A Cross Sectional Study of Prevalence of COVID-19 and ENT Manifestations among Health Care Workers in Our Centre

Background : Health Care Workers are among the frontline COVID warriors who have been fighting all odds in serving their patients at the cost of their lives. Bangalore has been one among the hot cities in news during this pandemic and our centre, being one of the busiest working hospitals right in the middle of the city, we hereby throw limelight to the Health Care Workers of our centre who have been fighting over COVID-19 with all might and courage. This study was done to know the prevalence of COVID-19 and its ENT manifestations among Health Care Workers in our centre. Materials and Methods : A cross sectional study was done in KIMS Hospital, Bangalore, targetting all Health Care Workers of our centre, divided into 3 groups. Prevalence of ENT manifestations was studied. Results : In our study, majority who tested positive for COVID-19 were Doctors (67.6%) followed by staff nurse (27.9%) and auxiliary HCW (4.5%). One fourth of the study subjects had anosmia as the most common ENT manifestation followed by nasal obstruction (24.3%), cough and loss of taste (19.8% each). Conclusion : With inadequate precautions being taken with the mutating virus in air, causing a surge in cases, the health care workers are the most vulnerable group to acquire the deadly infection, during both the waves of the pandemic. We hereby, stress on this, with the help of our study, done during the first wave, targeting our Health Care Workers.

Assessment of dehydroepiandrosterone sulphate (DHEAS) and cortisol levels in saliva and their correlation to cervical vertebrae maturation method in males and females at different growth stages: a clinical study

ABSTRACT Objective: The aim of this in-vivo study was to assess the salivary dehydroepiandrosterone sulphate (DHEAS) and cortisol levels, and their correlation to the Cervical Vertebrae Maturation method (CVM) in males and females at pre-pubertal, pubertal and post-pubertal growth stages. Methods: 48 patients (24 males, 24 females) who were to undergo routine orthodontic treatment were screened according to the inclusion and exclusion criteria. Then subjects were grouped according to CVM stages, using lateral cephalogram, in pre-pubertal, pubertal and post-pubertal groups. Unstimulated saliva from the selected subjects was collected. DHEAS and cortisol levels in the salivary samples were estimated by Enzyme-Linked Immunosorbent assay (ELISA). Then they were compared to Cervical Vertebrae Maturation Method stages. One-way ANOVA test followed by Tukey's post-hoc test was used to compare the salivary DHEAS and cortisol levels between different CVM stages in males and females. Independent Student t-test was used to compare the mean salivary DHEAS and cortisol levels between different males and females in each CVM stage. Result: There was a progressive increase in salivary DHEAS and cortisol concentration as skeletal maturation progressed from CVM stages 1 and 2, CVM stages 3 and 4, reaching the highest value at CVM stages 5 and 6. Their levels were higher in males than females. Conclusion: The salivary DHEAS and cortisol levels can be useful as a potential indicator of skeletal maturation, to aid in the assessment of pubertal status.

RESUMO Objetivo: O objetivo deste estudo in vivo foi avaliar os níveis salivares de sulfato de dehidroepiandrosterona (DHEAS) e de cortisol, e sua correlação com o método de maturação das vértebras cervicais (CVM) em homens e mulheres nas fases de crescimento pré-puberal, puberal e pós-puberal. Métodos: 48 pacientes (24 homens, 24 mulheres) que se submeteriam a tratamento ortodôntico de rotina foram selecionados de acordo com os critérios de inclusão e exclusão. Em seguida, usando telerradiografia lateral, os indivíduos foram agrupados de acordo com os estágios CVM, em grupos pré-puberal, puberal e pós-puberal. Foi feita coleta de saliva não estimulada nos indivíduos selecionados. Os níveis de DHEAS e cortisol nas amostras salivares foram avaliados pelo teste ELISA (Enzyme-Linked Immunosorbent assay). Em seguida, foram comparados aos estágios do método CVM. O teste ANOVA de uma via seguido pelo teste post-hoc de Tukey foi usado para comparar o DHEAS salivar e os níveis de cortisol entre os diferentes estágios de CVM em homens e mulheres. O teste t de Student independente foi usado para comparar a média de DHEAS salivar e os níveis de cortisol entre diferentes homens e mulheres em cada estágio de CVM. Resultados: Houve um aumento progressivo no DHEAS salivar e na concentração de cortisol à medida que a maturação esquelética progrediu dos estágios CVM 1 e 2, para os estágios CVM 3 e 4, atingindo o valor mais alto nos estágios CVM 5 e 6. Seus níveis foram maiores nos homens do que nas mulheres. Conclusões: Os níveis salivares de DHEAS e cortisol podem ser úteis como um potencial indicador de maturação esquelética, para auxiliar na avaliação do estado puberal.

