Institutional Human Ethics Committee Research Articles

Socio-demographic and Risk Factors Study of Cervical Cancer among Women in South India

Cervical cancer is the second most common cancer among women in the world. Despite the good achievements in this type of cancer prevention and treatment in developed countries, developing countries are still reporting high rates of new cases and mortalities, India as an example. In the current study, we aimed to study the most associated risk factors with cervical cancer in Coimbatore City, India. The study was first approved by the institutional Human Ethics Committee and then by the Sri Ramakrishna Hospital Human Ethics Committee. Then the data collected from cervical cancer patients after getting their informed consent. The collected data then analyzed statistically based on age, age at marriage, parity, smoking, and alcohol, level of education, and place of living. The study results showed that cervical cancer risk increases with age especially between 50 and 59 years old. The age of marriage data analysis revealed that 44% of the women married before 18 years old. The study found 51% of the patients have three or more children. The majority of the cases were women who had no education (64%) and the incidence decreased in the educated women (19% of 10th class, 9% 12th class, 8% degree or higher).75% of the cases are living in the rural areas. The study clearly showed the risky age (50 -59) and the importance of screening before this age as well as the role of education level, age of marriage, parity, and living place as key factors in cervical cancer.

EVALUATING THE IMPACT OF HYBRID SIMULATION IN ENHANCING THE LEARNING DOMAINS OF MEDICAL UNDERGRADUATES: A QUASI-EXPERIMENTAL STUDY

Objectivs: Medical education, crucial for understanding physiological processes and clinical application, faces limitations in traditional methods. Simulation-based training addresses this gap, providing a secure environment for hands-on skill practice. The objectives of the study are to (1) evaluate the impact of simulation on enhancing the learning domains of medical undergraduates and (2) gauge students’ perceptions of simulation based medical education (SBME) through a pre-validated, pre-designed questionnaire. Methods: A quasi-experimental study, involving 60 medical undergraduates, selected by convenient sampling. The study began after obtaining approval from the Institutional Human Ethics Committee and obtaining informed consent from students. A pre-test was conducted for all 60 students followed by a lecture on simulation and then a post-test. The students were then divided into two groups: Group A – SBME using part-task trainers and standardized patients and Group B – (non-SBME) with video lectures on simulation. After 1 month, an assessment of all domains, namely cognitive, affective, and psychomotor, was done by post-test and objective structured clinical examination, respectively. Perception was obtained using the pre-validated questionnaire. Results: The assessment scores of all domains of Group A (SBME) showed significant improvement p<0.05 except cognitive domain. Conclusion: SBME is an effective teaching method for improving the learning domains of medical undergraduates.

Is Antibiotic Prophylaxis Needed for the Extraction of Premolars for Orthodontic Purposes?

Introduction Antibiotic prophylaxis for tooth extractions is a common practice in dentistry to prevent postoperative infections. However, the routine use of antibiotics has been questioned due to concerns about bacterial resistance and potential side effects. This study aimed to evaluate the necessity of postoperative antibiotics in patients undergoing orthodontic tooth extraction. Materials and methods This prospective study involved 100 patients requiring orthodontic tooth extraction, divided into two groups. The patients were recruited from Saveetha Dental College and Hospital, Chennai, India, after obtaining approval from the Institutional Human Ethics Committee, Saveetha Dental College (approval number: IHEC/SDC/OMFS-2103/23/293). Group 1 (n = 50) received antibiotics (amoxicillin 500 mg, three times a day for three days) after extraction, while Group 2 (n = 50) did not receive antibiotics. Postoperative infection was assessed on postoperative days (POD) 3and 7.Data analysis was conducted using IBM SPSS Statistics for Windows, version 26.0 (released 2019, IBM Corp., Armonk, NY). Categorical variables were presented as frequencies and percentages, and differences between groups were assessed using chi-square or Fisher's exact tests. A p-value of <0.05 was considered statistically significant. Results The incidence of postoperative infection was recorded in both groups. In group 1 at POD 3 and POD 7, there were two patients and one patientwith infection, respectively. In group 2 at POD 3 and POD 7, there were four patients and two patients with infection, respectively. Conclusion The findings of this study suggest that the routine administration of antibiotics for the non-traumatic extraction of teethin healthy patients might not be necessary. The absence of postoperative infections in patients who did not receive antibiotics indicates that antibiotics may be avoidable in many cases of orthodontic tooth extraction. These results emphasize the importance of reconsidering the widespread use of antibiotics to combat the growing concern of bacterial resistance. Antibiotics should be prescribed judiciously, only for patients with specific medical conditions who are prone to infection. One of the limitations of this study is the limited sample size; hence, studies with larger and heterogeneous groups should be done to validate the same.

