Prevalence and Factors Associated With Adolescent Pregnancy Among an Indigenous Ethnic Group in Rural Nepal: A Community-based Cross-sectional Study / 예방의학회지

Objectives@#The Chepang people, an indigenous ethnic group in Nepal, experience substantial marginalization and socioeconomic disadvantages, making their communities among the most vulnerable in the region. This study aimed to determine the prevalence and factors associated with adolescent pregnancy in the Chepang communities of Raksirang Rural Municipality, Makwanpur District, Bagmati Province, Nepal. @*Methods@#A cross-sectional study was conducted from October 2022 to April 2023 among 231 Chepang women selected using simple random sampling from Raksirang Rural Municipality. A semi-structured questionnaire was used for interviewing the mothers. Bivariate and multivariate logistic regression analyses were performed, using odds ratios with 95% confidence intervals (CIs). Variables with a variation inflation factor of more than 2 and a p-value of more than 0.25 were excluded from the final model. @*Results@#The study revealed that the prevalence rate of adolescent pregnancy among Chepang women was 71.4% (95% CI, 65.14 to 77.16). A large percentage of participants (72.7%) were married before the age of 18 years. Poor knowledge of adolescent pregnancy (adjusted odds ratio [aOR], 10.3; 95% CI, 8.42 to 14.87), unplanned pregnancy (aOR, 13.3; 95% CI, 10.76 to 19.2), and lack of sex education (aOR, 6.57; 95% CI, 3.85 to 11.27) were significantly associated with adolescent pregnancy. @*Conclusions@#The prevalence of adolescent pregnancy among the Chepang community was high. These findings highlighted the importance of raising awareness about the potential consequences of adolescent pregnancy and implementing comprehensive sexuality education programs for preventing adolescent pregnancies within this community.

A study of prevalence of anaemia in pregnant women among rural population in Rajasthan

Background: Anaemia in pregnancy is a major contributor in morbidity seen in pregnancy and childbirth. Prevalence of anaemia in India is still as high as 52%. Aim of the present study is to study the prevalence of anaemia and its socio demographic variables in rural population of Rajasthan.Methods: This study was done in our tertiary care teaching institute in obstetrics and gynecology department in Rajasthan. 2384 women who came to the ANC clinic were screened for anaemia. 1442 women found anemic were enrolled for study. They were interviewed through a structured questionnaire and data thus obtained was analyzed.Results: Prevalence of anaemia was found to be 60.4% in the study. Out of these 58.8% had mild anaemia, 39.8% had moderate anaemia, 1.04% severe anaemia and 0.2% had very severe anaemia. Maximum women were in the age group 20-24years (48.8%). A large proportion of women were from the lower socioeconomic strata 58.9%. Maximum anemic women had received primary education (63%), while 25% were illiterate and 12% received more than primary education. Prevalence of anaemia was almost similar in both primigravidas 49.1% and multigravidas 50.9%. Regular iron intake was seen in 56% women, 27.7% took iron folic acid (IFA) tablets but irregularly and 16.3% had not taken any supplements.Conclusions: Anaemia is still highly prevalent among pregnant women in rural Rajasthan. So, there is a need for effective implementation of the existing programmes for prevention and treatment of anaemia for healthy future generation.

Climate Change Knowledge Assessment for Farmers in Bundelkhand, Uttar Pradesh: Test Development and Validation

An assessment of climate change knowledge is important to understand farmers' knowledge. There are several tests available to measure it, but they are all dispersed, making the study tedious. The present study, conducted in 2022-23, aimed at developing a composite climate change knowledge test that would aid in the amalgamation of various aspects to holistically study climate change such as farmers’ knowledge of climate change; climate change extreme events knowledge (rainfall, temperature, relative-humidity, drought and so on); and adaptation strategies. Initially, items from diverse literature were collected and discussed with specialists. A total of 63 items were selected. At two levels, the knowledge item was judged and screened. For the first level of screening, 63 items were sent to 100 experts for review. 39 items were chosen for item analysis based on the opinions of 60 experts. These 39 items were distributed to 60 non-sample farmers for second-level screening. The difficulty and discrimination indexes were calculated using the item analysis score. Items with difficulty index of 0.30 to 0.80 and discrimination index of 0.25 and higher were chosen. Following that, 29 items were selected for the final climate change knowledge test for farmers. Finally, the split-half method reliability of the test was 0.85. The developed knowledge tool aids in identifying knowledge gaps and planning the future policy for better adaptation. Furthe, enhancing farmers' knowledge can also help them solve problems more effectively and with a more optimistic outlook when dealing with the challenges posed by climate change.

