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Introduction: Pelvic stress fractures have been reported commonly among women military trainees from worldwide. They have been reported as the most common stress fracture in women in Indian military training academies. With the recent increase in avenues for women to join the armed forces and other paramilitary forces, there is a need for medical personnel to be familiar with the epidemiology of pelvis stress fractures unique to women. This article presents a clinical and epidemiological profile of these fractures and suggests approaches for their prevention. Methods: Fifty-one cases of pelvic stress fractures were observed among a cohort of 608 women trainees in the military training establishments of the Indian, Army, Navy, and Air force. Data on clinical presentation, diagnosis, and management were collected for those women trainees who developed radiologically confirmed pelvic stress fractures. Information was also taken to identify the possible risk factors. Measures which can be implemented during training have been suggested to reduce the risk of these fractures during training. Results: All women trainees with stress fracture pelvis presented with groin pain and difficulty in running and drill usually in the 6–9th week of training. X-rays showed involvement of the inferior pubic ramus. All of them made good recovery with conservative management. A large number of training-related factors and certain individual-related anatomical and physiological factors seem to have a role specifically leading to these fractures. Approaches to minimize the risk of pelvic stress fractures have been recommended for making the changes in training and managing individual factors. Conclusion: Specific measures for the prevention of pelvic stress fractures are required to be instituted, addressing the risk factors for Indian women undergoing military training along with general measures.

Context: Lymphangiogenesis correlates with poor prognosis in Invasive Ductal Carcinoma (IDC) breast. D2-40 antibody, a specific marker for lymphatic endothelium, differentiates lymphatic from vascular endothelium. Therefore, the aims of this study were to estimate lymphangiogenesis using D2-40 antibody and correlate with lymphatic invasion (LI) and axillary lymph node (LN) status and compare lymphatic mean vessel density (LMVD) with Tumor (T) and Node (N) stages and grade of tumor. Methods and Material: The study was conducted on fifty consecutive cases of IDC breast who underwent modified radical mastectomy (MRM) from Jan 2009 to March 2011. Hematoxylin-eosin sections and Immunohistochemistry (IHC) slides were studied along with their LN status. LMVD was counted after D2-40 immunostaining (100x magnification) in three hot spots in peritumoral areas and averaged. LI as opposed to vascular invasion (BVI), and LN status for all cases were assessed. Statistical Analysis: Statistical analysis was done using SPSS software (version 14.0 for Windows). Pearson's correlations, χ2 tests and Mann-Whitney U test were used. Results: Lymphangiogenesis varied from 0 to 58 with mean LMVD of 11. Of 50 cases, five showed no lymphatic vessels in peritumoral areas; of these five, three had positive LNs. 21/50 cases had LI. No statistical significant association was seen between lymphangiogenesis and LI. 34/50 cases had positive LNs. Mean LMVD was higher in patients with N2/N3 stage as compared to N0/N1 stage and was statistically significant (P = 0.013). Conclusions: D2-40 is specific marker for lymphatic endothelium. LI and lymphangiogenesis, as opposed to BVI, are better prognostic indicators in IDC breast.

Background: Emotional Intelligence has been associated with positive outcome process in varied professions. There is paucity of Indian literature on the subject; especially involving medical undergraduates; and presently there is no scale available to measure the same in the Indian scenario. Objective: To develop a scale to measure Emotional Intelligence among medical undergraduates. Materials and Methods: Four domains of Emotional intelligence were selected, viz. Self-Awareness, Self-Management, Social-Awareness & Social-Skills and these were included for the purpose of domains of the scale. On the basis of focused group discussions and in-depth deliberations with experts, undergraduate and postgraduate medical students a pool of 50 items was generated. The items were reduced to 27 based on expert consensus and on the basis of frequency of endorsement by expert reviews. It was followed by a pilot study of 50 undergraduates. This completed the preparation of the preliminary draft based on content analysis. The questionnaire was then administered in 480 students and the data was analyzed by appropriate statistical methods. For the purpose of concurrent validity, emotional intelligence scale developed by Dr. Ekta was used. Results: The Cronbach′s Alpha for Internal Consistency Reliability was 0.68. The EIS had a significant correlation with social awareness domain of Emotional Intelligence Test (EIT) establishing Concurrent Validity. Conclusion: Emotional Intelligence Scale for medical undergraduates was constructed. Reliability and concurrent validity were also established for the same.

