Rubella immunity among pregnant women and the burden of congenital rubella syndrome (CRS) in India, 2022.

BACKGROUND: India aims to eliminate rubella and congenital rubella syndrome (CRS) by 2023. We conducted serosurveys among pregnant women to monitor the trend of rubella immunity and estimate the CRS burden in India following a nationwide measles and rubella vaccination campaign. METHODS: We surveyed pregnant women at 13 sentinel sites across India from Aug to Oct 2022 to estimate seroprevalence of rubella IgG antibodies. Using age-specific seroprevalence data from serosurveys conducted during 2017/2019 (prior to and during the vaccination campaign) and 2022 surveys (after the vaccination campaign), we developed force of infection (FOI) models and estimated incidence and burden of CRS. RESULTS: In 2022, rubella seroprevalence was 85.2% (95% CI: 84.0, 86.2). Among 10 sites which participated in both rounds of serosurveys, the seroprevalence was not different between the two periods (pooled prevalence during 2017/2019: 83.5%, 95% CI: 82.1, 84.8; prevalence during 2022: 85.1%, 95% CI: 83.8, 86.3). The estimated annual incidence of CRS during 2017/2019 in India was 218.3 (95% CI: 209.7, 226.5) per 100, 000 livebirths, resulting in 47,120 (95% CI: 45,260, 48,875) cases of CRS every year. After measles-rubella (MR) vaccination campaign, the estimated incidence of CRS declined to 5.3 (95% CI: 0, 21.2) per 100,000 livebirths, resulting in 1141 (95% CI: 0, 4,569) cases of CRS during the post MR-vaccination campaign period. CONCLUSION: The incidence of CRS in India has substantially decreased following the nationwide MR vaccination campaign. About 15% of women in childbearing age in India lack immunity to rubella and hence susceptible to rubella infection. Since there are no routine rubella vaccination opportunities for this age group under the national immunization program, it is imperative to maintain high rates of rubella vaccination among children to prevent rubella virus exposure among women of childbearing age susceptible for rubella.

Knowledge, attitude, and hesitance toward COVID-19 vaccination - a cross-sectional study from Jharkhand.

Introduction: In order to enhance public acceptability and reduce vaccine hesitancy in the face of the disease, it is necessary to examine the general public's awareness of the coronavirus vaccination. Vaccination resistance to the coronavirus disease 19 (COVID-19) vaccination continues to be a problem throughout the world. Some of the greatest hurdles to dedication to hygienic standards are a lack of scientific testing for the vaccination, the fear of vaccine side effects, and reports of active viruses in immunizations. National and international health groups are launching initiatives to promote public knowledge about the COVID-19 vaccinations. This study aimed to understand the knowledge, attitude, and hesitancy toward the COVID-19 vaccine among the people of the Hazaribag district from Jharkhand. Methodology: The present study was conducted in Sheikh Bhikhari Medical College and Hospital, a tertiary care hospital of Jharkhand. It was a cross-sectional study. The research was conducted from June 2021 to December 2021. Result: The majority of respondents (83.3%) were confident in taking the COVID-19 vaccine, and 76% respondents agreed that the COVID-19 vaccinations now in use were safe; nevertheless, concern was expressed by 8% of respondents, whereas neutrality was expressed by 15.1%. Conclusion: Overall, the participants in the study had a good understanding of the coronavirus vaccine and agreed to take it. The development of mild or major side effects following immunization is the most important determinant for vaccine reluctance. Vaccine acceptability may improve whenever more information about vaccine safety and efficacy becomes available in the public domain, preferably from a centralized, trustworthy source. To promote public vaccination acceptance and reduce vaccine hesitancy, ongoing training and health education programs are required.

Morphological study of the menisci of the knee joint in human cadaver in Jharkhand population.

