Role of Bilateral Inferior Turbinoplasty as an Adjunct to Septoplasty in Improving Nasal Obstruction and Subjective Performance in Patients With Deviated Nasal Septum Associated With Allergic Rhinitis: An Interventional, Prospective Study.

BACKGROUND: Patients with nasal obstruction due to deviated nasal septum (DNS) often have allergic rhinitis (AR) as contributing factor. When optimal medical therapy for AR fails, septoplasty alone may not adequately treat nasal obstruction. Therefore, with bilateral inferior turbinate hypertrophy representing long-standing AR, adding bilateral inferior turbinoplasty (BIT) to septoplasty might be beneficial. OBJECTIVE: To assess whether septoplasty with/without BIT alleviates nasal obstruction in the above patient cohort and whether adding BIT to septoplasty brings significant benefit. METHODOLOGY: In this interventional, prospective study, patients with nasal obstruction due to DNS and persistent, moderate-severe AR refractory to optimal medication were randomly allocated into group A (septoplasty alone) and group B (septoplasty with BIT). Nasal Obstruction and Symptom Evaluation (NOSE) score, along with Subjective Performance parameters (days-off/month; number of outdoor visits/month; overall satisfaction score [OSS]) were used to assess the symptom and quality of life, respectively, at follow-up. RESULTS: Each group had 40 age/sex-matched patients. Friedman test, and subsequent pair-wise comparison within groups without Bonferroni correction, revealed that septoplasty with/without BIT elicited significant reduction in NOSE scores and in the Subjective Performance parameters (days-off/month; number of outdoor visits/month) at 3 and 6 months. Wilcoxon Signed Rank test revealed that the OSS within groups also improved significantly with time. Further, comparison between groups revealed significant improvement in NOSE scores at all levels of follow-up when BIT was included. However, there were no significant differences between groups in the Subjective Performance parameters at any level of follow-up. Improvement in OSS between groups was significant only at 3 months but not subsequently. CONCLUSION: Septoplasty with/without BIT is helpful in treating patients with DNS and refractory AR. However, although adding BIT brings significant benefit in decreasing nasal obstruction, it does not significantly improve the Subjective Performance parameters during follow-up, except for OSS at the third month.

Cost of Outpatient Department Services at a Community Health Center of Bankura, West Bengal.

BACKGROUND: Changing trends of privatization and globalization of health care compel the hospitals to practice cost accounting for providing accurate information about the cost of patient care. OBJECTIVES: The objectives were to determine unit cost and to identify major cost areas of outpatient department (OPD) services provided by the community health center (CHC) of Bankura district, West Bengal. MATERIALS AND METHODS: A cross-sectional study was conducted at Amarkanan CHC in 2016. Work sampling (WS) and time motion (TM) study were conducted for assessing the workforce cost, otherwise complete enumeration was done to assess the cost of different service areas such as medicine, logistic, maintenance, transport, electricity, building, equipment, and furniture. A predesigned pro forma and a questionnaire were used for WS and TM study and for interviewing the key informants for collection of information pertaining to different costs. Unit cost of different services as well as overall unit cost was estimated. RESULTS: If a patient received injection, undergone dressing, and had electrocardiogram and X-ray both done in a day, then the total cost of OPD services for workforce was Rs. 85.33/. Cost of logistics per patient per day was maximum in X-ray room. Manpower exerted the maximum cost incurred by the government to conduct OPD in Amarkanan CHC. Overall, the unit cost in OPD incurred by the government was Rs. 44.53/-. CONCLUSION: Close monitoring is required by aligning the staffing pattern and patient activities and having adequate number of staff with right skill at right place and time for efficiency, productivity, and cost-effectiveness.

Sociobehavioural matrix and knowledge, attitude and practises regarding HIV/AIDS among female sex workers in an international border area of West Bengal, India.

