INTRODUCTION: The revised definition proposed in 2013 by the Centers for Disease Control and Prevention (CDC) replaced ventilator-associated pneumonia (VAP) surveillance with ventilator-associated event (VAE) surveillance for monitoring both infectious and noninfectious complications in mechanically ventilated patients in intensive care unit (ICU). Few studies have been reported from India using the new VAE surveillance definition. OBJECTIVE: The objective of the study was to determine and compare the incidence and mortality of VAE in patients on mechanical ventilation in medical versus surgical ICU of a superspecialty hospital. MATERIALS AND METHODS: All patients on mechanical ventilation for more than 2 days in two ICUs (medical and surgical) were followed daily, and VAE data were collected using a checklist obtained from CDC website (National Healthcare Safety Network VAE Surveillance tool). The incidence and mortality of VAEs were determined. The percentage was used to analyze clinical and demographic data. RESULTS: A total of 189 patients were followed up over a period of 8 months. The overall VAE rate was 23.7/1000 ventilator days. Ventilator-associated condition (VAC) only (6.7/1000 ventilator days), infection-related VAC (IVAC) (11.57/1000 ventilator days), and possible VAP (PVAP) (5.7/1000 ventilator days). All VAC cases (100%) survived, which was statistically significant (P = 0.0002), and 83.3% of IVAC cases expired, which was also statistically significant (P = 0.0069). However, 77.7% of PVAP cases expired but were not found to be statistically significant (P = 0.2616). The mean duration of mechanical ventilation days and ICU days for VAE cases was 18.5 and 18.6 days, respectively. VAC and IVAC incidence was almost similar in both ICUs; however, the incidence of PVAP was more in medical ICU (9.1/1000 ventilator days) as compared to surgical ICU (1.45/1000 ventilator days), which was found to be statistically significant (P = 0.0044). CONCLUSION: The new VAE surveillance definition targets many other complications of mechanical ventilation apart from infection/pneumonia in ICU patients. The IVAC subtype of VAE is associated with significant mortality. VAE incidence rates help in guiding the hospitals to plan VAE prevention programs for better patient care.

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INTRODUCTION: The fact that the incidence of acute kidney injury (AKI) is increasing globally, and that data from low- and middle-income countries are scarce and inadequate, necessitates that health-care professionals being knowledgeable and aware of all aspects of this underestimated disease. This study aimed to assess the knowledge and practice of physicians working in different specialties about AKI. MATERIALS AND METHODS: This was a cross-sectional study; 169 physicians from Omdurman Military Hospital, practicing in different specialties, who were available at the time of the study, were included. Participants were assessed using a self-administered questionnaire. Data were analyzed using the Statistical Package for the Social Sciences. RESULTS: The majority of the respondents were aged 29 years or less (74.1%), and 81.7% were female. Most of the respondents (63.9%) had <3 years of experience. About 62.1% of the samples were medical officers mainly from the department of emergency, internal medicine, and surgery. Nearly 56.8% of the participants were found to have moderate knowledge, whereas 23.7% had a good knowledge; there was a significant association between knowledge and professional level. Regarding AKI management practice, 56.6% of the respondents were found to have poor practice, whereas 5.7% found to conduct good practice. The practice was found to be not associated with years of experience, profession level, or specialty. There was a significant association between knowledge and practice scores (P < 0.001). CONCLUSION: This study demonstrated knowledge and practice gaps as only one-fifth of the participants had a good knowledge and only 5% had a good practice.

