The world is passing through the unprecedented crisis of COVID 19 pandemic. A large section of the global population has been living under mandatory mass quarantine, the lockdown, as a strategy towards slowing down the expansion of the pandemic. This lockdown is being eased out across world in a phase wise manner. India being one of the most populous countries is hardest hit by the pandemic and soon the number of positive cases is likely to touch one million mark. One of the most significant phenomenons observed during the Indian lockdown, has emerged as the long march of migrant workers from cities to their native places. Bihar, one of the Indian provinces is the major provider of migrant labourers for Indian agriculture and the industry sectors. As depicted on social media and television, the plight of migrants was disturbing and exposed modern Indian democracy's vulnerabilities. Many of them had to walk on foot for thousands of kilometers, with their hungry families, from the industrial cities to their native places. Nothing has changed for the migrant workers through the past three centuries, including the first century of postcolonial India. Why are they called migrant workers? Are they not citizens of India? How come being Bihari—a native of Bihar province, one of the primary sources of migrant workers in India, become a stigma? So how did the historical symbol of the most significant accomplishments of Indian history, literature, science, and culture come to be identified with poor migrant workers' image? Bihar's underdevelopment is often blamed on corrupt local politicians and caste politics. However, the history of migrant workers from Bihar and eastern Uttar Pradesh states of India is worth a closer attention for possible solutions. The phenomenon has a historical linkage with the fall of once upon a time the great Indian civilization; centuries of occupation, colonization, slavery, and indentured servitude. India has made steady progress in economic terms since 1947, India's independence from the British empire. The economy's size and rise in gross domestic product (GDP) are meaningless if ordinary citizens continue to be disfranchised, not protected, and liberated from the colonial processes. For India's sovereign economic development, there is no option but to invest in long-term and rebuild the civilization and build a system of the indigenous Indian knowledge economy based on the core principles and values of the Indian civilization. Keywords: Migrant workers, Slavery, Indentured workers, Indian Independence, Indian Civilization, History of India, History of Bihar, Magadha Empire, Buddha, Ashoka, Chanakya, Indian economy, Development of India, Culture of India, Tourism industry, Visit Bihar, India Arrival Day, India diaspora, Future of India, Rebuilding Bihar, Bihari people, Patliputra, Magadha empire, Gupta Empire, Colonization of India, the British empire, Independence of India, Bhikhari Thakur, Mahatma Gandhi, Satyagrah. Champaran movement, Mr. Rajkeshwar Purryag, History of Mauritius, BIMARU States, Ancient India, Future of India, Indian economy, COVID-19, Corona, Pandemic in India, Public Health, Archeological Survey of India, GDP of India, Economy size of India, Niti Ayog, Government of India, Indian Agriculture Sector, Development of Bihar

This write-up is a brief reflection of a rural doctor couple, Dr. Himmatrao Saluba Bawaskar (HSB) and Dr. Pramodini Himmatrao Bawaskar (PHB), working in the remote area of Maharashtra state of India during COVID-19 pandemic. During the pandemic, rural doctors are routinely exposed to symptomatic COVID-positive cases in the outpatient as well as indoor setting. The authors, both husband and wife, were in compulsory quarantine for twice at home and experienced social stigmas attached to a positive case. Here is a report the details of COVID-19 pattern and its management learned from the published scientific papers on COVID-19, and severe acute respiratory syndrome due to SARS-CoV-2 from December 2019 and their own experience in rural setting and the current literature shared in the form of personal narration. Apart from the personal experience of patients experience regarding quarantine period, COVID-19 is discussed in detail for the benefit of rural practitioners.

It took only days to a few months, for the coronavirus to spread across the globe from it's place of origin, Wuhan city, China. Though, India is not among the worst affected countries of coronavirus, it is still a major Public Health emergency which pose a serious threat of crippling the nation's economy. A densely populated country like India, cannot afford getting it's population infected with coronavirus, as that will have an enormous strain in existing healthcare facilities. Although the government of India has implemented complete lockdown, there are many economic concerns to be addressed. Even though, relief fund was announced, the nation's huge population could use additional financial support, to take care of their essential needs like groceries, provisions and medicines. The livelihood, employment and income of many citizens remains questionable. This article attempts to give a socio-economic perspective of the coronavirus pandemic in India.

Disaster management is the execution of various resources and responsibilities that deal with all civilized aspects of tragedies in the consequences of natural or human hazards. There are multiple factors that lead to the outbreak of epidemics after natural disasters, but often the association between natural calamity and the outbreak of epidemics is misconstrued. The health care system of any country has an imperative role in combating the disaster-related epidemics. In developing countries like India, where resources are limited, the public healthcare system plays a vital role against battling epidemics after a natural disaster, hence, preparedness of public health care system to combat epidemics after natural disasters is considered as a narrative review.

The origin and spread of current novel coronavirus had raised serious concerns among stakeholders around the globe. Different speculations that may unfold the mystery in the future are taking roots, but now there is no globally acceptable opinion about the origin and spread of this novel coronavirus. It is reported that Wuhan city of Hubei Province of central China was the epicenter of this outbreak of novel coronavirus. However, initial inadequate preventive measures allowed the infection to cross the borders of China and that pulls the world into drastic public health and economic crisis. This coronavirus disease now named as COVID-19 by World Health Organization (WHO) and the responsible coronavirus is named as “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).” The spread of SARS-CoV-2 is alarming even after 5 months of inception and WHO further warns the world to be prepared for more intense spread of COVID-19. Different diagnostic tools to detect SARS-CoV-2 are being used around the globe, but the identification of asymptomatic carriers of the disease is a serious challenge in countering the COVID-19 pandemic. There is no specific treatment available, only preventive, symptomatic, and supportive treatments are being used for clinical management of COVID-19. The available knowledge is limited, therefore, any escalation of information on the disease will help to combat this global challenge of COVID-19. In this review, we have discussed and summarized the available multi-factorial information and recent updates on the SARS-CoV-2 which can help support future research and may help in the strategic management of the current COVID-19 pandemic. The articles available online before June 30, 2020, on bioRxiv, medRxiv, ChemRxiv, Google Scholar, and PubMed have been assessed for the compilation of this review. Information on the official portal of WHO, CDC, ICMR, etc., were also assessed and used with due credit.

The coronavirus (COVID-19) pandemic has caused the world to undergo an unprecedented change in a short period. Personal protective equipment such as the face mask or face cover has become a daily necessity. Moreover, since some states and countries have made the use of face covers or face masks compulsory, one cannot ignore or afford to have a wrong or incomplete awareness about face masks. Current information suggests that the two main routes of transmission of the COVID-19 virus are respiratory droplets and contact. This article aims to review the existing information and highlight the need for the use of face masks or face covers to combat the COVID-19 pandemic and promote and provide necessary recommendations. Many countries have implemented or recommended mask wearing in the community, but recommendation for rational use of masks is being issued, as the crisis and shortage for masks are universally existing. The use of different types of masks has been assigned according to the risk of exposure and should be therefore judiciously used. As this is a novel disease, the guidelines are changing every day and one needs to be updated with correct information so that one can protect themselves and their families from this extreme level of the crisis faced by the world now. The use of face covers or masks should not be discouraged as there has been substantial evidence that its use can help reduce the spread of infection. “Mass masking” along with hand hygiene and social distancing are the only effective recommended measures to prevent the spread of the disease.

Maintaining a patient's quality of life is main the aim while treating cancer patients. Patients getting treated for oral cancer encountered with numerous symptoms at the time of radiotherapy and most of these are side effect which can persist even after few months to year after the treatment gets over. Radiotherapy is a vital aspect of both curative and palliative cancer care. Understanding the basics complications of radiotherapy along with its primary management of oral symptoms can assist family physicians in providing complete primary care for their cancer patients. Palliative oral care helps to ease symptoms from the cancer treatment. Oral care negligence is still a major cause of worsening of posttreatment quality of life of an individual. The article mainly empathies on the oral health care need to be taken care by primary care physicians in the cancer patients during and after the radiotherapy. Consequences associated with radiotherapy in oral cavity and its systematic overview of preventing and managing acute and chronic condition. It enlightens the importance of dentist role on improving quality of life of these patients.

