Effects of Child Abuse and Neglect on Oral Hygiene and Nutrition in North Indian School Students: A Cohort Study

This study investigated the relationship between dental hygiene and child maltreatment, malnutrition, and overall development. The researchers examined 900 students aged 5-15 years from government schools in Lucknow district, Uttar Pradesh. The study observed nutritional status by assessment of the physiological status of the body based on its height and weight and signs of abuse/neglect. The results showed that 260 abused students had poor dental hygiene, and 236 of them were mild to moderately malnourished. In comparison, 362 non-abused students had dental neglect, and 232 were moderately malnourished. These findings highlight a significant association between dental care neglect, child maltreatment, and malnutrition. It is crucial to address the social stigma surrounding this issue, normalize discussions, and encourage dentists to identify signs of abuse and inform relevant authorities about potential discrepancies.

Correlation between parasitemia and different complications of malaria – The clinical outlook

Background: Malaria is one of the most severe public health problems worldwide. India contributes a substantial burden of malaria. It can cause several complications. Aims and Objectives: This study was conducted to determine the association of parasitemia of current malaria with age of patients, hemoglobin level, liver function test (LFT), platelet count, previous history of malaria, and relapse/recrudescence of malaria up to 1 year. Materials and Methods: An observational study conducted in hospital settings included thin and thick smear preparation with Leishman’s staining to determine the parasitemia as per the WHO guidelines from the blood samples of 280 malaria parasite dual antigen (MPDA) kit positive patients and their details were taken during study period of 2 years. Hemoglobin, LFT, and platelet count were tested and they were correlated with parasitemia. The previous history of malaria was taken and follow-up was done up to 1 year for relapse/recrudescence and their association with parasitemia in current disease was evaluated. Statistical tool R was used for data analysis. Results: Age group 20–40 years was most commonly affected with maximum mean percentage parasitemia. Higher parasitemia was associated with higher grade of anemia, LFT derangement, and thrombocytopenia. Disease severity was maximum for mixed infection followed by falciparum and vivax malaria. About 9.28% of patients with the previous history of malaria developed lower parasitemia in current infection. Relapse rate in vivax malaria –2.325% and recrudescence rate in falciparum malaria–12.5%. Conclusion: Malaria parasitemia should be reported routinely as it carries prognostic importance.

Immunohistochemical appraisal of epithelial mesenchymal transition type III in gall bladder cancer

Background: Epithelial-mesenchymal transition (EMT) is the heart of invasion. EMT associated with cancer progression and metastasis is known as type III EMT. Beta-catenin, E-cadherin, and MMP9 markers of EMT are routinely employed for diagnostic purposes. Aims: We employed these markers to study EMT by immunohistochemistry (IHC) in gall bladder cancer (GBC) with respect to depth of tumor invasion, clinical outcome, and disease-free survival. Settings and Design: This was a prospective case-control study. Material and Methods: Seventy gall bladders were included (50 GBC and 20 CC). After detailed histology, immunoexpression was studied in terms of percentage and strength of expression. Statistics Analysis Used: Expression was compared between CC and GBC by Student t test and analysis of variance. Kaplan–Meier was used for survival analysis, and the extent of agreement (“Kappa”) was calculated. Results and Conclusions: The age of incidence of GBC was 49.40 (+11.6) years with female predominance (F:M = 4:1). In 88% (44/50) of GBC, the fundus was involved. Moderately differentiated adenocarcinoma was most frequent [54%; 27/50]. Significant downregulation of E-cadherin (P = 0.022) and beta-catenin (P < 0.001) and upregulation in MMP9 (P < 0.001) were seen in GBC with respect to CC with significant association among them. MMP9 expression was significantly associated with higher tumor stage but with chemotherapeutic response. Our results display that epithelial-mesenchymal transition type III plays a role in GBC invasion. MMP9 overexpression and loss of membranous beta-catenin may be considered a marker for poor clinical outcomes and advanced disease.

Small cell neuroendocrine carcinoma with primary orbital involvement – The unseen, and a review of literature

Neuroendocrine neoplasms are derived from the epithelial lineages mainly of respiratory tract, with predominant neuroendocrine differentiation. There are only a handful of documented cases of paranasal small cell neuroendocrine carcinomas (SNEC) with primary orbital involvement. Here, the authors describe a 33-year-old male patient with rapidly progressive swelling of the right lower lid with proptosis since 4 weeks. On contrast-MRI orbit, an ill-defined multilobulated mass measuring 3.6 × 3.1 cm with intense homogenous enhancement was seen in the right retrobulbar space involving the right ethmoid sinus. On incisional biopsy, a poorly differentiated mass containing numerous small round blue cells and scanty intervening stroma with prominent necrosis and apoptosis was seen. Immunohistochemistry was strongly positive for synaptophysin. He was diagnosed as a case of SNEC and received chemotherapy, with good response till date of 9 months of follow up. The authors present a literature review and describe challenges in management of a primary orbital SNEC.

