Abstract: Background: Sufficient and quality healthcare services are basic requirement for overall development of a nation. Public healthcare infrastructure is one of the major determinants of health outcomes in a country, and public healthcare services have a considerable impact on people's health status. The rural population primarily relies on public healthcare services. Assam is not an exception in this regard, where the insufficiency of public healthcare services is still an issue. 86 % of the population of Assam lives in rural areas. Objectives: The present work attempts to study the inter-district variation regarding public health infrastructure in 33 districts of Assam. Methods: The Inter district variation is estimated with a composite index of public health infrastructure. Principal Component Analysis (PCA) is adopted to construct a composite index using nine health infrastructure indicators. Results: The study has observed variations in health infrastructure among the various districts of Assam, reflecting the shortage of health infrastructure-physical and human in rural and remote areas of the state. The study finds inter-district variations in the state.
Key words: Public Health Infrastructure, Assam, Principal Component Analysis

Abstract: Objective: Reliable and disaggregated population-based data for cholesterol trends are needed to evaluate overall cardiovascular health, assess the effects of nutritional policies and pharmacological interventions, and guide priority setting. This study aimed to examine the trends and differences in serum total cholesterol-to-high density lipoprotein cholesterol (TC/HDL-C) ratio among U.S. residents by race/ethnicity. Study Design and Setting: Blood lipid measurements, taken from 53,964 noninstitutionalized participants, aged 6 to 80, were obtained from the National Health and Nutrition Examination Survey (NHANES) study. We described the distributions of TC/HDL-C ratio across the life span in four distinct cross-sectional surveys during 2005-2008, 2009-2012, 2013-2016, and 2017-2020, and compared the ratio levels by race/ethnicity. Results: Between 2005 and 2020, favorable trends in lipid ratio levels were observed. In youth aged < 20 years, mean TC/HDL-C ratios were 3.17, 3.15, 3.02, and 3.06 in males; and 3.12, 3.13, 3.03, and 3.02 in females from 2005 to 2020. In adults 20 years old and older, mean TC/HDL ratios declined from 4.30 in 2005-2008, to 4.27 in 2009-2012, 4.17 in 2013-2016, to 3.96 in 2017-2020 in males; while mean TC/HDL-C ratios declined from 3.67 in 2005-2008, to 3.66 in 2009-2012, to 3.54 in 2013-2016, to 3.46 in 2017-2020 in females. Overall, non-Hispanic black individuals tended to have lower mean TC/HDL ratio levels than other groups, while Mexican American individuals tended to have higher TC/HDL ratio levels on average. Conclusion: Further research is needed to determine how racial/ethnic differences in cholesterol ratio affect racial/ethnic differences in cardiovascular disease rates.
Key words: Serum lipids, aging, lipoprotein ratio, cholesterol, cardiovascular disease, health disparities

Abstract: Background: Polycystic ovarian syndrome (PCOS) is an endocrine disorder adversely affecting fertility and reproductive health with diverse clinical manifestations in women. Aim: The objectives of the present study are to determine and compare the prevalence of PCOS between rural and urban Assamese women in Guwahati, Assam. Methods: A total of 150 (75 rural; 75 urban) Assamese women aged 18-35 years have been collected at Pratiksha Hospital, Guwahati, Assam. The relevant data were collected through self-administered pre-structured and interview methods. Results: Higher prevalence of PCOS was found in the urban areas living in nuclear families in comparison to rural areas. Recent weight gain and obesity with a higher prevalence of oligomenorrhea were found to be higher among the urban participants. An excess androgen activity evidenced by increased hirsutism was higher in the urban areas as compared to rural areas in association with increased levels of serum insulin. Conclusion: A long-term personalized management program is required for effectively treating individuals with PCOS which may help in regulating the symptoms and various other metabolic complications.
Key words: Polycystic ovarian syndrome, oligomenorrhea, serum insulin, luteinizing hormone, follicle-stimulating hormone

