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In the midst of the coronavirus disease 2019 (COVID-19) pandemic, we are seeing widespread disease burden affecting patients of all ages across the globe. However, much remains to be understood as clinicians, epidemiologists, and researchers alike are working to describe and characterize the disease process while caring for patients at the frontlines. We describe the case of a 6-month-old infant admitted and diagnosed with classic Kawasaki disease, who also screened positive for COVID-19 in the setting of fever and minimal respiratory symptoms. The patient was treated per treatment guidelines, with intravenous immunoglobulin and high-dose aspirin, and subsequently defervesced with resolution of her clinical symptoms. The patient’s initial echocardiogram was normal, and she was discharged within 48 hours of completion of her intravenous immunoglobulin infusion, with instruction to quarantine at home for 14 days from the date of her positive test results for COVID-19. Further study of the clinical presentation of pediatric COVID-19 and the potential association with Kawasaki disease is warranted, as are the indications for COVID-19 testing in the febrile infant.

BackgroundCervical cancer continues to be a leading cancer among women in India. Despite availability of various screening techniques, majority of Indian women remain unscreened for cancer cervix. The increasing incidence could be attributed to the lack of awareness regarding cervical cancer screening and paucity of organized screening facilities in the country. This study assessed the knowledge, attitude and practices (KAP) towards cervical cancer screening among tribal women of coastal Karnataka, southern India.MethodsA community-based cross-sectional study was conducted among 1140 women aged 20–65 years from three tribes. Information on their KAP towards cervical cancer screening was collected using a semi-structured questionnaire.ResultsMean age of the participants was 39.8 ± 10.1 years. Although 82.9% of the participants reported to have heard of cervical cancer, 51% were aware that the disease could be prevented, and only 2.3% knew that it can be detected at an early stage. Over 75% of the participants did not have adequate knowledge regarding cervical cancer. However, majority of them (99.9%) had a favourable attitude towards cervical cancer screening. None of them had undergone cervical cancer screening prior to the study. The knowledge scores were significantly associated with age group, marital status, education level, socioeconomic status and tribal community of the participants (p ConclusionOverall knowledge regarding cervical cancer among the surveyed women was poor, though they exhibited a positive attitude. This calls for a sustained health education and screening program to create awareness and improve the uptake of cervical cancer screening among these women.

Background Exploring the cultural context of intergenerational continuity of warm and harsh parenting informs parents motivations to adopt specific parenting behaviours. Objective Parents’ perceptions of being parented in the past and their current parenting as well as adolescents’ perceptions of current parenting were explored applying a multi-method approach. Methods Following written informed consent, a total of 24 interviews with 10 families (dyads of 14 parents and ten adolescents) from Udupi taluk in southern India was conducted. In the first stage, in-depth interviews were conducted with parent participants (Generation 1 (G1)) and in the second stage, adolescents (Generation 2 (G2)) participated in the photovoice component. Multiple forms of data including photographs, journals and interviews facilitated using the SHOWeD model were collected and were analysed thematically using ATLAS.ti(v.8). Results Subtle changes in reinforcing culture-specific gender norms between generations were elicited. Differences in communication, granting autonomy to female adolescents, and in disciplining methods between G1 and G2 were observed. Warm parenting was transmitted between generations while harsh parenting in G1 in the presence of external social support was discarded in favor of warm parenting in G2. Conclusion We provide evidence for perceptions of parenting and adolescent behaviors across two generations. Transmission of warm parenting and interruption in the cycle of harsh parenting in the presence of external social support were significant findings. Related theoretical and methodological applications are discussed.

To explore the experiences of parents and their adolescent children, specifically the dimension of parental involvement in the lives of their adolescent children and how adolescents perceived it. Following informed consent, a total of nine families with 22 participants took part in the study including nine adolescents, aged between 14 and 16 y, and 13 parents. One-on-one in-depth interviews were conducted at their homes following informed consent. Following transcription, the data was coded and themes were identified using Atlas.ti software. A grounded theory approach was undertaken in analysing the data. Two main themes were identified including perceptions of parental involvement in the lives of their adolescent children and family strategies to improve bonding. Adolescents’ concerns centered on reduced interaction time with their family members. Concerns were also raised over the adolescents’ increasing academic burden and parents particularly emphasized the increasing use of media and mobile technology by adolescents as deterrents to interaction. Though mothers functioned as primary caregivers, fathers also took on more active roles in the rearing of their children, stepping away from the traditionally viewed role of being a distant patriarchal provider. To improve interaction, parents devised creative strategies to increase time spent interacting with family members such as having dinner, performing household chores, playing games, or visiting places together. The increasing academic burden and access to digital media were perceived as factors leading to reduced interaction between the parent-adolescent dyad. Creative parenting strategies to increase interaction were sought as a solution.

Background Cervical cancer is a major contributor to mortality and morbidity in women. Naked eye visual screening (NE test) and Pap test are commonly used for cervical cancer screening. Both tests have inherent limitations like low sensitivity (Pap test) and subjectivity in interpretation, lack of permanent record and overestimation (NE test). Here, Smart Scope® visual screening test (SS test) was compared with NE and Pap tests. Smart Scope® is a small, hand-held device that captures cervical images attached to a tablet to store data. Objective To compare SS test with Pap and NE tests. Study design This prospective observational study was conducted at a tertiary care hospital in India, over 16 months. A total of 509 women in the age group of 25 to 65 years were included in the study as per the inclusion criteria. All the participants underwent Pap test, NE test and SS test. Screen positives on any one test were advised colposcopy and biopsy. Results Out of 154 screen-positive women, 49 visited for follow-up colposcopy-guided biopsy. Nine incidental biopsies of screen-negative women were included in the data. Thus, statistical analysis was carried out based on 58 available histopathology results. Out of 58 biopsies, 8 were normal, 30 were benign lesions, 18 were precancerous and 2 were cancerous lesions. SS test was found to have a sensitivity and NPV of 100% each, PPV of 45.4% and a specificity of 36.8%. Sensitivity and specificity of NE test was 90% and 39.5% respectively, PPV was 43.9% and NPV was 88.2%. Pap smear had a sensitivity of 25% and specificity of 84.2%, PPV of 45.5% and NPV of 68.08%. Conclusion SS test has great potential to be a primary screening test in low-resource settings due to its better sensitivity and NPV as compared to NE and Pap tests. .

