Comparison of adnexal torsion in different phases of women’s life: a retrospective cohort study

Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology. Though it is more common in reproductive age group, it can occur in extremes of age group. So, we had analysed the clinical presentation, surgical characteristics, and causes of adnexal torsion among adolescent population, reproductive-age women, and postmenopausal women.Methods: Patients with adnexal torsion who were treated in department of obstetrics and gynecology, SRM Medical College Hospital and Research Centre from October 2016 to March 2019 were retrospectively analyzed.Results: Among the 53 cases of adnexal torsion during the study period, maximum (38, 71.6%) were in the reproductive age group. There were three patients with ovarian torsion during pregnancy. Acute pain abdomen was the significant presenting symptom in adolescent group compared to other two group (100% versus 80.6% versus 40%, p = 0.03). Adnexal pathology was in the ovary in 76% and isolated tubal pathology in 5%. Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients (100%), as opposed to conservative surgery- detorsion and cystectomy in premenopausal women (56%). In Adolescent patients 62% had polycystic ovaries as intraoperative finding. Histopathology were benign except for a patient in postmenopausal age group who had granulosa cell tumour.Conclusions: An early identification of adnexal torsion is necessary in order to achieve conservative treatment in order to maximize the future reproductive potential in younger patients

EXPLORING THE INTERRELATIONSHIP BETWEEN ELECTROLYTES, ANEMIA, AND GLYCOSYLATED HEMOGLOBIN (HBA1C) LEVELS IN TYPE 2 DIABETICS

  Objective: The aim of this study is to analyze the interrelationship and pattern of electrolyte imbalance and compare the correlation between serum electrolytes, glycosylated hemoglobin (HbA1C), and hemoglobin (Hb) levels between Type 2 diabetic patients and non-diabetic subjects.Methods: This study was conducted in 300 subjects (150 diabetics and 150 non-diabetics) and further categorized as anemic and non-anemic within each group. Blood samples were analyzed for HbA1C, hemoglobin, and serum electrolyte levels.Results: Sodium (Na+) levels in diabetics were significantly lower and potassium (K+) as well as chloride (Cl−) levels were significantly higher, when compared with non-diabetics. A significant positive correlation between HbA1C and potassium as well as chloride levels in contrast to negative correlation with sodium levels was observed in both genders. Among diabetics with anemia, we found significantly lower sodium and higher potassium and chloride.Conclusion: In diabetics, levels of sodium were significantly lower, and potassium as well as chloride was significantly higher when compared with non-diabetics. Our study clearly demonstrates an association between electrolytes, hemoglobin, and HbA1C levels in diabetes. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of several deleterious effects associated with electrolyte disorders and their treatment

Identifying low birth weight babies using calf circumference among neonates in a semi-urban area

Background: Low birth weight (LBW) still persists as a public health problem in low- and middle-income countries. There is a constant search to find newer methods to detect LBW babies so that early interventions can be taken. Objective: The objective of this study was to determine the critical limit and to assess the reliability of calf circumference (CaC) measurement in detecting LBW babies. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital between April 2018 and September 2018. In this study, a total of 185 newborns were included in the study. Anthropometric measurements (Calf Circumference [CaC], birth weight, head circumference, crown-rump length, chest circumference, and thigh circumference) were taken as per standard guidelines. Collected data were analyzed for determining the mean, standard deviation, critical limit, receiver operating characteristic curve, Pearson correlation coefficient, and regression analysis of the anthropometric measurements at birth in relation to birth weight. Results: The mean CaC of LBW babies was 9.16±0.11 cm and in normal weight babies, it was 10.86±0.09 cm. The mean values of CaC were significantly lower in LBW babies (p<0.0001). The mean cutoff value of CaC of LBW babies is found to be 9.90 cm, with a sensitivity of 85.6% and specificity of 82.2%. Conclusions: In our study, measuring CC is found to be a good methodin identifying LBW neonates. Hence, measuring CaC can be used as an alternative method to identify LBW babies in remote areas

Predicting pathological jaundice in term babies with ABO setting using cord blood bilirubin

