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Synovial chondromatosis of the shoulder is a rare entity that is generally mono-articular and uncommon in diarthrodial joints. Treatment of synovial chondromatosis of the shoulder includes open arthrotomy retrieval of loose bodies and synovectomy. With advances in arthroscopy, the same could be achieved using arthroscopic techniques. This case report describes a case report of a 35-year-old male patient who presented with complaints of pain and restriction of movement for 6 months. The MRI of the patient was suggestive of multiple loose bodies in the shoulder joint, in the subdeltoid region, and subscapularis muscle with subacromial bursitis. Arthroscopically more than 100 loose bodies were retrieved with subacromial decompression. Shoulder synovial chondromatosis has been rarely reported in the literature. The malignant transformation although rare, but it is still a possibility. The recurrence rate varies from 3.2% to 22.3%. Open arthrotomy, synovectomy, and retrieval of loose bodies cause delayed recovery and more morbidity with high chances of subscapularis insufficiency due to the need of subscapularis tenotomy. Arthroscopic treatment although have limitations such as limited visualization, limited synovectomy, and difficult interventions around the axillary recess or biceps sheath, but provides with the advantage of lesser morbidity and early rehabilitation. Synovial chondromatosis can be successfully treated arthroscopically as it provides intra-articular and extra articular access with early rehabilitation, lesser morbidity, and early recovery.

The current study was done to compare the effectiveness, safety and clinical outcome between Laparoscopic and Open Appendectomy in terms of operating time, complications and length of hospital stay. Patients undergoing Appendectomy by Laparoscopic and Open technique from November 2016 to October 2017 were enrolled in the study after fulfilling eligibility criteria. According to surgical approach patients were randomly divided into two groups Laparoscopic Appendectomy Group (LA group) & Open Appendectomy Group (OA group) respectively. The following parameters were assessed primarily in terms of operating time, resumption of oral diet, length of hospital stay, no. of analgesic doses, conversion rate, post-operative pain, Intraoperative and post operative complications like wound infection, prolong ileus, intraabdominal abscess, diarrhea and urinary tract infection. Results: We found that operating time was comparable in both groups, resumption of oral diet was earlier in LA Group as compare to OA Group (with p value of

Background and objective The burden of drug resistant tuberculosis (DRTB) has posed a huge challenge to for the governments, throughout the world. India has 27% of the global DRTB burden with incidence of 130,000 cases. India has kept an ambitious target of elimination of tuberculosis by 2025 which requires understanding and mitigating various determinants of DRTB. Methods The retrospective case control study was undertaken from May to September 2019 among drugresistant (cases) and drug sensitive (controls) tuberculosis patients from two districts of Himachal Pradesh, India. A total of 211 participants were recruited in the study, which includes all 102 cases and randomly selected, age and sex matched 109 controls. A semi structured questionnaire, adapted from a study by Lobo et al, was used for assessing the determinants of DRTB and DSTB. The data collection was undertaken from district and block level health care facilities followed by home visits to patients. Multivariate logistic regression was used to determine risk factors associated with DRTB. Results Diagnostic delay (aOR-7.72, p value 0.000), history of treatment default (aOR-2.97, self history of tuberculosis (aOR 1.42, p value 0.01), migration (aOR-4.84, p value 0.000), smoking (aOR-2.70, p value 0.014), and belonging to rural area (aOR-2.62, p value- 0.013) were found as independent risk factors for the occurrence of DRTB. Conclusion The risk factors identified in the study should be prioritized by the policy makers, implementators and educators for framing appropriate policies in TB control programme in India. The diagnostic delay as a risk factor merits active case finding of TB patients and educating health care staff and community.

Introduction: Sedentary lifestyle is associated with increased body mass index, increased waist circumference and type-2 diabetes, leading to metabolic syndrome. Various anthropometric variables are strong and consistent predictors for non communicable diseases. There is positive relationship between anthropometric measures and adiposity. Dyslipidemia is a marker for development of cardiovascular disease. Objective: To assess relationship of anthropometric variables with lipid profile in moderate and sedentary workers in Jammu region. Materials and Methods: The present one year cross-sectional study was carried out on healthy moderate workers (Group-I) and healthy sedentary workers (Group-II) in the age group of 20 to 60 years. Baseline data of anthropometric variables, including body mass index, waist-hip ratio, waist-height ratio, abdominal volume index was recorded as per WHO standards. Lipid profile values were assessed according to the National Cholesterol Education Programme of USA. Mean and standard deviation reported for quantitative variables were calculated and noted. Mean values were compared with the help of unpaired ‘t’ test and statistical result was obtained. For unilateral comparison, linear regression was used. A p-value of < 0.05 was considered as statistically significant. All p-values reported were two-tailed. Results: The mean values of age and anthropometric variables in moderate workers (Group-I) were significantly less as compared to those of sedentary workers (Group-II). Serum HDL-C and serum VLDL-C of the moderate workers showed significant relationship with waist circumference. Mean total cholesterol and serum LDL-C showed significant relationship with waist circumference in sedentary workers. Serum total cholesterol showed significant relationship with WHR in moderate workers. Conclusion: Anthropometric variables, total cholesterol and low density lipoprotein cholesterol had significant effect in sedentary workers. High de

