International Journal Of Community Medicine And Public Health

Atypical presentation of first-episode psychosis: pedal edema in a patient with autism

Parinda Parikh — 2025-09-30

First episode psychosis (FEP) in adolescents with autism spectrum disorder (ASD) presents unique diagnostic and management challenges due to overlapping symptomatology. Physical findings such as pedal edema are uncommon in early psychosis and warrant careful evaluation, particularly prior to initiating antipsychotic treatment. We report a case of a 16-year-old male with ASD who presented with FEP characterized by catatonia, behavioral rigidity, reduced sleep, and social withdrawal. On examination, he exhibited bilateral pitting pedal edema without evidence of systemic or pharmacologic causes. Collateral history revealed prolonged standing behavior due to motor immobility (catatonia) and behavioral abnormalities. Laboratory and imaging investigations were unremarkable. The edema was attributed to dependent fluid accumulation secondary to catatonic posturing. The patient was initiated on long-acting injectable aripiprazole and supportive measures, including compression therapy and hydration, with close monitoring. This case highlights the importance of distinguishing behavioral and physical manifestations of psychosis from baseline ASD traits and other medical conditions. Pedal edema occurring before antipsychotic treatment is uncommon and warrants a thorough evaluation to prevent inadvertently attributing it to medication side effects. Catatonia-related posturing may be an underrecognized contributor to dependent edema in this population. This case highlights the challenges of diagnosing psychosis in autism, where symptoms may overlap with baseline traits. Catatonia presenting as prolonged standing might result in pedal edema. Comprehensive history and multidisciplinary assessment enables accurate diagnosis and treatment, emphasizing the need for careful monitoring in this population.

When can a skin biopsy reveal Lafora disease

Asmae Dahmani — 2025-09-30

Lafora disease (LD) is a rare and particularly severe form of progressive myoclonic epilepsy (PME). It is an autosomal recessive hereditary disorder, with the responsible gene recently localized to chromosome 6q23-27. It is characterized by the onset, between the ages of 6 and 19, of generalized seizures followed by myoclonus. A major intellectual decline develops rapidly and progressively, eventually leading to dementia. Histological examination is essential for confirming the diagnosis of LD. The most practical procedure is a skin biopsy performed in the axillary region, allowing visualization of PAS positive inclusions within the excretory duct cells of the sweat glands-findings that are consistent with Lafora bodies. We report a clinical case of LD in a 16 years old adolescent girl and discuss the diagnostic challenges associated with this condition.

The paradox of care: dopamine super sensitivity psychosis and catatonia following excessive antipsychotic exposure in an adolescent with first-break schizophrenia

Parinda Parikh — 2025-09-30

Dopamine super sensitivity psychosis (DSP) is marked by rebound or treatment-resistant psychosis, typically linked to prolonged or poorly managed antipsychotic use. While increasingly recognized in adults, DSP in adolescents, especially with catatonia, remains underreported. The impact of fragmented psychiatric care and caregiver-driven treatment changes is rarely addressed. We describe a 13-year-old female with schizophrenia who developed severe functional decline and catatonia after years of inconsistent psychiatric management. Extensive workup, including EEG, brain MRI, and broad metabolic, infectious, autoimmune, and endocrine testing, was negative. Her history revealed frequent physician changes and abrupt medication switches without tapering, often initiated by parental concern over persistent symptoms. At presentation, she was wheelchair-bound, minimally responsive, and showed psychomotor retardation, tremors, and auditory hallucinations. Her course aligned with DSP complicated by catatonia, after incomplete or subtherapeutic trials of risperidone, olanzapine, quetiapine, aripiprazole, and cariprazine. Treatment with clozapine and high-dose lorazepam was initiated, alongside careful monitoring and structured support for the family. The patient gradually regained independence, resumed psychotherapy, and re-engaged socially, with significant improvement in psychosis. This case illustrates the rare intersection of adolescent DSP and catatonia, highlighting risks of inconsistent treatment and caregiver-driven decisions. It underscores the importance of coordinated psychiatric care, cautious medication adjustments, and comprehensive family education. Supporting caregivers emotionally and educationally is vital to improving adherence and long-term outcomes for youth with severe mental illness.

A scoping review exploring the uptake of the human papilloma virus vaccine amongst young women in Ireland

Varisha Shahzad — 2025-09-09

Human papillomavirus (HPV) is a sexually transmitted infection that can resolve spontaneously but may persist and lead to complications such as genital warts and cervical cancer. The National Cancer Registry Ireland (NCRI) reported an average of 264 new cases of invasive cervical cancer annually between 2015 and 2017, and 88 deaths per year between 2012 and 2014. Many of these could have been prevented through HPV vaccination. A scoping review was conducted to explore factors influencing HPV vaccine uptake among Irish women. The Arksey and O'Malley Framework guided the review process, and a preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart was used to map the literature selection. The search covered studies published between 2008 and 2022. Nine studies met the inclusion criteria, employing both qualitative and quantitative methods. These studies explored various perspectives, with increasing interest in recent years—six studies were published in the last seven years. Seven of the nine studies focused on adult women. This scoping review highlights the current literature on HPV vaccination in Ireland, identifies gaps in understanding vaccine uptake, and offers suggestions for future research to address these gaps.

Attitude and awareness of the public toward genetic testing in Saudi Arabia

Zayed Alnefaie — 2025-09-30

Genetic disorders are prevalent in Saudi Arabia due to high rates of consanguinity, making public awareness and attitudes toward genetic testing critical for national health strategies. This systematic review synthesized studies published between 2020 and 2025 from PubMed, Google Scholar, ScienceDirect, and the Saudi digital library, focusing on awareness, perception, and sociocultural influences on genetic testing in Saudi Arabia. The findings reveal generally positive public attitudes toward premarital screening (PMS) and genetic testing, with stronger acceptance among individuals with higher education or a family history of genetic disorders. However, barriers remain, including cultural resistance to altering marriage plans, limited knowledge, and low trust in genetic services. Sociocultural and religious beliefs strongly influence decision-making, with many couples proceeding with high-risk marriages despite unfavorable screening results. The review underscores the importance of integrating culturally sensitive education, expanding genetic counseling services, and leveraging public health initiatives to bridge the gap between awareness and behavior.

Intersecting pathways of pandemic emergence, tobacco control and noncommunicable diseases: a contemporary synthesis of global health determinants and policy implications

Karthika S. — 2025-09-30

The convergence of pandemic emergence, tobacco use and noncommunicable diseases (NCDs) presents a complex public health challenge. These domains are interlinked through shared determinants such as globalization, environmental degradation, socioeconomic inequities and weak health systems. Understanding these intersections is crucial for integrated policy responses in a post-COVID-19 world. This review synthesizes current global evidence on the interconnectedness of pandemics, tobacco control and NCDs, highlighting the implications for global health governance and policy innovation. A systematic search was conducted across PubMed, Scopus, Web of Science and WHO databases using MeSH terms such as "pandemics", "tobacco use", "noncommunicable diseases" and "global health policy". Studies published between 2000 and 2024 were included, with quality assessed using the MMAT-2018 tool. The review identifies four core intersections tobacco use exacerbates vulnerability to infectious disease severity and NCD comorbidities, NCD prevalence increases pandemic morbidity and mortality, tobacco control efforts were disrupted during global health emergencies; and pandemic policies overlooked integrated NCD and tobacco risk factors. Findings emphasize that siloed responses undermine resilience and health equity. Integrated global health policies must address the syndemic nature of pandemics, tobacco use and NCDs. Strengthening primary care, enforcing tobacco control and embedding NCD strategies in pandemic preparedness are essential. Multisectoral governance, health equity frameworks and sustainable development approaches must guide future policies.

Impact of baseline CD4 count on virologic suppression outcomes in people living with HIV on ART at Cibinong District Hospital

Dianita Rahayu — 2025-09-08

Background: Human immunodeficiency virus (HIV) remains a global health challenge, with viral suppression targets yet to be optimally achieved. A low baseline CD4 count at the initiation of therapy reflects immune system damage and increases the risk of viral suppression failure. This study aimed to assess the effect of baseline CD4 count on viral suppression failure among people living with HIV (PLHIV) receiving antiretroviral therapy (ART) at Cibinong District Hospital, Bogor Regency.

Methods: This case-control study utilized secondary data from electronic medical records. The study population included PLHIV who had been on ART for at least six months and had viral load (VL) results between November 2022 and March 2025 that met the inclusion and exclusion criteria. A total of 106 cases (VL>50 copies/ml) were selected through total sampling, while 212 controls (VL≤50 copies/ml) were randomly chosen. Multivariate logistic regression with a risk factor model was used for analysis.

Results: The findings revealed that 25.4% of PLHIV experienced viral suppression failure, the majority of whom had a baseline CD4 count <100 cells/mm³. Low baseline CD4 count significantly increased the risk of viral suppression failure (OR 4.5; 95% CI: 1.48-13.62) after adjusting for confounders (treatment duration, baseline BMI, CD4 change, baseline Hb, risk behaviors, TB history, and treatment adherence). An interaction was also identified between baseline CD4 count, nutritional status, and TB history, which further amplified the risk of viral suppression failure.

Conclusions: These findings underscore the importance of baseline CD4 testing at therapy initiation as a risk indicator. Early integration of HIV, TB, and nutrition services is essential to suppress viral replication and improve the quality of life of PLHIV.

Structured health education and risk of alcohol-related harm among youth in Kiambu, Kenya: a quasi-experimental study

Antony K. Mukui — 2025-09-25

Background: Alcohol remains a major contributor to mortality and increased disability adjusted life years (DALYs) among the youth. In Kenya, where youth alcohol consumption affects 13% of 15–24 year old and reaches 28.9% in Kiambu County, structured health education interventions remain underexplored as a prevention strategy, and this informs the current study title.

Methods: Fourteen trained community health promoters delivered 12 monthly one-hour structured sessions over 12 months, supported by educational materials and peer learning components. Using the World Health Organisation alcohol use disorders identification test (WHO AUDIT) tool, 356 participants were randomly allocated per arm, following power calculations to detect an 11% risk reduction with 80% power. AUDIT scores categorized participants as low-risk, risky-hazardous, harmful, or high-risk, while the questionnaire established sociodemographic characteristics. Qualitative data were analyzed thematically. Kenyatta University's ethics committee granted study approval.

Results: Comparing pre- and post-study results, the mean risk in the intervention group dropped from 14.4 (risky-hazardous) to 4.8 (low risk), while the control group increased from 11.4 (risky-hazardous) to 18 (harmful). Youths with higher odds of risk were male, aged 20-24 years, uneducated, unemployed, not living with parents, widowed, separated, divorced, and residing in suburban areas, particularly in Muguga ward. The study reported a DiD estimate of -16.197 and a Cohen’s d of -1.882, indicating that participants in the intervention group scored 16 points lower on the AUDIT scale. FGDs and KIIs revealed limited awareness and access to screening services, and intervention youths reported decreased alcohol consumption.

Conclusion: The intervention raised awareness of alcohol-related harm and reduced the risk of harm.

Assessment of community health promoters’ experiences and perspectives on mHealth utilization in Busia Teso North sub-county, Kenya

Zipporah M. Nyangacha — 2025-09-30

Background: The use of mobile health (mHealth) technology to manage health-related issues has shown great potential in enhancing the quality of healthcare and reducing maternal and child mortality rates. Many Low- & Middle-income countries (LMIC) countries have implemented this innovation in small scale programming and in pilot stages. In Kenya, mHealth technology was scaled nationally across all community health promoters (CHPs) providing an opportunity to gather insights on the CHPs experiences and perspectives on mHealth use for service provision in Busia's Teso North Subcounty.

Methods: A qualitative study design was used to collect data between August–September 2024 and involved three focus group discussions with 24 community Health promoters aged between 30-55 years. Participants were purposefully sampled and only those residing in Busia Teso North subcounty were eligible. Data analysis was done using thematic analysis.

Results: Findings showed that CHPs perceived the use of mHealth app as a beneficial tool for their work. They reported that the app had significantly simplified and reduced their workload, facilitated easier access to information from previous visits, track which families needed to be visited and enabled them to visualize their performance through an in-built dashboard. Some of the barriers that emerged included Unreliable power supply that significantly disrupted service delivery, network challenges and technical barriers such as app logouts and errors loading.

Conclusions: There is need to address emerging issues such as app logout, errors loading and power challenges. Further, integrating Basic trouble shooting skills into the training curriculum to help reduce turnaround time.

Readiness to integrate sexual assault nurse examiner curriculum: pilot study results on nurses’ perspectives in an Indian context

Elizabeth B. Simon — 2025-09-12

Background: Addressing the need for improved healthcare services for survivors of sexual assault in India is a crucial issue. It is recommended to add forensic content to nursing curricula in India, but effective implementation in this regard is limited. We assessed the readiness of nursing faculty to integrate the sexual assault nurse examiners (SANE) curriculum in India.

Methods: A pilot study was conducted among nursing faculty members from four nursing colleges in a selected district of Kerala, India. A total sample of 100 faculty members from the selected colleges was surveyed using a pre-tested structured questionnaire.

Results: Most participants (95%) agreed SANE would improve survivor care. Barriers to reporting included police/legal intimidation (98%), male examiners (12%), invasive procedures (25%), and social stigma. Most supported having a dedicated caregiver for survivors (85%). However, only 12% had provided care, and 6% were aware of SANE training. Major barriers identified were the lack of SANE-trained personnel (77%), clinician disinterest (35%), physician resistance to shared roles (12%), and insufficient legal support (40%). While 62% urged policy reform, few found the curriculum socially (2.1%) or educationally (11.5%) inadequate. Nonetheless, 94% strongly supported and 6% supported SANE legislation and implementation by the Indian Nursing Council and other bodies.

Conclusions: Nursing faculty supported the implementation of SANE education and practice, recognizing its importance to Indian society and its potential benefit for survivors of sexual trauma. This positive attitude among nurses represents a crucial step toward the successful integration of the SANE curriculum into nursing education.

Social determinants of health and frequency of hookah use among adults in Saudi Arabia: a cross-sectional study

Mansour Joharji — 2025-09-30

Background: Hookah smoking has become increasingly popular in Saudi Arabia, particularly among young adults. Despite rising prevalence, limited research has investigated how social determinants of health (SDOH) influence the frequency of use in this context. Objective was to examine the relationship between SDOH and the frequency of hookah use among adults in Saudi Arabia.

Methods: A cross-sectional study was conducted from October to December 2023 using an online questionnaire distributed in both Arabic and English. Adults aged 18 and above who reported current hookah use were included. The survey captured demographic characteristics and smoking behaviors. Descriptive statistics, chi-square tests, and ordinal logistic regression were used to analyze the data.

Results: A total of 227 participants completed the survey. Most respondents were Saudi nationals (75.8%), with 54.2% being male. Daily hookah use was reported by 38.8% of participants. Statistically significant associations were found between hookah use frequency and both education level (p=0.045) and place of use (p<0.001). Home use was most common among daily users, while café use was linked to occasional use. Income, gender, marital status, and employment were not significantly associated with use frequency.

Conclusions: Education level and setting of hookah use significantly influence frequency of smoking in Saudi Arabia. Findings suggest that public health policies should target specific environments and education groups to reduce hookah consumption and its associated health risks.

Social media usage influences dietary choices among university students at the Catholic university of Eastern Africa

Serena Joel — 2025-09-30

Background: Social media use is widespread among young adults, particularly university students, influencing various aspects of life including dietary choices. In Kenya, where youth comprise a significant population, exposure to misleading food trends and unhealthy content on platforms like Instagram and YouTube raises concern. Despite growing health risks such as obesity, little research has examined this influence locally.