DETECTION OF METALLO-BETA-LACTAMASE PRODUCING PSEUDOMONAS AND ACINETOBACTER SPECIES FROM DIFFERENT CLINICAL SPECIMENS IN A TERTIARY CARE HOSPITAL AT PUDUCHERRY.

Introduction Pseudomonas and Acinetobacter species are frequently isolated non-fermenting gram negative bacteria in a variety of hospital acquired infections. Metallo-beta-lactamases have become a serious threat in treating infections because of their multiple drug resistance including carbapenems. To determine Objectives the prevalence of MBL production among Pseudomonas and Acinetobacter species and to evaluate the different phenotypic MBL detection methods. A total of 104 isolates of carbapenem resistant Pseudomonas (78) and Materials and methods Acinetobacter (26) from different clinical specimens were tested for MBL production by Modi?ed Hodge Test, Combined Disk Test and Double Disk Synergy Test. Antibiotic susceptibility was performed by Kirby- Bauer Disk Diffusion method. Results Pseudomonas aeruginosa (11.29%) Acinetobacterbaumanii (11.53%) were the predominant MBL producers. MBL production was detected 61.53%, 84.61% and 38.46 % by DDST( Doule disc synergy test), CDT (Combined disc test), and MHT (Modi?ed Hodge test) respectively. Colistin and Polymyxin B are the only option available for treating such infections. MBL Conclusion production among Pseudomonas and Acinetobacter species are increasing due to the continuous use of carbapenems and selective antibiotic pressure. Strict antibiotic policy and infection control practices help prevent the further spread.

Enablers & challenges of tribal women & health system for implementation of screening of non-communicable diseases & common cancers: A mixed-methods study in Palghar district of Maharashtra, India

Background & objectives: Non-communicable diseases (NCDs) and cancers of breast, oral cavity and cervix contribute to around 5.87 million (60%) deaths in India. Despite this, there is limited evidence on preparedness of the tribal health system in mitigating these conditions. This mixed-methods study aimed at identifying enablers and challenges using a multistakeholder approach for the screening of NCDs and common cancers in a tribal block of Maharashtra, India. Methods: This study was conducted in a tribal community of Dahanu taluka in Palghar district of Maharashtra. A total of nine focus group discussions (FGDs) among tribal women and accredited social health activists (ASHAs), 13 key informant interviews (KIIs) among auxiliary nurse midwives (ANMs) and community health officers (CHO) and facility surveys of five public health facilities were conducted. The FGDs and KIIs were conducted using guides, recorded digitally, transcribed, analyzed and triangulated to identify emerging themes. Results: The tribal women had limited knowledge about NCDs and common cancers. Paucity of health facilities, out-of-pocket expenditure, misconceptions, belief on traditional healers and inability to prioritize health were identified as major challenges. The ASHAs were recognized as a key connecting link between health system and community while provision of culturally appropriate IEC materials and adequate training were recognized as critical enablers by healthcare providers in implementing screening for NCDs and common cancers. Interpretation & conclusions: The study recommends incorporating socioculturally relevant strategies in the tribal population and strengthening health facilities in terms of infrastructure and training with involvement of ASHAs for successful implementation of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) through health and wellness centres.

DRESS syndrome: Tricky to diagnose but easy to treat

A 27-year-old female presented to us with a short history of fever, jaundice, rash, and worsening hepatic dysfunction subsequent to treatment with intravenous antibiotics and alternative medicine for a urinary tract infection. The eosinophilia, lymphadenopathy, and transaminitis prompted us to consider a diagnosis of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) which can be fatal if not treated. The patient showed improvement in clinical and laboratory parameters after a course of steroids. This case is presented as DRESS syndrome that can prove rapidly fatal if not diagnosed and treated immediately.

