Quality of Life in Patients with Leprosy using WHOQoL-Bref Questionnaire: A Pilot Study

Quality of life (QoL) is a subjective measure which includes physical, psychological and social health and its relationship with the environment. Leprosy results in progressive damage to peripheral nerves in untreated or inadequately treated patients leading to nerve impairment and visible disabilities which may affect the quality of life. A descriptive cross-sectional study was conducted in a tertiary care centre among patients with leprosy over a period of six months, and quality of life status was evaluated using the WHOQoL Bref questionnaire based on four domains, namely physical, psychological, social and environmental. A total of 50 patients (males: females - 36:14) in the age group of 19-69 years were evaluated. Most patients (64%) belonged to the borderline tuberculoid spectrum. Patients with a disability accounted for 16% (8 out of 50) of the total cases. The psychological domain was the most commonly affected domain among patients. Females had lower scores than males in all domains. Elderly patients, patients with lepromatous leprosy and those with facial involvement had lower scores. Domain outcomes in lepra reactions were lower than in other types of leprosy. The study observed that leprosy in the ageing population, women and patients with severe forms of leprosy, associated with disabilities, have poorer quality of life.

Guided Tissue Regeneration with β-Tricalcium Phosphate and Platelet-rich Plasma for Fracture Repair in Dogs using Internal Fixation

The study was conducted on 19 adult dogs referred for treatment of fracture in diaphyseal region of three long bones, viz, radius-ulna, femur and tibia-fibula. These dogs were divided randomly into three groups viz T1, T2 and T3. In group T1, the diaphyseal fractures of the long bones were immobilized by an internal fixation technique using reconstruction plate or locking compression plate. In group T2, β- tri calcium phosphate granules were incorporated at fracture site after fixation. In group T3, one milliliter of PRP was administered locally at fracture site just before the closing the first suture line. Clinical and radiographic examination were also conducted during the study. There was a significant reduction in mean inflammation score at 7th day in groups T2 and T3 and at 30th day than 0 day in all the groups. At 90th day, the mean radiographic score was highest for group T3 and it was followed by the score in group T2. At day 90th, a radiograph in both the views was not able to delineate the granules from osseous tissue. The mean weight bearing score was also higher in group T3 than in group T2 at 30th, 60th and 90th post operative day showing that restoration of the function was better and earlier in groups T2 and T3 than in group T1

Evaluation of a training program on primary eye care for an Accredited Social Health Activist (ASHA) in an urban district

Purpose: An Accredited Social Health Activist (ASHA) available in community could be a potential primary eye care (PEC) worker. Training programme for ASHAs on PEC was undertaken & evaluated in a district of a capital city. Methods: ASHAs selected randomly from a district were imparted one day training on PEC & expected to refer patients to nearby Vision Centres (VC). Their knowledge was assessed before & after training and re-evaluated 1 year later. ASHAs were asked to conduct vision screening of 40+ population in their areas and ASHA referrals were noted by Optometrist in VC. Focus Group Discussions (FGD) of ASHAs were held to find barriers & facilitating factors in engaging ASHAs in PEC. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results. Results: Mean knowledge score increased from 14.96 (±4.34) pre-training to 25.38 (±3.48) post- training and sustained at 21.75 (±4.16) at 1year. Monthly average OPD of vision centres increased by 23.6% after ASHA training. FGDs revealed that ASHAs were willing to work in eye care for awareness generation and patient facilitation but were hesitant in conducting vision screening. Conclusion: ASHAs can be trained as PEC workers provided they have adequate support.

Assessing the inclusion of primary school children in vision screening for refractive error program of India

Purpose: In India, teachers screen middle school children using the 6/9 Snellen's optotype. Recently, the National Program for Control of Blindness included primary school students also. The present cross-sectional study was planned to assess the inclusion of primary school students. Compliance to spectacles was ascertained after 6 months follow-up. Methods: Randomly selected 23 Government primary schools. A total of 30 teachers were nominated and given hands-on training in vision screening and recording formats. Teachers conducted vision screening of primary school students of their respective schools using the 6/12 Snellen's chart and referred students with subnormal vision to optometrist. Optometrist also validated the screening done by teachers. Optometrist screened the vision of 5% randomly selected children screened by teachers as having normal vision. Descriptive statistics used STATA version 13.0. Results: A total of 6056 students screened by the teachers. Sensitivity and specificity of teacher screening were 92.3% (confidence interval [CI] 88.6–95.0) and 72.6% (CI 68.2–76.6)), respectively. About 277 students underwent refraction and 186 prescribed spectacles. The prevalence of myopia, hypermetropia, and astigmatism is 2.5% (2.1–2.9), 0.6% (0.4–0.8), and 1.3% (1.0–1.6), respectively. Compliance to spectacles usage is 36%. Conclusion: Burden of refractive error in primary school is very low. Trained teachers can identify children with subnormal vision, but the false-positive rate is very high. Compliance to spectacle use among primary school children is also less. Vision screening by teachers prioritized in secondary schools and preschool screening should be done by more skilled eye care workers preferably optometrist.

