An unusual case of left para-duodenal hernia as a cause of recurrent intestinal obstruction-managed with laparoscopic approach

Left para-duodenal hernia (PDH) makes for around 40% of all internal hernias. It is due to the prolapse of the bowel through the fossa of Landzert, an anatomic variant that is found in around 2% of the population. This hernia is presumed to be spontaneously reducible in many patients with recurrent symptoms. The present report shows the case of this condition in a 27-year-old female presenting with recurrent abdominal pain and subacute intestinal obstruction who was managed conservatively initially. She has been operated on with a laparoscopic approach. A proper diagnosis with an immediate surgical intervention is necessary for achieving the patient抯 cure and preventing complications in the future. The laparoscopic approach is usually suitable for patients with or without small bowel obstruction and hemodynamically stable.

Ocular manifestations in moderate-to-severe psoriasis in India: A prospective observational study

Purpose: Ocular manifestations in psoriasis are due to direct eye involvement with psoriatic plaques or psoriasis?related, immune?mediated inflammatory processes. The commonly reported pathologies are blepharitis, conjunctivitis, keratitis, dry eyes, and uveitis. Limited data is available on the ocular findings in psoriasis patients in India. In this study, we evaluated various ocular changes associated with moderate-to-severe psoriasis. Methods: In this prospective cohort study, treatment?naive psoriasis patients with Psoriasis Area Severity Index (PASI) score of more than 10 were included. The Ocular Surface Disease Index (OSDI) score, Schirmer’s score, tear film breakup time (TBUT), corneal and conjunctival staining score, and meibomian gland dysfunction score were noted. All these parameters were re?evaluated at 8 weeks of follow?up after systemic treatment. Results: Sixty-eight patients were enrolled in the study. The most common ocular pathologies observed in this study were tarsal hyperemia and anterior blepharitis in 128 (94.1%) and 64 (47%) eyes, respectively. Mild, moderate, and severe dry eyes were seen in 26 (19.1%), 14 (10.2%), and 34 (25%) eyes, respectively. Thirty?nine (57.3%) patients complained of significant difficulty watching television or digital screen. In 21 patients evaluated on follow?up at 8 weeks, cornea and conjunctiva’s ocular surface staining score increased and TBUT decreased significantly. Conclusion: The most common ocular pathologies observed in this study were anterior blepharitis and moderate dry eye, which significantly affected most patients’ daily routines. Screening patients with greater severity of psoriasis would help in early management of such problems.

Complete response in metastatic breast cancer with visceral crisis using a combination of cyclin-dependent kinase 4/6 inhibitor and aromatase inhibitor: A case report from the eastern region of India

Patients with metastatic breast cancer (MBC) in visceral crisis require systemic chemotherapy. However, a coexisting cardiac failure that contradicts the use of systemic chemotherapy often demands an alternative treatment. Here, we report a case of hormone-receptor-positive MBC with cardiological comorbidities. She was treated with a combination treatment of tablet Ribociclib (600 mg once daily for 21 days followed by 7 days gap) and tablet Letrozole (2.5 mg once daily). The patient had a complete metabolic response in 18-Fluorodeoxyglucose Positron Emission tomography-Computed Tomography (18F-FDG PET/CT), after 6 months of treatment. Combination treatment with Ribociclib and Letrozole is beneficial in postmenopausal females with hormone receptor-positive and human epidermal growth factor receptor 2 neu-negative MBC in visceral crisis who have a contraindication to chemotherapy.

Morbidity Patterns among Menopausal Women in Rural Uttar Pradesh, India: A Cross-Sectional Study

Objectives@#The quality of life declines gradually as women enter menopause, owing to the various problems associated with estrogen deficiency and aging, which adds to their morbidities. This study aimed to investigate the patterns of morbidity among rural menopausal women and compare the morbidity patterns among menopausal transition group and post-menopausal women. @*Methods@#This community-based cross-sectional study included menopausal women aged 45–55 years from rural areas of the Etawah district, Uttar Pradesh, India. To select blocks and villages of the district, multistage random sampling was performed. According to a pretested, semistructured schedule, data were collected through interviews. @*Results@#A total of 315 women participated in the study. The most frequent complaints among the participants were of feeling tired and worn out (85.1%) and of muscle and joint pains (67.6%). Poor memory (P = 0.046) and diabetes (P = 0.024) were more common in women who were in the menopause transition phase than in those who were in the postmenopausal phase. @*Conclusions@#This study showed that majority of the menopausal women suffered from physical problems. Lifestyle modification and awareness programs will be beneficial among women in menopausal transition, to reduce the morbidity later in post-menopausal stage.Behaviour change communication, family and community support are essential in post-menopausal women, to help them cope with various morbid conditions.

