Co-creating sexual and reproductive health interventions with adolescents: the experience from Rajasthan

Despite a clear policy recognition of the need for special programmatic attention for adolescents to ensure access to sexual and reproductive health information and services, almost all existing programs in India face critical challenges in effectively delivering sexual and reproductive health information and services, which leads to early marriages and teenage pregnancies. Teenage pregnancies directly threaten women's sexual and reproductive health and well-being. States like Rajasthan with high adolescent pregnancy rates demand better solutions. IPE Global implemented project Udaan to reduce teenage pregnancies in the state, adopting a 360 degree approach. Improving Sexual and Reproductive Health was one of the critical components of the project, and a human-centred design method was adopted to co-create an effective sexual and reproductive health intervention relevant to the community. The human-centred design approach incorporated multiple steps, including formative research, iterations, prototyping and piloting. Five potential interventions emerged after a series of iterative explorations. The in-school SRH intervention has emerged as an excellent model of reaching adolescents effectively in culturally sensitive rural geographies in the evaluation of the pilot, which successfully covered over 10,800 adolescent boys and girls across 66 government high schools in the Bari block of Dholpur. An independent evaluation suggested a significant increase in the awareness of contraceptive methods in the intervention area from 24 per cent to 50 per cent. Contraceptive self-efficacy, a measure of girls' agency, increased by 18 per cent in the intervention area. Further, qualitative findings showed a significant improvement in SRH awareness and service utilization.

A study on smart phone use and its perceived health effects among the adolescents attending Medical College and Hospital, Kolkata

Background: Smartphone usage is gradually escalating among Indian adolescents, which is having adverse consequences on their health and well-being. Awareness regarding adverse health impacts of smartphone usage among adolescents is thus necessary. Aims and Objectives: This study assessed the smartphone usage pattern and perception regarding its health effects among adolescents attending adolescent friendly health clinic (AFHC) at Medical College and Hospital, Kolkata. Materials and Methods: This cross-sectional study was conducted among 187 adolescents from January to March 2023 at AFHC of Medical College and Hospital, Kolkata selected by systematic random sampling technique. Pre-designed self-administered questionnaire was utilized for data collection. Data were analyzed using SPSS software. Factors associated with the duration of smartphone usage were analyzed using the Chi-square test. Results: Smartphone was used by all the study participants (n = 187). A significant proportion has utilized smartphones for >3-year duration, whereas 114 (60.9%) used them for 1–2 h per day and 56 (29.9%) used them for ?3 h per day. The major adverse health impacts of smartphone usage perceived by the participants were eye symptoms (64.2%), headache (50.8%), and neck pain (46.5%). Gender (?2=12.98, df = 2, P = 0.0012), type of residence (?2 = 7.98, df = 2, P = 0.018), and socioeconomic status (?2 = 34.96, df = 2, P < 0.001) were factors significantly associated with the duration of smartphone usage per day. Conclusion: Smartphone should be optimized to protect the physical and mental well-being of adolescents. Motivation and counselling regarding the adverse effects of smartphone usage is should be given the utmost priority. Generating awareness among parents at the community level through field health workers is also the need of the hour.

A cross sectional study on the determinants of railway fatalities in different age groups

Background: Over the last few decades many railway accidents and fatalities have occurred in India as well as worldwide. Cities having a high economic activity and are complex spatial structures, are supported by transport systems. The evolution of mass rapid transport system in the form of sub-urban railway network has increased railway casualties in the cities as the railroads pass through residential and commercial zones. Methods: This cross-sectional observational study was conducted at R. G. Kar medical college and hospital police Morgue attached to the department of forensic medicine and toxicology (FMT), Kolkata on the randomly selected medico legal postmortems over last 4 years. Results: Railway accidents were common in males with mean age group of 38.98 years and was almost identical with the female mean age. The accidents mostly occurred in the office hours during the day time. Chi square test of association gave significant results between the different age groups with sex and grievous injuries sustained the people. Injuries sustained by the train showed that they were found mostly over the head followed by spine and thorax. Major cause of death was due to head injuries. Conclusions: The article gives an idea about the relevant demographic profiles and association with the age-related factors that can be taken up as means to prevent the accidents.

