Determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending a rural tertiary care hospital of Haryana

Introduction : Rabies is a fatal but vaccine-preventable viral disease. Animal bite victims who report in primary and secondary level health care lack some measures which can help in protecting and preventing deaths due to rabies. The most important factor for prevention of death due to rabies is the timely administration of post-exposure prophylaxis (PEP) among animal bite victims. Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delay in PEP initiation. Objective: To determine the determinants of delay in initiation of post exposure prophylaxis for rabies prevention among animal bite cases attending anti-rabies clinic of a ruraltertiary care hospital in Sonepat, Haryana. Method: This cross-sectional study was conducted at an Immunization-cum-antirabies clinic of Bhagat Phool Singh Government Medical Collegefor Women, Khanpur Kalan, Sonepat, Haryana. A pre tested, structured questionnaire was used to collect information among 410 participants after taking consent. The Institutional Ethics Committee of institute approved the study. The groups were compared with Chi-square test for categorical data. Results: Delay was present among 27.3% of participants. Significant factors of delay were no local wound treatment, any treatment taken prior to anti-rabies vaccine administration, rabies clinic closed on holidays, unawareness about PEP, non-availability of accompaniment, transportation issues and money problem for transportation. Knowledge also played significant role as delay was significantly more among the participants not having knowledge regarding source of infection, mode of transmission and incubation period of rabies. Conclusions: Delay ininitiation of PEP was common and were significantly associated with lack of knowledge and unawareness, closure of rabies clinic on Sundays/holidays, non-availability of accompaniment and money problem during transportation

Prevalence and risk factors associated with prehypertension and hypertension among attendants of patients at a rural tertiary care institute of Haryana

Background: Hypertension (HTN) is the leading risk factor for death and disability globally and disproportionately impacts low-and middle-income countries. HTN is present in 25% of urban and 10% of rural subjects in India. Our objective was to estimate the prevalence of pre-HTN and HTN among the attendants of patients at a rural tertiary care institute of Haryana.Methods: This was a hospital-based cross-sectional study. A total of 309 attendants of patients were enrolled for this study. Diagnosis of pre-HTN and HTN was done on the basis of seventh joined national committee guidelines. Data were collected on a semi-structured proforma and were analysed by using R software.Results: The prevalence of pre-HTN and HTN was 18.4% and 21.4% respectively. Both the pre-HTN and HTN were significantly higher in males (p=0.002) and in the age group of 45 to 55 years (p<0.001). The multinomial logistic regression analysis revealed that sex, age >55 years and BMI >23 kg/m2 were significantly associated with pre-HTN and HTN.Conclusions: The prevalence of both prehypertension and hypertension is high in rural Haryana. This makes the people of this area vulnerable to several chronic diseases. The findings warrant urgent measures to lower the risk factors in rural communities. So, programs are needed to improve the surveillance systems and implementation of community based screening programs for early detection of hypertension.

Metabolic syndrome among students of BPSGMC for Women Khanpur Kalan, Sonepat

Background: A quarter of the world’s adult population has Metabolic Syndrome (MetS) and this condition is appearing with increasing frequency in children and adolescents due to the growing obesity epidemic within this young population. Objective: To determine the prevalence of metabolic syndrome (MetS) in the apparently healthy female medical students in BPSGMC for Women Khanpur Kalan, Sonepat and to find the risk factors associated with these conditions among the study subjects. Methods: This cross-sectional study was conducted in rural BPS Government Medical College for Women, Khanpur Kalan, Sonepat from April 2018 to September 2018 for a period of six months. The study population included all the undergraduate medical students of 2016 and 2017 batches. Semi-structured and pretested questionnaire was used to collect the data regarding demographic characteristics, anthropometric parameters and biochemical markers using standardized methods. MetS was defined as per National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP III) criteria modified in 2004. Statistical analysis was carried out with R v 3.5.1 Results: The prevalence of metabolic syndrome was 9.8%. It was 7.7% in 17-19 years age group and 11.2% in 20-23 years age group. All the study subjects with MetS had abdominal obesity. MetS was significantly associated with elevated blood pressure, fasting plasma glucose ≥100 mg/dl, serum triglyceride ≥150 mg/dl and serum HDL cholesterol level <50 mg/dl. Conclusions: Metabolic syndrome exists in significant number among apparently healthy female medical students. Policy makers and healthcare providers can develop effective lifestyle interventions such as diet and physical activity for addressing the risk factors for metabolic syndrome.

The relationship between test anxiety and academic performance among undergraduate medical students

Background: Undergraduate medical education comprises strenuous study and training for five and half years. Mental health of medical students remains affected throughout this period. Objective: To assess the test anxiety in the undergraduate medical students and to find out the relationship between the test anxiety and academic performance in the students. Methods: This cross-sectional study was conducted in a Rural BPS Government Medical College for Women, Khanpur Kalan, Sonepat. The study population included all the undergraduate medical students enrolled from 2012 to 2016. Data pertaining to various socio-demographic characteristics were obtained by interview technique using a pre-designed, pre-tested questionnaire ensuring privacy and confidentiality and reviewing academic records. Nist and Diehl test anxiety questionnaire was used to determine the anxiety score of students. Statistical analyses were carried out with R v 3.5.1. Results: A total of 240 students participated in the study. More than one quarter (26.3%) of the students did not suffer from test anxiety, 62.9% students exhibited healthy test anxiety and 10.8% of the students experienced unhealthy test anxiety. In relation to academic performance of the respondents, 4 (12.5%), 47 (24.9%) and 12 (63.2%) of respondents who performed fair, good and excellent respectively had no anxiety level as against those who had healthy anxiety and unhealthy anxiety level and these differences were statistically significant. Conclusions: Text anxiety is significantly associated with academic performance. These findings suggest the need of healthcare provision to prevent unhealthy test anxiety among medical students, as it decreases the academic performance.

Determination of the biometric characteristics of palatine rugae patterns in Uttar Pradesh population: A cross-sectional study.

Background: Identification is the establishment of identity of an individual. The basis of dental identification is based on the observation that no two individuals can have same dentition. Palatal rugae are irregular, asymmetric ridges of the mucous membrane extending laterally from the incisive papilla and the anterior part of the palatal raphe. The location of palatal rugae inside the oral cavity confers them with stability even when exposed to high temperatures or trauma. Their resistance to trauma and their apparent unique appearance has suggested their use as a tool for forensic identification. Aims: To record the biometric characteristics of shape, size, direction, number and position of palatal rugae and analyze whether palatal rugoscopy can be used as a tool for personal identification and for sex determination. Settings and Design: A cross‑sectional study. Materials and Methods: The sample consisted of 100 subjects (50 males, 50 females) between 18 and 25 years. Maxillary impressions were made with elastomeric impression material and dental stone was used to make models. The palatal rugae patterns were traced and analyzed with a magnifying hand lens. The biometric characteristics of number, size, shape, and direction were analyzed using Thomaz and Kotz classification (1983). The casts were coded to blind the examiners about the identity of the subjects. Statistical Analysis Used: Unpaired t‑test and one‑way ANOVA using SPSS 19.0 statistical program for Windows. Results: The average number of rugae was slightly more in females. Wavy (44.9%) and curved (41.8%) shapes were more prevalent. Maximum number of rugae was found in E quadrant (40.73%). The average size was 9.221 mm. Most rugae were forwardly directed in both groups. Conclusion: This study concluded that rugae pattern are highly individualistic and can be used as a supplementary method for personal identification and sex determination. Further inter‑observer and intra‑observer variability were not found to be significant, which further validates the use of rugoscopy as a forensic tool.

