“Oxygen Pheriwala: ” An Innovative Model for SARS-CoV-2 Screening in Resource-Limited Settings

The second wave of SARS?CoV?2 infection came as a hypoxic emergency and situation became worse in rural India, where undiagnosed COVID-19 patients died without any diagnosis or intervention. The primary aim of this innovative model was the early diagnosis of suspected SARS?CoV?2 cases, providing empirical treatment and timely referral to appropriate COVID care facilities. Fever was measured with infrared thermometer and oxygen saturation level with pulse oximeter. A total of 8203 people were screened, of which 274 persons were febrile and 69 (25%) were hypoxic too. Sixty?four out of 69 (93%) patients turned COVID?19 positive on reverse transcription?polymerase chain reaction. At the end of 3 weeks, 48/64 (75%) patients were successfully discharged. This model can be easily implemented in resource?limited regions to identify and prioritize the patients not only in this pandemic but also in outbreak of other communicable diseases.

Pseudoaneurysm of Splenic Artery - A Severe Vascular Complication of Pancreatitis

Acute pancreatitis is one of the common abdominal pathologies having an incidence of 10 to 100 cases per 100,000 population worldwide with varying type of presentation ranging from self-limiting abdominal pain to high mortality and morbidity due to organ failure. The major risk factors leading to pancreatitis include gall stones and alcohol consumption, others being trauma, drugs, and infections.1,2 The revised Atlanta classification (2012) has classified acute pancreatitis on the basis of local, systemic complications and organ failure as mild, moderately severe and severe type of pancreatitis. One of the dreaded local complications of pancreatitis are the vascular complications occurring with a frequency of 1.2 - 14 %, with a greater incidence seen in chronic pancreatitis (7 - 10 %) than acute pancreatitis (1 - 6 %). The two main types of vascular complications being splenic vein thrombosis (more common) and pseudo aneurysm of (in order of decreasing frequency) the splenic, gastro duodenal, and pancreaticoduodenal arteries.3,4 The common symptoms of pseudoaneurysm of splenic artery are abdominal pain, hematemesis, melena, flank pain, and chest pain. Haemorrhage from pseudo aneurysm can be found in the pseudo cyst, stomach, pancreatic duct, peritoneal cavity, or retro peritoneum making the patient highly haemodynamically unstable at presentation having high rates of morbidity and mortality.5 The mortality rate due to haemorrhages directly related to the pancreas is up to 50 %.2 Clinical diagnosis in these patients is highly difficult due to varied range of symptoms and hence ultrasound coupled with contrast enhanced CT imaging helps in accurate diagnosing of such an entity.Pancreatitis is one of the common abdominal pathologies having variable type of presentation. Vascular complications are rare, but severe in nature having high mortality and morbidity rates. Ultrasound coupled with computer tomography helps in fast and accurate diagnosis of these vascular complications like pseudo aneurysms, aneurysms and thrombosis of peri pancreatic arteries. We are presenting a case report of pseudoaneurysm of splenic artery.

Knowledge, attitude and practices regarding breastfeeding and infant milk substitutes among mothers of upper middle-class society in a baby friendly hospital initiative accredited hospital of New Delhi, India

Background: Exclusive breastfeeding is considered a major public health intervention to promote both child and maternal health. Introduction and awareness of infant milk substitutes among mothers appear as a threat to this important practice.Methods: The study is an observational cross-sectional study using a questionnaire containing socio-demographic variables. The study was conducted among 300 mothers who reported to immunization clinic and paediatrics OPD of a BFHI accredited hospital in Delhi. Data collected in the study has been analysed using SPSS version 21.0 and MS-Excel. Student 't' test for quantitative variables and 'chi square test' for categorical variable have been used for statistical significance. p-value <0.05 was considered to be significant.Results: In this study 78.7% mothers intended to breastfeed. 71.3% knew that breastfeeding should be continued up to 2 years and 96.3% knew exclusive breastfeed should be given till 6months. Major source of knowledge were doctors and elders of society. However, 49.6% mothers started breastmilk substitutes before 6 months of age. Major causes that appeared as barriers against exclusive breastfeeding were insufficient quantity of milk (23.4%), child refusal (61%) and maternal health problems (15.6%).Conclusions: Despite good knowledge about breastfeeding among upper middle-class mothers, practice of exclusive breastfeeding remains suboptimal. There is a need for more reinforcement upon importance of breastfeeding, its benefits for both mother and baby so as to foster the practice.

Cystic Clear Cell Epithelioid Leiomyoma: An Unusual Presentation.

