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Shivarajkumar K Lakshmana, Prakashini Koteshwar, Tanushree Kamath Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, IndiaCorrespondence: Prakashini Koteshwar; Tanushree Kamath, Email prakashini.k@manipal.edu; tanushree.kamath@manipal.eduPurpose and Motivation: Chronic kidney disease (CKD) is a major global public health problem with eventual progression to end-stage renal disease which tends to increase kidney stiffness. Shear wave elastography (SWE) is a recently developed ultrasound based technique which can be used to assess tissue stiffness noninvasively. The aim of this study was to evaluate the potential diagnostic value of SWE to assess renal parenchymal stiffness in CKD and its correlation with estimated glomerular filtration rate (eGFR), which may be used as a marker for detecting and staging CKD.Materials and Methods: The study protocol was approved by the Institutional ethics Committee at Kasturba medical college, Manipal and written informed consent was obtained from all participants. The study included 93 control subjects and 108 patients with CKD. SWE imaging was performed to assess renal cortical stiffness, as measured by the Young’s modulus (YM). Correlations between SWE and conventional ultrasound parameters with age, serum creatinine, eGFR and serum urea were analysed using Pearson’s correlation coefficient (p ≤ 0.05) and receiver operating characteristic (ROC) curves were derived.Results: The diagnostic performance of SWE correlated with serum creatinine levels and eGFR. We found a statistically significant difference in kidney stiffness values between healthy individuals and CKD patients. The Spearman correlation coefficient revealed moderate negative linear correlation between the YM measurements and eGFR. We obtained a YM measurement cut-off value of 4.43 kPa, a value less than or equal to this suggested a no diseased kidney. This yielded sensitivity and specificity of 92.6% and 80.6%, respectively, with an AUROC of 0.92.Conclusion: Our results demonstrated that shear wave elastography may provide a low-cost, non-invasive method for the morphological assessment and progression of the disease status in chronic kidney disease patients with CKD.Keywords: chronic kidney disease, shear wave elastography, renal parenchymal stiffness

Traditional position and image-based visual servoing techniques often pose challenges in terms of target loss and actuator saturation. These challenges arise due to the requirement of calculating inverse Jacobians to determine robot motions and the susceptibility of these methods to image noise. To address the aforementioned challenges, this article presents a nonrecursive augmented dynamics control (NRADC) that establishes a direct correlation between variations in image pixels and the thrust and torque commands of a multirotor. By incorporating pixel variations into the dynamics of the multirotor, this approach enables the utilization of state constraints to address the issue of target loss. In addition, the correlation between image pixels and control commands allows for the integration of image noise with system uncertainties. Consequently, a single controller can be designed to simultaneously handle both aspects while considering input constraints, effectively addressing the problem of actuator saturation. Notably, unlike conventional control approaches that handle input and state constraints, the proposed NRADC approach is nonrecursive, making it well suited for implementation on systems with limited on-board computational resources, such as multirotors. The effectiveness of the proposed method is demonstrated through experimental validations, including a performance comparison with a nonrecursive controller from recent literature.

Granulomatosis with polyangiitis (GPA) is a rare disease affecting the small- to medium-sized vessels of various organs. The respiratory tract, lungs, and kidneys are usually affected. The gingival involvement in GPA is rare and features a classical presentation called strawberry gingivitis. GPA is associated with subepithelial neutrophilic microabscesses, leukocytoclastosis, vasculitis, geographic fibrinoid necrosis, and palisading macrophages. The elevated levels of cytoplasmic-antineutrophilic cytoplasmic antibody (c-ANCA) differentiate it from other vasculitis. A rare case of GPA who presented with strawberry gingivitis with further systemic involvement and elevated c-ANCA, confirming our diagnosis has been discussed with an emphasis on the clinical presentation, histopathological features, and management protocols followed.

