The Nodovenous Shunt and Reduction Surgery for Post-Filarial Lymphedema-Surgical Technique and Clinical Outcomes.

Background Most of the patients in our Indian setting present with grade 4 lymphedema in which no other surgical option is available and in these debilitating cases the nodovenous shunt followed by reduction surgery provides acceptable outcomes. We would like to describe the surgical technique used for the nodovenous shunt procedure and debulking surgery done in post-filarial lymphedema and share our experience with clinical outcomes. Materials and Methods This was a descriptive study. The study period was from 2010 to 2019. Patient records were reviewed retrospectively, and the data was analyzed. All patients with post-filarial lymphedema, operated by two surgeons, were studied. The surgical technique was described. Results In the study period, 16 patients with lymphedema were treated surgically. The number of procedures done was 32. In 14 of them nodovenous shunt followed by debulking surgery was done. Two of the patients with post-filarial lymphedema had multiple nodules following secondary skin changes and in them sculpting surgery was done following the nodovenous shunt. Most of the patients presented with grade 4 lymphedema. In all the patients there was significant (>5 cm) reduction in limb circumference postoperatively. Conclusion Nodovenous shunt followed by reduction surgery for lymphedema is a reliable surgical option to reduce disease morbidity in patients with post-filarial lymphedema.

Exploration of dietary diversity and its associated factors among infant and young children in Rural Tamil Nadu - A mixed-method study.

BACKGROUND: A child receiving an acceptable diet is expected to reach the optimal anthropometric measures. More than 60% of dietary requirement has to be met through complimentary diet. OBJECTIVES: This aimed to estimate the prevalence of dietary diversity and to assess factors associated with it from caregivers' perceptions by quantitative and qualitative participatory techniques. METHODS: A mixed-method study comprising community-based cross-sectional quantitative and participatory rural appraisal qualitative components was conducted in 25 villages from the field practice area of medical institute in South India during 2017. Caregivers of eligible children 6-23 months from villages were interviewed regarding various food groups consumed in the last 24 h using a validated checklist. Association of demographic-, child, and mother-related characteristics with inappropriate dietary diversity was identified using multivariate negative log-binomial model. RESULTS: Of the 603 eligible children, 75.1% had inappropriate dietary diversity. Although inappropriate dietary diversity prevailed across all categories, mothers with less than primary education (adjusted prevalence ratio [PR]: 1.26) children <1 year (adjusted PR: 1.29) and not on current breastfeeding (adjusted PR: 1.15) had significantly more inappropriate diversity. Restraining and motivating forces for dietary diversity were initially recorded from free listing and subjected to force-field analysis. Ignorance, lack of literacy, affordability issues, nuclear family pattern, and influence of junk foods are restraining forces. CONCLUSION: Inappropriate dietary diversity among 6-23 months children in the rural block of Tamil Nadu, South India, is extensive (75%). Current Child development programs should focus to address these issues based on these identified contextual factors.