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BACKGROUND: Prolonged sitting in desk-based office workers is found to be associated with increased cardiometabolic risk and poor cognitive performance. Technology-based physical activity (PA) interventions using smartphone applications (SmPh app) to promote PA levels might be effective in reducing cardiometabolic risk among sedentary population but the evidence remains inconclusive. OBJECTIVE: The objective is to investigate the effects of a technology-based PA intervention compared to PA education with a worksite manual or no intervention on PA levels, cardiometabolic risk, cognitive performance, and work productivity among desk-based employees. METHOD: A three-arm clustered randomized trial will be conducted. The study will be conducted among various administrative offices of a multifaceted university in India. Desk-based employees aged between 30 and 50 years (n = 159; 53 in each arm) will be recruited. Employees from various constituent institutions (clusters) of the university will be randomized into one of the three following groups - SMART: SmPh app-driven break reminders (visual exercise prompts) plus pedometer-based step intervention, TRADE: worksite PA education with a manual plus American College of Sports Medicine guided PA prescription, or CONTROL: usual work group. At baseline and after the 1st, 3rd and 6th month of the trial period, accelerometer-measured sitting time and PA levels, cardiometabolic risk (fasting blood glucose, triglycerides, insulin, blood pressure, heart rate variability, functional capacity, and subcutaneous fat), cognitive performance (executive function), sickness absenteeism and work limitations will be assessed by a blinded assessor. Therapist delivering interventions will not be blinded. CONCLUSION: This trial will determine whether a combined SmPh-app and pedometer-based intervention is more effective than education or no intervention in altering PA levels, cardiometabolic risk and cognitive performance among desk-based employees in India. This study has the potential to foster institutional recommendations for using SmPh-based technology and pedometers to promote PA and reduce sedentary behavior at work.

Background: Serration pattern analysis helps in the classification of subepidermal autoimmune blistering disorders; more precisely, it helps to differentiate epidermolysis bullosa acquisita from other subepidermal autoimmune blistering disorders. Most of the published reports of this tool have come from a single center. Objectives: The objectives of the study were to study the utility of serration pattern analysis in classifying subepidermal autoimmune blistering disorders. Methods: Seventy five cases of subepidermal autoimmune blistering disorders were enrolled in this prospective study. A three millimeter punch biopsy was taken from the perilesional skin or mucosa for direct immunofluorescence; indirect immunofluorescence was carried out using salt-split skin. Subclassification of subepidermal autoimmune blistering disorders was done based on direct immunofluorescence, indirect immunofluorescence on salt-split skin, indirect immunofluorescence using knockout skin and serration pattern analysis findings. Results: Indirect immunofluorescence was positive in 68 cases; 14 cases showed a dermal staining pattern while the rest showed either an epidermal or a combined pattern. All patients with epidermal or combined staining patterns showed “n” serrated pattern on direct immunofluorescence. Nine patients with dermal staining on indirect immunofluorescence also revealed an “n” serration pattern on direct immunofluorescence indicating the diagnosis of anti-p200 pemphigoid, and the rest showed a “u” serrated pattern. Three patients with negative indirect immunofluorescence showed “u” serration on direct immunofluorescence while the rest showed “n” serration. Limitations: ELISA and immunoblotting could not be performed due to resource constraints. Conclusion: Based on indirect immunofluorescence and serration pattern analysis, classification of the majority of patients with subepidermal autoimmune blistering disorders was possible in our study. Pattern recognition is a cost-effective tool and can be easily learnt. It is recommended to be practiced in all laboratories where facilities for advanced immunological diagnosis are unavailable.

BackgroundHackathons are a popular trend in the technology domain and is considered a powerful tool to spur creativity and innovation. In a health hackathon, an interdisciplinary team of health, technology and management experts work collaboratively to solve a common problem. Health hackathon can be one of the quickest means to derive technology or process-based solutions to the challenges faced by clinicians.MethodsA 2-day hackathon: Hacking Cancer was conducted at a tertiary cancer centre in India to develop quick, cost-effective solutions in cancer care. Twelve oncology-related problem statements were explored. Undergraduate and postgraduate students of health and dental sciences, pharmacy, nursing, engineering and business management were the participants.OutcomesOne hundred and fifty-seven participants expressed interest, and 90 participated in the event. The participants did a time-bound exploration of 12 challenges in oncology elucidated problem statements. The oncology specialists mentored the participants during the hackathon. Seventeen teams presented their solutions. Judges reviewed the solutions and scored the teams based on feasibility, relevance and applicability. The top-scoring three projects were acute lymphoblastic leukaemia (ALL) better-improving adherence to treatment in ALL patients, Donate Life—application for voluntary blood donation and Lumiflex—a novel illuminated flexible abdominal retractor. They received seed funding to develop prototypes and implement their ideas.ConclusionHacking Cancer was an effective way of developing quick, cost-effective solutions to the common problems faced in cancer care. The pool of local participants developed solutions that were relevant and applicable to the practice setting. This one was the first oncology themed hackathon in the country.