Optimizing Ideal Thickness of Sections for Epidermis in Intra-Operative Frozen Sections.

To estimate and evaluate the optimal thickness of tissue section for skin and dermal appendages intra-operatively and to compare the morphology and architecture of the epidermis and its appendages at 7 and 10 microns. After obtaining clearance from the institutional human ethical committee, 101 skin margins were prospectively analyzed using a two-step embedding technique. After multiple trials and errors, 7- and 10-micron thicknesses were selected for the present study. Artefacts, staining characteristics, cellular morphology, cellular outline, and nuclear outline were assessed and scored as unacceptable or acceptable. The data were entered in a Microsoft Excel spreadsheet and analyzed using SPSS software. There was a statistically significant difference between the sections obtained at 7 microns and 10 microns (p-value: <0.001), the latter were better in all the parameters analyzed. However, no difference was noted in the characteristics of the dermal appendages (p-value: >0.05). While mucosal margins can be obtained at the usual 5-7 microns, the same thickness is not optimal for skin margins intra-operatively. Frozen sections for the skin margins may be set at 10 microns, to save time, minimize artefacts, and for better readability.

Awareness on cosmetic-related health hazards and measures to address them among service providers of beauty salons.

Cosmetic products may contain ingredients whose safety is not certain with several instances of death and anaphylaxis due to service/cosmetic usage in beauty salons. With the mushrooming of beauty salons and with a large consumer base, there is a dearth in the literature to assess the awareness of the health hazards among the employees. This study aims to measure the awareness levels on health hazards and their emergency management among employees working in beauty salons in Coimbatore. A cross-sectional study using a semi-structured questionnaire, after Institutional Human Ethics Committee (IHEC) approval, was conducted*** to assess the awareness of the health hazards including emergency management among employees of beauty salons. The sample size was estimated to be 160. All the workers working in unisex beauty salons, selected by convenience sampling within 5 km radius of PSG IMS and R, were assessed based on their awareness toward cosmetics and the data were analyzed using SPSS software version 24 (IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY). Around 160 service providers of beauty salons participated in the study, among which 84% use several cosmetic products. Only 40% are aware of the health impacts and 21.3% are aware about the side effects which included rashes and itching associated with the products used for bleaching. Only 36.9% knew about the regulations for usage of cosmetic products and 30% knew that there is a governing body for the same. Awareness of health hazards and its emergency management is less among the workers; the literacy programs to improve the awareness on use of cosmetics is the need of the hour.

Evaluation of the pulmonary responses, stride length, and perceived exertion during uphill, level, and downhill walking in various body weights involving youngsters

