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Background: Digitization of health records and health delivery processes in health care settings may have an impact on the Patient-Physician communication, wait times, that affect the overall patient satisfaction with the health care services. Aim & Objective: We ascertained the effect of digitization of medical case files on the doctor patient relationship (DPR) domain of patient satisfaction at an urban primary health center in India. Settings and Design: Comparative, cross-sectional study in primary health centres. Methods and Material: The patient satisfaction was compared between the patients attending the Public Health Dispensary (PHD) that uses digitized medical case file system and a Civil Dispensary (CD) which follows the conventional paper based medical records, using a Patient Satisfaction Questionnaire (PSQ). Statistical analysis used: Univariate analysis was done by chi-square test and adjusted analysis was done by multiple linear regression. Results: Patient satisfaction in DPR was found to be similar between the digitized medical case files based and conventional OPD (p=0.453). Significantly higher overall patient satisfaction was reported in the conventional paper based OPD than the digitized OPD (p<0.001). Conclusions: Patient satisfaction towards the doctor-patient relationship (DPR) was similar between paper based OPD and the digitized medical case files based OPD. [ABSTRACT FROM AUTHOR]

Background: Cryosurgery remains an important treatment modality in dermatology practice. HYDROZID®, a new portable cryosurgery medical device using norflurane as a cryogen, was recently introduced in the Indian market. This paper reports the findings of the phase IV study conducted in India. Aims: This is a prospective phase IV study to evaluate its safety and efficacy in the treatment of superficial epidermal and dermal lesions. Methods: The study was conducted across 4 centres in India. The cryosurgery cycles were decided based on the skin lesion considered for the treatment. Safety and efficacy parameters were assessed at day 1, day 7, day 14, day 30 (±2) (end of treatment), and day 60 (±2) after the initial cryosurgery treatment. The local skin reactions scale, pain VAS scale, and Vancouver scale for assessment of pigmentation and scarring were used for the assessment of cutaneous reactions. Assessment of efficacy was done by evaluating the total disappearance of skin lesions at the end of the study visit. Results: Ninety-seven patients completed the study. The reported post-procedural pain was mild to moderate and subsided over the period of 24 hours. There was no pain observed in 84.76% of patients at the end of 24 hours. Complete disappearance of the lesion was seen in 47.4% of patients at the end of the study, while the reduction in the diameter of skin lesions by more than 50% was observed in 79.38% of patients. Conclusion: The data from this study support good clinical tolerability and safety of the Hydrozid® portable cryo device. [ABSTRACT FROM AUTHOR]

Over-The-Top (OTT) platforms have seen a significant rise in popularity, especially during the COVID- 19 pandemic. They offer convenience and a vast array of content, but their impact on mental health presents a complex picture. This SWOT analysis explores the strengths, weaknesses, opportunities, and threats of OTT platforms in relation to mental health. The proliferation of digital streaming services has redefined entertainment consumption patterns, presenting both opportunities and challenges for societal norms and individual well-being. Through a multidimensional analysis, this study investigates the evolving dynamics of Indian culture in the context of OTT content, examining how it shapes societal values, interpersonal relationships, and traditional norms. Furthermore, the paper scrutinizes the potential effects of OTT content on mental health, considering factors such as content diversity, representation, and the psychological implications of binge-watching. [ABSTRACT FROM AUTHOR]

Background: Primary care physicians are not adequately trained to tackle mental health problems. The study aimed to evaluate undergraduate training in Psychiatry: An observational perspective of medical officers. Materials and Methods: It was a cross-sectional study conducted in North India. Participants were assessed on a self-designed questionnaire developed by the Indian psychiatric society to assess various aspects of undergraduate training. Other questionnaires measured residents' satisfaction with the quality of training programs and perceived need for psychiatric training in undergraduate courses. Results: The participant's mean age was 32.4 years; majorities were male medical officers. About one-tenth reported that there were no separate psychiatry departments and designated psychiatry consultants in their college. Approximately 50% reported: No regular supervision by any psychiatric faculty or having psychiatric disorders discussions in clinical rounds. More than half (50.9%) were not confident enough to identify common signs and symptoms of psychiatric problems. From one-third to half of the participants were unsatisfied with various aspects of the training program, like teaching skills, diagnostic interviews, clinical posting, etc. Majority (77.3%–83.7%) agreed that there is a need to improve the psychiatry training program; during the clinic rounds, psychiatric diagnosis should be discussed, and psychiatry should be a separate subject in under-graduation. Conclusion: Primary health-care physicians were unsatisfied with an undergraduate psychiatry training program. Hence, psychiatry should be an independent subject during the undergraduate training program, with dedicated theoretical and clinical hours for psychiatry training and a separate paper for evaluation. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: New modern era, new modern age, the paper has been replaced by the screen. However, this screen might be started from the age of the television to the computer, smartphones, and tablets. With this new era the health is lacking and has taken a back step. Aim: This study aims to assess the screen time usage and its effects on mental well-being to promote the mental health among students. Methods: A quantitative research approach, nonexperimental descriptive research design was used. Data were collected from 100 professional college students and 100 school-going students. Nonprobability convenient sampling technique was used. Responses were collected on sociodemographic profile, self-structured screen time usage, The Warwick–Edinburgh Mental Well-being (2006), and Self-Structured Screen Time Effects Likert Scale. Results: The study revealed that 55% of the college students and 42% of the school-going students were using smartphone for 1–3 h on weekends, 56% of the college students and 45% of the school-going students were using smartphone for 1–3 h on weekdays (58%) of the professional college students having high mental well-being and 42% having low mental well-being, almost half (54%) of the school-going students having high mental well-being and 46% having low mental well-being. Conclusion: The study concluded that the professional college students had higher screen time usage than school-going students on both weekdays/weekends and majority of them were using it for educational purpose. High mental well-being was found in both groups of students. [ABSTRACT FROM AUTHOR]

Hand hygiene remains one of the most effective methods of preventing healthcare-associated infections. Hand drying is the end point of hand hygiene. Hand drying after hand hygiene is less explored, and the practice varies in different facilities. This explorative study was done to know the various hand-drying methods and practices of healthcare workers in Indian settings. This was a descriptive cross-sectional questionnaire-based observational study initiated from a tertiary care setup in Uttarakhand. Healthcare workers over 18 years of age directly involved in patient care were enrolled. A semi-structured questionnaire with both open-ended and close-ended questions was used with snowballing sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS). Out of the eligible 395 respondents, 62.8% were female. The mean age of the respondents was 31.34 ± 8.44 years and average working hours were 8.87 ± 2.97 (range 4-24) hours. Only 72.7% did hand hygiene always before touching a patient. Nurses were more compliant about hand hygiene than doctors (P < 0.0001). A total of 82.8% were aware of appropriate hand-drying methods. Staff in the Intensive care unit Intensive care unit (ICU) setup were more aware of hand drying practices (P = 0.033). A total of 21.8% wiped their hands on their clothing to dry their hands. This was more in staff from paraclinical departments (P = 0.001). A total of 35.7% used handkerchiefs to dry hands. Resident doctors used handkerchiefs more than senior doctors or nursing staff (P = 0.01). A total of 49.9% of respondents spent less than 10 seconds in hand drying. Hand-hygiene knowledge is high among healthcare workers in India, but the knowledge of appropriate hand-drying practices is lacking. There is wide variation in the practice of hand drying. Better hand drying guidelines and incorporating hand drying as the essential endpoint of the hand hygiene ritual are warranted. [ABSTRACT FROM AUTHOR]