Menopause is an inevitable phase in every woman's life. Women may suffer from unpleasant symptoms during perimenopause. Understanding the health needs of the community during this period will help in developing menopause management programs that can improve quality of life., Aim: To study the symptoms of menopause and perception of women in relation to menopause in order to understand their needs., Settings and Design: A cross-sectional, multi-centric study was undertaken at three institutions (called DH, SJ, and SK) at two cities in India. The study population comprised women between the ages of 40 and 60. Institutional Ethics Committee approval and consent of participants were ensured., Material and Methods: Two instruments, a pilot-tested, peer-reviewed, validated, structured questionnaire and the Menopause Rating Scale (MRS) were utilized for the study. The minimum sample size was calculated to be 385 per site. Statistical analysis was conducted using the IBM Statistical Package for Social Sciences., Results: A total of 1297 forms were analyzed. MRS scores showed psychological symptoms to be most prevalent. Joint and muscular pains were the most common somatic symptoms. Hot flashes and urogenital symptoms were experienced by a lower number. Our MRS scores were significantly higher than those seen in other regions. Urban women, site SJ, those with irregular menstrual cycles, and lower incomes scored higher than their counterparts. Awareness about menopause was patchy, especially regarding medication or support services available., Conclusions: The high MRS scores emphasize the need to institute awareness programs, providing information on choices available for care (hormone replacement therapy, medications, or counseling) and information on where to access services. Primary care physicians can play a vital role in fulfilling this need by ensuring timely knowledge to the community, providing correct diagnosis and treatment. This will help improve the quality of life and sense of well-being of this community., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Context: Lymphangiogenesis correlates with poor prognosis in Invasive Ductal Carcinoma (IDC) breast. D2-40 antibody, a specific marker for lymphatic endothelium, differentiates lymphatic from vascular endothelium. Therefore, the aims of this study were to estimate lymphangiogenesis using D2-40 antibody and correlate with lymphatic invasion (LI) and axillary lymph node (LN) status and compare lymphatic mean vessel density (LMVD) with Tumor (T) and Node (N) stages and grade of tumor., Methods and Material: The study was conducted on fifty consecutive cases of IDC breast who underwent modified radical mastectomy (MRM) from Jan 2009 to March 2011. Hematoxylin-eosin sections and Immunohistochemistry (IHC) slides were studied along with their LN status. LMVD was counted after D2-40 immunostaining (100x magnification) in three hot spots in peritumoral areas and averaged. LI as opposed to vascular invasion (BVI), and LN status for all cases were assessed., Statistical Analysis: Statistical analysis was done using SPSS software (version 14.0 for Windows). Pearson's correlations, χ 2 tests and Mann-Whitney U test were used., Results: Lymphangiogenesis varied from 0 to 58 with mean LMVD of 11. Of 50 cases, five showed no lymphatic vessels in peritumoral areas; of these five, three had positive LNs. 21/50 cases had LI. No statistical significant association was seen between lymphangiogenesis and LI. 34/50 cases had positive LNs. Mean LMVD was higher in patients with N2/N3 stage as compared to N0/N1 stage and was statistically significant (P = 0.013)., Conclusions: D2-40 is specific marker for lymphatic endothelium. LI and lymphangiogenesis, as opposed to BVI, are better prognostic indicators in IDC breast., Competing Interests: There are no conflicts of interest

