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The COVID-19 pandemic has exposed the fragmentation of the healthcare delivery systems and highlighted the role of resilient primary healthcare systems for a robust public health response during health emergencies. Primary care while being the first point of contact between the citizens and the health systems has received scant attention or targeted investments over the past several decades. Through this narrative review, we aim to outline the potential role of telehealth in augmenting health systems capacity. While teleconsultations have increased exponentially during the pandemic, evidence suggests that utilisation of primary care for non-emergency and non-COVID-19 conditions such as chronic medical conditions has significantly decreased, suggesting that most telemedicine utilisation has been to address an immediate crisis. In countries with pre-existing national digital health framework and enabling regulatory environments, telehealth interventions while strengthening the public health response to COVID-19 also supported the continuum of care at the primary care level. Even after COVID-19 is controlled, telemedicine has the potential to address persistent obstacles to primary care in the South East Asia region, including scarcity of trained healthcare workers, access challenges and costs associated with in-person care. Telemedicine holds promise in strengthening primary care and has the potential to catalyse achieving universal health coverage.

Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries.Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily physiologic and laboratory parameters (3) discharge data. KDIGO workgroup AKI definition modified for neonates was used for defining AKI. Data entry was carried out by individual participating centers using a web-based database (akiregistry.org). De-identified data has been maintained and handled by the principal investigator (PI). This collaboration plans to disseminate data through peer-reviewed publications and through presentations at educational conferences.Conclusions: The purpose of this study is to create the first prospective neonatal all-cause AKI data repository and describe the incidence of neonatal AKI in NICUs in the country and determine the risk factors as well as the outcomes of such neonates—both short-term and long-term outcomes. This will eventually spur therapeutic advancements, facilitate decipherment of epidemiological trends, risk factors as well as outcomes and identify disparities in management across the nation.

Malaria is a parasitic infection of global importance but has a high prevalence in the developing countries. Renal failure is a common complication of severe Plasmodium falciparum malaria and has been reported in up to 40% of all cases. Acute kidney injury (AKI), however, is not commonly associated with Plasmodium vivax infection. In those patients who develop AKI following P. vivax infection, the cause is commonly attributed to mixed undiagnosed falciparum infection or coexistent sepsis, dehydration, or hypotension. Infrequently, an association of P. vivax infection with thrombotic microangiopathy (TMA) has been reported. The purpose of this report is to describe renal failure due to TMA following malaria caused by P. vivax. A 24-year-old female presented with a history of fever and jaundice of two weeks duration followed by progressive oliguria and swelling of the face and feet five days after the onset of fever. The evaluation revealed normal blood pressure, anemia, thrombocytopenia, azotemia, unconjugated hyperbilirubinemia with mildly elevated transaminases, and elevated lactate dehydrogenase. Peripheral smear was positive for P. vivax, and schistocytes were seen. She was given intravenous artesunate followed by oral primaquine for 14 days. Urine examination showed proteinuria and microscopic hematuria. She remained oliguric and dialysis dependent, and her kidney biopsy revealed patchy cortical necrosis involving 40% of sampled cortex with widespread fibrinoid necrosis of the vessel wall, red blood cell fragmentation, and luminal thrombotic occlusion. Hemodialysis was discontinued after three weeks when there was the improvement of renal function over time, and her serum creatinine decreased to 2.2 mg/dL by six weeks. Patients with P. vivax malaria developing renal failure may have TMA. Renal biopsy, if performed early in the course of the disease, may identify TMA and institution of plasma exchange in such patients could help in early recovery.

BACKGROUND Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. METHODS The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. RESULTS The neonates with admission in the NICU within

Micronutrient deficiencies, majorly iron, iodine, vitamin-A, pose a serious threat to public health in many developing countries, including India. A surfeit of nutrition and health programs was developed to address micronutrient malnutrition in India, covering many aspects of lifecycle. The importance of nutrition education and communication is emphasized in public health nutrition policies. Concomitantly, there is a surge in various interventional studies with the integration of nutrition education and communication. However, there is a lack of clarity on the overall impact of community level nutrition education/communication interventions on micronutrient (mal)nutrition in India, which may be due to the lack of critical evaluation of the nutrition education/communication components in these studies. Given this background, this article reviews the studies conducted in the last two decades in India. This systematic review identified and analyzed the studies that aimed to use nutrition education an...

