Awareness of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana in the Rural Community: A Cross-Sectional Study in Eastern India.

Background Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is one of the flagship programs intended to provide financial protection to people availing of secondary and tertiary level health care. It's been nearly three years since the implementation of AB-PMJAY in Bihar, yet the level of awareness, especially in rural communities, is unknown. So, this study was planned to explore the awareness and utilization of AB-PMJAY in the selected rural area of Bihar. Methodology This community-based cross-sectional study used a multistage sampling strategy to select 802 households within a radius of 5 Km from the rural health training centre, Naubatpur. A pre-tested, semi-structured questionnaire was used to collect the necessary data regarding awareness of AB-PMJAY. The association between category, occupation, education, age group, and ration card with the awareness of AB-PMJAY was assessed using Pearson's chi-square test. Results The awareness of the AB-PMJAY was 68.6% (95% CI: 65.30%-71.7%), while out of 459 eligible study participants, 362 (78.9%) were aware of the AB-PMJAY. Utilization of AB-PMJAY was only 1.3% among the eligible study participants. There was a statistical significance between the category of eligible study, ration card, and employment status with the awareness of the AB-PMJAY. Conclusion Every two out of three rural individuals and three out of every four eligible participants were aware of the AB-PMJAY scheme, while the level of utilization was found to be very low at 1.3%; hence, training of the healthcare workers at the grass-root level, like accredited social health activists (ASHA) and Anganwadi workers (AWW), should be done regularly to improve the connection in the community and for effective utilization of the Ayushman Bharat-PMJAY.

A Rare Case Presentation of Retroperitoneal Teratoma in Adults.

Primary retroperitoneal teratoma is a tumor originating from each of the three germ cell layers and generally presenting as a large mass in the gonadal and sacrococcygeal region. It is very rarely seen in adults with scarcely any cases reported in literature (Gatcombe et al. J Surg Oncol 86(2):107-113, 2004). Here, we describe an unusual case of a 48-year-old female, presenting with a large retroperitoneal mass -diagnosed on radiological work-up and was later confirmed as a retroperitoneal teratoma by histological examination. Exploratory laparotomy with tumor excision was performed. The patient's recovery was uneventful and is doing well on follow-up.

Goal-Directed vs Traditional Approach to Intraoperative Fluid Therapy during Open Major Bowel Surgery: Is There a Difference?

INTRODUCTION: Optimum perioperative fluid therapy is important to improve the outcome of the surgical patient. This study prospectively compared goal-directed intraoperative fluid therapy with traditional fluid therapy in general surgical patients undergoing open major bowel surgery. METHODOLOGY: Patients between 20 and 70 years of age, either gender, ASA I and II, and scheduled for elective open major bowel surgery were included in the study. Patients who underwent laparoscopic and other surgeries were excluded. After routine induction of general anaesthesia, the patients were randomised to either the control group (traditional fluid therapy), the FloTrac group (based on stroke volume variation), or the PVI group (based on pleth variability index). Fluid input and output, recovery characteristics, and complications were noted. RESULTS: 306 patients, with 102 in each group, were enrolled. Five patients (control (1), FloTrac (2), and PVI (2)) were inoperable and were excluded. Demographic data, ASA PS, anaesthetic technique, duration of surgery, and surgical procedures were comparable. The control group received significantly more crystalloids (3200 ml) than the FloTrac (2000 ml) and PVI groups (1875 ml), whereas infusion of colloids was higher in the FloTrac (400-700 ml) and PVI (200-500 ml) groups than in the control group (0-500 ml). The control group had significantly positive net fluid balance intraoperatively (2500 ml, 9 ml/kg/h) compared to the FloTrac (1515 ml, 5.4 ml/kg/h) and PVI (1420 ml, 6 ml/kg/h) groups. Days to ICU stay, HDU stay, return of bowel movement, oral intake, morbidity, duration of hospital stay, and survival rate were comparable. The total number of complications was not different between the three groups. Anastomotic leaks occurred more often in the Control group than in the others, but the numbers were small. CONCLUSIONS: Use of goal-directed fluid management, either with FloTrac or pleth variability index results in a lower volume infusion and lower net fluid balance. However, the complication rate is similar to that of traditional fluid therapy. This trial is registered with CTRI/2018/04/013016.

