Pulmonary Hydatid Disease with Aspergillosis - An Unusual Association in an Immunocompetent Host

Echinococcosis is a common cause of pulmonary cavities. Aspergillus fumigatus, a saprophytic fungus, can colonise pulmonary cavities caused by tuberculosis, sarcoidosis, echinococcosis, bronchiectasis and neoplasms. Infection by Aspergillus is often seen in immunosuppressed cases. However, co-infection of Aspergillus with pulmonary echinococcosis is unexpected and very unusual, especially in an immunocompetent patient. We present the case of a 45-year-old immunocompetent male who came with non-resolving pneumonia and fever for 8 months and dyspnoea since 15 days accompanied by recurrent episodes of hemoptysis since 5 days. Chest X Ray and Computed Tomography scan showed a cystic lesion in the middle lobe of the right lung. Middle lobectomy with video-assisted thoracoscopic surgery was performed and histopathology revealed ectocyst of Hydatid cyst which was also colonised by septate fungal hyphae exhibiting acute angled branching, morphologically consistent with Aspergillus. Gomori Methanamine Silver and Periodic Acid Schiff stains highlighted the hyphae of Aspergillus as well as the lamellated membranes of ectocyst and an occasional scolex of Echinococcus. Sections from surrounding lung parenchyma also showed these fungal hyphae within an occasional dilated bronchus. Thus a diagnosis of dual infection of Aspergillosis and Pulmonary Echinococcosis was established. The possibility of dual infection by a saprophytic fungus must be kept in mind while dealing with a case of a cavitary lesion in long-standing and non-resolving pneumonia, even in an immunocompetent patient. Establishing the correct diagnosis of Aspergillosis with Echinococcosis is essential for proper and complete management.

Risk factors of type-2 diabetes mellitus in rural Wardha: A community based study

CONTEXT:

The rise in diabetes mellitus (DM) portends a disaster of major proportion worldwide. AIM: To study the determinants of type-2 DM in people who are ≥45 years of age by selective screening methodology in rural area of Wardha district.

SETTINGS AND DESIGN:

A cross-sectional study in a rural area of Wardha district.

METHODOLOGY:

A cross-sectional population-based study was conducted among those who are at risk of developing DM, as per the WHO guidelines on Laboratory Diagnosis and monitoring of Diabetes Mellitus 2002. Blood glucose estimation was done using a blood glucose meter.

STATISTICAL ANALYSIS USED:

Multiple Logistic Regression.

RESULTS:

Eight point four nine percent of the 306 persons above the age of 45 years were diabetic. This study also revealed that the proportion of people diagnosed with DM increases with increasing age groups. Mean fasting and post meal blood glucose level (in mg%) among the study participants (nondiabetics) were 83.6 ± 1.6 and 129.9 ± 1.9 and mean fasting and post meal blood glucose level among diabetics were 138.8 ± 2.1 and 220.7 ± 1.9, respectively. The difference between the post meal blood glucose level among the diabetics and nondiabetics was statistically significant. The proportion of diabetics was more among those who had family history of diabetes (8.6%), BMI more than 25 (24.1%) and those with sedentary lifestyle (10.4%).

CONCLUSIONS:

Implementation of preventive measures to reduce the burden of diabetes is needed. Identification of the environmental factors adversely related to glucose intolerance helps evolve preventive strategies.

Predictors for antenatal services and pregnancy outcome in a rural area: a prospective study in Wardha district, India

BACKGROUND

Antenatal care is essential to reduce morbidity and mortality among newborn babies and pregnant women.

AIMS

To study the pattern of utilization of antenatal services and to find out the potential predictors, their distributions and their association with antenatal care utilization and pregnancy outcomes.

SETTINGS AND DESIGN

A prospective longitudinal study was conducted in Deoli, a rural teaching area of a medical college of Wardha district, Maharashtra state.

MATERIALS AND METHODS

Medical social workers contacted all the registered 305 pregnant women in 1 month. A total of 274 women were included in the study. The response rate was 89.83%.

