Tertiary Health Care Setup Research Articles

Barriers to efficient provision of healthcare facilities: An experience from a developing country.

Pakistan has nearly 200 million people, of which almost 20 million people live in Karachi, which has 17 tertiary care hospitals, and it is no secret that they are overburdened (1). Despite the healthcare workers’ competency, several issues hinder administering proper care in a tertiary healthcare setup. Firstly, spatial distancing-spatial access to facilities within a hospital also proves a challenge for patients. Patients have little idea regarding specific departments in a large tertiary care hospital due to low literacy rates compounded with a lack of health literacy. At times many patients have reportedly circled the hospital twice and can still not find their desired specialist. A study conducted in Delhi that closely matches Karachi in demographics suggested that patients with one-time visits to secondary care facilities had lower follow-up rates than those who were more familiar with the system (2). Patients may take time to acclimatize to healthcare setup when visiting as first-timers, and if found too challenging to adapt, they may not make an effort again. Unsurprisingly, this renders many facilities- the administration spends, sometimes a fortune, procuring- useless. Continuous...

Prevalence of Falls and Fractures in Alzheimer's Patients Compared to General Population.

IntroductionAlzheimer’s disease (AD), found in the aging elderly population, is a progressive neurodegenerative disorder that leads to worsening memory loss and cognitive impairment. Falls and fractures are common in the overall elderly population. Hence, the purpose of this study is to determine the prevalence of falls and fractures in Alzheimer’s patients compared to the general population.MethodologyThis longitudinal study was conducted at the neurology outpatient department (OPD) in a tertiary healthcare setup in Pakistan from November 2019 till April 2020. Previously confirmed diagnosed Alzheimer’s patients from neurology OPD were included in one group. Equal number of gender and age-matched healthy participants were included in the reference group. Participants were followed for 12 months to determine the incidence of falls and non-vertebral fractures.ResultsThe incidence of fall was significant in the Alzheimer group compared to the reference group (22.8% vs. 10.9%; relative risk (RR): 2.08; P-value: 0.01). Fractures were also significantly more common in the Alzheimer group compared to the reference group (12.8% vs. 5.1%; RR: 2.51; P-value: 0.03).ConclusionThis study demonstrated a higher incidence of falls and fractures in Alzheimer’s patients compared to healthy non-Alzheimer individuals. Management of AD should include measures to reduce falls and fractures in addition to standard therapy.

Comparison between Device Closure and Surgical Method of Closure in Atrial Septal Defects in a Tertiary Health Care Setup

Comparison between Device Closure and Surgical Method of Closure in Atrial Septal Defects in a Tertiary Health Care Setup

A survey on management of hypertension by tertiary health-care physicians in Pune

Background: Hypertension poses a major public health challenge in India due to high prevalence and poor control. Outpatient care provided by tertiary healthcare setup plays key role in diagnosing and controlling hypertension as patients usually approach them first for any kind of ailment. Hence, awareness of physicians in such setups regarding the diagnosis, recent developments in pharmacotherapy of hypertension and comorbidities is of utmost importance. Therefore, this survey study was planned and conducted on physicians working in an outpatient facility in a tertiary health-care setup. Aim and Objectives: (1) Assessing the current knowledge of physicians regarding the diagnosis, investigations required and related pharmacological and therapeutic measures for dealing with hypertension as well as hypertension related comorbidities and (2) determining the necessity of familiarizing physicians with newer and advancing lines of management of hypertension. Materials and Methods: A cross-sectional observational study was conducted for a period of 6 months among 60 physicians from department of Medicine and Obstetrics and Gynaecology who treat patients of hypertension. Questionnaire about diagnosis, investigation, target blood pressure, and treatment based on Joint National Committee 8 and Indian Guidelines on Hypertension III guidelines as well as non-pharmacological measures and continued medical education programs was provided to them. After receiving filled questionnaire, physicians were assessed for their adequacy of knowledge by calculating their scores. Physicians whose score signified adequate knowledge were divided into two groups, that is, staff (professors, associate professors, and assistant professors) and resident doctors. Results were expressed as mean ± standard deviation and statistical significance was assessed using Mann–Whitney test. Results: Thirty-four physicians were shown to have adequate knowledge out of which 16 were staff doctors and 18 were resident doctors. Both the groups were comparable in their knowledge. All the physicians agreed to update the recent knowledge in treatments which will benefit the health of patients. Conclusion: Most of the physicians were seen to have adequate knowledge but still there was a requirement for boosting up the knowledge among physicians.

