BACKGROUND: Central Sterile Supply Department (CSSD) has broadened its significance from just an area where things just come cleaned and go with an autoclave machine to a huge department which regulates all the practices with standard procedures and has a huge role in infection control practices. A good CSSD indicates a good hospital infection control setup. We are nowadays more focused on standard practices following appropriate guidelines that can prevent nosocomial infections. CSSD has a huge role to play in the assurance of sterility check and the traceability of all the sterilized instruments for any suspected outbreaks from CSSD. OBJECTIVES: The objectives of this study were (1) to audit the existing infection control practices in CSSD in a tertiary care hospital, (2) to implement the Infection control practices in the study area, and (3) to evaluate the impact of the progress after implementing changes in the study area. METHODOLOGY: This is a descriptive interventional and hospital-based study carried out in Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry. The tools for the audit include questionnaire. Data was analyzed by SPSS 23.0 (IBM Corp. Released 2015.SPSS Statistics 23 for Windows, Armonk, New York, United States). RESULTS: Pretest results for various questions ranged from 20% to 100% among the participants. The posttest was conducted after the training and teaching of and showed 100% results among all the participants. CONCLUSION: We conclude that the auditing done in CSSD had basic knowledge of the needs and facilities. Implementation of practices in CSSD had been a huge learning process for all of us and was very fruitful. The impact of progress has been shown with the improvised quality of work being done now at various stages of CSSD.

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INTRODUCTION: Competency-based medical education (CBME) is an outcome-based education system. There is a big shift in roles and responsibilities of teachers, students, and teaching methods. This study was planned to evaluate the faculty perceptions and concepts toward the CBME and its implementation. METHODOLOGY: This is a mixed-method study with elements of qualitative (free listing and pile sorting) and quantitative (three-point Likert scale) assessment of faculty perceptions on CBME designed through Google Forms, and the responses obtained were analyzed. Three hundred faculties were recruited for a quantitative study, out of which 125 responded. For qualitative analysis, the preclinical faculties (n = 20) were recruited. Percentages for the responses were calculated. Free-listing and pile-sorting exercise data were analyzed in Visual Anthropac 1.0 software. RESULTS: The responses from participants showed encouraging analysis. A total of 128 faculty members responded that a response rate was 43%. Thirty-eight responses were obtained through interview pertaining to the concepts (qualitative study) of CBME. From the free-listed items or responses, the items were selected based on salience or ranking or investigator's judgment for pile sorting to understand clustering of responses. CONCLUSION: Majority of the faculties had a positive perception about the implementation of CBME. Coordination between the Preclinical, paraclinical and clinical departments and proper lesson plan were the factors facilitating effective implementation. Inadequate faculty training and unanticipated holidays were the challenges for the implementation of CBME. Proper faculty training is the utmost important aspect in the effective implementation.

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Cancer arising out of diets and protective role of diet from cancers to preserve health and nutritional status is a debate in the healthcare arena. In search of perennial conflict on diet and cancer, researchers of this review emphasized conceptual and contextual details from commonly used dietary items and practices for optimum healthcare model. Twenty-four research studies were identified from 91 potentially relevant data bases and published literatures to collate an updated idea of diet and cancer. Studies were selected on, first; all emerging nutritional plans and related reports on cancer among published literature were sketchily searched. Second, “diet” and 'cancer control was also sourced from different journals, conference proceedings, and different media reports, Third, published reports from apex bodies of global importance like different professional national and international organizations were given due weightage. We have assembled diversity of opinion on prevention and control of cancer in different academic sources. Although there is no paucity of quantitative and qualitative data on diet and cancer, there is dearth of scientific and valid suggestions from scholars on this sensitive issue. In a holistic approach, we require more translational research about diet and cancer with definitive and conclusive evidences for day-to-day application in medical practice for the improvement in clinical approach of this complex debatable paradigm.