Background: In India, the active case-finding (ACF) strategy began in 2017 under the Revised National Tuberculosis Control Programme to find its missing tuberculosis (TB) cases. Few studies have been conducted in India to assess the treatment outcome of TB patients detected by ACF. Aim: The aim of this study was to assess the treatment outcomes of patients detected through ACF campaigns during the year 2018 in Haridwar district, Uttarakhand. Study Design: This was a cross-sectional study which used the existing data and records. Materials and Methods: The ACF campaign records of 2018 were extracted from six TB units of Haridwar district. Details of sociodemographic, clinical profile, and treatment outcome of 100 diagnosed patients were obtained and analyzed. Results: Out of the total 100 TB patients detected, the site of disease was pulmonary in 98% of patients. Almost all (92%) the patients were diagnosed microbiologically and treatment was initiated by 78% of the patients. The proportion of successful treatment outcome was found in 64% of the patients. The median time interval from diagnosis to treatment was found to be 2 days. Conclusion: In spite of these efforts of ACF, a high proportion of initial loss to follow-up (22%) and unsuccessful treatment outcome (18%) among ACF patients is a major concern. Findings of ACF campaign pose a concern for active follow-up after diagnosis and close monitoring during treatment.

Background: Sore throat is one of the commonest symptoms that patients present to a primary care physician. We describe the epidemiology of sore throat and performance of an algorithm to predict viral sore throat in a part of India. Methods: Children below 10 years of age were followed in 4 villages of Haryana, India from Aug 2012 to Aug 2014 through weekly domiciliary visits by trained field workers who screened for symptoms of acute respiratory infection (ARI) including sore throat. Nasal and throat swabs were obtained from a random sample of sore throat cases by nurses and sent in appropriate transport media for real-time polymerase chain reaction for detection of viral nucleic acid. Incidence of sore throat and viral sore throat are reported as number of sore throat episodes per 1000 child-years (EPTCY) with 95% confidence-interval (CI). Symptoms, associated with viral sore throat were identified by logistic regression, combined into a clinical score and Receiver Operating Characteristic curve was plotted. Results: Over a two-year period, 3765 children were followed up for 5578 child years. 1069 episodes of sore throat were reported, and swabs were collected from 8% of the cases randomly. The incidence of sore throat and viral sore throat was 191.7 (95%CI: 180.5-203.6) and 60.1 (95%CI: 55.1-68.2) EPTCY, respectively. Fever (aOR 5.40,95%CI: 1.16-25.18) and running nose (aOR 10.16,95%CI: 1.01-102.42) was significantly associated with viral sore throat. The clinical score (fever, running nose, and headache) had an overall sensitivity of 86.2% (68.3-96.1%), specificity of 62% (47.2-75.3%) and AUC of 0.78 (0.67-0.87) in predicting viral sore throat. Conclusion: Viruses contributed to one-third of burden of sore throat and clinical score can be used in primary care settings to aid antibiotic prescription by physicians.

Background: The world is going through a pandemic caused by newly emerged “Novel Coronavirus,” which was originated from Wuhan, China in December 2019. This pandemic caused havoc in the world. So far, more than 200 countries have been affected by Novel Coronavirus. India is also not untouched by this outbreak. The corona virus transmits through droplets, contact, and fomites in human and become a chain transmission by human to human. SARS-CoV-2 spread worldwide by air transport, and it is also reaches to local and small societies or villages by domestic transport through the travelers. Methods: In this study, data are accessed from Ministry of Health and Family Affaires, Ministry of Home affairs, Ministry of Transport, Government of India, World health organization, and www.worldometers.info. The accessed data are analyzed by origin 6.1 software. Results: In India, till April 8, 2020, 5274 people were found infected with COVID-19, out of which 410 were recovered, and the remaining 149 died. The infection of SARS-CoV-2 reaches to several places by international and domestic through human travelers. To avoid local and community transmission in India, it was decided for complete lockdown of 21 days from March 25, 2020 in country to prevent mass gathering and promote social distancing. Further, the lockdown was extended to May 3, 2020. The decision of lockdown has been successful in getting control of COVID-19 in India so far. Conclusions: The effective measure of lockdown to control COVID-19 was found to be very successful in India and it can be apply by other countries to control the COVID-19.

Background: Oral health means much more than just having healthy teeth. Various oral diseases have significant side effects on general health; also systemic diseases can show a reciprocal effect on oral health. So oral health needs to be regarded by multi-professional approaches and should be combined into comprehensive health-promotion strategies and actions. The present study aimed to determine oral hygiene habits amongst chromium mine workers. Materials and Methods: The present observational, cross-sectional study was conducted for a period of 4 months from April to October 2017. The present study evaluated the oral hygiene habits amongst the chromium mine workers of Odisha. A total of 1140 males were enrolled in the study. The study was conducted after the institutional ethical board clearance and informed written consent for participation in the study and written consent was obtained from all in their vernacular language. Data were entered using MS-EXCEL 2016 and the statistical analysis was done using SPSS software. Results: There were 91.9% of subjects who brushed once a day, 6.9% brushed twice a day and 1.1% brushed after every meal. The results of the study showed that 75.9% and 8.1% of subjects used tooth paste and tooth powder respectively for brushing there teeth regularly.the results of this study also showed that 11.9% of study participants used indigenous means (other means) as an aid to tooth brushing. Conclusion: There is a lack of awareness and education about oral hygiene practices amongst mine workers due to which they do not resort to good oral hygiene practices.

Background: Assessment of risk factors and clinical profile for acute lower respiratory tract infections (ALRIs) with severe and very severe pneumonia in children <5 years age is obligatory. Objective: To study the clinical profile, risk factors, and clinical outcomes associated with ALRIs in children aged 2–60 months. Methodology: In total, 130 children of either gender, diagnosed with ALRIs, admitted in a tertiary care hospital were enrolled. Demographic data and clinical history was collected. Clinical profile data such as respiratory and heart rate, oxygen supplementation, ventilator use, and lab investigation such as erythrocyte sedimentation rate, hemoglobin, total leucocyte count, differential leucocytes count, and blood culture were analyzed and noted. Results: The study findings demonstrated male gender predominance for ALRIs with 1.3:1 male to female ratio. Around 16% of them had pneumonia, 61% had severe pneumonia, and 23% had very severe pneumonia. The birth weight of child, maternal and paternal literacy, socioeconomic status, overcrowding at home, immunization status of children, type of kitchen and fuel used for cooking, malnutrition, anemia, and need for oxygen supplementation were found to be associated with the occurrence of ALRIs (P < 0.05). Most of the presented symptoms were cough (100%), breathlessness (96.92%), and fever (92.31%). Bronchiolitis (63%), bronchopneumonia (27%), and lobar pneumonia (25%) were the major clinical outcomes. Conclusion: The study identified various sociodemographic, environmental, and nutritional risk factors for ALRIs along with the clinical profile, which can be managed by effective peripheral health personnel's training and persuasive community health education.

Background: Folic acid (FA) supplementation is an important intervention to avoid nutritional deficiencies during pregnancy and later on will have an effect on mother and fetus. Inadequate dietary intake will lead to nutritional deficiency which further requires to depend on supplementation. FA is one of the vital nutrients which is mandatory for improving pregnancy outcomes. Previous studies have documented the pregnant women who know about supplementation of FA but not consuming during pregnancy will lead to complications in their neonates. This study aimed to inspect the knowledge and awareness about supplementation of FA in Saudi pregnant women and to compare present study results with other prior studies carried out in the Saudi population. Methods: In this study, we have opted 406 Saudi pregnant women with the age range of 18–65 years of age through questionnaire-based research, was further assessed for FA supplementation usage during the pregnancy. Involved pregnant women have filled questionnaire and signed the consent form. Results: The results of this study showed 38% of women were pregnant during 31–40 years of the age range. Almost 96% of pregnant women have awareness about FA supplementation during pregnancies, and 5.9% of women had histories for not using FA supplementation and had abnormal offspring. The current study questionnaire survey confirms 55.7% of pregnant women have information about FA supplementations. Nearly 89% of women have used FA in their previous pregnancies. Conclusion: Saudi pregnant women has good knowledge and awareness about the usage of FA supplementation during pregnancy. Limited efforts should be implemented national wide in all the hospitals and clinics to improve the awareness about maternal nutrition during pregnancy. Nutritional counselling should be conducted in remote areas to get a perception in Saudi Arabia.

Background and Aims: Interpersonal violence is a socially traumatic and unpleasant phenomenon. These violence-related injuries are sometimes irreparable and can become a permanent problem, Violence in Iran is one of the five most socially harmed and has increased dramatically in recent years, therefore the present research aimed to investigate epidemiological study of injuries caused by violence and conflict in forensic medical records of selected cities of Sistan and Baluchistan province in 2020 considering this subject must be one of our priorities. Methods: This study was a descriptive study performed in forensic medicine centers of two cities in Sistan and Baluchistan province, Iran. The population consisted of existing citations and records, sample size based on similar studies and the recommendation of professors, all available records were considered and census method was used to select the samples. The data gathering tool consisted of two sections: demographic information and violence and conflict. Content validity method and reliability test were used to determine the validity and reliability. Data were analyzed using SPSS24 software. Results: The results showed that the majority of the sample was 20-29 years old, male, married, self-employed and high school graduated, living in the eastern part of the city, with no history of mental illness, domestic violence, child abuse, and spouse abuse. The majority of the study units did not use any drugs. The most violent were beatings and bullying. It included several organs such as limbs, soft tissue damage with bleeding. Conclusion: The results of this study indicate the importance of epidemiological analysis of violence and conflict in the provinces under study and show that appropriate solutions and culture building, as well as increasing awareness of the impact of violence and conflict on individuals and their injuries.