Estimated Deficits in Nutrient Intake of ICDS Beneficiaries Who Receive Take Home Ration at Two Districts in Karnataka

Background: The current estimates of energy and protein to bridge nutrient gap in the beneficiaries of the Integrated Child Development Services (ICDS) supplementary nutrition program use sub-optimal methodology for deficit calculation. Objective: To estimate the nutrient deficit and the risk of inadequate nutrient intake in beneficiaries of the ICDS, aged 6-36 months, using individual 24-hour diet recalls, from districts of Chitradurga and Davanagere in Karnataka. Study design: Cross-sectional design. Participants: Children (aged 6 to 36 months) registered as beneficiaries of the ICDS in these districts. Methods: Data were collected on socio-demographic factors, child feeding patterns, perception and usage of take home ration (THR), between August to October, 2019. Three non-consecutive days’ 24-hour diet recall data of children were obtained from mothers, and anthropometric measurements were taken. The proportion of children at risk of inadequate nutrient intakes was estimated using the probability approach. Assuming that 50% of a healthy population will be at risk of nutrient inadequacy such that intake and requirement distributions overlap, the proportion at actual risk of nutrient inadequacy (?50%) was calculated. Results: A combined district analysis showed a median energy deficit of 109 kcal and 161 kcal in children belonging to the age groups of 6-12 month and 13-36 month, respectively. The actual risk of inadequate intake for both age groups ranged between 12- 47% for fat and other micronutrient (iron, calcium, zinc, folate, vitamin B12 and vitamin A), despite breastfeeding, complementary feeding and reported THR use. Conclusion: Children who receive supplementary nutrition as part of the national program fail to meet their nutrient requirements that are essential for growth and development. The study results may help in strengthening the IYCF counselling and in modification of the existing THR, with quality and cost implications.

Video-dermoscopic Assessment of Capillaroscopic Pattern in Hansen's Disease

Leprosy is a chronic granulomatous infectious disease with a proven role of Mycobacterium leprae invasion into endothelial cells. Animal studies have shown evidence of involvement of vasa nervorum in the process of nerve invasion. Capillaries act as the mirror image of vascular involvement in any rheumatic disorder and holds good for leprosy also. Nailfold capillaroscopy (NFC) is a non-invasive, easily reproducible technique to study proximal nailfold capillaries. The aim of this study is to investigate morphological nailfold capillaroscopic alterations in patients with leprosy in its various forms and comparison with the normal individual. Total 20 Leprosy patients and 20 normal age and sex matched individuals recruited for nailfold capillaroscopic examination using video dermoscopye. Among 20 normal individuals, 3(15%) individuals showed tortuous capillaries and microhemorrhages each, 2(10%) showed meandering vessels, 1(5%) each showed megacapillaries, dilated/ectatic capillaries and bizarre vessels. Out of 20 leprosy patients, 11 (55%) patients showed bizarre and meandering capillaries, 10(50%) showed dilated vessels and avascular areas, 9(45%) showed capillary dropouts and neovascularisation, 8(40%) showed tortuous vessels, 6(30%) haemorrhages and 4 (20%) showed megacapillaries. Findings like avascular areas, capillary dropouts, haemorrhages were more noticed in lepromatous and borderline lepromatous leprosy, whereas early capillary abnormalities like dilated, meandering, bizarre vessels and neoangiogenesis were noticed more in borderline tuberculoid leprosy. However, statistical significant difference between clinical and dermoscopic observations was not seen in this study. Further studies with a large sample size are required to find out the same. Morphological changes may denote micro-vascular invasion by Mycobacterium leprae and may act as warning signs of fore- coming complications like loss of sensation and trophic ulcers. Follow-up studies are required to understand such correlation, if any.

Diagnosis and Management of Global Development Delay: Consensus Guidelines of Growth, Development and Behavioral Pediatrics Chapter, Neurology Chapter and Neurodevelopment Pediatrics Chapter of the Indian Academy of Pediatrics

Justification: Global developmental delay (GDD) is a relatively common neurodevelopmental disorder; however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. Process: Seven subcommittees of subject experts comprising of writing and expert group from among members of Indian Academy of Pediatrics (IAP) and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of IAP. Guidelines: GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/ hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.

