Manipal-Tata Medical College, Jamshedpur

Abstract Digitization of health records in public health facility and its instant availability in the form of electronic records anywhere any time health service is yet to be implemented in developing nations like India and other countries. In India, patient care is mainly delivered through 3 levels namely Primary/Community Healthcare Centre (PHC/CHC), Secondary healthcare centre (District Hospital), and Tertiary Healthcare Centre (National level). The healthcare facilities face many challenges in collecting, processing, and storing these data and managing it without compromising security and privacy. Presently, some of the secondary and tertiary care facilities have started implementing healthcare IT application in terms of Hospital Information System, Hospital Management Information System, Electronic Medical Records (EMR) etc. to manage the patient data in electronic format. However, these systems are developed by different vendors by using different programming languages and databases. This approach makes the system unique but the patient details remains in the same hospital and cannot be shared with other hospitals when patient moves from one hospital to other for advanced or specialized treatment. This is because the data is not interoperable and semantic. In the proposed work, a standard secure Electronic Health Record(EHR) framework is developed using standard medical terminology and coding standards. Implementation of EHR framework for Indian health system will improve the work-flow of health services to the population. EHR at all levels of healthcare system enable efficient and continuous care to the patient.

Introduction: Geriatric hip fractures are a major cause of concern globally and often a frequent reason for morbidity and mortality. Postoperative delirium (POD) is a frequent but often under-diagnosed complication, especially after a major hip surgery. Some of the factors that have been associated with POD are diabetes, high American Society of Anesthesiologists (ASA) grading, electrolyte imbalance, and blood pressure fluctuations. Malnutrition as a risk factor is only recently being recognized. Although there are many possible risk factors reported, they are quite conflicting and not very clear. Therefore, we have attempted to conduct this study to identify the potential risk factors for the development of POD in patients with hip fractures. Materials and Methods: A prospective observational study was performed on 110 geriatric hip fracture patients admitted to tertiary health care in South India. Data regarding preoperative blood investigations, ASA grading, hypertension and diabetes status, MNA (mini nutritional assessments) status, serum albumin, and serum electrolytes values were recorded. The Confusion Assessment Method tool (CAM) was used to diagnose delirium in the postoperative period. Statistical analysis was done for various factors influencing the occurrence of POD. Results: Among the total of 110 cases of geriatric hip fractures patients, 44.5% of the patients developed postoperative delirium. Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes played an important role to the development of post operative delirium in patients with hip fractures. Conclusion: Advancing age, hypoalbuminemia, malnourishment, and uncontrolled diabetes are strong predictors for the development of postoperative delirium in geriatric hip fracture patients. Since age is a non-modifiable risk factor, interventional strategies aimed at correcting modifiable risk factors like nutrition, serum albumin levels, and diabetes control play an important part in preventing delirium in the postoperative period in elderly hip fracture patients.MeSH terms: Hip Fractures, Postoperative Complication, Delirium, Nutrition Assessment, Serum Albumin.

Objectives: This study aimed to determine self-medication prevalence and its associated factors. Methods: A community-based cross-sectional study was conducted in the urban and rural catchment areas of Uttar Pradesh, India, among 440 adults using a pretested, semistructured questionnaire. The Chi-square test and logistic regression were used to determine the association of self-medication prevalence with various independent variables. The associations were reported as adjusted odds ratios and 95% confidence intervals. Results: The prevalence of medication use was 66.4%. The majority of participants (45%) took medicine for fever, cough (40.1%), and cold (31.8%). Allopathy (83.2%) was the most common medicine system used for self-medication. More than half reported taking medicine such as paracetamol (52%), followed by cough syrup (21%) and antihistaminic (17%). Convenience (46%) and lack of time (35.3%) were commonly cited reasons for self-medication. Also, 64.4% of the respondents practiced self-medication on the pharmacist's recommendation. Urban participants (adjusted odds ratio: 9.85, 95% confidence interval: 5.32-18.23), females (adjusted odds ratio: 2.32, 95% confidence interval: 1.18-4.57), skilled workers (adjusted odds ratio: 5.62, 95% confidence interval: 1.80-17.5), and those who completed primary school (adjusted odds ratio: 2.48, 95% confidence interval: 1.16-5.25) were more likely to self-medicate than rural, male, unemployed, and illiterate participants, respectively. Also, participants whose income was 30,000 Indian rupees (adjusted odds ratio: 3.21, 95% confidence interval: 1.00-10.21) were more likely to self-medicate than those whose income was less than 4000. Conclusions: A high prevalence of self-medication was found, particularly in urban areas. Convenience and lack of time were commonly cited reasons for self-medication. Allopathy was the most widely used medicine system for self-medication. Antipyretics, cough syrups, and antiallergics were most commonly self-medicated. Gender, education, and income were associated with self-medication. The study highlighted the increased usage among females which could be further explored and role of pharmacists' recommendation as a major driver for self-medication.

