Prevalence and determinants of anemia among school going children in the state of Tamil Nadu, India: applications of two-level logistic regression model

Background: Anemia still remains as one of the major public health problems in India despite implementing preventive measures. The objective was to find the prevalence and determinants of anemia among school going children in Tamil Nadu. Methods: We used the data from the fourth round of district level household survey (DLHS-4) for Tamil Nadu pertaining to the year 2012-13. Our analysis included 23997 children. Descriptive statistics, Random intercept and empty models of two-level logistic regression analysis were used. Results: The overall prevalence of anemia was found to be 41.4% (95% CI: 40.77%-42.02%). We observed a district level variation on anemia (District level variance=0.1, p<0.001) and the intra class correlation coefficient was 0.0295. The prevalence of anemia was more in coastal districts as compared to non-coastal districts (43.85% vs. 40.18%, p<0.001). Variables that are found to have significant association with anemia on multilevel analysis were younger age (Adjusted odds ratio (AOR)=1.343, 95% CI: 1.270-1.420), female children (AOR=1.462, 95% CI: 1.387-1.541), more than eight family members in the household (AOR=1.120, 95% CI: 1.008-1.245), rural residence (AOR=1.103, 95% CI: 1.038-1.172) and lower standard of living (AOR=1.203, 95% CI: 1.084-1.334). Conclusions: Half of school going children were anemic in the state. Geospatial distribution of anemia varied significantly. Governments and regional health centres should take adequate measures to avert the consequences of anemia in school going children considering these factors.

COVID-19 vaccination status and its effect on outcome and disease severity

Background: The cardinal method for preventing future SARS-CoV-2 infections, hospitalizations, long-term sequelae, and death is COVID-19 vaccination, despite the possibility that the epidemiology of COVID-19 may change as new variants appear. There is little research on the vaccination status of adult COVID-19 patients and the role of vaccines in mitigating the severity and clinical presentation of COVID-19 patients among local population in Kerala. Objectives were to assess vaccination status and clinical profile of adult COVID-19 patients in Arpookara, Panchayath in Kerala and its association with disease severity and outcome among same. Methods: A cross sectional study was conducted in Arpookara Panchayath in central Kerala, among adult COVID-19 patients during the months of September and October 2021. The required 380 samples were selected by simple random sampling and data was collected by interviewing the subjects using semi structured questionnaire. Results: It was found that 46.1% of the study population were unvaccinated, whereas 30.8% of the population were partially vaccinated and 23.1% were fully vaccinated at the time of COVID-19 infection. A significantly higher proportion of unvaccinated population required hospital admissions, oxygen support and ICU stay when compared to those who took at least one dose of vaccine. Conclusions: Increasing the vaccination coverage of at least single dose of vaccine can reduce rate of hospital admission, ICU stay, oxygen requirement and can improve the outcome of disease. Steps to increase vaccine coverage should be implemented for better outcome of COVID-19 disease as well as to reduce the admission load on the hospitals.

The role of librarians in healthcare interprofessional collaboration: a literature review

Background: As the delivery of healthcare evolves to become more interconnected, coordinating care between nurses, pharmacists, physicians, social workers as well as medical librarians and other disciplines has become increasingly important. Librarians are more deeply involved in ward rounds routine exercise, provision of instruction in health information literacy, medical informatic, evidence-based research skills, and problembased learning. This article introduces key concepts relating to the interprofessional collaborative teamwork among health professionals and its impact on medical librarians. Methods: Data for this paper was collected through the literature review and it was done using various online searching tools with relevant information including, PubMed, LibHub, Science Direct and Google Scholar. Results: The results show that the emerging and changed roles have resulted in a shift in professional identity with the health sciences librarians moving toward a collaborative, consultative practice that is more closely aligned to user's needs and approaching patient care from a team-based perspective. Conclusion and Recommendation: The paper concludes among others that there is a need for library science educators and health sciences librarians to seek and identify skills needed for evolving library practice and formal documentation of new roles within clinical settings. It is recommended that they should add technology, collaborative, consultative, instructional design, and teaching skills to their professional toolbox

Spatiotemporal Pattern of Thyroid Cancer Incidence in South Kerala: A Population-based Study