Subconjunctival Dirofilariasis presenting as orbital cellulitis

Background: Dirofilariasis is an emerging zoonosis in India. Most of the cases from India have been reported from the states of Kerala, coastal Karnataka and Maharashtra, and a few from the North India, Orissa and Assam. Dogs, cats, foxes and other wild animals are definitive hosts for dirofilaria. Human ocular parasitosis is prevalent in geographical areas where environmental factors and poor sanitary conditions favor parasitism between humans and animals. However, in recent years, migrating population have facilitated the spread of certain parasitic diseases from endemic to non-endemic areas. We report a case of subconjunctival dirofilariasis in a 91-year-old man, who presented with features of orbital cellulitis. An intact live worm, measuring 13.5 cm, was extracted from the subconjunctival space, following which there was prompt resolution of symptoms. Purpose: Given the increase in the frequency of dirofilariasis in humans in recent years, medical practitioners should bear in mind the possibility of ocular dirofilariasis when a patient presents with an ocular or orbital inflammatory lesion. Synopsis: This video illustrates various presentations of ocular dirofilaria and surgical extraction of a live worm from the subconjunctival space. Highlights: Lifecycle and human ocular manifestations of dirofilaria ared elucidated. Rare presentation of subconjunctival dirofilariasis as orbital cellulitis and its resolution following removal of the live worm has been demonstrated.

Emotional and Spiritual Intelligence of the Middle Aged in Coping Midlife

This study on the middle aged was carried out with a view to implement an empowerment programme for the middle-aged people to promote an active aging. The transition of middle age consists of important components like leaving the middle adulthood, crossing the line of retirement (for working people) and entering the late adulthood. The sample size was 500 middle aged parents of children who were studying in the residential colleges of Kannur district. Majority of the sample (54.8%) had an average and above emotional intelligence levels and only less than two percent of them had low emotional intelligence. Majority of the samples (65.4%) possessed an average level of spiritual intelligences and around 21.4 percent of the samples had low levels of spiritual intelligence. Out of the 500 samples, majority (65.2%) had less than medium resilient level of coping ability. Moderate degree positive correlations existed between emotional intelligence and coping ability (signifi cant at 0.01 level) and low degree negative correlation between the spiritual intelligence with the coping ability (signifi cant at 0.05 level. The present study also revealed that low level negative correlation existed between the spiritual intelligence and emotional intelligence in general among the middle-aged parents whose children were studying in residential institutes.

Rehabilitation of atrophic posterior partial edentulous maxilla with TTPHIL ALL TILT® technique: 3 year follow-up case report / Reabilitação de maxila atrófica posterior parcialmente desdentada com técnica TTPHIL ALL TILT®: relato de caso de acompanhamento de 3 anos

Maxillary sinus pneumatisation pose a grave clinical challenge for implant fixed rehabilitation in posterior maxilla owing to diminished bone volume. This necessitates sinus lift and grafting which increase the duration and cost and possible surgical complications. Pterygoid implant has a greater short term osseointegration and is a proven treatment method for rehabilitation of highly resorbed posterior maxilla. To overcome the limitations of sinus grafting techniques, the current case report describes the use of flapless, tilted and pterygoid implant for restoration of partially edentulous atrophic maxilla eliminating grafting (AU).

A pneumatização do seio maxilar representa um grande desafio clínico para a reabilitação fixa por implante na região posterior da maxila devido ao volume ósseo diminuído. Isso requer elevação do seio e enxerto, fatores que aumentam a duração, o custo e as possíveis complicações cirúrgicas. O implante pterigóide tem uma osseointegração maior em curto prazo e é um método de tratamento comprovado para reabilitação de maxila posterior altamente reabsorvida. Para superar as limitações das técnicas de enxerto de seio, o relato de caso atual descreve o uso de implante sem retalho, inclinado e pterigóide para restauração de maxila atrófica parcialmente edêntula eliminando o enxerto.(AU)

Prevalence of Temporomandibular Disorders and its Correlation with Stress and Salivary Cortisol Levels among Students

