A critical review of autopsy findings in deaths due to COVID-19

Not much is known about the pathological post-mortem findings of people dying of the novel coronavirus disease. There is a great need of such information for better clinical management of COVID-19 cases. A detailed literature search was conducted followed by its critical review. The search was made in databases like Pub Med, Scopus and EMBASE. The histopathological alterations were found to be mainly confined to the lungs. This included diffuse alveolar damage with formation of hyaline membrane and pulmonary microvascular thrombosis. There was a high incidence of deep venous thrombosis and pulmonary embolism in COVID-19 patients which hints towards possible endothelial involvement. The findings of the review have been derived from very few and restricted studies. These claims need to be substantiated by doing further studies.

Live experience of community health workers on respectful maternity care in rural Odisha, India: a phenomenological study

Background: Every woman deserves respectful maternity care, throughout her journey to motherhood. However, disrespectful maternity care is prevalent in various settings. It has an effect on the utilization of services. It can be more explored from the witness of maternity. The aim of this study was to explore the experience of accredited social health activists on respectful maternity care in Odisha, India. Methods: A qualitative exploratory study was conducted among 24 ASHAs with more than two years of experience to gain a deeper understanding of the phenomenon. This study was conducted in three distinct Odisha districts, India. Results: Two main themes emerged: Community health workers’ experiences and perception towards disrespectful care, and Factors contributing to irrational care. Participants explained that verbal abuse was the most common use of health care providers. The consequences of such abusive behavior hinder the effective and efficient performance of their role, especially when it comes to their role in the facility. The study highlighted major gaps in the behavior and attitudes of healthcare providers at the facility level. Conclusions: Despite the lack of knowledge and training related to RMC, ASHAs acknowledged the abusive and disrespectful behavior of health care providers not only towards the child-bearing women but also towards the accompanying person, i.e., ASHA or a member of the family. Such mistreatment often acts as a barrier to the use of public health services, such as the institutional delivery of child-bearing mothers. A need for orientation and training on RCM among healthcare professionals, along with appropriate monitoring of implementation.

Abnormal communication between cephalic and basilic veins-a case report

The cephalic vein and basilic vein begin respectively from lateral and medial ends of the dorsal venous arch of hand. The basilic vein is confined to the medial side of upper limb and continues upwards as the axillary vein whereas the cephalic vein is confined to the lateral side of upper limb and drains into the axillary vein. The aforesaid veins communicate with one another through the median cubital vein that lies in the roof of cubital fossa. The superficial veins are used for venepuncture, cardiac catheterization, bypass grafting and arteriovenous fistula for hemodynamic access. The authors chanced upon a variation in the cephalic and basilic veins in the right upper limb of a cadaver of a sixty years old female dying due to natural causes. The cadaver was used for routine dissection classes of first year MBBS students in a medical college of Eastern India. The cephalic and basilic veins of the said cadaver joined with each other in the cubital fossa. The brachial vein began from the point of union of the two former superficial veins and the single brachial vein replaced the paired brachial veins which is usually the norm.

What they know about their work, barriers, and challenges faced by the community health workers while performing their multiple roles: mixed method study in India

Background: Accredited social health activist (ASHA) forms the backbone of National Health Mission (NHM) as they are the important link between the community and the health system, her services become very crucial for the success of NHM. They are occupied by multiples roles, responsibilities and they are expected to perform at optimum level. Aim was to assess the knowledge and practice of ASHA workers regarding their work responsibilities and to explore the barriers and challenges faced by them while performing their multiple roles. Methods: An explanatory mixed-methods study was conducted among community health workers (ASHA) of having at least one years of experience at Uttarakhand, India with 150 ASHAs for quantitative and 14 for qualitative. Purposive sampling was employed for both the approaches. Results: Quantitative approach shown that almost 91% of ASHA are having the knowledge about the importance of colostrum milk followed by importance of Anganwadi center (83%), immunization (79%), general health (70%), and birth preparedness (69%). The core thematic areas in qualitative result represented as personal, psychological, economic, social and environmental factors. They showed a level of unhappiness and distress related to their work overload and incentives. Conclusions: In general, ASHAs are having adequate knowledge about their job responsibilities, there is more training needed about maintaining the records and documentation process. There is immediate need to overcome the barriers and challenges they are facing, which can hamper their performance level.