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BACKGROUND: Overweight and obesity are a rapidly growing threat to health in most countries. It is an epidemic that increases the risk of diabetes, hypertension, heart disease, cancer and hence threatens to inundate health-care resources. Different form of exercises including Pilates and aerobics help improve the side effects of obesity. This study was conducted to compare the effects of Pilates and aerobics on peak expiratory flow rate (PEFR), body composition and core strength in overweight and Grade 1 obese individuals. MATERIALS AND METHODOLOGY: Thirty-three overweight and obese individuals aged 20–30 years were divided into two groups - Pilates group (n = 17) and Aerobics group (n = 16). Pilates included warm up, mat exercises, and cool down. Aerobics included warm up followed by choreographed dance, strength training, high intensity, and relaxation. PEFR by peak flow meter, body composition by body composition analyzer and core strength by pressure biofeedback were assessed, before and after the intervention. Fifty minute session were conducted thrice a week, for 4 weeks. RESULTS: Data were analyzed in the Winpepi and Primer software. Participants in both the groups showed significant improvement at the end of the study. However, the differences in between the group were not statistically significant. CONCLUSION: Pilates and aerobics are equally effective in improving the PEFR, body composition and core strength in overweight and Grade 1 obese individuals.

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PhyGeometry is a visual learning and teaching aid, combining physiological information into and part of geometric triangles. PhyGeometry is a useful summary picture of key factors that affect or are part of a physiological event or mechanism. PhyGeometry helps to “ORGANize,” bring order, beauty, and symmetry into learning and teaching physiology.

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BACKGROUND: Acne vulgaris is a chronic inflammatory, pilosebaceous condition. It is one of the world's most common skin diseases, affecting millions of patients. The frequency and length of the acne may not represent explicitly the psychological condition of a patient. This research was aimed at measuring perceived stress and anxiety of appearance among people with acne vulgaris. MATERIALS AND METHODS: It is a cross-sectional, observational study, carried out at tertiary care teaching hospital following approval by the Institutional Ethics Committee. Seventy-five outpatients with acne vulgaris were included in the study and the perceived stress scale (PSS) and appearance anxiety inventory (AAI) administered to them. RESULTS: There were 55 females and 20 males among the 75 acne patients. The mean age of the study patients was 23.55 ± 3.83. The mean duration of the acne was 3.35 years. The mean PSS was 19.48 ± 6.44 among the patients. The total AAI score among all the patients was 13.67 ± 5.67. The avoidance AAI score was 7.09 ± 4.5 and the threat AAI score was 5.82 ± 3.35. As the mean duration increased, the level of the stress was also increased. CONCLUSION: The results show that the PSS and AAI have psychometric properties to decide whether improvements in cognitive processes and behaviors mediate outcomes in patients. The duration of acne vulgaris had a direct positive association with the higher PSS and AAI score.

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CONTEXT: Student approaches to learning are a significant determinant of success in the medical profession. AIM: This study assesses the study processes utilized by undergraduates in a medical college in North India. SETTINGS AND DESIGN: Cross-sectional, questionnaire-based study. METHODOLOGY: The study process questionnaire by Biggs et al. was adapted to Google forms and administered to 313 medical students. Individual domain scores assessing deep-motive, deep-strategy, surface-motive, and surface-strategy approaches were obtained. Other variables measured included gender, year of training, whether the student found online distance learning useful, and students' perceptions of their academic performance compared to their peers. STATISTICAL ANALYSIS USED: The association between the categorical variables was assessed using a Chi-square test. The continuous measures were compared using a t-test or Mann–Whitney U-test. One-way ANOVA or Kruskal–Wallis test was applied for multiple groups. RESULTS: Deep approach to learning was the most popular overall (66.1%). Females significantly favored deep approaches compared to males. There was no association between the year of training and the study process. The deep approach was associated with better academic performance. Online learning was significantly favored by females, students with a deep learning approach, and better academic performance. CONCLUSIONS: Gender and academic performance are associated with the study process adopted by medical students. An understanding of the learning methods used by students is helpful in training well-rounded health-care professionals.

