Farmer's health externalities in pesticide use predominant regions in India.

The use of pesticides in Indian agriculture, though beneficial in reducing crop loss both before and after harvest, has been associated with threats to human health often due to the misuse of these chemicals. This study was an initial attempt to explore health externalities of farmers and agricultural labourers in pesticide use predominant 28 districts in 12 Indian states. Doctors, pesticide vendors and agricultural officers of regions were interviewed to study the health externalities related to pesticide use. Data were collected through pre-tested schedules by trained field investigators. From a total sample size of 1577 and analysed. The results revealed a steady decrease in overall consumption of pesticides since 1990. About 19.4% of the respondents had experienced negative side effects on health after handling pesticides. The symptoms include headache, weakness, dizziness, fever, blurred vision, and nausea/vomiting. Most of the respondents are aware of pesticide-related symptoms and possible routes of absorption, during application of pesticides. Farmers make only short-term assessments of pesticides and spray these chemicals without taking proper protective clothing. Records on serious pesticide poisoning cases were available only in a few government hospitals, but such details were not even accessible from private hospitals as pesticide poisoning incidences are subjected to medico-legal cases. Training for agriculture and health workers in safety measures, recognition, and management of pesticide-related ill health is a matter of exigency. There is a tremendous scope for agricultural extension activity through which pesticide stewardship can be achieved in India

Female-assigned genetic males with severe hypospadias: Psychosocial changes and psychosexual treatment

Introduction: Disorders such as severe hypospadias presenting as ambiguous genitalia have serious and potentially life-long consequences for affected individuals and, depending on the underlying cause, are likely to entail surgery in childhood and in later life, psychosocial and psychosexual support and possible fertility treatment including assisted conception. Materials and Methods: Genetic males with severe hypospadias who were wrongly brought-up as females formed the study group. They were reassigned as males and underwent surgery for correction of hypospadias. Results: Three children with severe hypospadias were reassigned to male gender. Psychosocial changes were made psychosexual counseling was done. All three have adjusted to their new environment and gender. Conclusions: Management of children with wrongly assigned sex is complex. It is preferable to reassign these children who are genetic males but wrongly assigned as females at birth. Repair of hypospadias, psychosocial changes and psychosexual counseling will help these children to reorient themselves

Dorsal inlay inner preputial graft for primary hypospadias repair

Background: The most commonly performed operation to repair distal  hypospadias is the Tubularised incised plate (TIP) repair. The key step is midline incision of the urethral plate, which widens a narrow plate and converts a flat into a deep plate groove, ensuring a vertical, slit neomeatusand a normal-calibre neourethra. At times in cases of proximal  hypospadias, the urethral plate is very narrow and needs to be augmented or substituted for further tubularisation. We report our experiencewith primary single stage dorsal inlay urethroplasty using preputial skin grafts.Patients and Methods:Children with proximal hypospadias with a narrow urethral plate formed the study group. Children needing transection of the urethral plate, having undergone circumcision/hypospadias repair  previously or having an inadequate prepuce was excluded. Results: Twelve children with a mean age of 48.83 months underwent primary dorsal inlay preputial graft urethroplasty for proximal hypospadias with a very narrow urethral plate. At an average follow-up of 42.16 months, 2 (16.66%) children had a breakdown of ventral shaft skin. None of the children had meatal stenosis, and none of these 12 children developed  urethrocutaneous fistula.Conclusion: Primary dorsal inlay inner preputial graft urethroplasty  successfully fulfills all traditional hypospadias repair criteria. It offers a viable, safe, rapid and easy option in the management of proximal hypospadias with a narrow urethral plate.Key words: Hypospadias, primary repair, urethra, urethroplast

Bedwetting in adolescent girls staying at residential school

Background and objectives:Nocturnal enuresis (NE) is a common, yet underreported problem among school children which has an impact on the child’s psychology causing anxiety and social stigma. Nocturnal enuresis is classified as primary or secondary and monosymptomatic or non monosymptomatic. It can be the presenting symptom of urinary tract infection, underlying neurological disorder (spina bifida, epilepsy), vesicoureteric reflux, posterior urethral valve or diabetes mellitus. Thus, the present study was undertaken to assess the bedwetting among the girls during a routine school annual health check-up.Methodology:This study was conducted as a part of routine annual health check-up of girls staying in a residential school by a female physician. A detailed history regarding bedwetting was noted and physical examination was done in children with complaints of bedwetting. The children were evaluated regarding the risk factors associated with NE and scholastic performance as well as stress and the stigma associated with it on an outpatient department basis and were asked to follow up in a bed wetting clinic in our hospital.Results:A total of 342 girls of a residential school underwent heath check-up for general fitness conducted by the physicians of our hospital. History of NE was noted in 37 girls (10.82%). Most of the girls (62.16%) had secondary NE and 37.84% had primary NE. The diagnosis of NE was common among the girls aged 12 years (40.54%) and the mean age was 12.00±1.40 years. Most of the girls reported symptoms of constipation (48.65%). Eighteen girls had symptoms suggestive of attention deficit hyperactive disorder (ADHD) and stress due to NE was noted in 40.54% of the girls. Furthermore, 13 (35.14%) girls were average performers.Conclusion and interpretation:Nocturnal enuresis is a significant paediatric health problem and there is high prevalence of monosymptomatic NE in school going girls. Further it is affects the scholastic performance of the child and also likely to induce stress