Sruthi Vijendran,1,&ast; Yogish S Kamath,1,&ast; Yash Alok,2 Neetha IR Kuzhuppilly1 1Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Department of Community Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India&ast;These authors contributed equally to this workCorrespondence: Neetha IR Kuzhuppilly, Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 98861 61979, Fax +91-820-2571934, Email neetha.kir@manipal.eduPurpose: Refractive error is a major cause of visual impairment in children and its early detection can prevent ocular morbidity such as amblyopia and strabismus. Brückner test is a comprehensive test which can be easily administered in children using a direct ophthalmoscope. We aimed to determine refractive error in children by analysis of the red reflex using modified Brückner test.Patients and Methods: This prospective observational study was conducted on 683 undilated eyes of 683 children aged four to 10 years. They were evaluated with a direct ophthalmoscope from one meter in a dimly lit room. The characteristics of the red reflex and crescent obtained were compared with photoscreener refraction value and analyzed.Results: The presence of superior crescent was associated with hypermetropia (Chi square 37.11, p < 0.001, kappa = 0.15) and inferior crescent with myopia (Chi square 157.29, p < 0.001, kappa = 0.477). Superior crescent was 98.4% sensitive in detecting hypermetropia. Hypermetropia greater than +1.5D, was associated with larger superior crescent crossing horizontal midline of pupil (Chi square = 5.29, p = 0.021).Conclusion: The modified Brückner test is useful in detection and quantification of refractive error in children. It is easy, simple, quick and can be employed in the community as a screening test to detect potentially amblyogenic refractive errors.Keywords: visual impairment, pediatric refraction, hypermetropia, myopia, Brückner test, refractive error

Health-care settings have an important responsibility toward environmental health and safety. The operating room is a major source of environmental pollution within a hospital. Inhalational agents and nitrous oxide are the commonly used gases during general anesthesia for surgeries, especially in the developing world. These greenhouse gases contribute adversely to the environmental health both inside the operating room and in the outside atmosphere. Impact of these anesthetic agents depends on the total consumption, characteristics of individual agents, and gas flows, with higher levels increasing the environmental adverse effects. The inimical impact of nitrous oxide is higher due to its longer atmospheric half-life and potential for destruction of the ozone layer. Anesthesiologist of today has a choice in the selection of anesthetic agents. Prudent decisions will help in mitigating environmental pollution and contributing positively to a greener planet. Therefore, a shift from inhalational to intravenous-based technique will reduce the carbon footprint of anesthetic agents and their impact on global climate. Propofol forms the mainstay of intravenous anesthesia technique and is a proven drug for anesthetic induction and maintenance. Anesthesiologists should appreciate growing concerns about the role of inhalational anesthetics on the environment and join the cause of environmental responsibility. In this narrative review, we revisit the pharmacological and pharmacokinetic considerations, clinical uses, and discuss the merits of propofol-based intravenous anesthesia over inhalational anesthesia in terms of environmental effects. Increased awareness about the environmental impact and adoption of newer, versatile, and user-friendly modalities of intravenous anesthesia administration will pave the way for greener anesthesia practice.

Background and Aims: The autonomic nervous system (ANS) is cardinal for systemic homeostasis. Autonomic dysfunction is prevalent in as high as 65% of patients presenting for cardiac surgery in the Indian scenario. Pre-existing cardiac autonomic dysfunction (CAD) in surgical patients can accentuate perioperative haemodynamic fluctuations during stressful intraoperative events, predispose to adverse cardiac events, and contribute to morbidity and mortality. The prevalence and predictors of CAD in the elective neurosurgical population are unknown in the Indian scenario. The current study was conducted to bridge this knowledge gap. Methods: In this single-centre prospective observational study conducted at a tertiary care neurosciences centre, among 400 consenting adult patients of either gender, between 18 and 80 years of age, undergoing elective neurosurgery, the preoperative ANS function at the bedside was assessed as the primary outcome measure. The ANS status was evaluated using ANSiscopeTM-derived indices of heart rate variability. The diagnosis of CAD was made when the ANS index exceeded a threshold of 13.5. Data regarding predictors of CAD were collected from patient records as the secondary outcome measure. Statistical analysis was done using the R software. A P-value of

