Understanding the Factors Leading to High Prevalence of Teenage Pregnancies in the Four Aspirational Districts of Assam, Namely Goalpara, Barpeta, Dhubri, and Darrang

Background: The prevalence of teenage pregnancy in Assam is higher than the national average as per both NHFS‑4 and NHFS‑5. Four districts in Assam, falling under the NITI‑Aayog Aspiration Districts Transformation program of 2018, namely, Goalpara, Barpeta, Darrang, and Dhubri, have a prevalence of teenage pregnancy at levels higher than the state’s average (12% as per NHFS‑5). Teenage pregnancy affects several health and nutritional indicators. Objectives: The objective of the study was to identify the factors associated with teenage pregnancies in the Aspirational Districts of Assam in both social and public health contexts. Methods: A comparative cross‑sectional study was carried out across these four districts, with sample size of teenage pregnant women as 388 and an equal number of controls. Results: The study presents several factors to be statistically significant, viz., lower level of education of the teenage mothers or their spouses and lesser access to adequate health‑related information by teenage mothers. Furthermore, less number of teenage mothers are aware of contraceptive availability and face objection from spouses to use contraception. A unique factor presented by the study is the higher elopement rate among teenage mothers. Conclusion: Many of the factors upheld by the study are rooted in social and cultural fabric of the communities and could be addressed by mobilizing local institutions like panchayat and religious bodies to act as deterrence to teenage marriages in the communities. Men should also be brought into the fold of discussions on this sensitive subject through information and awareness generation.

Ex Vivo T Cell Cytokine Expression Predicts Survival in Patients with Severe Alcoholic Hepatitis

Alcoholic hepatitis (AH) is an acute inflammatory liver condition with high early mortality rate. Steroids improve shortterm survival but nonresponders have the worst outcomes.There is a clinical need to identify these high-risk individuals at the time of presentation. T cells are implicated in AH and steroid responsiveness. We measured ex vivo T cell cytokine expression as a candidate biomarker of outcomes in patients with AH. Consecutive patients (bilirubin >80 µmol/L and ratio of aspartate aminotransferase to alanine aminotransferase >1.5 who were heavy alcohol consumers with discriminant function [DF] ≥32), were recruited from University Hospitals Plymouth NHS Trust. T cells were obtained and stimulated ex vivo. Cytokine expression levels were determined by flow cytometry and protein multiplex analysis. Twenty-three patients were recruited (10 male; median age 51 years; baseline DF 67; 30% 90-day mortality). Compared to T cells from nonsur-vivors at day 90, T cells from survivors had higher baseline baseline intracellular interleukin (IL)-10:IL-17A ratio (0.43 vs 1.20, p=0.02). Multiplex protein analysis identified interferon γ (IFNγ) and tumor necrosis factor-α (TNF-α) as independent predictors of 90-day mortality (p=0.04, p=0.01, respectively).The ratio of IFNγ to TNF-α was predictive of 90-day mortality (1.4 vs 0.2, p=0.03). These data demonstrate the potential utility of T cell cytokine release assays performed on pretreatment blood samples as biomarkers of survival in patients with severe AH. Our key findings were that intracellular IL-10:IL-17A and IFNγ:TNF-α in culture supernatants were pre-dictors of 90-day mortality. This offers the promise of devel-oping T cell-based diagnostic tools for risk stratification.

Evaluation of the Versatility of Pectoralis Major Myocutaneous Flap in Reconstruction of Head and Neck Cancer: A Prospective Study.

Background and Objective: Myocutaneous flaps play a prominent role in the immediate reconstruction of surgical defects following ablative oncological procedures in head and neck. Pectoralis major myocutaneous flap is one such flap which is probably the most reliable and commonly used flap in orofacial reconstruction of tumour and trauma related defects of oral and maxillofacial region. The aim of the current study is to check the versatility of Pectoralis major myocutaneous flap in reconstruction of head and neck cancers. Methods: The prospective study was conducted among the patients, who were treated for ablative surgery of head and neck cancer in whom reconstruction was done using Pectoralis major myocutaneous flap in our department of oral and maxillofacial surgery, VS Dental College, Bengaluru between 2012 to 2015. A total of 8 patients were included in this study where primary reconstruction was carried out with Pectoralis major myocutaneous flap. Results: The results of this study clearly demonstrate that Pectoralis major myocutaneous flap can be used for orofacial defects with high degree of reliability and minimal complications. The test showed that the observed difference for partial necrosis and partial dehiscence at different time duration was statistically not significant. Conclusion: It appeared in this study that, functional and aesthetic results were consistently satisfactory with minimal complications. In the current era of microvascular surgeries this flap still remains a valuable tool in head and neck reconstruction.