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Introduction: A positive childbirth experience and satisfaction are the key indicators defining the quality of care pregnant mothers receive in a healthcare institution. Therefore, researchers have sought multiple strategies to improve childbirth experience and maternal satisfaction. In light of this background, the current research aims to evaluate the effectiveness of peanut ball intervention in improving maternal satisfaction and promoting positive childbirth experiences and behavioural responses. Methods: The current research employed a randomised control trial in which 768 low-risk primigravid women were recruited into two groups: treatment (n = 384) and control (n = 384). A comparative evaluation of the outcomes was carried out between the peanut ball intervention provided to the treatment group and the standard care provided to the control group. Data was collected using an observation checklist for behavioural response and a questionnaire for childbirth experience and maternal satisfaction. Results: The study revealed a significant mean score difference in behavioural response, childbirth experience and maternal satisfaction, indicating the effectiveness of the peanut ball intervention in improving these outcomes. Conclusion: The peanut ball intervention can effectively improve positive behavioural response, childbirth experience and maternal satisfaction among low-risk primigravid women. The current study provides insight into healthcare providers' consideration of the peanut ball intervention among pregnant mothers as a safe and comfortable method of childbirth.

Objective: In India, despite a reduction in perinatal mortality rate from 2014 to 2019, still birth rate is still the same at the national average of 4/1000 live births. As yet there is no nation-wide audit in India except for facility based audits. Hence the need for a simplified yet effective audit process exists. The aim of this study was to perform a qualitative perinatal audit and devise methods for future audits. Methods: We conducted a one year audit for all perinatal deaths using WHO ICD PM and 3-delay classification. Gestational age (GA) specific mortality was calculated for significant underlying factors using fetuses-at risk approach. Results: We recorded a perinatal mortality rate of 6.1/1000 births among booked cases and 21.32/1000 births among referred cases. Fetal growth restriction was the most common antenatal condition, accounting to 33.3% of antepartum deaths. Prematurity accounted to 52% of neonatal deaths. Phase 2 delay with delayed referrals in severe pre-eclampsia and Phase 1 delay with late visit (> 24 h) to hospital after experiencing absent fetal movements were the most common identifiable delays. Hypertension stood out to be the single most common risk-factor. GA specific mortalities, calculated using fetuses-at risk approach, show a peak mortality rate at 30 weeks, 37 weeks and 38 weeks in pregnancies with early-onset preeclampsia, severe fetal growth restriction and medically treated gestational diabetes respectively. Conclusion: The audit identified significant contributing factors to the mortality. ICD-PM and 3-delay classification was simpler and easier to apply with wide areas of opportunities for secondary analysis.

Seashell powder (SSP) is a waste from aquatic life that is generally available near the coastal region. Due to its high calcium content, SSP can be utilized as a supplementary cementitious binder. SSP can be used as a sustainable binder to replace ordinary Portland cement (OPC) and significantly reduce the carbon footprint. The present study investigates the effects of SSP and waste glass powder (WGP) on the fresh, mechanical, and microstructure properties of high-strength concrete (HSC). The SSP utilized in this research was varied, with 5%, 10%, and 15% cement replacement levels. The impact of WGP was also observed with two replacement levels, 5% and 10%, replacing natural sand. The slump flow of all the HSC mixes varied between 700 and 785 mm. A maximum compressive strength of 112.91 MPa was found for the C75SSP5 mix at 56 days. The split tensile strength values of all the HSC mixes were found in a range from 5.45 to 10.56 MPa. The modulus of elasticity values of all the HSC mixes were found to lie between 40.2 and 46.8 GPa. The lowest water absorption was observed in the mix containing 5% SSP. The SEM image of the HSC with increased SSP showed that it was denser and had fewer unreacted particles. XRD and EDS showed the presence of various gels, such as calcium silicate hydrates (CSHs), ettringite, calcium hydroxide (CH), and calcium carbonate (CC). The predicted equations for its split tensile strength, flexural strength, modulus of elasticity, and water absorption were also carried out in the present research.

A clinical syndrome that is consistent with intravascular hemolysis and that mimics hemolytic transfusion reaction is called pseudo-hemolytic transfusion reaction (PHTR). We present one such clinical scenario with PHTR. A 24-year-old patient was referred to our center with all the signs and symptoms of hemolytic reaction (HTR) on the second postoperative day following cesarean section. HTR was ruled out following a detailed transfusion reaction workup. Ultrasound abdomen was suggestive of gross ascites. Exploratory laparotomy showed large rectus sheet hematoma and hemoperitoneum. Internal bleeding and resolution of hematoma caused the signs and symptoms mimicking HTR in the present case. The literature review revealed the other causes of PHTR. Any adverse event occurring in temporal association with transfusion is a trigger for detailed reaction workup. In a case with PHTR, laboratory workup to rule out HTR is one of the important steps in patient management.