In the changing global socio-economic and epidemiological landscapes, non communicable diseases (NCDs) are affecting the health and wellbeing of populations. The burden is worse among people in low- and middle-income countries with more than 32 million deaths attributable to NCDs each year. This scenario can be explained through the concept of collateral damage, where intentional actions often lead to adverse consequences alongside the primary outcomes. Thus, NCDs can be viewed as collateral damage of unplanned urbanization, rapid globalization, fast pace of life etc., In addition, a lack of appropriate public health approaches has aggravated the situation. It is essential to build a collaborative approach engaging public health agencies to ensure that the developmental initiatives are without the threat of collateral damages and are people-friendly. This will help in reducing the burden of NCDs in primary care settings.

Introduction: Virtual clinic is a new concept in India. This summary describes that how a virtual clinic is transforming the healthcare scenario in rural India. Virtual clinic is based on a social business model, which may involve diverse stakeholders to promote primary care. Aim: This virtual e-clinic aims to expand health outreach in rural and hard-to-reach areas of India and provide primary health care services by connecting local practitioners and health workers visiting patients with qualified allopathic doctors in city through video conferencing technologies. Methodology: This was a cross-sectional study evaluating the feasibility and acceptance of virtual primary care. A convenient sampling method was used. Data on demographic profiles, morbidity patterns, and referrals were collected with proper consent. This virtual clinic comprises of smartphones, monitors, and assistive devices so that patient can interact with the doctors through video-conferencing and can have authenticated prescriptions with standardized protocols. The private organization who initiated the virtual care program had two centers at the beginning and gradually expanded them to 20 in Uttar Pradesh. Consultations charges were kept minimum to no-profit, no-loss. Data were collected from January 2019 to June 2010. Results: Total number of consultations made was 800. Out of 800 patients, 157 patients belonged to age group of ≥60 years. Mean age the patient was 56 ± 1.56 years, among them 421 (52.62%) were male. The participants actively engaged in clinical interactions and completed full sessions of consultations, which highlight the acceptability of the virtual care system and feasibility of effective patient-provider communication and service delivery using digital technologies. Conclusion: The concept of virtual primary care is becoming very popular in rural region where no qualified doctors are available. The initial results of this technological startup appears to be promising; however, it is necessary to evaluate the quality of care, health outcomes, potentials to integrate such innovations in existing primary care, and the legal as well as ethical issues in the future research.

Background and Aims: Diabetic retinopathy is the most common diabetes-associated microvascular complication and is among the leading causes of vision loss or blindness in the adult population. The present study is a retrospective study that reported the natural history of diabetic retinopathy.Methods: Retrospective medical records of 170 patients aged > 20 years with a confirmed complication of diabetic retinopathy were recruited into the present study. A questionnaire was also sent to each subject for gathering their experiences, and verification was done by the attending medical physicians. The questionnaire was answered by all recruited patients.Results: The results showed that 23 (13.5%) subjects have a family history of diabetic retinopathy with 10 (5.9%) having mild NPDR, 63 (37.1%) with moderate NPDR, 60 (25.3%) have severe NPDR while 37 (21.8%) have PDR complications. The presence of co-morbidities was found in 139 (81.8%) subjects. Patients with PDR reported a significantly longer duration of diabetes mellitus with worse glycemic control.Conclusions: The study revealed and concluded that adherence to the prescribed management regimen is important, for which patient education was the key which was lacking.

Hepatitis B virus (HBV) infection is a global health concern, and it is considered one of the deadliest infections in the world, having nearly 1.2 million deaths annually. Around 75% of all global HBV carriers live in the Asia-Pacific region. In this regard, India has a prevalence ranging between 2% and 7% with exposure rates of 10%–60%. Hepatitis B is a vaccine-preventable disease. In India, the World Health Organization protocol for hepatitis B vaccination has been followed, and it is given free of cost in public health facilities under the National Immunization Schedule. Despite the free hepatitis vaccination program in India, coverage and awareness are low. Low awareness, followed by low coverage of hepatitis vaccination, can prove dangerous for the Indian population in the long run. A majority of chronic hepatitis cases progress silently to end-stage liver disease without having many signs and symptoms. Once occurred, a complete cure is not possible with currently available drugs. The studies from neighboring countries such as China and Taiwan documented that the impact of single-dose booster for children of 10 years has made a significant difference from the cost-effectiveness perspective. They have also included the booster dose in their national vaccination program. Considering the low level of vaccination awareness, small coverage, high disease burden, and high treatment cost, now, it is high time for India to introduce hepatitis B booster vaccine.