Megaloblastic anemia in children from Eastern Odisha, India: A clinical and hematological profile analysis

Background: Anemia can have severe implications on the health of children including motor development, behavioral and cognitive development. Furthermore, morbidity from infectious disease is higher in anemic children. Nutritional anemia is a major concern in rural India. Aim and Objective: We aimed to observe the percentage of megaloblastic anemia among the anemic children and their clinical and hematological parameters. Materials and Methods: After obtaining permission from the Institutional Ethics Committee, this cross-sectional study was conducted from September 2018 to August 2021. The setting was a tertiary care hospital in the eastern part of Odisha, India. Children of 1� years of age presenting with anemia were included in the study. Details clinical examination and blood tests namely mean corpuscular volume, red blood cell count, total leucocyte count, and platelet count were carried out from venous blood. Descriptive statistical analyses were conducted in STATA software version 15.1. Results: Among the total 150 anemic patients, the majority (126 [84%]) were in the 11� years of age group followed by 24 (16%) in 6� years of age (P < 0.0001). Girls were more (94 [62.7%]) than boys (56 [37.3%]), P < 0.0001. Anorexia was the most frequently encountered clinical symptom (99.3%) followed by pallor (94%), weakness (86%), fatigue (62%), and hyperpigmentation (37.4%). According to hemoglobin level, 40% were suffering from severe anemia, 38.7% was having moderate, and 21.3% was having mild anemia. The majority (74%) were having both Vitamin B12 and folic acid deficiency followed by 16.7% Vitamin B12, and 9.3% folic acid deficiency. Conclusion: Girls were presenting with megaloblastic anemia more than boys. Majority of them were suffering from both Vitamin B12 and folic acid deficiency. Children suffering from megaloblastic anemia present with anorexia, pallor, weakness, and fatigue. A proper health promotion program may be designed to aware the parents about the prevention of nutritional anemia.

Lynch syndrome: An unusal case of familial cancer unearthed

Lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) is a type of inherited cancer syndrome with a genetic predisposition to different types of cancer. There is an increased predisposition to cancers in the endometrium, colon, stomach, ovary, uterus, skin, kidney, and brain in patients of Lynch syndrome. We are reporting a 48-year-old male who presented with a pea-sized growth in his left arm which was found to be sebaceoma on histopathology. On further detailed history, examination, and genetic study, it was proved to be a familial case of Lynch syndrome. The case is being reported to stress the importance of knowledge about clinical manifestation, associated neoplasms, and molecular genetic profile of Lynch syndrome which will enable physicians and pathologists to provide highly targeted surveillance and management for patients with high cancer risk.

Childhood Leprosy Scenario at a Tertiary Level Hospital: A Four - Year Retrospective Study