Morbidity Patterns among Menopausal Women in Rural Uttar Pradesh, India: A Cross-Sectional Study

Objectives@#The quality of life declines gradually as women enter menopause, owing to the various problems associated with estrogen deficiency and aging, which adds to their morbidities. This study aimed to investigate the patterns of morbidity among rural menopausal women and compare the morbidity patterns among menopausal transition group and post-menopausal women. @*Methods@#This community-based cross-sectional study included menopausal women aged 45–55 years from rural areas of the Etawah district, Uttar Pradesh, India. To select blocks and villages of the district, multistage random sampling was performed. According to a pretested, semistructured schedule, data were collected through interviews. @*Results@#A total of 315 women participated in the study. The most frequent complaints among the participants were of feeling tired and worn out (85.1%) and of muscle and joint pains (67.6%). Poor memory (P = 0.046) and diabetes (P = 0.024) were more common in women who were in the menopause transition phase than in those who were in the postmenopausal phase. @*Conclusions@#This study showed that majority of the menopausal women suffered from physical problems. Lifestyle modification and awareness programs will be beneficial among women in menopausal transition, to reduce the morbidity later in post-menopausal stage.Behaviour change communication, family and community support are essential in post-menopausal women, to help them cope with various morbid conditions.

Review of Paediatric Typhoid Perforation Cases Managed at a Tertiary Care Centre

Background: Any criteria (clinical, pathologic, microbiological or histo-pathologic) attributing a case of Paediatric gastrointestinal perforation to Typhoid would be of help in reaching a proper diagnosis to guide appropriate management.Aims and Objectives: To review all cases of Typhoid perforation for their clinical, pathologic and intra-operative findings.Materials and Methods: A retrospective study was conducted on all cases of typhoid perforation (gastrointestinal perforation with positive Widal test) operated at a tertiary care centre from September 2015 to September 2018. Data regarding their clinical findings, investigation results, intraoperative findings, nature of thesurgical intervention, postoperative results and histopathological findings were collected from their records and analysed.Results: A total of 13 patients were operated during this period with positive Widal’s test at presentation. 6/13 had single ileal perforation; two patients had multiple ileal perforations; perforation at atypical sites were found in four patients (one each at gastric, duodenal, caecal and rectal); one patient presented with Meckel’s band obstruction with multiple ulcers –this patient was sick and died despite a diverting ileostomy in the postoperative period. While 8/13 patients had primary closure of the perforation site, diversion through ileostomy was performed in five patients. All patients did well in the post-operative period except one patient of multiple ulcers and obstructing Meckel’s band who died in the post-operative period. Conclusion: On encountering a gastrointestinal perforation, no definite symptomatology or its pattern, no clinical examination findings, no intraoperative characteristics of the perforation and no biopsy can definitively point towards Typhoid as the cause. Therefore, we still have to depend on serological tests in correlation with clinical features to reach a conclusive diagnosis. Cultures and PCR, although sensitive are either time-taking or expensive to guide management. Typhoid perforation can have vivid and atypical presentation depending on the number and site of perforation

Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study / 中华创伤杂志(英文版)

PURPOSE@#Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.@*METHODS@#During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.@*RESULTS@#In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motorcyclists (54.2%) followed by pedestrian (25.1%).@*CONCLUSION@#There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

Evaluation of Fetal Transcerebellar Diameter as a Sonological Parameter for the Estimation of Fetal Gestational Age in Comparison to Biparietal Diameter and Femur Length