Introduction: Sports are the leading cause of joint injuries, particularly in the knees. Knee menisci are an important functional unit that aids in load distribution and hence reduces stress on the knee joint. Meniscal morphology provides information on exact size and shape, which is important for meniscal transplantation in cases of meniscal damage. The study's goal is to determine the morphological variation in the shape of menisci, as well as the width and thickness of menisci. Method: This study was conducted at the Rajendra Institute of Medical Sciences (RIMS) Ranchi, Department of Anatomy. In this study, 100 menisci were taken from 50 adult cadaver knee joints available in the dissection hall. Result: Six morphological kinds of menisci were identified after a morphological and morphometric study of 100 menisci. The most common crescent-shaped menisci (96%) were found in 50 medial menisci (MM), while the most common C-shaped menisci were found in 50 lateral menisci (LM, 94%). There was no statistically significant difference in thickness between the anterior, middle, and posterior thirds of the MM in the morphometric analysis. The thickest section of the lateral meniscus (LM) was in the middle third. There was no significant variation in the width of the LM among the different thirds in the current study. The posterior portion of the medial meniscus (MM), on the other hand, was the widest. Conclusion: The findings of this study support meniscal anatomy in terms of surgical technique and arthroscopy of the knee joint, as well as contributing to a better understanding of meniscal architecture and meniscal transplantation. As a result, health workers who treat meniscal injuries should be aware of the probable anatomical differences.

A comparative study between bone transport technique using Ilizarov/LRS fixator and induced membrane (Masquelet) technique in management of bone defects in the long bones of lower limb.

Introduction: In earlier times due to difficulty in managing segmental long bone defects, amputation was the preferred treatment. Nonunion with bone loss of long bones is a challenging problem, requiring serious attention. Post-traumatic segmental bone defects can have severe long-term ill impact on patient's lives. Reconstruction is more difficult and functional outcome is usually less satisfactory compared to bony outcome. Distraction osteogenesis and induced membrane technique are the techniques that can be used. Aims and Objectives: To find out and compare clinical, radiological, and functional outcome of bone transport technique and induced membrane technique in management of bone defects in the long bones of lower limb. Materials and Methods: A comparative study was conducted on 24 patients (22 males and 2 females) of lower extremity fractures with bone defect more than 3 cm. Patients were divided into two groups according to the method of reconstruction used, that is, either bone transport technique in 12 patients (group A) or masquelet in the other 12 patients (group B). The mean age of the patients was 44 years in group A and was 38 years in group B. Regular follow-up was done with a mean period of follow up of 18.35 ± 5.58 months in group A and 18.25 ± 3.95 months in group B. Result: In group A (bone transport), 67% showed union, 25% showed union with bone graft and 8% showed delayed union. In group B (masquelet), 75% showed union and 25% showed delayed union. bone transport technique showed excellent results in 58.3% and good in 41.7% while Masquelet technique showed excellent result in 50% and good in 50%. Conclusion: For an orthopaedic surgeon, long bones defects with a substantial loss of bone volume are one of the most challenging bone defects encountered in clinical practice. Induced membrane technique and bone transport both offer successful options for filling of bone defects. Both techniques have its own pros and cons and provide varied option for healing. In our study, both methods have comparable results statistically although induced membrane technique required soft tissue reconstructive procedures.

A Study on the perception of medical students using online teaching during covid -19 pandemic.

Introduction: COVID-19 has caused unprecedented disruption to the medical education process and the health care system worldwide. It has also affected clinical training and forced medical colleges to switch over to the online mode of teaching. This study aimed to learn about the experience and perception of undergraduate students regarding online learning and to study the advantage and disadvantages of online learning. Method: This was a cross-section study conducted among the undergraduate students of government medical colleges of Jharkhand. A validated electronic questionnaire was sent to students of all five government medical colleges in the google form. Response from 501 students was received and analyzed using SPSS software. Result: Only 30% of students were satisfied with the frequency, organization content, and preparedness of class. More than half of students were not satisfied with the preparedness, content, and frequency of online classes. Among various teaching methods, live online lectures were most common, and they were also preferred by the majority of students. Most of the students wanted a regular face-to-face classroom or hybrid teaching after the COVID-19 pandemic. Conclusion: The majority of the medical students preferred face-to-face teaching methods over online teaching methods. Lack of interpersonal interaction and poor infrastructure for online might be the reason for this. However, a hybrid method of learning can be included as a part of the medical curriculum that helps in better learning of medical students.