Clinical-audit-on-the-practice-of-documentation-at-preanesthetic-evaluation-in-teaching-institute

Introduction: The preanesthetic evaluation, documenting it and maintaining the record is the responsibility of anesthetist. Better documentation practices can improve the patient's outcome. It has the pivotal role in medicolegal aspects. However, the documentation is one of the challenges when it comes to quality of care. The objective of the study was to assess the practice of documentation at preanesthetic evaluation and completeness of Preanesthetic evaluation tools. The descriptive study was conducted in tertiary care hospital. Modied global quality index (GQI) isMethod: used to prepare the Predefined twenty-two indicators. The data analysis is done using SPSS version-20. A total ofResult: 300 pre-anesthetic evaluation tools (PAETs) were reviewed. There was different trend in terms of completion rate for elective and emergency cases. However, there was no PAETs found complete. Indicators with high completion rate (>90%) were signed a consent, past medical history (PMH), history of medication, allergy, surgical procedure, cardiovascular examination, airway examination and respiratory examination. Anesthetic plan, premedication, vital signs, a name, per-oral status and age were found with below average (<50%) completion rate. andConclusion recommendations: Documentation during the preanesthetic visit observed below the standard. Which need to be standardized for uniformity. Use of electronic system with prefilled formats and training of personnel involved in the process is the way forward

Study of Clinical and Outcome Profile of Neonatal Sepsis with Thrombocytopenia Patients Admitted at Tertiary health care Centre Nanded

Background: Thrombocytopenia is a frequent problem in neonatal sepsis and is among the most predic?ve, independent risk factors for sepsis-associated mortality. The present study was undertaken to correlate neonatal sepsis and thrombocytopenia in terms of severity, clinical course, organism specificity and outcome. Method: Total 384 neonates age <28 days with sepsis and thrombocytopenia were studied and analyzed with their clinical profile, symptoms, lab findings and outcomes. Results: Male babies (55.86%), age <72 hrs (80.35%), preterm (68.70%) and LBW babies (85.58%) were more prone to sepsis. Maternal fever (67.44%), foul smelling liquor (53.79%) and PROM >18 hrs (66.74%) make babies more prone to neonatal sepsis. The Commonest clinical features were not accepting feed (69.95%), lethargy (67.85%) and breathing difficulty (79.04%). Early onset sepsis (82.54%) and probable sepsis (40.26%) were more common and associated with preterm and LBW babies. Leucocytosis was seen in 64.57%, thrombocytopenia moderate degree 45.67% and severe degree 34.65%, MPV >12 69.11%, ANC <1800 47.50%, micro ESR >15 mm 72.16% and CRP posi?vity 28.60%. Severe degree thrombocytopenia (<50000) was more common with PROM >18 hrs (83.02%), maternal fever (83.09%) and gram-nega?ve organism(61.29%). Leucopenia (<4000) was more common with maternal fever (75.79%), proven sepsis (43.16%) and gram-nega?ve organism (70.31%). Severe degree thrombocytopenia (61.29%), leucopenia (70.31%) and mortality (64.51%) were more commonly associated with gram-nega?ve organism. Outcome was bad with severe degree of thrombocytopenia (62.32%), leucopenia (73.91%), and gram-nega?ve organism (64.51%). Conclusion: Proper antenatal mother care, hygiene and early evalua?on for illness can prevent early onset of sepsis in neonates. Severity of degree of thrombocytopenia directly propor?onal to the worst outcome.