A study to evaluate the outcomes of traditional lecture classes and self-directed learning sessions among the first MBBS students in the department of physiology

Background: To become lifelong learners, it is essential for medical students to develop self-directed learning (SDL) skills from early medical schools. Aim and Objective: The present study was conducted to compare the outcome of traditional lecture classes (LCs) and SDL sessions among the first MBBS students in the department of physiology. Materials and Methods: This pilot study was conducted over a period of 1 year in the department of physiology among the first MBBS students to compare the outcome of traditional LCs with SDL sessions. The first 12 traditional LCs were conducted among Group A (roll no. 1–100) and the first 12 SDL sessions were conducted among Group B (roll no. 101–200). For the rest 13 traditional LCs and SDL sessions, crossover of two groups was done, that is, traditional LCs were conducted among Group B and SDL sessions were conducted among Group A. Results: Students performed significantly better in the 3rd, 7th, 10th, 11th, 12th, 13th, 15th, 18th, 19th, 21st, and 22nd SDL sessions as compared to LCs in post-test sessions. Students performed significantly better in the 4th, 6th, 8th, 16th, 23rd, 24th, and 25th LCs as compared to SDL sessions in posttests. Students performed significantly better in post-test sessions as compared to pre-test sessions. Students were highly satisfied with the program (as per evaluation done by Kirkpatrick model: Level 1). Conclusions: The students were highly satisfied with the teaching-learning program implemented by the department of physiology and their performance was better following SDL sessions as compared to traditional LCs.

Birth Preparedness and Complication Readiness Among Pregnant Women Attending an Urban Health Centre in Surat, India

Background: Birth preparedness is an important strategy to reduce MMR. It includes knowledge of key danger signs; identification of: birth place; birth attendant, fund, transport and compatible blood donor for emergency use beforehand. Objective: This study aims to explore birth preparedness in Surat and determine factors associated with it. Methods: Study conducted facility based cross-sectional study among 310 antenatal women at Urban Health Training Centre attached to Government Medical College, Surat, Gujarat. Predesigned, semi- structured, pretested questionnaire was used for data collection after acquiring informed written con-sent. Result: A total of 310 women participated in the study. Mean age of participants was 22.9 + 3.6 years. Almost one-third (30.3%) of participants were illiterate. Almost six-tenth (61.9%) of participants were involved in unskilled or semi-skilled work and two-fifth (38.1%) of participants were homemakers. Ma-jority of participants (96.7%) were registered in first trimester. Most known factor during pregnancy as danger sign was bleeding (81.9%). BPACR index was calculated as ∑Indicator/7 which was observed to be 62.3%. There was statistically significant association between awareness about health problems dur-ing pregnancy and type of family. Conclusion: Raising awareness regarding components of BPACR among antenatal women will help to reduce morbidity and mortality in antenatal women and achieve sustainable development goal

Parents’ Perception Towards Covid-19 Vaccination for Children in Surat: A Cross Sectional Study

Background: Vaccine hesitancy has been recognized as a public health issue which needs to be ad-dressed urgently. With reopening of school unvaccinated children might become major carriers of COVID-19. An assessment of the determinants of vaccine hesitancy will aid in the acceleration of vaccine administration among children. Objective: This study aims to explore parental COVID-19 vaccine hesitancy in Surat and determine fac-tors associated with it. Methodology: This is a cross sectional study in Surat among 250 participants selected from Rural and Urban field practice area by Systematic Random Sampling. Data collection was done by data collectors in an interview during the month of January and February, 2022. Univariate analysis was done, followed by Chi square test to establish associations. Predictors were determined by Binomial Logistic Regression. Results: Mean age of population was 31.3 + 10.7 years. Vaccine Hesitancy was recorded in 154 (61.6%) participants. Urban address (p=0.013), Full Vaccination status of parents (<0.001) and Perceived Bene-fits of vaccine to the child (p=0.001) were significant predictors of Vaccine Hesitancy. Conclusion: High proportion of Vaccine hesitancy was found in this study. Interventions can be planned on the basis of factors affecting Vaccine Hesitancy.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes

Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ?16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Determinants of infant mortality in rural India: An ecological study

