformin.Conclusions: This study shows the beneficial effects of fenugreek seeds on lipid profile in patients of Type 2 DM and can be used as an add-on therapy with metformin in controlling the lipid profile of Type 2 DM.

Electrolyte Changes in the Term Neonates Following Phototherapy in Neonatal Hyperbilirubinemia

Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during first week of life in approximately 60% of term neonates and 80% of preterm neonates. Phototherapy is the most common therapeutic modality used in the treatment of uncomplicated neonatal hyperbilirubinemia. Objective: To study electrolyte (Ca, Na, K, Cl) changes in the term neonates following phototherapy in neonatal hyperbilirubinemia. Methods: This study was performed on 100 term neonates (65 males, 35 females) admitted to the Department of Pediatrics, Bebe Nanki Mother and Child Care Centre, Government Medical College, Amritsar, Punjab with unconjugated hyperbilirubinemia and were managed with phototherapy. These neonates were completely normal on physical examination. Electrolytes were checked at 0 hr (at the time of admission) and after 48 hours of phototherapy or at discontinuation of phototherapy (second sample) whichever was earlier. The first sample was considered as control. Results: After phototherapy, among electrolytes (Ca, Na, K ,Cl) there was significant fall in serum calcium (ionized) level. 16 neonates developed hypocalcemia after 48 hr or less of phototherapy and 11 neonates developed hypocalcemia after 48 hr or up to 96 hr of phototherapy. The difference between pre and post phototherapy serum calcium (ionized) levels was found to be statistically significant (p <0.005). Of the 27 term neonates who developed hypocalcemia, 7 (26%) developed jitteriness and none of them developed irritability, seizures and aponea. No statistically significant fall/rise in levels of Na, K, Cl were observed in term neonates after phototherapy. The incidence of potassium, sodium and chloride changes following phototherapy was found to be nonsignificant irrespective of gestational age, birth weight and duration of phototherapy. Conclusion: The study concluded that among electrolytes (Ca, Na, K, Cl), phototherapy induced hypocalcemia is a significant problem. Thus calcium supplementation should be considered.

To Study the Effect of Ursodeoxycholic Acid in Lowering Neonatal Non – Hemolytic Hyperbilirubinemia: A Randomized Control Study

Hyperbilirubinemia is a common and in most cases, a benign problem in neonates. Conventional treatment for severe indirect hyperbilirubinemia consists of phototherapy and exchange transfusion. Phototherapy, which is the main treatment modality has its own side effects and it also upsets maternal and fetal interactions. So there is a need for adjuvant therapies to decrease duration of phototherapy and hospital stay. Objective: This study was planned to assess the role of UDCA in decreasing the duration of phototherapy in neonatal hyperbilirubinemia. Methods: Study setting: Pediatrics department, Bebe Nanki Mother & Child Care Centre, GMC Amritsar. Participants: 100 newborns with bilirubin levels in phototherapy range. Study design: Double blind, placebo controlled study. Participants were divided into two groups and UDCA (10mg/kg/d) and microcrystalline cellulose were given to group A and group B respectively. Outcome variables: Rate of fall of bilirubin levels in both the groups and total duration of phototherapy needed in both groups. Results: Mean duration of phototherapy was 36.26±8.41 hours in group A and 38.94±9.86 hours in group B. P value was 0.147 that is statistically not significant. Level of fall of bilirubin in both groups at 12hrly intervals were also compared and difference was not statistically significant. Conclusion: UDCA administration to the neonates receiving phototherapy does not hasten the fall in bilirubin levels and does not reduce the time of phototherapy significantly.

Assessment of timely immunization in an urbanized agglomeration of East Delhi, India

Background: The under-5 mortality rate in India has shown a decline in the last few decades. However, there is still a lot of work to be done for our country to achieve sustainable developmental goals. One of the factors contributing to child survival is immunization coverage, but high coverage does not mean timely vaccination. ‘On time’ immunization is an important yet little researched factor shielding a child from susceptibility to vaccine preventable diseases. This study aims at assessing the extent of timely immunization and predictors of intentional delay in vaccination of children.Methods: A cross-sectional study was conducted in East Delhi among caregivers having a child in the age group of 13-24 months. Sample size was calculated at 95% confidence limit and 3.5% absolute precision. The final sample size obtained was 350.Results: The percentage of fully and timely vaccinated children is 67.1%, whereas children fully vaccinated but with a delay of 4 weeks from the recommended age of administration is 19.7%. Partial vaccination was found in 11.2% of children and 2% of children were found to be not vaccinated. The most common reason for delay in immunization was pain at the time of administration leading baby cries and fear of needles (26.1%), followed by bad experience with previous vaccination (11.6%). Fear of side effects (14.5%) and being denied vaccination without card (11.6%) were other reasons.Conclusions: The immunization program should include timely completion of vaccination as a quality indicator. Delayed immunization can lead to epidemics in the community and threaten the goal of elimination of vaccine preventable diseases. Improving timeliness can be successfully achieved if the reasons for delay are taken into account.

