A study to assess knowledge of primary health workers on malaria epidemiology, diagnosis, and treatment in Patiala district, India

Background: India accounts for (4%) of all malaria cases worldwide. The World malaria report 2017 showed that, by 2016, global progress against malaria had stalled and was off track to meet the Global Technical Strategy milestones for 2020. Aims and Objectives: The aim of the study is to assess knowledge of rural medical officers (RMO) and health workers on malaria epidemiology, diagnosis, and treatment as per National Vector Borne Disease Control Program of India guidelines. Materials and methods: A descriptive, observational, and cross-sectional study was done among government health personnel’s using a semi-structured questionnaire. Results: In the present study, 258 health personnel’s participated comprising multipurpose health workers female (MPHW-F), multipurpose health worker male (MPHW-M), and RMO. The standardized score on knowledge of vector biology and epidemiology was 72% and 54% for RMO and (MPHW-M), respectively. On malaria diagnosis, MPHW-M has got median score (53%) as compared to RMO (46%). On national malaria drug policy, there is a marginal difference between median score of RMO (42%) and MPHW-M (40%). Overall, there is incomplete and poor knowledge of treatment of malaria among all health personnel’s with lack of concept about presumptive treatment. Training showed some positive impact on the knowledge of MPHW-F but no impact on MPHW-M. Graduates and experienced workers have got better knowledge than undergraduates and MPHW-M have more knowledge than MPHW-F. There is poor knowledge of reporting formats, and usage of rapid diagnostic kits among all the health personnels. There was no significant impact of education qualification, in service training and work experience on the knowledge of Male health workers. Conclusion: Training needs to be suitably tailored as there is a lot of scope of improvement in the knowledge regarding malaria diagnosis and treatment among health workers.

A study to assess anxiety, stress and depression among private medical practitioners during COVID-19 pandemic: An observational study

Objectives: This study aims to assess the magnitude of anxiety, stress, and depression among private practitioners during the COVID pandemic 2020. Materials and Methods: A descriptive, observational and cross-sectional study was done using a semi-structured questionnaire through electronic media in the form of Google Forms. Patient health questionnaire 4 (PHQ4) and Perceived Stress Scale-10 were incorporated into the questionnaire to assess the psychological status in November 2020. Results: A total of 157 private practitioners participated in the study. Males constituted 60%. Participants have mean age (SD) of 44.2 (6.9) years with work experience and a mean (SD) of 16.3 (6.78) years. The anxiety and depression subscales of the PHQ-4 scale showed that 54.7% of the private practitioners have anxiety subscale ?3 and 28% have depression subscale >3 needing further psychiatric evaluation. Significant predictors of anxiety and depression were female gender, younger and less experienced, and those providing inpatient services in COVID care isolation facilities. Conclusion: There is a high prevalence of anxiety, stress, and depression among private practitioners comparable with other countries.

A study to Assess Anxiety, Stress and Depression among MBBS interns working in Covid care Isolation facility of a tertiary level Hospital: An Observational study

Introduction: The Emergence of new Delta strain of Corona virus has created havoc with all health care systems across the globe, there has been tremendous pressure due to shortage of health care workers forcing government to involve MBBS interns to overcome the shortage of health staff in Covid care. Aims & Objectives: To assess magnitude of anxiety, stress and depression among MBBS interns working in Covid Isolation facility of Government Medical College, Patiala. Material and methods: The Google form was created and the link to the online questionnaire was circulated through whatsapp group to the MBBS Interns working in Covid isolation facility during June to July 2021. The form included two instruments the Perceived Stress Scale-4 (PSS-4) and the Patient Health Questionnaire for Depression and Anxiety-4 (PHQ-4). Results: A total of 144 interns participated in the survey .Patient Health Questionnaires and Perceived Stress Scale-4 (PSS-4 ) scores of interns were 56% and 49% respectively. Anxiety and depression symptoms requiring further evaluation were seen in 19% of the Interns. Univariate analysis of PHQ-4 and PSS-4 shows statistically significant association with past history of psychiatric ailment .Conclusion: Careful monitoring of psychological and mental wellbeing of interns during the pandemic will go a long way in mitigating the worsening psychological wellbeing of budding doctors and interns.