Background Identification of gestational diabetes mellitus (GDM) risk factors is pertinent, for it can be an effective intervention for its prevention. As previous information regarding GDM risk factors from India were mostly descriptive and scarce from coastal Karnataka, a current prospective case-control study was designed to identify GDM risk factors among pregnant women seeking antenatal care. Methods A hospital-based prospective matched case–control study was carried among antenatal subjects seeking routine antenatal care at two secondary-level care private hospitals, affiliated to a University Medical College in coastal Karnataka. It comprised of 100 incident GDM cases and 273 frequency-matched controls. Data was collected by personal interviews using a pretested questionnaire. Data was entered and analyzed using Statistical Package for Social Sciences(SPSS), version 15.0. Results Risk factors using Carpenter and Coustan criteria and DIPSI criteria were found similar. Pooled data identified following significant GDM risk factors: marital age (25–29 years)(adjusted OR:18.2; 95% CI:1.9–177.6; p=0.012), delayed menarche (adjusted OR:11.4; 95% CI:1.1–124.6; p=0.045), multiparity (adjusted OR:14.1; 95% CI:1.8–109.8; p=0.011), family history of DM (adjusted OR:66.6; 95% CI:6.9–645.2; p Conclusions Modifiable risk factors identified were low physical activity, high antenatal perceived stress, multiparity, marital age ≥25 years, and low pre-pregnancy intake of GLV, which were also comparable using two criteria in vogue for GDM diagnosis. Pre-conception advice on healthy lifestyle may prove beneficial.

Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

Problem considered Despite enough evidence available supporting temporal relation between gestational diabetes mellitus (GDM) and overt DM, former has earned less attention while managing current diabetes epidemic. This calls for a community-based ‘Life-cycle approach' that could employ mutually-linked interventions specific to GDM prevention at various stages of life cycle by utilizing involving already existing Indian health system. Methods Freely accessible, full-text articles published between 1990 and 2018, available in PubMed and Google Scholar in English language, pertaining to GDM risk factors and its preventive strategies were reviewed using combination of medical subject headings (MeSH) and keywords. Results GDM prevention begins right from pre-pregnancy phase. Adoption of a healthy lifestyle, mass awareness of risk factors, early identification and prompt referral are key to avert pre-GDM development. During pregnancy, government of India (GoI) mandates universal GDM screening for all Indian pregnant women, avoiding any undiagnosed/untreated GDM woman, thus preventing occurrence of complications including overt DM. Those screened GDM positive are more likely to develop overt DM throughout postpartum. During postpartum, American Diabetes Association (ADA) recommends postpartum diabetes screening for all women with GDM, by employing two h 75 g oral glucose tolerance test (OGTT) and HbA1C prior to and beyond three months postpartum, respectively. Conclusions Promotion and practice of life-cycle approach would be key to curb overall diabetes incidence.

Background: Type 2 diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia that affects various body systems. Elevated blood glucose levels cause brain malfunction, sorbitol-induced blood vessel damage, and degeneration of the nerves that can lead to dementia or cognitive impairment. Cognitive impairment can result in nonadherence of patients to diabetes treatment, such as diet, medication, and exercise. Methods: We used a cross-sectional design to individually interview 194 patients with type 2 diabetes in a rural field practice area in India. A questionnaire was used to collect sociodemographic and diabetes disease characteristics; anthropometric measurements were also collected. Cognitive dysfunction was assessed with the Kannada version (local language) of the Montreal Cognitive Assessment (MoCA) tool. Blood pressure was measured for all subjects using a standardized sphygmomanometer on the right arm with the patient in a sitting position. Results: Among the 194 diabetic subjects interviewed, 98 (50.5%) were cognitively impaired. More than half of the subjects (56.2%) were ≥65 years, and female participants (53.6%) outnumbered males (46.4%). The majority of patients (62.4%) had had diabetes for

