• Print ISSN: 2395 - 1400, Online ISSN: 2455 - 8923

JBCR VOL V - Issue 1, Jan ‐ June 2018

EDITORIAL

CHALLENGES IN HEALTH CARE DELIVERY IN RURAL POPULATION

Dr. (Col). M.E. Luther

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Original Articles

Etiological Evaluation of Primary Amenorrhea In A Rural Teaching Hospital

Asma Akhtar1,Sunita Sudhir P2

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Original Articles

BONE MARROW STUDY IN A TERTIARY CARE HOSPITAL,ELURU- ASRAM

Lalitha S 1,Asha T2,Priyanka A A3

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CASE REPORT

Denovo Histoid Hansen’s Disease - “Bolt from the Blue”

K. Udaya Sri1, M. Arun Kumar2, Ch. Vijay Bhasker Reddy3, P Vidya Sagar4

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CASE REPORT

Case Records of Kamineni Institute of Medical Sciences Narketpally: A Woman with Progressive Abdominal Pain

*Gousia Ummae Salma Shaik1

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IMAGES IN CLINICAL MEDICINE

Erythema Ab Igne

*Avinash Kumar Gupta1, *Boudhayan Das Munshi2, Vivek Podder3, Arup Kumar Kundu4

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EDITORIAL

CHALLENGES IN HEALTH CARE DELIVERY IN RURAL POPULATION

Dr. (Col). M.E. Luther

Abstract

Our country, since independence continues to be a state which has a large majority of its population living in rural areas. We have nearly 638,000 villages and approx 740 million people reside in these villages. As per the last World Bank report in 2011; 60% of our population is still below the poverty line, in rural areas. The health care need of these people goes largely unmet. This gap in healthcare provisioning is essentially multifactorial. Deficiency of healthcare has to be expected as some of these villagers live in remote geographic locations; with meagre finances, poor communication ( both road & telecom facilities) and such villages have very less population; so the public sector healthcare system does not accord much priority over other areas. The problem of illiteracy ( which is as high as 71%) in the rural population; compounded by their poverty further adds to the problem, as early recognition of a serious disease & timely care may not be easily available. Poverty leading to poor nutritional status; inability to procure lifesaving medication; inadequate treatment due to lack of funds further increase the morbidity & mortality rates.

Tradition and beliefs certainly play a negative role in the outcomes. Gender bias is also known to contribute to poorer outcomes in girls as the male child is getting more attention and the family is willing to spend money on a potential bread earner. There is also a burden of the joint family system which is prevalent in rural areas and their limited resources need to be shared with all family members. Pre hospital Trauma Care is another area of concern. While automation & industrial expansion is occurring in developing countries the preventable death rate in trauma cases is as high as 73 . 7%; especially affecting the age group of 15-45 years. The pre hospital trauma care is non-existent, at best is in a very primitive form with lack of trained manpower.

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ORGINAL ARTICLE

Etiological Evaluation of Primary Amenorrhea In A Rural Teaching Hospital

Asma Akhtar1,Sunita Sudhir P2

1Junior Resident, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally 2Professor, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally

ABSTRACT

Introduction: Menstruation is the physical herald to physiologic capacity of conception. Attainment of menarche in a girl brings a lot of confidence and feminism in a girl. Though the incidence of primary amenorrhea is less than 1%, it accounts for significant amount of psychological trauma. In the present day scenario, there are a lot of treatment modalities which can at least restore her menstrual functions, and prevent complications.

Objectives: To determine various causes of primary amenorrhea in a rural Medical College and to emphasize general approach to primary amenorrhea.

Materials and Methods: A retrospective study was performed using 15 complete medical records of women with primary amenorrhea who attended Gynecology OPD, Department of Obstetrics & Gynecology, from June 2016 to June 2018. Cases were analyzed according to clinical profile, development of secondary sexual characters, physical examination, pelvic and rectal examination, hormone profile, pelvic USG, MRI and cytogenetic study including karyotype.

