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Introduction: Efficient cold chain and vaccine logistics management are made possible by the health system's processes, practices, and policies, which are evaluated by Effective Vaccine Management, a diagnostic tool. A significant number of urban Jabalpur children receive vaccinations from a government health facility. The aim of the study was to Assess the cold chain maintenance and vaccine management practices at urban government Cold Chain Points of Jabalpur district. Methods: A cross-sectional study was carried out at all of 13 urban government Cold Chain Points across Jabalpur district. Globally validated World Health Organization - United Nations International Children's Emergency Fund Effective Vaccine Management tool was used for this study. Criteria wise and Consolidated Effective Vaccine Management scores were calculated as per World Health Organization guidelines. Results: All the urban service point stores or cold chain points scored more than the target 80% in two criteria: storage capacity and building. The consolidated criteria score of all the cold chain points in urban Jabalpur, criteria like maintenance, stock management, management information system, and supportive functions, were lagging behind the 80% mark. Low scores in maintenance, stock management, and management information system and supportive functions criteria are somehow a setback for all the preparation and hard work done towards optimal vaccine management and supply chain in the area. Conclusion: The overall performance of the urban cold chain points in Jabalpur district was far better as compared to the state-level effective vaccine management assessment done in Madhya Pradesh in 2011 and 2016. Planned preventive maintenance for buildings and equipment needs to be strengthened. Issues like Lack of information for stock management, need for periodic refresher trainings are to be emphasized.

Background: A Nurse’s fatigue raises significant concerns for individual and patient safety. The impact of sleep deprivation on the quality of patient care is an important consideration in today’s health-care environment. Aims and Objectives: The aim of this study was to find the proportion of sleep deprivation among nurses in a tertiary care hospital and to find the association between sleep deprivation and mood states among staff nurses. Materials and Methods: It was a cross-sectional design done in a duration of 2 months from September to October 2022. The study group consisted of nurses working in a tertiary care hospital located in Jabalpur district. A sample size of 70 nurses was calculated through the statistical formula. The questionnaire has three sections: Demographics (nine questions), Epworth sleep scale (eight questions), and Profile of mood states (65 questions). The collected data were tabulated and analyzed using MS Office Excel and SPSS version 21. Results: Interviews were conducted with 70 nurses and 8.6% of them were found to be excessively sleepy and should seek medical attention. Significant results have been obtained for the association with tension, depression, anger, fatigue, and confusion with sleep deprivation. Conclusion: The findings suggest that sleep deprivation exists in a considerable state. Some workplace interventions need to be done to make the efforts of nurses worthwhile and to increase their vigor and positive mood.

Synchronous Tumours (ST) are defined as two or more neoplasms originating within six months of diagnosing the first neoplasm. Due to the rarity of synchronous cervical Squamous Cell Carcinoma (SCC) and ovarian Brenner tumours, their pathology has been poorly understood. These patients usually present with symptoms related to cervical cancer and are often diagnosed early. Since many synchronous tumours are incidentally discovered postoperatively, it is important to conduct thorough grossing and histopathological examinations. The primary differential diagnosis for synchronous tumours is multiple metastases from a single primary tumour. The management of multiple tumours is not well-defined and depends on various factors. In the present case, authors present a rare occurrence of synchronous neoplasms: cervical SCC and preoperatively undiagnosed benign Brenner tumour of the left ovary in a 52-year-old postmenopausal female. Immunohistochemistry helped rule out metastasis from a single primary and metastasis from cervical cancer to the ovary. The ovarian tumour showed immunoreactivity for GATA Binding Protein 3 (GATA) but was negative for Carcinoembryonic Antigen (CEA). The cervical SCC was immunopositive for CEA and p40, while no immunoreactivity was observed with GATA 3.

Penile hair strangulation is a rare clinical entity seen in infants and young children caused by entanglement of maternal hair around coronal sulcus. It is mostly accidental, and circumcision is a risk factor. An interesting case of penile hair strangulation in a 64-year-old adult uncircumscribed paraplegic male with erectile dysfunction has been described.

