Good menstrual hygiene is fundamental to health, education, work and wellbeing of women everywhere. Menstruation is a natural part of human existence. Yet it has been neglected for decades in all sectors as well as at individual level. Menstruation remains a taboo in many societies and various negative cultural attitudes and beliefs are still associated with it. Menstruating women and girls are often associated with terms like dirt, filth, stink, impure and so which leads to forceful seclusion, reduced mobility, social, cultural and dietary restrictions. Adolescent girls are mostly kept away from facts and thus remain ignorant of the issues they suffer due to ignorance in their daily health and hygiene practices which result into adverse health outcomes. To delineate determinants of menstruation and to assess progress on perspectives with respect to change in the process of menstruation. Relevant available literature with appropriated methodology on the topic menstruation was taken up with focus on studies over the last decade. The search was strategically done to include an extensive list of concepts, beliefs, process and management to capture the various degrees of difference in perceptions and expressions, demographic and sociocultural factors as well as related subject matter adjusted accordingly to different set of data. The United Nations millennium development goal 2 and 3 directly focused on menstrual hygiene and management for universal education and on gender equality and women empowerment. However, less attention was paid on these issues in developing countries and even the work done on this is not much to explore this neglected aspect of women health. Literature on these particular aspects of women remain extremely scarce and to make things even worse sanitary section is just not touched and more so combined with stigma around it.

BACKGROUND: Young adulthood is often marked by beginning of studying in university, in which certain factors contribute to the development of stress and stress-related illness. OBJECTIVE: We aimed to determine the prevalence of depression, anxiety, and stress and their sociodemographic correlates among undergraduate medical students of Arsi University. MATERIALS AND METHODS: An institutional-based cross-sectional study was conducted on 265 sampled medical students. Participants were selected by a systematic random sampling technique. Data were collected by a pretested, structured, and self-administrative questionnaire. Afterward, it was double entered into EpiData-3.1 and was analyzed by SPSS-21 software. Logistic regression analysis was employed and statistical significance was accepted atP < 0.05. RESULT: In the present study, five questionnaires were rejected for incompleteness, giving a response rate of 98.1%. Ages of respondents ranged between 18 and 27 years. Most respondents were male (63.1%), single in marital status (75.4%), living in campus (91.5%), had low monthly income (52.7%), from 6^th year (20%), orthodox believers (50%), and Oromo in ethnic (53.9%). The current prevalence rates of depression, anxiety, and stress were 52.3%, 60.8%, and 40.4%, respectively. From all sociodemographic characteristics, depression was specifically associated with monthly income and residency. Moreover, anxiety was significantly associated with residency and educational level. Finally, stress was associated with monthly income, 2^nd year educational level, and residency. CONCLUSION: Generally, overall prevalence rate of depression, anxiety, and stress is alarmingly high among Arsi University medical students. Therefore, implementing a structured orientation program with stress reduction interventions and establishing a student counseling center is highly recommended.

BACKGROUND: The construction industry is one of the hazardous industries in the world. Injuries that are taking place in the construction sector are one of the significant public health problems, and this can be prevented if appropriate measures are taken. AIM: This study aimed to identify the pattern and factors associated with occupational injuries. SETTINGS AND DESIGN: A cross-sectional study was conducted in building construction sites located in Mangalore city in Dakshina Kannada district. MATERIALS AND METHODS: The research was carried out in 19 construction sites located in Mangalore during the period between January and April 2017. A total of 576 respondents were selected using multistage sampling techniques. A semi-structured questionnaire was used to collect the information using the interview method. The inferential test, such as Chi-square test, and the likelihood test were used to find the associations and odds ratio, and its 95% confidence interval was obtained.P < 0.05 was considered as statistically significant. RESULTS: Occupational injuries during 12 months were reported by 36.28% of the workers. The most common body parts injured were lower limb (48.3%) and upper limb (17.7%). The majority of injuries were abrasions (73.6%) and cuts (24.4%). Age, work experience, and various other risk factors were significantly associated with occupational injuries. CONCLUSION: Attention should be given to reduce the occurrence of accidents in the construction industry. Occupational health and safety training should be provided to the workers to raise the awareness of occupational hazards, which will help to reduce the injuries.