Introduction: Mobile phone usage has become essential, especially among students to the extent of addiction and poor sleep quality. Inadequate sleep can affect cognitive performance and increase cardiovascular risk. Aims: The aim of the study was to find relation of smartphone use with sleep quality and attention in college students. Material and Methods: Observational study was conducted among college-going students aged 18–27 years from Ahmedabad by convenience and snowball sampling. Data were collected using a self-administered questionnaire using Google Docs/paper copies. Smartphone Addiction Scale-Short Version (SAS-SV) for smartphone addiction, Pittsburgh Sleep Quality Index (PSQI) for quality of sleep, and Attentional Control Scale (ACS) for attention were used. The level of significance was kept at 5%. Results: A total of 321 participants completed the study - 91 males and 230 females with mean age 21.27 ± 2.46 years. Mean scores for SAS-SV (28.9 ± 10.7), PSQI (5.50 ± 4.5), and ACS (51.7 ± 11.5) were seen. Correlation was found using Spearman's correlation for SAS-SV with PSQI r = 0.28, P = 0.001 and SAS-SV with ACS r = −0.22, P = 0.001. Conclusions: College students were found to be at risk of addiction to their smartphones with affected sleep quality and attention. There is a weak, statistically significant correlation between smartphone addiction and sleep and attention. [ABSTRACT FROM AUTHOR]

Education being one of the major services directly impacting the nation's growth, the sector has been ever growing with changing nature of national and international demands. The globalization has brought significant demands for changes in the education sector and keeping in view of the national and international expectations, Government of India initiative Education Policies to enhance the access, facility and empowerment of people through implementation of policies. Right from the inception of Kothari Commission on Education, the Education Policies introduced in India have focalized on various dimensions such as value spent on education, providing equitable opportunities, Universal Enrollment and empowering School Education, Professional Education, Higher Education and strengthening of education to all. Objectives: The paper presents the study on scenario of Government spent on expenditure to Education Sector and present the critical issues on New Education Policy, 2020 pertaining to Higher Education. An Attempt is made to present the key observations on NEP, 2020 with an aim to draw challenges ahead for implementation of policy. Methodology: Study is based on Descriptive Research Design and sources of data primary include Economic Survey Reports, reports of MHRD, UNO and NITI Aayog Reports. Key Observations: Study explored the policy statements and its concerned issues pertaining to Higher Education. Study further drawn insights on the new Education Policy, 2020 and issues to be considered for the effective implementation of NEP, 2020. [ABSTRACT FROM AUTHOR]

Objective: The primary objective is to assess the vulnerability of Matrija Bhava for the causation of metabolic disorders in the purview of epigenetics. Data Source: This study was conducted at the PG Department of Rachana Sharir, CBPACS, New Delhi, and AIIMS, New Delhi. Materials and Methods: Twenty subjects of metabolic disorders, namely diabetes mellitus, obesity, and hypothyroidism cases, were taken to collect the data. The self-structured information sheet/case paper pro forma followed by a consent form was used to record all the data of the subject along with their mother's history (at the time of pregnancy) included in the study. All the observations were recorded and furnished for statistical analysis. Results: It was observed that Lavana, Madhura, Amla, and Katu Rasa Ahara; Viruddha Ahara, Ratrijagrana and Divaswapna were observed as a potential factor affecting the Metabolism of the mother at the time of their pregnancy with the subject; thereby causing related metabolic disorders to the subject. Conclusion: Maternal factors (Matrija Bhava) are vulnerable to cause metabolic disorders in childhood. [ABSTRACT FROM AUTHOR]

Purpose: There is a paucity of comparative literature on pathway to care among patients with co-occurring disorders and those with only substance use disorders. This paper aims to compare the pathways to care among patients with co-occurring disorder and those with only substance use disorders. Design/methodology/approach: A cross-sectional observational study was carried out on male treatment seekers at a tertiary care substance use disorder treatment center in India. Participants were recruited in two groups, those with co-occurring psychiatric and substance use disorders and those with only substance use disorders. The two groups were matched for age and socio-economic status. Findings: A total of 189 subjects with co-occurring psychiatric and substance use disorders and 197 subjects with substance use disorders only were recruited. Psychiatric services were the most common first point of care. However, a larger proportion of the subjects in the co-occurring disorder group received the first care from faith healers, while a greater proportion received first care from the therapeutic communities in substance use disorder only group. Initial care was sought mostly following suggestion from the family members in both the groups. The time to treatment for substance use disorders did not differ between the two groups, though the treatment seeking for substance use disorder was more delayed than that of psychiatric disorder in the co-occurring disorder group. Research limitations/implications: The findings shed light on the pathway of care followed in India and is a matter of further research. Practical implications: Expansion of services and dissemination of information about psychiatric disorders and substance use disorders can provide timely care to patients with substance use disorders and co-occurring disorders. Social implications: The findings have a social implication as well. More awareness is needed currently in India for timely treatment of dual disorders. Originality/value: The paper is an original research by the authors. The data were collected from the participants who reported to the dual diagnosis clinic. The findings are important as they tell us about the current understanding of dual diagnosis by the general public. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic negatively influenced the entire life globally including various aspects of patients' care. Its effect on medical research production is not known. The aim of this study is to assess the impact of COVID-19 pandemic on medical research reporting trend. Methods: Advanced search on PubMed was performed over 2011- August, 2021. Monthly comparison was done for the years 2019, 2020, and 2021. Kruskal Wallis test was used to compare continuous distributions. Results: The total publication count showed constant increment over the study period. Faster rise was noticed on 2020 (15.7%). A steady growth in publications over the years and through the pandemic was also seen in seven studied countries with variable, both in total and also after exclusion of COVID-19 related papers. Italy and India have the highest proportions of COVID-19 related publications in comparison to the total papers in 2020, but USA has the highest quantity. Statistically significant differences exist between the first eight months of the last three years with and without counting COVID-19 related publications (p-values=0.0003907 and 0.001084, respectively). Conclusion: Our results reflect that investigators world-wide succeeded to reconfigure their work style and utilize the spared time induced by the lockdown to enrich the medical research platform. [ABSTRACT FROM AUTHOR]

Background Accurate assessment of gestational age (GA) and identification of preterm birth (PTB) at delivery is essential to guide appropriate post-natal clinical care. Undoubtedly, dating ultrasound sonography (USG) is the gold standard to ascertain GA, but is not accessible to the majority of pregnant women in low- and middle-income countries (LMICs), particularly in rural areas and small secondary care hospitals. Conventional methods of post-natal GA assessment are not reliable at delivery and are further compounded by a lack of trained personnel to conduct them. We aimed to develop a population-specific GA model using integrated clinical and biochemical variables measured at delivery. Methods We acquired metabolic profiles on paired neonatal heel prick (nHP) and umbilical cord blood (uCB) dried blood spot (DBS) samples (n=1278). The master data set consists of 31 predictors from nHP and 24 from uCB after feature selection. These selected predictors including biochemical analytes, birth weight, and placental weight were considered for the development of population-specific GA estimation and birth outcome classification models using eXtreme Gradient Boosting (XGBoost) algorithm. Results The nHP and uCB full model revealed root mean square error (RMSE) of 1.14 (95% confidence interval (CI)=0.82–1.18) and of 1.26 (95% CI=0.88–1.32) to estimate the GA as compared to actual GA, respectively. In addition, these models correctly estimated 87.9 to 92.5% of the infants within ±2 weeks of the actual GA. The classification models also performed as the best fit to discriminate the PTB from term birth (TB) infants with an area under curve (AUC) of 0.89 (95% CI=0.84–0.94) for nHP and an AUC of 0.89 (95% CI=0.85–0.95) for uCB. Conclusion The biochemical analytes along with clinical variables in the nHP and uCB data sets provide higher accuracy in predicting GA. These models also performed as the best fit to identify PTB infants at delivery. [ABSTRACT FROM AUTHOR]