Background The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US$, 2020 US$ per capita, purchasing-power parity-adjusted US$ per capita, and as a proportion of gross domestic product. We used various models to generate future health spending to 2050. Findings In 2019, health spending globally reached $8. 8 trillion (95% uncertainty interval [UI] 8.7-8.8) or $1132 (1119-1143) per person. Spending on health varied within and across income groups and geographical regions. Of this total, $40.4 billion (0.5%, 95% UI 0.5-0.5) was development assistance for health provided to low-income and middle-income countries, which made up 24.6% (UI 24.0-25.1) of total spending in low-income countries. We estimate that $54.8 billion in development assistance for health was disbursed in 2020. Of this, $13.7 billion was targeted toward the COVID-19 health response. $12.3 billion was newly committed and $1.4 billion was repurposed from existing health projects. $3.1 billion (22.4%) of the funds focused on country-level coordination and $2.4 billion (17.9%) was for supply chain and logistics. Only $714.4 million (7.7%) of COVID-19 development assistance for health went to Latin America, despite this region reporting 34.3% of total recorded COVID-19 deaths in low-income or middle-income countries in 2020. Spending on health is expected to rise to $1519 (1448-1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. For complete list of authors see http://dx.doi.org/10.1016/S0140-6736(21)01258-7

Background: The indirect immunofluorescence test is useful in the serodiagnosis of pemphigus. As indirect immunofluorescence titers correlate with disease activity in pemphigus, it is often used as a monitoring tool. The sensitivity of indirect immunofluorescence depends on the substrate used, and the preferred substrates are monkey esophagus for pemphigus vulgaris and normal human skin for pemphigus foliaceus. Aims: We evaluated oral mucosa as a substrate for indirect immunofluorescence in pemphigus. Methods: Fifty patients with pemphigus (40 with pemphigus vulgaris and ten with pemphigus foliaceus) and 50 controls were enrolled for study. Demographic and clinical details were recorded and indirect immunofluorescence using two substrates (oral mucosa and normal human skin) was carried out in serial dilution. Desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay was also evaluated simultaneously. Results: Indirect immunofluorescence was positive in 40 patients (80%) with oral mucosa substrate and 34 patients (68%) with normal human skin substrate. Circulating antibodies were detected with oral mucosa in 33 (82.5%) of the 40 pemphigus vulgaris patients and in 26 (65%) patients using normal human skin. Antibodies were detected in eight of the ten pemphigus foliaceus patients (80%) with normal human skin and in seven (70%) patients with oral mucosa. Dsg enzyme-linked immunosorbent assay was positive in 45 (90%) patients, and 37 of these were also indirect immunofluorescence positive with oral mucosa. In the five Dsg enzyme-linked immunosorbent assay-negative patients, indirect immunofluorescence with oral mucosa was positive in three. Limitations: A comparison of oral mucosa with monkey esophagus could not be performed. Conclusion: Oral mucosa is a suitable and sensitive substrate for indirect immunofluorescence in pemphigus. Further studies comparing the sensitivity of indirect immunofluorescence using oral mucosa with monkey esophagus are recommended.

To assess prevalence of goiter and associated factors among school going children in Udupi district. A school based cross-sectional survey was conducted among 6–12 year old children. A sample of 30 villages was selected from the entire district by probability proportionate to size. One school was then randomly selected from each of the 30 villages. Goiter was assessed clinically and was graded as per the recommended criteria of World Health Organization (WHO)/ United Nations Children’s Fund (UNICEF)/ International Council for the Control of Iodine Deficiency Disorders (ICCIDD). Salt and urine samples were collected from a subsample for iodine estimation. A total of 2703 children were examined. The mean (±SD) age of the participants was 9.6 y (±1.9). The overall prevalence of goiter in Udupi district was found to be 9.3% with 7.0% and 2.3% having grade 1 and grade 2 goiter respectively. Prevalence of goiter was significantly higher among females [153(11.1%)] as compared to males [98(7.4%)] (p = 0.001). Of the 543 salt samples analyzed, 379 (69.8%) salt samples had adequate salt iodine content (> 15 ppm); while among the children with goiter 32 (8.4%) had inadequate salt iodine. Median iodine value was 202.12 mcg/l among the 270 urine samples tested for iodine levels. Goiter prevalence at 9.3% in the coastal district contributes to the endemicity of the public health problem. The district had adequate iodine nutrition based on median urinary iodine levels. Hence, other contributing factors for the persistence of endemic goiter need to be explored.