Background: Walking uphill and downhill on motor-driven treadmills has been included in different exercise programs for athletes or for rehabilitation purposes. The body’s response to uphill, level, and downhill walking is different, and those responses vary from one group of individuals to another. Abundant work has been done by considering the treadmill, but very few studies have been done by changing the gradient levels in these treadmills. Aim and Objective: The aim of the study was to evaluate pulmonary responses, Stride Length, and perceived exertion during Uphill, Level, and Downhill walking in various Body weights among young adults in undergraduate students. The objectives were – (i) To evaluate pulmonary responses, stride length, and perceived exertion while Uphill walking; (ii) To evaluate pulmonary responses, stride length, and perceived exertion while level walking; (iii) To evaluate pulmonary responses, stride length, and perceived exertion while Downhill walking; (iv) To compare the pulmonary responses, stride length, and level of exertion experienced when walking uphill, level, and downhill. Materials and Methods: After receiving approval for the study from the institutional human ethics committee, a sample of 60 people were enrolled who were subsequently divided into three groups based on their body mass index (BMI). Each group has 20 participants: the overweight group has a BMI of 25–29 kg/m2, the normal group has a BMI of 18.5–24.9 kg/m2, and the underweight group has a BMI of &lt;18.5 kg/m2. Before being involved in the study, Informed consent was obtained after participants received a brief explanation of the study. 3 days in the laboratory were scheduled for the participants. Initially, the participant’s personal history and medical history were recorded. The anthropometric measurements were taken as per the recommended guidelines. On the 1st day, participants walked on a treadmill at level ground (0% gradient); on the second and 3rd days, they walked uphill (15% gradient) and downhill (15% gradient), respectively. For each session, tidal volume, minute breathing, and rate of perceived exertion, were measured. Results: Findings within the intergroup revealed a substantial increase in the rate of perceived effort during uphill walking among the overweight groups compared to the normal and underweight groups. None of the BMI groups experienced any appreciable changes in tidal volume or minute ventilation (MV). When the intra-group comparison was made, it was discovered that uphill walking significantly changed the tidal volume, MV, and rate of perceived exertion when compared to level and downhill walking in all the BMI categories. Conclusion: These findings provide a complete picture of the pulmonary changes carried on by the uphill, level, and downhill walking that we all perform daily as well as the variations in lung response at various body mass indices during exercise. These conclusions can therefore be used to recommend exercises for various BMI categories.

Electroacupuncture use for treatment of taxane-induced peripheral neuropathy in patients with breast cancer: protocol for a pilot, randomised, blinded, sham-controlled trial (EA for CIPN)

IntroductionChemotherapy-induced peripheral neuropathy (CIPN) is a common dose-limiting side effect of neurotoxic chemotherapy. Acute symptoms of CIPN during treatment can lead to dose reduction and cessation. Trials using electroacupuncture (EA)...

Vacuum-assisted caesarean delivery assessment of maternal &amp; fetal outcome

: The baby is delivered via incisions made in the mother's abdomen and uterus during a Caesarean delivery, sometimes known as a C-section. Whether medically necessary or elective, caesarean sections have increased sharply in recent decades all throughout the world, exceeding the WHO-recommended 10-15% rate. Every effort should be taken to give cesarean sections to women in need rather than aiming to achieve a target rate, according to a 2015 WHO statement. Therefore, we must investigate the strategies that can improve CD's maternal and neonatal health condition. This study compares the outcomes for the mother and the newborn in the vacuum-assisted CD and manual CD groups.: A progressive study was conducted at Lucknow's Green cross Hospital between June 2012 and April 2018. 500 pregnant ladies took part in this study as participants. This research was approved by the institutional human ethical committee. 250 caesarean sections were performed as part of this cohort study, each with vacuum assistance utilizing a soft cup vacuum extractor on the fetal scalp and manual removal of the skull as usual with fundal compression as support. Due to the absence of uterine activity and amniotic fluid, all of the patients underwent preplanned caesarean sections. The study's findings showed that manual extraction Caesarean birth is inferior to vacuum-assisted Caesarean delivery. Additionally, it was noted that Vacuum Assisted Caesarean Delivery resulted in less uterine incision extension, estimated blood loss, and maternal discomfort. : There was no difference between Vacuum and Manual Extraction caesarean deliveries in terms of Apgar Score, the requirement for infant resuscitation, or admission to the NICU.

