Effectiveness of a comprehensive educational programme for Accredited Social Health Activists (ASHAs) to identify individuals in the Udupi district with bleeding disorders: A community-based survey

INTRODUCTION

The awareness and knowledge on bleeding disorders is generally poor among the rural population. Accredited Social Health Activists (ASHAs) serve as the facilitators between the rural community and the health care system. Training of ASHAs in screening of rural population for early identification of bleeding disorders can enable prompt referral, timely detection and management of bleeding disorders.

AIM

The aim of the study was to evaluate the effectiveness of an ASHA training programme for identification of suspected bleeding disorder cases.

METHODS

A population-based, cross-sectional survey was implemented by 586 Accredited Social Health Activists (ASHAs) in rural Udupi district, who underwent a structured training programme on identification of bleeding disorders. A survey record book with a screening tool on assessment of bleeding symptoms was given to each ASHA. The screening tool consisted of symptoms related to bleeding disorders and family history of bleeding disorders. Using the screening tool, ASHAs carried out a door-to-door survey. After screening, those who reported with bleeding symptoms were referred by the ASHAs to the investigator, who conducted further assessment. A detailed bleeding history was documented and bleeding symptom assessment was carried out using bleeding assessment tool (BAT) at the haemophilia treatment centre. Further coagulation assessments were carried out as per the treatment centre protocol. This paper highlights the evaluation of an ASHA training programme on identification of individuals with bleeding symptoms in the rural population.

RESULTS

A total of 586 trained ASHAs surveyed a population of 318 214 in rural Udupi district. Out of the 124 cases reported by ASHAs, 29 bleeding disorder cases were identified; haemophilia (A and B) was the most commonly found bleeding disorder 22 (75.8%), followed by von Willebrand disease (vWD) 3 (10.3%) and 4 (13.8%) immune-mediated thrombocytopenic purpura (ITP), with an overall prevalence of 2.2/10 000 population.

CONCLUSION

Training ASHA health care workers, who are the most important link between the community and health services, resulted in increased awareness among the public for the early detection of bleeding disorders.

Late post transplant HIV infection with BK viremia and allograft tuberculosis in a renal transplant recipient with Kaposi sarcoma

In this report, we discuss a case of a 51-year-old African renal transplant who presented with metastatic Kaposi sarcoma 1 year after transplant. The Kaposi sarcoma was treated with a switch of immunosuppressants and chemotherapy. Six years after transplant, he presented with chronic allograft nephropathy, allograft tuberculosis, BK viremia, and was diagnosed to have contracted HIV infection.

Task completion time: Objective tool for assessment of technical skills in laparoscopic simulator for urology trainees

CONTEXT

Laparoscopic surgical simulation is a valuable training tool for urology trainees.

AIMS

We assessed the validity of task completion time (TCT) as an objective tool for practicing and acquiring technical skills in a simulated laparoscopy environment.

MATERIALS AND METHODS

Fifteen participants comprising postgraduate urology trainees from first to third year (n = 12), urology fellow (n = 1) and consultants (n = 2) underwent basic laparoscopic training on the "Beetle Universal" endotrainer. Training included 10 attempts each comprising four tasks; placing a ball in a cup (Task 1), threading five rings (Task 2), threading five balls (Task 3) and tying a suture (Task 4). Individual task (IT) time was measured. The TCT was defined as sum of IT time for a single attempt.

STATISTICAL ANALYSIS USED

Statistical analysis was done by Pearson's correlation coefficient and student's t test using SPSS software 10.

RESULTS

The average TCT for the first attempt to complete the four tasks by the participants was 76.5 +/- 13.0 min (range 38 to 92.5, skew -1.8), compared to the 10(th) attempt 33 +/- 4.23 min (range 25 to 38.5, skew -0.5). There was statistically significant correlation (r = mean -0.91, range -0.97 to -.83, skew -0.5), (P = < 0.001) between the number of attempts and decreasing TCT for all participants. Correlation decreased when TCT between the sixth to 10(th) attempt was compared (r = mean -0.67, range -0.99 to 0.76).

CONCLUSIONS

The TCT is practical, easy and a valid objective tool for assessing acquired technical skills of urology trainees in a laparoscopic simulated environment.

Structural Compromise of Disallowed Conformations in Peptide and Protein Structures

Using a data set of 454 crystal structures of peptides and 80 crystal structures of non-homologous proteins solved at ultra high resolution of 1.2 A or better we have analyzed the occurrence of disallowed Ramachandran (phi, psi) angles. Out of 1492 and 13508 non-glycyl residues in peptides and proteins respectively 12 and 76 residues in the two datasets adopt clearly disallowed combinations of Ramachandran angles. These examples include a number of conformational points which are far away from any of the allowed regions in the Ramachandran map. According to the Ramachandran map a given (phi, psi) combination is considered disallowed when two non-bonded atoms in a system of two-linked peptide units with ideal geometry are prohibitively proximal in space. However, analysis of the disallowed conformations in peptide and protein structures reveals that none of the observations of disallowed conformations in the crystal structures correspond to a short contact between non-bonded atoms. A further analysis of deviations of bond lengths and angles, from the ideal peptide geometry, at the residue positions of disallowed conformations in the crystal structures suggest that individual bond lengths and angles are all within acceptable limits. Thus, it appears that the rare tolerance of disallowed conformations is possible by gentle and acceptable deviations in a number of bond lengths and angles, from ideal geometry, over a series of bonds resulting in a net gross effect of acceptable non-bonded inter-atomic distances.

The bone marrow in Hodgkin's disease--a two year study

A total of forty bone marrow trephine biopsies and aspirates were studied from thirty five patients suffering from Hodgkin's disease during the two year period 1994 and 1995. Of these twenty five were at the time of diagnosis of the disease and fifteen after treatment. The biopsies were studied for incidence of involvement as well as associated findings in both the positive and negative biopsies. A comparison of the trephine biopsy with marrow aspirate with respect to yield of positivity was made. Five patients (20%) at the time of diagnosis and two (13.33%) after treatment showed involvement of the marrow. None of the seven corresponding aspirates were positive for involvement showing that biopsies were superior to aspirates in detecting marrow infiltration in Hodgkin's disease. Suppression of the marrow, fibrosis and lymphocytic aggregates were the other findings in positive biopsies. Eosinophilia and myelosuppression were notable changes in the negative biopsies. One biopsy also showed granulomas. The probable significance of these findings are also discussed.

Seasonality and other epidemiological features of haemolytic uraemic syndrome and E. coli O157 isolates in Scotland

The main objective was to determine whether there was seasonality in presentation of haemolytic uraemic syndrome (HUS) in children and adults, and compare this with the reporting of E. coli O157. The data came from Scotland, examining admissions during 1980-95 and E. coli isolates 1984-95. Seasonality was sought by fitting a sine curve to monthly or four-weekly data throughout the year. Seasonality was present for HUS and E. coli isolates in patients under 15 years of age but not in those above that age. The highest point of the sine curve was in July/August but there was a high plateau from June to September. The timing was similar to other diarrhoeal disease. This is an epidemiological study, the purpose being to clarify the seasonal features of HUS. E. coli infection is an important food hazard and a sound knowledge of the epidemiology, could lead to optimal control. The Scottish geographic distribution is illustrated.

Hypertension secondary to progressive vascular neurofibromatosis

A 4 year old girl with neurofibromatosis type 1 (NF1) was referred for hypertension. An aortogram showed narrowing of the left main renal artery. An angiogram three and a half years later showed coarctation of the abdominal aorta. She underwent aortoplasty but the stenosis recurred. Vascular involvement in NF1 may be progressive and requires long term follow up.