Laparoscopic evaluation of female genital tuberculosis in infertility: An observational study

Background & objectives: Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB. Methods: This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB. Results: Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases. Interpretation & conclusions: The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.

Transient Bell’s palsy following Covid-19 vaccination

Bell’s palsy is described as an acute, unilateral mononeuropathy of the facial nerve resulting in partial or complete paralysis of the face with no identifiable cause. Although facial palsy is often idiopathic, its development soon after the BB-152 Covid vaccine is exceedingly rare. We report a patient with transient acute-onset unilateral infranuclear facial palsy following vaccination, after an exhaustive work-up for other common causes was negative. With no detectable aetiology the likelihood of an association of the Covid-19 vaccine and Bell’s palsy remains.

Effect of immunoglobulin Y formulations on oral microorganisms in human subjects - A systematic review and meta-analysis of clinical trials

Background: Passive immunization using egg yolk-based antibodies has been tested against oral microorganisms. Our study assessed the effect of immunoglobulin Y (IgY) formulations on Streptococcus mutans, Porphyromonas gingivalis, and Candida albicans in human subjects. Highlights: VS and UT independently searched articles using keyword combinations in four search engines; studies in English were selected. Either parallel-arm or split-mouth randomized controlled trials on healthy human subjects were considered. Ten studies remained in the selection; six studies compared the effect of IgY formulations on S. mutans, three on P. gingivalis, and one on C. albicans. Five studies (422 subjects) compared the effect of IgY formulations on S. mutans. When fixed-effect model (FEM) was applied, the risk ratio (RR) (confidence interval [CI]) was found to be 7.81 (6.00, 10.18). Three studies (167 subjects) compared the effect of IgY formulations on P. gingivalis. When FEM was applied, the RR (CI) was found to be 0.06 (?0.03, 0.15) in relation to reduction in probing depth. When FEM was applied, for percentage reduction in bleeding on probing (BOP), the RR (CI) was 1.99 (1.64, 2.41). Only one study (26 subjects) was available of IgY formulation and C. albicans; hence meta-analysis was not performed. The search was extended using Google Scholar, Semantic Scholar, cross-references and by contacting authors and researchers in the field which further yielded five articles. . Conclusions: IgY formulations were effective in the reduction of S. mutans. They were not effective on P. gingivalis in relation to probing depth but were effective in relation to reduction in BOP. No harms were reported. Evidence is of low quality due to high heterogeneity. The ROB was moderate and publication bias was low.

Comparison of Ultrasound / Anatomical landmark guided technique for superior laryngeal nerve block along with Topical Anesthesia for awake nasal intubation in various Oral& faciomaxillary & Dental surgeries

ABSTRACT:Background: Endotracheal intubation is gold standard of general anesthesia. various oral,Maxillofacial, Dental surgeries are carried out in high-risk patients having chances ofdifficult intubation. If we give sedation or general anesthesia, we can be trapped in criticalairway accidents.Aims & objectives: To access & compare efficacy of anatomical landmark guided/Ultrasound guided superior laryngeal nerve block associated with topical Anesthesia &transtracheal block for awake blind nasal intubation.Method:Group A: Anatomical landmark guided superior laryngeal nerve block given(n=30)Group B: ultrasound guided superior laryngeal nerve block(n=30)In both groups topical Anesthesia & transtracheal block for awake blind nasal intubation wasgiven.Results: upper airway block provide clinical ease to facilitate blind nasal awake intubation.ultrasound guided block has less adverse reactions.Conclusion: Both methods provide good quality of Endotracheal intubation, but ultrasoundguided block is more efficient & scientific method to block superior laryngeal nerve forawake nasal intubation.

A Vesicular Drug Delivery for Futuristic Drug Delivery Applications: Ufasomes

In vesicular drug delivery devices, aqueous cubicles are covered by one or more concentric bilayers comprised of amphiphilic molecules. Due to their ability to localise drug exercise to the website online or organ of action, they are an incredible distribution strategy for focused medicine transport. The vesicular drug delivery method keeps the drug motion moving at a steady pace. The body’s opioid frequency is thereafter maintained while the negative side effects are diminished. Vesicles made of unsaturated fatty acids are known as ufasomes. They are closed lipid bilayer suspensions of fatty acids and their ionised species that have their pH regulated. Fatty acid vesicles are regularly produced by the lipid movie hydration system. Oleic acid is the fatty acid that produces ufasomes most frequently. Unsaturated fatty acid vesicles are suspensions of fatty acid-based closed lipid bilayers, with the pH range in which their ionised species can exist being between 7 and 9. Recent developments might make it possible to create ufasomes with customizable properties such a wider pH range, resistance to divalent cations, and greater stability.