Social media, purpose, and use of it: A community-based cross-sectional study in a rural area of a developing nation (India)

Background: Over the past two decades, the world has witnessed drastic progress in the field of communication. Social media are the collective of online communications channels dedicated to community-based input, interaction, content-sharing, and collaboration. Objectives: The objectives of the study were to determine the prevalence of social media use, pattern, and purpose of use and usefulness for conveying health education. Materials and Methods: The current study was undertaken; in a rural community of Punjab province of India from September 2018 to February 2019. Participants were interviewed using a pre-designed, pre-tested structured interview schedule. Results: The total number of participants in the study was 4000. Six hundred eighteen (15.5%) had a smartphone and among them, nearly 90% were using internet. The proportion of male participants (22.9%) using smartphone was significantly higher than female. Seven hundred and forty-two (18.5%) had heard of any form of social media, in which WhatsApp (13.1%) was the most common. The prevalence of the use of social media among the participants was 13.5% (n = 542). Friendship and entertainment were the major purposes for using of social media. Nearly 80% of the social media users think that it should be used more for health education, but only 11.8% of the users thought that the government was using this platform very successfully. Young, male, educated, employed, and business class was using significantly more social media for communication. Conclusions: Media is changing as well as health care and medicine, so time has come to consider one of the cost-effective and popular media to solve complex and diverse problems of health and disease.

Myeloid sarcoma of bile ducts presenting as obstructive jaundice – A case report

Myeloid sarcoma is an extra medullary manifestation of acute myeloid leukemia (AML). Primary involvement of the biliary tract with myeloid sarcoma presenting as obstructive jaundice without evidence of leukemia is very rare. Here we present a case of 72 year old lady, who initially presented with features of biliary obstruction and was clinically considered as cholangiocarcinoma. She was diagnosed as myeloid sarcoma involving right and left hepatic duct, common bile duct (CBD) on histopathological and immunohistochemistry (IHC) examination after surgical resection. Since she did not show evidence of leukemia on peripheral blood and bone marrow examination treatment was deferred. However, she developed full blown picture of AML within two months and succumbed to her disease. We conclude that obstructive jaundice can be the presenting symptom in myeloid sarcoma without evidence of AML in peripheral blood and bone marrow. However, these cases have to be treated aggressively to obtain remission.

Pattern of Serious Adverse Events Associated with Administration of Different Vaccines: A US Vaccine Adverse Event Reporting System (VAERS) Database Analysis

: Different vaccine adverse event surveillance systems have been developed down the years to act as an early warning system to detect signals regarding adverse events following vaccination. Different types of serious adverse events were characterized through the analysis of US VAERS registry. Methods: The VAERS data from 2010-2019 was analysed statistically for exploration of different types of serious adverse events and the signs and symptoms associated with administration of these vaccines. Vaccines implicated in serious adverse events through VAERS were further explored for correlates in WHO Vigibase database. Results: The maximum number of patients with serious events were administered FLU3 vaccine (n=4024, 12.71%), followed by PNC13 (n=2740, 8.66%), VARZOS (n=2310, 7.30%), PPV (n=1964, 6.20%) and HIBV vaccine (n=1448, 4.57%). Of all symptoms in patients with serious adverse events, pyrexia was the major symptom in patients with life threatening illness (16.06%), hospitalization (18.83%), prolongation of hospitalization (19.64%), disability (12.05%) and mortality outcome (9.95%). Among the top three vaccines implicated in serious adverse events, analysis through WHO Vigiaccess database found general disorders and administration site conditions and skin and subcutaneous tissue disorders to be the MedDRA major system organ classes for both pnemococccal and varicella zoster vaccine. Conclusion: FLU3 (Influenza), PNC13 (pneumococcal) and VARZOS (varicella zoster) vaccines were the top three vaccines implicated in serious adverse events through VAERS database analysis though a cause and effect relationship cannot be established through the this data alone.