BACKGROUND: Mobile health solutions can address looming problems of health. Smartphones have been integrated into global population with minimal constraints. Walking is the most convenient exercise as it can be self-regulated in intensity, duration, and frequency. MATERIALS AND METHODS: A single group pre–post experimental study without any comparison group was carried out for a period of 12 months. A total of 150 study participants were enrolled using nonprobability sampling from households who had to walk for 40 min/day for 5 days in a week for 3 months with Google Fit health app as an exercise adherence tool, and mental health status was assessed using Patient Health Questionnaire-9. Data were entered using Microsoft Excel and were analyzed using SPSS version 22 (IBM Corp, USA). Statistically significant P value was defined asP < 0.05. RESULTS: Of the 150 study participants, 64 (42.7%) belonged to 21–25 years, majority belonged to nuclear family, 100 (66.7%) participants had completed high school, and 86 (57.3%) of study participants were females. Around 14 participants (9.3%) before the intervention were found to have depression postintervention of exercise therapy, only 2 (1.3%) had depression. The baseline evaluation done showed higher depression scores, and postintervention had lower scores there was a statistically significant difference in scores. The study participants in all age groups, different educational status, different type of family, and gender showed statistically significant difference preexercise intervention and postexercise intervention. CONCLUSION: Walking as an exercise although has established beneficial effects in preventing noncommunicable diseases, but its beneficial effects in fighting depression needs more evidence. Exercise can be a substantial alternative guided with health app to cope with the emerging noncommunicable diseases.

BACKGROUND: Fast changing technology applications in intensive care units (ICUs) are believed to enhance the result of nursing care. We expect the nurses to work with constantly updated technology and presume that they are receptive to any revised version of medical devices. The nurse's perception on technology is infrequently discussed in hospitals or among medical device manufacturers. AIMS: The aim of this study was to assess the nurses' perception about the advancement of technology in ICUs. SETTINGS: The study was conducted among the nurses working in different ICUs in a selected tertiary care hospital in Bengaluru, India. MATERIALS AND METHODS: An exploratory study was done using a hybrid method of qualitative and quantitative techniques. Semi-structured interviews were conducted with nurses having ≥5 years of experience in ICUs, and thematic analysis was applied. Quantitative data were collected from the population of nurses with 1 year or more experience using survey questionnaire. STATISTIACAL ANALYSIS USED: ANOVA test and sample t-test were conducted on the applicable parameter. RESULTS: Most of the nurses found that high-tech equipment in ICUs is easy to operate, reduce their effort, prevent errors, and increase the comfort of the patient. The study found that nurses' perception about the advancement of technology does not vary according to age, experience, qualification, and whether they have attended any continued nursing education on technology applications. Statistically significant relationship was found between total perception and the nature of ICU in which the nurses work. CONCLUSIONS: The study found that nurses perceive advanced technology in ICU as beneficial. Nurses expressed their satisfaction about the advancement of technology, and they perceive it as a good learning opportunity for them. The participants expressed their need for more training when equipment with advanced technology or a revised version is brought in.

BACKGROUND: Increase in life expectancy brings certain health-related conditions with age. Malnutrition is an underlying factor for much morbidity and hence, its identification and appropriate intervention has a great value in averting poor clinical outcomes. OBJECTIVE: The present study was conducted to find the nutritional status of elderly patients admitted to the hospital. MATERIALS AND METHODS: Hospital-based cross-sectional study was conducted among 163 indoor elderly patients from the different departments of a government hospital for the duration of 2 months and their nutritional status was assessed using internationally validated tools, Mini-Nutritional Assessment – Short form (MNA-SF). Data were entered and analyzed statistically using Microsoft Excel software. RESULTS: The overall prevalence of malnutrition among hospitalized elderly patients was found to be 10.43% and half of the patients (50.31%) were at risk of malnutrition, as per the MNA-SF score. The rate of malnutrition was high among male patients than female patients, and the prevalence of malnutrition rises with an increase in age. Hospitalized patients were found to have decreased intake of food, weight loss of >3 kg, restricted in mobility, and body mass index <19. More than half suffered psychological stress in the past 3 months and around 70% of patients suffered from mild-to-severe dementia or depression. CONCLUSION: Malnutrition among hospitalized elderly patients needs to be identified and intervened at the earliest to postpone or alleviate poor health outcomes.

