Study of knowledge, attitude, practices regarding PPIUCD among antenatal women at a tertiary care centre in Northern India

Background: PPIUCD has been introduced in the national family welfare program since March 2010 in several states. AN IUCD can be inserted in 48 hours postpartum, referred to here as postpartum intrauterine contraceptive device. This study was done to assess the Knowledge, attitude and practice of postpartum Intrauterine contraceptive device in antenatal patients at a tertiary care centre in Northern India.Methods: This is a questionnaire based cross sectional observational study including 350 antenatal women attending antenatal OPD over a period of 6 months.Results: Out of these 350 women, 126 women (36%) had knowledge of PPIUCD. only 30 % of women had previous knowledge about PPIUCD however only 10 % of women practiced it in the past. After appropriate counselling 18% of women agreed for insertion of PPIUCD after this delivery.Conclusions: The study concludes that the antenatal women had poor knowledge regarding PPIUCD. Practices were even worse. This might be attributed to low education ,  refusal by family especially male partner, and religious beliefs. But once appropriate knowledge and information is provided, attitude gradually changes.

Antibacterial stability of Spondias pinnata (L. f.) Kurz leaves extract and its mechanism

Aims@#This study was conducted to observe the stability of Spondias pinnata leaf (SPL) extract antibacterial at different pH, salt concentration and temperature, to examine its antibacterial effectivity on minced fish, and to determine its fraction’s antibacterial mechanism.@*Methodology and results@#The tested SPL ethanolic extract, n-hexane, chloroform, ethyl acetate and water fractions’ antibacterial activity against Bacillus cereus and Vibrio parahaemolitycus. Its stability against pH, salt, and thermal variation was studied, as well as the mechanism and application in fish. Ethyl acetate fraction and water fraction showed the highest activity against B. cereus (MIC 0.62 mg/mL). Protein profile analysis using gel electrophoresis showed that B. cereus cells exposed with SPL ethyl acetate fraction and water fraction showed thinner protein bands as compared to control. Severe damage of the cells treated with 3 MIC was also observed under SEM. Antibacterial activity of SPL ethanolic against Bacillus cereus and Vibrio parahaemolitycus were stable against heat treatment (80–121 °C for 15 min) and NaCl treatment (0–10% w/v), whereas the inhibition zone respectively at pH 4 (10.31±0.25 and 8.09±0.97 mm) was higher than pH 7 (8.45±0.52 and 6.66±1.84 mm). Application of SPL ethanolic extract in fish broth showed higher antibacterial activity than in fish flesh, which gave bactericidal effect at 3 MIC.@*Conclusion, significance and impact of study@#Ethanol extract can be developed as a natural preservative in fish

Metastatic adenocarcinoma of the cervix presenting as a choroidal mass: A case report and review of literature of cervical metastases to the eye.

Cervical cancer is the most common cancer among females in India. Cervical cancer usually spreads by local extension and through the lymphatic drainage to the lymph nodes. Hematogenous spread, the mechanism responsible for distant metastases, is rarely seen in cervical malignancies. In this communication, we report a case of a 45-year-old woman who presented with unilateral decrease in vision of 3 months duration. She was found to have a serous retinal detachment with underlying diffuse, subretinal yellowish-cream colored infiltrates in the right eye, suspicious of choroidal metastases. Systemic evaluation showed disseminated systemic metastases arising from a primary adenocarcinoma of the cervix. In this communication, we review all the documented cases of metastases to the eye and adnexa arising from cervical cancer and their clinical characteristics. Unilateral choroidal metastasis arising from an adenocarcinoma of the cervix is extremely rare with only one previous documented case. Although uncommon, choroidal metastasis may be the presenting feature of primary cervical malignancy. Furthermore, cervical malignancy must be ruled out in women who present with orbital or choroidal metastases arising from unknown primary.

Bilateral periorbital and cervicofacial emphysema following retinal surgery and fluid gas exchange in a case of inadvertent globe perforation.