BACKGROUND: HIV/AIDS is still a big public health challenge of India. Female Sex Workers (FSWs) belong to an important high risk group (HRG) in the transmission of HIV/AIDS. International borders have intermingling of population and also plenty of migrant population. Thus study on FSW s with relation to HIV/AIDS in an international border area is an important area of Research. AIMS: The present study was planned with the objectives of: to determine the sociodemographic profile of the FSW under the study, to assess their knowledge and attitude towards HIV/AIDS and to find out their sexual practices. SETTINGS AND DESIGN: It was a community based descriptive cross sectional study, done at the Indo-Bhutan border town of Jaigaon in Alipurduar District of West Bengal with the help of a Non-governmental organization (NGO) working on Targeted Interventions (TI) for FSW. METHODS AND MATERIAL: Total 90 FSWs were interviewed using predesigned pretested questionnaire. The questionnaires used were prior validated by National AIDS Control Organisation (NACO). STATISTICAL ANALYSIS USED: The data were analysed by SPSS 14.0. RESULTS AND CONCLUSIONS: The analysis revealed that 35 % of the study population were illiterate. It was also found that 81% of respondents had heard about HIV/AIDS; 76.7% had knowledge about its spread through vaginal sex, 67.8% had idea regarding its Mother to Child transmission. 92% felt PLHIV should not be kept away from others, 93% felt they shouldn't be deprived from property. Regarding sexual activity, 76.7% had sexual activity more than 3 times/week and 97.8% used condom persistently in last one year. Coordinated Efforts is required to be taken in this regard to tackle these problems.

Magnitude of Mental Morbidity and Its Correlates with Special Reference to Household Food Insecurity among Adult Slum Dwellers of Bankura, India: A Cross-Sectional Survey.

BACKGROUND: Mental disorders cause considerable morbidity and disability, and there is ample evidence that mental disorders are positively associated with household food insecurity. METHODS: A cross-sectional survey was conducted for a period of 2 months at Bakultala slum of Bankura town involving 152 people of ≥18 and ≤60 years of age selected using simple random sampling technique to estimate the prevalence of mental disorders and to find out its correlates. Information pertaining to socio-demographics and household food security (HHFS) and " potential psychiatric case" were collected through a house to house interview of the head of the household, using predesigned questionnaire, Bengali version of self-reporting questionnaire, and 6-item household food security scale (HFSS). RESULTS: In total, 45% of the study participants belonged to food unsecured households. Overall, 21% of the respondents were identified as "potential psychiatric case," which was found to be associated with higher age, illiteracy, divorcee female, and people living in households without food security. CONCLUSION: Study results reflecting high prevalence (21%) of "potential psychiatric case" with various correlates such as age, sex, education, marital status, and HHFS among the slum dweller of Bankura town may be helpful in formulating policies for combating mental health morbidities.

Road Traffic Injuries: A Study on Severity and Outcome among Inpatients of a Tertiary Care Level Hospital of West Bengal, India.

BACKGROUND: Road traffic injuries (RTIs) are a complex phenomenon caused by nonlinear combination and interaction of man, vehicles, road, and environment. AIM: This study aims to find out the outcome and severity of RTI in a district of West Bengal, India. SETTINGS AND DESIGN: A cross-sectional study was conducted among inpatients of Departments of Surgery and Orthopedics of Bankura Sammilani Medical College and Hospital, West Bengal, India. MATERIALS AND METHODS: The study was conducted for 1 year interviewing 295 RTI selected through scheduled sampling. Information pertaining to demographic and correlates of RTI was collected by face to face and over telephone using semi-structured questionnaire. Nine-item Simplified Injury Severity Scale (SISS) was used to assess injury severity. Internal consistency of SISS scale was showed by Cronbach's alpha and association with the correlates was done by Mann-Whitney U-test. STATISTICAL ANALYSIS USED: With SPSS version 22.0, binary logistic regression, and Mann-Whitney U-test. RESULTS AND CONCLUSION: Fatal outcome in terms of death and permanent disability was 34.24% and they had higher marginally significant (P = 0.06), SISS score (45.17 ± 12.59). Participants with absence of protective devices, presence of comorbidities, drunkenness, with accidents over national highways, in-between 6 am and 6 pm, mechanized two-wheelers, and nonreceipt of first aid were found to have significantly high scores compared to their counterpart. SISS, as a proxy measure of severity assessment, could throw a light on it and awareness generation and legislative stringency might be need of the hour for the country.

Pediatric Otolaryngological Emergency: An Experience from a Tertiary Care Teaching Institution at Kolkata, India.

