Context: Nutritional anemia is a major public health problem of women in India. Kerala has good health indicators in comparison to other states of India. However, the health of tribals, one of the marginalized communities, of the state is poor. Aims: Primary objective of the study was to estimate the prevalence of anemia among tribal women of 15-45 years of age of Wayanad District. Settings and Design: A cross-sectional survey in 10 clusters of Wayanad district of Kerala. Subjects and Methods: A cross-sectional survey was done among a sample of 347 tribal nonpregnant, non-lactating women aged between 15-45 years in 10 clusters of Wayanad on the basis of probability proportional to size in 2010. Anemia was diagnosed by estimating the hemoglobin concentration in the blood with the use of direct cyanmethemoglobin method. Results: The mean hemoglobin of the study group was 9.04 gm% (Standard deviation (SD) 1.64) and coefficient of variance is 18.14%. Prevalence of anemia was found to be 96.5% (n = 335) (Standard error = 0.986 and 95% confidence interval, CI, 94.53, 98.47). Mild anemia (Hemoglobin = 10-11.9 gm%) was found to be 30.5%. About (55.9%) had moderate degree anemia (Hb 7-9.9 gm%). Prevalence of severe anemia (<7 gm%) was found to be 10.1%. Conclusions: Prevalence of anemia was substantially high among women of reproductive age group of Wayanad.

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Background: Prevalence of dental caries not only varies according to age, gender, and arch but also according to the involvement of individual tooth. The study on individual tooth will help in providing incremental dental care and reducing burden of dental caries in this group of population. Objective: To find out the prevalence of dental caries in individual tooth among 6-12-year-old school children in Shimla city, Himachal Pradesh. Materials and Methods: This study was conducted among 1,200 school-going children over a span of 5 months from 11 government schools in Shimla city, in the state of Himachal Pradesh in India. Examination was performed using a mouth mirror and blunt sickle-shaped explorer under natural light, according to World Health Organization (WHO) oral health survey 1997. Results: Females were having higher prevalence of dental caries than males of the same age-group in both primary and permanent dentition (79.3% vs. 74.9%). First molars were most affected with dental caries than other teeth in both the dentitions (78.69% and 48.93%, respectively). Dental caries prevalence was high in mandibular arch than in the maxillary arch i.e. (80.0% vs. 77.38%) in permanent dentition and (51.3% vs. 46.56%) in deciduous, dentition respectively. Statistically, this difference was significant (Fischer's exact test P < 0.05). Conclusion: High prevalence of dental caries among government school children in Shimla city is a cause of concern. There is utmost necessity of regular periodic check-up, application of preventive measures, and treatment modalities as soon as teeth erupt in the oral cavity.

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Background: The Indian elderly population is currently the second largest in the world. Mental disorders have got high prevalence and low priority among elderly in most of the countries around the world, of which depression being the most common treatable condition. In India, there is scarcity of research on prevalence and factors influencing depression among elderly from urban poor locality by adopting a geriatric depression scale-15 (GDS-15) scale. Objectives: (1) To find out the prevalence of geriatric depression, (2) to find out the factors associated with depression. Methodology: A cross-sectional study was conducted at urban poor locality of Bengaluru on 100 elderly people by applying GDS-15 Kannada version to assess the prevalence of depression and information regarding the sociodemographic characteristics, financial status, and comorbid conditions were collected. Results: The prevalence of depression assessed by using GDS-15 Kannada version was found to be 36%. Depression was more among 12 (70.6%) from medium standard of living index (SLI) group compared to 24 (28.9%) from high SLI group, which was shown to be statistically significant. Among the elderly with depression, 31 (86.1%) had some medical comorbidities when compared with 33 (51.6%) elderly without depression, which was found to be statistically significant. Conclusions: The current research has shown prevalence of depression according to GDS-15 (Kannada version) as 36% and influenced by SLI, hold on assets, insomnia and comorbidities, which needs to be confirmed by undertaking further studies.

