Comparative study on menstrual disorders in post-tubal ligated and non-ligated women.

Background: The term post-tubal sterilization syndrome has been used variously to include abnormal menstrual bleeding, pre-menstrual dysmenorrhea distress, hysterectomy, and miscellaneous other conditions like the need for recanalization, the feeling of regret, and menopausal syndrome. Objectives: To compare the menstrual disorders in post-tubal ligated and non-ligated women and also to compare the histopathology of endometrium in both post-tubal ligated and non-ligated groups in order to compare the menstrual disorders. Materials and Methods: It is a comparative cross-sectional study on 200 women between 30 and 50 years, divided into two groups and further into two sub-groups in each group. Group 1 includes cases (post-tubal ligated), and group 2 includes controls (non-tubal ligated); sub-group I includes patients with abnormal uterine bleeding (AUB), and sub-group II includes patients without AUB. Data were recorded using standard performa along with investigations and detailed examination. Results: In the case group (post-tubal ligated), maximum patients of 39.22% were having polymenorrhea and 29.41% patients had menorrhagia, whereas in the control group (non-tubal ligated), maximum patients of 38.78% had polymenorrhea and 30.61% had menorrhagia, respectively. However, the difference is statistically non-significant (P value = 1.00). Conclusion: Our study suggests that the incidence of menstrual disorders did not differ significantly with tubal ligation. The patients worried about the effects of tubal ligation on their future life that must be counseled and that tubal ligation has no adverse effect on their life including their menstrual pattern. The findings of the study help family physicians in educating the clientele. We also recommend large studies with multiple centers so as to give statistically significant findings of associations.

Study of aggression and its factors among school going adolescents of Delhi, India.

Background: Adolescence is an important developmental phase of life associated with various ideas and emotions filled with energy, many times spent in the form of aggressive behavior. Mental Health, as an important part of healthy well-being, cannot be ignored, and hence it becomes imperative to study aggression and associated factors among adolescents. Objective: To determine the prevalence of aggression among school-going adolescents and to study factors associated with aggression amongst study participants. Materials and Methods: A cross-sectional study was conducted using a self-administered semi-structured questionnaire having questions regarding socio-demographic data, details of friends, history of substance use etc. and the Buss and Perry Aggression Questionnaire (BPAQ). Data were analyzed using appropriate statistical tests. Ethical clearance was obtained from the Institutional Ethics Committee of Safdarjung Hospital, and informed written consent was taken from participants. Results: The study involved a total of 463 school-going adolescents with a mean age of 13.78 ± 2.06 years. More than half (50.5%) of the participants were found to be aggressive. Male gender, history of family member ever jailed, parent's argument in front of them, ever tried cigarette/smoking, being involved in some fight and provocation by friends for aggression were the factors found to be significantly associated with aggression. Conclusion: The prevalence of aggression among school-going adolescents of Delhi was quite high. There is a need to make the students aware about aggression and how to deal with it. A holistic approach may be adopted in which all authorities and stakeholders must work together to provide safer and nurturing environment to all students.

HIV positive children living in orphanages and home care: Assessment of nutritional deficiencies and opportunistic infections.

Objectives: With the introduction of antiretroviral treatment (ART), opportunistic infections (OIs) reduced a lot and most HIV-associated OIs are preventable and treatable with safe cost-effective interventions. But however, in order to prevent and early diagnosis, we need to have baseline estimation of OIs among HIV positive children and other factors associated, especially nutritional deficiencies. Methodology: A cross-sectional study was carried out in pediatric outpatient department (OPD) of a large multicentric hospital among 106 children. Data were collected by means of pretested predesigned semi-structed questionnaire prepared on consultation with experts in the subjects and clinical assessment was done in day light to detect signs of nutritional disorders. Institutional ethical clearance was taken, and strict confidentiality was maintained. Results: Majority (39.6%) of the children belong to 5-9 years. Children were equitably distributed between orphanage and family care giver. Bitot's spots, cheilosis, and gum bleeding were found to be more than twice as common in subjects living with family, as compared to those living in orphanage while aphthous ulcer, knock knee, bow leg were found to be more than twice as common in female subjects as compared males. The prevalence of Pneumonia, Mumps, Herpes zoster, Pulmonary Tuberculosis, Oral candidiasis, and recurrent upper respiratory tract infections (URTI) was found to be about twice as common in subjects living with family, as compared to those living in orphanage while males had more Chicken pox, Herpes zoster, Pulmonary Tuberculosis, Oral candidiasis, and Recurrent URTI as compared to those in females. Conclusion: Vitamin deficiencies and opportunistic infections were higher than the prevalence reported by the various studies done on normal children. All efforts to be made to improve adequate nutrition to HIV positive children and ensure protection against opportunistic infections especially for children in home-based care.

