A community based study to determine incidence of cervical cancer and willingness of women to participate in cervical cancer screening program in Navsari, Gujarat, India

Background: Carcinoma of the uterine cervix is a major health problem faced by the Indian women. Regular cervical cytological examination by all sexually active women can prevent the occurrence of carcinoma cervix. Early detection of cervical cancer is possible with Pap smear tests. Methods: Women above 25 years of age, living in study area and want to participate in study were included. Total 2352 women were enrolled in study. House to house visits were conducted in all the village area by using simple random sampling method. Information about cervical cancer was given. Pap test for cervical cancer screening was carried out by gynaecologist. Cytological examination and confirmation was done by pathologists.Results: A total of 3001 women had attended village level IEC session and out that, 2352 (78.4%) women took part in the screening program. Out of these 2352 women, 2007 women (85.3% compliance) had given consent for physical cervical examination and Pap smear. The incidence of cervical cancer was 0.2% on the basis of clinical examination and biopsy.Conclusions: Higher compliance for undergoing vaginal examination and Pap test shows the positive health seeking behaviour of the women but for that, strong IEC and sensitization about the disease must be done to improve the participation. Sensitivity of Pap test was poor and couldn’t find true positive cases

Primary pleuropulmonary synovial sarcoma with brain metastases in a paediatric patient: an unusual presentation

  Primary lung neoplasms are rare in children. The most common primary lung malignancies in children are pleuropulmonary blastoma and carcinoid tumour. Synovial sarcoma (SS) accounts for approximately 1% of all childhood malignancies. In absolute terms, the SS of the lungs and pleura are extremely rare and pose a diagnostic difficulty. Soft tissue sarcomas usually have a high potential for metastases, however, metastasis to the brain is rare, even in widely disseminated disease, and it has been described only in 3 case reports previously. Primary pleuropulmonary SS with brain metastases is even rarer. Here we present a case of an 11-year-old boy who presented with respiratory complaints, viz. fever and cough for 20 days. Initial impression was lung abscess, however, on histopathological, immunohistochemical and molecular study, the disorder was diagnosed as synovial sarcoma. After a week from the first consult, the child developed neurological symptoms, viz., an episode of convulsion and gradually worsening power of the lower limb. Computed tomography scan and Magnetic Resonance Spectroscopy was suggestive of brain metastases. Given the rarity of primary lung neoplasms in children, clinical detection remains a challenge. Delayed diagnoses are common as respiratory symptoms may be attributed to inflammatory or infective processes. Primary pleuropulmonary synovial sarcoma is a rare tumour and it is not known to commonly metastasise to the brain. Though rare, primary pleuropulmonary SS should be considered an important differential among peadiatric primary lung neoplasms due to its potential for curability if detected early, and more aggressive metastatic pattern, e.g. brain metastases making early detection imperative.

Controlling the plasmonic properties of ultrathin TiN films at the atomic level

By combining first principles theoretical calculations and experimental optical and structural characterization such as spectroscopic ellipsometry, X-ray spectroscopy, and electron microscopy, we study the dielectric permittivity and plasmonic properties of ultrathin TiN films at an atomistic level. Our results indicate a remarkably persistent metallic character of ultrathin TiN films and a progressive red shift of the plasmon energy as the thickness of the film is reduced. The microscopic origin of this trend is interpreted in terms of the characteristic two-band electronic structure of the system. Surface oxidation and substrate strain are also investigated to explain the deviation of the optical properties from the ideal case. This paves the way to the realization of ultrathin TiN films with tailorable and tunable plasmonic properties in the visible range for applications in ultrathin metasurfaces and flexible optoelectronic devices.Comment: 24 pages, 8 Figures, research articl

An Optimistic-Robust Approach for Dynamic Positioning of Omnichannel Inventories

We introduce a new class of data-driven and distribution-free optimistic-robust bimodal inventory optimization (BIO) strategy to effectively allocate inventory across a retail chain to meet time-varying, uncertain omnichannel demand. While prior Robust optimization (RO) methods emphasize the downside, i.e., worst-case adversarial demand, BIO also considers the upside to remain resilient like RO while also reaping the rewards of improved average-case performance by overcoming the presence of endogenous outliers. This bimodal strategy is particularly valuable for balancing the tradeoff between lost sales at the store and the costs of cross-channel e-commerce fulfillment, which is at the core of our inventory optimization model. These factors are asymmetric due to the heterogenous behavior of the channels, with a bias towards the former in terms of lost-sales cost and a dependence on network effects for the latter. We provide structural insights about the BIO solution and how it can be tuned to achieve a preferred tradeoff between robustness and the average-case. Our experiments show that significant benefits can be achieved by rethinking traditional approaches to inventory management, which are siloed by channel and location. Using a real-world dataset from a large American omnichannel retail chain, a business value assessment during a peak period indicates over a 15% profitability gain for BIO over RO and other baselines while also preserving the (practical) worst case performance