Background: Cord blood bilirubin analysis helps not only in predicting the pathological jaundice in ABO incompatibility but is also useful for early referral and intervention for better outcome. Objective: The objective of this study was to identify the best cut off value of cord blood bilirubin for predicting pathological hyperbilirubinemia in newborns with ABO setting. Materials and Methods: This cohort study was conducted in the Department of Pediatrics at a Medical College during February 2018–July 2018. In this study, healthy term babies with blood Group A, B, and AB born to O positive mothers with birth weight >2.5 kgs and gestational age >37 weeks were included in the study. Cord blood bilirubin and the 4th day (>72 h of life) serum bilirubin value were evaluated. Receiver operating characteristic curve and sensitivity and specificity were used to analyze the data. Results: A total of 70 babies were studied; of which, 45 babies developed physiological jaundice and 25 developed pathological jaundice. The mean cord blood bilirubin value of newborns with physiological jaundice was 2.2 mg/dl, while the value among pathological jaundice was 2.6 mg/dl. Taking cord blood bilirubin value of 2.25 mg/dl as cutoff, the sensitivity and specificity of predicting pathological jaundice was 84% and 71.1%, respectively. Conclusion: Babies with cord bilirubin >2.25 mg/dl are more prone to pathological hyperbilirubinemia.&nbsp

Randomised trial to evaluate the effectiveness and safety of varying doses of linezolid with bedaquiline and pretomanid in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary tuberculosis: study protocol.

INTRODUCTION Drug-resistant tuberculosis (DR-TB) is a global public health problem. Patients suffer for months if undiagnosed or treated inadequately, transmitting DR-TB in the community before succumbing to the disease. Early diagnosis, prompt treatment initiation and completion play a significant role in treatment success. However, extended regimens with injectable result in poor treatment adherence and outcomes. Our objective is to evaluate the effectiveness, safety and tolerability of various doses and duration of linezolid (LZD) in combination with bedaquiline (BDQ) and pretomanid (Pa) after 26 weeks of treatment in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary TB. METHODS AND ANALYSIS A multicentric, randomised pragmatic clinical trial in India will enrol participants in one of the three arms-control arm (arm 1): BDQ, Pa and LZD 600 mg daily for 26 weeks or intervention arms (arm 2): BDQ, Pa and LZD 600 mg for 9 weeks followed by 300 mg for 17 weeks or arm 3: BDQ, Pa and LZD 600 mg for 13 weeks followed by 300 mg for 13 weeks. The primary endpoint is the proportion of patients with favourable outcomes as sustained cure and treatment completion. The secondary endpoint is unfavourable outcomes, including deaths, treatment failure, toxicity/adverse events and lost to follow-up till 48 weeks post-treatment. ETHICS AND DISSEMINATION The study has been approved by the ethics committees of participating institutes and the National Institute for Research in TB. The trial results will help establish evidence towards a safe and effective dose of LZD that can be used in a fully, all-oral short course regimen for highly DR-TB patients. The results of this study will be shared with the National TB Elimination Programme of the country and the WHO guidelines development group through publications and dissemination meetings. TRIAL REGISTRATION NUMBER NCT05040126

Extent of knowledge and attitudes on plagiarism among undergraduate medical students in South India - a multicentre, cross-sectional study to determine the need for incorporating research ethics in medical undergraduate curriculum

BACKGROUND: Undergraduate medical students in India participate in various research activities However, plagiarism is rampant, and we hypothesize that it is the lack of knowledge on how to avoid plagiarism. This study’s objective was to measure the extent of knowledge and attitudes towards plagiarism among undergraduate medical students in India. METHODS: It was a multicentre, cross-sectional study conducted over a two-year period (January 2018 – December 2019). Undergraduate medical students were given a pre-tested semi-structured questionnaire which contained: (a) Demographic details; (b) A quiz developed by Indiana University, USA to assess knowledge; and (c) Attitudes towards Plagiarism (ATP) questionnaire. RESULTS: Eleven medical colleges (n = 4 government medical colleges [GMCs] and n = 7 private medical colleges [PMCs]) participated. A total of N = 4183 students consented. The mean (SD) knowledge score was 4.54 (1.78) out of 10. The factors (adjusted odds ratio [aOR]; 95% Confidence interval [CI]; p value) that emerged as significant predictors of poor knowledge score were early years of medical education (0.110; 0.063, 0.156; < 0.001) and being enrolled in a GMC (0.348; 0.233, 0.463; < 0.001).The overall mean (SD) scores of the three attitude components namely permissive, critical and submissive norms were 37.56 (5.25), 20.35 (4.20) and 31.20 (4.28) respectively, corresponding to the moderate category. CONCLUSION: The overall knowledge score was poor. A vast majority of study participants fell in the moderate category of attitude score. These findings warrant the need for incorporating formal training in the medical education curriculum

Depression and its associated factors among the older adults in rural, Tamilnadu, India