Context: HIV continues to be a major global public health issue. Links between sex work and HIV vulnerability have been recognized since the earliest days of the epidemic. Targeted Interventions (TIs) are aimed at offering prevention and care services to high risk populations within communities. Present research is an endeavor to grasp the different aspects indigenous to NGOs implementing TI projects. Aim: To understand the perspectives of NGOs implementing TIs projects for prevention of HIV/AIDS in Female Sex Workers. Settings and Design: A cross sectional qualitative study. Methods and Materials: Six NGOs registered with District AIDS Control Society, working for implementation of TIs projects for FSWs in a Metropolitan City were studied. Statistical Analysis: Data was analysed with SPSS version 20. Results: Rapid turnover of ORWs is major constraint faced by project managers in recruitment of ORWs. In PEs' recruitment, availability of candidates is major constraint. Stigma related to STI clinic and interference of key stakeholders are the major barriers preventing service utilization by FSWs. Client's dislike for using condom is one of the major barriers in condom utilization by FSWs. Conclusion: The realistic problems, constraints experienced by the programme managers became evident during the study. Integration of programs into the existing system and interventions should be tailor-made to local needs. Here lies the opportunity of 'Operational Research' for the institute like NACO to have the practical insights from TI projects.

Introduction and objectives: Estimated complementary and alternative medicine (CAM) usage in Saudi Arabia is 70%. The Saudi Food and Drug Authority, National Center for Complementary and Alternative Medicine (NCCAM) regulates the license-based practices of various CAM modalities including procedures, herbs, and devices. As an aid to help primary care physicians for understanding CAM practices among general population, this study aimed to explore the prevalence of CAM along with its most common modality, and to understand attitude and practices among patients attending primary care center in Riyadh (Saudi Arabia). Methods: A prospective cross-sectional study was conducted among 403 literate patients aged more than 18 years, coming to the primary care center for regular check-up from 1^st April 2019 to 1^st April 2020 Saudi Arabia. Data was collected using self-administered questionnaire. Results: Around 44.5% participants had practiced one method of alternative medicine in their life. Majority of participants who attended primary care centers belonged to the age group of 18–39 years (71.1%). The most common used method of alternative medicine was honey healing. More than half of the study participants had heard about the CAM from their family and friends. Nearly 45.7% had stated that the CAM cannot be used without consulting a medical professional. Nearly 3/4^th population used it for treating up to 3 ailments. Conclusion: Use of alternative medicine was found to be prevalent in Riyadh. Family and friends were recognized as gatekeepers for propagating information about CAM usage in the society. Primary healthcare physicians need to be trained on prevalent practices of CAM to understand the societal needs.

Background: Cardiovascular diseases (CVD) and its complications are on an increasing trend in the younger age group. In this study, we aimed to identify the different risk factor profile and coronary angiographic characteristics of young adults presenting with coronary artery disease. Methods: We conducted this retrospective observational study at Tata Main Hospital, Jamshedpur, Jharkhand, for 5 years between April 2015 and March 2020. Inclusion criteria being patients admitted for acute coronary syndrome or chronic stable angina, aged ≤40 years, who underwent coronary angiography. Those below 40 years of age who underwent angiography in non-CAD (coronary artery disease) setting were excluded. Results: Among the 117 cases included in this study, 81.1% were males and 18.8% were females. Majority of cases, i.e., 52.2% were in the age group of 36–40 years. Risk factor evaluation showed hypertension as the major risk factor, present in 30.76% of patients, followed by diabetes mellitus in 21.36%, Dyslipidaemia was noted in 7.6%. History of smoking was present in 8.54%, history of smokeless tobacco use was in 7.69%, family history of CAD was noted in 9.4% of patients. Among 117 cases, SVD (single-vessel disease) was most prevalent, seen in 55.5% cases. 21.3% had normal or recanalized coronaries. Among SVD, LAD (Left anterior descending artery) was the most commonly involved vessel (80%). Conclusions: Young patients with CAD are mainly males, and SVD in the form of LAD is more commonly involved. In this vulnerable age group, more emphasis should be given on diagnosis and management of risk factors.

Introduction: Given the role of angiogenesis in tumor growth, the evaluation of tissue vascularization by Doppler ultrasound has been thought to be useful in the prediction of malignant endometrial changes. The aim of this study was to evaluate the efficacy of transvaginal color Doppler ultrasound (TV-CDU) findings in the differentiation between endometrial hyperplasia and endometrial carcinoma and its relation with pathologic findings. Methods: This observational study included 48 women with either endometrial hyperplasia (n = 10) or endometrial carcinoma (n = 38) that had been diagnosed by endometrial biopsy. The intratumoral blood flow characteristics including resistance (RI), pulsatility (PI) and peak systolic velocity (PSV) index were analyzed using TV-CDU before surgery. Endometrial thickness and myometrial invasion also was assessed in all patients using gray-scale ultrasound. Then the relationship between these ultrasound findings and histologic results was evaluated with EC. Results: RI, PI, and PSV indices in endometrial carcinoma were significantly higher than endometrial hyperplasia (P < 0.0001). There was also a significant difference between the mean endometrial thickness between the two groups of endometrial hyperplasia and endometrial carcinoma (P < 0.0001). Intratumoral blood flow index were higher in high grade tumors than in low grade tumors (P < 0.05). Conclusion: TV-CDU may be useful to show a difference the difference in tumor angiogenesis between endometrial hyperplasia and endometrial carcinoma and therefore be used in differentiation of endometrial hyperplasia and carcinoma. Evaluation of intratumoral blood flow using RI, PI, and PSV indices in patients with endometrial carcinoma may be helpful distinguishing between low-grade and high-grade tumors as well as preoperative tumor invasion before surgery.

Introduction: Trauma is the leading cause of mortality and one of the main causes of disability among the active populations in the battlefields. Therefore, trauma education is an important need for asymmetric warfare, which is met through training based on existing needs and possibilities. Methods: In this qualitative study, validated using Delphi technique in Tehran in 2019, the participants were selected from the experts and activities in the field of trauma in asymmetric warfare. Inclusion criteria included willingness to participate in the research, history of treatment activity, and trauma training in asymmetric warfare. This study is based on the two axes: (1) Investigating existing upstream documents and resources on trauma in asymmetric warfare. (2) Conducting structured interviews (based on training elements and trauma experiences in asymmetric warfare) with trauma experts and professors in asymmetric warfare. Results: The results obtained from the above resources, are defined and classified as 10 element training model (Akker). These results and related tables have also been reviewed and validated by trauma experts. Conclusion: The achievements of the present research explained the dimensions and indicators of trauma needs based training in asymmetric warfare that is an effective approach to increase the effectiveness of trauma learning and training in asymmetric warfare and increase the cost effectiveness. It is also an effective approach to organize trauma preparedness for all troops present in asymmetric warfare and can be presented as an operational protocol in terms of methodology and roadmap.

Introduction: A brain tumor occurs when neurons are mutated and thus abnormal cells are formed. Glioma and meningioma are the two most common types, comprising approximately 75% of all brain tumors. The incidence rate of all primary brain tumors was 15.80/100,000 person-years in females and 14.33/100,000 person-years in males. An association of higher risk of brain tumors in adults with cured meat and fruit/vegetable consumption, the primary source of dietary N-nitroso compounds, is seen. Cigarette smoking is a major source of chemical carcinogens. The present study aimed at determining the effects of lifestyle and dietary habits in the development of brain tumor. Methods: The study aimed at the assessment of various dietary factors, lifestyle, and occupational and personal habits in patients diagnosed with brain tumor in a rural tertiary health-care hospital, using a structured questionnaire and statistical analysis. Results: It was observed that – (1) people with stressful, sedentary lifestyle and wrong diet and those addicted to alcohol consumption and the habit of cigarette smoking have higher risk of brain tumors; (2) males are more prone to brain tumors; and (3) among subtypes, majority had glioblastoma and the least had meningioma and opdivoglioblastoma and according to location, majority had cerebellopontine angle tumor and the least had left thalamic glioma and multicentric glioma. Primary care to preoperative brain tumor patients should be given in terms of preventing exposure to radiations, avoiding cigarette smoking, providing healthy diet, and avoiding chronic stress and environmental pollution and postoperative patients should be taken care including avoiding infections by maintaining proper hygiene and providing healthy diet for their speedy recovery. Conclusion: People with stressful life condition, wrong diet, and sedentary lifestyle and those addicted to alcohol, with the habit of cigarette smoking, have higher risk of brain tumors. Males are more prone to brain tumors.

