The Long?Forgotten Technique of Pin Retained Restoration ? A Case Report

To restore severely damaged teeth to the greatest state for health, function, and aesthetics continues to be a challenge for all practising dental surgeons. A pin retained restoration is an intricate restoration involving the insertion of one or more pins into the dentin to provide sufficient resistance and retention. These pins help in anchoring dental amalgam or composite to the tooth structure. This auxiliary retentive means help in the restoration of mutilated teeth in young individuals whose pulp chambers are relatively large and the dentinal tubules are comparatively immature. This case study sheds insights on the successful rehabilitation of a severely damaged premolar tooth with pins and composite resin restoration.

Immediate and early engagement of same-day antiretroviral therapy initiation among newly diagnosed people living with HIV in urban Zambia: a retrospective cohort study

Introduction: as Zambia moves towards attaining human immunodeficiency virus (HIV) epidemic control, it is clear significant efforts are required to facilitate achievement of UNAIDS treatment targets by 2030. To accelerate progress towards global target of 95% of people living with HIV (PLHIV) knowing their status, country is promoting community-based HIV testing and same-day antiretroviral therapy (ART) initiation. However, there are uncertainties of how this strategy affects immediate and early engagement in program settings. To address this research gap, we analysed a programme data of PLHIV newly diagnosed and initiated on ART in community and health facility settings. Study objectives were to estimate the proportion of immediate engagement, to estimate early engagement among newly diagnosed PLHIV and, to examine factors independently associated with immediate and early engagement in care among newly diagnosed PLHIV offered same-day ART initiation. Methods: we included all newly diagnosed PLHIV aged 18 years or older and provided same-day ART initiation between October 2018 and January 2019 in Lusaka District. Immediate engagement was estimated as proportion of newly diagnosed PLHIV who visited the health facility at least once within 14 days after same-day ART initiation, whereas early engagement as proportion of newly diagnosed PLHIV active 6 months after same-day ART initiation. Pearson's chi-squared test was used to assess association of outcomes with key background characteristics. Results: of 12,777 newly diagnosed PLHIV who initiated same day ART 7,943 (62%) were tested and initiated in the community. Overall, 6,257 (49%) engaged within 14 days (median 15, IQR: 13-37). Older individuals (36-49 years) were more likely to be engaged at 14 days (aRR 1.29; 95%CI 1.06 - 1.18; p<0.001) and retained at 6 months (aRR1.27;95%CI 1.21-1.34P<0.001) whilst risk of attrition at 6 months was highest in younger ages (18-24 years) (aRR 0.79;95 %CI 0.76-0.82; p<0.001). Conclusion: to adequately address the HIV epidemic targeted engagement approaches are required particularly in the younger ages.

Quinary Prevention and Lower Segment Cesarean Section

Lower segment cesarean section (LSCS) is a safe mode of delivery and has definite indications. However, at times, patients do not accept the advice to undergo elective or emergency LSCS, as appropriate. This leads to avoidable complications and cost. This communication discusses the style and salient features of counseling patients to understand and accept LSCS, as part of informed consent-taking. This discussion is geared towards obstetric care providers who encounter LSCS hesitancy in spite of having explained the indication(s) for surgery.

Addressing Lower Segment Cesarean Section Hesitancy: A Patient-centered, Pragmatic Communication Guide

In women in whom a normal vaginal delivery is not possible or is not indicated, delayed acceptance of lower segment cesarean section (LSCS) or outright LSCS refusal, leads to complications that can easily be avoided. Hence, it makes sense for obstetricians and other health care professionals, to address LSCS hesitancy as an integral part of obstetric care. In this article, we discuss both the communication style and communication content, that is required to manage LSCS hesitancy in women in whom the intervention is indicated. We highlight the need to analyze the reasons for hesitancy, and address them in an appropriate and affable manner, using accurate information to buttress one’s points. We also encourage seeking assistance from colleagues in the health care team, utilizing audio-visual and social media aids, and offering alternatives if the patient so desires.