Background: Knowledge of the expected date of delivery is essential in the management of all pregnancies, particularly those which require active management. Presently the most effective way to date the pregnancy is by the use of ultrasound. Several sonographically derived fetal parameters are used to date pregnancies, those include Biparietal diameter (BPD), Head circumference (HC), Abdominal circumference (AC) and femur length (FL). However, the variability of these parameters increases with increasing age. Transverse cerebellar diameter (TCD) measurement can be used as a new parameter to estimate the fetal gestational age. The present study was undertaken to evaluate the usefulness of Trans cerebellar diameter (TCD) as against other conventional parameters (like Biparietal diameter and Femur length) in normal pregnancies. Objectives: To evaluate the usefulness of Trans cerebellar diameter (TCD) as against the conventional parameters of Biparietal diameter (BPD) and Femur length (FL) in normal pregnant mothers between 15-37 weeks, to derive nomogram for estimating the gestational age of the fetus from measured transverse cerebellar diameter. Sumanta Kumar Mandal, Sandip Kumar Ghosh, Saikat Roy, Barun Prakash. Evaluation of Fetal Transcerebellar Diameter as a Sonological Parameter for the Estimation of Fetal Gestational Age in Comparison to Biparietal Diameter and Femur Length. IAIM, 2019; 6(6): 41-50. Page 42 Materials and methods: Study of 100 normal pregnant women between 15-37 weeks of gestation. For each patient BPD, FL and TCD were measured. From the above measured parameters gestational age was measured using Hadlock tables. TCD was compared with BPD, FL in normal pregnancies. Results: It was observed that there was a statistically significant curvilinear relationship between TCD and gestational age in normal pregnancies. The growth pattern of cerebellum followed a second degree polynomial similar to that of BPD and FL. Gestational age estimated by TCD correlated well with the estimated gestational age by BPD and FL. Conclusion: Transverse cerebellar diameter (TCD) shows good correlation with gestational age and can be used as a single growth parameter to estimate the gestational age where LMP is uncertain.

Painless Limbs and Moving Extremities Syndrome: A Variant of Painful Moving Limbs and Extremities.

Painless limbs and moving extremities is a rare condition. Only few case reports or short series of cases are reported. It is believed to be a variant of painful legs and moving toes. It can affect the lower limbs causing painless moving legs and toes or can affect the upper extremities causing painless moving hands and fingers. Various mechanisms of this condition have been postulated, but it requires further studies regarding the exact mechanism of this type movement and the treatment of choice for this condition. Here a case of painless moving lower extremity and upper limb is described, who showed a good response to combination of clonazepam and gabapentine.

Characteristics of hollow viscus injury following blunt abdominal trauma; a single centre experience from Eastern India

Objective: To determine the presentation, anatomical distribution, diagnostic method, management and outcome of hollow viscus injury [HVI] from blunt abdominal trauma

Methods: This was a retrospective cross-sectional study including patients with blunt abdominal trauma leading to HVI admitted at Rajendra Institute of Medical Sciences, Ranchi, over a period of 4.5 years [January 2009 to July 2014]. Data were retrieved from patients' medical records. Total 173 patients with HVI due to blunt abdominal trauma, who underwent laparotomy at our institute, were reviewed. Data regarding clinical presentation, anatomical distribution, management and outcome were recorded and analysed

Results: Out of 173 patients 87.1% were men and 12.9% were women. Mean age of patients was 29 +/- 14.02 years. The most common site of injury was ileum [46.2%] followed by jejunum [44.5%]. There were 5 gastric perforations [2.9%], 2 [1.15%] duodenal, 2 [1.15%] colonic, 2 [1.15%] sigmoidal and 2 [1.15%] rectal injuries. One caecal injury was also recorded. Road traffic accident was the most common mechanism of injury [57.2%] followed by fall from height [36.4%] and assault [6.4%]. Free gas under diaphragm on erect abdomen radiography was seen in 85.5% of cases while preoperative CT Abdomen was done in 11.6% of cases. Treatment consisted of simple closure of the perforation [66.5%], resection and anastomosis [11.0%] and stoma [22.5%]. Major complication was anastamotic leak which was recorded in 6.4% cases and 15.6% patients developed burst abdomen. Average hospital stay was 13 +/- 6 days. Overall mortality rate was 12.7%

Conclusion: Although early recognition of intestinal injuries from blunt abdominal trauma may be difficult in all cases, it is very important due to its tremendous life threatening potential. Age of the patient, anatomical site and time of presentation are probably main prognostic factors

