Primary exophytic laryngeal amyloidosis presenting as sudden airway obstruction

Primary amyloidosis of larynx is an uncommon phenomenon, the precise etiopathogenesis of which is not yet clear. It can present with slowly increasing hoarseness or difficulty in breathing. It presents more commonly as infiltrative lesion, exophytic presentation is a rare occurrence.     

Profile of women substance users seeking treatment at tertiary care treatment center in India: A retrospective chart review study

Introduction: Among substance users, women represent a small, unique subpopulation. Studying their socio-demographic and substance-use profile helps us understand their concerns and formulate management strategies. Materials and Methods: In this retrospective chart review, all the available records of outpatient treatment seekers at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), Ghaziabad, from 1 January 2011 to 31 December 2015 were screened. Data from the women substance users were entered into a specially designed MS Excel format and analyzed. Results: In these 5 years, 217 women (mean age 36.75 ± 11.84 years) sought treatment. Majority were married (75.6%), housewife (53.5%), educated (59.4%), from an urban background (70.0%). Most common primary substance used was opioid (61.3%), including heroin (30.0%) and pentazocine (16.1%). About 20.3% reported injectable opioid use. The mean duration of opioid use was 5.44 ± 4.68 years. History of prior treatment seeking was reported by 4.6% and no prior significant abstinence attempts by 77.4%. Discussion and Conclusion: Majority of female treatment seekers, are young, married urban women and seek treatment for opioid use, particularly heroin (as opposed to pentazocine, suggested by previous studies). Prior treatment seeking and abstinence rates are low. Data indicates the need of specialized services for this population.     

Exposure density and neighborhood disparities in COVID-19 infection risk

Although there is increasing awareness of disparities in COVID-19 infection risk among vulnerable communities, the effect of behavioral interventions at the scale of individual neighborhoods has not been fully studied. We develop a method to quantify neighborhood activity behaviors at high spatial and temporal resolutions and test whether, and to what extent, behavioral responses to social-distancing policies vary with socioeconomic and demographic characteristics. We define exposure density (Exρ) as a measure of both the localized volume of activity in a defined area and the proportion of activity occurring in distinct land-use types. Using detailed neighborhood data for New York City, we quantify neighborhood exposure density using anonymized smartphone geolocation data over a 3-mo period covering more than 12 million unique devices and rasterize granular land-use information to contextualize observed activity. Next, we analyze disparities in community social distancing by estimating variations in neighborhood activity by land-use type before and after a mandated stay-at-home order. Finally, we evaluate the effects of localized demographic, socioeconomic, and built-environment density characteristics on infection rates and deaths in order to identify disparities in health outcomes related to exposure risk. Our findings demonstrate distinct behavioral patterns across neighborhoods after the stay-at-home order and that these variations in exposure density had a direct and measurable impact on the risk of infection. Notably, we find that an additional 10% reduction in exposure density city-wide could have saved between 1,849 and 4,068 lives during the study period, predominantly in lower-income and minority communities.

