The acceptability of waiting times for elective general surgery and the appropriateness of prioritising patients

Background  

Problematic waiting lists in public health care threaten the equity and timeliness of care provision in several countries. This study assesses different stakeholders' views on the acceptability of waiting lists in health care, their preferences for priority care of patients, and their judgements on acceptable waiting times for surgical patients.     

Preventing childhood obesity and diabetes: is it time to move out of the school?

Abstract:  Childhood obesity interventions in the USA and Europe have predominantly focused on the school environment for over two decades with mixed or modest success. The focus on school – while intuitive, apparently efficient, and convenient – does not address larger upstream environmental factors, which affect obesity among youth. In this article, we examine potential drawbacks and limitations of previous school-based obesity and diabetes prevention programs. The future of school-based obesity and diabetes interventions and potential strategies for improvement is explored. Increased use and reporting of diversified theoretical frameworks, formative research to inform the interventions, and process evaluations to improve programs are recommended. More importantly, addressing the broader issue of the overall food environment and its impact on children's diet with intensified involvement of key stakeholders, including families, supermarkets, and corner stores is essential. We discuss the development of healthy eating zones around schools as a potential tool in the fight to reduce childhood obesity.     

Cochlear implantation in branchio-oto-renal syndrome — A surgical challenge

Branchio-oto-renal syndrome (Melnick-Fraser Syndrome) is a rare Autosomal Dominant disorder characterized by the syndromic association of branchial cysts or fistulae along with external, middle & inner malformations and renal anomalies. Incomplete penetrance and variable expressivity are common with the phenotypic variation ranging from mild to severe forms & consisting of various eye, ear, oral and craniofacial abnormalities. Mutations in the EYA1 gene on chromosomal site 8q13.3 are identified as the primary cause of BOR syndrome. We present a 3year old child with BOR syndrome, who came to us with bilateral low set, malformed ears & profound cochlear hearing loss along with bilateral branchial fistulae & unilateral renal agenesis. This child underwent successful cochlear implantation recently. The clinical presentation, pre-operative investigations, intra-operative findings & post-op habilitation status are presented with special highlights on the unique facial nerve course along with middle and inner ear anomalies which posed a surgical challenge during cochlear implantation.     

Unerupted maxillary primary canine associated with compound composite odontoma: a case report

Unerupted primary teeth is very rare especially in the maxillary anterior teeth. A case of unerupted left maxillary Cuspid due to the presence of compound composite odontoma in a 10 years old female child is presented.     

An epidemiological study on patients undergoing dacryocystorhinostomy

Dacryocystorhinostomy is performed in patients with naso-lacrimal duct obstruction to bypass the site of obstruction so as to relieve the patient of the irritating and socially embarrassing symptoms of epiphora. We discuss the various epidemiological aspects especially the vast difference by which the females out-number the males in patients undergoing DCR and the likely explanations for this difference in our study on 74 patients which underwent DCR in our institute.     

Development of standard therapeutic guidelines for selected common diseases for the primary health care centres of a South Indian district

Method A questionnaire survey of medical officers was conducted to collect data on the most commonly‐presenting diseases and doctors' treatment choices in PHCs in Mysore. Draft guidelines were developed for these conditions based on available literature, together with microbiological sensitivity data from the three district hospitals. User feedback on the draft guidelines and on guidelines in general was obtained from medical officers using a postal questionnaire. Objective To develop standard therapeutic guidelines for selected common diseases for the primary health care centres (PHCs) of a South Indian district and to evaluate medical officers' perceptions about the proposed guidelines and about guidelines in general. Setting Sample of 17 of the 93 PHCs in Mysore. Key findings Upper respiratory tract infection was the most commonly‐presenting condition. Procaine penicillin was the most commonly‐used drug and there were examples of inappropriate treatment choices. The survey produced evidence that access to medicines on the government's “essential” list was not uniform, with many patients having to purchase prescribed drugs that were not on the list. The response rate to the user feedback questionnaire was 62 per cent (31 doctors). The medical officers had positive opinions about guidelines in general and felt that the guidelines we proposed were useful and would help them to improve their prescribing habits. Conclusions Prescribing in primary care in India needs to be improved. The involvement of potential users of the guidelines in their development should increase their acceptability and thus their use in practice.     

Role of antral Catheterization in cases of chronic maxillary sinusitis

The Present study has been conducted on 25 Patients of chronic Maxillary Sinusitis proved Radiologically and confirmed sinoscopically. After antral Catheterrization for 2– 3 weeks repeated Antral Irrigation with normal Saline solution was done on every alternate day. The patients were followed up for 2 months and it was observed that in 92% cases there was complete recovery while remaining 8% cases (Basal CYST/Mucosal thickening) had partial recovery. Hence this procedure can replace repeated antral punctures and can be advocated as a routine method of treament in cases of chronic maxillary sinusitis not responding to conventional treatment.     

Squamous cell carcinoma in long-standing untreated lichen sclerosus et atrophicus of the penis

Lichen sclerosus et atrophicus is an uncommon disease of skin and genital mucosa in both sexes. Involvement of the male genital mucosa is usually complicated by recurrent balanoposthitis, ulceration, phimosis, and meatal stenosis. The development of a squamous cell carcinoma is extremely rare in genital lichen sclerosus et atrophicus in males as compared with females. We report a 70-year-old male with a squamous cell carcinoma of the glans superimposed on long-standing lichen sclerosus et atrophicus of glans and prepuce. The patient in addition had a basal cell carcinoma on his face. Awareness of this rare complication of lichen sclerosus et atrophicus in males is emphasized.