Autoimmune Haemolytic Anaemia following ChAd Ox 1 nCoV-19 in Haemodialysis

Autoimmune haemolytic anaemia (AIHA) is caused by autoantibodies that react with self-red blood cells (RBCs) and cause them to be destroyed with or without complement mediated mechanism. Its clinical presentation is heterogeneous, ranging from asymptomatic to severe forms with fatal outcomes, also it can be either idiopathic or secondary to a coexisting disorder. We report an elderly gentleman on haemodialysis, who presented with severe haemolytic anaemia after one month of first dose of ChAd Ox 1 nCoV-19 vaccine (viral vector vaccine) for SARS- CoV – 2, who also had asymptomatic COVID 19 infection around 6 months prior to vaccination. This is the first reported case of AIHA following COVISHIELD vaccine and till now there are no other reported cases from India.

Awareness about disaster management among accredited social health activists in field practice area of a medical college in Mysuru

Background: The changing global climate due to human influences is leading to a greater incidence of extreme weather events and natural disasters. The natural and man-made disasters have a great impact on physical and mental health and health system. Disaster preparedness is therefore important at all levels of the health system. Being the first contact of the health system to the communities, accredited social health workers have a great role in managing the disasters at the village level. This study attempts to assess the awareness regarding disaster management among accredited social health activists (ASHAs) in the field practice area of J.S.S. Medical College in Mysuru, Karnataka.Methods: A community-based cross-sectional study was conducted for one month in July 2019. A total of 40 ASHAs were assessed by direct interview method using a pre-structured, validated questionnaire. The data were entered into the Microsoft Excel spreadsheet and analyzed using SPPS version 22.Results: The median years of experience of ASHAs were 10 years (interquartile range: 5.75-10) with a minimum and maximum experience of 2 and 10 years respectively. None of the study participants had received any trainings or mock drills for disaster management/ preparedness. The awareness about disaster management was low among the ASHAs assessed. Most of the ASHAs (92.5%) had average knowledge about disaster management while 7.5% had only poor knowledge.Conclusions: The awareness about disaster management among ASHAs is very poor. We recommend training programs and mock drills for the frontline health workers to improve awareness and disaster preparedness.

Anaemia prevalence among school children of southern districts of Karnataka

Background: Anaemia is a major health problem creating an extreme burden on public health, especially in developing countries. Globally, anaemia affects 1.62 billion people, which corresponds to 24.8% of the population. The government of India is implementing various programs to bring down the prevalence of anaemia including iron and folic acid supplementation to school going children. This study attempts to assess the prevalence of anaemia among school going children of first to the tenth standard, in rural and urban areas of Mysore and Chamarajanagara districts of southern part of Karnataka state, India.Methods: A cross sectional study was conducted in 50 selected schools of Mysore and Chamarajanagara districts for a period of one academic year, and 8719 students were evaluated for anaemia. The data was analyzed using appropriate software and statistical methods.Results: The prevalence of anaemia among school going children in Mysore and Chamarajanagar districts was 27.6%. While 22.7% of the girls showed the signs of anaemia, only 19.2% of boys showed anaemia. The prevalence of anaemia was high in rural areas than urban areas and maximum prevalence was seen among high school students followed by upper primary school students and lower primary school students.Conclusions: The total prevalence of anaemia among school children in Mysore and Chamarajanagara districts was 27.6%. The prevalence of anaemia was below the currently available national standards. This low prevalence could be attributed to the continuing care with yearly screening and iron and folic acid tablets provided to the study population under National Health Mission.

Prevalence and severity of depression among people residing in flood affected areas of Kerala

Background: The world is witnessing significant change in its climate leading to an increase in natural disasters. Kerala state of India recently witnessed its worst Monsoon rainfall in the century. Floods have significant effects on mental health. Screening of psychological problems is necessary in the background of recent floods in Kerala. So this study was done with the objectives to assess the prevalence of depression in the flood affected people of Kerala and to assess the severity of depression among people residing in flood affected areas of Kerala.Methods: Cross sectional study was done four weeks after flood. Individuals aged ≥15 years residing in flood affected areas were included and people not willing to participate were excluded. Purposive sampling was done and 306 participants were studied. Participants were assessed by interview technique using PHQ9 questionnaire. Data was analysed using SPSS-22. Descriptive statistics like percentage were applied. Inferential statistical tests like chi-square test were applied for association.Results: Among the participants 48% showed symptoms of depression. 28.10 % were mildly depressed, 12.74% were moderately depressed, 5.56% had moderately severe and 1.63% had severe depression. Maximum prevalence of depression was observed in geriatric age group.Conclusions: A significant amount of people residing in flood affected areas showed signs and symptoms of depression. An urgent intervention is therefore required to improve mental health status of the flood affected individuals.