Abstract: Introduction: This study aimed to evaluate the etiology and prognosis in burn children and adolescents referred to Shahid Motahari Trauma and Burn hospital. Materials and Methods: This cross-sectional study was conducted on burn children and adolescents who were hospitalized in Shahid Motahari Burns Hospital between 2009 and 2019 due to burns. Results: In this study, 3,520 patients were studied; of which 2,151 subjects were boys (61.1%) and 1,369 subjects were girls (38.9%). The mean age of the subjects was 2.84 ± 3.66 years. 138 (3.9%) patients died in the study. The relationship between mortality and gender was not statistically significant (P value = 0.336). The highest percentage of burns was 10 to 19% in 1284 patients (36.63%) and the lowest was 80 to 89% burns in 7 patients (0.19%). In terms of burn site, the most areas related to the trunk, lower limbs except the legs and upper limbs except the hands with 22.56%, 18.95%, and 18.45%, respectively, and the lowest related to the legs and the whole body with 6.39% and 8.46%. Also, the highest cause of burning was boiling water in 1915 patients (56.12%). Conclusion: The study showed that boys were more likely to be the victim of burns. Also, the highest percentage of burns was less than 20% and most of the areas are related to the trunk, limbs. The mortality rate was 3.9%. In addition, these evaluations showed that the most common cause of burns was boiling water.
Key words: Children, Adolescent, Burns, Epidemiology, Iran

Abstract: Purpose: Breast fine needle aspiration cytology (FNAC) has a long history of providing accurate, rapid and cost-effective diagnosis of palpable breast lesions. Recently, International Academy of Cytology (IAC) at Yokohama proposed a new reporting system for breast cytology, in order to bring uniformity across the globe. Any new classification system needs to be validated for its practical applicability. Objectives: This study was conducted to categorize the breast lesions as per this classification and further determine the diagnostic efficacy and risk of malignancy in each category. Material and methods: This was a cross sectional observational analytical study. All the cases presenting to cytology OPD from Janurary 2020 upto December 2022, (N=296) with breast lesions for FNAC were included in the study. All the cases were divided into five categories as per the newly proposed IAC Yokohama reporting system. The risk of malignancy for each category was determined and diagnostic efficacy was evaluated.Results:The sample were distributed as follows: insufficient material 4.39%, benign 66.21%, atypical 10.47%, suspicious for malignancy 1.35% and malignancy 17.56%. Histopathology was obtained in 88 cases, out of which 82 (93.18%) showed concordant diagnosis. The sensitivity and specificity were 85.71% and 98.11% respectively. Risk of malignancy (ROM) in each category was as follows-benign (0.01%), atypia (71.4%), suspicious (100%) and malignancy (96.66%) respectively.Conclusion:The high efficacy of FNAC obtained in the present study, when IAC Yokohama reporting system was applied, confirms the usefulness of this scheme in reporting breast lesions. A risk-based stratification is essential in the present era to guide and alert the clinician about the subsequent management plan and the ROM.
Key words: IAC Yokohama,Breast, FNAC, Cytology, Risk of malignancy

Abstract: High blood pressure (BP) remains a public health issue of concern in low- and middle-income countries (LMICs). Cooking with solid biomass fuel is common in LMICs, producing hazardous levels of household air pollution (HAP), and exposure to which results in significant morbidity and mortality. The primary victims are women, who are the immediate users. Therefore, a potential relationship between these factors would have massive public health reverberations. Our objective was thus to perform a literature review of the studies investigating the association between HAP and BP in women. We searched the PubMed, CORE, and Semantic Scholar databases from inception through March 2022 to identify reports investigating the relationship between BP and HAP from solid fuel use. The studies included in this report point to an increased risk of high BP from HAP generated as a consequence of using solid fuels for cooking. Conversely, few studies have reported a negative association between HAP and BP. Notably, this inconsistency and the limited evidence base necessitate confirmation of the association by more extensive and robust studies. Further, this report identifies a need to introduce and implement effective clean cooking solutions for public health benefits.
Key words: Air pollution, Blood pressure, Cardiovascular, Household Air Pollution, Hypertension