Gender-based Variations in Trunk Motion and Isometric Strength in Young Adults with Low Back Pain: A Prospective Case-control Study / Variações baseadas em gênero no movimento e na força isométrica do tronco em jovens adultos com dor lombar: Um estudo de caso-controle prospectivo

Abstract Objective To determine gender-based variations in trunk range of motion (RoM) and isometric strength (IS) in symptomatic and asymptomatic young adults. Methods In this prospective case-control study, 73 subjects with low back pain (LBP) and 80 asymptomatic subjects were analyzed. Dynamometer-based device trunk RoM and IS measurements in extension, flexion, and rotation were compared in both groups and gender-based subgroups. Multivariate analysis was used to determine factors influencing trunk RoM and IS. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusion Males with LBP had significant global ITS weakness when compared with asymptomatic males. Despite no significant ITS difference in symptomatic versus asymptomatic females, LBP caused significant extension-flexion RoM and ITS imbalance in females. These gender-based variations in trunk RoM and IS, especially the extensor-flexor IS imbalance in females, must be considered while designing rehabilitation treatment protocols for LBP.

Resumo Objetivo Determinar as variações na amplitude de movimento (ADM) do tronco e na força isométrica do tronco (FIT) em jovens adultos sintomáticos e assintomáticos baseadas no gênero dos indivíduos. Métodos Neste estudo caso-controle prospectivo, 73 indivíduos com dor lombar (DL) e 80 indivíduos assintomáticos foram analisados. As medidas de ADM do tronco e FIT de extensão, flexão e rotação foram comparadas em ambos os grupos e em subgrupos organizados por gênero. A análise multivariada foi usada para determinar os fatores que influenciam a ADM do tronco e a FIT. Results Symptomatic males had significantly less extension RoM and extension, flexion, and rotation isometric trunk strength (ITS) (p < 0.0001) compared with asymptomatic males, whereas no significant difference was found between asymptomatic and symptomatic females. However, the mean extension-flexion RoM and mean extension-flexion ITS ratios were significantly lower (p = 0.04) in asymptomatic females compared with symptomatic females. Female gender was significantly associated with less extension and flexion ITS in both asymptomatic and symptomatic subjects. Conclusão Indivíduos do sexo masculino com DL apresentaram significativa fraqueza global relacionada à FIT quando comparados com indivíduos do sexo masculino assintomáticos. Apesar de não haver diferença significativa de FIT em indivíduos do sexo feminino sintomáticos versus assintomáticos, a DL impactou a ADM e a FIT de extensão-flexão em indivíduos do sexo feminino. Essas variações de ADM do tronco e FIT baseadas no sexo, especialmente o desequilíbrio extensor-flexor de força isométrica em indivíduos do sexo feminino, devem ser consideradas ao projetar-se protocolos de tratamento de reabilitação para lombalgia.

The Effect of Thriving and Workplace Spirituality on Innovative Work Behavior and Career Adaptability Among Railway Employees

Introduction-This research aimed to study the effect of Thriving and Workplace Spirituality on Innovative Work Behavior and Career Adaptability among railway employees (TC) because of the competitive environment they experience. Method- The participants were 105 railway employees between the age of 40-60 years, residing in Mumbai, Maharashtra. The purposive and snowball sampling methods were used for the study. The scales used were - Thriving at work scale (Porath et al,2012), Spirit at work scale (SAW) (Kinjersky, 2013), Innovative work behavior ( Jesson, 2009), Career Adapt Abilities Scale – short form (CAAS- SF) (Maggiori et al, 2012). The data were analyzed using 4 independent ‘t tests’. Results-Thriving had a significant effect on Innovative Work Behavior and Career Adaptability among railway employees. Thus Thriving might act as an advantage in the competitive work environment of TCs. Since Thriving cannot be developed individually as a skill, there is a need to study Workplace Spirituality. Results obtained suggest that there was no significant effect of Workplace Spirituality on Innovative Work Behavior which can be attributed to the Covid-19 situation. Later analysis shows that Workplace Spirituality has a significant effect on Career Adaptability, suggesting that the Workplace Spirituality plays will help in better career adaptability among railway employees. Conclusion- Thriving is considered to be a human aspect of sustainability which is important to produce high performance. Thus if we can enhance Workplace Spirituality for railway employees, they might experience Thriving which will eventually contribute to enhancing IWB and Career Adaptability.