BackgroundRegulated breathing facilitates ventilation and reduces breathlessness. However, the effect of Yogic breathing on patients with COVID remains unclear. We aimed to evaluate the efficacy of two breathing protocols, i.e., short breathing technique (SBT) and long duration breathing technique (LBDT).MethodsThree groups including COVID-positive patients, COVID-recovered patients, and healthcare workers (HCWs) were included in the study and segregated into Yoga and control groups. SBT was administered to COVID-positive patients. Both SBT and LBDT were administered to COVID-recovered patients and HCWs. A total of 18 biochemical parameters, a 6-min walk test (6MWT), and a 1-min sit-stand test (1MSST) were assessed on 0th, 7th, and 15th days, where biochemical parameters were the primary outcome. Pre-post estimation of neuropsychological parameters (nine questionnaires) and heart rate variability (HRV) were carried out. The paired t-test or Wilcoxon rank test was applied for pre-post comparison and the Student's t-test or Mann–Whitney U test was used for group comparison. Repeated measures test was applied for data recorded at three time points.ResultsA significant elevation in white blood cell (WBC) count was observed in COVID-positive intervention (p < 0.001) and control groups (p = 0.003), indicating no role of intervention on change in WBC number. WBC count (p = 0.002) and D-dimer (p = 0.002) significantly decreased in the COVID-recovered intervention group. D-dimer was also reduced in HCWs practicing Yogic breathing as compared to controls (p = 0.01). D-dimer was the primary outcome, which remained below 0.50 μg/ml (a cutoff value to define severity) in the COVID-positive yoga group (CYG) and decreased in the COVID-recovered yoga group (RYG) and the HCW yoga group (HYG) after intervention. A 6-min walk test (6MWT) showed an increase in distance covered among the COVID-positive patients (p = 0.01) and HCWs (p = 0.002) after intervention. The high-frequency power (p = 0.01) was found to be reduced in the COVID-positive intervention group. No significant change in neuropsychological parameters was observed.ConclusionYogic breathing lowered D-dimer, which is helpful in reducing thrombosis and venous thromboembolism in patients with COVID-19 besides lowering the chances of vaccine-induced thrombotic thrombocytopenia in vaccinated individuals. The breathing intervention improved exercise capacity in mild to moderate cases of COVID-19. Further studies can show if such breathing techniques can influence immunity-related genes, as reported recently in a study. We suggest that Yogic breathing may be considered an integrative approach for the management of patients with COVID.Trial registrationhttp://ctri.nic.in/Clinicaltrials/login.php, identifier: CTRI/2020/10/028195.

Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.

Abstract Background In India, around 20,000 women die every year due to abortion-related complications. In count data modeling, there is sometimes a prevalence of zero counts. This article is concerned with the estimation of various count regression models to predict the average number of spontaneous abortions among women in Punjab and few northern states in India. The study also assesses the factors associated with the number of spontaneous abortions. Methods This study includes 27,173 married women of Punjab obtained from the DLHS-4 survey (2012–13) to train the count models. The study predicts the average number of spontaneous abortions using various count regression models, and also identifies the determinants affecting the spontaneous abortions. Further, the best model is validated with other northern states of India using the latest data (NFHS-4, 2015–16). Results Statistical comparisons among four estimation methods reveals that the ZINB model provides the best prediction for the number of spontaneous abortions. The study suggests total children born to a woman, antenatal care (ANC) place, place of residence, woman’s education, and economic status are the most significant factors affecting the instance of spontaneous abortion. Conclusions This article offers a practical demonstration of techniques designed to handle count outcome variables. The statistical comparisons among four estimation models revealed that the ZINB model provides the best prediction for the number of spontaneous abortions, and it suggests policymakers to use this model to predict the number of spontaneous abortions. The study recommends promoting higher education among women in Punjab and other northern states of India. It also suggests that women must receive institutional antenatal care and have a limited number of children.

Abstract This study tries to elicit the unexplored nexus between the contraceptive failure and abortions in India’s most populous state Uttar Pradesh. Condom being the most used modern method contributes to 47% of all observed episodes in the calendar period. Of all accidental pregnancies occurred because of modern contraceptive failures, 35.2% terminated with induced abortions. Gross failure rate of modern methods is conspicuously higher for urban poor, uneducated women, and marginalized section of population living in urban area. From a total of 7496 episodes of all reversible methods, abortions are estimated as high as 29.2%, whereas for the traditional method it accounts for around 21%. The empirical evidence of induced abortions due to contraceptive failure put serious concern regarding unintended pregnancies and hence discourages fertility intentions among the potential couples.

Abstract Contraceptive policies have been derived to achieve desired reductions in the growth rate and also applied to the data of Uttar Pradesh, India, for illustration. Using the Lotka integral equation for stable population, expressions for the proportion of contraceptive users at different ages have been obtained. In order to reduce the present annual growth rate from 0.036 to 0.020, it is imperative that there will be 42% contraceptive users at age 20, assuming that 40% of them will discontinue at age 25 and 30% will resume the contraceptive use at age 30. Assuming furthermore that 75% of females start using contraceptives at the age of 23 years, 50% of the remaining females start using them at the age of 28 years, and the rest of the females start using them at the age of 32 years, if we set the minimum age at marriage at 20 years, a reduction of 0.019 in the growth rate will be obtained. This study describes how the level of contraceptive use at different age groups of females has helped reduce the growth rate in the state of Uttar Pradesh. It also promotes delayed marriage in the region.

Abstract Background In India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women’s menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept. Methods This study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept. Results Only one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle. Conclusions There is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India.

Background: Reproductive choice is one of the rights of any woman, but women are often ambivalent towards fertility desires and choice of contraception. Our study explores how the change in fertility desires influence the change in use of modern contraception over time in six cities of Uttar Pradesh, India. Methods: Data for this study comes from the Measurement, Learning and Evaluation (MLE) Project for Urban Health Initiative in six cities of Uttar Pradesh. Our study sample consists of 8735 women (weighted n=8655) who were fertile, non-sterilized and non-pregnant at the time of baseline survey. Potential bias due to lost to follow up was addressed using inverse probability weighing and then generalized estimating equations were applied to get odds for change in use of modern contraceptives. Results: Contraceptive use increased by different magnitudes from baseline to endline across all six cities. At baseline and endline, women who desired no more children reported a higher use of modern contraception than those who desired more children over time. Women from all cities who desired no more children at baseline had higher odds of modern contraceptive use than that of women who desired more children. The tempo of change in use of modern contraception over time among women with different fertility desires differed across the considered cities. Conclusion: Although there were city-wise differences observed, women’s fertility intentions have an impact on their use of modern contraceptives over the time period between baseline to endline. To obtain greater insight into city-level differences, mixed method studies will be more effective.