Tuberculous meningitis in Bhubaneswar, Odisha, during 2016 to 2022

BackgroundThe burden of tuberculous meningitis varies substantially by location, and is influenced by the overall burden of tuberculosis in that geographical area, and the age structure of the population. Conventional methods for diagnosis of tuberculous meningitis include acid fast bacilli (AFB) smear and culture. AFB smear has low sensitivity and culture techniques are time consuming. During the last few years, rapid and sensitive molecular methods such as cartridge based nucleic acid amplification technique (CBNAAT) is being used for the diagnosis of tuberculous meningitis. In this study, we evaluated the burden of tuberculosis and rifampicin resistance in suspected cases of tuberculous meningitis in Bhubaneswar, Odisha, during February 2016 to December 2022 using CBNAAT. MethodsUnder the National Strategic Plan 2012–2017, CBNAAT machines were rolled out in 2016, of which 1 was installed in the National Reference Laboratory (NRL) for Tuberculosis in Bhubaneswar. For this study, retrospective data on CBNAAT testing of cerebrospinal fluid (CSF) samples at the NRL was collected and analyzed from February 2016 to December 2022. All the demographic and laboratory data were entered in Excel 2010 (Microsoft office, USA) for data analysis. The age and sex distribution of the presumptive TB patients, proportion of samples referred from public and private health care facilities, proportion of M. tuberculosis positive CSF samples along with sensitivity to rifampicin was evaluated. The study was approved by the Institutional Human Ethics Committee. ResultsDuring February 2016 to December 2022, a total of 1627 CSF samples from presumptive TB meningitis patients were received in the NRL for CBNAAT testing. 60.7% (988/1627) of the presumptive TB patients were males. Of the 1627 patients, 3.1% (50/1627) were positive for M. Tuberculosis by CBNAAT. 56% (28/50) of the patients positive for tuberculous meningitis were males. The positivity for M. tuberculosis varied from 2.1% in 2017 to 5.1% in 2021. The CSF positivity for M. tuberculosis ranged from 0.7% in patients aged >60 years to 6.1% in 15–30 years age group. Of the 50 M. tuberculosis positive samples, 6% (3/50) were resistant for rifampicin. ConclusionOur study which included more than 1600 samples over a period of approximately 7 years found a 3.1% positivity for M. tuberculosis in CSF samples using CBNAAT. 6% of the M. tuberculosis positive samples were resistant to rifampicin. Future studies involving data from other districts of Odisha will help provide a more accurate information on the prevalence of tuberculous meningitis in Odisha state.

PULMONARY FUNCTION CHANGES IN SANITARY WORKERS OF KANCHIPURAM POPULATION

Objectives: The main objective of this study is to evaluate the respiratory function of sanitary workers as they are most exposed to environmental air pollutants. Methods: The study was done among sanitary workers of Kanchipuram Municipality, Tamil Nadu, with 190 subjects, who were divided into two groups such as Group I and Group II. Group I with 96 sanitary workers and Group II with 94 as the control group with age- and morphometric-matched subjects. The subjects involved are both gender with the age group between 20 and 60 years. Various functional parameters, namely FVC, FEV1, FVC/ FEV1, FEF 25%, FEF50%, and FEF75%, were done using RMS Helios 3.1.37 in the Physiology Department, Meenakshi Medical College and Research Institute. Institutional Ethical Committee approval was obtained from Institutional Human Ethical Committee. Results: The pulmonary findings showed a significant decrease in FVC, FEV1, FVC/FEV1, FEF 25%, FEF50%, and FEF75% when compared to the control group. Conclusion: The sanitary workers showed a significant decrease in the pulmonary function tests as they were exposed to a variety of solid waste particles which might have caused inflammatory and immunological responses with the small and large airways of the respiratory tract.

