No time to waste for wasted children in Bihar: time to reset

Background: Severe acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar, 48% of children are stunted, 21 % are wasted, and 7% are severely wasted. Even during the first six months of life, 31% are wasted. The objective of this study was to study wasting trends and contributing factors responsible for changes in Bihar among children 0-5 years. Methods: This cross-sectional study was done using a data of NFHS-5 survey in Bihar (N=35,834) conducted in all 38 districts of the state from July, 2019 to February, 2020. The Bihar NFHS-5 report and factsheets, including NFHS-4 data, were downloaded and converted to excel to enable data visualization and trend analysis. The outcome variable Wasting was measured using NFHS-5 relevant questionnaires given under nutrition category. We analyzed trends between NFHS-5 and NFHS-4 Bihar data for severe wasting/wasting, determinants, and coverage of interventions.Results: The prevalence of severe wasting has increased from 7% to 8.8%, while wasting increased from 20.8% to 22.9% (NFHS-5). The severe wasting and wasting has reversed or worsened in 27 districts. There is a mixed picture of infant feeding- early initiation of breastfeeding worsening and some improvements in exclusive breastfeeding and timely introduction of complementary feeding. Consistent improvement across districts for underlying determinants, but slight, in women抯 education, teenage pregnancy, and marriage before 18 years. Conclusions: Need to invest in improving maternal determinants-age at marriage, education, ANC coverage, and teenage pregnancy. It is imperative to focus on preventing, identifying, and treating wasting.

A rare nexus: G6PD deficiency's uncommon affiliation with rapidly progressive renal failure through the prism of pigment nephropathy

Acute kidney injury (AKI) with evidence of hemolysis is associated with tropical infections. However, pigment-induced AKI can happen with relatively uncommon genetic causes of hemolytic anemia, i.e., glucose 6-phosphate deficiency (G6PD). We share our experience of one such patients whose clinical presentation was rapidly progressive glomerulonephritis. On evaluation, she had a history of usage of some drugs and with G6PD estimation revealing deficient status even during the episode while other tests such as Coomb's test and bone marrow biopsy was normal. The kidney biopsy revealed diffuse tubular injury with presence of several coarse granular/pigmented casts in tubular lamina. She was managed with hemodialysis and showed complete recovery. Thus, in tropical countries G6PD deficiency although is not common, should be considered among patients who presented as rapidly progressive renal failure (RPRF) and having history of precipitating factors for G6PD deficiency and a detailed hemolytic work-up needs to be carried out as an important cause of preventable recurrent AKI in tropical countries.

Incarcerated Grynfelt-Lesshaft's giant lumbar hernia: a case report

A uncommon posterior abdominal wall defect called the Grynfeltt-Lesshaft hernia permits the herniation of retro and intraperitoneal tissues via the upper lumbar triangle. We describe a case of a post-menopausal woman who visited the surgical OPD because of a bulge that was steadily growing in the right lumbar area. She had a history of spinal tuberculosis and underwent computed tomography (CT) guided aspiration of a paravertebral abscess and surgical fixation of vertebrae. During the initial clinical examination, the swelling resembled a large lipoma, but other potential diagnoses considered were an incisional hernia, large lipoma, abscess, or hematoma. Ultrasonography was inconclusive in differentiating due to the large size and limited visibility. Consequently, contrast-enhanced computed tomography (CECT) scans of the abdomen revealed a substantial defect in the right lumbar area with herniation of the small bowel, large bowel, and omental fat. The diagnosis of a right Grynfelt hernia was established, and the patient was referred for surgical repair. Preoperatively, the hernia was classified as a type "A" lumbar hernia, according to Moreno-Egea et al classification. For the diagnosis of lumbar hernia and surgical planning, computed tomography (CT) is the most commonly used imaging modality. It allows for accurate visualization and assessment of the hernia, aiding in both the diagnosis and the planning of the surgical procedure.

Pulmonary Hydatid without Liver Involvement: A Case Series

Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.

