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Background: Health camps are effective medical intervention, especially in inaccessible terrains. However, because of age, health, and COVID-19 fear, many patients avoid visiting these camps because of crowding. Door-to-door health camps could be a solution to this. National Medical Commission has also introduced early clinical exposure and family adoption for medical undergraduate students. Aim and Objectives: The authors had planned to conduct this research to study the advantage of door-to-door health camps involving medical undergraduate students as camp team members as compared to traditional health camps regarding patient satisfaction and student satisfaction. Material and Methods: This study was done in rural hilly areas of Himachal Pradesh. There were 8 traditional health camps and 8 door-to-door health camps also involving medical undergraduate students organized between August 2022 and November 2022. These camps were analyzed for patients’ satisfaction and students’ satisfaction. Results: Patient satisfaction was much higher in door-to-door camps as compared to traditional health camps. More patients attending door-to-door camps visited our hospital for follow-up. Students were also satisfied participating in door-to-door camps. It also improved their interest in studying medicine. Conclusion: Door-to-door health camps are more beneficial for patients, especially in hilly inaccessible terrain. Involving students in these camps improves their interest in studying medicine and can be beneficial.
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Medical ethics education along with attitude and communication training has been incorporated into the regular MBBS curriculum in India from 2019, so as to encourage a caring and communicative approach by doctors towards patients. It would be important to understand the relevance of the educational module in the form of cases to ensure an optimal learning process for future students and doctors in the making. We selected three cases and conducted online debates among small groups of second year MBBS students. Students submitted narratives and their reflections after discussing each case and gave overall feedback. Our findings suggested that the students recognised the complexity of taking decisions when presented with ethical dilemmas and appreciated the opportunity to voice opposing views. The online platform was effective and may be considered in the future as a medium to help integrate discussions on medical ethics alongside clinical work.
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In recent years there is a rapid rise in coming out of sexual and gender minority adults to their family members and society. Unfortunately, studies on unmet health needs of transgenders with a special focus to mental health is under-researched in India. The current paper aimed to explore about the mental health of transgenders and a literature search was done using PubMed, Google Scholar, and Scopus databases for the following medical subject headings (MeSH) key terms “transgender”, “mental Health”, “social stigma”, “LGBT”, “gender dysphoria”, “genderqueer”, “intersex”, “MSM”, “hijra”, “gay”, “lesbian”, “bisexual”, and “homosexual”. Transgender individuals were found to show high rates of mental health concerns. The most common mental health problems that we have shown in this review article are depression, obsessive-compulsive disorders, generalized anxiety disorders, suicidal attempts and bipolar disorders. Transgender people are at more risk for mental health problems than their heterogenous counterparts. The intervention program to eliminate or reduce these problems needs to be planned carefully, considering all the determinants
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Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities. Materials and Methods: After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Results: In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11–12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11–12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusions: In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2–3 days with morbidities.
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Lesão perirradicular é uma doença de etiologia microbiana, cuja evolução possui forte relação com a resposta imunológica do hospedeiro, que ocorre no intuito de conter essa infecção. O tratamento endodôntico nesses casos tem como objetivo biológico final a desinfecção do sistema de canais radiculares para possibilitar o reparo da região periapical. Esse reparo é um processo complexo que consiste em hemostasia, inflamação, proliferação celular, maturação e remodelação. Diversos estudos vêm sendo realizados no intuito de relacionar fatores sistêmicos ou hábitos adquiridos com o desenvolvimento, diagnóstico, severidade e cura das lesões perirradiculares. Essas condições são referidas como modificadores da doença e podem esclarecer o surgimento de sintomatologia dolorosa em casos assintomáticos, a cura tardia de algumas lesões, e explicar o porquê alguns canais adequadamente tratados resultam em fracasso. As doenças hereditárias de coagulação causam alterações na hemostasia dos portadores, gerando propensão para sangramento abundante e modificações importantes na cicatrização de feridas. Essa revisão bibliográfica identificou as associações existentes entre os transtornos hereditários de coagulação mais comuns (hemofilias A e B e doença de von Willebrand) e o reparo de lesões endodônticas e concluiu que tal condição clínica pode afetar as respostas imunes, interferindo no reparo perirradicular.