Nutrition, physical activity and psychological status during lockdown due to Covid-19

Aim of the present study was to assess physical activity, nutrition and psychological status of the population during lockdown due to covid-19. Online survey was conductedamong 534 participants within the age range of 16-78 years using convenient sampling. Participantsfrom varied regions within India and abroad were enrolled for the present study. Volunteered participants were solicited to take part in a survey that has to be carried out by filling an online questionnaire form available to them as a URL link in the invitation through WhatsApp/Messenger. The gathered data has been compiled, coded and cleaned using Microsoft Excel. Analysis has been carried out employing descriptive and inferential statistics in SPSS 17.0.Majority of participants in the studied population showed significant change in their nutrition and physical activity status due to lockdown. Covid-19 lockdown did limit their daily activities. It also had impacted their psychological status.The current investigation accentuates the need to pursue suitable life style for the maintenance of optimum metabolism and physiology. Sticking to more regular timetable of meals, effective management of stress levels and continued physical activity during the quarantine and in all the following phases of living is desirable.

CCR6 expression reduces mouse survival upon malarial challenge with Plasmodium berghei NK65 strain

BACKGROUND It has been demonstrated that proteins expressed by liver-stage Plasmodium parasites can inhibit the translocation of transcription factors to the nucleus of different cells. This process would hinder the expression of immune genes, such as the CCL20 chemokine. OBJECTIVE Since CCR6 is the only cognate receptor for CCL20, we investigated the importance of this chemokine-receptor axis against rodent malaria. METHODS CCR6-deficient (KO) and wild-type (WT) C57BL/6 mice were challenged with Plasmodium berghei (Pb) NK65 sporozoites or infected red blood cells (iRBCs). Liver parasitic cDNA, parasitemia and serum cytokine concentrations were respectively evaluated through reverse transcription-polymerase chain reaction (RT-PCR), staining thin-blood smears with Giemsa solution, and enzyme-linked immunosorbent assay (ELISA). FINDINGS Although the sporozoite challenges yielded similar liver parasitic cDNA and parasitemia, KO mice presented a prolonged survival than WT mice. After iRBC challenges, KO mice kept displaying higher survival rates as well as a decreased IL-12 p70 concentration in the serum than WT mice. CONCLUSION Our data suggest that malaria triggered by PbNK65 liver- or blood-stage forms elicit a pro-inflammatory environment that culminates with a decreased survival of infected C57BL/6 mice.

Secondary Bacterial Infection in Patients with COVID 19 Infections Attending a Tertiary Care Hospital in Ahmedabad

Introduction: The COVID-19 disease caused by SARS COV -2 is highly contagious. Many bacterial infections were found among patients with COVID 19 infection. Aim: To estimate the prevalence of secondary bacterial infections in patients infected with COVID 19 infection attending a tertiary care hospital. Methods: Various samples were collected from COVID 19 positive patients showing signs and symptoms of bacterial infection and were subjected to culture examination. Results: In the present study, 47 (6.48%) out of total 725 COVID positive patients were positive for secondary bacterial infections. Klebseilla species followed by Escherichia coli were the most commonly isolated organisms. Pneumonia followed by Urinary tract infection were the most commonly encountered infections in our study. Conclusion: Prevalence of secondary bacterial infections in patients with COVID-19 infection attending our hospital is low. Majority of secondary bacterial infections were seen among admitted patients attributable to longer hospital stays, use of steroid and invasive procedures in such patients.

Upper limb arterial pattern: clinical correlation and embryological perspective / Padrão arterial dos membros superiores: correlação clínica com perspectiva embriológica

Abstract Background Variations in the upper limb arterial pattern are commonplace and necessitate complete familiarity for successful surgical and interventional procedures. Variance in the vascular tree may involve any part of the axis artery of the upper limb, including the axillary artery and brachial artery or its branches, in the form of radial and ulnar arteries, which eventually supply the hand via anastomosing arches. Objectives To study the peculiarities of the arterial pattern of the upper limb and to correlate them with embryological development. Methods The entire arterial branching of forty-two upper limbs of formalin fixed adult human cadavers was examined during routine dissection for educational purposes, conducted over a 3-year period in the Department of Anatomy, Lady Hardinge Medical College, New Delhi. Results The study found: 1) One case in which a common trunk arose from the third part of the axillary artery, which immediately splayed into four branches (2.4%); 2) High division of the brachial artery into ulnar and radial arteries, in 3 cases (7.1%); 3) Pentafurcation of the brachial artery into ulnar, interosseus, radial, and radial recurrent arteries and a muscular twig to the brachioradialis in 1/42 cases (2.4%); 4) Incomplete Superficial Palmar arch in 3/42 cases (7.1%); and 5) Presence of a median artery in 2/42 case(4.8%) Conclusions This study observed and described the varied arterial patterns of the upper limb and identified the various anomalous patterns, supplementing the surgeon's armamentarium in various surgical procedures, thereby helping to prevent complications or failures of reconstructive surgeries, bypass angiography, and many similar procedures.