Water, sanitation, and hygiene (WaSH) practices among people living with HIV/AIDS (PLHA) - need to relook, in the era of COVID-19 pandemic.

Background: Water, sanitation, and hygiene (WaSH) practices always have been neglected among HIV/AIDS (Human immunodeficiency virus/ Acquired immunodeficiency syndrome) programs, even when HIV and WaSH services have robust bearing on each other. With COVID-19 pandemic on the go, it is utmost necessary for the people living with HIV/AIDS (PLHA) to ensure adequate WaSH practices. Objective: This study was carried out with an objective to assess baseline WaSH practices among PLHA and to find out if any association between nutritional status and WaSH parameters so as to identify the shortcomings and highlight the importance of WaSH practices among PLHAs and give suitable recommendations to program managers. Methodology: A cross-sectional study was carried out among PLHA registered in ART centres of western Maharashtra. A sample size of 378 consented to be part of the study were included in the study, by means of systematic random sampling. Data were collected by means of pretested questionnaire prepared from guidelines and previous studies. Institutional ethical clearance was obtained and informed consent was taken from study participants before data collection. Strict confidentiality was maintained throughout the study period. Results: When asked about the water processing method, 76% of them told they do not treat/process the water supplied to them. In contrast, only a few PLHA told they would filter (17%), boil (7%), and use aquaguard (1%). The majority (67%) had their latrines, and while 29% of them were using public latrines and its hygienic sanitation was a concern for them and 4% were still practising open-air defecation in rural areas. Almost all study participants were handwashing after toilet use and handwashing before consuming food. The majority (79%) told they used soap and water, while 20% were using only water, soil and water (1%) and ash and water (1%) which was a concern. Of all the households, 87% cooked their food twice and consumed it thrice a day, while 4% prepared thrice. 10% of them cooked only once and consumed thrice a day; 56% practised consumption of leftover food of the previous night which was a concern. A majority (54%) did not consume street food while remaining said that they used to consume street food. But majority (59%) said they did not follow the habit of checking hygiene or sanitation of hotel where they used to consume food while the remaining 41% did not check the hotel before ordering the food; 50% of them bought packaged milk while 40.9% brought from unpasteurized dairy. On analysis, hygiene and sanitation factors had no statistically significant association with the nutritional status of study participants. Conclusion: WaSH factors act synergistically with other factors to affect the holistic health of PLHA. Information, Education and Communication (IEC) activities (continuous and regular), that focus on improving awareness level on WaSH practices, need to be promoted and integrated into HIV program, including providing basic care packages to PLHA like household water treatment products and soap, etc., Such measures will go a long way in maintaining health of PLHA even during ongoing COVID-19 pandemic scenario.

Knowledge and practices of bioethics - Need for periodic assessment and reinstatement for budding family physicians.

Objective: The study has been designed to assess the knowledge of ethics amongst young students and professionals, and practices of health care ethics among medical professionals in a government teaching hospital in India. Methodology: A cross-sectional study was carried out at one of the teaching hospitals in Southern India with a sample size of 84 among fresh medical graduates, post-graduate trainees, and young consultants with work experience of 6 months to 8 years. The data were collected by means of a structured and validated questionnaire, and the questionnaire was administered before and after a lecture/seminar on ethical principles, and results were analyzed using SPSS software. Results: The maximum participants were in the age group of 20 to 24 years with 0-2 years of clinical experience. The basic awareness and practices before the workshop were quite less when compared to after the workshop which showed a very good improvement in the correct responses to the questions. The maximum change seen, reflected in curiosity to learn bioethics. The workshop was an eye-opener for many participants in terms of the Nuremberg Code and its origin. The ethics committee was an alien concept to many participants, and it was reflected in the response postworkshop. The students felt a strong need to discuss ethics and implement them postworkshop. The segment on attitudes in clinical practice showed an impact on autonomy and truth-telling (32% to 50%). The segment on ethical practices reflected a confused audience. The increase in sensitivity to police information, and the concept of error of judgment and negligence were positive. The fact that medical practitioners are legally bound to help accident victims showed a positive response. Conclusion: Based on the assessment of pre-and post-workshop, there is a strong need to stress the ethical principles and revision of these ideas from time to time. Workshops and interactive sessions are a good way for periodic assessment and reinstatement of these values in our research and clinical practice. Thus, these should be part of the curriculum across all educational institutions for budding primary care providers and family physicians.

A rare case of spontaneous heterotopic pregnancy with intrauterine gestational trophoblastic neoplasia and tubal ectopic pregnancy at a remote secondary care hospital.

A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.

A study of clinical pattern and seasonal variation of dermatoses in children: Contemplating findings for family physicians.

Introduction: Pediatric skin disorders are different from the adult type in their presentations, types, treatment and prognosis. Their presentation varies from place to place. Aim: To study the different clinical pattern and seasonal variation of dermatoses in children attending a multispecialty hospital in Uttar Pradesh. Materials and Methods: This study was conducted among 640 children who attended the OPD of multispecialty hospital over a period of one year. All children up to 10 years of age with cutaneous presentations were included in the study. Results: Study showed that there was a male preponderance among the study participants. According to the age group, school-aged children (6-10 years) constituted the highest percentage (53%) followed by toddlers or pre-school children (41%). The most common skin conditions were infections (47%) followed by eczematous group (31%) of disorders. Among the infections, the most common infections were fungal - 35.64% (107) followed by parasitic infection (31%), viral infections (20%) and then bacterial infections (12.5%). Out of total eczematous dermatoses, Atopic dermatosis was maximum in number (61; 30%). This was followed by pityriasis Alba (47; 23.15%), and acute eczemas (32; 15.76%). Third most common dermatosis was Appendageal disorder (33; 5.15%). It included 15 cases of miliaria i.e. approximately 45.45%. Seventeen (2.65%) children reported for treatment of different kind of nevi. Pigmentary disorders were seen in 16 cases (2.5%). Three nutritional disorders were also seen. Season wise, most of the cases were seen in monsoons (June to October). Conclusions: Dermatoses is very common in children in the western region of Uttar Pradesh. The largest group was formed by infections followed by eczemas. Few cases increased in number depending upon the weather like fungal and bacterial infections, acne, miliaria in summers and xerosis, scabies in winters. This variation strongly suggests that weather has a very important role. Thus various measures including health education programs to be initiated to control and prevent the sudden spread of the diseases. Thus, Primary care providers and family physicians being the first responders should always keep in mind the seasonal variations while dealing with dermatosis in children.

Intussusception - A common entity but seldom diagnosed (lesson learnt from case series for family physicians).

Intussusception is one of the common causes of acute abdomen in paediatric age bracket with ileocolic type being the most prevalent. This happens when a proximal segment of bowel (intussusceptum) telescopes into the lumen of the adjacent distal segment (intussuscepiens). Here we report six cases of intussusception in which five were in paediatric age group and one was adult. All children were admitted, resuscitated well, USG abdomen was done to confirm the diagnosis, written and informed consent for surgery and anaesthesia, was taken from parents. However, all were managed successfully by hydrostatic saline reduction under sedation. Only one child had recurrence after one year who was again treated conservatively. Adult case was managed by means of laparotomy by excision of benign polyp being the pathological lead point. We present this case series to analyse the spectrum of presentation, diagnostic and therapeutic options available with review of literature. Since primary care providers and family physicians are first responders, this case series would help them for differential diagnosis and prompt referrals for further management.

Comparison of nutritional status of HIV positive children with homecare and institutional care/ orphanage - An eye opener cross sectional study.