Background & Aims: Despite several recent international guidelines, no consensus exists on the bleeding risk nor haemostatic parameter thresholds that define the safety of invasive procedures in patients with cirrhosis. The aim of this study was to establish a position paper on the bleeding risk associated with invasive procedures in patients with cirrhosis among the experts involved in various guidelines. Methods: All experts involved in recent guidelines on the management of invasive procedures in patients with cirrhosis were invited to classify 80 procedures as ''high risk'' or ''low risk'' with respect to bleeding. Procedures were considered high risk when the estimated risk of major bleeding was 1.5% or more, or when even minor bleeding might lead to significant morbidity or death. The experts were also asked to choose safety thresholds for laboratory test values at which elective invasive procedures could be safely performed. The predetermined threshold considered as “consensus” was ≥75% agreement. Results: Fifty-two experts participated in the study. Out of 80 procedures, a consensus opinion was reached for 52 procedures (65%): 17 procedures were classified as “high risk”, primarily interventional endoscopic procedures, percutaneous organ biopsies, or procedures involving the central nervous system; and 35 as “low risk”, primarily “diagnostic” procedures. The lowest platelet counts at which performance of a low-risk procedure or a high-risk procedure/surgery were deemed acceptable were 30 × 109/L and 50 × 109/L, respectively. Experts did not believe that international normalised ratio should be considered before performing low-risk procedures; 71% also indicated that it should not be considered before performing high-risk procedures. Conclusions: This experience-based classification may be helpful to refine future study designs and to guide clinical decision making regarding invasive procedures in patients with cirrhosis. Impact and implications: Several risk classifications and management guidelines for invasive procedures in patients with cirrhosis have been proposed, but with conflicting recommendations. By providing a position paper, based on the opinion of a broad panel of experts, on the bleeding risk associated with 52 invasive procedures in patients with cirrhosis, this survey will help to provide a framework for future study design. The consensus on platelet count, international normalised ratio, fibrinogen and activated partial thromboplastin time identified in this survey will inform physicians regarding the laboratory test values considered acceptable by the experts prior to the performance of an elective invasive procedure in patients with cirrhosis.

Vishak K Acharya,1,2 Deepthi K Sharma,1,2 Sindhu K Kamath,1,2 A Shreenivasa,1,2 Bhaskaran Unnikrishnan,1,3 Ramesh Holla,1,3 Manish Gautham,2,4 Priya Rathi,1,3 Jane Mendonca1,2 1Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India; 2Faculty in Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India; 3Faculty in Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India; 4Royal Liverpool University Hospital, Liverpool, UKCorrespondence: Vishak K Acharya, Department of Pulmonary Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, 575001, India, Tel +91-9448331570, Email vishak.acharya@manipal.eduIntroduction: The impact of the coronavirus 2 (SARS-CoV-2) pandemic and the effect of preventive health strategies on acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are largely unknown. The public health model imposed during the pandemic and the lessons learnt have implications on recommending future preventive strategies for COPD care in general and exacerbations in particular.Aim: This study endeavors to assess the role of preventive strategies of COVID-19 on exacerbation rates of COPD during the lockdown period compared to similar periods the previous year and assess the compliance to preventive strategies for COVID-19 among COPD patients.Methods: This is a hospital-based descriptive cross-sectional study at a tertiary care center. AECOPD in patients during a period spanning five months in the pre-lockdown days was compared with exacerbation rates for a similar period during the national lockdown.Results: Sixty-eight patients were recruited (mean age: 67.38) among whom 47 were males and 21 were females. There were only 7 (10.3%) reported admissions during the lockdown period of 5 months compared to 50 (73.5%) during the corresponding period pre-lockdown. Mild exacerbations reported during the lockdown period were also significantly less with only 17 (25%) against 58 (85.3%) during the pre-lockdown period. Adherence to measures such as donning of masks, hand hygiene, and social distancing was observed among COPD patients with good compliance to the health practices promulgated in the pandemic.Discussion: A significant reduction in exacerbation rates among AECOPD patients during the period of lockdown was observed compared to a similar period the year prior. Noticeable were the findings that both community-based milder exacerbations and severe exacerbations necessitating hospitalizations showed a reduction during the period of lockdown. Adaptability, compliance and acceptance to usage of masks, hand hygiene measures, and norms such as physical distancing were observed in the majority of COPD patients.Keywords: COPD, exacerbation, pandemic, physical distancing, face masks

Objectives: Anemia after surgery is common and is associated with adverse clinical outcomes. Understanding the incidence and risk factors for postoperative anemia is important to reduce anemia-related complications and blood transfusion. There is lack of data regarding postoperative anemia and its contributing factors in neurosurgery. This study evaluates the incidence and risk factors of postoperative anemia, and its impact on clinical outcomes. Methods: This was a single centre, retrospective study of patients who underwent elective neurosurgery over seven months. Data regarding age, gender, body mass index, American Society of Anesthesiologists (ASA) physical status, diagnosis, surgery, preoperative hemoglobin, surgery duration, intraoperative blood loss and red blood cell (RBC) transfusion, dose of tranexamic acid, intraoperative fluid balance, years of surgeon’s experience, postoperative hemoglobin, postoperative RBC transfusion, Glasgow Coma Scale (GCS) score at hospital discharge, and duration of postoperative intensive care unit and hospital stay were collected. Logistic regression was used to identify predictors of postoperative anemia. Results: The incidence of postoperative anemia was 11.3% (116/1025). On univariate analysis; age, preoperative hemoglobin, surgery duration, gender, ASA grade, surgery type, and surgeon’s experience were associated with postoperative anemia. Lower preoperative hemoglobin (p

Aim: The present study aims to evaluate the efficacy of naturally-derived bovine hydroxyapatite (Cerabone) versus demineralized freeze-dried bone allograft both combined with platelet-rich fibrin for treatment of grade II mandibular furcation defects.