Methods: A descriptive cross-sectional study was conducted among undergraduate students aged 18-25 at The Catholic university of Eastern Africa, Nairobi. Using Fischer’s formula (1998), a sample size of 242 was determined and recruited through consecutive sampling. Data were collected via structured questionnaires and analyzed using SPSS 21.0. The data was presented in tables and pie charts.

Results: The study revealed that 64.4% of university students reported unhealthy dietary choices. Frequent fast-food consumption was also common, with 44.8% eating it three times weekly. However, no significant association was found between dietary choices and social media variables.

Conclusions: This study revealed that the most students had unhealthy dietary choices (64.4%), no significant link was found with social media usage, indicating other influencing factors. Universities should promote nutrition education, and health authorities should partner with influencers to encourage healthy eating.

Trends in substance use and associated risk factors among adolescents in Belize

Olusola Oladeji — 2025-09-30

Background: Adolescents are at a crucial stage of development, making them more likely to engage in risk-taking behaviors, including substance use. This study aimed to describe the trends and patterns of substance use and risk factors among adolescents who accessed treatment and rehabilitation outreach services between 2017 and 2024.

Methods: This exploratory study utilized both qualitative and quantitative methods.

Results: During the reporting period, adolescents aged 10-19 years represented 45% (1,055 out of 2,365) of reported substance use cases. Marijuana and alcohol were the most frequently used substances among both genders, while cocaine and tobacco use were significantly lower, particularly among girls. The highest usage rates were observed among adolescents aged 15-19, with a notable gender disparity: 82% of reported cases were males, compared to 18% females. The risk factors were categorized using a socio-ecological approach into four themes: (1) individual factors: emotional stress; (2) interpersonal factors: household environment and peer pressure; (3) community factors: accessibility, affordability, lack of structured activities and recreational alternatives, and the influence of social media; and (4) policy factors: regulation and enforcement of the sale and distribution of substances.

Conclusion: This study highlights adolescent substance use as a critical public health concern in Belize. The findings highlight the importance of moving beyond generalized prevention frameworks and adopting context-specific strategies that actively engage adolescents and address their developmental and psychosocial needs. Integrating efforts from various sectors through a multisectoral approach is crucial to effectively address substance use problems among adolescents.

Prevalence of anemia and its association with nutritional, reproductive health, and antenatal care factors among pregnant women in a peri-urban health facility in Kenya

Faith Wanjiku — 2025-09-30

Background: Anemia in pregnancy, defined by WHO as hemoglobin below 11 gm/dl, is a major public health concern, especially in sub-Saharan Africa. In Kenya, its prevalence stands at 67%, contributing to poor maternal and neonatal outcomes. In Kajiado County, food insecurity and low ANC uptake persist, yet the exact burden and associated maternal factors remain poorly documented.

Methods: A descriptive cross-sectional study was conducted at Ngong Sub-County Hospital, Kajiado County, among pregnant women aged 16-35 attending ANC clinics. Sample size of 108 was calculated using Cochran’s formula, and participants were recruited through consecutive sampling. Data were collected using structured questionnaires and analyzed using SPSS 21.0. Descriptive statistics and Chi-square tests were used, with significance set at p<0.05 and the data was presented in tables and pie charts.

Results: The study revealed that 5% of the women were anemic ( 1.9% mild and 2.8% moderate cases). No severe anemia was recorded. Significant associations were found between anemia and pregnancy trimester (p=0.013) and IFAS compliance (p=0.000).

Conclusions: The study found a low prevalence of anemia (5%), with pregnancy trimester and compliance with iron and folic acid supplementation significantly associated with anemia (p=0.013 and p=0.000 respectively). It recommends targeted antenatal programs to enhance awareness and adherence to IFAS, especially in early and late pregnancy, along with strengthened nutritional counselling, routine anemia screening, and timely interventions for improved maternal health outcomes.

Analysis of nutritional policies implemented to tackle the double burden of under-five malnutrition in Zambia: a case study of Levy Mwanawasa University Teaching Hospital, Lusaka

Christopher Tuishime — 2025-09-30

Background: This study analyzed the global nutritional policies to tackle the double burden of under-five malnutrition, and this was a case study of Levy Mwanawasa university teaching hospital in Lusaka. The main objective was to analyse the nutritional policies implemented to tackle the double burden of malnutrition at Levy Mwanawasa university teaching hospital.

Methods: Qualitative phenomenological study methodology was used to identify the key elements of the nutritional policies implemented. The qualitative data gathered was analyzed using thematic analysis using Nvivo 14 software for data analysis. One-on-one interviews using a structured interview guide were conducted on 12 purposively selected participants that were enrolled in the study.

Results: The results from the thematic data analysis produced three themes with regard to effectiveness of the adopted policies which are low level effectiveness, medium level effectiveness and high-level effectiveness. The major theme being medium effectiveness. With regard to challenges the themes that emerged were lack of knowledge among individuals on nutritious foods, healthy foods are expensive, lack of policy for regulate food market pricing and lack of information of nutritious foods which was the major theme. The main themes emerging from the suggestions were government regulation of food pricing, government help of orphans and vulnerable children with food handouts and government regulation of food market prices.

Conclusions: The level of implementation of the adopted policies to address the double burden of malnutrition was medium. The study also suggested that the major challenge in the implementation was that individuals lack information on nutritious foods.

Factors associated with adherence to anti-hypertensive medication among patients attending a secondary referral hospital, in Kirinyaga county, Kenya

Beatrice Muchiga — 2025-09-30

Background: In Kenya, hypertension is rising, but adherence levels are poorly documented. The purpose of this study was to assess the level of adherence to antihypertensive medication and identify the patient- and health system-related factors influencing adherence among hypertensive patients in Kirinyaga County.

Methods: This descriptive cross-sectional study assessed medication adherence among 237 hypertensive patients aged 18–60 years at Kerugoya County Referral Hospital between October and December 2024. Systematic sampling was used. Data was collected using a structured questionnaire incorporating the MMAS-8 and analyzed using SPSS with descriptive and inferential statistics.

Results: Slightly more than a third of patients did not take their hypertension medication as prescribed. 39% (n=93) lacked health insurance and married individuals were more likely to adhere than the unmarried, while higher hospital fees were linked to non-adherence. Two-thirds had comorbidities and patients with diabetes (89%, n=82), those who monitored their blood pressure at home (91%, n=136) and those aware that skipping medication worsens hypertension (89%, n=133) showed better adherence. Resources and education were generally available. Longer doctor waits times discouraged adherence. Adherent patients were 6 times more likely to report no side effects (OR = 6.058) and more likely to spend less time at the pharmacy (OR=0.977).

Conclusions: This study recommends strengthening health education on adherence, especially regarding home blood pressure monitoring and the risks of missed doses. The facilities should reduce waiting times, sensitize on NHIF enrollment. Further research is necessary to explore the role of social support in promoting adherence.

Evaluating risk factors and surgical outcomes in diabetic foot patients at a tertiary care hospital

Shyamal Kumar Roy — 2025-09-30

Background: Diabetic foot disease is a serious and common complication of diabetes, often leading to chronic ulcers, infections and lower limb amputations. This study aims to assess the clinical outcomes of surgical interventions and identify key risk factors influencing prognosis in diabetic foot patients treated at a tertiary care hospital. The aim of the study was to evaluate the clinical outcomes of surgical interventions and identify key risk factors influencing prognosis in diabetic foot patients treated at a tertiary care hospital.

Methods: This prospective observational study at the Department of Surgery and SOPD, Dhaka Medical College Hospital (January-December 2018), included 73 diabetic foot patients aged 20–80 years, excluding those with renal failure, chronic liver disease or malignancy. After ethical approval and consent, data on clinical features, treatments and outcomes were collected alongside relevant investigations. Patients were followed every two months post-discharge. Data were analyzed using SPSS v22 with significance at p<0.05.

Results: Of 73 diabetic foot patients (mean age 51 years), most were male (61.6%) with diabetes duration of 1–5 years. Ulcer was the main complaint (71.2%). Uncontrolled diabetes (65.8%) and elevated HbA1c (58.9%) were common. Key risk factors included neuropathy (64.4%) and hyperlipidaemia (63.0%). Surgical treatment was significantly associated with poor glycemic control (p<0.001), with highest recovery seen after debridement and reconstruction (89.3%).

Conclusions: Uncontrolled diabetes and associated risk factors significantly influence the need for surgical intervention and affect outcomes in diabetic foot patients.

Effect of peer support group in sustaining exclusive breastfeeding practice among women of reproductive age, Kenya

Teresia M. Kyulu — 2025-09-30

Background: Breastfeeding is a high-impact and low-cost health intervention. Late initiation and poor practice of exclusive breastfeeding for six months after delivery is linked to infant morbidity and mortality. This study determines the effect of peer support group in sustaining exclusive breastfeeding practice for six months with no other liquids or solids after delivery.

Methods: A quasi-experimental intervention study was undertaken in Makueni County between 2022 to 2023. Mothers recruited in their second trimester of pregnancy, mother-baby pair followed up for 6 months post-delivery. Peer support groups initiated in the intervention group sessions guided by WHO/UNICEF infant and young child feeding policy. The control group received routine health information as indicated by the ministry of health. Data analyzed by use of Mantel-Haenszel common odds ratio estimate and independent t-test.

Results: A sample size of 721 participants, Common Odds Ratio Estimate calculated to determine the effect of peer support group on time of initiating breastfeeding after delivery indicated neonates in the intervention site were 6.36 times more likely to have been initiated to breastfeeding within one hour after delivery compared to those from control site (natural log estimate 1.851) (OR: 6.364; 95% CI: 3.285 to 12.326). Independent t-test for exclusive breastfeeding practice mean score, the intervention site improved from 54.11% to 83.04% (p<0.001).

Conclusions: Peer support group intervention was effective in the initiation of breastfeeding and nurturing the practice of exclusive breastfeeding for six months after delivery.

Proportion and patterns of ocular morbidity among garment workers in Savar, Dhaka, Bangladesh

Farhan A. Pathan — 2025-09-30

Background: Ocular morbidity is a growing but neglected issue among garment workers in low- and middle-income countries, with poor lighting, dust, and near work raising risks. Despite their vital role in Bangladesh’s economy, research and interventions on their eye health remain scarce.

Methods: A cross-sectional study was conducted among 250 garment workers (18-60 years) from two Savar factories (August 2023 to July 2024). Participants engaged in fine near work were randomly selected, while others were excluded. Data was collected via interviews and comprehensive ocular examinations. Ethical approval was gotten, and data were analyzed using statistical package for the social sciences (SPSS) version 26.

Results: Among 250 garment workers examined, most were male (62%) and aged 21-30 years (47.2%; mean 30.98±8.39). Normal visual acuity was found in 78.8% (right eye) and 75.2% (left eye). Anterior segment diseases (61.2%) were more common than posterior (1.2%). Refractive errors were the leading morbidity (35.2%), mainly myopia (21.2%), followed by presbyopia (7.2%), blepharitis (2.4%), cataract (1.6%), and diabetic retinopathy (0.8%). Overall, 62.4% had at least one ocular morbidity.

Conclusion: This study expresses a high burden of refractive errors and anterior segment diseases among Savar garment workers, highlighting the vital need for policy-driven eye screening and better workplace conditions.

Beyond conventional markers: admission serum lactate levels as an early predictor of dengue disease severity: a retrospective cross-sectional study from a tertiary care hospital in Karachi, Pakistan

Sadaf H. Musani — 2025-09-30

Background: Dengue is a significant global health concern, with clinical manifestations ranging from mild fever to severe, life-threatening hemorrhagic shock. Despite the use of established warning signs, an effective biomarker for the early identification of severe cases remains elusive. This study aimed to investigate the utility of admission serum lactate levels as an early predictor of dengue disease severity.

Methods: A retrospective cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, reviewing medical records from 2018 to 2022. The study included adult patients aged 18 and above who were admitted with a primary diagnosis of dengue fever and had admission serum lactate levels available. Patients with pre-existing chronic liver or kidney disease were excluded. Data on demographic characteristics, comorbidities, laboratory results (including lactate, hematocrit, and platelet count), and disease outcomes such as ICU admission, intubation, and systemic complications (cardiovascular, ARDS, CNS, acute liver failure, AKI, and mortality) were collected. Data analysis was performed using IBM SPSS Statistics, with a p value of <0.05 considered statistically significant.

Results: A total of 203 eligible patients were included in the final analysis. The study found a statistically significant association between higher median serum lactate levels and various indicators of disease severity. Higher lactate levels were significantly associated intubation, and mortality (p value <0.05). A weak negative correlation was also observed between admission lactate levels and platelet counts. No significant correlation was found between lactate and hematocrit levels.

Conclusions: Admission serum lactate levels can serve as a valuable and early predictor of overall dengue disease severity. Higher lactate levels upon hospital admission are significantly associated with a range of severe outcomes, including cardiovascular complications, ARDS, acute liver failure, AKI, intubation, and mortality.

Her right to know: exploring contraceptive awareness in female college students of Mysuru: a cross-sectional study

Shweta Neminath Kurkuri — 2025-09-09

Background: Contraceptive use is a critical component of reproductive health, empowering women to make informed decisions about their fertility. However, among young adults, particularly female college students, gaps in awareness remain prevalent despite generally favourable attitudes. This study aimed to assess the awareness, attitudes, and preferences regarding contraception among female college students in Mysuru, Karnataka.

Methods: A cross-sectional study was conducted among 542 female students from various colleges in Mysuru using a pre-tested, semi-structured questionnaire. Data were analysed using SPSS v29, with chi-square tests used to assess associations.

Results: While 81.9% believed contraception is beneficial and 83% were willing to recommend it, only 57.5% had awareness of both family planning and contraceptive availability. Awareness regarding contraceptives was good among 50.9% (mean score: 20.95±5.81), while awareness remained low at 24.4% (mean score: 1.90±0.91). Attitude scores were generally positive (57.9% with good attitude; mean: 11.23±2.53). Participants were more familiar with condoms than implants and injectables. Perceptions about safety and ease of use influenced preference for traditional methods. Educational year and marital status were significantly associated with awareness (p<0.05).

Conclusions: Despite positive attitudes, gaps in awareness suggest the need for improved contraceptive education tailored to students' academic level and marital status. Including reproductive health sessions in curricula, healthcare professionals, and digital platforms may enhance awareness of contraceptives.

Association between obesity and liver enzyme levels: a cross-sectional observational study among individuals visiting a diagnostic laboratory in Burdwan, West Bengal

Subhasish Dan — 2025-09-12

Background: Obesity is a global health crisis, acting as a risk factor for various chronic diseases. Elevated levels of liver enzymes are important biomarkers of liver disease and may signal metabolic changes resulting from obesity. The aim of this study was to explore the association between obesity and liver enzyme levels, while also assessing the role of sociodemographic, behavioural, and dietary factors in obesity prevalence.

Methods: This was a cross-sectional observational study carried out among 390 individuals aged 18 to 59 years without any diagnosis of liver disease. Information regarding sociodemographic, behavioural, and dietary habits were collected using structured questionnaires. Anthropometric measures, blood pressure, fasting blood glucose, lipid profile, and liver enzyme levels were assessed using standard methods. Chi-square tests, t-tests, Pearson correlation, and univariate logistic regression were performed to evaluate the relationships between variables.

Results: Obesity prevalence among the study participants was 67.2% and a statistically significant relationship was found between obesity and elevated liver enzyme levels (p<0.05). No significant associations were found between obesity and sociodemographic or behavioural variables, but excess oil and sugar consumption were linked to obesity. Furthermore, logistic regression analysis revealed that sugar consumption, high systolic blood pressure, fasting plasma glucose, and liver enzyme levels were significantly associated with obesity.