ABSTRACT Objective: To evaluate the prevalence of temporomandibular disorders (TMD) in students and to evaluate if any relationship existed between the stress levels, salivary cortisol levels, and TMD. Material and Methods: A total of 348 students, 187 female, and 161 male students, participated in this cross-sectional study. Students were evaluated based on the Research Diagnostic Criteria for TMD. The stress levels were evaluated using the Perceived Stress Scale. The students were divided into the control and TMD groups. Salivary cortisol levels in the salivary samples were analyzed. Results: The prevalence rate of TMDs was 30.7% in the study population. Of the female students, 61% had TMD compared with 46% of male students. Muscle disorders were the most predominant disorder in 14.2% of the students with TMD. The TMD group showed significantly higher salivary cortisol and stress levels than the control group. The TMD group also showed a moderate positive correlation between cortisol and stress levels (p=0.01). Conclusion: The study showed a strong association between salivary cortisol levels, stress, and temporomandibular disorders. Salivary cortisol could be used as a prognostic biomarker for stress while assessing the severity of TMJ problems in stressed individuals.

Pregnant women’s knowledge and practice of preventive measures against COVID-19: a study from Mysore city, Karnataka, India

Background: The presently ongoing COVID-19 pandemic has not spared any segment of society including pregnant women. It is absolutely essential that pregnant mothers and their caregivers be fully aware of accurate facts about COVID-19. Objective of this study was to assess the knowledge and practice of preventive measures against COVID-19 infection among pregnant women of Mysore City.Methods: This was a cross sectional study, conducted among pregnant women attending prenatal care at a tertiary care centre. Data was collected using a validated questionnaire administered via google form to consenting pregnant women. The variables assessed were knowledge about aetiology, mode of spread and preventive measures to protect against COVID-19. Data was also collected on socio-demographic characteristics, which included age, parity, marital status, residence, occupation, participant’s education, husband’s education.Results: Out of the 93 responders, majority 71 (76.3%) were in the age group 20-30 years. 17 (18.3%) were in the 30-40 years age group. Regarding number of children 41 (44.1%) had one child 16 (17.2%) had 2 children and 32 (34.3%) were primigravida. With respect to educational status 70 (75.26%) were having graduate degree. 19 (20.4%) were non graduates, but had completed high school. Educational level of the husbands of the respondents was along similar lines with 62 (66.66%) having completed graduation, and 28 (30.1%) had completed high school. 91(97.8%) respondents were correct in identifying virus as the cause of COVID-19. 88 (94.6%) rightly chose mode of spread by sneezing or cough. 1 (0.1%) respondent wrongly indicated that injections were the mode of spread. Main symptoms cough and fever were correctly identified by 80 (86%) respondents. The practice of preventive medicine was low with respect to all aspects of COVID prevention. Only 27 (29.7%) were following frequent handwashing recommendation. Only 26 (28.6%) were following staying indoors advise. 28 (30.8%) of the respondents were wearing masks. However, 82 (90.1%) were following at least one of the preventive measures.Conclusions: The knowledge levels of pregnant women were satisfactory However this was not translated into practice by majority of the respondents.

Clinical Spectrum of Primary Polycythaemia and Its Complications -Experience from a Single Center in Karnataka.

Awareness and diagnosis of Philadelphia Negative Chronic Myeloproliferative Disorders has now improved and there is a need for more epidemiological data from India. MethodsThis is a retrospective study of patients of polycythaemia conducted at clinical haematology services, BMCRI, Bengaluru from 2010 to 2017. Results88 patients of polycythaemia were retrospectively studied. 84.1% were male and 15.9% were female. Their ages ranged from 19 to 79 years. 75 (85.23%) had Polycythaemia Rubra Vera (PRV). JAK-2 (V617F) mutation was positive in 33.33%. The commonest presentation was with unexplained erythrocytosis in 50 (66.66%), thrombosis in 20 (26.66%) and with bleeding in 2 (2.66%). 22 thrombotic events occurred in 20 PRV patients. Cortical sinus thrombosis was seen in 27.3%, cerebrovascular accidents in 22.8%, portal vein thrombosis in 13.6%, pulmonary embolism in 9.1%, central retinal artery occlusion in 13.6%, myocardial infarction in 4.5% and digital infarction in 9.1% patients. 3 cases of PRV presented with diplopia. No other definitive cause for ocular palsy could be found. The JAK 2 positive group was slightly older than the negative group and had higher frequency of splenomegaly (p<0.05) and higher values for haemoglobin (p<0.001) and neutrophil counts (p<0.001) and platelet counts (p<0.05). ConclusionsPatients with thrombosis, erythrocytosis, thrombocytosis and haemorrhage should be suspected to have myeloproliferative disorders like PRV and investigated. Ophthalmoplegia is a rare presentation and should raise the suspicion for polycythaemia. There is a higher probability of splenomegaly and higher values for haemoglobin and neutrophil counts and platelet counts in JAK 2 positive group.