Introduction: Psoriasis is a common, chronic, inflammatory skin disease that can have a significant impact on the quality of life of those who are afflicted due to chronicity of the disease and frequent remissions and relapse. There is a vast array of drugs for the treatment. Methotrexate, cyclosporine and retinoids are the most commonly used conventional systemic drugs. Newer studies provide insight into their more effective and safer use and as combination therapy with biologics. Apremilast is an orally administered, small molecule inhibitor of phosphodiesterase 4 (PDE4). Apremilast 30 mg twice daily reduced the severity of moderate to severe plaque psoriasis, palmoplantar psoriasis and guttate psoriasis. Objective: To evaluate efficacy, tolerability and adverse effects of apremilast. Materials and Methods: A clinical trail was conducted in department of Skin & VD of Saraswathi institute of medical college on 80 patients. Apremilast was started after initial titration and followed for 8 weeks. Results: Out of 80 patients 73 patients completed the study of which 69% patients have responded well and 14% patient did not show satisfactory result. No major side effect encountered during the study. Conclusion: Apremilast was effective in plaque psoriasis, palmo plantar psoriasis and guttate psoriasis and is well tolerated with mild adverse effects. Also the regular lab investigations as required in others systemic treatment modalities are avoided. Keywords: Apremilast, Plaque psoriasis, Phosphodiesterase 4 (PDE4), Guttate psoriasis, Palmo plantar psoriasis.

Airplane ear or ear discomfort during flight is common irrespective of ticket price we pay for our flights according to class. Whether we get extra leg space or extra facilities during flying in business class, air travelers often face this problem of airplane ear (Figure 1). Airplane ear is also known as ear barotrauma, barotitis media or aerotitis media [1]–[5]. Severe earache affects individuals of varying levels of social determinants of health as it is entirely a physiological phenomenon [3]. Airplane ear is commonly experienced when the airplane is ascending or descending, which makes it one of the commonest health problems for people travelling in air routes. Open in a separate window Figure 1. Airplane ear. 2. Etiology Generally, airplane ear occurs due to quick changes in altitude and quick changes in air pressure [4]. In normal physiological conditions, the air pressure in our middle ear cavity is nearly equivalent to that of the external ear canal. This equalization of air pressure is maintained physiologically and contributes to regular auditory function and maintenance of normal balance among individuals. However, the eustachian tube dysfunction may occur with any changes in pressure and failure to ventilate through the middle ear space. This may result in outward bulging of the tympanic membrane causing moderate to severe earache. This phenomenon can be compared with a bread expanding while baking [3],[5]. Conversely, due to the vacuum effect, if the air pressure inside the middle ear space reduces rapidly compared to the external ear pressure, the tympanic membrane may be pulled inside due to the pressure gradient. The eustachian tube becomes flattened during the pressure changes and it necessitates bringing air into the middle ear (Figure 2). During sudden ascend or descend of an aeroplane, ear cavity pressure is often decreased complemented by an increase in the cabin compared to the outside air pressure. In such a scenario, the unusual stretching of the eardrum or tympanic membrane may precipitate pain in the ear. At the same time, individuals may also experience decreased hearing abilities and muffled sounds as the eardrum as it becomes unable to vibrate normally [2]–[4]. Open in a separate window Figure 2. Imbalance of air pressure in the middle ear. The pathophysiology remains the same in cases of scuba diving, in hyperbaric oxygen chambers, and during explosions happening nearby [2].

The term NOMOPHOBIA or NO MObile PHone PhoBIA is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. The term NOMOPHOBIA is constructed on definitions described in the DSM-IV, it has been labelled as a “phobia for a particular/specific things”. Various psychological factors are involved when a person overuses the mobile phone, e.g., low self-esteem, extrovert personality. The burden of this problem is now increasing globally. Other mental disorders like, social phobia or social anxiety, and panic disorder may also precipitate NOMOPHOBIC symptoms. It is very difficult to differentiate whether the patient become NOMOPHOBIC due to mobile phone addiction or existing anxiety disorders manifest as NOMOPHOBIC symptoms. The signs and symptoms are observed in NOMOPHOBIA cases include- anxiety, respiratory alterations, trembling, perspiration, agitation, disorientation and tachycardia. NOMOPHOBIA may also act as a proxy to other disorders. So, we have to be very judicious regarding its diagnosis. Some mental disorders can precipitate NOMOPHOBIA also and vice versa. The complexity of this condition is very challenging to the patients’ family members as well as for the physicians as NOMOPHOBIA shares common clinical symptoms with other disorders. That's why NOMOPHOBIA should be diagnosed by exclusion. We have to stay in the real world more than virtual world. We have to re-establish the human-human interactions, face to face connections. So, we need to limit our use of mobile phones rather than banning it because we cannot escape the force of technological advancement.

Background and Aims: Reduced inhalational anaesthetic requirement in end-stage liver disease during living donor orthotopic liver transplantation (LD-OLT) is due to increased endogenous opioids. This study evaluated the changes in bi-spectral index (BIS) monitored end-tidal desflurane (ETDes) requirements during ‘dissection’, ‘anhepatic’, and ‘neohepatic’ phases of LD-OLT. Methods: This prospective, cohort study included 40 adults undergoing LD-OLT under general anaesthesia (GA). All patients received BIS-guided desflurane GA. ETDes requirements in three phases of LD-OLT (primary objective); relationship between inhalational anaesthetic requirements and severity of liver disease; and effect of changes in mean arterial pressure (MAP) and body temperature on ETDes concentration for all three phases were also evaluated. Results: ETDes during the ‘dissection’ phase (2.92 ± 0.65%) was > ‘anhepatic’ (2.68 ± 0.85%, P = 0.049) and ‘neohepatic’ phases (2.58 ± 0.71%, P = 0.005). Patients with model of end-stage liver disease (MELD) score < 20 returned significantly greater ETDes than those with MELD score ≥20 during the ‘dissection’ (MELD

The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11.In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility.The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P 0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P 0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P 0.0001) and no floor or ceiling effects. All parturients completed the questionnaire in a (median (IQR) time of completion of 3 (1.5 - 5.5) min).The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India as well as in other languages.