Conclusion: A significant association was identified between obesity and elevated levels of liver enzymes, indicating that they could be used as non-invasive biomarkers for detecting liver disease in early stages among overweight and obese individuals.

Comparative study on job motivation and job stress among urban and rural community health workers of Hubballi taluk in Karnataka

Kantesh Siddareddy — 2025-09-04

Background: Health workers account for the largest share of public expenditures on health and play a crucial role in efforts to improve the availability and quality of health services. The performance of community health worker depends on their job satisfaction which is derived from certain intrinsic and extrinsic motivators. Objectives were to compare the motivation and job stress among community health workers in Hubballi Taluk in Karnataka.

Methods: Comparative cross-sectional study was conducted among 134 community health workers of 3 rural PHCs from Noolvi, Byahatti, Adargunchi, and 3 urban PHCs from Bantikatta, Ayodhyanagar, Navanagar of Hubballi taluk. After obtaining informed consent, data was collected using pretested structured questionnaire and 4 point Likert scale method used.

Results: Out of 134 community health workers, 68 were from rural areas and 66 were from urban areas. In urban area 24.2% were ANMs and 75.8% were ASHA workers while in the rural 8.8% were ANMs and 91.2% were ASHA. 56.1% in the urban and 50% in the rural were aged between 31-40 years respectively. The mean score of total motivation was higher in urban (72.13) than in rural (70.04) and also mean score of total occupational stress was higher in urban (60.3939) than rural (58.5588).

Conclusions: Our study showed that the motivation and job stress is more among the urban as compared to rural There is a need to motivate more in the rural health workers and reduce the job stress in urban area.

Assessment of knowledge, attitude and practices regarding hepatitis C virus disease among university students: a cross-sectional study

Pahari Chetia — 2025-09-15

Background: Hepatitis C virus (HCV) remains a significant public health issue in India due to lack of awareness. This research assessed the knowledge, attitudes and practices of university students regarding HCV.

Methods: A cross-sectional study design was conducted among 390 students. Random sampling technique was used to select the participants. Data was collected by using a questionnaire included four sections which are demographic, knowledge, attitude and practices and were analyzed using descriptive statistics and chi-square tests

Results: Although majority of the students (65.6%) had heard of HCV and 60.8% correctly identified it as a viral liver infection, many misconceptions persisted including the belief that a vaccine is available (55.7%). Risky behaviors such as receiving injections from unregistered practitioners (8.7%) and sharing personal items (39.5% not always avoiding) were reported. A significant association was found between education level and comfort in interacting with HCV-positive individuals (p=0.006).

Conclusions: These findings highlight the urgent need for targeted educational interventions to improve awareness and reduce stigma regarding HCV disease.

Utilization of intranatal and postnatal health services among tribal women in India: a cross-sectional study

Simarjeet Kaur — 2025-09-18

Background: Utilization of intranatal and postnatal health services significantly influences maternal and neonatal outcomes in India. Despite a notable increase in institutional deliveries, access to skilled care remains inconsistent, particularly in rural and tribal regions. This study aims to assess the utilization of intranatal and postnatal health services among married tribal women in India.

Methods: A quantitative cross-sectional study was conducted among 245 married women selected via disproportionate stratified sampling from villages in Sirmaur district, Himachal Pradesh. Data was collected using a structured interview schedule and analyzed using SPSS version 24.

Results: The majority (81.6%) of participants reported institutional deliveries, with 86% undergoing normal vaginal delivery. Despite high rates of institutional births, 72.7% did not receive the Janani Suraksha Yojana (JSY) incentive and 63.3% did not access Janani Shishu Suraksha Karyakram (JSSK) services. While 96.3% of children were fully immunized, only 51.8% of mothers-initiated breastfeeding within 30 minutes post-delivery.

Conclusions: Although institutional delivery rates and immunization have improved, significant gaps persist in utilization of government maternity schemes. Enhanced outreach, community engagement and tailored interventions are critical for improving maternal and child health outcomes in tribal regions.

Comparison of Doppler studies in normal pregnancy and high risk pregnancy and their perinatal outcome

Rita D. — 2025-09-18

Background: Doppler ultrasound is one of the most valuable techniques available for assessing fetal well-being, especially in high risk pregnancies. It helps to evaluate fetal circulation by measuring blood flow in key vessels. These waveforms are generated based on ultrasound frequency shifts from blood movement and are influenced by factors such as fetal cardiac contraction, blood viscosity, vessel elasticity and vascular resistance.

Methods: This is a prospective study.100 pregnant women including normal and high risk pregnancy are selected and they undergo Doppler ultrasonography to assess the umbilical artery, middle cerebral artery, and uterine artery flow parameters. The following indices will be measured: pulsatility index (PI); resistance index (RI) and systolic/diastolic (S/D) ratio. Perinatal outcomes will be recorded and analysed.

Results: The PI, RI, and S/D values normal with normal pregnancy group whereas in the high risk group, these values are variable in the uterine and umbilical arteries. In high risk pregnant women shows higher umbilical artery PI and lower middle cerebral artery PI compared to normal pregnant women. Neonatal intensive care unit (NICU) admissions in normal pregnancy and high risk pregnancy (5% versus 35%; p<0.01), low APGAR scores in normal pregnancy 3% and high risk pregnancy 25% (p<0.01) and respiratory distress syndrome in normal pregnancy 3% and high risk pregnancy 25% (p<0.01).

Conclusions: Evaluating doppler waveforms across different maternal and fetal conditions, we can predict early complications of pregnancy like preeclampsia, IUGR in high risk pregnancy and its management. Abnormal doppler results need frequent antenatal checkups and follow up with doppler waveforms to guiding clinical decision making.

Anthropometric evaluation of the olecranon coronoid angle in the North Indian population for sex identification

Vandana Sidhu — 2025-09-15

Background: The olecranon-coronoid angle, a significant anatomical parameter in the proximal ulna, is increasingly being studied as a potential indicator of biological sex in skeletal remains. This study investigated the morphometric variability of this angle in the north Indian population, aiming to establish its utility as a reliable sex indicator. The data thus obtained were tabulated, scrutinized, analyzed, and compared with the earlier studies wherever possible. By analyzing a sample of adult ulnae, the study provided insights into population-specific differences and their implications for forensic anthropology and bioarcheology. If any variant from the normal was observed, an attempt has been made to explain the same.

Methods: A cross-sectional morphometric study was conducted on 100 dry, intact adult ulnae (right and left) of known sex. These 100 adult human ulnae were obtained from embalmed cadavers used for dissection in the Department of Anatomy, Government Medical College, Amritsar, and formed the material for the current study. Data were statistically analyzed using SPSS.

Results: In the study of 100 ulnae (M:F- 50:50), the olecranon coronoid angle was determined to be 22.56°±3.32 in males and 15.71°±4.39 in females.

Conclusions: The olecranon-coronoid angle exhibits significant sexual dimorphism, and its measurement is helpful in reconstruction of elbow disorders observed after treatment of distal humerus fractures. The primary objective of applying anthropometric methods in anatomy and forensic medicine is to assist law enforcement agencies in establishing the personal identity of unknown human remains.

Awareness of preconception care among married women in West Champaran and Banka districts of Bihar

Rajnee Kumari — 2025-09-25

Background: Preconception care (PCC) is vital for maternal and child health, but awareness in India remains very low, especially in rural and tribal areas. This study examines PCC awareness and its socio-economic determinants among married women in Bihar’s West Champaran and Banka districts.

Methods: Primary data were collected from 300 married women aged 15–49 years using a multistage sampling design. Districts were purposively chosen for tribal population and high prevalence of early pregnancy. Data were analysed using chi-square tests and bivariate analysis. Variables included residence, caste, education, employment, income, age at marriage, media exposure and place of delivery.

Results: Awareness of PCC was higher in West Champaran (24.0%) than Banka (9.3%). Urban women were more aware than rural women (West Champaran: 44.0% vs. 23.0%, χ²=7.00, p<0.008; Banka: 36.0% vs. 5.0%, χ²=24.67, p<0.001). Education showed strong influence: 75.0% of graduates versus 13.8% of illiterate women in West Champaran (χ²=26.78, p<0.001) and 37.5% versus 3.2% in Banka (χ²=18.47, p<0.002). Employment raised awareness (West Champaran: 56.4% employed vs. 14.7% homemakers, χ²=28.74, p<0.001; Banka: 28.9% vs. 8.2%, χ²=11.19, p<0.001). Media exposure also showed significant effects (p<0.001). Place of delivery had the strongest link: 92.3% awareness among private facility users vs. 10.0% home deliveries in West Champaran (χ²=65.21, p<0.001) and 43.5% vs. 3.1% in Banka (χ²=22.01, p<0.001).

Conclusions: PCC awareness is very low, with marked gaps across districts and social groups. Urban residence, higher education, employment, media access and private deliveries significantly improve awareness. Focused education and rural outreach are essential.

Reimagining care: unravelling the psychological toll of tuberculosis through patient narratives in Mysuru, India: a qualitative study

Shruddha — 2025-09-18

Background: Tuberculosis (TB) remains a major public health issue in India, with significant psychological and social consequences. Despite medical advancements, the emotional toll of TB is often neglected. Stigma, isolation, and fear can adversely impact patients’ mental health and treatment adherence. The objective of the study was to explore the psychological experiences of TB patients and understand the psychosocial barriers affecting their treatment in Mysuru, India.

Methods: A qualitative phenomenological study was conducted using in-depth interviews with 20 TB patients from public health facilities under the National Tuberculosis Elimination Programme (NTEP) in Mysuru. Participants were purposively sampled across age, gender, TB type, and treatment phase. Data were collected through semi-structured interviews in Kannada, focusing on emotional experiences, stigma, support systems, and treatment challenges. Depression was assessed using the patient health questionnaire (PHQ-9). Interviews were transcribed, translated, and thematically analyzed using NVivo 12.

Results: Four major themes emerged: psychosocial burden, marked by stigma, isolation, and fear of mortality; barriers to adherence, including side effects and emotional strain; socioeconomic hardship, such as financial insecurity and lack of support; and stigma-driven avoidance of healthcare engagement. PHQ-9 scores indicated moderate to severe depression in nearly half the participants. Stigma and emotional distress significantly influenced patients’ willingness to seek care and follow treatment.

Conclusions: TB patients face substantial psychological and social challenges. Integrating mental health support, addressing stigma, and providing economic aid are essential to enhance treatment adherence and patient well-being. A holistic, patient-centered approach to TB care is urgently needed.

Assessing the effectiveness of planned teaching programme on knowledge regarding human rights of mentally ill among B.Sc. nursing students

Garima Shukla — 2025-09-30

Background: As per the amendments in mental health care act 2017 regarding the rights of mentally ill is highly affected on basis of knowledge among the nursing professional students that helps to maintain the quality care of the future nurses. Objectives were to assess the level of knowledge regarding human rights of mentally ill among B. Sc. nursing students, to evaluate the effectiveness of planned teaching program on knowledge regarding human rights of mentally ill, and to find out the association between level of knowledge regarding rights of mentally ill among B. Sc. nursing student in selected nursing college at Meerut.

Methods: Pre-experimental, convenient sampling study was done among 90 samples of B. Sc. nursing students with structured questionnaire.

Results: The effectiveness of the planned teaching program on knowledge regarding human rights of mentally ill individuals among B. Sc. nursing students. The mean pretest knowledge score was 12.53±3.535, while the post-test mean score increased to 19.31±3.871.

Conclusions: Study reveal that the majority of students (82.2%) have an adequate level of knowledge after the intervention, while 17.8% have an inadequate level of knowledge indicate planned teaching program was effective and participant knowledge was improved.

Impact of social media on medical education as assessed by a structured questionnaire among medical students of a medical college in a metropolitan city

Pranav Bharadwaj Arun — 2025-09-30

Background: The integration of social media into medical education has redefined access to and dissemination of knowledge. Platforms such as YouTube, WhatsApp, Instagram, and Telegram are increasingly used for collaborative discussions, exam preparation, and procedural learning. In urban India, where internet access is widespread, understanding its impact on medical education is highly relevant. This study assessed patterns of social media usage among medical students enrolled in a metropolitan medical college, examined the educational relevance of their social media content, and evaluated students’ perceptions of social media as a learning tool.

Methods: A cross-sectional study was conducted using an online questionnaire with both open- and closed-ended questions among undergraduate students at a tertiary hospital in Bengaluru. A total of 117 responses were analysed using descriptive statistics. The survey examined platform use, content relevance, recall, behavioural influence, and overall attitudes.

Results: YouTube (98.3%), WhatsApp (97.43%), and Instagram (83.76%) were the most used. While 60.68% spent 1-3 hours daily, only 5.99% crossed 6 hours. About 58.12% reported 26-50% medically relevant feeds. Students preferred “edutainment”: 70.94% engaged with memes, and 56.41% with mnemonics. Although 83.76% believed social media improved education and 63.25% recalled better than lectures, 76.1% admitted to poor long-term retention. Only 36.75% said it helped pass exams.

Conclusions: Social media is an engaging and beneficial adjunct to medical education, but is limited by retention and accuracy. Structured integration, student-led creation, and regulatory oversight can optimise its academic utility.

Prevalence of internet addiction and its effects on lifestyle choices and snacking patterns in young adults

B. Spandana — 2025-09-30

Background: The significant role of internet addiction in influencing dietary behaviour, particularly among young adults, has become a prominent cause for concern. The continuous connectivity provided by the internet, alongside the widespread use of social media and online platforms, has created an environment where individuals often find themselves deeply engrossed in virtual realms. This digital immersion frequently disrupts established routines, including eating habits.

Methods: An exploratory study was conducted to examine the prevalence of internet addiction and dietary habits of young adults of 254 respondents. Data was collected using the Korean internet addiction scale (KS scale). The KS scale comprises demographic information, patterns of internet addiction, and lifestyle and snacking patterns. Statistical analysis done by SPSS.

Results: The results of the study revealed that majority of the respondents were potential internet users (40.55%) followed by low risk (37.01%) and high risk (22.44%). Individuals at high risk exhibit markedly higher scores, reflecting more intense symptoms and reinforcing the need for specialized interventions tailored to this group.

Conclusions: The study highlighted the concerning prevalence of internet addiction among young adults and its significant impact on dietary behaviours. With a substantial portion of respondents categorized as potential or high-risk users, it was evident that internet addiction disrupts traditional eating habits and routines. The findings underscore there is a need for targeted interventions aimed at addressing internet addiction, particularly among those at higher risk, to promote healthier dietary practices.

Prevalence and pattern of post COVID-19 health problems among adults attending post COVID-19 clinics of selected tertiary care centres in Kolkata

Uma Rani Adhikari — 2025-09-30

Background: Post COVID-19 health problem is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. This study aimed to determine the prevalence and pattern of post COVID-19 health problems in adults of post COVID -19.

Methods: A descriptive cross-sectional survey was conducted in post COVID-19 clinic of two tertiary care government sectors in Kolkata. Data collected through pre tested interview schedule and record analysis from the patients with COVID-19 positive through SARS-Cov-19, RT-PCR positive or rapid antigen positive test. Data collected from 150 post COVID-19 patients after ethics committee approval. All data were analysed using SPSS version 19.