Background: Thyroid cancer (TC) is the most common endocrine cancer and has been increasing over the past decades worldwide. A notable finding is that Kerala’s capital Thiruvananthapuram ranks the first among men and the second highest among women in the incidence of TC in India. Reasons for this increase have not been established. Objectives: Here, we investigated the spatiotemporal pattern of TC incidence in Thiruvananthapuram. Materials and Methods: TC incidence data (n = 1937) of Population Based Cancer Registry Thiruvananthapuram, Kerala, India, between 2012 and 2016, were analyzed for identifying geographical patterns by spatial methods, temporal methods for studying spatial variation in TC incidence, distribution of age, gender, and histology in lowland (coastal), midland, and highland. Results: Spatial clustering of TC incidence was identified consistently near the coastal region based on all geospatial analyses. 56.9%, 23.9%, and 19.2% of TC cases were observed in the coastal, midland, and highland areas, respectively. A significant clustered pattern of TC incidence was revealed by Moran’s index I (0.49), high-high clusters by local Moran’s, hotspot by Getis-Ord-Gi* (P < 0.05), point pattern analysis by nearest neighbor ratio and kernel density estimation. The relative risk of the significant cluster was obtained as 1.60 (95% confidence interval: 1.03–1.84) by SaTScan analysis. Conclusion: This study identified spatial variations in the pattern of TC cases with significant clusters near the coastal region of Thiruvananthapuram. This would help to pinpoint the high-risk geographical areas of TC and for more effective cancer control programs.

Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

Extensive Resection for Treatment of Locally Advanced Primary Mucinous Adenocarcinoma Arising From Fistula-in-Ano

We report a case of a 66-year-old male who presented with a locally advanced primary mucinous adenocarcinoma arising from a fistula-in-ano. The presentation was typical for perianal sepsis and fistula-in-ano with anal pain and chronic discharge. Initial treatments with fistula debridement and seton were performed. Subsequent review of histology revealed underlying adenocarcinoma, while magnetic resonance imaging (MRI) showed local invasion into the prostate. The patient received neoadjuvant chemoradiotherapy followed by pelvic exenteration to maximize the chance of achieving cure. Features of this case are discussed together with its implications, including treatment guidelines and typical MRI findings.

A shark attack treated in a tertiary care centre: Case report and review of the literature

Although uncommon, shark attacks can lead to devastating outcomes for victims. Surgeons also face unique challenges during operative management such as exsanguination, shock, specific injury patterns and infections. This case report presents the management of a 39-year-old previously healthy female attacked by a shark while on vacation in Mexico. The patient sustained severe injuries to her left arm and her left thigh. She was transferred to a Canadian institution after ambiguous operative management in Mexico and presented with no clear antibiotic coverage and a Volkman's contracture of the left upper extremity. In total, the patient underwent four washouts of wounds, two split-thickness skin grafts, one free anterolateral thigh flap, and one free transverse rectus abdominus myocutaneous flap for the reconstruction and salvage of the left lower extremity. This article highlights the specifics of this case and describes important points in managing these devastating injuries.

Optimizing treatment and analysis of prognostic factors for locally advanced nonsmall cell lung cancer in resource‑limited population.

BACKGROUND: Lung cancer most commonly presents in advanced stages in developing countries, where combined modality treatment using chemo‑radiotherapy (CTRT) is the standard of care. MATERIALS AND METHODS: A retrospective audit of patients of nonsmall cell lung cancer (NSCLC) treated at a single Institute from January 2008 to December 2012 was conducted. Various prognostic factors affecting disease‑free survival (DFS) and overall survival (OS) were studied by univariate and multivariate analysis. All patients were meticulously followed‑up clinically and telephonic contacts. RESULTS: Overall 171 patients of NSCLC were treated with definitive CTRT using concurrent chemotherapy in 66% patients and sequential therapy in 28% patients. The actuarial 2 years DFS was 17.5% and 2 years OS was 61.5%. Complete response to treatment resulted in significantly better DFS and OS. Definitive CTRT was very well‑tolerated in these patients with good compliance. CONCLUSION: Definitive CTRT, sequence being individualized depending on performance status and disease stage at presentation, is a feasible and effective treatment modality for locally advanced NSCLC patients in the developing world. Response to treatment is an important prognostic factor for treatment outcomes.

Stereotactic body radiotherapy in early stage non-small cell lung cancer: First experience from an Indian Centre.

BACKGROUND: Surgery is the standard of care for early stage (T1-2, N0, M0) non-small cell lung cancer. A considerable number of these patients are ineligible for surgery due to age and comorbidities. Hypo fractionated high-dose stereotactic body radiotherapy (SBRT) is being performed for these group of patients. There is paucity of literature regarding this novel technique from the Indian subcontinent. AIMS AND OBJECTIVES: We hereby report the dosimetry, response and outcome of our small cohort of early stage non-small cell lung cancer patients treated with SBRT. MATERIALS AND METHODS: Between December 2007 and December 2010, 8 patients of early stage (T1-2N0M0) underwent SBRT at our centre. All the patients had undergone whole body PET-CT scan, MRI brain and pulmonary function test (PFT with DLCO). The SBRT schedules included 48 Gy in 6 fractions for peripherally located and 48 Gy in 8 fractions for centrally located tumors. Response and toxicity were assessed in 3 monthly follow up visits. RESULTS: The median duration of follow up was 18 months (range 8-44 months). The median age of the patients was 70 years (range 63-82 years) and the median tumor diameter was 4 cm (range 2.8-5.0 cm). The mean PTV volume was 165 cc(range 127.3- 193.9 cc). The mean dose to the PTV was 99.5% (range 97.7- 102.1%). After 3 months, 7 patients had complete metabolic response and 1 patient had partial metabolic response. Overall survival at 1.5 years was 87.5%. One patient had grade 2 pneumonitis. No toxicities of grade 3 or higher were identified. CONCLUSION: SBRT for early stage NSCLC resulted in excellent local control with minimal toxicity and can be considered as a treatment option in properly selected patients.