Background: Nutrition has an important bearing on the health of Human immunodeficiency virus (HIV) positive children. Ascertaining the nutritional demands correctly and provisioning the nutritional needs to HIV positive/ Acquired Immunodeficiency syndrome (AIDS) children will go a long way in maximizing the therapeutic benefits reaped through ever improving pharmaceutical initiatives, and thus, contribute to prolonging the longevity of these children who have a whole life ahead of them. Objectives: To study the nutritional status, including dietary assessment and anemia status of HIV-positive children, and compare the outcomes among children under homecare (staying with families) and orphanages/institutional care. Methodology: A cross sectional study was carried out among children between 2 and 15 years who were attending Pediatric Outpatient department (OPD) of a tertiary care hospital in western Maharashtra. Data were collected from 106 children by the interviewer himself using pretested validated questionnaire along with anthropometric measures and relevant blood tests. A 24-h recall method was used to collect the dietary intake. Institutional ethical clearance was taken, and data were collected through informed consent of the parent/guardian accompanying the children. Results: Out of the 106 subjects studied, 54 (50.9%) were living in orphanages and 52 (49.1) were living with the family. Out of the 52 subjects of children under caregivers, 48.1% of the caregivers were unskilled workers and more than half of the subjects had a monthly family income of less than Rs 3,000. About 46.1% of the subjects' caregivers were illiterate. In the orphanage, 28 (51.8%) were males and 26 (48.2%) were females; 52 (49.1%) children were living with family of whom 30 (57.7%) were males and 22 (42.3%) were females. The prevalence of anemia (86.5%) and undernutrition (61.1%) was more among those living with family compared to the orphans living in orphanages and the same was statistically significant (P < 0.05). Among the children living in orphanages, the mean intake for most of the nutrients was more across all age groups. Within homecare, the mean nutrient intake of the females for all nutrients was more than the males across all age groups except 3-9 years, where it was more in males. Overall, all the children received less of water-soluble vitamins compared to recommended daily allowances (RDA), and the children of age group 5-15 years received less vitamin A and iron also. Conclusion: Adequate nutrition, which is best achieved through the consumption of a balanced healthy diet, is vital for health and survival for all HIV-infected children. Specific measures to be directed to children under homecare and measures directed to improve social factors need to be undertaken.

Non-communicable disease risk factors among people living with HIV/AIDS (PLHA) - A relook during the covid-19 pandemic.

Background: The Covid-19 pandemic has resulted in syndemic due to factors like overcrowding, loneliness, poor nutrition, and lack of access to health care services. With the ongoing pandemic, people with NCDs, including PLHA, are at high risk for developing severe and even fatal Covid-19 infections. Our study, which was carried out prior to the pandemic gives us an insight into the NCD risk factors profile of PLHAs so that effective interventions could be initiated to protect them from Covid-19 severity and NCDs. Materials And Methods: A prospective study was carried out among PLHA in western Maharashtra, where PLHA were selected from five ART centers by means of a systematic random sampling method. Data were collected by means of a pretested questionnaire to assess NCD risk factors and anthropometric measurements were done. Data were collected at the baseline during the time of ART initiation and then after one year. Analysis was done by means of SPSS software (version 20.0). Results: The mean age of the study participants was 41.73 years. 59% belonged to rural areas, 21% were illiterate, and 12% belonged to the lower class as per the Modified BG Prasad scale. 33% were laborers by occupation, 66% were married, and 22% were widowed. At baseline, during the start of ART, 26% of the subjects were found to be overweight or obese, 36% had tobacco or smoking habits, and 15% had alcohol consumption habits. Even after one year, despite repeated counseling, about 32% of the subjects were found to be overweight or obese, 28% had tobacco and 8% had alcohol consumption habits, pointing to the need to integrate NCD prevention measures, such as screening routinely as per the national program, even in the PLHAs. 34% had normal BMI, while 35% were underweight, 14% overweight, and 17% obese after one year. 24% of PLHA had abnormal waist circumference at the end of one year. Conclusion: These findings indicate the incorporation of early screening for NCD risk factors among PLHA and effective behavior change communication (BCC) strategies to prevent and manage the same at the earliest before it can aggravate the already compromised immune status in these subjects, particularly during this Covid 19 pandemic. It will also act as a guiding article for family physicians or primary care physicians to help them look at specific basic parameters while screening of NCDs among PLHAs.