Anesthesia- patient’s apprehension, concerns, and counseling

Introduction: To allay anxiety and resolve the patient’s apprehension regarding general anesthesia through counseling. Patients presenting to PAC were asked to participate in a 2-way conversation meant to evaluate and study his apprehension, concerns in relation to anesthesia, and subsequently, a counseling session was given to answer his doubts and resolve his fear. Material and Methods: In the study, it was found the fear of death was the greatest concern. The other major concerns were fear of paralysis and heart attack. Results: The level of fear decreased as the severity of surgery decreased. For major surgery, the fear of death differed significantly with age, especially with increasing age came a lessened fear of death. Counseling by anesthesia provider regarding the fear that the patient reported help to reduce the anxiety. It allows for a more personalized approach towards the patient. It helps anesthesia provider to tailor the informed consent process. Conclusion: In general, the study increases awareness regarding anesthesia among patient and their relatives.

Sociodemographic and anthropometric factors influencing diabetes mellitus in an urban population of district Bareilly: A cross-sectional study

Background: Diabetes mellitus (DM) is a common non-communicable disease even in a developing country like India. Diabetes in all its forms imposes unacceptably high human, social, and economic costs on countries at all income levels. Objective: The objective of this study was conducted to assess the sociodemographic and anthropometric factors influencing DM in an urban population of district Bareilly. Materials and Methods: A cross-sectional, community-based study was conducted from February 2014 to February 2015 among adults in the age group of 30 years and above residing in the area covered under the Urban Health Training Centre of Bareilly City. A simple random sampling technique was adopted to achieve the desired sample size. House to house survey was done for collecting data. Data tabulated and subjected to statistical analysis. Results: Education status more than high school level were more prone for DM and maximum frequency of DM was also found in postgraduates and the minimum occurrence of DM was found those were having education up to primary school level. Body mass index increases the proportion of DM increases. The maximum number of diabetic individuals was found in obese Class II, followed by obese Class I and pre-obese. The pervasiveness of DM and impaired fasting glucose was more in those who were having a high waist-hip ratio. Conclusion: The study showed that in spite of having health-care facilities nearby, the indiscretion of healthiness was a major concern. The higher proportion of DM patient is prominent in who is from nuclear family, having sedentary lifestyle. There is a high proportion of obesity among them.

Assessment of awareness and practices regarding breastfeeding in rural community

Background: Breastfeeding remains the simplest, healthiest, and least expensive feeding method that fulfills the infant’s needs and it is also important for reducing child morbidity and mortality. It has nutritional, immunological, behavioral, and economic benefits and also provides desirable mother-infant bonding. Objectives: The objectives of this study were (1) to assess the awareness and practices regarding breastfeeding of rural mothers and (2) to find out the influence of sociodemographic variables on breastfeeding practices. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of Rural Health Training Centre, Integral Institute of Medical Sciences and Research, Lucknow. Mothers having children between 0 and 2 years age group were included in the study. A pre-designed, semi-structured questionnaire was used as a study tool. Data were compiled in MS Excel and statistical analysis was done using SPSS version 20. Results: About 54.8% were aware that breastfeeding should be initiated within 1–24 h after birth, but 66.7% initiated breastfeeding within 1–24 h after birth, 73.9% were aware and feed their infant on demand, and 46.2% were aware that exclusive breastfeeding (EBF) should be continued up to 6 months of age, but only 37.6% practiced EBF. Factors such as literacy status, place of delivery, and mode of delivery were found to be associated with breastfeeding practices. Conclusion: It is seen in the study that practice of EBF and early initiation of breastfeeding are still low.

Incidence of Hypothyroidism in Infertile Patients with Menstrual Irregularities

Background: - It is important to estimate in females the level of serum thyroid hormones throughout infertility to avoid its existence later on. The aim in this study, was to estimate thyroid function tests in infertile patients with menstrual irregularities. Methodology: - This case control study was performed in 90 infertile patients with menstrual irregularities and 50 healthy matched women. Biochemical parameters were measured was serum hormones triiodothyronine (T3), tetraiodothyronine (T4) and serum thyroid stimulating hormone (TSH). Result: - Serum T3, T4 and TSH level were statistically significant in infertile women. Serum thyroid stimulating hormone level was found at higher side in infertile women. Conclusion: - This study concludes that, high occurrence of hypothyroidism was found in infertile women and it shows a positive correlation with menstrual disorder.