Childhood leprosy is an important marker of the status of any ongoing leprosy control programme because it is an indicator of active disease transmission in the community. Studies pertaining to proportion and characteristics of paediatric cases from Bihar are few in number. Hence, present study was carried out to know the scenario of childhood leprosy. A retrospective analysis of 4 year records of leprosy patients aged up to 14 years in a tertiary care hospital of Bihar, was carried out from June 2014 to May 2018. A total number of 72 (9.31% of total leprosy) cases of childhood leprosy reported to AIIMS, Patna, Bihar, India during this 4-year period. The majority of cases belonged to the age group of 11-14 year (84.72%) with a male preponderance. Borderline tuberculoid was the commonest clinical type (44%) followed by tuberculoid type (29%). Borderline lepromatous, Indeterminate form, Histoid leprosy and Pure Neural type was seen in 2, 4, 1, 2 cases respectively. Multibacillary (MB) cases constituted a total of 39 (54.16%), while remaining 33 (45.83%) were of paucibacillary (PB) type. A solitary skin lesions either a hypo-pigmented or an erythematous patch with decreased sensation with or without thickened nerve was the most frequent manifestation in 34 cases (47.22%) followed by 2-5 skin lesions in 29 (40.27%) and more than 5 skin lesions or diffuse infiltration in 9 (12.5%) patients. Although nerve thickening was seen in 32 (44%) cases, neuritis and lepra reactions were less common. Disability was noted in 15.27% cases (Grade1 disability in 2.7% and Grade 2 disability in 12.5%). History of contact was found in 51.38% cases. Continuous and sustained efforts for early case detection of leprosy cases in the community in general, and a close follow-up of susceptible children amongst household contacts of leprosy cases will be desirable to treat these cases of childhood leprosy early before they develop any disability. Intense efforts are thus required to achieve the target of zero disability in child leprosy cases set in the Global Leprosy Strategy 2016-2020.

Clinico-Epidemiological Profile of Leprosy in Post Elimination Era: A Hospital Based Study

In December 2005, National leprosy Eradication Programme of India announced elimination of leprosy as a public health problem at national level. However, a significant number of new cases continue to be diagnosed in India. This study was carried out in Department of Dermatology, Venerology and Leprology, AIIMS, Patna where we have retrospectively analysed the clinicoepidemiological profile of of registered cases of leprosy between January 2016 and December 2017. Out of 464 fresh / default leprosy patients who reported to our department, a majority proportion (24.35%) belonged to 30 to 39 years age group followed by 20-29 yr (23.49%) 40-49 yr (19.39%), remaining belonged to other age groups. There was male preponderance. By occupation most of patients were farmers and labourers. Borderline Tuberculoid (29.41%) was the most frequent morphological type, but the proportion of Lepromatous Leprosy (21%) was significant. Overall, multi-bacillary leprosy (80.17%) cases were the most dominant type. 34.91% patients presented in reaction, among these Type 1 in 40.74% and type 2 in 59.25%. Disabilities were found in 172 (37.06%) patients with Type 1 disabilities in 76 (16.37%) patients and Type 2 disabilities in 96 (20.68%) patients. Clinically thickened peripheral nerve enlargements were recorded in 421 patients (90.73%). Ulnar nerve was found to be the most commonly involved nerve. History of contact was present in 10.34% of cases. 296 (63.79%) patients belonged to rural area whereas 168 (36.28%) belonged to urban area. Very high proportion of multi-bacillary cases, reactions and also high disability rates indicate the need for in depth studies at community level and appropriate remedial public health measures.

Gastric carcinoma and acute myeloid leukemia: A case report of a double malignancy

A double malignancy involving a solid organ and hematopoieteic system is rare. We report an interesting case of gastric adenocarcinoma with subsequent development of acute myeloid leukemia, in the absence of any therapeutic intervention.

Clinico-epidemiological Profile of Pure Neuritic Hansen's Disease in Western Odisha: a Hospital Based Retrospective Cross Sectional Study

There is a complete lack of data on clinico epidemiological profile of pure neurotic leprosy from Western Odisha region, despite the area still being endemic for leprosy. This study has been carried out to address this issue to identify the profile of pure neuritic leprosy reporting to a Tertiary Care Centre in Western Odisha. Patient's case records with clinical diagnosis of PNL who reported to this centre between October 2012 to October 2014 were studied. Demographic details, educational qualification, clinical presentation, pattern of peripheral nerve involvement, type of disabilities and complications occurring if any, were noted from the patient records and analyzed. Data collected and analysed shows that out of total 1460 of these leprosy patients 145 (9.93%) patients had been diagnosed with pure neuritic form of the disease. The mean age of PNL patients was 34.43 + 1.09 years. The various clinical presentations, that were observed and recorded, included sensory loss, tingling, pain, hypoesthesia, trophic ulcer and various grades of motor nerve disabilities. Neuropathic pain was complained by 28.3% patients. Mononeuritic presentation was observed in 79/145 (54.5%) patients with ulnar nerve being the most commonest nerve involved. Grade 2 disabilities were present in a large proportion of these PNL cases. Disabilities were more common in polyneuritic type of cases compared with mononeuritic cases. Such high disability rates in these PNL cases at our Tertiary Care Centre might be due to late self reporting of cases for treatment or diagnosis being delayed. These figures may not reflect the proportion/percentages at population level which should be verified by actual surveys after proper training of staff. As PNL demands early diagnosis to prevent progression of nerve damage and multiple nerve involvement, all patients having the above clinical presentations should be suspected of PNL in leprosy endemic areas

Association of Internet Addiction with Insomnia, Depression, Anxiety and Stress among University Students - A Cross-Sectional Study.

Background & Objectives: Internet is undoubtedly leading to the fourth industrial revolution. Use of internet comes with its misuse, namely Internet Addiction (IA). Mood disorders have been reported to be associated with heavy internet use, especially among young adults. We assessed the prevalence of IA and its association with insomnia, anxiety, depression and stress among University students. Material & Methods: In a cross-sectional survey using an anonymous, self-administered questionnaire, information on socio-demographic characteristics was collected from all willing students. Previously validated and standardized scales like Insomnia Severity Index (ISI), Depression Anxiety Stress Scale (DASS 42) and Young Internet Addiction Test (YIAT) were used. Results: Among 430 average YIAT score was 29.69 ± 16.66. Potential IA prevalence rate was 13% with a 95% CI of 10 - 16%. Prevalence of depression was 44.1%, Anxiety was 59.1% and stress was 37.2%. Significant correlations were found between potential IA and insomnia, stress, anxiety and depression (p-value < 0.0001). ISI, DASS stress scores were significantly associated with internet addiction. Conclusion: Potential internet addiction often exists with other psychological problems which warrant its detection in order to provide appropriate counselling and supervision.

Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.

Impact Of Health Awareness Intervention Among The Women Sweepers Working Under The Midnapore Municipality Of West Bengal, India.

Background: Women sweepers is the vulnerable segment of our community and suffering from different occupational health problems due to limited education, lack of knowledge on occupational health hazards. The present study aimed to assess the awareness level regarding occupational health and personal hygiene and to evaluate the effect of occupational health intervention among the women sweepers. Methods: The study adopted a pre-test and post-test design. A total of 52 women sweepers in the age group of 25 to 60 years were selected randomly from Midnapore Municipality of West Bengal, India. At first, a self-structured questionnaire was prepared on the aspects of general health, occupational health, personal hygiene, environmental health and nutritional aspects. After the pre-awareness assessment an intervention package was delivered covering said domains. Than post testing was done on the participants after the period of intervention. Results: Results demonstrated that there was a considerable increase in the awareness levels among the women sweepers with regard to knowledge of health problems, occupational health. The knowledge of participants regarding personal hygiene improved markedly after imparting the intervention. With regards to preventive approaches of diseases among the women has increased after the intervention. Overall health knowledge increased significantly post-awareness stage than pre-awareness stage (P<0.001). Conclusion: The study concluded that occupational health intervention has a positive effect towards the improvement of awareness level among the women sweepers which may change their health habits.

Novel applications of nanotechnology in medicine.

