Uptake and impact of COVID-19 vaccination among HIV key populations: a cohort study from Tamil Nadu, India / Journal of Rural Medicine

Objective: Human Immunodeficiency Virus (HIV) Key Populations (KPs) include Female Sex Workers (FSWs), men who have sex with men (MSM), transgender (TG), and transsexual (TS) persons. This study assessed coronavirus disease 2019 (COVID-19) vaccine uptake among KPs for HIV in India, adverse events following immunization (AEFI), and breakthrough infections among the vaccinated.Materials and Methods: This retrospective cohort study was conducted among 421 KPs enrolled in 41 Targeted Intervention (TI) clusters in 31 districts of the Tamil Nadu State Acquired Immunodeficiency Syndrome (AIDS) Control Society (TANSACS), India, from June to September 2022. A semi-structured, bilingual (English and Tamil), interviewer-administered questionnaire was used to collect data on socio-demographic characteristics, vaccination status, AEFIs, and breakthrough infections among the KPs under the TIs.Results: Among the KPs, 45.4% were FSWs, 37.1% were MSM, 16.2% were TG, and 1.4% were TS persons. Among them, 4.3% had HIV, and 2.9% had syphilis or other sexually transmitted infections (STIs). The COVID-19 vaccine uptake rate was 96%. Among the KPs, TG/TS persons had the highest vaccine uptake (98.6%), followed by FSWs (96.3%) and MSM (94.2%). AEFIs were reported by 85.4% of the participants. HIV positive status was significantly associated with the incidence of AEFI. The breakthrough infection rate was 5.4% among the vaccinated participants.Conclusion: The COVID-19 vaccine uptake among HIV KPs was high in Tamil Nadu. AEFIs and breakthrough infections among COVID-19 vaccinated HIV KPs may be low, with mild AEFIs.

Acute scrotum in children: Jordan university hospital experience

Introduction: acute scrotum is one of the common surgical emergencies in pediatric age group. Although the differential diagnoses are many, most of the conditions are not urgent; of paramount importance is the prompt diagnosis and surgical treatment of torsion of the test is to avoid permanent ischemic damage. In this study we present our experience at University of Jordan Hospital in management of acute scrotum in children

Methods: a retrospective review of the pediatric patients who were admitted to the pediatric surgical unit at Jordan University Hospital with acute scrotum from March 2008 to March 2013. The characteristics of symptoms, clinical and imaging findings prior to operation, operative findings and type of management were recorded

Results: a total of 59 patients with acute scrotum were admitted and constituted the basis of this study. Operative exploration was performed in all of the 59 cases: Four patients [7%] had testicular torsion, 28patients [48%] had torsion of testicular appendix, 13 patients [22%], had epididymo-orchitis, three patients had idiopathic scrotal edema; three patients [5%] had scrotal hematomas due to trauma; two patients[3%] had incarcerated inguinal hernias; two patients[3%] had hydroceles and four patients [7%] had normal findings

Conclusions: testicular torsion is a common surgical emergency in children which should be treated promptly with early scrotal exploration; since no diagnostic test in the pre-operative work up could differentiate between the different causes and excludes torsion testis which is the major concern. A prospective study to evaluate the diagnostic accuracy of Doppler ultrasonography is suggested based on the results of the predictive values seen in our study

Management of oesophageal foreign bodies

The aim of the study was to evaluate the management of foreign bodies in the oesophagus and to determine the association with socioeconomic status. This cross-sectional analytical study was carried out in the Department of Ear, Nose and Throat and head and neck surgery of Bahawal Victoria Hospital affiliated with Quaid-i-Azam Medical College, Bahawalpur, Pakistan, between December 2012 and May 2013. The medical records of 34 consecutive cases of foreign body ingestion were searched, and the data were recorded on a questionnaire prepared for this purpose. The average age of the patients was 10.38 years; 29 cases [85.2%] were in children under 12 years. There were 18 females [52.9%] and 16 males [47.1%]. Thirty patients [88%] presented with a history of dysphagia, and 25 [73.6%] had vomiting. The site of impaction was the post-cricoid region in 22 patients [66%], the lower oesophagus in 5 [15%], the mid-oesophagus in 4 [13%], the posterior pharyngeal wall in 1 [3%] and the pyriform fossa in 1 patient [3%]. Coins were the most common foreign body [61.8%]. Socioeconomic analysis showed that 18 patients [52.9%] were in the low socioeconomic class, 12 [35.3%] in the middle class and 4 [11.8%] in the upper class. The presence of a foreign body in the oesophagus is a serious condition, and early removal is recommended. Foreign body lodgement is commoner among poor families