Ectopic hidradenoma papilliferum of eyelid: A rare entity with diagnostic challenge

Hidradenoma papilliferum is a rare cutaneous adnexal tumour of middle aged females arising mainly in the apocrine sweat glands of perianal and genital region. Ectopic forms of this entity have been described with majority of them occurring on the head and neck region. We report a case of 16 years young male who presented with two small, well circumscribed, greyish-brown, firm, nodules on his left upper and lower eyelid. A clinical impression of basal cell carcinoma was assumed but on histopathological examination it was diagnosed as hidradenoma papilliferum of eyelid. Immunohistochemistry was performed to support the diagnosis due to its unusual clinical presentation. To the best of our knowledge, only six cases in the upper eyelid and one case in the lower eyelid have been reported in the English literature. This is the first case report of hidradenoma papilliferum involving both upper and lower left eyelid in an adolescent boy.

A novel surgical procedure for papilla reconstruction using connective tissue graft and platelet rich fibrin: A case report

If the search for beauty is timeless, then having the perfect smile is always in style. One of the techniques to achieve that is regaining the lost interdental papilla. There has been a definitive void in the dental arena pertaining to papilla esthetic. Loss of interdental papilla prompts to phonetic, functional, and esthetic problems. Surgical techniques are multifarious, but are perplexing and very erratic. The refurbishment of the lost papilla is elusive. Previous attempts have been made to augment the interdental papilla using displaced flaps, connective tissue grafts and repeated inflammatory stimulation with diverse results. This clinical study was aimed to reconstruct the lost or blunted interdental papillae with connective tissue graft and plasma rich fibrin for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetic.

A cross sectional study of sociodemographic profile and treatment seeking behavior of cases of animal bite attending anti Rabies clinic at tertiary health care center in central India.

Rabies is 100% fatal zoonotic disease which can be prevented by appropriate anti rabies post exposure prophylaxis. The incidence of animal bite is managed poorly due to ignorance and rampant myths & misconceptions. It is discovered that a vital time period is lost in taking medical aid as people due to ignorance opt for traditional medications the authenticity of which is not completely established. Aims & objectives: 1) To study the social, demographic characteristics of victims of animal bites. 2) To study the treatment seeking behavior of persons and to find their correlations. Methods: An observational cross-sectional study. The respondents were selected amongst new cases of animal bites attending Anti Rabies clinic of Gandhi medical college Bhopal M.P. India for 3 months using pretested questionnaire. Data was analyzed & interpreted using percentages and tests of significance using Epi info 7. Results: Out of total 315 cases of animal bite nearly 38.75% were below 15 years of age. In total, 82.5% cases were bitten by dogs. The majority of cases (73%) had a category III bite, only 45% consulted within 24 hours of the bite. Nearly 9% did not wash the wound with soap & water instead applied home remedies or opted for traditional or non-allopathic treatment. A statistically significant (P <0.0001) association was found between educational status & knowledge of fatality due to rabies. Conclusions: Rising level of literacy enhances knowledge about the fatality of rabies.

The impact of hereditary colorectal cancer on the Indian population.

INTRODUTION: The incidence of colorectal cancer in India is lower compared to the Western world. In Western countries, most cases of colorectal cancer are sporadic and the hereditary variety accounts for only 10‑15% of all cases. The aim of the present review is to determine the clinical and epidemiological characteristics of hereditary colorectal cancer in India. MATERIALS AND METHODS: A Medline search was conducted to review the literature published from India regarding colorectal cancer. The keywords used included India, colorectal cancer, hereditary nonpolyposis, and familial adenomatous polyposis. All relevant articles were reviewed and the characteristic features of this disease in Indian population were collated and presented. RESULTS: Literature search revealed eighty two articles pertinent to India, of which only ten articles had relevant information on hereditary cancers. Although the overall incidence of colorectal cancer was low in both genders, there were a high proportion of patients developing colorectal cancer before the age of 45 years. Additionally, there was a higher proportion (10‑15%) of hereditary nonpolyposis colorectal cancer cases, as confirmed by microsatellite instability. CONCLUSION: The overall incidence of colorectal cancer is low in India. There is a tendency to affect a relatively younger age group, and we infer that the incidence of hereditary colorectal cancer is high and is similar to the Western countries.