Epithelioid leiomyoma is a rare variant of leiomyoma.The tumour includes three distinct entities,leiomyoblastoma, clear cell leiomyoma and plexiformleiomyoma. It is histologically characterised byepithelioid cells, clear cells or plexiform pattern invaried proportions. We report a case of a 49-year-oldfemale with complaints of palpable mass per abdomenand spotting per vagina. Radiology revealed a complexcystic mass with obscured right ovary. She underwenttotal abdominal hysterectomy with bilateral salpingooophorectomy. Pathological examination showed aposterior wall lesion with central 9 × 8 cm cyst withmultiple septations and surrounding rim of solid areas.Microscopic examination showed a clear cellepithelioid leiomyoma. No mitosis/tumour cell necrosiswas seen. The clinical course of epithelioid leiomyomais still unclear owing to absence of large studies. Smallsize, clear cell histology, mitosis of < 2/10 High PowerField (HPF) and hyalinization are features of a benigncourse, whereas cellular atypia, mitosis of > 5/10 HPFare definite indicators of a malignant outcome. Anepithelioid leiomyoma with, size >6 cm moderateatypia, necrosis and mitosis of 2-5/10 HPF are termedas smooth muscle tumours of uncertain malignantpotential and should be under close follow up.

Prognostic Information From Chemotherapy–Associated Changes In Bone Marrow Metastasis Of Neuroblastoma– A Case Report

Neuroblastoma is the most common extra–cranial solid tumour in children. Bone marrow examination is a part of diagnosis and staging workup of neuroblastoma. Chemotherapy forms mainstay of treatment and post–chemotherapy histological changes are an important indicator of prognosis. A 4–year–old male child came with complaints of fever and hepatomegaly. Investigations revealed a retroperitoneal neuroblastoma. Bone marrow was involved by neuroblasts (stage 4S). Platinum–based chemotherapy was started and post–induction phase bone marrow showed differentiation of neuroblasts to ganglion cells and schwannian stroma (tumour load <5%, minimal disease). The patient was lost to follow up thereafter. The patient returned after one year with the reappearance of neuroblasts (tumour load >20%, relapse) in the bone marrow. Use of immunohistochemical markers like chromogranin and S100 are helpful to map the tumour load and identify the tumour cells when they are sparse. Persistence / reappearance of neuroblasts post–chemotherapy or increasing tumour load indicate a relapse.

Intravascular Large B-cell Lymphoma – Morphological Diagnosis in the Molecular Era

Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of diffuse large B-cell lymphoma, characterized by its unique morphology. Modern-day diagnostic methods like flow cytometry have limitations in accurate diagnosis of the disease making morphology the mainstay for its diagnosis and adequate management. Here, we present a case of IVLBCL with emphasis on diagnostic aids and adjuncts. A 63-year-old female presented with fever of unknown origin, seizers, hepatosplenomegaly, and peripheral cytopenias. Bone marrow aspirate shows a small number of atypical lymphoid cells. Flow cytometry done on the aspirate yielded 7% abnormal lymphoid cells; however, further, subclassification of this non-Hodgkin lymphoma was not aided by it. Bone marrow biopsy revealed the intrasinusoidal localization of the tumor cells, which were positive for CD20, BCL2, and Mum1 and along with flow cytometric expression of CD5 and lambda restriction of tumor cells; a diagnosis of IVLBCL was made. IVLBCL is a rare entity with protean clinical presentation which frequently leads to a delay in diagnosis. Modern diagnostic modalities like flow cytometry help in picking up even a small number of tumor cells; however, it is limited by failure to subcategorize the entity making morphology and immunohistochemistry as the backbone of its diagnostic workup.

Neonatal sepsis in a tertiary care hospital in Delhi, India: study of microbial profile and antimicrobial susceptibility pattern

Background: Sepsis is one of the most common cause of neonatal deaths globally more so in low and middle-income countries. The key to management is high degree of clinical suspicion and prompt initiation of empirical antibiotic therapy pending investigations' results. Knowledge of one's own NICU flora and antimicrobial susceptibility pattern guides in choosing correct antibiotic therapy to pediatrician. If this data is standard and comparable across different sites, then it also helps in formulating regional and National treatment guidelines. Present study was therefore undertaken to study microbial flora of present NICU and analyze their antimicrobial susceptibility pattern and formulate antimicrobial policy.Methods: Data of blood culture isolates sent from suspected cases of neonatal sepsis received from January 2017 to July 2018 was analysed by 'WHONET'.Results: One hundred ninety-three non-repeat isolates were obtained from 992 blood culture samples. Coagulase negative Staphylococcus and K. pneumoniae were the most common isolates. Non albicans Candida were responsible for majority of fungal infection. There was an outbreak of C. pelliculosa for six months. Most of the bacteria were multidrug resistant (MDR). However, except one all other Candida isolates were sensitive to antifungal drugs.Conclusions: WHO guidelines suggest use of penicillin and gentamicin for neonatal sepsis. But in present study, they were not found useful, instead amikacin, netilmicin and piperacillin-tazobactam were found useful and changes were made in antibiotic policy. Authors therefore recommend regular monitoring of antimicrobial susceptibility pattern followed by necessary changes in antibiotic policy for reasonable empirical therapy.