Sinonasal polyposis and fungus: a growing relationship

To determine the frequency of underlying fungus in nose and paranasal sinuses in patients present with nasal polyposis. A total of 324 patients presented with nasal polyps were included in this study. Data collected from all the patients admitted in ENT department with diagnosis of nasal polyposis. All the relevant information about their presenting symptoms was recorded in a proforma. Post operatively the removed material was sent for histopathology and fungal culture. Later the findings of biopsy and culture reports were also recorded and analysed. Out of 324 patients 159 were males and 165 were females. Underlying fungus was present in 226[69.75%] and out of them, 102[45.13%] were males and 124[54.86%] were females with a P value of 0.039. The mean age was 25.95 +/- 9.32 [15-45] years for the patient with fungus. Aspergillus was the commonest organism found. Underlying fungus was found in a significantly high number of patients presented with nasal polyps and Aspergillus was the commonest organism found

Tonsillectomy under local anesthesia: is it safe, feasible and practicable?

Background: Tonsillectomy is one of the most common ENT surgeries

Objective: The study was done to evaluate the feasibility of tonsillectomy under local anesthesia

Subjects and Methods: A total number of 80 consecutive patients whose tonsillectomy was performed under local anesthesia with systemic analgesic injections were included in this cross- sectional study. Peroperative difficulties and problems were noted. Similarly in post-operative period, the rate of complications was noted to conclude upon the feasibility of tonsillectomy under local anaesthesia

Results: A total of 80 patients were included in this study, with 36 females. Following complications were noted, Trismus [5%], difficult dissection [10%], primary hemorrhage [3.7%], reactionary hemorrhage [2.5%] and throat pain [10%]

Conclusion: We concluded that the procedure is safe, feasible and practicable but should be done with certain precautionsi

Can heart rate and Qtc duration be used as a marker of cirrhotic cardiomyopathy? a case control study

To assess the value of QTc prolongation and heart rate variation as a marker of cirrhotic cardiomyopathy and severity of liver disease. This comparative study was conducted on selected patients with cirrhosis of liver, fulfilling inclusion criteria and were enrolled as group 1. An equal number of non cirrhotic patients were enrolled and included in group 2. QTc and heart rate were calculated and compared between the two groups. Analysis of QTc prolongation and increase in heart rate with regard to severity of liver disease was also made. Fifty confirmed cases of cirrhosis of liver were included in group 1 with equal number of age and sex matched non-cirrhotic patients included in group 2 as controls. The mean +/- SEM of QTc in group1 and group 2 were 0.4707 +/- 0.0065 and 0.3893 +/- 0.00542 seconds respectively. The mean +/- SEM of heart rate was 90.50 +/- 2.839 beats/min and 82.85 +/- 2.207 beats/min in group 1 and 2 respectively. The mean of QTc and heart rate in group 1 was significantly higher as compared to group 2 [p=.001 and p=.0179 respectively]. The mean of QTc and heart rate in subgroup 1A, 1B and 1C was not statistically significant. Patients with cirrhosis have a higher mean QTc and heart rate as compared to non cirrhotic adults. Both tests may be useful markers of Cirrhotic Cardiomyopathy

Prevalence of dental caries in the permanent dentition of patients seeking orthodontic treatment in Bara Kahu