Measuring tuberculosis patient perceived quality of care in public and public-private mix settings in India: an instrument development and validation study.

BACKGROUND: At present, there are no validated quantitative scales available to measure patient-centred quality of care in health facilities providing services for tuberculosis (TB) patients in India and low-income and middle-income countries. METHODS: Initial themes and items reflective of TB patient's perceived quality of care were developed using qualitative interviews. Content adequacy of the items were ascertained through Content validity Index (CVI) and content validity ratio (CVR). Pilot testing of the questionnaire for assessing validity and reliability was undertaken among 714 patients with TB. Sampling adequacy and sphericity were tested by Kaiser-Meyer-Olkin and Bartlett's test, respectively. Exploratory and confirmatory factor analysis was undertaken to test validity. Cronbach's α and test-retest scores were used to test reliability. RESULTS: A 32-item tool measuring patient-perceived quality of TB distributed across five domains was developed initially based on a CVI and CVR cut-off score of 0.78 and cognitive interviews with patients with TB. Bartlett's test results showed a strong significance f (χ2=3756 and p<0.001) and Kaiser-Meyer-Olkin was measured to be 0.698 highlighting data adequacy and correlation between the variables. Exploratory factor analysis with varimax rotation extracted 4 factors related to 14 items with Eigen values >1 which accounted for 60.9% of the total variance of items. Correlation (z-value >1.96) between items and factors was highly significant and Cronbach's α was acceptable for the global scale (0.76) for the four factors. Intraclass correlation coefficient and the test retest scores for four factors were (<0.001) significant. CONCLUSION: We validated a measurement tool for patient-perceived quality of care for TB (PPQCTB) which measured the patient's satisfaction with healthcare provider and services. PPQCTB tool could enrich quality of care evaluation frameworks for TB health services in India.

Clinical profile of patients infected with suspected SARS-CoV-2 Omicron variant of concern, Tamil Nadu, India, December 2021-January 2022.

Background & objectives: COVID-19 cases have been rising rapidly in countries where the SARS-CoV-2 variant of concern (VOC), Omicron (B.1.1.529) has been reported. We conducted a study to describe the epidemiological and clinical characteristics and outcomes of COVID-19 patients with 'S' gene target failure (SGTF, suspected Omicron). Furthermore, their clinical outcomes with COVID-19 patients with non-SGTF (non-Omicron) were also compared. Methods: This study was conducted in Tamil Nadu, India, between December 14, 2021 and January 7, 2022 among patients who underwent reverse transcription-PCR testing for SARS-CoV-2 in four laboratories with facilities for S gene screening. Consecutively selected COVID-19 patients with SGTF were telephonically contacted, seven and 14 days respectively after their date of positive result to collect information on the socio-demographic characteristics, previous history of COVID-19, vaccination status and clinical course of illness along with treatment details. To compare their outcomes with non-SGTF patients, one randomly suspected non-Omicron case for every two suspected Omicron cases from the line-list were selected, matching for the date of sample collection and the testing laboratory. Results: A total of 1175 SGTF COVID-19 patients were enrolled for this study. Almost 6 per cent (n=72) reported a history of previous infection. 141 (13.5%) suspected Omicron cases were non-vaccinated, while 148 (14.2%) and 703 (67.4%) had received valid one and two doses of COVID-19 vaccines, respectively. Predominant symptoms reported included fever (n=508, 43.2%), body pain (n=275, 23.4%), running nose (n=261, 22.2%) and cough (n=249, 21.2%). Five (0.4%) of the 1175 suspected Omicron cases required oxygen supplementation as compared to ten (1.6%) of the 634 suspected non-Omicron cases. No deaths were reported among omicron suspects, whereas there were four deaths among suspected non-Omicron cases. Interpretation & conclusions: Majority of the suspected Omicron cases had a mild course of illness. The overall severity of these cases was less compared to the suspected non-Omicron cases.

Comparative study to evaluate efficacy of prolotherapy using 25% dextrose and local corticosteroid injection in tennis elbow - A prospective study.