DIAGNOSTIC ROLE OF GALECTIN-3 EXPRESSION IN BENIGN FOLLICULAR PATTERNED THYROID LESIONS, NON-INVASIVE FOLLICULAR THYROID NEOPLASM WITH PAPILLARY-LIKE NUCLEAR FEATURES (NIFTP), AND INFILTRATIVE FOLLICULAR VARIANT PAPILLARY THYROID CARCINOMA (IFVPTC)

Objectives: The objective of the study was to determine the role of Galectin-3 expression in distinguishing Benign follicular patterned thyroid lesions, non- Invasive follicular thyroid neoplasm with papillary-like nuclear Features (NIFTP), and invasive follicular variant of papillary thyroid carcinoma (IFVPTC). Methods: The Institutional Human Ethics Committee reference number is 271/pathology/09/2022. A total of 85 cases were included in the study after the histopathological evaluations based on strictly defined inclusion and exclusion criteria. Study groups were created as nodular hyperplasia, follicular adenoma, follicular carcinoma, NIFTP, invasive EFVPTCs, and classical papillary thyroid carcinomas. Cytoplasmic Galectin-3 Immunohistochemistry (IHC) expression was evaluated in these cases. Galectin-3 IHC scores data were analyzed using IBM SPSS statistics. The Chi-square test was used to determine the association between the variables. p&lt;0.05 was considered statistically significant. Results: Cytoplasmic galectin-3 IHC expression was significantly increased in malignant follicular patterned thyroid lesions compared to benign lesions with p&lt;0.00001. Similarly, cytoplasmic galectin-3 IHC expression was significantly increased in IFVPTC when compared to NIFTP with a p-value of 0.01358. The Odds Ratio showed the positive cytoplasmic Galectin-3 expression in IFVPTC with a 7.5 times higher risk of having adverse outcome when compared to NIFTP. Conclusion: Cytoplasmic Galectin-3 IHC expression may serve as a useful biomarker in predicting the invasiveness of FVPTC and distinguishing NIFTP from infiltrative FVPTC.

Early Diagnosis through Estimation of Inflammatory Biomarkers and the Neuroprotective Role of Metformin in Diabetic Peripheral Neuropathy

Purpose: Diabetic peripheral neuropathy (DPN), a chronic neurological complication of type 2 diabetes mellitus (T2DM) with signs and symptoms of peripheral nerve dysfunction such as numbness, tingling or burning sensation, paresthesias etc. Several lacunae exist in relation to the cause and effect of DPN. Therefore diagnosis, as well as treatment of DPN remains unsatisfactory. The involvement of chronic low-grade inflammation in DPN is a rapidly emerging concept and therefore the present study adds weight to it. We estimated some of the biomarkers of inflammation which may be the early markers of DPN. This study is the earliest of its kind to correlate the biomarker levels with metformin, a drug less reported in terms of its anti-inflammatory and neuroprotective activity. &#x0D; Methods: After approval from the institutional human ethical committee, 90 patients attending the outpatient ward of a tertiary care hospital were included in the study. They were divided into two groups: M- group (patients on non metformin) and M+ group (patients on metformin). 5ml serum sample from each patient was processed for estimation of IL-1, IL-6, IL-8, TNF- α, INF- α, GMCSF and MCP-1 according to the manufacturer’s instructions on the commercially available ELISA kit. Metformin levels in the serum were estimated by HPLC. Data was put into statistical analysis. &#x0D; Results: Results showed that IL-1, IL-2, IL-6 and TNF- α were significantly higher in the M- group. The difference was statistically significant between the two groups. The level of biomarkers showed a negative correlation with drug levels in the initial 2m treatment with the drug but was not statistically significant. However, after 6m treatment with metformin the correlation was found to be of statistical significance.&#x0D; Conclusion: we conclude that these biomarkers can be work tested for their clinical utility to be used as diagnostic tools for early detection of DPN and short-term metformin treatment greatly benefits DPN patients. Longitudinal studies may be more insightful as to the long term neuroprotective action of metformin.

The Role of Cytomorphometric Image Analysis in the Diagnosis of Thyroid Nodules.