Periradicular injury is a disease of microbial etiology, whose evolution has a strong relationship with the host's immune response, which occurs in order to contain this infection. The endodontic treatment in these cases has the ultimate biological objective of disinfecting the root canal system to enable repair of the periapical region. This repair is a complex process consisting of hemostasis, inflammation, cell proliferation, maturation and remodeling. Several studies have been carried out in order to relate systemic factors or acquired habits with the development, diagnosis, severity and cure of periradicular lesions. These conditions are referred to as disease modifiers and can clarify the onset of painful symptoms in asymptomatic cases, delayed healing of some lesions, and explain why some properly treated channels result in failure. Hereditary coagulation diseases cause changes in patients' hemostasis, generating a propensity for heavy bleeding and important changes in wound healing. This bibliographic review sought to identify the associations between the most common hereditary coagulation disorders (Hemophilia A and B and von Willebrand's disease) and the repair of endodontic lesions and concluded that such a clinical condition can affect immune responses, interfering with periradicular repair.
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Background: India saw one of the stringent lockdowns during the COVID-19 pandemic. In the wake of this period, the normal functioning of medical services was affected. People were reluctant to seek medical attention and notification of Tuberculosis dipped. The aim of the study was to estimate the proportion of non-adherence to anti-tubercular treatment and to identify the factors affecting the non-adherence to treatment. Methods: A retrospective community-based study was conducted among 284 tuberculosis patients. They were interviewed using a pre-designed questionnaire consisting of WHO dimensions of non-adherence and lockdown related questions. Results: The proportion of non-adherence to treatment was found to be 5.3%. Factors like chronic diseases, depression, without knowledge on how the disease is transmitted and that medication can be discontinued once the symptoms subsided, alcohol consumption, and trouble accessing medicine were found to be the determining factors in non-adherence to the treatment. Conclusions: Non-adherence to anti-tuberculosis treatment in our study was low but the various dimensions of adherence along with lockdown related factors had significant impact on it. To further minimize non-adherence during emergency like the lockdown due to COVID-19 pandemic, corrective measures must be explored and implemented.
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Background: Dengue fever is an acute febrile illness, ranging from asymptomatic to severe state in connection with hosts immune response. Several biochemical markers such as decreased platelet count, prolonged prothrombin duration, and increased hematocrit level have been recommended to evaluate disease severity. Due to lack of their clinical relevance, evaluation of serum ferritin is distinguishing feature to predict the disease severity at the early stage of infection. Aims and Objectives: The aim of the study was to assess the levels of serum ferritin as an early predictor of infection severity in children with dengue fever. Materials and Methods: Seventy-four patients diagnosed with dengue fever by non-structural protein 1 antigen positive and ?12 years of age were recruited. Hematological investigation such as platelet count, C-reactive protein (CRP), complete blood picture, liver function tests, renal function tests, and serum ferritin was assessed. Cases were monitored for disease progression status and platelet count too. Categorical variables were assessed by Chi-square test and descriptive statistics were used to represent demographic data. Results: The mean differences of the levels of platelet count, CRP, total cholesterol, triglycerides, and low-density lipoprotein were statistically significant among severe and non-severe dengue cases. Serum ferritin levels in children with severe dengue fever showed 876.42 ng/ml, 1048.94 ng/ml and 1573.20 ng/ml on 3rd, 4th, and 5th day, respectively. Whereas, cases with non-severe dengue showed 431.12 ng/ml, 612.20 ng/ml, and 698.41 ng/ml on 3rd, 4th, and 5th day, respectively. Conclusion: Serum ferritin levels were significantly increased with severity dengue fever on 3rd, 4th, and 5th day of infection. Thus, serum ferritin is an efficient biomarker in estimating the dengue fever severity and progression at early stage of infection in children.