The present study aims to assess the knowledge on use of diaper and its impact on child health among mothers of infants. The objectives of the study was to assess the knowledge on use of diaper and its impact on child health among mothers of infants and to find out the association between the knowledge onuse of diaper and its impact of child health among the mothers of infants and selected socio personal variables. Non experimental descriptive study design was used in the study. The data was collected by using a semi structured questionnaire. The collected data was analysed using descriptive and inferential statistics. The result shows that out of 50 samples majority of the children are of age range 0-2 months, 52% were male children and was first born (54%). Majority of the sample are at age group 26-30 years (36%), 58% samples are educated upto graduate level, 42% of samples were housewives and 48% have family income above 30,000, 94% of children were using disposable diapers ,42% of children using diapers for 3-4 hours and 80% children had no exposure to diaper rash. Among the samples, 56% of mother had moderate knowledge, 34% of mothers had poor knowledge and, 10% of mothers had good knowledge. There is significant association between the age of mother and occupation of mother and there is no association between age of child, sex of child, birth order of child, education of mother, income of family, type of diaper used, duration of diaper used, previous exposure to diaper rash. [ABSTRACT FROM AUTHOR]

Global health research partnerships are increasingly taking the form of consortia. Recent scholarship has proposed what features of governance may be necessary for these consortia to advance justice in global health. That guidance purports three elements of global health research consortia are essential — their research priorities, research capacity development strategies, research translation strategies — and should be structured to promote the health of the worst-off globally. This paper adopted a reflective equilibrium approach, testing the proposed ethical guidance against the experience of a global health research consortium with equity objectives. Case study research was performed with Future Health Systems (FHS), a health systems research consortium funded over two phases. Data on FHS Phase-2 were gathered through in-depth interviews with steering committee members and junior researchers and collection of consortium-related documents. Thematic analysis of the data for consistency with the proposed guidance generated recommendations for how the guidance might be better articulated and identified areas where it could usefully be expanded. Factors facilitating FHS alignment with the ethical guidance were also identified, including early engagement and partnership with low and middle-income country stakeholders, the learning developed during FHS Phase-1, and aspects of the grant program funding it. [ABSTRACT FROM AUTHOR]

This paper examines the grid of sentiment that structures medical travel to India. In contrast to studies that render emotion as ancillary, the paper argues that affect is fundamental to medical travel's ability to ease the linked somatic, emotional, financial, and political injuries of being ill 'back home'. The ethnographic approach follows the scenes of medical travel within the Indian corporate hospital room, based on observations and interviews among foreign patients, caregivers, and hospital staff in Mumbai, New Delhi, Chennai, and Bangalore. Foreign patients conveyed diverse sentiments about their journey to India ranging from betrayal to gratitude, and their expressions of risk, healthcare costs, and cultural difference help sustain India's popularity as a medical travel destination. However, although the affective dimensions of medical travel promise a remedy for foreign patients, they also reveal the fault lines of market medicine in India. [ABSTRACT FROM AUTHOR]

Objective: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. Method: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. Results: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan–Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). Conclusion: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the demographic, aetiopathological and diagnostic profiles of patients presenting with hoarseness to a laryngology unit of a tertiary care centre in India. Methods: A retrospective observational study was conducted. Results: The 1033 patients who presented with dysphonia showed a male predominance (70 per cent), high rates of malignancy (18 per cent), late presentation (mean, 24 months) and poor follow-up trends (53 per cent with 3 months' follow up), which contrasts with data from developed countries. The patient population hailed from different states in India and neighbouring countries around India, serving as a good sample for the subcontinent. The majority (67 per cent) were managed conservatively; however, surgical management was the preferred choice for those who presented with airway stenosis (91 per cent) and laryngeal trauma (75 per cent). Significant associations between vocal professionalism level and co-morbidities and dysphonia aetiopathologies are discussed. Conclusion: These findings give insight into the trends of hoarseness in the developing Indian subcontinent, which can aid understanding and management. [ABSTRACT FROM AUTHOR]

Despite decades of research on India's plural health care market, the practices of many local health traditions outside the allopathic and codified traditions are under-studied. Drawing on interview and observational data, this paper explores the space in which indigenous traditional Khasi healers in Meghalaya state, northeast India, practice. Khasi indigenous healers describe themselves as doktor sla, plant doctors, to distinguish themselves from doktor kot, or book doctors. This distinction operates as a rhetorical resource, utilised to carve a distinct sphere of expertise in relation to the allopathic sector, and to mark claims for the specifically local appropriateness of traditional practices within a shifting market of state-sponsored provision. Khasi healers are a heterogeneous group who treat a wide variety of conditions, including physical ailments which have no obvious correlates in biomedical systems, and musculoskeletal disorders, with which they have recognised expertise. In addition to claiming these discrete strengths, healers also present themselves as accommodating deficiencies in biomedicine, including inherent generic weaknesses of allopathic care as well as specific local gaps in rural health care provision. Thus, the expertise niches of traditional healers have evolved through their interactions with, and the needs of, the community, but also through managing a shifting boundary with biomedical practitioners, who are explicitly sceptical of their efficacy, but tacitly accepting of the ways in which they manage the gaps in biomedical provision. While codified non-biomedical traditions in India have engaged in universalising professionalising projects, in this setting at least, non-codified practitioners have instead utilised discourses of localism. [ABSTRACT FROM AUTHOR]

Background: Condom is an integral part of all interventions for female sex workers (FSWs). However, certain situations hinder them from practicing consistent condom use. This paper aims at identifying the situations that predict inconsistent condom use by FSWs of Sonagachi red-light area, Kolkata. Subjects and Methods: The cross-sectional community-based observational study was conducted among 296 brothel-based FSWs of Sonagachi. Outcome variable, that is, inconsistent condom use was said to be present if any sex act with any type of partner was not protected by condom. Association with sociodemographic, occupational, and behavioral characteristics of FSWs was examined. Results: Inconsistent condom use was present among 37.5% of the study participants, and this was predicted by the presence of a nonpaying partner (NPP) (adjusted odds ratio [AOR] [95% confidence interval (CI)]: 15.04 [7.52-30.08]), violence (AOR [95% CI]: 2.08 [1.07-4.03]) and sexual intercourse under the influence of alcohol (AOR [95% CI]: 1.86 [1.02-3.39]). The major cause behind nonuse of condom as reported by the participants was trust on partner. Conclusion: NPPs need to be given emphasis in program strategies for FSWs. The FSWs should constantly be motivated for safe sex emphasizing the fact that trust on partner may be detrimental for their health. [ABSTRACT FROM AUTHOR]

