Want to operate an abdominal lump? Think twice; it might be spontaneous rectus sheath hematoma: a case report

Rectus sheath hematoma is a rare, but potentially misdiagnosed clinical entity. It occurs when there is direct tear in the rectus abdominis muscle fibres or in the supplying blood vessels. It may be associated with trauma, raised intra-abdominal pressure, or muscle weakness. When non-traumatic, the condition is termed as spontaneous rectus sheath hematoma. Because of its rarity, spontaneous rectus hematoma can be easily missed, endangering patient management. With progressively increasing use of anticoagulant and antiplatelet agents, the incidence of this pathology is rising. We are reporting a case of spontaneous rectus sheath hematoma in a 56 year old female, known diabetic, hypertensive with dyslipidaemia on combination drug therapy but not on anticoagulant/antiplatelet medications, that was clinically misdiagnosed as omental hernia. The main presenting complaint was swelling in abdomen for 1 month. There was no history of trauma. Radiologic findings showed hypoechoic multiloculated complex cystic lesion. Cytological findings showed features of old hematoma. This case report intends to increase awareness in considering rectus sheath hematoma as an important differential diagnosis of lump abdomen. Rectus sheath hematoma, a rarely seen pathology, often confuses clinicians leading to unnecessary negative laparotomies. Definitive operative procedure should not be undertaken depending on sonographic findings alone, as the images are prone to subjective error. The main treatment modality of rectus sheath hematoma is conservative management

Letter in response to original research article; oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial

We read with great interest the original research article entitled oral misoprostol solution in comparison to vaginal misoprostol for induction of labour in a randomized controlled trial by Abbas et al published in your journal in September 2020 issue. We want to congratulate the authors for this successful research article. It is indeed a great effort to shed light on the choice of preferred route and dose of administration of misorostol as a cervical ripening agent for induction of labour. However, we want to highlight a few points that are worth considering during interpretation of the trial results. All participants recruited in the study were primigravidae at term gestation. While term gestation starts from 37 weeks onwards, but in the inclusion criteria gestation range was mentioned from 36 to 42 weeks

Work-related stressors and coping strategies during COVID-19 pandemic: A qualitative study on reflections of frontline health care workers from India

Background: Frontline healthcare workers, a vital workforce in developing countries is often out of mainstream vision and their challenges and coping behaviors under stressful conditions remain unclear to stakeholders. This study was undertaken with the objective to explore the challenges faced by community surveillance workers and their coping strategies during COVID-19 pandemic. Methods: A qualitative descriptive study with constructivism paradigm was undertaken for a period of one year by conducting eight focus group discussions and eight in-depth interviews among the health workers undertaking COVID-19 surveillance selected purposively from eight wards within three Boroughs of a Municipal Corporation using interview guide. Thematic analysis was used to compare and contrast the codes to generate themes inductively under two constructs. Results: The first construct, factors influencing work related stress was categorized into four themes related to- work environment, community’s response towards pandemic surveillance, organizational support and personal factors. Main predisposing factors of work place stress were risk of self-infection, concern for family safety, inadequate training, shortage of manpower and protective equipment etc. While a strong commitment towards work, assistance from local community influencers, administrative appreciation and supportive supervision were protective factors against stress. Second construct on coping strategies was categorized into managing stress by problem-focused strategies like adapting with experience, gathering information and sharing experiences, adopting self-care practices; while emotion-based coping strategies included denial, venting out, or turning to religion etc. Conclusion: Community surveillance workers faced considerable and variable stress during pandemics due to various underlying work stressors, managed innovatively, using self-coping strategies

Evaluation of prevalence, clinical presentation and risk factors of coronary slow flow phenomenon: a single-center study

Background: The coronary slow flow phenomenon has been revealed to be associated with life-threatening arrhythmias and sudden cardiac death. Currently, clinical features and risk factors of patients with the coronary slow flow phenomenon are incompletely understood. The present study aimed to evaluate the prevalence, clinical presentation, risk factors and evidence of ischemia in patients with coronary slow flow.Methods: This observational study was conducted at a tertiary-care center in India between February 2013 and August 2014.  A total of 60 consecutive patients whose coronary angiogram revealed coronary slow flow were included in the study. According to the number of blood vessels involved, patients were divided into group-1 (29 patients with single-vessel disease), group-2 (22 patients with double-vessel disease), and group-3 (9 patients with triple-vessel disease). Clinical presentation and risk factors were compared among groups.Results: Prevalence of coronary slow flow was 2.97% with greater prevalence amongst male patients (p=0.030). Unstable angina was the most common presentation (p=0.030). Among the traditional risk factors, there was a significantly higher prevalence of smoking (p=0.036), family history of coronary artery disease (p=0.049) and dyslipidemia (p=0.045) in group-3 patients compared to other groups. Among all groups, triglycerides (p=0.020), low-density lipoprotein cholesterol (p=0.046), highly sensitive C-reactive protein (p=0.007) levels, homocysteine (p=0.481), and patterns of ECG abnormalities were significantly different between the three groups. In addition, mean frame counts with coronary slow flow phenomenon in left anterior descending artery (p<0.001), left circumflex artery (p<0.001) and right coronary artery (p=0.005) increased significantly with increase in number of vessels involved.Conclusions: Coronary slow flow was relatively common among patients who presented with unstable angina. Male sex, smoking, and dyslipidemia can be considered as independent risk factors for this phenomenon. 