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Background: The World Health Organization had proclaimed the outbreak of the novel coronavirus (COVID-19) as a worldwide pandemic on March 11, 2020. Immunization against the disease was the need of the hour to curtail the spread of COVID-19 pandemic. Two vaccines manufactured in India were approved for emergency use authorization initially. They are ChAdox1CoV-19 vaccine – CoviShield and Covaxin. Aims and objectives: This study aimed at assessing the occurrence of adverse effects following immunization (AEFI) among individuals who received the CoviShield vaccine. The objective of this research was to evaluate the type of AEFI among vaccinated beneficiaries and to determine the factors contributing to the development of AEFI. Materials and Methods: A cross-sectional study was done at a teaching hospital in Kerala. All beneficiaries who were administered CoviShield vaccine during the study period, that is, from January 2021 to June 2022 were incorporated in the study. Data regarding AEFI were collected from all vaccinated individuals by direct or telephonic enquiry. Results: The incidence rate of AEFI is 4.5/1000 doses (111/24925 doses). The reporting of AEFI was high among age group of 20–30 years and commonly seen in males (97.3%). The most common AEFI reported with CoviShield vaccine were fever (63%), myalgia (51%), and headache (40%). AEFI were seen commonly after administration of first dose (94%). Only 7 cases (6.3%) of serious AEFI were reported which included death, autoimmune encephalitis, Bell’s palsy, hypotension, and hypersensitivity reactions. There was no significant association between age and type of AEFI (P > 0.05) and dose of vaccine and type of AEFI (P > 0.05). Conclusion: The immunization with CoviShield vaccine is safe among adults (>18 years) with lesser incidence of serious adverse effects. Higher incidence of AEFI is witnessed after administration of first dose and it was commonly seen in males.
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Background: Preeclampsia is one of the major complications affecting the pregnancy. It is an important cause of both maternal and fetal morbidity and mortality worldwide. Aims and Objectives: The aim of the study was to assess the renal function and serum C reactive protein (CRP) levels in pre-eclampsia. Materials and Methods: Our study was a cross-sectional study conducted among 90 pregnant women in a tertiary care center in Kerala. The Institutional Ethics Committee approved the study. Blood urea, serum creatinine, and serum CRP levels were estimated in 30 normotensive pregnant women, 30 mild preeclamptic, and 30 severe pre eclamptic women. Statistical analysis was done. Results: The mean values of all the three parameters were highest in severe pre-eclampsia when compared to the normotensive pregnant women. The mean values in mild pre-eclampsia lies in between the values of other two groups. The results were statistically significant. Conclusion: Significant alteration in renal function tests and serum CRP levels prove to be an important indicator in assessing the severity of preeclampsia.
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Inflammatory myofibroblastic tumors (IMTs) are uncommon; intermediate grade soft tissue tumors occurring in young individuals with an uncertain behaviour. The incidence of pulmonary lymphangitis carcinomatosis (PLC) is around 6-8% of all pulmonary metastases. However, PLC due to papillary thyroid carcinoma (PTC) is very uncommon. We present a case of a 26-year-old male, who presented with a solitary left lung nodule on radiological scans. There was also a past history of thyroid surgery done two years back for PTC. Histology revealed a soft tissue tumor reminiscent of IMT. The periphery of the IMT nodule showed metastatic PTC in the form of extensive PLC. In view of this unusual histology, a diagnosis of PTC with nodular fasciitis-like stroma (PTC-NFS) was initially considered. However, molecular studies for anaplastic lymphoma kinase (ALK) gene rearrangement confirmed the diagnosis of IMT. This case highlights the unusual occurrence of tumor-to-tumor metastasis causing diagnostic challenges and also the importance of molecular testing.
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Background: Slipped upper femoral epiphysis (SUFE) is a common adolescent hip disorder with a multifactorial etiology affecting the growth plate. 25-hydroxy (OH) Vitamin D has a main role in maintaining adequate bone mineralization. There are only few studies in India that relates the association between SUFE and serum 25(OH)vitamin D deficiency. Aim and Objective: The objective of the study was to estimate the serum levels of 25(OH)vitamin D in diagnosed cases of SUFE and to compare the levels with healthy controls. Materials and methods: Our study was a case–control study conducted in a tertiary care center. The Institutional Ethics Committee approved the study. Serum 25(OH)vitamin D levels in a total of 40 subjects including 20 confirmed cases of SUFE and 20 healthy controls were estimated and statistical analysis was carried out. Results: Serum 25(OH) vitamin D levels were found to be decreased in SUFE cases when compared to control group and the difference is statistically significant with P < 0.001 by independent t-test. Conclusion: Our study establishes the need for estimation of serum 25(OH) vitamin D levels in diagnosed cases of SUFE and adequate correction of the deficiency in its management.
