Deception in simulation-based education: a randomised controlled trial of the effect of deliberate deception on the performance of anaesthesia trainees.

The use of deliberate deception in simulation allows for a level of realism that is not normally feasible. However, the use of deception is controversial, and carries the risk of psychological harm to learners. There are currently no quantitative data on the effect of deception on learner performance, making it difficult to judge its usefulness. The objective of this study was to examine the impact of deception on learners' performance during a life-threatening scenario. In this simulation study, second-year anaesthesia residents were randomly allocated into two groups: the non-deception group was told that the participating consultant was acting a part, while the deception group was told that the consultant was a subject in the study. Learners then participated in a simulated crisis that presented them with situational opportunities to challenge the consultant regarding clearly wrong decisions. Two independent raters scored the performances using the modified advocacy-inquiry scale. Forty-four participants were analysed. The median (IQR [range]) highest scoring modified advocacy-inquiry scale was 5.0 (4.5-5.1 [4.0-5.5]) for the non-deception group and 4.0 (3.0-4.0 [2.5-5.0]) for the deception group, (p < 0.001), and the median total number of challenges per participant was 26.8 (21.0-31.1 [16.5-35.5]) and 18.0 (14.3-23.3 [7.0-33.0]), respectively (p = 0.001). Trainees exposed to deliberate deception, who thought that the consultant anaesthetist was a subject, had a less-effective best challenge, likely mimicking real-life behaviour. Deliberate deception appears to modify behaviour, particularly relating to communication involving hierarchical relationships. This technique may improve authenticity, especially with a steep power gradient, and so has demonstrable value which must be balanced against the ethical considerations.

Offering HCV treatment to prisoners is an important opportunity: key principles based on policy and practice assessment in Europe.

BACKGROUND: Prisoners have a high prevalence of hepatitis C virus (HCV) infection but may find it difficult to access healthcare services. This may be related to risk behaviour including history of injecting drugs and marginalisation related to problem drug use/ opioid use disorder (OUD). Direct-acting antiviral products with superior efficacy and safety compared to interferon-based regimens offer HCV cure. Many citizens in Europe have been treated, although few received therapy in prisons. METHODS: Analysis of prisoner HCV treatment need and policy determinants of clinical practice was completed for 5 EU countries. Evidence was collected from national statistical sources and peer-reviewed publications to describe prison populations and HCV prevalence, to map national prison/ HCV health policy or guidance. A consensus of important principles for prisoner HCV care was developed. RESULTS: Data from published sources describing prisoner HCV prevalence is limited. Prisoner population requiring HCV treatment is not known; estimated numbers based on analysis of evidence: England and Wales, 9000, France, 8000, Spain, 6000, Italy, 6000, Germany, 6000. Treatment access: national law defines right to equivalent care in all countries implying access to HCV therapy in prison similar to community; useful prisoner HCV guidance facilitating treatment decisions present in: 4 of 5 national/ regional HCV policy documents, 4 of 5 national prison healthcare policies. Four of five had practical prison HCV clinical guidelines. Despite existence of policy, implementation of guidance, and so HCV treatment, is suboptimal in many locations. CONCLUSIONS: Prison is an important location to detect, address and treat HCV infection in people who may be underserved for healthcare and find it difficult to navigate community treatment pathways. This is often related to problems with OUD and resulting social inequity. HCV management in prisons must be improved. Policy and clinical practice guidance must be set to promote treatment, and practical steps to make treatment easy should be followed including education to promote engagement, set-up of optimal screening and work up processes with modern tools to reduce time needed/ achieve efficiency; programs to make it easier to get specialists' input include remote working and nurse-led services.

Modelling invasive group A streptococcal disease using bioluminescence.