Correlation between preoperative axillary ultrasound and histopathology of resected lymph nodes in patients with carcinoma breast

Background: Axillary Ultrasound is an important tool in assessing regional lymph node status in women who are node negative clinically as many of them will prove to have axillary lymph node involvement on histopathology. The aim of the present study was to establish the role of axillary ultrasound in preoperative assessment of lymph node status in women with carcinoma breast and to correlate the findings of axillary ultrasound with the histopathology of resected axillary nodes.Methods: Forty patients (all women) were included in this study and the preoperative axillary ultrasound was done to know the status of axillary lymph nodes and the findings were correlated with histopathological findings of the resected nodes.Results: The sensitivity of axillary ultrasound was found to be 66.67%, specificity was 87.5%, accuracy 75%, positive predictive value (PPV) of 88.89% and negative predictive value of 63.4%.Conclusions: Axillary ultrasound is very important tool in assessing preoperative axillary lymph node status in patients with carcinoma breast. It is also important in assessment after inadequate axillary dissection and for follow up of non-treated axilla.

Management of Renal Colic during Pregnancy

To determine an optimal medical and invasive intervention for renal colic patients during pregnancy. Amongthe available interventions, we investigated the reliability of a medical and inavasive interventions duringpregnancy. Between Nov 2015 and Nov 2016, a total of 200 pregnant patients came to the obstetrics andgynaecology opd, and 15 of these patients had renal colic that were referred to urological opd. The meanpatient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed tocollect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain followingtreatment and pregnancy complications. Based on ultrasonography diagnosis, 15 patients had urolithiasis,all had ureteric calculi with one having hydronephrosis and pyonephrosis and other one patient havingsevere hydronephrosis, pyonephrosis and sepsis. Conservative treatment was successful in 13 patients.Five patients were in the first trimester and ten patients in the second trimester. Out of the five patients inthe first trimester four were managed conservatively using antibiotics, hydrations and analgesics and oneamong them had severe hydronephrosis with pyonephrosis with sepsis with upper ureteric calculi in whomconservative management failed and patient was counselled and MTP was done and following that PCNLwas done as a definitive procedure. Ten patients in the second trimester medical expulsive therapy usingTamsulosin .4mg was used and complete stone clearance was achieved in Nine patients and one didn'tresponded , developed severe hydronephrosis and pyonephrosis in whom USG guided PCN was placedfor rest of the gestational period and after delivery patient underwent PCNL and complete stone clearancewas achieved. Only one patient required urological intervention that is PCN insertion. Renal colic due tocalculus during pregnancy can be effectively managed by conservative measures using hydration,antibiotics,analgesics and tamsulosin .4mg in most of the instances. Cases who do not respond to the conservativemeasure or who develops severe hydronephrosis, pyonephrosis PCN insertion and Ureteral stent insertioncan be done and patient in who develops life threatening sepsis MTP should be done followed by definitivetreatment that is PCNL.

Comparison of Low Urinary Tract Symptoms during Pregnancy between Primiparous and Multiparous Women

Low urinary tract symptoms (LUTS) are a common problem during pregnancy. This study aimed to compare changes in the prevalence of LUTS during pregnancy between primiparous and multiparous women. A chart review of consecutive pregnant women who attended our antenatal clinic from August 2015 to December 2016 was performed. All of the women were asked to respond to a LUTS questionnaire in either of the three trimesters. Of the 270 women included, 164 were nullipara and 106 were multipara. The most common LUTS during pregnancy were frequency (77%), followed by nocturia (75.6%), stress urinary incontinence (SUI) (51.1%), incomplete emptying (43.7%), dysuria (17.8%), and urgency incontinence (10.4%). There was a significantly higher prevalence of SUI (P < 0.001) and urgency incontinence (P= 0.005) in the multiparous compared to the nulliparous women. Increasing prevalence rates of frequency, nocturia, SUI, and incomplete emptying were reported with gestational age in both the nulliparous and multiparous women. Frequency and nocturia were the two most common LUTS during pregnancy. The prevalence rates of all LUTS increased with increasing gestational age except for frequency in the nulliparous women during the second trimester. In addition, multipara was a predictor of SUI during Pregnancy.