Sanger Brown and Edward Schäfer before Heinrich Klüver and Paul Bucy: their observations on bilateral temporal lobe ablations.

Fifty years before a report on the complete bitemporal lobectomy syndrome in primates, known as the Klüver-Bucy syndrome, was published, 2 talented investigators working at the University College in London, England-neurologist Sanger Brown and physiologist Edward Schäfer-also made this discovery. The title of their work was "An investigation into the functions of the occipital and temporal lobes of the monkey's brain," and it involved excisional brain surgery in 12 monkeys. They were particularly interested in the then-disputed primary cortical locations relating to vision and hearing. However, following extensive bilateral temporal lobe excisions in 2 monkeys, they noted peculiar behavior including apparent loss of memory and intelligence resembling "idiocy." These investigators recognized most of the behavioral findings that later came to be known as the Klüver-Bucy syndrome. However, they were working within the late-19th-century framework of cerebral cortical localizations of basic motor and sensory functions. Details of the Brown and Schäfer study and a glimpse of the neurological thinking of that period is presented. In the decades following the pivotal work of Klüver and Bucy in the late 1930s, in which they used a more advanced neurosurgical technique, tools of behavioral observations, and analysis of brain sections after euthanasia, investigators have elaborated the full components of the clinical syndrome and the extent of their resections. Other neuroscientists sought to isolate and determine the specific temporal neocortical, medial temporal, and deep limbic structures responsible for various visual and complex behavioral deficits. No doubt, Klüver and Bucy's contribution led to a great expansion in attention given to the limbic system's role in action, perception, emotion, and affect-a tide that continues to the present time.

Root coverage using subepithelial connective tissue graft with platelet-rich plasma in the treatment of gingival recession: A clinical study.

INTRODUCTION: The presence of gingival recession associated with an insufficient amount of keratinized tissue may indicate gingival augmentation procedure. It is a multifaceted problem for which several treatment options are available. The most predictable technique used for gingival augmentation is the subepithelial connective tissue graft (SCTG). Platelet-rich plasma (PRP) is an enhanced source of growth factors and helps in accelerated periodontal repair and regeneration. AIMS: The aim of this study was to evaluate the efficacy of SCTG along with PRP in the treatment of Miller's class I and II gingival recessions. MATERIALS AND METHODS: Eleven subjects with Miller's class I and II gingival recessions were treated using SCTG with PRP. Clinical variables, including plaque index, gingival index, recession depth (RD), Recession width (RW), width of the keratinized gingiva, probing pocket depth (PD) and clinical attachment level (CAL) were recorded. Patients were recalled at baseline, 3 months, 6 months and 1-year after surgery and clinical recordings were taken. Root coverage percentage (%) was measured at the end of 1-year. RESULTS: The clinical parameters were analyzed during the follow-up period by repeated measures ANOVA test. Twelve months follow-up results showed significant improvements in all the clinical parameters. Reduction of recession resulted in a significant decrease in CAL, PD, RW and RD at the end of 12 months. A statistically significant gain in width of keratinized gingiva and a mean root coverage of 84.72 ± 19.10 was obtained at the end of 12 months. CONCLUSION: From the results of this study, it may be concluded that SCTG with PRP is an effective and predictable method to treat miller's class I and II gingival recession.

Semi-automated breast cancer tumor detection with thermographic video imaging.

Screening for breast cancer enables early detection by which curative treatment can be possible. While mammography is the current gold standard for screening, it has low sensitivity in younger women and its harmful X-rays in frequent screening can increase the risk of cancer. Incidence rates are rising in younger women, causing a relook at thermography for low cost and non-harmful screening. In this paper, thermography is compared to mammography correlated with sono-mammography in 65 FNAC/biopsy proven cancer subjects in India. Thermography is comparable to mammography correlated with sono-mammography, having 94% and 95% sensitivity, respectively. A novel semi-automated thermographic tumor detection and location algorithm used in this paper also provides 97% sensitivity. This shows the promise of automated thermographic screening for reaching large populations in a cost effective manner in low resource settings in countries like India. Further studies in a large scale need to be done to evaluate the specificity to enable such solutions.

Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness.