Surgical emphysema is defined as gas or air trapped in the subcutaneous tissue plane. Here, we report a rare case of bilateral periorbital and cervicofacial subcutaneous emphysema following a vitreoretinal surgery for inadvertent globe perforation during the administration of peribulbar anesthesia. This condition, although self‑resolving when restricted to the subcutaneous plane has the potential to spread into deeper tissue planes such as the retropharyngeal space. The presence of crepitus helps to distinguish it from angioneurotic edema. Ophthalmologists must be sensitive to the fact that surgical emphysema can be a very rare, but possible complication of an intraocular surgery following globe perforation.

Diagnostic accuracy of spot and timed measurements of urinary albumin concentration to determine microalbuminuria in sickle cell disease / Precisión diagnóstica de las mediciones puntuales y cronometradas de la concentración de albúmina en orina para determinar la microalbuminuria en la enfermedad de células falciformes

OBJECTIVE: Whereas measurement of albumin:creatinine ratio (ACR) in spot urine samples is indicated for determining microalbuminuria, its performance or that of urinary albumin excretion rate (UAER) in predicting microalbuminuria in sickle cell disease (SCD) is unclear. We therefore tested the diagnostic performance of these measures in spot and timed urine samples in predicting a UAER in 24-hour samples. METHODS: Thirty participants with SCD had spot, two-hour and four-hour, followed by 24-hour urine collections for ACR, urinary albumin concentration (UAC) and UAER determinations. Receiver operating characteristic (ROC) curve analyses were performed. RESULTS: The areas under the ROC curves for microalbuminuria were 0.99 (CI: 0.97, 1.00) for ACR and 0.97 (CI: 0.92, 1.00) for UAC in spot urine samples. For ACR, at the cut-point of 4.13 mg/mmol, there was 100% sensitivity and 82.6% specificity, allowing an 86.2% correct classification. At the cut-point of UAC = 20.9 mg/L, there was 100% sensitivity and 73.9% specificity, allowing a 79.3% correct classification. Corresponding areas for microalbuminuria in two-hour timed samples were 0.99 (CI: 0.95, 1.00) for ACR and 0.96 (CI: 0.89, 1.00) for UAER. For ACR, the cut-point was 4.64 mg/mmol with 83.3% sensitivity and 91.3% specificity, allowing an 89.7% correct classification. Similarly for UAER, at the cut-point of 21.8 µ/min, there was 83.3% sensitivity and 91.3% specificity, allowing 89.7% correct classification. CONCLUSIONS: The diagnostic performance of ACR and UAC in a spot as well as ACR and UAER in two-hour timed urine samples in patients with SCD is excellent. Healthcare professionals can confidently utilize these measures in this patient population.

OBJETIVO: Si bien la medición del índice urinario albúmina:creatinina (IAC) en muestras de orina puntuales se indica para la determinación de la microalbuminuria, no está clara su eficacia, ni la de la tasa de excreción de albúmina urinaria (TEAU), en la predicción de microalbuminuria en la enfermedad de células falciformes (ECF). Por lo tanto, sometimos a prueba la eficacia diagnóstica de estas mediciones puntuales y cronometradas de las muestras de orina a la hora de predecir una TEAU en muestras de 24 horas. MÉTODOS: A treinta participantes con ECF se les tomaron muestras puntuales de orina, a las dos horas y a las cuatro horas, seguidas por muestras de orina de 24 horas para el IAC, la concentración de albúmina urinaria (CAU), y las determinaciones de TEAU. Se realizaron análisis de la curva de las características operativas del receptor (ROC). RESULTADOS: Las áreas bajo las curvas ROC para la microalbuminuria fueron 0.99 (CI: 0.97, 1.00) para IAC y 0.97 (CI: 0.92, 1.00) para CAU en muestras puntuales de orina. Para IAC, en el punto de corte de 4,13 mg/mmol, hubo 100% sensibilidad y 82.6% de especificidad, lo que permite una clasificación 86.2% correcta. En el punto de corte de CAU = 20,9 mg/L, hubo un 100% de sensibilidad y 73.9% de especificidad, lo que permitió una clasificación 79.3% correcta. Las áreas correspondientes para la microalbuminuria en muestras de tiempo de dos horas fueron 0.99 (CI: 0.95, 1.00) para IAC y 0,96 (CI: 0.89, 1.00) para TEAU. Para IAC, el punto de corte fue 4.64 mg/mmol con 83.3% de sensibilidad y 91.3% de especificidad, lo que permitió una clasificación 89.7% correcta. Del mismo modo para TEAU, en el punto de corte de 21.8 µ/min, hubo una sensibilidad de 83.3% y una especificidad de 91.3%, lo que permitió una clasificación 89.7% correcta. CONCLUSIONES: La eficacia diagnóstica de IAC y UAC en un punto así como el IAC y la TEAU en muestras de orina de tiempo de dos horas en pacientes con ECF es excelente. Los profesionales de la salud pueden utilizar estas mediciones con confianza en esta población de pacientes.