Background: Long-term reductions in infant mortality (IM) are possible only by addressing the distal determinants. Objectives: The objective of the present study was to determine the relationship between IM and its major distal determinants in rural India. Methods: The dependent variable used in the study was state wise IM rate (IMR), the values of which were obtained from the Sample Registration System, 2015. State level literacy rate in females, unemployment rates of females, GINI index, and round-the-clock neonatal services in primary health centers in the rural areas and the per capita gross state domestic product at purchasing power parity (GSDP at PPP) of the states, were used as the predictor variables for IM. Relationship between the variables was obtained by the Pearson's correlation coefficient. Bivariate and multivariable linear regressions were used to identify the magnitude and direction of the predictors on IM. Results: Correlation statistics showed none or weak positive correlation between the Gini coefficient and 24 � 7 primary health-care services and IMR. There was a strong negative correlation between female literacy rate and IMR, while the unemployment rates and per capita gross state domestic product (GSDP) were moderately negatively correlated to IMR. Bivariate analysis revealed that, for unit increase in unemployment rates in females, proportion of literate women, and 1000$ increase in the GSDP at current prices, IMR decreased by 0.07, 0.763, and 1.702, respectively. However, after adjustment, only the female literacy rates showed significant association with IMR. Conclusions: Of the major determinants included in the study, rural female literacy is the most important distal determinant of IM in rural areas of India.

Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India

Background: Despite evidence regarding the beneficial effects of vaccines, vaccination uptake has not been up to the mark across the globe in various sociocultural and sociodemographic groups. Logistics and workforce have been issues of concern to public health managers, but the latent issue of vaccine hesitancy leading to vaccine delays and refusals has not been widely addressed particularly in the Indian context. Objectives: The present study was conducted to find out the proportion and factors contributing to vaccine hesitancy for childhood vaccinations in slums of Siliguri, India. Methods: A cross-sectional study was carried out among 194, 0–59 months' children residing in slums of Siliguri in 2016. Data were collected at the household with interviews of mothers/primary caregivers using a predesigned pretested interview schedule developed based on the validated version of vaccine hesitancy survey questionnaire originally developed by the World Health Organization Strategic Advisory Group of Experts working group on vaccine hesitancy. Associations were analyzed using logistic regression. Results: Majority 161 (83%) of the families were vaccine-hesitant and only 33 (17%) were not hesitant. Nuclear families and mothers of lower educational status had significantly higher odds of vaccine hesitancy. Reluctance to vaccinate (26.1%) and to be unaware/having no reliable information (20.5%) were the major reasons cited for vaccine hesitancy. Conclusion: Most of the families of the children were vaccine-hesitant in the area. Uniformity in schedules in different health facilities in slum areas, appropriate antenatal information, and counseling regarding childhood vaccinations, widespread awareness, and improving mothers' education can address the issue of vaccine hesitancy.

Anti-epileptic effect of morin against experimental pentylenetetrazol-inducedseizures via modulating brain monoamines and oxidative stress

Objective: To evaluate the protective effect of morin against pentylenetetrazol (PTZ)-induced tonic-clonic convulsions in mice. Methods: Swiss albino mice (18-22 g) was used to induce convulsions by intraperitoneal (i.p.) administration of PTZ (90 mg/kg). Mice were either pretreated with morin (10, 20 and 40 mg/kg) or vehicle (distilled water, 10 mg/kg) 45 min before PTZ administration. Various behavioral and biochemical parameters were assessed. Results: PTZ administration resulted in significant production (P<0.001) of tonic-clonic conclusion and mortality in mice. PTZ-induced increase in the duration of convulsion, onset of convulsion and mortality was inhibited significantly by morin (20 and 40 mg/kg) administration. The PTZ-induced decrease in brain GABA, dopamine and Na+K+ATPase levels and increase in xanthine oxidase activity were inhibited significantly by morin (20 and 40 mg/kg) treatment. The increased levels of malondialdehyde and nitric oxide level were significantly decreased by morin (20 and 40 mg/kg) treatment. Also, reduced levels of superoxide dismutase and glutathione were increased significantly by morin treatment. Conclusions: Results of the present study indicate that morin showed its anti-convulsant effect via modulating the levels of brain GABA, Na+K+ATPase, and oxido-nitrosative stress. Thus, morin can be a potential candidate for further clinical evaluations as an anti-epileptic agent.

Serum lipoprotein ratios as markers of insulin resistance: A study among non-diabetic acute coronary syndrome patients with impaired fasting glucose.