Pneumonia is the leading cause of death among children globally. Most pneumonia deaths in low-income and middle-income countries (LMICs) occur among children with HIV infection or exposure, severe malnutrition, or hypoxaemia despite antibiotics and oxygen. Non-invasive bubble continuous positive airway pressure (bCPAP) is considered a safe ventilation modality that might improve child pneumonia survival. bCPAP outcomes for high-risk African children with severe pneumonia are unknown. Since most child pneumonia hospitalisations in Africa occur in non-tertiary district hospitals without daily physician oversight, we aimed to examine whether bCPAP improves severe pneumonia mortality in such settings.This open-label, randomised, controlled trial was done in the general paediatric ward of Salima District Hospital, Malawi. We enrolled children aged 1-59 months old with WHO-defined severe pneumonia and either HIV infection or exposure, severe malnutrition, or an oxygen saturation of less than 90%. Children were randomly assigned 1:1 to low-flow nasal cannula oxygen or nasal bCPAP. Non-physicians administered care; the primary outcome was hospital survival. Primary analyses were by intention-to-treat and interim and adverse events analyses per protocol. This trial is registered with ClinicalTrials.gov, number NCT02484183, and is closed.We screened 1712 children for eligibility between June 23, 2015, and March 21, 2018. The data safety and monitoring board stopped the trial for futility after 644 of the intended 900 participants were enrolled. 323 children were randomly assigned to oxygen and 321 to bCPAP. 35 (11%) of 323 children who received oxygen died in hospital, as did 53 (17%) of 321 who received bCPAP (relative risk 1·52; 95% CI 1·02-2·27; p=0·036). 13 oxygen and 17 bCPAP patients lacked hospital outcomes and were considered lost to follow-up. Suspected adverse events related to treatment occurred in 11 (3%) of 321 children receiving bCPAP and 1 (1%) of 323 children receiving oxygen. Four bCPAP and one oxygen group deaths were classified as probable aspiration episodes, one bCPAP death as probable pneumothorax, and six non-death bCPAP events included skin breakdown around the nares.bCPAP treatment in a paediatric ward without daily physician supervision did not reduce hospital mortality among high-risk Malawian children with severe pneumonia, compared with oxygen. The use of bCPAP within certain patient populations and non-intensive care settings might carry risk that was not previously recognised. bCPAP in LMICs needs further evaluation before wider implementation for child pneumonia care.BillMelinda Gates Foundation, International AIDS Society, Health Empowering Humanity.

Objective: To promote complementary feeding (CF) practices and to improve the physical growth of children less than 2 years of age through, counseling mothers and the family members.Methods: A community based cluster randomized controlled trial (CRT) was conducted in Udupi taluk. All the pregnant mothers registered during the third trimester and the newborn children followed until 2 years of age in the selected Anganwadi (AW) centers. Home based counseling was provided to the family at different points of time. Counseling was based on continuation of breastfeeding, complementary feeding and different types of foods, optimal feeding, hygiene and care of sick child. All the newborns were followed until 2 year of age. Results: Baseline characteristics of the subjects found to be similar in both the groups. The baseline knowledge assessed on a 15-point scale, the mean score in both groups was very much similar. Mean measured weight increased significantly in the intervention group (0.794 kg, p

A lyophilized bovine-human rotavirus reassortant pentavalent vaccine (BRV-PV, Rotasiil®) was licensed in 2016. A liquid formulation of this vaccine (LBRV-PV, Rotasiil - Liquid) was subsequently developed and was tested for non-inferiority to Rotasiil® and for lot-to-lot consistency.This Phase II/III, open label, randomized study was conducted at seven sites across India from November 2017 to June 2018. Participants were randomized into four arms; Lots A, B, and C of LBRV-PV and Rotasiil® in 1:1:1:1 ratio. Three doses of study vaccines were given at 6, 10, and 14 weeks of age. Blood samples were collected four weeks after the third dose to assess rotavirus IgA antibody levels. Non-inferiority of LBRV-PV to Rotasiil was proven if the lower limit two-sided 95% confidence interval (CI) of geometric mean concentration (GMC) ratio was at least 0.5. Lot-to-lot consistency was proven if 95% CI of the GMC ratios of three lots were between 0.5 and 2. Solicited reactions were collected by using diary cards.Of the 1500 randomized infants, 1436 infants completed the study. The IgA GMC ratio of LBRV-PV to Rotasiil® was 1.19 (95% CI 0.96, 1.48). The corresponding IgA seropositivity rates were 60.41% (57.41, 63.35) and 52.75% (47.48, 57.97). The IgA GMC ratios among the three LBRV-PV lots were: Lot A versus Lot B: 1.34 (1.03, 1.75); Lot A versus Lot C: 1.22 (0.93, 1.60); and Lot B versus Lot C: 0.91 (0.69, 1.19). The 95% CIs for the GMC ratios were between 0.69 and 1.75. The incidence of solicited reactions was comparable across the four arms. Only one serious adverse event of gastroenteritis event in the Rotasiil® group was causally related.The immunological non-inferiority of LBRV-PV against Rotasiil® as well as lot-to-lot consistency of LBRV-PV was demonstrated. LBRV-PV had safety profile similar to Rotasiil®.Clinical Trials.Gov [NCT03474055] and Clinical Trial Registry of India [CTRI/2017/10/010104].

Objectives: The present study aimed at assessing high school teachers’ mental health literacy (MHL) and predictors related to study outcomes.Design: Cross-sectional studyMethods: We employed 460 high school teachers who engaged with adolescents for at least six hours per week with a minimum of five years of teaching experience in southern India. Semi-structured questionnaires were used to assess their MHL. Descriptive analysis and backward logistic regression analysis were performed. A p-value < 0.05 was set as significant.Results: Teachers’ MHL on depression was less than desirable; however, they identified 288 (62.6%) adolescents with mental health problems during their career, and 172(59.72%) were referred to mental health professionals. On logistic regression analysis, teachers’ educational status, their marital status, teaching a class with an average strength of 31-60 students per class, previous mental health training and having self-efficacy concerning seeking informationon mental health, perceived ability to spread awareness and to provide referrals were found to predict MHL among teachers.Conclusion: Sociodemographic factors including teachers’ educational status, average class strength and having had previous mental health training were predictors for MHL among high school teachers. Establishing training programs and referral networks may be key in early intervention among adolescents.

Objective: The term ‘‘Human Papillomavirus’’ or ‘‘HPV’’ has become synonymous with uterine cervical cancer leading to feminisation of all the preventive measures, especially immunisation. Taking into consideration the rising number of HPV associated cancers among men in many developed countries and the risk of transmission to women, male HPV infection is a serious concern. A systematic review and meta-analysis of literature was performed to determine the global prevalence of HPV among men with oropharyngeal and anogenital cancers. Methods: A systematic review and meta-analysis of literature was performed searching electronic databases for published articles in English between January 1984- April 2020 based on standard systematic review guidelines. The meta-analysis component was modified appropriately for the synthesis of prevalence study results. National Institutes of Health checklist for observational, cohort and cross-sectional studies was used to assess the quality of the studies selected after the abstract and content review. The meta-analysis was performed in STATA version 13.0 (College Station, Texas 77,845 USA) and the forest plots were constructed using metan package in STATA. Results: Through the electronic search of databases, 3486 original articles were screened for eligibility. Fifty-eight articles were systematically reviewed and 42 articles were qualified for meta-analysis including 4,250 men with oropharyngeal, penile and prostate cancers. The pooled prevalence of HPV DNA in oropharyngeal cancers was 45% (95%CI 24.0%-66.0%). Meanwhile the pooled prevalence rates of 48% (CI 40.0%- 57.0%) and 19% (CI 10.0%-29.0%) were observed in penile and prostate cancers respectively. Even though, articles regarding HPV prevalence in anal cancers were systematically reviewed, none of the studies were qualified for meta-analysis. Conclusion: Higher pooled prevalence of HPV DNA was observed among men with oropharyngeal and penile cancers. Multicentric molecular studies investigating the prevalence of HPV in prostate cancers have to be planned in future.