Results: The most common cause of primary amenorrhea was Mullerian anomalies (60%) in present study. There were 2 cases of early gonadal failure, 1 case of pure gonadal dysgenesis, 1 case of Turner mosaic, 1 case of Androgen insensitivity syndrome and 1 case of congenital adrenal hyperplasia.

Conclusion: In this study, Mullerian anomaly was the most prevalent etiological factor leading to amenorrhea followed by premature ovarian failure. However, this was a small scale study and larger study group study must be needed. Racial, genetic and environmental factors could play role in the cause of primary amenorrhea.

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CASE REPORT

BONE MARROW STUDY IN A TERTIARY CARE HOSPITAL, ELURU- ASRAM

Lalitha S M1,Asha T2,Priyanka A A3

1Final yearPostgraduate, Department of Pathology, ASRAM Medical College 2 Professor and HOD, Department of Pathology, ASRAM Medical College 3Assistant professor, Department of Pathology, ASRAM Medical College

Abstract

Introduction: Examination of bone marrow aspirate (BMA) and bone marrow biopsy (BMB) are essential for the diagnosis of bone marrow pathology. Bone marrow examination will give information about hemopoietic tissue in various conditions in addition to findings of blood sample as the bone marrow can be affected by both hematological and non-hematological disorders.

Aim and Objectives: To analyze the cause of hematological, non-hematological disorders and to interpret the bone marrow findings with various conditions.

Methods:A retrospective and prospective study of 112 patients over a period of two years (June 2015 to July 2017). Clinical details and ethical clearance from institute were obtained. Three modalities peripheral smear(PS), BMA, and BMB were used for diagnosing hematological and non-hematological disorders were included in the study.

Results: Out of 112 cases studied 68(60.7%) were male and 44(39.3%) were female with age group ranging from 3 to 82 years. In both aspiration and biopsy most common findings were Reactive marrow (25.0%), Megaloblastic anemia (20.5%) 2 (1.7%)biopsy samples were found to have Metastasis and 1 (0.8%) case was of SLE.

Conclusion: Bone marrow study is highly informative diagnostic test procedure in evaluating hematological, non-hematological disorder. The final interpretation requires the integration of PS, BMA, and trephine biopsy findings together with the results of supplementary tests such as immunophenotyping, and molecular genetic studies as appropriate, in context of clinical and diagnostic findings.

Keywords: Peripheral smear, Bone marrow aspirate, Bone marrow biopsy.

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CASE REPORT

Denovo Histoid Hansen’s Disease - “Bolt from the Blue”

K. Udaya Sri1, M. Arun Kumar2, Ch. Vijay Bhasker Reddy3, P Vidya Sagar4

1Junior Resident, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally 2Professor, Dept. of OBG, Kamineni Institute of Medical Sciences, Narketpally

Abstract

Histoid Hansen’s is a rare form of multibacillary leprosy with distinct clinical and histopathological features. Histoid Hansen’s is an uncommon variant of lepromatous leprosy that usually follows treatment failure. Occasionally it occurs de novo without any history of previous treatment. We report a case of 16 year old boy with multiple nodules on neck, chin and areolae with diffuse infiltration of both lips. Histopathology revealed Histoid Hansen’s with typical spindle shaped histiocytes and bacillary index of 5+. Patient was started on WHO’s multidrug therapy (MDT) for 12 months. A high index of suspicion is necessary especially when patients present with unusual skin lesions and estimation of bacterial index is highly indicated as proven in our case.

Key words: Histoid Hansen’s, lepromatous leprosy, spindle shaped histiocytes

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CASE REPORT

Case Records of Kamineni Institute of Medical Sciences Narketpally: A Woman with Progressive Abdominal Pain

Gousia Ummae Salma Shaik1

*1Post graduate, Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally

Abstract

The learning ecosystem of any medical college depends on how the students and faculty learn from their regular clinical individual patient based problem solving workflow. The study of actual cases of various diseases has been an effective way of making small steps towards a better medical teaching and a learning system. When such actual cases are presented as case records it brings out together the experience of various practitioners involved with the patient, and the discussions illustrate their decision- making process, their understanding of the literature around the disease affecting the patient, the further approach and management of the disease. This experience and knowledge could be applied to treat different cases which are involved with multiple factors of not a single disease entity but various diseases.

We describe the case record of a 40-year-old female from West Bengal who had presented with severe abdominal pain for the past 2 months. A set of radiological investigations were carried out which included an Ultrasound abdomen revealing findings suggestive of right ovarian tumor, which was later followed by an MRI which had revealed a long vascular pedicle to an enlarged right ovary. In view of her severe abdominal pain, a clinical diagnosis of ovarian torsion was suspected which was followed by the decision to do an emergency exploratory laparotomy, The ovary sample was sent for a histopathological investigation.

Key words:Case record, abdominal pain, fibrothecoma, lymphadenopathy, laparotomy, ovarian torsion, pain management, cancer pain.

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CASE REPORT

Erythema Ab Igne

*Avinash Kumar Gupta1, *Boudhayan Das Munshi2, Vivek Podder3, Arup Kumar Kundu4

1Independent Researcher,2Consultant, IQ City Medical College, Durgapur, West Bengal,3Independent Researcher, 4Professor, IQ City Medical College, Durgapur, West Bengal

Abstract

A 45 year man presented with pain in right leg and reticular lesion on skin on posterior side of right leg. He met with a road traffic accident 2 years back when he was a professional driver and having weakness in right hand since then. Twelve days back he went back on a driving job where he had to drive for 12 hours daily, and since then he had started feeling pain in right leg. As days passed, pain worsened so he used hot water balloon behind legs for some relief. With every passing day his situation became more painful so he ended up in hospital. Such reticular lesions are present in Livedo reticularis, cutis marmorata and erythema Ab Igne and in this case; it was

diagnosed as erythema Ab Igne (figure 1) which happens on prolonged exposure to any heat source as occurred in this case by hot water balloon. It is easy to miss the diagnosis and go for unnecessary tests while only avoiding exposure to heat source may be the only required intervention in such case.1 Some other common heat sources are hot water bottles, laptops, kangri, space heaters, electric heaters, heating blankets, heat pads, and occupational hazard to bakers and chefs. Squamous cell carcinoma of skin is the common complication which is called Kang cancer in China and Tibet, because of sleeping on beds of hot bricks. Kangri cancer in Kashmir and Kario cancer in Japan do occur because people keep kanger and kangri or burning material in any container beneath clothing.2

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EDITORIAL

CHALLENGES IN HEALTH CARE DELIVERY IN RURAL POPULATION

Dr. (Col). M.E. Luther

Abstract

Our country, since independence continues to be a state which has a large majority of its population living in rural areas. We have nearly 638,000 villages and approx 740 million people reside in these villages. As per the last World Bank report in 2011; 60% of our population is still below the poverty line, in rural areas. The health care need of these people goes largely unmet. This gap in healthcare provisioning is essentially multifactorial. Deficiency of healthcare has to be expected as some of these villagers live in remote geographic locations; with meagre finances, poor communication ( both road & telecom facilities) and such villages have very less population; so the public sector healthcare system does not accord much priority over other areas. The problem of illiteracy ( which is as high as 71%) in the rural population; compounded by their poverty further adds to the problem, as early recognition of a serious disease & timely care may not be easily available. Poverty leading to poor nutritional status; inability to procure lifesaving medication; inadequate treatment due to lack of funds further increase the morbidity & mortality rates.

Tradition and beliefs certainly play a negative role in the outcomes. Gender bias is also known to contribute to poorer outcomes in girls as the male child is getting more attention and the family is willing to spend money on a potential bread earner. There is also a burden of the joint family system which is prevalent in rural areas and their limited resources need to be shared with all family members. Pre hospital Trauma Care is another area of concern. While automation & industrial expansion is occurring in developing countries the preventable death rate in trauma cases is as high as 73 . 7%; especially affecting the age group of 15-45 years. The pre hospital trauma care is non-existent, at best is in a very primitive form with lack of trained manpower.