BACKGROUND: The development of vaccines and evaluation of novel treatment strategies for invasive group A streptococcal (iGAS) disease requires suitable models of human infection that can be monitored longitudinally and are preferably non-invasive. Bio-photonic imaging provides an opportunity to reduce use of animals in infection modelling and refine the information that can be obtained, however the range of bioluminescent GAS strains available is limited. In this study we set out to develop bioluminescent iGAS strains for use in in vivo pneumonia and soft tissue disease models. RESULTS: Using clinical emm1, emm3, and emm89 GAS strains that were transformed with constructs carrying the luxABCDE operon, growth and bioluminescence of transformed strains were characterised in vitro and in vivo. Emm3 and emm89 strains expressed detectable bioluminescence when transformed with a replicating plasmid and light production correlated with viable bacterial counts in vitro, however plasmid instability precluded use in the absence of antimicrobial pressure. Emm89 GAS transformed with an integrating construct demonstrated stable bioluminescence that was maintained in the absence of antibiotics. Bioluminescence of the emm89 strain correlated with viable bacterial counts both in vitro and immediately following infection in vivo. Although bioluminescence conferred a detectable fitness burden to the emm89 strain during soft tissue infection in vivo, it did not prevent dissemination to distant tissues. CONCLUSION: Development of stably bioluminescent GAS for use in vitro and in vivo models of infection should facilitate development of novel therapeutics and vaccines while also increasing our understanding of infection progression and transmission routes.

Peptic Ulcer Disease in Bangladesh: A Multi-centre Study.

The incidence of peptic ulcer has steadily declined through out the world. This decreasing trend is also noticeable in this subcontinent. The point prevalence of peptic ulcer (PUD) in Bangladesh was around 15% in eighties. The aim of this study was to see the present prevalence of peptic ulcer at endoscopy and to identify changing trends in the occurrence of peptic ulcer in Bangladesh. This retrospective analysis of the endoscopic records of multiple tertiary referral centres of Dhaka city were done from January 2012 to July 2013. A total of 5608 subjects were the study samples. We included those patients having peptic ulcer in the form of duodenal ulcer, benign gastric ulcer including pre-pyloric ulcer and gastric outlet obstruction due to peptic ulcer. Duodenal ulcer and benign gastric ulcer were found in 415(7.4%) and 184(3.28%) patients respectively and gastric outlet obstruction due to peptic ulcer was found in 23(0.40%) patients.

A 15-year single centre retrospective study of antiphospholipid syndrome patients from Northern Malaysia.

BACKGROUND: Antiphospholipid syndrome (APS) is an autoimmune disorder characterised by thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPLs) based on the Sydney criteria. We aimed to explore the clinico-laboratory features and treatment strategies of APS patients retrospectively. METHODOLOGY: The medical records of APS patients registered under Hospital Universiti Sains Malaysia (Kelantan state) between 2000 and 2015 were reviewed. RESULTS: A total of 17 APS subjects (age 40.7 ± 12.8 years) including 11 primary (64.7%) and six secondary APS (35.3%) patients were identified. The follow-up period was 9.5 ± 6.7 years with male:female ratio of 1.0:4.7. Pregnancy morbidity was the most common clinical manifestation (11/14; 78.6%) followed by recurrent venous thrombosis (10/17; 58.8%). For other clinical features, menorrhagia was the most frequently observed manifestation (4/14; 28.6%) followed by aPLs-associated thrombocytopenia (4/17; 23.5%) and ovarian cyst (3/14; 21.4%). LA and aCL were positive in 94.1% (16/17) and 81.8% (9/11) of the patients, respectively. APTT value (76.7 ± 17.0 sec) was significantly high (p < 0.05). Low intensity warfarin alone was successful to maintain target INR (2.0 - 3.0) and prevent recurrence of thrombosis. CONCLUSION: The tendency of pregnancy morbidity in this cohort of Malaysian Kelantanese APS patients was high compared to other previously reported APS cohorts. Low intensity warfarin was successful in preventing recurrence of thrombosis, however, APS women receiving long-term anticoagulants should be monitored for possible occurrence of menorrhagia and ovarian cysts.