Seroprevalence Of Hepatitis B Virus In Patients Admitted To Era’S Lucknow Medical College And Hospital

Hepatitis-B Virus infections are a serious global and public health problem. To assess the magnitude and dynamics of disease transmission and for its prevention and control, the study of its seroprevalence is important. A medical college catering to the needs of a large population represents an important centre for serological surveys. Available data, on the seroprevalence of these bloodborne pathogens is also very limited. A study was undertaken to estimate the seroprevalence of Hepatitis-B Surface Antigen (HBsAg) in both the sexes and different age groups in a hospital-based population. Serum samples collected over a period of 24 months from patients admitted to various IPDs of Era’s Lucknow Medical College and Hospital, Lucknow were subjected within the hospital-based microbiology lab for the detection of HBsAg using ELISA test. The seroprevalence of HBsAg was found to be 1.92%. The study throws light on the magnitude of viral transmission in the community in Lucknow city and provides a reference for future studies.

Rupture of Term Noncommunicating Rudimentary Horn of Uterus.

Pregnancy in noncommunicating rudimentary horn is rare. It occurs following transperitoneal migration of sperms or zygote. Uterine rupture usually occurs in 70-80% cases in the second trimester by 20 weeks. Neonatal survival in rudimentary horn pregnancy is poor occurring in only about 11% of cases.

Reliability of Fine Needle Aspiration Cytology (FNAC) in Very Small Breast Lumps.

FNAC diagnosis and subsequent histopathology of 166 breast lumps of different sizes, depth and mobility were studied prospectively over a 10-year period (1990-2000) and grouped into two groups. Group-I of lumps <2cm and Group-II of lumps >2cm (control 80 cases). They were again subclassified as deep or not deep and mobile or fixed. Statistically significant positive correlation was found in all categories for less accurate diagnosis of lumps of <2 cm as compared to those of >2 cm. Therefore, because of low diagnostic accuracy in Group- I, it is recommended that for lumps <2cm even if the FNAC diagnosis is “non-malignant” a lumpectomy histopathological examination be done.

Sentinel lymph node biopsy in gastrointestinal malignancies-Where do we stand.

Sentinel lymph nodes (SLNs) are the nodes in direct communication with the primary tumor and are therefore the first group of nodes to be involved in lymphatic metastasis. Though the role of SLN biopsy is well established in cancers of the breast and melanoma, its role in gastrointestinal malignancies is still evolving and controversial. In this paper, the literature is reviewed with respect to the status of SLN biopsy in gastrointestinal malignancies.

Simultaneous Gastric and Ileal Trichobezoars Causing Small Bowel Obstruction: A Case report.

Bezoars are conglomerates of food or fiber in the alimentary tract of humans and certain animals, mainly ruminants. A trichobezoar represents a mass of accumulated hair. Trichobezoars may present as an isolated gastric mass, as an extension into the small intestine, or as an independent fragmented mass in the small intestine. The presence of discrete coexisting gastric and ileal trichobezoars has been reported only rarely in the literature. This is a case report of a 10-year-old girl presenting with small-bowel obstruction secondary to synchronous trichobezoars in the stomach and ileum. The case highlights the role of imaging and importance of complete evaluation of the gastrointestinal tract at the time of surgical evacuation.

Presence of Hb S in Uttaranchal.

Haemoglobin-S has been reported in several studies on remote populations from various parts of India eg Maharashtra, Madhya Pradesh, Andhra Pradesh, Orissa, West Bengal, Rajasthan and Malaysian Indians. Uttaranchal also has got scattered areas with people living in remote-pockets due to its geophysical nature. There has been no previous report from this state about prevalence of Hb-S. In the present study on 38 individual eight were found to have Hb-S positivity by sickling test. In one of these electrophoretic confirmation was positive with demonstration of associated Beta thalassaemia. The group was a family of muslims in village Baghori near Haldwani. Due to technical, geographical and social restrictions further study could not be done. However, this study does establish the presence of Hb-S-Beta thalassaemia in Uttaranchal State for the first time. Follow up study in the affected area and elsewhere in the state might discover more of Hb-S positivity, other haemoglobinopathies and thalassaemias.

Prophylactic beclomethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study.

