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Pregnancy or the motherhood beyond the edge of reproductive age is referred as Pregnancy in “Elder gravida”. In the developing and developed countries age of marriage and there by child bearing are relatively late in life. Chances of pregnancy for healthy couples in their 20s and early 30s are around 1 in 4 women, 40s around 1 in 10women. Generally reproductive potential decreases as women get older, one of the common reasons is due to low AMH. Age is the single biggest factor affecting a women’s chance to conceive and to have a healthy baby and fertility can be expected to end 5 to 10 years before menopause. Risk of pregnancy complications increases with age. The risk of miscarriage and chromosomal abnormalities in the fetus increases from the age of 35years. Complications such as GDM, Placenta previa, Caesarian section and still birth are common among older women than younger women. According to Ayurveda, Infertility primarily refers to the biological inability of women to contribute to conception and also who is unable to carry pregnancy to full term. Ayurvedic management gives a new hope in women by strengthening body’s own self-healing and balancing mechanism without any intervention by outside or foreign substance to replace or correct the hormones in the body. Case Study: A female patient aged 38 years diagnosed as Primary Infertility due to low AMH treated with Virechana followed by Matrabasti and Shaman Chikitsa, after 3 months of treatment her AMH level increased and also patient got Conceived.

The etiological factor of Yoni Vyapat are mainly due to the vitiation of Doshas, among which Paripluta Yoni Vyapat is due to the vitiation of Vata Dosha, which can be correlated to Dyspareunia. Dyspareunia means the coital act is difficult and or painful. There is different etiology depending upon the site of pain, out of which Vagina Atrophy prevalence of 67.5% associated with vaginal dryness – 62%, itching 40%. For the better and fruitful result Sthanika Chikitsa (local therapies) has been enumerated as an important part of Yoni Vyapad Chikitsa, which includes Yoni Parisheka (cleansing of vagina), Yoni Abhyanga (massaging of vagina with medicated oil), Yoni Pralepa (semisolid drug applied on the vaginal wall), Yoni Pichudharana (medicated soaked tampon place in vagina). Case Study: A female aged 49 years, approached OPD complaining of painful coitus along with dryness and itching of vagina, which increased after her menopause. The condition was treated with Sthanika Chikitsa followed by internal medications.

Background: Pregnancy is the state of carrying a developing embryo or fetus within the female body. Profound biochemical, anatomical and physiological changes occur during the course of pregnancy. Urinary tract infections are the second most common infections worldwide. Pregnant women have 4 times higher rate of developing UTI as compared to non-pregnant women. Pregnant women develop ureteral dilation resulting in increased urinary stasis and ureterovesical reflux due to increased progesterone level and the pressure of gravid uterus on the bladder. The classical Lakshanas of Mutrakricchra like frequent micturition, difficulty during micturition, burning sensation during micturition are similar to the signs and symptoms of Urinary tract infection. Shatavari Ksheerapaka has been mentioned in Sahasrayogam for the management of Mutrakricchra. Shatavari is Sheeta in Virya, acts as a diuretic and helps in the reduction of Mutrakricchra symptoms. According to Bhavprakash Nighantu, Sita is Ruchikara and Ksheera is Rasayana. Aim: To evaluate the efficacy of Shatavari Ksheerapaka in Garbhini Mutrakricchra w.s.r UTI in Pregnancy. Method: It is a controlled clinical study of two groups consisting 15 patient each in control and trial group. Conclusion: Shatavari Ksheerapaka and Trinapanchmoola Ksheerapaka both are equally effective in treating the Garbhini Mutrakricchra w.s.r. UTI in Pregnancy.