Background: Iron-deficiency anemia in pregnancy is a major public health problem despite the efforts taken by the Ministry of Health and Family Welfare for the past five decades. Adherence to iron and folic acid supplementation (IFAS) is the key factor for the prevention and management of nutrition anemia. Aim: The aim of this study was to assess the adherence to its associated factors and to explore the reasons for the non-adherenc among pregnant women attending a tertiary care center. Materials and Methods: It is an explanatory mixed-methods design (quantitative cross-sectional analytical design and qualitative descriptive design). Statistical Analysis Used: Results presented as proportion with 95% confidence interval (CI). Chi-square test was done to assess the association of the factors to adherence. Qualitative data were transcribed verbatim, translated to English, and analyzed by manual content analysis. Results: A total of 340 pregnant women were included, and the adherence to IFAS among the antenatal mothers was 63.8 (95% CI [58.61–68.6]). The factors associated with adherence to IFAS (prevalence ratio with 95% CI) were primigravida status [1.22 [1.02–1.45]), nonanemic in the first trimester (1.27 [1.09–1.49]), and absence of side effects (3.16 [1.95–5.12]). Conceptual framework was constructed using the emerging themes: (i) knowledge-related factors, (ii) behavior-related factors, and (iii) facilitating factors. Conclusion: About three-fourth of the participants were adherent to IFAS. Compliance is directly influenced by the gravida status, anemic status, and absence of side effects. Based on qualitative results, measures to improve palatability and the quality of IFAS are recommended.

Context: Progress of any nation depends on the health status of the population. A nation's health directly and indirectly depends on the quality of health-care facilities and how healthy the health care workforce is in that country. To achieve the health for all goal and to provide for most of the health services like maternal health services, child health services, nutrition, vaccination, and family planning services, the Indian health system have multipurpose health workers (female and male) and Accredited Social Health Activist to provide these services at the grass-root level. There is a paucity of literature revealing the health problems or the health status of grassroot level primary health care worker in India or abroad. Methods and Material: All the grass-root level health workers, i.e., MPHWF and ASHAs in the BMC area were included in this cross-sectional study. Data was collected using a semi-structured interview schedule, followed by general examination and anthropometry using standard procedures. Results: Half of the study participants 111 (50.2%) were having some or other kind of health issues during the data collection time; among them, 107 (48.4%) had a chronic disease condition. 10% of them had diabetes mellitus. More than half of the study participants 141 (63.8%) were found to be obese and hypertension was found in 27 (12.2%) study participants. 21 (9.5%) study participants were under high depression. One-fourth of the health workers among those who could conceive had not gone for antenatal check-ups and more than one-third (33.5%) never consumed iron and folic acid (IFA) tablets during their first pregnancy. 19.1% have children with incomplete immunization as per age. One-fifth of the participants know about the balanced diet and half of them could not ensure that their family eat a balanced diet and in the majority, the diet was calorie deficient as per the daily requirement. Conclusions: There is an urgent need to formulate a policy to improve the health of the primary care grass-root level health-care workers and regular on-the-job training on nutrition needs to be given to them.

Background: Data on otorhinolaryngology and head and neck diseases in patient with chronic renal disease are rare in developing African countries. This study was aimed to determine the epidemiology and management of otorhinolaryngology and head and neck diseases among chronic renal disease patient seen in our tertiary health-care facility. Materials and Methods: This was a prospective, hospital-based study that was conducted in the ear, nose, and throat department in a Nigerian University Teaching Hospital. Informed consent was obtained, and pretested interviewers-assisted questionnaires were administered to each patient. Otoscopy, indirect laryngoscopy, and rhinoscopy were carried out. Renal functions were assessed by routine urine analysis and biochemical tests. Audiological tests were carried out for hearing assessment. Data collected were collated and analyzed using the SPSS software version 20.0. Results: The prevalence of chronic renal disease in otorhinolaryngology practice was 1.1%. There were 67.9% male with a male-to-female ratio of 2.1:1. The duration of illness was more than 1 year in 39.6% of our patients. The most common presentation was 58.5% tinnitus, 34.0% neck pain, 28.3% nasal blockage, 28.3% sore throat, 26.4% rhinorrhea/epistaxis, 18.9%% pharyngeal wall nodularity, and 15.1% enlarged neck lymph node. The most common affected organ was the ear in 90.6%. Major diagnosis was sensorineural hearing loss, rhinosinusitis, pharyngitis, and cervical adenitis in 58.5%, 30.2%, 20.8%, and 7.5%, respectively. Hearing impairment occurred in 69.8% of the patients, out of which 43.4% were found to be mild hearing loss. Only 19 (35.8%) had dialysis, while 34 (64.2%) of them had conservatively treated. Conclusion: The prevalence of chronic renal disease in otorhinolaryngological practice was 1.1%, otological presentation was the most common in 90.6% of patients and 64.2% did well on conservative treatment. Avoidable otorhinolaryngologic complications among patients with chronic renal disease were noted. Periodic otorhinolaryngology referral for review and prompt management of this complication is advised.

Background and Aim: Road traffic injuries (RTIs) are a leading cause of mortality and morbidity globally. This study aimed to assess the incidence and pattern of RTIs in the tribal population of Jharkhand. Methods and Materials: This prospective observational study was conducted for a period of 1 year (June 2018 to May 2019) at the Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A pretested semi-structured questionnaire was administered. A total of 1713 road traffic accident (RTA) victims belonging to tribal population were interviewed during the study period. Data were entered in a Microsoft Excel sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 16. Results: There were 1258 (73.4%) males and 455 (26.6%) females. The majority (31.4%) of patients belonged to the age group of 21–30 years, followed by 19.2% in the age group of 31–40 years. The majority (52.13%) of RTAs involved a two-wheeler vehicle. Head injury was the most common type of injury (40.86%), followed by lower limb injury (26.68%). Common upper limb injuries were in the humerus and radius and ulna region. The majority of lower limb injuries involved tibia and femur. Common thoracic-abdomen injuries were soft tissue injury and lung contusion. Drunk driving (alcohol influence) was seen in 34.68% of cases of RTI. Conclusions: RTA is a major public health problem which needs to accelerate the efforts of road safety preventive measures. Road safety education should be promoted.

Background: Domestic violence was identified as a major contributor to the global burden of ill health in terms of female morbidity leading to psychological trauma and depression, injuries, sexually transmitted diseases, suicide, and murder. Aims: The study was conducted to find out the prevalence of different types of lifetime domestic violence against women, factors associated with it, and care-seeking behavior. Settings and Design: An observational cross-sectional study conducted at a slum of Burdwan district of West Bengal, India. Methods and Material: Study was done among 320 ever-married women of 15–49 years of age using a predesigned pretested proforma from March 2019 to December 2019 by face-to-face interview. Statistical Analysis Used: Data were compiled and analyzed by EpiInfo 6 and SPSS 20 version. Results and Conclusions: The overall prevalence of any form of violence during the lifetime among the study population was 35.63%. Verbal/psychological violence was the most common form of domestic violence (91.23%) followed by physical (82.46%) and sexual violence (64.91%). Slapping and/or beating, kicking, and object throwing were the major forms of physical violence; humiliation (88.46%) was the commonest form of psychological violence and most common form of sexual violence was forced sexual intercourse (51.35%). About 20% of the study population faced violence every day. Older age, lower age at marriage, longer duration of marriage, lower education of husband and wife, lower family income, unemployment of the husband, and alcohol consumption of husband were associated with the occurrence of domestic violence. We have found that the prevalence of domestic violence in this group of population is high. The alarming issue is that approximately one-third of women (32.46%) who faced violence in their lifetime had never sought any help. The findings indicate to develop appropriate and culturally relevant public health interventions to increase awareness.