The aim of the study was to determine the frequency and distribution of carious lesions in patients seeking orthodontic treatment. A total of 100 patients including both males and females were recruited consecutively during a one year period. Patients' pretreatment orthodontic records including charts, radiographs and photographs were examined carefully for the presence of carious lesions. Descriptive statistics were used to analyze data. Prevalence of caries was high in the maxilla as compared to mandible. Most frequently involved teeth in both the arches were first molars followed by second molars. An assessment of caries risk of the patients is mandatory before initiating orthodontic treatment in order to gain favorable outcomes of the treatment

Distribution of dental caries and its relationship to risk factors

The aim of this study was to assess the distribution of caries in the oral cavity and its relationship to risk factors. A total of 115 patients including both males and females were randomly selected for the study. Information about risk factors was collected by face to face interviews. Oral examination was performed to evaluate distribution of caries. Descriptive statistics were used to analyze data. Mean DMFT index of the studied population was calculated to be 5.04. The value was higher in females than males. Prevalence of caries was high in the mandible as compared to maxilla. Most frequently involved teeth were first and second molars and occlusal surface was the commonly affected surface. There was a significant relationship between caries and risk factors. Distribution of dental caries in the oral cavity follows a specific pattern. Risk factors influence the caries susceptibility of the individuals

Association between hypomagnesaemia and foot ulcers in type II diabetes mellitus

The aim of the study was to seek the association between hypomagnesaemia and foot ulcers in type II diabetes mellitus and to verify the effect of age, sex, grades of ulcer, duration of ulcers and duration of diabetes and presence of hypomagnesaemia in the association with type 2 diabetes mellitus. Cross sectional study. This study was carried out in the indoor, setting of Medical Department Peoples Medical College Hospital Nawabshah from September 2009 to May 2010. The subjects were divided into two groups. One was with Grade-I Diabetic foot ulcer and the other with Grade-II diabetic foot ulcers with type II diabetes mellitus. Both the groups contained 50 subjects each and were selected according to the inclusion and exclusion criteria. After a brief interview of 100 patients regarding age, sex, duration of Type II diabetes mellitus, duration of foot ulcer and grade of foot ulcer, both groups underwent fasting serum Magnesium level and categorized on the basis of foot ulcers Grade-I and Grade-II according to Wagner's classification of diabetic foot ulcers. Chi - square test was applied to see the association and then odds ratio was calculated to check the strength of association. Out of 100 Type II diabetic patients, hypomagnesaemia was detected in 20 with grade I diabetic foot ulcer and in 37 patients with grade II diabetic foot ulcers having chi-square value of 13.071 and significance of 0.000 with likelihood ratio 13.554. There is strong association between hypomagnesaemia in foot ulcers with Type II diabetes mellitus

Survival probability of Plasmodium falciparum against chloroquine and its combination with sulphadoxine-pyremethamine in Punjab, Pakistan

Survival probability of P.falciparum was determined against the chloroquine and its combination with sulphadoxine-pyremethamine, Type of study: Prospective nonrandomizcd descriptive study. Place and duration of study: Study was conducted in five districts [Muzaffargarh, D.G, Khan, Jhang, Sheikhupura and Multan] of Punjab, Pakistan, During the non-transmission season of the year 1999 to 2000 and 2008, among the rural populations 5952 persons were screened for malarial parasites, Methodology: During the malaria non transmission season [November, December and January], 5952 persons were screened for malaria and 1409 positive cases were detected, 404 subjects out of total positive cases were selected to be tested against chloroquine and 50 with combination of chloroquine and sulphadoxine-pyremethamine by in vivo technique. Follow up was carried out for 28 days [on day 1, 2, 3, 7, 14, 21 and 28], Over all 35, 4% resistance-I was detected against chloroquine monotherapy and 4% with combination therapy [chloroquine and sulphadoxine-pyremethamine] Resistance-Ill was not found. Two variables were found important predictors of drug resistance; a young child and a high parasitaemia count [>6000/micro1] at day 0, It is concluded that malaria is still significant problem and resistance against monotherapy is increasing, hence adoption of combination therapy as first line treatment for uncomplicated falciparum malaria in Punjab Pakistan is recommended

Clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]