Background: Gaps in Tuberculosis Preventive Treatment (TPT) cascade among household contacts (HHCs) of Tuberculosis patients are often attributed to the knowledge gaps among the HHCs. Objectives: To examine the factors affecting the uptake of IGRA testing among HHCs of drug-susceptible, pulmonary TB patients registered between January and May 2023 in Kolar district, Karnataka using Health Belief model and qualitative interviews. Methodology: Between April and June 2023, 196 HHCs of 70 registered TB patients were included in the mixed methods study. Using a four-point Likert scale questionnaire, adult HHCs were interviewed regarding their knowledge of TB disease, perceived susceptibility and severity of TB Infection, benefits, and barriers in testing for TB Infection (IGRA) and cues for action. Mann Whitney U test was used to compare the scores of those who were tested and those who were not. Further, reasons for not undergoing IGRA testing were also assessed qualitatively. Results: Among 196 HHC, 45 were children under 5 years. IGRA testing had been done in 47% (71/151) of eligible HHCs. Among adult HHC, self- perceived and Index case-attributed susceptibility score was significantly associated with testing; while perceived severity scores, knowledge and perceived benefit scores were not. Major themes in barriers to testing were misinterpretation of ‘TB Infection’, selective testing of HHCs, delayed contact tracing, lack of logistics and lack of planning and coordination. TPT was given to 84% (38/45) under five HHCs. Major cue for TPT provision was availability of TPT, followed by caregiver’s perceived susceptibility. Conclusion: Perceived susceptibility of HHC to TB infection is often misinformed. Group counselling of HHCs, provision of IGRA at doorstep and a well-established referral system will improve the uptake of IGRA.

Respiratory management is an important aspect of care in neuroanesthesia practice for neurosurgical patients. A wide variety of procedures are performed under sedation in the neurosurgical population, and maintaining oxygenation is of paramount importance during these procedures. The high-flow oxygen devices improve arterial oxygenation by providing higher inspiratory oxygen concentration and maintaining higher dynamic positive airway pressure. These devices have gained importance during the recent years with regard to enhancing patient safety. This narrative review focuses on the role of trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) and high-flow nasal oxygenation (HFNO) techniques in the neuroanesthesia practice and electroconvulsive therapy.

Background and Aims: Many patients suffer from post-operative pain after neurosurgery despite using intra-operative opioids. Opioid side effects are problematic in neurosurgical patients. Hence, non-opioid alternatives for the management of nociception and pain are needed. Previous studies comparing opioids with non-opioids in the neurosurgical population were few, from single centres, of small sample sizes and were equivocal in findings, which prevented change in clinical practice. To overcome these limitations, we are conducting a multi-centre trial with objectives to compare intra-operative rescue opioid requirements and post-operative pain scores (primary objectives), adverse events, quality of recovery from anaesthesia, quality of sleep and patient satisfaction during hospital stay, and persistent post-surgical pain and quality of life at 3 and 6 months (secondary objectives) in patients receiving opioid and non-opioid analgesia for brain tumour surgeries. Methods: This study protocol describes the methodology of a multi-centre randomised controlled trial. Ethics committee approval has been obtained from all five centres, the trial has been registered with the Clinical Trial Registry- India, and insurance has been obtained for this investigator-initiated funded study. In patients undergoing supra-tentorial brain tumour surgery (population), we will compare fentanyl (intervention) 1 μg/kg/h with dexmedetomidine (comparator) 0.5 μg/kg/h administered during surgery with regards to intra-operative rescue opioid requirement and post-operative pain (primary outcomes). Results: We describe the study protocol of the multi-centre trial (protocol version 2, dated 29/01/2022). The first patient was recruited on 19/10/2022, and we will complete recruitment before March 2024. Conclusion: We expect our study to establish dexmedetomidine as an effective non-opioid analgesic vis-à-vis opioids in the neurosurgical population.

