Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Patch testing with expired Indian patch test kits: Results of a pilot study

Background: The reliability of patch testing with expired Indian standard patch test kits has been not evaluated before. Methods: Thirty adults (men:women 25:5) with allergic contact dermatitis were divided into three groups of ten patients each for patch testing by Finn chamber® method using Indian standard patch test kits having expiry in 2016, 2015 and 2014. The results were compared with those from a new kit with 2018 expiry. Results: Ten patients in group-1, eight patients in group-2 and seven patients in group-3 developed positive reactions of identical intensities and mostly from identical allergens from all four kits. The major contact allergens eliciting positive reactions of identical intensities were parthenium in nine, five and three patients, colophony in four, one and zero patients, fragrance mix in three, three and one patients, thiuram mix in three, one and one patients, and paraphenylene diamine in two, one and three patients from group-1,-2, and -3, respectively. Limitations: Small number of patients in each group remains the major limitation of the study. Whether or not these results can be extrapolated with patch test results from other similar patch test kits available across countries also needs confirmation. Conclusion: The patch test allergens can be used beyond labeled expiry dates but needs confirmation by a few large studies and using other available patch test kits. This is important as the relevance of patch test results for individual allergen in this scenario may remain debatable requiring careful interpretation

Computed Topographic-Guided Core Needle Biopsy of Lung Masses: Our Experience at a Diagnostic Center in Western India

Introduction: Lung carcinomas are one of the most common malignancies and major cause of cancer-related deaths worldwide. India also shares a great burden of this disease. Computed topography (CT)-guided fine-needle aspiration cytology of lung masses is a widely used and simple diagnostic tool which is being replaced increasingly by CT-guided core biopsies. This study shows our experience at a diagnostic center.Materials and Methods: This was a prospective study conducted over a period of 1 year from April 2018 to April 2019 and consisted of 107 cases. After taking detailed history, CT-guided core biopsies were obtained using coaxial needles of 17–19 gauge and biopsy needles of 18–20 gauge. The tissues were then examined histopathologically and the results were noted.Results: Out of the 107 patients, 81.3% were male and 18.7% were female. The age range of patients was from 33 to 92 years, with mean age being 63.7 years. Majority of the lesions were located in the right lung (57.9%). The most common histopathological diagnosis was squamous cell carcinoma 74.7%, followed by small cell carcinoma (12.1%) and adenocarcinoma (9.3%), Hodgkin lymphoma (1.8%), malignant mesothelioma (0.9%), and angiosarcoma (0.9%).Conclusions: This study shows our experience regarding lung malignancies in a diagnostic center in Western India. The epidemiology of lung malignancies seen across the Indian subcontinent reflects in our study. CT-guided core needle biopsies though less invasive may cause complications in some patients. Hence, utmost care should be taken during the procedure to ensure patient safety.

The study of efficacy of injection iron sucrose in treatment of iron deficiency anemia in pregnancy

Background: Iron deficiency is the most common cause of anaemia in pregnancy amounting to almost 50% of pregnant ladies in India. All pregnant women, irrespective of haemoglobin status, should receive prophylactic doses of iron from second trimester. Iron sucrose has an advantage of being cost effective and readily available. The objective of this was to study the efficacy of injection Iron Sucrose in treatment of iron deficiency anaemia in pregnancy.Methods: About106 patients were given in injection iron sucrose in pregnancy, who had intolerance to oral iron or were non-compliant, in pre calculated (Ganzoni’s formula) doses and were followed up with rise in hemoglobin and ferritin after 6 weeks and at term.Results: Statistically significant increase in hemoglobin levels was observed at 6 weeks after initiation of treatment (9.689±0.821 gm% vs 10.906±0.775 gm%) as well as at term (mean 10.981±0.690 gm%). The serum ferritin levels too increased significantly at term (26.7 ng/mL±12.92 vs 65.34 ng/mL±15.73).Conclusions: Present study demonstrates that iron sucrose is an excellent option to treat iron deficiency anemia in patients where oral iron therapy has either failed or not suitable. It significantly increases hemoglobin levels in the study population. It is readily available in the market and can be infused on an outpatient basis.