Objective To assess incidence of spontaneous preterm births and determine biochemical and obstetric risk factors for spontaneous pre-term births in a cohort of antenatal women visiting a secondary care hospital. Methods A prospective cohort study was designed to include 1420 pregnant women coming for antenatal care at a secondary care hospital. The cohort was followed throughout pregnancy and relevant history, obstetric and ultrasonographic examination and biochemical investigations was carried out in 2nd (20-24 weeks period of gestation) and 3rd trimester (28-32 weeks period of gestation). Outcome of delivery was noted for all the subjects. Results A total of 1133 women were recruited. Among the 1071 respondents, 11 had abortions, 93.1% delivered at term while 5.9% had preterm deliveries. Preterm deliveries were noted among 6.5% women with short stature, 13.3% with cervical length Conclusions The incidence of preterm births (5.9%) was low in the present cohort. Oligohydramnios and Intrauterine Growth Retardation (IUGR) were identified as significant risk factors for preterm births. Conventional risk factors like short cervix, short stature and biochemical inflammatory markers were not identified as predictors of prematurity. Lower levels of salivary estriol identified among women at risk of preterm births demonstrates the utility of the test as a non-invasive investigation for early identification of preterm births.

A variety of risk factors have been reported for the development of gestational diabetes mellitus (GDM). But limited review on the role of antenatal perceived stress necessitated the design of the present study to evaluate the association between GDM and perceived stress during pregnancy.A prospective case-control study was carried out among 100 GDM cases and 273 matched controls, attending regular antenatal clinic at two private hospitals of Karnataka. Data was collected by personal interviews using a standard questionnaire. Perceived stress was assessed using the Cohen 10-item Perceived Stress Scale. Score of ≥20 was identified as high stress. Statistical Package for the Social Sciences version 15 was used for analysis.Exposure rates for high maternal perceived stress among cases during pregnancy were noted. The odds of GDM were 13 folds higher among those with high antenatal stress (≥20) compared to those with low (20) (p 0.001) perceived stress. No correlation between maternal antenatal stress and blood glucose following OGTT was noted.The study identified high perceived stress during pregnancy as a potential risk factor for GDM.

Objectives: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. Methods: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Results: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent’s intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height

In India, less research has been dedicated to reproductive health needs of boys as compared to girls. Various sociocultural aspects hinder the caregiving process towards adolescent boys. Our aim was to assess the views and perceptions of adolescent boys and their caregivers about reproductive health (RH) for adolescent boys. This qualitative study was conducted in rural urban settings of an entire Taluk (sub-district). It examined the perception and expectations of RH and the services that would cater their unmet needs. The perceptions of parents, teachers and clinicians who interacted with adolescent boys were also taken in to account. RH issues of boys were considered to be completely neglected by all caregivers. The boys felt ‘only girls have all sort of facilities and help’. Masturbation and wet dreams were considered as ‘problems’. Pornography and Internet influenced young minds negatively. Awareness about HIV/AIDS and premarital sex were good among the boys. Boys stressed on ‘counselling’ and ‘online services’ that would help them to discuss their RH issues with experts. Parents and teachers highlighted the importance of ‘sex education’. Doctors mentioned the problems they face to address the boys in community settings. It could be concluded that RH aspects of adolescent boys need further research.

Background: Stress is a major contributor to the physiology of hypertension (HTN) and is linked closely to mental well-being and overall quality of life (QoL). Health issues pertaining to women's health have usually focused on reproduction, while mental well-being has largely been neglected. Objectives: The objective of the study was to assess the perceived stress and QoL among homemakers with HTN. Materials and Methods: A community-based cross-sectional study was carried out, among 426 homemakers with HTN residing in Udupi, Karnataka. The sociodemographic and disease characteristics, Cohen's Perceived Stress Scale-10, World Health Organization QoL Brief Questionnaire (WHOQOL-BREF), anthropometry, and vitals were measured. Results: Of the study participants, 245 (57.5%) were aged ≤60 years and 317 (74.4%) had been diagnosed with HTN in the past decade. Low and high perceived stress was seen among 306 (71.8%) and 120 (28.2%) women, respectively. Among the four domains of WHOQOL-BREF, the physical domain had the highest mean (±standard deviation) score of 67.44 (±16.50), whereas the lowest score of 54.49 (±19.75) was observed in the social domain. The odds of high stress among single women and those with a pill burden of >2/day were 1.93 (P=0.004, 95% CI=1.228, 3.054) and 1.77 (P=0.038, 95% CI CI=0.962, 3.270) respectively. The QoL was significantly better among those aged