Irritancy potential of 17 detergents used commonly by the Indian household.

Background: Detergents are used by almost every household in the developed and developing world. Soap and most detergents are anionic surfactants and attack the horny layer of the skin and increase its permeability with little or no inflammatory change and may result in hand eczema, which is very distressing and incapacitating. Aim: To evaluate the irritant potential of common household detergents (laundry and dish wash) used by the Indian population using a 24-hour patch test and to convincingly educate the patients on the detergents less likely to cause irritation in the particular individual. Methods: Seventeen commonly used detergents found in Indian market were included in the study, of which, 12 were laundry detergents (powders - seven, bar soap - five) and five were dish wash detergents (powder - one, liquid - one, bar soap - three). The irritant potential of the 17 detergents were evaluated in 30 volunteers. Thirty microliters of each of the detergent bar solutions, distilled water (negative control), and 20% SDS (positive control) were applied to Finn chambers with a micropipette and occluded for 24 hours. Erythema, scaling, and edema were graded in comparison to the reaction at the negative control site (distilled water) for each volunteer separately. The scoring of erythema / dryness and wrinkling on a 0 - 4 point scale and edema on another 0 - 4 point scale was based on the Draize scale. The pH of each of the detergent solutions was determined using litmus papers (Indikrom papers from Qualigens fine chemicals). Results: The difference between detergents (F value) was significant for erythema / dryness and wrinkling (F = 3.374; p = 0.000), but not significant for edema (F = 1.297; p = 0.194). [Table 2] lists the means for erythema / dryness and wrinkling, and edema. The F value of the totals of the means for erythema / dryness and wrinkling and edema was significant (F = 2.495; p = 0.001). The pH of all the detergents was found to be alkaline except Pril utensil cleaner which tested acidic (pH 6). The positive control, 20% SDS also tested acidic (pH 6). Conclusion : Similar to patch testing in allergic contact dermatitis, 24-hour patch testing with detergent solutions (8% w/v), will educate the patient on what detergent to avoid. This may bring down the total medication requirement and frequent hospital consultations for these patients.

A tale behind the rectum.

Tailgut cysts, also called benign retrorectal hamartomas, are uncommon developmental cysts found behind the rectum. Here, we present a rare case of a tailgut cyst associated with uterine anomaly, sacral and vertebral anomalies and vascular duplication, in a young lady who presented with constipation and infertility.

Crohn's disease in rheumatology clinic--an Indian experience.

BACKGROUND: Prevalence of Crohn's disease (CD) among patients with rheumatic illnesses in India is grossly under estimated, especially when it has overtaken that of Ulcerative Colitis in the West. AIM: To study the frequency of histologically unequivocal CD amongst clinically suspected patients with enteropathic arthropathy and to ascertain if the arthritics with CD have any independent clinical predictor. Settings and designs: Retrospective datasheet analysis from a Rheumatology clinic of a large tertiary care centre. MATERIALS AND METHODS: Patients of suspected enteropathic arthropathy were studied by ileocolonoscopy and segmental colonic biopsy for histological evidence of Crohn's disease and followed up. STATISTICAL ANALYSIS: Logistic regression analysis was done to find out any clinical predictor of histologically proven CD. RESULTS: Fourteen of the twenty-nine patients studied had histologically confirmed CD. Those with CD were younger than those without (34.7 yr vs 41.6 yrs, p=0.057). The CD group also had significantly higher number of people with loss of weight (12 vs 1), fever (11 vs 0), perianal fistula (4 vs 0), abdominal pain (8 vs 2), history of dysentery (4 vs 0) and uveitis (6 vs 1) (p=0.00002, 0.00001, 0.026, 0.013, 0.026 & 0.01 respectively). However logistic regression analysis of the most relevant ones among these, namely, loss of weight, fever, and perianal fistula showed loss of weight as only independent predictor of CD in this subset of patients (p=0.03 with odds ratio of 28). CONCLUSION: Presence of significant loss of weight in an Indian patient with clinically suspected enteropathic arthropathy is an independent predictor of CD.