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INTRODUCTION: Fluid and dietary restrictions play a vital role in rehabilitative care of patients on dialysis. Good adherence to the treatment regimen in hemodialysis (HD) patients can also reduce hospitalization risk. Therefore, this study was carried out to assess the compliance to fluid and dietary restrictions and treatment adherence among chronic HD. MATERIALS AND METHODS: A cross-sectional study of chronic HD patients at JIPMER Hospital was carried out from September to October 2018. Compliance to fluid and dietary restriction and medication adherence was measured through the prevalidated End-Stage Renal Disease Adherence Questionnaire. Continuous variables such as age, income, body mass index, and hemoglobin were described as mean and standard deviation and categorized as proportion where necessary. Categorical variables such as gender, marital, comorbidities, adherence characteristics, and perception/attitude behavior were described as proportions with 95% confidence interval. RESULTS: A total of 96 patients with end-stage renal disease participated in the study. Overall, 83.3% were good, 14.6% had moderate, and 2% had poor in compliance to fluid and dietary restrictions and treatment adherence. Compliance behavior is significantly related to marital status (P = 0.01). The odds of unmarried and widowed are 3.2 times higher than the odds of married within the confidence interval of 0.8–13 for compliance behavior. CONCLUSIONS: Enhanced patient education plays an important role in slowing the development of kidney failure and detaining the need to begin kidney dialysis. Educational intervention is needed for HD patients to improve the compliance with diet and fluid restrictions.

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INTRODUCTION: The objective of this study was to assess the knowledge and awareness regarding needlestick injury (NSI) among health-care workers (HCWs) in a tertiary care hospital. MATERIALS AND METHODS: This cross-sectional observational study was conducted among HCWs of a tertiary care hospital, India. A predesigned closed-end questionnaire, which assessed knowledge and awareness about NSI, immunization status, and management of NSI, was the tool of data collection. RESULTS: A total of 104 HCWs participated in the study. The annual incidence of NSI was 29.80% (n = 104), whereas only 35.48% (n = 31) of these NSI cases or 10.58% (n = 104) of total HCWs reported to the concerned authority. The causes of underreporting were ignorance about contacting authority (70%), busy schedule (15%), and nonsignificant (10%). Recapping was considered as the most common cause of NSI in 31.7% followed by “haste” in 28.8%. All the HCWs received vaccination against hepatitis B; however, only 71.2% got 3 doses and booster, but only 60% knew about their protective antibody level. Unprotected sexual contact and sharp injury were known to all as the route of human immunodeficiency virus (HIV) transmission, whereas blood transfusion as a source of HIV was known to 98%. CONCLUSION: The knowledge of health-care professionals on NSIs and their preventive measures is adequate; however, training on the universal precautions guidelines and the use of safe devices has to be delivered to prevent such injuries. The importance of timely reporting and following protocols regarding postexposure prophylaxis needs emphasis. There is an urgent need for re-strengthening and expanding our knowledge of HIV transmission routes in the hospital. Awareness and importance of hepatitis B immunization status need more attention.

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INTRODUCTION: Despite the significant role played by Zinc, the body stores of Zinc are very minimal and easily depleted. Zinc deficiency is known to be associated with various pathological conditions, including impaired immunity, delayed wound healing, retarded growth, neural development disorders and degenerative diseases. The loss experienced due to zinc deficiency sums to nearly 16 million global disability-adjusted life years (DALYs). This study focuses on the magnitude of Zinc deficiency and the effect of Zinc Supplementation among the hospitalized Elderly. MATERIALS AND METHODS: A prospective interventional study has been carried out in Department of General Medicine, JSS medical college and hospital, Mysore, from November 2016 to August 2018. The serum zinc level was assessed by Zinc Colorimetric Method. Tools like Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA)-SF and The KATZ Index of Independence in Activities of Daily Living were used to collect relevant data from the participants. RESULTS: A total of 100 elderly subjects were included in the final analysis. 38(38%) people had normal Zinc level. The mean serum Zinc levels pre and post interventions were reported to be 7.27 ± 1.33 gm/dl and 11.49 ± 1.83 gm/dl respectively. The difference in the pre and post intervention serum Zinc level was statistically significant (P value < 0.001). Among the people with Oral ulcers decreased taste before zinc supplementation only 6 (23.1%) participants had oral ulcers after supplementation. Decrease in vision before supplement 18 (78.3%) had improved after supplement. The difference between decreased vision before and after supplementation was statistically significant (P value-0.015). CONCLUSION: The magnitude of zinc deficiency is noted in majority of the subjects. Supplementation in old age has a positive effect in Zinc levels. As ageing is a risk factor for Zinc deficiency, prophylactic doses of Zinc could be an option to prevent Zinc deficiency.