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CONTEXT: Senior citizens with comorbidities are more vulnerable to severe illness and associated high mortality rate due to the prevailing pandemic. AIMS: The aim of this online survey is to evaluate the psychological stress, awareness, and attitude regarding COVID-19 and the infection control measures taken by the senior citizens. SETTINGS AND DESIGN: The present study involves an online descriptive cross-sectional questionnaire survey conducted at a senior citizen home. SUBJECTS AND METHODS: The questionnaire of the study consists of 20 questions and was performed among 84 older adults of two senior citizen homes supervised by nongovernment organizations through video conferencing on WhatsApp. STATISTICAL ANALYSIS USED: Participant's response was calculated and expressed as percentages and frequency, with the mean values. RESULTS: Seventy-one percent of senior citizens responded to the study, and 91.6% accepted phobic anxiety due to COVID-19 lockdown, while 97.6% reported behavioral disorders. Majority of the senior citizens (96.4%) had awareness regarding COVID-19 infection, 97.6% were aware of water and hand sanitization, while 98.8% of the respondents had a positive response toward COVID-19 protection practice in the future. CONCLUSIONS: The awareness regarding COVID-19 was found to be satisfactory among the senior citizens, although psychological counseling and more precautions are required to make them feel secure from the current pandemic scenario.

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BACKGROUND: In recent years, hysterectomy has received increased attention in health policy debates in India. The objective of the study was to examine induced and noninduced menopause and its associated factors among menopause women in India. METHODS: The study has used the Indian fourth round of National Family Health Survey data (2015–2016), which is a cross-sectional nationally representative sample of 48,771 menopause women in the age group of 30–49 years. Bivariate and multivariate logistic regressions were used to examine differences and factors of induced and noninduced menopause among menopause women in India. RESULTS: In India, among menopause women, 35.3% were induced menopause. Eight states and two union territories have reported induced menopause above the national average. On the other hand, the lowest induced menopause was seen in Assam state. Younger age women had a higher risk of induced menopause, and its reverse was true in older age women. Bivariate results have shown induced menopause was higher in rural (36.4%), secondary educated (39.1%), married (37.0%), Hindu (36.4%), and other backward castes (OBC) caste (39.3%) women. The differences of induced menopause were significantly high in women with high body mass index, belongs to OBC caste, married, Hindu religion, and South and Central regions compared to their counterparts. CONCLUSION: The estimations could be beneficial for planning and implementation of reproductive and postreproductive health services related to menopause, especially among women of younger age groups.

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Fibrous dysplasia is a rare congenital bone disorder which manifests as a localized defect in osteoblastic differentiation and maturation with the replacement of normal bone with an abnormal scar-like fibrous connective tissue. It can be classified into monostotic and polyostotic variety with the former seen mostly in the adults and the latter common in children. Craniofacial involvement in case of fibrous dysplasia is very common, affecting maxilla more commonly than the mandible. This report, however, describes a case of fibrous dysplasia in a 10-year-old female patient who presented with a swelling of the left mandible.

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OBJECTIVES: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. This study was aimed to assess the clinical, biochemical, and phenotypic profile of patients newly diagnosed to have PCOS. SUBJECTS AND METHODOLOGY: A cross-sectional study was conducted for a period of 1 year in the Department of Endocrinology, Guwahati Medical College and Hospital. A total of 50 female patients newly diagnosed to have PCOS by the Rotterdam criteria 2003 were enrolled for the study. Clinical Characteristics, thyroid profile, other hormonal tests, oral glucose tolerance test, and phenotypic assessment were done. RESULTS: Twenty-four percent of patients had dysglycemia, while the rest 76% had normal glucose levels. Glucose abnormalities were noted in 13.7% of lean PCOS and 32.2% of overweight PCOS. There was no difference in insulin resistance among the three phenotypes of PCOS. CONCLUSION: Women with PCOS are at increased risk of developing glucose intolerance and diabetes. Dysglycemia in PCOS women was mainly evident in postglucose challenge glucose levels. Since there is no difference in insulin resistance among various phenotypes, all the phenotypes equally merit screening for glucose abnormalities.