Antibiotics in the times of COVID 19’- A Mixed-Methods study among patients attending OPD of an Urban Health Centre of West Bengal

Introduction: Antibiotic Resistance has become a global threat attributable to the overuse and misuse of Antibiotics and exacerbated by the ongoing COVID19 pandemic. Objective: Present Mixed Methods study, envisages finding out the knowledge and practice regarding Antibiotic usage and exploring changes if any brought about due to the pandemic among patients attending OPD of an Urban Health Centre in Kolkata. Method: Study was conducted from May to July 2021, in the urban field practice area of the institute. The quantitative component was evaluated by interviewing 200 patients using a pretested questionnaire and the Qualitative component was evaluated up to the point of data saturation in 3 FGDs. SPSS was used to analyze the Quantitative component, while the Qualitative component was analyzed thematically. Results: Among the 200 participants, self-medication with Antibiotics was seen in 74.0%; 26.0% had satisfactory Knowledge regarding Antibiotics and their use, whereas only 19.5% had satisfactory Practice regarding the same. Education and Health Literacy Score were significant predictors associated with unsatisfactory Knowledge and Practice regarding Antibiotic usage patterns. Economic constraints, Lack of transportation during the lockdown, and fear of institutional quarantine were some of the major factors which further contributed to Antibiotic misuse during the COVID19 pandemic. Conclusion: Advocacy for increasing health literacy, overall literacy status, and awareness regarding the perils of Antibiotic Resistance using appropriate IEC by health providers would be beneficial in the long run to prevent Antibiotic resistance. With that said, strict government regulations along with curbing the fallacies in the health system would further aid in making people use Antibiotics wisely.

Changes in reactive oxygen scavenging systems and protein profiles in maize roots in response to nitric oxide under waterlogging stress

Twenty days old pot grown seedlings of two genotypes of maize viz. HUZM-265 (waterlogging resistant) and HUZM-55 (waterlogging susceptible) were subjected to root zone waterlogging supplemented with 50, 500 and 2000 µmol/L sodium nitroprusside (SNP) as a donor of NO. Levels of reactive oxygen species (ROS) scavenging enzymes and non-enzymes were quantified in terminal root portions at 9, 12, 15, 18 and 21 h after waterlogging. In waterlogged plants, there was a significant increase in the levels of catalase (CAT), peroxidase (POX), superoxide dismutase (SOD), ascorbate peroxidase (APX) and alcohol dehydrogenase (ADH) and the increment was more in the resistant genotype. Levels of non-enzymatic antioxidants viz. ascorbic acid and phenols decreased, but to a lesser magnitude in the resistant genotype. After waterlogging, there was a differential pattern in variation in the levels of studied enzymes and non-enzymes with time. It is observed that ADH, CAT, and APX play a significant role to scavenge ROS at an early stage, while POX and SOD at later stages of waterlogging stress. In normal and waterlogged plants of HUZM-265, a low molecular weight protein of 20 kDa was visible, and at 500 and 2000 μmol/L SNP treatments another protein of 43 kDa appeared in this genotype under the influence of SNP. No such proteins were evident in HUZM-55. NO influenced studied parameters, but response varied with respect to genotypes, dose, and duration of waterlogging

Vertebro-cerebral cryptococcosis mimicking tuberculosis: A diagnostic dilemma in countries with high burden of tuberculosis.

We report a case of a 30-year-old immunocompetent man with disseminated cryptococcosis who was initially treated with antitubercular therapy due to clinical and radiological diagnosis of vertebro-cerebral tuberculosis. The diagnosis of Cryptococcus infection was made due to incidental isolation of this fungus from blood culture with negative cerebrospinal fluid culture results. Though disseminated cryptococcosis with central nervous system, skeletal, and skin involvement is an uncommon manifestation of Cryptococcus neoformans infection, a high clinical suspicion and early initiation of therapy is needed to recognise and treat such patients efficiently.

Detection of butachlor in viscera by thin layer chromatography.