Merits and demerits of technical shift of biochemistry classes of medical undergraduates from classroom to online teaching in COVID-19 pandemic: A cross-sectional survey

Background: The ongoing global pandemic due to novel corona virus (SARS-CoV2) has jeopardized our lives from all corners. With the exponential growth of cases, even Medical institutes have curtailed physical classes and shifted to virtual classrooms. The medical graduates have exposure to online education due to vanguard of technology. However, in dwindling of COVID-19 struck economy in a developing country like India, all the medical graduates may not be privileged to have access the android phone or fast-streaming internet. Aims and Objectives: The purpose of this survey was to evaluate the impact and impression of online classes among facilitators and students. Materials and Methods: This cross-sectional study was conducted in the Department of biochemistry of Nil Ratan Sircar Medical College after obtaining Institutional Ethical Clearance. The students and faculties who voluntarily agreed to participate in the study were given a questionnaire. The responses were recorded in five-point Likert Scale. Results: Both the medical undergraduates and facilitators had a consensus opinion (0.61 and 0.71, respectively) that simultaneous access to multiple website is merit of e-learning. About 81.5% had a strong consensus opinion that there less chances of interaction with the facilitators. About 66.7% of facilitators either agreed or strongly agreed that there are hurdles to motivate the students in virtual platform. The ordinal logistic regression analysis revealed interaction with facilitators and easy of assessment is important predictors for successful outcome of online education. Conclusion: The study concluded that scope of interaction and self-motivation of the students remains to be cornerstone for the successful outcome of virtual teaching sessions. The outcome of this study may guide to identify lacunae and advantages of online methodologies in comparison to the physical classrooms.

Assessment of mental well-being in first year medical students

Background: Mental health is one of the most important domains of the overall health of an individual and has received a worldwide concern as an important public health issue. In the present times, health professionals have to face a lot of issues regarding the work stress for providing the best healthcare to the needed ones. Hence, the foundation for emerging as an efficient health-care provider starts from the time when one enters into a medical college. Aim and Objectives: The aim of the study was to assess the status of mental health in first medical students. Materials and Methods: A self-administered questionnaire based on Depression, Anxiety, and Stress Scale-21 (DASS-21) scale was provided to the participants who were willing to participate in the study. Percentage of total subjects enrolled was categorized into normal, mild, moderate and severe degrees of depression, anxiety, and stress depending on feedback provided by them based on DASS-21 scale. Results: Mild depression was present in 40% and moderate degree of depression was seen in 50% of total subjects taken. About 70% of students reported a state of moderate anxiety and 20% students reported severe anxiety. Severe stress was seen in 30% of total subjects taken and 60% of subjects reported moderate degree of stress. Conclusion: It was reported that moderate level of depression, anxiety, and stress is present in a significant percentage of 1st year medical students as indicated by the score of DASS-21 scale.

Evaluation of awareness, acceptability, and clinical outcome of postpartum vaginal insertion and intra-cesarean insertion of intrauterine contraceptive device

Background: Post-placental and intra-cesarean insertion of intrauterine contraceptive devices (PPIUCD) is a lucrative family planning method which provides safe, effective reversible, inexpensive, non-hormonal, and long-acting contraception. Aims and Objectives: The objective of the study is to evaluate the postpartum insertion of intrauterine contraceptive device in terms of awareness, acceptance, safety, efficacy, continuation, and removal rate and its complications in both vaginal as well as intra-cesarean section (CS) insertion. Materials and Methods: Prospective observational study conducted in Obstetrics and Gynaecology Department GMERS sola for 6 months. Two thousand and ninety-four pregnant women from labor room who delivered vaginally or by CS during study period were asked regarding their knowledge and acceptability for PPIUCD. Results: Total 2094 women evaluated for awareness and acceptance for PPIUCD. About 68.66% were familiar with the concept with 29.99% giving verbal consent for its insertion. About 60.01% women refused for various reasons. Conclusion: This study shows that PPIUCD insertion is a safe and convenient method which requires more population awareness, counseling, and usage.

AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair

@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients

@#Introduction: Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods: This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results: None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion: This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Diagnostic accuracy of saliva as a specimen for detection of SARS-CoV-2 by RT-PCR

Context: COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emerging pandemic that is rapidly spreading with more than 114 million confirmed cases and 2.5 million deaths by far. Nasopharyngeal swab (NPS) in VTM has been used as the gold standard respiratory specimen for SARS-CoV-2 reverse-transcriptase real-time PCR (rRT-PCR) tests. But now the virus can also be detected in other clinical specimens like bronchoalveolar lavage, sputum, saliva, throat swab, blood, and stool specimens. Aims: The aim of this study was to determine the diagnostic potential of saliva as a sample in comparison to NPS for detection of SARS-CoV-2 by rRT-PCR. Settings and Design: A cross-sectional study was conducted among 256 paired samples (NPS and Saliva) received in the Department of Microbiology, SMS Medical College, Jaipur over a period of 2 months Methods and Material: NPS from individuals were collected in a sterile tube containing Viral Transport Medium™. Before swab collection, whole saliva was collected by spitting from the suspected patient into a sterile container. Both were stored at room temperature and transferred to the diagnostic laboratory within four hours of collection where extraction was done using Perkin Elmer chemagic extractor and rRT- PCR was performed using NIV, Pune mastermix. Results: Sensitivity, specificity, PPV, and NPV of RT-PCR for the diagnosis of COVID-19 in saliva were 84.26%, 100%, 100%, and 54.05%, respectively. The accuracy of detection of COVID-19 by saliva samples compared to the routinely used NPS samples (considered as the standard reference) for RT PCR was 86.72%. Conclusions: Our results show that saliva as a reliable sample type for SARS-CoV-2 detection.