Background: Hamstring, being a two-joint muscle, tends to shorten over time, resulting in tightness, affecting performance in daily activities and is also capable of generating exaggerated posterior pelvic tilt, leading to decreased lumbar lordosis. Weak core muscles have been associated with hamstring tightness, and strengthening the core has been attempted in an effort to relax the hamstring tightness. It is believed that the hamstrings overact and over a period of time tightens, when the core is weak, to compensate for postural stability. Method: Thirty-three subjects, both male and females with and without hamstring tightness, were assessed for their core endurance through McGill's core endurance test battery. It was followed by active knee extension test to determine degree of hamstring tightness on both sides. Correlation between the two variables was statistically analyzed. Results: Pearson's correlation was used to analyze the collected data. A moderate positive but significant correlation (p = 0.02) was found between flexor endurance test and active knee extension (both sides). A weak positive but significant correlation (p = 0.05) was found between extensor endurance test and active knee extension (both sides). Correlation between the right and left lateral bridge with their respective side hamstring flexibility was negative and not significant (p = 0.916 (right lateral torso endurance); p = 0.339 (left lateral torso endurance)). Conclusion: Since there is a moderate positive but significant correlation between the flexion torso endurance test and both side hamstring flexibility and a weak positive but significant correlation between extension torso endurance test and both side hamstring flexibility, the core (flexor, extensor, and lateral) should be thought of as a whole unit when strengthening in order to maintain and improve hamstring flexibility. [ABSTRACT FROM AUTHOR]

Background: Telemedicine-assisted buprenorphine (BNX) induction (TABI) has the potential to reduce the treatment gap for opioid use disorder. Aim: This study investigated the acceptability and feasibility of TABI in India. This was a retrospective study from a specialized addiction treatment center in a teaching hospital. Methods: TABI was introduced in November 2022; patients enrolled till May 2023 were included in the analysis. Feasibility was assessed by the proportion of patients who completed the TABI program, continued treatment for at least 3 months, and self-reported nonprescription opioid use during and after TABI. Acceptability was measured by patient satisfaction with TABI. Results: Sixty patients were enrolled: Fifty-three patients (88.3%) were retained during the TABI program, and 50 patients (83.3%) remained in treatment at the 3-month follow-up. Thirty-five patients (58.3%) reported using nonprescription opioids during TABI, and 28 patients (46.7%) reported such use after completing the program. Thirty-five (58.3%) were satisfied with the program, and 15 (25%) said they would recommend it to others. Patients who missed scheduled in-person appointments (P < .001) at 1 week, did not return unused BNX-naloxone (P < .001), and were not satisfied (P = .004) were more likely to report nonprescription opioid use. Those who attended the in-person follow-up at 1 week (P = .004) and were satisfied (P = .01) and did not use nonprescription opioids either during (P = .003) or after (P < .001) TABI were more likely to be retained in treatment at 3 months. Conclusion: The study shows TABI's acceptability and feasibility in a specialized addiction treatment setting; further research is needed for broader applicability. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to review the clinical profile, management, and outcome of solid tumors in the head-and-neck region in children at our institute. Methods: We retrospectively reviewed children with head-and-neck solid tumors who were treated jointly under the departments of Pediatric Surgery and Otorhinolaryngology at our institute between 2016 and 2019. Results: In the study period, 10 children (6 males, 4 females) with a median age of 9.5 years (range 5 days–16 years) were treated by our unit. The patients had four tumors arising from the parotid, 2 from nose/naso-pharynx, 1 each from the tongue, submandibular gland, para-pharyngeal space, and infratemporal fossa. A majority (90%) of the patients underwent complete surgical excision of the tumor, preserving the loco-regional neurovascular structures to minimize postoperative morbidity. Malignant lesions were seen in 4 patients (2 rhabdomyosarcoma, 1 primitive neuro-ectodermal tumor, 1 mucoepidermoid carcinoma) and 6 patients had benign pathology (3 pleomorphic adenoma, 2 mature teratoma, 1 schwanomma). Additional therapy with chemotherapy and local radiotherapy was required in 3 out of 4 patients with malignant pathology. The median follow-up duration is 15 months. At last follow-up, all patients are alive and 9 out of 10 patients (90%) are disease-free. Conclusion: Our experience highlights rare and difficult tumors in the head-and-neck region in children. These tumors are not commonly managed by the pediatric surgeon in routine practice. The paper outlines the multi-modality management of these tumors, which is essential for an optimal outcome. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate cardiac autonomic modulation using short‐term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. Methods: A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre‐frail (n = 70), and non‐frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5‐min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. Results: The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre‐frail and non‐frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre‐frail and non‐frail subjects (P < 0.05). Measures of sympatho‐vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Conclusions: Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre‐frail and non‐frail individuals, although maintaining a balanced sympatho‐vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents and young adults place significant value to appearance. Medical students are likely to be vulnerable to dissatisfaction with appearance and maladaptive eating attitudes. Aims and Objectives: This study was designed to study the eating attitudes, body image perception, and self-esteem in MBBS students and their correlations with each other and with body mass index (BMI), to identify students at risk and possibly plan measures for intervention. Methodology: A study was conducted on 700 medical students (including interns), with electronic questionnaires assessing sociodemographic data, eating attitudes, body image perception, and self-esteem. Using the Chi-square tests and t -tests, the parameters were studied and correlations using Spearman's rank correlation were established. Results: Students with a higher BMI were at a greater risk of eating disorder (ED), higher concerns with body perception, and lowered self-esteem. Those with a higher risk of ED were associated with body dissatisfaction and lower self-esteem. Body image distortions were associated with low self-esteem. Conclusions: ED risk is associated with body dissatisfaction and lower self-esteem in medical students. Future studies are required to establish this relation. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia is a significant and disabling condition that puts a financial and emotional burden on the supporting family members. The aim of the study was to explore the family functioning among the persons diagnosed with schizophrenia and differences across genders. Materials and Methods: The study was a cross-sectional, hospital-based observational research conducted at the tertiary care institution. A purposive sampling technique was used to select participants, resulting in a sample size of 65, calculated using G*Power software. Inclusion criteria included individuals diagnosed with schizophrenia according to ICD-10, with a duration of illness over two years and an age range of 21 to 60 years. Family caregivers with co-morbid psychiatric or organic illnesses, substance abuse history, or those caring for more than one patient were excluded. Data was collected using a Socio-Demographic Data Sheet and the Family Assessment Device (FAD), a standardized measure assessing seven subscales of family functioning. SPSS version 20 was used for statistical analysis, including tests of normality and descriptive statistics such as frequency, percentage, mean, and standard deviation. Results: The family assessment data using the McMaster Family Assessment Device (FAD) shows significant dysfunction across multiple domains among individuals with schizophrenia, with notable gender differences. Conclusion: These findings highlight the need for tailored interventions that address specific challenges faced by males and females to improve family functioning and support recovery. [ABSTRACT FROM AUTHOR]

This study aimed to assess anxiety, stress, and depression levels among 300 nurses during the COVID-19 pandemic, utilizing a quantitative, cross-sectional design. Findings revealed that a majority experienced mild anxiety (53.7%), stress (64.3%), and depression (71.7%). Pearson's correlation showed moderate positive associations between stress and anxiety (p=0.002, r=0.376) and anxiety and depression (p=0.040, r=0.119), with a weak positive correlation between stress and depression (p=0.068, r=0.105). Age, professional experience, and marital status were associated with anxiety, stress, and depression levels. Work-related variables and fears significantly influenced anxiety and stress but not depression. The study underscores the need for targeted interventions and support to enhance nurses' well-being amid ongoing and future challenges. [ABSTRACT FROM AUTHOR]

