Notes

Treatment of octogenarians and also nonagenarians using aneurysmal subarachnoid hemorrhage: the 17-year institutional investigation.
Adenoid squamous cell carcinoma (ASCC) is a variant of squamous cell carcinoma. As this variant is rare it is difficult to distinguish it from other variants of squamous cell carcinoma. It commonly originates in the head and neck region as these parts are highly exposed to the sunlight. There are very few cases reported in the literature. Here we report a case in a 30-year-old male who reported with a nodular lesion over the upper lip with no unusual signs, which was confirmed as adenoid squamous cell carcinoma after various histopathological tests.Corynebacterium diphtheriae is a gram-positive bacillus with characteristic polar metachromatic granules. It was a significant public health problem, infecting the throat and upper airways and producing a highly potent exotoxin but with the advent of diphtheria vaccine, cases have rapidly decreased. Now over the last decade, the reemergence of this infection has been noted and case reports from India have been documented. India represents 78% of globally reported cases with significant mortality despite national immunization programs in place. This case study indicates the severity of an improperly managed case, the importance of microbiological diagnosis with a special interest in molecular detection, and reinforces a resurgence of diphtheria infection.The recreational use of nitrous oxide (N2O) is a growing public health concern. Increasing numbers of young individuals are presenting to accident emergency departments complaining of adverse neurological symptoms as a result of N2O induced vitamin B12 deficiency. Despite its increasing popularity, many are still not aware of its devastating potential to cause a myriad of severe longstanding neurological impairment. Herein we present a case that highlights the effects of N2O abuse and the best way to investigate and manage such patients.Myocarditis in patients with diphtheria is a toxin-mediated complication that sets in after one week of onset of respiratory illness. Early administration of antidiphtheritic serum in patients with clinical diphtheria before the onset of myocarditis is of utmost importance to prevent this fatal complication. We report three patients who presented late in illness after the myocarditis had set in, to stress on the need of prompt administration of antitoxins by primary care physicians and highlight the importance of immunization.As per latest Global TB Report (2018), an estimated 2.2 lakh children get tuberculosis (TB) each year in India and illness constitutes a very high global burden. Here we report an unusual case of a child aged 14 years (female), who presented to Emergency with complaints of cough and restlessness for the past 1 day. Working diagnosis of septic shock was kept and child was started on intravenous ionotropes, vasopressors, and an antibiotic. There was no significant history suggestive of TB. Patient was shifted to PICU and managed for shock accordingly. X-ray lung showed single right-sided cavitatory lesion. Bronchoalveolar lavage was positive for acid fast bacilli, confirming the diagnosis of pulmonary TB. The patient was started on antitubercular drug regimen (ATT) for 6 months and showed significant improvement with complete resolution. Literature was searched for association of septic shock in tubercular patients as a presenting complaint, which is a rare entity.The aim of this study is to report a 7-year-old girl with psychogenic visual disturbance that improved upon staying at home after the declaration of a state of emergency in relation to Coronavirus disease. Her uncorrected visual acuity (UCVA) in the right eye was 0.4 and in the left eye was 0.3. Slit-lamp examination and fundoscopy showed no abnormalities. selleck kinase inhibitor She had a tight schedule on six days a week due to various lessons. To prevent the spread of infection, her school was closed, and she was not able to attend any lessons. She enjoyed spending time at home. Six months after her initial visit during school closure, her UCVA had improved to 1.2. The situation of staying at home may have had a positive psychological effect after removing factors contributing to her stress.Hepatic hemangioma is a commonly encountered benign vascular tumour of liver during infancy. Acquired hypothyroidism is one of the rare manifestation of this entity. We report a 4-month-old infant born to a diabetic mother who developed acquired hypothyroidism not responding to treatment due to multiple hepatic hemangiomas. The mechanism behind is increased type 3 deiodinase activity due to hemangiomas of liver, which catalyses conversion of T4 to rT3 and T3 to T2. Hemangiomas were successfully treated with propranolol which lead to its regression and ultimately resulted in euthyroidism. Hence, screening for hepatic hemangioma should be done in all cases of congenital hypothyroidism not responding to thyroxine treatment. We also propose early initiation of treatment of hemangiomas with propranolol as the first line therapy to prevent growth retardation and intellectual loss.
Janani Sishu Suraksha Karyakram (JSSK) is a flagship program of India to reduce out of pocket expenditure (OOPE) of the families during childbirth and neonatal sicknesses.

To assess the utilization of JSSK while availing services for childbirth and newborn care in a secondary care hospital in Southern India; estimate the OOPE in services covered by JSSK and identify the associated factors with OOPE.

228 mothers who delivered in the previous 2 days, were recruited from a secondary-level government hospital in Chittoor. Expenditure incurred under various components of JSSK was asked during the recruitment and subsequently through telephonic interviews.

All components of JJSK, except transport, were fully utilized by the families. 138 mothers (60.5%, 95% CI 54.0, 67.0), and all sick children (
= 138, 100%) who visited government hospital, incurred OOPE in the form of transport cost. The median expenditure of transport (from home to hospital and hospital to home) of the mothers was 250 INR (IQR 100-513 INR). Transport expenditure was greater for the rural families (300 INR) than the urban families (100 INR) (
< 0.05). In multiple logistic regression, nuclear families were associated with high OOPE (AOR- 2.0, 95% CI 1.1- 3.7). Though education of the mother showed high association (AOR- 2.7, 95% CI 1.0- 7.8), it was not statistically significant (
= 0.05).

The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.
The families utilize most of the components of JSSK, except transport. Family-centric counselling of the beneficiaries during antenatal check-ups and home visits by the healthcare workers can reduce transport-related OOPE.
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