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INTRODUCTION: First aid training is an important community survival skill necessary for all individuals as injuries and accidents have become the major epidemic of noncommunicable disease in India. OBJECTIVE: The objective of the study was to assess the awareness and attitude regarding first aid among the college students in Urban Bangalore. MATERIALS AND METHODS: A cross-sectional study was done in a private general degree college in Urban Bangalore. This tool included questions on awareness of first aid measures for various situations as well as questions to capture the attitude of students toward learning first aid. RESULTS: Of the total 370 students, the mean age was 18.42 (standard deviation [SD]: 1.23) years with equal number of boys and girls. The mean knowledge score was 7.86 (SD: 2.17) and was significantly correlated with age (Pearson correlation coefficient: 0.149). Only 192 (52%) had attended a lecture related to first aid before, and 48 (13%) had been shown how to perform first aid. About 188 (51%) reported learning about first aid by reading newspapers or magazines. The mean attitude score was 7.95 (SD: 1.67) which shows a general positive attitude toward learning first aid. CONCLUSION: Even though they have good attitude and perceptions toward learning first aid, there are not enough opportunities for them to learn about first aid. Teaching the students about first aid and training them on basic first aid skills will go a great way in making first responders available at all places.

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INTRODUCTION: Estimation of sex from different dimensions has considerable forensic value, for the identification of human remains, in the estimation of sex at disaster sites and in corroborating reports from scientists. This study evaluated calcaneal angles of Kwara populace and estimated sex using X-ray (Bohler's angle [BA], crucial angle of Gissane [CG], Fowler–Philips angle [FPA], calcaneal inclination angle [CIA], and calcaneal compression angle [CCA]). MATERIALS AND METHODS: One hundred and ten lateral radiographs consisting of 59 males and 51 females (unilateral) were used in this study. The study was carried out on randomly collected lateral calcaneal radiographs of adults in several hospitals in Kwara state. Standard anthropometric methods were used to measure the right and left calcaneal angles: BA, GA, FPA, CIA, and CCA. Data were analyzed using SPSS version 23 (IBM^® Armonk, New York, USA) statistical software. Confidence level was set at 95% as P ≤ 0.05 was considered statistically significant. RESULTS: For right and left calcaneus in both sexes, the calcaneal angles were not significant. The P value was >0.05 (P > 0.05), indicating a nonstatistically significant values for the calcaneal angles. This present study, following measurements of calcaneal parameters in determining the sex of the right and left foot, showed no significant statistical difference across all five parameters. CONCLUSION: The findings showed that the measured calcaneal parameters cannot be used for determining sex.

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INTRODUCTION: Polypharmacy, defined by the World Health Organization as “the administration of many drugs at the same time or the administration of an excessive number of drugs,” is frequent among the elderly as they often suffer from chronic diseases with concomitant pathologies. Polypharmacy is a debated concept. Various definitions have ranged from two medications at a time to 18 or to more medications than clinically necessary. Five or more concurrent regular medications appear to be the most common definition. Despite the uncertainty around a definition, experts generally agree on the magnitude, potential for harm, and potential for the reduction in medication regimens for elderly people. AIM: The study aimed to assess the patterns of polypharmacy and its associated aspects among the elderly outpatient department (OPD) patients. OBJECTIVES: (1) The objectives of this study were as follows: to study patterns of polypharmacy and its associated aspects and (2) to study general ailments and their association with polypharmacy. MATERIALS AND METHODS: A cross-sectional study was conducted on 371 elderly patients of ≥60 years old with concomitant use of 4 or more medications, defined as polypharmacy. RESULTS: The results of the present study regarding drug use pattern revealed that majority, i.e., 50.9% were questioned most of the times for medicines before prescribing new set of medicines, 41.0% mostly preferred self-medication, 53.1% had no knowledge about the use of medication, 89.2% had no knowledge of the clinical purpose of the medicine they were using, 51.8% mostly forgot the dose and time of medicines, 18.6% had faced intolerable consequences of discontinuing medicine use, and 13.7% had encountered serious problem due to stocking up of the medicines. Majority, i.e., 84.6% experienced side effects of taking medication. The association reveals that polypharmacy was affected significantly by knowledge about the use of medication (P = 0.01), remembering the doses and timing of the medicines (P = 0.01), and encountering serious problem due to stocking up of the medicines (0.01), nasal problems (P = 0.001), and throat problems (P = 0.001). CONCLUSION: There is a pattern of polypharmacy that combines the factors such as aging and the risk of polypharmacy. RECOMMENDATION: The application of specific criteria before prescribing drugs, appropriate monitoring of drug therapy, and careful periodic review of the patient's list of medicines will assist with preventing the lethal complications of polypharmacy. The results indicate the need for additional research into many other aspects of polypharmacy.