Results: More than 3/4^th of the participants (77.3%) had reported post COVID-19 health problems and majority (43.3%) of the subjects had fatigue, 30% of the subjects had joint pain 28.67% of the subjects had cough. Majority (65.1%) of the subjects had mild illness during their COVID-19 infected period and 25% had other health problems among them maximum (40%) of the subjects had interrupted sleep, 28% of the subjects had uncomfortable in walking and (6%) of the patients had depression. Less common health problems were hematuria (4%), blurred vision (4%) and anosmia (4%). 21.5% participants reported ≥7 post COVID-19 health problems among all participants.

Conclusions: The present study reveals that the commonest health problems in post COVID-19 patients were fatigue, headache, joint pain, shortness of breath. Comprehensive rehabilitation program and monitoring is essential for management.

From risk to prevention: diabetes screening in an urban community of Uttara Kannada district

Shubhangini Singh — 2025-09-30

Background: Diabetes is rapidly increasing in India due to urbanization, sedentary habits and unhealthy lifestyles. Early identification of high-risk individuals is essential to prevent complications. The Indian Diabetes Risk Score (IDRS) is a simple, low-cost tool that can be used in community settings. To assess the risk of type 2 diabetes among adults aged 30–70 years in an urban community using the IDRS and to identify associated socio-demographic and lifestyle factors.

Methods: A cross-sectional study was carried out among 448 adults selected through systematic random sampling in an urban field practice area of Uttara Kannada district, Karnataka. Data were collected using a structured questionnaire and anthropometric measurements. Diabetes risk was categorized as low, moderate or high using the IDRS tool. Associations were tested using chi-square analysis.

Results: Older age, sedentary lifestyle, positive family history and increased waist circumference were significantly associated with higher diabetes risk. Central obesity was the strongest predictor.

Conclusions: More than half of the study population was at moderate-to-high risk of diabetes. Incorporating IDRS-based screening into primary health care and community programs can help in early detection and prevention.

Assessment of self-care practices among type 2 diabetics in urban Bengaluru: a cross-sectional study

Sathiabalan Murugan — 2025-09-30

Background: Self-care is a vital aspect of diabetes management, significantly influencing glycemic control and prevention of complications. This study aimed to assess self-care practices among adult diabetic patients and compare individual self-care components with findings from similar studies conducted in India.

Methods: A community-based cross-sectional study was conducted among 136 adult type 2 diabetic patients attending primary health centers (PHCs) in urban Bengaluru between November 2024 and January 2025. Self-care behaviors were assessed across seven domains based on the American Association of Diabetes Educators (AADE) framework. Univariate and multivariate logistic regression analyses were used to identify factors associated with poor self-care, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: The mean age of participants was 53.8 years (SD: ±10.4), and overall mean self-care score was 33.9 (SD: ±12.3). Medication adherence showed the highest compliance (mean 6.1 days/week), while exercise had the lowest (mean 3.6 days/week). The median total self-care score was 35 (IQR: 28-42), with 38.2% (95% CI: 36.4-40.0%) classified as having good self-care. Females showed better self-care, especially in diet and foot care. In multivariate analysis, being female (aOR: 1.76, 95% CI: 1.1-2.8) and having higher education (aOR: 2.14, 95% CI: 1.3-3.5) were positively associated with good self-care, while diabetes duration under 5 years was linked to poorer practices (aOR: 1.69, 95% CI: 1.1-2.7).

Conclusions: Moderate self-care practices were observed, highlighting need for targeted health education and behavioral strategies to improve diabetes management.

Incidence of vascular and biliary anomalies found during laparoscopic cholecystectomy and their outcomes

Kalesha Shaik — 2025-09-30

Background: Laparoscopic cholecystectomy represents the preferred surgical approach for gallbladder pathology, yet remains technically challenging due to frequent anatomical variations of the hepatobiliary system. Undetected preoperatively in many cases, these anomalies substantially influence procedural difficulty and patient outcomes. This investigation systematically evaluated their incidence and clinical consequences.

Methods: This was a prospective observational study conducted at a tertiary care center from April 2023 to April 2024, enrolling 50 consecutive patients meeting inclusion criteria. Intraoperative documentation of vascular and biliary variations was performed, with subsequent analysis of operative duration, complication rates, and conversion frequencies. Statistical comparisons employed appropriate tests with significance set at p<0.05.

Results: Among study participants, 26% demonstrated anatomical variations- predominantly biliary (20%) rather than vascular (6%). Specific anomalies included short cystic duct (6%), accessory bile ducts (10%), and double cystic artery (2%). Procedures involving anatomical variations required significantly extended operative times (p=0.047), with 23% exceeding two hours compared to 5% in standard anatomy cases. The overall complication rate remained low (8%), including bile leaks (4%) and hemorrhage (2%), without statistically significant difference between groups (p=0.72). Conversion to open procedure occurred in 6% of cases, principally due to challenging dissection (4%) or significant bleeding (2%).

Conclusions: While anatomical variations prolong operative duration during laparoscopic cholecystectomy, meticulous surgical technique maintains acceptable complication rates. These findings underscore the importance of preoperative imaging evaluation and intraoperative vigilance. Future technological advances in three-dimensional reconstruction and robotic assistance may further enhance procedural safety in complex anatomical scenarios.

Sickle cell disease in Sundargarh: understanding local beliefs and screening efforts among tribal population, Western Odisha

Aishwarya Mishra — 2025-09-30

Background: Sickle cell disease remains a significant health challenge among Odisha’s tribal communities, where limited awareness and healthcare access lead to delayed diagnoses. This study examined the incidence of sickle cell disease and local perceptions of it in Sundargarh’s Subdega and Balisankara blocks.

Methods: This cross-sectional study, conducted from June 2023 to March 2024 in Sundargarh, Odisha, examined the prevalence of sickle cell disease and assessed community perceptions using questionnaires, screenings, and HPLC analysis. 280 respondents participated, providing insights into sickle cell disease awareness, while 210 children were screened for early detection. Findings were presented through descriptive statistics, Pearson correlation, and Kruskal-Wallis tests, with significance set at p<0.05.

Results: A total of 280 adults (males: 117 and females: 163) with 95 children (below 15 years) from the same families were freshly diagnosed with sickle cell disease, and they were unaware of the condition. Of the 280 people sampled, 54.3% had not even heard of sickle cell disease; only 9.37% knew it was an inherited disease. Limited awareness of sickle cell disease led to misconceptions, with many relying on traditional healers.

Conclusions: The study found a prevalence of sickle cell anemia (HbSS) among variants of sickle cell disease, with limited awareness and testing. Strengthening education and healthcare access is essential for better detection and support, though overall perceptions of the disease were positive.

A cross-sectional study on the quality of life of economically productive age group rural women at Keelara CHC, Mandya

Bagyalaxmi Hirehanamantagoudar — 2025-09-30

Background: Household upkeep, food security, and rural lives depend heavily on economically active women in rural areas. However, they face major environmental and socioeconomic obstacles that have a significant impact on their standard of living.

Methods: A cross-sectional study (CSS) was conducted within a community, involving 1,250 rural women aged 15 to 65 years who attended the Keelara Community Health Centre (CHC) in Mandya. Data were collected utilizing the WHOQOL-BREF questionnaire, which encompasses physical, psychological, social, and environmental domains. Socio-demographic and economic variables were recorded as well.

Results: Among participants, 63.4% were aged 19-44 years, and 95.9% were Hindu. Educational attainment varied, with 24.9% illiterate and 32.0% completing secondary education. Most lived in nuclear families (54.2%) and belonged to lower socioeconomic classes (75.8% in Class IV). The mean overall QOL score was 103.40±11.92. Statistically noteworthy associations were established between QoL and education, marital status, family type, socioeconomic status, and religion (p<0.05); age and occupation were not significant.

Conclusions: A notable proportion of women inside rural areas indicate a less than satisfactory QoL, which is profoundly influenced by variables including educational attainment, socioeconomic conditions, and familial support systems. Targeted interventions that focus on these determinants are crucial for enhancing the well-being and societal contributions of women in rural areas.

Developing a smartphone-based training strategy for tobacco control in India: a formative study using consolidated framework for implementation research

Priyanka Ghosh — 2025-09-30

Background: Tobacco free teachers-tobacco free society (TFT-TFS) is an evidence-based intervention (EBI) for making schools tobacco-free. Because scaling via in-person training has limitations, we conducted a formative study to develop a smartphone-based training strategy for TFT-TFS implementers in Madhya Pradesh (MP), India.

Methods: We conducted key informant interviews (KIIs), focus group discussions (FGDs), and school observation visits in four districts of MP, India. We applied framework analysis guided by the consolidated framework for implementation research (CFIR).

Results: Identified facilitators were from the domains: Innovation (a gamified Android app), outer setting (government campaigns, technological familiarity), inner setting (official permissions, WhatsApp groups, compliance with tobacco control guidelines, training feasibility), and individuals (smartphone access, implementers designated by principals). Barriers were from the outer setting domain, which included additional government tasks, smokeless tobacco use, alcohol consumption, pan masala advertisements by celebrities, and lack of statutory warnings on ‘over the top’ contents delivered over the internet.

Conclusions: Understanding contextual factors is crucial for successful program implementation. The contribution of CFIR was instrumental in tool development, data analysis, training design, and TFT-TFS implementation.

Sociodemographic status and health profile of scheduled tribes in West Tripura and Sepahijala district of Tripura, India: an observational study

Niral Sojeetra — 2025-09-30

Background: The scheduled tribe (ST) population of Tripura constitutes 31.76% of the total population of the state and is one of the most vulnerable groups in India. Despite various kinds of policies and programmes, they remain the most excluded and live in miserable conditions due to various factors such as geographical isolation, poor healthcare delivery systems, beliefs, and customs. The main aim of this study was to determine the socioeconomic status, living conditions, educational status, dietetic habits, lifestyles, prevalence of non-communicable diseases and other information of the scheduled tribe (ST) population.

Methods: The study was conducted in the four ST populated villages of west Tripura and Sepahijala district of Tripura from April 2020 to March 2021. Essential information was collected through door-to-door visits using a structured close-ended questionnaire format.

Results: A total of 1,299 households were surveyed, covering 7,014 individuals, including 2,639 males, 2,584 females, and 1,791 children. The survey revealed that 73.52% of the houses were Kutcha (temporary or semi-permanent structures). A significant proportion, 77.37% of households, relied on hand pumps as their primary source of drinking water. Open drainage systems were present in most households, while toilet facilities were available in the majority. Additionally, 38.74% of the population reported alcohol consumption.

Conclusions: Survey data indicates the need for improvements in basic infrastructure, sanitation, and access to safe drinking water, along with focused public health interventions to address the high rate of alcohol consumption within the surveyed population.

The role of hydroxychloroquine during the periconception period for recurrent miscarriage – a prospective observational study

Mamta Singh — 2025-09-30

Background: Recurrent miscarriage (RM) remains a significant clinical challenge with multifactorial etiologies, many of which are immunological or unexplained. Hydroxychloroquine (HCQ), an antimalarial with immunomodulatory properties, has shown promise in improving pregnancy outcomes in autoimmune conditions. However, its role in RM, particularly during the periconception period, has not been extensively explored. Objective was to evaluate the safety and efficacy of hydroxychloroquine administered during the periconception period in women with a history of recurrent miscarriage.

Methods: A prospective observational study was conducted on 160 women with a history of ≥3 miscarriages. Participants were administered 200 mg of HCQ daily for three months prior to attempting conception. Comprehensive clinical, hematological, and biochemical assessments were performed at baseline and during follow-up. Adverse events and pregnancy outcomes were recorded.

Results: A total of 115 women (71.9%) conceived following periconception HCQ therapy. Among them, 45.2% had full-term normal vaginal deliveries, 26.1% underwent cesarean sections, and 15.7% experienced preterm deliveries, while 13.0% had first-trimester losses. Most participants (75%) were asymptomatic during therapy, with 12.5% reporting mild gastrointestinal symptoms and 6.25% experiencing transient hepatic enzyme elevations. Laboratory parameters remained stable, with no significant deterioration. HCQ was well-tolerated overall, and no new infections or seroconversions were observed.

Conclusions: Periconception use of HCQ appears to be a safe and potentially effective therapeutic option in improving conception and pregnancy outcomes in women with recurrent miscarriage. Further randomised controlled trials are recommended to validate these findings.

Which school-based model produces adolescent advocates for tobacco prevention in rural Maharashtra? A quasi-experimental study

Rajashree Kadam — 2025-09-30

Background: India’s rising non-communicable disease (NCD) burden has prompted school-based health programmes that aim to build student health and students as advocates for healthy behaviours in communities. We compared two tobacco-prevention delivery models in government schools: teacher-only tobacco-free school (TFS) training versus TFS training plus an external facilitator to examine which one encouraged more student advocates.

Methods: Post-test-only quasi-experimental study conducted in four rural districts of Maharashtra. Teachers in two districts received TFS training, while two other districts received teacher training plus an external facilitator assigned for classroom delivery of health and hygiene sessions. Grade-8 students (n=1,348) from 50 schools (24 teacher-only, 26 teacher+facilitator) were surveyed. The primary outcome, “consistent commitment to advocacy,” required reporting “always” for awareness-raising with both family and community. Bivariate tests and logistic regression examined associations with knowledge, perceived TFS implementation, participation in activities, and self-efficacy (refusal, persuasion).

Results: Consistent advocacy was higher in teacher-only schools [49% (293/596)] than in teacher+facilitator schools [40% (302/752)]. In adjusted analyses, being in a teacher-only school, awareness of tobacco initiatives, higher perceived fulfilment of TFS criteria, and greater refusal and persuasion self-efficacy were independently associated with consistent advocacy (all p≤0.05). Sex and knowledge scores were not significant.

Conclusions: Teacher-led delivery of the TFS programme produced more consistently committed adolescent advocates. Training teachers to create health advocates/ambassadors may be a scalable approach for student-led tobacco and NCD prevention in the large-scale Ayushman Bharat government school-health program. Future research should explore mechanisms and assess impacts on actual tobacco use.

Prevalence of non-adherence to management plan and lifestyle advice among type 2 diabetes mellitus patients and its associated factors in rural north Kerala: a community based cross-sectional study

Remya Thattarath Kottayi — 2025-09-30

Background: The prevalence of diabetes mellitus is increasing especially in developing countries, along with rise in obesity and sedentary lifestyle. The complication due to diabetes are also leading to serious public health problem.

Methods: A community based cross sectional study conducted among 240 study participants with type 2 diabetes mellitus above 18 years in north Kerala. Four wards are selected by using cluster sampling. Data was collected by interview using semi structured questionnaire with scoring, then categorized as non-adherent and good adherent for medication, diet and physical activity.

Results: There were 240 study participants with mean age of 63±9.42 years. 63% were having comorbidity other than Diabetes, among them HTN (50.7%) was most common followed by dyslipedmia.62% were taking treatment from public health sector. The duration of diabetes between 5 years and 10 years were 42.1% (majority). 19% were having complication. Among the 240 study participants only 7% were non adherent to medication, 34.5% to diet and 51.2% to physical activity. There was a significant association noted among non-adherence to physical activity in elderly age group and those who take treatment from government hospital. Those who were non adherent to diet had an unsatisfactory blood sugar value. Patients with short duration of diabetes, employed and those with no comorbidities were non adherent to medication.

Conclusions: The study shows that only 7% participants are non-adherent to diabetic medication. But more than half of the participants are non-adherent to exercise and one third are non-adherent to diet.

A study to assess the knowledge, practice, and personal hygiene among respondents regarding childhood diarrhoea in a selected area of South Delhi, India: a cross-sectional study

M. Azam — 2025-09-30

Background: Diarrhoeal disease is a leading cause of morbidity and mortality among children under five, particularly in developing countries. Awareness of spreading, preventive measures, and healthy practices such as breastfeeding, immunization, and proper sanitation are essential to reduce this burden. This study aimed to assess knowledge, practices, and personal hygiene regarding diarrhoeal disease among caregivers of under-five children in South Delhi.