Aims: Our primary objective is to investigate the baseline status of patients' awareness, knowledge, and attitudes to patient safety. The secondary objective of this research is to determine factors that influence patients' knowledge regarding patient safety. Methods: We performed a cross-sectional study with a targeted sample of 410 patients at King Khalid University Hospital, Riyadh, Saudi Arabia. Self-administered paper-based questionnaires were distributed to outpatient clinics on February 2, 2019 until March 20, 2019. Finally, the data were analyzed by (SPSS). Results: There were 450 questioners distributed, and 410 were completed and returned (91% response rate). Most of the patients were below the age of 50 (77.9%), 54.8%, of them were females, and almost half received higher education (54.1%). Among the respondents who are taking drugs, 21.6% do not have any knowledge about the side effects of their drugs, and 47.8% of patients said that their physicians do not tell them the side effects of their prescribed drugs. Whereas 20.7% of patients claimed that they experienced a medical error, 66.3% did not report the errors, and the reason was not knowing how to report or to whom in 54.4% of the patients. In regards of infection control, 47% of the participants misunderstood means to prevent the spread of the infections and how it could be transmitted. Conclusion: Patients' knowledge about patient safety need to be improved. We suggest educating the patients by providing training programs for patients, and we recommend further studies.

Introduction: The present study was conducted to assess the association of tobacco and alcohol consumption with cardiovascular risk factors among elderly population living at high altitude regions of India. Materials and Methods: A cross-sectional study was conducted among 1003 elderly people living in district Nainital, Uttarakhand state, India. Thirty subjects were identified from 30 villages using population proportionate to size sampling methodology. The data on the consumption of tobacco and alcohol, mini nutritional assessment, Barthel activities of daily living scale, height, weight, blood pressure, fasting blood sugar, triglycerides, and total cholesterol was collected. Results: We found that smoking tobacco was associated with high cholesterol, lower body mass index, and low nutritional status (all, P < 0.05). Elderly subjects who consumed alcohol had 1.56 times higher risk of having high fasting blood glucose. Conclusions: Consumption of tobacco and alcohol increased the risk of cardiovascular diseases among elderly subjects. There is a need to improve these modifiable health behaviors through targeted educational and rehabilitation programs.

Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis and hepatocellular carcinoma. Thus, this study was undertaken for detection and to observe genotypic distribution of the virus in this geographical region. Aims and Objectives: The aim of the study was to quantitatively detect HCV RNA in Hepatitis C patients and to determine the distribution pattern of its genotypes by real time polymerase chain reaction. Materials and Methods: This is a retrospective study conducted in a tertiary care hospital. In seropositive Hepatitis C patients, quantification of HCV-RNA was done by real time PCR and in HCV-RNA positive samples, genotyping for HCV was conducted. Result: A total of 300 patients were recruited in the study, of which 165 were anti HCV positive and among them, 127 were HCV-RNA positive. These positive samples were further subjected to genotype determination using real time PCR. 98 samples were positive for genotype, where genotype 3 was seen in 90 patients, genotype 1, in 3 patients and genotype 4, in 5 patients. Conclusion: Knowledge of genotype is crucial for management of HCV infection and prediction of prognosis. Patients infected with HCV genotype 1 and 4 will have to receive IFN and ribavirin for a period of 48 weeks and show a poor sustained viral response. On the contrary, patients infected with HCV genotype 2 and 3 are reported to have better response to therapy.

Background: Caffeine use and abuse is a concern among treatment seekers for psychological problems. This aspect has not been documented an Indian context as well as its relevance in primary care setting. The aim of the present study was to explore and compare the caffeine intake and prevalence in Indian psychiatric patients and healthy subjects. Materials and Methods: Caffeine analysis in urine samples was carried out using a gold technique, gas chromatograph and mass selective detectors. This analytical technique is highly sensitive for identification of unambiguous compound. Two hundred and forty-three subjects having psychiatric disorders, along with forty-two healthy subjects were included in the study. They were assessed by using structured interview for caffeine use and screened for substance dependence as well. Results: One hundred twenty-eight subjects had history of substance use along with other comorbid psychiatric problems The mean of caffeine values was 1459 ± 1140 ng/mL, Whereas 42 subjects in control group (male 26, female 16) in the age group of 21–60 years had the mean caffeine levels of 1023 ± 788.8 ng/mL. The Caffeine use was significantly higher (P ≥ 0.84) in the subjects with psychiatric problems in comparison to the healthy subjects. Conclusions: It implies the need to enable and sensitize the primary care physicians in screening and educating treatment seekers with psychiatric morbidities for the management of caffeine use.

Background and Objectives: Pleuroscopy is an appropriate technique for visualization and biopsy of the pleural lesions, performed by two different techniques. In this study, we aimed to investigate the diagnostic accuracy of semi-rigid and rigid pleuroscopy in patients with lymphocyte dominant exudative pleural effusion. Materials and Methods: In this study, patients with lymphocyte dominant pleural effusion with negative results for tuberculosis who referred to Imam Khomeini Hospital, Ahvaz, Iran; from 2018 to 2019 were selected by census method and randomized to undergo semi-rigid or rigid pleuroscopy (30 in each group). Patients' demographic, such as age and gender, were recorded and the pathologic results reported by the two pleuroscopy methods were compared and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported for each method. All statistical analyses were performed using SPSS v. 21. Results: Thirty patients were included in each group. The frequency of tuberculosis, malignancy, and other causes of pleural effusion had no difference between the two methods (P > 0.05). Semirigid pleuroscopy had a sensitivity of 81.5%, specificity of 66.6%, PPV of 75.6%, and NPV of 74%, while the relevant values in rigid pleuroscopy were 87.2%, 68.4%, 87.2%, and 68.4%, respectively. Conclusion: These results, consistent with previous studies, indicated that both semi-rigid and semi-flexible pleuroscopy methods are accurate for diagnosis of lymphocyte dominant pleural effusion when performed by skilled specialists and other considerations, such as availability and costs, can be used for selection of each method.

Introduction: The Quality of life is a broad-ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs, and their relationship to salient features of their environment.The ongoing COVID-19 pandemic has resulted in many quarantine and isolation measures and lockdown of the nation for the foreseeable future. Although these initiatives are necessary to prevent the spread of coronavirus they may be causing adverse mental health effects. Medical students are backbone and future of the health system and the general public always looks up to them as a role model of society. With this background, this study aims to assess the quality of life among medical students during the lockdown period amid the COVID-19 pandemic. Material and Methods: A self-administered, pretested, questionnaire based on World Health Organization Quality of Life: Brief Version (WHOQOL-BREF) standard quality of life was used. For internal reliability and structural validity, Cronbach's alpha coefficient and confirmatory factor analysis (CFA) were calculated, respectively. t-test, one way ANOVA, and Pearson Chi-square test were used. Results: The mean scores of domains of the present study were highest for the environmental domain (72.10 ± 13.0) followed by physical (67.23 ± 13.74), social (57.13 ± 20.1), and lowest for the psychological domain (52.10 ± 17.45). The level of internal consistency was found to be 0.883, which is considered as sufficiently reliable. One-third of the medical students were spending >6 h on-screen, and merely 15.6% were doing physical activity >1 h. Conclusion: It was found that during this time of crisis medical students were weaker in the psychological domain of Quality of Life among all the four domains. Physical activity and screen time was an important factor to the QOL of students, and it is likely that students would benefit from increased physical activity and minimizing screen time.

Background and Aims: Vast first MBBS course has been posing great problems for a fresh entrant in medical college. A student is merely 18-19 years when he gains entry to a medical college in India. Multiple problems pile up for him at the very onset of his academic year in Department of Anatomy. The present study aimed to identify various stress factors and further assess the effect of counselling/mentorship programme on solving such issues. Materials and Methods: A pre-validated, predesigned questionnaire was administered to hundred first year medical students. They were individually counselled with various faculty persons. Based on the questionnaire given, the results were analysed. Results: 45% of the students were sure that their language problem was solved after the session. 48% students accepted that they did have some adjustment problems, which were solved then. 30% expressed that some of their personal problems were also solved. 54% were now able to manage their time judiciously. 64% opined that counselling helped to plan their studies well. 52% students admitted that counselling improved their performance in theory. 46% expressed that counselling also helped to improve their performance in practicals. 65% told us that their skills both in theory and practical had improved after the session. 39% consented that counselling relieved them of anxiety. 67% recognised that their knowledge in the subject of anatomy had increased. 75% were of the view that similar sessions should be conducted more frequently. 40% preferred to express their views in their regional language. 85% students advised us to carry forward these sessions to the next batches. Conclusion: Our study highlights the need for counselling to solve multifaceted adjustment problems.

