The Pyramid of Transgender Health Therapeutics

Transgender care needs a multidisciplinary team approach. The awareness about transgender health has increased over the past few years in India. The pyramid of transgender health helps to demystify the care of transgender individuals. The 7 S's of lifestyle modification need to be followed in the routine clinical care of transgender individuals. The individuals also need psychological care and support, metabolic and medical care, endocrine management, and later surgery in some cases. The policy makers can use the pyramid to decide about financial help to the community for their holistic care. The physicians involved in the care of transgender individuals can also take guidance about comprehensive care and management of transgender and gender diverse individuals.

Therapeutic Patient Education in Transgender Care

This communication visits the concept of therapeutic patient education (TPE), and explores its relevance to transgender health care. It suggests a novel term, therapeutic education (TE), and defines it as “educational activities essential to the optimization of health, offered by health care providers duly trained in the field of education, designed to help a transgender individual (or a group of individuals and their families) to manage their treatment and prevent avoidable complications, while maintaining or improving their quality of life. It describes the soft and hard skills required for TE, and suggests a classification that can help in structuring TE programs.

Imaging resemblance but diagnostic disparity in cervix cancer: a rare case report

F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy.

An unusual case of ileo-uterine fistula discovered after full term normal delivery

Entero-uterine fistula is a very rare type of fistula between the small intestine and the genital tract. They may result from obstetric or gynaecological procedures like post D and C perforation of the uterus. Timely detection and management reduce morbidity and mortality of the patients. We present a case of entero uterine fistula in a lady which was diagnosed on second postnatal day when she complained of passage of stool per vaginum. She had a previous history of mid trimester abortion followed by D and C after which she remained hospitalised for a week for pain abdomen. The diagnosis of this fistula was based on her symptoms and clinical evaluation of passage of intestinal content through the cervix and CT scan finding of gas in the abdomen. Intraoperatively an ileal loop was found adherent to the posterior wall of uterus with large fistula between bowel and the uterus. There was no intraperitoneal faecal contamination. Adherent small bowel was separated from the posterior wall of the uterus and fistula dismantled. Side to side functional end to end anastomosis was done using TLC 75 stapler. Repair of the uterine rent was also done. Post op recovery was uneventful.

Clinical study comparing outcome of post in vitro fertilisation triplet pregnancy reduced to twins versus non reduced in vitro fertilisation triplet pregnancies

Background: There has been an upsurge in the number of multiple pregnancies with its attributability to increasing use of artificial reproductive techniques. To study clinical outcome of post IVF triplet pregnancy reduced to twin pregnancies   compared to those without triplet reduction.Methods: Hospital designed comparative study. 31 subjects were studied for comparative study design with triplets obtained after infertility treatment (assisted post-IVF). Out of 31, 15 subjects were expectantly managed who refused reduction while 16 subjects chose reduction to twins. Outcomes like prematurity, complications in neonate, birth weight discordance, neonatal mortality and maternal complications were studied.Results: The fetal (triplet) reduction group was associated with significant (p<0.002) higher neonatal birth weight as compared to non-reduced group. The fetal reduction group had significantly lower incidence of prematurity and neonatal complications like hyperbilirubinemia, respiratory distress syndrome and neonatal sepsis. The maternal complications were also higher in nonreduced in terms of PPROM, gestational hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension.Conclusions: It is indicated that the reduction of triplet to twins is effective considering more complications with non-reduced group and hence reduction improves favorable pregnancy outcomes.

Multiparametric Magnetic Resonance Imaging of the Prostate: An Update

Multiparametric magnetic resonance imaging (mp-MRI) has emerged as an important tool for the detection and characterization of prostatic lesions. It now plays a quintessential role in the surveillance, diagnosis, and staging of prostate cancer (PCa), as well as for the detection of local recurrence. As reliance on serum prostate-specific antigen has declined in the recent times, mp-MRI has emerged as the go-to tool for urologists all over the world. Hence, for the clinician, it has become necessary to be well versed with the technique, image interpretation, and fallacies of mp-MRI. Since mp-MRI has the advantage of better contrast resolution, combining PSMA PET (prostate-specific membrane antigen–positron emission tomography) with MRI could provide additional functional information. However, due to the absence of enough evidence supporting its routine use, mp-MRI still has the unsurpassed role in the initial diagnosis and local staging of PCa.