A clinical study on vocal cord paralysis in a tertiary health care setup in Andhra Pradesh, South India

Introduction: Vocal cords (VCs) are delicate structures situated in the larynx and controlled by a number of muscles. A study was conducted to elucidate the symptoms and signs of VC paralysis and to identify the muscles involved and various systemic illnesses that cause VC paralysis. Methods: It was a cross-sectional, clinical study, conducted in the department of ENT, GSL Medical College, Rajahmundry. Individuals aged 15 to 75 years, who were cooperative for clinical examination were considered. Extremes of age, unwilling, critically ill, persons with Pulmonary Tuberculosis, HIV positive individuals were excluded. Meticulous tabulation of the symptoms and a thorough history was recorded. Detailed ENT examination including indirect and video laryngoscopy was performed on these patients. Results: A total of 38 individuals with VC paralysis were included. Gender wise, the male-female ratio was 0.9. Left VC palsy was identified in maximum persons (63.2%). The age group of 41-60 years is common (47%). In left VC palsy, dyspnoea (31.6%) was most common. Among the etiological factors, lung lesions and idiopathic cases accounted for 23.68% each. Conclusion: Fourth to the sixth decade of life is the commonest age group, females are commonly involved. Left VC paralysis accounted for the maximum number of cases. Hoarseness of voice and dyspnoea are the major symptoms and in about 23.68% cause of paralysis was not known (idiopathic).

Evaluation of Individual Quality of Life (QOL) Among Patients with Tracheostomy Using WHO-QOL BREF Questionnaire.

Tracheostomy is one of the most frequently performed surgical procedures worldwide. The placement of tracheostomy in a patient is associated with significant morbidities as apart from the physical impact of the procedure, a profound and persistent effect on psychosocial, financial, environmental and other aspects of global health of the patient becomes inevitable. However, there is a surprising paucity of literature assessing the Quality of Life (QOL) in patients with tracheostomy tube placement. This study was undertaken with the objective to assess the effect of tracheostomy on Quality of Life (QOL) of patients in an urban tertiary health care setup in India. Patients who underwent tracheostomy tube placement irrespective of the indication were included in the study and followed up for a period of up to 3months to determine the effect of tracheostomy tube placement on the Quality of Life. A questionnaire based on World Health Organisation (WHO) QOL BREF scheme was utilized to evaluate QOL in the immediate post operative period and again appraised after a period of 3months. The results were statistically analyzed, tabulated and compared using paired t test to evaluate the 'p' value in every domain i.e., physical, social, psychological and environmental, of the WHO QOL-BREF evaluation tool. 63 patients were enrolled in the study after excluding the patients not fulfilling the selection criteria. The majority of patients were male over the age of 50years (mean age 57years). There was a noteworthy depreciation in QOL score in patients as WHO-QOL-BREF scores in all the 4 domains were significantly lower after 3months. The most affected were the Environmental domain (p value 5E-15) whereas the domain of Psychological showed least depreciation of mean QOL score (p value 7.7E-5). Insertion of a tracheostomy tube has a significant impact on the quality of life of the patient and the amount of burden increases with worsening quality of life. A holistic and scientific approach to assess and manage tracheostomy induced morbidity on the patient is necessary. The patients' views of the aspects of life should be used by health policy makers, clinicians, and caregivers as a reliable guide to the most important priorities for treatment and medical interventions. Large prospective multicenter studies may be undertaken for the developement of a standardized and internationally accepted tracheostomy specific quality of life evaluation tool.

Study of Effectiveness of IDRS as a Screening tool in OPD attending Adults at a Medical College Hospital in Central India