Introduction Fine needle aspiration cytology (FNAC) plays a vital role in the diagnosis of thyroid nodules. However, it is challenging due to the heterogeneity of thyroid nodules, overlapping cytomorphological features, and interobserver variability. Cytomorphometric analysis turns subjective observations into quantitative values. In this study, we performed cytomorphometric image analysis on cytological smears of thyroid nodules, classified according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC). Materials and methods A retrospective analysis of Papanicolaou (PAP) and Hematoxylin & Eosin (H&E) stained fine needle aspirate smears from 50 patients with thyroid nodules with available follow-up histopathology was performed for a period of two years (March 2021 - March 2023), after obtaining approval from the institutional human ethical committee (IHEC-LOP/2020/IM0355). The nodules were categorized according to TBSRTC and werethen subjected to cytomorphometric image analysis. Each nucleus was analyzed for 14 parameters, including aspect ratio, intensity, diameter, perimeter, roundness, area, fractal dimension, feret diameter, circularity, radii, fournier description, and chromatin texture parameters such as heterogeneity and clumpiness. The data obtained was analyzed through relevant statistical methods using SPSS version 23 (IBM Inc., Armonk, New York) and was compared by using the analysis of variance (ANOVA) test and post hoc test. Results Our results revealed that cytomorphometric image analysis not only distinguishes benign and malignant thyroid nodules but also can aid in categorizing thyroid nodules with predominant follicular patterns, such as follicular variant of papillary carcinoma, follicular adenoma and follicular carcinoma (p<0.001). Conclusions Morphometric analysis of cytological smears combined with cytomorphology has the potential to be an important tool in the diagnosis of thyroid nodules. It can improve diagnostic accuracy for better treatment and improved prognosis.

The roles and perspectives of an informatics pharmacist practicing in the Australian healthcare setting: a qualitative study

AbstractBackgroundThe implementation of digital healthcare systems in hospitals globally and in Australia has led to the introduction of the informatics pharmacist as a career in the healthcare system. However, informatics pharmacists are not yet part of routine clinical services in Australia, so their perspective and roles are not well understood.AimTo explore pharmacists' and other health professionals' perspectives of the roles of informatics pharmacists within interprofessional teams in Australian health care.MethodThis study used semi‐structured interviews with experts in pharmacy and/or informatics. They were recruited using convenience sampling and snowballing. The interviews were audio‐recorded and transcribed and analysed using inductive thematic techniques to identify major themes. Ethical approval was received from the local institutional Human Research Ethics Committee (Approval No: 2020000069).ResultsThe process of inductive thematic analysis was used to analyse the interview transcriptions of 11 participants. Six themes were identified: (1) a promising future for the informatics pharmacists, (2) education, (3) specific skills, (4) scope of informatics role, (5) impacts, and (6) barriers. Participants described the career of informatics pharmacists as an emerging specialty in today's healthcare systems. The roles of informatics pharmacists in Australian health care are described together with the skills and knowledge required for these roles.ConclusionA key role of informatics pharmacists is to facilitate the appropriate use of digital systems to prevent medication errors and improve patients' safety. While international experience has shown the potential scope for an informatics pharmacist, this research shows the use of informatics pharmacists in Australia is in its infancy.

STUDY OF DEPRESSION, ANXIETY &amp; STRESS AMONG FAMILY MEMBERS OF HOSPITALIZED COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL OF CENTRAL GUJARAT.

Background: COVID-19 pandemic has caused mental health issues along with physical, social, and economic issues in both patients and their relatives.COVID-19-positive patients were hospitalized in isolation with no or limited access to relatives. These conditions may have contributed to signicant psychological distress in relatives and this study was designed to assess the same. Objectives: To nd the prevalence of Depression, Anxiety, and Stress among Relatives of hospitalized COVID-19 patients. Methods: A cross-sectional quantitative tertiary care hospital-based study was conducted after approval from Institutional Human Ethics Committee. Relatives of hospitalized COVID-19 patients were assessed by purposive sampling method using Semi-Structured Performa including socio-demographic details, illnessrelated details, and DASS-21 (Depression, Anxiety, and Stress scale-21) via a telephonic mode of interview. Results: A total of 200 relatives of COVID-19 positive turned negative patients were interviewed on the rst day of the COVID 19 negative report. Majority of participants were male,mean age 41 years,literate,married &amp; having rst degree relation with the patient. The prevalence of Depression, Anxiety and Stress was 12%. On individual parameters, Depression, Anxiety and Stress was found 25%,21%,and 20% respectively. Female relatives were signicantly associated with depression (χ2= 8.689,P=.003) &amp; anxiety(χ2= 5.790,P=.016) where as longer hospitalization was signicantly associated with anxiety(χ2= 10.216,P=.006) and stress(χ2= 8.936,P=.011). Conclusions: Relatives of COVID-19 patients had a signicant amount of psychological stress. Female gender of relatives and longer duration of hospitalization of patients were important predictors