OBJECT: Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans. METHODS: The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements. The standard supraorbital (SO) pin site is several centimeters above the lateral orbit, whereas the FL pin site is 2-3 cm posterolateral to the SO site. Frontolateral placement is just anterior to the temporalis muscle close to a triangular anterior projection of the temporal hairline. For quantitative information on skull thickness at the SO and FT pin sites, thin 0.625-mm CT scan measurements of the outer table, diploic space, and inner table were obtained in 40 adults (80 sites). RESULTS: The mean values for total skull thickness at the SO and FT sites were not significantly different. The inner table was significantly thicker at the FL site in both males and females, buttressed by the nearby greater sphenoid wing. The mean total skull thickness was significantly less in females than in males, but the values were not significantly different at the SO and FL sites. CONCLUSIONS: The FL and SO anterior pin sites are comparable with respect to skull thickness CT measurements, with a significantly thicker inner table at the FL site. In the senior author's experience, the FL anterior pin site yielded secure fixation without skull perforation, neurovascular injury, or propensity to infection. The cosmetic result of the FL site is more acceptable, and the authors recommend its general usage be adopted.

Chronic epilepsy due to low grade temporal lobe tumors and due to hippocampal sclerosis: do they differ in post-surgical outcome?

Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed. All low-grade temporal lobe gliomas were selected and relevant variables were compared to the same variables in HS patients. There were 34 tumors (out of 233 cases of chronic temporal lobe epilepsy = 14.6 %) with a mean age of onset of 19 years, and the preoperative duration was 12.3 years. When compared to 120 HS patients both of these factors were significantly different (p < 0.001). Age at the time of surgery for tumors was 31.08 (p = 0.5). Tumors were left sided in 20 patients. In tumor cases amygdala resection was complete in 75 %, for hippocampus 24 % were complete and 39 % partial. Astrocytoma, ganglioglioma and oligodendroglioma constituted 80 % of tumor cases. Good outcome (Engel's Class I) was achieved in 88.2 % of tumor cases and 71 % of HS cases while poor outcome (Class III + IV) was seen in 5.9 and 16.7 % respectively. The follow up period for the two groups was not significantly different. In multivariate logistic regression analysis, the groups differed significantly in preoperative delay (between diagnosis and surgery) and in epilepsy outcome. Chronic temporal lobe epilepsy due to low-grade tumors had significantly better surgical outcome with considerably less preoperative delay. The age of onset of seizures was younger in HS patients but a delay in surgical treatment was significantly longer. Given that the diagnosis of treatment-resistant TLE secondary to HS can be established after two failed AED trials at optimal doses, shortening the interval between diagnosis and surgery may improve epilepsy outcome.

Temporal lobe gangliogliomas associated with chronic epilepsy: long-term surgical outcomes.

OBJECTIVE: To review the clinical features and surgical outcome in patients with temporal lobe gangliogliomas associated with intractable chronic epilepsy. METHODS: The Rush University Surgical Epilepsy Database was queried to identify patients with chronic intractable epilepsy who underwent resection of temporal lobe gangliogliomas at Rush University Medical Center. Medical records were reviewed for age of seizure onset, delay to referral for surgery, seizure frequency and characteristics, pre-operative MRI results, extent of resection, pathological diagnosis, complications, length of follow-up, and seizure improvement. RESULTS: Fifteen patients were identified. Average duration between seizure onset and surgery was 14.3 years. Complex partial seizures were the most common presenting symptom. Detailed operative data was available for 11 patients - of these, 90.9% underwent complete resection of the amygdala and either partial or complete resection of the hippocampus, in addition to lesionectomy. Average follow-up was 10.4 years (range 1.6-27.5 years), with 14 patients improving to Engel's class I and one patient to Engel's class III. There were no recurrences, and permanent complications were noted in one patient. CONCLUSIONS: Long-term follow-up of patients with temporal lobe gangliogliomas associated with chronic intractable epilepsy demonstrates excellent results in seizure improvement with surgery and increasingly low incidence of complications with improvements in microsurgical techniques.

Repositioning of supraorbital nerve stimulation electrode using retrograde needle insertion: a technical note.