Pattern of Changes in the Findings among the Patients Undergoing Diagnostic Esophagogastroduodenoscopy in Bangladesh.

This cross-sectional observational study was conducted in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Sir Salimullah Medical College and Mitford Hospital, Holy family Red Crescent Medical College and Hospital and Popular Diagnostic Centre, Shantinagar branch, Dhaka, Bangladesh from January 2012 to July 2013. Study subjects were included in the study irrespective of age and sex having different upper GI tract. Complaints like dysphagia, heart burn, abdominal pain/dyspepsia, nausea, vomiting, haematemesis and/or malena, anorexia, unexplained anemia, weight loss etc. All the findings of oesophagus, stomach and duodenal lesions were observed and data were recorded. The results were considered positive based on the macroscopic appearance using standard diagnostic criteria. During the study period endoscopy was performed in 5608 subjects. Among which 2968(52.92%) were male and 2640(47.07%) were female. The patients age range from 7 years to 108 years. The majority of the patients were from 40-50 years. Normal findings were observed among 3321(59.21%) cases. Gastroduodenal erosions were present among 684(12.19%) cases, Oesophageal varices in 444(7.91%) cases, duodenal ulcer diseases in 415(7.40%) cases and gastric ulcer in 184(3.28%) cases. Ca stomach was found among 165(2.94%) cases. A number of diseases were identified through this procedure. Current study observed a large proportion of patients (40.79%) had positive upper GI endoscopy.

Pigtail Catheter in the Management of Liver Abscess.

Amoebic liver abscess is a common condition in Bangladesh. Though conservative treatment plays a major role, refractory patients can be successfully treated with minimally invasive approach. This prospective study was carried out to evaluate the prospect of sono-guided percutaneous catheter drainage for liver abscess patients not responding to conservative treatment. This study was done at Dhaka Medical College Hospital from January 2005 to June 2006 among patients with liver abscess that were treated conservatively outside and got admitted in different surgery and medicine units. Included 35 patients were evaluated clinically and through relevant investigations. Sono-guided percutaneous pigtail catheter was introduced for drainage and patients were followed up for two weeks on average at hospital indoor by amount of drainage, clinical improvement and serial follow up USG. After discharge from the hospital, all patients were followed up monthly and assessed clinically and ultrasonographically up to two months on outdoor basis. Thirty five patients underwent pigtail catheter drainage that was refractory to conservative treatment or needle aspiration. Following insertion of catheter patients who were pyrexic, fever subsided in two to three days and never back during the postoperative period and follow up. Antimicrobials were changed according to the report of the culture and sensitivity of the aspirate that was done routinely. Maximum total (4300 ml) amount of pus was drained in a patient. Average duration of catheter drainage in this study was 8 days. With a very low morbidity and zero mortality rates, minimum treatment costs and early return to regular life style proved this minimally invasive procedure to be a rational treatment option for amoebic liver abscess in selective cases.

Influence of Zn-substitution on structural, magnetic, dielectric, and electric properties of Li-Ni-Cu ferrites.

The polycrystalline Li0.15Ni0.6-xZnxCu0.1Fe2.15O4 ferrites are fabricated by the method of conventional solid-state reaction technique. The X-ray diffraction (XRD) confirms that the structure of the composition is a single-phase cubic spinel structure for all samples. The particle size of the compositions is varied from 36 to 52 nm. The lattice parameter and densities are found to increase with enhancing Zn content, as the ionic radius and atomic weight of Zn are greater than Ni. The porosity exhibits a decreasing trend. The average grain size determined using Field Emission Scanning Microscopy (FESEM) increases until x = 0.40, then declines. The Energy-Dispersive Spectroscopy (EDS) examination revealed that the percentage of obtained elements is well matched with the stoichiometric elements. The addition of Zn content acts as an accelerator for enhancing the value of the real part of initial permeability and the highest value is obtained (µi' = 276) for the x = 0.40 sample, as well as the highest relative quality factor (RQF) of around 3000. The loss factor for the Zn substituted composition is nine times lower than for the parent composition. The optimum saturation magnetization of around 77.49 emu/g is found for the x = 0.40 sample. The maximum dielectric constant (ε' = 2.85 × 103) is found for x = 0.10 samples at 10 kHz. Further, from impedance studies, the non-Debye type dielectric relaxation is seen for the Zn-substituted samples. The observed region of the imaginary electric modulus peak signifies the transition of charge carrier mobility from a larger range to a short-range distance. The phenomenon of ac conductivity is attributed to the process of the small polaron hopping mechanism.