Surgical Management of Giant Skull Osteomas in Western UP Region

Benign osteoblastic anomalies are uncommon bone tumors and commonly divided into osteoid osteomas and benign osteoblastomas according to their biological behaviour. Among these primary benign bone tumor osteomas are the most commonly found at the site of skull and face. Osteomas are usually asymptomatic as they increase in size slowly. Therefore, present study was designed to evaluate the clinical, radiological, and surgical aspects of osteomas in patients with giant skull lesions. Methods: This study was conducted in CNS Hospital, Centre for Neurosciences and Narayan Superspeciality hospital, Meerut and SVBP Hospital associated with LLRM Medical College, Meerut between the period of 2015 and 2018. The 12 successive patients with giant osteomas were treated surgically in the hospital. The patient population consisted of adult female patient ranging from 12 to 70 years with median age of 40 years and having giant cranial osteomas involving the cranial vault and some with extension into the paranasal sinuses or orbital wall. Results: Most common site of lesions was frontal portion of skull. Further, most common complaint of the patients was headache (50%). Further, slowly growing mass (44.4%) was the second most common complaint followed by proptosis in one patient. The mean diameter was 5.75 cm with range of 3 to 10 cm in all patients. The mean time duration of the patients of the onset of the tumor was 3 years with range from 6 months to 5 years. Histopathology picture of the patients revealed that tumors were composed of oestoid lamina. Further, different quantity of osteoid with major cement lines were found in trabeculae of laminae. Conclusion: Osteomas are normally benign tumors without any symptoms; However, surgical removal could be required for the cosmetic reasons. On the other hand, for the osteomas with different symptoms surgical treatment is the only choice of treatment. A considerable precaution and care of blood supply and surrounding brain tissue should be taken during radical extraction of the giant tumors.

Ferricarboxy maltose to treat iron deficiency anemia in pregnancy: is it a feasible option?

Background: Iron deficiency is a common cause of anaemia in pregnancy which influences the health of mother and developing fetus. Intravenous (IV) iron preparations are considered, when oral iron therapy is ineffective or intolerant. Ferric carboxymaltose is an IV preparation that can be given with ease of administration and better tolerated. The aim of this study was to assess the efficacy and safety of IV ferric carboxymaltose in pregnant mother with all grades of anemia in the second and third trimester.Methods: This is a prospective observational study where 44 pregnant women with iron deficiency anemia [IDA] received ferric carboxymaltose up to 15mg/kg in second and third trimester. The parameters that were taken into account, to assess the effectiveness of the treatment was repeat haemoglobin [Hb] measurements and the subjective sense of wellbeing in the patient. The safety of the drug was analysed by continuous fetal heart rate [FHR] monitoring during the infusion and observation of any adverse reactions.Results: Ferric carboxymaltose intravenous infusion significantly increased Hb levels above baseline values in all women. The Increase in Hb levels were observed at 3- and 6-weeks post infusion therapy. FHR monitoring did not show any drug related unfavourable effect on the fetus. Of the 44 women interviewed, 33 (75%) women reported sense of well-being, 7 (15.9%) women could not feel any difference after the infusion and 4 (9.1%) patients could not comment. No serious adverse effects were noticed but minor side effects occurred in 3 (6.8%) patients.Conclusions: This prospective study showed safety and efficacy of ferric carboxymaltose in pregnancy with IDA which is consistent with available observational data.

Presence Of Enthesophytes In Both Appendicular And Axial Skeleton Of A Cadaver: A Case Report

During the routine anatomy dissection for the undergraduate students, an uncommon variation in relation tobones was observed. The muscle attachments of the axial and appendicular skeleton were associated with theformation of extensive enthesophytes. The bones mainly responsible for the weight transmission especially inthe lower limbs were observed to have an abundant new bone formation in the area for muscle and ligamentattachments. This information may be of importance to radiologist, surgeons who are seeking to reduce themorbidity associated with dissections in this region, particularly related to paresthesias and nerve compressions

Prevalence of nonalcoholic fatty liver disease in an adult population in a rural community of Haryana, India.