Otolaryngological conditions constitute a major share of emergency medical problem among children. The present study was conducted to assess the patient profiles, incidences morbidities, mode of presentation and managements of different otolaryngological emergencies among pediatric patients presented in a tertiary care hospital. Descriptive cross-sectional study by analysing retrospectively collected information pertaining to the patients attended ENT emergency service department of a tertiary care hospital, Kolkata. Data were collected using predesigned proforma and were analysed with the help of SPSS version 20. About 39.0% of total ENT emergency attendance was contributed by pediatric age group. The male female ratio was 1:1.33 with average age of 58.95 ± 34.42 (mean ± SD) months. Half of the attendees had ear problem and almost one-third reported complaints related to nose. The major complaints at the time of presentation were earache (32.3%), nasal foreign body (24.0%) and aural foreign body (13.3%) closely followed by aero-digestive tract foreign body (12.0%). Inflammatory conditions affected the ears more, foreign bodies found most commonly in nose and miscellaneous condition such as impacted wax was found to be related to ear in significantly higher proportion. Conservative management was provided to 96.25% of patients. Foreign body insertion was found to be associated with lower age group. Most of the emergencies were managed conservatively which might be done at subdivision or district level to reduce the undesirable burden on the tertiary care medical colleges.

Correlation among perceived stress, emotional intelligence, and burnout of resident doctors in a medical college of West Bengal: A mediation analysis.

BACKGROUND: Perceived stress and burnout are by-products of powerless responsibility imposed on resident doctors. Emotional intelligence (EI) works as an adapting and coping tool. OBJECTIVE: The objective of this study is to find out the role of work-related perceived stress on burnout and influence of EI on it. METHODS:: A descriptive cross-sectional study was conducted from February to April 2016 among 63 resident doctors of different departments of Bankura Sammilani Medical College and Hospital. Data were collected through a self-administered questionnaire for background characteristics and work-related variables. Cohen perceived stress scale, Trait EI, and Shirom-Melamed burnout questionnaire were applied for measuring perceived stress, EI, and burnout, respectively. Statistical analysis was done with of SPSS version 22.0, and for mediation analysis, Andrew F. Hyne's SPSS macro was adopted. Nonparametric bootstrapping was done assuming small sample. RESULTS: Out of complete responses, 67%, 22.9%, and 9.8% were from clinical, paraclinical, and preclinical specialties, respectively. Burnout had a significant positive correlation with perceived stress and in negative correlation with EI-well-being and positive correlation with EI-self-control and sociability. Physical fatigue factor of burnout had a significant positive correlation with EI-emotionality. Perceived stress had a negative correlation with EI-well-being. On mediation analysis, assuming EI as a mediator, total, direct, and indirect effects of perceived stress on burnout were significant (<0.05). Mediation was proved to act with percent mediation of 0.07. CONCLUSION: There was definite mitigating effect of EI on burnout by perceived stress among resident doctors. This necessitates more attention by decision-makers toward this burning problem for the sake of care of caregivers.

Status of early childhood education under integrated child development services scheme in Bankura Municipality, West Bengal.

BACKGROUND: Early childhood education (ECE) is an important service provided by Integrated Child Development Services (ICDS). It is largely responsible for developing school readiness in children. OBJECTIVE: The objective of this study is to assess ECE component of ICDS services through measurement of school readiness and find out other correlates. METHODS: A cross-sectional evaluation study was carried out among Anganwadi centers (AWCs) under Bankura Municipality, West Bengal, India from July to November 2015. AWCs were selected by 30 cluster sampling. From each selected center Anganwadi worker (AWW), 7 randomly selected children of 5 years of age and their caregivers were included in the study. Data were collected by assessment of children, interview of AWWs and caregivers of children, observation of ECE activity and record review using ECE Program Evaluation Package developed by World Bank and predesigned schedule. Mean, standard deviation, proportions were estimated for description and correlation, unpaired t-test, analysis of one-way variance, multivariable linear regression were performed to find out correlates of school readiness using SPSS 22.0 version. RESULTS: Average duration of ECE activity was 66.0 min/day which was far less than the norm. Overall average score of school readiness of 210 children was 14.0 out of 40. Inadequate physical facility, poor classroom performance acted as deterrents for school readiness. Help in the study at home was revealed to be a determinant of school readiness. CONCLUSION: For the preparation of formal schooling of children most important needs of the hour are physical facility of AWCs, supportive supervision of AWWs, and creation of congenial environment at home.

