Healthcare Seeking Behaviour of Hospitalised COVID-19 Patients During Second Wave in Tertiary Care Hospital of Northern India

Background: The Coronavirus Disease (COVID-19) pandemic continues its deadly reign all over the world. Devising effective strategies for detecting and controlling the infection has become ever more critical. Effective prevention and control of the pandemic is entirely dependent on human behavior in terms of practicing preventive and curative measures. During the second wave of COVID-19, people’s perceptions of preventive and curative measures changed. Objective: To study healthcare-seeking behavior of hospitalized COVID-19 patients. Methods: Hospitalized patients due to COVID-19 in the month of March, April and May of 2021 were included in the study. Their attendants/close relatives were contacted telephonically to know about the admitted patients’ healthcare-seeking behavior. Verbal consent was taken from attendants before the commencement of the interview, followed by informing them about the purpose of the interview. Results: Amongst the subjects, there were more males than females (67.5 vs 32.4%), age ranged between 18 to 88 with a mean value of 56.61 ± 14.7 years. Self-medication was significantly associated with study subjects’ mortality (p=0.03). Conclusion: Elderly people were having higher mortality rate than their younger counterparts. People were hesitant to visit primary care physicians after having symptoms of COVID-19.

Comparison of MRI with x-ray in the evaluation of tuberculosis of spine

Introduction: MRI is the most valuable method for detecting early disease and is preferred technique to define the activity and extent of infection followed by x–ray. Aim: To evaluate MRI as a valuable noninvasive diagnostic tool in spinal tuberculosis and to correlate with plain radiograph for the early detection of spinal tuberculosis. Material and method: This cross-sectional study was carried out on 40 patients who were suspected as cases of spinal tuberculosis. Plain X-ray were done before the MRI examination. Results: The comparison of X-ray and MRI for evaluating spinal TB on the basis of end plate irregularity, thecal sac compression, cord compression and cord changes was statistically highly significant. It was statistically significant on the basis of Disk Space Narrowing/Disk Involvement, paravertebral Widening/Psoas abscess and Posterior Element Involvement. X-ray when compared to MRI was found to have a sensitivity of 48.72% and a specificity of 100% in detection of end plate irregularities, sensitivity of 89.47% and specificity of 100% in detection of vertebral height reduction, sensitivity of 78.79% and specificity of 100% in detection of disk Space narrowing / disk Involvement and sensitivity of 28.57% and specificity of 92.31% in detection of paravertebral widening/psoas abscess. Conclusion: MRI is a better and more Informative imaging modality in evaluation of patients of Pott’s spine providing the diagnosis earlier than conventional methods.

Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy

Introduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy. Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings. Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied. Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy. Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.

To Study the Correlation between Iron Deficiency Anemia and HbA1c Levels in Non Diabetics

Purpose: Iron deficiency anemia is the most occurring formof anemia in India. Hemoglobin A1c (HbA1c) is used in diabeticpatients as an maker to reflect glucose levels of the last 3months. Like blood sugar levelsHbA1c levels are also affectedby presence of variant hemoglobin, hemolytic anemia,nutritional anemias, uremia, pregnancy and acute blood loss.However, reports on the effects of iron deficiency anemia onHbA1clevels are inconsistent. We conducted this study with anaim to analyze the effects of iron deficiency anemia onHbA1clevels among non-diabetics.Methods: 200 patients with Hb<10g/dl underwent peripheralblood film testing. All patients with microcytic hypochromicanemia underwent iron studies .Out of these, 100 non diabeticpatients diagnosed with iron deficiency anemia underwentHbA1c test and data was statically analysed.Results: We found that incidence of iron deficiency anemiawas 54%. Serum iron and ferritin concentrations are inverselyassociated with HbA1c concentration and that HbA1cconcentration tended to be higher in the presence of irondeficiency anemia.Conclusion: This study found a positive correlation betweeniron deficiency anemia and increased HbA1c levels. Hence,Iron deficiency anemia has to be kept in mind before using theHbA1c to diagnose diabetes.

Relation between Obesity and Osteoporosis in Women

Osteoporosis is a multifactorial skeletal disease, whose mechanisms are not fully understood. It is more common in older people, especially in Post menopausal women. Body Mass Index (BMI) is often used to predict Bone Mineral Density (BMD). Obese women have always been considered protected against Osteoporosis and Osteoporotic fractures. Objectives: Several studies have challenged the widespread belief that obesity is protective against fracture. The aim of this study was to assess the effects of BMI on BMD in premenopausal and postmenopausal women

Role of neo‑adjuvant chemotherapy in locally advanced breast cancer.