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Background: Childhood fitness is an emerging area of concern as prevalence of childhood obesity is rising. Indian studies, have identified decreased fitness levels and increased obesity in urban children. However, studies incorporating a comprehensive fitness evaluation are unavailable. In order to establish appropriate school fitness programs, baseline fitness levels in the target children is essential. Aims: The aim of this study is to evaluate health and performance related fitness levels of school going children between the ages of 8 and 14 years old. Settings and Design: Schools from Udupi Taluk, observational design. Materials and Methods: Fitness testing battery adapted from Presidential fitness challenge. Statistical Analysis Used: Descriptive statistics, parametric tests of comparison, and correlation were carried out using Pearson's correlation coefficient. Results: Children were divided into age groups consisting of 1 year age intervals. Reference values are guidelines given by President's challenge. Children who scored 25-32 points were considered as very fit; 17-24 as being adequately fit and 8-16 as unfit. Children from vernacular schools were more fit than those from English medium schools, with boys doing better (P = 0.01). Conclusions: From the results of this study, we can conclude that basic levels of health-related fitness are low among school children of Udupi Taluk, Karnataka.

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Context: Cardiac arrest or respiratory arrest is the most common emergency which results in grave consequences and mortality and can be easily prevented by simple maneuvers and skills with the knowledge of basic life support (BLS), thus ensuring the survival of the patient. This study aims to assess the awareness of BLS and cardiopulmonary resuscitation (CPR) among the medical, dental, and nursing students. Aims: To assess the awareness of BLS among medical, dental, and nursing undergraduate students. Settings and Design: The study was carried out on undergraduate students randomly chosen from medical college, dental college, and nursing institute using response to a structured questionnaire. Materials and Methods: A cross-sectional study was conducted in Mysore during April-May 2012 among medical, dental, and nursing student. A questionnaire was given interrogating them regarding various aspects of awareness and skills involved in BLS. The results were analyzed using an answer key employing appropriate statistical tools. Statistical Analysis Used: The data was analyzed using software version Statistical Package for Social Sciences (SPSS) 12.0. Demographic data were analyzed using analysis of variance. Unpaired t-test and Chi-square tests were used where appropriate. Sample size of 500 was determined. Standard tests of significance were applied to determine the P < 0.05 was considered significant. Results: More than half of the medical students had fair knowledge of the basics in BLS. Poorer number of students had a general idea about the skills and techniques used in BLS. Response during an emergency real life situation was disappointingly low among the respondents and it was found that the students considerably lagged behind in the knowledge of cognitive and practical skills of BLS. Conclusions: We conclude that awareness regarding BLS among the study groups was varied and was generally poor, which calls for standardizing training in BLS and making it a mandatory part of all medical and paramedical teaching program.

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Background: Advance in mechanization and acceleration of travel has been accompanied by an increase in number and severity of fractures and those of the tibial plateau are not an exception. As it is one of the major weight bearing joints of the body, fractures around it will be of at most importance. Aims: (1) To restore articular congruity and limb alignment by open reduction and rigid internal fixation. (2) To enable early knee motion and improve quadriceps and hamstring power. (3) To study the role of surgical treatment and functional outcome in tibial plateau fractures and its complications. Settings and Design: A prospective study was carried out, 32 cases of the tibial plateau fractures, which were admitted from August 2010 to April 2012 at Department of Orthopedics of our Hospital. Materials and Methods: 32 patients underwent surgical treatment for tibial plateau fractures. Fractures were classified according to the Schatzker's system. The indications for surgery were defined as the presence of displacement, depression and instability being more than 4 mm, 10 mm and 10 degrees. The mean follow-up was 12 months. The selected patients were evaluated and were taken up for surgery. The indicated fractures were treated with closed reduction and internal fixation with percutaneous cannulated cancellous screws, external fixator, open reduction and internal fixation with buttress plate with or without bone grafting. The range of motion was started soon after surgery. The patients were advised nonweight bearing up to 6-8 weeks. Total weight bearing deferred until 12 weeks or complete union of fracture. Statistical Analysis: All parameters before and after the treatment were expressed in mean ± standard deviation and analyzed by the Student's t-test using SPSS version 16. Results: The knee range of motion was excellent to very good and weight bearing after complete union was satisfactory. Malunion in two cases, knee stiffness in three, redepression in one case, wound dehiscence in two cases and no cases of nonunion were recorded.