To evaluate the clinical spectrum of autosomal dominant polycystic kidney disease [ADPKD]. Hospital base perspective and retrospective study. This study was conducted in Department of Nephrology Sandeman, Provincial Hospital Quetta, from Nov. 2008 to Dec. 2010. In this study, 50 patients were taken with autosomal dominant polycystic kidney disease diagnosed by abdominal ultrasonography which were evaluated for their clinical spectrum by symptoms, clinical examination, ultrasonography, urine detailed report, urea, creatinine, 24 hours urinary creatinine and also evaluate for the extra-renal manifestation by abdominal utrasonography, gastrointestinal endoscopy and computed tomography [C.T Scan] of brain

Penetrating colonic injuries: primary repair versus colostomy

To compare the primary repair with colostomy in colonic injuries at tertiary care hospital in terms of morbidity and hospital stay. Quasi experimental study. This study was conducted in the Department of Surgery, Unit II BVH Bahawalpur from 27-01-2010 to 31-8-2010. A total of sixty patients fulfilling the inclusion criteria were selected for this study. Patients were randomly allocated in two groups. Group A [Primary Repair] and Group B [Colostomy], 30 patients in each group. Follow up in group A patients was done twice after 2 weeks and after one month. The follow up in group B was done for multiple times. Initially the visit was advised after every two weeks until the patient was called back for colostomy closure. The mean age in group A was 28.9 +/- 8.1 years and in group B was 30.1 +/- 14.0 years. The mean hospital stay in group A was 8.9 +/- 3.65 days and in group B was 11.0 +/- 4.7 days. At two weeks follow up, in group A, there was one [3.3%] patient of abscess, one [3.3%] of suture repair leak, one [3.3%] patient of sepsis and 2 [6.7%] patients of wound infection. In group B, there were 2 [6.7%] patients of abscess, one [3.3%] patient of suture repair leak, 3 [10%] patients of sepsis and 4 [13.3%] patients of wound infection. This is concluded from our study that primary repair was safe and effective treatment modality in the management of colonic injuries as compared to colostomy

Prevalence of hydatidosis in animals in different abattoirs of Punjab, Pakistan from 2004-2008

Hydatidosis is a zoonotic public health problem globally and in Pakistan also causing illness in human and animals. The purpose of this study was to determine the prevalence of disease. None randomized prospective study. This study was conducted in different abattoirs of Pujab [Faisalabad and Lahore], Pakistan from 2004-2008. In present study 39738 male and female animals [sheep, goats, buffaloes, cattle and camels] were examined. Liver and Lungs were main visceral organs with bigger size of cyst collected and processed on Real Time PCR. Highest prevalence [%] was found 7.29 [102/590] in camels and lowest 5.18 [155/2990] in cattle. Prevalence of fertile cysts was also determined and found highest [95%] in camels and lowest [75%] in cattle. Sterile, calcified and under developed cysts were also seen but without any significant number, except in cattle sterile cysts were significantly high [P<0.05]. Study showed high prevalence in two [Faisalabad and Lahore] out of six abattoirs visited in different big cites. It is concluded that in Punjab hydatidosis is significantly prevalence. The major cause of this prevalence is improper disposal of infected organs and unhygienic conditions of abattoirs

Different clinical presentations of breast cancer: an overview of 100 patients

To describe different modes of presentation of carcinoma breast in patients presenting at Bahawal Victoria Hospital Bahawalpur. It was a descriptive case series study, conducted in surgical units, Bahawal Victoria Hospital Bahawalpur. The duration of study was from January 2009 to December 2009. 100 female patients of proven carcinoma breast with informed consent were included in this study. All the data was collected on pre designed proforma and results were analyzed using SPSS 10,0 version, The commonest age group developing carcinoma breast was 31-50 years [59%]. Seventy six patients came from rural areas of Bahawalpur and nearby districts. Eighteen patients completed 10 years of schooling while only 5 patients were post-graduate. Twelve patients [12%] were un-married, Total 81% patients presented with lump in the breast. Left breast was involved in 56% of cases and right in 43% cases, One patient had bilateral carcinoma of breast. The duration of illness was ranged from 1 month to 5 years. The commonly observed stage of presentation was Stage III with 46 cases and 16 patients presented in stage IV. Infiltrating ductal carcinoma was the most common histological type 87% cases proved on histology to be infiltrating ductal carcinoma, Breast cancer is very common in the females, when diagnosed at an earlier stage have a more favorable prognosis compared to those at late stage. The females try to hide this problem and present at more advance stage

