Effects of transcutaneous electrical nerve stimulation on recovery of gastrointestinal motility after laparotomy: A randomized controlled trial.

INTRODUCTION: Postoperative Ileus (POI) negatively impacts patient outcomes and increases healthcare costs. Transcutaneous electrical nerve stimulation (TENS) has been found to improve gastrointestinal (GI) motility following abdominal surgery. However, its effectiveness in this context is not well-established. This study was designed to evaluate the role of TENS on the recovery of GI motility after exploratory laparotomy. METHODS: Patients undergoing exploratory laparotomy were randomized in a 1:1 ratio into control (standard treatment alone) and experimental (standard treatment + TENS) arms. TENS was terminated after 6 days or after the passage of stool or stoma movement. The primary outcome was time for the first passage of stool/functioning stoma. Non-passage of stool or nonfunctioning stoma beyond 6 days was labeled as prolonged POI. Patients were monitored until discharge. RESULTS: Median (interquartile range) time to first passage of stool/functioning stoma was 82.6 (49-115) hours in the standard treatment group and 50 (22-70.6) hours in the TENS group [p < 0.001]. Prolonged POI was noted in 11 patients in the standard treatment group (35.5%) and one in the TENS group (3.2%) [p = 0.003]. Postoperative hospital stay was similar in the two groups. CONCLUSION: TENS resulted in early recovery of GI motility by shortening the duration of POI without any improvement in postoperative hospital stay. TRIAL REGISTRATION NUMBER: CTRI/2021/10/037054.

Acute Intestinal Obstruction Due to Obturator Hernia: A Case Series.

Most obturator hernias are diagnosed intraoperatively due to their vague signs and symptoms. However, they are associated with a high mortality rate mainly because of the patient's age, comorbidities, and late diagnosis. We present three cases of obturator hernia in patients admitted under our care with signs of acute intestinal obstruction. All the patients were elderly with comorbidities, and they underwent open surgery with anatomical repair of the hernial defect with or without resection of any gangrenous bowel. They were discharged in good health, and during the limited follow-up period, there has been no recurrence. We would like to emphasize that obturator hernia should be considered in the differential diagnosis when an elderly, thinly built woman presents with acute intestinal obstruction. Though the outcome of such cases depends on the clinical status and comorbidities of the patient, early diagnosis and treatment can help in reducing postoperative morbidity and mortality.

Mental Health Disorders among Children and Associated Parental Stress: A Cross-Sectional Study in Pediatric OPD of Burdwan Medical College, West Bengal.

Background: Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents. Materials and Methods: It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July-December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23. Results: The median age of the children was 7 years (5-8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1-5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7-8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3-27.2) were significant correlates of AMHD. Parental stress [median: 60 (55-63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others. Conclusion: The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action.

Epithelial myoepithelial carcinoma of the parotid gland with high-grade transformation.

A woman presented with a painless swelling in front of her right auricle, which, on examination, seemed to be a hard, immobile mass arising from the right parotid gland. CT scan showed a heterogeneously enhancing mass lesion in the superficial lobe of the parotid gland with partial extension into the deep lobe. Fine needle aspiration cytology suggested a high-grade transformation (HGT) with the presence of bizarre tumour cells. She underwent a right-sided total parotidectomy with transient facial neuropraxia in the postoperative period. The final pathological diagnosis of the specimen came out to be epithelial myoepithelial carcinoma with HGT, which is a relatively rare entity, with no defined guidelines for management. Our patient was managed by surgical resection alone without any postoperative radiation therapy, and short-term follow-up results seem to suggest no recurrence.

Post-COVID-19 Intestinal and Mesenteric Mucormycosis.

A thirty-eight-year-old uncontrolled diabetic with a recent COVID-19 infection presented with extensive bowel ischemia and gangrene with a microscopic diagnosis of intestinal and mesenteric mucormycosis. Although there are a few reported cases of primary gastrointestinal mucormycosis, our case showing involvement of the intestine and/or mesentery, that too in a post-COVID patient, is quite uncommon. The immunosuppressive effect of the COVID-19 disease, uncontrolled diabetes, and the use of corticosteroids for the treatment of severe COVID are the most probable reasons for the emergence of severe opportunistic infections, both as a coinfection and as a sequalae to COVID.

