Comparison of adnexal torsion in different phases of women’s life: a retrospective cohort study

Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology. Though it is more common in reproductive age group, it can occur in extremes of age group. So, we had analysed the clinical presentation, surgical characteristics, and causes of adnexal torsion among adolescent population, reproductive-age women, and postmenopausal women.Methods: Patients with adnexal torsion who were treated in department of obstetrics and gynecology, SRM Medical College Hospital and Research Centre from October 2016 to March 2019 were retrospectively analyzed.Results: Among the 53 cases of adnexal torsion during the study period, maximum (38, 71.6%) were in the reproductive age group. There were three patients with ovarian torsion during pregnancy. Acute pain abdomen was the significant presenting symptom in adolescent group compared to other two group (100% versus 80.6% versus 40%, p = 0.03). Adnexal pathology was in the ovary in 76% and isolated tubal pathology in 5%. Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients (100%), as opposed to conservative surgery- detorsion and cystectomy in premenopausal women (56%). In Adolescent patients 62% had polycystic ovaries as intraoperative finding. Histopathology were benign except for a patient in postmenopausal age group who had granulosa cell tumour.Conclusions: An early identification of adnexal torsion is necessary in order to achieve conservative treatment in order to maximize the future reproductive potential in younger patients

EXPLORING THE INTERRELATIONSHIP BETWEEN ELECTROLYTES, ANEMIA, AND GLYCOSYLATED HEMOGLOBIN (HBA1C) LEVELS IN TYPE 2 DIABETICS

  Objective: The aim of this study is to analyze the interrelationship and pattern of electrolyte imbalance and compare the correlation between serum electrolytes, glycosylated hemoglobin (HbA1C), and hemoglobin (Hb) levels between Type 2 diabetic patients and non-diabetic subjects.Methods: This study was conducted in 300 subjects (150 diabetics and 150 non-diabetics) and further categorized as anemic and non-anemic within each group. Blood samples were analyzed for HbA1C, hemoglobin, and serum electrolyte levels.Results: Sodium (Na+) levels in diabetics were significantly lower and potassium (K+) as well as chloride (Cl−) levels were significantly higher, when compared with non-diabetics. A significant positive correlation between HbA1C and potassium as well as chloride levels in contrast to negative correlation with sodium levels was observed in both genders. Among diabetics with anemia, we found significantly lower sodium and higher potassium and chloride.Conclusion: In diabetics, levels of sodium were significantly lower, and potassium as well as chloride was significantly higher when compared with non-diabetics. Our study clearly demonstrates an association between electrolytes, hemoglobin, and HbA1C levels in diabetes. This insight should pave the way for pathophysiology-directed therapy, thus contributing to the avoidance of several deleterious effects associated with electrolyte disorders and their treatment

Global Perspectives of COVID-19 Pandemic on Health, Education, and Role of Media

Stigma has been documented to act as a significant barrier to healthcare access and healthcare-seeking behavior. Traditional frameworks of stigma and discrimination have been used in the past to explain the stigma associated with diseases such as tuberculosis, leprosy, and HIV. However, increasing globalization and unprecedented access to information via social media and the internet have altered infectious disease dynamics and have forced a rethink on mechanisms which propagate stigma. SARS, MERS, Ebola, and more recently COVID-19 have been associated with fear in communities across the globe due to the inherent uncertainties associated with emerging infectious diseases and a concurrent spread of misinformation— an infodemic. The authors present a theoretical framework to explain the evolution of COVID-19 associated stigma by exploring the complex interplay of various international and national mechanisms. It is anticipated that a conceptual framework which explains the evolution of stigma in fast-spreading global pandemics such as COVID-19 may also prove to be useful as a starting point for furthering the discussion on the progenitors, pathways, and manifestations of COVID-19-related stigma. This should be of practical use to researchers who are interested in exploring,validating, and identifying interventions for informing other frameworks for similar diseases

Identifying low birth weight babies using calf circumference among neonates in a semi-urban area

Background: Low birth weight (LBW) still persists as a public health problem in low- and middle-income countries. There is a constant search to find newer methods to detect LBW babies so that early interventions can be taken. Objective: The objective of this study was to determine the critical limit and to assess the reliability of calf circumference (CaC) measurement in detecting LBW babies. Materials and Methods: This cross-sectional study was conducted in a tertiary care hospital between April 2018 and September 2018. In this study, a total of 185 newborns were included in the study. Anthropometric measurements (Calf Circumference [CaC], birth weight, head circumference, crown-rump length, chest circumference, and thigh circumference) were taken as per standard guidelines. Collected data were analyzed for determining the mean, standard deviation, critical limit, receiver operating characteristic curve, Pearson correlation coefficient, and regression analysis of the anthropometric measurements at birth in relation to birth weight. Results: The mean CaC of LBW babies was 9.16±0.11 cm and in normal weight babies, it was 10.86±0.09 cm. The mean values of CaC were significantly lower in LBW babies (p<0.0001). The mean cutoff value of CaC of LBW babies is found to be 9.90 cm, with a sensitivity of 85.6% and specificity of 82.2%. Conclusions: In our study, measuring CC is found to be a good methodin identifying LBW neonates. Hence, measuring CaC can be used as an alternative method to identify LBW babies in remote areas

Predicting pathological jaundice in term babies with ABO setting using cord blood bilirubin