Dentigerous cyst with an impacted third molar obliterating complete maxillary sinus.

Dentigerous cyst is the most commonly occurring odontogenic cyst after radicular cyst and accounts for 15% of all true cysts in the jaws. The cyst is more common in mandible than in maxilla. The dentigerous cyst is commonly associated with impacted mandibular third molars. In maxilla, the incidence is rare. Dentigerous cyst in maxillary sinus in association with an impacted third molar is an uncommon entity. We present a case of dentigerous cyst associated with an impacted third molar, completely obliterating the maxillary sinus in a 28-year-old female.

Impact of yoga on haemodynamic function in healthy medical students / Impacto del yoga en la función hemodinámica de estudiantes de medicina saludables

OBJECTIVES: Yoga improves cardiovascular health in both healthy individuals and those with diagnosed heart disease. This study compares changes in some cardiovascular parameters before and after the practice of Yoga in healthy medical students. METHODS: Sixty-four healthy medical students (57 females and 7 males), mean age 21.3 ±2.6 years, attending a Special Study Module 'Role of Dhyana Yoga in Stress Management', participated in this study. Systolic (SYS) and Diastolic (DIA) blood pressure, Heart Rate (HR), Stroke Volume (SV), Cardiac output (CO), Total Peripheral Resistance (TPR), Interbeat Interval (IBI), Left Ventricular Ejection Time (LVET), Arterial Compliance (Cwk) and Ascending Aorta Impedance (Zao) were measured before and after six weeks of yogic exercises. Various exercises included asanas (Postures), pranayama (Breathing), and dhyana (Meditation). Data were analyzed using Statafor WindowsTM. RESULTS: Two-tailed paired t-test revealed that practice ofyoga caused significant increases in HR (p < 0.05), SV (p < 0.01), CO (p < 0.001) and Cwk (p < 0.01) and decreases in TPR (p < 0.001), IBI (p < 0.05) and Zao (p < 0.001) after practising yoga for 6 weeks as compared to before yoga practice. No significant differences were, however, observed in SYS, DIA, Mean arterial blood pressure (MAP) and LVET. CONCLUSIONS: Practice of yoga even for a short period showed ability to improve most of the cardiovascular functions. Regular practice ofyoga for a longer period may further improve these functions and possibly result in improved management oftheir daily stress.

OBJETIVOS: El yoga mejora la salud cardiovascular tanto en individuos sanos como aquellos con diagnóstico de enfermedad cardíaca. Este estudio compara cambios en algunos parámetros cardiovasculares antes y después de la práctica del yoga en estudiantes de medicina saludables. MÉTODOS: Sesenta y cuatro estudiantes de medicina saludables (57 mujeres y 7 hombres), con una edad promedio de 21,3 ± 2.6 años, que asistían a un módulo especial de estudio "Papel de DhyanaYoga en el manejo del estrés", participaron en este estudio. Antes y después de seis semanas de ejercicios yoga, se midieron la presión arterial sistólica (SIS) y diastólica (DIA), ritmo cardíaco (RC), volumen sistólico de eyección (VS), gasto cardíaco (GC), resistencia periférica total (RPT), tiempo de intervalos interpulsos o interlatidos cardiacos (IBI), tiempo de eyección ventricular izquierda (TEVI), distensibilidad arterial Windkessel (Cwk) y la impedancia de la aorta ascendente (Zao). Los diversos ejercicios incluyeron asanas (posturas), pranayama (respiración) y dhyana (meditación). Se analizaron los datos usando Stata de Windows. RESULTADOS: La prueba T pareado de dos colas, reveló que la práctica del yoga causaba importantes aumentos del RC (p < 0,05), VS (p < 0,01), GC (p < 0,001) y Cwk (p < 0,01) y disminuciones de RTP comparación con la situación antes de la práctica de yoga. Sin embargo, no se observaron diferencias significativas en SIS, DIA, MAP y TEVI. CONCLUSIONES: La práctica del yoga incluso durante un corto período mostró capacidad para mejorar la mayoría de las funciones cardiovasculares. La práctica regular del yoga por un período más largo puede mejorar aún más estas funciones, y posiblemente traer como resultado una mejoría en el manejo del estrés cotidiano.