Globally, the cervical cancer burden is huge, more so in low-resource countries. Human immunodeficiency virus (HIV) infection increases a woman's risk of human papillomavirus (HPV) infection and cervical cancer. There is a lack of opportunistic, as well as, organized cervical cancer screening structure for HIV-positive women. A large proportion of women have invasive cervical cancer as their initial acquired immune deficiency syndrome (AIDS)-defining illness. There is an especially high-incidence in countries where there are no organized cervical cancer prevention programs. Additionally, there are cultural, social, psychological, and system barriers that women living with HIV have to overcome when accessing healthcare services. We believe that educating women and healthcare providers regarding the need for screening, early detection, and treatment is as important as bringing about a systematic change in healthcare services to improve participation of HIV-positive women in screening for cervical cancer.

Background Exposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India. Methods We carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status. Results We obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings. Conclusion Exposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries.

The objective of the study was to determine the prevalence of foot complications among people with type 2 diabetes mellitus in the rural part of Udupi district, Karnataka, India. A cross-sectional observational study design was conducted in the rural area of Udupi district. In the study, accredited social health activists were trained to screen people with type 2 diabetes mellitus for diabetic foot complications at a community level. Adults over 35 years of age were screened for the presence of type 2 diabetes mellitus by accredited social health activists who reside in the rural part of Udupi district. Participants with type 2 diabetes mellitus were included in the study. Blood glucose level was measured using a glucometer. Foot examination was done by visual inspection, monofilament, tuning fork, and pedal pulse. In the present study, 2110 among the total participants were found to have type 2 diabetes mellitus. The prevalence of musculoskeletal foot complications was 1218 (58%), vascular problem 466 (22.2%), sensory neuropathy 634 (30.2%), autonomic neuropathy 1729 (81.9%), ulcer 134 (6.38%), and infection 561 (26.7%) among people with type 2 diabetes mellitus. In the current study, we found 84.7% of people residing in rural Udupi had type 2 diabetes mellitus. Hence, there is a strong need to create awareness about diabetic foot care in these people.

INTRODUCTION The awareness and knowledge on bleeding disorders is generally poor among the rural population. Accredited Social Health Activists (ASHAs) serve as the facilitators between the rural community and the health care system. Training of ASHAs in screening of rural population for early identification of bleeding disorders can enable prompt referral, timely detection and management of bleeding disorders. AIM The aim of the study was to evaluate the effectiveness of an ASHA training programme for identification of suspected bleeding disorder cases. METHODS A population-based, cross-sectional survey was implemented by 586 Accredited Social Health Activists (ASHAs) in rural Udupi district, who underwent a structured training programme on identification of bleeding disorders. A survey record book with a screening tool on assessment of bleeding symptoms was given to each ASHA. The screening tool consisted of symptoms related to bleeding disorders and family history of bleeding disorders. Using the screening tool, ASHAs carried out a door-to-door survey. After screening, those who reported with bleeding symptoms were referred by the ASHAs to the investigator, who conducted further assessment. A detailed bleeding history was documented and bleeding symptom assessment was carried out using bleeding assessment tool (BAT) at the haemophilia treatment centre. Further coagulation assessments were carried out as per the treatment centre protocol. This paper highlights the evaluation of an ASHA training programme on identification of individuals with bleeding symptoms in the rural population. RESULTS A total of 586 trained ASHAs surveyed a population of 318 214 in rural Udupi district. Out of the 124 cases reported by ASHAs, 29 bleeding disorder cases were identified; haemophilia (A and B) was the most commonly found bleeding disorder 22 (75.8%), followed by von Willebrand disease (vWD) 3 (10.3%) and 4 (13.8%) immune-mediated thrombocytopenic purpura (ITP), with an overall prevalence of 2.2/10 000 population. CONCLUSION Training ASHA health care workers, who are the most important link between the community and health services, resulted in increased awareness among the public for the early detection of bleeding disorders.

Introduction: Hemophilia and other bleeding disorders are underreported and cause significant morbidity and mortality in resource-constrained countries. Training and the creation of awareness among accredited social heath activists (ASHAs) will aid in the early detection of bleeding disorders at the community level. Objective: To develop awareness and skills for the screening and identification of cases with bleeding symptoms among ASHAs in Udupi District, Karnataka, India. Methods: An interventional study was undertaken in Udupi District, which has three taluks and approximately 233 villages. All ASHAs with a current role (586) from rural Udupi were provided a competency-based training program at the community health center using a specifically designed training manual for the identification of cases with bleeding disorders. A pre-test/ post-test evaluation was performed to discover the training outcomes. Results: Sixteen (2.7%) participants had average knowledge in the first post-test, and 570 (92.2%) participants had good knowledge. Thirty-nine (6.6%) participants had average knowledge in second post-test, and 547 (94.3%) participants had good knowledge. The effectiveness of the training program was assessed using Friedman’s two-way test. A significant difference in knowledge scores (χ2 = 955.1) was found at baseline evaluation and end of the training test 1 and at 30 days of training test 2 among the ASHAs. Conclusion: Accredited social heath activists health care workers, who are the most important link between the community and health services, successfully created public awareness concerning the early detection of bleeding disorders.

Human papillomavirus (HPV) infections continue to be one of the most common sexually transmitted infections worldwide. The oncogenic potential of this virus was well established in anogenital malignancies and oropharyngeal cancers. Even though a fall in cervical cancer rates has been reported worldwide, the subsequent rise in HPV-associated head and neck cancers among men and women have been reported from developed countries, necessitating the vaccination of adolescent boys as well. The objective of this narrative review is to provide an update on the current status of HPV vaccination worldwide. This will be helpful for clinicians in counseling parents and guardians as this vaccine mainly targets sexually naive preadolescents. An electronic search of the databases was carried out to retrieve information concerning HPV vaccine implementation between July 2006 and 2017, with special emphasis on the current viewpoints, controversies and ethical issues. Globally, 74 countries have implemented the HPV vaccine in the national immunization schedule, and this vaccine is listed as an essential medicine by WHO. About 60% of the low- and lower-middle-income countries have implemented the vaccine with financial assistance from Gavi and WHO. The HPV vaccine is a safe vaccine with no serious adverse effects as per the data available from developed nations as well as low/lower middle/upper middle-income countries. However, long-term follow-up is essential to substantiate the impact of the vaccination programs in cancer prevention.

Objective To assess incidence of spontaneous preterm births and determine biochemical and obstetric risk factors for spontaneous pre-term births in a cohort of antenatal women visiting a secondary care hospital. Methods A prospective cohort study was designed to include 1420 pregnant women coming for antenatal care at a secondary care hospital. The cohort was followed throughout pregnancy and relevant history, obstetric and ultrasonographic examination and biochemical investigations was carried out in 2nd (20-24 weeks period of gestation) and 3rd trimester (28-32 weeks period of gestation). Outcome of delivery was noted for all the subjects. Results A total of 1133 women were recruited. Among the 1071 respondents, 11 had abortions, 93.1% delivered at term while 5.9% had preterm deliveries. Preterm deliveries were noted among 6.5% women with short stature, 13.3% with cervical length Conclusions The incidence of preterm births (5.9%) was low in the present cohort. Oligohydramnios and Intrauterine Growth Retardation (IUGR) were identified as significant risk factors for preterm births. Conventional risk factors like short cervix, short stature and biochemical inflammatory markers were not identified as predictors of prematurity. Lower levels of salivary estriol identified among women at risk of preterm births demonstrates the utility of the test as a non-invasive investigation for early identification of preterm births.

