Assessment of patients satisfaction with mobile medical clinics in the two districts of north Bengal, India

Background: Patient satisfaction is an important indicator to measure the quality of healthcare services and plays a crucial role in enhancing the quality of health service delivery. The aim of the study was to assess the patient’s satisfaction level with the quality of health care delivered at the mobile medical clinics (MMC) in two districts of north Bengal, India. Methods: A cross-sectional survey was done using a purposive sampling method, and total of 294 samples were recruited. A questionnaire (PSQ-18) was used to assess the patient satisfaction level. Chi-square tests were used for categorical variables. F-test and t-test were used for mean differences between the variables. Linear regression analysis was done to examine the linear effect of social factors on patient satisfaction. Results: The present study shows that overall satisfaction was 74.04%, with a mean value of 3.702. In the Jalpaiguri district, 27.5% of patients are highly satisfied, whereas 17.0% are in Alipurduar. Alipurduar district has a higher low satisfaction rating (39.7%) than Jalpaiguri district (19.7%), and a district-wise significant association was found (p<0.001). Overall satisfaction level effects by occupation (p<0.001), population and socio economic status (p<0.05). Conclusions: Policymakers may consider that MMCs could be an effective strategy to improve primary health care in remote, underserved areas where there are no public health care facilities.

Separation of thoraco-omphalopagus Siamese twin.

A pair of female thoraco-omphalopagus twins, with two pairs of lungs, common diaphragm and separate pleural cavities was separated at the age of 5(1/2) months after a parasitic relationship had developed between them. Before separation both the babies developed recurrent respiratory tract infection and frequent diarrhea. They were treated with medical therapy and made fit for anesthesia. The combined weight of the twins was 4(1/2) kg at birth and the combined weight at the time of separation was 9(1/2) kg. One baby was smaller in growth compared to the other baby. The closure of anterior abdominal wall was difficult in both babies. However, we could close it without use of any biodegradable patches or tissue expander. Both the babies survived and are doing well after 3 months of separation.

Microbes: therapeutic targets or therapeutic tools?

Antimicrobial resistance has produced alarming situation worldwide. Use of antibiotics in large scale is one of the common cause for developing microbial resistance. Newer and newer antibiotics are coming for their use and more resistance problem is arising out. A complete new method of treatment by bacterial interference has been evolved. However, a new method of treatment has evolved ie, bacterial interference.

High-resolution analysis of Y-chromosomal polymorphisms reveals signatures of population movements from Central Asia and West Asia into India.

Linguistic evidence suggests that West Asia and Central Asia have been the two major geographical sources of genes in the contemporary Indian gene pool. To test the nature and extent of similarities in the gene pools of these regions we have collected DNA samples from four ethnic populations of northern India, and have screened these samples for a set of 18 Y-chromosome polymorphic markers (12 unique event polymorphisms and six short tandem repeats). These data from Indian populations have been analysed in conjunction with published data from several West Asian and Central Asian populations. Our analyses have revealed traces of population movement from Central Asia and West Asia into India. Two haplogrops, HG-3 and HG-9, which are known to have arisen in the Central Asian region, are found in reasonably high frequencies (41.7% and 14.3% respectively) in the study populations. The ages estimated for these two haplogroups are less in the Indian populations than those estimated from data on Middle Eastern populations. A neighbour-joining tree based on Y-haplogroup frequencies shows that the North Indians are genetically placed between the West Asian and Central Asian populations. This is consistent with gene flow from West Asia and Central Asia into India.

Evaluation of stroke patients with reference to CT scan findings.

Eighty patients suffering from stroke were studied on the setting of clinical and computerised tomography (CT) scan findings and were followed up to 6 months. Even though some of the clinical and CT scan findings are found to be important in prediction of outcome of stroke patients, clinical assessment appears to be more important.

Cord blood diazepam: clinical effects in neonates of eclamptic mothers.

Diazepam used in the treatment of eclampsia crosses the placental barrier readily, and may cause various clinical effects in the neonates. Twenty-five (25) live born babies of eclamptic mothers receiving diazepam were studied and cord blood diazepam concentration was estimated. Effect of low dose of diazepam is minimal apart from lowering of rectal temperature and the effects lasted for a period of 12 hours. But high dose (> 30 mg) of diazepam and prolonged duration of diazepam therapy in mothers causes significant depression of the newborn and the effects lasted for a period of 36-48 hours. As the clinical condition of the newborn is not related to the diazepam concentration in cord blood, the cord blood estimation is not helpful in the assessment of clinical effects of the drug in newborn. The tissue storage of the drug in newborn appears to be responsible for the clinical effects.

Sclerema neonatorum--histopathologic study.

Histopathological study of 10 cases sclerema neonatorum showed subcutaneous fibrosis with lobulation in all the cases. 8 (80 percent) cases showed non-specific chronic inflammation of dermis and thinning of epidermis with atrophy of rete pegs and hypercollgenisation of dermis was evident in 70 percent cases. Fat necrosis with crystallisation of fat content was not a conspicuous feature.