BACKGROUND AND AIMS: Radiation induced wet desquamation of skin in carcinoma breast patients is a painful condition. In this study topical beclomethasone dipropionate spray was used as prophylaxis with the purpose of reducing risk of the wet desquamation of skin in irradiated field. MATERIALS AND METHODS: Sixty patients of carcinoma breast were planned for postoperative loco regional radiotherapy (50 Gy in 25 fraction over five weeks) were prospectively randomized into two groups (1) steroid group-patients were advised to use beclomethasone dipropionate spray in irradiated axilla from day one of radiotherapy, (2) control group-patients were not allowed to use any topical agent in irradiated area. Radiation induced skin reaction was noted in terms of erythema, dry desquamation and wet desquamation weekly till end of prescribed 50 Gy dose of the radiation therapy. STATISTICAL METHOD: Chi-square test was used to see the statistical significance of the difference in wet desquamation between two arms of the study. Chi-square value and P-value was calculated for the difference of wet desquamation in two study arms. RESULT: In steroid group 4/30 (13.33%) patients developed wet desquamation of the axillary skin at the end of the radiotherapy. For the control group, this figure was 11/30 (36.66%). The difference in wet desquamation of the axillary skin in the two groups was statistically significant (P-value = 0.0369). CONCLUSION: Topical steroid (beclomethasone dipropionate spray) for skin during radiotherapy significantly reduces the risk of wet desquamation of the skin.

Adjuvant radiation therapy in gall bladder cancers: 10 years experience at Tata Memorial Hospital.

INTRODUCTION AND PURPOSE: In gall bladder cancers, even after curative surgery, survivals are dismal and loco-regional failure accounts for 40-86%. Although these are considered radio-resistant, adjuvant radiation, with or without chemotherapy, has been tried to improve loco-regional control and overall survival rates. With an aim to evaluate the natural history of gall bladder cancers, role of radiation therapy (RT) and prognostication, a retrospective analysis was undertaken. MATERIALS AND METHODS: Between 1991-2000, 60 patients with gall bladder cancer, treated with radical intent, were evaluated. Patients details including history, physical examination, liver function tests, ultrasonography of the abdomen and chest X-ray; and CT scan Abdomen if done, were noted. In patients who underwent surgery, surgical details, histopathology and pathological staging, were recorded. The details of post-operative adjuvant treatment, including radiation therapy details, as well as chemotherapeutic agents, number of cycles and type of infusion [bolus/infusion], were noted. RESULTS: Sixty patients underwent surgery. On histopathological staging, 28 patients (46.5%) had stage II, 19 (32%) had stage III, 12 (20%) had stage-I and 1 patient had stage IV disease. Thirteen (21%) patents did not receive any adjuvant treatment, 32 (53%) patients received adjuvant RT alone, 8(14%) received post-operative CT+RT and 7 (12%) patients received CT alone. With a median follow-up of 18 months (12-124 months), 27 (45%) patients were disease free, 11 (19%) had local failures, 7 (11%) had loco-regional, 7 (11%) loco-regional+distant, 4 (7%) distant and 4 (7%) patients had local+distant failures. The Overall Disease Free Survival (DFS) and overall survival was 30% and 25%, at 5 years, respectively. Stage grouping ('P' = 0.007), Pathological T ('P' = 0.01) had significant impact on DFS on univariate analysis, where as histological grade ('P' = 0.06) showed trend towards significance. CONCLUSION: Gall bladder cancers are aggressive and lethal. Early diagnosis and curative surgery, followed by appropriate adjuvant radiation therapy, may improve survivals, with no established consensus till date. Following curative surgery, pathological T stage and stage grouping, are the significant prognostic factors for outcome.

TORCH infection in women with bad obstetric history--a pilot study in Kumaon region.

TORCH infections in the mother are transmissible to fetus in the womb or during the birth process and cause a cluster of symptomatic birth defects. In mother they are inapparent or asymptomatic and hence difficult to diagnose clinically. Over a nine months period 20 pregnant women with bad obstetric history were-studied. Seropositivity of Toxoplasma, rubella, CMV, and HSV infections (TORCH) were demonstrated by the presence of IgM and IgG antibodies by ELISA method. It was found that, IgM antibodies were positive in 4 cases (20%) for Toxoplasma, 4 cases (28.6%) for rubella and 4 cases (26.7%) for CMV and HSV each. IgG antibodies were positive in 11cases (55%) for Toxoplasma, 10 cases (66.6%) for rubella, 14 cases (93%) for CMV and 11 (73%) for HSV. Therefore all antenatal cases with BOH should be routinely screened for TORCH as early diagnosis and appropriate intervention will help in proper management and fetal outcome.

Breast metastases of gastric signet ring cell carcinoma: a differential diagnosis with primary breast signet ring cell carcinoma.

Metastatic deposits within the breast may be difficult to distinguish from primary breast carcinoma. Radiological features and immunohistochemistry especially for steroid hormone receptors and expression of gross cystic disease fluid protein may be helpful in differentiating these two conditions. In this report, we present a case of signet ring cell stomach cancer with metastasis to the breast and discuss the differential diagnostic options.