Introduction: Tennis elbow is a common painful condition with a prevalence rate of 1-3%. The condition starts as a micro-tear in extensor carpi radialis brevis and its degeneration because of repetitive overload. Conservative measures are undertaken initially because symptoms in most patients improve with time and rest. Adjunctive treatment includes steroid injection, autologous plasma, exercise, and prolotherapy. Dextrose prolotherapy by virtue of its multi-modal mechanism of action has emerged as a cost-effective treatment option for chronic musculoskeletal and arthritic pain. Materials and Methods: A total of 260 patients were included in the study and divided in two groups for administration of steroids or dextrose prolotherapy. The Visual Analog Scale (VAS) and Mayo Elbow Performance Scale (MEPS) scores were taken for patients at regular follow-up. Results: All patients showed improvement in VAS score and MEPS score following dextrose prolotherapy as well as patients injected with steroids. Conclusion: Both prolotherapy and steroid injection offer adequate pain relief and functional outcome, although prolotherapy has been shown to be superior and given long-lasting results compared to steroid injection in management of tennis elbow.

Comparison of Femoral Neck System Versus Cannulated Cancellous Screws for the Fixation of Femoral Neck Fracture in Young Adults: A Systematic Review and Meta-Analysis.

A femoral neck fracture is a very common injury in the elderly. However, its incidence is low among young adults, usually presenting as an emergency. In young adults, implant choice is one of the important factors. This systematic review aims to analyze the femoral neck system (FNS) versus cannulated cancellous (CC) screw for the fixation of femoral neck fractures in young adults through well-defined objectives. A comprehensive search from the electronic database (PubMed, Google Scholar, Web of Science, Cochrane Library) was conducted from the beginning till February 18, 2022. The data regarding study type, authors, year of publication, country, union time, Harris hip score, intraoperative blood loss, operating time, neck shortening, and hospital stay were extracted from the selected articles and analyzed using RevMan 5.4.1 software. For continuous data, e.g., healing time, intraoperative blood loss, operation time, Harris hip score, neck shortening, and hospital stay, the mean difference (MD), either weighted mean difference (WMD) or standardized mean difference (SMD), with a 95% confidence interval (CI) was recorded. A p-value less than 0.05 was taken as statistically significant. The Newcastle Ottawa scale was used for the risk of bias assessment. Six retrospective cohort studies including 427 patients were selected for the meta-analysis. There was significantly less healing time (WMD= -1.10, 95% CI: -1.73 to -0.47), shorter operation duration (WMD=7.70, 95% CI: -0.06 to 15.46), and better Harris hip score (WMD=4.79, 95% CI: 2.12-7.46) in the FNS than CC screw fixation method. However, intraoperative blood loss was significantly less in the CC screw system (WMD=21.27, 95% CI: 8.20-34.35). There was no significant difference between the two approaches in-hospital stay duration and femoral neck shortening. This can be concluded that FNS is better than CC screw fixation for treating neck of femur fractures in adults on the outcome basis of union time, less operation time, and better Harris hip score (HHS) with significant heterogeneity.

An Epidemiological Analysis of SARS-CoV-2 Genomic Sequences from Different Regions of India.

The number of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) cases is increasing in India. This study looks upon the geographic distribution of the virus clades and variants circulating in different parts of India between January and August 2020. The NPS/OPS from representative positive cases from different states and union territories in India were collected every month through the VRDLs in the country and analyzed using next-generation sequencing. Epidemiological analysis of the 689 SARS-CoV-2 clinical samples revealed GH and GR to be the predominant clades circulating in different states in India. The northern part of India largely reported the 'GH' clade, whereas the southern part reported the 'GR', with a few exceptions. These sequences also revealed the presence of single independent mutations-E484Q and N440K-from Maharashtra (first observed in March 2020) and Southern Indian States (first observed in May 2020), respectively. Furthermore, this study indicates that the SARS-CoV-2 variant (VOC, VUI, variant of high consequence and double mutant) was not observed during the early phase of virus transmission (January-August). This increased number of variations observed within a short timeframe across the globe suggests virus evolution, which can be a step towards enhanced host adaptation.

Understanding health care-seeking behaviour of the tribal population in India among those with presumptive TB symptoms.