Current modalities of diagnosis and treatment of various diseases, especially cancer have major limitations such as poor sensitivity or specificity and drug toxicities respectively. Newer and improved methods of cancer detection based on nanoparticles are being developed. They are used as contrast agents, fluorescent materials, molecular research tools and drugs with targeting antibodies. Paramagnetic nanoparticles, quantum dots, nanoshells and nanosomes are few of the nanoparticles used for diagnostic purposes. Drugs with high toxic potential like cancer chemotherapeutic drugs can be given with a better safety profile with the utility of nanotechnology. These can be made to act specifically at the target tissue by active as well as passive means. Other modalities of therapy such as heat induced ablation of cancer cells by nanoshells and gene therapy are also being developed. This review discusses the various platforms of nanotechnology being used in different aspects of medicine like diagnostics and therapeutics. The potential toxicities of the nanoparticles are also described in addition to hypothetical designs such as respirocytes and microbivores. The safety of nanomedicine is not yet fully defined. However, it is possible that nanomedicine in future would play a crucial role in the treatment of human diseases and also in enhancement of normal human physiology.

Hepatoprotective activity of six polyherbal formulations in paracetamol induced liver toxicity in mice.

Background & objective: Polyherbal formulations available with a wide range of indications like protective to liver, appetite and growth promoters, gastrointestinal and hepatic regulator, as treatment for hepatic dysfunction, for hepatic regeneration as well as liver stimulant and tonic. Despite the widespread use, there is a lack of scientifi c evidence on their effi cacy and safety. This study was undertaken to evaluate the hepatoprotective activity of six commercially available formulations, namely Liv 52, Livergen, Livokin, Octogen, Stimuliv and Tefroliv in acute liver toxicity in mice model induced by paracetamol (PCM). Methods: Swiss albino mice of either sex were used, divided in 28 groups with six in each group. The dose of the polyherbal formulations was calculated from human dose (20 ml/day) using a standard conversion table. They were given as pretreatment (2.60 ml/kg/day) for 7 days by oral route twice a day prior to PCM administration. Hepatotoxicity was induced by administering a single oral dose of PCM (500 mg/kg bw) on day 8. The study parameters were conducted on day 9. The biochemical parameters included liver enzyme levels alanine tranaminases (ALT), aspartate transaminases (AST) and alkaline phosphatase (ALP). The pharmacological and pathological parameters were phenobarbitone sleeping time and macroscopic and microscopic changes of liver tissues respectively. Results: PCM toxicity signifi cantly increased ALT, AST and ALP (321.00 ± 87.93, 273.17 ± 45.68, 257.50 ± 17.64 IU/l vs normal control, 33.33 ± 0.61, 89.33 ± 9.50, 152.17 ± 11.40 IU/l respectively, P<0.05), prolonged phenobarbitone induced sleeping time (from 277.50 ± 8.04 min to 335.83 ± 7.00 min, P<0.05). When PCM higher dose (1g/kg p.o. single dose) was used, the liver tissue, in macroscopic appearance, showed extensive necrosis associated with haemorrhages. Low dose (500 mg/kg p.o. single dose) showed punctate haemorrhagic necrosis of liver tissue. In the microscopic studies, PCM induced toxicity showed haemorrhages, fatty changes and necrosis. The pretreatment in low doses (2.6 ml/kg/day) with liquid formulations of Liv 52 and Livergen reversed the PCM induced liver toxicity. At higher doses (5.2 ml/ kg/day), all the six herbal formulations conclusively showed marked benefi cial effects in the studied pharmacological, biochemical and histological parameters. Interpretation & conclusion: The present fi ndings demonstrated the effi cacy of polyherbal liquid formulations at two dose levels in PCM induced hepatotoxicity in mice. However, it suggests that a dose adjustment may be necessary to optimize the effects in clinical settings.

Reye syndrome: a case report with review of literature.

Here we describe a case of Reye syndrome diagnosed at postmortem liver biopsy of a three-year old girl who presented with vomiting, low grade fever for three days and loss of consciousness for 18 hours. Clinically, the differential diagnoses were meningitis, encephalitis and septicemia. No history of past illness or any drug ingestion including aspirin were present. Laboratory investigations indicated a diagnosis of Reye syndrome. The child was given supportive treatment but died after two days of admission and postmortem needle-biopsy of the liver showed microvesicular steatosis consistent with Reye syndrome.