BACKGROUND: Tacrolimus is an immunosuppressive drug used for the prevention of rejection in kidney transplant recipients (KTRs). There are many factors that can affect tacrolimus blood levels, include nonadherence, blood sampling time, food effect, and co-medication. This study aimed to assess Sudanese KTRs knowledge and practice about tacrolimus use. MATERIALS AND METHODS: This was a descriptive cross-sectional hospital-based study. The study population was Sudanese KTRs under tacrolimus-based therapy attending the renal transplant outpatient clinic in Khartoum renal dialysis and transplantation center from April to July 2018. A total of 190 KTRs were interviewed. The collected data were manually scored, coded, and then analyzed using SPSS. RESULTS: Regarding overall knowledge, approximately 46% of enrolled KTRs have a low level of knowledge about tacrolimus therapy, and there is a significant association between KTRs knowledge and their level of education. There is a variation between the knowledge about tacrolimus monitoring and KTRs' practice. The primary source of information for the KTRs was doctors, and more than half of them never forget to take the tacrolimus. Only 32.1% of KTRs have nonadherence problems. The association between KTRs knowledge and their level of education and the transplantation period was statistically significant. Regarding tacrolimus side effects, 50% of KTRs said they have been informed or read about the drug side effects. CONCLUSION: Knowledge of the Sudanese KTRs enrolled in this study was inadequate, and the behavior of them when suffering from a new complaint was relatively good. Great efforts are needed to improve their knowledge, to maintain graft function, and to prevent graft loss.

BACKGROUND: Hydatid disease remains an important parasitic infection requiring surgical intervention. The liver is the most common site of infection, and several methods of surgery have been described to treat this common disease. Extensive research is going on to find the best operative treatment procedure for hydatid liver diseases. AIM: The aim of the study was to compare the results of two surgical methods used in the treatment of hydatid disease of the liver, namely omentoplasty and tube drainage. MATERIALS AND METHODS: Fifty-seven cases of hydatid liver were treated from January 2005 to January 2011, out of which thirty patients were treated with omentoplasty (Group A) and 27 were treated with tube drainage (Group B). The results of the surgery in terms of mortality, complications, hospital stay, and recurrences were analyzed by unpaired t-test or Fisher's exact test, and P value was calculated. RESULTS: Overall postoperative complications were seen in 9.4% in Group A and 22.5% in Group B. The average hospital stay and time to resume routine work in Group A was shorter as compared to Group B. The percentage of complications such as wound infections and abscesses formation were 3.4% each in omentoplasty group and 11.2% and 7.2% in tube drainage group, respectively. The comparison of infection frequency among two groups showed strong statistical significance withP = 0.002 in wound infection and 0.0014 in abscess formation. The comparison of jaundice development after both procedures was statistically insignificant (P = 0.037). No patient in omentoplasty group developed biliary fistula, and the percentage of this complication in tube drainage was 3.7%. The recurrence of hydatid disease in omentoplasty was nil and 7.41% in tube drainage patients. There were no recurrences in either group for a follow-up of 4 years. CONCLUSION: Omentoplasty is better and must be preferred operative procedure than tube drainage in the treatment of hydatid cyst liver disease.

INTRODUCTION: Cough is one of the common symptoms that alert patients to seek medical attention from physicians, which may lead to an increase in the cost of health-care services. The pharmacist is one of the medical professionals to whom parents can go for consultation and request cough medications for their children. The study aimed to assess the knowledge and practice of community pharmacists toward dispensing of cough medication for children. MATERIALS AND METHODS: A cross-sectional study was carried out among 325 community pharmacists using a pretested, standardized questionnaire. A stratified random sampling method was used to select the participants. The knowledge and practice were assessed, and then the associations between knowledge and practice with different demographic variables were assessed using Chi-square test and analyzed using the Statistical Package for the Social Sciences. RESULTS: Of 325 participants, the majority of them were females (74.2%) with B. Pharm (73.5%) and experienced <5 years (68.6%). About 53.8% of pharmacists were showed to have moderate knowledge, whereas 35.7% and 10.5% of them had a high and low level of knowledge, respectively. Regarding practice, 56.6% was found to show a fair level of practice, whereas 11.4% and 32% showed a good and poor level of practice, respectively. The majority of pharmacists still dispense cough medications for children <2 years despite the lack of efficacy and safety. Antibiotics were dispensed by pharmacists to children with cough without prescription, in the presence of fever and cough for a long period. CONCLUSION: More than half of the participants showed moderate knowledge and practice toward dispensing of cough medication in children, no significant association between knowledge and demographic variables, but practice showed a significant association with participants' qualifications.