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Resumen El trasplante hepático con donante vivo (THDV) es un procedimiento complejo y desafiante para el cirujano, ya que exige garantizar tanto la máxima seguridad para el donante, así como también, la mejor calidad del injerto para el receptor. Debido a lo anterior, la implementación de la cirugía mini-invasiva ha sido lenta en esta área. Sin embargo, en los últimos 10 años, gracias a los avances que ha experimentado la cirugía hepática laparoscópica, ha aumentado el interés de algunos grupos altamente especializados por incorporar la cirugía mini-invasiva a la cirugía del donante, principalmente en trasplante hepático donante vivo adulto-pediátrico (THDVA-P). Los favorables resultados obtenidos en esta área incluso han llevado a los expertos en el tema, a categorizar el abordaje laparoscópico para la cirugía del donante como el procedimiento estándar en THDVA-P. Contrario a lo anterior, la implementación de la laparoscopía para trasplante hepático donante vivo adulto-adulto (THDVA-A), es más compleja y requiere en su mayoría, una hepatectomía de lóbulo derecho o izquierdo para cumplir con las necesidades volumétricas del receptor. Esta cirugía es de mayor dificultad y riesgo para el donante, por lo que su indicación por vía mini-invasiva está limitada a centros de alto volumen y preparación, tanto en laparoscopía, como en trasplante hepático. En este trabajo, se busca dar a conocer la técnica quirúrgica y nuestra experiencia inicial con la primera hepatectomía derecha totalmente laparoscópica (HDTL) para THDVA-A realizada en Chile.
Living donor liver transplantation is a complex and challenging procedure. The surgeon needs to guarantee maximum safety for the donor, as well as the best quality of the graft for the recipient. For this reason, the implementation of mini-invasive surgery has been slow in this area. However, in the last 10 years, due to the advances in laparoscopic liver surgery, the interest of some highly specialized groups has increased in incorporating mini-invasive surgery into donor surgery, mainly in pediatric living donor liver transplantation. The favorable results obtained in this field, have even led to turn this procedure, into the technique of choice for pediatric living donor liver transplantation. Nevertheless, this procedure is even more challenging for adult-to-adult living donor transplantation. To meet the volumetric criteria of an adult, a complete hepatectomy of right or left lobe is mostly required. This surgery is of greater complexity and risk for the donor, so its indication by minimally invasive approach is limited to high-volume centers with preparation, both in laparoscopy and liver transplants. In this report we seek to present our surgical technique and initial experience with the first pure laparoscopic right hepatectomy for adult-to-adult living donor liver transplantation carried out in Chile.
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Humanos , Femenino , Adulto , Laparoscopía , Donadores Vivos , Neoplasias Hepáticas/cirugía , Tomografía Computarizada por Rayos X/métodos , Chile , Trasplante de Hígado/métodos , Imagenología Tridimensional , Abdomen/diagnóstico por imagen , HepatectomíaRESUMEN
Abstract Aim: This study verified the combined effects of game result and match location on centrality measures based on the interactions of Brazilian handball players. Methods: The sample consisted of 3435 interactions performed by 15 players during 7 official Brazilian Regional Championship matches. Social network analysis was applied to investigate the following network properties: degree of centrality, closeness centrality, degree of prestige, proximity prestige, and network density. Results: Results revealed that playing at home increases closeness centrality (η2 = 0.99; p = 0.01), and network density (η2 = 1.00; p = 0.01). When the handball team lost the game, an increment in the network density in relation to the draw and win scenario was observed (η2 = 1.00; p = 0.01). It was observed that closeness centrality and network density increased when the team had lost and played at home, while when the team was playing away from home and losing, closeness centrality decreased (η2 = 0.99; p = 0.01). Conclusions: In conclusion, contextual variables impact the way that handball players interact during a match.
