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Background: Type 2 Diabetes (T2D) is a global challenge with rising prevalence, inadequate compliance, and poor outcomes. Aims: Assess the effect of a 2-only-daily-meals with exercise lifestyle (2-OMEX) on (a) HbA1c, (b) anti-diabetic medication count (ADMC), (c) Kcal intakes, body weight, fasting insulin, and subjective well-being. Materials and Methods: This is a single-arm follow-up study conducted in a free 2-OMEX clinic in 2019–2020. Information for two meals and exercise compliance was obtained during the clinic visit. HbA1c was tested by HPLC and fasting insulin by the CLIA/CMIA method in private laboratories. Results: Eligible subjects (f = 49, m = 116) completing two or more visits and 60 days of follow-up had a mean age of 55.92 (10.43) years, a T2D duration of 8.20 (6.28) years, and a median observation period of 140 days. Statistically significant changes included HbA1c decline from 7.69 (1.70) to 7.00 (1.20) gm% (equivalent by the LogNormal method to 1.088 gm%), average weight loss at 5%(m), and 2%(f). ADMC declined from 2.32 to 2.14, the difference being significant with the WSR test (z = 2.0087, P = 0.0223). Subjects attaining anti-diabetic medication-free and normoglycemic status (HbA1c < 6.5 gm%) were 20 (12%). The number attaining HbA1c ≤ 7 gm%) significantly rose from 73 (44%) to 101 (61%) with an ADMC of 1.9 (chi-square = 9.531, df1, P = 0.0020203). Participants reported 'feeling energetic' (79%), feeling lighter (50%), and better sleep (35%). Average energy intakes dropped by 120 Kcal to 1580/day. Fasting insulin remained unchanged, from 12.61 (11.06) to 12.34 (11.78) mlU/L. The dropout rate was 35%. Conclusions: The 2-OMEX lifestyle showed a sizeable, favorable, and significant change in HbA1c, body weight, ADMC use in five months, and subjective benefits. Studies are necessary for remission impact and pathways.

Context: Skinfold thickness (SFT) and body-fat (BF%) are infrequently used for childhood undernutrition. Aims: a) Estimation of SFT at peripheral and truncal sites (b) Estimation of BF% from SFTs (c) Correlate SFT estimates with MUAC, BMI and Waist. (d) Compare rural/tribal SFTs with urban schoolchildren. Settings and Design: Ashram schools in rural/tribal settings and one urban school. Methods and Material: Using three stage sampling, four tribal schools were randomly selected and an urban school was added for comparison. A sub sample of 405 students in the age group of 7 to 15 years were included. Height, weight, MUAC and SFTs were measured BF% was estimated with Slaughter equation. Statistical Analysis: Using Excel, Epi Info 7.1 and R software, appropriate t tests were applied for comparisons, and correlation was estimated between the quantitative variables. Results: Average SFT among schoolchildren (405) was 6.64 mm. Girls (n = 215) had a BF% of 13.1%, while boys (n = 190) had BF at 11.5%. Average SFT for boys (6.69) and girls (6.48) had no statistically significant difference (t = 1.3, P = 0.1929). Boys had higher average peripheral SFT than truncal SFT while girls had higher truncal SFTs. In girls subscapular SFT was higher than triceps SFT. Median BF% in rural was lower than urban schoolchildren. BF% correlated strongly with BMI (0.56), Waist (0.63), Hip (0.61) and MUAC (0.59). Conclusion: SFT and BF % can be effectively used to detect undernutrition. Geographical and Gender differences are observed. SFT and BF% correlated well with BMI and MUAC.

Introduction: Appropriate use of antibiotics is important for (a) Better therapeutic results (b) Saving costs (c) Minimize resistance to antibiotics. This is a descriptive cross-sectional study of pre- scriptions in a tertiary hospital and health center. Objective was to evaluate antibiotic usage in a teaching institute. Methodology: For a sample size of 220, 256 prescriptions from IPD and OPD, containing any antimicrobial, at the pharmacy and an- other 240 prescriptions from the peripheral Health Centre were collected over a fortnight in 2018. Prescriber identity was con- cealed and protected. Prescriptions were assessed by two inde- pendent raters based on the AMR National Guidelines on antibiot- ics. Rater 1 and Rater2 had fair agreement (quadratic kappa 0.3348, 95%CI 0.2207-0.4489). Data were compiled and analyzed on excel and EPI info. Results: Hospital pool yielded 203 medical and 53 surgical cases, of which 60% prescriptions were rated appropriate, 35% border- line and 5% un-acceptable. Health center data (n=240) showed 89% had no diagnosis. Amoxicillin+Clavulinic acid, ceftriaxone, azithromycin, Ofloxacin topped the hospital usage, while Amox+CA and Cefixime topped the health center usage. Conclusions: Hospital prescriptions nearly conformed to guide- lines, the Health center prescribing called for adherence to proto- cols. Cost –reducing options and minimizing resistance to higher antibiotics.

Introduction: Heavy school-bags and the musculo-skeletal complaints are common concerns across countries, but Indian rural studies are scant. This rural study was undertaken to explore school-bag weights, and association of bag-weights with reported pain/discomfort. Methods: This is a cross sectional study covering 261 students (m 128, f 131) in 8th and 9th divisions in 3 rural schools in Nashik district. Standard procedures were used for anthropometry and school-bag weights. Reported musculo-skeletal complaints were ascertained with structured questionnaire. Teachers were interviewed. Excel and Epi-Info were used for analysis. Results: Average schoolbag-weight was 3.7kg.47% schoolbags weighed>10% bodyweight. More girls than boys had heavy bag-packs and musculoskeletal complaints. Heavy school-bags and musculoskeletal complaints showed association with Chi-square; but a t-test showed no association of musculoskeletal complaints with product of bag-weight and walking-duration; while domestic /farm work were confounding variables. Teachers were aware of bag-weight guidelines and health issues but not about the problem in their schools. Conclusions: Despite awareness, these rural schools had sizeable proportion of heavy bags. Hence counseling of stakeholders and reworking classroom schedules are necessary for safety limits.

Background: Institutional birth and Emergency Obstetric Care (EmOC) are important strategies of the National Rural Health Mission (NRHM). While the Community Health Center (CHC) is expected to serve EmOC needs in NRHM, the CHCs are hamstrung due to chronic shortage of specialist doctors. Alternative strategies are therefore needed for ensuring EmOC. Objectives: This study aims to estimate the EmOC needs in a private rural hospital from case records and find some useful predictors for caesarian section (C-section) and to assess C-section needs in the context of on-call specialist support. Materials and Methods: We analyzed a two-decade series of 2587 obstetric cases in a private rural hospital for normal deliveries and EmOC including C-section. Results: About 80% of the obstetric cases were normal deliveries. Of the remaining 20% cases that required EmOC, nearly one-third required C-section. In the series, two maternal deaths occurred due to hemorrhage. About 13% case records showed past abortion, which adds to EmOC workload. Primipararous mothers with higher age had a greater incidence (23%) of C-section. The C-section rate shows a steady rise from 3% to above 10% in the series. Conclusions : This rural hospital required C-section in 6.4% cases. This C-section workload was managed with the help of on-call specialists. The local hospital team could manage 93.6% of the cases and abortions with only two maternal deaths. This strategy of an on-call specialist team can be an option for CHCs till resident specialists are adequately available.