Methods: A community-based cross-sectional study was conducted from October 2019 to September 2020 among 493 randomly selected households with at least one child under five. A total of 460 respondents who met the inclusion criteria were enrolled. Data were collected using a structured questionnaire on socio-demographics, knowledge, practices, and hygiene. Analysis was done using SPSS version 23 with chi-square tests; p<0.05 was considered statistically significant.

Results: Among respondents, 46.3% were aware that tooth eruption is a cause of diarrhoea, while 72.8% and 79.3% attributed unsafe water and food exposed to flies as causes, respectively. Poor knowledge of vaccination was reported by 29.3%. During diarrhoeal episodes, 74.8% of respondents reported using the same or more water, whereas 25% reduced intake. Regarding hygiene, 84.1% practiced hand washing with soap after child’s faeces disposal, 90.7% after defecation, and 44.6% before cooking.

Conclusions: The practices of respondents were not proper in spite of their knowledge regarding diarrhoeal disease where whereas personal hygiene was performed better than practices. Therefore, health education should be utilized as a tool to promote knowledge, good practices, and personal hygiene, ultimately reducing morbidity and mortality.

Effects of digital devices usage in children

Vidhya Chandran — 2025-09-30

Background: Aim of study was to assess the impact of digital device use on ocular parameters in children.

Methods: A cross-sectional study was carried out wherein patients were grouped depending on the duration of use and the break in between the usage of digital devices. The impact of screen time and break time were correlated with symptoms of digital eye strain and various orthoptic abnormalities in these children.

Results: A total of 127 children were enrolled in the study. Most of the children had a screen time exposure of 4-6 hours (41.6%), while the most common finding in respect to orthoptic abnormality was fusional vergence dysfunction (33.9%). The common symptoms in children were headache (91.3%) and eye pain (61.4%). Most of the children took a break time of <10 minutes in an hour (69.3%). Mobile-based devices were associated with fusional vergence dysfunction and accommodative excess (AE) (p<0.001). The association between the break time and orthoptic dysfunction was statistically significant (p=0.001).

Conclusions: Increased screen time and reduced break time between screen usage in our study have been correlated with an increased incidence of orthoptic abnormalities and symptoms related to digital eye strain.

A cross-sectional study on socio-demographic status and status of non-communicable diseases among tribal community of Tamia block in Chhindwara district

Madan M. Sharma — 2025-09-30

Background: Madhya Pradesh hosts a large tribal population with diverse traditions and socio-demographic characteristics. Tribal communities across India are increasingly affected by non-communicable diseases (NCDs). This study aimed to assess the health status, socio-demographic profile, living conditions, and prevalence of NCDs among the tribal population in selected villages of Tamia block, Chhindwara district.

Methods: An observational cross-sectional survey was carried out between July 2021 and March 2022 (total 09 months) after approval from the Institutional Ethical Committee. A door-to-door household survey was conducted by the Institute’s team across 118 field visits, covering 5953 individuals from 1175 households.

Results: The surveyed population had nearly equal male–female distribution, with a higher proportion (28.1%) in the 18–30 years age group. Most households (75.8%) lived in kutcha houses, reflecting poor living conditions. The overall prevalence of anemia was high (54%), with females more affected (47.13%) than males (6.88%). Among NCDs, osteoarthritis (10.52%) was most common, followed by hypertension (5.96%). Access to basic amenities such as safe drinking water, cooking fuel, sanitation facilities, and proper drainage was inadequate. Open drainage systems and poor environmental hygiene further posed risks for disease spread.

Conclusions: The tribal population of Tamia block was found to have unsatisfactory living conditions, limited access to health and education facilities, and inadequate basic amenities, contributing to a higher disease burden. The findings highlight the urgent need for strengthening policies and programs focused on tribal welfare, with emphasis on education, sanitation, and prevention and control of NCDs.

A survey of factors influencing standards and outcomes of care for patients with diabetes mellitus attending the urban health centre and its community clinics in South India: a cross-sectional study

Ruby Angeline Pricilla — 2025-09-30

Background: Diabetes mellitus is a rising health challenge in south-east Asia and India in particular. The World Health Organization advocates for effective management of diabetes at the primary and secondary care centres. The first contact and longitudinal care of patients with diabetes should be effective to improve their health outcomes. This study was undertaken to determine the standard and outcome of care and the factors influencing them among patients with diabetes attending the low-resourced urban health centre (UHC) and its community clinics (CCs) in south India.

Methods: A cross-sectional study was done among adults with diabetes for more than a year. A structured questionnaire was used to collect data from 100 participants at the UHC and 200 from the CCs.

Results: The mean standard of care score was significantly higher (p=0.00001) at the CCs than at the UHC. Overall, the glycemic control was poor. Participants who were male (p=0.03), belonging to religion other than Hindu (p=0.03), on oral drugs (p=0.004) and no complications (p=0.02) had better glycemic control at the UHC. At the CCs, those with ≤ six years of diabetes (p=0.001), with ≤ five clinic visits (p=0.004), on oral drugs (p=0.01) and without complications (p=0.04) had better glycemic control.

Conclusions: Better glycemic control was noted among patients with lesser duration of diabetes, those without complications and those on oral hypoglycemics alone. The spectrum of challenges in improving standard of care in low resourced communities is beyond the implementation of clinical guidelines alone.

Prevalence and risk factors for type 2 diabetes mellitus in South India

Rajesh S. S. — 2025-09-30

Background: Diabetes mellitus is an iceberg disease. It has reached epidemic proportions globally. According to the World Health Organization, approximately 340 million people have diabetes mellitus worldwide. The prevalence rates have been estimated to be 12% in urban areas and 4% in rural areas. The objectives of the study were to identify the prevalence of type 2 diabetes mellitus in urban field practice area and to study risk factors for type 2 diabetes mellitus in urban field practice area.

Methods: This cross-sectional study was conducted in Mangalore. The study comprised 827 subjects. A pre-tested semi-structured questionnaire was used to collect the data regarding the socio-demographic profile, personal habits, and medical history. Capillary blood glucose estimation was done by using glucometer. Statistical analysis was performed using SPSS version 16.

Results: A total of 827 subjects were participated in the study. The socio-demographic characteristics of the study population showed that 390 (47.2%) were males and 437 (52.8%) were females. The overall prevalence of type 2 diabetes mellitus was 13.5%. Prevalence of diabetes was 15.6% among males and 11.7% among females. The prevalence among overweight and obese was 13.2% and 21.1% respectively. The prevalence among hypertensive subjects was 28.6%. Prevalence of diabetes among smokers was 18.6%. The prevalence of diabetes among alcohol users was 27.2%.

Conclusions: The prevalence of diabetes was slightly higher in comparison to earlier studies. Hence, it is necessary to take steps to implement primary and secondary prevention of diabetes.

A study of menstrual health perceptions, practices and prevalence of premenstrual symptoms in school-going adolescent girls in Chandigarh

Anuna Vinod — 2025-09-30

Background: Menstruation is a universal physiological process, yet it remains shrouded in cultural taboos and misinformation, particularly in low- and middle-income countries like India. These barriers contribute to poor menstrual health awareness and suboptimal hygiene practices, impacting adolescent girls’ physical and psychosocial well-being. This study aimed to assess menstrual health perceptions, practices, and the prevalence of premenstrual symptoms (PMS) among adolescent girls in government schools of urban Chandigarh.

Methods: A descriptive cross-sectional study was conducted among 100 adolescent girls (aged 15-18 years) attending two purposively selected government schools in urban sectors of Chandigarh. Data were collected using a structured questionnaire and analyzed using descriptive statistics and chi-square/Fisher’s exact test to explore associations.

Results: The mean age of participants was 15.4 years. Premenarche awareness was reported by 63%, with mothers and sisters as the primary information sources (64%). Only 19% had good perception scores, and 34% reported good menstrual hygiene practices. While 94% used sanitary pads and 63% changed pads at school, 66% reported food restrictions and hesitance to discuss menstruation with male family members. PMS were common: 67% reported headaches, 62% breast pain, and 59% experienced anxiety or tension. Poor maternal education was significantly associated with poor perception among daughters (p=0.040).

Conclusions: Despite good access to sanitary products and school-based hygiene facilities, substantial gaps persist in menstrual perception and practices. Cultural stigma, dietary restrictions, and limited awareness of PMS are prevalent. Targeted health education and supportive school environments are vital to improving menstrual health outcomes among adolescents.

Factors associated with delayed presentation for cataract surgery among patients with senile mature cataract in North Karnataka

Vivekanand Jivangi — 2025-09-30

Background: Cataract remains one of the preventable causes of blindness in India. Early intervention is important, as delay in surgery can cause more complicated preoperative and postoperative problems. Identifying patients who present late for cataract treatment is a common occurrence in our outpatient department (OPD). Local data on the determinants of late presentation for cataract surgery is lacking.

Methods: This is a cross-sectional study conducted for a period of four months in 206 patients with senile mature or hypermature cataracts attending for treatment at a tertiary care centre in North Karnataka, India. Patients were interviewed with the help of a structured questionnaire, and their answers were evaluated.

Results: 76.69% of the 206 patients were illiterate. 65% of the patients were rural residents, and all the patients had access to transport. The most frequent reason for late presentation to the hospital was lack of an accompanying family member/caretaker (24.27%), followed by good vision in the other eye (22.33%). Other reasons were fear of surgery (16.02%) and possible loss of income (12.62%).

Conclusions: A multi-faceted approach is needed to tackle these problems, involving community health education programmes, patient support systems, psychological counselling services, reducing financial constraints, and improving accessibility in ophthalmic cares.

Assessment of perceived stress and daytime somnolence in health science students in North India

Mohita Singh — 2025-09-30

Background: Recent studies have increasingly underscored the high prevalence of stress and sleep disturbances among medical students that adversely impacts their general well-being and academic performance. The present research was conducted with the aim to assess the perceived stress and daytime sleepiness levels in medical and paramedical students. Additionally, relationship between the two was also examined.

Methods: This cross-sectional study was conducted in 200 undergraduate students in the age group of 18-25 years, pursuing medical and paramedical courses at a government medical college in Karnal district, Haryana, north India. Perceived stress scale (PSS)-10 was used to evaluate the perceived stress level and Epworth sleepiness scale (ESS) to assess daytime somnolence. Association between study variables was determined using Pearson’s correlation analysis.

Results: Study sample encompassed 51% (n=102) females, 49% (n=98) males and had mean age of 20.46 (SD=1.47) years. 84% (n=168) of students reported moderate stress while 12% (n=24) demonstrated high stress levels. Around four out of five (n=159) experienced excessive level of daytime sleepiness. Pearson’s correlation analysis demonstrated a significant, positive (r=0.15, p=0.03) association between perceived stress and daytime somnolence.

Conclusions: Our findings were concerning as the prevalence of moderate to severe stress and excessive daytime sleepiness was found to be alarmingly high, regardless of gender. Also, daytime sleepiness showed positive relationship with perceived stress. There is an urgent need to identify and address these issues well in time.

Current pattern of use and barriers to implementation of eSanjeevani telemedicine services in Kerala, India

P. S. Nabil Rosh — 2025-09-30

Background: Kerala State in India presents a distinctive context for studying the implementation and impact of telemedicine, owing to its high levels of digital literacy and relatively well-structured public health infrastructure. This study analyses the adoption and utilization patterns of eSanjeevani, the national telemedicine service, examining both beneficiary and provider perspectives within the state of Kerala.

Methods: We conducted a survey among 300 eSanjeevani beneficiaries by covering details of socio-demographics, experiences, motivations for use, patterns of use and challenges. The in-depth interview of key informants assessed implementation challenges in both Outpatient Department and Health and Wellness Centre platforms. Univariate and bivariate analyses were performed for quantitative analysis, while qualitative data were thematically analyzed.

Results: Majority (75%) of the beneficiaries were satisfied with eSanjeevani services. However, 21.3% were unaware that the service’s continuation. Users appreciated time savings but reported system glitches, slow platform response, connectivity failures and interface difficulties. Younger, employed, college-educated males found the service easier to use. The findings from stakeholder perspectives highlight critical technical, operational and policy challenges affecting the effective implementation of eSanjeevani. Stakeholders recommended integrating eSanjeevani with national health programs, expanding awareness and improved training for healthcare providers, particularly in mental health services.

Conclusions: eSanjeevani has strong potential to expand healthcare access in Kerala, but challenges remain for more awareness on continuity of the services. Efforts to enhance digital skills and address healthcare professionals' concerns are key to ensuring equitable and sustained use of the platform.

Prevalence of anxiety disorder among undergraduate medical students: a cross-sectional study

Janani Subramanian — 2025-09-30

Background: It is widely acknowledged that medical colleges are stressful places that frequently have a detrimental impact on students academic performance, physical, mental health and psychological well-being. Depression, anxiety, stress, are very common among them. The objective of the study was to estimate the prevalence of anxiety disorder among undergraduate medical students, and to study the relation of anxiety disorders with sociodemographic factors.

Methods: A cross-sectional, descriptive study was conducted among undergraduate medical students of Gulbarga Institute of Medical Sciences, Kalaburagi for 2 months from September to October 2024. For the study 600 students from 1^st year to 4^th year (final year) were selected using convenience sampling method using Google form. General anxiety disorder-7(GAD-7) was used for assessing the level of anxiety among undergraduate students.

Results: Among 474 medical students who participated in our study, the prevalence of anxiety disorder was found among 171 students (36%). The prevalence of anxiety was more among students studying 1^st year (43.5%), 4^th year (41.4%) and low prevalence was seen among 2^nd year students (30.2%). Among 171 students who were having anxiety disorder, 66% of students were having mild anxiety, 29% were having moderate anxiety and 4.70% were having severe anxiety. There was a significant association seen between anxiety disorder and some socio-demographic factors like family size and age.

Conclusions: With regular psychiatric evaluation and counselling for medical students in the initial stage we can detect the presence of any mental disorders and provide them immediate treatment early.

Attitude of MBBS students towards opting for the medical profession in colleges of Uttarakhand

Amit Mittal — 2025-09-30

Background: Medical profession is considered as the most highly rated profession. Many students join the medical profession by their own interest but some join under parental or peer pressure. The current study was carried out to find out the reasons for choosing medical profession as career among the medical college students.

Methods: This cross-sectional study was carried out among phase I medical students (batch 2024) from all over the state of Uttarakhand through a predesigned and pre validated questionnaire. Google form was circulated through social media platform to phase-I MBBS students of Uttarakhand. Data entry and analysis were done by using Microsoft Excel and Chi square test of association was used.

Results: Out of 314 students enrolled in the study maximum 85.4% were in the age group of 17-20 years. Majority 79.6% of students have chosen self-interest for their profession as the reason for choosing MBBS as their career. Only female students chose obstetrics and gynecology as their preferred specialty and this association was statistically significant (p=0.0236).

Conclusions: Self-interest was the most common reason for choosing the medical profession as career. Most students planned to specialize in surgical and medicine branches. A follow-up study would be useful to identify further trends in career choices as well as in choosing specialties because it is observed that their interests in specialities change due to one reason or another.

A study on knowledge, attitude and practice of hand hygiene among medical students at a tertiary care center in Indore

Bharat Singh — 2025-09-30

Background: Hand hygiene is a critical global healthcare issue and a proven cost-effective measure to reduce healthcare-associated infections. Assessing awareness and compliance among healthcare workers is therefore essential. Aim was to evaluate the knowledge, attitude, and practice (KAP) of hand hygiene among final-year medical students and its association with selected variables.