This paper introduces a novel approach for dengue fever classification based on online learning paradigms. The proposed approach is suitable for practical implementation as it enables learning using only a few training samples. With time, the proposed approach is capable of learning incrementally from the data collected without need for retraining the model or redeployment of the prediction engine. Additionally, we also provide a comprehensive evaluation of machine learning methods for prediction of dengue fever. The input to the proposed pipeline comprises of recorded patient symptoms and diagnostic investigations. Offline classifier models have been employed to obtain baseline scores to establish that the feature set is optimal for classification of dengue. The primary benefit of the online detection model presented in the paper is that it has been established to effectively identify patients with high likelihood of dengue disease, and experiments on scalability in terms of number of training and test samples validate the use of the proposed model.

Introduction: Polycystic ovarian syndrome affects 4% to 23% women, worldwide. Obesity, insulin resistance and uncontrolled eating are usually reported in PCOS. However, there is paucity of data describing associations between eating disorder and PCOS. Aim: To compare the anthropometric profile and eating behavior polycystic ovarian syndrome cases with those of healthy age-matched women. Method: Eighty-five PCOS cases and 85 controls were selected for the study from Gyne OPD of PGIMER, Chandigarh. Anthropometric assessments were performed on the cases and controls. Three-Factor Eating Questionnaire (TFEQ-R21) was used for determining the eating behavior. In addition, the frequency of eating processed food from outside was recorded. Results: The average weight of the cases and controls was 65.16 kg and 57.07 kg, respectively. The average frequency of eating processed food in a month was 15 in cases and 4.41 among controls. The average raw score of uncontrolled eating was 23.26 (cases) in comparison to 18.97 (controls). Average raw scores of emotional eating were 12.67 in cases and 10.76 in controls. The cognitive restraint average raw scores were 11.34 (cases) and 13.62 (controls). The cases had higher BMI than the controls. Monthly consumption of processed food was three times higher than the controls in cases. Uncontrolled eating and emotional eating scores were significantly higher in cases. Conclusion: More of PCOS cases were overweight/ obese with higher BMI, and higher emotional eating and uncontrolled eating scores in comparison to the healthy controls.

Background: Infertility is a neglected service component in the public health-care system in India. Objectives: This study aims to assess the availability and practices on prevention and management services for infertility in the district health system. Methodology: A cross-sectional survey of selected health facilities and the staff from 12 district hospitals (DHs), 24 community health centers (CHCs), 48 primary health centers (PHCs), and 48 subcenters was conducted using qualitative and quantitative methods. Interviewed staff included 26 gynecologists; 91 medical officers; 91 auxiliary nurse midwife; 67 laboratory technicians; and 84 accredited social health activist workers. Results: The findings indicate that adequate staff was in place at more than 70% of health facilities, but none of the staff had received any in-service training on infertility management. Most of the DHs had basic infrastructural and diagnostic facilities. However, the majority of the CHCs and PHCs had inadequate physical and diagnostic facilities related to infertility management. Semen examination service was not available at 94% of PHCs and 79% of CHCs. Advanced laboratory services were available in

Referral is a dynamic process, in which a health worker at one level of the health system, having insufficient resources (drugs, equipment, skills) to manage a clinical condition, seeks the help of a better or differently resourced facility at the same or higher level to assist in. Health care systems of every country are designed in such a way to encourage patients to first attempt to get care at the primary level and then to approach a higher level of care according to the need. This protocol minimizes the costs for the caretaker/patients. However, in most of the countries, patients often bypass primary care facilities and directly go to the higher center thereby, increasing the burden on higher level facilities, the picture is not very different in India also. Health care system in India is plugged by: overpopulation, lack of expert clinicians, skewed distribution of physicians, lack of motivation among existing health care personnel and an ineffective referral mechanism. Due to failure of conventional paper-based referral systems in our country, we can introduce an e-referral system in the era of internet. It is evident from our experiences, that this artificial intelligence enabled e-referral system has many advantages over the traditional paper-based referral system. It will aid health workers for timely management of cases. Most importantly, it will streamline the existing unorganized referral process. Although, for effective e-Referral system, there should be a collaborative platform where easy search and discovery for health care providers is possible and help in decision making. e- Referral should be incorporated in our health system to strengthen it by bridging the access gap may be through Public Private Partnership model.