Mortality from fall: A descriptive analysis of a multicenter Indian trauma registry.

INTRODUCTION: Fall is the second most common mechanism of trauma worldwide after road traffic injuries. Data on fall predominantly comes from the high-income countries (HICs) and mostly includes injuries in children and elderly. There are very few studies from low- and middle-income countries(LMICs) that describe fall related injuries other than fragility fractures in elderly. This study describes the profile of poly-trauma patients admitted with a history of 'fall' and assesses the variables associated with mortality. METHOD: We analyzed data from the 'Towards Improved Trauma Care Outcome' (TITCO) database which prospectively collected data of poly-trauma patients admitted to four major tertiary care hospitals of India between 2013 to 2015. Patients across all age groups admitted to hospital with the history of 'fall'; were included in our study. Single bone fractures were excluded.  The Kaplan Meier survival analysis was used to estimate the survival probability in different age groups. RESULTS: A total of 3686 patients were included in our study. The median age of the patients was 28 years (IQR: 9, 47) with the majority being males (73.6%). Almost one-third of the patients were within the age group of 0-14 (30.4%). Most of the patients (79.9%) had a diagnosis of traumatic brain injury (TBI). The overall in-hospital mortality was 18% (664), but higher at 39.0% among patients over 65 years of age. Probability of survival decreased with increase of age. CONCLUSION: Falling from height is a common injury mechanism in India, occurring more in young males and usually associated with TBI. Isolated TBI and TBI associated with other injuries are the main contributors of mortality in fall injuries. Mortality from these injuries increased with age and ISS.

Are home environment injuries more fatal in children and the elderly?

INTRODUCTION: 'In-home injuries' are those that occur within the house or its immediate surroundings. The literature on the prevalence and magnitude of home injuries is sparse. This study was designed to characterize the mechanisms of 'in-home' injuries and compare their outcomes with 'outside home injuries'. MATERIALS AND METHODS: The Australia-India Trauma Systems Collaboration (AITSC) Project created a multicentric registry consisting of trauma patients admitted at four urban tertiary care hospitals in India from April 2016 to March 2018. This registry data was analysed for this study. All admitted patients except for dead on arrival were included. Patients were categorised into 'in-home' and 'outside home' cohorts based on the place where the trauma occurred. The outcome measures were 30 day in-hospital mortality and the length of hospital stay. Two subgroup analyses were performed, the first comprised pediatric patients (<15 years) and the second elderly patients >64 years). RESULTS: Among 9354 patients in the AITSC data registry, 8398 patients were included in the study. Out of these, 29 percent were in-home injuries, whereas the rest occurred outside home. The 30 day in-hospital mortality was 10.6 percent in the 'in-home' cohort, as compared to 13.7 percent in the 'outside home' cohort. This difference although significant on univariable analysis (p <0.01), there was no significant difference on multivariable regression analysis, after adjusting for age and injury severity score (OR = 0.88, 95% CI = 0.73-1.04; p = 0.15). The length of hospital stay was shorter in the home injuries group (median = 5 days; IQR = 3-12 days) compared to the outside-home group (median = 7 days; IQR = 4-14 days) (p < 0.01). In the pediatric and the elderly, on multivariable regression analysis, in-home injuries were associated with higher mortality than outside home injuries. CONCLUSION: There was no significant difference in the 30 day in-hospital mortality amongst admitted trauma patients sustaining injuries at home or outside the home. However, in pediatric and elderly patients the chances of mortality was significantly higher when injured at home.

Validation of the adapted clavien dindo in trauma (ACDiT) scale to grade management related complications at a level I trauma center.