Melita Sheilini,1 H Manjunatha Hande,2 Elsa Sanatombi Devi,1 Asha Kamath,3 Baby S Nayak,4 Donald E Morisky,5 Anice George4 1Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Department of Medicine, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, Karnataka, India; 3Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India; 4Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India; 5Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USACorrespondence: Anice George, Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Udupi District, Manipal, Karnataka, India, 576104, Tel +919632094766, Fax +0091-08202922572, Email anice.george@manipal.eduPurpose: The aim of the study was to assess the predictors of adherence among elderly on antihypertensives and to examine the difference in adherence among males and females.Patients and Methods: Cross-sectional survey design was adopted for the study. The data were collected from 800 patients of age 60 years and above using demographic proforma, clinical proforma and Morisky Medication Adherence Scale (MMAS-8) with due approval from the institutional ethical clearance committee and written informed consent from the participants.Results: The findings revealed no significant difference in the non-adherence rates among males and females. Number of medications was identified as the major predictor of adherence.Conclusion: Awareness of factors influencing medication adherence is crucial for health professionals to provide appropriate advice for patients to maintain quality health. The findings of the study highlight the importance of nurses’ role towards imparting knowledge on hypertension and emphasizing on the importance of adherence to antihypertensives among elderly.Keywords: hypertension, aged, adherence, medication, gender, medication nonadherence, drug adherence, elderly, antihypertensive agents

Alisha Kulkarni,1,&ast; Yogish Kamath,1,&ast; Lavya Shetty,2 Neetha I R Kuzhuppilly1 1Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India; 2Division of Yoga, Centre for Integrative Medicine & Research, Manipal Academy of Higher Education, Manipal, Karnataka, India&ast;These authors contributed equally to this workCorrespondence: Neetha I R Kuzhuppilly, Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 98861 61979, Fax +91-820-2571934, Email cinnineetha@gmail.com; neetha.kir@manipal.eduPurpose: Glaucoma is an optic neuropathy where intraocular pressure is the only modifiable risk factor. Yoga is thought to adversely affect intra-ocular pressure (IOP) but we do not know if yogic breathing exercises can influence IOP. With this study, we aimed to determine the effect of specific nasal breathing techniques on intra-ocular pressure in normal individuals.Patients and Methods: One hundred and sixty-four normal subjects were randomly assigned to one of four specific breathing groups - right nostril breathing (RNB), left nostril breathing (LNB), alternate nostril breathing (ANB), normal breathing (NB). The IOP was measured in both eyes at baseline and following the breathing exercise; and the change was analyzed.Results: Eighty-five women and 79 men participated and there was no significant difference in baseline age or IOP between the groups. In RNB, IOP reduced significantly in both right and left eyes, from 14.3 ± 3.0mmHg to 13.9 ± 2.6mmHg, (p=0.022) and from 14.7 ± 3.2mmHg to 14.2 ± 3mmHg (p=0.016) respectively. In LNB, there was no significant IOP change in the right eye, whereas in the left eye, there was a significant reduction from 14.2 ± 2.7mmHg to 13.3 ± 2.5mmHg (p< 0.0001). There was no significant IOP change in ANB and NB.Conclusion: Specific breathing techniques like right and left nostril breathing, alternate nostril breathing are safe and do not raise IOP in normal subjects. Additionally, right and left nostril breathing techniques have a beneficial effect of lowering IOP.Keywords: eye, glaucoma, yoga, risk-factor, breathing exercises

Background: Reading is a vital aspect of the learning process for students and should be encouraged. Any effort or innovation that improves the motivation of students to read is worth sustaining. The materials often used are textbooks and reference materials. This study aimed to assess the readership and preference for e-books and print books across contexts. In addition, this study aims to identify factors that contribute to e-book usage. Methodology: This cross-sectional study was conducted among MBBS students of KMC Mangalore. A Semi-structured questionnaire which contained demographics, knowledge, practices and awareness of the use of e-books was used for data collection. The collected data was analysed using SPSS version 25.0. Results were expressed as proportions and for comparison across groups, the Chi-square test was used. A ‘p’ value

Background: Health information exchange (HIE) is the electronic exchange of data or information between healthcare institutions, despite the fact that, the format and context of the information may vary. A robust HIE, which provides the seamless networking is not currently available. The gap in research pertaining mainly to Indian scenario where this study will be proposed would provide the much-needed evidence. The proposed study aims to develop a comprehensive framework for Health information exchange and interoperability for a group of teaching hospitals. Objectives: To understand and assess the current state, barriers and challenges related to HIE and interoperability; understand the perspectives and challenges of HIE and Interoperability among healthcare providers. Methodology: A qualitative study would be carried out among healthcare stakeholders which will serve in understanding the perspective and challenges of HIE and interoperability and develop a comprehensive framework for HIE and interoperability. Results: Coordinated care among the healthcare providers can be increased and serves in reducing the lost to follow up of patients which promotes patient quality of life and lowers the rate of mortality and morbidity. This will facilitate the quick access to the patient critical information, leading to better – informed diagnosis and treatment plans. This framework will significantly elevate the quality of care, streamline operations, will contribute to a reduction in mortality and morbidity.