Introduction: There is a dearth of standardized recorded tests for the assessment of speech-in-noise in Marathi. This study aims to fill this lacuna by developing a computerized Marathi open-set sentence-in-noise test; to investigate the significance of the difference between signal-to-noise ratio-50 (SNR-50) of adults with hearing loss (AWHL) and adults with normal hearing sensitivity (AWNH); and to investigate the difference between the aided versus unaided SNR-50 in AWHL. Method: A multi-centric study was conducted to develop normative data for SNR-50 in 130 AWNH using MISHA-Random Adaptive Marathi Sentence in Noise (M-RAMSIN). SNR-50 was compared in AWHL and their age-matched controls, and SNR loss was determined. Thirty AWHL were tested for SNR-50 in unaided and aided conditions to determine if there was a significant difference in the two conditions. Results: Normative values for SNR-50 under headphones and in sound field were 2 dB and 0 dB, respectively. There was a significant difference in SNR-50 of AWNH and AWHL. The median SNR loss of AWHL was 6 dB. There was a low positive correlation between SNR-50 and audiometric thresholds in AWHL. Aided SNR-50 was significantly better than the unaided SNR-50 in AWHL. Aided SNR-50 was better with binaural hearing aids than monaural hearing aids. Conclusion: M-RAMSIN is time efficient and reliable tool with good construct validity since it documented the difference in performance of AWNH and AWHL. Poor correlation of SNR-50 with audiometric thresholds signifies the differential effects of SNHL on audibility and distortional effects. The test can document the benefit from hearing aid fitting; thus has the potential to be incorporated into the hearing aid validation process for Marathi-speaking AWHL. [ABSTRACT FROM AUTHOR]

Background and Purpose: Physical fitness (PF) is a powerful health indicator in children. The study aimed to measure PF and to evaluate age and gender differences in PF in school children of Surat city aged between 11 and 14 years. Methodology: The tests adopted from the EUROFIT Fitness Test Battery were used to measure the components of PF among 872 school children. Initially, body composition (height and weight) of children was measured, and body mass index (BMI) was noted. A 20-m shuttle run test to assess cardiorespiratory fitness, a hand-grip strength test to assess the strength of the hand muscles, a standing broad jump test to assess lower body explosive power, sit-ups in 30 s to evaluate abdominal muscular endurance, a sit-and-reach (SAR) test to assess flexibility, and a 10 × 5 m shuttle test to assess agility/speed were used. Results: Overall, boys performed better than girls for all the PF components except for the flexibility (SAR test), in which girls performed better. As the age increases, there would be an increase in body composition (BMI) along with increased performance on different PF components except VO2 max of 20-m shuttle run test. Conclusion: The present study concluded that a lower level of PF was noted among school children in comparison to the results of international studies, and girls are less physically fit than boys. [ABSTRACT FROM AUTHOR]

Introduction: Mortality in the case of ovarian malignancy is high due to late diagnosis. Early and accurate diagnosis can improve case-specific management. Paired-box gene 8 (PAX8) has proved to be expressed in the ovarian epithelial cells and is considered a new biomarker for early diagnosis. Case–control studies show that the level of PAX8 in the serum and tissue expressions are positively correlated and increased in ovarian malignancy, especially in the high-grade serous type, the most common variety of ovarian malignancies. Aims: The aim of this study was to assess the epidemiological spectrum of ovarian neoplastic lesions and a comparative study of conventional cytology and a cellblock of ascitic fluid and subsequent PAX8 immunohistochemistry (IHC) expression to diagnose ovarian neoplasm. Materials and Methods: We collected clinical data from participants using a predesigned pro forma. We made a cytological diagnosis using conventional cytology, followed by cellblock preparation and subsequent assessment of PAX8 IHC expression. Ascitic fluid received for cellblock was centrifuged, tissue sediment was mixed with plasma, and then drops of thrombin were added. We fixed the clotted sample by adding 10% formalin for 30 min. The formalin-fixed, paraffin-embedded cellblocks were sliced into 4–5 μ sections and stained with hematoxylin and eosin. Subsequently, we used an immunohistochemical stain for PAX8 expression to diagnose ovarian malignancy. Results: We received 55 ascitic fluid samples. On cytological smear examination, 12 (21.8%) cases were benign, 35 (63.6%) were malignant, and the remaining 8 (14.6%) were suspicious of malignancy. On histological examination of cellblock preparation, 43 (78.2%) were malignant cases, and among these 43 cases of cellblocks studied, 37 were positive for PAX8 status; six were negative for PAX8. There was a statistically significant association between malignant cell positivity and PAX8 status in the cellblock (P < 0.001). Conclusion: An evaluation of PAX8 status in ascitic fluid cellblock study should be considered for high-grade ovarian cancers in patients who may benefit from targeted therapies. Patients with ovarian mass and ascites can be evaluated for PAX8 status in their ascitic fluid cytology study for the purpose of neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Background: The global COVID-19 pandemic has brought forth multifaceted healthcare challenges, including the emergence of COVID-19-associated mucormycosis (CAM). This study investigates demographics, clinical presentation, endoscopic grading, radiological correlations, treatment modalities, and outcomes of CAM in Central India. Methods: A retrospective analysis of 312 CAM patients (April-June 2021). Data included demographics, clinical profiles, endoscopic and radiological findings, laboratory results, and treatments. A novel endoscopic grading system was utilized to assess the severity of mucormycosis lesions. Statistical analysis, including chi-squared tests, was performed. Results: Among 312 patients, 65% were male, 82% had comorbidities, and 84% presented with facial swelling. Endoscopic grading correlated with radiological manifestations (p < 0.05) and intraoperative findings. Surgical debridement and antifungal therapy were common treatments, yielding varied clinical outcomes. Mortality was 13% in advanced grades. Conclusion: This study underscores the role of endoscopic grading in risk stratification and prognosis. Findings contribute to CAM management knowledge, underscoring tailored interventions' significance. [ABSTRACT FROM AUTHOR]

Introduction: Conventional teaching in microbiology revolved around the study of microorganisms without clinical relevance. Therefore, a New Competency-based Undergraduate (UG) Medical curriculum (New CBME) was rolled out in the academic year 2019 to make Indian Medical Graduates more clinically competent yet globally relevant. Aim: To assess the impact of the change in curriculum on students' performance and desired educational outcomes before and after the implementation of the new curriculum. Likewise, the study aimed to analyse the experiences and reflections of medical teachers towards these amendments. Materials and Methods: A cross-sectional observational study was conducted on 82 students from the second year Bachelor of Medicine, Bachelor of Surgery (MBBS) with a traditional curriculum and 74 with the new Competency-based Medical Education (CBME) curriculum at the Department of Microbiology, Smt. B.K. Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat, India, between February 2020 and November 2021. In both batches, topics from core as well as non core areas of various systems were included along with the Attitude, Ethics and Communication (AETCOM) modules. A comparison of both groups was done, and Chisquare values and p-values were calculated. Results: The batch with the new CBME curriculum was able to provide a provisional diagnosis for a case-based question better than the Traditional batch {n=60/74 (81%) vs n=44/82 (54%), p-value=0.0005, significant}. However, the correct aetiology, pathogenesis, and laboratory diagnosis were written better in the traditional batch compared to the new one, n=44/82 (54%) vs n=24/74 (32%). Regarding the AETCOM skills, the new batch had a better understanding of proper communication and ethics, i.e., 73/74 (99%), p-value<0.00001, Significant, while 66/82 students (80%) of the traditional batch and 67/74 (90%) of the new batch were aware of confidentiality issues. In viva voce, the new batch showed a lot of confusion regarding the names, types of micro-organisms, and the laboratory diagnosis of diseases caused by them compared to the traditional batch (p-value <0.00156, significant). Conclusion: After implementing the new CBME curriculum to undergraduate students and analysing the feedback of teachers and the performance of students, it was felt that an appraisal of the new curriculum is required for a satisfactory outcome in microbiology so that microbiology content can be incorporated with clinical relevance. [ABSTRACT FROM AUTHOR]