Carcinoembryonic antigen (CEA) and other surrogate inflammatory biomarkers in COVID-19

It has been two years since the global outbreak of the highly contagious and deadly corona virus disease (COVID-19) caused by SARS-CoV-2 first emerged in China. Since then, various diagnostic, prognostic and treatment strategies undertaken to address the pandemic have been dynamically evolving. Predictive and prognostic role of various biomarkers in COVID-19 has been a subject of intense exploration. We aimed to determine the association of Carcinoembryonic antigen (CEA) and various surrogate inflammatory biomarkers with the severity of COVID-19 disease. This retrospective cohort study was carried out on 98 patients admitted in Jaypee Hospital, Noida with COVID-19 disease. Information regarding demographics, laboratory parameters and clinical history was collected from Hospital Information System. Serum levels of CEA and other biomarkers such as Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), Ferritin, and Procalcitonin (PCT) were assessed. Correlation analyses were performed between the parameters and acute respiratory distress syndrome (ARDS) stages. Logistic regression and ROC curve analysis were performed to assess the various parameters for distinguishing COVID-19 patients requiring ICU admission. Mean hospital stay, NLR, CEA, IL-6, CRP, Ferritin (P< 0.0001) and PCT (P =0.01) were significantly higher in ICU patients when compared to general ward patients. NLR, median serum CEA, IL-6, and CRP levels were significantly higher in non-survivor compared to the survivors (P< 0.0001, 0.0341 and 0.0092). CEA correlated well with disease severity based upon ARDS classification and was a better marker to differentiate patient according to ARDS stages (ARDS 0 vs 2 P= 0.0006; 0 vs 3 P< 0.0001; ARDS 1 vs 2 P= 0.0183; 1 vs 3 P=0.0006). The area under the Receiver operating characteristic (ROC) curve for CEA was 0.7467 (95% CI- 0.64885- 0.84459) which revealed the potential of CEA as a biomarker to distinguish COVID-19 patients requiring ICU admission. CEA can be used to predict the severity of COVID-19 associated ARDS as well as patients requiring ICU admission. Along with routine inflammatory biomarkers (NLR, CRP, IL-6, PCT, and ferritin), CEA should be used for early identification of critical COVID-19 positive patients and for assessing prognosis.

Clinical profile and outcome of scar endometriosis in a tertiary care centre of Northern India

Background: Endometriosis is defined as the presence and proliferation of the endometrium outside the uterine cavity affecting an estimated 89 million women of reproductive age worldwide. Endometriosis occurs in 5% to 10% of all women, often resulting in debilitating pain and infertility, endometriosis at the scar site known as Scar endometriosis has also been described following obstetrical and gynecological surgery. Scar endometriosis has a much rarer incidence with an illusive presentation and is often misdiagnosed and definitive treatment gets delayed. Objectives of this study was to review the demographic profile, clinical presentation, treatment modalities and outcome in patients with scar endometriosis.Methods: The retrospective study of patients with scar endometriosis managed at DMCH during January 2014 to December 2018 was done.Results: Eight patients of scar endometrosis were diagnosed and operated in our institution over a period of five years. All patients (six with previous caesarean section scar site and two at episiotomy site) presented with tender nodules with pain which got exaggerated during menstruation.Conclusions: A high index of suspicion of scar endometriosis should be kept in patients presented with cyclical pain and tender mass getting exaggerated during menstruation.

Sensitivity and specificity of prenatal screening methods for detection of risk of fetal chromosomal abnormalities

Background: Babies born with chromosomal abnormalities pose a burden on the family as well as the society at large. Early detection and management of fetal chromosomal abnormalities has become an essential component of antenatal care. Hence pregnant women of all ages are offered screening methods for early detection of chromosomal abnormalities. We intended to study the sensitivity and specificity of prenatal screening methods for detection of risk of fetal chromosomal abnormalities.Methods: A three-year retrospective study was conducted from January 2015 to December 2017 in 258 singleton pregnant mothers attending antenatal clinic and delivering at DMCH. The patients were screened for chromosomal abnormalities in the first trimester by NB NT scan along with dual marker and level II anomaly screen scan along with quadruple test in the second trimester. Based on the test results the patients were classified into high risk and low risk pregnant mothers. All the patients with abnormal quadruple test were subjected to amniocentesis for karyotyping. The results of the first trimester and second trimester screening methods were statistically analyzed using chi square test, sensitivity and specificity of the prenatal screening methods was calculated.Results: The sensitivity and specificity of dual marker test for detection of chromosomal abnormality is 50% and 85.94% respectively and that of quadruple test sensitivity is 50%, specificity is 95.3%. The difference was highly significant in the favour of the quadruple marker with P-value of 0.0004.Conclusions: While counseling the patients regarding possibility of having abnormal fetus, obstetrician should keep in mind the false negatives and false positives of prenatal screening and diagnostic methods.