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Patient safety refers to the prevention of harm and minimizing the chances of injuries or mistakes in the field of health care delivery. In-fact, the global estimates depict that on an annual basis in excess of 130 million adverse events are reported exclusively in health care settings in developing nations. The careful analysis of the trends has revealed that the issue of medication safety is of utmost importance in three settings, namely high-risk circumstances, consumption of multiple drugs and during the transition of care. The presence of comprehensive policies, better leadership from the managers, skilled team of health workforce, meaningful involvement of patients and strengthened surveillance mechanism to document reports of medication errors, can together reduce the magnitude of the entire problem. In conclusion, the time has come to adopt a multi-sectoral approach involving workforce, patients, policy makers, researchers and health sector to ensure not only patient safety, but even make it as a priority in the current era of health care delivery.

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Mucinous carcinoma of the gallbladder is an uncommon variant encountered predominantly in the elderly population. An unusual occurrence of this relatively uncommon malignancy is described herewith in a young female.

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Supernumerary tooth may be encountered by the general dental practitioner as an incidental finding on a radiographic examination or as the cause of an impacted tooth. However, in certain cases, it may be misinterpreted as a bony growth (mandibular torus) when it makes its appearance in the lingual aspect of mandibular arch. We present two cases of peridens, a form of supplemental tooth, the former case with the clinical feature of bony swelling and ending in a dilemmatic differential diagnosis and another case of impacted supernumerary tooth, accidentally found on radiograph, thereby stressing the role of radiographs in arriving at final diagnosis apart from clinical counterpart.

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Some of the biggest challenges in clinical practice remain in understanding all aspects that affect the person presenting in ill-health. One of the challenges is in explaining medical concepts to patients. Analogies can be an effective tool of the therapeutic armamentarium. This article elucidates a theory of analogies, principles of effective analogies in clinical practice, steps in discussing analogies, examples, and implications in clinical practice.

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BACKGROUND: This study was aimed to understand prescribing patterns of anti-cancer agents in patients with head and neck cancer, and to provide practice recommendations/educational interventions to optimize medication use in patients with head and neck cancer. MATERIALS AND METHODS: This study was carried out in an oncology specialty hospital for 3 years. The retrospective data were collected for 6 months for head and neck cancer patients treated in a last one year, and the prescribing pattern was studied. The selection of anticancer drug(s), dosage of the anticancer drugs, and emesis management were reviewed with respect to the National Cancer Comprehensive Network guidelines, whereas the administration was reviewed with respect to the hospital policies. The deviations were observed, and practice recommendations were developed. Health care professionals (oncology treatment team) were updated/educated on these recommendations. This was followed by a prospective phase for 18 months wherein the prescribing pattern was reviewed in a similar manner as retrospective phase. Compliance to treatment standards was assessed in both phases and reviewed to study an impact of educational interventions provided. RESULTS: One hundred and four retrospective prescriptions were reviewed and showed a compliance of 88% in selection of anticancer drug, 71% in its dosing, and 75% in its administration whereas antiemetics prescription showed 55% compliance in selection, 53% in dosing, and 88% in administration. Two hundred and eighty-eight prescriptions were reviewed prospectively and showed 92% compliance in selection of anticancer drug, 80% in its dosing, and 85% in its administration, whereas antiemetics prescription showed 87% compliance in selection, 75% in dosing, and 92% in administration. CONCLUSION: This study demonstrated that practice recommendations provided by research panel, in form of educational interventions were useful in improving use of medications in study population. It was evident from relatively higher compliance rate to treatment standards after interventions.