Methods: A cross-sectional study was conducted among 270 final-year medical students at a tertiary care teaching hospital in Indore, central India. Knowledge, attitude, and practices related to hand hygiene among previously trained and untrained participants were assessed using a self-administered questionnaire, including the WHO hand hygiene knowledge assessment tool. Data were entered into Microsoft Excel and analyzed using the Chi-square test. A p value <0.05 was considered statistically significant.

Results: Overall, participants demonstrated moderate knowledge, attitude, and practice of hand hygiene. Among trained students, 55.7% had adequate knowledge compared to 49.6% of untrained students. Similarly, a positive attitude was observed in 61% of trained versus 51.7% of untrained students. Practice compliance was also higher among trained participants (59.5%) than untrained ones (56.8%). Although both groups showed moderate responses, trained students consistently outperformed untrained peers.

Conclusions: The study highlighted the need for rigorous and comprehensive training programs on hand hygiene. Regular reinforcement of hand hygiene techniques can motivate medical students and ensure they remain updated on current best practices. Effective training during medical education may significantly improve compliance and reduce healthcare-associated infections.

Perspectives on hemorrhoids and their management among gastroenterologists across India: findings from in-clinic questionnaire-based survey studies

Harshad Khairnar — 2025-09-30

Background: Hemorrhoids are associated with bleeding, pain, itching, exudation and swelling with a high increasing prevalence, hence the current survey was designed to assess the real-world perspectives of demographic characteristics and practical approaches utilized by Gastroenterologists in managing hemorrhoids and bleeding hemorrhoids with a focus on Euphorbia prostrata (EP) and its combinations.

Methods: Two real-world in-clinic observational surveys, which utilized digitally enabled questionnaires for data collection, were conducted between January and March 2023 and July and September 2023, involving 325 Gastroenterologists from various regions of India.

Results: 40% of gastroenterologists managed 10 to 20 cases of bleeding hemorrhoids per month, while the patients suffering from various grades of hemorrhoids were Grade 1 (25%), Grade 2 (45%), Grade 3 (20%) & Grade 4 (10%), with bleeding (85%), pain (82%) as major sign and symptoms. In bleeding hemorrhoids, the thrombosed complication was higher, i.e., 59.75%, as compared to hemorrhoids patients. The notable role of EP was reduction in 67% bleeding, 57% pain with wound healing in 78% of patients. Further in bleeding hemorrhoids combination of flavonoids plus calcium dobesilate was most preferred (96.28%), which corelated to the usage of EP plus calcium dobesilate in clinical practice with its high effectiveness (73.07%) in bleeding hemorrhoids.

Conclusions: Hemorrhoids are the most prevalent diagnosis among patients treated by Gastroentrologist. EP is the most commonly used drug for the treatment of hemorrhoids, while EP plus calcium dobesilate, being the preferred combination in management of bleeding hemorrhoids.

Study of new onset hyperglycemia and insulin resistance in COVID-19 patients

Azhar Qureshi — 2025-09-30

Background: COVID-19 has been associated with new onset hyperglycemia and insulin resistance, even in patients without pre-existing diabetes. This study aimed to evaluate the prevalence and characteristics of new onset hyperglycemia and insulin resistance in COVID-19 patients.

Methods: This case-control study included 90 COVID-19 patients admitted to Era’s Lucknow Medical College and Hospital. Patients were divided into a case group with new onset hyperglycemia (n=57) and a control group with normoglycemia (n=33). Fasting blood glucose, post-prandial glucose, HbA1c, fasting insulin, and HOMA-IR were measured. Disease severity and outcomes were also assessed.

Results: The prevalence of new onset hyperglycemia was 61.1% among COVID-19 patients. The case group had significantly higher mean fasting glucose (132.11 versus 90.43 mg/dl, p<0.001), post-prandial glucose (212.53 versus 157.91 mg/dl, p<0.001), HbA1c (5.86% versus 4.03%, p<0.001), fasting insulin (9.24 versus 7.67 μU/ml, p=0.004), and HOMA-IR (2.99 versus 1.72, p<0.001) compared to controls. Insulin resistance was present in 71.9% of cases versus 0% of controls (p<0.001). There was no significant difference in disease severity or mortality between groups.

Conclusions: New onset hyperglycemia and insulin resistance are common in COVID-19 patients, even without pre-existing diabetes. This metabolic dysregulation may contribute to worse outcomes and requires further study. Glucose monitoring and management should be considered in all hospitalized COVID-19 patients.

District health governance to improve service delivery of tea garden hospitals in selected districts of Assam: drivers of change

Tapashi Adhikary — 2025-09-30

Background: Decentralized governance across different tiers of healthcare delivery has proven to yield positive outcomes globally. To strengthen governance and improve service delivery in PPP Tea Garden Hospitals (TGHs), District Task Force (DTF) committees were instituted across selected districts in Assam. This study examines how DTFs influenced health service delivery using the World Development Report 2017 framework, focusing on credible commitment, coordination, and cooperation.

Methods: A qualitative study was conducted across four districts in Assam namely Dibrugarh, Sivasagar, Jorhat, and Golaghat. Data collection included observation of DTF meetings and 23 in-depth interviews with key stakeholders in tea gardens. Data were analyzed thematically and triangulated across sources.

Results: DTFs enhanced credible commitment through active participation of district administration, improving accountability and transparency in TGH operations. Coordination among NHM block officials and TGH staff was facilitated through structured reporting tools. However, inconsistent participation from non-health sectors and tea garden management limited cooperative efforts.

Conclusion: DTFs have emerged as a promising model for decentralized, multi-sectoral health governance in Assam’s tea garden areas. Formalizing DTF protocols, incentivizing stakeholder participation, and addressing inter-departmental gaps can further enhance their effectiveness and scalability.

Efficacy of Artocarpus heterophyllus leaf extract mouthwash in gingivitis subjects: a clinico microbiological study

Nagaraj B. Kalburgi — 2025-09-30

Background: Gingivitis is the inflammatory disease of gingiva that supports the teeth. The prevailing belief regarding the cause of gingivitis is the toxins produced by anaerobic bacteria in oral cavity particularly that cause the formation of plaque. The tropical climacteric fruit Artocarpus heterophyllus, commonly known as jackfruit possess anti carcinogenic, antimicrobial, antifungal, anti-inflammatory, wound-healing and hypoglycaemic properties. Hence the objective of this study is to evaluate clinical parameters at baseline and 21 days post non-surgical periodontal therapy after the use of jackfruit leaf extract mouthwash and to evaluate the colony count of P. gingivalis in plaque samples at baseline and 21 days after the use of jackfruit leaf extract mouthwash.

Methods: A total of 30 gingivitis subjects were selected and divided randomly into group A and B. Group 1, non-surgical periodontal therapy alone (15). Group 2, non-surgical periodontal therapy followed by jackfruit leaf extract mouthwash (15). The supra gingival plaque samples were collected from both the groups at baseline and 21 days post non-surgical periodontal therapy.

Results: Significant reduction in clinical parameters and colony count of P. gingivalis after the use of Artocarpus heterophyllus mouthwash.

Conclusions: Jackfruit leaf extract mouthwash has better promising effect on inflammation in gingivitis subjects when compared to gingivitis subjects with non-surgical periodontal therapy alone.

An open label, prospective, observational study on role of homoeopathic medicine in geriatric age group of patients and its analysis using Barthel index

Sunita Tomar — 2025-09-30

Background: An ordinal scale called the Barthel scale is used to measure how well people conduct activities of daily living (ADL). The likelihood of being able to live at home with some degree of independence increases with a higher score. A study on elderly patients aged 60 to 80 with a variety of illnesses, including dementia, osteoarthritis, benign prostatic hyperplasia, hypertension, diabetes mellitus and stroke, was carried out at Government Homoeopathic Medical College and Hospital in Bhopal, Madhya Pradesh.

Methods: To study the role of homoeopathic medicine in geriatric group of patients and its analysis using Barthel Index. It was observational, individualistic, descriptive study.

Results: A total of 944 patients were included in the study and after the statistical analysis of data the paired samples t-test results show that there is a statistically significant difference between the "AFTER" and "BEFORE" measurements, with the "AFTER" measurements being significantly higher. The results suggest a highly significant difference between the two groups being compared, with a large effect size. The extremely small p-value (4.076 × 10-151) indicates that the observed difference is very unlikely to have occurred by chance if the null hypothesis were true.

Conclusions: It is concluded that homoeopathic medicine seems to be efficacious in treating and managing various kinds of ailments in geriatric group of patients like dementia, osteoarthritis, benign prostatic hyperplasia, hypertension, diabetes mellitus, stroke etc. using Barthel index scoring.

Behavioural and socio-emotional issues among primary school students and their association with academic performance: a descriptive cross-sectional study using strength and difficulties questionnaire

Pragadeeshwer S. — 2025-09-30

Background: Behavioural and socio-emotional challenges are vital in shaping students’ academic performance and overall development. Understanding these issues early can guide targeted interventions, helping students succeed academically and emotionally. This study investigated the prevalence and impact of these challenges among primary school students.

Methods: To estimate the prevalence of emotional problems, conduct problems, hyperactivity-inattention, peer problems and pro-social behaviour among primary school students. To assess the association of the above factors with their academic performance. To assess the gender differences in mental health status among primary school students. Using the teachers- strength and difficulties questionnaire (T-SDQ), a descriptive cross-sectional study was carried out on 450 primary school students. Data on socio-demographics, domain-specific impairments, and academic performance were obtained. The objectives were evaluated through prevalence rates, correlation analysis, and independent samples t-tests. The relationship between SDQ parameters and academic performance was analysed.

Results: As per SDQ questionnaire Total score, 48% of the students reported with slightly raised difficulties, and 27.33% had very high difficulties. A statistically significant negative correlation (r=−0.29, p<0.001) was found between the total difficulties score and academic performance. Gender analysis revealed higher total difficulties scores in males than females (t=6.59, p<0.001).

Conclusions: The study highlighted the prevalence of socio-emotional and behavioural difficulties among primary school students and how these challenges negatively influence their academic outcomes. The results emphasize the SDQ as a valuable tool for assessing students at risk and aiding the development of targeted educational and psychological support interventions.

Prescription patterns and clinical perspectives on intranasal corticosteroids in allergic rhinitis: insights from a nationwide survey of ENT specialists in India

Gayatri S. Pandit — 2025-09-30

Background: Allergic rhinitis (AR) is an atopic disorder that presents with symptoms like nasal congestion, watery nasal discharge, sneezing, postnasal drip, and nasal itching. The worldwide prevalence of AR is about 10% to 25% and in children the prevalence rate is up to 40%. In India, around 20-30% of the population suffers from AR. The objective of this survey was to assess knowledge, attitude, and prescription patterns of intranasal corticosteroids (INCS) in the management of AR among ear-nose-throat (ENT) specialist in India.

Methods: A cross-sectional, real-world, in-clinic survey was conducted among 625 ENT specialists across India from August 2024 to October 2024. The respondents were administered a validated 30 questions survey.

Results: In the survey, 62.24% of ENT specialists consistently prescribe INCS for AR management, with 84.48% of them prefer fluticasone furoate. Most specialists (69.12%) prescribe INCS for a duration of 1 to 3 months, and 50.88% always use INCS for seasonal AR. Around 55.52% consider age as a key factor while prescribing INCS. For elderly patients 80.96% of the specialist preferred fluticasone furoate. Additionally, 89.12% believe INCS are the most effective AR treatment, and 76.00% routinely educate patients on proper nasal spray techniques.

Conclusions: The survey suggests that INCS are the top choice among ENT specialists for treating AR due to their efficacy and safety. Among the INCS, fluticasone furoate was the most preferred molecule. INCS play a key role in enhancing patients’ quality of life and delivering positive clinical outcomes.

Incidence and trends of cancer in Goa, India: a single center retrospective study

Chitralekha A. Nayak — 2025-09-30

Background: Cancer incidence and mortality are major global health concerns influenced by lifestyle, environment, and healthcare access. This study analyzed cancer trends in Goa, India, and estimates cancer incidence from 2019 to 2024. With India facing a high cancer burden impacting its workforce and healthcare, the study examines the socio-demographic profiles of cancer registry patients, providing insights into regional cancer patterns.

Methods: This retrospective study, conducted at a tertiary care hospital analyzed data from the cancer registry over five years (April 2019 to March 2024), including histopathologically confirmed cancers. Demographic data, cancer types, and treatment details were collected. Cancer trends were analyzed by year, gender, and age group using descriptive statistics and time series analysis.

Results: Data from 570 cancer cases revealed a crude incidence rate of 39.14 per 100,000. The male-to-female ratio was 1.35:1, with 57.37% males and 42.63% female cases. The highest prevalence was in ages 60-70 (27.4%) and 70-80 (26%). Common cancers were breast (26.85%) and colon (19.09%) cancer. Tiswadi and Bardez regions had the highest cases, contributing 30.53% and 30%, respectively.

Conclusions: The study highlighted a rising cancer trend in Goa, with a higher prevalence among older adults and females, particularly for breast, colon, and oral cancers. These findings emphasize the need for enhanced screening programs, early detection, and targeted interventions to mitigate the cancer.

Parental perspectives on typhoid vaccination: knowledge, awareness, and acceptance in Mysuru district: a cross-sectional study

Shweta Neminath Kurkuri — 2025-09-30

Background: Typhoid fever remains a persistent public health burden in India, with school-aged children at highest risk. Although the typhoid conjugate vaccine (TCV) has been recommended for inclusion in India's universal immunization programme (UIP), public acceptance remains a challenge. The study aims to assess parental knowledge, awareness, and acceptance of typhoid vaccination, and to identify socio-demographic factors influencing these domains.

Methods: A community-based cross-sectional study was conducted among 385 parents/guardians of children aged 6 months to 15 years in urban and rural areas of Mysuru between October and December 2024. Data were collected using a pre-tested semi-structured questionnaire covering socio-demographic factors, knowledge of typhoid fever, awareness of typhoid vaccines, and vaccine acceptance. Descriptive statistics were used, and associations were tested using chi-square analysis.

Results: Out of 385 participants, 53% were aware of typhoid fever and 51.43% were aware of the vaccine. While 35.32% believed the vaccine was effective, 57.4% were unwilling to vaccinate their children. Fear of side effects (26.7%), cost (19.91%), and lack of awareness (17.19%) were key reasons for vaccine refusal. Only 17.14% had vaccinated their children. Preventive practices, such as maintaining clean sanitation (89.87%) and handwashing (37.14%), were more widely adopted. A significant association was found between age and reasons for vaccine refusal (p=0.0234).

Conclusions: Despite moderate awareness about typhoid fever and its vaccine, vaccine acceptance and uptake among parents in Mysuru remain low. Fear, misconceptions, and lack of knowledge are major barriers. Strengthened health communication, trust-building, and accessible immunization services are essential to bridge the gap between awareness and practice and to enhance the success of typhoid vaccination programs in endemic regions.

Awareness and attitude regarding human papilloma virus, its vaccine and HPV vaccination acceptability among medical undergraduate students in Central India

Priyanka Shegokar — 2025-09-30

Background: India is a major contributor to the global burden of human papilloma virus infection. Cervical cancer is the leading cause of death globally as well as in India. Highest prevalence observed among adolescents and young adults. Vaccination against HPV is an important mode of primary prevention against cervical cancer. As future healthcare providers, medical students can significantly influence community perspectives and HPV vaccine adoption; thus, cultivating the right mindset in them is essential to expedite its implementation for societal benefit.