Resumo Contexto As variações no padrão arterial dos membros superiores são comuns e, assim, necessitam de total familiaridade para que os procedimentos cirúrgicos e de intervenção sejam bem-sucedidos. A variância na árvore vascular pode envolver qualquer parte da artéria axial dos membros superiores, incluindo a artéria axilar, a artéria braquial ou os seus ramos, na forma das artérias radial e ulnar, as quais, em algum momento, suprem as mãos através dos arcos anastomosados. Objetivos Avaliar as peculiaridades do padrão arterial dos membros superiores e correlacioná-las ao desenvolvimento embriológico. Métodos Foram examinados os ramos arteriais completos de 42 membros superiores de cadáveres adultos conservados em formalina, os quais eram rotineiramente dissecados para fins educacionais durante 3 anos no Departamento de Anatomia Lady Hardinge Medical College, Nova Delhi. Resultados O estudo apresentou cinco desfechos. 1. Foi constatado um caso em que um tronco comum surgiu da terceira parte da artéria axilar que imediatamente se disseminou em quatro ramos (2,4%). 2. Houve divisão maior da artéria braquial em artérias ulnar e radial em três casos (7,1%). 3. Em um caso, ocorreu pentafurcação da artéria braquial em ulnar, interóssea, radial, radial recorrente e de um galho muscular em braquiorradial (2,4%). 4. Foi constatado arco palmar superficial incompleto em três dos 42 casos (7,1%). 5. Foi observada a presença da artéria mediana em 2 dos 42 casos (4,8%). Conclusões Este estudo compreende o padrão arterial do membro superior e identifica os diversos padrões anômalos para agregar ao arsenal terapêutico de cirurgiões para diversos procedimentos cirúrgicos, com o objetivo de combater quaisquer complicações ou falhas de cirurgias reconstrutivas, de angiografias de cirurgias de revascularização e muitas outras.

Maternal mortality assessment in a tertiary care hospital in Uttar Pradesh, India

Background: Objective of this study was to calculate the maternal mortality rate in our hospital and to assess the epidemiological aspects and causes of maternal mortality to further analyse ways to reduce the maternal mortality rate (MMR).Methods: This was a retrospective analytical study done in the department of obstetrics and gynecology, MLN Medical College and District Women Hospital, Prayagraj over a time period of 10 years i.e., October 2009 to October 2019. Retrospective analysis and evaluation of the medical records and statistics was done to find out and collect specific causes of maternal deaths in the give time period.Results: There were 357 maternal deaths from October 2009 to October 2019. Maternal mortality rate in the study was calculated to be 498.42 per 1 lakh live births. Maximum deaths were in 21-30 years age group with multipara, unbooked and illiterate cases. Majority of the deaths reported were from direct causes of maternal mortality i.e., hemorrhage, hypertensive disorders and sepsis.Conclusions: In the selected hospitals, the mean maternal mortality rate in the study period was 498.42/100000 births. 71.4% had direct cause and 21.56% had indirect cause of maternal mortality several factors like regular antenatal visits, early identification of high-risk cases, timely referral, institutional deliveries, adequate post-partum care and follow-up can contribute to decrease the maternal mortality rate effectively.

A study to compare the diagnostic accuracy of GeneXpert MTB/RIF/assay and its comparison with liquid culture in clinically suspected cases of genital tuberculosis attending outpatient department of tertiary center