Measles & Rubella Vaccination Campaign in India: Why, How, When and Where

Globally, in 2015, measles killed an estimated 1,34,200 children - mostly under-5 years of age and an estimated 49,200 deaths occurred due to measles in India. Most of these children were the ones who have not received two doses of measles vaccine. This is despite the fact that the Government of India is providing vaccines free of cost under the Universal Immunization Programme. Even today some of the children in the country are not protected against the deadly life-threatening diseases. Some of these children are left unvaccinated because their parents are hesitant to immunise, believes that vaccines are dangerous. (1)

A Study of Acute Febrile Illness with Thrombocytopenia from Tertiary Care Centre of Uttarakhand

Background:Acute febrile illness with thrombocytopenia is a common condition that is associated with an increased risk of morbidity and mortality. Infection is a common cause of thrombocytopenia. Infections like Malaria, Dengue, Typhoid and septicaemia are some of them. The present study is intended to know the various clinical presentation, laboratory studies, aetiology, clinical complications, relationship between platelet count and severity of disease and prognosis associated with acute febrile illness and thrombocytopenia. Material and Methods: Total 200 patients of age more than 12 years with acute febrile illness with thrombocytopenia attending medicine department were enrolled and studied for demographic details, clinical presentation and complications. Results: Majority of patients were aged <40 years (66.0%) with males (72%) preponderance. Out of total 200 cases enrolled in this study, 82 cases (41%) were diagnosed as dengue fever, 60 cases (30%) were of malaria, 36 cases (n=36;18%) were of scrub typhus, 6 cases (3%) were of Septicemia, 5 cases (n=5;2.5%) were of typhoid fever and 11 cases(5.5%) remain undiagnosed. Conclusion: Dengue was the commonest cause of fever with thrombocytopenia. Common Bleeding manifestations were petechiae /purpura and gum bleeding. Thorough clinical and laboratory evaluation would be helpful to evaluate different causes of fever with thrombocytopenia.

Changing panorama for surveillance of device-associated healthcare infections: Challenges faced in implementation of current guidelines

Healthcare-associated infections (HAI) are preventable in up to 30% of patients with evidence-based infection prevention and control (IPC) activities. IPC activities require effective surveillance to generate data for the HAI rates, defining priority areas, identifying processes amenable for improvement and institute interventions to improve patient's safety. However, uniform, accurate and standardised surveillance methodology using objective definitions can only generate meaningful data for effective execution of IPC activities. The highly exhaustive, complex and ever-evolving infection surveillance methodology pose a challenge for effective data capture, analysis and interpretation by ground level personnel. The present review addresses the gaps in knowledge and day-to-day challenges in surveillance faced by infection control team for effective implementation of IPC activities.

Clinical Implication of ApoB (12669G/A) Gene Polymorphism and Risk of Cardio Vascular Disease in Indian Population

Background: Cardiovascular disease is rising day by day due to having high fat diet and due to genetic alterations. Materials & Methods: Study included 70 CVD patients and their peripheral blood samples were collected for genotyping by venipuncture under aseptic condition in EDTA vials (2ml) as well as in serum vials (3ml) for biochemical parameters. Genomic DNA extraction was done by phenol chloroform method from blood samples collected in EDTA vials from cases as well as controls for genotype study. Results: The difference of genotype between cases and controls was found to be significant (p=0.0003). Study observed that high percentage of GA 29 (41.4%) and AA 8 (11.4%) genotype was found in patients compared to controls GA 10 (20%) and AA 0 (0%) while lower GG 33 (47.2%) genotype in patients compared to control GG 40 (80%) genotype. Compared to the GG genotype, the OR 3.51 (1.49-8.25) and 20.55 (1.14-369.6) for the heterozygous GA and homozygous AA genotypes were estimated, suggesting a possible dominant effect of Apo B polymorphism on CVD risk. In smokers, compared to the GG genotype, the OR 2.19 (0.69-6.88) and 1.71 (0.29-9.87) for the heterozygous GA and homozygous AA genotypes. In alcoholism, compared to the GG genotype, the OR 2.66 (0.93-7.57) and 8.4 (0.92-76.19) for the heterozygous GA and homozygous AA genotypes. Patients with mutant  homozygous AA, heterozygous GA genotypes showed 123.3+14.34 (mg/dl) and 76.92+24.09 Apo B level in CVD patients compared to wild type GG homozygous genotypes were 70.82+17.12. Conclusion: It was observed that Apo B gene polymorphism and smoking behaviour found to be associated with increased risk of CVD in Indian population.

