A simultaneous presence of intrauterine and extrauterine gestation is called as heterotopic pregnancy (HP). The incidence of spontaneous HP is 1: 30000, which is very rare. In this case report, we are reporting a rare case of spontaneous HP in a 40-year-old lady with intrauterine gestational trophoblastic neoplasia (GTN) and ruptured tubal ectopic pregnancy in a remotely located secondary care hospital. The lesson learnt from our case report is that detection of intrauterine gestation does not rule out the possibility of the presence of ectopic pregnancy. Also, HP can occur without any obvious risk factors like in our case. It should be always kept in mind that HP can occur in any woman of reproductive age group. In the end, our patient was fortunate that she presented to us in a stable haemodynamic condition in spite of having ruptured tubal ectopic with spontaneous stoppage of bleeding from the ruptured tube. Hence, to achieve a great chance of favourable obstetric outcome, all treating doctors including family physicians should have a high index of suspicion to have accuracy in early diagnosis and treatment of a various variety of HP as these can occur with or without predisposing risk factors.
Objective:
The study has been designed to assess the knowledge of ethics amongst young students and professionals, and practices of health care ethics among medical professionals in a government teaching hospital in India.
Methodology:
A cross-sectional study was carried out at one of the teaching hospitals in Southern India with a sample size of 84 among fresh medical graduates, post-graduate trainees, and young consultants with work experience of 6 months to 8 years. The data were collected by means of a structured and validated questionnaire, and the questionnaire was administered before and after a lecture/seminar on ethical principles, and results were analyzed using SPSS software.
Results:
The maximum participants were in the age group of 20 to 24 years with 0–2 years of clinical experience. The basic awareness and practices before the workshop were quite less when compared to after the workshop which showed a very good improvement in the correct responses to the questions. The maximum change seen, reflected in curiosity to learn bioethics. The workshop was an eye-opener for many participants in terms of the Nuremberg Code and its origin. The ethics committee was an alien concept to many participants, and it was reflected in the response postworkshop. The students felt a strong need to discuss ethics and implement them postworkshop. The segment on attitudes in clinical practice showed an impact on autonomy and truth-telling (32% to 50%). The segment on ethical practices reflected a confused audience. The increase in sensitivity to police information, and the concept of error of judgment and negligence were positive. The fact that medical practitioners are legally bound to help accident victims showed a positive response.
Conclusion:
Based on the assessment of pre-and post-workshop, there is a strong need to stress the ethical principles and revision of these ideas from time to time. Workshops and interactive sessions are a good way for periodic assessment and reinstatement of these values in our research and clinical practice. Thus, these should be part of the curriculum across all educational institutions for budding primary care providers and family physicians.
Background:
Water, sanitation, and hygiene (WaSH) practices always have been neglected among HIV/AIDS (Human immunodeficiency virus/ Acquired immunodeficiency syndrome) programs, even when HIV and WaSH services have robust bearing on each other. With COVID-19 pandemic on the go, it is utmost necessary for the people living with HIV/AIDS (PLHA) to ensure adequate WaSH practices.
Objective:
This study was carried out with an objective to assess baseline WaSH practices among PLHA and to find out if any association between nutritional status and WaSH parameters so as to identify the shortcomings and highlight the importance of WaSH practices among PLHAs and give suitable recommendations to program managers.
Methodology:
A cross-sectional study was carried out among PLHA registered in ART centres of western Maharashtra. A sample size of 378 consented to be part of the study were included in the study, by means of systematic random sampling. Data were collected by means of pretested questionnaire prepared from guidelines and previous studies. Institutional ethical clearance was obtained and informed consent was taken from study participants before data collection. Strict confidentiality was maintained throughout the study period.
Results:
When asked about the water processing method, 76% of them told they do not treat/process the water supplied to them. In contrast, only a few PLHA told they would filter (17%), boil (7%), and use aquaguard (1%). The majority (67%) had their latrines, and while 29% of them were using public latrines and its hygienic sanitation was a concern for them and 4% were still practising open-air defecation in rural areas. Almost all study participants were handwashing after toilet use and handwashing before consuming food. The majority (79%) told they used soap and water, while 20% were using only water, soil and water (1%) and ash and water (1%) which was a concern. Of all the households, 87% cooked their food twice and consumed it thrice a day, while 4% prepared thrice. 10% of them cooked only once and consumed thrice a day; 56% practised consumption of leftover food of the previous night which was a concern. A majority (54%) did not consume street food while remaining said that they used to consume street food. But majority (59%) said they did not follow the habit of checking hygiene or sanitation of hotel where they used to consume food while the remaining 41% did not check the hotel before ordering the food; 50% of them bought packaged milk while 40.9% brought from unpasteurized dairy. On analysis, hygiene and sanitation factors had no statistically significant association with the nutritional status of study participants.
Conclusion:
WaSH factors act synergistically with other factors to affect the holistic health of PLHA. Information, Education and Communication (IEC) activities (continuous and regular), that focus on improving awareness level on WaSH practi...
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