Background : Fine needle aspiration cytology (FNAC) has a high rating in the assessment of breast lesions. Various methods have been used to diagnose cytology of breast lesions. Aims : Present study was undertaken to evaluate the feasibility of application of systematic pattern analysis based on morphology in diagnosing breast aspirates. Materials and Methods : This is a retrospective study of FNAC of the breast done over a period of 4 years in a tertiary care centre. A total of 225 cases of breast lesions for which FNAC was done with histological follow-up were included in the study. Breast aspirates were provisionally diagnosed based on systematic pattern analysis. Aspirates were grouped into six categories based on predominant cellular pattern, and correlation between cytological and histological diagnosis was assessed. Results : Application of pattern analysis on FNAC of breast lesions in our study had a sensitivity of 94.5%, specificity of 98%, diagnostic accuracy of 97%, positive predictive value of 95.8%, and negative predictive value of 97.4%. Conclusions : Systematic pattern analysis based on morphology of FNAC smears was found to be highly reliable and could be easily reproducible in the assessment of breast masses.

Background: Birth weight of new born is known to be influenced by several maternal biosocial factors. The study was undertaken to find association of various maternal biosocial factors influencing birth weight of the new born.Methods: The study subjects were 150 postnatal women and their new born delivered in an Urban Municipal Corporation Maternity Home. Study subjects were chosen by purposive sampling. Socio demographic and pregnancy related information was collected by interview method and from antenatal records.Results: The proportion of low birth weight noted was 8.6%. Statistically significant association was noted between new born birth weight and maternal health status during pregnancy which includes weight gain during pregnancy, intake of iron and folic tablets and antenatal check-up. Maternal haemoglobin levels had a positive correlation with new born birth weight.Conclusions: Maternal health is vital for new born wellbeing. Birth weight of new born has shown steady improvement over a period of time and this is as a result of availability of better maternal health care services in urban corporation maternity home.

Background: Assigning a score to cytology/FNA of thyroid lesions can provide important information regarding their neoplastic or non-neoplastic nature. The present study was undertaken to score thyroid lesions on aspirates based on various characteristics and correlating with standard cytological classification. Histopathology was done and the two cytological classification systems (Cytological scoring and Standard method) were compared. Methods: 196 cases of thyroid lesions with preoperative cytologic diagnosis were assigned cytological score/classified. Histopathology diagnosis was compared and statistical analysis was performed; correlation between cytologic score and histopathology was established using Spearman correlation coefficient. Regression analysis was done to assess the significance of each cytological score. Results: Multivariate analysis of cytologic features revealed that the amount of colloid, nuclear features and background pattern are the most influential features. There was high degree of correlation between the scoring methods on cytology with histopathology compared to standard cyto classification with histopathology. There was a significant association (p

Calcinosis cutis is a condition of accumulation of calcium salts within the dermis. We are presenting four cases of calcinosis cutis, with different clinical presentations, occurring in healthy individuals, with normal serum calcium and phosphorus levels. Histologically, all cases showed similar morphology, the lesions were composed of large and small deposits of calcium. Foreign-body giant cell reaction was seen in one case. Another case had intact and ruptured epidermal cysts and calcification within the cyst.

Background: There are several problems associated with menstruation. Common problems are dysmenorrhea, premenstrual syndrome (PMS) and menstrual irregularities. These problems significantly lower the quality of life in adolescents. Aims & Objectives: Present study was undertaken with the objective of assessing the frequency of dysmenorrhea and PMS and the effect of dysmenorrhea and PMS on school attendance and daily activities of adolescent girls and their treatment seeking pattern. Materials and Methods: A descriptive study was carried out in Government high schools in rural field practice area of Kempegowda Institute of Medical Sciences, Bangalore, India. All girls studying in high schools who had attained menarche were included in the study. Totally 304 subjects fulfilled inclusion criteria and participated in the study. Statistical analysis was done using descriptive statistics, chi square test and odds ratio. Results: Dysmenorrhea was reported by 183 (60.19%) study subjects and PMS was reported by 159 (52.30%) subjects. During menstruation, 208 (68.42%) study subjects reported that they could not attend school, 196 (65.13%) reported that they could not concentrate on studies, 181 (60%) reported inability to participate in sport activities. Whereas 235 (77.30%) reported inability to carry out household activities like cooking and 76 (25%) study subjects did not attend any social gatherings. Conclusion: More than half of study subjects suffered from dysmenorrhea and PMS which significantly affected school attendance and daily routine activities. Comprehensive health education regarding menstruation, awareness regarding menstrual problems and the treatment available for these problems should be provided at schools.