Aim: To assess the prevalence of tobacco consumption among the ESI-insured patients. The study also assessed the knowledge, practice, and attitude among industrial workers as well as nicotine dependence with different forms of tobacco products consumed.Materials and Methods: A cross-sectional study was conducted among industrial workers from various industries (small and large scale) insured under the employee state insurance corporation scheme. The study was conducted for 3 months included 500 workers of which 470 were males and 30 were females. A predesigned, pretested, and structured interviewed administered questionnaire was used to collect the data on sociodemographic factors, reasons for tobacco consumed, and level of dependencies among industrial workers. Questionnaire also included questions related to awareness regarding health hazards and lesion present in the oral cavity as a result of tobacco consumption. Fegarstrom scale was used to access nicotine dependency level. A Hindi translated version of Fegarstrom test for Nicotine dependence in the questionnaire was used which included six standard questions for both smokeless and smoked form. Result: Majority of both males and females consumed tobacco in smokeless (58.8%) form. Out of which 92.85% in males and 7.15% in females followed by the smoke (28.8%) form. 93.04% in males and (7%) in females (79.86%) of the tobacco users in our study were aware that consuming tobacco causes health related problems. 38.6% of the users have moderate dependency in both smoke and smokeless form. Seventy six percent of the consumers feel that they didn't have any changes in the mouth by consuming tobacco and thus never thought of quitting tobacco. Conclusion: Tobacco consumption among the ESI-insured patients is high. Execution of tobacco cessation programs are required to curb this trend.

Context: Associations between age at menarche and risk of type 2 diabetes and cardiovascular disease are well established in adults. But little is known about these risks in adolescents. Aim: To examine the association between age at menarche and anthropometric indicators, and also examine nutrition among the rural adolescent girls of KONKAN region. Setting and Design: We investigated 1,071 school going adolescent girls who underwent holistic education and various clinical investigations as a part of community program. Age at menarche was recorded and anthropometric measurements were performed. Macronutrient intake was estimated by 24 h recall. Statistical Analysis Used: We used trend statistics and logistic regression to examine the association. Results: A total of 813 girls had attained menarche. Mean age at menarche was 13.0 years. When compared with premenarchal girls anthropometric parameters were significantly higher in postmenarchal girls (P < 0.05 for all) and the prevalence of stunting and thinness was lower (P < 0.001 for both). There was a decreasing trend for weight (P < 0.001), BMI (P < 0.001), and waist circumference (P < 0.05) with increasing age of onset of menarche, and increasing trend for stunting and thinness (P < 0.001 for both). More than 65% of the girls were eating below the recommended daily allowance of calories, protein, and fat. Adolescents with late onset of menarche had increased likelihood of stunting (P < 0.01) and thinness (P < 0.001). Conclusions: Adolescent girls in the KONKAN region with late menarche are thin and stunted. There is an urgent need to improve nutritional status of adolescent girls from KONKAN as malnutrition can affect the onset of menarche.

Context: Osteoarthritis (OA) is a degenerative joint disease, having multifactorial etiology affecting mainly the articular cartilage. Knee OA with its physical symptoms affects daily activities thereby deteriorating the quality of life. Most of the patients delay their visit to health sectors for seeking medical care in musculoskeletal conditions. Aims: To find the prevalence and determinants of osteoarthritis among the adult population in the rural area and to assess their health-seeking behavior. Settings and Design: A community-based, cross-sectional study. Methods and Material: A community-based, cross-sectional study was conducted among 232 adults living in a rural area in village Kirpind of R.S. Pura block, Jammu. Knee OA was diagnosed using the clinical criteria laid down by the American College of Rheumatology (ACR). Statistical Analysis Used: Descriptive statistics, OR with 95% CI, and Chi-square test were used for the purpose of analysis. Results: The overall prevalence of knee osteoarthritis was 35.7% (females: 44.5% Males: 23.1%). Age more than 60 years, female gender, history of trauma, BMI >30 were found to be significantly associated with higher odds of OA knee (P < 0.05). Descriptive statistics, OR with 95% CI and Chi-square test were used for the purpose of analysis. Conclusions: Strategies focusing on creating awareness among the rural elderly regarding the role of a balanced diet, exercise, and weight management along sensitization of primary health care providers concerning benefits of early screening, diagnosis, and referral should be undertaken to minimize this burden.

Context: In India, despite implementation of the strategies under National Tobacco Control Programme [NTCP], women are easily exposed to tobacco consumption that is smokeless (SLT) and smoking tobacco along with second-hand smoke [SHS], making them highly susceptible to tobacco hazards. Aims: This study aimed to assess the exposure of women to tobacco use and SHS at home and to elicit predictors of tobacco exposure in a rural community of West Bengal. Methodology: A community based, cross-sectional study was conducted among 176 women aged 18 years and above. Data was collected by cluster sampling technique (16*11) using predesigned pretested structured schedule. Tobacco exposure was measured using a composite score including tobacco consumption and SHS at home. Results: Tobacco use (SLT and smoking tobacco) was significantly associated with educational attainment [AOR = 2.12], occupation [AOR = 2.13] and knowledge [AOR = 1.22]. There was significant association between SHS at home with knowledge [AOR = 1.16] and attitude of the study subjects. [AOR = 1.93]. Overall tobacco exposure (SLT, smoking tobacco, and SHS), was found to be 79.5%. Significant association was found between high tobacco exposure with age group [AOR = 3.82], educational attainment [AOR = 1.74] and knowledge regarding hazards of tobacco [AOR = 1.31]. Conclusion: Prevalence of SLT use as well as exposure of women to SHS at home is unexpectedly high in the study population. Women specific information and education campaigns focusing on tobacco hazards (both tobacco use and SHS) through existing primary health care infrastructure should be strategized under NTCP.

Background: Medical records are important documents that should be stored for at least 3 years after the commencement of the treatment of an adult patient in India. In a health care facility, patients' data is saved in an online or offline retrieval system. However, in the case of the primary care physician, the data is not commonly kept in an easily retrievable system. Aim: To test the feasibility of using a set of free web-based services in digitization, preservation, and retrieval of prescription on a smartphone by primary care physicians. Methods: This study was conducted with 12 primary care physicians. They were provided hands-on guides on creating an online form for uploading a prescription and using an application for retrieval of the prescription on a smartphone. Their feedback on the training material was collected by a telephonic survey, which had a 10-point Likert-type response option. Then, an in-depth interview was conducted to ascertain their perception on the tutorial and the process of digitization and retrieval system. Results: All of the participants were able to create an online form on their smartphone. They uploaded their prescription and associated data and were able to retrieve it. The physicians opined positively on the “cost of the system,” “portability” on a smartphone and ease of the “tutorial”. They opined negatively on the “limited storage,” chances of “loss of data,” and “time constraints” for entry of the patients' data. Conclusion: Free web-based and smartphone applications can be used by a primary care physician for personal storage and retrieval of prescriptions. The simple tutorial presented in this article would help many primary care physicians in resource-limited settings.

Background: Visually impaired patients are at a higher risk of developing periodontal disease because of greater difficulty in attaining good oral hygiene. This study aims to assess and compare the oral hygiene status of visually impaired students before and after oral health education interventions using special customized methods. Methods: The present study was a randomized control trial of 180 visually impaired students divided into three groups. Each group includes 60 students selected randomly from blind school. Oral health education was given using Braille in Group 1, Audio Tactile performance (ATP) technique in Group 2, and a combination of Braille and ATP technique in Group 3. Plaque index (PI) scores and gingival index (GI) scores were calculated and evaluated at baseline and after 3 months. Intergroup comparison and intragroup comparison of PI and GI at baseline and 3 months was by using one way ANOVA and Paired t test, respectively. Results: There was a highly significant difference seen for the intergroup comparison of post PI (P < 0.01) and post GI (P < 0.01) with least mean in Group 3. There was a statistically highly significant difference seen for the intra group comparison of pre and post PI and GI (P < 0.01) with lesser means in post as compared to pre in all three groups. Conclusions: Visually impaired children could maintain an acceptable level of oral hygiene when taught using combination of Braille and ATP technique.

Introduction: The occupational environment influences oral health to a greater extent. The unique environment in the steel factory might influence oral health and oral health-related quality of life of its workers, especially those who are exposed to its environment. Aim and Objectives: To determine oral health status and Oral Health-Related Quality of Life among production line and administration workers of a steel factory and assess their relationship with occupation exposure. Method: A cross-sectional study was conducted among 533 production line and 517 administration workers of the steel factory aged 31–60 years using simple random sampling. The collected data includes information on demographic factors, adverse habits of the study subjects, and oral health-related quality of life using Oral Health Impact Profile-14 (OHIP-14). The oral health status was assessed using the WHO oral health assessment form 2013. Statistical Analysis: SPSS Version 20 was used for statistical analysis. A student t-test was done to compare means. Results: The prevalence of dental caries is 62.5% in the production line and 74.9% in administration workers, and the prevalence of periodontal status is 91.6% and 74.8%, respectively. The mean of OHIP-14 was 2.13 ± 0.73 in the production line and 2.33 ± 0.77 in administration workers. All domains of OHIP-14 were found to have high statistical significance with dental caries, periodontal pocket depth, loss of attachment, oral mucosal lesions, dental erosion, and dental trauma in both study groups (P < 0.001). Conclusion: OHIP-14 scores were related significantly with oral health status indicators in both study groups. The prevalence of the periodontal disease, oral mucosal lesions, and OHIP-14 scores was found to be significantly higher among production line workers.