Intestinal endometriosis: a diagnostic dilemma

Background: Endometriosis is a benign gynaecological condition that causes significant morbidity to women of reproductive age group. It uncommonly affects the gastrointestinal tract and acute bowel obstruction is a rare manifestation.Methods: A retrospective observational study was conducted on eight patients.Results: In three patients (37.5%), small intestinal involvement was seen, and colon was involved in five patients (62.5%). One (12.5%) patient presented with complete bowel obstruction while in others partial obstruction of the intestine was seen.Conclusions: Intestinal endometriosis is a diagnostic challenge and should be considered in young menstruating women with gastrointestinal symptoms. Intestinal endometriosis is the most common extra-pelvic site and it is found in 12% of women with endometriosis. The true incidence of endometriosis causing bowel obstruction is unknown. Pre or intraoperative sigmoidoscopy may prove helpful in ruling out malignancy. The gold standard for diagnosis is laparoscopy and biopsy, which allows a full assessment of the pelvis as well as surgical resection if required. The management of endometriosis is an integrated approach of both medical and surgical therapy. Bowel resection is usually undertaken if there are features of obstruction or bleeding, and if there is suspicion of malignancy.

Basal Cell Adenoma: A Rare Case Report With Immunohistochemical Analysis

Basal cell adenoma (BCA) of the salivary gland is a rare benign monomorphic adenoma accounting for approximately 1–2% of all salivary gland tumors. It is characterized by the presence of sheets/nests of monomorphic cells with a prominent basement membrane. An absence of myxoid and chondroid stroma separates it from the pleomorphic adenoma. Participation of myoepithelial cells is still a controversial issue in the histogenesis of this tumor. We are presenting a case of BCA of the parotid gland in an elderly male patient. A panel of immunohistochemical markers is used to confirm its benignity and emphasize its use to differentiate it from other common histological entities. We briefly review the literature and discuss the differential diagnosis of this rare entity.

Landscaping capacity-building initiatives in epidemiology in India: bridging the demand–supply gap.

India, the second most populous country in the world, has 17% of the world’s population but its total share of global disease burden is 21%. With epidemiological transition, the challenge of the public health system is to deal with a high burden of noncommunicable diseases, while still continuing the battle against communicable diseases. To combat this progression, public health capacity-building initiatives for the health workforce are necessary to develop essential skills in epidemiology and competencies in other related fields of public health. This study is an effort to systematically explore the training programmes in epidemiology in India and to understand the demand–supply dynamics of epidemiologists in the country. A systematic, predefined approach, with three parallel strategies, was used to collect and assemble the data regarding epidemiology training in India and assess the demand–supply of epidemiologists in the country. The programmes offering training in epidemiology included degree and diploma courses offered by departments of preventive and social medicine/community medicine in medical colleges and 19 long-term academic programmes in epidemiology, with an estimated annual output of 1172 per year. The demand analysis for epidemiologists estimated that there is need for at least 3289 epidemiologists to cater for the demand of various institutions in the country. There is a wide gap in demand–supply of epidemiologists in the country and an urgent need for further strengthening of epidemiology training in India. More capacity-building and training initiatives in epidemiology are therefore urgently required to promote research and address the public health challenges confronting the country.

Human Resource Capacity Building Initiatives for Public Health Laboratories in India.

Public health laboratories play a critical role in disease surveillance and response. With changes in disease dynamics and transmission, their role has evolved over time, and they serve a range of important public health functions. For their effective functioning, it is important to have specialized manpower in these laboratories, which can contribute to their maximum utilization. The present manuscript is an attempt to explore the human resource capacity building initiatives for public health laboratories in India. Using three parallel methods we have attempted to gather information regarding various human resource capacity building initiatives for public health laboratories in India. Our study results show that there is a paucity of programs providing specialized training for human resources in public health laboratories in India. It highlights the urgent need to address this scarcity and introduce capacity building measures to generate human resources for public health laboratories to strengthen their role in public health action.