INTRODUCTION: Primary fungal laryngitis is a fungal infection of the larynx without affecting the other body parts such as the lungs, pharynx, and oral cavity. It is an extremely rare clinical entity. Hoarseness of the voice is common clinical presentations. OBJECTIVE: This study aimed to evaluate the etiology, clinical presentations, diagnosis, and treatment of primary fungal laryngitis at a tertiary care teaching hospital in Eastern India. MATERIALS AND METHODS: This is a retrospective study of seven cases of primary fungal laryngitis managed between 2014 and 2019. The detailed etiology, clinical presentations, investigations, and treatment of primary fungal laryngitis patients were studied. RESULTS: Primary fungal laryngitis is common among males with a mean age ranging from 15 to 63 years. There were five male and two female patients. The most common clinical symptom was hoarseness of voice (n = 7), dry irritating cough (n = 2), odynophagia (n = 1), discomfort in throat (n = 1), and dyspnea (n = 1). Laryngoscopic pictures of primary fungal laryngitis included leukoplakic lesions (n = 3), ulcerative lesions (n = 1), polypoidal lesions (n = 1), and nonspecific lesions (n = 2). Histopathological examination is confirmatory for the diagnosis. All the patients had taken antifungal treatment for 3–4 weeks after confirmation of the diagnosis. CONCLUSION: The diagnosis of the primary fungal laryngitis is often overlooked and delayed among patients, as it is usually evident among immunocompromised patients. It often confuses with certain laryngeal diseases such as granulomatous diseases, leukoplakia, and malignancy. Delayed diagnosis and treatment will lead to high morbidity and mortality of the patients.

BACKGROUND: Hormonal variations during pregnancy can lead to otological and rhinological manifestations. Majority of the manifestations have no harm to the expectant mother or fetus but some of them can become pathological. The objective of this study is to study the audiological and rhinological manifestations occurring during pregnancy. MATERIALS AND METHODS: This is a prospective study where 82 pregnant women participated. Otological and rhinological manifestations were assessed by asking a questionnaire and detail clinical examinations of the ear, nose, and paranasal sinuses. RESULTS: The mean age of the pregnant women participated in this study was 24.62 years. The most common otological manifestation was blockage feeling in the ear, whereas the most common rhinological manifestation was rhinitis. Eustachian tube dysfunction was common in the last trimester of the pregnancy. CONCLUSION: It is important to have clinical knowledge in all clinicians regarding the manifestation of otological and rhinological manifestations and its treatment with precautions considering effects on mother and fetus during pregnancy.

BACKGROUND: Urine culture contamination is the result of mixing commensal flora of the lower urinary tract during the collection of midstream urine. As patients themselves collect urine sample, urine culture analysis depends on their collection method, which is an important preanalytical issue. OBJECTIVES: This study was conducted in the Department of Microbiology, Institute of Post Graduate Medical Education and Research and SSKM Hospital, Kolkata, during the month of May and June 2016, with aim to assess the role of communication and verbal instructions explaining “Midstream clean-catch (MSCC) technique” before collection of urine to the adult female outpatients on urine “Culture Contamination Rate” (CCR). MATERIALS AND METHODS: Three hundred and ninety-six female patients were assigned in one of the two groups: “I” (Instructed) group (n = 196) and “N” (Nothing) group (n = 200). Verbal instructions in local (Bengali) language only provided to the Group “I”. Urine samples were processed in the laboratory. Laboratory technicians and microbiologists were blinded about the groups. Urine culture results were collected from laboratory records. RESULTS: The CCR in the Group I and Group N was 6.1% and 19.5%, respectively (P < 0.001). Positive culture was observed in 31.6% (62/196) in Group I and 24.0% (48/200) in Group N, which was comparable statistically (P = 0.09). Instruction and communication have been found to be more effective at reduction of urine culture contamination among patients of the age group of 21–30 years (P < 0.001) and lower socioeconomic class (P < 0.001). CONCLUSIONS: CCR was significantly lower in the group who were provided verbal instruction for MSCC. Thus, proper collection technique may reduce the need of the repeat sample due to contamination and prevent from the unnecessary antibiotic treatment.

BACKGROUND: In spite of being an integral part of family and pivotal force in any kind of progress, women are traditionally less involved in decision-making at all levels. OBJECTIVE: The objective of this study was to assess the extent of women's participation in household decision-making and find its correlates. MATERIALS AND METHODS: A cross-sectional survey was conducted in rural and urban field practice areas of Bankura Sammilani Medical College, West Bengal, from January to June 2017. Married women were selected by multistage sampling. After obtaining informed consent, interview using a predesigned schedule was done at their houses regarding participation in various household-level decisions. The relationship between variables was determined by Chi-square test, unpaired t-test, and multiple logistic regression analysis. RESULTS: Most of the participants were within 18–26 years of age and belonged to general caste of lowermiddle socioeconomic status. Majority of the participants in both the study areas were married for ≥5, homemakers with education ≥ secondary level and belonged to joint family. High level of overall participation was found among urban women than their rural counterpart. The extent of participation was statistically associated with age, occupation, and type of family in both urban and rural areas. CONCLUSION: Women's empowerment through vocational training and creating conducive environment for availing job is important for improving women's participation in household-level decision-making.