The Novel corona virus disease (COVID-19) is highly communicable viral infection caused by SARS-CoV 2. WHO mentions that pregnant women or recently pregnant women seem to have an increased risk of developing severe COVID-19. Due to physiological changes in the body and immune system, pregnant women can be badly affected by respiratory infections. It is therefore important that they take precautions to protect themselves against COVID-19. Overall, 10% of pregnant women suffered from COVID-19. Ayurveda mentions Garbhini paricharya (antenatal care of the pregnant) which recommends ahara (dietary regimen) and vihara (specific activity for physical, emotional and mental wellbeing) that is required for the safe motherhood and healthy progeny. Here is an attempt to understand how Garbhini paricharya helps in preventing corona. KEY WORDS: Garbhini paricharya, COVID-19, Pregnancy

Objectives: A deluge of techniques are made available for students to encourage for self-directed learning. Microteaching is one of the old techniques which is traditionally used as a method to improve pedagogical skills. Incorporating microteaching techniques in student seminars enhance the effectiveness of the learning process. The objectives of the study were to assess the effectiveness and perceptions regarding microteaching methodology in improving the undergraduate student seminars. Materials and Methods: The study was conducted among ten randomly selected 1st year MBBS students. They were assigned a seminar topic from pre-discussed lecture in Physiology. They were divided into two equal groups and one group underwent training in microteaching through a workshop. Each student from both the groups presented seminar which was evaluated on Likert’s scale by standardised blinded observers consisting of 13 faculty and 12 students. Perceptions of students were assessed by self-evaluation. The data were analysed by Chi-square and Mann–Whitney U-test. Results: Each student was evaluated by 25 members and got 125 responses from each group. The median score for all the components in the assessment was significantly higher in the intervention group as compared to the control group. The presentation skills, providing non-verbal clues and stating the objectives were significantly better among the microteaching trained group (P ≤ 0.05). Common perception among the intervention group was that they found it interesting, innovative, improved presentation skills, interactive and needed preparation for application and analysis, whereas some students felt lack of time and motivation were the obstacles for implementation of microteaching methodology for student seminars. Conclusion: The students found microteaching methodology to be very interesting and useful learning tool. Microteaching technique assists students to develop competence and confidence in seminar presentations.

A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of labor is called episiotomy (Perineotomy). It is in fact an inflicted second-degree perineal injury. It is the most common obstetric operation performed. This is done to enlarge the vaginal introitus to facilitate easy and safe delivery of the fetus and to minimize overstretching and rupture of the perineal muscles and fascia thus to reduce the stress and strain on the fetal head. This wound of episiotomy is associated with a delicate area of the female with immense pain and discomfort and seeks appropriate medical care and attention. If ignored, it may lead to puerperal wound infections and delayed healing that can interfere mother-infant interaction, lactation and prolonged hospital stay. Episiotomy wound care should be start immediately after suturing the wound in order to reduce pain and inflammation. The surgical wound of episiotomy can be considered as Sadyo Vrana. Different treatment modalities have been told in Ayurveda for Vrana Chikitsa. Drugs having Shodhana and Ropana qualities are essential for healing. In this research study total 30 patients were registered and treated in two groups, group A with application of Jatyadi Taila on episiotomy wound after Ushna Jala Parisheka as a standard control group and Group B with application of Murivenna after Ushna Jala Parisheka as a trial group. Encouraging results were observed in Murivenna. Study emerges that Murivenna possess better pain relieving and tenderness diminishing properties.

Background: Streevandhyatva or Female Infertility is a Gynaecological disorder. The etiological factors include the defect in the immature Sperm and Ovum during the fertile period. Incidence rate according to W.H.O is 20-30% is primary while 70-80% of cases are secondary Infertility. Now a day’s maximum number of Female Infertility is due to sedentary lifestyle, Psychological factors, Nutritional deficiency and Stress leads to different condition like PCOD, Obesity, Irregular Menstrual cycle and anovulatory cycle etc. The present study was carried out as a pilot study on 10 subjects of female infertility with the use of Phalagruta Uttarabasti followed by Prakshalana and Pichudharana. Three to five consecutive cycles of Phalagruta Uttarabasti was administered, Posology - Uttarabasti with Phalagruta 5ml daily for 3 days. Diagnostic criteria - Patients are diagnosed based on signs and symptoms like anovulation, PCOD etc., before and after treatment with USG. Results - Among 10 patients, 4 patients - Well response, 2 patients - Improved with follicular study, 3 patients - Poor responded, 1 Patient discontinued the study.