Teaching of public health ethics in India: a mapping exercise.

Public health ethics has been receiving increasing attention in recent years. Frequently, public health practitioners have to confront complex decisions, with numerous and often conflicting ethical implications. The objective of this study was to obtain information on the teaching of public health ethics in India by making a detailed examination of the public health and community medicine curricula. The specific areas of interest included the content and structure of the courses and electives available to students. The results of this study indicate that ethics courses are yet to find their rightful place in the teaching of public health in India. The curricula vary across institutes in terms of the time and content devoted to the teaching of public health ethics. It is suggested that public health programmes in India develop and incorporate ethics courses so as to keep pace with the emerging challenges in the field. An interdisciplinary consortium should preferably be formed at the national level to take up this academic endeavour.

Engagement of National Board of Examinations in Strengthening Public Health Education in India: Present Landscape, Opportunities and Future Directions.

A trained and adequate heath workforce forms the crux in designing, implementing and monitoring health programs and delivering quality health services. Education is recognized as a critical instrument for creating such trained health professionals who can effectively address the 21st century health challenges. At present, the Public Health Education in India is offered through medical colleges and also outside the corridors of medical colleges which was not the scenario earlier. Traditionally, Public Health Education has been a domain of medical colleges and was open for medical graduates only. In order to standardize the Postgraduate Medical Education in India, the National Board of Examinations (NBE) was set up as an independent autonomous body of its kind in the country in the fi eld of medical sciences with the prime objective of improving the quality of the medical education. NBE has also played a signifi cant role in enhancing Public Health Education in India through its Diplomat of National Board (DNB) Programs in Social and Preventive Medicine, Health and Hospital Administration, Maternal and Child Health, Family Medicine and Field Epidemiology. It envisions creating a cadre of skilled and motivated public health professionals and also developing a roadmap for postgraduate career pathways. However, there still exists gamut of opportunities for it to engage in expanding the scope of Public Health Education. It can play a key role in accreditation of public health programs and institutions which can transform the present landscape of education of health professionals. It also needs to revisit and re-initiate programs like DNB in Tropical Medicine and Occupational Health which were discontinued. The time is imperative for NBE to seize these opportunities and take necessary actions in strengthening and expanding the scope of Public Health Education in India.

Transforming Public Health Education in India Through Networking and Collaborations: Opportunities and Challenges.

A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20th century educational strategies are unfi t to tackle 21st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated through existing networks.

Childhood acute erythtoleukemia diagnosis by flow cytometry.

Acute erythroid leukemia in children is very. Here is a case of erythroleukemia in a child of a age 1.5 years, which was diagnosed on peripheral smear, bone marrow examination, cytochemistry but was confimed on immunophenotyping. CD45 versus side scatter demonstrated blast population (29%) expressing CD45 of variable intensity (dim to negative). The myeloid nature of blast population showed bright expression of CD13, CD33. These blasts also showed bright positivity of CD71 which showed erythroid nature of blasts. Flow cytometry can be comprehensive enough to completely subtype cases of leukemias/myelodysplastic syndromes, polycythemia rubra vera, non-neoplastic conditions like reactive erythroid hyperplasia following immunosuppressive therapy or viral infections or nutritional deficiencies, unlyzed RBCs or thrombocytosis which may mimic acute erythroid leukemia on flow cytometry.

JAK2-positive Philadelphia-negative myeloproliferative neoplasms.

The recent discovery of the JAK2 mutations has rekindled interest in the approach to classic BCR/ABL-negative myeloproliferative neoplasms (MPNs) in terms of both diagnostic evaluation and treatment. However, additional clinical, laboratory and histological parameters play a key role to allow diagnosis and subclassification, regardless of whether JAK2 V617F mutation is present or not. Here are two cases which incidentally presented with splenomegaly and moderate leukocytosis, and were diagnosed as MPN-primary myelofibrosis (PMF) in prefibrotic phase and polycythemia vera (PV), respectively, using revised World Health Organization (WHO) 2008 criteria.