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Reduction in the incidence of tobacco use and the attributed health consequences has been acknowledged as one of the important international public health priorities. The available global estimates suggest that in the last two decades, the use of tobacco has declined, and this has been mainly because of the decrease in the number of females using the same. However, for the very first time in 2019, a major shift in the tobacco epidemic has been highlighted owing to the reduction in the number of males using tobacco or its products. This reported decline is a clear marker of the fact that sustained political commitment and implementation of the evidence-based targeted strategies can deliver encouraging outcomes. In conclusion, the reported trend of decline in tobacco use among men is an important milestone in our battle against the global tobacco epidemic. However, the national policymakers should not reduce the intensity of the efforts and should strive hard to meet the set global targets.

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An infarct at the brain stem or cerebellum is rarely associated with vertigo without any other localizing clinical features. Stroke at the posterior circulation of the brain may cause spontaneous vertigo and imbalance. In some cases, isolated posterior inferior cerebellar artery infraction presents isolated vertigo and nystagmus. The diagnosis of the brain stem vertigo can be done easily when associated with other neurological symptoms along with vertigo, whereas, when the vertigo occurs in isolation, it may be difficult to differentiate it from the other benign disorders affecting the inner ear. A head impulse test may differentiate the acute isolated vertigo with cerebellar stroke from more benign disorders associated with labyrinth. Appropriate evaluation of the patient is better than imaging for diagnosis of the brain stem vertigo. Here, we are presenting a case of isolated acute onset of the vertigo due to brain stem infarct which mimics to the peripheral vestibular pathology.

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BACKGROUND: The National Family Health Survey 4 data state that health insurance (HI) coverage is 28.2% in urban areas, 29.0% in rural areas, and overall 28.7% in India. To achieve universal health coverage and to reduce out-of-pocket expenditure, it is prudent to enhance coverage of HI, especially among middle and low socioeconomic status (SES) strata. OBJECTIVES: The objectives of this study were to estimate HI coverage among rural and urban households and compare the sociodemographic determinants of HI. METHODOLOGY: A community-based, cross-sectional study was conducted in 179 rural and 193 urban households. The tool was a structured questionnaire administered to all consented participants. RESULTS: Awareness about any type of HI scheme was almost equal in rural and urban areas (74.9% and 74.6%, respectively) whereas coverage was much better in urban (58.0%) than rural areas (38.5%). TPA/private schemes were mostly availed by rural while the majority in urban areas availed employer-based or public sector HI schemes. The main reason for availing HI as quoted by rural families was tax gains (66.7%) and to cover medical expenses (46.4%) or compulsion from employer (41.1%) by urban families. HI coverage was observed to be better among urban families having dependents (children or elderly) as compared to rural and rural Hindus as compared to urban. HI coverage was significantly higher among upper- and upper-middle-class strata (as per BG Prasad classification) rural households than urban (P = 0.005 and 0.008, respectively). However, lower-middle and lower classes in urban areas have better coverage (P = 0.028 and 0.076, respectively). CONCLUSION: HI awareness among the rural as well as the urban population is quite good. There is a need to bridge the gap between awareness and coverage of HI by motivating middle and low SES strata and introducing affordable and acceptable HI schemes for them.