Human islet amyloid polypeptide:A therapeutic target for the management of type 2 diabetes mellitus / 药物分析学报

Type 2 diabetes mellitus(T2DM)and other metabolic disorders are often silent and go unnoticed in patients because of the lack of suitable prognostic and diagnostic markers.The current therapeutic regimens available for managing T2DM do not reverse diabetes;instead,they delay the progression of diabetes.Their efficacy(in principle)may be significantly improved if implemented at earlier stages.The misfolding and aggregation of human islet amyloid polypeptide(hIAPP)or amylin has been associated with a gradual decrease in pancreatic β-cell function and mass in patients with T2DM.Hence,hIAPP has been recognized as a therapeutic target for managing T2DM.This review summarizes hIAPP's role in mediating dysfunction and apoptosis in pancreatic β-cells via induction of endoplasmic reticulum stress,oxidative stress,mitochondrial dysfunction,inflammatory cytokine secretion,autophagy blockade,etc.Furthermore,it explores the possibility of using intermediates of the hIAPP aggregation pathway as potential drug targets for T2DM management.Finally,the effects of common antidiabetic molecules and repurposed drugs;other hIAPP mimetics and peptides;small organic molecules and natural compounds;nanoparticles,nanobodies,and quantum dots;metals and metal complexes;and chaperones that have demonstrated potential to inhibit and/or reverse hIAPP aggregation and can,therefore,be further developed for managing T2DM have been discussed.

Alleviating Diagnostic Dilemma of Maduramycosis: A Case Series

@#Maduramycosis1 is chronic infection of cutaneous and subcutaneous tissue caused by bacteria and fungi. It involves skin, subcutaneous tissue and bones.2 Here we report a case series of 14 patients of mycetoma describing their epidemio-clinical features and laboratory investigations. The most common clinical presentation in the patients were infiltrated subcutaneous swelling with multiple discharging sinus tracts (fistulas). Lesions were located on the foot in all the cases.

A rare case of pregnancy in the rudimentary horn of unicornuate uterus (on table diagnosis): a case report

A rudimentary horn with a unicornuate uterus results due to failure of the complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in non-communicating rudimentary horn of unicornuate uterus is a rare form of ectopic gestation and it carries grave consequences for mother and the fetus. The most dreaded complication is rupture during pregnancy which can be life threatening to the mother. The continuation of pregnancy is rare till 3rd trimester and usually ruptures in 2nd trimester. The primary strategy of the management is surgical excision of the rudimentary horn. Here is a case of 24year old, gravida1 with unruptured rudimentary horn pregnancy at gestational age 28 weeks diagnosed on table. IOL (induction of labour) was done with misoprostol for fetal demise and later cesarean section done in view of failed induction. Laparotomy was done and dead fetus with placenta delivered followed by excision of the rudimentary horn. The post-operative period was uneventful. This highlights the need   of an increased awareness of this condition especially in developing countries where most pregnancy are unbooked and uninvestigated as in present case.

Comparative study to assess the outcome of omitting bladder flap formation from caesarean delivery