Use Of Baska® Mask In Military Trauma & Disasters : Military Medicine On The Move

Introduction: Airway management is an essential component in the first aid of medical emergencies in the combat medical care. Though Endotracheal tube (ETT) is considered ideal for airway management, supraglottic airway devices (SGA) are gaining popularity as an alternative. We studied the use of a novel SGA device (BASKA® mask) in hospital which can be extended to the combat situation. Methods: In this randomised, clinical study, we compared two airway devices (ETT and Baska® Mask) for ventilation in patients (n=100) undergoing laparoscopic surgery. We evaluated the mean airway seal pressure, ease of insertion, time taken for insertion and the complication rates with the use of airway devices. The data were analyzed using appropriate statistical tests. Results: We found that the mean airway seal pressures were comparable with the two devices. The first–time success rate for insertion was higher with the Baska® mask than with the ETT (94% vs 70%) respectively (p < 0.001). The overall device insertion success rates were comparable between the two devices (100% vs 96% respectively, p = 0.5412). Conclusion: Baska® mask is comparable on various parameters to the ETT and is easier to insert due to its flexible head. This is relevant for airway management during combat medical support in field situations.

Bilateral Prehilar Branching Of Renal Arteries

Background: Variation in renal arteries are very common but bilateral variation is rare and is clinically importantfor urologist especially during the renal transplantation. Generally main renal artery divides into anterior andposterior branches just before entering the hilum of kidney, but sometimes two or more polar arteries; prehilarbranching and segmental arteries arise from main renal artery .Renal artery variations are often seen and aregenerally categorized into presence of accessory or aberrant renal arteries, polar arteries and prehilar branches.Prehilar multiple branching of main renal artery variation is frequently seen.Materials and Method: The present study was conducted in 80 kidneys from 40 cadavers during the routinedissection in the Department of Anatomy Maharishi Markandeshwar Medical College and Muzaffarnagar MedicalCollege .Out of 80 kidneys studied bilateral prehilar branching of renal arteries from the main renal artery wereobserved in 5 kidneys (6.5%).Conclusion: Different arterial branching patterns was observed in five cases in which prehilar branches originateddirectly from main renal artery, entering the upper pole of kidney. Knowledge of such variation is important forradiologists, anatomists and urologists while performing renal transplantation, laparoscopic renal surgeries,nephrectomies, and other renal surgeries and diagnosis.

Role of 1% alendronate gel as adjunct to mechanical therapy in the treatment of chronic periodontitis among smokers

Abstract Objective Alendronate (ALN) inhibits osteoclastic bone resorption and triggers osteostimulative properties both in vivo and in vitro, as shown by increase in matrix formation. This study aimed to explore the efficacy of 1% ALN gel as local drug delivery (LDD) in adjunct to scaling and root planing (SRP) for the treatment of chronic periodontitis among smokers. Material and Methods 75 intrabony defects were treated in 46 male smokers either with 1% ALN gel or placebo gel. ALN gel was prepared by adding ALN into carbopol-distilled water mixture. Clinical parameters [modified sulcus bleeding index, plaque index, probing depth (PD), and periodontal attachment level (PAL)] were recorded at baseline, at 2 months, and at 6 months, while radiographic parameters were recorded at baseline and at 6 months. Defect fill at baseline and at 6 months was calculated on standardized radiographs by using the image analysis software. Results Mean PD reduction and mean PAL gain were found to be greater in the ALN group than in the placebo group, both at 2 and 6 months. Furthermore, a significantly greater mean percentage of bone fill was found in the ALN group (41.05±11.40%) compared to the placebo group (2.5±0.93%). Conclusions The results of this study showed 1% ALN stimulated a significant increase in PD reduction, PAL gain, and an improved bone fill compared to placebo gel in chronic periodontitis among smokers. Thus, 1% ALN, along with SRP, is effective in the treatment of chronic periodontitis in smokers.

Accessory Spleen A Rare Finding: A Cadaveric Study.