Background: Reproductive choice is one of the rights of any woman, but women are often ambivalent towards fertility desires and choice of contraception. Our study explores how the change in fertility desires influence the change in use of modern contraception over time in six cities of Uttar Pradesh, India. Methods: Data for this study comes from the Measurement, Learning and Evaluation (MLE) Project for Urban Health Initiative in six cities of Uttar Pradesh. Our study sample consists of 8735 women (weighted n=8655) who were fertile, non-sterilized and non-pregnant at the time of baseline survey. Potential bias due to lost to follow up was addressed using inverse probability weighing and then generalized estimating equations were applied to get odds for change in use of modern contraceptives. Results: Contraceptive use increased by different magnitudes from baseline to endline across all six cities. At baseline and endline, women who desired no more children reported a higher use of modern contraception than those who desired more children over time. Women from all cities who desired no more children at baseline had higher odds of modern contraceptive use than that of women who desired more children. The tempo of change in use of modern contraception over time among women with different fertility desires differed across the considered cities. Conclusion: Although there were city-wise differences observed, women’s fertility intentions have an impact on their use of modern contraceptives over the time period between baseline to endline. To obtain greater insight into city-level differences, mixed method studies will be more effective.

An endeavour to delineate the salient details of the treatment of head lice infestation has been made in the present article. Treatment modalities including over the counter permethrin and pyrethrin, and prescription medicines, including malathion, lindane, benzyl alcohol, spinosad are discussed. Salient features of alternative medicine and physical treatment modalities are outlined. The problem of resistance to treatment has also been taken cognizance of.

We report a case of chemical leucoderma (CL) in a 15-year-old girl, who developed patterned depigmentation at the back of both ear lobules after contact with plastic ear-ring stoppers made of polyvinyl chloride (PVC) after continuous use for 6-7 months. Patch test with Indian standard series and cosmetic series was negative after 48 h, but she refused patch testing for extended duration as the possibility of induced depigmentation at the test site was unacceptable to her. To the best of our knowledge, this is the first report of plastic ear-ring stopper induced CL.

Background: Nursing students are at increased risk of acquiring blood borne infections, this is largely due to NSI which they encounter in there every day work. They are frequently unaware of prevention and management of NSI and proper BMW disposal. Objective: To assess and enhance knowledge of nursing students for prevention and management of NSI . Methods: This was a Quasi experiment study conducted at Nursing College, NSCB Medical College Jabalpur (M.P.) among 100 nursing students. A preformed questionnaire was used to assess existing knowledge of prevention and management of NSI, then students were given series of lectures and interactive sessions to prevent and manage NSI then same group was subjected to post intervention assessment. Results: It was observed that 78% respondents suffered NSI was during recapping of needle. Other than needle,86% respondents mentioned of getting struck by stylet of IV catheter, 14% subjects recalled more than 5 incidences of NSI in past 15 days. In post intervention assessment it was observed that intervention made a significant (Wilcoxon signed rank Test Z=6.68,p

Ochronosis is a rare disease characterized by speckled and diffuse pigmentation symmetrically over the face, neck, and photo-exposed areas. It is characterized histologically by banana-shaped ochre-colored deposits in the dermis. It can present in exogenous or endogenous form. We report a case of exogenous ochronosis in a 50-year-old Indian woman after prolonged use of topical hydroquinone which is a rare complication with a commonly used drug which is available over the counter.

An elderly man, a known case of generalized vitiligo of long duration, presented to us with an ulcerated exophytic growth arising from the vitiliginous skin. The histopathological study confirmed the clinical suspicion of squamous cell carcinoma. Cutaneous neoplasia arising from the vitiliginous skin is a rare situation. Lack of melanin leaves the skin vulnerable to ultraviolet radiation damage, which may predispose to cutaneous neoplasia. Therefore, the importance of photoprotection has been stressed upon through this illustration.

Tumid lupus erythematosus (LE) is a rare variant of lupus erythematosus, which often follows a favorable course. A case of a young woman is illustrated, who presented with an asymptomatic erythematous, solitary plaque over her face. Histopathological and direct immunofluorescence examination established a diagnosis of tumid lupus erythematosus. She responded slowly and near-completely to hydroxychloroquine sulfate; however, a flare up occurred a month later. Addition of topical tacrolimus 0.1% resulted in complete regression without leaving any residual changes. No recurrence was seen subsequently.

We present here a case of inflammatory nevus comedonicus (NC) in a young male distributed along the Blaschko′s lines only over the right lower limb and associated with epidermoid cysts. The case was unique in terms of isolated involvement of lower limb and the rare association of epidermoid cyst.