Methods: A cross-sectional study was conducted among 524 medical undergraduate students in government medical college. Data was collected using a pre-designed semi-structured self- administered questionnaire, entered into Microsoft Excel, and analysed.

Results: The study of 524 medical undergraduates in central India found that while most participants (75.95%) were aged 19-24 and predominantly female (58.78%), awareness of HPV and its vaccine was moderate. Although cervical cancer and genital warts were commonly recognized as HPV-related, knowledge of other associated cancers was limited. Nearly 29% were unaware of any HPV vaccine. High vaccine cost (50%) and limited awareness (20%) were key barriers to uptake, highlighting the need for improved education and affordable access.

Conclusions: This study found moderate but insufficient awareness of HPV and its vaccine among medical students in Central India. Many lacked knowledge of HPV-related cancers and vaccines like Gardasil-9, with cost and access as major vaccination barriers. Strengthening education is essential to improve vaccine uptake and reduce HPV-related disease burden.

Assessing geriatric nursing competence in acute urban hospitals in India: a multicenter cross-sectional study

Vinit Kumar Ramawat — 2025-09-30

Background: The growing elderly population in Indian hospitals underscores the need for geriatric nursing competence, even in non-specialized acute care wards. However, structured geriatric training remains uncommon in these settings. Aim was to assess geriatric nursing competence among acute care nurses in urban India and identify key influencing factors such as training, clinical experience, and institutional support.

Methods: A cross-sectional study was conducted among 210 registered nurses across three tertiary care hospitals in Delhi NCR. The geriatric nursing competence scale (GNCS) assessed four domains of competence. ANOVA and multiple regression identified associations with demographic and professional variables.

Results: Participants had a mean age of 29.6 years; 85% were female, and 60% had no prior geriatric training. The mean GNCS score was 3.2/5. Higher scores were noted in physical assessment (3.8) and medication safety (3.6). Lower scores were observed in communication and psychosocial care (2.7), interdisciplinary collaboration (2.9), and end-of-life care (2.8). Significant predictors included prior geriatric training (β=0.32, p<0.01), clinical experience (β=0.28, p<0.01), and institutional support (β=0.21, p<0.05).

Conclusions: Targeted training and institutional reforms are urgently needed to address cognitive, collaborative, and end-of-life care gaps.

Prevalence of anemia among women in reproductive age group employed in garment factories in Bengaluru urban: a cross-sectional study

Indu M. — 2025-09-30

Background: Anemia is a major global public health concern, particularly affecting women of reproductive age. Occupational settings like garment factories may pose additional risks due to poor working conditions, nutritional inadequacies, and workplace-related health hazards. India has the highest burden of anemic women globally, with over half of reproductive-age women affected.

Methods: A cross-sectional analytical study was conducted among women aged 15-49 years working in garment factories in Bengaluru Urban. Multi-stage cluster sampling was used to select participants. Data was collected through structured interviews, anthropometric measurements, and hemoglobin estimation using the digital hemoglobinometer method. Anemia was defined as hemoglobin levels <12.0 gm/dl according to WHO criteria. Statistical analysis included descriptive statistics and multivariable logistic regression to identify associated factors.

Results: The overall prevalence of anemia was found to be 71.3%, with 37.2% having mild anemia, 52.9% moderate anemia, and 9.8% severe anemia. Significant risk factors included low socioeconomic status, inadequate dietary intake, long working hours, and poor workplace conditions.

Conclusions: Anemia prevalence among female garment workers in Bengaluru urban area was substantial, indicating an urgent need for targeted interventions focusing on nutritional supplementation, improved workplace conditions, and comprehensive occupational health programs.

Anxiety, perceived mental healthcare need and coping strategies regarding COVID-19 pandemic among pre-university students at Bangalore: a cross-sectional study

Sowmya A. V. — 2025-09-30

Background: Although the COVID-19 pandemic has declined, cases still occur in some countries, continuing to cause concern. This situation affects not only health but also academic progress especially among students. Public health measures such as social distancing, while necessary, have contributed to isolation, stress and anxiety, thereby significantly impacting global mental health. To assess the impact of the COVID-19 pandemic on anxiety, coping strategies and perceived mental health care needs among pre-university students.

Methods: An institutional-based descriptive cross-sectional web survey was conducted in May to June 2020 among 30 pre-university students selected through non-probability convenience sampling. Students with internet access who were willing to participate were included, while those who were seriously ill or unable to cooperate were excluded. Data were collected online using Google Forms with a semi-structured questionnaire.

Results: The results showed that the majority of pre-university students, 63.3% (n=19), demonstrated a high level of coping strategies, while 36.7% (n=11) had a moderate level. The overall mean score was 52.5 with a standard deviation of 5.8. No significant association was found between the levels of anxiety, perceived mental health care needs and coping strategies related to the COVID-19 pandemic with their selected demographic variables. Conclusions: Our study revealed that most pre-university students experienced high anxiety, with equally high perceived mental health care needs and coping strategies. To support psychological adaptation, students should have access to programs like seminars and team-building activities. Adopting proper coping methods, stress management skills and international guidelines can help mitigate stress and anxiety.

Immunization coverage, quality, and socio-demographic determinants: a cross-sectional study of children aged 0-24 months in Pune slums under the National Immunization Programme

Surjit Singh Gangwar — 2025-09-30

Background: Immunization is an established and effective method for controlling and even eradicating diseases. However, despite decades of commitment to achieving universal coverage, the current vaccination rates for EPI vaccines remain incomplete. Immunization is a cornerstone of global health and development, playing a crucial role in achieving the SDGs, particularly SDG 3. Aim and objectives were to assess immunization coverage, quality, and socioeconomic demographic determinants with it among 0-24 months children.

Methods: This community-based, descriptive cross-sectional study was conducted from January 2023 to July 2024 at the urban health centre under the department of community medicine. The study included all 179 children aged 0-24 months residing in the slums of the urban field practice area. Data analysis was performed using SPSS software version 23 and Microsoft Excel.

Results: 164 (91.62%) study subjects were fully immunized and 15 (8.38%) were partially immunized. Proportion of study subjects fully immunized differs significantly from those partially immunized with respect to type of family, education and occupation of mother. No significant association was observed between gender, religion, socioeconomic scale, immunization card and birth order of child with immunization status.

Conclusions: The study concluded high immunization coverage among children in the slums of Pune Cantonment. However, areas for improvement still exit, particularly in addressing partial immunization and ensuring that all children receive complete protection against vaccine-preventable diseases. There is need to evaluate different aspects of religion and socioeconomic status which are responsible for significant difference in immunization coverage.

Why rural communities in India delay seeking eye care

Maneck D. Nicholson — 2025-09-30

Background: The purpose of the study was to assess the willingness to use eye care services among individuals with self-reported visual difficulties in rural Maharashtra, and to identify demographic and psychosocial factors influencing service uptake.

Methods: A cross-sectional survey was conducted among participants with visual complaints during rural outreach camps. Data on sociodemographic characteristics, duration of visual symptoms, and willingness to utilize various eye care services were collected. Logistic regression was used to evaluate associations between demographic variables and the desire to use each service.

Results: While willingness to undergo an eye examination was high (91.6%), the uptake of treatment services was significantly lower: 67.4% for eyeglasses, 56.7% for medications, and 58.5% for surgery. Older age, longer symptom duration, and unemployment were negatively associated with willingness to use eyeglasses. Literacy and employment status showed no consistent link with willingness to accept surgery or medications. Notably, no demographic variable strongly predicted willingness for surgery, indicating that broader awareness and perception-related barriers are influential.

Conclusion: Despite the availability of free services, a significant number of individuals with visual complaints remain hesitant to seek treatment particularly surgery and medications. These results underscore the importance of targeted educational efforts, community awareness programs, and trust-building initiatives to promote service utilization among underserved populations.

Assessment of knowledge and practice of nurses regarding infection prevention and associated factors at Maharana Bhupal Government Hospital, Udaipur, Rajasthan, India

Mohammed Shaquib Aslam — 2025-09-30

Background: Healthcare-associated infections (HAIs) are common complications during medical care. Poor infection prevention practices significantly contribute to the spread of various diseases, particularly in healthcare settings. Effective infection prevention and control (IPC) measures are crucial to protect patients and healthcare workers (HCWs). This study aims to assess nurses knowledge, adherence to infection prevention and associated factors at Maharana Bhupal government hospital, Udaipur.

Methods: It was a hospital based cross-sectional study conducted among 219 nurses for a period of 3 months after IEC approval. A stratified random sampling technique with a pre-tested structured self-administered questionnaire was used to collect data. A multivariable logistic regression model was fitted to identify factors associated with the knowledge and practice of nurses regarding infection prevention.

Results: The study shows that overall knowledge and practice of nurses regarding infection prevention are 60% and 58.4% respectively. Older age, more work experience, and higher levels of education were strongly linked to both knowledge and practice of infection prevention. In-service training, access to infection prevention supplies and compliance with its guidelines were found to be associated with better practices.

Conclusions: More than half nurses had good knowledge and practices. Knowledge and practice were linked to work experience, training, and education level. Adherence to national protocols is crucial, and policy makers should offer training to improve infection prevention. Future research should include qualitative studies.

Evaluation of clinicians’ perspectives and approaches to the challenges in the management of diabetes mellitus in tribal population: a cross-sectional, observational pilot study

Sukant Pandit — 2025-09-30

Background: Management of diabetes mellitus in tribal population poses unique challenges due to their distinct socio-cultural fabric. Understanding clinicians’ perspectives and their approach is crucial for effective management strategies. Objective was to study clinicians’ perspective and approach to managing the challenges in treatment of diabetes mellitus (DM) in tribal population.

Methods: A cross-sectional observational pilot study was conducted with 50 clinicians treating minimum of 5% tribal patients. Data collected using a validated semi-structured questionnaire via Google forms, focusing on challenges related to comprehension, communication and compliance, alongside open-ended questions for potential solutions.

Results: 50 clinicians participated, with median clinical experience of 4 years. The median estimated prevalence of diabetes was 20% with 15.2% patients attending regular follow-ups. Tribals preferred non-allopathic treatments, with Ayurveda being the most favoured (76%). Healthcare-workers (70%) were primary source of health-related information. Major challenges included lack of follow-ups (78.3%) and low awareness (66%). Language barrier (28%) leading to extended counselling time (26%) were predominant communication issues. Metformin and glimepiride were the most prescribed medications due to their free availability from government programs. Moderately positive correlation (0.515) was observed between follow-up and awareness. Clinicians suggested increased community health programs (32%), ensuring adequate drugs and glucometers (26%) as some solutions.

Conclusions: The study highlighted various challenges faced in the management of diabetes in tribal population. Language barriers, low medication adherence, disease awareness and negligent approach are critical barriers. Community educational initiatives, improved diagnostic availability, and improving awareness may help in mitigating these challenges.

Assessing long-term impact of soft drinks and acidic beverages on dental health

Abdulaziz Fareed Alsulaimani — 2025-09-12

Soft drinks and acidic beverages are immensely widespread, raising questions about potential long-term effects on dental health. Their high sugar content and acidic makeup demineralize enamel, erode teeth, and increase the risk of cavities. Frequent consumption weakens tooth structure and promotes bacterial growth, which accelerates decay. Due to the extensive marketing and accessibility of these drinks, their consumption has increased, especially among younger people, raising concerns about dental health. With a focus on caries development, erosion mechanisms, and preventative measures, this review examines recent studies on the effects of these beverages. Peer-reviewed research from 2016 to 2024 was selected after a comprehensive literature search using PubMed, Web of Science, and Google Scholar. The review assesses the effects of several variables on enamel deterioration and cavity formation, including pH levels, sugar content, and frequency of consumption. Important tactics like applying fluoride, altering one's diet, and using protective coatings are being researched to reduce damage. New developments in dental care, such as protective dental coatings and remineralization procedures, are also investigated as possible ways to lessen the negative effects of acidic and soft drinks. To protect long-term dental health, the results highlight the need for greater awareness and legislative measures to support better oral hygiene practices and healthier beverage choices.

Progesterone therapy in the prevention of pregnancy loss

Amani A. Altaiam — 2025-09-30

Pregnancy loss, including early miscarriage and recurrent pregnancy loss (RPL), is a significant concern in reproductive health. Progesterone, a key steroid hormone, plays a critical role in preparing the endometrium, modulating immune tolerance, and maintaining uterine quiescence. This narrative review explores the current evidence on the mechanisms of progesterone action, its clinical efficacy in preventing pregnancy loss, available routes of administration, international guideline recommendations, and emerging therapeutic strategies. Randomized controlled trials (RCTs) notably the progesterone in spontaneous miscarriage (PRISM) and progesterone in recurrent miscarriage (PROMISE) studies-have demonstrated mixed results, with benefits more apparent in women with a history of RPL and those experiencing early pregnancy bleeding. These findings are supported by recent meta-analyses, which suggest that treatment success may depend on proper patient selection and timing of intervention. Among administration methods, vaginal progesterone remains the preferred route due to its targeted endometrial effects and reduced systemic side effects. However, oral dydrogesterone, a synthetic progestin, has shown potential in improving patient adherence. Recommendations from major clinical guidelines including those from the National Institute for Health and Care Excellence (NICE), the American College of Obstetricians and Gynecologists (ACOG), and the International Federation of Gynecology and Obstetrics (FIGO)-differ slightly based on interpretation of available data and individualized care approaches. Emerging directions include novel synthetic progestins with enhanced receptor specificity, combination regimens incorporating progesterone with surgical or immunologic therapies, and biomarker-guided approaches involving serum progesterone and progesterone-induced blocking factor (PIBF) levels. Advances in genetic and molecular profiling offer further potential for personalized medicine. Further research is warranted to refine patient selection, establish standardized protocols, and ultimately improve pregnancy outcomes

Oxidative stress and its contribution to chronic periodontal inflammation

Ayman M. Albalbisi — 2025-09-30

Periodontal disease is a group of diseases that affect the tissues that support the teeth. It is among the most prevalent oral diseases worldwide. Various mechanisms contribute to the pathogenesis of chronic periodontal inflammation, including oxidative stress. Oxidative stress leads to the production of reactive oxygen species (ROS), both exacerbating inflammatory reactions and worsening the health of gums and surrounding tissues, thus increasing disease severity. In addition, oxidative stress is a key factor mediating the influence of periodontitis on systemic diseases. However, the role of oxidative stress in the pathogenesis of chronic periodontal inflammation is unclear. This review aims to discuss the mechanisms through which oxidative stress contributes to chronic periodontal inflammation. Chronic periodontitis leads to continuous activation of polymorphonuclear neutrophils, which may be hyperactivated, resulting in overproduction of ROS and exacerbation of oxidative stress. Oxidative stress results in intracellular damage of proteins, lipids, and DNA, along with connective tissue destruction and bone resorption. Oxidative stress biomarkers, such as malondialdehyde and hydrogen peroxide, are closely linked to the development and severity of periodontitis. Antioxidants, such as vitamin C, vitamin E, and glutathione, can play a key role in the prevention and treatment of chronic inflammatory diseases, including periodontitis. Periodontitis also contributes to systemic diseases, such as cardiovascular diseases, diabetes mellitus, chronic kidney diseases, and liver diseases, via mechanisms, including systemic inflammation and oxidative stress. Future research should focus on clarifying oxidative stress molecular pathways in chronic periodontal disease, improving antioxidant-based therapies, and integrating personalized approaches through genomics and biomarkers.