Background: Girls in many low and middle-income countries enter puberty with knowledge gaps and misconceptions about menstruation may lead to unsafe hygienic practices that increase health risk. Despite such importance, educated girls' knowledge and hygienic practice towards menstruation are not well addressed in India. Consequently, the present study attempted to assess menstrual hygiene knowledge and practice among college students in Lucknow city in north India. Method: An online college-based cross-sectional study design was employed in Lucknow, the capital of Uttar Pradesh in India. Data collection was carried out from September 11 to September 25, 2020, using a google form among undergraduate and Postgraduate students. All variables that were significant at bivariate level (at P-value < 0.05) were entered into multivariate analysis using a logistic regression model to control for confounding factors. In the final model, P-value of less than 0.05 was used as a base to identify factors having a statistically significant association with poor knowledge and hygiene practice at corresponding 95% confidence interval. Results: More than half of students' ages of menarche were between 12-15 years, and duration of menses flow was between 3-5 days. The most common premenstrual symptom was abdominal pain (67%) and back pain (50.5%). Majority of the students had first time discussed menstrual problems with their mothers (69.2%). Around 94% of students were currently using a sanitary pad as an absorbent. Regarding cleanliness, about (90.9%) girls clean their genitals after urinating during mensuration. Around 18.9% used medication during menstruation. Multivariate analyses reveal that students of Science and Technology (vs Commerce and Management Students) and monthly family income 50-100 thousand (vs < 25 thousands) were associated with good knowledge about menstruation. In contrast, students' fathers were graduates (vs school educated); the occupation was 'Other'(vs Farmer) ; living in a nuclear family(vs Joint family) and residing in urban areas(vs Rural) were less likely to have good menstruation knowledge. Besides, good hygiene practices are less likely to have with 'Other' Religion(vs Hindu), working mother(vs Housewife), monthly family income between 25 to 50 thousand(vs <25 thousands), and Nuclear family(vs Joint family) (p<0.05). Conclusions Most college students had poor knowledge but followed hygienic practices correctly. It demonstrates a need to design acceptable awareness creation and advocacy programs to improve college students' knowledge during menstruation. Of all the sociodemographic factors, monthly income and types of family influenced students' knowledge and practices related to menstruation.

Introduction: India accounts for approximately half of the worldwide snakebite deaths. It is often a neglected public health problem and particularly in Jharkhand region where medical facilities are limited. Epidemiological and clinical profile-related studies are scarce. The present study aims to assess the epidemiological profile and clinical features of snakebites encountered in a tertiary-care teaching hospital at Jamshedpur, Jharkhand, India. Aims and Objective: The aim of this study was to assess the clinical profile, outcome and epidemiological factors of snakebite cases, admitted to a tertiary care hospital in Jamshedpur. Material and Methods: This was a retrospective study from 2014 to 2021 wherein a total of 427 snakebite patients were admitted and had received treatment for snakebite at a tertiary-care teaching hospital at Jamshedpur, Jharkhand. All patients who reported with a history of snakebite were included in this study. The demographic and clinical details of each case were obtained and analysed. Result: A total of 427 snakebite cases were admitted to the hospital during the study period. The victims were predominantly males. Majority of the bite cases encountered were from rural areas and were in the second quarter of the year. The site of the bite was largely on the lower limb and the upper limb had fewer bites. The Glasgow Coma Scale was normal in those who presented early. Acute kidney injury, neutrophilic leucocytosis and deranged liver enzymes were associated with bad prognosis. Timely intervention with anti-snake venom offered good result. Conclusion: We had more male patients (69.55%), belonging to rural areas (67.91%), more bites in lower limbs and more cases in the second quarter of the year. Mortality rate was 0.7%.

Introduction: School refusal is a broad term that encompasses a child-motivated refusal to attend or remain at school, or a clear and apparent difficulty in doing so. Different factors that may influence the development of school refusal include a genetic predisposition, the home and family environment, the school environment, and social pressures. the present study aimed at examining, the psychiatric diagnostic status of children and adolescents who presented with school refusal. Materials and Methods: 92 consecutive subjects who attended the Child guidance clinic at Tata Main Hospital Jamshedpur were taken up for this study. The Clinical Diagnosis was based on the classificatory system of the International classification of diseases-10(ICD-10) through interviews. Results: findings show that the mean age of the patient was 9.6 years. The prominent psychiatric co-morbidity present was Childhood emotional disorder unspecified, separation anxiety, conversion disorder, over-anxiety disorder, and somatoform disorder. Conclusion: Among children who refuse school, emotional reasons and anxiety disorders are most prevalent. This calls for early recognition and appropriate culturally relevant intervention to ensure early return to school.

CONTEXT: Patella fracture is frequently encountered in day to day practice of every orthopedic surgeon, yet conventional modalities of fixation that are associated with a high incidence of implant removal continue to be standard practice. AIM: To estimate the incidence of implant removal in surgically managed patella fractures. SETTINGS AND DESIGN: Retrospective study. MATERIALS AND METHODS: Data of surgically managed patella fractures in our institution from January 2017 to December 2019 was collected from the hospital management system and analyzed retrospectively. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA) was used for the analysis of data. Nominal and categorical variables were analyzed using Chi-square, and continuous data were expressed as mean and standard deviation. A p-value ≤0.05 was considered significant. RESULTS: The study group had a total of 106 patients, with 74 males and 32 females and an average age of 47.67 ± 17.85 years. Most commonly the fractures occurred following an accidental fall and road traffic accident. A comminuted pattern was most common. The mean length of stay was 7.34 ± 4.21 days. Osteosynthesis with Kirschner wire and tension band wires was done in 83 cases. The average follow-up was 13 months (range, three to 48 months). Twenty-two patients (one in five) required a second surgery for implant removal and the rate was higher in patients more than 60 years of age, females, and comminuted fractures. Cases managed with cannulated cancellous screws did not require any removal. The average timing of removal was 14 months (range, seven to 28 months). Relief of symptoms following removal was observed in 86% of cases. CONCLUSION: Conventional fixation techniques offer good union rates but at a cost of a high incidence of removal. Multi-centric trials are required to compare the rates of removal of conventional methods with new techniques being adopted.

Background: Stillbirth is a traumatic experience for both the patient and the obstetrician. Determining its cause and early interventions can reduce stillbirths. The study was undertaken to determine the incidence, evaluate causes and surrogate markers for intrapartum and antepartum stillbirths. Methods: A retrospective study was carried out from August 2015 to December 2018. All stillbirths more than 22 weeks or a birthweight of ≥500 g were included in the study. Demographic and all clinical details were collected from the indoor case records and cause of fetal death assigned. Results: There were 520 stillbirths and 28,580 deliveries in the study period. Majority of these women with stillbirths were in the age group of 20-25 years at 33-37 weeks period of gestation, had parity 1 to 3 and were unbooked. Intrapartum deaths accounted for only 8.46% stillbirths. Extreme prematurity was the most common cause for stillbirths (20.38%) followed by chorioamnionitis (16.73%), hypertensive diseases (15.77%) and abruption (10.38). The cause remained unknown in 53.27%. Fetal movement appeared a better surrogate of antepartum /intrapartum deaths than macerated/fresh stillborns. Conclusions: Incidence of stillbirths was 1.8%. Most of the deaths were antepartum (91.53%). Extreme prematurity was the commonest cause. Fetal movement appeared a better surrogate marker of intrapartum / antepartum deaths.

Background The knowledge of renal artery (RA) and its segmentation is critical before attempting any surgical procedure of kidney. The RA receives blood supply from various arteries during its descent in the embryonic period. As a result, the segmental RAs show a lot of variability in the site and pattern of origin as well as its point of entry in the kidney. Aim/objective The aim is to study the variable pattern existing in different segmental RAs and the arrangement of structures at the renal hilum. Methods The RA of 205 kidneys (68 paired and 69 unpaired) was studied and the segmental pattern was exclusively observed in cadavers by dissecting 161 kidneys, making resin/silicon casts of 34 kidneys and radiological imaging of 10 kidneys. Results The results obtained were quite significant and provided in detail understanding of the five main segmental arteries and the arrangement of structures at the renal hilum. Great variations were seen in the disposition of structures at the renal hilum. Six different patterns of structures at the renal hilum were obtained. Pattern 1 was the commonest pattern with an incidence of 30.3% followed by pattern 2. The site of origin of segmental arteries and their point of entry into the kidney were recorded and tabulated. The segmental arteries were classified into different types based on the frequency of their occurrence in decreasing order. In each of them, Type 1 is the commonest variant seen based on the origin of the apical artery (A), anterior upper segmental artery (AU), anterior middle segmental artery (AM), lower segmental artery (L), and posterior segmental artery (P). Conclusions The arrangement of hilar structures has been classified into six patterns and the variations existing in each of the segmental branches of the RA have been categorized as well. The knowledge will be invaluable for accurate radiographic interpretation of the renal vasculature and effective surgical planning in cases involving kidney transplantation, renal trauma, and partial nephrectomy. Furthermore, it will serve to prevent complications during surgical procedures.

Objectives: This study was aimed at determining the histomorphometry of the cerebellar cortical laminae and the dentate nucleus of the human fetal cerebellum; the number and shape of the neurons; and the gestational age of appearance of the cerebellar folia, white matter and arbor vitae cerebelli. Methods: Microscopic sections of the human fetal cerebellum stained with hematoxylin and eosin and Bielschowsky silver stain were studied. Results: The thickness of the cortical laminae of the human fetal cerebellum varied among gestational weeks as follows: external granular layer: 36.06 ± 9.36-50.05 ± 34.06 μm, molecular layer: 32.76 ± 17.16-52 ± 28.6 μm, Purkinje cell layer: 9.36 ± 6.8-15.6 ± 4.68 μm and internal granular layer: 66.65 ± 24.42-146.63 ± 47.79 μm. Similarly, the number of neurons per field of view at 1000X under a compound microscope varied among gestational weeks as follows: external granular layer: 89.92 ± 42-142.84 ± 50, molecular layer: 15 ± 12.5-25 ± 8.25, Purkinje cell layer: 3.5 ± 1-5 ± 2.5 and internal granular layer: 98.5 ± 69.75-224 ± 47.White matter in the fetal cerebellum was already present at the age of 12th gestational week, whereas cerebellar folia appeared at 16-20 gestational weeks. Arbor vitae cerebelli and the dentate nucleus became conspicuous after the 20th gestational week. Fetal neurons were round except for Purkinje cells. Conclusions: The thickness and neuronal counts of the human fetal cerebellar cortical layers and the measurements of the dentate nucleus along with other histomorphological features varied with gestational age from the 12th week of gestation until birth.

Background: Since the COVID-19 pandemic hit the globe, it has not been possible to conduct traditional classroom teaching in view of the closure of schools and colleges in our country since March 2020. Hence, it is important to study the highlights, demerits, and bottlenecks in the implementation of online education from a student’s perspective. Methods: The present study was carried out to assess perceptions regarding virtual classroom among undergraduate students of a tertiary medical college in U.P. A pre-designed, semi-structured questionnaire was used. Study was conducted through an online survey. Data was analyzed with the help of SPSS version 21. Results: A total of 377 participants were included in the study. More than half of the participants (54.9%) preferred a mixed mode of learning which includes both online and offline learning. Lack of interaction with teachers (66.3%) and fellow students (57.6%) and lack of quiet space at home to listen to online classes (44%) were a few of the perceived demerits of online classes. Internet speed was found to be one of the most challenging issues faced in online learning (78.5%). Conclusion: Students’ perception of the blended learning mode was positive. They were, however, less enthusiastic about online learning than they were about conventional classroom learning.

Fine-needle aspiration cytology, a simple and inexpensive technique can aid in early diagnosis of aspergilloma. Here, we present a case of 55-years-old female with a past history of pulmonary tuberculosis and a right-lung cavitary lesion, diagnosed as aspergilloma.

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix-Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.

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Background Adequate post-operative analgesia in the obstetric patient is necessary to facilitate breastfeeding and the care of the newborn. Considering the limitations of intravenous analgesic options such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, other alternatives have been tried for offering better analgesia with fewer potential side effects. Transversus abdominis plane (TAP) block is one such option that has been tried with various local anesthetic drugs, either alone or in combination with other adjuvants. The addition of dexmedetomidine to bupivacaine in TAP block has been shown to prolong the duration of post-operative analgesia when compared to local anesthetic alone. This study was conducted to determine the efficacy of dexmedetomidine, as an adjuvant to ropivacaine, when administered in TAP block in patients undergoing cesarean section. Methodology The study was a prospective, randomized, parallel assignment, triple-blinded controlled trial. Hundred patients posted for elective lower segment cesarean section, fulfilling the inclusion criteria, were randomly divided into two equal groups, group R and group RD, comprising 50 patients each. Patients in group R were administered bilateral TAP block by landmark technique using ropivacaine alone, whereas patients in group RD were administered TAP block with dexmedetomidine 1 micrograms/kg, in addition to a similar dose of ropivacaine. Mean arterial pressure (MAP), heart rate (HR), visual analog scale (VAS)-R (pain score on VAS scale at rest), VAS-C (pain score on VAS scale on coughing), nausea and vomiting, and Ramsay sedation score were recorded on admission to post-operative care unit (PACU), and at first, fourth, eighth, 12th, 18th, and 24th hours post-operatively. Rescue analgesia was provided with intravenous morphine. Short Assessment of Patient Satisfaction Score (SAPS) was noted on a five-point scale after 24 hours based on patient satisfaction regarding the quality of post-operative analgesia. Results While there was no significant difference between groups R and RD with respect to VAS-C and VAS-R immediately after shifting and at the first, fourth, and eighth hours, a significant difference was observed at the 12th and 18th hours post-operatively. After 24 hours, no significant difference was observed between groups R and RD with respect to VAS-C and VAS-R. While 50% of patients needed rescue analgesia in group R, only 28% of patients needed rescue analgesia in group RD. There was significantly better patient satisfaction measured by the Short Assessment of Patient Satisfaction Score (SAPS) with respect to the quality of analgesia in patients in group RD as compared to those in group R. Conclusions The addition of dexmedetomidine to ropivacaine increased the duration of post-operative analgesia up to 18 hours post-operatively in cases of elective lower segment cesarean section. Also, the quality of post-operative analgesia is better in such patients, as shown by a significant difference in patient satisfaction scores between the two groups.

Aims A prospective observational study was performed to assess the feasibility and safety of three-port laparoscopic cholecystectomy. Parameters comprising age, sex, number of cases in which intra-operative difficulty were encountered, and outcomes such as number of cases that required conversion to four-port laparoscopic cholecystectomy, postoperative pain on the visual analog scale (VAS), and postoperative hospital stay were assessed. We also documented difficult cases that were operated successfully with three ports, and the number of cases that needed conversion to four ports along with the reason for the conversion. Material and methods The patients were operated upon in the supine position in all cases. A pre-emptive analgesia with 1% lignocaine was administered in all cases prior to making the incision. The first port was 10-mm supraumbilical and inserted by the open technique. After insertion of the umbilical port, pneumoperitoneum was created by maintaining a maximum pressure of 12 mmHg and a flow rate of 8 L/minute. A camera head with a 30° telescope was introduced in the peritoneal cavity, and diagnostic laparoscopy was performed. A 10-mm subxiphoid port and a 5-mm subcostal port were placed under vision, with the latter placed more lateral and inferior to the conventional port position for better triangulation and ergonomics. The outcomes measured were operative time, the number of cases requiring a fourth port, postoperative pain (VAS), and postoperative hospital stay (number of days patients stayed in the hospital post-surgery until discharge). Data were collected using MS Excel, and an analysis was performed using SPSS Version 21.0. Results Data of 102 patients were analyzed prospectively. The mean age of the patients was 50.98 years, with an SD of 16.88, and the gender ratio was 73:29 (female: male). The mean operative time was 52.68 ± 20.84 minutes, with an SD of 20.84. Difficulty was encountered in 18.6% of cases in the form of pericholecystic adhesions, aberrant Calot’s anatomy, empyema or mucocele of the gallbladder, or bleeding from the liver bed or cystic artery stump. Postoperative pain was less in our study due to the reduced number of ports and the use of a pre-emptive analgesia, with a mean VAS score of 1.22 and an SD of 0.56. The mean postoperative hospital stay was 1.08 days, with an SD of 0.31. We needed to convert to a four-port procedure for safety in 2.9% cases. The operative time and postoperative hospital stay in our study were similar to those of other studies, but our average pain score was less due to the use of the pre-emptive analgesia. Only three cases required conversion to four ports, and 99 cases were successfully managed with three ports without compromising safety. No bile duct injury occurred in any of our 102 cases. Conclusion From this study, we conclude that three-port cholecystectomy is feasible, and it can be performed even in difficult cases without compromising safety. The surgical time is similar to that of four-port cholecystectomy, and the postoperative stay is shorter. The decreased number of ports and the pre-emptive analgesia reduced postoperative pain, cosmesis was better, and the incidence of bile duct injury did not increase. The procedure can also be converted to four-port cholecystectomy at any time if safety is compromised. Therefore, three-port cholecystectomy is a viable and safe option in the treatment of gallstone disease.

Aims: Dengue fever is a major health problem with high morbidity and mortality especially during epidemic season; pregnant females being no exception. But, there is paucity of published data on dengue fever during pregnancy. Hence, this study was planned to study the clinical profile, maternal outcome and predictors of poor outcome in pregnant dengue patients. Materials and Methods: All pregnant females attending labour room of Tata Main Hospital, Jamshedpur from April 2016 to October2020 with acute febrile illness caused by dengue virus at any gestational age were included in the study. Diagnosis of dengue was made by detection of NS1 antigen or dengue serology. A predesigned proforma was used to record materno-foetal outcomes and were analysed. Results: Dengue was the cause of fever in 7.1% febrile patients. Maternal complications included abortions (26%), abruptio (1.9%), postpartum haemorrhage (11.9%) . Of all the pregnant dengue patients, five had severe dengue(SD) with high mortality (3/5; 60%). Fetal complications were intrauterine death(7.7%),preterm(42.3%). Thrombocytopenia and elevated transaminases were associated with adverse outcome. Conclusions: Dengue fever in pregnancy is associated with poor outcomes more in cases of SD rather than dengue fever . Pregnant females with high risk predictors should be identified and managed aggressively in intensive care units to improve outcomes.

A BSTRACT Background: Postpartum depression (PPD) is a significant mental health issue affecting mothers globally, with varying prevalence across different settings. This study aimed to determine the magnitude and identify the risk factors for PPD among urban mothers in Jharkhand using the Edinburgh Postnatal Depression Scale (EPDS). Materials and Methods: A hospital-based cross-sectional study was conducted among 270 postpartum women. Data were collected through a structured questionnaire. PPD was assessed using the EPDS, with a score of ≥10 indicating symptoms suggestive of PPD. Various sociodemographic, obstetric, and psychosocial factors were analyzed to determine their association with PPD using descriptive and inferential analyses. Results: The prevalence of PPD was 18.5% ( n = 50). Unmarried and separated women had a higher prevalence of PPD ( P < 0.001). Occupation played a role, with daily wage earners exhibiting a greater likelihood of PPD ( P = 0.001). Other risk factors included dissatisfaction with living conditions ( P < 0.001), lower meal intake ( P < 0.001), and reduced sleep (<6 hours) ( P < 0.001). Pregnancy-related factors such as unplanned pregnancy ( P = 0.047), inadequate antenatal care (ANC) visits ( P < 0.001), and complications like premature rupture of membranes (PROM) and fetal growth restrictions ( P < 0.001) were also significantly associated. Lack of partner support ( P = 0.001), partner addiction ( P = 0.010), and a history of antepartum depression ( P < 0.001) further increased the risk. Conclusion: The study highlights a high prevalence of PPD, emphasizing the need for routine mental health screening and psychosocial interventions. Improving ANC, strengthening family and community support, and integrating mental health services into maternal healthcare could help mitigate the burden of PPD.

Immune thrombocytopenia (ITP) caused by infectious and non-infectious conditions has been reported in coronavirus disease 2019 (COVID-19) patients too. Here we present a 64-year-old male patient with post-COVID-19 pneumonia who presented with a gastrointestinal bleed and was found to have severe isolated thrombocytopenia (22,000/cumm) diagnosed as ITP with extensive investigations. He was treated with pulse steroid therapy and later was also given intravenous immunoglobin in view of poor response. The addition of eltrombopag also resulted in a sub-optimal response. He was also having low vitamin B12, and his bone marrow also supported the megaloblastic picture. Hence, injectable cobalamin was added to the regimen, which resulted in a sustained rise in platelet count that reached 78,000/cumm, and the patient got discharged. This shows the possible hindrance to treatment response by concomitant B12 deficiency. Vitamin B12 deficiency is not an uncommon entity and should be tested in those who show no or slow response to thrombocytopenia.

PURPOSE: The assessment of cardiac performance in septic new-borns is crucial for detecting hemodynamic instability and predicting outcome. The aim of the study is to assess myocardial performance in neonates with sepsis for the early identification of cardiac dysfunction. PATIENTS AND METHODS: A case control study was carried out from September 2022 to May 2023 at the Neonatal Intensive care unit, Kasturba Medical College, Manipal. A total of 68 neonates were included in the study, with 33 females and 35 males. The study population was further subdivided into 3 groups namely preterm septic neonates (n = 21), term septic neonates (n = 10) and non-septic healthy controls (n = 37). The cardiac structure and function were assessed using conventional method, Tissue Doppler imaging (Sm) and speckle tracking echocardiography (GLS). The study was approved by the Institutional Ethics Committee at Kasturba Medical College, Manipal (approval number IEC: 90/2022). The CTRI registration number for the study is CTRI/2022/09/045437 and was approved on September 12, 2022. Prior to the neonate's enrolment, informed consent was obtained from their mothers or legal guardians. RESULTS: Out of the total 68 neonates, 31 were cases and 37 were controls which included 33 females and 35 males. LV systolic function was not statistically significant between cases and controls. E/A ratio of the mitral valve was significantly lower in septic newborns than in healthy neonates. (1.01 ± 0.35 vs 1.18 ± 0.31, p < 0.05) preterm neonates showed significantly lower Lateral E' and RV E' velocities than term neonates. TAPSE was significantly lower in septic preterm neonates. (8.61 ± 1.28 vs. 10.7 ± 2.11, p < 0.05) No significant difference was noted in the Myocardial Performance Index between septic neonates and healthy neonates. LV Global Longitudinal Strain was slightly lower in preterm septic neonates than in term neonates with sepsis. CONCLUSION: Septic newborns are associated with LV diastolic dysfunction, RV systolic dysfunction and substantially higher pulmonary systolic pressures.