Nutritional status and growth of children with hemophilia: a cross-sectional study

Background: Haemophilia A and B are the most common severe bleeding disorders and are inherited as X linked recessive pattern. The main clinical manifestations include bleeding into musculoskeletal sites or soft tissues mainly causing joint impairment and thus resulting in various morbidities. Prophylaxis therapy and inhibitor management have contributed a lot to the management of haemophilia cases. However in resource poor setting countries, like India, availability of factors, prophylactic therapy is farfetched leading to joint abnormalities, decreased physical activity and thus leading to different nutritional states. Studies from developed countries reveal obesity and overweight instances in children with Hemophilia. However not many studies have been undertaken to evaluate the nutritional status of such children in India.Methods: This study was conducted in the Comprehensive hemophilia Care Centre, Victoria Hospital, attached to Bangalore Medical College. A total of 50 children were included in the study. Children aged between 4 and 18 years attending the hemophilia Clinic were included in the study. Observations and review of relevant documents were done.Results: Among 50 children of haemophilia, 18(36%) children were aged less than 10 years and 32(64%) children were aged more than 10 years. The mean age of onset of disease in haemophilia A was 27.5 months (SD of 24.84; range 6-120) and in haemophilia B was 8 months (SD of 2.72; range 3-12). The mean BMI among children aged more than 10 years was more (21.35; SD= 4.02) compared to the children less than 10 years (16.87; SD= 3.41).Conclusions: The prevalence of overweight and obesity among children with Haemophilia is more in adolescent age group compared to children in the first decade.

Clinical Spectrum of Intracranial Bleeds in Patients with Bleeding Disorders- Experience from a Tertiary Center in Karnataka.

The most frequent emergency event in haemophilia and other bleeding disorders is intracranial haemorrhage (ICH), most of which is caused by trivial trauma, affecting around 3–10%. We studied the spectrum of presentation of ICH at our institute.METHODSThis was retrospective analysis of all patients with diagnosed or suspected bleeding diathesis and ICH presenting at the Clinical Haematology Department, BMCRI. They underwent complete coagulation workup, inhibitor screening, plain CT- brain and other relevant investigations.RESULTS3.26% of patients with bleeding disorders presented with ICH of over 2 years. M:F ratio was 13:1. 78.6% had Haemophilia A, 7.1% each had Haemophilia B, Factor XIII deficiency and Hypofibrinogenemia. 13 (92.9%) had severe Haemophilia A or B and 1 (7.1%) had mild Haemophilia B. Their ages ranged from 2 - 69 years. 50% were adults with the oldest being 69 years. Out of 7 children with Intracranial bleeds, 5 (71.4%) were <5 years. 2 (18.2%) with Haemophilia A had inhibitors. None were hypertensive. There was recent history of trauma in 9 (64.3%). All (100%) had severe headache, 21.4% had vomiting and 28.6% had seizures at presentation. Subdural haemorrhage was seen in 9 (64.3%), subarachnoid haemorrhage in 1 (7.1%), epidural bleed in 1 (7.1%), and intraparenchymal bleed in 3 (21.4%). All patients received appropriate factor replacement and supportive treatment. 9 (64.3%) received factor replacement only, 5 (35.7%) with SDH required additional burr hole evacuation. 2 (14.3%) patients died and 12 (85.7%) responded to treatment. None had sequelae in this series.CONCLUSIONS3.26% of our cohort presented with intracranial bleed over a period of two years. Majority with ICH were Haemophilia A and had severe deficiency with history of trauma. Headache is the commonest presentation and astute and keen clinical suspicion is paramount for instituting early treatment. SDH was most common in our series and majority responded to conservative management with factors.