INTRODUCTION: With growing interest and acceptance of peripheral nerve stimulation (PNS) approach, there is now an increasing need in developing clear procedural details to resolve frequent complications and minimize associated tissue injury. Migration and suboptimal positioning of PNS electrodes are one of the most commonly observed complications of PNS approach. MATERIALS AND METHODS: We present a simple technique for repositioning a supraorbital electrode using retrograde insertion of introducer needle that allows one to place percutaneous (cylindrical) PNS electrode into appropriate anatomical location with minimal additional injury to surrounding tissues. RESULTS: This approach has been successfully used in multiple cases. An illustrative case of electrode revision with proposed technique is described in detail. CONCLUSION: This technically simple approach to repositioning of cylindrical supraorbital electrodes using retrograde needle insertion eliminates the need for a more elaborate and invasive procedure. The technique can be used for electrode repositioning in most PNS applications.

Vitamin A decreases pre-receptor amplification of glucocorticoids in obesity: study on the effect of vitamin A on 11beta-hydroxysteroid dehydrogenase type 1 activity in liver and visceral fat of WNIN/Ob obese rats.

BACKGROUND: 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) catalyzes the conversion of inactive glucocorticoids to active glucocorticoids and its inhibition ameliorates obesity and metabolic syndrome. So far, no studies have reported the effect of dietary vitamin A on 11ß-HSD1 activity in visceral fat and liver under normal and obese conditions. Here, we studied the effect of chronic feeding of vitamin A-enriched diet (129 mg/kg diet) on 11ß-HSD1 activity in liver and visceral fat of WNIN/Ob lean and obese rats. METHODS: Male, 5-month-old, lean and obese rats of WNIN/Ob strain (n = 16 for each phenotype) were divided into two subgroups consisting of 8 rats of each phenotype. Control groups received stock diet containing 2.6 mg vitamin A/kg diet, where as experimental groups received diet containing 129 mg vitamin A/Kg diet for 20 weeks. Food and water were provided ad libitum. At the end of the experiment, tissues were collected and 11ß-HSD1 activity was assayed in liver and visceral fat. RESULTS: Vitamin A supplementation significantly decreased body weight, visceral fat mass and 11ß-HSD1 activity in visceral fat of WNIN/Ob obese rats. Hepatic 11ß-HSD1 activity and gene expression were significantly reduced by vitamin A supplementation in both the phenotypes. CCAAT/enhancer binding protein α (C/EBPα), the main transcription factor essential for the expression of 11ß-HSD1, decreased in liver of vitamin A fed-obese rats, but not in lean rats. Liver × receptor α (LXRα), a nuclear transcription factor which is known to downregulate 11ß-HSD1 gene expression was significantly increased by vitamin A supplementation in both the phenotypes. CONCLUSIONS: This study suggests that chronic consumption of vitamin A-enriched diet decreases 11ß-HSD1 activity in liver and visceral fat of WNIN/Ob obese rats. Decreased 11ß-HSD1 activity by vitamin A may result in decreased levels of active glucocorticoids in adipose tissue and possibly contribute to visceral fat loss in these obese rats. Studying the role of various nutrients on the regulation of 11ß-HSD1 activity and expression will help in the evolving of dietary approaches to treat obesity and insulin resistance.

Evaluation of the prognostic indicators of giant intracranial aneurysms.

The indicators of poor outcome in giant intracranial aneurysms have been the subject of several studies in the literature. We conducted a retrospective analysis to evaluate the predictors of poor outcome in giant intracranial aneurysms. We studied consecutive cases with aneurysms admitted over a 9-year period in our institution. All the aneurysms were treated with clipping. Patient demographics, clinical profile, and aneurysm characteristics were evaluated in a multivariate analysis as probable indicators of Glasgow Outcome Scale (GOS) score. The outcome of the aneurysms (GOS score) was compared with the remaining non-giant aneurysms. A total of 41 giant and 348 non-giant aneurysms were identified in our series. In the multivariate analysis, the indicators of poor outcome were identified as poor clinical grade (p < 0.0004), intraoperative rupture (p < 0.007), and posterior circulation of the aneurysms (p < 0.01). Non-giant aneurysms had a better outcome compared with the giant aneurysms (p < 0.01). Giant aneurysms impose a relatively higher risk of morbidity and mortality to the patients. The predictors of the postsurgical outcome of the giant aneurysms include the clinical condition of the patient, location of the aneurysm, and intraoperative rupture.