Background: Tuberculosis is a major health issue globally despite a declining trend in mortality with effective diagnosis and treatment, an estimated 10.4 million persons developing active TB each year with 1.33 million deaths. Objective of this study was to evaluate role of GeneXpert MTB/RIF/assay in diagnosis of female genital tuberculosis in suspected cases of tuberculosis.Methods: It was a cross sectional study done in department of obstetrics and gynecology in S. N. Medical college Agra for a period of 2 year (July 2017 to October 2019). 70 cases were selected from OPD of department of obstetrics and gynecology, S. N. Medical College Agra who met the inclusion and exclusion criteria after taking proper consent. In all selected cases endometrial biopsy sample was taken using endometrial biopsy curette in premenstrual period. All samples of endometrial biopsy were taken under all aseptic precaution from both corneal ends, anterior and posterior wall and lower part of uterus using endometrial biopsy curette and sample was collected in two separate sterile vials having normal saline and was sent for GeneXpert MTB/RIF/assay and liquid culture simultaneously.Results: Out of total 70 clinically suspected cases of female genital tuberculosis in between 20-45 years of age cough with expectoration 94% was the most common respiratory symptom followed by fever 81%, weight loss 56% and anorexia 54%. Prevalence of genital tuberculosis in active pulmonary tuberculosis patients was 30%. Irregular menstruation, vaginal discharge and pelvic pain were present in 69%, 60% and 52% patients respectively.Conclusions: The overall sensitivity of CBNAAT was 22% and specificity was 77%. The overall sensitivity of liquid culture was 28% and specificity was 71%.

Progressing haemolysis, elevated liver enzymes, low platelet count syndrome: near miss case

A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine).

Sero-prevalence of unvaccinated adolescent girls susceptible to rubella virus infection seen in a tertiary care hospital of Patna, Bihar, India

Background: Rubella infection occurring during early pregnancy results in congenital rubella syndrome (CRS).  WHO estimates that worldwide more than 100,000 children are born with CRS each year and most of them are in the developing countries. For assessing population immunity against rubella, sero-surveys are generally recommended among adolescent girls and reproductive age female. In India, sero-surveys conducted by different authors have indicated that about 10-30% of adolescent females are susceptible to rubella infection. Adolescent girls are selected because they are at a critical stage of child bearing age and their immunity against Rubella infection is the particular area of interest. objective of this study was to estimate the sero-prevalence of unvaccinated adolescent girls susceptible to Rubella virus infection attending a tertiary care hospital of Patna and then accordingly counsel for vaccination.Methods: A total 150 adolescent girls in the age group of 10-19 years who had not received MMR vaccine were included in the study. Serum IgG antibody titer for rubella was estimated by the ELISA method.Results: A total 65.33% of the adolescent girls were found to be rubella seropositive and (34.67%) were seronegative. The urban adolescent girls had a higher seropositivity of 85.2% as compared to rural adolescent girls.Conclusions: The study indicates that a substantial number of adolescents (34.67%) are seronegative and hence susceptible to rubella infection.

Role of serum anti mullerian hormone as a predictor for miscarriage

Background: Recurrent Miscarriage is defined as three or more failed clinical pregnancies at less than 20 weeks of gestation or fetal weight less than 500 grams that ends spontaneously. Ovarian reserve demonstrates reproductive potential and includes FSH, estradiol, inhibin B, and S. AMH levels. Women with very low AMH levels may have altered folliculogenesis that may influence early implantation to increase the risk of miscarriage. This study aimed to determine the serum AMH levels in patients with recurrent miscarriage and pregnancy outcomes in low (<1 ng/ml), normal (1-3.5 ng/ml) and high (>3.5 ng/ml) AMH groups and to evaluate the role of serum ovarian biomarkers in prediction of miscarriages.Methods: This was a case-control study conducted over a time period of 1 year, on 120 women attending the antenatal clinic in department of obstetrics and gynecology, Swaroop Rani Nehru Hospital, Prayagraj. The patients were divided into two groups, Group 1 (n=80) included women with previous history of abortions and Group 2 (n=40) included women with no history of abortions. S. AMH levels were analyzed and compared in both the groups.Results: In the present study, a significant negative correlation was seen between S. AMH and rate of miscarriages (p <0.05). Low AMH values were observed in patients with history of previous pregnancy loss.Conclusions: Diminished ovarian reserve contributes to recurrent pregnancy loss and should be considered part of the work-up for RPL. AMH levels in recurrent miscarriage patients were lower than those in a normal population.

