A study of factors associated with tokophobia and its effect on pregnancy

Background: Tokophobia is pathological fear of childbirth which has bearing on the women’s health with the physical and psychosocial morbidity. It includes fear of injury to the baby, genital tract, death and is a common cause for which a woman opts for caesarean section. Recognition of tokophobia and close liaison with  obstetricians/specialists can help to reduce its severity and ensure treatment. Aim of the current study was to assess the incidence of tokophobia and correlation with the sociodemographic variables to evaluate the possibility of reducing the requests for caesarean section.Methods: 150 pregnant women attending the antenatal OPD and labour ward in a tertiary care centre constituted the study population. Data was gathered using standard questionnaire to assess fear of child birth, anxiety associated and was analysed with chi-square test for statistical significance.Results: 150 women included in the study, the incidence of tokophobia was 55.3% and severe tokophobia was 30.7%. Of these 62% were primigravidae and 38% multigravidae.15.3% of the total requested for caesarean section with the major reason being fear of childbirth. However, 84.7% of the study population did so without any such request for caesarean section. Higher incidence of tokophobia was observed in women with intermediate education as against those who completed their graduation and post-graduation.Conclusions: Tokophobia is associated with pregnant women in different severity. It’s influenced by sociodemographic variables like educational and socioeconomic status. Improvement in sociodemographic conditions could reduce tokophobia

Communicating root of auriculotemporal nerve with inferior alveolar nerve-looping around accessory meningeal artery

Background: The auriculotemporal nerve has been described as having two roots in standard textbooks of anatomy. It lies on the tensor veli palatini muscle while passing backwards behind the lateral pterygoid muscle. It runs behind the temporomandibular joint after passing between the sphenomandibular ligament and the neck of mandible. It ascends over the posterior root of zygoma posterior to superficial temporal vessels. It gives superficial temporal branches and also branches to facial nerve and otic ganglion. The branches to the facial nerve join at the posterior border of masseter. On the face the cutaneous branches supply the tragus, part of the adjoining auricle of the ear and posterior part of temple.Methods: Variations in the origin of the auriculotemporal nerve have been described by many authors in the past and this prompted the study of the auriculotemporal nerve, its origin and course, in 36 specimens (18 cadaveric heads) in bodies that were allotted for dissection purpose to first year medical students in the department of anatomy in P.E.S Medical College, Kuppam.Results: It was seen that the auriculotemporal nerve had two roots of origin and they formed a loop to enclose the middle meningeal artery in all the 35 specimens except in one side of the cadaveric heads. In only one half of a cadaveric head it was found to arise by three roots which formed two nerve loops. The first and second nerve roots joined with each other to form a nerve loop. The third root joined with the inferior alveolar nerve and formed the second nerve loop. The accessory meningeal artery passed through the second nerve loop. The normal presentation of two roots enclosing the middle meningeal artery was not present. Instead the accessory meningeal artery was enclosed between the third root and the inferior alveolar nerve. The middle meningeal artery entered the skull through the foramen spinosum as usual but was not enclosed by the nerve roots. The trunk of the auriculo temporal nerve was seen between the middle meningeal artery and inferior alveolar nerve and the study reports the presence of variant nerve loops encircling the accessory meningeal artery.  Conclusion: The variations in the roots of auriculotemporal nerve have been reported in the past and since it is important in the clinical implications of the region especially for the facio-maxillary surgeons and dental surgeons. The incidence of variation has to be documented as this helps in updating the clinical database for surgical procedures and treatment in the region of infratemporal fossa.

Optimizing Techniques and Suture Materials for Caesarean Section

Cesarean section is an important part of comprehensive emergency obstetric and neonatal care and their numbers are increasing worldwide in the recent times. Proper healing of the scar after cesarean section is of paramount importance to avoid various obstetrical complications in future pregnancies. There is no standard technique on the method of closure following cesarean delivery. It is unclear as which technique and suture material should be used for closure of cesarean section in order to get the best results with minimal complications. The objective of this chapter is to review the literature, analyze the available resources and evaluate the evidence for closure of each layer post cesarean section. The following discussion will review closure of each step post cesarean section and provide evidence-based recommendations for closure technique

DORMEX®-hydrogen cyanamide poisoning

Case reports of acute and chronic exposure to hydrogen cyanamide (DORMEX®) have been reported but mainly as a result of occupational or accidental exposure and without any mortality. We report a case of acute hydrogen cyanamide poisoning in a young male due to suicidal intent. The patient was managed under intensive care with all the standard protocols for detoxification. However, in spite of aggressive management, patient could not be rescued. An extensive literature search did not yield any similar case reports. Hence, we report this case to the medical community to be aware of the entity

Impact of community-level socioeconomic disparities on quality of life after burn injury: A Burn Model Systems Database study

INTRODUCTION: Individual-level socioeconomic disparities impact burn-related incidence, severity and outcomes. However, the impact of community-level socioeconomic disparities on recovery after burn injury is poorly understood. As a result, we are not yet able to develop individual- and community-specific strategies to optimize recovery. Therefore, we aimed to characterize the association between community-level socioeconomic disparities and long-term, health-related quality of life after burn injury. METHODS: We queried the Burn Model System National Longitudinal Database for participants who were \u3e 14 years with a zip code and who had completed a health-related quality of life (HRQOL) questionnaire (VR-12) 6 months after injury. BMS data were deterministically linked by zip code to the Distressed Communities Index (DCI), which combines seven census-derived metrics into a single indicator of economic well-being, education, housing and opportunity at the zip code level. Hierarchical linear models were used to estimate the association between community deprivation and HRQOL 6 months after burn injury, as measured by mental (MCS) and physical (PCS) component summary scores of the SF12/VR12. RESULTS: 342 participants met inclusion criteria. Participants were mostly male (n = 239, 69 %) and had a median age of 48 years (IQR 33-57 years). Median %TBSA was 10 (IQR 3-28). More than one-third of participants (n = 117, 34 %) lived in a community within the highest two distress quintiles. After adjusting for age, race/ethnicity, number of trips to the operating room (OR) and pre-injury PCS, neighbourhood distress was negatively associated with 6-month PCS (ß-0.05, 95 % CI [-0.09,-0.01]). Increasing age and lower pre-injury PCS were also negatively associated with 6-month PCS. There was no observed association between neighbourhood distress and 6-month MCS after adjustment for age, participant race/ethnicity, number of trips to the OR and pre-injury MCS. Higher pre-injury MCS was associated with 6-month MCS (ß0.54, 95 % CI [-0.41,0.67]). CONCLUSIONS: Community distress is associated with lower PCS at 6 months after burn injury but no association with MCS was identified. Pre-injury HRQOL is associated with both PCS and MCS after injury. Further study of the factors underlying the relationship between community distress and physical functional recovery (e.g., access to rehabilitation services, availability of adaptations) is required to identify potential interventions