Study of foetal antigen in haematological malignancy.

Forty patients with different varieties of leukaemia and lymphoma were studied before and after therapy. Red cells and lymphocytes from each patient were tested for foetal antigen by lectin-agglutination test. The antigen was detectable on red cells in all untreated cases, the highest titre being found in chronic myeloid leukaemia. The titre showed significant reduction after treatment in all cases. We conclude that foetal antigen on red cells is a useful diagnostic aid in haematological malignancy and is a good indicator of the outcome of therapy.

Study of ascitic fluid in relation to systemic and portal venous blood in hepatic cirrhosis.

Twenty uncomplicated cases of cirrhosis of liver, proved by liver biopsy, and free from other systemic diseases were studied. Glucose (pre- and postprandial) and electrolytes (Na+, K+, Cl-) values were compared to those of systemic and portal venous blood. Chloride level in ascitic fluid was found to be significantly high in cirrhosis, as compared to portal and systemic venous blood. Sodium and glucose levels were similar in ascitic fluid and portal venous blood except in two cases complicated with tuberculous peritonitis, where pre- and postprandial glucose levels were considerably low. In 55% cases, there was impaired glucose tolerance, as measured by pre- and postprandial glucose levels in systemic venous blood.

Incidence of neonatal bacterial infection in cases of prolonged rupture of amniotic membrane.

Thirty cases of premature rupture of amniotic membrane were studied bacteriologically. Twenty cases showed growth of organisms from one or more sites at birth. From 20 control cases no pathogenic organism could be isolated. Out of these 20 cases showing growth of organisms 8 neonates developed clinical infection (deep and superficial) subsequently. The organisms grown from vaginal swab and umbilical swab culture showed maximum correlation to the organism from the infected neonates. Esch coli was found to be most common organism causing infections, next to it was Staph aureus. Growth of anaerobic organisms was found only in cases of prolonged rupture of membrane in mother, but not isolated from infected babies. So bacteriological studies of vaginal, placental, umbilical and nasal swabs and cord blood just after the birth of baby may be of some help in predicting the onset of neonatal infection.

Immunoclinical correlation in diabetes mellitus. A preliminary report on the lectin-agglutination test.

Twenty cases with insulin dependent diabetes mellitus (IDDM) were studied and compared with a control group with non insulin dependent diabetes mellitus (NIDDM) and another group of nondiabetic healthy persons. Lymphocytes of each group were tested for agglutination with three sets of lectins: concavalin A (ConA), soyabean agglutinin (SBA) and peanut agglutinin (PNA). SBA test, being highly positive in IDDM and persistently negative in NIDDM, is the most significant of the three tests for differentiating between the two types of diabetes mellitus.

Study of serum myoglobin and serum electrolytes in acute uncomplicated myocardial infarction.

Forty patients with uncomplicated acute myocardial infarction were studied within 6-18 hours after the infarction. Serum myoglobin was elevated in all the cases and was markedly high in cases studied 18 hours after the acute infarction, though the level did not show any relation with the severity of the attack. Myoglobin level showed no correlation with SGOT level, which did not rise appreciably within 6 hours. Serum sodium and potassium levels did not show any change, even in the most severe cases. Serum myoglobin estimation is thus a good diagnostic test in the early hours of acute myocardial infarction.

The effect of malnutrition on placenta.

Effect of malnutrition was studied on placentas of eighty-five malnourished mothers, taking the placentas of sixty-five well nourished mothers as control. Nutritional status of mothers were studied by estimation of haemoglobin, total R.B.C. count and serum protein. Mothers of the malnourished group, showed anaemia of normocytic, microcytic, a few macrocytic type and hypoproteinaemia. Their placentas were of lower weights and sizes than those of control group. Placentas of both the groups showed infarction, degenerative, calcification, fibrinoid necrosis of villi, intervillous fibrin deposition, villous fibrosis, syncytial knotting of villi and proliferation of Langhan's cell of the villi. But the extent and degree of these changes were much more in malnourished group than control group. Activities of the enzyme such as alkaline phosphatase and Glucose-6-phosphatase in placental villi were increased in malnourished group than those in control group. So it appears that placentas of malnourished mothers become underdeveloped having pathological changes greater in extent and degree than control group resulting in inadequate supply of nutrients from mother's blood to foetus blood.

Studies on outbreak of viral hepatitis at Calcutta with special reference to serological investigations.

Sixty cases of acute viral hepatitis were studied from clinical, biochemical and in particular serological point of view. Majority of the patients had significant pre-icteric and icteric phase with moderate elevations of bilirubin, SGOT and SGPT and marginal elevations of serum alkaline phosphatase. Cholestatic features were observed only in 6.7% of cases. All subjects improved and there was no death in this series. Serological marker studies revealed hepatitis A in 8 (13.3%) cases and hepatitis B in 3 (5.0%) cases. Rest 49 cases were possibly due to non-A, non-B hepatitis. As there was no evidence of parenteral transmission, it was concluded that this epidemic was water borne from contaminated municipal water supply.