BACKGROUND AND AIMS: Locally advanced breast cancer (LABC) is common in developing countries. The advancement of disease leads to decreased probability of radical cure and increase in treatment cost. The study evaluated neo adjuvant chemotherapy with MRM and MRM followed by adjuvant chemotherapy and also the effectiveness of neo‑adjuvant chemotherapy in down staging advanced disease and offering radical cure. SETTINGS AND DESIGN: A rural hospital‑based prospective comparative study. MATERIALS AND METHODS: All histologically proven and investigated LABC (T3 N0, T3N1, Any T4, Any N2/N3, M0) were selected as subjects and divided into two groups. One group received neo adjuvant chemotherapy (5 fluorouracil, adriamycin and cyclophosphamide) followed by modified radical mastectomy and other group received adjuvant chemotherapy after modified radical mastectomy. Both groups were compared for disease free survival, overall survival and post‑operative complications. Tumor response to chemotherapy in neo adjuvant group was also studied. STATISTICAL ANALYSIS: All continuous variables were analyzed using student’s’ test and categorical variable by Fischer exact test. RESULTS: Thirty one patients were enrolled, of these 16 patients received neo adjuvant chemotherapy. Clinical complete response was observed in two patients (12.5%). Clinical partial response was found in 12 patients (75%) and no response was seen in two patients (12.5%). Disease free survival and overall survival was 82% in neo adjuvant group while in adjuvant group disease free survival was 75% and overall survival was 83%. Post operative complications were similar in both groups. CONCLUSION: Neo adjuvant chemotherapy helps in down staging LABC and offers opportunity in vivo to assess the effect of chemotherapy on individual basis. There was no significant difference in disease free survival, overall survival and post operative complication in between two groups.

Study Of Road Traffic Accidental Deaths (RTA) In and Around Valsad (Gujarat).

Accidents are now one of the major causes of death. Present study consists of 439 medico legal post mortems performed in Forensic Medicine Department, GMERS Medical College and Hospital, Valsad, Gujarat during the period of last 2 calendar years (1st January. 2012 to 31st December. 2013). Out of them, 90.66% cases were of unnatural deaths. Out of unnatural death we found 146 cases (36.68%) died in road traffic accidents. In 36.98% cases were age group of 21- 30 years. 44.83% accidents occur in time period of 12- 18 hours. Thus all data including type of vehicle involved, head injuries, regional injuries,type of skull fracture in head injury, type of haemorrhage and how long victim survived.

Various Obturation methods used in deciduous teeth.

Pulpectomy is one of the treatment options used to maintain primary teeth with radicular pulpal tissue inflammation or that have become nonvital, until normal exfoliation. The primary goal of this procedure is to maintain arch length and function by preserving primary teeth that are essential to proper guidance of the permanent dentition. Other objectives of preserving primary teeth are to enhance esthetics and mastication, prevent aberrant tongue habits, aid in speech, and prevent the psychological effects associated with tooth loss. The treatment consists of removing the pulp tissue associated with micro-organisms and debris from the canal and obturating with resorbable filling material. Familiarity with the complexity of primary tooth canal systems, their formation and resorption pattern dictates the parameters that affect the probability of success of root canal therapy. Moreover, the obturating material as well as obturation technique used that is capable of densely filling the entire root canal system and providing a fluid tight seal from the apical segment of the canal to the cavosurface margin in order to prevent reinfection also significantly influences the success rate of the endodontic therapy. Several methods have been used to deliver obturating materials into the root canals. The purpose of this article is to throw light on various obturation techniques used in deciduous teeth with their comparison, pros and cons.

Role of Ilizarov ring fixator in infected non union tibia.

Background: The main surgical principle in the management of diaphyseal bone infection is thorough debridement of all nonviable tissue. None of the previously mentioned techniques afford surgeon the ability to correct deformities, eliminate antibiotic therapy, regenerate new bone without grafts and allow weight bearing during treatment. Objectives: The present study was conducted to evaluate the clinical follow-up results with Ilizarov technique using three parameters: union, infection and function and to know the complications if any faced by the patients. Material and Methods: This was a prospective study planned to evaluate the results of Ilizarov ring fixator on follow-up of 18 cases of either sex with infected non-union tibia. Average age of presentation was 34.5 years. Follow-up roentgenographs were used to assess alignment, bone contact and later callus formation. Healing status of the fracture was monitored using biplane roentgenographs, unchanged fracture alignment with loosening of the frame, absence of pain during ambulation with the frame destabilized. The data thus collected were analysed by using percentage and valid conclusions were drawn. Result: Pain and swelling were the most common complication after application of ilizarov ring fixator. In this study of 18 cases, 11 (61.11%) patients had excellent, 2 (11.11%) good, 5 (27.77%) fair and none had poor results as per criterion laid down by Catteneo et al. Conclusion: Ilizarov technique was found to be useful to progressively lengthen the extremity, achieve union without bone grafting and to correct deformities in infected non-union with or without bone gap.