Background: Most studies on stress fractures in India have been carried out among recruits as against officer trainees and limited to males. With the continuous induction of women in the Armed Forces, it was decided to carry out a study among officer trainees of the three services and compare the epidemiology among genders., Methods: A prospective study was carried out in 2011-2012 at Training Institutes of the three services where male and female cadets train together. Baseline data was collected for all trainees who joined the academy during the study period. All cadets were followed up for development of stress fractures for which details were taken. Additional information was taken from the Training Institute., Results: A total of 3220 cadets (2612 male and 608 female cadets) were included in the study. Overall 276 cadets were observed to have stress fractures during training - making an incidence of 6.9% for male cadets and 15.8% for female cadets. Females were found to have a significantly higher incidence of stress fractures. Further the distribution and onset of stress fractures in females was observed to be distinct from males., Conclusion: The significant gender differential observed in the study indicates differential role of intrinsic and extrinsic risk factors in the causation of stress fractures among male and female. Special consideration needs to be given to these while planning and implementing measures for prevention. Further studies may be carried out on subject and on the effect of interventions in stress fracture prevention.

Background & Objectives: Violence against women cutting across diverse socio-economic classes is an under-recognized human rights violation in the world. This analysis was undertaken to examine the prevalence along with predictors of intimate partner violence (IPV) and its association with HIV/AIDS and sexually transmitted infections (STIs) in Indian ever-married women., Methods: The data obtained from 2005 to 2006 third round of National Family Health Survey-3 (NFHS-3) were used in this study. Analyses were conducted on ever-married women by linking individual women data including violence information and HIV test results., Results: The analyses indicated all forms of violence to be prevalent in India. The prevalence of lifetime IPV reported was 35.3 per cent. Multivariate analysis using logistic regression identified younger age of women, higher number of children, low level of education of women as well as her partner, working status of women, higher spousal age, rural residence, alcohol consumption by husband, childhood witness of violence among parents, nuclear household and lower standard of living to be positively associated with the experience of IPV by the women (P<0.05). HIV-positive status of women, as well as women from high HIV prevalent State, were at increased odds of IPV (P<0.05)., Interpretation & Conclusions: Significantly higher reporting of HIV/STIs by women experiencing IPV hints at new pathways that link violence and HIV. Further, our analysis showed a high prevalence of IPV in India.

Background: This study was done to compare the accuracy of the Lactate Pro LT 1710 (Arkray Inc., Kyoto, Japan) with the Combiline Plus (Eschweiler GmbH & Co. KG Holzkoppelweg, Kiel, Germany), and also, to analyze the prognostic significance of serum lactates and Simplified Acute Physiology Score 3 (SAPS 3) in patients of severe sepsis., Methods: 106 patients of severe sepsis admitted to the ICU were screened. The serum lactate from an arterial sample analyzed in both the machines was recorded at admission and at 48 h. These patients were then followed up to the 28th day for mortality., Results: The Lactate Pro LT 1710 handheld point of care lactate meter provides consistent results comparable to the Eschweiler Combiline blood gas analyser. Serum lactate concentration was significantly higher in nonsurvivors at the time of admission (3.30 ± 1.26) and at 48 h (4.34 ± 1.73). Lactate clearance at 48 h appears to be a better predictor of mortality than the lactate levels at 0 h and 48 h. The mean SAPS 3 at admission amongst survivors was significantly less as compared to nonsurvivors. The SAPS 3 had improved to 47.44 (±11.79) in survivors at 48 h, while in nonsurvivors it had worsened to 81.98 (±12.32) ( p  = 0.00); thus, a worsening SAPS 3 at 48 h had a poorer prognosis., Conclusions: The Lactate Pro LT 1710 provides similar results to the Combiline Eschweiler blood gas analyser and is a cheaper alternative. It would prove to be a boon in peripheral hospitals in the aggressive management of critically ill patients.