Cerebral ischemia as a presenting feature of intracranial aneurysms: a negative prognostic indicator in the management of aneurysms.

OBJECTIVE: Cerebral ischemia (stroke) can be a presenting clinical feature of intracranial aneurysms and may herald poor prognosis. METHODS: A retrospective review of admissions for aneurysms over a 6-year period revealed that 12 patients (5%) had stroke or stroke-like presentations among 236 patients with intracranial aneurysms. Patient demographics, characteristics of aneurysms, and management were analyzed. RESULTS: Of 12 patients reviewed, nine had anterior circulation aneurysms. Two patients presented with subarachnoid hemorrhage and 10 with unruptured aneurysms. Eleven patients had stroke at the time of presentation, and five had a previous history of transient ischemic attacks. Ten patients had hypertension and eight were active smokers. The mean size of 10 aneurysms was 11.8 mm. Surgical extirpation of the aneurysms was performed in all cases. Four cases revealed thrombus in the aneurysm and one was atherosclerotic. The 6-month outcome was good in seven patients (58%) and fair in four patients (33%). One patient died. This outcome was significantly worse (P < 0.01) compared to that of good grade aneurysms in our database. Hypertension was a significant indicator of poor outcome (P < 0.02). CONCLUSION: Ischemic episodes as a presenting feature of intracranial aneurysms could be indicators of poor prognosis. Routine evaluation of stroke patients for aneurysms may help in early diagnosis. In addition, surgical obliteration of aneurysms could prevent subsequent strokes and neurological deficits.

Pyle's disease: an incidental finding in a routine dental patient.

Pyle's disease (PD) or metaphyseal dysplasia is an extremely rare genetic disorder, transmitted as an autosomal recessive trait. The peculiarity of the disease is that the striking radiographic manifestations contrast with the relatively normal clinical features. The oral findings and radiographic features of the disease are not well documented. The present paper describes the radiographic features of Pyle's disease in a 17-year-old girl and draws attention to the findings in the jaw bones.

Postnatal expression profile of OBCAM implies its involvement in visual cortex development and plasticity.

This study examined the expression of a neuron-specific cell adhesion molecule, OBCAM (opioid-binding cell adhesion molecule), at both the mRNA and protein levels in the cat primary visual cortex at various postnatal ages, using cDNA array analysis and immunocytochemistry. Results obtained using both methods showed that the expression level of OBCAM was high in young and low in older and adult visual cortex. OBCAM-immunoreactivities were associated predominantly with perikarya and dendrites of pyramidal neurons, and OBCAM-immunopositive neurons were present in all cortical layers. Immunostaining of OBCAM in adult visual cortex showed a reduced number of immunopositive neurons and neurites and relatively lower staining intensities as compared with younger animals. In addition, the number of OBCAM-immunopositive neurons was significantly higher in the visual cortex of 4-month-old animals dark-reared from birth than those in age-matched normally reared animals. These results suggest that OBCAM may play an important role in visual cortex development and plasticity.

Management of subtrochanteric femoral fractures and metastases using long proximal femoral nail.

We report our initial experience with a new reconstruction nail, the long proximal femoral nail (L.PFN), in the treatment of subtrochanteric femoral fractures and metastases. We performed 52 L.PFN in 49 patients over a period of 18 months with an average follow-up period of 47.7 weeks. Group I consisted of 24 patients, who had L.PFN for traumatic subtrochanteric femoral fractures. Group II consisted of 25 patients, who had L.PFN for femoral metastases and pathological fractures. (Three bilateral.) In nine patients in group I, the fracture was extending to the intertrochnateric region with involvement of the piriformis fossa. Eight patients in group I had open reduction and cerclage cabling of the fracture prior to L.PFN. All the traumatic fractures in group I had united with an average time to union of 19.4 weeks. In eight operations there were technical difficulties with the insertion of proximal locking screws. Five patients in our series had complications but we had no mechanical failures of the implant. L.PFN is a reliable implant for subtrochanteric femoral fractures and metastases. We also showed that open reduction and cerclage cabling of unstable subtrochanteric fractures prior to nailing was not detrimental to fracture healing in our series.