BACKGROUND AND OBJECTIVES: Understanding the drivers for care-seeking among those who present with symptoms of TB is crucial for early diagnosis of TB and prompt treatment, which will in turn halt further TB transmission. While TB is a challenge among the tribal population, little is known about the care-seeking behaviour and the factors influencing care-seeking behaviour among the tribal population across India. METHODOLOGY: This community-based descriptive study was carried out in 17 states of India across 6 zones, covering 88 villages from tribal districts with over 70% tribal population. The sample population included individuals ≥15 years old who were screened through an interview for symptoms suggestive of pulmonary TB (PTB), currently and/or previously on anti-TB treatment. Those with symptoms were then assessed on their health-seeking behavior using a semi-structured interview schedule. RESULTS: Among 74532 eligible participants screened for symptoms suggestive of TB, 2675 (3.6%) were found to be presumptive TB cases. Of them, 659 (24.6%) sought care for their symptoms. While 48.2% sought care after a week, 19.3% sought care after one month or more, with no significant difference in the first point of care; 46.9% approaching a private and 46.7% a public facility. The significant factors influencing care-seeking behaviour were knowledge on TB (OR: 4.64 (3.70-5.83), p < 0.001), age<35 years (OR: 1.60 (1.28-2.00), p < 0.001), co-morbidities like asthma (OR: 1.80 (1.38-2.35), p < 0.001) and blood pressure (OR: 2.59 (1.75-3.85), p < 0.001), symptoms such as blood in sputum (OR: 1.69 (1.32-2.16), p < 0.001), shortness of breath (OR: 1.43 (1.19-1.72), p < 0.001) and weight loss (OR: 1.59 (1.33-1.89), p < 0.001). The cough was the most often reported symptom overall. There were gender differences in symptoms that prompted care-seeking: Males were more likely to seek care for weight loss (OR: 1.78 (1.42-2.23), p<0.001), blood in the sputum (OR: 1.69 (1.25-2.28), p<0.001), shortness of breath (OR: 1.49 (1.18-1.88), p<0.001) and fever (OR: 1.32 (1.05-1.65), p = 0.018). Females were more likely to seek care for blood in sputum (OR: 1.68 (1.10-2.58), p = 0.018) and shortness of breath (OR = 1.35, (1.01-1.82), p = 0.048). The cough did not feature as a significant symptom that prompted care-seeking. CONCLUSION: Delayed healthcare-seeking behaviour among those with symptoms presumptive of TB in the tribal population is a major concern. Findings point to differences across gender about symptoms that prompt care-seeking in this population. Gender-sensitive interventions with health system strengthening are urgently needed to facilitate early diagnosis and treatment among this population.

Incidence and pattern of road traffic injuries in tribal population of Jharkhand: One-year study in a tertiary care teaching hospital.

BACKGROUND AND AIM: Road traffic injuries (RTIs) are a leading cause of mortality and morbidity globally. This study aimed to assess the incidence and pattern of RTIs in the tribal population of Jharkhand. METHODS AND MATERIALS: This prospective observational study was conducted for a period of 1 year (June 2018 to May 2019) at the Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A pretested semi-structured questionnaire was administered. A total of 1713 road traffic accident (RTA) victims belonging to tribal population were interviewed during the study period. Data were entered in a Microsoft Excel sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 16. RESULTS: There were 1258 (73.4%) males and 455 (26.6%) females. The majority (31.4%) of patients belonged to the age group of 21-30 years, followed by 19.2% in the age group of 31-40 years. The majority (52.13%) of RTAs involved a two-wheeler vehicle. Head injury was the most common type of injury (40.86%), followed by lower limb injury (26.68%). Common upper limb injuries were in the humerus and radius and ulna region. The majority of lower limb injuries involved tibia and femur. Common thoracic-abdomen injuries were soft tissue injury and lung contusion. Drunk driving (alcohol influence) was seen in 34.68% of cases of RTI. CONCLUSIONS: RTA is a major public health problem which needs to accelerate the efforts of road safety preventive measures. Road safety education should be promoted.