Sexual behavior of transgenders and their vulnerability to HIV/AIDS in an Urban Area of Eastern India.

Transgender (TG) people experience a gender identity that is different from their anatomical sex. For their high-risk sex behavior, they are important group for targeted intervention of HIV/AIDS. The objective of the study was to find the sexual behavior of TG people and to assess few aspects of their vulnerability to HIV/AIDS. This cross-sectional survey was done from June to August 2012, in field practice area of "Kosish," a nongovernmental organization run by TGs in Alipore of Kolkata metropolitan city, India. Information was collected by interviewing 90 TG of 11 selected hotspots using a predesigned questionnaire. Results revealed that 4.5% were illiterate. Drug abuse was reported by 22.2% participants. Inconsistent condom use was found. Venereal disease research laboratory reactivity was found in 11.11%. Nearly 16.7% had experienced sexual violence in the past 3 months. Thus, interventions for overall empowerment of the TGs are recommended.

Estimation of partitioning of airflow in septal surgery: A prospective study with reference to the NOSE scale.

Improper patient selection for septal surgery often has been found to result in therapeutic failure, and there needs to be an objective assessment of nasal obstruction before the surgery and for postoperative follow-up that can be applied in the routine otolaryngology practice. The purpose of this study is to assess the usefulness of a cost-effective device for objective measurement of the nasal airway partitioning in selecting patients for septal surgery and for postoperative outcome evaluation. A hospital-based, prospective, observational study was carried out in a tertiary-care teaching institution involving 74 patients waiting for septal surgery. Each patient was exposed to subjective assessment of nasal obstruction by the Nasal Obstruction Symptom Evaluation (NOSE) scale and objective measurement by Nasal Partitioning Ratio (NPR) using a new device, Nasal Airway Partition Meter (NAPM), once before and twice after surgery. Overall, average NOSE score and NPR values were 66.42 ± 9.42 and 0.57 ± 0.18, respectively, at preoperative assessment (correlation coefficient 0.441). Sixty of the 74 patients had high values for both NPR and NOSE scores (Group 1), but in the remaining 14, NPR values were found to be lower despite high NOSE scores (Group 2). Postsurgery, the NOSE score and NPR values were significantly reduced in Group 1. In contrast, participants in Group 2 showed no alteration in the values of both the parameters after the same operative maneuver. However, 2 patients in Group 1 had NOSE score and NPR values unaltered, while 1 patient in Group 2 had a reduced NOSE score after surgery. Therefore, the validity of the new equipment was calculated to be 96.7% sensitive and 92.9% specific to identify patients who needed to undergo septal surgery for their nasal obstruction. It can be deduced from the present study that NAPM can be a cost-effective device for clinicians to objectively measure nasal airway obstruction and screen patients for septal surgery.

Socio-demographic Correlates of Rhinosporidiosis: A Hospital-Based Epidemiologic Study in Purulia, India.

The present paper attempts to explore the socio-demographic profile of patients with rhinosporidiosis in an endemic area. A cross-sectional study was carried out in a tertiary-care hospital in Purulia district, India, including consecutive patients with histologically-proved rhinosporidiosis. Their socio-demographic profiles were obtained through a pre-designed proforma with given epidemiologic parameters. Data was statistically analyzed with inputs from literature review. Of the 39 patients included, 87 % were fresh/new cases. The age-group of 10-20 years was mostly involved, with multiple peaks around 50. About 82 % were from rural background, commonly involved in cattle farming and agriculture, with a universal habit of pond-bathing. There was a male preponderance; however women were being increasingly affected. Nasal cavity was the predominant site involved; nasal obstruction and epistaxis were the primary complaints. About 13 % had recurrent lesions that were statistically related to higher age-group (≥15 years) and occupation (agriculture, labor). Rhinosporidiosis is predominantly the disease of young rural adults engaged in field activities and habituated to pond-bathing. A bimodal age distribution was noticed. The present article provides an update on the socio-demographic perspectives of rhinosporidiosis in an endemic zone. It also summarizes the factors that would identify the vulnerable population and help formulate preventive measures.