Adolescence is a vulnerable period in an individual’s life during which several physiological and psychological changes occur. Increasingly, across the globe, there is increasing incidence of mental health and behavioural problems documented, especially among the youth. The WHO states that mental health conditions and delinquent behaviours contribute significantly to the global disease burden. The transition from adolescence to adulthood is also marked by increasing manifestation of emotional and behavioural disorders with first episodes making their appearance in early adolescence. This review attempts to delve into the influence of microsystem and mesosystems as described by Bronfenbrenner on adolescent behaviours.

Objective: To assess the success rate of DOTS for tuberculosis patients and the secondary objective was to identify the factors associated with unsuccessful treatment outcome. Methods: A retrospective study was conducted to review the medical records of patients (n = 1113) registered at the Directly Observed Treatment Short-Course (DOTS) clinic of Government Infectious Disease (Govt. ID) Hospital, Guntur, India. Multivariate logistic regression model was used to determine the factors associated with the treatment success rate. Results: The overall mean success rate of TB patients was found to be 82.8%. Treatment success rate (TSR) was steadily increased across the years from 73.9% in 2015 to 84.3% in 2016 and 88.9% in 2017 while the death rate was steadily decreased from 11.2% in 2015 to 6.25% in 2016 and 4.33% in 2017. Risk factors significantly associated with unsuccessful treatment outcome were found to be HIV positive (P Key words: Directly observed treatment short-course, Retrospective study, Risk factors, Treatment success rate, Tuberculosis.

Sexually transmitted infections (STI) have a major impact on the reproductive health of women. Among the different etiological agents of STIs, Chlamydia trachomatis and Neisseria gonorrhoeae are the main bacterial pathogens that cause sexually transmitted infections in women. The aim of the study was to estimate the prevalence of genital chlamydial and gonococcal infection among women in the age group of 18–65 years from a community-based setting. A community-based cross-sectional study was performed using the archived urine samples (n = 811) of women in the age group of 18–65 years for C. trachomatis and N. gonorrhoeae using a multiplex conventional Polymerase Chain Reaction (PCR). Out of 811 samples tested in the present study, 2 (0.24%) were tested positive for C. trachomatis and none were positive for N. gonorrhoeae. The study demonstrates the very low prevalence of C. trachomatis and N. gonorrhoeae infection in a rural community. For large population-based screening, urine samples were observed to be more socially acceptable and cost-effective. Keywords: Detection, Chlamydia trachomatis, Neisseria gonorrhoeae, Community, Urine sample

Background Rotavirus infection is the common cause of severe diarrhea among under-five children. Globally it is responsible for majority of the hospital visits and admissions due to diarrhea in this age group. This hospital-based surveillance aimed to assess the burden of rotavirus diarrhea and to identify its prevalent strains among under-five children. Methods The study was conducted in two secondary level health care facilities of Manipal University, Manipal during November 2011 through July 2012. All under-five children admitted with acute diarrhea were recruited into the study. Results A total of 95 children were admitted with acute diarrhea during the study period. Of the 95 stool samples collected, 14 were inadequate and 81 samples were tested for the presence of rotavirus using commercial enzyme immunoassay kit (Premier Rotaclone Qualitative ELISA). Rotavirus positive samples were shipped to Central laboratory at CMC, Vellore for strain surveillance and characterization. Out of the 81 stool samples tested for rotavirus, 31 samples (38.3%) were positive for rotavirus VP6 antigen. Rota positivity was observed to be highest during the month of December (29.0%) and lowest in the month of June. Majority of the rotavirus positive cases (45.2%) were among children aged 13–24 months and among those who had very severe diarrhea (56.5%). The most common genotypes identified were G1P[8] and G2P[4] strains (25.8% each). Conclusions Though the burden of overall diarrhea among under-five children is not very high in this area, the proportion of rotavirus diarrhea among the hospitalized children is considerably high.

This case-controlled clinical trial was performed on the salivary 8-hydroxyguanosine (8-OHdG) levels in smokers and non-smokers with chronic periodontitis after non-surgical periodontal therapy. Subjects (N = 40) with periodontitis (smokers and non-smokers) and with clinically healthy conditions (smokers and non-smokers) were assigned to this study. At baseline, clinical periodontal parameters (plaque index, gingival index, pocket probing depth and clinical attachment levels) were evaluated. Saliva samples were obtained pre- and post-treatment to quantify the 8-OHdG levels using Elisa technique. Subjects diagnosed with chronic periodontitis with smoking habit (CPs) and non-smokers (CPns) received scaling and root planing. In clinically healthy subjects with smoking habit (CHs) and non-smokers (CHns), only oral hygiene tutoring was performed. All clinical measurements and salivary collection were repeated in a 3-month recall interval. Data were analyzed using Anova, Tukey post hoc test and Mann–Whitney ‘U’ tests (P

Author(s): Wilson, Casey; Rose, David; Kelen, Gabor D.; Billioux, Veena; Bright, Leah | Abstract: Introduction: We sought to determine whether ultrasound-guided arterial cannulation (USGAC) is more successful than traditional radial artery cannulation (AC) as performed by emergency medicine (EM) residents with standard ultrasound training.Methods: We identified 60 patients age 18 years or older at a tertiary care, urban academic emergency department who required radial AC for either continuous blood pressure monitoring or frequent blood draws. Patients were randomized to receive radial AC via either USGAC or traditional AC. If there were three unsuccessful attempts, patients were crossed over to the alternative technique. All EM residents underwent standardized, general ultrasound training.Results: The USGAC group required fewer attempts as compared to the traditional AC group (mean 1.3 and 2.0, respectively; pl0.001); 29 out of 30 (96%) successful radial arterial lines were placed using USGAC, whereas 14 out of 30 (47%) successful lines were placed using traditional AC (pl0.001). There was no significant difference in length of procedure or complication rate between the two groups. There was no difference in provider experience with respect to USGAC vs traditional AC.Conclusion: EM residents were more successful and had fewer cannulation attempts with USGAC when compared to traditional AC after standard, intern-level ultrasound training.

This quality improvement study examines the accuracy and user experience of a cost estimator tool delivered via an online patient portal and informed by real-time data from third-party payers., Key Points Question Can a cost estimation tool provide accurate, user-friendly, personalized information for ambulatory procedures via an online patient portal? Findings This quality improvement study included 4610 estimates during a 10-month period and found that the new tool showed an accuracy rate of 83.9%. A survey of a subset of users found that most respondents were satisfied with their experience using the tool and would recommend it to others. Meaning These findings suggest that a cost estimation tool can be easy to use and provide accurate real-time estimates integrated into the online patient portal., Importance Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed. Objective To assess accuracy and initial user experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third-party payers. Design, Setting, and Participants This quality improvement study included patients aged 18 years and older at an integrated health care system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019. Main Outcomes and Measures Tool accuracy and user experience and satisfaction. Results As of April 30, 2019, 4610 estimates (3569 [77.4%] via internet; 1041 [22.6%] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287 estimates (83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (44.0%) with an income of $100 000 per year or higher. Mean (SD) age was 46.8 (13.1) years. Ninety-nine participants (79.2%) found the tool easy to use, 109 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate. Conclusions and Relevance This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the next steps for the tool.

