A Novel Diabetes Education Program to Improve Diabetes Knowledge, Awareness and Glycemic Control

Diabetes self-management education (DSME), an integral part of diabetes management is delivered by trained educators in well-developed countries. Unfortunately, there is a dearth of an organized, concise and easy-to-deliver diabetes education module in India. The relationship between diabetes self-care and glycemic control has been studied extensively. The present review discusses an innovative diabetes self-education training module that can be easily reciprocated by others to benefit the larger population.

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.

Comparative evaluation of colposcopy, cytology and histopathology for diagnosis of cervical lesions

Background: Cervical cancer is the fourth most frequent cancer globally in women with an estimated 570,000 new cases and 311,000 deaths in 2018 representing 6.6% of all female cancers. To correlate the cytology, colposcopy and histopathology of cervical lesions in patients attending gynaecology OPD in a tertiary care centre, Ghaziabad.Methods: 208 women were enrolled from Gynaecology OPD of Santosh Medical College and Hospital, Ghaziabad, irrespective of their chief complaints. Women aged 19-80 years were included in the study group. Those with pregnancy and already diagnosed or treated with CIN, Cervical cancer or Cervical HPV infection were excluded from the study. PAP-smear was taken for all the patients followed by colposcopy without waiting for PAP-smear report. Cervical biopsy was taken from patients with abnormal colposcopic findings (90 patients).Results: Majority of women were in age group 30-39 years. 37.5% had unhealthy, 21.6% had hypertrophied cervix and only 9.1% had normal cervix. It was found that PAP -smear has a sensitivity of 33.33%, specificity of 92.59%, accuracy of 68.89%, positive predictive value of 75% and negative predictive value of 67.57%. Test parameters calculated for colposcopy revealed that it has sensitivity of 73.33%, specificity of 92%, PPV of 64.7%, NPV of 94.52% and accuracy of 88.89%.Conclusions: The results from the current study conclude that it is better to use cytology and colposcopy together as part of routine screening for cervical cancer rather than pap smear alone in order to detect maximum number of lesions.

Identification of factors determining the initiation of breastfeeding in postnatal women in a tertiary care centre: an observational study

Background: The WHO recommends that mothers worldwide to initiate breastfeeding within an hour of delivery to achieve optimal growth, development and health but the breastfeeding rates remain far below the recommended standards. The aim of this study was to find the prevalence of delay in initiation of breast feeding, to identify various factors which determine the initiation of breastfeeding and to correlate their association with delayed onset of breast feeding.Methods: Hundred and thirty six postnatal women, who delivered in Santosh Medical College and Hospital, Ghaziabad, were recruited in the study. They were interviewed after their informed consent using a pretested structured questionnaire. Socio-demographic and obstetric factors were compared between subjects who initiated breast feeding in less than and more than 1 hours. Frequencies were calculated for different variables. Data was statistically analyzed and p value of <0.05 was taken significant.Results: The prevalence of delay in initiation of breast feeding in our study was found to be 74.2% (n=101).The mean time of initiation of breast feeding was 18.43 hours. Significant association (p <0.05) was found in various sociodemographic, obstetrical and social factors.Conclusions: Identifying mothers at risk of delayed breastfeeding initiation should be the target for breastfeeding promotion during prenatal, antenatal as well as postnatal period. Public health officials and health care providers should consider interventions to promote and support early initiation of breast feeding.

Knowledge, attitude, and practice of contraception among women attending a tertiary care hospital

Background: This study was carried out to assess the knowledge, attitude and practice of contraceptive methods among women attending a tertiary care hospital, to know the influence of various factors on use of contraceptives and to identify the reasons for not using contraception.Methods: A cross sectional, observational study was conducted in Obstetrics OPD, Santosh Medical College, Ghaziabad. 408 married women of reproductive age group (15-45 years), randomly selected, were interviewed with the help of a predesigned questionnaire to elicit information regarding their demographic profile, knowledge, attitude and practice of contraception.Results: In our study 73.3% women interviewed were aware about family planning methods.  Awareness was lowest among adolescents less than 20 years of age (28%) and highest among 31-35 yr age group (84.1%). The main source of knowledge was “friends/relatives” (37.8%) and mass media (26.8%). Awareness was high in Para-1 (96.5%), higher SES (97.4%), with higher education (90.7%), in working women (80.4%), women living in nuclear families (80.2%) and Hindu females (73.7%).  But in spite of high level of awareness, contraception usage was less (54.4%), the main reason being fear and misconceptions regarding contraceptives.Conclusions: It can be concluded that high level of knowledge and awareness does not match with contraceptive usage rate. Converting family planning knowledge into practice is the real challenge for India. Hence, we recommend sustained efforts to increase awareness and motivation for contraceptive use through more information, education and communication with the reproductive age couples, and improved social and welfare services.

Evaluation of genital tuberculosis as a cause of female infertility in a tertiary care hospital in North India

Background: Female genital tuberculosis (FGTB) poses a great diagnostic challenge in women of reproductive age. It causes significant morbidity or short and long term sequelae, especially infertility. The disease often remains silent or may present with non-specific symptomatology. As a result, the prevalence of genital tuberculosis is largely underestimated. A high degree of suspicion aided by intensive investigations is important in the diagnosis of the disease, especially in its early stage, so that treatment may improve the prospects of cure before the tubes are damaged beyond recovery. Objectives were to find out the prevalence of genital tuberculosis in females presenting with infertility in a tertiary care hospital over a given period of time, and diagnostic comparison of endometrial tuberculosis by histopathological examination (HPE) and GeneXpert.Methods: The prospective observational study was conducted over one year duration. A total of 96 endometrial samples were collected from the women, satisfying the inclusion and exclusion criteria.Results: On HPE, out of 96 patients, proliferative endometrium (anovulatory) was found in 38 cases (39.6%), non-specific endometritis in 2 cases (2.08%) and 2 cases (2.08%) were found positive for tubercular endometritis. GeneXpert scored negative in our study.Conclusions: Endometrial biopsy shows not only the tuberculous endometritis, but also gives additional information about local factors of endometrium concerning non-specific and specific infections and anovulatory cycles. GeneXpert if positive on endometrial biopsy is a reliable test for FGTB and treatment can be started on its basis

Prescribing pattern in ophthalmological outpatient department of a tertiary care teaching hospital in Dehradun, Uttarakhand: a pharmaco-epidemiological study.