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BACKGROUND AND OBJECTIVE: Obesity has been linked with various factors and one of them is the amount of sodium intake by an individual. Spot urine examination is an accepted method of sodium estimation which is accurate, patient compliant and reliable. Hence, the study plans to assess the sodium intake by analyzing spot urinary sodium in normal, overweight, and obese individuals and also to compare and correlate urinary sodium with body mass index (BMI) and waist-hip ratio (WHR). MATERIALS AND METHODS: A cross-sectional study was conducted on 90 individuals grouped into normal, overweight, and obese categories in an urban set up. The Kawasaki formula was used to estimate urinary sodium excretion per day. Comparison between the BMI, WHR, and sodium intake per day for all the categories were done using ANOVA. Pearson's correlation coefficient was calculated to find the correlation between the sodium intake per day, BMI and WHR. A P < 0.05 was considered as statistically significant. RESULTS: Total sodium intake per day by obese individuals was 316.69 ± 170.86 (mEq/day) with the P = 0.0645 using Kawasaki formula. According to Kruskal–Wallis test, there was no statistical difference between values of sodium intake between normal, overweight, and obese categories (P > 0.05). However, significant positive correlation was noted between BMI and sodium intake (P < 0.05) and that of WHR and sodium intake (P < 0.05). CONCLUSION: Sodium intake was positively correlated with the indices of obesity (BMI and WHR) and was found to be an independent risk factor for obesity.

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Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is characterized by left ventricular hypertrophy unexplained by secondary causes and a nondilated left ventricle with preserved or increased ejection fraction. Mitral regurgitation is common in HCM secondary to distortion of mitral valve apparatus leading to systolic anterior motion. We report a case of HCM with rheumatic involvement of mitral valve with severe pulmonary artery hypertension and atrial fibrillation. With regard to hemodynamic management in patients with postcardiac surgery status, anesthetic management seems to be a “walk a tight rope.”

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Radiotherapy plays an important role in the treatment for head and neck cancer. The radiation to the head and neck region can lead to a rare long-term swallowing and breathing defect by causing stenosis at the pharynx which reduces the quality of life. We are presenting a case of radiation-induced severe pharyngeal stenosis in a 44-year-old female diagnosed with nasopharyngeal carcinoma. Nasopharyngeal carcinoma is a rare variety of the cancer where radiation therapy is the treatment of choice because of its high radiosensitivity. Radiation-induced dysphagia may occur due to structural, mechanical, and neurological deficits. Although radiotherapy has a promising outcome in nasopharyngeal carcinoma, complications around the irradiation areas are inevitable and lead to compromised quality of life. Although there is no effective treatment option available for pharyngeal stenosis, many supportive, restorative, and palliative treatments are available under different clinical situations. Here, we report a case of postradiation-induced pharyngeal stenosis presenting with dysphagia and stridor that underwent treatment with pharyngeal dilation with coblation.

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The concept of integrated teaching in medical education has been advocated to provide meaningful connections between the topics and problems which are interrelated so that understanding between theory and practical application can be ameliorated. The integrated teaching has been associated with multiple advantages for both the teachers and students. However, it is important to explore the educational initiative in terms of the opportunity which it presents to the students, as eventually our aim is to produce a competent medical graduate. However, for the successful implementation of the integrated teaching and accomplishment of the intended learning outcomes, we have to give due consideration for the existing challenges. There are no doubts that challenges exist from the perspective of administrators and from the faculty perspective, but we cannot ignore the potential challenges attributed to the students. In conclusion, integrated teaching has been linked with multiple benefits for the students in the medical education. However, we have to understand the opportunity and the challenges attributed to the same from the students' perspective for better and successful implementation.

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BACKGROUND: Caregivers play an important role in dealing with people with chronic mental disorders. Rates of caregiver burden are high and it increases the risk of caregiver depression and health problems. Therefore, an in-depth study is needed to understand the burden faced by primary caregivers of patients suffering from chronic mental disorders. AIM: The aim of the study is to examine the burden borne by families of individuals suffering from chronic mental disorders. MATERIAL AND METHODS: From the caregivers of patients with chronic mental disorders some were chosen. It is a cross sectional study. Purposive sampling technique has been adopted. Patients were diagnosed as having mental disorders using International Classification of Disease -10, classification of Mental and Behavioral Disorders, Diagnostic Criteria for Research ICD-10 criteria. Pollack and Perlick scale was used to identify the key family caregivers. Patients with two or more than two-year duration of illness were included in the study group. RESULTS: Caregivers of patients with chronic mental disorders experienced considerable high degree of family care burden. CONCLUSION: The study finds that a high burden is borne by caregivers of patients suffering from chronic mental disorders.