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Background: Socio-economic status (SES), human immunodeficiency virus (HIV) knowledge and self-efficacy influence risky behaviors and female sex workers (FSWs) are not exception. Aims: This study was aimed to investigate if SES, HIV knowledge and self-efficacy predict frequency of unprotected sex with injecting drug users (IDUs) among a sample of FSWs in Iran. Setting and Design: Universal Network for Health Information Dissemination and Exchange HIV Risk Study was a survey of IDUs and FSWs, conducted in eight different provinces of Iran, 2009. Materials and Methods: A total of 55 FSWs were entered in this study. Frequency of unprotected sex with IDUs during the past 6 months was the dependent variable. Number of sexual partners during the past 6 month, SES, HIV Knowledge, self-efficacy, perceived HIV risk and intention for change were predictors. Statistical Analysis: We used hierarchical regression for data analysis. In each step, a block of predictors were added to the model. SES block composed of education level, owning a house and living alone. Results: In the absence of SES in the model, HIV knowledge and self-efficacy were not significantly associated with the frequency of unprotected sex with IDUs during the past 6 months, However, with adding SES block to the model, HIV knowledge became significant predictor of the outcome. Thus, among our sample of Iranian FSWs, SES has a suppressor effect for the effect of HIV knowledge on frequency of unprotected sex with IDUs during the past 6 months. Conclusion: Studies which wish to understand the role of theory-based psychological constructs such as HIV knowledge on high risk behaviors need to include SES an essential contextual factor. This finding may also explain why literature is mixed on the effect of HIV knowledge on HIV risk behaviors.

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Context: Fertility rates have started declining in West Bengal, India in the last few decades. In vitro fertilization (IVF) is one of the major treatment modalities available to infertile couple. Aims: This study was aimed to evaluate and compare the growth parameters of IVF and spontaneously conceived children. The objective of this study is to relate the physical status of IVF children with that of spontaneously conceived group. Settings and Design: In a cross-sectional case-control study, growth parameters of 3-14-year-old children were assessed. Subjects and Methods: Weight and height of 3-14-year-old children were assessed. Birth weight and length of each case and control group was also recorded. The case group consisted of term, singleton babies who were outcome of IVF in the studied area in 2009. The control group consisted of term, first child, singleton, and spontaneously conceived 3-14-year-old children who were also resident of the studied area. A sample of 150 IVF and 150 spontaneously conceived children were examined. Statistical Analysis Used: Chi-square and student's t-test were used for data analysis. Results: No statistically significant difference found in the studied (IVF children) and the control group (spontaneously conceived children). Conclusions: Growth retardation is more prevalent in babies born through IVF in the initial phase of life, but later on, IVF children are considered same as spontaneously conceived children.

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Drug therapy management (DTM) is one of the new terms introduced recently and is defined as "services that optimize therapeutic outcomes for individual patients." DTM programs if implemented effectively can greatly enhance patient care, leading to improved overall health, while at the same time decreasing overall health care system costs by reducing improper medication use, preventing adverse drug events and other undesirable outcomes and supporting achievement of therapeutic goals. The safe, effective, appropriate, and economical use of medications is the influencing goal of DTM. Doctor of Pharmacy (Pharm D) reflects an evolutionary change for pharmacy students in the field of pharmacy practice to a more patient-centered focus and there is a great necessity of a Pharm D course in a country like India, where it's required to achieve better drug control and compliance among patients, who are unknown to drug knowledge. The combined patient treatment by a physician and pharmacist is the ultimate and superior most way of achieving better patient compatibility.

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Background: Double valve replacement (DVR) is usually done through median sternotomy. However, right anterolateral thoracotomy is an alternative approach. Aim: The aim of this study was to analyze the results of right anterolateral thoracotomy for DVR. Patients and Methods: This was a prospective study conducted on during the period from January 2009 to January 2012. This study consists of 56 patients who had a concomitant mitral and aortic valve disease and were subjected to DVR. Patients were studied according to their age and sex, New York Heart Association (NYHA) class, valve pathology, concomitant procedures, urgent/elective, length of incision, surgical exposure, mean bypass time, operating time, hospital stay, and cosmesis. Results: Majority of the patients were in 3 ^rd and 4 ^th decade (61%). Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 ^th day. The average size of incision in males was 7.5 cm and in females the size of incision was 7.25 cm with a mean of 7.3 cm in both genders. Rheumatic heart disease was responsible for 89.28% of cardiac valvular lesions, degenerative disease in 7.14% and endocarditis in 3.5%. Postoperatively at 2 months, there was a statistically significant improvement in the NYHA class with 94% of the survivors in class I-II. There was a statistically significant difference in the outcome in patients having higher ejection fraction as compared to those who had low ejection fraction preoperatively. Thirty days mortality was 1.78%. Over the first 24 postoperative hours, only about 30% of patients were pain free, and this proportion increased to about 50% by day 2, 60% by day 3, 70% by day 4, 75% by day 5 and stabilized. Postoperative length of stay was 7-12 days, 70% of patients were discharged by the 7 ^th day. Conclusion: DVR via thoracotomy appears to be associated with faster recover, early discharge and reduced use of rehabilitation facilities that translate into a shorter hospital stay and cost. In addition to early benefits of thoracotomy approach, late cosmetic results are also better than conventional sternotomy.