Objectives: Complications during trauma management are the main factor responsible for the overall increase in treatment cost. There are very few grading systems to measure the burden of complications in trauma patients. A prospective study was conducted using the Adapted Clavien Dindo in Trauma (ACDiT) scale, with the primary aim of validating it at our center. As a secondary aim, it was also wanted to measure the mortality burden among our admitted patients. Material and Methods: The study was conducted at a dedicated trauma center. All patients with acute injuries, who were admitted, were included. An initial treatment plan was made within 24 hours of admission. Any deviation from this was recorded and graded according to the ACDiT. The grading was correlated with hospital-free days and ICU-free days within 30 days. Results: A total of 505 patients were included in this study, with a mean age of 31 years. The most common mechanism of injury was road traffic injury, with a median ISS and NISS of 13 and 14, respectively. Two hundred and forty-eight out of 505 patients had some grade of complication as determined by the ACDiT scale. Hospital-free days (13.5 vs. 25; p <0.001) were significantly lower in patients with complications than those without complications, and so were ICU-free days (29 vs. 30; p <0.001). Significant differences were also observed when comparing mean hospital free and ICU free days across various ACDiT grades. Overall mortality of the population was 8.3 %, the majority of whom were hypotensive on arrival and required ICU care. Conclusion: We successfully validated the ACDiT scale at our center. We recommend using this scale to objectively measure in-hospital complications and improve trauma management quality. ACDiT scale should be one of the data points in any trauma database/registry.

Exploring challenges of teenage pregnancy and motherhood from beneficiaries and providers' perspectives: A qualitative study in a rural area of Purba Bardhaman District, West Bengal.

Context: Teenage pregnancy and motherhood are globally important public health concerns. In India, 6.8% women between 15 and 19 years were already mothers or pregnant, whereas in Purba-Bardhaman district of West Bengal it was 21.9% (National-Family-Health-Survey-5). Challenges of teenage pregnancy and motherhood needs to be understood from beneficiaries' and providers' perspectives. Aims: This study aimed at exploring the various challenges faced by teenagers during their pregnancies and motherhood and understanding the barriers of service delivery to them in a block of West Bengal. Settings and Design: A qualitative study with phenomenological approach was conducted between January and June 2021 in Bhatar community development block of Purba-Bardhaman district, West Bengal. Methods and Material: In-depth interview (IDI) of 12 purposively selected teenage mothers and two sessions of Focus Group Discussions (FGDs) among 17 Auxiliary Nurse Midwives (ANMs) were conducted. Data was collected by audio recording the IDI and FGD sessions as well as by taking notes. Analysis Used: Inductive thematic analysis was done by using NVIVO software (Release 1.0, QSR International). Results: Throughout teenage pregnancy and motherhood, subjects were found to face various types of medical problems, lack of awareness, and non-supportive family environment. Various social constraints and psychosocial stressors emerged as significant challenges. Communication gaps, behavioural barriers, socio-cultural issues, and administrative issues were major themes emerged as barriers of service delivery. Conclusions: Lack of awareness and medical problems were important challenges faced by the teenage mothers whereas behavioural barriers were the most important service level barriers perceived by the grass root level service providers.

Superconductivity assisted change of the perpendicular magnetic anisotropy in V/MgO/Fe junctions.

Controlling the perpendicular magnetic anisotropy (PMA) in thin films has received considerable attention in recent years due to its technological importance. PMA based devices usually involve heavy-metal (oxide)/ferromagnetic-metal bilayers, where, thanks to interfacial spin-orbit coupling (SOC), the in-plane (IP) stability of the magnetisation is broken. Here we show that in V/MgO/Fe(001) epitaxial junctions with competing in-plane and out-of-plane (OOP) magnetic anisotropies, the SOC mediated interaction between a ferromagnet (FM) and a superconductor (SC) enhances the effective PMA below the superconducting transition. This produces a partial magnetisation reorientation without any applied field for all but the largest junctions, where the IP anisotropy is more robust; for the smallest junctions there is a reduction of the field required to induce a complete OOP transition ([Formula: see text]) due to the stronger competition between the IP and OOP anisotropies. Our results suggest that the degree of effective PMA could be controlled by the junction lateral size in the presence of superconductivity and an applied electric field. We also discuss how the [Formula: see text] field could be affected by the interaction between magnetic stray fields and superconducting vortices. Our experimental findings, supported by numerical modelling of the ferromagnet-superconductor interaction, open pathways to active control of magnetic anisotropy in the emerging dissipation-free superconducting spin electronics.

Developmental delay among children under two years of age in slums of Burdwan Municipality: A cross-sectional study.