Butachlor, a selective systemic herbicide, was isolated, analyzed and detected in viscera obtained from medi-colegal autopsy. Butachlor was extracted by using solvent extraction methods and then identified by Thin Layer Chromatography (TLC). For chromatographic separation, various solvent systems were used. Bromophenol blue was used as chromogenic reagent on developed TLC plates which successfully increased the sensitivity without dispensing with the simplicity of the method. For the study, a total of 15 solvent systems in different ratios were chosen. Of these, the best two solvent systems, namely, Benzene:Diethyl ether (8.5:1.5) and Hexane: Acetone (9:1) were chosen for statistical analysis, which included the calculation of mean Rf value and value of standard deviation and coefficient of variance.

Smear microscopy as surrogate for culture during follow up of pulmonary MDR-TB patients on DOTS plus treatment.

Background: DOTS Plus site at LRS Institute, New Delhi, covering 1.8 million population. Aims: To ascertain if sputum smear could be used as a surrogate for culture during intensive phase of treatment of MDRTB patients thereby enabling early shift from intensive phase to continuation phase, reducing the need for frequent cultures and saving time and cost in their management. Methods: The study is a retrospective analysis of 138 MDR-TB patients on DOTS Plus treatment whose sputum samples were simultaneously subjected to smear microscopy and culture, monthly during Intensive Phase and once in two months during Continuation Phase. Sputum results in the treatment card were supplemented from laboratory register, if required, and analyzed. Predictive values, sensitivity and specificity of smear were compared with culture results. Results: The Negative Predictive Value (NPV) of smear was high from the 3rd month onwards (above 91%), at four months 98% or more and approached 100% from eight months onwards. The specificity of smear test gradually increased during treatment and from five months onwards, it was above 90%. Conclusions: Considerable correlation was observed between sputum smear and culture during follow up of DOTS Plus treatment in the Intensive Phase. Accordingly, sputum smears can be recommended instead of culture.

Tuberculous Pneumonia as a primary cause of respiratory failure-report of two cases.

Tuberculosis (TB) is one of the treatable diseases rarely causing Acute Respiratory Failure (ARF). Hypoxic respiratory failure is often fatal in miliary tuberculosis and acute tuberculous bronchopneumonia. We describe two patients of tuberculous pneumonia with ARF who were successfully treated with early appropriate anti-tuberculosis therapy.

Collection, preservation and forwarding of biolgical samples for toxicological analysis in medicolegal autopsy cases : A review.

Collection of proper autopsy specimen is an essential step in the process of toxicology case work¹. Improper collection of these specimens can greatly alter or negate chemical and toxicological analysis. This article is an update about the standard methods of biological specimen collection procedures for toxicological analysis which will be helpful for the forensic pathologist and forensic scientists.

Determination of malathion in blood and urine using thin-layer chromatography.

Malathion is a broad-spectrum Organophosphorus insecticide generally used to control a variety of insects. Routinely it is analysed by Gas Liquid Chromatography & High Performance Liquid Chromatography. Now an attempt has been made to develop a new method for analysis of Malathion in biological samples using Thin Layer Chromatography (TLC) technique, which is inexpensive, accurate and non-destructive. Malathion was extracted from blood and urine using solvent extraction methods and then identified on the TLC plates. For chromatographic separation, various binary and tertiary solvent systems were used to demonstrate in the laboratory. For detection on developed plates, palladium chloride reagent was used which successfully increased the sensitivity without dispensing with the simplicity of the method. For the analysis, a total of 20 solvent systems were chosen. Out of these 20 solvent systems, the three best solvent systems namely Cyclohexane: Chloroform (60:40), Hexane: Acetone (80:20) and Acetone: Hexane: Toluene (40:40:20) were chosen for statistical analysis which included the calculation of mean Rf value, value of standard deviation and coefficient of variance. The method developed is simple, inexpensive, accurate and non-destructive that allows for sensitive and reproducible analysis of Malathion.

A thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy: a rare association.

An 18-year-old boy presented with a rare association of a thyroid tubercular abscess and bilateral symmetrical hilar lymphadenopathy. He was put on a Category I regimen with standard short course daily chemotherapy of four anti-tubercular drugs under the National Tuberculosis Programme. After a six-month of anti-tubercular treatment (ATT), the boy showed clinical and bacteriological improvement. The thyroid scan with Technetium 99 (Tc 99) and the chest skiagram also became normal.

Foramen magnum tumors: a series of 30 cases.