Introduction: Type 2 Diabetes Mellitus (T2DM) has established itself as a silent pandemic with devastating multiorgan involvement. The only way forward is to nip it at its bud by proactive screening at every available circumstance. There are many types of cost-effective screening tools available at national and international level. Indian Diabetic Risk Score (IDRS) developed by Madras Diabetes Research Foundation (MDRF) is one of them. The sensitivity of this simple non-invasive tool has been studied mostly in the Southern part of India. Aim: To study the screening accuracy of the IDRS among Outpatient (OPD) attending adults at a tertiary health care setup. Objective: To screen the OPD attending adults aged between18 -60 years for risk of T2DM by IDRS score and check its sensitivity and specificity by univariate, bivariate and Receiver Operating Characteristic (ROC) Curve analysis taking Random Blood Sugar (RBS) as control. Method: A cross-sectional study was carried out on OPD attending patients at a Medical college in central India. A total of 101 subjects were screened over a one-month period by purposive sampling method and their pertinent sociodemographic information along with RBS was collected in addition to IDRS data. Data coding and analysis was done in SPSS version 20. Result: The participants mean age was 38.65±12.54), literacy rate at (63;62.4%).and male representation at 56 (56.5%). The prevalence of high risk, moderate risk and low risk for diabetes among participants as per IDRS were found to be 19.8 %,55.4% and 24.8 % respectively. 11 subjects (10.89%) recorded a RBS levels ? 140 mg/dl. The area under the ROC curve was in the acceptable range (.7-.8). Fixing the IDRS core ? 35 (moderate risk zone) the predicted risk of T2DM had a sensitivity of 90% and specificity of 64%. Conclusion: IDRS may be considered as a viable screening method for OPD attending patients in central India for risk evaluation in asymptomatic cases. How to cite this article: Barjatya P, Mishra BN, Panwar NKS, Chouhan DS. Study of Effectiveness of IDRS as a Screening tool in OPD attending Adults at a Medical College Hospital in Central India. J Adv Res Med Sci Tech 2019; 6(3&4): 19-24. DOI: https://doi.org/10.24321/2394.6539.201908

A study to isolate various bacteria causing osteomyelitis in a tertiary health care setup

Introduction: Osteomyelitis (OM), an inflammation of bone or bone marrow caused by various infectious agents, can cause any age. With this, a study was taken to isolate various bacterial etiological agents that cause OM. Material and Methods: It was a laboratory-based study, conducted in the Department of Microbiology, GSL Medical College from June to Nov 2019. Individuals of all ages, both genders, clinically, radiologically confirmed cases of OM were included in the study. Bone, tissue, and swabs collected with utmost sterile precautions were considered, cultured as per the standard methods. Antibiotic susceptibility test was performed for various pathogenic isolates using Kirby Bauer disc diffusion method; P<0.05 was considered statistically significant. Results: During the study period a total of 72 samples were collected, 61 were culture positive (CP). Age-wise, maximum (18%) CP results were identified in 31-40 years of age group followed by 41-50 years group. Gram-negative rods were isolated maximum (59%) and Staph. aureus was the maximum isolate. Conclusion: OM can occur at any age and there is no gender difference. Staph. aureus was a common isolate followed by Pseudomonas.

Study of Prevelance and Pattern of Senserineural Hearing Impairment in Stage 5 Chronic Kidney Disease Patients on Haemodialysis- at a Tertiary Health Care Setup in India

Study of Prevelance and Pattern of Senserineural Hearing Impairment in Stage 5 Chronic Kidney Disease Patients on Haemodialysis- at a Tertiary Health Care Setup in India

Prevalence of cardiac dysfunction in type 2 diabetes in a tertiary health care setup

Introduction: Diabetes mellitus (DM) may be one factor that specifically influences cardiac diastolic function. The present study was designed to examine cardiac dysfunction in diabetes subjects with non-chronic renal failure (CRF). Materials and methods: Study was approved by Institutional ethics committee, Informed consent from the study subjects. Diagnosis of diabetes was made according to WHO criteria. Plasma glucose concentration, serum lipids (total cholesterol, triglycerides, LDL cholesterol and HDL plasma cholesterol concentrations) were measured as per standard procedures. Glycosylated hemoglobin (HbA1c) was estimated by ion exchange resin method. ECG recording was obtained for every subject to rule out ischemic heart disease. Results: Of the 150 study Type 2 diabetes participants, the male female ratio was 1.1. The mean HbA1C was 9.112±1.36 %. 2D ECHO findings showed 34% left ventricular hypertrophy and 51.3% diastolic dysfunction. Dyslipidemia was identified in 54.7% and statistically there was no significant association between dyslipidemia and diastolic dysfunction (P = 0.532). Conclusion: In this study, diastolic dysfunction dyslipidemia was identified in 51.5% participants without dyslipedemia. Though, there was no significant difference, this number is to be considered. However, studies should be conducted with big samples size.