CONTEXT: Development is an ongoing process through which an individual acquires competence to function adequately. Developmental delay is said to occur when a child fails to reach the age-appropriate anticipated milestones. This imparts long-term direct as well as indirect effects on the health of a community obviating routine measurement of its prevalence especially in high-risk populations. AIM: To find out the prevalence and correlates of developmental delay among children under two years of age in slums of Burdwan Municipality, West Bengal. SETTINGS AND DESIGN: A community-based descriptive cross-sectional study. METHODS AND MATERIALS: This study was conducted between September-November 2019 among 240 study subjects selected by multistage simple random sampling. Data were collected by interviewing the respondents using a predesigned, pretested schedule. Developmental status was assessed by applying Trivandrum Developmental Screening Chart (TDSC). Chi-square test and logistic regression was done to find associations. RESULTS: Prevalence of developmental delay was 6.6%(95%CI 3.6-9.8) and proportion was more among male infants. Chi square test revealed gender (p = 0.03), mothers' education (p = 0.00), socio-economic status (p = 0.00), parity (p = 0.02), birth spacing (p = 0.01) birth weight (p = 0.00) to be significantly associated with developmental delay and multivariable analysis showed all the factors to be significant predictors except gender, parity and birth spacing. Gestational duration, maternal age at delivery, mode of delivery was not found to be significantly associated with developmental delay. CONCLUSION: Developmental delay is considerably high in the study area. A larger study using appropriate tool and follow-up may elicit the burden and associated determinants.

Identification of pleiotropy at the gene level between psychiatric disorders and related traits.

Major mental disorders are highly prevalent and make a substantial contribution to the global disease burden. It is known that mental disorders share clinical characteristics, and genome-wide association studies (GWASs) have recently provided evidence for shared genetic factors as well. Genetic overlaps are usually identified at the single-marker level. Here, we aimed to identify genetic overlaps at the gene level between 7 mental disorders (schizophrenia, autism spectrum disorder, major depressive disorder, anorexia nervosa, ADHD, bipolar disorder and anxiety), 8 brain morphometric traits, 2 cognitive traits (educational attainment and general cognitive function) and 9 personality traits (subjective well-being, depressive symptoms, neuroticism, extraversion, openness to experience, agreeableness and conscientiousness, children's aggressive behaviour, loneliness) based on publicly available GWASs. We performed systematic conditional regression analyses to identify independent signals and select loci associated with more than one trait. We identified 48 genes containing independent markers associated with several traits (pleiotropy at the gene level). We also report 9 genes with different markers that show independent associations with single traits (allelic heterogeneity). This study demonstrates that mental disorders and related traits do show pleiotropy at the gene level as well as the single-marker level. The identification of these genes might be important for prioritizing further deep genotyping, functional studies, or drug targeting.

Contraceptive behavior and unmet need among the tribal married women aged 15-49 years: A cross-sectional study in a community development block of paschim Bardhaman District, West Bengal.

BACKGROUND: Contraceptive behavior and unmet need for family planning, particularly among the tribal women of reproductive age in India, still remains a public health concern. This needs to be explored in different geographical regions. OBJECTIVES: : This study aimed to ascertain the contraceptive behavior of tribal married women of 15-49 years and to assess the unmet need for family planning and its determinants. METHODS: : A descriptive, cross-sectional study was conducted during May 2019 to April 2020 in Barabani Block of Paschim Bardhaman District, West Bengal. A calculated sample of 530 study participants was selected from the study area by the simple random sampling. Required data on contraceptive behavior characteristics, unmet need, and correlates were collected by interviewing them with a predesigned schedule. Bivariate analysis and multivariable logistic regression were done. Data were analyzed using the SPSS software v. 20. RESULTS: : All study participants were Hindu and belonged to Santhal ethnicity; 53.4% were illiterate; 51.7% had early marriage, and 52.4% had adolescent pregnancy. Only 41.1% women were found currently using any contraceptives, another 14.5% ever used and 44.4% never used any methods. Apprehension of side effects and spouse disapproval were reported as two common reasons for never using contraceptives. The age of the women appeared as a significant predictor of current contraceptive use. Overall, unmet need for family planning was 19.4% and age of the women, socioeconomic status, and type of the family were found as significant predictors. CONCLUSION: Issues contributing to unsatisfactory contraceptive behavior and high unmet need for family planning need to be addressed appropriately.