Dilemma in diagnosing ovarian ectopic pregnancy

To study different presentation of ovarian ectopic pregnancy and its management. All the 4 patients of ovarian ectopic pregnancy presented in our hospital in the month of April 2019 were analysed. We reported 4 cases with a pre-operative provisional diagnosis of ruptured ectopic pregnancy and intra-operative diagnosis of? ovarian ectopic pregnancy, however histopathological examination confirmed the diagnosis of ovarian ectopic pregnancy in only 2 of the cases while the other 2 were ruptured corpus luteal cyst. Wedge resection was performed in all 4 patients. Ovarian ectopic pregnancy is rare and can be missed radiologically and intra-operatively. Establishing early diagnosis is a challenge to the clinician, it commonly mimics tubal ectopic or ruptured corpus luteal cyst. Provisional diagnosis can be made intra-operatively when a hemorrhage mass is seen near the ovary with a normal fallopian tube but can be confirmed by histopathological examination. The chief goal of the treatment remains life-saving intervention by early diagnosis to reduce maternal mortality and morbidity.

Polycystic ovarian syndrome among adolescent and young women: a hospital based observational study in a tertiary care teaching Hospital

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorder among women of fertile age. The incidence of PCOS as claimed by various observer ranges from 2.2% to as high as 26%. India is considered as an emerging epidemic area for PCOS and limited studies are done. Hence aim of this study is to find the prevalence of PCOS and determine the associated determining factors in adolescent girls.Methods: All the girls aged 15-24 years were approached and after undergoing detailed history, examination and investigations were further diagnosed as PCOS. The study subjects were then classified into two group: the PCOS and non-PCOS group and compared to determine significant differences as per the Rotterdam criteria.Results: The prevalence of PCOS was 7.5%, 18.68% and 11.18% as per NIH, Rotterdam and AES criteria respectively. BMI more than 30, waist circumference > 80 cm, hyperandrogenic manifestations, menstrual irregularity (oligomenorrhea) and family history of PCOS and DM showed statistically significant association with PCOS. Serum LH, LH/FSH ratio, S. Testosterones, serum insulin and HOMA-IR had significant association with PCOS. No significant association of Fasting blood sugar levels and deranged lipid profile was found with PCOS.Conclusions: PCOS is an emerging disorder during adolescents and hence awareness creation, early screening in order to inculcate early life style modifications and prevent metabolic and reproductive complications of this disease.

Pelvic Organ Prolapse - Four Years Review from IGIMS, Patna.

Introduction: Pelvic organ prolapse is a common problemamong women in developing countries. It is the herniationof uterus into or beyond the vagina often accompanied byprolapse of vaginal walls involving the bladder or rectum orboth. This study was done to determine its prevalence andidentify the risk factors so that advice could be given to preventits occurance and also to find out the current managementpractices in uterine prolapse.Material and methods: During the study period (2014-2018)a total of 224 cases of prolapse reported in GynaecologyOPD. Prevalence was calculated to be 1.05% of the total OPDregistrations of our department.Results: The mean age of patients in this study was 49.5years. The most common presenting complaint was somethingcoming out per vaginum (73.1%). Majority had paritybetween 2 to 6. 84.5% had vaginal home delivery and 15.4%had hospital vaginal delivery. Most patients presented withthird degree uterovaginal prolapse (58.7%). Vault prolapseconstituted 11.3%. Associated cystocele was present in35.7%, and rectocele in 14.2% of cases. The most commonpredisposing factor identified was unsupervised homedelivery. Pessary application(n=25) and Kiegel’s exerciseadvice (n=102) were done on OPD basis.Conclusion: Improvement in general health, propercontraception and institutional delivery is required to preventprolapse.Treatment should be tailored according to age andrequirement.

Obstructive mullerian anamolies: a case series

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly.

Socio-demographic co-relates of depression among housewives in rural area of district Ludhiana

Background: Depression is the most common psychiatric disorder in general practice. It is much more common among women than men, with female/male ratio roughly 2:1. In today’s hectic life, stress is increasing in housewives. Very few data is available on depression among housewives in India. So the present study is aimed to assess the prevalence of depression and study its epidemiological co-relates among housewives aged 18-59 years in rural area of district Ludhiana. Objectives were to assess depression among housewives aged 18-59 years in a rural area and determine the association of depression with socio-demographic co-relates. Methods: This study is a community based cross-sectional study carried out in the field practice area of Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab. 300 subjects were selected by systematic random sampling. Assessment of depression among the housewives was done by using Patient Health Questionnare-9 (PHQ-9). Results: In the present study, 43% of the subjects were found to have depression. Mean age of subjects with depression was found to be 42.4 (±10.3) years. There was an increasing trend of depression among housewives with increasing age (p=0.000). Inverse relationship was found between level of education and depression (p=0.000). Lower socio-economic status was found to be associated with higher rates of depression (p=0.039). Conclusions: Depression was seen to be on higher side among housewives in rural area of Ludhiana. Housewives should be educated about warning signs and symptoms of depression and motivated to avail the primary health care services.