Success of dental amalgam as a retrograde filling material - a comparative observational study

The objective of the present study was to evaluate the efficiency of dental amalgam as retrograde filling material compared to gutta-percha. A prospective and comparative observational study was carried out on 30 patients at Khyber College of Dentistry, Peshawar from October 2004 to October 2009 with or without retrograde amalgam filling and the success was determined at the end of the year both radio-graphically and clinically. The radio graphic success rate was 86.6% and the clinical success rate was 73.3% where amalgam was used as retrograde filling material

Frequency of cardiac defects among children at echocardiography centre in a teaching hospital

To assess frequency of cardiac defects among children from birth to 12 years of age on echocardiography basis. A cross sectional study was conducted at echocardiography centre in coronary care unit at Bahawal Victoria Hospital Bahawalpur for fifteen months from April 2007 to July 2008. A sample of 150 patients [<12 years age] were selected by non-probability convenience sampling technique. The cardiologists performed echocardiography by Paediatric Transthoracic echo probe; 2-D colour Doppler, Acuson CV-70 and Niemo-30 echocardiography machines. Mothers of children with cardiac defects were interviewed at the echocardiography centre. Variables included were A- Muscular plus Vascular defects; B- Valvular defects; C-Pericardial effusion; D- Dextrocardia and E- Congestive cardiac failure. History of children for sore throat followed by joint pains; history of mothers for drug intake [antihypertensive, antipyretic, anti-emetic, hypoglycaemic] as well as chronic diseases [diabetes mellitus, hypertension, anaemia] during pregnancy were surveyed. Parity of mothers, their cousin marriages, and family socio-economic status was also inquired. The results were tabulated, analyzed and finally subjected to suitable test of significant [SR of proportion] to find out statistical significant if any. It was found that out of 150 patients, 76 [50.66%] were suffering from Cardiac muscular and Vascular defects, 61 [40.66%] Valvular defects, 7 [4.66%] Pericardial effusion, 2 [1.33%] Dextrocardia and 4 [2.66%] from Congestive Cardiac Failure. According to age, 54 [36%] were from birth to 3 years of age and 51 [34%] from 10 to 12 years. There was history of Rheumatic fever among 45 [30%] children. There were 106 [70.6%] children from lower socio-economic class and 79 [52.6%] parents had history of cousin marriages. Frequency of cardiac defects was more in children of male sex, lower socio-economic group, from birth to three years age and children from primipara mothers in our specified locality. Rheumatic fever, cousin's marriage, and prescribed drugs intake during pregnancy [for metabolic and hormonal disorders] were other contributors to cardiac defects