Prevalence and Profile of Central Serous Chorioretinopathy in an Indian Cohort.

To determine the profile of CSCR patients from a tertiary health care set-up in India. A total of 2780 (2447 males and 333 females) patients with a diagnosis of CSCR were included. Data regarding the demographics, profile of CSCR and systemic diseases, if any, were collected from a tertiary eye care network in South India from January 2012 to December 2016. The prevalence of CSCR was found to be 1.7% (A total 2780 patients, with mean age of 42.3±10.1 years). A total of 2031 patients had a unilateral and 749 had bilateral involvement. Acute and chronic CSCR was seen in 1932 (69.5%) and 848 (30.5%) eyes respectively. The mean uncorrected visual acuity of the patients was 0.51±0.45 log MAR (Snellen equivalent 20/60) while the mean best corrected visual acuity was 0.32±0.40 log MAR (Snellen equivalent 20/40). History of smoking and steroid use was present in 214 (7.7%) and 758 (27.3%) individuals respectively. Hypertension and diabetes mellitus was present in 106 (3.8%) and 51 (1.8%) patients respectively. Most of patients {824 (29.6%) patients} were shift-workers. Laser was done in 336 (12.1%) acute and 223 (8%) chronic CSCR patients. Photodynamic therapy was used in 12 acute and 12 chronic cases. Prevalence of CSCR was 1.7%. The study provides an overview of patient profile among Indian subjects.

A preliminary association study between serotonin transporter (5-HTTLPR), receptor polymorphisms (5-HTR1A, 5-HTR2A) and depression symptom-clusters in a north Indian population suffering from Major Depressive Disorder (MDD)

Major Depressive Disorder (MDD) is a broad heterogeneous diagnostic construct. Previous studies have shown that it can be resolved into several symptom-clusters which are proposed to be associated with single nucleotide polymorphisms (SNPs) of the serotonergic pathway (5-HTTLPR, 5HTR1A, 5-HTR2A). In a cross-sectional study conducted at a tertiary level mental health care set-up in north India, 80 out-patients with MDD were evaluated with Montgomery Asberg Depression Rating Scale (MADRS) and then genotyping was done. The different clinical and genetic variables were compared across the factor structures of MADRS. Also, the comparison of the genetic data of cases was done with the pre-existing database of the non-blood related healthy ethnically-matched controls. There was no significant association between age, gender, other clinical variables, SNPs like 5-HTTLPR SS/SL, rs6295 CC/CG/GG, rs6311GG/GA/AA, rs6313 CC/CT/TT and different factor-structures like 'detachment' consisting of items like concentration difficulty, lassitude, inability to feel; 'psychic anxiety' consisting of suicidal thoughts and inner tension; 'mood-pessimism' consisting of symptoms like apparent sadness, reported sadness, pessimistic thoughts and 'vegetative symptoms' like decreased sleep, poor appetite. Neither there was any association between genotype of the cases compared with the controls. No significant association was obtained between the four-factor structures of depression in MADRS and serotonin transporter and receptor SNPs in a study with a small sample size. This study evaluates whether depression symptom-clusters have distinct genotypic determinants and necessitates more comprehensive studies for unravelling the genetic determinants of depression.

STRESS SYNDROME;

Background: The house officers face multiple challenging situations at work throughout their internship year leading to House Officer Stress Syndrome. Objectives: The paper addresses the aspects of house officer stress syndrome and its influence on their work. Study Design: Cross sectional study. Setting: Tertiary health care setup of Karachi. Period: October to November 2017. Method: A self-designed and self-explanatory questionnaire was prepared and distributed among house officers during work hours. Verbal consent was taken. Confidentiality of the participants was observed. The data was analyzed using SPSS-20, ANOVA and also via a 5 point Linkert scale. Result: A total of 278 responses were obtained from 13 different hospitals, maximum from Jinnah Postgraduate Medical Centre. Among the respondents, 83.9% were females and 15.8% were males. Mean age was 24. Around 42.6% worked 96 hours weekly while 64% reported to be on call 7-9 times monthly. On call available sleep time was as low as 1-2 hours. Nearly 56.4% found work physically tiring. Conclusion: It can be concluded that house officers are susceptible to stress which affects their overall work performance. Henceforth, a holistic approach must be taken in order to promote a healthy working environment and effective patient care.