Structural updates of alignment of protein domains and consequences on evolutionary models of domain superfamilies.

BACKGROUND: Influx of newly determined crystal structures into primary structural databases is increasing at a rapid pace. This leads to updation of primary and their dependent secondary databases which makes large scale analysis of structures even more challenging. Hence, it becomes essential to compare and appreciate replacement of data and inclusion of new data that is critical between two updates. PASS2 is a database that retains structure-based sequence alignments of protein domain superfamilies and relies on SCOP database for its hierarchy and definition of superfamily members. Since, accurate alignments of distantly related proteins are useful evolutionary models for depicting variations within protein superfamilies, this study aims to trace the changes in data in between PASS2 updates. RESULTS: In this study, differences in superfamily compositions, family constituents and length variations between different versions of PASS2 have been tracked. Studying length variations in protein domains, which have been introduced by indels (insertions/deletions), are important because theses indels act as evolutionary signatures in introducing variations in substrate specificity, domain interactions and sometimes even regulating protein stability. With this objective of classifying the nature and source of variations in the superfamilies during transitions (between the different versions of PASS2), increasing length-rigidity of the superfamilies in the recent version is observed. In order to study such length-variant superfamilies in detail, an improved classification approach is also presented, which divides the superfamilies into distinct groups based on their extent of length variation. CONCLUSIONS: An objective study in terms of transition between the database updates, detailed investigation of the new/old members and examination of their structural alignments is non-trivial and will help researchers in designing experiments on specific superfamilies, in various modelling studies, in linking representative superfamily members to rapidly expanding sequence space and in evaluating the effects of length variations of new members in drug target proteins. The improved objective classification scheme developed here would be useful in future for automatic analysis of length variation in cases of updates of databases or even within different secondary databases.

Analysis of karyometric variables in spontaneously occurring canine mammary tumors.

OBJECTIVE: To study alteration in karyometric variables to distinguish benign from malignant canine mammary tumors. STUDY DESIGN: Formalin-fixed, paraffin-embedded tissue sections from 16 cases of canine mammary tumors were stained with hematoxylin-eosin and analyzed for mean nuclear area, mean nuclear perimeter and shape factor. The morphometric descriptors were then correlated with conventional histologic diagnosis. RESULTS: On Mann-Whitney U-test, nuclear variables, that is, mean nuclear area and mean nuclear perimeter, revealed significant difference between malignant and benign groups (p < 0.01), while shape factor showed significant difference at p < 0.05. All morphometric descriptors showed significant correlation with each other and with histopathologic diagnosis. Contrary to expectations, shape factor was lower in benign compared to malignant tumors. In benign mammary tumors, the highest mean nuclear area and perimeter were 39.59 +/- 10.34 microm2 and 25.39 +/- 4.14 microm, respectively, for fibroadenoma; and in malignant tumors the highest mean nuclear area and perimeter were 48.44 +/- 12.89 microm2 and 27.36 +/- 4.31 microm, respectively, for papillary adenocarcinoma. CONCLUSION: This study provides insight into the alterations in karyometric variables in canine mammary tumors. Mean nuclear area and perimeter appear to have potential to differentiate benign and malignant canine mammary tumors.

Germ cell tumors of the ovary: a clinicopathologic study of 121 cases from Nepal.

BACKGROUND: Although many reports have been published about germ cell tumors of the ovary in developed countries, there has been no such documentation from Nepal. The retrospective study presented here reports the clinicopathologic profile of germ cell tumors of the ovary studied at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. METHODS: A retrospective analysis of 121 histopathologically proven cases of germ cell tumor of the ovary operated on at either our institute or somewhere else (but processed in our institute) from November 1995 to April 2001 (5.5 years) was done. Clinical data, histopathologic findings and complications were recorded. RESULTS: The prevalence of germ cell tumors was 43.36% (121/279) of all ovarian neoplasms. Patient age varied from 8 to 65 years (median 31 years). Tumor occurrence was most frequent in patients aged 21-40 years. Only eight of 121 cases (6.61%) were malignant; the rest (93.39%) were mature teratomas. Of great interest was the unexpectedly high number of cases (47.93%) found in patients who were hill natives such as Rai and Gurung. Pain and abdominal fullness were common symptoms noted in 85.95% and 79.31% of patients, respectively. Seventeen (14%) asymptomatic cases were found either on routine physical examination (12 cases) or during pregnancy (five cases). The left ovary was involved in 39.7% cases and the right in 35.5%. Bilateral involvement was seen in 24.8% of cases. Torsion was noted in 20.66% and was the most common complication. Of all the germ cell tumors 93.39% were cystic and only 6.61% were solid on gross appearance. There were three cases of monodermal benign teratoma, four cases of immature teratoma and one case of malignant transformation. CONCLUSION: Mature teratoma is the most common germ cell tumor and accounts for 40.50% of all ovarian neoplasms. The high prevalence of germ cell tumors of the ovary found among patients who were hill natives needs to be explored further.