Background This study was undertaken to explore the treatment-seeking pathways traversed by women with PCOS and elicit their behavior, experiences and perspectives regarding it. Methods This concurrent mixed-method study was conducted on 18–40 years old women diagnosed with PCOS at the Gynecology outpatient department, PGIMER, Chandigarh, India. Of the 275 women, who were administered a questionnaire to elicit their treatment-seeking behavior, 62 willing participants were subjected to in-depth interviews. Quantitative responses were descriptively analyzed and presented as count, proportion, mean or median. Framework analysis was performed for the qualitative data. The findings of both types of data were triangulated to construct the pathways to treatment traversed by PCOS patients. Findings Many (~45%) respondents had no information regarding PCOS. Only 9.1% received some information from their doctors. Though the internet was the primary source of information for 37.5% of respondents, they expressed dissatisfaction with the quality of information. Multiple health care agencies were consulted by most (85.8%) of the respondents. Allopathy was the preferred choice of treatment. The average delay in initiating the treatment was 3 months. The major reasons for this were ignorance, the concept of ‘normality’ and ‘endurance’. Deviations from the normal self (like irregular-menstruation, obesity, hirsutism, infertility) were the concern that led them to consult a doctor. They were also dissatisfied with the treatment due to a late diagnosis, lack of relief, taboo, side-effects, expenses involved and the need for repeated laboratory tests. Participants’ course of treatment was influenced by the interplay of individual, distress, health-system, and social-economic factors. Conclusions Women with PCOS were dissatisfied with the quality of the information and treatment received. There were treatment delays. The patients consulted multiple health agencies, including indigenous therapies, in the hope of relief. The findings provide an empirical basis on points to focus on for building better coping strategies for managing the condition.

Good hand hygiene practices include cleaning of hands either by handwash or by hand rub In healthcare settings, it is not easy to wash hands with soap after seeing each patient and is time-consuming as doctors are already working overtime Hence, in hospital settings, it is also recommended to use alcohol-based hand sanitizers that can rapidly kill microorganisms, which spread various contagious diseases Amidst the COVID-19 outbreak, the demand for essential commodities such as hand sanitizer, masks, etc , increased and hampered the hospital supplies To address the shortage and limited supply of hand sanitizers to the various medical and paramedical departments of a tertiary hospital, the Department of Community Medicine and School of Public Health in coordination with the Pharmacology and Medical Microbiology Department prepared hands sanitizers following the World Health Organization (WHO) guidelines The paper discusses the procedure that was followed for the preparation of hand sanitizer to meet the institutional demand and motivate others in similar settings to address the issue of restricted supply during the COVID-19 pandemic

Background: Ideal mode of treatment is always debatable for Schatzker type 5 and type 6 fractures in proximal tibia. The aim of the study was management in tibial plateau fracture are to obtain anatomic reduction of the articular surface, restoration of axial alignment, and achieve stable fixation which can be done by open reduction and internal fixation (ORIF) using bicolumnar plating.Methods: 26 patients with Schatzker type 5 and type 6 fractures were managed by bicolumnar plating. They were followed up to six months in terms of radiological union, functional outcomes and complications. Functional outcome at the end of follow up was assessed using knee society scoring system.Results: Good to excellent results were obtained in almost all the patients using knee society scoring system, mean knee ROM achieved was 114.5 degree. Average time to achieve radiological union was 14.4 weeks. These results were in comparison with the studies done earlier.Conclusions: Bicolumnar plating is an effective method of treatment of Schatzker type 5 and type 6 fractures and provide excellent result in expert hands. Rehabilitation using early CPM (continuous passive movement) is very effective in reducing the post-operative complications like knee stiffness.

Childhood blindness due to corneal ulceration has historically been prevalent among poor Indian children. To tackle this situation the National Institute of Nutrition (NIN), Hyderabad, India, launched (after field-testing) massive dose based national vitamin A (Vit-A) prophylaxis program. Over a period of time reduction in childhood mortality was also hailed as a beneficial effect of the program. Data from the Indian Council for Medical Research (ICMR) indicate that in most Indian states there has been a gradual reduction in the prevalence of Bitot's spots. However, it was not attributed to the prophylaxis program because of its low and patchy coverage. It was, rather, attributed to the control of malnutrition, along with measles vaccination and improvement in healthcare access. Various studies have concluded that massive dose vitamin A prophylaxis does not reduce childhood mortality; this may have been due to the Hawthorne effect; whereby beneficial effects arose from frequent contact of health workers with community members. Paradoxically, harmful effects of massive doses of Vit-A are documented, e.g. acute toxicity in certain groups of children, ranging from increased intracranial pressure, mental retardation (postnatal period), and even death. Vit-A also intensifies bone demineralization, and increased levels can lead to calcium deficiency and, hence, growth retardation in vulnerable children. According to the present authors, for children who have Bitot's spots or who have just recovered from an attack of measles, the best approach is to give Vit-A in therapeutic doses along with adequate daily intake of vegetables and fruits. Public-spirited citizens, along with the scientific community, must ensure the scrapping of the universal massive dose Vit-A prophylaxis approach, to avoid Vit-A toxicity and reduce economic burden to the health system.