Management of recurrent aqueous misdirection by anterior segment surgeon after failed pars plana posterior vitrectomy

Aqueous misdirection (AM) is a dreaded complication, but fortunately quite rare. It usually occurs after intervention for angle closure glaucoma. When pharmacotherapy and/or laser interventions are unsuccessful, then the surgical management hitherto most commonly undertaken is pars plana posterior vitrectomy. We describe the management of recurrent AM via the anterior route, when it occurred following relapse as pars plana posterior vitrectomy failed to result in long-term normalization of anterior chamber and intraocular pressure. Anterior vitrector with anterior vitrectomy settings was used by a glaucoma specialist to carry out the procedure.

Immunoglobulin G4 related pancreaticobiliary disease: Report of two cases highlighting the diagnostic criteria

Two cases of immunoglobulin (IgG4)-related biliary and pancreaticobiliary disease are reported to define its diagnostic features. Case 1 presented with obstructive jaundice and showed IgG4-related disease (RD) involving right and left hepatic duct, common bile duct and gallbladder. Case 2 presented as periampullary mass. Both patients underwent surgical intervention. However, certain clinical and radiological features were present in these cases indicative of the possibility of IgG4-RD.

Morphological Variations of the Thyroid Gland in the North Indians: A Cadaveric Study with its Clinical Relevance

Introduction: The morphological variations of the thyroid gland are not an uncommon phenomenon and may due to embryological remnant or non-specific development of different parts of it. Prior anatomical knowledge of these variations is of immense importance to prevent catastrophies during or after thyroid surgeries. Therefore, in this study we aimed to investigate the prevalence of morphological variations of the thyroid glands in north Indian cadavers. Subjects and Methods: This study was conducted on 50 formalin embalmed adult human cadavers aging between 40–65 years, of which 40 were males and 10 were females. Thyroid glands were dissected and examined properly for the presence of pyramidal lobe, levator glandulae thyroidae, accessory thyroid tissue and complete absence of isthmus. Results: The pyramidal lobe was present in 9 (18%) and frequently arising from the right side of the isthmus. LGT was found in 7 (14%) and almost in all cases it was extending from the apex of the pyramidal lobe to the hyoid bone. Only 2 (4%) cadavers did not show an isthmus while accessory thyroid tissue was found only in one case. Morphological variations were more common in females than in males and the difference was statistically significant (p value<0.05). The means of all measured parameters were higher in female than in male but these gender differences were not significant (p>0.05). Conclusion: Morphological variation of the thyroid gland is a common phenomenon, particularly in female. Hence it requires proper detection and documentation prior to any thyroid surgery, so that iatrogenic catastrophies can be avoided

Uterine tumor resembling ovarian sex cord tumor: Histomorphological features

Uterine tumors resembling ovarian sex cord tumors are rare neoplasms with varied histological and immunophenotypic profile, uncertain histiogenesis and biological behavior. A critical evaluation of histological features is essential for diagnosis and management of these cases.

Role of C Reactive Protein as a Rapid Screening Test for the Judicious Use of Antibiotics in Neonatal Sepsis.

Neonatal infections according to WHO cause mortality in 42% of cases out of which neonatal sepsis is a major cause. C-reactive protein plays a very important role in screening of neonatal sepsis as it can predict an early infection. C-reactive protein added to the full clinical picture contributes usefully to diagnosis, prognosis and management. Sometimes, the antibiotics have to be given for a longer time but CRP can help in early discontinuation of antibiotics. In the present study, 7032 neonates in the age group 0-28 days were screened, using latex agglutination test kit by Tulip diagnostics. A concentration of 0.6mg/dl was taken as positive. Negative and positive controls were always included in the test. The prognosis of a case of sepsis was judged by repeated estimation of CRP at 48 hours, then 72 hours and subsequent to the clinical response and effect of antibiotic therapy. In cases showing CRP more than or equal to 0.6mg/dl, serial doubling dilutions of patients serum were tested to find out its exact amount. Of 7032 neonates examined, 2707 (38.5%) had CRP level >0.6mg/dl.

Prevalence of Extended Spectrum β-lactamases Producing Clinical Isolates from Patients of Urinary Tract Infection in a Tertiary Care Hospital in Delhi.