Presentation and management of allergic fungal sinusitis

To assess the presentation of allergic fungal sinusitis and describe the line of management in our setup. Descriptive study. Study was conducted in Otorhinolaryngology Department, Dow Medical College and Civil Hospital, Karachi, from January 2004 to January 2005. Culture and sensitivity / fungal stain proven 20 cases of allergic fungal sinusitis were selected for the study, irrespective of age and gender. Data including age, gender, socioeconomic status, signs, symptoms, laboratory findings [especially Immunoglobulin E and eosinophil count] and imaging studies [Computed Tomography and /or Magnetic Resonance Imaging] were noted for the study. Pre and postoperative medical treatment, surgery performed, follow-up; residual/recurrence disease and revised surgery performed were also recorded. In this series, allergic fungal sinusitis was a disease of younger age group with an average age of 20.75 years with male dominance [70%]. Poor socioeconomic status [80%], allergic rhinitis [100%] and nasal polyposis [100%] were important associated factors. Nasal obstruction [100%], nasal discharge [90%], postnasal drip [90%] and unilateral nasal and paranasal sinuses involvement [60%] were the commonest presenting features. Aspergillus [60%] was the most common etiological agent. In all cases [100%], increased eosinophil count and IgE levels were present. Orbital [20%] and intracranial [10%] involvement were also seen. Surgical management was preferred in all cases. Functional endoscopic sinus surgery in 90% cases and lateral rhinotomy in 10% cases were performed. Recurrence / residual disease was seen in 20% cases. In this series, allergic fungal sinusitis was seen in immunocompetent, young males, belonging to poor socioeconomic status, suffering from allergic rhinitis and nasal polyposis, presenting with nasal obstruction, nasal discharge and postnasal drip. Functional endoscopic sinus surgery was the most important problem solving procedure while lateral rhinotomy was reserved for extensive disease

Early detection of macro vascular diseases of carotid and femoral arteries in patients with Rheumatoid arthritis

Rheumatoid arthritis [RA] is a multi-system disorder with inflammatory process associated with increased cardiovascular risk. The duplex scanning is a noninvasive technique to detect early atherosclerotic plaques and arterial wall changes either in symptomatic or asymptomatic patients. Early detection of asymptomatic vascular disorders allows early intervention and possibly retards the development of symptomatic cardiovascular diseases. A higher risk of cardiovascular morbidity and mortality persists among patients with an abnormal ankle brachial index [ABI] and it is useful to identify asymptomatic patients with established disease. To detect the early manifestations of atherosclerotic changes of carotid and femoral arteries in patients with rheumatoid arthritis. Twenty-four patients with chronic rheumatoid arthritis [six males and eighteen females] aged 26-65 years [45.7 +/- 14.7 years] with mean disease duration 11.12 +/- 6.4 years [2-18 year] were included in the study. All patients were on methotrexate, corticosteroids and nonsteroidal anti-inflammatory lines of treatment. Twenty apparently normal subjects were included in the study as controls. Patients with other types of collagen diseases or patients with ischemic peripheral manifestations, ischemic heart disease, diabetics or smokers were excluded from the study. Full history and thorough clinical examination, including full joints and vascular examination for all peripheral arteries and calculation of ankle brachial index [ABI] was done using pocket Doppler and sphygmomanometer. Patients and controls were subjected for Hb, WBC, platelet count, rheumatoid factor, blood sugar, ESR, levels of plasma cholesterol, triglyciride, HDL and LDL. Duplex study was performed on carotid and femoral arteries. The mean ABI in patients was 1.21 +/- 0.3, non-significantly lower than controls but still within the range of normal. There was a significant increase in the levels of cholesterol, triglyciride, LDL and HDL than controls and still within the range of normal. Duplex changes of carotid and femoral arteries were present in 18/24 [75%] of patients including hemodynamic changes, intimal thickness, plaques, stenotic segment. Duplex of carotid arteries detected hemodynamic changes in 12.5%, intimal thickness, plaques and stenotic segment in 25% of patients for each and detected intimal thickness of femoral arteries in 25% of patients. There was a significant negative correlation between the ABI and duration of disease [r = - 0.506, p<0.01] and a significant positive correlation between the intimal thickness and duration of disease [r =-0.807, p<0.001]. There was no relation between drug intake or type of drug and ABI or intima thikness and there was no relation between cholesterol, triglyciride, LDL or HDL levels and ABI or intimal thickness. There is increased risk of vascular disease in RA patients involving carotid and femoral arteries in the form of hemodynamic changes, intimal thickness, plaques and stenotic segment. Low ABI together with Duplex study are helpful for detection of subclinical ischemic changes in such high-risk patients. Normal levels of plasma cholesterol, triglyciride, HDL and LDL do not exclude underlying vascular changes. So we recommend ABI and Duplex examination for all RA patients and further studies are needed to elucidate non-traditional risk factors such as endothelial dysfunction, immune activation and impaired fibrinolysis in addition to oxidative stress