Bilateral massive angiomyolipomatosis associated with tuberous sclerosis

Angiomyolipoma is an uncommon tumor consisting of vascular, smooth muscle, and fatty elements. Angiomyolipoma can present in two forms; as an isolated unilateral lesion which occurs sporadically or as bilateral lesions associated with tuberous sclerosis and Von Hippel- Lindau syndrome. Bilateral massive angiomyolipomatosis is a very rare entity. Only three cases have been reported in medical literature. We present a case of bilateral massive angiomyolipomatosis associated with tuberous sclerosis

Audiçäo central (I): nas lesöes supratentoriais das vias auditivas / Central hearing (I): in the supratentorial lesions of the auditory pathways

Os testes auditivos indicados para diferenciar patologicas periféricas normalmente näo säo apropriados para avaliaçäo das patologias centrais e vice versa. Os problemas centrais mostram limiar normal ou próximo do normal e sintomas contralaterais. O presente estudo avaliou a audiçäo central e periférica de dez indivíduos com patologias que acometiam o lobo temporal, utilizando exames audiométricos convencionais, testes de audiçäo central (SSI - Synthetic Sentences Intelligibility) e avaliaçäo da comunicaçäo. Apesar das poucas queixas auditivas dos pacientes com lesöes do Sistema Auditivo Central, houve grande incidência de sinais relacionados aos testes de audiçäo e comunicaçäo (como a afasia). O desempenho dos pacientes frente ao teste de inteligibilidade de fala, utilizando frases curtas, foi ruim notadamente no ouvido contralateral à lesäo, quando a mesma era unilateral, demonstrando assim alteraçöes das vias auditivas centrais, mesmo quando a discriminaçäo de monossílabos e outros testes audiométricos convencionais eram normais. Desta forma, um teste que utilize frases pode ser um importante meio para avaliaçäo da inteligibilidade da fala, de fácil interpretaçäo, e se mostra melhor que os testes de discriminaçäo de monossílabos para avaliaçäo de comprometimento das vias auditivas centrais em pacientes com patologias do lobo temporal, fornecendo também informaçöes quanto ao lado acometido.

Audiçäo central (II): nas lesöes infratentoriais das vias auditivas / Central Hearing (II): in the undertentorial lesions of the auditory pathways

Apesar de conhecidas alteraçöes sobre a emissäo da fala, nas lesöes cerebelares, muito pouco ainda se sabe sobre os efeitos destas alteraçöes e das conexöes do cerebelo na ponte, sobre a inteligibilidade da fala, uma vez que a discriminaçäo de monossílabos é quase sempre normal nestes casos. No presente trabalho, avaliamos a audiçäo periférica e central de seis pacientes semqueixas auditivas, com diagnóstico firmado de Ataxia Cerebelar Autossômica Dominante (AGAD), com graus E1 e E2 de estadio clínico e com atrofia da ponte, quantoàs alteraçöes do VIII nervo craniano, ramo coclear e de suas conexöes, utilizando testes audiométricos convencionais, teste de audiçäo central (SSI - Synthetic Sentences Intelligibility), audiometria de tronco cerebral (BERA) e o Decay do Reflexo do Estapédio. A inteligibilidade da fala para frases curtas (teste SSI) mostrou-se discretamente alterada em alguns pacientes em um ou nos dois ouvidos, apenas quando houve competiçäao ipsilateral, com boa correlaçäo entre este testee as alteraçöes também encontradas para a audiometria de respostas elétricas (BERA). A associaçäo de um exame subjetivo e o BERA mostra melhor a sutileza das lateraçöes de discriminaçäo da fala que acompanham as alteraçöes de vias auditivascentrais infratentoriais, devendo o audiologista e o otorrinolaringologista estarem atentos para que estas, quando presentes, näo passem desapercebidas