Patient-physician communication / La comunicación paciente-médico

Extensive research has shown that no matter how knowledgeable the physician might be, if he/she is not able to open good communication channels with the patient, he/she may be of no help to the latter. Despite this known fact and the fact that a patient-physician consultation is the most widely performed 'procedure ' in a physician's professional lifetime, effective communication with the patient has been found to be sadly lacking. This review article seeks to discuss 'the what, 'the why' and 'the how' of doctor-patient communication.

Las investigaciones han demostrado abundantemente que no importa cuán profundos sean los conocimientos del médico, si no puede abrir un buen canal de comunicación con el paciente, no podrá ser de ayuda alguna a este último. A pesar de este hecho conocido y el hecho que una consulta paciente-médico es el 'procedimiento' más ampliamente realizado a través de la vida profesional de un médico, se ha hallado que lamentablemente falta una comunicación efectiva con el paciente. Este artículo examina discutir "el qué", "el por qué" y "el cómo" de comunicación doctor-paciente.

Anterior dislocation of a sulcus fixated posterior chamber intraocular lens in a high myope.

A 31-year-old man with high axial myopia and strabismus fixus convergens underwent bilateral refractive lens exchange followed by a squint surgery (bilateral superior partial Jensen's procedure and medial rectus recession). After one year he presented with traumatic anterior dislocation of the sulcus fixated posterior chamber polymethyl methacrylate lens. The lens was dialed back into the ciliary sulcus without any complications. This case highlights the importance of implanting an intraocular lens (IOL) in-the-bag. If the IOL needs to be implanted in the sulcus, a larger diameter of the IOL with larger optic size and overall length is desirable, especially in highly myopic eyes.

Intrathoracic and pelvic extramedullary haematopoiesis in sickle cell disease: a case report

Intrathoracic extramedullary haematopoiesis is a rare entity encountered in patients with long standing anaemias such as thalassaemia and congenital spherocytosis. It is rare in patients with homozygous sickle cell disease; only 11 cases of intrathoracic and two cases of pelvic extramedullary haematopoiesis have been documented in the literature. We report the case of a 30-year old man with homozygous sickle cell disease with intrathoracic and pelvic extramedullary haematopoiesis, the first case to be documented from the Caribbean.

La hematopoyesis extramedular intratorácica es una entidad que raras veces se encuentra en pacientescon anemias de larga duración tales como la talasemia y la esferocitosis congénita. También es rara en pacientes que padecen la enfermedad de células falciformes homocigóticas. En la literatura se han documentado sólo 11 casos de hematopoyesis extramedular intratorácica y dos casos de hematopoyesis extramedular pélvica. Reportamos el caso de un hombre de 30 años de edad con la enfermedad decélulas falciformes homocigóticas con hematopoyesis extramedular intratorácica y pélvica – el primercaso que se documenta en el Caribe.

Component structure of the SF-36 in Jamaicans with sickle cell disease

OBJECTIVES: Sickle cell disease (SCD) is the commonest genetic disorder in Jamaica and greatly affects the quality of life (QOL) of those who are afflicted. The Short Form 36 survey (SF-36) questionnaire is one of the most commonly utilized measures of QOL. Physicians cannot interpret QOL measures until the instruments being used to make assessment are adequately established in their population. The Jamaican cultural and educational systems expose its people to many stresses which likely impact on their QOL. It is thus postulated that the QOL construct may exhibit a different structure for the population with sickle cell disease. SUBJECTS AND METHODS: The SF-36 v.2 was interviewer administered to the Jamaican Sickle Cell Disease Cohort Study participants ('Cohort' sample) and a random sample of adult sickle cell unit patients ('Main'sample). Demographic data were also collected on both groups. Both of the samples did not meet the five rule criteria for compliance with the original SF-36 component structure. Hence, principal components analysis was used to determine the component structure of the SF-36 in both groups. RESULTS: Three dimensions may underlie the SF-36 for both groups and these could be labelled 'Physical Health', 'Mental Health' and 'Role Limitations'. This solution accounted for 45.8% of the variability underlying the SF-36 in the 'Cohort'sample and 54.6% of the variability in the 'Main' sample. CONCLUSIONS: It concluded that within Jamaican samples of patients with sickle cell disease, the SF-36 has a component structure which is quite distinct from that initially proposed by its creators.

Objetivos: La enfermedad de células falciformes (ECF) es el trastorno genético más común en Jamaica y afecta grandemente la calidad de vida (CdV) de quienes la padecen. El cuestionario de salud SF-36 es una de las mediciones de la CdV más comúnmente usadas. Los médicos no pueden interpretar lasmediciones de la CdV hasta que los instrumentos usados para realizar la evaluación se establezcan de forma adecuada a su población. La cultura y los sistemas educacionales en Jamaica, exponen a su población a muchas formas de estrés que afectan probablemente su CdV. De este modo, se postula que el constructo CdV puede presentar una estructura diferente para esta población. Métodos: El cuestionario SF-36 v.2 fue aplicado por el entrevistador a los participantes en un estudio de cohorte de la enfermedad de células falciformes en Jamaica (muestra de “cohorte”) y a una muestra aleatoria de pacientes adultos de la unidad de anemia falciforme (muestra “principal”). Se recogierondatos demográficos de ambos grupos. Ninguna de las muestras satisfizo los cinco criterios normativos de conformidad con la estructura original de los componentes del SF-36. Por consiguiente, se recurrió al análisis de los componentes principales a fin de determinar la estructura de componentes del SF-36 en ambos grupos. Resultados: Tres dimensiones pueden subyacer en el SF-36 para ambos grupos. Estas pueden ser llamadas “salud física”, “salud mental”, y “limitaciones de roles”. Esta solución dio cuenta del 45.8% de la variabilidad subyacente en el SF-36 en el caso de la muestra de “cohorte” y el 54.6% dela variabilidad en la muestra “principal”.Conclusiones: Se concluyó que en las muestras de pacientes de Jamaica con la enfermad de células falciformes, el SF-36 posee una estructura de componentes que puede ser bien distinta de la que inicialmente propusieron sus creadores.

A clinical audit of the quality of care of hypertension in general practice / Una Auditoría Clínica de la Calidad del Cuidado de la Hipertensión en la Práctica Médica General

Clinical audits monitor the use of particular interventions, or the care received by patients, against agreed standards. Any departures from [quot ]best practice[quot ] can then be examined, and causes can be determined and acted upon. The Ministry of Health (MOH), Jamaica, has recently published standards of care for hypertension. The medical records of a convenience sample of 125 hypertensive patients being managed by five current family medicine residents in their respective primary care practices were audited Initial results showed limited adherence to the MOH recommended hypertension management guidelines. The same practices were re-audited after an interval of six months, during which time the physicians were sensitized to the results of the preliminary audit. Marked improvements were noted in the second audit. Assessment for co-risk factors for hypertension-related diseases improved: nutritional advice (33% to 74%), smoking and alcohol intake history (40% to 65%) and history taking of physical activity (30% to 47%). Assessment for target organ damage also improved: fundoscopy done (11% to 54%), foot examination done (30% to 58%) and yearly electrolytes done (28% to 62%). There are clear gaps between current practice and standards that exist internationally and locally for management of hypertension. The MOH needs to disseminate and educate general practitioners about the standards of care guidelines

Los auditores clínicos monitorean el uso de intervenciones particulares, o la atención recibida por los pacientes, a fin de verificar si se cumplen las normas establecidas. Cualquier desviación de "la práctica estándar" puede ser entonces analizada, determinándose de ese modo las causas, y empren-diéndose las correspondientes acciones sobre ellas. El Ministerio de Salud (MS) de Jamaica, ha publicado recientemente las normas del cuidado de la hipertensión. A las historias clínicas de una muestra de conveniencia de 125 pacientes hipertensos tratados por cinco residentes de medicina familiar en sus respectivas consultas de atención primaria, se les practicó una auditoría. Los resul-tados iniciales mostraron una correspondencia limitada con las pautas para el tratamiento de la hipertensión recomendadas por el MS. Las mismas prácticas fueron sometidas de nuevo a auditoría, luego de un intervalo de seis meses, durante el cual se sensibilizó a los médicos con los resultados de la auditoría preliminar. En la segunda auditoría se observaron mejorías considerables. Mejoró la evaluación de los factores de co-riesgo por enfermedades relacionadas con la hipertensión: consejo nutricional (33% a 74%), historia de hábito de fumar y consumo de alcohol (40% a 65%), confección de historia de la actividad física (30% a 47%). También mejoró la evaluación de daños dirigida a órganos predeterminados: fondoscopia realizada (11% a 54%), examen de pies realizado (30% a 58%) y electrólitos anuales hechos (28% a 62%). Evidentemente hay lagunas entre la práctica común y las normas existentes internacional y localmente para el tratamiento de hipertensión. El MS necesita diseminar y educar médicos generales versados en las normas de cuidado establecidas.

Effect of yogic exercises on physical and mental health of young fellowship course trainees.

A study was undertaken to observe any beneficial effect of yogic practices during training period on the young trainees. 54 trainees of 20-25 years age group were divided randomly in two groups i.e. yoga and control group. Yoga group (23 males and 5 females) was administered yogic practices for the first five months of the course while control group (21 males and 5 females) did not perform yogic exercises during this period. From the 6th to 10th month of training both the groups performed the yogic practices. Physiological parameters like heart rate, blood pressure, oral temperature, skin temperature in resting condition, responses to maximal and submaximal exercise, body flexibility were recorded. Psychological parameters like personality, learning, arithmetic and psychomotor ability, mental well being were also recorded. Various parameters were taken before and during the 5th and 10th month of training period. Initially there was relatively higher sympathetic activity in both the groups due to the new work/training environment but gradually it subsided. Later on at the 5th and 10th month, yoga group had relatively lower sympathetic activity than the control group. There was improvement in performance at submaximal level of exercise and in anaerobic threshold in the yoga group. Shoulder, hip, trunk and neck flexibility improved in the yoga group. There was improvement in various psychological parameters like reduction in anxiety and depression and a better mental function after yogic practices.

Prevention of malaria-induced foetal abnormalities following immunization of mice with Plasmodium berghei merozoite antigen.

Pre-pregnancy immunization of Swiss albino mice with merozoite antigen of P. berghei entrapped in multilamellar phosphatidyl choline liposomes resulted in (i) increased prepatent period, (ii) either no or low parasitaemic levels, (iii) reduced mortality, and (iv) normal foetal and placental development, upon challenge with P. berghei on 13th gestational day. The unimmunized animals which received either phosphate buffered saline or empty multilamellar phosphatidyl choline liposomes before pregnancy developed high parasitaemic and 30-40 per cent animals died before parturition while 60-70 per cent unimmunized animals revealed foetal abnormalities such as low body weight and larger spleen size. Placentae of unprotected animals had hyperplasia of trophoblastic membrane and plugging of placental sinusoids with parasitized erythrocytes and malarial pigments. The data suggest that prior immunization of animals with merozoite antigen entrapped in multilamellar phosphatidyl choline liposomes could abrogate the ill effects induced by malaria infection under the stress of pregnancy.