Background: Michel's medium (MM) is currently the recommended transport medium for skin biopsy specimens prior to direct immunofluorescence (DIF) microscopy. Objective: To compare the utility of honey with that of MM as a transport medium for skin biopsy specimens used for DIF and antigen mapping. Methods: Group I consisted of 45 freshly-taken skin specimens earmarked for DIF testing. It was divided into three groups (A, B and C), each containing 15 specimens. Biopsy specimens were sliced into two, one each for MM and honey. Samples in group A were processed at the end of week 1 while those in group B and C were processed at the end of weeks 2 and 4, respectively. Group II consisted of five specimens of epidermolysis bullosa (EB) which was further divided into three groups; two specimens were processed for antigen mapping at the end of week 1, while others were processed at the end of week 2 (two specimens) and 4 (one specimen). Results: Sensitivity of honey as a transport medium for skin biopsy specimens was 100%, 92.6% and 53.8% at weeks 1, 2 and 4, respectively. The antigen mapping was positive in all specimens. Conclusion: Utility of honey was comparable to MM for DIF samples tested at weeks 1 and 2 but was lower at week 4.

Objective: The study was conducted to find the utility of three dimensional (3-D) ultrasound and Doppler sonography in differentiating benign and malignant endometrial lesions and to ascertain the association of sonology parameters with type, grade and stage of endometrial cancer. Materials and methods: Women attending the gynaecology department of a tertiary care hospital, with a provisional diagnosis of carcinoma endometrium were subjected to three dimensional power Doppler ultrasound evaluation and assessment of vascular patterns. VOCAL (Virtual Organ Computer-aided Analysis) software was used to assess volume, Vascularisation Index (VI), Flow Index (FI) and Vascularisation Flow Index (VFI). Ultrasound parameters were compared with histologic diagnosis to evaluate the diagnostic performance using Receiver Operating Characteristic (ROC) Curve. Results: Sixty-four women were included in the study, 33 with benign and 31 with malignant endometrial lesions. Larger endometrial volume and higher Doppler indices correlated with malignant lesions. The variables with good discriminatory potential between benign and malignant status were VI and VFI, having a sensitivity of 90.3% and specificity of around 80%. VFI (adjusted odds ratio of 40.4; (95% CI – 8.46–192.88), p value

Introduction. Preterm birth is the leading cause of newborn deaths and the second leading cause of death in children under five years old. Three-quarters of them could be saved with current, cost-effective interventions. The aim of this study was to identify the risk factors of preterm birth in a secondary care hospital in Southern India. Methods. In the case-control study, records of 153 antenatal women with preterm birth were included as cases. Age matched controls were women who had a live birth after 37 weeks of gestational age. Gestational age at delivery and associated risk factors were analyzed. Results. The preterm birth rate was 5.8%. Common risk factors associated with preterm birth were hypertensive disorders of pregnancy (21.4%), height Conclusion. The commonest obstetrical risk factor for preterm birth was hypertensive disorders of pregnancy and nonobstetrical risk factor was height

Background: India is the largest provider of generic medications globally. Despite this, several essential medicines remain inaccessible to majority of the general population, due to poor awareness, unavailability of drugs, distrust about the quality of the medicines, poor policy implementation and inadequate recommendation by doctors.Methods: A community-based cross-sectional study was carried out among 1151 adults in rural and urban areas attached to the community outreach area of a University Medical College. Written informed consent was taken from the participants. Data was collected using a pre-tested semi-structured online questionnaire and analysed using SPSS 15.0.Results: Knowledge regarding generic medicines was found to be low among the surveyed population (666, 57.9%), irrespective of their socio-economic status, education, occupation, place of residence or presence of chronic illnesses. As the knowledge was poor, participants were briefed about the generic medicines and their benefits. Thereafter, the attitude was assessed and found to be favourable among more than half (633, 55.0%) of the surveyed population. The usage of Generic medicines was found to be poor among the respondents. Only 53 (4.6%) of the total study population had switched from branded to generic medicines in the past six months as generic medicines were less expensive compared to their branded counterparts.Conclusions: The awareness about generic drugs and its usage was poor in the surveyed population. A favourable attitude towards generic drugs was achieved by educating the people about their similarity to branded medications. Therefore, there is a need to educate people not only about the quality, safety and efficacy of the generic medicines but also about the government initiatives like the Jan Aushadhi scheme.

Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial.Objective. To review different diagnostic criteria for GDM.Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed.Results. First diagnostic criteria for GDM in 1964 by O’Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014.Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required.

Introduction: Postpartum is the most neglected period in reproductive cycle of woman. Prevalence of anaemia in developing countries ranges from 50-95%. Aim: To estimate the prevalence of anaemia among postnatal mothers. Setting and design: A community based cross-sectional study among recently delivered mothers residing in field practice area of Department of Community Medicine, Kasturba Medical College, Manipal, India. Materials and Methods: The study sample included 401 respondents who were selected using stratified random sampling with proportionate allocation from all rural health centres. Data was collected by personal interviews followed by haemoglobin estimation by indirect cyanomethaemoglobin method. Results: The prevalence of postnatal anaemia was 26.5% (Anaemia = Hb

In India it is taboo to discuss sexual and reproductive health (RH) issues, especially with adolescent boys. Minimal research has been done in India to address the adolescent mindset of boys. Our aim was to study the unaddressed issues among boys and to highlight their perspectives regarding RH. Methods: A qualitative study design-using focus group discussions (FGD) in a rural-urban setting in South India was conducted. A convenient sample of 60 boys aged 16–19 years participated in six FGD and 10 boys had participated in in-depth interviews. Results: The study revealed that a cordial environment both at home and school were primary needs. Peer pressure and media instigated adolescents to get involved in risky behaviour and substance use. “Pornography”, “wrong myths about RH”, “substance use”, and “sexual attractions” were the primary unaddressed issues of boys. Participants had poor awareness about RH services. Conclusion: RH services are inadequate and proper infrastructure is required for providing these services to adolescent boys.

Background Lymphatic filariasis is an important public health problem in India. Inspite of National filarial control programme (NFCP) being in place for lymphatic filariasis (LF) elimination,several important issues need to be addressed. There is uncertainty about the coverage and compliance to treatment in order to achieve elimination. Method A community based cross-sectional study was conducted as per the National Vector Borne Disease Control Programme (NVBDCP) directions. The study included survey of 200 households of Dakshina Kannada District, South India where the Mass drug administration (MDA) program was conducted. The main objective of the study was to assess the coverage and compliance to MDA. Results Out of the total 1050 eligible people, 876 (83%) received the DEC tablets; so, the coverage was 83%. Among those who received the tablets, only 777 (88.7%) received the adequate dose and only 670 (76.8%) people actually consumed the tablets. Hence, compliance rate was only 76.8%. Conclusion The planning and implementation of MDA programme needs to be strengthened by efficient micro planning, inter sectoral co-ordination and motivating the community to participate in the MDA programme

Background The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub- Saharan Africa. The effect of malnutrition is high morbidit and mortality among young children. The objective of this study was to determine the nutritional status of children aged between 3-6 years registered in government sponsored maternal and child care Anganwadi centres in India. Method A cross-sectional study was conducted in 35 centres in 11 villages situated in the field practice area of Community Medicine Department of a Medical College situated in Southern India. Results Of the 585 children in the study, 46.5% of the children were aged between 36 to 48 months. Assessment of nutritional status using the ICDS growth chart revealed malnourishment to be present among 189 (32.3%) children, of whom 166 children were grade I malnourished and 23 children were grade II malnourished. Proportionally girls (46.2%) were more malnourished than boys (33.6%). No significant association was found between the nutritional status of children and their duration of stay in an Anganwadi centre (p-value=0.56).Conclusion The findings of this study indicate that malnutrition is still an important problem even among children attending Anganwadis. Further improvements in functioning of Integrated Child Development Services need to be made in order to address the problem of malnutrition

BACKGROUND: Vision loss and age-related eye diseases are major global public health problems. The burden of visual impairment worldwide varies depending on the methods of assessment. The need for local data on the prevalence of visual impairment in adults coupled with limited resources necessitated the conduct of the study in a limited geographical area. METHODS: A cross-sectional study was conducted in the field practice area of Department of Community Medicine of a Medical College. Study patients included adults aged ≥18 years, identified through purposive sampling. A semi-structured questionnaire was used to collect sociodemographic data. Snellen's chart for distant vision; reduced Snellen's chart for near vision and Ishihara chart for color vision was used. Data were analyzed using SPSS software version 15. RESULTS: The study included 411 patients. Nearly 40% of the patients were ≥50 years. Among the patients, 195 (47.4%) had H/o refractive error, 78 (19%) had H/o hypertension, 56 (13.6%) had H/o diabetes, and 43 (10.5%) had H/o cataract. The most common ocular morbidity was arcus senilis 113 (27.5%) and cataract 28 (6.8%). Using Snellen's distant vision chart low vision ( CONCLUSIONS: Farsightedness was detected among a quarter of the population, while impaired near vision was detected among two.fifths of the study group. Nearly 7% of patients had cataract and were referred for further evaluation. Advancing age and the presence of comorbidities were significant determinants of visual impairment.