Primary malignant melanoma of vagina--a case report with review of literature.

Primary vaginal malignant melanoma is a very rare tumor with less than 300 cases reported to date. We describe a case of primary vaginal melanoma and review the literature. A 60 years postmenopausal female patient presented with painless mass coming out of the vagina with occasional bleeding for last 2-3 weeks. On vaginal examination there was a firm polypoidal growth of size 7 cm attached to the right lateral wall of vagina and coming out of the introitus. Histopathology of the mass showed features of malignant melanoma. Wide local excision was done and adjuvant therapy was given. However patient came back after three months with widespread metastasis and expired 6 months after the initial diagnosis. Vaginal melanoma is a very aggressive tumor and the overall prognosis is very poor despite the treatment modality.

Accuracy of ultrasonography in the diagnosis of acute appendicitis.

AIMS AND OBJECTIVES: To assess the accuracy of ultrasonography in the diagnosis of acute appendicitis. METHODOLOGY: A prospective randomized study was carried in the Dept. of Radiology and Imaging, Tribhuvan University, Teaching Hospital, Maharajgunj, Kathmandu, Nepal. A total of 120 patients, who were clinically diagnosed as acute appendicitis were subjected to ultrasonography of the abdomen. A detailed ultrasonography was performed and the findings were recorded. Twenty one cases had alternate diagnosis. Ninety nine cases ultimately underwent laparotomy and the retrieved appendices were sent for histopathological examination. Intra-operative, histopathological and ultrasonographic diagnoses were then statistically analyzed. RESULTS: Ultrasonographic, intra-operative and histopathological findings were statistically insignificant (P0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy percentage of ultrasonography in the diagnosis of acute appendicitis was 85.7%, 100%, 100%, 6.7% and 85.9% respectively. CONCLUSION: Ultrasonography has a high degree of accuracy in the diagnosis of acute appendicitis. However, the diagnosis should be considered with the diameter of appendix over 6 mm. Therefore acute appendicitis with diameter of appendix having less than 6 mm should be evaluated with other diagnostic parameters.

Diagnostic variability and therapeutic efficacy of ECT in Nepalese sample.

BACKGROUND: Though electroconvulsive therapy (ECT) has been used in Nepal for last twenty years, researches regarding its use, its efficacy and other data are non-existent. AIMS: The objective of this study was to know about diagnostic variability and therapeutic efficacy of the use of ECT in hospitalized patients. METHODS: This is a prospective comparative study between patients who received ECT and who did not using ICD-10 as diagnostic confirmation. Psychopathology was evaluated using Brief Psychiatric Research Scale (BPRS), Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Functional assessment of patients was done using Global Assessment of Function (GAF). Modified ECT was performed using general anaesthetic agent. RESULTS: 47 patients received ECT as compared to 78 patients who were non-receivers. The patients with most common five diagnosis were paranoid schizophrenia (14.4%); psychotic depression (13.6%) ; undifferentiated schizophrenia (8.8%) ; bipolar mania (7.2% ) ;severe depression without psychosis (5.6%) . There was significant decrease in BPRS in ECT receiver as compared to non-receivers at discharge (p=0.0001), 1st month (p=0.0001), 6th month (p=0.0001) and 12th month (p=0.0001) ; in YMRS at discharge (p=.008), 1st month (p=.002) and at 12th month (p=.015) ; in HAMD-M at discharge (p=0.0001), at 1st month (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001) ; in GAF at discharge (p=0.0001), at 6th month (p=0.0001) and at 12th month (p=0.0001). CONCLUSION: There was significant improvement in overall psychopathology of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in BPRS, YMRS, HDRS and GAF at the time of discharge, 1st month, 6th month and 12th month which were statistically significant. Day to day functional status of patients also improved as shown by GAF. The efficacy of ECT was very significantly shown in this study with all the psychiatric spectrum disorders.