Background: The aim of this study is to evaluate the effects of omitting the step of bladder flap formation at lower-segment caesarean delivery.Methods: It is a RCT (randomised control trial), non-blinded study conducted in a tertiary care hospital. A total of 104 women who underwent caesarean delivery (elective or emergency) were prospectively randomized to one of the two groups. In the study group (n= 54), caesarean was performed without formation of a bladder flap. In the control group (n=50), caesarean was performed with the formation of a bladder flap before the uterine incision.Results: There were differences of median skin incision to delivery interval (5 versus 6.5 minutes, P <0.0001), median total operating time (35 versus 44.5 minutes, P 0.0002), and median blood loss (haemoglobin 0.5 versus 1g/dl, P 0.0001) in favor of the study group. Postoperative incidence of urinary tract infection was reduced in the study group (1% versus 9%, P <0.0006) and bowel function returned early in the study group (day 2 versus 3, P<0.0001).  Bladder flap formation step was successfully omitted in (11/18, 61.11%) of previous CS (caesarean section) patients in the study group and (7/12, 58.33%) in control group illustrating that unless required, BF (bladder flap) formation step can even be omitted in previous CS patients.Conclusions: Omission of the bladder flap provides short term advantages such as reduction of total operating time, incision-delivery interval, and reduced blood loss and that this technique can even be applied in previous caesarean section patients.

Recurrent decidual cast with membranous dysmenorrhea

Decidual cast is the entire sloughed endometrium that takes the form of the endometrial cavity. It causes membranous dysmenorrhea because the intact cast passes through an undiluted cervix. It may be associated with ectopic pregnancy, incomplete abortion, non-pregnant state with use of progesterone, Depot medroxyprogesterone acetate (DMPA), rarely with oral contraceptive pills. Authors are reporting a case of recurrent decidual caste formation with membranous dysmenorrhoea in 33 years old women P3L3 who was on norethisterone acetate treatment for a typical uterine bleed (AUB). She presented with heavy menstrual bleeding with severe dysmenorrhea in Gynae causality of ESI Basaidarapur medical college, Delhi. She expelled decidual caste and required therapeutic Dilation and Curettage (D and C) to control bleeding per vaginum. Her histopathology report showed marked decidua like change of the stroma but no villi suggestive of endometrial caste.

Evaluation Of Immunomodulatory Activity Of Diosgenin In Rats

Background: Theimmune system is intrinsic to health. Modulation of the immune responses to alleviate the diseases by using herbal plants has been of interest for many years. Diosgenin, a naturally occurring steroid saponin mainly present in the seeds of fenugreek (Trigonella foenum graecum)and in the root tubers of wild yams (Dioscorea vil-losa). Activation of specific and nonspecific immunity results in stimulation of immune response. Diosgenin has the positive effects on both specific and nonspecific immunity.Aim: To study the immunomodulatory activity of Diosgen-in in rats. Method: The suspension of Diosgenin wasgiven orally at the dosage level of 50, 100 and 150 mg/kg for 21 days in a rat. The immunomodulatory activity on specific and non-specific immunity was studied by haemagglutina-tion antibody (HA) titer, delayed type hypersensitivity (DTH) response and carbon clearance test. Immunosuppres-sion in a rat was induced by using Cyclophosphamide (100 mg/kg, p.o.). Sheep red blood cells (SRBCs) were used as antigen (0.1ml 20% SRBCs) in haemagglutinating antibody titer and delayed type hypersensitivity response methods. Result: Diosgenin exhibited significant increase in the production of antibody titer in response to SRBC antigen. A significant increase in both primary and secondary HA titer was observed in immunosuppressed group treated with Diosgenin when compared with negative control. A significant increase in the DTH response was observed in immu-nosuppressed animals treated with Diosgenin, pre-sensitized with SRBCs antigen. Diosgenin exhibited significant in-crease in phagocytic index against control group, indicating the stimulation of the reticuloendothelial system. Con-clusion: The study indicates that Diosgenin triggers stimulatory effect on specific and nonspecific immune response. The immunostimulant effect of Diosgenin could be attributed due to its saponin glycoside.