Comparative clinical evaluation of chemomechanical caries removal agent Papacarie® with conventional method among rural population in India: in vivo study

The use of minimally invasive procedures and attention to patient comfort are of great importance, especially for dental treatment in young children. This has led to the development of chemomechanical methods for caries removal. Aim: To evaluate and compare the antimicrobial efficacy, efficacy in terms of time consumption and pain perception of chemomechanical caries removal agent Papacarie® and conventional method of caries removal. Methods: Subjects for this study were chosen from children admitted to dental clinic for restorative procedures. Forty children (age 4-8 years) with early childhood caries were included in this study. Two primary teeth with comparable degrees of carious destruction were chosen in each child for caries removal with either Papacarie® or rotary instruments. The time taken for caries removal was measured using stopwatch. Pain response during caries removal was evaluated using the Wong Baker Face Pain Scale. Dentin samples of both groups were taken prior to, and after caries removal for microbiological analysis. Results The time taken for caries removal in chemomechanical caries removal method was three times longer than the conventional method. Pain score during chemomechanical method of caries removal was 1.525 as compared with 6.65 when conventional method was used. The antimicrobial efficacy of chemomechanical caries removal was significantly similar to conventional method. Conclusions: Papacarie® can be an effective clinical alternative treatment for the removal of occlusal dentinal caries in cavitated primary molars.

A comparative study of p53 expression in hyperplastic, dysplastic epithelium and oral squamous cell carcinoma

Aim: To study oral hyperplastic epithelium, dysplastic epithelium and squamous cell carcinoma to determine (1) the prevalence of p53 protein immunoreactivity, (2) number of p53 positive cells, and (3) the area of localization of p53 protein immunoreactivity. Methods: Two contiguous sections from 30 tissue specimens (10 each from oral hyperplastic epithelium, dysplastic epithelium and squamous cell carcinoma) were subjected to hematoxylin and eosin (H/E) staining forhistopathological diagnosis and immunohistochemical (IHC) staining for demonstration of p53. p53 positivity was looked for in each IHC stained slide and the number of positive cells amongst 1,000 epithelial cells were recorded. The localization of these p53 positive cells within the strata (i.e.basal/suprabasal, spinous and superficial layers) of epithelium between 3 groups, and also with ineach group according to histological grades was recorded. Results: Higher p53 positive cell counts were demonstrated in oral squamous cell carcinoma compared to hyperplastic and dysplastic tissues. The expression of p53 in epithelial hyperkeratosis was mainly localized to basal epithelialcells whereas in epithelial dysplasia, it was predominantly localized to spinous epithelial cells. Conclusions: Qualitatively p53 is not a specific marker for malignancy of oral epithelium. However the quantitative analysis of p53 positive cells and their localization in oral epithelium is of importance as a marker for oral squamous cell carcinoma.

Multiple disseminated abdominal hydatidosis presenting with gross hydatiduria: a rare case report.

Cystic hydatid disease may develop in almost any part of the body. Approximately 70% of the hydatid cysts are located in the liver followed by the lung (25%). The kidneys, spleen, mesentry, peritoneum, soft tissues and brain are uncommon locations for hydatid cysts. Renal involvement in echinococcosis is extremely rare. Hydatiduria accompanies only 10-20% of all cases of renal hydatidosis and is usually microscopic. Gross hydatiduria is an exceptional presentation of hydatidosis. We report an exceptionally rare case of multiple hydatidosis with cysts in the liver, spleen, kidney and peritoneal cavity, presenting with gross hydatiduria.

Omental myxoid hamartomas - A case report with review of literature.

Omental mesentric myxoid hamartomas are benign infantile lesions, however they may simulate a malignant tumour both clinically and pathologically. Here, we report the case of an omental myxoid hamartoma in a 10-months old infant which was per operatively suspected to be a malignant retroperitoneal tumour, due to adhesions with the surrounding structures as well as the presence of satellite nodules.

Ectopic decidual reaction mimicking peritoneal tubercles: a report of three cases.

Ectopic decidual reaction is commonly seen in the ovary and cervix; however, peritoneal localization is rare. Peritoneal deciduosis is usually an incidental histological finding. It may present a diagnostic dilemma by mimicking grossly peritoneal carcinomatosis or tubercles and deciduoid mesothelioma, microscopically. We report three cases of ectopic decidual reaction discovered incidentally during caesarian sections, as whitish yellow nodules resembling tubercles. Histology revealed extensive decidualisation. To the best of our knowledge, this is the first report of ectopic decidua mimicking peritoneal tubercles.