Background Primary cystic neoplasms of the peritoneum are rare lesions and not commonly encountered in practice. Many intra-abdominal processes may mimic cystic masses within the peritoneal cavity and pose a diagnostic challenge to both the pathologist and radiologist. Clinical presentation is diverse and varied. These lesions are usually benign. Hence complete surgical excision is the treatment of choice in most of the cases. Methods Study design: Descriptive Retrospective study. Cystic peritoneal lesions were identified and studied from data over a period of 5 years in the Histopathology Section at a tertiary care hospital in Pune, India. Mode of presentation, imaging findings in addition to gross and histopathologic findings of these lesions were studied. Results Out of 50 peritoneal lesions studied over a period of 5 years, only 7 were identified to be cystic peritoneal masses. Of these two were found to be peritoneal cysts, two mesenteric cysts, one an infected mesenteric cyst and one each a mucinous cystadenoma and lymphangioma. Conclusions Correct diagnosis rests in the hands of the pathologist and ensures that the patient receives appropriate and timely management. Hence knowledge of the spectrum of these rare cystic peritoneal masses is necessary to distinguish from other potential cystic abdominal mimicker masses and avoid a potential pitfall.

Education develops man’s faculty, specially his mind so that he may be able to enjoy the contemplation of supreme truth, goodness and beauty. Education plays a vital role in the programme of nation building. The most powerful instruments to meet the challenge of poverty and deprivation and of the widening gap between the rich and the poor among countries are education and research. The present study aims at investigating the teacher effectiveness of women student teachers in relation to their adjustment. For the purpose of investigation, descriptive survey the method was employed. A random sample of 600 women student teachers was drawn from Colleges of Education few affiliated to north Karnataka Akkamahadevi Women’s University. The tools used for the present study include Teacher Effectiveness Scale developed by Umme Kulsum, Adjustment Scale Constructed and standardized by Dr. S. K. Mangal. There were used for the collection of data. The statistical techniques such as Mean, SD and t values co- efficient of correlation Two way ANOVA, Regressions analysis, Path analysis were applied. The teacher effectiveness of differential between married and unmarried adjustment teachers are also found positively different. This paper studied the problem related to student teachers. Every research leaves new scope and opens new ideas for further study. Accordingly the researcher hopes that readers of this paper will be benefited in developing insight me the field of teacher education.

Increased competition, highly educated consumers, and increase in standard of living are forcing many businesses to review their customer service strategy. Many business firms are channeling more efforts to retain existing customers rather than to acquire new ones since the cost of acquiring new customer is greater than cost of retaining existing customers. This Paper focuses on customer satisfaction of various nationalized banks in comparison with Private Banks. A survey was conducted for 600 respondents, 300 respondents who were customers of Private Banks and 300 respondents were customers of nationalized banks.

Background: Hysterectomy is the commonest major surgical procedure performed in gynecology. It can be done by abdominal or vaginal route and with the help of laparoscopy. Laparoscopic assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) although gaining more popularity now a days, though it is associated with higher cost, longer duration of operation, and need general anaesthesia. The latest value study concluded that major haemorrhage, hematoma, ureteric injury, bladder injury, and anesthetic complications were more in laparoscopic assisted hysterectomy (LAVH) group when compared to abdominal and vaginal hysterectomies. In addition LAVH was accomplished in twice the time required for vaginal hysterectomy.The objective of the study was to analyse the indication and to study the complications of nondescent vaginal hysterectomy. Methods: This is a retrospective cohort study. 60 women who underwent nondescent vaginal hysterectomy in the department of OBG, B.G.S. Global Institute of Medical Sciences, Banglore, India were included in the study. Patients’ records were retrieved. Data regarding patient’s age, parity, indications for hysterectomy, uterine size in weeks, previous surgeries in the past, duration of surgery and complications were recorded. Data collected on a semi structured proforma and the same was analysed using suitable statistical analysis. Results: A total of 60 cases were operated for different indications. Among the study participants majority were in the age group of 41-45 years with 28 (46.7%). Most common indication for hysterectomies were dysfunctional uterine bleeding (DUB) with 27 (45%), followed by fibroid uterus 15 (25%). The mean duration of surgery time taken was 50+10minutes. Majority of the women who underwent hysterectomies had bulky uterus with 42 (70%). Complications were very few. Fever, UTI (urinary tract infection) and headache were seen in 3 (5%) cases. There was one case of vault sepsis and one case of upper respiratory tract infection (URTI). In one patient vaginal hysterectomy could not be completed and abdominal hysterectomy was carried out. Mean hospital duration was 4 days. Conclusions: Vaginal hysterectomy is the least invasive with fewer complications and most economical route for hysterectomy. Nondescent vaginal hysterectomy should be the gynaecologists first choice for hysterectomy.