Introduction: Acute Flaccid Paralysis (AFP) is a group of diverse clinical conditions with Guillain–Barré syndrome (GBS) as one of the most common cause. The aim of this study was to study the clinical features and predictors for the requirement of ventilation in children with GBS. Materials and Methods: This is a prospective observational study done at a tertiary care hospital where all consecutive children less than 15 years who presented with AFP were enrolled. Demographic characteristics, symptomatology, and physical findings of those patients who were diagnosed with GBS were recorded using a pre-defined questionnaire. Univariate analysis was done to identify clinical variables associated with a higher requirement of ventilation. Results: Of a total of 53 children with AFP enrolled in the study, a total of 30 patients were diagnosed with GBS. A total of 12 (40%) patients required ventilation, while five of these patients eventually died. The following variants of GBS were identified: AIDP (13/30), AMAN (12/30), and ASMAN (2/30). Lower limbs were affected in 97% of the patients, whereas upper limbs were affected in 83% of the patients. Deep tendon reflexes of the upper limb and lower limb were preserved in 56% and 7% of the patients, respectively. Presence of antecedent URTI was associated with a lower requirement of ventilation. Presence of bulbar palsy, lower upper limb power on presentation, and absence of deep tendon reflex in upper limbs were associated with a higher requirement of ventilation. Conclusion: GBS is an important cause of AFP in India with no significant difference between the variants in terms of frequency and prognosis. Simple physical findings can be used by primary care physicians to predict the requirement of higher levels of care.

Background: Outbreaks of scabies have been documented in 2018 among school children in Western and Central regions of Saudi Arabia. There have been concerns about the awareness of healthcare providers. Objective: The objective of the current study was to evaluate the knowledge of primary health care physicians about scabies diagnosis and management, as well as the factors influencing such knowledge. Methods: An observational cross-sectional study was conducted between September and October 2019. The target population was physicians working in primary care centers in Riyadh. Filling either hard or soft copies of the study questionnaire was used for data collection. The knowledge score was calculated from the answers for 16 knowledge questions. Results: A total of 216 physicians were included in the final analysis, mainly general practitioners (56.5%) and registrars (31.5%). The overall knowledge score was 67.5%± 13.9%. The highest level of knowledge was associated with age susceptibility (80.6%), followed by clinical presentation and diagnosis (78.1%), mode of transmission (75.8%), pathogen cause & incubation period (66.9%), and finally management (61.7%). In multivariate logistic regression models, a shorter time since last time information about scabies was reviewed was significantly associated with better knowledge (defined as score > median), with odds ratio = 5.84 (95% confidence interval = 2.43–14.01). Similarly, older age and higher qualification were significantly associated with better knowledge.Discussion: As expected, the knowledge about scabies among primary care physicians was generally inadequate. The current findings highlight the need for educational and training programs lead by health care authorities, targeting these physicians.

Background: Gestational diabetes mellitus (GDM) causes several maternal and neonatal complications. Aims: This exploratory study was conducted to estimate the prevalence, determine the risk factors and morbidities among pregnant women. Methods: In this prospective study, 1557 pregnant women attending the Gyn. & Obs. clinic of a hospital in an urban area of Bhubaneswar were enrolled. Various socio-demographic factors and clinical profiles were assessed. We used a Glucometer for the diagnosis of GDM. Results: More younger pregnant women residing in slums, sedentary and overweight were having diabetes. A large percentage of pregnant women living in rural areas and slums visit the government hospitals as they are benefitted by the State govt.'s scheme, Mamata. Pregnant women residing in the urban areas prefer to go for ante-natal check-ups in private Nursing homes/Clinics owing to the crowd and prolonged waiting hours. In this study, body mass index (BMI) and family history of the pregnant women appeared to be the significant risk factors for the gestational diabetes. Out of 1557 pregnant women, 154 were having diabetes, the prevalence being 9.89%. This is low when compared to the studies reported from other regions of the country. Conclusions: Gluco-One is suitable for screening gestational diabetes using the optimal threshold capillary glucose level of 140 mg/dl. As the pregnant women find it difficult to come the next day just to collect the results, this facilitated in getting the test results promptly and appropriate consultation by Doctor the same day. Glucometer can be used for accurate screening of gestational diabetes mellitus. Pregnant women with screening values not normal were identified on the spot and followed up at regular intervals. Screening for diabetes among pregnant women would result in early case detection indirectly resulting in better outcomes of treatment and prevention of complications.

Background: Phobia is an extreme form of anxiety or fear which is triggered by a given situation or object or even danger associated with a situation or object for more than 6 months. There are three main forms of phobia: social phobia (social anxiety disorder), specific phobia, or agoraphobia. Agoraphobia is a form of anxiety disorder where one fears and avoids situations or places that might cause them to panic. The main purpose of this study is to investigate phobia among residents in broad training programs in Abha city and compare phobia between residents in broad training programs and general practitioners in Abha city. Methods: It is a cross-sectional study. The study was conducted in Abha city of Saudi Arabia from December 2019 to March 2020. It included a representative sample of medical doctors under broad training programs and general practitioners (none trained) in all the health-care centers. A link for the survey questionnaires was created and shared with the respondents. The questionnaire included sociodemographics of the participants, the Kutcher Generalized Social Anxiety Disorder Scale, and the Psychometric Properties and Clinical Utility of the Specific Phobia Questionnaire in an Anxiety Disorders Sample for specific phobia. Results: The study included 300 physicians. Majority of them (81%) were in the age group between 25 and 30 years. Males represent 54% of them. There was no statistically significant difference between resident physicians and general practitioners regarding the avoidance of different social situations. Conclusion: Overall, the residents in board training programs in Abha city expressed lower levels of discomfort, anxiety, distress, avoidance, fear, and life interference of some social and specific situations compared to general practitioners.

Introduction: Measles, mumps, rubella, and varicella (MMRV) represent risk to HCWs. Checking on antibodies against MMRV is an important part of infection control among nursing staff for their own health, their colleagues and for the health of patients. Screening for immunity against MMRV is an initial step before vaccination of nursing staff. This study is to describe immunity status against MMRV by screening nursing staff in a tertiary care hospital in Riyadh. Methods: A cross sectional survey among nursing staff was conducted from July to August 2019 at Prince Sultan Military Medical City. A convenience sampling was used to screen 1534 nursing staff working at several high-risk departments. Record for their immune status and antibody titer for MMRV were reviewed using a data collection form. Results: Screening for immunity among nursing staff found that; 79.3% were immune against measles; 75.5% to be immune against mumps; 95.8% were immune against rubella; and 67% were immune against varicella. The highest proportion of immune nursing staff against measles (96.3%) and varicella (93.5%) was found in Intensive care department while the highest proportion of immune staff against mumps (89.4%) was found in Long Stay department, and against rubella (97.5%) in Hemodialysis department. On the other hand, It was found that Hemodialysis Department had the Highest proportion of non-immune staff against measles (35.6%), mumps (39%), and varicella (56.3%), while Emergency Department had the lowest proportion of immune staff (6%) against rubella. Conclusion: Despite that immunity among nurses screened was good on some departments; however, such results need improvement in these critical areas. These finding emphasize the importance of the currently mandatory screening for MMRV before employment. We suggest conducting comprehensive programs to increase awareness and vaccination coverage in areas with low rates of immunity.

Background: As per the World Health Organization (WHO) Global Report 2017, among the 9.6 million cases of tuberculosis (TB) that occur annually in the world, 2.8 million are found in India. TB is the biggest killer in the 15 to 49 years age group—an age range during which people are the most productive. It is a disease that creates and thrives in poverty. Several studies have shown that TB has a negative impact on the socioeconomic status of patients. Limited data are available on the long-term impact of this disease on the families of patients. Aims: This study aimed to analyze the impact of TB on the socioeconomic condition and educational status of the family members of patients and the nutritional status of children younger than 12 years in the family of the patient. Methods: This was a retrospective cohort study conducted in Vellore, Tamil Nadu, India in the month of March 2017. The exposed group consisted of families with a member who completed treatment for TB in the past 5 years obtained from two tuberculosis units under the Revised National Tuberculosis Control Programme. The unexposed group was composed of families in the same neighborhood as the exposed families, matched for the age of one child. Results: Upon analysis, the multifaceted impact of TB led to an increased risk of “financial crises,” delayed and disrupted education among children, and wasting among children younger than 5 years (as measured by weight-for-height Z scores). Older children and adults were also at a higher risk of being undernourished as assessed by BMI-for-age Z scores and BMI, respectively. Reduced social participation as a marker of stigma was found to be higher but not statistically significant. Conclusions: This study found that despite the obvious multifaceted impact of TB on the family, the screening and protective measures often fail to encompass the scope of the disease. These are of great importance to the primary physician, often the only contact of the medical fraternity with the family members of patients.