Parental Expectation from Children with Cochlear Implants in Indian Context: a Questionnaire Based Study

Abstract Introduction Parental support is important in the habilitation/rehabilitation of children using cochlear implant devices. Hence, it is important for families to know the realistic expectations regarding outcomes from CIs. Objective The objective of the present study is to know the parents' expectation from children using CIs. Methods For this study, we recruited 23 parents of children using CIs. We administered 15 questions translated in to Hindi related to communication abilities, social skills, academic achievement, change in future life, rehabilitation demand, and stress due to hearing impairment. Results The response of the questions (5-point rating scale) related to communication abilities showed that parents were expecting children using CIs to use the telephone (95%), to be able to detect soft sounds (99%), to listen in crowds (86%), to be able to easily understand others (76%), and to show improvement in communication skills (78%). Similarly, for questions related to social skills showed 90% of the parents expecting that their children with CIs should be able to easily make friends with normal hearing peers, and 80% of the parents were expecting the children to achieve high standards in their reading and writing skills. Questions related to change in future life showed 86% of the parents expecting their children with CIs to act like normal hearing children. Further, 78% parents showed positive response regarding importance of intensive training. However, 70% of the parents reported stress in the family due to the existence of the hearing impaired child. Conclusion Overall, the existing questionnaire-based study showed that parents have high expectations from their children with cochlear implant.

Comparison of the Effect of Transpalatal Arch on Periodontal Stress and Displacement of Molars When Subjected to Orthodontic Forces. A Finite Element Analysis.

Introduction: The transpalatal arch has been used successfully for decades during routine orthodontic treatment for various purposes, including reinforcing anchorage. In the light of current scientific advancements with more precise knowledge of biology of tooth movement, it is prudent to study whether transpalatal arch is effective in preserving anchorage. Objectives: The aim of this finite element study was to evaluate and compare the effects of the transpalatal arch on periodontal stresses of molars and displacements when subjected to orthodontic forces. Methods: Stress patterns and displacements between models with and without a transpalatal arch were investigated by means of 3-dimensional finite element analysis. A finite element model of the maxillary first molars, periodontal ligament, alveolar bone, and transpalatal arch was created, that consisted of 1, 69,036 elements and 29,518 nodes. A simulated orthodontic retraction force of 2N was applied to the maxillary first molar in a mesial direction. Resultant von mises stresses were evaluated and compared in models with and without transpalatal arch, as well as displacement in models with and without transpalatal arch. Results: Results suggested that the presence of a transpalatal arch has no effect on molar tipping, decreases molar rotations, and reduces periodontal von mises stress magnitudes by less than 1%. Conclusions: The presence of the transpalatal arch induces only minor changes in the dental and periodontal stress distribution. Alternative methods can be used where absolute anchorage is required however transpalatal arch should not be considered an unnecessary tool in the treatment of orthodontic patients because of its various functions.

MSX1 Polymorphism in an Eastern Nepalese Non Syndromic cleft lip/palate patient population.

This study was carried out to evaluate the role of MSX1 799 G >T gene polymorphism with non Syndromic cleft lip/palate in Eastern Nepalese patient population. For the study, whole blood samples (2 ml) were obtained from 40 subjects and controls. Genomic DNA was extracted from the blood of the subjects by using ethanol, chloroform treatment. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to check for the presence of polymorphism. The results indicated that a patient has MSX1 799 G>T variant. The patient was a male aged 24 years was a complete unilateral left sided cleft lip/palate involving alveolus, hard and soft palate. He had normal development and no associated anomaly. There was no family history of cleft lip/palate and no history of any teratogenic exposure during embryonic life as revealed by his mother. This may be a case of sporadic polymorphism. It may be concluded that ,although we detected the presence of a MSX1 799 G>T polymorphism in one patient, a further investigation with large sample size, including many SNP’s on families must be performed to get conclusive results.

Perceived Source of Stress Among Undergraduate Dental Students at BPKIHS, Nepal.

Stress is defined as the body's nonspecific response or reaction to demands made on it, or to disturbing events in the environment. The current study was undertaken to determine the prevalence of the sources of stress among the undergraduate dental students of, BPKIHS, Nepal. The descriptive cross sectional study was conducted using the Dental Environmental Stress Questionnaire (Westerman et al, 1993). The questionnaire was administered in the classroom. Data analysis was carried out using SPSS version 12.0.Based on the results obtained it was concluded that fear of failing, academic workload and requirements for completing the graduation were the most prevalent stressors. Clinical factors related to lack of time, patients unavailability and attitude of the faculty were considerately stressful. The living conditions and social factors were found to be the least of the stressful events. Factors related to marriage and children were deemed not related to creating any stress in the academic environment.This study highlights a need to review the current curriculum of the undergraduate students and to make suitable modifications to create a less stressful study environment for the future dentists of the country.