Beyond the surface: understanding dentine hypersensitivity through literature and expert opinion

Swati Nehete — 2025-09-30

Dentine hypersensitivity (DH) is a prevalent condition marked by acute, transient pain resulting from exposed dentine, which can severely impact a patient’s quality of life and daily activities. The transient and often underreported nature of DH complicates both diagnosis and management. This expert opinion addresses current diagnostic and therapeutic approaches for DH, with a specific focus on practices within Indian clinical settings. Diagnosis necessitates a detailed patient history, clinical examination and the application of various stimuli to confirm hypersensitivity whilst excluding other dental pathologies. Enhanced diagnostic protocols and advancements in biomaterials are crucial for optimizing DH management and improving patient outcomes. The experts discussed current clinical practices and future directions in managing DH, with a focus on bioactive glasses like BioMin® that may be used to reduce tooth sensitivity and protect against tooth decay.

The role of Helicobacter in gastric cancer prevention

Khalid Mohammed Al Ghamdi — 2025-09-15

Gastric cancer is one of the most common cancers worldwide. It is associated with high mortality risk. Helicobacter pylori (H. pylori) is a major significant risk factor for gastric cancer, as its virulence factors significantly contribute to gastric carcinogenesis. H. pylori eradication has been associated with reduced incidence of gastric cancer. H. pylori mechanisms in achieving long-term and sustained cancer prevention remain unclear. The aim of this review is to explore the effectiveness and mechanisms of H. pylori in gastric cancer prevention. H. pylori contribute to gastric cancer by molecular mechanisms, such as activating the NF-κB pathway, and cellular mechanisms, such as oxidative stress. Studies have shown that H. pylori eradication reduced the incidence of gastric cancer in healthy populations and patients with early gastric cancer undergoing endoscopic mucosal resection. H. pylori vaccination can be an effective method in the prevention of H. pylori infection, thus preventing gastric cancer. Future studies should develop an integrated approach combining targeted eradication, microbiome management, and innovative vaccination strategies to prevent the occurrence of gastric cancer.

Pollution, climate extremes, and psychosocial stress: emerging environmental risks for cardiovascular disease: a review

Aman Aher — 2025-09-30

Environmental stressors like pollution, extreme temperatures, and psychosocial stress are increasingly recognized as significant but underappreciated contributors to cardiovascular disease (CVD), including cardiomyopathy. These exposures disrupt cardiovascular homeostasis through oxidative, inflammatory, and metabolic pathways, yet their integrated mechanisms remain poorly addressed in clinical risk frameworks. We aim to bridge this gap. We searched PubMed, Embase and Scopus for studies linking pollution, extreme climate changes and psychosocial stress with cardiomyopathy or other CVD outcomes using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A total of 17 epidemiologic and experimental studies reporting CVD outcomes and mechanistic data were included. Air pollution (PM2.5 and PM10) was significantly associated with increased systolic and diastolic blood pressure with 0.2-0.6% higher all-cause mortality, and 0.3-0.7% cardiovascular mortality. These outcomes were mediated by reactive oxygen species (ROS) generation, endothelial dysfunction, and systemic inflammation. Noise and light pollution disrupted circadian rhythms, elevating cortisol, IL-6, and TNF-α levels. Heat exposure triggered autonomic imbalance and endothelial injury via heat shock protein activation, increasing arrhythmia risk. Shared molecular mechanisms included eNOS uncoupling, NADPH oxidase–mediated ROS production, and Ly6C⁺ monocyte activation, promoting atherogenesis and plaque instability. Environmental stressors are emerging, modifiable, and underrecognized contributors to cardiovascular morbidity and mortality. Despite varied triggers, these exposures converge on common mechanistic pathways that fuel myocardial dysfunction. Our findings underscore a need for preventive action. Targeted preventive strategies including air quality regulation, heat stress mitigation, urban greening, and psychosocial support programs are urgently needed. Future research should further delineate these pathways and guide the integration of environmental risk into cardiovascular disease prevention and policy.

Impact of substance abuse among adolescents: a narrative review

M. Hemamalini — 2025-09-11

Substance abuse among adolescents are considered as a critical public health issue which leads to impact on individual development and societal well-being. Around 1.5 crore (15 million) minors aged between 10–17 years uses substance in India and 34% used any substances in Tamil Nadu. There are no enough evidences on impact of substance abuse. Hence, this study aimed to explore the various impact of substance abuse among adolescents. The literature search was carried out in Pub-med central, Google scholar and Web of science databases with suitable search terminology like impact of substance abuse, addictions, drug abuse, drug dependence, substance use disorders drug user, drug intoxication, and toxicity. In addition, demographic variables, new innovative policies and programs for substance abuse among adolescents in India were reported in the present review. Understanding the impact of substances among adolescents helpful in development of targeted health policies and community-based programs. It ultimately promotes the healthier lifestyles and also enhances future outcomes among adolescents.

Reimagining mental health: the role of artificial intelligence and brain computer interfaces in advancing mental health care

Shreevallabh A. Deshmukh — 2025-09-19

This review elucidates the transformative impact of artificial intelligence (AI) on the diagnosis and management of prevalent mental health conditions. It highlights real world applications that are currently augmenting clinical decisions and refining therapeutic strategies, moving the field beyond traditional, subjective paradigms. Furthermore, this paper projects a future in which the confluence of AI and brain computer interfaces (BCIs) will catalyze revolutionary treatment paradigms, building upon precursors like deep brain stimulation. As neurotechnology continues its rapid advancement, AI is poised to evolve from a sophisticated decision support tool into an active therapeutic agent, directly integrated with the human brain. This synergy promises to usher in an era of precision mental healthcare, characterized by personalized, proactive, and highly effective interventions. This exploration also critically examines the profound ethical and societal challenges that must be navigated to ensure this technological evolution serves humanity equitably and responsibly.

Vairagya and adaptability as psychological buffers: yogic perspective on coping with grief and loss

Sridevi K. J. — 2025-09-30

Grief is a profound and universal human experience, yet its expression and management are deeply shaped by cultural, psychological, and spiritual factors. Traditional models such as the Kübler-Ross stages and the dual process model have contributed to understanding bereavement, but they often lack the transpersonal dimension that many individuals rely on for healing. Yogic philosophy, particularly the principles of Vairagya (detachment) and adaptability (psychological flexibility), offers valuable complementary perspectives for coping with loss. Vairagya provides an inner anchor through balanced detachment, allowing individuals to acknowledge sorrow without becoming consumed by it, while adaptability supports adjustment to new realities and fosters resilience in the aftermath of change. Together, these concepts create a dual framework that promotes emotional regulation, cognitive flexibility, and post-traumatic growth. Contemporary evidence indicates that yoga, mindfulness, and related practices enhance resilience, reduce rumination, and strengthen coping capacity, aligning closely with these philosophical ideals. Community-level applications, including yoga-based grief support programs and collective rituals, further highlight the potential for integrating these approaches into culturally sensitive mental health strategies. By synthesizing insights from psychology, yogic philosophy, and therapeutic practice, this paper underscores the transformative potential of Vairagya and adaptability in navigating grief, offering an integrated model that bridges ancient wisdom with modern clinical relevance.

Implementation and effectiveness of Swachhata Pakhwada activities by a tertiary care hospital in improving the health and hygiene promotion

Pooja Bhadoria — 2025-09-30

Swachhata Pakhwada, introduced under the Swachh Bharat Mission (SBM), plays a pivotal role in institutionalizing cleanliness and hygiene across various sectors, including healthcare. This paper reviews the implementation and effectiveness of Swachhata Pakhwada activities at AIIMS Rishikesh, assessing their impact on health promotion, waste management, and public awareness. The study highlights key initiatives such as cleanliness drives, community outreach, green initiatives, biomedical waste management, and hygiene awareness campaigns. Special focus is given to the role of Swachhata Special Campaigns in addressing emerging challenges beyond routine activities. By analysing achievements, challenges, and best practices, this paper provides insights into the long-term sustainability of hygiene initiatives in tertiary care institutions. The findings emphasize the importance of continuous engagement, resource allocation, and policy reinforcement to sustain and enhance the progress made under Swachhata Pakhwada.

Delayed sleep phase syndrome: the sleep disorder that’s out of sync

Asha Lourdes — 2025-09-30

Delayed sleep phase syndrome (DSPS) is a chronic sleep disorder marked by a persistent delay in the sleep-wake cycle, causing individuals to fall asleep and wake up much later than desired. It affects people of all ages but is especially common in teenagers and young adults. DSPS significantly disrupts daily functioning, leading to mood swings, cognitive impairment, daytime sleepiness, and social or occupational difficulties. The disorder’s pathophysiology is complex, involving circadian rhythm misalignment, melatonin secretion irregularities, and sleep-wake imbalances. Genetic predisposition, environmental influences, and lifestyle choices can increase susceptibility and perpetuate the condition. Clinically, DSPS is characterized by late sleep onset, late rising, and a strong preference for a delayed sleep schedule. Associated traits include erratic melatonin levels, inconsistent sleep patterns, and circadian rhythm disturbances. Diagnosis requires a thorough clinical evaluation, including sleep diaries, actigraphy, polysomnography (PSG), and a detailed history. Differentiating DSPS from conditions such as insomnia, narcolepsy, or sleep apnoea is essential to avoid mismanagement. Treatment typically combines behavioral, environmental, and pharmacological strategies. Behavioral approaches include consistent sleep routines, relaxation methods, and cognitive behavioral therapy. Environmental interventions involve light therapy, sleep hygiene improvements, and melatonin supplementation. Pharmacological options may include melatonin receptor agonists, sleep-promoting agents, or wakefulness-enhancing medications. Early recognition and treatment are vital to preventing long-term impairment and improving quality of life. Raising awareness among patients, families, and healthcare professionals is crucial. This study emphasizes bridging clinical practice and research, while providing a valuable resource for students, clinicians, and investigators in sleep medicine.

Burn injuries in rural India: a comprehensive review of epidemiology, risk factors and preventive strategies

Ranjit K. Sahu — 2025-09-30

In India, burns rank as the second leading cause of unintentional injuries. Few studies have examined the trend of burn injuries in rural India. Managing burn injuries poses a significant challenge in the country, which has the highest rate of female fatalities worldwide from flame burns. Burns can occur anywhere; however, they are more prevalent in rural areas, impacting the impoverished. The most frequent type is flame burns, with kerosene and flammable clothing worn by women being the factors involved. The healthcare network's infrastructure is strong, but there is a significant shortage of resources. To achieve a positive transformation, it will be necessary to have more qualified individuals ready to serve in the rural regions. In many instances, burn patients face mistreatment in the community before reaching the healthcare facility. The community holds misconceptions about burn management that hinder effective management within the facility. On the other hand, the facility's preparedness poses a significant challenge. To maintain quality and consistency in burn care in rural India, it is essential to foster knowledge and awareness within the community regarding burn prevention and their involvement. In this way, timely availability of facilities will enhance community confidence, consequently saving thousands of lives from burn injuries in rural India.

Primary care providers perspective on the strengths, challenges, opportunities, and threats of the integrated disease surveillance program in Puducherry

Durgesh Roy — 2025-09-30

Integrated disease surveillance program (IDSP) is a decentralized district-based system of weekly surveillance for communicable diseases. Reviewing the existing system gives valuable insight into the surveillance system as we move toward a technology-enabled integrated health information portal (IHIP). Hence, this study explored the primary care provider's perspective on the strengths, challenges, opportunities, and threats (SCOT) of various components in IDSP, Puducherry. We conducted this qualitative study following a descriptive theoretical underpinning and included in-depth interviews of selected medical officers (MO) of primary health centers (PHCs) in Puducherry district. SCOT analysis was done by interviewing eight purposively selected MO working in the PHCs. It's a manual thematic analysis. The strength perspective is regular review, monitoring, good communication, capabilities of the IDSP unit, and Outbreak response. The challenges are offline data reporting and inadequate manpower. Opportunities are Intersectoral coordination. The perspective of threats is data quality and community participation.

Evaluation of the efficacy of plain silk sutures versus chlorhexidine coated silk sutures on bacterial adherence post periodontal flap surgery

Nagaraj B. Kalburgi — 2025-09-30

Periodontal disease management is based on non-surgical measures like scaling and root planning and surgical treatment like periodontal flap surgery. Sutures are used for wound approximation following periodontal flap surgery. Sutures impregnated with antibacterial agents have been developed in an attempt to reduce bacterial adherence and colonization. Chlorhexidine, a synthetic antimicrobial drug can be used in such situations. This study aimed to evaluate the wound healing and colony count of P. gingivalis in plain silk suture and chlorhexidine gel coated silk suture 7 days post periodontal flap surgery. Twelve periodontitis subjects were selected and divided into group A with 6 subjects who undergone periodontal flap surgery followed by placement of plain silk sutures, group B with 6 subjects who undergone periodontal flap surgery followed by placement of chlorhexidine gel coated silk sutures. On 7^th day, wound healing was analysed and the sutures were sent for bacterial culture of P. gingivalis bacteria. On intergroup comparison, significant reduction in the CFU count of P. gingivalis was observed in group B. But there was no significant difference in wound healing between both groups. The chlorhexidine coated silk sutures resulted in a satisfactory clinical behavior for routine use without the risk of bacterial contamination of the surgical wound. Hence it can be used in the routine wound closure post periodontal flap surgery without the hindrance of bacterial adhesion.

Effectiveness of injectable platelet-rich fibrin in conjunction with scaling and root planing as local drug delivery in the treatment of periodontitis

Bhagyashri N. Vanaki — 2025-09-30

Periodontitis is a multifactorial disease, characterized by the progressive destruction of periodontal supporting tissues, resulting in periodontal pocket formation. Scaling and root planing (SRP) is not frequently resolute at repairing disease-related defects. To enhance the regeneration, adjunctive therapeutic procedures have been added to conventional therapy. Platelets are important reservoirs of various GFs and cytokines, which are vital in wound repair and homeostasis. Therefore, this study aimed to assess the effectiveness injectable formulation of platelet rich fibrin (I-PRF) enables easier use of the platelet concentrate in a liquid state. A total of 20 periodontitis subjects were selected and divided using a split-mouth study design into control site: SRP alone and test site: SRP + I-PRF injection. Clinical parameters like-gingival index (GI), plaque index (PI), bleeding on probing (BOP), clinical attachment loss (CAL), pocket probing depth (PPD) were evaluated at baseline and 6 weeks. Statistically significant reduction in the clinical parameters observed in both the sites. But comparatively, test site showed more reduction in clinical parameters with gain in CAL when compared to control site. I-PRF when used along with SRP show therapeutic benefit in periodontal regeneration.

Simulation-based training for ICU nurses: a crucial investment

Neha Rai — 2025-09-30

The evolving complexity of critical care settings has placed increased demands on nursing professionals, particularly those working in Intensive Care Units (ICUs). In this context, I would like to highlight the urgent need to integrate simulation-based training as a core component of ICU nurse education and professional development in India. Simulation offers a safe, reproducible, and learner-centric approach to mastering essential clinical competencies, and is no longer a luxury but a necessity in modern healthcare education.

The mental health and legal perspective of child sexual abuse: a case series

Sarada P. Swain — 2025-09-19

Child sexual abuse (CSA) is not only a health concern, but also remains a socially neglected issue in every country. It has significant psychological and social issues that are often underreported. The immediate psychological effects have a negative impact on the child’s mental health and social development, creating long-term physical and mental health consequences. CSA victims are always at risk of anxiety, adjustment issues, dissociation, depression, dysfunctional sexual behaviors, somatization, and suicidality. The long-term mental health morbidities and sociocultural issues are frequently experienced by the adult survivors of CSA.