Background: Acne is a common skin disorder that affects both adolescents and adults. Epidemiological data on acne are limited from developing countries. Objective: The objective of this study is to estimate the prevalence and pattern of acne vulgaris among adolescent students of Chandigarh (India), and to study the impact of acne on quality of life. Materials and Methods: Children from three schools were enrolled to investigate the demographic profile, severity and causative factors of acne and its impact on quality of life using a predesigned questionnaire and followed by examination for presence, site and severity of acne. Results: Acne was present in 72.3% of 1032 children included in this study. Mild acne was present in 81.9% students, moderate in 17.1%, and severe in 0.9%. There was a significant association of acne with stress (P = 0.001) and premenstrual flare (P = 0.000). No association was found between acne and diet, hygiene, weather, family history, and smoking. The quality of life was affected in 29% of children and was directly related to the severity of acne (P = 0.000). No difference of impact on quality of life was seen between boys and girls. Conclusions: This study presents the demographic features and clinical characteristics of acne in school children. This large-scale analysis reveals that acne is a very common dermatosis among Indian school children having a significant impact on their quality of life.

Background/Hypothesis: Creeping monotony in the treatment provides minimal motivation for children with beta-thalassemia major, leading to noncompliance for adequate blood transfusions and iron chelation therapy. This study was envisaged to formulate a clinical compliance score and correlate the score with their linear growth velocity and weight gain. Materials and Methods: A prospective longitudinal study among 30 thalassemia children aged between 1 and 18 years was conducted in the Department of Pediatrics, Tata Main Hospital (TMH), Jamshedpur, from July 2012 to January 2014. Relevant clinical information and investigations were recorded using a predesigned pro forma. Compliance score was calculated using pre-, post-transfusion hemoglobin and serum ferritin levels. The height velocity and weight gain were calculated. The same patients were re-assessed in January 2015. Results and Discussion: Mean age of children was 10.18 ± 4.98 years. Forty percent were females. Using the scoring table, 33% were in good category of compliance while 4% had poor compliance. The mean height velocity was significantly higher in good compliance category as compared to average or poor score category in 2014 (P = 0.017). Good compliance score children continued to maintain higher height velocity during the 1-year follow-up (P = 0.02). Average weight gain was higher in good compliance category. Conclusion: This paper brings out a simple, regularly monitored scoring system to promote growth in thalassemia children through improved compliance to treatment, which incentivized them to maintain or improve their scores for better height velocity and weight gain. No such compliance score has been tabulated for thalassemia patients as of date.

INTRODUCTION: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. MATERIAL AND METHODS: This study was carried out using institution based cross section study. The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. RESULTS: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days ( Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. CONCLUSION: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

In any treatment taken by patient, cost is an important dimension. These days, diagnostic tests comprise of a significant part of the health cost borne by patient for the treatment. Catastrophic expenditure is a commonly discussed issue by the health care administration. It is often argued that, outsourcing of the medical diagnostic tests is quite frequent. Daniel et al observed in their research survey that there were so many institutes which were outsourcing the tests.

Background: Osteochondroma is the commonest benign bone tumor in humans. This tumor may either be solitary or present as multiple lesions. Solitary osteochondromas are much more common. Femur is the single most common long bone involved followed by tibia and humerus. Osteochondromas may be either asymptomatic or may present as pain, pressure symptoms or functional impairment. Most of the symptomatic lesions need surgical excision.Methods: This was a prospective study which included 32 patients with solitary osteochondromas of femur, who were managed with surgical excision. Only the symptomatic cases were operated. Minimum follow-up period was 18 months after surgery.Results: This study involved 23 males (71.87%) and nine females (28.12%). 30 osteochondromas (93.75%) were located in the distal femoral metaphysis while as only two cases (6.25%) of proximal metaphyseal involvement were seen. The commonest indication for surgery was pain. Other indications included cosmetic causes, restricted joint movement, fracture of osteochondroma and paresthesia or numbness. The complications included post-operative hematoma formation which was seen in 2 patients (6.25%), infection which was seen in one patient (3.12%), post-operative hypoaesthesia in 2 patients (6.25%) and recurrence of the tumor occurred in one patient (3.12%).Conclusions: Surgical excision of the solitary symptomatic femoral osteochondromas is a rewarding and safe procedure with minimal complications.

Once a young lady, walked in the OPD with history of bleeding per vagina for last 24 hours. It was a case of retained products of conception subsequent to induced incomplete abortion. Later we came to know that a team of local private doctors with portable ultrasound machine and MTP kits used to come in the study areas at night hours. This mobile team offered a package deal to the clients. Part one was sex determination test. When a female fetus was detected they offered to do induce abortions (on the spot). This is done in a clandestine way. The team used to leave after initiating the procedure. For any complication they were advised to go to hospital OPD presenting as P/V bleeding to avoid punishment under Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994. As we know every action has an opposite reaction. To prevent female feticides government enacted PNDT Act as an action. Reaction to this people started prenatal sex selection. Again the governmental action was amendment of Pre-Natal Diagnostic Techniques (Regulation and Prevention of misuse) (PNDT) Act, 1994 to PC-PNDT ACT. People's reaction was sex selection in a static van. Due to raids it was converted to mobile van. In our case study it is seen that, to avoid the PC-PNDT Act, people devised a newer strategy. A strategy for sex determination and female feticide by a mobile team with portable ultrasound machines. Our case study is important because we have just explored the tip of the iceberg only. A lot of efforts should be done. Until and unless the people understand the value of women in the society, this kind of reaction will take place again and again.