Considering few H1N1 pathology reports based on autopsies & biopsy studies only in seasonal influenza; our series of 70 postmortem needle biopsies in H1N1 Influenza is worth documenting. Decedents with severe respiratory illness & strong clinical suspicion of H1N1 influenza in 2009 pandemic were studied. Nasopharyngeal swabs for RT-PCR & post mortem biopsies were taken. 51.4% were H1N1 positive & 48.6% were negative on RT-PCR. Most of H1N1+ve cases showed interstitial pneumonia & intra-alveolar hemorrhages & DAD in lung & fatty change in liver. Similar histopathology of majority of H1N1 RT-PCR negative & positive cases prompts need for confirmation of negative cases by ancillary methods. Rapid & safe diagnosis of H1N1 Influenza can be obtained by biopsy if supplemented by IHC to get accurate estimate of disease prevalence & mortality. Sufficient biopsy sampling can provide insight into H1N1influenza pathology & eliminate need for autopsies considering high infectivity of disease.

Entomophthoromycosis (subcutaneous zygomycosis) is a sporadic subcutaneous infection that is largely restricted to tropical areas of Africa, Asia, and South America. It presents in two clinically distinct forms. Subcutaneous zygomycosis, caused by Basidiobolus ranarum and rhinofacial zygomycosis caused by Conidiobolus coronatus. Neither of these two forms occur preferentially in patients with underlying disease or defective immunity1. Entomophthoromycosis is characterized by the formation of firm and nontender swellings, generally on the extremities, trunk, & rarely other parts of the body2. Subcutaneous zygomycosis can also mimic soft tissue tumors3. We present 2 cases with large, rapid-growing zygomycotic subcutaneous lesions, initially misdiagnosed as a soft tissue tumor, emphasizing importance of rapid & thorough diagnosis with a high index of suspicion, especially in endemic areas. Our experience with these cases highlights importance of awareness & early recognition of this condition to prevent disfigurement produced by advanced disease, misdiagnosis, & unnecessary delay in treatment. Subcutaneous zygomycosis should be considered in differential diagnosis of subcutaneous swellings, especially in tropical countries. Treatment should be given on histopathological diagnosis as fungus is difficult to grow in culture with immunology & serology having limited basis in use for diagnostic purposes.

Background: Diabetes mellitus (DM) is a leading non-communicable disease in India and contributes to 34% of mortality. Optimal management of DM involves a multipronged approach due to diverse factors including lifestyles, culture, myths, and socioeconomic condition. Self-care practices go a long way in the prevention of complications and improving quality of life. Objectives: The objectives of this study were to assess the self-care practices among type 2 adult diabetic populations in a tertiary health-care setting. Materials and Methods: A cross-sectional descriptive study was conducted on type II adult diabetic subjects in a tertiary care hospital. A pre-tested, structured pro forma was used to collect the baseline data and self-care practices including knowledge of the disease, dietary practices, exercise, habits, health-seeking practices, complications, and prevention of complications. Chi-square test and descriptive statistics were analyzed using SPSS (17.0). Results: A total of 101 patients were studied where 60% of them were males; 57% had diabetes history of >5 years, 44% overweight, and 16% obese. Knowledge about the disease such as risk factors (59%), complications (67%), and dietary practices (92%) was good. Self-care practices were poor with 17% following strict diet, 7% exercised regularly, and 52% of them got their blood glucose monitored periodically. 21% of them never took care of their feet, and up to 96% of them never carried diabetes identification card. The self-care practices were significantly better among literates as compared to illiterates. Conclusion: Although the awareness of the disease and complications is good, self-care practice is poor among the study population.