Fat Plug Myringoplasty Vs Trichloroacetic Acid Cauterization as Office Procedures for Managing Small Central Perforation

Introduction&#x0D; In a series of day care office procedures, techniques like fat plug myringoplasty and Trichloroacetic acid (TCA) cauterization are becoming increasingly popular for managing small central perforations now-a-days[Office1] . These are minor, cost effective procedures and have success rates that match success rates of conventional tympanoplasty[Office2] . The aim of this prospective randomized controlled trial, was to compare the effectiveness of fat plug myringoplasty and chemical cauterization in the management of small centrally located perforations of the pars tensa.&#x0D; Materials and Methods&#x0D; The study was carried out over a period of 2 years on 62 patients selected from ENT OPD in our tertiary health care setup of central India. All the selected patients were grouped into two using a random allocation software EPi Info7.1.1.14. Group A included those who underwent fat plug myringoplasty while group B were those who underwent TCA cauterization.&#x0D; Results&#x0D; At 6 months follow up there was closure of perforation in 29 out of 30(96.6%) patients of group A and 29 out of 32(91%) patients of group B. In both groups success was defined by closure of perforation. Comparison of results was done using Fisher Exact Test. The difference between the success rates of the two procedures was statistically insignificant with p value of 0.6624, indicating that both the office procedures are equally effective and can be used according to the needs of the patients.&#x0D; Conclusion&#x0D; These office procedures can revolutionize the protocol of tympanoplasty which has an obvious higher morbidity and more days of absenteeism as compared to these minor procedures.

Role of serum MicroRNA-499 as a diagnostic marker in acute myocardial infarction (AMI)

Acute myocardial infraction is one of the leading causes of morbidity and mortality in developing countries such as India and even worldwide. Its etiology is complicated because of several confounding factors involved in its pathogenesis. Recently, MicroRNA has been recognized to play an important role in predicting the diagnosis and prognosis of myocardial infarction. MiR-499 plays a pivotal role in the recovery of cardiac cell, following injury. Since several studies have profiled several miRs in cardiovascular diseases and of which miR-499 is mainly expressed in the myocardium. Our study is primarily designed to explore the diagnostic role of miR-499 in AMI. The study included 60 AMI patients aged 30–60 years and an equal number of age and gender matched controls. All cases were taken from Mahatma Gandhi Medical College and Research Institute a tertiary healthcare setup and analyzed for miR-499 by RT-PCR, lipid profile, CK (NAC), CK-MB and high sensitivity cardiac Troponin T were analyzed by IFCC approved methods. Unpaired Student's test was performed to compare the mean of the cases with the controls. Pearson correlation was used to study the association of miR with conventional markers. Receiver Operating Characteristic curve was plotted to find out the sensitivity and specificity of miR-499 in AMI. Our study showed significantly high levels of miR499 in AMI patients in comparison to the healthy controls (p=0.012). MiR-499 levels positively correlated with hs-cnTn T (r=0.582, p<0.01) and CK-MB (r=0.443, p<0.01). ROC for miR-499 showed an AUC 0.974 with 93.33% sensitivity and 86.67% specificity which was comparatively higher than the current markers CK-MB (86.67% and 71.67) and hs-cnTn T (90.00% and 81.56%). When these biomarkers analyzed for combined sensitivity increases but the specificity decreases. The results showed that miR-499 has a significant correlation and also had higher sensitivity and specificity when compared to other conventional markers and thus it could serve as a better early diagnostic marker of AMI.

SURGICAL SITE INFECTION;

