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Abstract Background The pandemic has put at risk the social and emotional development of children on account of the paucity of arenas for social interaction. This study from Kerala, India was conducted to assess the resilience factors, behavioural concerns, psychological distress symptoms among the children aged 3 to 5 years. We also tried to look into the lost opportunities that could have aided the social and emotional development of children like peer interaction, child care hours. Methods The cross-sectional study was conducted among the children aged 3 to 5 years. A total of 535 children attending the immunisation clinics were enrolled by consecutive sampling. Devereux Early Childhood Assessment P2 (DECA P2) questionnaire was used to assess the levels of resilient factors and behavioural concerns in the study population. Results We observed a high proportion of children in the area of need category of protective factors under DECA P2. The proportion of children falling under area of concern was 64.5%, 49%, 68.4% for attachment/relationship, self-regulation, and initiative respectively. 24.9% study subjects have a behavioural concern score that puts them in the area of need category. The logistic regression model we created identified ‘Male Gender,’ ‘Mothers could spend only less time for child care’ and ‘electronic devices used as pacifier’ as significant predictors for belonging to Area of need Behavioural Concerns T score category. Conclusion A large proportion of children aged between 3 to 5 years with reported behavioural concerns and lack of protective factors for socioemotional development. This can be attributed partly to the ongoing pandemic and its associated restrictions. The increased child care hours invested by parents or grandparents could have sized down the full impact that the pandemic would have had on the socio emotional development of the child. Increased time spent using electronic devices coupled with dwindled opportunities for interaction with peers have been notable challenges.

Objective: This study aims at understanding the level of knowledge, attitude, and practice of breastfeeding among mothers and the factors associated with good knowledge about breastfeeding. Materials and methods: A cross-sectional study among 251 mothers of infants admitted in the pediatric wards of SAT Hospital, Thiruvananthapuram was conducted during November-December 2019. The mothers of infants born between 37 and 42 weeks of gestation and without major birth defects were included in the study. The data were entered into an MS Excel sheet and analyzed using Statistical Package of Social Sciences version 26.0. Significance of association was tested using Chi-square test and multivariate analysis was done using binary logistic regression test. Results: The mean age of the participants was 26.25 (SD 4) years. On multivariable analysis, higher education and older age were found to be significantly associated with good knowledge. Independent sample T-Test results show that there was a statistically significant difference between the mean age of mothers with good knowledge (26.4(±4), 25.14(±3.7)), p-0.015 and statistically significant association was found between the mean attitude scores (34.07(5.58)) with current breastfeeding practices (p=0.002). Chi-square test shows that exclusive breastfeeding was significantly associated with the mother’s age (p=0.006); 64.2% of women practicing exclusive breastfeeding were less than 25 years of age. This study also demonstrated a significant association between the initiation of breastfeeding within an hour and exclusive breastfeeding (p=0.003). Conclusion: This study shows that mothers with higher age and higher educational qualifications were significantly associated with good knowledge about breastfeeding. Even though mothers have good knowledge, nearly half the mothers only exclusively breastfeed their infants for six months. Improving the educational qualification of women and increasing awareness about the benefits of breastfeeding among young women will promote breastfeeding practices.

Objective: This study aims to assess the knowledge, attitude, and practices regarding menstrual cups use and the factors associated with it among females of the reproductive age group in an urban setting of South Kerala. Materials and methods: We conducted a cross-sectional study from December 2021 to January 2022 among females of the reproductive age group. Data was entered in MS Excel and was analyzed using Statistical Package for Social Sciences version 26.0. The significance of association was tested using the Chi-square test. Binary logistic regression was done to predict the factors associated with knowledge levels regarding menstrual cup. Results: The mean age of study participants was 25.68(SD 6.64) years. Lack of knowledge (22.6%) and fear of insertion (56.2%) were the major reasons for not trying a menstrual cup. Out of the 350 study participants, 258(73.7%) had good knowledge scores and 92(26.3%) had poor knowledge scores. Discomfort and leakage were the most important problems reported by participants. A statistically significant association was found between younger age, educational status, socioeconomic, status, marital status of females in the reproductive age group, and knowledge about the menstrual cup. Conclusion: Most of the participants (93.4%) were aware of menstrual cups. Even though two third of the participants had good knowledge regarding menstrual cups, only 15.1% have tried to use a menstrual cup. Fear of insertion was the most common concern for not trying a menstrual cup. Discomfort and leakage were the most important problems reported by participants. Younger age and higher educational qualifications were found to be independently associated with knowledge levels regarding menstrual cups.