The accessory spleen is rarely present in the human body. If present it is present in the gestrosplenic ligament or in the tail of pancreas. Mostly it is reported by radiologists, through MRI or ultrasonography. Accessory spleen has no clinical consequence unless a patient suffers from a haematological disease like idiopathic thrombocytopenic purpura. In some haematological diseases in which the spleen is to be removed but after removal of spleen the sign and symptomsre occur. This recurrence is due to the presence of accessory spleen. In the present study the accessory spleen was found while doing routine the dissection of abdomen. In the present study 20 human cadavers were dissected which were embalmed with 10% formalin and fixed. The aim of our study is highlight the presence of accessory spleen in the body and importance in the human body and to compare the study with studies done by other authors. This study will be helpful for the surgeons and physicians in their diagnosis and treatment.

Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve.

Aim: To report our experience with the fibrin sealant as a suture substitute for securing the human scleral patch graft during implantation of Ahmed glaucoma valve (AGV). Materials and Methods: A retrospective, non-comparative study of 12 eyes of 12 patients who underwent an AGV implantation with fibrin sealant for part of the procedure during June 2009 to September 2010. Results: The mean patient age was 21.5 ± 20.6 years. Male: Female ratio was 2 : 1. Seven (58.3%) patients were monocular. The indications for AGV were varied. The mean number of intra-ocular surgeries prior to an implantation of AGV was 1.8. The mean follow-up duration was 24.5 ± 17.9 weeks. There was a statistically significant reduction in the mean IOP and in the mean number of anti-glaucoma medications at the final visit compared to the pre-operative values (P < 0.01, paired t test). Conjunctival retraction was seen in 1 (8.3%) case. The scleral patch graft was retracted posteriorly in another (8.3%) case. There was no case of AGV tube exposure, tube-cornea touch, or conjunctival erosion. Vision threatening complication viz. late post-operative rhegmatogenous retinal detachment, unlikely to be related to the use of the fibrin sealant, occurred in 2 (16.6%) eyes. Conclusion: The fibrin sealant offers the advantages of safety and convenience to the placement of a scleral patch graft during an AGV implantation.

Pancreaticoduodenectomy with left lateral hepatic segmentectomy : A rare procedure for the management of complex pancreaticoduodenal and liver injuries in blunt abdominal trauma.

Context : Pancreaticoduodenal complex injuries are uncommon after blunt abdominal trauma and are difficult to diagnose. Case Report : We report a case of 25 years old male who suffered massive Pancreaticoduodenal complex with liver injuries due to blunt abdominal trauma. At exploration we found that 2nd part of duodenum and head of pancreas were completely shattered and segment II & III of liver were lacerated. We performed Pylorus preserving Pancreaticoduodenectomy with segment II and III resection. Conclusion : Pancreaticoduodenal injuries should be suspected in every patient with trauma to upper abdomen. Exploration should be done at the earliest.

Doctors and Padma awards.

Background. The announcement of the annual Padma awards in January always generates a great deal of interest as well as controversy and, some believe that many good candidates are excluded and many less deserving ones included. We analysed the recipients in the field of medicine to determine whether or not a pattern emerged regarding who were bestowed these honours. We were not able to objectively evaluate whether or not the honours were ‘deserved’. Methods. We obtained and then analysed the list of awardees from newspapers and the official website of the Ministry of Home Affairs. Between 2000 and 2010, a total of 1166 awards were announced, of which 157 (13.4%) were in the field of medicine. We excluded foreigners and those from ‘alternative’ fields (20), and evaluated the remaining 137 in detail. Results. Sixty-two (45.3%) recipients were from Delhi, 18 (13.1%) from Maharashtra and 17 (12.4%) from Tamil Nadu. Of the 137 awardees, 31 (22.6%) were cardiologists or cardiac surgeons. Many large states of the country, such as West Bengal, Gujarat, Rajasthan, Madhya Pradesh, Punjab and Haryana, did not have a single awardee. Conclusion. The over-representation of Delhi and cardiology in the Padma awards for medicine suggests that their distribution is not entirely fair.