Background: Depression is a significant public health concern, especially among older adults due to its distressing morbidity and mortality rate. This study aimed to assess the prevalence of depression and the associated risk factors among older adults (age ≥ 60 years) in Tamilnadu, India. Materials and methods: A community-based cross-sectional study was carried out from July 2016 to May 2018 among the older adults in the rural area of three districts of Tamil Nadu, India. Geriatric Depression Scale item 15 (GDS-15) was used to assess depression with face to face interviews from 7200 participants. Descriptive statistics and multivariable logistic regression analysis were employed. Adjusted odds ratio (OR) with a 95% confidence interval was used to calculate the significance. Results: Prevalence of depression among older adults were found to be 67.5% (95% CI-0.66–0.68). The multivariable logistic regression model revealed that older adults above 80 years (OR = 1.91; CI = 0.885–1.344), female sex (OR = 0.88; 95% CI = 0.803–0.982), widow (OR = 0.88; 95% CI = 0.77–1.00), living with children (OR = 0.86, 95% CI = 0.77–0.97), lack of family support (OR = 1.48; CI = 1.321–1.638), and physically dependent (OR = 1.01; CI = 0.88–1.15) were associated with depression among older adults. Additional to this, people with diabetes (OR = 1.15; CI = 1.007–1.33), and with the history of fall (OR = 1.28; CI = 1.017–1.620) also associated with the depression. Conclusion: Prevalence of depression among the elderly population is reported to be high in this study. Screening the elderly for depression at the primary care level helps in early detection of depression. This suggests the need for community-based interventions for effective management of older adults with chronic diseases

Prevalence of pain among rural adults seeking medical care through medical camps in Tamil Nadu

Background: One of the most common complaints of the patient seeking medical care is pain, and it has been recognized by the World Health Organization as a problem of global importance. Objectives: The aim was to estimate the prevalence of pain among people above the age of 40 years, to identify the common sites of pain complaints and to study the association of body mass index (BMI) with musculoskeletal pains. Materials and Methods: A cross-sectional study was carried out among 1246 participants through our weekly medical camp in 12 villages of Kattankulathur block in Kancheepuram District of Tamil Nadu from August 2013 to October 2013. Individuals over the age of 40 years who had attended our medical camp with complaint of pain (intermittent or continuous) for 1 month or longer were included in the study. Descriptive data were presented as measures of central tendency and dispersion. Chi-square test was used for analyzes of categorical variables. Results: Nearly 51.1% of the respondents reported some form of pain. The prevalent sites of pain include knee pain (18.6%), low back pain (8.9%), generalized body pain (7.8%), multiple joint pain (4.9%) and pain in the legs (2.7%). Prevalence of musculoskeletal pain in men and women were 32.7% and 53.7%, respectively. Respondents with BMI more than 25 are at higher risk of suffering from knee pain, hip pain, low back pain and leg pain and it was found statistically significant for Knee pain and low back pain. Conclusion: An appropriate strategy and guidelines have to be developed to manage the problem of pain among above 40 years age group at primary care level of the rural communities in India

Prevalence of prediabetes and its associated risk factors among rural adults in Tamil Nadu

Background: Considerable number of people in the prediabetic stage will go on to develop type 2 diabetes. Early diagnosis and intervention of prediabetic and their cluster of risk factors can prevent the cardiovascular events and other complications of diabetes. Objectives: To estimate the prevalence of prediabetes and associated factors among adults attending fixed mobile clinic in a rural block in Tamil Nadu. Materials and Methods: A cross-sectional study was carried out among 544 individuals over the age of 20 years through our fixed mobile clinic among 30 villages of a block in Tamil Nadu with a structured interview schedule. Results: A total of 544 participants above the age of 20 years were studied of which 72.6% were women and 27.4% were men. The prevalence of prediabetes was 8.5% and diabetes was 10.1%. Higher risk of being prediabetic and diabetic was noted above the age of 40 years (odds ratio [OR] = 7.79, 2.17), male gender (OR = 1.46, 2.34), body mass index of more than 23 kg/m 2 (OR = 1.52, 2.13), waist hip ratio of men >1 and women >0.8 (OR = 1.49, 2.28), alcohol intake (OR = 1.59, 2.45), and systolic blood pressure of more than 140 mm of Hg (OR = 2.23 and 2.15). Conclusion: Identifying people with prediabetes and creating awareness on the prevention of diabetes by lifestyle modification and development of cost-effective strategy to prevent or delay the progression of the prediabetic stage to diabetic stage is the need of the hour for the prevention of diabetes in country like India