Routine medical check-up and self-treatment practices among population living in mountainous area of a tribal district of Odisha

Background: Self-treatment is recognized as one of the global public health issues. Geographical distance, constrained financial resources, and lack of awareness are the main barriers for people in remote areas to access health care. Self-treatment may also have risky consequences such as side effects and antibiotic resistance. It is assumed that the rate of self-treatment is high in the unreachable hilly tribal areas because of the geographical factor. Aim and Objective: The primary objective of the present study is to find out the prevalence and reason of self-medication, and the sources of drug information. The secondary objective is to assess the awareness of routine medical check-up among the tribal population of the hilly areas of the Koraput district of Odisha. Materials and Methods: A retrospective study was conducted after receiving clearance from the Institutional Ethical Committee, SLN MCH, Koraput. The study was conducted from February 2022 in some hilly villages near Koraput, which is a typical mountainous commune with the terrain divided by many mountains. Simple random sampling was done using computer software for selecting participants (sample size: 200). The participants were contacted and our interviewer visited door-to-door for face-to-face interviews. The research team developed a structured questionnaire to use in the face-to-face interviews. The questionnaire included questions about demographic characteristics, access to medical facilities, frequency of routine medical check-ups in the past 12 months, health information sources, and distance to the nearest health facility. A series of questions regarding self-treatment practices were also asked: Whether they had purchased any medication without prescription in the past 3 months, what the symptoms were, and what kind of medicines they bought, and the reasons they bought the medicines on their own. Results: The study found that prevalence of self-medication was 92 (46%, C.I. 95%). The majority of residents had self-medication when they suffered from common cold and cough (16% of participants), fever (8%), diarrhea (6%), body pain or myalgia (8%), and allergy (2%). The most prevalent groups of drugs used were antipyretics such as paracetamol (36%), antibiotics (30%), antihistamines (14%), and analgesics such as diclofenac and nimesulide (26%). The most common reason for choosing a local practitioner or private pharmacist and health worker was the subjects’ proximity to them. Of the self-medicated population in our study, 62% procured medicines from local practitioners, chemists, or health workers residing in their villages or nearby villages. Conclusion: Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time and at the lowest cost to them and their community. Self-medication unfortunately does not follow the standard, scientific, and rational criteria. Due to self-medication quality of medicine, scientific, and rational procurement, rational prescription is always questionable.

Medical devices associated adverse events under Materiovigilance Programme of India in a Tertiary Care Hospital of Tribal District of Odisha

Background: A materiovigilance program is a system that is used for the identification, collection, and reporting of possible adverse reactions resulting from the use of medical devices. This monitoring program ensures the safety of patients and aids the post-marketing surveillance process. The Materiovigilance Programme of India (MvPI) was launched on July 6, 2015. Aims and Objectives: The primary objective of the study was to generate evidence based data on the safety of the medical devices used in our institute and to analyze the risk benefit ratio of reported adverse events of medical devices and to communicate the safety information to the stake holders. The secondary objective was to educate and advocate the concept of MvPI and creating a culture of adverse events reporting among health workers. Materials and Methods: A retrospective study was conducted after receiving clearance from the Institutional Ethical Committee, Saheed Laxman Nayak Medical College and Hospital (SLN MCH), Koraput. Data about Medical Device-Associated Adverse Events (MDAEs) were collected from MDMC, SLN MCH, Koraput, for the period from October 2019 to February 2022. MDAE reports were collected by a materiovigilance associate during the period from October 2019 to February 2022. Events were reviewed to verify whether or not they were documented in patient’s electronic records and a database of devices was created, which included the events associated with each device. Device-related MDAEs were classified by patient characteristics and the medical devices used. Results: In the 15-month study period, a total of 56 cases of MDAE were reported to MDMC, SLN MCH, Koraput. Of these, 17.9% MDAEs (10 cases) were adverse events related to surgical gloves, 8.9% (five cases) were associated with pulse oximeters, 7.14% of cases (4 cases) were due to glucometer malfunctioning, and 7.1% were related to HIV diagnostic kits such as false positives and false negatives. Adverse events such as skin rashes, irritation on skin, itching, redness of eyes, and gum bleeding in patients with dental braces were reported. A majority of device defects involved inaccuracy in the data reported by the devices (seen in 10.7% of cases), while six cases were due to device malfunctioning. Conclusion: This study shows only the tip of iceberg of the reporting trends of MDME. There is inequality in reporting by different grades of health care workers and from different departments. It highlights the necessity of conducting awareness programs, training and workshops regularly. Device-related safety and reporting of device-related adverse events should be subject of attention and further research.

Clear cell variant of chondrosarcoma of calcaneum: A case report with review of the literature

Clear cell chondrosarcoma (CCC) is an uncommon variant constituting less than 2% of all chondrosarcomas. CCC arises most commonly in the proximal end of the femur, followed by the humerus, and other small bones. CCC involving the tarsal bone is very rare, and to the best of our knowledge, only one case has been described involving the calcaneum in the English literature to date. In this article, we discuss a case of CCC involving the right calcaneum with complete clinico-immuno-histomorphological features, which is successfully managed by below-knee amputation. We also reviewed the reported cases of chondrosarcomas involving the calcaneum with special reference to clinical features, therapy, morphology, and follow-up data.

Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population

@#Introduction: The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes. Materials and methods: A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded. Results: Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females. Conclusion: The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.

Evaluating the effect of monocrotophos and glyphosate on microbial population and certain important exoenzyme activities in soil

Aim: The study aimed to evaluate the effects of various concentrations of organophosphate agrochemicals, namely monocrotophos and glyphosate on soil chemical parameters, microbial population and activities of certain vital exoenzymes e.g. invertase, amylase, cellulase, dehydrogenase and protease at 7 days interval over an incubation period of 84 days. Methodology: Three concentrations of monocrotophos (1.0 g kg-1 soil-low T1, 2.0 g kg-1 soil-medium T2, 3.0 g kg-1 soil-high T3) and glyphosate (0.1 g kg-1 soil-low T1, 0.15 g kg-1 soil-medium T2, 0.2 g kg-1 soil-high T3) were applied to soil. Soil pH, electrical conductivity, organic carbon (OC), available nitrogen, phosphorous and potassium (NPK) were assessed. Bacterial and fungal population along with activities of exoenzymes were also studied. Data were analysed using two way ANOVA and Duncan's multiple range test (DMRT). Results: Significant variations (p<0.05) of chemical parameters, except P and K, in treated soil between concentrations and time over the incubation period were observed. Microbial population and exoenzymes showed significant variations (p<0.05) in response to agrochemical treatments. Invariably, lower microbial load and enzyme activities were noticed in treated soil relative to control. Interpretation: The study indicated that monocrotophos and glyphosate at recommended and elevated concentrations in soil could adversely impact microbial growth. Inhibited microbial population culminated in lower exoenzyme activity

Pregnancy with Wilson’s disease complicated with thrombocytopenia: a case report.

Wilson’s disease in pregnancy is rare. It manifests in the form of liver and neurological disorder due to abnormal copper accumulation. Pregnancy becomes high risk due to involvement of liver and high incidence of abortion, preeclampsia, HELLP syndrome. High risk pregnancy management and treatment with zinc sulphate have shown successful pregnancy outcomes. Reporting here a case of pregnancy with Wilson’s complicated with thrombocytopenia managed successfully.

Epidemiological Study of Male Infertility.

Advanced male age has been associated with signicant reductions in pregnancy rates, increased time-to-pregnancy and increased subfecundity.The present study was aimed at analyzing the male factor causing infertility and epidemiological factors in the rural institute situated in the eastern part of Maharashtra. Aims and Objectives: Study the profile of male infertility in this rural area over a period of 20 years and correlate the various factors responsible for male infertility. Materials and Methods: The present study comprised of retrospective as well as prospective analysis of infertility cases over a period of 20 years. Analysis of the records was done for male factors thoroughly in relation to age, duration and type of infertility, age at marriage, addiction. Statistical Evaluation: Statistical analysis was done in EPI-6 software. Chi square test and variance analysis was used for analyzing the data. Observations:The incidence of primary infertility (62.00%) was higher as compared to secondary infertility (38.00%) in all the five blocks.The semen analysis reports revealed that the most affected age group was 31-40 years. The abnormalities of semen were 35.49%, 86.49% and 53.75% in smokers, alcoholics and in cases having more than one addictions respectively. Cases with no addictions were having the maximum of (82.96%) normozoospermic males. Conclusions:The relationship between smoking and alcoholism was evident. Both of these addictions were found to impair the reproductive functions in male.

Cerebral venous sinus thrombosis as presenting feature of Crohn's disease.

Hepatobiliary and vascular manifestations are rare form of extraintestinal manifestations in Crohn's disease. We report a 20-year-old man in whom cerebral venous sinus thrombosis was the presenting symptom and preceded the diagnosis of Crohn's disease.

Toxic megacolon in a renal allograft recipient with cytomegalovirus colitis.

We report a 35-year-old man, a renal allograft recipient, who presented with toxic megacolon. Segmental biopsies from the colon were consistent with cytomegalovirus colitis. Serum polymerase chain reaction for cytomegalovirus DNA confirmed the diagnosis. He was treated with ganciclovir but, though his abdominal condition improved initially, he worsened later and succumbed to his illness.

VIPoma of pancreas in a child.