Role of 2-D echocardiography in detecting cardiovascular abnormalities in chronic kidney disease patients: Case series of 50 chronic kidney disease patients

Background: Chronic kidney disease is a major public health problem worldwide with continuously increasing incidence and prevalence. Diabetes and hypertension are the leading causes of chronic kidney disease worldwide, whereas hypertension is a cause as well as effect of chronic kidney disease. Objectives: To evaluate and analyze the echocardiographic changes in the end stage renal disease patients on maintenance haemodialysis by the help of 2-D echocardiography. Materials and methods: End stage renal disease (ESRD) patients who were on maintenance haemodialysis for at least 3 months, in MG hospital were included in the study. We performed 2- Dechocardiography in 50 ESRD patients during inter-dialytic period. Patients with clinical evidence of coronary artery disease, previous history of hypertension, valvular heart disease, congenital heart disease and pericardial effusion were excluded from this study. Results: out of 50 chronic kidney disease patients, echocardiography revealed LVH in 29 (58%) patients, LVDD in 25(50%) patients, pericardial effusion in 10 (20%) patients, pulmonary hypertension in 23(46%) patients, dilated left atrium in 14(28%) patients, dilated left ventricle in 4 (8%) patients and regional wall motion abnormalities in 3 (6%) patients. Hypertension was present in Saxena N, Dhamija JP, Saxena S. Role of 2-D echocardiography in detecting cardiovascular abnormalities in chronic kidney disease patients: Case series of 50 chronic kidney disease patients. IAIM, 2017; 4(1): 122-126. Page 123 46 (92%) out of 50 CKD patients out of which LVH was in 29 patients. Severe Anaemia was present in 10 (20%) patients. Conclusion: LV diastolic dysfunction and left ventricular hypertrophy were the most common and significant echocardiographic findings among 50 CKD patients. There was statistically significant correlation between anaemia and the presence of left ventricular hypertrophy and positive correlation between presence of hypertension and left ventricular hypertrophy.

Sarcomatoid Renal Cell Carcinoma: A Rare Case Report

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive variant of renal cell carcinoma. It is thought to originate predominantly from clear cell carcinoma through de-differentiation. It is a rare entity constituting about 1-5% of all renal malignant neoplasms and is more commonly associated with conventional (clear cell) renal cell carcinomas. We report a case of 62 years old male who presented with complaints of haematuria and abdominal pain. The histopathology confirmed sarcomatoid renal cell carcinoma.

Incidental renal cell carcinoma with endometrial adenocarcinoma: A rare case report

Incidental detection of two primaries call for oncosurgeon’s own judgment to decide the best therapeutic approach as no guidelines exist for the rarity of condition. This is the rare case of incidental renal cell carcinoma in a patient of endometrial carcinoma. Renal cell carcinoma was detected on preoperative MRI in a patient who presented as postmenopausal bleeding and histology proven endometrial carcinoma. Final histology confirmed dual primaries with uterine primary being endometrioid adenocarcinoma, whereas renal primary was clear cell carcinoma stage II. Estrogen receptors (ER) have been identified in Hamster and Mouse kidneys as well as in renal cell carcinoma tissues. High plasma estrogen found in some patients of synchronous renal and endometrial cancer may partly explain the association of these two primaries, though not in all cases. Increased serum leptin levels and a common low penetrance susceptibility gene have been reported in both these cancers.

A Rare Case of an Adult with Untreated Bladder Exstrophy Presenting with Adenocarcinoma of Urinary Bladder.

Untreated bladder exstrophy in an adult is rare, as the defect is obvious and primary reconstruction is usually done in infancy. There are less than 90 reported cases of primary adenocarcinoma in an untreated bladder exstrophy in literature and only two such case reports from India. We report the case of adenocarcinoma in a 29 year old male with untreated bladder exstrophy to highlight the extreme rarity, yet distinct possibility and challenges faced in surgical management of such cases.

Diabetic Peripheral Neuropathy And Its Metabolic Determinants In A North Indian Population.

Background: The estimates of Diabetic Peripheral Neuropathy prevalence vary widely from 9.6 to 78% in different populations. this study was undertaken to study the prevalence of peripheral neuropathy in diabetes mellitus type-2 pateints and to find the association between biochemical parameters like blood sugar (Fasting, PP), HbA1c, lipid profile, 24-hours urinary albumen excretion with diabetic peripheral neuropathy. Methodology: This observational study was conducted among randomly selected outdoor and indoor Diabetes Mellitus type-2 patients of GSVM Medical College Kanpur. Diagnosis of diabetes peripheral neuropathy was made on the basis of history, clinical examination and vibration perception. Multivariate regression analysis was used to find the predictors of Diabetic peripheral neuropathy. Results: Majority of patients were aged 60 years and above (57.84%). Prevalence of diabetic neuropathy was 60.7%. Significant association between high blood sugar and peripheral neuropathy was found (<0.05). Conclusion: Screening of Diabetes mellitus and Diabetic peripheral neuropathy can be useful in its early detection and prompt treatment.