Background: Irrational prescribing is a common phenomenon, seen among medical practitioners. Knowledge, awareness, and attitude denote the practicing trends among the practitioners. The objective of this study was to describe the prescribing practices in Ophthalmology outpatient department (OPD) to promote rational prescribing. Methods: This study was conducted between January 2011 to June 2011, in Department of Pharmacology and Ophthalmology, SGRRIM and HS, Dehradun, Uttarakhand. A total number of 255 prescriptions were randomly collected from the Ophthalmology OPD and were analyzed for various parameters using national essential medicine list 2011 and World Health Organization drug use indicators. Results: A total number of 255 prescriptions were evaluated for prescribing pattern, 153 (60%) patients were between 16 and 45 years of age, the male: female ratio was 1.13:1. 237 (93%) patients from middle socioeconomic status. Diseases pattern observed were conjunctivitis 102 (40%), refractive error 45 (17.64%), stye 12 (4.7%), cataract 9 (3.52%), and miscellaneous 87 (34.12%). One hundred and thirty-eight (54.11%) patients received antimicrobial agents, fluoroquinolone (ofloxacin, moxifloxacin, gatifloxacin, etc.) were the most frequently prescribed antimicrobial drugs, analgesics (diclofenac and ketorolac) were prescribed to 45 (17.64%) patients, 54 (21.17%) received steroids (dexamethasone and prednisolone), 96 (37.64%) patients received other drugs (carboxymethylcellulose [CMC], multi-vitamins, zinc preparations, acyclovir, and anti-allergics). Fixed dose combinations (FDCs) were used in 90 (35.29%) patients, the most common combination was antimicrobials with steroids. All the drugs were prescribed by brand names and 1.9 drug/prescription was used. Conclusion: Topical antimicrobial agents are the most commonly used drugs in ophthalmic OPD in our setup; the most common FDCs prescribed were antimicrobials with steroids, the other commonly used drugs were analgesics, CMC and anti-allergic drugs.

Violation of children's rights: Can forensic medicine help.

"Today's child is tomorrow's citizen" so goes a popular saying, stressing the need for proper care and protection of the children. India has ratified the UN convention on the Rights of Child, which came into force on 2nd September 1990 and our own National Policy for Children was adopted way back in 1974. However, if we look at the outcome of all the measures that have been taken "on paper" the record is dismal. Child abuse goes unabated in our country, right in front of the eyes of the Law. The present study was undertaken to assess whether our specialty - Forensic Medicine - can bring to focus the atrocities perpetuated on children. During the 5-year period of the study, 155 cases were examined medicolegally in the Emergency department of the Govt. Medical College Hospital, Sector 32, Chandigarh; of which 6% were referred for medicolegal autopsy. Physical abuse accounted for 70% cases and sexual for 30%; the police brought 61% of the children to the hospital. Boys were more at risk in cases of physical abuse, however of the cases of sexual abuse, 23% were boys. Maximum cases of abuse - both physical and sexual occurred at the home/ eighborhood of the victim. It was concluded that the society as a whole, including the Govt. NGOs, Parents, teachers, elders etc. has the responsibility for the proper upbringing of the child and until and unless all of us shoulder the responsibility with sincerity, the children will continue to be abused.

Duodenal metastases from squamous cell carcinoma of the lung: endoscopic management of bleeding and biliary and duodenal obstruction.

Intestinal metastases from cancer of the lung are rare. We report a 65-year-old man with duodenal metastases from squamous cell cancer causing GI bleeding and biliary and duodenal obstruction; these were managed endoscopically.

Improving environmental conditions of a slum in Chandigarh by an awareness campaign.

An intervention project, in the form of an environmental awareness campaign was conducted in a slum of Chandigarh with a population of about 40,000, from December 1998-April 1999. The activities enforced during this campaign included focus group discussions with general public and mothers, household visit by medical students, distribution of literature, use of mass media by involving local residents, primary child care workers, teachers and school children. Evaluation of this campaign was carried out in May 1999 and compared with the baseline data obtained from a survey done in 1997. The study revealed that the method of storing water in covered buckets and utensils had improved significantly from 14.3% and 4.7% in the baseline survey to 35.2% (P < 0.001) and 16.2% (P < 0.01) respectively. Refuse disposal in the community bin and own bin had significantly improved to 22.2% (P < 0.001) and 19% (P < 0.01) from 8.4% and 11.2% respectively in the baseline survey. 51.2% of the residents using own bins disposed the refuse finally into the community bin. The use of community latrines had significantly increased among males (50.0%), females (47.7%) and children (41.2%) after intervention as compared to 32.8%, 32.5% and 16.7% respectively as found in the baseline survey (P < 0.001) and similarly open defaecation had significantly reduced among them. Further the study shows that the awareness regarding diarrhoea as hazard of unsafe water had improved significantly from 28.7% in baseline survey to 55.6% after intervention (P < 0.001). Knowledge of the residents regarding hazards of refuse disposal in the open and open defaecation had also improved significantly. Simple environmental awareness campaign can change the knowledge and behavioural practices of slum dwellers and could be a model for launching similar projects in other slums of India and other developing countries.