Acute appendicitis: a quality assurance study.

The parameters that indicate the quality of patient care in acute appendicits (AA) were evaluated. One hundred sixty-four patients, who underwent emergency appendectomy (EA) at the B.P. Koirala Institute of Health Sciences, Dharan, Nepal were studied prospectively. The mean duration of the symptoms was 42.2 +/- 69.5 hours (range 2-720 hours, median 24 hours). The mean waiting period in the hospital was as 12.7 +/- 21.8 hours (range 1-188 hours, median 7 hours). Special investigations' such ultrasonography, computed tomography or laparoscopy, were not used for diagnosis. The perforation rate was 39%. The histopathology report of 79% of the patients was available. Diagnostic accuracy in histologically evaluated patients was 91.5%. One patient (0.6%) died. The mean hospital stay was 3.2 +/- 2.0 days (range 1-17 days). Patients who had to wait in hospital for < 24 hours before surgery had a longer duration of symptoms, underwent exploratory laparotomy through a mid-line incision more frequently, had a higher incidence of perforated/gangrenous appendix and longer hospital stay. The mean medical expenditure for patients treated in the general ward was Nepali Rupees (NR) 2485 +/- 504 (range NR 1372-4500). The majority of patients/guardians (88%-97%) were satisfied with the medical expenditure incurred, promptness of service, behaviour of the hospital staff and the facilities available in the hospital. The diagnostic accuracy and cost of treatment were favourable. The longer duration of symptoms, non-utilization of special investigations for diagnosis, high perforation rate and less than cent-per cent biopsy rate are the aspects that require attention to improve the quality of surgical care.

Massive ovarian edema with contralateral mature cystic teratoma--a case report of an uncommon combination.

A case with massive ovarian edema (MOE) of left ovary--a rare pseudotumour and mature cystic teratoma of right ovary is described in a young unmarried girl of 16 years. The etiopathological concepts, morphological changes and differential diagnosis are described. Knowledge about the entity and its existence are important for correct treatment. This is the first reported case from Nepal.

Primary squamous cell carcinoma of the endometrium: a case report.

Squamous cell carcinoma of the endometrium is extremely rare female genital malignancy. Only 64 cases have been reported in the literature. A case of primary squamous cell carcinoma of endometrium in a 55-year old-woman is reported. Examination revealed pyometra and cervical stenosis. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathology confirmed the diagnosis.

Pure red cell aplasia--report of 11 cases from eastern Nepal.

There were eleven cases of pure red cell aplasia diagnosed over a period of 2 years (January 2000-December 2001). All the patients had anemia with pallor and weakness being the presenting complaints. Hematological profile depicted normocytic normochromic anemia, reticulocytopenia and marked paucity of erythroid precursors on bone marrow aspiration and biopsy studies. In the present study, one case was of congenital pure red cell aplasia, in one other case of pyrexia of unknown origin, no definitive diagnosis could be made. Other associated diseases seen with pure red cell aplasia were thymoma, septicemia, protein energy malnutrition, non-Hodgkin's lymphoma, juvenile rheumatoid arthritis, acute myeloid leukemia, tuberculosis and hepatitis C. The association of pure red cell aplasia with haematologic malignancies is rare. There are very few case reports on pure red cell aplasia with hepatitis C.