Evaluation of 2-D echo findings in chronic kidney disease: Case study of 35 end stage renal disease patients

Background: Chronic kidney disease (CKD) is a major public health problem worldwide with increase in incidence and prevalence. Diabetes and hypertension are the leading cause of CKD worldwide, whereas hypertension is a cause as well as effect of CKD. Objectives: To evaluate and analyze the echocardiographic changes in the end stage renal disease patients on maintenance hemodialysis. Materials and methods: End stage renal disease (ESRD) patients who were on maintenance Haemodialysis for at least 3 months, in MG hospital were included in the study. We performed 2D echocardiography in 35 ESRD patients during inter-dialytic period. Patients with clinical evidence of coronary artery disease, valvular heart disease, congenital heart disease and pericardial effusion were excluded from the study. Results: Out of 35 ESRD patients, echocardiography revealed LV dilatation and diastolic dysfunction in 18 patients (51.2%) , LV hypertrophy in 17 patients (48%), systolic dysfunction and pericardial effusion in 10 patients (28.57%) and 6 patients (17.14%) respectively. RWMA was present in 3 patients (8.5%) and no valvular calcification was seen in any patient. In a sub group of 21 patients with Hb <10g%, LVH was present in 15 patients (71.42%) vs 2 out of 14 patients (14.28%) in patients group with Hb >10 g%. Hypertensive patients were 27 of 35 ESRD patients, 13 out of 27 had Dhamija JP, Saxena N, Saxena S. Evaluation of 2-D echo findings in chronic kidney disease: Case study of 35 end stage renal disease patients. IAIM, 2016; 3(9): 61-65. Page 62 higher prevalence of LVH (51.85%). Systolic dysfunction and RWMA was absent in normotensive group. Conclusion: LV diastolic dysfunction and hypertrophy were most common echocardiographic findings. There was statistically significant correlation between anaemia and presence of LVH and positive correlation between presence of hypertension and LVH.

S-Beta Thalassemia leading to avascular necrosis of left hip joint in a young male – A rare case report

Sickle beta thalassemia is a disorder which represents the double heterozygous state for the Hb-S and the beta-thalassemia genes. The clinical and hematological manifestations of sickle beta thalassemia are highly variable due to existence of two types of genes, beta0 thalassemia gene and beta+ gene. Beta0 gene leads to complete absence of Hb-A levels, whereas beta+ gene leads to production of Hb-A levels 10-30%. This disorder is diagnosed by levels of HbS, HbA2 and HbF in Hemoglobin Electrophoresis. We are presenting one such young male patient with features of Sickle Beta+ thalassemia who presented with anemia, fatigue and joint pain with characteristic features of avascular necrosis of left hip joint in X-Ray and MRI. For the etiological diagnosis further investigation in the form of capillary haemoglobin electrophoresis and for final confirmation genetic analysis by PCR is done.

Uterus Didelphys presenting with ruptured uterus in third pregnancy: A rare case report

Uterus Didelphys “double uterus” is a congenital malformation that results from complete failure of fusion of the ipislateral paramesonephric ducts during embryonic development. Ideally, diagnosis should be made before pregnancy and labor to prevent adverse outcomes. Here we report a case of uterus didelphys in 30 year old female Gravida4 Para3 Living2 at 31st week of pregnancy admitted with prolonged rupture of membrane, hypovolemic shock and intrauterine fetal death. Postoperative recovery of the mother was uneventful. Clinicians should have high index of suspicion of uterine anomaly when assessing cases of dysfunctional labor to avoid delayed diagnosis and the associated adverse outcome

Design, architecture and application of nanorobotics in oncology.

Oncologists all over the globe, relentlessly research on methodologies for detection of cancer and precise localization of cancer therapeutics with minimal adverse effects on healthy tissues. Since the previous decade, the fast growing research in nanotechnology has shown promising possibilities for achieving this dream of every oncologist.Nanorobots (or nanobots) are typical devices ranging in size from 0.1 to 10 μm and constructed of nanoscale or molecular components. Robots will augment the surgeon’s motor performance, diagnostic capability and sensations with haptics and augmented reality. The article here aims in briefly describing the architecture of the nanorobots and their role in oncotherapy. Although, research into nanorobots is still in its preliminary stages, the promise of such technology is endless.

Brachytherapy of intra ocular tumors using ‘BARC I-125 Ocu-Prosta seeds’: An Indian experience.

Aim: To report our experience of brachytherapy using ‘BARC I‑125 Ocu‑Prosta seeds’ for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011. Materials and Methods: We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty‑one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult‑onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15‑ or 20‑mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor. Results: For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow‑up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow‑up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage. Conclusion: The results of this retrospective study confirms that the use of ‘BARC I‑125 Ocu‑Prosta seeds’ in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.