An eleven-year-old girl had massive watery diarrhea. She was found to have pancreatic VIPoma. It responded favorably to surgical resection of the tumor. There was no tumor recurrence at 18 months of follow-up.

Menstrual disorders in genital tuberculosis.

Study included 120 cases of genital tuberculosis proved by histopathology. Analysis of their menstrual history showed that the common menstrual disorder was oligohypomenorrhoea found in 54.0% cases, menorrhagia in 19.0% cases, and postmenopausal bleeding in 1.6% cases. History of amenorrhoea was present in 14.3% cases. There were 8 cases of secondary amenorrhoea and one case was of primary amenorrhoea. The pelvic examination showed cervical involvement in 43.1% of cases. Tubo-ovarian mass was present in 19.8% cases. Genital tract tuberculosis is a disease of varied symptomatology. A high degree of suspicion and efficient investigation are important for diagnosis.

Tracheo-bronchial remnants: a rare cause of dysphagia.

A 14-year-old girl presented with dysphagia since the age of one year. Investigations revealed two strictures at the lower esophagus. Endoscopic mucosal biopsy from the strictures showed pseudostratified columnar epithelium suggesting that tracheobronchial remnants was the cause of the stenosis. Esophageal dilatation failed to relieve her symptoms.

Gastrointestinal problems in the elderly.

Improvements in nutrition and health care have led to increased life expectancy in our country, which occasioned this review of gastrointestinal problems in the elderly. Some gastrointestinal symptoms may be secondary to age-related physiological changes (e.g., presbyoesophagus). Certain diseases (e.g., diverticulosis) may be more common in the elderly. On the other hand, the elderly may have unusual presentations of common diseases (e.g., complicated peptic ulcer disease). Each of these types of problems has been detailed in this review. Included is a preliminary analysis of hospitalised elderly patients which illuminates serious gastrointestinal problems afflicting the elderly in India.

Role of envelope glycoproteins of bovine respiratory syncytial virus in cell fusion.

To investigate the requirements for bovine respiratory syncytial virus (BRSV) cell fusion, the fusion (F), the attachment (G) and the small hydrophobic (SH) glycoproteins were expressed individually or coexpressed, using the vaccinia virus-T7 polymerase transient expression system. The contribution of individual glycoproteins in cell fusion was studied by a reporter gene activation assay. Activation of a reporter gene, beta-galactosidase, was assessed by colorimetric assay of detergent cell lysates or by in situ staining. Quantitative measurements indicated much higher sensitivity compared with analysis of syncytium formation. Our results showed that expression of any individual BRSV envelope gene or coexpression of F + G genes, did not induce significant cell fusion; however, coexpression of F + G + SH genes induced extensive cell fusion. To examine the role of N-linked glycosylation, each of the four potential glycosylation sites were individually removed by mutagenesis. The fusogenic activities of these F glycosylation mutants was examined using the reporter gene activation assay. Our results showed removal of individual carbohydrate chains on F2 subunit had no significant deleterious effects on cell fusion.

Fibrocalculus pancreatic diabetes in western Orissa.

Skiagram proved 35 cases of fibrocalculus pancreatic diabetes in order to analyse the clinical profile and its correlation with different descriptive epidemiological parameters were studied. Mean age was 25.17 +/- 7.85 years and male to female ratio was 6:1; 65.7% patients were poor (income < Rs 500 per month) and another 28.6% having average income (Rs 500 to Rs 1,000 per month); 74.3% came from rural areas having a family size of about > or = 7 members and sanitation was poor in all the cases. Mean body mass index was 15.93 +/- 3. Severe diabetes (ie, fasting blood sugar level > 251 mg%) and moderately severe diabetes (ie, fasting blood sugar level > 181 mg% but < 250 mg%) were noted in 51.4% and 11.4% cases respectively. Recurrent pain abdomen, infections, neuropathy, retinopathy, nephropathy and keto-acidosis were observed in 52.2%, 40.0%, 42.9%, 8.6%, 11.4% and 2.9% cases respectively. Mean soluble insulin requirement was 41.81 +/- 13.94 units. Four cases in whom pancreatic lithotomy was done, showed less insulin requirement and disappearance of pain. Parotid swelling, chronic diarrhoea and insulin resistance were not observed. Insulin requirement, epidemiological and biochemical parameters were similar to other young diabetics.

Chronic myeloid leukaemia with massive lymphadenopathy.

A 35 year old patient with chronic myeloid leukaemia presented with massive lymphadenopathy and unilateral limb oedema, when still in the chronic phase. Four weeks later, she passed into frank blast crisis, despite treatment with busulphan and palliative radiotherapy to the lymph nodes.

Schmidt's syndrome.

Schmidt's syndrome is a condition where there is auto-immune Addison's disease associated with primary hypothyroidism. We present one such case in view of its rarity in Indian literature.