Optimizing the outcome of transnasal endoscopic sphenopalatine artery ligation in managing refractory posterior epistaxis: A case-control analysis.

OBJECTIVE: To optimize the outcome of transnasal endoscopic sphenopalatine artery ligation (TESPAL) by determining the key surgical steps and applying them accordingly. METHODS: This is a case-control study carried out in a tertiary care teaching institution on subjects who underwent TESPAL during the period of October 2010 to September 2015. Their surgical and clinical records were reviewed, and success (no re-bleed) and failure (return with re-bleed) were considered the main outcome measures of TESPAL. Accordingly, depending on whether the subjects returned with re-bleed or not, they were classified as "failure" and "success" groups. After appropriate matching in terms of age, gender and a given set of exclusion criteria that could influence per-operative decision-making or contribute to post-operative epistaxis, the groups were considered as cases (subjects undergoing TESPAL and returned with re-bleed; part of the "failure" group following matching) and controls (subjects undergoing TESPAL and did not return with re-bleed; part of the "success" group following matching). Per-operative/surgical factors executed or followed in varied combinations in each group that influenced the outcome of TESPAL were then identified from the surgical notes and were subsequently analyzed statistically. RESULTS: In 89% of cases, the sphenopalatine artery (SPA) pedicle was either clipped or cauterized, whereas in 90% of the controls, it was both clipped and cauterized. The posterior nasal artery (PNA), when found, was cauterized in 25% of the cases, compared to 85% in the controls. Also, the septal artery region was cauterized in only 33% of cases. Both cauterization/clipping of the SPA along with cauterization of PNA was done in 69% of the controls, whereas in 59% the septal artery region was also cauterized. However, there were no cases when all these steps were combined. The results were statistically significant. CONCLUSION: When only the per-operative/surgical factors were considered, the outcome of TESPAL was most favorable when the procedure could be done combining both clipping and cauterization of the SPA, along with cauterization of the PNA and the septal artery region.

Perception, awareness and practice of research-oriented medical education among undergraduate students of a medical college in Kolkata, West Bengal.

BACKGROUND: The addition of research-oriented medical education (ROME) to the existing curriculum could promote logical thinking, rapid literature search and a better understanding of research methodology. Creation of research temperament could lead to innovations in healthcare. We assessed the perception, awareness and practice of ROME among undergraduate students. METHODS: We conducted a cross-sectional survey among 234 students of R.G. Kar Medical College, Kolkata selected by the simple random sampling technique. Data were collected using a pre-designed, pre-tested, validated questionnaire by direct interviews. RESULTS: The mean (SD) perception score was 44.2 (5.03). Students from outside West Bengal (p=0.05), women (p=0.03) and students whose parents were doctors (p=0.01) had significantly higher scores. Students in the second and fourth semesters had a better perception than those in the sixth and eighth semesters. Awareness of research fellowships granted to undergraduate students such as the Indian Council of Medical Research-Short-term studentship (ICMR-STS) was low among the second semester students (13.9%), but more than half (59.3%) of the students in the eighth semester were aware (difference across semesters, p<0.001). Awareness about journals, conferences and 'research bodies promoting student research' was low. Students in the senior semesters spent more time on research (6th semester 72.2% and 8th semester 88.9%) than those in the junior semesters (2nd: 66.7% and 4th: 77.8%; difference across semesters, p=0.03). About 3% of students participated in extracurricular research and/or had presented work at a conference. CONCLUSION: There is a good perception about the need for research but a lack of awareness of the why and how, as well as hardly any practice of ROME among medical students of this medical college.

Postoperative hypofunctioning of the thyroid gland after total laryngectomy.

