CPK: The new tool in the diagnosis of ectopic pregnancy

Background: Ectopic pregnancy is still a diagnostic dilemma presenting with various complaints. The classic triad of amenorrhea, abdominal pain, vaginal bleeding and /or syncope is not always seen. Misdiagnosis can lead to delay in treatment, blood loss is found to be the major cause of death. Early and accurate diagnosis is critical in bringing down the maternal mortality and morbidity. Prompt and effective treatment of an ectopic pregnancy can help preserve the chances of future healthy pregnancies. Aim of present study was to investigate whether creatinine phosphokinase (cpk) can be used as an effective diagnostic tool in the early diagnosis of ectopic pregnancy which can help in decreasing the maternal mortality and morbidityMethods: This observational comparative three group clinical study was conducted at Chinmaya Mission Hospital, Bangalore, between May 2016 to January 2017.120 women in their early trimester were studied of which 40 were diagnosed cases of ectopic pregnancies, 40 women presented with intrauterine abortive pregnancies and 40 women had normal healthy pregnancies. Serum CPK, serum B-HCG, vaginal scans were done in all, along with routine investigations.Results: The mean CPK values in normal, abortive and ectopic pregnancies were 36.92±6.44, 43.95±11.96 and 91.55±30.43 respectively. It was found to be significantly higher in ectopic Pregnancies. Also, the mean CPK in ruptured and unruptured ectopic pregnancy were 97.26±25.97 and 63.82±34.92 respectively.Conclusions: Present study shows that maternal CPK levels are significantly higher in women with ectopic pregnancies. CPK can serve as the reliable biochemical marker to diagnose ectopic pregnancy particularly ruptured. CPK can be used to increase the diagnostic efficacy in ectopic pregnancy, which followed by rapid and appropriate treatment can reduce the mortality, morbidity and preserve future fertility

Utilization of Integrated Child Development Services (ICDS) Scheme by child beneficiaries in Coastal Karnataka, India

Background: India’s main early childhood development intervention the ICDS Scheme has been sustained for 40 years and has been successful in some ways. However, nearly half of the children under six years are still under nourished. The program in reducing the proportion of undernourished children over the past decade has been modest and slower in India than what has been achieved in other countries with comparable socio-economic indicators. Aims & Objectives: 1. To study the utilization of services offered to children under ICDS, 2. To assess the perception about the services. Materials & Methods: A community based cross sectional study was done among mothers of 271 children in the age group three to six years registered in anganwadis. Results: Median duration of absenteeism to anganwadi was five months during the last six months enquired. About 95.9% of registered child beneficiaries utilized supplementary nutrition services and only 48.7% mothers of child beneficiaries were attending nutrition and health education sessions. Among mothers who were aware of growth monitoring, only 73.6% of their children’s weight was checked regularly.  About 60% of mothers were not happy with the quality of food served to their children in the anganwadi. Among children adherent to anganwadi, 72.5% children’s weight remained normal. Conclusion: Only 75% children were regularly attending. Median duration of adherence to anganwadi services was only 12 months and the most common reason for not adhering to the services is due to their simultaneous enrollment in other private nursery school

A pilot study to assess compliance and impact of health warnings on tobacco products in the Udupi district of Karnataka State, India

Introduction: The Government of India has taken several steps to reduce tobacco use, including legislation in the Cigarettes and Other Tobacco Products Act (COTPA) requiring health warnings on tobacco products. This study assessed compliance with the legislation on warnings, and awareness of these warnings and their perceived impact in preventing tobacco uptake among college students in a district of Karnataka, India. Material and Methods: This study consisted of two components, pack collection and a survey. For the first, tobacco packs were obtained from all tobacco selling shops in an urban and a rural locality in the Karkala block of Udupi district. Empty cigarette packs were collected from shops, and full packs were purchased if empty packs were not available . The packs were collected to measure their dimensions, as per the Tobacco Pack Surveillance System guidelines, and assessed for compliance, as per COTPA. For the second component of the study, a questionnaire was distributed to each college student to fill in; this was done to assess awareness of the new warnings at the time of the pilot survey, knowledge of harms, and perceptions of the warnings in reducing tobacco uptake. Results: We collected 26 tobacco packs. Two (8%) packs had warnings that were the correct size (85% of the main display areas), 15 (58%) packs had clear and legible warnings, and 18 (69%) packs had warning messages in the appropriate language. In the student survey, 60% of males and 52% of females indicated that they would not start using any tobacco products on seeing the new warnings. Conclusions: Only a few studies other than our pilot study have assessed compliance with legislation on health warnings in low- or middle-income countries. Although health warnings were perceived as a deterrent to tobacco use among students, compliance with national legislation in this pilot study was found to be low