Interosseous Access Osteomyelitis

Intraosseous (IO) access is a recommended technique in cases of an emergency situation where IV access cannot be obtained. Despite advancements in IO devices and FDA approval of many types of IO devices, it has various complications that although are rare, can be potentially life-threatening. We report a case of acute tibial osteomyelitis in an adult female with a history of polysubstance drug abuse a few weeks after an IO access from a previous hospital stay

Pierwotny maziówczak opłucnej i płuca z przerzutami do mózgu u dziecka: nietypowe objawy

Pierwotny nowotwór płuc rzadko występuje u dzieci. Najczęściej spotykane pierwotne złośliwe nowotwory płuc u dzieci to blastoma opłucnej i płuc oraz rakowiak. Maziówczak stanowi około 1% wszystkich nowotworów złośliwych występujących u dzieci. Maziówczak opłucnej i płuca jest zjawiskiem rzadkim i trudnym do rozpoznania. Mięsaki tkanek miękkich zazwyczaj posiadają dużą skłonność do przerzutów, jednak przerzuty do mózgu występują sporadycznie, nawet w zaawansowanych postaciach rozsianej choroby. Taki przebieg choroby został przedstawiony zaledwie w 3 opisach przypadków. Pierwotny maziówczak opłucnej i płuc z przerzutami do mózgu jest jeszcze rzadziej spotykany. W niniejszej pracy przedstawiono przypadek 11-letniego chłopca, u którego pojawiły się gorączka i trwający od 20 dni kaszel. Początkowo sądzono, że przyczyną jest ropień płuc, lecz po wykonaniu badań histopatologicznego, immunohistochemicznego i molekularnego rozpoznano maziówczaka. Po upływie tygodnia od pierwszej wizyty u dziecka pojawiły się objawy neurologiczne, tj. drgawki i stopniowo postępujące osłabienie siły kończyny dolnej. Wyniki tomografii komputerowej i rezonansu magnetycznego wskazywały na istnienie przerzutów do mózgu. Biorąc pod uwagę rzadkość występowania nowotworów płuc u dzieci, rozpoznanie kliniczne choroby pozostaje prawdziwym wyzwaniem. Często zdarza się, że rozpoznanie jest opóźnione, ponieważ objawy ze strony układu oddechowego mogą być przypisywane stanom zapalnym lub chorobom zakaźnym. Pierwotny maziówczak płuc i opłucnej występuje rzadko i sporadycznie wywołuje przerzuty do mózgu. Powinien być jednak brany pod uwagę przy rozpoznaniu różnicowym pierwotnych nowotworów płuc u dzieci, ponieważ przy wczesnym rozpoznaniu może być uleczalny, zaś w przypadku agresywnego przebiegu z przerzutami na przykład do mózgu, wczesne rozpoznanie jest szczególnie ważne.Pierwotny nowotwór płuc rzadko występuje u dzieci. Najczęściej spotykane pierwotne złośliwe nowotwory płuc u dzieci to blastoma opłucnej i płuc oraz rakowiak. Maziówczak stanowi około 1% wszystkich nowotworów złośliwych występujących u dzieci. Maziówczak opłucnej i płuca jest zjawiskiem rzadkim i trudnym do rozpoznania. Mięsaki tkanek miękkich zazwyczaj posiadają dużą skłonność do przerzutów, jednak przerzuty do mózgu występują sporadycznie, nawet w zaawansowanych postaciach rozsianej choroby. Taki przebieg choroby został przedstawiony zaledwie w 3 opisach przypadków. Pierwotny maziówczak opłucnej i płuc z przerzutami do mózgu jest jeszcze rzadziej spotykany. W niniejszej pracy przedstawiono przypadek 11-letniego chłopca, u którego pojawiły się gorączka i trwający od 20 dni kaszel. Początkowo sądzono, że przyczyną jest ropień płuc, lecz po wykonaniu badań histopatologicznego, immunohistochemicznego i molekularnego rozpoznano maziówczaka. Po upływie tygodnia od pierwszej wizyty u dziecka pojawiły się objawy neurologiczne, tj. drgawki i stopniowo postępujące osłabienie siły kończyny dolnej. Wyniki tomografii komputerowej i rezonansu magnetycznego wskazywały na istnienie przerzutów do mózgu. Biorąc pod uwagę rzadkość występowania nowotworów płuc u dzieci, rozpoznanie kliniczne choroby pozostaje prawdziwym wyzwaniem. Często zdarza się, że rozpoznanie jest opóźnione, ponieważ objawy ze strony układu oddechowego mogą być przypisywane stanom zapalnym lub chorobom zakaźnym. Pierwotny maziówczak płuc i opłucnej występuje rzadko i sporadycznie wywołuje przerzuty do mózgu. Powinien być jednak brany pod uwagę przy rozpoznaniu różnicowym pierwotnych nowotworów płuc u dzieci, ponieważ przy wczesnym rozpoznaniu może być uleczalny, zaś w przypadku agresywnego przebiegu z przerzutami na przykład do mózgu, wczesne rozpoznanie jest szczególnie ważne