Background: In Assam, gestational diabetes mellitus (GDM) screening is not routinely done during antenatal check-up in Assam, whereas anemia screening is done. Consequently, state-wide GDM estimate and its association with anemia in rural Assam is not available. Hence, we aim to study the demographic profile of pregnant women and their anaemia in relation to prevalence of gestational diabetes mellitus in rural Assam.Methods: The present study was part of a larger community based cross-sectional study, conducted in Assam to determine the prevalence of GDM. The pregnant women in the gestational age of 24-28 weeks, who were free of any chronic illnesses, screened for Anaemia and, GDM through oral glucose tolerance test (OGTT) as per diabetes in pregnancy study group in India guideline.Results: A total of 1212 pregnant women underwent the OGTT and test for haemoglobin estimation. Mean age of GDM women was (24.40±4.60 years), slightly higher than non-GDM women (23.50±4.04 years, p=0.007). After hemoglobin estimation, 83% of pregnant women found to be anaemic, 77% of these were GDM positive, which is quite significant with p value 0.025. A higher fraction of the pregnant mothers in our study were found suffering from anemia (83%). The independent association of GDM and anemia adjusted for other variables showed an inverse relationship.Conclusions: Though prevalence of anaemia and GDM in low resource setting in rural Assam found to be quite high, but they have inverse relationship. Anaemic pregnant women were found to be GDM protective.

Background: Animal bites are a neglected public health problem and remain a significant cause of morbidity and mortality worldwide. There are many myths and misconceptions regarding animal bites i.e. application of herbs, lime, chilli powder etc., on wound, consulting faith healers/quacks. There is dearth of evidence pertaining to it thus we aim to estimate the pattern, profile and determinants of care seeking behavior of animal bite cases reported at the ARCs, Chandigarh.Methods: We undertook a cross sectional study at the ARCs of Chandigarh. Annual data on all reported animal bite cases during the period of January 2014 to December 2015 were collected from the hospital records to estimate case load and pattern of animal bite. 100 cases were purposively selected animal bite victims were interviewed during a four months period from January 2015 to April 2015. Pattern of animal bite cases and care seeking behaviour was ascertained by using pre tested questionnaire. Data was analysed using EpiInfo and MS excel.Results: Majority of victims were males and above 15 years. Dog was the principal biting animal. Legs (61%) were most common biting site and 71% category III bites were recorded. Around 27% victims applied chili/salt/lime etc., 40% used water for wound washing and 4% applied Turmeric/Neem/Tulsi etc. Majority (65%) took local treatment within 10 minutes of bite.Conclusions: Majority of victims presented with category III bites. Applying chili/salt/lime or some other form of irritant at the wound was a common practice amongst victims.

Health systems in low- and middle-income countries like India continue to struggle with the overwhelming burden of noncommunicable diseases (NCDs) alongside the coexistence of multiple medical conditions. Such cases are challenging to diagnose and treat, especially in places where electronic health records are not readily available. In such contexts, using colour coding system for recording health conditions may ensure optimal documentation, effective patient-provider communication, adherence to treatment and follow up, quality of health services, and an overall improvement in health systems performance for NCDs. Colour coding is a common tool used in several service industries including public health programmes locally and globally. Despite such promising aspects, colour coding is not widely used for NCDs in health services organizations, which necessitates a translation of evidence from other sectors and the adoption of innovative and evidence-based approaches to promote the use of colour coding for better addressing NCD epidemic.

In this case study, we describe our experiences with a rural poor family from north India that initially contacted faith healers for treatment of their child who was having symptoms suggestive of epilepsy, but the seizures continued even after this. The family migrated to a city, where they started allopathic treatment, but eventually they had to discontinue it as there was no apparent relief. Again, they went back to their native village and restarted the treatment from the faith healer. This case study highlights the fact that in spite of the significant development of medical science, many questions pertaining to epilepsy treatment are still unanswered. Such dissatisfaction with the allopathic treatment of epilepsy is very common. Complexity of the disease and high cost of modern medication, side effects of drugs, efficient but heavy treatment protocols and unpredictable outcome are responsible for continued practice of people consulting faith healers for treatment of epilepsy. However, these remain unnoticed and undocumented.

This paper presents two methods for detecting abnormal electricity consumption by utilizing usage patterns in the vicinity. The methods use contextual and factual information including, energy consumption patterns, nature of supply and category of day to logically group meters and find abnormalities. Using heuristics proposed in the paper, data collected from fifty smart meters deployed inside hostels of IIIT-Delhi were investigated for abnormal electricity consumption. Multiple abnormalities were found and their causes were verified after discussion with campus administrators. Our results show that the proposed heuristics successfully found abnormal energy consumption behavior. Therefore, these methods could be used for real-time abnormality detection. This will result in reducing operating costs by automatically detecting and reporting abnormalities without human intervention.