Background: Though nonalcoholic fatty liver disease (NAFLD) is increasingly becoming prevalent in the Indian population, knowledge regarding the burden and risk factors of NAFLD is limited, more so from rural areas. This study was thus conducted to estimate the prevalence of NAFLD among adults in a rural community of Haryana, India and to measure the association of diet, physical activity, and other selected risk factors with NAFLD. Materials and Methods: The present study was conducted in a rural community of Haryana, India among resident adults ≥35 years of age. Eight out of 28 villages were selected by probability proportion to size sampling. The number of eligible and consenting participants randomly selected from each village was 27. Out of 216 participants thus recruited, 184 participants reported for undergoing ultrasonography (USG) of the liver, anthropometry, blood pressure recording, and blood sample collection. Finally, 176 participants were analyzed. Results: Prevalence of NAFLD was 30.7%. There was no significant difference in the calorie intake and average total physical activity between participants with and without NAFLD. On multivariate analysis, hypertension [adjusted odds ratio (OR): 2.3, 95% confidence interval (CI): 1.1-5.0, P 0.03] and an increased waist circumference (adjusted OR: 4.9, 95% CI: 1.5-7.0, P < 0.001) were independently associated with NAFLD. A normal high-density lipoprotein (HDL) level was protective against NAFLD (adjusted OR: 0.4, 95% CI: 0.2-0.8, P 0.001). Conclusions: The high prevalence of NAFLD is already a public health problem, even in the rural parts of India. Urgent public health interventions are required to prevent its development by controlling the cardiometabolic risk factors associated with it.

A Study of Male Sterilization with No Scalpel Vasectomy.

No scalpel vasectomy (NSV), a minimal invasive technique for vasectomy is simple, safe, fast, more effective and less expensive operation for male sterilization with better patient compliance. In this study 280 patients were operated for NSV in sub district hospital of J&K State w.e.f. January 2009 to December 2010. Mean age of patients was 35.95 years. Mean time taken for surgery was 23 minutes. Complications were recorded and included bleeding during surgery 4 cases (1.43%), scrotal hematoma 3 cases (1.07%), wound infection 3 cases (1.07%) and minor scrotal pain 4 cases (1.43%). One patient in our study had chronic testicular pain. There was no decrease in sexual desire and satisfaction in any patient followed up and no case of failure of vasectomy was detected. NSV is becoming standard method of vasectomy around the world with less complications and discomfort, smaller scar and fast recovery time with positive post operative psychological state. India, where population control is major concern, this technique should be popularized to increase its acceptance among general population.

Solventless coating for Tablets: An alternative to conventional coating technique.

There are many ways to coat tablets. Coatings are a very important part in the formulation of pharmaceutical dosage form to achieve excellent formulation quality (e.g., color, texture, mouth feel, and taste masking), physical and chemical protection for the drugs in the dosage forms, and modification of drug release characteristics. Most film coatings are applied as aqueous or organic-based polymer solutions. Such film coating brings their own disadvantages. Solventless coatings are alternative technique of coating. Solventless coating technologies can overcome many of the disadvantages associated with the use of solvents (e.g., solvent exposure, solvent disposal, and residual solvent in product) in pharmaceutical coating. Solventless processing reduces the overall cost by eliminating the tedious and expensive processes of solvent disposal/treatment. In addition, it can significantly reduce the processing time due to reduction of step of drying/evaporation. These environment-friendly processes are performed without any heat in most cases (except hot-melt coating) and thus can provide an alternative technology to coat temperature-sensitive drugs. This review includes various solventless coating methods like magnetic assisted impaction coating , hotmelt coating, supercritical fluid spray coating, electrostatic coating, dry powder coating, and photocurable coating that can be used to coat the pharmaceutical dosage forms.

An unusual cause of optic atrophy in a child.

A 13‑year‑old child presenting with gross visual impairment was diagnosed as a case of optic atrophy. However, radiological investigations revealed osteopetrosis, which, though rare, can result in optic atrophy. The aim of this case report is to highlight this possibility while evaluating cases of optic atrophy in young patients.