Institutional tensions, corporate social responsibility and district-level governance of tobacco industry interference:Analysing challenges in local implementation of Article 5.3 measures in Karnataka, India

INTRODUCTION: Accelerating progress on tobacco control will require Article 5.3 of the WHO Framework Convention on Tobacco Control to be systematically integrated into policies and practices of sectors beyond health at diverse government levels. However, no study has explored implementation challenges of Article 5.3 within multilevel systems such as India, where political decisions on tobacco control occur at diverse government levels, which may constrain action at local level. METHODS: Based on 33 semi-structured interviews with diverse government and civil society stakeholders across four districts in Karnataka, India (Mysore, Mangalore, Bengaluru (rural) and Udupi), this study examines challenges to implement Article 5.3 arising from competing agendas and policies of different actors at multiple levels. RESULTS: Our analysis reveals generally low levels of awareness of Article 5.3 and its guideline recommendations, even among those directly involved in tobacco control at district level. Efforts to implement Article 5.3 were also challenged by competing views on the appropriate terms of engagement with industry actors. Scope to reconcile tensions across competing health, agriculture and commercial agendas was further constrained by the policies and practices of the national Tobacco Board, thereby undermining local implementation of Article 5.3. The most challenging aspect of Article 5.3 implementation was the difficulties in restricting engagement by government officials and departments with tobacco industry corporate social responsibility initiatives given national requirements for such activities among major corporations. CONCLUSIONS: Promoting effective implementation of Article 5.3 in Karnataka will require policymakers to work across policy silos and reconcile tensions across India’s national health and economic priorities

Assessment of tobacco imagery and compliance with tobacco-free rules in popular Indian films

Background: Exposure to smoking in films causes smoking uptake among adolescents. Investigation of the extent to which tobacco imagery appears, or tobacco control laws are complied with in Indian films is limited, and especially so for films in regional languages. This study presents an analysis of tobacco content and compliance with tobacco control laws in popular films in several languages from the Karnataka state of India.Methods: We used 5 min interval coding to measure actual tobacco use, implied tobacco use, tobacco paraphernalia and tobacco branding in the top 10 films identified from national box office ratings and regional distributor reports in Karnataka in 2015 and 2016. We also assessed compliance with tobacco-free film rules in India.Findings: A total of 47 films, in English, Hindi, Malayalam, Tamil, Telugu and Tulu languages were coded. Any tobacco imagery was observed in 72% of films, and actual tobacco use in 50%. Tobacco imagery was equally prevalent in films classified as suitable for universal viewing (U category) or at age 12 or more (U/A category) films; and significantly more common in films made in regional than national language (Hindi). None of the films were fully compliant with legal requirements on health spots, audiovisual disclaimers and health warnings.Conclusions: Tobacco content was common in films classified as suitable for viewing by children, more among regional than national languages. Compliance with tobacco control laws was low. Stricter enforcement of tobacco-free film rules will protect children and adolescents from exposure to tobacco use on screen

Role of magnetic resonance imaging in distinguishing fungal from nonfungal multiple brain abscesses

AbstractCladophialophora bantiana is a neurotropic dematiaceous fungus known for affecting immunocompromised and immunocompetent hosts. We report a case of 24year old immunocompetent male presenting with headache, fever and vomiting. MRI was suggestive of multiple fungal brain abscesses. He underwent total excision of abscesses. Pus culture was suggestive of brain abscess caused by C. bantiana. We report a culture proven case of C. bantiana emphasizing on specific MRI features which are critical in differentiating fungal from nonfungal brain abscesses

Quantifying audio visual alcohol imagery in popular Indian films: A content analysis

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating. Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances. Setting India. Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017. Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined. Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films. Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis

Background: Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. Objectives: To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. Methods: Data from the Global Adult Tobacco Survey 2 (GATS, 2016–17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. Results: The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. Conclusion: The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

Objective This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.Design Qualitative semi-structured interviews.Setting Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.Participants Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.Results The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an ‘application’ for ‘compliance and monitoring indicators’ in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.Conclusion Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly