ABSTRACT
Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology. Though it is more common in reproductive age group, it can occur in extremes of age group. So, we had analysed the clinical presentation, surgical characteristics, and causes of adnexal torsion among adolescent population, reproductive-age women, and postmenopausal women.Methods: Patients with adnexal torsion who were treated in department of obstetrics and gynecology, SRM Medical College Hospital and Research Centre from October 2016 to March 2019 were retrospectively analyzed.Results: Among the 53 cases of adnexal torsion during the study period, maximum (38, 71.6%) were in the reproductive age group. There were three patients with ovarian torsion during pregnancy. Acute pain abdomen was the significant presenting symptom in adolescent group compared to other two group (100% versus 80.6% versus 40%, p = 0.03). Adnexal pathology was in the ovary in 76% and isolated tubal pathology in 5%. Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients (100%), as opposed to conservative surgery- detorsion and cystectomy in premenopausal women (56%). In Adolescent patients 62% had polycystic ovaries as intraoperative finding. Histopathology were benign except for a patient in postmenopausal age group who had granulosa cell tumour.Conclusions: An early identification of adnexal torsion is necessary in order to achieve conservative treatment in order to maximize the future reproductive potential in younger patients.
ABSTRACT
Background: Lead toxicity in children is a serious problem affecting their neurodevelopment. Although CDC mandates screening for lead toxicity regularly in children, India doesn't have any lead related public health program in place. In resource limited India a prescreening lead risk assessment questionnaire will be more economical than universal screening for blood lead levels (BLL). Authors aim to evaluate the accuracy of a validated modified CDC lead risk assessment questionnaire in predicting elevated BLL.Methods: Authors conducted an explorative cross-sectional study from July to August 2017 in 340 children aged 6 months to 6 years. A standardized self-administered questionnaire modified from CDC lead risk assessment questionnaire was administered in the children. Also, BLL were measured in all study subjects using lead care II analyser. Data from questionnaire were compared with BLL to test the accuracy of questionnaire.Results: Blood lead levels was high (>5ug/dl) in 57.9% of study subjects especially in children between 24-35 months. Employment in battery manufacturing companies (P=0.0001), usage of cosmetics (P=0.019), parental smoking history (P=0.001), involvement in painting, arts (P=0.0001) and malnourished children (P=0.018) were the risk factors associated with undesirable BLL. The modified questionnaire had a sensitivity of 87.9% and specificity of 66.7% for detecting elevated BLL.Conclusions: The modified CDC lead risk assessment questionnaire is a sensitive tool in identifying high risk cases of lead toxicity in children.
ABSTRACT
Background: Accredited Social Health Activist (ASHA) forms the backbone of NRHM who provides promotive, preventive, and curative health facilities in especially the vulnerable groups. There is a need to comprehensively look into the knowledge and performance of ASHA in terms of her job responsibilities in maternal health, hence this study was conducted to assess knowledge regarding maternal health care among the ASHA workers and to assess the impact achieved after the training programme.Methods: Community based interventional study was conducted among ASHA’s in Jawadhu Hills between April to July 2017, a pretested semi structured questionnaire was administered to elicit the knowledge of ASHA in regard to maternal health care. After the initial assessment, an intervention training programme was conducted based on a module prepared in their native language and post training assessment was done after two months. The statistical tests used were proportions, chi-square test. A p value less than 0.05 was considered to be significant.Results: Based on the initial assessment around 60% of ASHA knew about the core ANC, which statistically (p<0.05) improved after the training programme. Based on danger signs of pregnancy less than 10% knew about vaginal bleeding (3.8%), swelling of legs (4.8%), visual disturbances (6%) which statistically (p<0.05) improved after the training.Conclusions: Knowledge of ASHAs on various aspects of maternal health care was moderately adequate, before the training programme and it was significantly improved after the training programme, which shows that there is a need for regular fixed training programme to maintain the performance of ASHA