Objective:A possible role of the APC/beta-catenin pathway in the pathogenesis of sporadic juvenile nasopharyngeal angiofibroma has been suggested. This paper presents its current status and clinical association in our patients.Method:A prospective observational study was conducted at King George Medical University and Central Drug Research Institute, in Lucknow, India. Western blot analysis was undertaken in 16 cases to examine beta-catenin expression. The clinical details were recorded along with follow up observations, to determine associations.Results:Up-regulation of beta-catenin expression was seen in 69 per cent of cases. The clinical variables did not reveal significant differences between patients with extremes of expression (extreme under- vs over-expression). However, absent expression was shown exclusively in young adults aged over 18 years, while enhanced expression was associated with an altered facial profile.Conclusion:Although a beta-catenin association was seen in a subset of our sporadic juvenile nasopharyngeal angiofibroma cases, its expression was not homogeneous. This is in contrast to the Western literature that suggests a universal (homogenous) enhanced expression in the majority. Hence, further research is required to better define its molecular cascade. [ABSTRACT FROM PUBLISHER]

• Disruptions during the COVID-19 lockdown caused children to miss immunizations. • Government catch-up efforts substantially reversed these effects. • Yet, children that were due vaccinations during the lockdown remained 10–15% less likely to be immunized 4–5 months later. • Catch-up was more likely to be incomplete among children of low socioeconomic status. • Ensuring all children are fully immunized requires careful tracking and disaggregated data. Governments around the world suspended immunization outreach to control COVID-19 spread. Many have since resumed services with an emphasis on catch-up vaccinations. This paper evaluated immunization disruptions during India's March-May 2020 lockdown and the extent to which subsequent catch-up efforts reversed them in Rajasthan, India. In this retrospective observational study, we conducted phone surveys to collect immunization details for 2,144 children that turned one year old between January and October 2020. We used logistic regressions to compare differences in immunization timeliness and completed first-year immunization status among children that were due immunizations just before (unexposed), during (heavily exposed), and after (post-exposure) the lockdown. Relative to unexposed children, heavily exposed children were significantly less likely to be immunized at or before 9 months (OR 0.550; 95% CI 0.367–0.824; p = 0.004), but more likely to be immunized at 10–12 months (OR 1.761; 95% CI 1.196–2.591; p = 0.004). They were also less likely to have completed their key first-year immunizations (OR 0.624; 95% CI 0.478–0.816; p = 0.001) by the time of survey. In contrast, post-exposure children showed no difference in timeliness or completed first-year immunizations relative to unexposed children, despite their younger age. First-year immunization coverage among heavily exposed children decreased by 6.9 pp to 10.4 pp (9.7% to 14.0%). Declines in immunization coverage were larger among children in households that were poorer, less educated, lower caste, and residing in COVID red zones, although subgroup comparisons were not statistically significant. Disruptions to immunization services resulted in children missing immunization during the lockdown, but catch-up efforts after it was eased ensured many children were reached at later ages. Nevertheless, catch-up was incomplete and children due their immunizations during the lockdown remained less likely to be fully immunized 4–5 months after it lifted, even as younger cohorts due immunizations in June or later returned to pre-lockdown schedules. [ABSTRACT FROM AUTHOR]

Antenatal morbidities and associated malpractices are quite prevalent in slums of Delhi. This paper aims to highlight the relationship between calories intake, seasonality and gravida. It also draws attention towards inter-related aspects of antenatal practices and morbidity among women. Survey of 400 women conducted in the slums of Delhi indicated high occurrence of antenatal and post-natal malpractices. The findings indicated that discrepancies in the advice given by the medical practitioners and traditional birth attendants (TBAs). This was seen to adversely impact a majority of expectant mothers. The finding support a strong direct relationship between calories intake, seasonality morbidity and mortality patterns among women as well as their children. Although ample research has been done on homebirths and their challenges, the perspectives of TBAs (who assist in the majority of homebirths) remain unexamined. The present study sought to add to this knowledge base by uncovering various practices prevalent in low income households of a cosmopolitan city like Delhi. [ABSTRACT FROM AUTHOR]

Background: Recognizing the need to increase access to safe abortion services to reduce maternal mortality and morbidity, the state government of Bihar, India introduced an innovative mechanism of accrediting private health care facilities. The program, Yukti Yojana ('a scheme for solution'), accredits eligible health facilities and supports them in providing abortion-related services free of charge to rural and low-income urban women. This paper describes implementation of Yukti Yojana. Methods: A descriptive analysis of abortion services provided under the Yukti Yojana program was conducted using four data sources: 1) assessment of accredited facilities over 6 months; 2) induced and incomplete abortion service registers; 3) client exit interviews and associated direct observation of client-provider interaction for a sample of accredited facilities; and 4) in-depth interviews with providers and key stakeholders responsible for providing or influencing abortion services. These analyses assessed characteristics of women receiving abortion services, quality of care and client satisfaction, and barriers and facilitating factors of a successful accreditation process. Results: Forty-nine private facilities were accredited during the first two years of the program, and 84 % had begun providing abortion services, in all 27,724 women were served. Overall, 53 % of beneficiaries reported holding a "Below Poverty Line" card, while 71 % had low living standard. The majority of women (n = 569) reported satisfaction (90 %) with their care, while 68 % perceived good quality of services. Having a government-led initiative was considered a key element of success, while stringent requirements for site approval, long waiting time for accreditation, complicated and delayed reimbursement process and low reimbursement fees for abortion services were identified as barriers to implementation. Conclusions: Yukti Yojana provides a model for successfully involving private OB/GYNs and general physicians to deliver safe abortion services to poor women on a large scale and offers additional evidence that public-private partnerships can be used to ensure availability of high-quality maternal health services to women in low-income countries. Private facility accreditation also offers a promising solution to the limited availability of safe abortion services in low resource settings such as Bihar, India. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the most commonly occurring disease which leads to hemiparesis along with other symptoms like spasticity, sensory disturbances etc. considered to be a part of positive signs of upper motor neuron (UMN) syndrome. Spasticity is a common disorder in patients with injury of the brain and spinal cord. Aim: The aim of the present study was to corelate the foot posture index, H/M ratio and spatial gait parameters in the assessment of poststroke patients with ankle planter-flexor spasticity. Methodology: It was an observational study which consisted of 32 chronic stroke patients. Both male and female with age group 45-70 years and stroke duration more than 3 months were included in the study. Spasticity was assessed using H/M ratio, foot posture was assessed by Foot Posture Index (FPI) and Step length and Stride length were taken. Result: Statistical analysis was done using SPSS 20 for windows. The correlation between Hmax/Mmax ratio, FPI, step length and Stride length were evaluated using Spearman's correlation coefficient test. It was suggestive of strong negative correlation between FPI and Hmax/Mmax ratio, weak negative correlation between step length Hmax/Mmax ratio, strong negative co-relation between stride length and H/M ratio, moderate positive co-relation between Foot Posture Index (FPI) and step length and strong positive corelation between FPI and stride length. (p<0.05) Conclusion: From the present study it can be concluded that there is co-relation between Spasticity, Foot posture and Gait parameters in planter-flexor spasticity in post-stroke patients. It can also be concluded that Hmax/Mmax ratio and FPI are needed to be assessed in every post stroke patient as it has influence on Gait parameters such as step length and stride length. [ABSTRACT FROM AUTHOR]