A total of 250 urinary isolates (188 Escherichia coli and 62 Klebsiella pneumoniae) were studied for ESBL production by double disc approximation test and disc diffusion confirmatory test (NCCLS). ESBL production was found to be 56% in E. coli and 52% in K. pneumoniae. The double disc approximation test showed false ESBL production in five (2.6%) isolates of E. coli and one (1.6%) K.pneumoniae. The susceptibility of ESBL producers to imipenem, amikacin, nitrofurantion was found to be 100%, 86% and 84% respectively. A high degree of co-resistance to co- trimaxazole and norfloxacin was found in strains of ESBL producers. Seventy five per cent of ESBL producers detected were from hospitalized patients admitted in ICU or undergoing surgery.

Occurrence and detection of AmpC beta lactamases among clinical isolates of E. coli and K. pneumoniae causing UTI.

Presence of Bush class C enzymes in uropathogenic strains of Klebsiella pneumoniae & E. coli resistant to extended spectrum cephalosporins is an emerging threat to clinical therapeutics. These resistant strains result in considerable treatment failure and cannot be detected by routine antibiotic sensitivity screening methods. An effort was therefore made to study AmpC beta lactamase production in E. coli and Klebsiella pneumoniae strains causing UTI. A total of 126 E. coli and 49 K. pneumnoniae strains isolated from urine samples were selected for study out of which AmpC beta lactamase production was seen in 23% E. coli (29 isolates) and 18% K. pneumoniae (49 isolates). The susceptibility of AmpC beta lactamase producers to Imipenem, Nitrofurantoin and Amikacin was found to be 100%, 92% and 80% respectively. Thereby the present study emphasizes the importance of monitoring and control of usage of extended spectrum cephalosporins.

Effect of alternate nostril breathing exercise on cardiorespiratory functions.

Pranayama (breathing exercise), one of the yogic techniques can produce different physiological responses in healthy individuals. The responses of Alternate Nostril Breathing (ANB) the Nadisudhi Pranayama on some cardio-respiratory functions were investigated in healthy young adults. The subjects performed ANB exercise (15 minutes everyday in the morning) for four weeks. Cardio-respiratory parameters were recorded before and after 4-weeks training period. A significant increment in Peak expiratory flow rate (PEFR L/min) and Pulse pressure (PP) was noted. Although Systolic blood pressure (SBP) was decreased insignificantly, the decrease in pulse rate (PR), respiratory rate (RR), diastolic blood pressure (DBP) were significant. Results indicate that regular practice of ANB (Nadisudhi) increases parasympathetic activity.

Isospora belli infection in a malnourished child.

Isospora belli, a coccidian parasite usually causes a self limiting illness of acute onset with fever, diarrhoea and colicky pain in a normal host. In immunocompromised patients human isosporiasis becomes chronic. We report a case of a malnourished 9 year old female child who presented with complaints of loose stools, nausea, vomiting and weight loss for the past three months. Stool examination revealed immature oocysts of Isospora belli. The patient was successfully treated with TMP-SMX.

Visceral leishmaniasis masquerading as chronic liver disease.

We report a patient with fever, progressive jaundice and abdominal distension, having marked pallor, icterus, ascites and hepatosplenomegaly. Investigations revealed pancytopenia and deranged liver functions. Doppler study revealed portal hypertension and endoscopy showed grade II oesophageal varices. Liver biopsy suggested leishmanial hepatitis and bone marrow demonstrated multiple LD bodies. Diagnosis of "visceral leishmaniasis with leishmanial hepatitis with portal hypertension" was made. The case is being reported because of its rarity apart from it being an unusual presentation of kala-azar.

Emphysematous pyelonephritis: report of 4 cases.

Emphysematous pyelonephritis is a rare, life endangering suppurative infection of the renal parenchyma and perirenal spaces. The disease is encountered mainly in patients with diabetes mellitus and is characterized by the production of intrarenal and, occasionally, perirenal gas. We present 4 cases of emphysematous pyelonephritis encountered in our hospital with review of the literature.

Seborrheic keratosis of the conjunctiva.

Seborrheic keratosis can simulate a malignant melanoma and should form the differential diagnosis of a malignant melanoma. Histopathology is confirmatory.