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INTRODUCTION: This study was conducted to assess the effectiveness and safety of low-dose oral triamcinolone (Kenacort^®, Abbott Healthcare Pvt. Ltd) in combination with disease-modifying antirheumatic drugs (DMARDs) in Indian patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Patients with an established diagnosis of RA, on a stable dose of DMARDs for at least 6-weeks, with evidence of disease flare-up or insufficient response to DMARDs were enrolled. Effectiveness of triamcinolone (4 mg) on disease activity (Disease Activity Score-28 [DAS28]), severity (Visual Analog Scale) and duration of morning stiffness, tender joint count (TJC), swollen joint count (SJC), patient global assessment of disease activity (Health Assessment Questionnaire-Disability Index [HAQ-DI]), quality of life (RAND 36-Item Health Survey score [SF-36]), and safety at 6 and 12 weeks of treatment were assessed. RESULTS: About 98.3% of patients completed the study (119/121; female: 64.5%). A significant improvement in DAS28 score was evident at weeks 6 and 12 compared to baseline (baseline: mean [standard deviation (SD)]: 6.6 (0.9); week 6: mean (SD): 5.5 (0.9); 95% confidence interval difference (CI): −1.3 to −1.0; P < 0.001; week 12: mean [SD]:4.7 [0.7]; 95% CI difference: −2.1 to −1.8; P < 0.001). Severity and duration of morning stiffness also improved significantly at the end of 6 and 12 weeks of treatment (P < 0.001). Substantial improvement in TJC, SJC, HAQ-DI score, and RAND 36-Item score was also evident (P < 0.001). Commonly reported adverse events were gastroesophageal reflux disease (3.3%), headache (3.3%), and fever (2.5%), which were mild and resolved subsequently. CONCLUSION: Low-dose triamcinolone with DMARDs was effective and well-tolerated in Indian patients with RA and in those with evidence of disease flare-up or insufficient response to DMARDs.

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INTRODUCTION: Pneumococcal infection is a significant public health problem and leading cause of death among young children in developing countries. In most of the cases, “Streptococcus pneumonia” is the common human pathogenic bacterium. It further increases the risk of otitis media, meningitis, sepsis, paranasal sinuses, and upper respiratory infections. To fight against this condition advanced antibiotic therapies are available, but due to less awareness and knowledge people are unable to access. AIM: The present study aims to measure the level of awareness and knowledge among the population of North Delhi about pneumococcal infection and vaccination. MATERIALS AND METHODS: To conduct the survey, questionnaire was developed. The questionnaire consists of 17 questions, which are divided into three sections such as awareness, knowledge, and attitude. A total of 281 (males: 105; females: 176) participants participated in the present survey. RESULTS: The present study revealed that only 46.02% of females have seen advertisements related to pneumococcal, whereas 60% of males said that they have never seen any advertisement. A total of 43 (40.95%) males and 57 (32.38%) females reported that pneumococcal vaccination (PCV) may help in curing pneumococcal disease; however, only 8.57% males and 19.09% females agreed that PCV can cure the pneumococcal disease. Only 29.89% population knew that pneumococcal can also cause ear infection, whereas only 29.89% were aware of the fact that pneumococcal infection can be fatal for neonates. CONCLUSION: From the present study, we can conclude that after all the initiatives taken by government, general population still has low level of awareness about the PCV. We suggest that more campaigns, street play, advertisement, and other methods need to introduce to increase the level of awareness.