Introduction Adolescent behavioural problems are a growing public health concern. The authors in this study investigated paternal and maternal reports of parenting attitudes and dimensions as predictors of adolescent behavioural problems in the Indian context. Materials and methods Using stratified sampling at the community level, 640 parents including 419 mothers and 221 fathers participated in the study. Tools included a socio-demographic pro-forma; Parental attitude inventory (PAI) to assess parenting attitudes, Parent Global Report of the Alabama Parenting Questionnaire (APQ) to assess current parenting dimensions, and the parent version of the Strengths and Difficulties Questionnaire (SDQ) to assess behavioural problems among adolescents. We examined the prevalence and predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents from paternal and maternal reports. Results Paternal and maternal reports of total difficulties (11.3 %, 13.6 %), externalizing (2.3 %, 1.9 %) and internalizing behaviours (8.6 %, 7.4 %) among adolescents are reported. Predictors of abnormal behaviours per paternal reports included lower social class and poor paternal control. Being a male adolescent increased the odds of total difficulties and externalizing problems. Favourable maternal attitude, good maternal warmth and control predicted the reduced likelihood of total difficulties and externalizing behaviours per maternal reports. Paternal control and maternal warmth and control were found to reduce the likelihood of internalizing behaviours among adolescents. Conclusion Maternal attitude, paternal control and maternal warmth and control dimensions emerged as significant predictors of total difficulties, externalizing and internalizing behavioural problems among adolescents.

The role of parents is very pivotal in a child’s overall development. Discussing about adolescent changes especially reproductive health (RH) is still considered a taboo in our society. Even imparting sex education at schools has remained a debatable topic in India. The aim of our study was to study the perception of parents and teachers about adolescent upbringing with a special focus on RH, services and schemes provided for RH of adolescents. A qualitative study was conducted in rural–urban settings in two districts of Coastal Karnataka. By the technique of stratified purposeful sampling, 50 parents and 40 teachers in the age group of 30–60 years participated in 10 focus group discussions (FGD). All participants were related to adolescents. For data collection, a pre-tested FGD guide was used. All tape-recorded data was fully transcribed and thematic analysis was done. Bad peer company, excessive restrictions, bad habits, misconceptions about sex, mobiles, internet-negative influence, and sexual harassment were few factors that parents were worried about. When compared to males, they believed that female adolescents suffer both physically and mentally. Male adolescents do not have any “reproductive health problems”. All parents were unaware of any health care services provided for adolescents by the government.

In India, less research has been dedicated to reproductive health needs of boys as compared to girls. Various sociocultural aspects hinder the caregiving process towards adolescent boys. Our aim was to assess the views and perceptions of adolescent boys and their caregivers about reproductive health (RH) for adolescent boys. This qualitative study was conducted in rural urban settings of an entire Taluk (sub-district). It examined the perception and expectations of RH and the services that would cater their unmet needs. The perceptions of parents, teachers and clinicians who interacted with adolescent boys were also taken in to account. RH issues of boys were considered to be completely neglected by all caregivers. The boys felt ‘only girls have all sort of facilities and help’. Masturbation and wet dreams were considered as ‘problems’. Pornography and Internet influenced young minds negatively. Awareness about HIV/AIDS and premarital sex were good among the boys. Boys stressed on ‘counselling’ and ‘online services’ that would help them to discuss their RH issues with experts. Parents and teachers highlighted the importance of ‘sex education’. Doctors mentioned the problems they face to address the boys in community settings. It could be concluded that RH aspects of adolescent boys need further research.

Background: Cervical cancer is the second commonest cancer among Indian women and its association with human papilloma virus (HPV) is well established. This preventable cancer accounts for the maximum number of cancer related deaths among rural Indian women. Unlike in developed countries there are no organized cervical cancer screening programmes in India due to lack of resources and manpower. Objective: To detect genital HPV infection using urine samples among asymptomatic rural women in the age group of 18-65 years. Materials and Methods: The study area chosen was Perdoor village in Udupi Taluk, Karnataka State and all the women in the age group of 18-65 years formed the study cohort. A cross sectional study was conducted by house visits and 1,305 women were enrolled in the study. After taking written informed consent a data sheet was filled and early stream random urine samples were collected, transported to a laboratory at 4OC and aliquoted. Samples were tested using nested HPV PCR with PGMY09/11 and GP5 /6+ primers. Positive cases were genotyped by sequence analysis. Results: Study participants included 1,134 sexually active and 171 unmarried women with a mean age at marriage of 22.1 (SD=3.9) years. Study area showed high female literacy rate of 86.6%. Five urine samples tested positive for HPV DNA (0.4%). Conclusions: We found very low genital HPV infection rate among women from monogamous community. This is the first major population based study carried out amongasymptomatic rural women to detect genital HPV infectio from Karnataka using urine samples.

The growth of cancerous cells in lungs is called lung cancer. The mortality rate of both men and women has expanded due to the increasing rate of incidence of cancer. Lung cancer is a disease where cells in the lungs multiply uncontrollably. Lung cancer cannot be prevented but its risk can be reduced. So detection of lung cancer at the earliest is crucial for the survival rate of patients. The number of chain- smokers is directly proportional to the number of people affected with lung cancer. The lung cancer prediction was analysed using classification algorithms such as Naive Bayes, SVM, Decision tree and Logistic Regression. The keyobjective of this paper is the early diagnosis of lung cancer by examining the performance of classification algorithms.

Background and Aims Peroral endoscopic myotomy (POEM) has become the mainstay for the treatment of achalasia at many institutions around the world since its inception in 2008. POEM can be performed using either the anterior or posterior approach. The primary aim of this study was to compare the efficacy of the anterior and posterior approaches at 1 year after POEM. Methods This is a single-blinded, randomized, noninferiority international clinical trial. Eligible participants were adult patients with a confirmed diagnosis of achalasia via high-resolution esophageal manometry. Patients were randomly allocated with a 1:1 ratio to receive POEM with anterior or posterior approach. The primary aim was to compare the rate of clinical success (Eckardt score Results One hundred fifty patients were randomized to receive either anterior (n = 73) or posterior (n = 77) POEM. One hundred forty-eight patients received the POEM treatment, and 138 patients completed the 1-year follow-up and were included in the primary efficacy analysis. Technical success was achieved in 71 patients (97.3%) in the anterior group versus 77 patients (100%) in the posterior group (P = .23). The median (interquartile range) length of hospital stay after the procedure was 2 (1-3) days for both groups. Adverse events occurred in 15 patients (10%), 8 patients (11%) in the anterior group and 7 patients (9%) in the posterior group (P = .703). Clinical success was achieved in 90% of patients in the anterior group and 89% of patients in the posterior group. Abnormal esophageal acid exposure was detected in 29 of 59 patients (49%) and 25 of 60 patients (42%) in the anterior and posterior groups, respectively (P = .67). GERD questionnaire scores were also not significantly different between the study groups. In both groups, quality of life improved after POEM for all 36-Item Short-Form Health Survey measures and was similar between both groups. Conclusions Posterior myotomy during POEM was not inferior to anterior myotomy in terms of efficacy and safety in the treatment of patients with achalasia. (Clinical trial registration number: NCT02454335.)

Introduction: Children are the foundation of a strong and healthy nation. Morbidity among school-going children adversely affects their normal growth and development and hence is a major public health concern. School health program was started as an important component of total health care delivery system in the country with a purpose of addressing the health needs of children. Aim: To assess the morbidity pattern and nutritional status among school children. Materials and Methods: Study design: A cross-sectional study. Study period: 1-year from 1 st July 2012 to 30 th June 2013. Study setting: 14 schools with a total strength of 909 children in a rural area of coastal Karnataka. Data collection: Health examination of the school children was carried out by a trained team. Data regarding anthropometric measurements, refractory error, medical problems and minor ailments were collected using a predesigned proforma. Results: A total of 797 children were examined. Dental caries was the most common ailment observed in 31.86% of children 43.32% of the children were underweight, 53.03% were normal, and 3.65% were overweight for age. Conclusion: The school health program provides a good opportunity to screen, identify and impart education regarding health related issues. The common morbidities found were dental caries, pallor, upper respiratory tract infection and refractory error. Overweight was also observed in the school children and needs to be addressed. There is a scope of providing comprehensive school health services by incorporating dental care.

Background: Objective of the study was to assess the effectiveness of the family level counseling to mothers on breastfeeding practices and weight gain in children. Methods: A community based cluster randomized controlled trial was conducted in Udupi District in Karnataka State, South India. All the children born to pregnant mothers registered in the third trimester were followed until 2 years of age in selected Anganwadi (AW) centres. Results: Baseline characteristics of the subjects were found to be similar in both intervention and control groups. The baseline knowledge assessed on a 15-point scale showed similar mean score in both groups. Mean measured weight increased significantly in the intervention group (0.794 kg, p < 0.002) at 24 months of age. At 24 months more babies in intervention group were receiving breastfeeding than control group (68.6 % vs. 14.7 %, 95 % CI 2.01 – 10.80, and p < 0.001). Frequency of breast feeding at 4 months was 77.1 % in intervention and 57.8 % in control group (p < 0.0001) while at 6 months it was 77.1 % in intervention and 33.3 % in control group (p < 0.0001). The breastfeeding position assessed on a ten-point scale showed mothers in intervention group followed more than 7 correct positions than control group at birth, 4 months and 6 months of age (p < 0.001). Conclusions: The study shows promotion of child nutrition and breastfeeding practices in developing countries through family level counselling (IYCF strategy) will improve the nutritional status of children less than 2 years of age.

Inventory management is the core of pharmaceutical supply system. It is all about ordering, receiving, storing, issuing, and again reordering of limited list of products. On a realistic bases inventory management is a difficult task, because in many countries possession of a poor inventory management system in the pharmaceutical supply system has resulted in wastage or blockade of financial resources, shortage and overage of essential drugs, increase in out-of-pocket expenditure and decline in quality of healthcare services. Objective: This study is undertaken to assess the pharmaceutical inventory management and store keeping practices followed at the rural primary health centers in Udupi district, Karnataka. Methods: Retrospective data was collected by conducting a situational analysis in selected 20 primary health centers located across Udupi district. The collected data is related to the system of inventory management adopted, procurement practices, purchasing documents, essential drug lists, stock records, rate of correct items received and supplied, rate blacklisted and expired drugs, and rate of drug storages. The key performance indicatorswere collected from 2013 to 2015 to study the system and to identify the existing bottlenecks. Results: The inventory management and store keeping system implemented in primary health care (rural division) is still a piecemeal and ad hoc in nature. With the provided infrastructure, work force, complex procedures, manual system of record maintenance, lack of co-ordination between the activities and players only causes plethora of bottlenecks resulting in irrational usage of limited resources. Conclusion: Overall, there are still chances for improvement within the public pharmaceutical supply system at the primary healthcare level in the state. If corrective standardized measures are implemented in the areas of procurement, drug quantification, distribution, and inventory control, then the problems associated with stock-outs and wastage can be minimized. Key words: Drug inventory control, Stock management, Primary health centers in Karnataka, Pharmaceutical storage, Drug supply and distribution.

Objective: A study was conducted to develop and validate a screening model using risk scores to identify individuals at high risk for developing oral cancer in an Indian population. Methods: Life-course data collected from a multicentre case-control study in India were used. Interview was conducted to collect information on predictors limited to the time before the onset of symptoms or cancer diagnosis. Predictors included statistically significant risk factors in the multivariable model. A risk score for each predictor was derived from respective odds ratios (OR). Discrimination of the final model, risk scores and various risk score cut-offs was examined using the c statistic. The optimal cut-off was determined as the one with good area under curve (AUC) and high sensitivity. Predictive ability of the regression model and cut-off risk score was determined by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Models were validated from a bootstrap sample. Results: Smoking, chewing quid and/or tobacco, alcohol, a family history of upper aero-digestive tract cancer, diet and oral hygiene behaviour were the predictors. Risk scores ranged from 0 to 28. Area under the receiver operating characteristic (ROC) curve for risk scores was good (0.866). The sensitivity (0.928) and negative predictive value (0.927) were high, while specificity (0.603) and positive predictive value (0.607) were low for a risk score cut-off of 6. Conclusion: A risk score model to screen for individuals with high risk of oral cancer with satisfactory predictive ability was developed in the Indian population. Validation of the model in other populations is necessary before it can be recommended to identify subgroups of the population to be directed towards more extensive clinical evaluation. Refereed/Peer-reviewed

Background: Cervical cancer is one of the commonest cancers among women all over the world. The association of cervical cancer with human papilloma virus (HPV) is well established. Knowledge about the causal relationship between HPV and cervical cancer is important to make appropriate, evidence-based health care choices. In this context we conducted a community based study among women about the knowledge, attitude and practice about HPV infections and their health effects. Materials and Methods: A cross sectional interview based house to house survey was conducted with a validated data collection tool covering sociodemographic factors, knowledge, attitude and practice about HPV and its health effects, among 1020 women from a rural village, Perdoor, in Udupi district, Karnataka, India in 2013-14. Results: The mean age of participants was 38.9 years (SD=12.6). Study participants showed a high literacy rate (85.7%). Only 2.4% of sexually exposed women had undergone Pap smear testing. Partners of 4.4%women had undergone circumcision and they belonged to the Muslim community. Male condom usage was reported by 26 women (2.6%). However, none of the participants had heard of HPV and its health effects. Conclusions: This community based study found complete ignorance about HPV among rural South Indian women in spite of a high literacy level.