Strain induced structural phase transition and compositional dependent magnetic phase transition in Ti doped Bi0.80Ba0.20FeO3 ceramics.

Bi0.80Ba0.20Fe1-xTixO3 ( 0 ≤ x ≤ 0.10 ) samples are prepared using solid state reaction technique. Bi3+ site is replaced with 20 % Ba2+ which induced structural modification from rhombohedral to pseudo cubic accompanied by the creation of oxygen vacancies owing to the charge reimbursement. Fe3+ site is replaced with different concentrations of Ti4+ keeping Ba content fixed. All the samples exhibited similar morphology and no significant variation in grain size is observed by substituting Ti at Fe site. All of the samples exhibited ferromagnetic behavior, which is ascribed to the destruction of spiral spin structures and changes in super-exchange interaction strength caused by variations in bond lengths of Fe-O and Fe-O-Fe. The decrease in magnetization with increasing Ti concentration is due to magnetic moment dilution caused by non-magnetic Ti4+. An anomalous trend in magnetization is observed for magnetic measurements at low temperature (77 K) where structural transformation from ferromagnetic to diamagnetic behavior was noted for 10% Ti content. Further, because of the incorporation of Ti4+, an improved dielectric property was observed due to increase in resistivity and decrease in the defect concentration (oxygen vacancies). In the present study, it was concluded that optimum concentration of Ba2+ (20%) and Ti4+ co-doped BiFeO3 systems have shown enhanced multiferroic properties at room temperature.

A Case of Bilateral Middle Cerebral Artery Stenosis with Unilateral M1 Stenting.

Stroke is not only the third leading cause of death in Bangladesh but it also causes a high number of disability adjusted life years loss (485 per 10,000 people). Appropriate treatment of recurrent stroke has to be established. Here we present A 60 year's old male patient with history of recurrent stroke who came in our out patient department. He had progressing bilateral middle cerebral artery atherosclerotic stenosis (100.0% on right side and 52.0% on left side) which was less severs but symptomatic at dominant hemisphere (left). Percutaneous transluminal angioplasty with stenting was done to prevent further ischemia and to increase the blood supply of remaining brain parenchyma. On post stenting follow-up patient did not suffered from any new event of stroke for about 22 months. Percutaneous transluminal angioplasty with stenting is an effective procedure to prevent recurrent stroke for intracranial atherosclerotic disease.

Extent of MGMT promoter methylation correlates with outcome in glioblastomas given temozolomide and radiotherapy.

BACKGROUND: Epigenetic silencing of O(6)-methylguanine-DNA-methyltransferase (MGMT) by promoter methylation is associated with improved survival in glioblastomas treated with alkylating agents. In this study, we investigated MGMT promoter methylation in glioblastomas treated with temozolomide and radiotherapy in a single UK treatment centre. METHODS: Quantitative methylation data at individual CpG sites were obtained by pyrosequencing for 109 glioblastomas. RESULTS: Median overall survival (OS) was 12.4 months with 2-year survival of 17.9%. Pyrosequencing data were reproducible with archival samples yielding data for all glioblastomas. Variation in methylation patterns of discrete CpG sites and intratumoral methylation heterogeneity were observed. A total of 58 out of 109 glioblastomas showed average methylation >non-neoplastic brain in at least one clinical sample; 86% had homogeneous methylation status in multiple samples. Methylation was an independent prognostic factor associated with prolonged progression-free survival (PFS) and OS. Cases with methylation more than 35% had the longest survival (median PFS 19.2; OS 26.2 months, 2-year survival of 59.7%). Significant differences in PFS were seen between those with intermediate or high methylation and unmethylated cases, whereas cases with low, intermediate or high methylation all showed significantly different OS. CONCLUSIONS: These data indicate that MGMT methylation is prognostically significant in glioblastomas given chemoradiotherapy in the routine clinic; furthermore, the extent of methylation may be used to provide additional prognostic stratification.