Background: Prevalence of metabolic syndrome among adults in India, is reported to be around 20%-25%, with significantly higher proportion among women than men. Yoga interventions has been promoted as an important non- pharmacological tool to address the growing burden of non-communicable diseases. Objectives: To assess the effectiveness of a pranayama and intervention (yoga) intervention on various components of metabolic syndrome among 30 to 60-year-old women with hypertension. Methodology: A community based repeated measures design was undertaken 156 among hypertensive women (79 intervention, 77 controls) residing in coastal part of southern India. Anthropometric measurements, blood pressure, fasting blood glucose (FBS) and lipids were measured. Six-month pranayama and dhyana intervention were administered to the intervention arm, whereas routine treatment was continued for the control arm. Follow-up was done to ensure practice of interventions while investigations were done at baseline and 6th month. Results: Majority of the women in the intervention and control arm were aged 45-60 years. In the intervention arm, using the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria, most [57(72.2%)] of the women had elevated blood pressure. Nearly half of them [38(48.1%)] had abdominal obesity, elevated FBS was seen among 39(49.4%) and 50.6% had low HDL. Hypertriglyceridemia was seen in less than a third [23(29.1%)] women. In the control arm, most [52(70.3%)] of the women had elevated blood pressure, 27(36.5%)] had abdominal obesity, half of them had elevated FBS [39(52.7%)] and low HDL [36(48.6%)]. Hypertriglyceridemia was seen in 21(28.4%) women. No significant change was noted at the end of 6th month follow-up in body mass index (BMI) (p=0.533), systolic(p=0.051) and diastolic blood pressure (p=0.485). Conclusion: There was no significant difference in the 6th month prevalence of components of metabolic syndrome compared to baseline, in both arms of the study.

Background: Over the past decades, cancer has become the second leading cause of death and morbidities around the world, accounting for nearly 1 in 6 of the total global deaths. The cost of treatment depends on the type of cancer, the duration of treatment, the type of hospital, and whether they are covered under any health insurance. Objectives: 1. Cost of cancer treatment, before and after registration under VAS, among cancer patients attending an empanelled tertiary care hospital in South India 2. Pattern of OOPE incurred by households of cancer patients. 3. Proportion of expenditure spent on cancer treatment in comparison to the annual family income. Methodology: A hospital-based cross-sectional study was conducted in tertiary care centre among cancer patients covered under VAS, from April to May 2018. Patients who were not covered under the schemes were excluded from the study. Results: Out of the 150 cancer patients actively receiving cancer treatment, a majority, i.e., 65% of them were females. More than half of them (66%) were in the age group of 20-60 years. Only 9% of patients had additional health insurance to aid their expenditures while the rest were dependent only on VAS. The median (IQR) monthly income of the patient and family members was 153(83;293) USD. The overall median (IQR) cost was 525(230;980) in our patients. Costs before initiation of treatment under VAS constituted almost 90% of direct medical OOPE spent by the patient and his family. The overall mean OOPE in this study was 856 USD. 70% of the patients incurred a monthly cost of ≥40% of their monthly family income and 41% of the patient’s OOPE was more than 100% of their monthly family income. Conclusion: A monthly cost-to-income ratio of 240% is seen in 70% of the patients, Loans were taken and donations received to combat the expenditures. Hence VAS should reimburse the medical cost before enrolment under VAS. VAS can step up and protect its objectives by reimbursing the diagnostic costs and any long-term non-medical costs associated with the illness, as this would help reduce the OOPE by 1/3 making a huge difference to their financial status.