Among the Health care associated infection (HCAI) Surgical Site Infection(SSI) is one of the most common complications occur after surgery and increases mortalityand morbidity rate. The objective of this study is to identify the common causative organisminvolved in postoperative wound infections along with their sensitivity and resistivity patterns.Study Design: Prospective cross sectional study. Setting: Tertiary Health Care setup inKarachi, Pakistan. Period: Six month from April 2016 till September 2016. Method: A total of100 patients are included in this study that underwent various surgical procedure. Result: Inthis study E. coli isolated from 32% of cases followed next in frequency by S.aureus in 16%,Coagulase negative Staphylococci in 14 %.the other less common pathogen involved Klebsiella,P. aeuroginosa, Enterococcus &amp; Acinetobacter, Enterobacter, Streptococcus group D. AmikacinIimipenem and Meropenem is found to be of more Sensitive against E. Coli while Ampicillin andco trimaxazole showed higher resistivity against E. coli or other various organism. Teicoplannand vancomycin and linzolid have shown absolute sensitivity to various pathogens. Penicillinis found to be highly resistant against Coagulase negative Staphylococci. Conclusion: E.coli is the most common pathogens involved in Post-surgical Infection Amikacin, imipenem,Meropenem, Teicoplann, vancomycin. linzolid is found to be more Sensitive against variousorganism isolated in our study. Acinetobacter are highly resistant to various drugs while P.aeuroginosa have also shown optimal sensitivity pattern against various groups of antibiotics.Present study signifies the adaptation of antibiotic combination in rational way for prophylacticuse and the exploitation of a synchronized system of surgical wound management and cure.

Neonates with critical congenital heart defects: Impact of fetal diagnosis on immediate and short-term outcomes.

Background:Fetal echocardiography is being increasingly used for prenatal diagnosis of congenital cardiac malformations, but its impact on the neonatal outcomes in low- and middle-income countries is still unknown.Aims:The objective of this study is to determine the impact of fetal echocardiography on immediate postnatal and short-term outcome in a tertiary pediatric cardiac center.Study Design:This is a prospective study.Materials and Methods:One hundred consecutive patients with critical congenital heart defects (CHD) requiring active medical or surgical interventions in the 1st month of life were included in the study. The detailed history, postnatal examination findings, and fetal echocardiogram report were recorded. They were divided into two groups as antenatally diagnosed and postnatally diagnosed. Pre- and post-procedural variables were compared between the two groups.Results:Twenty-nine neonates were diagnosed antenatally while 71 were diagnosed postnatally. Totally, 10 babies (34.5%) among the antenatally diagnosed group were delivered in a tertiary health-care setup. The mean age at presentation was 0 day in the antenatally diagnosed group while 10 days (0–30 days) in the postnatally diagnosed group (P = 0.01). A total of 17 (58.6%) patients in the antenatal group had duct dependent CHD, and 15 (88.2%) of these patients were transported on prostaglandin E1. In comparison, 19/34 (55.9%) patients in the postnatal group were transported on prostaglandin. The pH on admission in the antenatal group was 7.32 ± 0.05 as compared to 7.28 ± 0.05 in the postnatal group (P = 0.0004). There were 4 (5.6%) deaths in the postnatal group during transfer. There was no significant difference in the postoperative variables in both groups.Conclusions:Fetal echocardiography identifies patients with complex CHD resulting in better parental counseling, thus facilitating delivery at a tertiary care center and preoperative stabilization. This results in improved preoperative mortality and better stabilization.

Community Awareness - A Key to the Early Detection of Head and Neck Cancer

INTRODUCTION&#x0D; Mortality and morbidity associated with head and neck cancers have decreased to a great extent in many developed countries of the world due to early diagnosis and treatment with advances in surgical techniques and better availability of radiotherapist and oncologists. But the situation in developing countries like India is quite different.&#x0D; AIMS AND OBJECTIVES&#x0D; This study was conducted amongst the patients attending the Otolaryngology department of a teaching hospital in Kolkata to find the incidence of various types and sites of head and neck cancer, to assess time delay from the date of onset of symptom to the final disease confirmation in relation to patients’ demographic profile, to assess time delay in histopathological diagnosis after reaching a tertiary care setup and also to correlate tobacco consumption and alcohol intake as risk factors for head and neck cancer and to note the reasons for late presentation, as described by the patient.&#x0D; MATERIALS AND METHODS&#x0D; The descriptive study was conducted at a tertiary level teaching hospital, in the Department of Otorhinolaryngology for a period from August 2013 to August 2015 with a study population of 133. &#x0D; OBSERVATIONS &#x0D; An average time lag from the onset of symptom to final diagnosis as malignancy was found to be 6 months to one year in nearly 72% of cases. Most of the patients were uneducated males of more than 50 years of age, hailing from rural areas. Cancer larynx was found to be the commonest of all head and neck cancers (31.6%). More than 65% of the patients were addicted to tobacco chewing or smoking or consumption of alcohol. &#x0D; DISCUSSION &#x0D; Poverty, lack of education, poor communication, lack of health care infrastructure in rural areas, community awareness about various risk factors, lack of effective health policy to achieve early diagnosis of head neck cancer were common factors related to delay in diagnosis. &#x0D; CONCLUSION &#x0D; Tobacco use and alcohol intake are the modifiable risk factors of head and neck cancer. Educating the field workers about the danger signs of head and neck cancer may promote early referral of the suspected cases to tertiary health care setup for early detection of cancer.

The utility of immunofluorescence in diagnosing dermatological lesions and its correlation with clinical and histopathological diagnosis in a tertiary health care setup

Context: Immunofluorescence (IF) is an immunological technique which is used for identifying antibodies against antigens that are bound to tissues or those circulating in body fluids. This study is an attempt to evaluate the dermatological lesions such as noninfectious vesiculobullous lesions, connective tissue disorders, vasculitis, and lichen planus using histopathology techniques and direct IF (DIF) studies. Furthermore, an attempt was made to evaluate the diagnostic utility of the IF technique in our hospital. Aims: (1) To determine the utility of IF in the diagnosis of skin lesions. (2) To correlate IF with histopathological findings. Settings and Design: A cross-sectional, observational study. Subjects and Methods: The present study was conducted in the Pathology Department, Coimbatore Medical College, Coimbatore, from August 2012 to August 2013. Fifty cases received during the period were included in our study. Two skin biopsies for each case - one in formalin for routine histopathological examination and other in phosphate buffer solution for IF studies - were received. Statistical Analysis Used: Fisher's exact value, mean, and coefficient of mean were calculated. Results: The lesions were diagnosed by both light microscopy and IF study. Out of fifty cases, 42 cases were positive with the IF technique and the overall sensitivity of IF was 84% in our study. When histopathological and IF findings were correlated, statistically significant two-tailed P = 0.0130 was obtained. Both light microscopic findings and IF findings complemented each other in our study. IF proved to be a necessary supplementary technique to both clinical and histopathological examinations, especially in cases of diagnostic dilemmas. Conclusions: IF is a rapid diagnostic procedure. IF was useful in early diagnosis, treatment, and monitoring of various disorders in our study. Positive and negative DIF had prognostic significance in certain cases. Clinicopathological correlation along with DIF studies proved to be a powerful tool in definite diagnosis of the skin lesions.

Spectrum of Abdominal Aortic Disease in a Tertiary Health Care Setup: MDCT Based Observational Study.

Abdominal aortic disease is an important cause of clinical disability that requires early detection by imaging methods for prompt and effective management. Understanding regional disease pattern and prevalence has a bearing on healthcare management and resource planning. Non-invasive, conclusive imaging strategy plays an important role in the detection of disease. Multi-Detector Computed Tomography (MDCT) with its technological developments provides affordable, accurate and comprehensive imaging solution. To evaluate regional demography of abdominal aortic disease spectrum detected using MDCT imaging data in a tertiary hospital. A descriptive study was conducted based on MDCT imaging data of patients who were investigated with clinical diagnosis of abdominal aortic disease, from March 2008-2010, over a period of 24 months. Patients were examined with the contrast-enhanced MDCT examination. Morphological diagnosis of the aortic disease was based on changes in relative aortic caliber, luminal irregularity, presence of wall calcification, dissection or thrombus and evidence of major branch occlusion. Patients were categorized into four groups based on imaging findings. MDCT information and associated clinical parameters were examined and correlated to management of patient. Descriptive statistical data, namely mean, standard deviation and frequency of disease were evaluated. A total of 90 out of 210 patients (43%) were detected with the abdominal aortic abnormality defined by imaging criteria. Group I, comprising of patients with atherosclerosis -including those with complications, constituted 65.5% of the patients. Group II represented patients with aneurysms (45.5%). Group III, consisting of 32.2% of the patients, contained those with dissections. The rest of the patients, including patients with aorto-arteritis, were classified as group IV. Eight patients with aneurysm and one patient with aorto-arteritis were considered for surgical treatment. Ten patients with dissection underwent endovascular procedure. Rest of the patients was managed conservatively. Aortic disease was observed in 43% of investigated patients. Atherosclerosis with and without aortic aneurysm constituted the largest group. MDCT provided comprehensive information about the lesion and associated complications. In view of the wider availability and desired imaging qualities, MDCT provided optimal information for diagnosis and management of aortic pathology. Majority of our patients (90%) were treated conservatively.