Cytologically Indeterminate Follicular Thyroid Nodule on Fine Needle Aspiration Cytology is an Indication for Total Thyroidectomy.

The magnitude of case management of indeterminate thyroid nodule is very difficult and controversial. In addition there is recent evidence that the incidence of follicular lesion may be increasing that will prove to be follicular cancer. This prospective observational study was done in the department of Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from February 2016 to January 2017 to investigates the rate of malignancy and inability of demographical, clinical and sonographic data to predict malignancy in indeterminate nodules and the unreliability of intraoperative frozen section biopsy with the scope of determining the need for total thyroidectomy in these patients. The study population consisted of 40 cases presenting indeterminate nodules (Thy3): females (80%) and males (20%) with a mean age of 35.73±11.11 years. All patients underwent total thyroidectomy. Malignancy was diagnosed in 27 out of 40 patients (67.5%). The mean nodule size was 3.67±1.69mm in malignant lesions, 40.7% of the malignant nodules were more than 3cm in size, 51.9% of malignant cases were irregular border and 29.6% of malignant lesions were hard in consistency; these data are statistically significant (<0.05) and correlated with malignancy. The rate of malignancy in cytologically indeterminate lesions was high in the present study sample compared to other reported studies. Thus, considering the fact that demographical, clinical and sonographic features were found to be inaccurate predictors of malignancy, it is our opinion that total thyroidectomy should always be recommend in such patients.

Electrosurgery Dissection versus Sharp Dissection: Effect on Early Postoperative Wound Complications in Modified Radical Mastectomy.

Modified radical mastectomy (MRM) is still the most commonly performed operation for breast cancer, despite the trends toward breast-conserving treatment. Since 1970s, electrosurgery (also known as electrocautery, diathermy) has been a widespread surgical tool to raise flaps and excise the breast specimen in order to perform a bloodless mastectomy. Use of diathermy has been well blamed for wound complications. To prevent undue delay in the adjuvant treatment, it is important to minimize the surgical complications. This quasi experimental study was conducted in the Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh to evaluate the effects of electrosurgery and sharp dissection on early postoperative wound complications in MRM. 46 patients were included in the study (23 in each group). Data analysis done in SPSS version 23.0 and 'p' value <0.05 considered significant at 95% confidence interval. In Electrosurgery Dissection (ED) group mean duration of drainage was 7.8±1.2 days and in Sharp Dissection (SD) group 6.4±1.0 days (p value 0.000). Mean total drainage in ED group found 1082±287ml and in SD group 693±194ml (p value 0.000). Seroma formation found 7(30.4%) in ED group and 3(13.0%) in SD group (p value 0.004). Wound dehiscence found 5(21.7%) in ED group and 2(8.7%) in SD group (p value 0.013). Flap necrosis rate was 4(17.4%) and 1(4.4%) in ED and SD group respectively (p=0.003). Demographic and clinical variables were similar or differences were not statistically significant in two groups. No difference found in operating time and wound infection rate in two groups. The result of the study showed that, electrocautery dissection caused early postoperative wound complications more than the sharp dissection.

Laparoscopic Adrenalectomy: Two Years Experience at Bangabandhu Sheikh Mujib Medical University.