Cervical effacement, as an independent parameter versus modified bishop score, for predicting the favorability of vaginal delivery in a primigravida at 40 weeks gestation and beyond

Background: Dr. Edward Bishop developed the original bishop score. He concluded that elective induction in multiparous women was successful with a score > 8. Calder introduced the modified bishop score in which he replaced cervical effacement with cervical length in cms. Score of 6-12 is favourable. In this study, studied the cervical effacement/ length as an independent predictor of vaginal delivery in a primigravida.Methods: A retrospective observational study was conducted from May 2018 to January 2019. Total participants were divided into two groups on the basis of spontaneous labor and induced labor. Both the groups were assessed individually and collectively in terms of cervical effacement/length and modified bishop score. Study primary outcome was vaginal delivery. The results were reflected in terms of sensitivity, specificity, PPV and NPV. These values were compared for cervical effacement/ length as well as modified bishop score and p value calculated. Also, association between modified bishop score and cervical effacement/length was established.Results: Total number of participants included was n = 91. Those with modified bishop score > 6, 78.16% had vaginal delivery. This gave a sensitivity of 78.16%, specificity of 50%, PPV of 97.14%. Those with cervical effacement of >/=50% or cervical length of </= 2 cms, 78.82% had vaginal delivery. This gave a sensitivity of 78.82%, specificity of 55%, PPV of 95.71%. Thus, it had similar sensitivity, specificity, PPV to that of modified bishop score, and therefore has the same accuracy in predicting vaginal delivery. Also, 89.01% participants who had cervical effacement >/= 50% had modified bishop score >/= 6, reflecting the association between them.Conclusions: Cervical effacement of >/= 50% or cervical length </= 2 cms yielded an equivalently high predictive ability similar to modified bishop score, for spontaneous as well as induced labor. Hence, cervical effacement can be taken as an independent parameter to assess the favorability of successful vaginal delivery in a primigravida.

Prevalence of premenstrual syndrome and dysmenorrhea among medical students and its impact on their college absenteeism

Background: Dysmenorrhea and premenstrual syndrome are two most common gynaecological problem leading to college absenteeism seen among female medical students. Aim of the study was to evaluate the factors associated and prevalence of dysmenorrhoea and PMS and its effects on the quality of life, particularly absenteeism from college in female medical students. The health care profession has an obligation to provide and to promote education on menstruation and related subjects.Methods: This is a prospective study, conducted on 100 MBBS students studying in a medical college at Mangalore. All participants were given a preformed questionnaire to complete. Dysmenorrhea was assessed based on WaLiDD scoring system. Diagnosis of PMS in the present study was made according to diagnosis criteria proposed by American College of obstetrician and gynecology. The severity of their condition was assessed based on their absenteeism from college/classes.Results: The average age of the participants was 21 year±1 year. The prevalence of dysmenorrhea was 45% and that of the pre-menstrual syndrome was 68%. Pre-menstrual syndrome (p = 0.05) is significantly associated with overweight, obesity and physical inactivity but not the same for dysmenorrhea. 73% and 60% of students consumed junk food suffered from PMS and dysmenorrhea respectively, 40% of students with dysmenorrhea reported limitation of daily activities and significantly associated with college absenteeism (p = 0.005). The most frequent somatic symptom of PMS in this study was breast tenderness (41%) and affective symptom was irritability (35%).Conclusions: Dysmenorrhea and PMS is highly prevalent among female medical students; it is related to college/class absenteeism. Unhealthy and sedentary lifestyle could be the attributing factors which has to be addressed by health education in order to improve the quality of life and academic performance by the medical students.

Association of cord blood and maternal lipid profile

Background: Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity with dyslipidemia as an important contributing risk factor. Objective of the study was to determine whether there is an association between maternal lipid profile and the cord blood lipid profile of their newborns.Methods: This was a hospital-based Cross-sectional study on 60 mothers and their respective newborns (30 term and 30 preterm) conducted in Yenepoya medical college hospital from August to November 2019. Umbilical cord blood samples from the newborns were collected after birth and the mother's venous blood was collected in the fasting state (8hrs of fasting) before delivery. The levels of total cholesterol, triglycerides, HDL, LDL and VLDL were determined in mothers and their newborns by an enzymatic colorimetric method. Data obtained was analyzed by the SSPS software 23.0 version and Pearson's correlation was done.Results: There was a significant correlation between the mean concentration of maternal Triglycerides and the Triglycerides and HDL levels of neonates (p-value <0.05).Conclusions: There was a significant association of cord blood and maternal lipid profile, hence changes in maternal lipid levels might influence the lipid levels in the cord blood of newborns.