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The aim of this study was to compare the frequency of dysplasia and human papillomavirus (HPV) infection in the anal canal of patients with Crohn's disease (CD) with a control group and assess whether there is a correlation between use of immunosuppressants and anal manifestation of CD. Patients with CD and control individuals were submitted to anal cytology and material collection for polymerase chain reaction (PCR). The cytology was classified as normal, atypical squamous cells of undetermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade (HSIL). PCR was considered positive or negative according to virus presence or absence. A total of 117 patients were included (54 in the control group and 63 in the CD group, being 32 without and 31 with immunosuppressants). ASCUS and LSIL were found in 25.9 and 22.2% of control patients and 28.6 and 39.7% of CD patients. HPV was identified in 14.8% of the control group and 27% of the CD group. In CD patients, HPV was found in 37.5 and 16.1% of those without and with immunosuppressants, respectively. Patients with perianal involvement had 15.6% of PCR positivity. There was no statistical difference in dysplasia and infection by HPV between the groups. Use of immunosuppressants did not influence the result, but anal manifestation was inversely proportional to viral detection.
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Gastroesophageal cancer (GEC) is an aggressive disease characterized by a high frequency of metastasis and poor overall survival rates. GEC presents HER2 overexpression in 5 to 25% of tumors eligible for HER2-targeted therapy. HER2 evaluation requires protein levels and copy number alteration analyses by immunohistochemistry (IHC) and in situ hybridization (FISH or SISH), respectively. These are semiquantitative methodologies that need an expert and well-trained pathologist. Therefore, the use of new surrogate methods for HER2 evaluation in cancer, such as gene expression analysis, might improve GEC HER2 classification. We evaluated HER2 positivity in GEC through conventional IHC and SISH analyses and investigated the potential application of HER2 mRNA expression by quantitative PCR to categorize GEC samples as HER2-positive or HER2-negative. Among 270 GEC samples, 10.9% were HER2-positive by IHC and SISH analyses. HER2 mRNA was overexpressed in HER2-positive GEC samples and presented high accuracy in distinguishing those tumors from HER2-negative GEC. Nevertheless, HER2 mRNA analysis was not capable of classifying HER2-equivocal GEC samples into HER2-positive or -negative according to SISH data. Quantitative PCR analysis showed HER2 overexpression in HER2-positive GEC samples. Nevertheless, HER2 mRNA analysis failed to classify HER2-equivocal GEC according to SISH data.
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The aim of this study was to verify the presence of glyphosate in breast milk and to characterize maternal environmental exposure. Sixty-seven milk samples were collected from lactating women in the city of Francisco Beltrão, Paraná, living in urban (n=26) and rural (n=41) areas, at the peak of glyphosate application in corn and soy crops in the region (April and May 2018). To characterize the study population, socio-epidemiological data of the women were collected. To determine glyphosate levels, a commercial enzyme immunosorbent assay kit was used. Glyphosate was detected in all breast milk samples analyzed with a mean value of 1.45 µg/L. Despite some descriptive differences, there were no statistically significant differences (P<0.05) between the categories of the variables tested. Also, glyphosate was detected in drinking water samples from the urban area and in artesian well water from the rural area of the region where the studied population lived. The estimation of the total amount of glyphosate ingested by breastfeeding babies in a period of 6 months was significant. These results suggest that the studied lactating population was contaminated with glyphosate, possibly through continued environmental exposure.
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ABSTRACT Infective endocarditis is less likely to sparkle out preferentially in our minds when evaluating and making differential diagnosis of patients with fever daily in emergency departments. We describe a case of infective endocarditis. He was initially diagnosed with pyelonephritis of the right kidney at a hospital because of the noted right flank knocking pain. His computed tomography showed two wedge-shaped low-density lesions in the spleen and the right kidney separately. It dropped a hint to the emergency department physician of thinking of the feature of infarct. The previously neglected cardiac murmurs were then an important clue. We then performed transthoracic emergent echocardiography and confirmed the diagnosis of infective endocarditis.