BACKGROUND AND AIMS: Foramen magnum tumors, especially those located ventrally, are surgically challenging. We studied clinical and surgical details of extramedullary tumors located in the region of the foramen magnum. MATERIAL AND METHODS: A series of 30 cases of extramedullary tumors at the foramen magnum, operated over a period of 8 years is presented. RESULTS: There were 10 neurofibromas, 8 meningiomas, 6 chordomas, 2 tuberculomas and 4 miscellaneous tumors. The clinical profile consisted of sensory symptoms in all the patients, quadriparesis in 24, lower cranial nerve affection in 8 and sphincter disturbances in 6 patients. The surgical approaches consisted of an extreme lateral approach in 10, a posterior or posterolateral approach in 18 and a per-oral route in 2 cases. Total excision of the tumor was performed in 24 and a subtotal excision of the tumor was done in 6 cases. Two patients died, one due to meningitis and the other due to chest infection. Eight other patients had complications like CSF leak, meningitis, pseudomeningocele, laryngeal edema, and transient worsening of neurological deficits. CONCLUSIONS: Foramen magnum tumors have long been regarded as difficult lesions both in terms of diagnosis and management. However, with the availability of MR imaging, newer surgical techniques and skull basal exposures, the excision of these lesions is becoming easier and safer.

Lymphocutaneous sporotrichosis treated with three different modalities.

Three cases of lymphocutaneous sporotrichosis were treated with three different modalities and oral saturated solution of potassium iodide was found to be best modality.

Painful bruising syndrome.

Painful bruising syndrome is a distinctive but rare clinical entity. A case of this condition in a psychiatrically normal teenage girl is reported.

Does pentoxifylline find a place in the armementarium of leprologists in type II reaction?

Alternative therapeutic interventions in Type II lepra reaction are being considered following serious problems associated with the use of steroids and thalidomide. Pentoxifylline (PTX) has been used in Type II reaction with varying degrees of success. The results of a study on the use of this drug in a dose of 1200 mg per day for a period of 2 months in patients with ENL reaction are discussed. Five patients, one of whom was HIV positive--all with severe Type II reaction, were regularly evaluated for regression of inflammatory symptoms and clinical involution of ENL lesions while on PTX therapy and thereafter. It was found that PTX led to a total elimination of systemic symptoms within a week. ENL lesions regressed in two weeks. However, in one patient, lesions recurred after one month of therapy. It appears that PTX is well tolerated and could be used as an additional drug in the armamentarium of leprologists in the management of Type II reaction, especially in HIV co-infection, where long-term steroids are contraindicated. However, further studies to compare the effects of PTX with currently, widely used drugs for the treatment of ENL reaction are necessary.

Ecologic perspective of dermatologic problems in North Eastern India.

In the nations of the developing world, the incidence of skin diseases is especially affected by geography. Epidemiological studies of skin diseases are important in the study of disease pattern, changes in disease pattern and for planning dermatology service and research for a country. This report records the pattern of skin diseases encountered in the North-East region of India. The incidence of non-infectious dermatoses was slightly higher than that of infectious dermatoses in this part of the country.

Acquired (digital) fibrokeratoma.

Acquired digital fibrokeratoma is a rarely reported disorder, especially in the Indian literature. We report our findings on one such case, occurring at an unusual site.

Changing trends in sexually transmitted diseases in North Eastern India.

A retrospective data analysis was carried out to find the trends in frequency and distribution of different STDs in North Eastern (NE) India during 1995-1999. The commonest STD was chancroid (25.7%) followed by condylomata acuminata (CA), nongonococcal urethritis (NGU), lymphogranuloma venereum (LGV), syphilis, gonorrhoea (GONO), herpes genitalis (HG), mixed infection (MI) and balanoposthitis (BP). Interestingly no case of donovanosis (Dono) was seen. HIV infection accounted for 9.62% of the total STD patients. A comparison of the present data with that reported a decade back (1986-1990) revealed a sharp decline in the incidence of syphilis, chancroid, GONO, whereas a conspicuous upward trend in CA and NGU. Factors responsible for these variations are analysed briefly.