Aetiologies of Acute Complications in Autoimmune Rheumatologic Diseases: A Hospital-Based Cross-Sectional Study.

Autoimmune rheumaticdiseases (ARD) present unique challenges in clinical practice. Many of them present in medical emergencies in an unstable state and need immediate evaluation for further plans of action. The clinical conundrum is to distinguish between sepsis, disease flare, or Addisonian crisis (AC) (secondary to steroid withdrawal). This may be further complicated by overlapping clinical features like shock/fever and the coexistence of a combination of the above pathophysiologic mechanisms (e.g. AC with sepsis or AC with disease flare). The known biomarkers may not perform optimally to distinguish them and additional supportive investigations like imaging, cultures, autoimmune serological markers, etc. are needed. Ultimately the boundaries between "the art of medicine" and "the science of medicine" may get blurred, as the established literature evidence falls short and the expert opinion is needed in a time-sensitive manner. In this pragmatic study, researchers have attempted to explore the presentation of rheumatologic emergencies on the above three differentials (sepsis, disease flare, and AC). In this hospital-based cross-sectional study, adult patients(age >18 years) with ARDwhohad unplanned hospital admission due to acute worseningwere enrolled. This study was conducted over one year, after getting the Institutional Human Ethics Committee's approval. All relevant hematological, immunological, and hormonal parameters(specifically morning cortisol) were collected and analyzed. The aim was to find the individual and combined prevalence of sepsis, disease flare, or AC in this study group. Forty-onepatients were analyzed, with females in the majority (95%) and the dominant age group being 26-49 years (56.1%). A majority had a diagnosis of rheumatoid arthritis (RA) (56.1%) or systemic lupus erythematosus (SLE) (31.7%); the rest were other connective tissue diseases (12.2%). High-risk Quick Sequential Organ Failure Assessment score (qSOFA) score 2-3 was present in 29.3% while the rest had low-risk scores (qSOFA score 0-1). Thirty-two percenthad severe disease activity, 46% had mild to moderate disease activity, and 22% of patients had no disease activity. While 78% of patients had low procalcitonin (PCT) values <0.5 microgm/L (low risk of sepsis), 15% had <20 microgm/L, and 7% percentage of patients had serum levels >20 microgm/L (high risk of sepsis). A total of 73.2% of patients had no evidence of infection while 26.8% had either microbiological/radiological evidence of infection. Only 7% of all patients had the presence of an AC. qSOFA scores didn't statistically correlate with a diagnosis of infection or AC but positively correlated with PCT and C-reactive protein (CRP) values. Serum PCT didn't correlate with the presence of infection with statistically significance (p-value 0.217). Infections and sepsis are the most important considerations in the emergency presentations of ARDs. Disease flare and AC are also important differentials. Current inflammatory biomarkers like serum CRP and PCT may be less valuable for discriminating between infectious and non-infectious sepsis, especially in chronic inflammatory diseases like ARDs. qSOFA scores may have a prognostic role with less discriminant value. Management of ARD emergencies needs better biomarkers and more research is warranted.