Gestational Gigantomastia (GG) is a rare condition that presents with excessive enlargement of breast which becomes uncomfortable and embarrassing. Here is a case report of a primigravida who presented to us with GG at term. Post-delivery she had abscess formation and difficulties in breastfeeding. She was conservatively treated by abscess drainage and lactation suppression.

Adrenal insufficiency can manifest with various symptoms ranging from haemodynamic compromise to non-specific symptoms like myalgia, anorexia, and loss of weight. Aetiology can be primary adrenal disorder or secondary to suppression of HPA axis. We report a case of secondary adrenal insufficiency presenting with persistent nausea and vomiting.

A 60-year-old postmenopausal woman, presented with a left ovarian cystic mass with mildly elevated CA125 levels. An intraoperative frozen section showed oedematous ovarian stroma with interspersed large aggregates of spindle shaped stromal cells. Subsequently, the excised specimen was reported as Sertoli-Leydig Cell Tumour (SLCT) of intermediate differentiation. The leydig cells were identified in the imprint smears, but were misinterpreted as luteinized cells. The lack of tubular differentiated cells in frozen section had contributed to the misdiagnosis. Immunohistochemistry (IHC) played an important diagnostic role in the absence of clinical suspicion and lack of virilising features that are classically described in association with SLCTs. This case is unusual, as the tumour was seen in a postmenopausal woman in the absence of virilising symptoms. The cytomorphological features, IHC findings and the reasons for misdiagnosis are discussed in this case report.

Background: Despite advances in diagnosis, management and critical care of patients with peritonitis due to hollow viscus perforation, prognosis remains poor. Early assessment by scoring systems will influence the management and prognosis. Aim: Evaluation of Mannheim Peritonitis Index (MPI) score for predicting the outcome in patients with peritonitis. Materials and Methods: Prospective study of 50 patients admitted and operated for peritonitis in JSS Medical College Hospital. The structured scoring system i.e. MPI was applied along with other clinical and biochemical parameters recorded in pre-structured proforma. Data was analysed for predicting mortality and morbidity using EPI info and SPSS software. Results: The overall mortality and morbidity was 14% and 38% respectively. MPI scores of ≤ 20, 21-29, and ≥ 30 had a mortality of 5%, 14%, and 50% respectively. MPI score of 25 had highest sensitivity of 72.09% and specificity of 71.43% in predicting mortality, 80.65% sensitivity and 57.89% specificity for morbidity. MPI score of > 25 were associated with 6.45 times higher risk of mortality (p=0.03), 5.72 times higher risk of morbidity (p=0.005) compared to patients with MPI score ≤ 25. Conclusion: MPI is disease specific, easy scoring system for predicting the mortality in patients with secondary peritonitis. Increasing scores are associated with poorer prognosis, needs intensive management and hence it should be used routinely in clinical practice.

Umbilical endometriosis is rare and challenging in both diagnosis and treatment. We report a case of an umbilical scar endometriotic nodule in a 39-year-old lady following laparoscopy-assisted vaginal hysterectomy. The wide local excision of the nodule and histopathological examination confirmed the diagnosis. We discuss the pathogenesis, diagnosis, differential diagnosis, and treatment options for the patient.

Background. Progressive proteinuria indicates worsening of the condition in hypertensive disorders of pregnancy and hence its quantification guides clinician in decision making and treatment planning. Objective. To evaluate the efficacy of spot dipstick analysis and urinary protein-creatinine ratio (UPCR) in hypertensive disease of pregnancy for predicting 24-hour proteinuria. Subjects and Methods. A total of 102 patients qualifying inclusion criteria were evaluated with preadmission urine dipstick test and UPCR performed on spot voided sample. After admission, the entire 24-hour urine sample was collected and analysed for daily protein excretion. Dipstick estimation and UPCR were compared to the 24-hour results. Results. Seventy-eight patients (76.5%) had significant proteinuria of more than 300 mg/24 h. Dipstick method showed 59% sensitivity and 67% specificity for prediction of significant proteinuria. Area under curve for UPCR was 0.89 (95% CI: 0.83 to 0.95, P

Hepatic mesenchymal hamartoma is a rare benign tumor. We present an unusual case of a fetal abdominal cyst, later diagnosed histopathologically to be mesenchymal hamartoma of liver. The organ of origin was indeterminate on both prenatal and postnatal ultrasounds. As there are no specific sonological findings, whenever a large multicystic fetal abdominal cyst is seen, mesenchymal hamartoma should be considered as a possibility.