Abstract: Although breast carcinoma is common, metastatic deposits to the breast from extramammary neoplasms are rare. Clinically and radiologically, metastatic neoplasms may mimic primary benign and malignant neoplasms of the breast. A correct diagnosis of metastasis to the breast is of considerable importance since the treatment of primary and secondary malignancies of the breast is different. We report 4 cases of extra mammary primary cancers metastasizing to the breast, diagnosed by biopsy, in a period of 5 years in our tertiary care centre. Each of the cases had different characteristics. A good knowledge of cytomorphology and histomorphology, together with clinical correlation and comparison with previous histopathological evidence, will prevent a misdiagnosis and aid in optimal management and therapy.
Key words: Breast malignancies, Non mammary metastases, Secondaries in breast, breast histopathology.

Abstract: Desmoid tumors are benign tumors of mesenchymal origin with a complex course of the disease, due to absence of a capsule, infiltrative growth, heterogeneous structure and shape, the true extent of which is difficult to assess before surgery. Despite its benign nature, the recurrence rate reaches 25-50% of cases, and surgical treatment is often accompanied by a number of difficulties with a decrease in the quality of life of patients. In the presented clinical case, a wide excision of desmoid tumor was performed, followed by reconstruction, which ensured a good postoperative result while preserving oncological principles.
Key words: Desmoid tumors, reconstruction, mesh endoprothesis.

Abstract: Background: Renal ganglioneuroma is an extremely rare benign tumour that affects neural crest cells. Here we report a case of renal ganglioneuroma with nodal metastasis managed by surgical resection. Case report: A 38-year-old female presented with anorexia and early satiety. On examination, she had a palpable mass per abdomen. CT scan revealed a large heterogenous mass in retroperitoneum in right suprarenal region with enlarged retrocrural lymph nodes. She underwent right radical nephrectomy as the mass was inseparable from the right kidney. Postoperative period was uneventful. HPE revealed renal ganglioneuroma. Conclusion: Primary renal ganglioneuroma is difficrult to differentiate from other etroperitoneal lesions. Surgical resection is the most effective treatment.
Key words: Renal Ganglioneuroma, Ganglioneuroma, Retroperitoneal ganglioneuroma, Nephrectomy

Abstract: Drug reaction with eosinophilia and systemic symptom (DRESS) syndrome is a rare severe drug-induced idiosyncratic hypersensitivity characterized by maculopapular and/or erythrodermic eruption, fever, peripheral lymphadenopathy, eosinophilia or atypical lymphocytosis, and visceral organ involvement. The estimated incidence of this syndrome ranges from 1/1000 to 1/10,000 drug exposures. In this report, we describe a case of DRESS syndrome in a young female with a unique presentation. The DRESS syndrome can be difficult to diagnose as its clinical findings can mimic those of other systemic diseases. This case emphasizes the importance of incorporation of the patient’s clinical and medication history in the interpretation of hematological investigations.
Key words: DRESS Syndrome, Leucocytosis, eosinophilia, Atypical lymphocytosis, Sulfasalazine

Abstract: We describe the case of a 72-year-old female diabetic who presented with epiphora and purulent discharge from the right eye for the past 2 years and multiple skin lesions over the right upper eyelid and right arm for 1 year. Computed tomography of the paranasal sinuses revealed mucosal thickening in the frontal and ethmoidal sinuses, with a polypoidal mass from the right side of the nasal septum and dacrocystitis. The histopathology of the skin lesion was suggestive of lupus vulgaris (LV). There was no evidence of pulmonary tuberculosis. This case was a rare coexistence of LV with sinonasal tuberculosis and dacrocystitis.
Key words: Dacryocystitis, eyelid, lupus vulgaris, sinonasal, sinusitis, tuberculosis