Self-reported tobacco smoking practices among medical students and their perceptions towards training about tobacco smoking in medical curricula: A cross-sectional, questionnaire survey in Malaysia, India, Pakistan, Nepal, and Bangladesh

<p>Abstract</p> <p>Background</p> <p>Tobacco smoking issues in developing countries are usually taught non-systematically as and when the topic arose. The World Health Organisation and Global Health Professional Student Survey (GHPSS) have suggested introducing a separate integrated tobacco module into medical school curricula. Our aim was to assess medical students' tobacco smoking habits, their practices towards patients' smoking habits and attitude towards teaching about smoking in medical schools.</p> <p>Methods</p> <p>A cross-sectional questionnaire survey was carried out among final year undergraduate medical students in Malaysia, India, Nepal, Pakistan, and Bangladesh. An anonymous, self-administered questionnaire included items on demographic information, students' current practices about patients' tobacco smoking habits, their perception towards tobacco education in medical schools on a five point Likert scale. Questions about tobacco smoking habits were adapted from GHPSS questionnaire. An <it>'ever smoker' </it>was defined as one who had smoked during lifetime, even if had tried a few puffs once or twice. 'Current smoker' was defined as those who had smoked tobacco product on one or more days in the preceding month of the survey. Descriptive statistics were calculated.</p> <p>Results</p> <p>Overall response rate was 81.6% (922/1130). Median age was 22 years while 50.7% were males and 48.2% were females. The overall prevalence of 'ever smokers' and 'current smokers' was 31.7% and 13.1% respectively. A majority (> 80%) of students asked the patients about their smoking habits during clinical postings/clerkships. Only a third of them did counselling, and assessed the patients' willingness to quit. Majority of the students agreed about doctors' role in tobacco control as being role models, competence in smoking cessation methods, counseling, and the need for training about tobacco cessation in medical schools. About 50% agreed that current curriculum teaches about tobacco smoking but not systematically and should be included as a separate module. Majority of the students indicated that topics about health effects, nicotine addiction and its treatment, counselling, prevention of relapse were important or very important in training about tobacco smoking.</p> <p>Conclusion</p> <p>Medical educators should consider revising medical curricula to improve training about tobacco smoking cessation in medical schools. Our results should be supported by surveys from other medical schools in developing countries of Asia.</p

Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society

BackgroundThere is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit.MethodsDevelopment of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed.ResultsThis guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections.ConclusionsIn this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions

Changes in the gastric enteric nervous system and muscle: A case report on two patients with diabetic gastroparesis

<p>Abstract</p> <p>Background</p> <p>The pathophysiological basis of diabetic gastroparesis is poorly understood, in large part due to the almost complete lack of data on neuropathological and molecular changes in the stomachs of patients. Experimental models indicate various lesions affecting the vagus, muscle, enteric neurons, interstitial cells of Cajal (ICC) or other cellular components. The aim of this study was to use modern analytical methods to determine morphological and molecular changes in the gastric wall in patients with diabetic gastroparesis.</p> <p>Methods</p> <p>Full thickness gastric biopsies were obtained laparoscopically from two gastroparetic patients undergoing surgical intervention and from disease-free areas of control subjects undergoing other forms of gastric surgery. Samples were processed for histological and immunohistochemical examination.</p> <p>Results</p> <p>Although both patients had severe refractory symptoms with malnutrition, requiring the placement of a gastric stimulator, one of them had no significant abnormalities as compared with controls. This patient had an abrupt onset of symptoms with a relatively short duration of diabetes that was well controlled. By contrast, the other patient had long standing brittle and poorly controlled diabetes with numerous episodes of diabetic ketoacidosis and frequent hypoglycemic episodes. Histological examination in this patient revealed increased fibrosis in the muscle layers as well as significantly fewer nerve fibers and myenteric neurons as assessed by PGP9.5 staining. Further, significant reduction was seen in staining for neuronal nitric oxide synthase, heme oxygenase-2, tyrosine hydroxylase as well as for c-KIT.</p> <p>Conclusion</p> <p>We conclude that poor metabolic control is associated with significant pathological changes in the gastric wall that affect all major components including muscle, neurons and ICC. Severe symptoms can occur in the absence of these changes, however and may reflect vagal, central or hormonal influences. Gastroparesis is therefore likely to be a heterogeneous disorder. Careful molecular and pathological analysis may allow more precise phenotypic differentiation and shed insight into the underlying mechanisms as well as identify novel therapeutic targets.</p