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INTRODUCTION: Microalbuminuria has been studied in some acute and chronic illnesses such as urinary tract infection (UTI), heart failure, and diabetes mellitus, but nothing much has been said about children with malaria and pneumonia which are most common in the tropics. Therefore, this study seeks to establish how common microalbuminuria is among acute febrile children. MATERIALS AND METHODS: This was a prospective longitudinal study. One hundred and eighty-nine febrile children admitted for febrile illnesses who met the inclusion criteria were recruited consecutively between November 2017 and January 2018. Five milliliters of urine was tested for proteinuria using ComboStik 10 strips (DFI Co. Ltd., Gyung-Nam, Korea); positive cases were excluded from the study. Another 5 ml of urine was tested for the presence of microalbumin using ComboStik 2AC strips (DFI Co. Ltd., Gyung-Nam, Korea). RESULTS: The age ranged from 1 year to 14 years, whereas the mean age was 5.54 ± 3.37 years. There were 138 (73%) males and 51 (27%) females, with a male-to-female ratio of 2.7:1. Most patients with malaria (57.8%), bacterial sepsis (62.5%), bronchopneumonia (42.8%), meningitis (100%), and UTI (72.0%) had high abnormal ratio; however, among the various subgroups, this was observed mostly among those with meningitis, UTI, and bacterial sepsis. The mean values and standard deviations of the age, urine creatinine, microalbumin, and the ratio of microalbumin/creatinine for the various illnesses showed higher values for UTI (age, microalbumin, and microalbumin/creatinine ratio) and bacterial sepsis (creatinine). CONCLUSION: Microalbuminuria is common in children with febrile illnesses such as malaria, bronchopneumonia, and meningitis; therefore, usage as a screening tool for microalbuminuria should be in afebrile children.

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Nasopharyngeal carcinoma (NPC) is an extremely rare malignancy among pediatric age group. The relative rarity of pediatric NPC makes the diagnosis difficult and associated with late diagnosis and advanced locoregional disease. The clinical presentations of pediatric NPC are usually nonspecific. The children with NPC have excellent survival except those with metastatic disease. The tumor, nodes, metastases (TNM) staging has the most relevant prognostic factor. Unfortunately, NPC tends to be locally advanced at the time of diagnosis in pediatric age group and sometimes associated with distant metastasis. NPC in pediatric age is usually not suspected clinically until the patient in the late stage. The diagnosis of pediatric NPC should prompt and require early treatment. Delayed diagnosis of NPC affects the management and prognosis. The purpose of this review article is to discuss the etiopathology, epidemiology, clinical presentations, diagnosis, current treatment, complications of treatment, and prognosis of pediatric NPC.

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Medical students are upcoming doctors, and their wellbeing is important for society. Mental health issues particularly depression is a matter of concern among the doctors in general as it usually not talked about. Medical education is considered stressful, and depressive symptoms are commonly reported among medical students across the world. There is need to address mental health issues at the earliest in medical colleges for students' well-being; more student-driven approaches should be incorporated. Group interventions are well recognized intervention strategies. An adopted single session of group approach is presented here.

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Feedback has been identified as an approach to provide information about students' performance in order to help and guide them in planning for the attainment of the learning goals and to improve their behavior and skills. However, it is important to understand that the mere provision of feedback won't meet the purpose of closing the feedback gap and it has to be supplemented with follow-up actions and evaluation of the entire process of feedback to measure the change in behavior. It is quite essential to understand that in order to ensure that the process of evaluation of feedback remains effective and meets the intended objectives, it has to be planned in a systematic manner and that too well in advance. In conclusion, evaluation of feedback has to be a continuous process and the criteria for the same has to be explicitly defined for better planning and corrective measures based on the obtained results.

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Sexually transmitted infections have been regarded as one of the major global public health problems owing to its immense impact on the sexual and reproductive health of adults and children. The available global estimates depict that more than 360 million infections are being reported on an annual basis. It is an eye opener for all the concerned stakeholders to together plan and take concerted efforts to ensure that all the people who are in need of the health services receives the same either to prevent or get cured of the disease. The role of health workers will be of extreme importance as they have to not only take measures towards the reduction in the incidence of the disease, but also work together to eliminate the stigma and other barriers associated with infections and reporting of the same. In conclusion, sexually transmitted infections continue to remain an endemic public health concern globally and it is the need of the hour to strengthen the prevention and control measures for containment of the infections.

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