Background: Perinatal mortality is a sensitive indicator of maternal and child health care. However, there is no universal perinatal death (PND) audit system in India. Objective: To identify the impact of the proposed model of PND audit on health care delivery in two districts of Karnataka. Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK- high performing) and Koppal (low performing) districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. The healthcare delivery system was analyzed in both districts. A PND audit system was designed. All neonatal deaths during the study period were analyzed by an expert committee (Local senior pediatricians and obstetricians). Following variables were studied: (i) Documentation and reporting systems in these hospitals; (ii) Role of health care personnel in documentation and reporting (iii) Existing system of audit, if any. Doctors feedback, in-depth interviews, death certification analysis, risk analysis, PND reporting format, expert committee feedback, medical social worker feedback, data from district health office were recorded and analysed. The changes in documentation, information yield, reporting of PND, time taken for submitting death report and changes in infrastructure in facilities in the two time periods of 6 months was analysed. Results: Significant changes were recorded in documentation of care delivered in the facility specially in Koppal district. There was an increase in reporting of PND in the second half. The PND audit assisted in preventability of death assertion. Improved data resulted in better performance of expert committee, thereby reducing the proportion of unclassified segment of neonatal deaths. There was significant improvement in infrastructure in the health facilities. Conclusion: Auditing perinatal deaths had a positive impact at point of care resulting in improved documentation, reporting and infrastructure upgradation.

Background: There is an established well reported link of intussusception with the use of rotavirus vaccines. Little is known about the newly introduced rotasiil vaccine causing intussusception. So, this study has been undertaken to study the epidemiology of intussusception and its potential risk among children vaccinated with Rotasiil vaccine. Methodology: A hospital based cross-sectional study was conducted for a period of 2 years among children

Background: Analyzing preterm deaths is crucial due to the significant contribution of preterm babies to neonatal mortality rates. However, there is no universal perinatal death (PND) audit system in India Objective: To analyze the preterm deaths in two districts of Karnataka with study model of PND audit Methodology: Hospitals with maternal and child care facilities which met inclusion criteria in Dakshina Kannada (DK), high performing and Koppal (KPL),low performing districts were included after institutional ethics committee approval and permission from Mission Director, National Health Mission, Directorate of Heath and Family Welfare Services, Government of Karnataka. A PND audit system was designed. Personnel with training in medico-social history taking were utilized for data accumulation. Causal analysis of death as certified by independent expert panels and certifying physician was carried out and was compared for functionality. To determine optimality of care, facilities were categorized depending upon available levels of maternity and neonatal care. Preterm deaths during the one-year study period with complete data were analyzed. Results: 119 preterm deaths in DK and 97 preterm deaths in KPL were analyzed. In utero transfer was 81.5 % in DK and 11.3% in KPL. More preterm deliveries were documented in public hospitals in both districts. Deaths of preterm babies in private hospitals at KPLwas 41.2% against 27.8% private deliveries. In KPL 22.6% babies died at home despite delivering in hospitals. Risk factor documentation was poor in both districts. Expert committee review increased preventability assertion from 7.5 to 11.7% in DK, 2 to 62.8% in KPL. Conclusion: Auditing perinatal deaths and analysing preterm deaths resulted in identification of specific deficiencies in healthcare system. DK had reasonably good facilities but KPL had serious concerns. The study model enhanced the preventability assertion in preterm deaths

Background: CDX2 has been established as a good prognostic marker for colorectal carcinomas. Differentiated adenocarcinomas are characterized by higher CDX2 expression than undifferentiated tumors with stronger reactivity in intestinal phenotypes. There is a close correlation between the degree of tumor differentiation and the Ki-67 score. It was also observed that strong CDX2 expression was associated with low Ki-67 index whereas negative or dim CDX2 expression was associated with high Ki-67 index. Methods: Gastric biopsies and gastrectomy specimens with gastric carcinoma were evaluated clinicopathologically and processed for immunohistochemistry (IHC) staining to assess CDX2 and Ki-67 expression. The relationship between 2 markers and each clinicopathological parameter was evaluated. Data was statistically analysed. P

Mental health disorders are a leading health issue among adults and teenagers. Public health organizations and governments have highlighted an increase in mental health issues during the COVID-19 pandemic. This research uses a survey of 83 students and 95 senior citizens to understand the impact of COVID-19 on mental health. The results indicate that COVID-19 has negatively affected the mental health of students, seniors living in nursing homes and, to a lesser extent, seniors living at home. The impact is greater for external factors than internal factors for students and seniors living in nursing homes. These results have implications for future research on online education, social media usage, and other forms of technologies that limit in-person interactions. The results also indicate that it is important for public health policy to weigh the benefits of various restrictions against the detrimental effects such restrictions have on mental health.