INTRODUCTION: Creutzfeldt–Jakob disease (CJD) is an uncommon, fatal, genetic, transmissible and degenerative, brain disorder. It affects one person in every one million in the United States. A definite diagnosis can be made by histopathological confirmation which is often not possible for various reasons. Therefore, great caution is needed before the diagnosis is offered. MATERIALS AND METHODS: Patients with radiological diagnosis of CJD in the past 2 years were assessed clinically, reassessed at 1-month, and results are discussed. RESULTS: Four out of the 12 patients seen had nonprion cause. Hyperacute onset with coma, nonprogressive changes in imaging and electroencephalography, were seen in those who improved. The presence or absence of 14-3-3 in cerebrospinal fluid was not useful in either confirming or excluding the diagnosis in a given case. CONCLUSION: All patients with cortical ribboning need correlation with clinical features and follow-up to confirm or exclude prion disease.

INTRODUCTION: Mortality data help in identifying the leading cause of death in populations and provide evidence to prioritize of disease prevention efforts. This study aims to describe the age and gender distribution and analyze the causes of fatalities certified after postmortem examinations to facilitate improved and more reliable certification of the cause of death. MATERIALS AND METHODS: This secondary data analysis is of data recorded from January 01, 2016, to December 31, 2017, in the postmortem registers of the forensic medicine and toxicology department of a medical college in Haryana. Probable time of death, time of conducting the postmortem examination, and the probable cause of death as per the police records are also entered in the register. The data were analyzed for age and gender distribution and cause of death. Diagnoses provided by postmortem examination were categorized. RESULTS: One thousand nine hundred and sixty-one postmortem examinations were conducted during the study period. About 52% of deceased persons belonged to the age group 21–40 years, 82.96% were male and 60% were from a rural area. Majority of deaths occurred at public places (57%). Deaths at home were more common among females (44%), while majority of deaths at public places occurred among males (59%). Unintentional deaths (74.50%) were more common. Deaths due to accidents were about 42.22%. CONCLUSION: Conventionally, the emphasis of postmortem examination has been viewed as serving the inquest. However, they now have an important role within public health such as surveillance and causes of death. There is a strong obligation to generate reliable information for formulating effective intervention policies.

Congenital maxillomandibular syngnathia is a rare disorder. It is usually seen in association with various syndromes such as Van der Woude, popliteal pterygium syndrome, or in association with other defects. Isolated case reports of bony fusion of jaws are sparse. We report an isolated case of congenital fusion of the mandible and maxilla in a newborn baby and describe the clinical and radiological features of this anomaly. A brief review of literature is also presented.

Otomycosis is a common clinical entity seen in both immunocompetent and immunocompromised patients. Aspergillus and Candida are the most common causative fungi in otomycosis. Aspergillus versicolor is an extremely rare causative agent for otomycosis. The clinical symptoms presented by patients are usually itching of the ear canal, otalgia, and discharge from the ear. The diagnosis of otomycosis is done on the basis of clinical presentations, microscopy and culture. The correct identification of A. versicolor is often challenging in routine clinical practice. Successful treatment of otomycosis due to A. versicolor requires prompt diagnosis and immediate treatment as delay or nontreatment may lead into rapid spread of this infection with lethal outcome. Here, we are presenting a case of an immunocompetent male presented with itching, ear discharge, pain, and ear block due to otomycosis caused by A. versicolor.

This case report highlights the management of single metastasis in the liver with stereotactic body radiotherapy in a previously treated case of carcinoma breast.

The use of formative assessments in the delivery of medical education is not very common in Indian settings. In-fact, it won't be wrong to state that undue importance has been given to summative assessments, with most of the assessments targeting only cognitive domain and very less emphasis on psychomotor, affective or communication domain. The best approach to make all these essential things a reality is via resorting to programmatic assessment. This approach optimizes the process of certification of any medical student and can play an immense role in accomplishing the vision of the medical education delivery system in India. In-fact, one of the most promising ways will be to consider the planning and implementation by means of adoption of ADDIE's (viz. Analysis, Design, Development, Implementation and Evaluation) 5-steps model. In conclusion, programmatic assessment is the need of the hour and employment of ADDIE model can significantly enhance the process of implementation of the same in the medical education delivery system in India.