Introduction: Tobacco use can affect human health adversely and can lead to loss of productivity due to tobacco-related illnesses. It is a major cause of premature death across the world and in India. Objectives: (1) To determine the prevalence of tobacco use among adults in rural field practice area. (2) To study the knowledge and attitude regarding tobacco use. (3) To study the willingness to quit tobacco among its users. Methods; Study design: Cross sectional study. Study area: Rural field practice area of Department of Community Medicine. Kasturba Medical College, Manipal University, Manipal. A pretested semi-structured questionnaire was used to collect data from consenting adults during field visits. Tobacco usage status was categorised as per the WHO guidelines and the data was entered and analysed using Statistical Package for Social Sciences (SPSS) version 15.0(SPSS South Asia, Bangalore). Results are presented in frequencies and percentages. Chisquare test was applied to study association of factors with tobacco usage. Results: A total of 223 individuals were included in the study which comprised 139 (62.3%) males and 84 (37.7%) females. Of the surveyed population, 77(34.5%) were ever users of tobacco with 63(81.8%) being current users and 14 (19.2%) ex-users. Majority (89.7%) of the people were aware that tobacco use has harmful effects on health. Among current consumers, 47 (74.6%) of them were willing to quit tobacco. Conclusion: The study shows that inspite of having adequate knowledge regarding the ill-effects of tobacco use; the prevalence of its use is considerably high. Hence, there is a need to convert the knowledge into practice by behaviour change communication and provide timely support services like tobacco cessation clinics in the community.

Ducchen’s muscular dystrophy is most common X-linked recessive disorder affecting 30 in 100,000 live male births. The primary cause of this disease is mutations in Dystrophin gene which is essential for the structural and functional integrity of muscle. It is a progressive muscle wasting disease in which patients frequently develop contractures and lose the ability to walk between 6 and 12 years of age. With progressive disease most patients succumb to death from respiratory failure and cardiac dysfunction in their twenties. As this is a genetic disorder we can consider it as Adibala Pravritta Vyadhi. As Mamsa Kshaya is seen at some muscles and Mamsa Vriddhi at other this is an Avarana Vata Vyadhi. In both Upsthambha and Nirupasthmbha Vatavyadhi, Basthi is considered as prime choice of treatment. A Variety of Ksheerabasti in the form of Kalabasti is studied in this condition by taking subjective and objective parameters. As this has given better improvement with no adverse effects in the patient, it can be tried in large number of patients.

Background A rotavirus vaccine could soon become part of India's national immunization program. However the occurrence of intussusception due to rotavirus vaccine is a potential safety concern. This surveillance aimed at the collection of baseline data on childhood intussusception which would facilitate the monitoring of intussusception cases after the introduction of rotavirus vaccines. Methods We retrospectively reviewed medical records of confirmed intussusception cases in children under the age of five, treated during 2007–2012 at two tertiary care hospitals attached to medical schools in India. Demographic, clinical, diagnostic and treatment practices data were obtained from hospital records. Results Over a five to six year observation period, we identified 187 confirmed cases of intussusception, of which 75% were males. The median age of intussusception was 8 months, and we observed a possible trend in the distribution of cases with the highest number of cases being reported in the month of April and lowest in the month of October. The most common diagnostic methods used were ultrasonography and abdominal radiography with most cases being treated surgically (71%). The median length of hospital stay was 8 days (range 1–40) and mean was 10.2 days. Records of any fatality due to intussusception were not found during the review of the records. Conclusions This analysis provides an estimate of the baseline data of childhood intussusception prior to the introduction of the rotavirus vaccination as a part of routine immunization in India. A prospective surveillance system using a standardized case definition is needed in order to better examine the incidence of intussusception in developing countries.

Introduction. Preterm birth is the leading cause of newborn deaths and the second leading cause of death in children under five years old. Three-quarters of them could be saved with current, cost-effective interventions. The aim of this study was to identify the risk factors of preterm birth in a secondary care hospital in Southern India. Methods. In the case-control study, records of 153 antenatal women with preterm birth were included as cases. Age matched controls were women who had a live birth after 37 weeks of gestational age. Gestational age at delivery and associated risk factors were analyzed. Results. The preterm birth rate was 5.8%. Common risk factors associated with preterm birth were hypertensive disorders of pregnancy (21.4%), height Conclusion. The commonest obstetrical risk factor for preterm birth was hypertensive disorders of pregnancy and nonobstetrical risk factor was height

Drug-induced dysrhythmias are frequently encountered with several drugs that are routinely used in the practice of medicine. However, it is difficult to predict in which group of patients the rhythm disturbances can happen. The clinician should try to identify the cause of the new onset rhythm disturbance (electrolyte imbalance, ongoing cardiac insult, hypoxia, hemodynamic disturbance, cerebrovascular event, etc.). Once a drug is suspected, it should be documented on medical case record and everyone involved in the patients care should be informed.

We studied the urinary abnormalities and acute kidney injury (AKI) as per RIFLE criteria in scrub typhus. A prospective case record-based study of scrub typhus was carried out from January 2009 to December 2010 in a tertiary hospital in South India. Patients were followed up until renal recovery or for at least 3 months after discharge. Univariate, chi-squared tests and multivariate logistic regression analyses were performed to identify the predictors of AKI. Scrub typhus was diagnosed in 259 patients. Urinary abnormalities were seen in 147 patients (56.7 %) with 60 patients (23.2 %) having AKI. All AKI patients had urinary abnormalities and 17 (28.3 %) were oliguric. Applying RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria, R, I, F were present in 23 (38.33 %), 13 (21.67 %), and 24 patients (40 %), respectively. Creatine phosphokinase (CPK) was raised in 33 patients (55 %) and hemodialysis was required in 6 patients (10 %). The case fatality rate in this study was 2 out of 259 (0.77 %), both having AKI and others recovering clinically. Significant predictors of AKI were tachycardia [odds ratio (OR) 2.28], breathlessness (OR 2.281), intensive care requirement (OR 2.43), mechanical ventilation (OR 3.33), thrombocytopenia (OR 2.90) and CPK >80 U/L (OR 1.76) by univariate analysis and intensive care requirement (adjusted OR 2.89) and thrombocytopenia (AOR 2.28) by multivariable logistic regression. Scrub typhus should be part of the differential diagnosis of acute febrile illness with AKI. AKI in scrub typhus is usually mild, non-oliguric, and renal recovery occurs in most patients. Rhabdomyolysis may be contributory to AKI. Thrombocytopenia and intensive care requirement are significant predictors of AKI in scrub typhus.

Rising number of infertile males in India provokes the need of evidence-based comprehensive formula addressing unattended causes of male infertility. There is an innovative product*, a combikit available in Indian market, containing 30 tablets of antioxidant, multivitamin, amino acid and mineral tablets, with documented evidence on ingredients in treatment of male infertility, and 25 tablets of clomiphene citrate which is a timetested drug in treatment of male infertility (in particular oligospermia and/or asthenospermia). In order to assess efficacy of the product in Indian infertile male patients, we undertook phase IV multicentric clinical study, at 18 centers across India in 100 patients. Very high couple pregnancy rate of 53% was reported. As first line treatment of male infertility (in particular oligospermia and/or asthenospermia), the use of this innovative product therefore holds a strong promise. How to cite this article Amin J, Mishra SK, Dutta AK, Kunwar K, Shinde VG, Chauhan A, Sud S, Maurya R, Nepal N, Sarode P, Biswas KP, Mazumder GP, Chitrabanshi M, Shibe S, Shukla R, Trivedi N, Dayal M, Sortey D, Shukla S, Gawade B. Indian Clinical Experience on Innovative Product in Treatment of Male Infertility. J South Asian Feder Obst Gynae 2013;5(2):76-79.