Laparoscopic surgery has become an efficient tool for many complex surgical procedures. In last decades, laparoscopic adrenalectomy has become a more viable option for removal of adrenal pathology, with many surgeons preferring it to the conventional open technique. This study was done to evaluate the outcomes of lateral transperitoneal adrenalectomy (LTA) in our department and evaluate the feasibility of lateral transperitoneal adrenalectomy (LTA) in our perspective. This study is case series observational study carried out at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2015 to May 2017. Suspected primary adrenal malignancies were excluded. Seventeen (17) patients (10 male and 7 females with mean age of 35.29 years) underwent 18 adrenalectomy (one bilateral). Seventeen (17) adrenal tumours were resected through laparoscopy and one adrenal tumour is resected through open approach due to conversion. All the patients underwent hormonal evaluation, ultrasonogram and computed tomography of whole abdomen. Ten (10) patients (58.82%) had hormonal active adrenal mass. Seven (7) patients (41.18%) were asymptomatic of which 2 had associated cholelithiasis, 7 patients had generalized weakness, 3 had weight gain with Cushing syndrome (one drug induced) and one had Hirsutism with musculanizing effect. Nine (9) patients had hypertension and 6 patients had diabetes mellitus. Eight (8) right, 8 left and 1 bilateral LTA were performed. The mean age of the patients were 35.29 years, adrenal tumour size ranges from 15-65mm and operation time ranges from 75-120 minutes for unilateral adrenalectomies and 220 minutes for bilateral adrenalectomy. Estimated blood loss ranges from 30 to 130 ml in 16 cases and in one case it was 220 ml in which conversion was done. Mean post operative stay in hospital was 3.94 days. In 16 cases no major or minor complications were observed but in one case due to haemorrhage and infiltration of the tumour to kidney conversion are done in the form of right adrenalectomy with upper partial nephrectomy (Histopathology revealed angiomyolipoma). In pathological examination 9 patients (52.94%) had adrenocortical adenoma, 2 patients (11.76%) had phaeochromocytoma including bilateral one, 2 patients (11.76%) had myolipoma of which one converted to open, 2 patients (11.76%) had adrenocortical hyperplasia, one patient (5.88%) had adrenal cyst and one patient (5.88%) had haemorrhagic cyst. LTA is a safe and efficient minimally invasive treatment options for both secreting and non secreting adrenal masses. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.

Nodular Mucinosis of Male Breast: A Rare Case Report.

Multinodular accumulation of stromal mucin in breast known as nodular mucinosis is an extremely rare condition of breast. Alternatively it is known as myxoma or nerve sheath myxoma of breast. This benign lesion is confined to only nipple and areola region presenting as slow growing, soft and non tender lobulated mass. Histopathologically it reveals well circumscribed non-encapsulated myxoid/mucinous lesion with few infiltration of spindle cells within a collaginized stroma. The mucinous substance is stained positively with Alcian blue. Mucinous carcinoma or phylloids tumour are important differential diagnosis of nodular mucinosis of breast. Here we report a case of nodular mucinosis of male breast with clinical, radiological and pathological findings with differential diagnosis and treatment modalities.

210Po concentration in selected diatoms and dinoflagellates in the northern Arabian Gulf.

Marine phytoplankton is a primary producer in the ocean that forms the base of the marine food web and supports the pelagic food chain. The two dominant groups of phytoplankton observed in northern Gulf waters are diatoms and dinoflagellates. The diatoms outnumber dinoflagellates in the Gulf waters. This study presents baseline information on the concentration of 210Po among selected phytoplankton in the northern Gulf. The concentration among diatoms varies between 6.99 and 11.4 Bq kg-1 wwt, whereas a higher concentration range of 8.51-15.41 Bq kg-1 wwt was observed among dinoflagellates. The diatoms analyzed includes Thalassiosira spp. - 10.2-11.4 Bq kg-1 wwt; Chaetoceros spp. - 6.99-7.14 Bq kg-1 wwt; Rhizosolenia spp. - 9.12-9.95 Bq kg-1 wwt. The analyzed dinoflagellate genera include Gymnodinium spp. - 8.51-8.78 Bq kg-1 wwt; Noctiluca spp. - 15.2-15.4 Bq kg-1 wwt; and Karenia spp. - 14.1-14.9 Bq kg-1 wwt. The 210Po concentration in seawater shows a seasonal variation, with a higher concentration range of 0.70 and 0.58 mBq L-1 during summer and autumn, whereas a lower range in concentration of 0.38 and 0.30 mBq L-1 occurring during winter and spring. The resultant computed concentration factors vary between 2 ∗ 104-5 ∗ 104 demonstrating a significant 210Po enrichment in the base of the pelagic food chain.