Multi-species biofilm of Candida albicans and non-Candida albicans Candida species on acrylic substrate

OBJECTIVE: In polymicrobial biofilms bacteria extensively interact with Candida species, but the interaction among the different species of the Candida is yet to be completely evaluated. In the present study, the difference in biofilm formation ability of clinical isolates of four species of Candida in both single-species and multi-species combinations on the surface of dental acrylic resin strips was evaluated. MATERIAL AND METHODS: The species of Candida, isolated from multiple species oral candidiasis of the neutropenic patients, were used for the experiment. Organisms were cultured on Sabouraud dextrose broth with 8 percent glucose (SDB). Biofilm production on the acrylic resins strips was determined by crystal violet assay. Student's t-test and ANOVA were used to compare in vitro biofilm formation for the individual species of Candida and its different multi-species combinations. RESULTS: In the present study, differences between the mean values of the biofilm-forming ability of individual species (C. glabrata>C. krusei>C. tropicalis>C. albicans) and in its multi-species' combinations (the highest for C. albicans with C. glabrata and the lowest for all the four species combination) were reported. CONCLUSIONS: The findings of this study showed that biofilm-forming ability was found greater for non-Candida albicans Candida species (NCAC) than for C. albicans species with intra-species variation. Presence of C. albicans in multi-species biofilms increased, whereas; C. tropicalis decreased the biofilm production with all other NCAC species.

Mediastinal haematoma: A rare complication following insertion of central venous catheter.

Mediastinal haematoma is a rare complication following insertion of central venous catheter, with few cases reported in the literature. We report a case of mediastinal haematoma in a 33-year-old male patient with end-stage renal disease. In this patient central venous catheter insertion through the right subclavian vein was attempted on the operation table for renal transplantation but the procedure was abandoned as the attempt was unsuccessful. Post-procedure chest radiograph showed a large mediastinal haematoma occupying right hemithorax that developed as a result of injury to the subclavian vein. Patient was managed conservatively and haematoma completely resolved in four weeks time. This case is being reported to signify the importance of routine obtaining a post-procedure chest radiograph and to state that even large mediastinal haematoma can be managed conservatively in asymptomatic patients.

Congenital Lumbar Hernia.

Lumbar hernia is a rare hernia. It constitutes less than one percent of all abdominal hernias. It can be congenital or acquired. Acquired can occur either spontaneously or after surgery or trauma. Only 300 cases of lumbar hernia are reported till date. We report a case of congenital lumbar hernia in one month old male baby.

Infarction in Fibroadenoma Breast During Pregnancy with Skin Necrosis and Fungation.

A 35 year old multigravida in the 24th week of gestation presented with history of swelling left breast of 2 years duration. The swelling rapidly increased in size during the pregnancy & underwent spontaneous necrosis of skin with fungation & haemorrhage. Fine needle aspiration cytology showed a diagnosis of fibroadenoma. Lumpectomy was performed in the emergency & histopathology of specimen revealed infarction in fibroadenoma. Patient delivered a normal healthy baby and is alright at 6 month follow up.

Clinical Spectrum of Pulmonary and Extrapulmonary Tuberculosis in End Stage Renal Disease in Jammu.

One hundred patients of End Stage Renal Disease (ESRD) (mean age 50.5 years, S.D. 14.0341) during a period of one year from April 1, 2004 to March 31, 2005 were studied. Detailed clinical history, physical examination and laboratory investigations were recorded. Chi-square and Fischer-exact tests were used for statistical analysis. Sixteen cases of tuberculosis were detected in 100 ESRD patients. Fifteen of them were pulmonary and one extrapulmonary. Increased association of tuberculosis was seen in – diabetics as underlying cause for ESRD (37.5%), lower socioeconomic status (62%), male patients (68.75%), and patients > 35 years of age (87.5%). Anorexia was most common symptom (100%), followed by fever (87.5%) and cough (68.7%). Keeping in view of high incidence and prevalence of tuberculosis, patients of ESRD should always be screened for tuberculosis, requiring a high index of suspicion.