Background: Empathy is essentially a desirable quality among clinicians and can be developed during medical education. Studies from outside India have shown that higher empathy is related to better competency and choice of specialty may be related to empathy levels in them. Change in empathy levels among undergraduate medical students with progressive training has been often ascribed to reasons such as curriculum content, timing of clinical rotations. Gender differences in empathy levels also vary among different countries. Since many of such factors differ in India there is a need therefore to understand empathy and its correlates among medical students in India., Method: A cross sectional study was undertaken in a large medical college among the undergraduates of first, third, fifth, seventh and ninth semesters to measure their empathy levels. The evaluation was done using the Jefferson's Scale for Physician's Empathy- Student version., Results: The study revealed highest empathy at entry level and a significant fall by seventh semester (p = 0.002). Female students had significantly higher empathy levels than male students (p = 0.012) across all semesters. The variance in empathy scores according specialty chosen is not statistically significant (p = 0.2468)., Conclusion: The progressive decline in empathy levels with years in medical college here is seen much later than in western studies. Female students are more empathetic than male students. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies.

Background: Ascitic fluid aspirate cytology, although reasonably specific is not a good screening tool for malignant ascites due to poor sensitivity. Simple test(s) on ascitic fluid or serum which can help differentiate between benign and malignant causes of ascites will be a boon. Ascitic fluid lactate dehydrogenase, cholesterol, and ferritin are the candidate markers evaluated in this study., Methods: Ascitic fluid cytology was done on 30 patients of malignant ascites. The modalities used for diagnosing malignant ascites were positive peritoneal biopsy or CT scan evidence of hepatic metastases. Ascitic fluid biochemistry was done in all these 30 patients as well as 30 cases of non-malignant ascites. The parameters analysed were cholesterol, lactate dehydrogenase, and ferritin. The biochemical parameters were estimated in serum as well., Results: Cytology had a sensitivity of 40% for the diagnosis of malignant ascites. Ascitic fluid cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 70%, 74%, and 100%, respectively. Serum cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 57%, and 91%, respectively., Conclusion: Hence, these biochemical markers in ascitic fluid as well as serum can be good screening tools for the diagnosis of malignant ascites.

Background: Emotional Intelligence has been associated with positive outcome process in varied professions. There is paucity of Indian literature on the subject; especially involving medical undergraduates; and presently there is no scale available to measure the same in the Indian scenario., Objective: To develop a scale to measure Emotional Intelligence among medical undergraduates., Materials and Methods: Four domains of Emotional intelligence were selected, viz. Self-Awareness, Self-Management, Social-Awareness & Social-Skills and these were included for the purpose of domains of the scale. On the basis of focused group discussions and in-depth deliberations with experts, undergraduate and postgraduate medical students a pool of 50 items was generated. The items were reduced to 27 based on expert consensus and on the basis of frequency of endorsement by expert reviews. It was followed by a pilot study of 50 undergraduates. This completed the preparation of the preliminary draft based on content analysis. The questionnaire was then administered in 480 students and the data was analyzed by appropriate statistical methods. For the purpose of concurrent validity, emotional intelligence scale developed by Dr. Ekta was used., Results: The Cronbach's Alpha for Internal Consistency Reliability was 0.68. The EIS had a significant correlation with social awareness domain of Emotional Intelligence Test (EIT) establishing Concurrent Validity., Conclusion: Emotional Intelligence Scale for medical undergraduates was constructed. Reliability and concurrent validity were also established for the same.