Bi2O3–PbO–CdO–B2O3 glass samples were prepared via melt quenching. The substitution of Bi2O3 for B2O3 resulted in a continuous increase in density from 4.334 to 5.742 g/cm3. The molar volume (V m) gradually increased from 37.197 to 38.429 cm3/mol when the Bi2O3 level increased from 10 to 25 mol%. With the addition of Bi2O3 from 10 to 25 mol%, Young’s, bulk, shear, and longitudinal modulus reduced from 40.80 to 35.07 GPa, 22.92 to 19.97 GPa, 16.95 to 14.52 GPa, and 45.53 to 39.33 GPa, respectively. These glasses are bendable rather than elongated and can withstand longitudinal stress over shear stress. Radiation protection qualities were investigated using EpiXS software, which is based on the ENDF/B-VIII EPICS2017 library, between 122 and 1275 keV. The mass attenuation coefficients are substantially higher at low energies. The radiation shielding properties of Bi2O3–PbO–CdO–B2O3 glasses were improved by replacing B2O3 with Bi2O3. Quantifying this improvement is critical in developing compact radiation shielding employing this glass system.

Background Patients with coronavirus disease 2019 (COVID-19) presenting for neurosurgery are not rare. Considering the lack of literature informing the outcomes in this subset, present study was conducted to compare perioperative management and postoperative outcomes between COVID-19 and non-COVID-19 neurosurgical patients. Methods After ethics committee approval, data of all patients with COVID-19 along with an equal number of age and diagnosis matched non-COVID-19 patients undergoing neurosurgery between April 2020 and January 2021 was analyzed retrospectively. Predictors of poor outcome were identified using multivariate logistic regression analysis. Results During the study period, 50 COVID-19 patients (28 laboratory confirmed (group-C) and 22 clinicoradiological diagnosed [group-CR]) underwent neurosurgery and were compared with 50 matched non-COVID-19 patients. Preoperatively, clinicoradiological diagnosed COVID-19 patients had higher American Society of Anesthesiologists (ASA) grade (p = 0.01), lower Glasgow Coma Scale (GCS) score (p

In this study, four tellurite–germanate glasses containing zinc, lithium, and bismuth with varied Bi2O3 and TeO2 amounts were investigated. The mechanical qualities of sample glasses were investigated and associated with their structural properties. Furthermore, the radiation-shielding capabilities of N1–N4 glasses were evaluated at 0.662 MeV using EPICS2017. The radiation-shielding characteristics were compared with the radiation-shielding parameters published in the literature for various glass systems. When TeO2 was replaced with Bi2O3, Young’s and bulk moduli of the material decreased. The L values of glasses were higher than their S values (14–13 GPa), indicating that they can tolerate longitudinal stress better than shear stress and can be bent rather than elongated readily. The MACs calculated were comparable to those obtained using WinXcom. The tenth-value layer (TVL) of all of the sample glasses was higher than that of the bismuth aluminosilicate glasses. All of the borate glass systems containing bismuth, sodium, and antimony had lower TVLs than N1–N3 glasses. The half-value layer was more in the N4 glass with the greatest Bi2O3 content than those in 50 and 60 mol% PbO-containing strontium borate glasses.

Introduction and Objectives: Severe alcohol-associated hepatitis (AH) is an entity with high morbidity and mortality; however, data in Latin America is limited. We aimed to characterize patients hospitalized for AH in a multinational cohort in Latin America. Materials and Methods: Multicenter prospective cohort study. We included patients admitted with severe AH between 2015-2022. Sociodemographic and clinical information was recorded. The analysis included survival analysis using Kaplan-Meier curves. This study was approved by the institutional ethics committee. Results: 470 patients from 24 centers (8 countries: Mexico, Chile, Argentina, Brazil, Peru, Bolivia, Colombia, and Ecuador) were included. Age 49.8 ± 10.6 years, 85.6% of men and 45% had a previous diagnosis of cirrhosis. Median MELD at admission was 26.9 [22-32] points. 26.5% met SIRS criteria and 34.3% had an acute kidney injury (AKI) on admission. Only 36.8% of patients were treated with corticosteroids. Survival at 30 days was 75.0% (95%CI: 70.1-79.3%) and 62.8% (95%CI: 57.1-68.0%) at 90 days. A total of 191 (45.8%) patients presented infections, 31.4% at admission and 24.9% during hospitalization. The most frequent locations of community-acquired infections were respiratory (33.5%), urinary (32.1%), spontaneous bacterial peritonitis (14.9%), and skin (10.5%), while the most frequent pathogens were Escherichia coli (40%), Klebsiella pneumoniae (12%), and Enterococcus (6%). The presence of infection at admission was associated with a decreased survival at 90-days (66.9% versus 48.1%, p=0.0002). AKI at admission was also associated with decreased survival at 90-days (86.8% versus 51.3%, p