Primary laryngeal carcinoma is a common cancer, predominantly affecting males. Hypothyroidism is an undesirable sequela of both surgery and radiotherapy, the two most commonly used modalities of treatment. For advanced cases, standard treatment protocol includes total laryngectomy and neck dissection along with pre- or postoperative radiotherapy. Hemithyroidectomy is also routinely performed as an integral part of total laryngectomy. In the present study, assessment of the function of the remaining half of the thyroid gland has been done in cases of total laryngectomies in combination with uni- or bilateral neck dissection and pre- or postoperative radiotherapy. This prospective, observational study was carried out for a period of 5 years in the Otolaryngology Department of R.G. Kar Medical College and Hospital, Kolkata, India, involving a dynamic cohort of patients with advanced laryngeal carcinoma (stage T3 or T4a) who underwent total laryngectomy (including hemithyroidectomy) and bilateral or unilateral neck dissection for primary laryngeal cancer along with preoperative and postoperative radiotherapy. Assessment of the thyroid function was based on the measurement of serum thyroid-stimulating hormone and free thyroxine levels. The results revealed that 23.8%, 45.2%, and 73.8% patients developed either clinical or subclinical hypothyroid state at 6, 12, and 24 weeks, respectively, after the surgery. The estimation of relative risk (RR) was found to be most prominent among the group belonging to the "preoperative radiation with bilateral neck dissection" group at all levels of assessments, but all of the RRs were found to be insignificant per their 95% confidence intervals. Superiority of any method could not be established or refuted firmly due to the small sample size of the study. We presume that in the future, a study with a larger sample size, involving a meta-analysis of multicentric data, would be the most suitable method to throw some light on this issue.

Is the coverage of mass-drug-administration adequate for elimination of Bancroftian filariasis? An experience from West Bengal, India.

BACKGROUND: Bancroftian filariasis is the second most common mosquito-borne disease in India. Government of India adopted mass-drug-administration (MDA) since 2004 for its elimination by 2015 AD. OBJECTIVE: The aim was to assess the coverage, compliance, factors-related to noncompliance to MDA. MATERIALS AND METHODS: A cross-sectional survey of 1 week was conducted within 2 weeks after completion of MDA for 2012 in three villages and two municipal wards of North 24 Parganas district of West Bengal, India selected as clusters by multistage random sampling. Information was collected via interview of inhabitants of the clusters selected by systematic random sampling and drug administrators of the selected clusters along with verifying left over medicines, if any. RESULTS: Both appropriate medicine distribution (83.4%) and 61.28% of people who received drug reported consumption and effective consumption rate (48.01%) fell short of the target. The lowest consumption (38.15%) was noted in one of the rural cluster (villages), followed by municipal wards (43.14%). Consumption was significantly higher among rural residents and Hindu community. Fear of the adverse reaction was the commonest (63.02%) cause of noncompliance. Contrary to the requirement, almost all consumptions were unsupervised by drug administrators. Only 10.71% of the respondents reportedly were paid house to house campaign of forthcoming MDA. About 64% participants had heard about filariasis out of which 71% & 47% mentioned swelling of legs as symptoms and mosquito bite as mode of spread, respectively. About one-third opined mosquito control and MDA each as means of prevention. Approximately, 60% participants had heard about MDA. Information education and communication related to MDA program was conspicuously inadequate in the last round. CONCLUSION: Mass mobilization as in intensive pulse polio immunization with effective monitoring and supervision is the need of the hour for universal coverage of MDA with supervised on the spot consumption of tablets.

Unmet need of contraception: a critical juncture toward family planning goals.

India is the first country in the world to implement a family planning program, and this program has succeeded in generating universal knowledge about family planning methods. In spite of this, there exists a wide gap between knowledge and acceptance of family planning methods reflecting an unmet need for contraception. Different communication channels used to disseminate knowledge like television, radio, and newspapers aim to change the family planning methods. Being a didactic method, these have the least potential to change the attitudes of the people. This article represents the tip of the iceberg of the fate arising out of incomplete information provided through mass media not supported by a formal family planning program. One primipara woman after getting pregnant took an emergency contraceptive pill and attended a clinic with vaginal bleeding, abdominal pain, and pallor. Ultimately she underwent suction evacuation and survived. This indicates that mass media should not be a substitute, but rather a supplement to the routine program of the health worker to promote contraception.

Clinico-pathological correlates of cervical lymphadenopathy: a hospital based study.