Background: Amputation of a limb affects almost all aspects of an individual's life. Psychological aspects are important factors for adjustment with the disability., Methods: The present study was carried out on 50 consecutive male patients admitted to the Artificial Limb Centre. Base line and post therapy psychological assessment was carried out on Hospital Anxiety and Depression Scale (HADS). Trauma Symptom Inventory (TSI) was administered along with Millon Index of personality styles (MIPS). Psychological intervention was given to them on a therapy module proposed by authors. Data was analyzed with the help of SPSS., Result: Findings revealed significant differences in scores on HADS, before and after therapy (p<0.05). On Trauma symptom Inventory defensive avoidance and depression were noted to be above cut off level of (>65). Predominant personality styles were self indulgence and internally focused in motivating styles (mean prevalence score <50) and thought guided in thinking styles, dominating and controlling in behaving styles. The analysis of prevalence score of above 50 and less than 50 indicated Confident/Asserting (9B), Submissive / Yielding (11A), having significant change after therapy on score of anxiety (P<0.05). The personality dimension of dutiful and conforming had shown significant influence after therapy (P<0.05) on score of depression., Conclusion: The findings indicated psychological assessment and intervention is to be included as a part of the management after amputation.

Background: Abnormalities of catecholaminergic function have been hypothesised in causation of depressive illness. Electroconvulsive therapy (ECT) is postulated to have noradrenergic mechanism of action. We studied the clinical utility of estimating catecholamines level changes after ECT., Methods: Plasma adrenaline, noradrenaline and dopamine in healthy controls and depressed patients were estimated by high performance liquid chromatography with electrochemical detection method before and after ECT., Result: Mean ± standard deviation of plasma adrenaline, noradrenaline and dopamine in controls was 36.7 ± 13.2, 209.3 ± 76, 21.8 ± 9.5 ng/L respectively, while in depressed patients before and after ECT it was found to be 32.5 ± 12.0, 419.3 ± 167.7, 22.1 ± 16.0ng/ L and 37.2 ± 19.6, 386.1 ± 168.4, 22.3 ± 15.5ng/L respectively. Correlation of adrenaline, noradrenaline and dopamine concentration with scores of Beck Depression Inventory, Suicidal Ideation Scale and Melancholia Inventory was positive but statistically not significant and poor. Based on the cut off values of noradrenaline, only 62% cases could be categorized as abnormal, which after ECT reduced to 50%, whereas post ECT psychiatric ratings was normal in about 78% cases., Conclusion: There is no clinical significance of estimating adrenaline, noradrenaline and dopamine in depressed patients.

Background: Training in medicine is emotionally demanding. Psychological well being of medical students is a matter of concern. There is lack of Indian studies in this area., Methods: A total of 105 medical student of one batch were assessed utilizing psychophysiological state inventory, Institute for personality and ability testing (IPAT) anxiety and depression scale, achievement motivation scale, scale for locus of control and 16 PF in three phases at one-year intervals., Result: Majority of the students had average achievement, motivation and adaptability. Anxiety and depression scores fell within normal limits. In personality profile factor 'B', 'M' and 'Q41' had changed significantly. Achievement motivation showed significant decreases and CSS1 and PO1 scores showed significant increase during the years of medical education., Conclusion: The results demonstrate that over satisfaction and relaxed attitude may have poor academic outcome.

Medical profession and nursing profession are noble professions. Both professions place heavy emphasis on desirable personality traits of being affectionate, humble and responsible. Personal qualities such as integrity, responsibility and empathy have often been mentioned in the literature as desirable qualities for these professions. The present study was planned to explore these personal attributes. Sample for the study consisted of 26 female medical students of first year MBBS and 29 female nursing students of first year B.Sc. Nursing course. The subjects were matched for age and sex. Personality profile was evaluated by administering 16 Personality Factor Form A. Findings revealed significant differences on factor 'A', 'F', 'H' and 'M'. On second order factors significant differences were noted on introversion-extroversion and independence-subduedness dimension.

Medical profession is one of the prestigious and esteemed professions amidst the professional opportunities available to young aspirants. Armed Forces Medical College by its virtue of selective admission procedures, training and induction becomes the primary focus of such research. The aim of the present study was to evaluate source traits of 300 medical students, 150 each from AFMC and civil medical college. 16 PF was administered to evaluate the source traits of study groups. Findings revealed significant differences between two colleges. The students from two colleges differed significantly on factors 'B', 'F', 'G', 'I', 'O', Q1, Q3, Q4.