Genetic aberrations comprise one-third of women with premature ovarian aging (POA). X chromosome abnormalities are seen in these women. We report a case of a 29-year-old lady with primary infertility and POA. She was phenotypically normal and her basal follicle stimulating hormone level was above the age-specific cut-off. Karyotype was triple X syndrome.

In Ophthalmic practice diazepam is often used a a premedicant. We report a case where administration of diazepam led to a state of acute delirium because of which surgery had to be postponed. The possible mechanisms for this reaction and the treatment is discussed. This side effect of diazepam should be kept in mind while dealing with delirium in the geriatric age group.

Intra-abdominal infections (IAIs) are one of the important contributors to sepsis in intensive care units. The emergence of antibiotic resistance and the diversification of etiological agents make it challenging to determine the optimal empirical therapy. This study attempts to know the etiological agents, their antibiotic susceptibility patterns, and the risk factors associated with IAIs in different settings. This prospective cross-sectional study was conducted in a tertiary care facility from January 2023 to June 2023. Adult and paediatric patients having primary IAI or developed infections during their hospital stay were included in this study. Specimen like peritoneal swabs or fluid from intra-abdominal drains placed for more than 24 hours were excluded. Matrix-assisted Laser Desorption/Ionization Time-Of-Flight was used to identify the etiological agents. Vitek®2 system was used to perform the antimicrobial susceptibility. Associated risk factors were documented. A total of 86 cases were analysed. The majority of the patients had complicated IAIs (95.3%), and 65.12 % acquired the infection in the community (CA-IAI). The vast number of cases presented with intra-abdominal abscesses (46.5%). Diabetes and hepatic disorders were the frequent underlying comorbid conditions associated with CA-IAIs. Prolonged hospital stay and the presence of concomitant conditions like malignancy and chronic renal failure significantly influenced the occurrence of hospital-acquired infections (HA-IAIs). E. coli was the frequently isolated Gram-negative pathogen both in the community and hospital settings. Whereas among Gram-positives, Enterococcus predominated and was commonly isolated from HA-IAIs. Enterobacterales were highly susceptible to meropenem and piperacillin-tazobactam. E. coli and Klebsiella were the frequent extended-spectrum beta-lactamase producers and showed the least susceptibility towards cephalosporins and fluoroquinolones. Multidrug-resistant organisms (MDROs) (p=.013), including carbapenem-resistant strains (p=.048), were significantly isolated from hospital-acquired IAIs. The high prevalence of IAIs with MDROs in hospital settings emphasizes the importance of developing hospital-based antibiotic policy, infection control measures, and judicious use of antibiotics.

Byline: V. Muralidhar, Atish. Pal Introduction Perioperative anaphylactic reactions increase the risk of mortality and morbidity significantly. There are no guidelines on how to proceed following an incident of drug-induced [...]

Summary: Background: Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality in patients receiving mechanical ventilation in India. Surveillance of VAP is essential to implement data-based preventive measures. Implementation of ventilator-associated events (VAE) criteria for surveillance has major constraints for low resource settings, which can lead to significant underreporting. Surveillance of VAP using common protocols in a large network of hospitals would give meaningful estimates of the burden of VAP in low resource settings. This study leverages a previously established healthcare-associated infections (HAI) surveillance network to develop and test a modified VAP definition adjusted for Indian settings. Methods: In this observational pilot study, thirteen hospitals from the existing HAI surveillance network were selected for developing and testing a modified VAP definition between February 2021 and April 2023. The criteria used for diagnosing VAP were adapted from the CDC’s Pediatric VAP definition and modified to cater to the needs of Indian hospitals. Designated nurses recorded each VAP event in a case report form (CRF) and also collected denominator data. The data was entered into an indigenously developed database for validation and analysis. At the time of data analysis, a questionnaire was sent to sites to get feedback on the performance of the modified VAP definitions. Findings: Out of 133,445 patient days and 40,533 ventilator days, 261 VAP events were recorded, with an overall VAP rate of 6.4 per 1000 ventilator days and a device utilization ratio (DUR) of 0.3. A total of 344 organisms were reported from the VAP events. Of these, Acinetobacter spp (29.6%, 102) was the most frequent, followed by Klebsiella spp (26.7%, 92). Isolates of Acinetobacter spp (98%) and Enterobacterales (85.5%) showed very high resistance against Carbapenem. Colistin resistance was observed in 6% of Enterobacterales and 3.2% of Acinetobacter spp. Interpretation: Data from this pilot study needs to validated in the larger Indian HAI surveillance network so that it can help in wider implementation of this protocol in order to assess its applicability p VAP across India. Funding: This work was supported by a grant received from the Indian Council of Medical Research (code I-1203).