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Background: The promotion of clinical abilities could represent a significant factor leading the clinicians to in making the correct diagnosis in a timely matter. Case: Our patient is a 42-year-old African male with a history of Hypertension, ESRD on hemodialysis via right-sided Permcath (PC), Mastoidectomy & Right ear surgery due to trauma in childhood, AV Fistula (Needed intervention 4 times) in left upper extremity, admitted due to witnessed seizures in the setting of hypertensive emergency. The patient denied family history and toxic habits. While the patient was at the emergency room, CT head revealed stable curvilinear hyper-attenuation thought to be a thrombosed developmental vein more likely than small subarachnoid hemorrhage. He was loaded with levetiracetam, received Ativan 1mg IV and HD done as per Nephrology. The patient was transferred to the floor he was not in acute distress and was asymptomatic, the cardiovascular (CV) examination showed regular pulse, normal S1, S2, S4+ appreciated with 2/4 diastolic murmur at second right intercostal space (ICS); 2/6 pansystolic murmur at third right intercostal space left parasternal border (LPSB) radiated to the right parasternal border (RPSB) and right mid-clavicular line (MCL); 3/6 systolic murmur at 5LICS MCL radiated to the posterior axillar line (PAL). Point of maximal impulse (PMI) displaced to mid axillar line (MAL). Parasternal heave present; the neurological exam was preserved. Endocarditis was suspected and echocardiogram was expedited, it showed severe aortic regurgitation, 1.60cm x 1.68cm mass in the tip of the catheter in the right atrium, possible vegetation in the tricuspid valve with mild regurgitation, moderate mitral valve regurgitation. Later, staphylococcus epidermidis was identified in blood cultures twice, as well as the culture from the PC. The transesophageal echocardiogram found 2.41 X 0.62 cm mass appears to be a fibrin sheath, possibly remnant of a prior catheter, small perforation in the non-coronary cusp likely in the setting of healed endocarditis. Infectious disease onboard for antibiotic management. Conclusion: The art of the clinician goes beyond the available technology; it could prevent the loss of critical time as well as unnecessary studies, guiding a better assessment and treatment of our patients and potentially improving their outcomes.

Early age at entry into the workforce makes it difficult for adolescents to obtain higher education and skills necessary for decent work and a better life. This study examines the factors determining engagement in paid and unpaid work and the age at entry into the workforce among young adults aged 23–27 years in Bihar, India, who were previously interviewed at the age of 15–19 years. The data were derived from the Understanding the Lives of Adolescents and Young Adults (UDAYA) in a sample of 2923 respondents. Young boys had significantly higher work participation than girls. Unmarried boys and girls started doing paid work earlier than married girls. A higher percentage of adolescents from the Scheduled Caste/Scheduled Tribes and Other Backward classes engaged in paid or unpaid work in young adulthood as compared to the General Caste. Children of educated mothers were more likely to delay their entry into the workforce. Adolescents who had attained 10–12 years (0.51, p

Cardiac cachexia (CC) represents a serious complication of heart failure (HF). This condition could be directly related to mortality. The weight or muscle mass loss has to be monitored in our patients with HF to avoid potential complications. We report a case of an elderly patient with a history of aortic stenosis (AS) who presented with progressive shortness of breath limiting his daily activities associated with weight loss. Signs of heart failure were evident on physical examination, and valvulopathy was also evident. His echocardiogram showed reduced ejection fraction (EF) with structural changes and severe aortic stenosis. He was not a candidate for cardiothoracic surgery, and a transcatheter aortic valve replacement (TAVR) was performed. After the procedure, his symptoms improved, and during the outpatient follow-up, his cardiac function and dry weight improved. Cardiac cachexia could be caused by reversible cardiomyopathy. Early assessment and approach are critical for the outcome of our patients, impacting their quality of life and outcome in terms of morbidity and mortality consequences.

Although the importance of working with young men to transform traditional gender norms has been widely acknowledged, programmes for young men remain sparse in highly gender stratified settings such as India, and those that have been implemented have not reached those in rural areas and those out-of-school. Drawing on data from a cluster randomised controlled trial with panel surveys, of a gender-transformative life skills education and sports-coaching programme conducted among young men aged 13-21 who were members of youth clubs, this paper examines the extent to which it transformed the gender role attitudes of young men and instilled in them attitudes rejecting violence against women and girls. The intervention succeeded in changing gender role attitudes and notions of masculinity, attitudes about men's controlling behaviours over women/girls, attitudes about men's perpetration of violence on a woman/girl and perceptions about peer reactions to young men acting in gender-equitable ways. Effects were particularly significant among young men who attended regularly, underscoring the importance of regular attendance in such programmes.

This study examines the association of individual and community-level characteristics with the choice of delivery location (home, public or private facility) for the most recent live birth of currently married women in Rural Uttar Pradesh, India. District Level Household Survey-Reproductive and Child Health Survey (DLHS-RCH, 2007-08) data on 30,856 currently married women belonging to 2827 villages in Uttar Pradesh, is used to assess effect of the village infrastructure and availability of public health services on choice of delivery location. Anderson Behavioural Model of health service use has been utilized through Multinomial Logistic regression analysis. Result indicates that other than usual individual risk factors, presence of government health facility, distance to nearest primary health centre and functioning of maternity benefit schemes in the villages has significant impact on choice of delivery location, where as presence of village health worker may not found to be associated with institutional delivery.

Access to quality care during pregnancy and especially at delivery seems to be the crucial factor in explaining the disparity in maternal health status. The choice of place of delivery has consistently been found to be associated with maternal and neonatal outcomes. The objective of the present paper is to understand the determinants of delivery location-institutional (public or private) and home; and reasons for non-utilization of facility for delivery care. The District Level Household Survey (2002-04) data for Rural Uttar Pradesh have been used, adopting the conceptual framework of Andersen Behavioural Model. A multinomial Logistic regression analysis was conducted to assess the determinants of home, public and private facilities for delivery. Most of the delivery had taken place at home, with public and private sector accounting for only seven percent and nine percent respectively. Women with higher birth order and those residing far from Primary health centres had greater odds of delivering at home than public facility, while maternal education, Antenatal care visits, regions and pregnancy complications are the significant predictor of institutional delivery. The results indicate that, after controlling for other variables access to health facilities do not have much effect on choice of public facility over home/private. Regional analysis showed significant differentials in reasons for not delivering at health facility. Given the predominance of home deliveries in the rural Uttar Pradesh, every attempt should be made to ensure that these are attended by trained birth attendants.