Central nervous system infections are an uncommon cause of acute febrile encephalopathy (AFE) in the elderly. Scrub typhus meningoencephalitis is uncommon and often missed in the elderly. A 70-year-old male presented with complaints of intermittent fever, maculopapular rash, and altered sensorium. Physical examination revealed fever, tachycardia, tachypnea, maculopapular rash on the trunk, and all four limbs, and an eschar on the right thigh. Initial laboratory evaluation revealed anemia, thrombocytopenia, and azotemia. The cerebrospinal fluid revealed lymphocytic pleocytosis, elevated proteins with normal glucose, and adenosine deaminase. Weil–Felix test was positive. The diagnosis of scrub typhus meningoencephalitis with acute kidney injury and atypical pneumonia was established. A prompt treatment with injection doxycycline and tablet rifampicin led to an uneventful recovery. We report the first case of scrub typhus meningoencephalitis as the cause of AFE in the elderly. This case highlights the importance of clinical examination in any febrile encephalopathy presenting in endemic areas or travelers returning from such places.

Background: COVID 19 is associated with the development of post COVID syndrome usually manifested as fatigue, anxiety, joint pain, headache, chest pain, dementia, depression, and dyspnea. Documented evidence of post COVID syndrome among patients with asymptomatic or mild infections, especially from India is less. Methodology: A community based prospective cohort study was conducted among 154 patients admitted in CFLTCs of coastal Thiruvananthapuram, Kerala during May-August 2020. They were enrolled at the time of their admission to CFLTCs and were followed up for three months after discharge. The discharged patients were followed up at regular intervals of three weeks and three months by telephonic interview using a structured proforma. Results: Out of the 154 patients followed up, 57 (37%) were men and 97 (63%) were women. The mean (SD) age of study participants was 31.49 (18.4) years. At least one symptom was present in 120 (78.0%) patients at the time of admission. Cough (29, 18.8%), fever (26, 16.8%), headache (25, 16.2%), rhinitis (23,14.9%) and sore throat (18, 11.7%) were the major symptoms reported at the time of admission. At the end of three weeks, 11 (7.1%) patients and at the end of three months 18 (11.7%) patients reported to have symptoms. Fatigue (5.8%), headache (5.8%) myalgia (3.2%) joint pain (2.5%) and exertional dyspnea (2.5%) were the predominant symptoms. Presence of fatigue, cough and breathlessness at the time of admission, and presence of another COVID positive family member were significantly associated with the appearance of post COVID symptoms. Conclusion: Post COVID syndrome is not uncommon in COVID 19 patients with minimal symptoms. Understanding long term consequences of COVID 19 is as important as management of acute COVID 19 due to its multisystem involvement and its implications on health and well-being.

Objective To understand the structures and strategies that helped Kerala in fighting the COVID-19 pandemic, the challenges faced by the state and how it was tackled.Design Qualitative descriptive study using focus group discussions and in-depth interviews.Setting State of Kerala, India.Participants 29 participants: four focus group discussions and eight in-depth interviews. Participants were chosen purposively based on their involvement in decision-making and implementation of COVID-19 control activities, from the department of health and family welfare, police, revenue, local self-government and community-based organisations. Districts, panchayats (local bodies) and primary health centres (PHCs) were selected based on epidemiological features of the area like the intensity of disease transmission and preventive/containment activities carried out in that particular area to capture the wide range of activities undertaken in the state.Results The study identified five major themes that can inform best practices viz social capital, robust public health system, participation and volunteerism, health system preparedness, and challenges. This study was a real-time exploration of the intricacies of COVID-19 management in a low/middle-income country and the model can serve as an example for other states and nations to emulate or adjust accordingly.Conclusion The study shows the impact of synergy of these themes towards more effective solutions; however, further research is much needed in examining the relationship between these factors and their relevance in policy decisions.

Aim: Several plan quality metrics are available for the evaluation of stereotactic radiosurgery/radiotherapy plans. This is a retrospective analysis of 60 clinical treatment plans of arteriovenous malformation (AVM) patients to study clinical usefulness of selected plan quality metrics. Materials and Methods: The treatment coverage parameters Radiation Therapy Oncology Group (RTOG) Conformity Index (CIRTOG), RTOG Quality of Coverage (QRTOG), RTOG Homogeneity Index (HIRTOG), Lomax Conformity Index (CILomax), Paddick's Conformity Index (CIPaddick), and dose gradient parameters Paddick's Gradient Index (GIPaddick) and Equivalent Fall-off Distance (EFOD) were calculated for the cohort of patients. Before analyzing patient plans, the influence of calculation grid size on selected plan quality metrics was studied on spherical targets. Results: It was found that the plan quality metrics are independent of calculation grid size ≤2 mm. EFOD was found to increase linearly with increase in target volume, and a linear fit equation was obtained. Conclusions: The analysis shows that RTOG indices and EFOD would suffice for routine clinical radiosurgical treatment plan evaluation if a dose distribution is available for visual inspection.