Background: Nowadays, the prevalence of coronary heart disease has challenged the lives of families around the world. Anxiety is one of the most important consequences of coronavirus. The nurse-led telephone follow-ups (tele-nursing) are a way to train nurses to further improve nursing services and increase the patients' well-being. The aim of this study was to determine the effect of nurse-led telephone follow-ups (tele-nursing) on the level of anxiety of people with coronavirus who spend their quarantine and treatment at home. Methods: In this semi-experimental study, the number of sample was 100 newly diagnosed patients with Corona, who were tested positive using the CT scan of the lungs and were selected by continuous sampling. In this study, Spielberger's state-trait anxiety inventory was used to collect data before and after the intervention. Samples were randomly divided into control and intervention groups (50 subjects in each group) after receiving initial training in the form of lectures on the corona disease, and the tele-nursing program was implemented on the intervention group every other day for 21 consecutive days. Finally, after the end of the 21^st day and the completion of the tele-nursing intervention, the questionnaire was again completed by the control and intervention groups and the results of both groups were compared. Results: The results indicated that the level of anxiety in the two groups after the training program and tele-nursing were significantly different (p < 0.001) and the mean score of the anxiety level after the training program and tele-nursing was significantly reduced (p < 0.001). Conclusion: This study showed that tele-nursing has had a significant effect on reducing the anxiety level of people with Cavid-19 virus. As the telephone technology is available in most clients' homes and its use is easy and accessible, it is recommend including this technology in the field of nursing care and training especially in relation to people with coronavirus.

Context: Health care workers (HCWs) are at high risk of COVID-19 infection but data on the risk factors for exposure and infection rate among Indian HCWs are limited. Aims: Our study aims to identify the risk factors and behavior of HCWs which make them high risk for COVID-19 infection and the infection rate among them. Settings and Design: This is a retrospective study conducted at All India Institute of Medical Sciences, New Delhi. Methods and Material: Fifty HCWs quarantined at our institute in April and May 2020 following exposure to confirmed or suspected COVID-19 cases, or due to development of Influenza-Like Illness (ILI) were included. Data was collected from medical records in a predesigned proforma and analyzed. Results: Thirty-eight (76%) of the 50 quarantined HCWs had high-risk exposure and there was a significant breach in personal protective measures. N-95 masks were worn by 59.6%, gloves by 61.7%, and goggles or face shields by 2%. Exposures were more common in non-COVID areas of the hospital. Hydroxychloroquine pre-exposure prophylaxis was taken by 7 (14%). 3 (6%) were confirmed to be COVID-19 positive during the quarantine period. Conclusions: Our study has shown leniency among HCWs in adhering to infection control and personal protective measures resulting in an increased quarantine and infection rate and loss of manpower. The safety of our HCWs must be given paramount importance during this pandemic and should be ensured by educating them about infection control, and persistently reinforcing and strictly adhering to standard precautions.

Context: Comprehensive management of mild COVID infection calls for better understanding of symptomatology in these group of patients as well as early identification and close monitoring of patients at risk, data on which is limited. Aim: To study association between inflammatory markers and clinical presentation with progression of disease and the duration of resolution of symptoms. Settings and Design: This is a retrospective study that has been conducted at a designated COVID -19 medical ward at AIIMS, New Delhi Methods and Material: Fifty healthcare workers and their dependents who were admitted with asymptomatic and mild COVID-19 infection were included. Their records were retrospectively reviewed, entered into a predesigned proforma and analyzed. Results: A total of 50 participants were included in the study of which 70% were healthcare workers. The patients were admitted with mild COVID illness out of which 22 (44%) were males. Most common symptom at presentation was fever (72%). Among patients who had mild disease versus those who progressed to moderate illness (n = 3), the patients with moderate illness were older [mean (SD): 57.33 (10.21) vs. 36.13 (14.05); P = 0.014] and had a longer duration of hospital stay [17 (1.41) days vs. 11.20 (3.86) days; P = 0.04]. Inflammatory markers, C-Reactive Protein (CRP) [2.46 vs. 0.20 (P = 0.024)], and Ferritin [306.15 vs. 72.53 (P = 0.023)] were higher in patients with moderate illness. There is also a significant correlation between the number of days taken for symptoms to resolve with Serum Ferritin (P = 0.007), CRP (P = 0.0256), and neutrophil lymphocyte ratio (NLR) (P = 0.044). Conclusions: Acute phase reactants/Inflammatory markers serve as good indicators of time taken to resolution of symptoms in acute COVID infection. NLR is a simple and inexpensive method to provide insight into symptomatic phase. These may be utility tools for primary care physician in the management in periphery and timely decision.

COVID-19 has caused an excruciating impact on the mentality of people. It has severally affected the different attributes of the personality of an individual. If we further investigate the problem, we would find that the period of quarantine in the COVID hospital is the most difficult one. It affects different attributes of the personality of an individual. If we look at the other side of this problem, we find that the solution to the problem lies within the person. It depends on the mental and physical strength of the person as to how he or she copes with a difficult situation. It is a general perception that a person who has ever played sports is more disciplined, cooperative, and coordinative in comparison to other persons. The basic hypothesis of the present research is that whether sportspersons have a positive approach towards life in comparison to other persons during the crises like a pandemic of COVID-19. To accomplish the task, a question-based survey was conducted to collect the desired data. Five behavioral aspect-bases were laid for the survey. The samples were collected from COVID patients identified as a sportsperson or non-sports persons. On these grounds, it was concluded that the behavioral pattern of players is better than the non-players; during the quarantine period of the COVID-19 pandemic. This finding offers great help to a primary care physician who provides care to the patient at the point of the first contact. Being a specialist in family medicine, internal medicine, or pediatrics such a person takes continuing responsibility for providing the patient's comprehensive care.

Primary peritoneal carcinoma (PPC) was first described in 1959 by Swerdlow. It is a rare malignant tumor of the peritoneal cavity. Clinically and histologically it is similar to advanced-stage serous ovarian carcinoma that develops from the peritoneum lining the pelvis and abdomen and is characterized by abdominal carcinomatosis, uninvolved or minimally involved ovaries, and no identifiable primary tumor. This cancer spreads widely inside the peritoneal cavity and mostly involves the omentum. There is some thought that the peritoneal cells that give rise to peritoneal cancer may actually be leftover ovarian cells that remained in the abdomen during development. It is almost exclusively found in women. Clinical features include abdominal swelling, constipation, gastrointestinal disorders, nausea, vomiting, anorexia, and weight loss.

We report a case of a 28-year-old male who presented in the emergency room with a history of two episodes of syncope in the last 3 days at home. ECG was done in the emergency room which was suggestive of complete heart block. The patient had a history of pain on and off in the right upper quadrant region (RUQ) after having a meal. Ultrasonography of the abdomen was advised which revealed acute calculous cholecystitis. A temporary pacemaker was inserted and an emergency laparoscopic cholecystectomy was planned. The patient recovered postoperatively and converted back to sinus rhythm. Considering the patient's age, normal cardiac workup, and his complete heart block disappeared after the removal of his gallbladder, it was postulated that this patient had a case of cardio-biliary reflex (Cope's sign).

A 38-year-old female patient presented with acute onset quadriplegia which was initially diagnosed as Guillain-Barre syndrome. ECG features were suggestive of hypokalemia. Blood investigations revealed severe hypokalemia. After replacement of potassium, patient's muscle power recovered within 20 h. Thus, if the patient presented with acute onset quadriplegia possibility of hypokalemia-induced paralysis should always be kept in mind.

Hemifacial spasm (HFS) is characterized by involuntary synchronous contractions or spasms of one side of the face, usually beginning around the eye. They are typically brief, irregular clonic movements but are occasionally tonic. We present a case of a 41-year-old female who presented to the neurology clinic with complaints of recurrent right facial spasms. These involuntary spontaneous movements had affected her quality of life. The neuroimaging revealed the vascular malformation right cranial nerves (CN) VII/VIII complex. It was considered to be responsible for the patient's HFSs. The patient responded well symptomatically to the botox injections without any neurovascular decompression.