Background: Cord blood bilirubin analysis helps not only in predicting the pathological jaundice in ABO incompatibility but is also useful for early referral and intervention for better outcome. Objective: The objective of this study was to identify the best cut off value of cord blood bilirubin for predicting pathological hyperbilirubinemia in newborns with ABO setting. Materials and Methods: This cohort study was conducted in the Department of Pediatrics at a Medical College during February 2018–July 2018. In this study, healthy term babies with blood Group A, B, and AB born to O positive mothers with birth weight >2.5 kgs and gestational age >37 weeks were included in the study. Cord blood bilirubin and the 4th day (>72 h of life) serum bilirubin value were evaluated. Receiver operating characteristic curve and sensitivity and specificity were used to analyze the data. Results: A total of 70 babies were studied; of which, 45 babies developed physiological jaundice and 25 developed pathological jaundice. The mean cord blood bilirubin value of newborns with physiological jaundice was 2.2 mg/dl, while the value among pathological jaundice was 2.6 mg/dl. Taking cord blood bilirubin value of 2.25 mg/dl as cutoff, the sensitivity and specificity of predicting pathological jaundice was 84% and 71.1%, respectively. Conclusion: Babies with cord bilirubin >2.25 mg/dl are more prone to pathological hyperbilirubinemia.&nbsp

Optimizing Pyrazinamide Use: A Low‑Hanging Fruit in Improving Outcomes with Tuberculous Meningitis? Narrative Review

Tuberculous meningitis (TBM) disables more than a third of its sufferers. Recent research has focused on optimizing the antitubercular regimen, mainly by increasing the dosage of rifampicin. However, pyrazinamide, with higher penetration into the central nervous system, is generally overlooked. We discuss the potential clinical impact of using pyrazinamide throughout antitubercular therapy in TBM, in contrast to only the intensive phase. This approach may improve the treatment outcomes and reduce disability in TBM. We summarize the available data regarding this approach from in vitro studies, clinical cohorts, toxicity data, and baseline resistance rates. Additionally, we discuss the two ongoing clinical trials evaluating this approach

Comparing cost-effectiveness of short-course regimens for drug-resistant tuberculosis treatment in India

Short-course regimens are currently explored to improve multidrug-resistant tuberculosis effects, reduce costs, as well as enhance patient adherence. Currently, we are determining the most cost-effective shorter regimen out of seven short-course regimens (6–9 months) to treat drug-resistant tuberculosis (DR-TB) compared to the current standard of care (SoC) 9- to 11-month regimen

Randomised trial to evaluate the effectiveness and safety of varying doses of linezolid with bedaquiline and pretomanid in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary tuberculosis: study protocol.

INTRODUCTION Drug-resistant tuberculosis (DR-TB) is a global public health problem. Patients suffer for months if undiagnosed or treated inadequately, transmitting DR-TB in the community before succumbing to the disease. Early diagnosis, prompt treatment initiation and completion play a significant role in treatment success. However, extended regimens with injectable result in poor treatment adherence and outcomes. Our objective is to evaluate the effectiveness, safety and tolerability of various doses and duration of linezolid (LZD) in combination with bedaquiline (BDQ) and pretomanid (Pa) after 26 weeks of treatment in adults with pre-extensively drug-resistant or treatment intolerant/non-responsive multidrug-resistant pulmonary TB. METHODS AND ANALYSIS A multicentric, randomised pragmatic clinical trial in India will enrol participants in one of the three arms-control arm (arm 1): BDQ, Pa and LZD 600 mg daily for 26 weeks or intervention arms (arm 2): BDQ, Pa and LZD 600 mg for 9 weeks followed by 300 mg for 17 weeks or arm 3: BDQ, Pa and LZD 600 mg for 13 weeks followed by 300 mg for 13 weeks. The primary endpoint is the proportion of patients with favourable outcomes as sustained cure and treatment completion. The secondary endpoint is unfavourable outcomes, including deaths, treatment failure, toxicity/adverse events and lost to follow-up till 48 weeks post-treatment. ETHICS AND DISSEMINATION The study has been approved by the ethics committees of participating institutes and the National Institute for Research in TB. The trial results will help establish evidence towards a safe and effective dose of LZD that can be used in a fully, all-oral short course regimen for highly DR-TB patients. The results of this study will be shared with the National TB Elimination Programme of the country and the WHO guidelines development group through publications and dissemination meetings. TRIAL REGISTRATION NUMBER NCT05040126

Qualitative Study of Nutritional Support-Related Perceptions and Preferences Among Persons Affected by TB, Family Caregivers, and Healthcare Providers in India

Evidence on the implementation aspects of nutritional support interventions for persons with TB in India is limited. This qualitative study employed focus group discussions with persons with TB (n = 71), their family caregivers (n = 17), and healthcare providers (n = 18). The study was conducted from August 2023 to April 2024 in five states in India. Participants’ knowledge, perceptions, and practices about nutritional intake, experiences, and expectations when accessing nutritional support were explored. Four nutrition-related themes emerged: (a) the experiences and perceptions of persons with tuberculosis and their caregivers, explained by their understanding of the importance of adequate nutrition and TB cures; (b) changes in food practices, explained by protein food adoption, alongside food insecurity experienced by those in poverty; (c) Direct Benefit Transfer (DBT)-related issues, explained by insufficiency and access-related gaps; and (d) preferred choices for nutrition support delivery, explained by less preference towards the involvement of intermediaries and a public distribution system alongside preference for the provision of nutrition through treatment facilities. Our findings underscore the importance of the provision of protein-rich food and an increase in financial support based on needs assessments. Mitigating the linkage and access gaps in DBT is needed. The delivery of ready-to-consume food through tuberculosis treatment facilities could be prioritized