As of December 17, 2020, there have been 73 million cases of COVID-19 in more than 200 countries, and 1.6 million people have lost their lives to the disease (1). The COVID-19 pandemic is considered the most severe public health crisis since the 1918 flu pandemic due to its transmission and infection characteristics (2–5). Social distancing (also referred to as physical distancing) has been shown to be an effective behavioral nonpharmaceutical intervention to reduce the transmission rate of COVID-19 (3–7). Social distancing reduces the probability of contacts between individuals who might be infected, resulting in reduced exposure risk (7, 8). Governments have implemented a range of social-distancing policies, including travel bans, restrictions on gatherings, school closures, nonessential business closures, and restaurant restrictions. In particularly hard-hit locations, mandatory “stay-at-home” orders have been issued to limit or avoid unnecessary close contacts outside of the home (7–9).Studies have found that social-distancing measures help to prevent transmission of the virus and reduce the reproduction (R₀) number (5–7, 10–14). These practices help to avoid overwhelming hospital intensive care units and healthcare systems, control doubling time of infections, and ultimately save lives (5, 8, 14, 15). Although not without potentially significant hardship to individuals and communities, social distancing is an important public health tool to flatten the epidemic curve and support longer-term economic and public health benefits (3, 15–17).However, the impact of, and response to, stay-at-home orders and social-distancing guidelines is not uniform across neighborhoods and communities (18, 19). In order to maximize the positive effects of social distancing, individuals need to change their typical behavior, often dramatically (3, 20). Despite government-mandated social-distancing policies (such as New York State’s PAUSE order), socio-behavioral responses vary across neighborhoods, further contributing to disparities in risk of infection (4, 7, 21). Disparities in social-distancing practices—namely, geographic or population subgroup differences in adopting behavior changes in response to the same policy context—may stem from varying levels of awareness, perception, or belief in the severity of the virus threat; differences in social and cultural norms; or the ability of households and communities to alter normal activity patterns given economic constraints or other existing responsibilities (7, 20–23). For example, lower-income households typically do not have the option to work from home, and going to a place of work (often in essential services) is unavoidable, meaning higher risk of exposure to COVID-19 for themselves, as well as their families and communities (7, 24). Within specific neighborhoods, norms can also be reinforcing; if large numbers of residents are essential workers and not socially distancing, other residents may have similar behavioral responses (20).A growing number of outbreaks are occurring in densely populated areas (25), with disproportionate impacts on lower-income and predominantly minority communities (18, 26–28). Measuring and understanding social distancing and behavior change across neighborhoods can provide critical insight into the design and implementation of more effective—and equitable—public health policy. Given the potential heterogeneity in localized responses to social-distancing recommendations, quantifying local patterns of activity represents an emerging tool to understand and eventually reduce local exposure risk and limit community outbreaks (7, 29, 30). Although there has been increasing awareness of the troubling disparities in infection rates and outcomes in vulnerable communities, the effectiveness of behavioral interventions at the scale of individual neighborhoods has not been fully studied. Often, studies that do attempt to observe effects at higher spatial resolutions rely on simulations or are limited to relatively coarse areal units (e.g., county or state) due to data availability and computational constraints (31–34). Absent a more complete understanding of neighborhood activity patterns in response to nonpharmaceutical interventions, disaggregating built-environment, behavioral, and social determinants of health in the context of COVID-19 remains a challenge.We develop a method to quantify neighborhood activity at high spatial and temporal resolutions to test whether—and to what extent—behavioral responses to social-distancing policies vary with socioeconomic, demographic, and built-environment characteristics. We define exposure density (Exρ) as a measure of both the localized volume of activity in a defined area and the proportion of activity occurring in nonresidential and outdoor land uses, areas that can be associated with an increased risk of exposure to others that may be infected. We utilize this approach to capture community inflows/outflows of people as a result of the pandemic and changes in mobility behavior for those that remain.Our focus is on New York City (NYC), the first epicenter of the pandemic in the United States, where a statewide stay-at-home order (NY on PAUSE) was introduced on March 22, 2020. By June 30, 2020, NYC had more than 212,000 confirmed cases of COVID-19, accounting for 8% of the nationwide total, resulting in at least 18,492 confirmed deaths and 4,604 probable deaths (35). Our methodology proceeds in three steps. First, we develop a generalizable method for assessing neighborhood activity levels using smartphone geolocation data over a 3-mo period (February, March, and April) covering more than 12 million unique devices within the Greater New York area, together with land-use classifications at 1-m grid resolution. Second, we measure and analyze disparities in community social distancing by estimating variations in neighborhood activity and associated patterns in community characteristics before and after the stay-at-home order. Finally, we evaluate the effect of exposure density on COVID-19 infection rates associated with localized demographic, socioeconomic, and built-environment characteristics in order to identify disparities in health outcomes related to mobility behavior. Our findings provide insight into the timely evaluation of the effectiveness of social distancing at the scale of individual neighborhoods and support a more equitable allocation of resources to vulnerable and at-risk communities.     

High proportion of pentazocine dependence among treatment-seeking female injecting drug users (FIDUs) in India: A distinct population?

Background. Adverse consequences of injecting are greater among female injecting drug users (FIDUs), yet treatment-seeking is low because of stigma, poor social support, and unavailability of gender-specific services. FIDUs, despite being a distinct subpopulation of women substance users, are sparsely studied.

Aims. We aimed to study the sociodemographic and clinical profile of treatment-seeking FIDUs at a tertiary drug treatment center in North India.

Methods. In this retrospective study, we reviewed medical records of all the FIDUs who sought outpatient treatment from January 1, 2011, to December 31, 2015.

Results. Out of a total of 217 records of female patients, 44 were current IDUs (20.27%), with mean age 35.48 ± 10.13 years. Majority were Hindu (84.1%), married (81.8%), homemakers (52.3%) educated up to 12 years (65.9%). Primary drug of dependence was injection pentazocine for 33 patients (75.0%) and injection smack (street heroin) for 8 (18.2%). Commonest reason for initiation of drug use was iatrogenic (n = 25; 56.8%). Major physical complications were reported by 29 (65.9%), while 12 (22.8%) reported psychiatric comorbidity.

Conclusion. A typical treatment-seeking FIDU is middle-aged, educated, homemaker using injecting pentazocine. High rate of injecting with iatrogenic onset highlights the need for women-specific services as well as awareness-building among physicians.     

Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre

PurposeTo categorize and compare the dental emergencies along with status of health services received in the tertiary dental health care centre during the pre covid- 19 periods and period of the complete lockdown in COVID 19 pandemic. Methods: A retrospective cross-sectional observational survey was conducted. Four different groups period were studied on patients who visited for dental emergencies at tertiary care centre. April 14 to 13 May 2020 assigned and analyzed as a test period group or group IV. The control period group i.e. group III was 14 February 2020 to 17 March, pre lockdown COVID 19 month when there was no consideration of epidemic in India. Same as periods of group II and IV, group I and II from last year 2019 were also assigned and analyzed. The tertiary care centre provision of health services during this pandemic was also inquired and evaluated. The information was recorded regarding availability of health services like non-emergency dental treatments, emergency dental services, and online professional consultation. To compare four different time period of obtained data, Analysis of variance (ANOVA) and Chi square test were used. Results: The overall proportion and percentage of dental emergencies were raised. The reason for emergency visits to dental clinic were the main problem related with pulpal (46.0%) followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%) or trauma (0.3%). In lockdown most of the dental emergencies 228(2 6 5) were endodontic related (86.1%) which managed mostly through ‘3A” approach (advise, analgesics and antibiotics) (60.1%) and remaining (26.0%) through extraction.     

An observational study assessing the pathways to care among treatment seeking users of natural opiates

Abstract

Background: Natural opiate users constitute a large proportion of opioid dependent individuals in India, and enjoy socio-cultural sanction in certain parts of the country. However, no study has assessed the pathways to care among this population in India.

Objective: To assess the pathways to care among treatment-seeking natural opiate dependent individuals.

Method: This cross sectional, explorative study was conducted at a tertiary care drug treatment centre located in North India. A total of 125 male participants aged >18?years, seeking treatment for natural opiate dependence from our outpatient clinic were included. A semi-structured proforma and WHO mental health encounter form was applied to assess socio-demographic, treatment details and pathways to care.

Results: The mean age was 46.17 (±11.98) years. Poppy husk (phukki/doda/posht) was the most common primary natural opiate used (84%). First point of treatment contact was addiction psychiatrist (n?=?90; 72%) in majority. First time treatment seeking was either by self-referral (60.8%) or referral by relatives and friends (24.8%) with mean time lag of 18.63?years after the onset.

Conclusion: Natural opiates dependent patients seek treatment late in the course of their illness, often directly from a tertiary addiction treatment centre. Barriers to seek treatment needs to be addressed.     

Quality of life of low vision patients: a systematic review and meta-analysis

ObjectiveQuality of vision plays an important role in everyday living, and low vision (LV) can take a toll on individual's quality of life (QOL). The objective of this paper is to evaluate the impact of LV on QOL and depressive symptoms in LV patients compared with healthy controls.DesignSystematic review and meta-analysis.MethodsLiterature was systematically searched to obtain all relevant records. Covidence software was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, risk of bias assessment was carried out. Data were extracted and meta-analysis was performed using STATA 15.0. Fixed-effect and random-effect models were computed based on heterogeneity.ResultsIn total, 2870 records were retrieved from database and grey literature searches. Twelve articles (35 341 subjects) were included for quantitative analysis. Overall, the QOL of LV patients was significantly lower compared with healthy individuals. Common QOL questionnaires, including 25-item visual function questionnaire (VFQ-25) (standard mean difference [SMD] = 0.91, confidence interval [CI]: [0.42–1.40]), 36-item short form survey (SMD = 0.53, CI: [0.26–0.80]), VFQ-14 (SMD = 0.58, CI: [0.42–0.74]), and visual function QOL questionnaire (SMD = 0.68, CI: [0.54–0.82]), demonstrated a poor QOL in LV patients compared with healthy controls. Additionally, odds of depressive symptoms were significantly greater (odds ratio = 2.25, CI: [1.58–3.21]) in LV patients compared with controls.ConclusionLV patients demonstrated a poor QOL and higher odds of depressive symptoms compared with healthy controls.     

Sphenochoanal polyp - a rare diagnosis in nasal obstruction

One of the most common nasal pathologies to present to an otolaryngologist is polyposis. Two well-recognized forms occur, the common antrochoanal polyp and the rare sphenochoanal polyp. Differentiation between the two is necessary for proper management by endoscopic sinus surgery.     

Natural opioid use in elderly in India: a case series

Introduction: Substance use among elderly is an emerging mental health problem and requires modification in management approaches. Systematic literature on natural opiates especially among elderly in India has been rather limited.

Materials and methods: This retrospective chart review included 24 elderly subjects (aged 60 and above) seeking outpatient treatment at a tertiary care de-addiction center in North India. Information pertaining to socio-demographic profile, clinical characteristics, and treatment seeking was extracted from the records.

Results: All the subjects were male with a mean age of 64.3 (±5.0) years. Most common substance used was doda (poppy husk) with a mean duration of dependence of 33.1 (±11.8) years. Six subjects (25.0%) had used other forms apart from natural forms of opiates. Most common reason for initiation of opiate use was to increase work efficiency (n = 9, 37.5%). Dependence on another substance (apart from opiate and tobacco) was present in seven subjects (29.2%). Majority of patients never sought any treatment previously despite using the substance for long duration.

Conclusion: Natural opioid use among elderly has a distinct profile, especially in Indian setting where its use has sociocultural sanction. There is a need for research on management of elderly natural opioid users which may pose an important clinical challenge in the future.