The analysis of prognostic factors in patients with thoracic ossification of the ligamentum flavum and thoracic ossification of posterior longitudinal ligament by posterior decompression / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the prognostic factors for patients with thoracic ossification of the ligamentum flavum (OLF) and thoracic ossification of posterior longitudinal ligament (OPLL).</p><p><b>METHODS</b>Clinical information of 83 patients suffering from thoracic OLF and OPLL was reviewed retrospectively from January 2006 to June 2010. The related factors such as gender, age, preoperative and postoperative Japanese Orthopedic Association (JOA) score, pathological segment, type of thoracic OPLL, degree of thoracic kyphosis, anteroposterior diameter of OPLL, range of circumferential decompression, cerebrospinal fluid leakage or not and dysfunction or not and carotid lumbar disorders or not were analyzed by Chi-square and Logistic regression.</p><p><b>RESULTS</b>All cases were classified into desirable group (58 cases) and undesirable group (25 cases) based on the postoperative JOA score improvement rate. Comparison of physical characteristics between two groups of age, preoperative JOA and the course of the disease had not statistically significant (P > 0.05). Two groups in pathological segment of thoracic OPLL (χ(2) = 6.290, P = 0.043), the ossification type of OPLL (χ(2) = 5.361, P = 0.021) and dysfunction or not in preoperative (χ(2) = 27.711, P = 0.000) had significant difference. Logistic regression analysis showed that the upper thoracic segments (P = 0.044), beak type ossification (P = 0.023) and with dysfunction in preoperative (P = 0.009) were risk factors. There were 24 patients (28.9%) with cerebrospinal fluid leakage, 3 patients with early postoperative deep infection and neurological deterioration of 2 cases in postoperative.</p><p><b>CONCLUSIONS</b>Patients with ossification on the upper section of thoracic have a better prognosis, but the beaked localized longitudinal ligament ossification in patients and associated with preoperative dysfunction show a poor prognosis, combined jumping segmental ossification and cervical or lumbar severe disorders are the influencing factor for poor prognosis.</p>

A study on prevalence of bacteria in the hands of children and their perception on hand washing in two schools of Bangalore and Kolkata.

Background: Contaminated hands play a major role in fecal-oral transmission of diseases. In 1847, Dr Semmelweis Ignac pointed to the link between infection and unclean hands, and demonstrated that washing hands could reduce transmission of puerperal fever (child birth fever), a dreaded disease with high mortality in those days. Materials and Methods: A cross-sectional study was conducted to find out the extent of germs present in hand, and also the students' perception on hand washing. This was assessed by questionnaire as well as by collection of swab from hand and performing bacteriological culture in the laboratory. Results: In regard to students' perception about the dirty areas of the hands, it was observed that majority (78%) felt palm was likely to be more dirty while less than 70% felt that web spaces could harbor dirt. Almost 86% reported that they washed hands before eating lunch, but only 21.3% said they always used soap while 47.3% never used it. Availability of soap all the time in the school was reported by only 18.4% students. The swabs of 61% children showed potential pathogens. The commonest of these was Staphylococcus aureus which was seen in 44% samples. Conclusion: The students' hands were contaminated before taking food. Although they washed hands before meals, they hardly used soap due to non-availability of soap. The school authority should be asked to keep soaps in the toilets for hand washing.

An assessment of rural health care delivery system in some areas of West Bengal-An overview.

A cross sectional observational study was carried out in three districts of West Bengal by following observational, quantitative and qualitative methods during July to December 2006 to find out the extent of utilization, strengths, weaknesses and gap as well as suggest recommendations in connection with health care delivery system for the state of West Bengal, India. A total of 672 episodes of illnesses were reported (2 weeks recall) by the study population of the three selected districts in three geographically separated divisions of West Bengal. None did seek care from any health facilities for treatment in case of 221 (32.89%) episodes; especially from tribal areas where in case of 76.19% none sought any health care from any facilities depended on their home remedies. In rest of episodes the (451), majority preferred government health facilities (38.58%), followed by Unqualified quacks (29.27%) due to low cost as well as living in close proximity, 27.27% preferred qualified Private practitioners and only 4.88% preferred AYUSH, as a first choice. Referral was mostly by self or by close relatives/families (61%) and not by a doctor. Awareness is required to avoid unnecessary referral. Cleanliness of the premises, face-lift, and clean toilet with privacy and availability of safe drinking water facilities could have an improved client satisfaction in rural health care delivery systems. This could be achieved through community participation with the involvement of PRI. However, as observed in the study RCH services including Family Planning as well as immunization services (preventive services) were utilized much better while there was a strong need of improvement of Post Natal Care, otherwise, Neonatal and Maternal mortality and morbidity will continue to be high.