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Background: Candida species are the third most common blood culture isolates recovered from cases of late onset sepsis in neonatal intensive care unit (NICU). Candida parapsilosis is probably, the species that have had the largest increase in incidence since 1990, becoming the predominant agent of candidemia in certain centers. We evaluated the prevalence of neonatal candidemia due to C. parapsilosis and the main clinico-epidemiological aspects of this disease in neonates. Materials and Methods: This retrospective observational study was conducted for a period of 18 months at our rural tertiary care and referral center. Hospital records of the neonates with candidemia due to C. parapsilosis were reviewed. The Candida species isolated were identified as per standard mycological techniques. Results: Of total 163 neonates diagnosed of candidemia, 43 (26.38%) corresponded to C. parapsilosis. Failure to thrive (74.42%), abdominal distention (67.44%), and feed intolerance (65.12%) were the most common clinical presentations seen. Among the risk factors observed broad spectrum antibiotics (81.40%), total parenteral nutrition (79.07%) and indwelling catheters (79.07%) were the most common followed by prematurity (72.09%) and low birth weight (65.12%). Early mortality accounted for 20.93%, whereas late mortality accounted for 11.63% of the cases. Conclusion: Progressive shift of C. albicans to non-albicans Candida species, particularly C. parapsilosis substantiates the need of continuous monitoring of laboratory data. C. parapsilosis is an emerging fungal pathogen and the major threat for neonates in NICU. Local epidemiological knowledge is critical in terms of prevention and management of invasive Candida infections.

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The supra condylar process is occasional beak like projection from anteromedial surface of distal 1/3 ^rd of humerus. It appears to be phylogenetic remnant of complete osseous bridge found in reptiles, marsupials, cats, lemurs and new world monkeys. Among 133 dried humeri studied only one right humerus showed SCP (incidence 0.75%) whose dimensions were recorded and photographed. SCP is usually clinically silent but can be the cause for median or ulnar nerve and brachial artery compression syndrome especially when associated with Struthers ligament. Therefore the knowledge of presence of SCP is important for clinicians and radiologists along with anatomists and anthropologists.

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Background: Kikuchi Fujimoto Disease (KFD) is a benign, rare, and self-limiting disease occurring among young individuals. This is commonly encountered as cervical lymphadenitis and due to its long-term presentation, it often gets mistaken as malignant lymphomas. The authors highlighted this benign entity that occurred in wide range of age group, which needs just a symptomatic therapy and follow-up. Study Design: A total four cases of KFD diagnosed in Employees State Insurance Corporation (ESIC) Medical College and Post Graduates Institute of Medical Science and Research (PGIMSR), Rajajinagar, Bangalore over a period from June 2010 to June 2013. The clinical and cytohistological features in all four cases were evaluated. Results: In the present study, all the 4 cases were females with wide age range from 14 to 37 years and presented with painful cervical lymphadenopathy and fever. The predominant cytological features of KFD were karyhorrechtic debris and necrosis; however, all four cases needed biopsy for confirmed diagnosis. On histopathological study, 3 of 4 cases confirmed the diagnosis of KFD except a single case, which posed dilemma with lymphoma, which on immunohistochemistry proved it to be KFD. Conclusion: KFD being rare, awareness of this entity and referral of patients with persistent lymphadenopathy to rule out this rare entity is of at most importance and reduces the apprehension associated with mis-diagnosis with lymphomas. Also it further emphasizes the fact that histopathology is the confirmatory diagnostic tool for KFD.

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