Background & objectives: Recent data suggest that insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity or dyslipidaemia. However, the majority of available methods to evaluate insulin resistance are complicated to operate, expensive, and time consuming. This study was undertaken to assess whether serum lipoprotein ratios could predict insulin resistance in non-diabetic acute coronary syndrome (ACS) patients. Methods: Ninety non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. At the time of admission fasting glucose and insulin concentrations were measured. The homeostatic model assessment-insulin resistance (HOMA-IR) was used for insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG) and high density lipoprotein cholesterol (HDL-C) levels were checked, and then TC/HDL-C and TG/HDL-C ratios were calculated. The areas under the curves (AUC) of the receiver operating characteristic (ROC) curves were used to compare the power of these serum lipoprotein ratios as markers. Results: Lipoprotein ratios were significantly higher in patients with HOMA-IR index > 2.5 as compared to patients with index <2.5 (P < 0.05). Both TG/HDL-C and TC/HDL-C ratios were significantly correlated with HOMA-IR (P<0.05). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratio for predicting insulin resistance was 0.80 (95% CI, 0.67 to 0.93), 0.78 (95% CI, 0.65 to 0.91), respectively. Interpretation & conclusions: The findings of this study demonstrate that serum lipoprotein ratios can provide a simple means of identifying insulin resistance and can be used as markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

Polymicrobial chronic endophthalmitis diagnosed by culture and molecular technique.

Accurate etiological diagnosis is the key to prevention of ocular morbidity in endophthalmitis cases. A 66 year old male was suffering from chronic endophthalmitis post-cataract surgery. Polymerase chain reaction examination on anterior chamber fluid was positive for Propionibacterium acnes but negative for the panfungal genome. He was advised vitrectomy with intravitreal injections. Polymerase chain reaction of vitreous aspirate was positive for P.acnes as well as panfungal genome. The vitreous sample also grew yeast in culture which was identified as Candida pseudotropicalis. Patient was treated on an alternate day regimen of intravitreal Vancomycin and Amphotericin B in the post-operative period. There was improvement in vision at final follow up. Chronic endophthalmitis can have polymicrobial etiology which will require appropriate diagnostic and therapeutic strategies. The role of molecular testing is vital in these cases as growth in culture is often negative.

A novel nested reverse-transcriptase polymerase chain reaction method for rapid hepatitis C virus detection and genotyping.

Purpose: Rapid and specific detection of viral nucleic acid is increasingly important in the diagnosis of infectious diseases. The objective was to develop a rapid, efficient process of nucleic acid based detection of hepatitis C virus (HCV) infection for its diagnosis and treatment follow‑up. Materials and Methods: A two‑step nested reverse‑transcriptase polymerase chain reaction (RT‑PCR) has been standardised on a sample set of 125 individuals from different liver clinics in Kolkata. The method utilises a novel fast nested RT‑PCR for HCV detection and genotyping from HCV infected patient plasma with high processivity. Results: The overall time required from ribonucleic acid (RNA) isolation to nested PCR amplified product detection is reduced to 42% when compared with conventional nested RT‑PCR amplification. The method is sensitive as conventional PCR and detected all HCV RNA positive samples. Sequencing, phylogenetic analysis of the PCR amplified product by this method showed concordant genotypes with conventional PCR. Conclusion: Though being a two‑step process, this method is fast, cost‑efficient, reliable and feasible for regular HCV RNA screening and apt even in resource limited settings. This method could be translated to regular nucleic acid screening for other infectious diseases as regular PCR regimen.

A rare case of cutaneous larva migrans due to Gnathostoma sp.

A 28-year-old lady presented with recurrent erythematous skin lesions in different parts of the body for 3 months. There were several episodes of worm coming out of the lesions. Examination of the worms in the parasitology laboratory revealed it to be a larva of Gnathostoma sp. She was advised treatment with Albendazole for 21 days, and there was no recurrence of lesions.

The role of a commercial enzyme immuno assay antigen detection system for diagnosis of C. trachomatis in genital swab samples.

In the present pilot study, endocervical and urethral swabs collected from 100 patients attending sexually transmitted disease (STD) clinics and regional centre for STD in two referral hospitals in New Delhi were analyzed by enzyme immune assay (EIA), polymerase chain reaction (PCR) and direct fluorescent antibody (DFA) for detection of C. trachomatis. It was found that EIA could detect a very low number of cases (3/100) as against DFA (11/100) and PCR (9/100). Thus, in spite of the widespread availability, lower cost and ease of performance of the enzyme-linked-immunosorbent serologic assay, the present study highlights the need to employ sophisticated diagnostic tools like DFA and PCR for detection of Chlamydia trachomatis in STD patients.

Cerebrotendinous xanthomatosis: a treatable cause of metabolic ataxia.

Cerebrotendinous xanthomatosis is an exceptionally rare condition in Indian subcontinent, however, it is potentially treatable if diagnosed. We present and discuss the clinical presentation and investigations in a case of cerebrotendinous xanthomatosis (CTX).