Patterns and outcome of acute bacterial meningitis in a South Indian tertiary level hospital.

A retrospective analysis of childhood Acute Bacterial Meningitis from a tertiary care hospital in Bangalore revealed a winter clustering of cases and an absence of typical signs and symptoms in 40% of patients, with Staphylococcus aureus (10%) and coagulase negative Staphylococcus (9%) being the most common etiological agents. Mortality rate was 8.5%. High priority for the prevention of disease by these pathogens, especially in rural population and during winter, and a high degree of alertness for the detection of atypical disease is warranted.

Massive gastrointestinal bleeding in a patient with AIDS.

Cytomegalovirus enteritis can lead to gastrointestinal bleeding in patients with the acquired immune deficiency syndrome. The commonest site of involvement is the colon, followed by the stomach and terminal ileum. Most of these lesions can be diagnosed by colonoscopy or gastroscopy. We present our experience of a patient with cytomegalovirus infection involving only the proximal jejunum causing massive lower gastrointestinal bleeding. Conventional endoscopy and imaging had failed to locate the source of bleeding. Enteroscopy performed at the time of laparotomy showed an ulcerated lesion in the jejunum. Resection followed by histological examination of the resected area confirmed the diagnosis of cytomegalovirus infection. In addition to highly active antiretroviral therapy, ganciclovir was given for 14 days in a dose of 5 mg/kg twice a day and tapered over a period of 3 months. There has been no further episode of gastrointestinal bleeding over a follow up of 9 months.

Malignant tumours of the minor salivary glands: a survival analysis of 17 years from a tertiary referral cancer centre.

BACKGROUND: Malignant tumours of the minor salivary glands are rare and constitute less than 0.5% of all malignant neoplasms. AIM: This study was carried out to evaluate the clinical presentation, site distribution, treatment, survival and predictors of survival in malignant minor salivary gland tumours. SETTING: A tertiary care, superspeciality referral hospital. DESIGN: Retrospective analysis. PATIENTS AND METHOD: Forty-two cases of minor salivary gland tumours treated over a period of 17 years were reviewed for clinical presentation, histopathology, stage distribution, treatment and treatment outcome. STATISTICAL ANALYSIS: Survival by Kaplan Meier Method and the outcomes were compared using log-rank test. RESULTS: The mean age of the patients was 46.9 years with a male to female ratio of 1.4:1. Majority of the patients presented with a painless progressive swelling, with 13 (31%) of them in T2 stage. About one-third of the patients had palpable lymph nodes at presentation, while none had distant metastasis. Palate was the commonest site and mucoepidermoid carcinoma was the commonest hispathological type. About 1/3 of the patients were treated with primary surgery and were followed up by adjuvant radiotherapy. Seven patients underwent palliative treatment alone. Over a mean follow-up of 30 months, 5 patients failed. The disease free survival was 72% at 5-year, none of the factors studied were found to significantly influence survival. CONCLUSIONS: Results of the present study suggest that minor salivary gland tumours should be treated with primary surgery irrespective of site and histological type to achieve best loco-regional control and survival.

Attributing death to cancer: cause-specific survival estimation.

Cancer survival estimation is an important part of assessing the overall strength of cancer care in a region. Generally, the death of a patient is taken as the end point in estimation of overall survival. When calculating the overall survival, the cause of death is not taken into account. With increasing demand for better survival of cancer patients it is important for clinicians and researchers to know about survival statistics due to disease of interest, i.e. net survival. It is also important to choose the best method for estimating net survival. Increase in the use of computer programmes has made it possible to carry out statistical analysis without guidance from a bio-statistician. This is of prime importance in third- world countries as there are a few trained bio-statisticians to guide clinicians and researchers. The present communication describes current methods used to estimate net survival such as cause-specific survival and relative survival. The limitation of estimation of cause-specific survival particularly in India and the usefulness of relative survival are discussed. The various sources for estimating cancer survival are also discussed. As survival-estimates are to be projected on to the population at large, it becomes important to measure the variation of the estimates, and thus confidence intervals are used. Rothman's confidence interval gives the most satisfactory result for survival estimate.

Primary malignant chest wall tumours.

Neoplasms of the chest wall are not uncommon. Majority of the tumours occurring in the chest wall are benign. The tumours may arise from the soft tissues,connective tissues or bone. Metastatic tumours can arise as a result of direct infiltration or haematogenous spread. The management of these tumours is challenging. Resection of the chest wall with or without the excision of ribs, require reconstruction not only for aesthetic reasons but also for providing the stability to the chest wall which is of prime importance in maintaining the respiratory functions. In this article, 46 cases of the primary malignant chest wall tumours seen over a period of 5 years are reviewed.