Background: India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics. Objective: To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital. Study Design: Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version. Results: Study included 466 patients. Majority were males, 301(64.6%) and in the and in the age group of 15-44 years, 267 (57.5%). Maximum number of cases were seen in 2007, 219 (47%) and in the month of September, 89 (19.1%). The most common presentation was fever 462 (99.1%), followed by myalgia 301 (64.6%), vomiting 222 (47.6%), headache 222 (47.6%) and abdominal pain 175 (37.6%). The most common hemorrhagic manifestation was petechiae 84 (67.2%). 391 (83.9%) cases presented with dengue fever, 41 (8.8%) dengue hemorrhagic fever, and 34 (7.3%) with dengue shock syndrome. Out of 66 (14.1%) patients who developed clinical complications, 22 (33.3%) had ARDS and 20 (30.3%) had pleural effusion. Deaths reported were 11(2.4%). Conclusion: Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.

Background: Differently-abled children may be particularly susceptible to skin disorders either as a direct consequence of their disability or due of lack awareness regarding personal and environmental hygiene. Aim: To study the prevalence of skin problems in differently-abled children. Materials and Methods: A total of 122 differently-abled children in two special schools were examined for this study. Details regarding the disabilities were obtained from the school records. Results: More than half (53.2%) of the children had skin problems. Infections and infestations, acne, and dermatitis were the common dermatoses encountered in the present study. Conclusion: Periodic skin examination is of vital importance for all people with disabilities to reach a proper diagnosis and to offer treatment. Health education for teachers and parents on maintenance of sound personal hygiene and a clean environment is also recommended.

Context and Objective: In view of the growing burden of type 2 diabetes mellitus (T2DM) globally and associated microvascular and macrovascular complications, the study was done to assess the prevalence and risk factors for diabetic neuropathy among T2DM patients attending a tertiary care hospital. Subjects and Methods: T2DM patients’ ≥30 years of both gender, presenting to the Medicine Department at a tertiary care hospital were included in the study. Diabetic Neuropathy Symptom (DNS) questionnaire to assess symptoms and Diabetic Neuropathy Examination (DNE) scoring to assess clinical signs were used. Results: A total of 273 patients were included. The mean age was 57.8 ± 11.5 years. The male to female distribution was 75% (202) and 25% (71), respectively. According to DNS instrument, 41.4% patients scored positive for the presence of neuropathy while only 24.5% had neuropathy according to DNE score. The proportion of males affected by neuropathy was more than females. 43.1% males had a positive DNS score while only 27.2% of them had a positive DNE score. Duration of the disease was positively correlated with neuropathy. Neuropathy was more prevalent among people who had higher systolic and diastolic blood pressure as per DNS and DNE instruments. Conclusions: The present study identified a higher proportion of males to be affected by neuropathy. Hence, more detailed evaluation must be accorded to elderly male diabetic patients with longer duration of the disease. Lifestyle modifications and watchful screening need to be incorporated as part of routine patient health education during follow-up clinic visits.

Background: Subepidermal autoimmune bullous diseases (sAIBD) are diverse of conditions with clinicopathological overlap. Circulating autoantibodies in the serum can be demonstrated using indirect immunofluorescence (IIF) microscopy. Artificially split normal human skin is considered as an optimum substrate for the demonstration of anti-basement membrane zone (BMZ) antibodies using IIF in sAIBD; it not only helps to detect the presence of circulating antibodies in the serum but also helps to subclassify these conditions into “roof” and “floor” binding disorders. Aim: In this study, we evaluated the utility of IIF to detect anti-BMZ antibodies in the blister fluid of patients with sAIBD. Materials and Methods: Twenty-two patients with a clinical diagnosis of sAIBD were enrolled in the study. IIF of serum and blister fluid were done simultaneously using salt-split skin as a substrate. Results: Anti-BMZ antibodies could be detected in the blister fluid using IIF in all patients in the study group. Limitation: We could not do enzyme-linked immunosorbent assay of blister fluid. This would have given us the quantitative data of circulating antibodies in the blister fluid. Conclusion: Blister fluid offers an alternate source for the detection of autoantibodies in patients with sAIBD. It may be of particular help in children and in elderly with poor venous access.