Status of salt iodization, related awareness and practice at the household level in slums of Burdwan Municipality, West Bengal.

BACKGROUND: Monitoring adequacy of salt iodization at consumption level and exploring the reasons for inadequacy, especially in marginalized communities, is crucial to achieve the target coverage of universal salt iodization. AIMS: To assess the iodine content of salt used at household level, related awareness and practice of respondents and their socio demographic correlates. SETTINGS AND DESIGNS: This cross-sectional descriptive study was conducted in the slums of Burdwan Municipality in 2019. METHODS AND MATERIAL: A total of 330 households were selected by cluster sampling. Salt iodine content was estimated at household level semi-quantitatively by Iodine testing kit, following recommended guidelines. One respondent from each household was interviewed to assess their awareness and practice regarding iodized salt. Kruskal Wallis test, Mann Whitney U test and Multivariable logistic regression was used. RESULTS: All 330 households were using iodized salt; 77.6% were consuming adequately iodized and 22.4% were consuming inadequately iodized salts. Only 30.9% of the respondents were aware about the importance of iodized salt, few had correct practice despite inadequate knowledge and none, except one, practiced adding salt at the end of cooking. Awareness and practice were associated with caste and age of the respondents, respectively. Keeping salt container near the oven, adjusting for keeping salt in uncovered container, significantly predicted inadequate level of iodization [AOR 6.17 (95% CI: 2.68-14.26)]. CONCLUSION: Inadequate iodization, lack of awareness regarding iodized salt and faulty storing practices amounting to increased risk of inadequate iodization are still prevalent emphasizing the need, in policy, for health education.

Strain driven emergence of topological non-triviality in YPdBi thin films.

Half-Heusler compounds exhibit a remarkable variety of emergent properties such as heavy-fermion behaviour, unconventional superconductivity and magnetism. Several of these compounds have been predicted to host topologically non-trivial electronic structures. Remarkably, recent theoretical studies have indicated the possibility to induce non-trivial topological surface states in an otherwise trivial half-Heusler system by strain engineering. Here, using magneto-transport measurements and first principles DFT-based simulations, we demonstrate topological surface states on strained [110] oriented thin films of YPdBi grown on (100) MgO. These topological surface states arise in an otherwise trivial semi-metal purely driven by strain. Furthermore, we observe the onset of superconductivity in these strained films highlighting the possibility of engineering a topological superconducting state. Our results demonstrate the critical role played by strain in engineering novel topological states in thin film systems for developing next-generation spintronic devices.

Status of Comprehensive Abortion Care Service in Paschim Bardhaman District, West Bengal - A Mixed-Method Study.

BACKGROUND: Delivering quality comprehensive abortion care (CAC) service, accessible and affordable to all care seekers, at every tier is essential to reduce maternal morbidity and mortality. OBJECTIVES: The study aimed to assess the infrastructural availability of the health facilities, describe beneficiary characteristics, and to explore constraints in CAC service provision from the providers' perspectives. MATERIALS AND METHODS: A mixed-method study was conducted during December 2019 to February 2020 in Paschim Bardhaman District, West Bengal. All 10 public health facilities of the district providing CAC services were visited for infrastructural assessment. Record review of all care seekers from 2015 to 2018 was done to assess their characteristics. In-depth interview of the administrative heads of facilities and district level program officers was done to explore constraints faced in service provision. Quantitative data were analyzed by SPSS version 20, and qualitative data were analyzed thematically using NVivo software. RESULTS: Physical infrastructure was adequate in only 40% of the facilities; however, drugs and contraceptives were universally available. About 49.5% of the care seekers had induced abortion; 63.5% underwent manual vacuum aspiration; 21.5% did not return for follow-up, and only 50% adopted postabortal contraception. Major issues explored were lack of trained manpower, logistics and physical infrastructure, and inadequate supervision and monitoring. CONCLUSION: The study highlighted gaps in preparedness of the health facilities for the provision of quality CAC services including some major constraints from the provider's perspectives.