Disease Pattern among Children attending Pediatric Outpatient Department in Community Based Medical College Hospital, Bangladesh.

Disease pattern is based on socio-demographic characteristics, comprehensive health care services, and environmental variables like water supply, basic sanitation and housing, illness behavior like quick decision to arrive at health care facility, and treatment behavior like the modality of treatment they receive. The descriptive cross-sectional study was conducted during the period of January 2014 to December 2015. The study was carried out among 310 purposively selected children attended at Pediatric Outpatient department of Community Based Medical College Hospital, Bangladesh. Data were collected by face to face interview of the parents and clinical examination and anthropometric measurement of children using case record form. Mean age of the children was 4.11 years with a SD of 4.35 years, male-female ratio was 1.25:1 with predominance 201(64.84%) of under-five children. The common diseases were 121(39.03%) with Acute Respiratory Infections (ARI), while 43(13.87%) diarrheal diseases, 25(8.06%) each with bronchial asthma and helminthiasis. Other diseases 96(30.97%) include anemia 17(5.48%), urinary tract infection 15 (4.84%), peptic ulcer disease 9(2.90%), enteric fever, oral candidiasis, apthous ulcer of mouth, scabies and vulvovaginitis. Average number of children per family was 2.2 including 251(80.97%) children having sanitary latrine in the family, 297(95.81%) with safe drinking water facilities and 270(87.10%) were fully vaccinated under EPI. More than three fourth 76(24.52%) of the children were underweight, 114(36.77%) were from poor families and 136(43.87%) lived in Kancha house. With the improvement of safe water supply and use of sanitary latrine diseases like diarrhoeal disease and helminthiasis are showing a decreasing trend.

Unique roles of nanotechnology in medicine and cancer-II.

Applications of nanotechnology in medicine and cancer are becoming increasingly popular. Common nanomaterials and devices applicable in cancer medicine are classifiable as liposomes, polymeric-micelles, dendrimers, nano-cantilevers, carbon nanotubes, quantum dots, magnetic-nanoparticles, gold nanoparticles (AuNPs) and certain miscellaneous nanoparticles. Here, we present review of the structure, function and utilities of the various approved, under trial and pretrial nanodevices applicable in the cancer care and medicine. The liposomes are phospholipid-vesicles made use in carrying drugs to the target site minimizing the bio-distribution toxicity and a number of such theranostics have been approved for clinical practice. Newly worked out liposomes and polymeric micelles are under the trail phases for nano-therapeutic utility. A multifunctional dendrimer conjugate with imaging, targeting and drug molecules of paclitaxel has been recently synthesized for cancer theranostic applications. Nano-cantilever based assays are likely going to replace the conventions methods of chemical pathological investigations. Carbon nanotubes are emerging for utility in regenerative and cancer medicine. Quantum dots hold great promise for the micro-metastasis and intra-operative tumor imaging. Important applications of magnetic nanoparticles are in the cardiac stents, photodynamic therapy and liver metastasis imaging. The AuNPs have been employed for cell imaging, computed tomography and cancer therapy. Besides these categories, miscellaneous other nanoparticles are being discovered for utility in the cancer diagnosis and disease management. However, the use of nanoparticles should be cautious since the toxic effects of nanoparticles are not well-known. The use of nanoparticles in the clinical practice and their toxicity profile require further extensive research.