Objectives: The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty. Methods: Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function. Results: Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome. Conclusion: The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction. [ABSTRACT FROM AUTHOR]

Aims and Objective: To evaluate the attitudes of Indian nurses towards the importance of family involvement in nursing care and the association between nurse attitudes and sociodemographic characteristics. Background: Involving the family in the care process is crucial for delivering family‐ and patient‐centred care and ensuring the best possible patient outcomes. Nevertheless, published literature revealed that the nurses may lack clarity regarding the role of family members in the patient's care, which in turn hinders families' participation in care. Design: Cross‐sectional descriptive study. The STROBE checklist was used to report the present study. Methods: A total of 203 Nurses participated in a prospective cross‐sectional study between May 2022 and August 2022. They were recruited through convenience sampling from two tertiary care centres in India. A two‐part questionnaire was used to gather the data; the first section contained questions for gathering sociodemographic information, and the second part contained the standardized FINC‐NA scale. Results: The mean age of the nurses was (28.08 ± 4.722) years, and their median professional experience was 2.5 (1–5.5) years. Nurses' attitude regarding family's importance in patient care was found to be significantly associated (p ≤.05) with education level, marital status, religion and hometown region. Conclusion: In several items Indian nurses have positive attitudes towards family involvement in care but some of the lower scoring items can present opportunities for focused improvement. Continuing development programmes about family‐centered care can constitute important strategies to improve the positive attitudes of nurses towards families in practice. Patient and public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Koebner phenomenon (KP) is a clinical indicator of disease activity in vitiligo. Few studies have suggested that it may also be used to predict the clinical profile, prognosis, and response to therapy. Aims: To compare the clinical characteristics of vitiligo patients with different types of KP in an Indian population. Methods: A prospective longitudinal observational study was conducted from January to November 2016. Classification of KP was done according to the Vitiligo European Task Force guidelines into KP1-by history and KP2-by clinical examination (2A: lesions on friction areas and 2B: trauma-induced lesions). Results: Of the total 160 patients, KP was observed in 102 (63.8%) cases. Type 1 KP was seen in 43 (26.9%), type 2A in 87 (54.4%), and type 2B in 34 (21.3%) cases. Patients with KP1 and KP2B had an earlier age of presentation and disease onset, while those with KP2A had a higher age of presentation and disease onset. Incidence of other autoimmune disorders, higher BSA involvement and requirement of betamethasone oral mini pulse therapy were significantly higher in cases with KP1 and KP2A, while significantly elevated anti-thyroid peroxidase levels were seen in cases with KP2A. Also, lesser treatment response was noted among cases with KP1 and KP2A. Conclusion: KP is associated with increased disease activity and more extensive involvement of vitiligo. Type 2A KP was associated with a higher incidence of other autoimmune disorders, more extensive disease, and the use of systemic steroids for treatment, which were not seen in KP2B. Thus, these groups might define two different subsets of patients. [ABSTRACT FROM AUTHOR]

Background: Healthcare costs are a major burden on the society of developing countries like India. Countries like India try to limit healthcare costs in support of generic medicine. So, the Indian government initiated the Jan Aushadhi scheme in 2008 to provide high-quality generic medication at a low cost. Aim: The aim of the study was to compare the cost difference between Jan Aushadhi generic pharmaceutical formulations and branded medications in Tamil Nadu. Settings and Design: Pharmaco economic - Cost minimization observational study. Methods and Material: Study Duration: Five months, from February 2023 to June 2023. Study Place: 10 Jan Aushadhi outlets from various districts of Tamil Nadu. Sampling technique: Convenience sampling technique Statistical analysis used: Mean median, mode and Percentage. Results: A total of 729 medications were available in 10 Jan Aushadhi outlets. The Jan Aushadhi outlet has the most cardiovascular medications and the fewest antimalarial medications among different categories of drugs. Erythropoietin has the biggest cost difference between the average cost of branded medications and Jan Aushadhi drug costs, while Digoxin has the lowest cost difference. Antitubercular drugs, Oxytocics, Antileprosy drugs, Antiparkinsonism categories of drugs also delisted in Jan Aushadhi outlet. Conclusions: Compared to branded drugs, Jan Aushadhi's generic drugs are 64.65 % less costly on an average as observed in our study. The manufacturer of Jan Aushadhi shops is a WHO and GMO-certified company, and they manufacture branded drugs. So, there will be no quality compromise in Jan Aushadhi's generic drugs. [ABSTRACT FROM AUTHOR]

Background: User satisfaction in healthcare is an important measure of the quality of services provided to the patient and their carers. Since treatment of psychiatric patients requires long follow-up periods, and this long follow-up treatment patients depends on their initial experience with health service,therefor user satisfaction is of increasing importance in the mental health field. Aims and Objectives: Assess the user satisfaction and perceptions of the attitude of emergency health- care professionals (including paramedical staff and physicians of respective specialties) toward psychiatric and nonpsychiatric patients as experienced by the patients and carers. To compare the user satisfaction and perceived attitude of emergency staff in patients with psychiatric illness and nonpsychiatric illness. To determine the service users' decision to revisit the same health-care facility in case of the same problem. Materials and Methods: This study was done in the hospital wing of a tertiary care teaching university hospital in northern India, and ethics approval was obtained from the institutional ethics committee patients' sociodemographic details and psychiatric and other relevant medical history after obtaining informed consent. The psychiatric diagnosis was made according to the ICD-10. A self-report questionnaire, comprising 9 questions, and was designed to assess the perceived attitudes of health-care workers toward the patient of psychiatric illness. The questionnaire was designed in Hindi. Descriptive statistics for categorical variables were done. Inferential statistics were calculated using the Chi-square test. Results: Out of a total of 95 respondents, 69 patients were diagnosed with a psychiatric disorder and the remaining 26 patients had medical illness or other non-psychiatric disorders. Females were a majority in both groups. Our study majorly showed that service users perceived the attitudes of medical and paramedical staff in emergency units mostly as satisfactory or extremely satisfactory, as well as the majority of service users reported that they were satisfied with the reaction of emergency paramedical staff towards the emotional well-being of the patient. Conclusions: The major strengths of this study were the quantitative analysis of health workers' attitudes toward patients with psychiatric illnesses, which showed user-rated satisfactory attitudes. There was less stigma and more of a positive impact noted. The semi-structured questionnaire was designed in the local language and tailored to cover topics such as emotional well-being and psychoeducation that can all affect the user experience. [ABSTRACT FROM AUTHOR]