Background: Basic medical graduate must possess skills of communication in health education for health promotion. There is a little scope for formal training in communication in health education in the current curriculum. Objectives: The objectives of this study were to assess the communication skills of undergraduates in health education and to assess the role of modular training in improving their communication skills. Materials and Methods: An interventional study conducted in a medical college in South India. A total of 88 2nd year medical students underwent four theory classes on health education. They were subsequently divided into two groups of 44 each. The intervention group underwent modular training for four sessions of 2 h duration each which included demonstration, video play, focused group discussion, and role play. The control group underwent repeat theory classes. All the students performed health education session of 15 min duration and were assessed by standardized blinded assessors using a questionnaire. Proportions and Z-tests were applied using SPSS (17.0). Results: Majority of the students in both the groups performed well in verbal communication skills such as clarity of speech (72.3% in control and 89.7% in intervention group) and being audible (84.1% in control and 89.7% in intervention group). Both the groups lacked non-verbal skills of interaction and involving the audience in discussion (45.5% in control and 43.6% in intervention group). There was no significant difference between the intervention and control groups in any of the parameters. Conclusion: Communication skills in health education among 2nd year medical students are poor. Short-term training has no effect in improving their communication skills.

Background: Symptomatic dengue virus infections can present with a wide range of clinical manifestations, from mild febrile illness to a life-threatening shock syndrome or organ dysfunction. Objectives: To study the clinical manifestations and laboratory findings of dengue cases, which is important for patient management and crucial for saving life. Material and Methods: Hospital-based cross-sectional study conducted from July to December 2015, included suspected dengue cases aged 16 years and above admitted in the medical wards of the hospital. Detailed epidemiological, clinical, and laboratory parameters recorded. Chi-square (χ2) test and descriptive statistics were analyzed using SPSS (17.0). Results: Of the total 114 patients, 64 (56.1%) males and 50 (43.8%) were females. Majority of the affected patients were in the age group of 31–40 years (6 (31.5%)). Commonest symptom and sign observed was fever in 103 (90.3%). Signs of quadrant/epigastric tenderness, tachycardia, flushing were observed in more than > 50% of the patients and bradycardia, right upper shifting dullness, evidence of pleural effusion, shortness of breath, low blood pressure, low urine output, cold extremities were observed in less than 30% of patients. The commonest complication was severe abdominal bloating (8 (7.0%)), major bleeding and hepatitis in 5 (4.3%) of the patients. Briefly, 13 (11.4%) required the ICU treatment. In total, 107 (93.8%) had thrombocytopenia, raised AST and ALT in 89 (78.0%), leucopania in 74 (64.9%), ascites in 71 (62.2%), gall bladder wall edema in 64 (56.1%), and hematocrit in 28 (24.5%) of the patients. Also, 92 (80.7%) patients were NS1 positive. Conclusion: Manifestations of dengue cases are acute and varied. Proper confirmation of diagnosis, early institution of therapy helps in dengue prevention and management.

Context: Majority of falls are multifactorial and results from a complex interplay of predisposing and precipitating factors. Falls and their sequelae are potentially preventable. Aims: To determine the risk factors for falls among the elderly. Settings and Design: A community-based cross-sectional study in urban part of Bengaluru. Subjects and Methods: Study conducted for a period of 1-year, among elderly population 60 years and above, were residents since 1-year. Complete enumeration by census methodology applied. A pretested semi-structured questionnaire was administered to collect information about falls. Statistical Analysis Used: Univariate and multivariate logistic regression employed using SPSS version 18. Results: Of the 416 elderly persons studied, prevalence of falls rate 29.8%. The rate of fall for medical factors varied 33.3% diabetes mellitus to 71.4% foot problems. Among the people with behavioral factors, higher fall rate seen among those who were underweight 77.7%, abnormal finding in balance test 59.5%, abnormal gait 51.4%, low Mini Mental State Examination score 50%, Obese 50%, those who had difficulty with steps/stairs 45.3%, habit of smoking 45.1%, low activities of daily living score 45.4%, persons with abnormal get up and go test 43.8% and those who were on alcohol 43.1%. Logistic regression analysis revealed elderly with backache, nonsteroidal anti-inflammatory drugs, visual problem, difficulty in getting on/off toilet, smoking, cataract, TCA's loose slipper outside home were at higher risk of fall, was found to be statistically significant. Conclusions: Majority of the falls in the elderly are due to medical, behavioral factors which are predictable and preventable.