Evaluation of cytotoxic activity of protein extracts from the leaves of Morinda pubescens on human cancer cell lines

ABSTRACT Biologically active proteins isolated from plant species can be used in traditional medicine as prolific resources for new drugs Morinda pubescens Sm., Rubiaceae, is a promising medicinal plant which is widely used in folk medicine to treat fever due to primary complex, ulcer and glandular swellings. In this study, proteins were extracted from the leaves of M. pubescens, and precipitated with ammonium sulphate at various saturation concentrations ranging from 20 to 80%. The precipitated protein sample obtained with 80% saturation was further purified using ultrafiltration membrane (<10 kDa). SDS-PAGE analysis identified the presence of crude and ultrafiltered protein bands. FTIR spectrum of the ultrafiltered protein fractions depicted the presence of hydroxyl and carbonyl groups of proteins. The ultrafiltered proteins exhibited increased cytotoxic activity on A549 cells at the concentrations ranging from 15 to 100 µg/ml. About 98% cell viability was also observed in Vero cells treated with the maximum concentration of 100 µg/ml of ultrafiltered protein extract. DNA fragmentation was observed in A549 cells treated with 10 µg/ml of ultrafiltered proteins, indicating the onset of apoptosis.

Odontogenic Myxoma of Mandible Appeared as an Ameloblastoma on CT Imaging.

Odontogenic myxoma is a rare benign tumor of ectomesenchymal origin, which can arise from dental papilla, follicle or periodontal ligament. Most commonly it arises from mandible followed by maxilla. We report a case of odontogenic myxoma in a 23 years old female who came with complaint of painless swelling in left mandible. CT scan revealed an expansile radiolucent lesion involving the left mandible body with cortical thinning and mild destruction at few places. Biopsy was done which was suggestive of odontogenic myxoma. Surgery was done and odontogenic myxoma was proved on the biopsy.

Case Study: Magnetic Resonance Imaging of Squamous Cell Carcinoma of Perianal Region, Vulva and Cervix.

Squamous cell carcinoma is the second most common skin carcinoma, which most commonly affects sun-exposed areas. However squamous cell carcinoma can rarely involve the anal and perianal region. It has been found in association with human papilloma virus infection, uterine cervix dysplastic changes and high-grade anal intraepithelial neoplasia (AIN). We report a case of extensive carcinoma of the perianal region, vulva and cervix. A 49 years old female came with complaint of swelling in the right inguinal region since one year, pain and swelling in the gluteal region since 7-8 months. Contrast enhanced CT scan and MRI were done which showed a mass involving the perianal region, vulva and cervix with a large inguinal lymph node. Biopsy revealed squamous cell carcinoma.

A Case of Successful Unilateral Singleton Pregnancy in Incidentally Detected Uterine Didelphys.

Uterine didelphys or duplication of uterus is a rare congenital anomaly, which constitutes approximately 5% of mullerian duct anomalies. There is failure of the fusion of mullerian ducts resulting in the duplication of uterus and cervix. We report a case of uterine didelphys, which was incidentally detected in a 23 years old G2P1 patient who came for ultrasound with complaints of bleeding per vaginum. MRI was done and uterine didelphys was confirmed. Six months later that patient came again with 6 weeks pregnancy in the right uterine body. We did all antenatal follow up scans in this patient till 36 weeks. Lower segment cesarean section (LSCS) was done at 38 weeks and patient delivered a normal baby of 2.9-kilogram weight.

Mucocele of the Sphenoid, Ethmoid and Frontal Sinuses Presenting with Proptosis, Visual Impairment and Diplopia.

Mucocele of the paranasal sinus is accumulation of the mucoid secretion within the sinus caused by obstruction of the sinus ostium. We report a case of paranasal sinus mucocele presented with proptosis in right eye, diplopia, visual impairment and headache. Magnetic resonance imaging(MRI) revealed a polyp in right anterior ethmoid sinus and nasal cavity resulted in mucocele of the sphenoid, ethmoid and right frontal sinuses.

Short Syndrome-An Expanding Phenotype.

The phenotypic description of SHORT syndrome (OMIM- 269880) is expanding since its initial description in 1975. There have been 26 case reports till date but the genetic locus of this syndrome is elusive. Involvement of PITX2 gene initially envisaged is probably is not the only gene involved but has an important role to play in ocular development. Our case did not demonstrate mutation in PITX2 gene. Here, we report a case of SHORT syndrome with two new unreported features – deviated nasal septum and cryptorchidism and stress on lipodystrophy, a cardinal feature but not a part of the pneumonic SHORT.