Role of predictors in acceptance of post-exposure prophylaxis with single-dose rifampicin among contacts of leprosy in rural area of Bankura: An explanatory mixed-method study

Background: India achieved the elimination of leprosy two decades ago although its sustenance continues to be threatened by ongoing active transmission in few remaining pockets. There is a paucity of data regarding the acceptance of single-dose rifampicin (SDR) prophylaxis among healthy contacts. Aims and Objectives: The aims and objectives of the study are to assess the factors influencing the acceptability of SDR among contacts. Materials and Methods: A community-based, sequential, explanatory mixed-method study was conducted over 6 months from September 2022 to February 2023 among 168 contacts of leprosy patients from two blocks in Bankura district, West Bengal. Quantitative analysis was done for SDR acceptance and its predictors among contacts using the Chi-square test, Mann–Whitney U test, and Logistic regression. This was followed by qualitative assessment using focus group discussions and in-depth interviews among contacts to explain the findings through a thematic approach. Results: Household contacts (aOR=13.72, 95% CI=2.09–90.19), increasing knowledge score of contacts (aOR=3.18, 95% CI=1.88–5.38), counseling by health workers (aOR=11.98, 95% CI=2.20–65.15), trust in health workers (aOR=152.96, 95% CI=13.17–1776.09), and not taking other medicines for comorbidity (aOR=35.82, 95% CI=2.94–436.02) were associated with increased SDR uptake among leprosy contacts. Barriers and facilitators of post-exposure prophylaxis (PEP)-SDR were categorized as contact, health workers, and program-related factors. Conclusion: SDR acceptability among contacts was 77.4%. Facilitators of SDR-PEP were awareness of side-effects, follow-up, prompt support by health workers, IEC, belief in National programs, etc. Lack of knowledge of PEP-SDR and contraindications, ineffective counseling by health workers, stigma of the disease, the increased workload of health workers, etc., were the barriers to SDR-PEP implementation

Endometrial Stromal Tumour: Clinicopathological Series of Seven Cases

Endometrial Stromal Tumour (EST) mimics other neoplasms and is difficult to diagnose due to its wide range of morphologies. This is a clinicopathological study of seven cases of EST, which includes Endometrial Stromal Nodule (ESN), Low-grade Endometrial Stromal Sarcoma (LGESS), and High-grade Endometrial Stromal Sarcoma (HGESS). The age ranges from 34 to 75 years. Five out of seven cases presented with abnormal uterine bleeding, abdominal pain, and were radiologically suspected to be leiomyomas. After histopathological and Immunohistochemical (IHC) examination, one was diagnosed as ESN, three as LGESS, and the remaining three cases as HGESS. One case was initially diagnosed as a cellular leiomyoma and experienced multiple recurrences, eventually being diagnosed as HGESS with a fatal outcome within 36 months of the onset of the first symptoms. ESN and LGESS should be differentiated from leiomyoma and leiomyosarcoma. IHC plays an important role in distinguishing these tumours from the more common smooth muscle counterparts

Phosphorylation of nucleoporin Tpr governs its differential localization and is required for its mitotic function

A major constituent of the nuclear basket region of the nuclear pore complex (NPC), nucleoporin Tpr, plays roles in regulating multiple important processes. We have previously established that Tpr is phosphorylated in both a MAP-kinase-dependent and MAP-kinase-independent manner, and that Tpr acts as both a substrate and as a scaffold for ERK2 (also known as MAPK1). Here, we report the identification of S2059 and S2094 as the major novel ERK-independent phosphorylation sites and T1677, S2020, S2023 and S2034 as additional ERK-independent phosphorylation sites found in the Tpr protein in vivo. Our results suggest that protein kinase A phosphorylates the S2094 residue and that the site is hyperphosphorylated during mitosis. Furthermore, we find that Tpr is phosphorylated at the S2059 residue by CDK1 and the phosphorylated form distinctly localizes with chromatin during telophase. Abrogation of S2059 phosphorylation abolishes the interaction of Tpr with Mad1, thus compromising the localization of both Mad1 and Mad2 proteins, resulting in cell cycle defects. The identification of novel phosphorylation sites on Tpr and the observations presented in this study allow better understanding of Tpr functions