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INTRODUCTION: Today, mobile phones (MPs) have become an indispensable tool because of the countless perks it provides. In India, there are more than a million MP users. When compared with total telecommunication users, MPs users are 88%. Extensive use of MP has led to exposure to a dangerous level of electromagnetic waves. Many investigations concluded that MP use reduces the cognitive function of the human brain, however, there is a difference of opinion within the research workers. The present research work can be used to plan the large-scale study which will be useful to decide safety limits and advice for advocating safety measures. MATERIALS AND METHODS: For the present study, 240 female medical students (age group: 18–23 years) from KIMS, Karad, were studied. Durations of visual reaction time, trail making test A and B, and letter cancellation test were studied. Digit span test scores were also measured. All the parameters were studied before and after 30-min mobile use. RESULTS: It was observed that there was a highly significant decrease in values of all the parameters studied (P < 0.001) after 30 min of mobile use. CONCLUSION: The present study showed that 30 min of mobile exposure affects the brain function. Hence, the large-scale study with more duration of exposure and large sample size is required to find conclusive results.

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E-learning refers to the employment of technology to facilitate access to learning resources on the internet to enhance acquisition of new knowledge, skills and/or behavior. It is very important to develop an understanding about the process involved in the development of an e-learning strategy, and it has to start with analyzing the existing situation and how e-learning can bridge the gap. Regardless of the e-learning course, if the organizers want to ensure that participants are maximally benefited, it is essential that the organizers take efforts to know their participants, especially in terms of their learning behaviors and needs, so that these areas can be targeted during the course. Finally, the organizers should be always aiming for the improvement of the program through modifications in the program based on the feedback received from the participants. In conclusion, e-learning is an important addition in the delivery of the medical curriculum or the health professions education. However, it is crucial for the organizers to adopt different strategies to ensure that the overall effectiveness of the program can be enhanced and the intended objectives are accomplished.

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BACKGROUND AND AIM: Pulmonary tuberculosis (PTB) is a major public health problem globally with relatively high morbidity and mortality rates. Chest radiography plays a key role in describing the patterns of appearances which help in predicting treatment progress. In this study, we evaluated the patterns of radiographic findings among patients diagnosed with PTB. MATERIALS AND METHODS: This was a retrospective study of clinical and chest radiographic features of PTB in 105 patients. All the radiographs were reported by a consultant radiologist. The age, gender, clinical presentation, nature and location of the lung changes, and diagnosis were recorded. Descriptive statistics were employed in analysing mean ± standard deviation, percentages, and frequencies. Data were analyzed using the SPSS software version 22.0. RESULTS: The male-to-female ratio was 3:2 with 58.1% (n = 61) male and 41.9% (n = 44) female. The average age of the patients was 36.29 ± 15.95 years with 21–30 years age group most affected. Fibrocavitatory changes alone were the most common finding and the majority of the lung changes involved the entire both lungs. CONCLUSION: Fibrocavitatory changes and involvement of the entire both lungs were found to be the common radiographic findings of patients diagnosed with PTB. Age group 21–30 years was most commonly affected.

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OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is the second major contributor to disease burden in India, courtesy to tobacco use, and air pollution. However, there are not many studies with a nationwide approach. The present paper aims to correlate Disability-Adjusted Life Years (DALY) due to COPD with tobacco use, secondhand smoking, the use of clean fuel, and economic condition. MATERIALS AND METHODS: The study adopted an ecological approach. A secondary analysis was carried out on data collected from the National Family Health Survey 4, the Global Adult Tobacco Survey 2: India 2016–17, and India: Health of the Nation's States. Spearman correlation coefficient and multivariate linear regression were used for state-wise analysis. RESULTS: It was found that states with higher COPD burden were confined to North India. Smoking and secondhand smoking had positive relationships with COPD burden. On regression, smokeless tobacco (SLT) was significantly associated with DALY due to COPD. CONCLUSION: States with the highest proportion of SLT need special intervention to reduce COPD burden in the country.

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