Lack of understanding of medical terms and healthcare information by patients can lead to adverse health outcomes and decreased satisfaction with the clinician and medical encounter. Moreover, due to advent of information technology, lot of health and medical information is available on World Wide Web. However, the information available is not reliable and trustworthy and cause serious consequences. Therefore, the right information should reach right person at the right time in order to support the patient in making health-related decisions. ‘Information therapy’ (Ix) is an attempt to provide patients with the timely, adequate and evidence-based health information for making informed decision regarding their treatment. The information provided should be relevant, accurate, complete, reliable, easy to understand and practical. Ix is exactly like treatment prescription by a physician but it also includes reference to healthcare information resources to patients following a clinical visit. The patients or the care takers after going through these resources can understand their medical condition and may raise patient satisfaction, leads to better health outcomes and reduce medical errors. Ix is a cost-effective solution that allows the healthcare industry to patient-centered care. It also allows patients to serve themselves, and save doctor’s precious time, which ultimately helps to utilize limited resources in an efficient way, especially in developing countries. Ix is a need of the hour in today’s world, however, scope is limited by the challenges like inadequate literacy level of population, poor IT access to majority rural population, limited resources to develop right information and lack of information specialists and medical librarians in developing countries.South East Asia Journal of Public Health Vol.4(2) 2014: 47-50

Congenital malformations (CMFs) are a major public health problem in India. Consanguineous marriages, infections during pregnancy, folic acid deficiency during the periconceptional period, exposure to pesticides and a history of intake of drugs during pregnancy have been hypothesized as risk factors. Drugs include oral contraceptive pills, progesterone analogues, medications for ailments and indigenous drugs to bear male offspring. It is important to analyze the risk factors in order to implement preventive measures. The prime objective of this study was to study the risk factors of visible structural CMFs, with a focus on indigenous medicines for sex selection. A population-based, case-control study was undertaken in Haryana state. Cases included children (0–18 months) with any apparent structural deformity as reported by various Government sources. A consecutive birth from the same area as the case was labelled and included as the control. The sample size calculated was 175 in each group. Mothers of every case and control were interviewed at their respective homes using a structured tool. Descriptive analysis, bivariate analysis, followed by logistic regression was conducted to establish the association between risk factors and CMFs. The sociodemographic profiles of the cases and controls were similar. Among the various risk factors studied, more than two living children (unadjusted odds ratio [OR] 1.6, 95 % CI 1.04–2.4) and intake of sex-selection drugs (unadjusted OR 2.8, 95 % CI 1.6–5.1) were significant risk factors on bivariate and regression analyses. The risk of having a child with CMFs was threefold more among mothers with a history of intake of indigenous medicines for sex selection (adjusted OR 3; 95 % CI 1.7–5.6). The intake of indigenous drugs during pregnancy increased the risk of CMFs almost threefold. This has social as well as economic implications, and hence needs further investigation.

Incidence of congenital hypothyroidism varies across countries and different geographic regions. A retrospective analysis of cord blood thyroid stimulating hormone values, and their subsequent follow-up, was done in a tertiary-care center in Kerala, India. Congenital hypothyroidism was found at the rate of 1 in 244, which is higher than reported incidence from other centers.

Background: Primary care physicians (PCPs) encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients' history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ) statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (

In this case study, we describe our experiences with a woman employed as a housemaid who sought unsafe abortion services from a private doctor. This was her sixth pregnancy, after previously giving birth to one son and two daughters and undergoing two induced abortions. Her husband remained opposed to the use of contraception. Initially, she had sought medical termination of pregnancy through a government hospital but was denied because of procedural delays, specifically the non-availability of an ultrasonography report consequent to a lack of proof of identity (ie, the AADHAAR card, a unique identification card for recording biometric and demographic data in India). She finally sought the services of an unqualified private physician and received oral abortifacient agents. Consequently, she was required to seek treatment for bleeding per vaginum from the dispensary staff at a government hospital. We note that many such incidents occur in our daily practice but remain unnoticed and undocumented. Although this patient was eligible for sterilisation (ie, tubectomy), her husband was uncooperative. This case illustrates the lack of decision-making power experienced by Indian women who have a low societal status.

India accounts for one-fourth of the global tuberculosis (TB) burden. The National TB Program was started in 1962. Over a period of time, some lacunae such as poor case detection rate and incomplete treatment were observed. Later, the government formulated the Revised National Tuberculosis Control Program (RNTCP), which achieved a case detection rate of 70% and a cure rate of 85%. Still, the problem of relapse and defaulter cases persists. In 2014, 6% defaulter cases were reported from India. RNTCP has also focused on microlevel aspects, that is, newer diagnostics such as GenXpert, line probe assay and medicines such as bedaquiline for drug-resistant TB. Action on the macrolevel aspects, for example, social determinants, is ignored. This is natural because these are out of the purview of the health sector. This case study reflects how a resident doctor in a rural clinic of North India tried to resolve the macrolevel and microlevel issues pertaining to defaulter TB cases.