Neck is the most common site of peripheral lymph node enlargement and is very frequently encountered in oto-laryngological practice. This study was done to delineate distribution of clinico-demographic parameters in patients presenting with cervical lymphadenopathy in the otolaryngology out-patient department of a state hospital in India in a 1 year period and to correlate them with fine needle aspiration cytological diagnosis. Record-based cross sectional study in the department of Otolaryngology and department of Pathology, Calcutta National Medical College and Hospital, Kolkata. Case reports and cytological reports of 423 patients who underwent Fine Needle Aspiration Cytology (FNAC) of cervical lymph nodes between January 2009 and December 2009 were reviewed in relation to their demographic and clinical profiles. The cases were divided into three groups according to age and different parameters were described according to these groups. In the cyto-pathological diagnosis, tubercular lymph-adenitis was most prevalent diagnosis (45.4%). Among the metastatic secondaries, squamous cell carcinoma was most common (8.5%). Non-specific/reactive lymphadenitis was significantly more common in <14 years, TB lymph node in 15-59 years and malignancy among the ≥60 years age group. Jugulo-omohyoid (level III) and Supraclavicular (level VB) groups of Lymph nodes were found significantly more involved by malignancy whereas Jugulo-diagastric (level II), Post-auricular, Submandibular groups (level IB) were more commonly involved in TB. Malignancy patients presented late in respect to the tuberculosis patients. Knowledge about clinico-demographic perspectives of cervical lymphadenopathy in respect to their cytopathological diagnosis will help care giver practioners to detect/refer the respective cases early for investigations and treatment.

Assessment of prognostic factors for locally advanced breast cancer.

In spite of apparent improvement in outcome in locally advanced breast cancer, the prognosis remains dismal in many patients. The aim of this study was to define prognostic subgroups within this heterogeneous entity. The prospective follow-up study was carried out for a period of three and half years involving patients attending the radiotherapy department of Burdwan Medical College and Hospital. Forty-five patients with clinical stages IIIA and IIIB breast cancer were treated with neoadjuvant chemotherapy followed by mastectomy, radiotherapy and completion of chemotherapy with an objective to assess the 2 years disease free and overall survival and to find out the correlates of prognosis. On follow-up disease-free survival and overall survival at 2 years were noted to be 60% and 80% respectively. Patients with age more than 45 years, earlier stage, less than 4 positive axillary nodes, tumour size less than 8 cm, oestrogen receptor positive and Her-2-neu negative status and lesser number of chemotherapy cycles required before surgery had better outcome though not statistically significant. Thus it can be concluded that the above mentioned prognostic variables are strong predictors of treatment outcome in locally advanced breast cancer though further studies with larger sample size are required to establish their statistical significance.

The silent burden of anemia in school age children: a community based study in West Bengal.

BACKGROUND: Under nutrition and anemia are common co-morbidities in school age children. Due to transition in dietary habits in developing countries, a paradoxical finding of coexistence of anemia and normal/over nutrition is also a cause of concern. OBJECTIVE: > T o assess the nutritional status and prevalence of anemia among school age children (6 - 16 years) residing in rural and urban areas of a district of West Bengal and also to find out the association between weight status, measured as Body Mass Index(BMI) and anemia. MATERIALS AND METHODS: Age, height & weight were measured in 86 rural and 86 urban school age (6 -16 years) children in rural and urban field practice areas of Midnapore Medical College. Their blood was estimated for haemoglobin concentration. RESULTS: Overall prevalence of anemia was 80.2%, and not significantly different between the rural (83.7%) and urban (76.7%) participants and across the genders both in rural (86.4% versus 80.9%) and urban (85.7% versus 72.4%) areas. Thinness was observed to be higher in urban area (48.8% versus 41.9%). However, severe thinness was higher in rural area (18.5% versus 13.9%). Significantly, higher proportion of boys revealed severely low BMI compared to girls in both rural (33.3% versus 4.5%) and urban (17.2% versus 7.1%) areas with no significant differences between the prevalence of anemia across the grades of underweight and normal nutritional status. CONCLUSIONS: Poor nutritional status and anemia are still, taking heavy toll and new program strategies are needed, particularly those that improve the overall nutrition status of children.