Context: Among the college population, it is assumed that medical students have better knowledge about healthy lifestyle and dietary practices when compared to other students. However, there is no evidence to indicate that this knowledge translates into practice in terms of maintaining good health. Also, medical students have been known to exhibit early risk factors for chronic diseases. Aim: To assess dietary practices and physical activity among medical students. Materials and Methods: A cross-sectional study was done among 438 medical students from a teaching hospital in South India. A predesigned questionnaire was used to assess diet and current physical activity levels [using the International Physical Activity Questionnaire (IPAQ) short version] among consenting medical students. Statistical Analysis Used: Data were analyzed using statistical package for social sciences (SPSS) version 15.0 from SPSS South Asia Bangalore, India. Chi-square test was used for univariate analysis. Results: Among 438 medical students, 97% were aware of balanced diet, but only 42.9% were following it. Nearly, 9.4% of students consumed junk foods everyday. Compared to the previous year, junk food intake had increased in 40.4% and fruit intake had decreased in 50% of students. Significant association was noted between overweight and obesity and daily consumption of junk foods. Over 95% of students were physically active. In comparison to the previous year, nearly 67% of students had increased their physical activity by walking. Conclusions: Although unhealthy eating habits were prevalent among medical students, practice of physical activity was good. It is, therefore, essential to identify and take corrective actions to promote healthy lifestyle practices.

Background: Salmonella enteric serotype Typhi has created a significant therapeutic problem as these strains have developed resistance to the commonly used antimicrobials for the treatment of typhoid fever. Objectives: To assess the clinical profile and sensitivity patterns to anti-typhoid drugs. Materials and Methods: A retrospective analysis of 106 culture-positive typhoid cases admitted in a tertiary care hospital during the years 2005-2008. Results: Records of 106 patients were evaluated, 83 (78.3%) males and 23 (21.7%) females. Fever was present in all patients. Headache in 63 (59.4%) patients and generalized body ache in 53 (32.5%) patients were the most common symptoms, while spleenomegaly in 47 (44.3%) patients and hepatomegaly in 42 (39.6%) patients were the common presenting signs. A maximum sensitivity of 96.6% was observed with cephalosporins, whereas a resistance of 29.2% was seen with fluoroquinolones. Conclusion: A high degree of sensitivity was noted to chloramphenicol, ampicillin and sulphonamides, showing a trend of roll-back of sensitivity to conventional antibiotics.

Background Maternal lower genital tract during pregnancy is a complex niche of microbes that normally inhabit or cause infections in few instances. Association of various microbial flora and adverse pregnancy outcomes is being increasingly explored. The study was aimed to determine the prevalence of lower genital tract infections (LGTI) among pregnant women and to determine the common etiologies of LGTI and their association with adverse pregnancy outcomes, Pre term birth (PTB) and Low birth weight (LBW).

Aim: To estimate the prevalence and study the socio-demographic correlates of type 2 diabetes among adults aged 30 years and above. Setting and Design: A cross-sectional community-based survey, among individuals of either sex, aged 30 years and above was carried out in the field practice area of a medical college. Methods and Materials: The study was carried out on 1,239 respondents, using a two-stage, stratified, random sampling technique. Data was collected by a personal, face-to-face interview followed by blood sugar estimation using a glucometer. Statistical Analysis: Was performed by using the Statistical Package for Social Sciences (SPSS) version 11.5. Results: The overall prevalence of diabetes was 16%. Self-reported diabetes was 11.2%, while 4.8% of previously normal people were found to have high fasting capillary blood glucose levels. Increasing age showed two-fold, four-fold, and six-fold higher odds for 40 – 49, 50 – 59, and ≥ 60 years age group, respectively, as compared to the 30 - 39 year age group (P < 0.001). Nineteen percent of the males had diabetes, (OR = 1.38, 95% CI = 1.01 – 1.88). In the high socioeconomic strata, 32% of the subjects had diabetes (P = 0.018 unadjusted odds ratio 3.29, 95% CI = 1.40 – 7.74). Conclusion: The high prevalence of diabetes in this coastal population needs further evaluation.

Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold