Open haemorrhoidectomy revisited: the study of 25 cases

Background: Haemorrhoids continue to be the commonest benign anorectal condition presenting with bleeding and constipation. The presentation may vary depending on the grade of haemorrhoids. Deciding the best therapeutic option is the biggest challenge faced by the attending surgeon in an era where newer therapeutic technologies for treatment continue to evolve. Therefore, revisiting the traditional surgical option of excision and ligation technique for grossly symptomatic piles was evaluated taking into consideration the cost of the procedure. Twenty five consecutive patients of symptomatic grade III and IV haemorrhoids were selected for the study to determine the outcome of the traditional open method (Milligan Morgan technique)Methods: Twenty five patients after having been checked for fitness for anaesthesia underwent the open method of haemorrhoidectomy under spinal anaesthesia. On admission to hospital a detailed proforma which contained demographic details, and comorbidities was completed. All 25 patients underwent the same procedure by ligation excision technique. Details of operative findings including post-operative outcomes were studied prospectively. Results were evaluated.Results: Of the 25 patients, one patient developed bleeding in the immediate post-operative period which required relook surgery and undermining of the oozing stump. Four patients required catheterisation for urinary retention. A six month follow up did not reveal recurrence or any sort of discomfort while passing stools.Conclusions: Open haemorrhoidectomy (Milligan Morgan) continues to be the most optimum method for treatment of symptomatic piles grade III and IV

Assessing Dietary Intake Patterns Through Cluster Analysis Among Adolescents in Selected Districts of Bihar and Assam From India : A Cross-Sectional Survey

Background: In the recent decade, dietary pattern assessment has evolved as a promising tool to describe the whole diet and represent inter-correlations between different dietary components. We aimed to derive the dietary patterns of adolescents (10–19 years) using cluster analysis on food groups and evaluate these patterns according to their socio-demographic profile. Methods: This community-based cross-sectional study was conducted in two districts, each from Bihar and Assam in India. Adolescents (10–19 years) were enrolled from both rural and urban areas. The dietary intake was assessed through a pre-validated single food frequency questionnaire. Cluster analysis was performed by a 2-step procedure to explore dietary patterns, pre-fixed at 2 clusters. Clusters were analyzed with respect to socio-demographic characteristics using binomial logistic regression. Results: A total of 826 girls and 811 boys were enrolled in the study. We found two major dietary patterns, namely a low- and high-mixed diet. The low-mixed diet (76.5% prevalence) had daily consumption of green vegetables, including leafy vegetables, with less frequent consumption of other foods. The high-mixed diet (23.5% prevalence) had more frequent consumption of chicken, meat, egg, and milk/curd apart from green vegetables. Adolescent boys had 3.6 times higher odds of consuming a low-mixed diet compared to girls. Similarly, adolescents with lower education grades and from marginalized social classes had two times higher odds of taking a low-mixed diet than their respective counterparts. Conclusions: The high consumption of a low-mixed diet and relatively less milk consumption limit the comprehensive growth of adolescents. Improvement in dietary intake of adolescents from marginalized sections of society can prove to be an important deterrent in mitigating India's nutritional challenges

Evaluation of a training program for life skills education and financial literacy to community health workers in India : a quasi-experimental study

Background: Accredited Social Health Activists (ASHA) are community health workers responsible for improving the health status of people by facilitating their access to healthcare services. The life skills of ASHA are known to be effective in negotiating behaviour change in the community; however, there has been a meagre focus towards improving them. Considering this gap, we adopted a comprehensive training program, known as Personal Advancement and Career Enhancement (P.A.C.E.), to empower ASHAs on life skills and financial literacy. The present study intends to assess the training program in two districts of Uttar Pradesh, India, by examining changes in knowledge, perceptions, and practices of ASHAs about life skills and financial literacy. Methods: We conducted a quasi-experimental, non-randomized, controlled study with pre-and post-test assessments. Data were collected on socio-demographic characteristics, knowledge, and practices related to life skills (communication skills, self-confidence, problem–solving and decision-making skills, time and stress management skills) and financial literacy. Additionally, change perceptions on gender-, life skills-, and savings-related practices at the personal, community, and workplace levels were assessed in the intervention group. Factor analysis was performed to obtain the change patterns by assessing the degree to which the four life skills, financial literacy, and change perceptions on practices were correlated. A general linear regression model was performed to assess associations among change pattern scores and socio-demographic variables. Results: We analyzed the data of 171 ASHAs (intervention group:86 and control group:85). There was a significant improvement in the average post-test scores of all the life skills and financial literacy in the intervention group (p < 0.001). Three distinct change patterns were found post-training in the intervention group. Factor 1 (high loadings for change perceptions on practices) was positively associated with ASHAs aged 38 and above and with experience of ≤12 years. On the contrary, the change in financial literacy and self-confidence scores was common among ASHAs with more than 12 years of experience. Conclusions: The P.A.C.E training program was found effective in improving the life skills and financial literacy of ASHAs in India