Comparative study of the characteristics of seed oil and seed nutrient content of three varieties of cucumis sativus l

The physicochemical characteristics of oils and nutrient contents of the seeds of three varieties of Cucumis sativus namely, Shahi-50, Naogaon-5 and Naogaon-Green, have been reported. Profile of fatty acid composition was not wholly similar in all varieties and unsaturated fatty acids were more than 77%, of which linoleic acid was 61.9-62.2%. High degree of unsaturation was indicated with lower peroxide value [3.7-4.2] and FFA [1.1-1.6%]. Triacylglycerols and neutral lipids were the most abounded components recorded as 82.1-83.7% and 92.1-94.0%, respectively. The seeds contained potentially useful amounts of lipid [28.0-31.1%] and protein [14.8-15.9%] and other nutrients

Hand washing practices in two communities of two states of Eastern India: An intervention study.

Background : Public health importance of hand washing as well as its importance in reduction of communicable diseases such as diarrhea and acute respiratory infections have been highlighted in many studies worldwide. Objective: This study was designed to study the hand washing practices followed in two urban slums as well as to assess and compare the status of different components of hand washing at the pre- and post-intervention phases. Materials and Methods: A community-based cross-sectional intervention study on hand washing practices was carried out at two urban slums situated in two states of Eastern India with similar sociocultural and linguistic background. The study was carried out by using an interview technique as well as observation of hand washing practices. Interpersonal communication for behavioural change was chosen as a method of intervention. Results: The majority (>90%) practiced hand washing after defecation in both the study areas. However, hand washing following all six steps and for stipulated time period was seen to be poor before intervention. Significant improvement was observed in all the aspects of hand washing after intervention in both the areas. The poor practice of hand washing was observed in some situations and needed attention. Use of soap and clean material for drying hands after hand washing was poor initially followed by improvement after intervention. Conclusion: Based on the findings of the study, it could be suggested that Behaviour Change Communication program should be further planned with emphasis on different components of hand washing with a final objective to bring down the incidence of target diseases.

National rural health mission--opportunity for Indian Public Health Association.

Indian Public Health Association (IPHA) welcomes the release of National Rural Health Mission (NRHM) documents. It suggests that manpower requirements of the Community Health Centre (CHC) should be rationally determined on the basis of work and patient load of the CHC. Importance should be given on availability of simple & life saving equipment, female staff when male staff is not available. Safe drinking water, an adequate sanitation and excreta disposal facility through Panchayet Raj Institution (PRI) or privatization was proposed. Accredited Social Health Activist (ASHA) has been accepted more streamlining based on the community was suggested. Capacity building or training should be CHC based for grass-root level functionaries with incentive to Medical officer (MO). IPHA proposes to extend support in capacity building, development of manual for ASHA & other categories of health professional as well as Program Implementation Plan (PIP).

Epidemiological study of measles in slum areas of Kolkata.

OBJECTIVE: An epidemiological study on measles was conducted among the under five children in slum areas of Kolkata to assess the incidence of measles. METHODS: 20 cluster sampling technique was followed and in each cluster 250 under five children were covered. Paramedical workers identified children of the target of age group who had history of measles in past one year and the medical officer confirmed the diagnosis following standard case definition. RESULTS: Incidence of measles was found as 5.76%. Incidence was equal in both the sex groups, but found more among infants. The incidence of measles gradually declined with the increase of age strengthening the view in favor of early immunization. Amongst the measles cases only 19.7% were immunized with measles vaccine. 100% of measles cases gave history of rash, 98.9% had history of fever, 82.8% reported that the rash started from face and progressed downwards to abdomen and leg. Cough, redness of eye and discoloration of skin were reported by 97.5%, 83.8% and 65.2% measles cases respectively. Only 16.9% and 8.6% children received Vitamin A oil before and after the illness respectively. 49% gave history of exposure to measles cases and 46.6% cases had measles within 2 weeks incubation period. CONCLUSION: The study highlighted the necessity of timely measles vaccine coverage, additional dose at a higher age and Vitamin A supplementation through IEC activities.