Introduction: Informed consent is an essential component in research involving human participants. However, the informed consent obtained may be incomplete and not fulfill the essential criteria of Informed Consent Forms (ICFs). Although the guidelines for developing ICFs have been clearly spelled out by various research bodies, these guidelines are not followed completely. Aim: To analyse the ICFs submitted to the Institutional Ethics Committee (IEC) of a Medical Institute in Southern India. Materials and Methods: The present study was a crosssectional observational study analysing ICFs submitted to the IEC of McGann District Teaching Hospital, Shimoga Institute of Medical Sciences (SIMS), Shivamogga, Karnataka, India, for the period 2014 to January 2023. All research projects containing ICFs during the study period were included in the study. Of the research projects submitted, only 70 had ICFs, and these were subjected to analysis as per Indian Council of Medical Research (ICMR) guidelines criteria. The criteria for ICFs were: statement of research, purpose/methods of the study, duration/frequency of the study, benefits to participants/community, foreseeable risks, discomfort/inconvenience, confidentiality, payment/reimbursement for participation. In addition to these, ICFs were also analysed for additional elements as per ICMR criteria for tissue and blood samples. The results were then subjected to descriptive statistical analysis and presented as mean and percentages. Results: Many of the required essential elements were present in nearly 50% of ICFs submitted to the IEC, which include information on the basic purpose/methods of the study 70 (100%), identity of the principal investigator/research team 57 (81.42%), freedom to participate/withdraw from the study 55 (78.57%), confidentiality of records 54 (77.14%), and foreseeable risks, discomfort, and inconvenience to participants 35 (50%). Other essential elements like benefits were present to participants/community 28 (40%), payment/reimbursement for participation 28 (40%), duration and frequency 12 (17.14%), statement of research 9 (12.85%), treatment/compensation for injury 4 (5.71%). Regarding additional elements of ICFs for biological samples, ICFs adhered to the ICMR requirements except none of the submitted forms had any information on the period of storage of biological samples. Conclusion: The ICF is an essential requirement for conducting research. Ensuring adherence of ICF to guidelines is important from a research perspective. The present study concludes that the majority of the essential elements were present in ICFs with a few exceptions like study as research and information on the storage of biological samples, which was nil. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program (P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients. [ABSTRACT FROM AUTHOR]

This paper is an attempt to examine the technical efficiency of Indian pharmaceutical industry over the period of 1997-2011 using a nonparametric technique, Data Envelopment Analysis (DEA). The study is carried out for all the selected firms as well as for groups which have been formed on the basis of size, expenditure on R&D, product varieties and other characteristics. The evidence shows that investment in R&D can substantially influence the efficiency of pharmaceutical firms. It is also observed that firms producing only bulk drugs exhibit higher efficiency as compared to the firms producing only formulations. The study also finds that there is a positive association between the size of firms and their technical efficiencies. One of the interesting findings of the study is that prior to the product patent regime, the industry was witnessing a gradual fall in its mean efficiency level, while after 2005, i.e., post-product patent regime, an increasing trend in the level of efficiency in almost all groups of firms has been observed. [ABSTRACT FROM AUTHOR]

The diagnostic utility of HLA B51 (Human Leukocyte Antigen) in association with Behçet's disease(BD) has been identified. However, the clinical manifestations of HLA B51 positive patients who have not satisfied the criteria for Behcet's have been rarely reported. Our objective was to study the clinical profile of HLA B51 positive patients and to include them under the spectrum of International criteria for Behcet's disease (ICBD) and the modified Japanese criteria, and also to study the outcome in these patients. This is a retrospective prospective observational study conducted over 3 years (2018-2021) in HLA B51 positive patients. The clinical presentations, treatment given and follow up response to treatment were observed. In the study cohort of 28 HLA-B51 positive patients, mean age was 41.7 years. 17 (60.7%) had oral ulcers, 5 (17.8%) genital ulcers, 7 (25%) skin lesions, 11 (39.2%) had Pathergy positivity, 19 (67.8%) ocular, 7 (25%) neurological, 3 (10.7%) Gastrointestinal (GI) and 3(10.7%) had vascular manifestations.12 (42.8%) satisfied ICBD criteria and 2 (7%) satisfied Japanese criteria for BD. 15 (53.5%) were given immunosuppressant therapy with [Azathioprine (AZA) in 10(35.7%), Mycophenolate mofetil (MMF) in 4(14.2%) and cyclophosphamide (CYC) in 1(3.5%)]. Biologics were given in 7 (25%) with [Adalimumab(ADA) in 6(21.4%) and Rituximab (RTX) in 1(3.5%)]. Our study showed female predominance, with more ocular manifestations, oral aphthous ulcers and less gastrointestinal involvement. Azathioprine (AZA) showed better response compared to Mycophenolate mofetil (MMF). [ABSTRACT FROM AUTHOR]

O'BRIEN T and ACKROYD S. Nursing Inquiry 2012; 19: 39-50 Understanding the recruitment and retention of overseas nurses: realist case study research in National Health Service Hospitals in the UK This paper illustrates one of the possible applications of critical realist ideas to the analysis of health services, in the use of comparative case study research design, to elucidate the causal social processes underlying events. In the research reported here, a comparative research design was used as a basis for improving our understanding of the processes involved in the assimilation of overseas nurses (OSN) into the salient long-term workforce of the National Health Service (NHS) hospitals in the UK. The work brought to light the salient experiences of overseas nurses during their initial work in the NHS hospitals, and these were used as a basis for developing an account of the general mechanisms typically underlying the recruitment and assimilation at work. The authors conclude that successful assimilation is often hindered by the presence of occupational closure mechanisms, by which home nurses effectively excluded recruits from participation and promotion; these mechanisms, which articulate with everyday racism, threaten successful assimilation for obvious reasons. If the treatment recruits receive does not lead to withdrawal, it is because they typically have very strong economic motives to continue despite unfavourable and sometimes inhumane treatment. Thus, the research offered substantial reasons why recruitment policies should be reviewed by policy-makers. [ABSTRACT FROM AUTHOR]

The objectives of the study were to assess and compare IPR score with parents among case (Delinquent children) and control (Non-delinquent children) group and to determine the association of IPR scores with selected variables among case and control group. A Non-Experimental Retrospective (Case and Control) design was used. One twenty participants were enrolled for the study. Out of which 60 delinquent children were enrolled as case group with total enumerative sampling technique and 60 school children were enrolled as control group based on matching and homogeneity with case group on convenient basis (Matching was done for age group and Homogeneity was done by enrolling only male children). Data was collected by using Modified Washington State Juvenile Court Assessment Scale for interpersonal relationship with self report technique. The findings of this study showed that the mean IPR score in case group was significantly lower than control group (70.83 Vs 74.58: t=4.74, p=0.01) which indicate control group had better IPR with parents. A significant association of IPR scores with selected variables was found i.e youth occupation (0.002) and father education (0.05) in case group and with religion(0.02), place of residence (0.008) and youth was raised by single parents(0.04) in control group. The overall prediction of IPR by the independent variables for case group was with the variability of R2= 31% (0.317) and for the control group was with the variability of R2=27% (0.271). [ABSTRACT FROM AUTHOR]

Ethno-racial minority families who come in contact with child protection services face unique challenges that include different ideas about appropriate child rearing practices, possibly different definitions of child maltreatment, the possibility of racial biases and service provision that does not address their particular needs. Ethno-racial minority immigrants encounter additional barriers to services associated with the challenges of settlement in a new cultural environment. Although considerable research has explored these issues, knowledge of the experiences of ethno-racial families who have been in contact with child protection is limited. The current paper provides insights from a qualitative study that explored the experiences of one ethno-racial group (South Asians) in Canada. Findings suggest a variety of reasons that families come into contact with the child protection system, and the characteristics of the sample highlight their difficult financial and employment circumstances. Themes include participants' desire to be better informed about the reasons for child protection involvement and about what they can expect from the worker and the agency. They also identified a wish for services that not only recognize their cultural diversity but also respond to the needs of the whole family. In-home services were especially appreciated. The findings reveal the resilience and personal agency among participants that can be enhanced through strength-based approaches to practice. Helping others, establishing community networks and developing needed services were avenues of resilience identified. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]