Study of hanging cases in Ahmedabad Region.

In spite of advancement in medical facilities, the natural end of life is inevitable. But for some persons, the death is destined earlier in an un-natural way. A few choose to make their own way by committing suicide. The major reasons are personnel problems, stress of life, family problems and financial problems. There are many methods for committing suicide like poisoning, hanging, self-immolation, drowning etc. Hanging provides painless death so it is one of the commonly adopted methods for suicide. However, in a few instances false allegations are made claiming that the ligature mark over neck is of strangulation rather than hanging. Vice versa cases are also likely. In such cases, the post-mortem findings are very helpful to differentiate between the two. Present prospective study was carried out at the mortuary of Civil Hospital, Ahmedabad over 2 years period ranging from December 2008 to November 2010 with a view to study to incidence, ligature materials, and post-mortem findings in hanging cases. The place of hanging, manner of death and reason for death were also studied in the study.

Use of Verbal Autopsy as a Proxy to Determine the Possible Cause of Neonatal Deaths.

Introduction: Information on causes of death is extremely important for policy making, planning, monitoring, field research, future management statergies and epidemic awareness. The best method of finding the cause of death is by post mortem examination but since this is difficult, post death analysis by verbal autopsy is a good method to determine the same. Objective: To asses the role of verbal autopsy method in the investigation of neonatal death and to determine the probable, causes of neonatal death. Materials and Methods: A pre-tested questionnaire in Hindi was administered to 50 mothers and/or next of kin or other care givers of the deceased residing in villages around 200 Kms. of Bhopal and in urban slums of Municipal Corporation, Bhopal. Results: 84 % of the total death occurred with in seven days of birth, 88 % of death occurred in villages where health facilities were available. As per verbal autopsy 36 % and 20 % of the infants died because of Birth asphyxia and Respiratory Distress Syndrome respectively and further 2%, 4% and 6% because of neonatal tetanus, hypothermia and other causes respectively. Conclusion: Verbal autopsy could be one of the possible cost effective and a reliable tool for determining the causes of neonatal deaths at present.

The Methods of Survival Analysis for Clinicians.

The methods of survival analysis are required to analyze duration data but their use is restricted possibly due to lack of awareness and the intricacies involved. We explain common methods of survival analysis, namely, life-table, Kaplan- Meier, log-rank and Cox model, in a simple and friendly language so that the medical fraternity can use them with confidence where applicable.

Radiation dose escalation by percutaneous interstitial brachytherapy in locally advanced non-small cell lung cancer.

Management of locally advanced non-small cell lung cancer is associated with a poor overall survival using concurrent chemoradiotherapy. Therefore, newer approaches to treatment which enable dose escalation are warranted. Interstitial brachytherapy in lung is a new emerging concept with many distinct advantages. We report here a case of locally advanced non-small cell lung cancer with residual disease after conventional treatment. The patient was successfully treated using percutaneous interstitial brachytherapy and is disease-free at 18-month follow-up.

Variance in the treatment of vertebral haemangiomas.

Vertebral haemangiomas constitute an infrequently encounterd entity in clinical practice. Although x-ray, computerised tomography scan and magnetic resonance Imaging scan provide a pathognomic picture confirming the diagnosis of vertebral haemangiomas, angiography constitutes an important tool for diagnosis and helps in deciding and execution of treatment. Various treatment modalities like surgery, radiotherapy, pre-operative embolisation, percutaneous vertebroplasty and intralesional ethanol have been discussed in the setting of asymptomatic vertebral haemangiomas to those presenting with features of cord compression.

Cleaning of leprosy case registers in Chhattisgarh.

Cleaning of register exercise was based on examination of records and not of patients. Because of this exercise, names of 5676 patients were deleted for various reasons viz. completed FDT, Defaulter, AMDT etc. The findings of the present study are more or less similar to the finding of similar other studies carried out in different countries from time to time. Updating of leprosy registers should be a routine activity. For this sensitization of health functionaries at various level must be carried out about importance of cleaning of register and for systematic effort to review the registers at least on sample basis.