Background: Unfavorable attitude towards mental health disorders are prevalent in the general population.Since teachers are considered as key resources in the promotion of adolescent’s mental health, assessing their attitudes and beliefs are crucial.Materials and Method: A descriptive cross-sectional study was conducted in Udupi Taluk. A semistructured questionnaire was used to assess their perceptions of regarding mental health disorders. A total of 93 high school teachers were included in the preliminary study.Results: Out of 93 respondents, 45(48.4%) were in the age group 30-39 years and 38 (40.9%) of the respondents had 5-9 years’ teaching experience. About (58.1%) of the respondents indicated that mental health problems were not a real medical illness and 80.6% of the respondents stated that mental health disorders were signs of personal weaknesses. About 53.8% cited that people with mental health problems were not dangerous to others and 55.9% of them reported that it is easier to give advice to someone else to seek help than for themselves in relation to mental health.Conclusion: Preliminary findings indicated that teachers were willing to participate in the study. There is a need to provide interventions to teachers to develop a positive attitude towards mental illnesses, which is very much essential in the promotion of mental health of the adolescents

Background: Hypertension in children and adolescents has become increasingly common. We sought to study the prevalence of hypertension among apparently healthy school children in Udupi Taluk, a rapidly developing coastal region in Karnataka in South India and correlate high blood pressures with age, gender and BMI. Method :A total of 2067 students (1055 boys and 1012 girls) between the ages of 5 – 16 years from rural schools in Udupi taluk were studied as part of school health services. Height (in cm) and weight (in kg) were recorded along with Blood Pressure measurements using the auscultatory method. Blood pressure was measured twice among children who were found to have a high reading (more than the 95th percentile) the first time. Using WHO charts for BMI for boys and girls, prevalence of overweight and obese children was determined. The evaluation of hypertension was based on the Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents. Results: Overall prevalence of hypertension in children was 2.2%. Prevalence of hypertension in female children was 2.4% and in males it was 2.1%. The proportion of hypertensives was found to the maximum in the 14-16 year age group. The prevalence of obesity among girls and boys was found to be 1.5% and 1.1% respectively. The prevalence of systolichypertension was found to be significantly higher (P=0.041) in obese children (12.5%) as compared to that in underweight children (1.4%). Conclusion: We found that higher BMI was associated with higher blood pressures. The results suggest that the prevalence of hypertension is mainly in the adolescent age group; therefore targeted screening in this group would be beneficial.

Background: Among adolescents, girls are particularly vulnerable not only because they are more likely to be coerced for unprotected sex but also because they are more susceptible biologically to sexually transmitted diseases (STDs), including HIV infection. This study was carried out to determine the effectiveness of an educational intervention programme aimed at girls focusing on knowledge of and attitude to HIV/AIDS. Method :An educational intervention study was carried out among 791 rural girls (16-19 years) randomly selected using stratified cluster sampling from coastal villages in Udupi Taluk, Karnataka, Southern India. They were educated regarding HIV/AIDS and their awareness levels were evaluated immediately and one month following intervention. Results: Around 35-50% of the girls had misconceptions regarding the modes of transmission which significantly reduced to about 8 % after intervention (95% CI of difference inproportion = (9.2, 17.9); p

Background: Menstrual abnormalities are a major gynaecological problem faced by adolescent girls leading to morbidity that may have an adverse effect on their school attendance. The objective of the study was to determine prevalence of menstrual disorders in girls aged 10-19 years and to study their treatment-seeking behaviour.Methods: We conducted a cross-sectional study on 592 girls in the age group of 10 to 19 years attending schools in Pune city during January 2016 to December 2016. Permission was sought from school authorities. Girls 10-17 years were included after obtaining parental consent. For 18 and 19 year olds, informed consent was taken from the girls themselves. Demographic information, height, weight and characteristics of menstrual period were noted.Results: Majority girls (36%) were in age group 12.1-14 years. Most prevalent menstrual disorder was painful menses reported by 70% of girls, followed by heavy menstrual bleeding (46%) and cycle irregularity (22%). All menstrual disorders were most commonly prevalent in the age group of 14.1 to 16 years. Proportion of girls visiting a doctor and taking medications for painful menses was 26.7% and 16.5% respectively, for heavy menstrual bleeding was 25.7% and 16.5% respectively and for cycle irregularity was 33% and 16.5% respectively. No association was found between mother’s education and treatment seeking behaviour for menstrual disorders.Conclusions: In spite of high prevalence of menstrual disorders, only a minority of the adolescents seek expert advice. This underscores the need for creating awareness among girls, mothers and teachers and developing a screening tool to identify girls who could benefit by further investigation and follow-up.

Background The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub- Saharan Africa. The effect of malnutrition is high morbidit and mortality among young children. The objective of this study was to determine the nutritional status of children aged between 3-6 years registered in government sponsored maternal and child care Anganwadi centres in India. Method A cross-sectional study was conducted in 35 centres in 11 villages situated in the field practice area of Community Medicine Department of a Medical College situated in Southern India. Results Of the 585 children in the study, 46.5% of the children were aged between 36 to 48 months. Assessment of nutritional status using the ICDS growth chart revealed malnourishment to be present among 189 (32.3%) children, of whom 166 children were grade I malnourished and 23 children were grade II malnourished. Proportionally girls (46.2%) were more malnourished than boys (33.6%). No significant association was found between the nutritional status of children and their duration of stay in an Anganwadi centre (p-value=0.56).Conclusion The findings of this study indicate that malnutrition is still an important problem even among children attending Anganwadis. Further improvements in functioning of Integrated Child Development Services need to be made in order to address the problem of malnutrition

Background: The ubiquitous use of electronic health records (EHRs) during medical office visits using a computer monitor and keyboard can be distracting and can disrupt patient-health care provider (HCP) nonverbal eye contact cues, which are integral to effective communication. Provider use of a remote medical scribe with face-mounted technology (FMT), such as Google Glass, may preserve patient-HCP communication dynamics in health care settings by allowing providers to maintain direct eye contact with their patients while still having access to the patient’s relevant EHR information. The medical scribe is able to chart patient encounters in real-time working in an offsite location, document the visit directly into EHR, and free HCP to focus only on the patient. Objective: The purpose of this study was to examine patient perceptions of their interactions with an HCP who used FMT with a remote medical scribe during office visits. This includes an examination of any association between patient privacy and trust in their HCP when FMT is used in the medical office setting. Methods: For this descriptive, cross-sectional study, a convenience sample of patients was recruited from an outpatient dermatology clinic in Northern California. Participants provided demographic data and completed a 12-item questionnaire to assess their familiarity, comfort, privacy, and perceptions following routine office visits with an HCP where FMT was used to document the clinical encounter. Data were analyzed using appropriate descriptive and inferential statistics. Results: Over half of the 170 study participants were female (102/170, 59.4%), 60.0% were Caucasian (102/170), 24.1% were Asian (41/170), and 88.8% were college-educated (151/170). Age ranged between 18 and 90 years (mean 50.5, SD 17.4). The majority of participants (118/170, 69.4%) were familiar with FMT, not concerned with privacy issues (132/170, 77.6%), and stated that the use of FMT did not affect their trust in their HCP (139/170, 81.8%). Moreover, participants comfortable with the use of FMT were less likely to be concerned about privacy (P