STATISTICAL ANALYSIS USED

Percentages, rate ratio.

RESULTS

Mean age at marriage was 19.8+/-3.6 years, and the average age at first pregnancy was 21.6+/- 4.5 years. Of the 274 pregnant women, 156 (56.9%) were pregnant for the first time (gravida 1), and the remaining 118 (43.1%) pregnant women, gravida 2 and above, had an average of 2.1 living sons and 1.9 living daughters. Only 92 (33.6%) women had undergone the minimum recommended antenatal checkup during their current pregnancy, and 188 (68.6%) women had institutional deliveries. A large proportion of women in Deoli do not receive proper health care during pregnancy and childbirth.

CONCLUSION

In Deoli, antenatal services, in spite of being essential to the care of pregnant women, are being poorly delivered.

Assessing self-care component of activities and participation domain of the international classification of functioning, disability and health (ICF) among people living with HIV/AIDS

Disability experience of persons with HIV illness has shifted from issues related to physical well-being to those concerning performance of daily life activities. This study aimed to find out the nature of self-care among people living with HIV/AIDS (PLWHA) in rural tertiary care center. The objectives were to determine reported self-care by performance qualifier of PLWHA and to find out reported self-care by capacity qualifier of PLHIV. A cross sectional study was conducted among the 194 PLHIV in rural tertiary care hospital. The Self-Care (d5) component of Activities and Participation domain (d) of the International Classification of Functioning, Disability and Health (ICF) was used. Among the 194 PLHIV patients studied, 82% were male. The average age was 36.87 years (SD+/-9.01) with a median of 35 years, varying from 15 to 65 years. Over 65% of the study group experienced one or more impairments. As HIV disease has become a more lifelong, unpredictable, but medically manageable condition, there is a need for more collaboration with other disability groups in order to identify commonalities in their experiences and to share collective concerns.

Current health scenario in rural India

India is the second most populous country of the world and has changing socio-political-demographic and morbidity patterns that have been drawing global attention in recent years. Despite several growth-orientated policies adopted by the government, the widening economic, regional and gender disparities are posing challenges for the health sector. About 75% of health infrastructure, medical man power and other health resources are concentrated in urban areas where 27% of the population live. Contagious, infectious and waterborne diseases such as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm infestations, measles, malaria, tuberculosis, whooping cough, respiratory infections, pneumonia and reproductive tract infections dominate the morbidity pattern, especially in rural areas. However, non-communicable diseases such as cancer, blindness, mental illness, hypertension, diabetes, HIV/AIDS, accidents and injuries are also on the rise. The health status of Indians, is still a cause for grave concern, especially that of the rural population. This is reflected in the life expectancy (63 years), infant mortality rate (80/1000 live births), maternal mortality rate (438/100 000 live births); however, over a period of time some progress has been made. To improve the prevailing situation, the problem of rural health is to be addressed both at macro (national and state) and micro (district and regional) levels. This is to be done in an holistic way, with a genuine effort to bring the poorest of the population to the centre of the fiscal policies. A paradigm shift from the current 'biomedical model' to a 'sociocultural model', which should bridge the gaps and improve quality of rural life, is the current need. A revised National Health Policy addressing the prevailing inequalities, and working towards promoting a long-term perspective plan, mainly for rural health, is imperative.

Spectrum of illness in rural areas of Ahmednagar District

At Pravara Medical Trust (PMT), Loni, Ahmednagar, multidiagnostic and treatment camps (MDTC) are organised by PMT every month in remote villages with active participation of villagers, to provide health care to needy and deprived population. From January 1987 to April 1992, 58 camps have been organised and 60,856 patients availed various medical and health services rendered by PMT. Average attendance of patients per camp was 1049, 48.36% being females and 51.64% males. According to the International Classification of Diseases (ICD) patients were broadly grouped. A total of 21,603 (35.5%) were referred to the Pravara Rural Hospital and 15,700 (72.67%) of them availed the indoor and outdoor services there.