COVID-19 anxiety among undergraduate students of a medical college in Chengalpattu district – A cross-sectional study

Background: COVID-19 is caused by severe acute respiratory syndromes-CoV-2, a virus that affects the physical as well as mental health of people. Aims and Objectives: Our study was conducted to estimate the COVID-19 anxiety prevalence and its associated sociodemographic factors in a medical college. Materials and Methods: Undergraduate medical students of a medical college in Chengalpattu district were the study participants, with inclusion criteria of students above 18 years of age from 2nd, 3rd, and final year and interns being included for the study. Using simple random sampling, students were selected with a sample size of 197. After obtaining approval from the Institutional Human Ethics Committee and informed consent, data were collected using a structured and pre-tested questionnaire, with anxiety being assessed using coronavirus anxiety scale and data analyzed using SPSS version 21. The statistical tests used were proportions, Chi-square test. P&lt;0.05 was considered to be statistically significant. Results: Among the 197 students, males constituted 82 (41.6%) and females 115 (58.4%), of which 60 (73.1%) of males and 88 (76.5%) of females had COVID-19 anxiety. Overall 75.1% had COVID-19 anxiety. Based on the year of study, 43 (22%) 2nd-year students and 38 (19.3%) 3rd-year students, 29 (14.8%) final-year students, and 38 (19.3%) inters had COVID-19 anxiety. Sociodemographic factors such as the type of family, year of study, and staying with parents had a strong association with COVID-19 anxiety. Conclusion: In our study, 75.1% experience Coronavirus related anxiety, and thus, there is need for focus on the mental well-being of undergraduate students requiring attention as well as support from college administration, family, and society to cope up with the pandemic situation.

Neutrophil–lymphocyte ratio as a diagnostic marker for predicting early-stage diabetic nephropathy in patients attending a tertiary health-care center

Background: Diabetes mellitus (DM) is a common metabolic disorder leading to microvascular and macrovascular complications. Chronic inflammation accelerates the development of complications associated with DM. Measurement of inflammatory mediators is not practically feasible. Neutrophil–lymphocyte ratio (NLR) serves as a cheap, reliable, and valid marker for assessing inflammatory activity. Aims and Objectives: (i) To evaluate the correlation of NLR and microalbuminuria in DM patients; (ii) to evaluate the correlation of NLR with HbA1c; and (iii) to evaluate the correlation of platelet count with microalbuminuria. Materials and Methods: One hundred patients of either sex with DM were evaluated for microalbuminuria, NLR, HbA1c, and platelet count after obtaining institutional human ethics committee clearance. NLR was evaluated for correlation with microalbuminuria and HbA1c. Platelet count was also evaluated for correlation with microalbuminuria. Results: Mean NLR of male patient was 2.1 and female was 2.33. The mean microalbuminuria level in male patient was 527.03 mcg/mg of creatinine and female was 215.36 mcg/mg of creatinine. There was a moderate degree of correlation of microalbuminuria with increased NLR. The study showed a strong correlation between NLR, microalbuminuria, HbA1c, and platelet count. Conclusion: NLR has a strong correlation with microalbuminuria and could be used to assess the onset and progression of diabetic nephropathy.

Health System Preparedness in Provision of Noncommunicable Diseases’ Services in Lakhimpur District, Assam State, India

Background: While noncommunicable diseases (NCDs) are one of the leading causes of mortality in the world today, we are unsure of the preparedness of the public health system in terms of provision for and utilization of NCD services in Assam. Methods: Preparedness of public health facility was assessed using WHO-SARA (Service Availability and Readiness Assessment) tool and Indian Public Health Standards tool. Ethics approval was obtained from the Institutional Human Ethics Committee of the Central University of Kerala. Results: The overall readiness of primary health centers (PHCs) ranged from 60% to 76% for NCD services, community health centers (CHCs) ranged from 72% to 87%, subdivisional hospitals from 70% to 87%, and district hospitals from 76% to 100%. Deficiencies were also noted in terms of the availability of equipment and medicines. Conclusion: The deficiencies in the PHCs and CHCs highlighted in the study emphasize the need to strengthen the health system, thereby strengthening the response of the health system to NCDs in India.

Measurement of Neck Circumference, Tongue thickness and Skin to Epiglottis Distance as Predictors of Difficult Intubation: A Prospective Study

Airway Assessment is essential in pre anesthetic assessment. Anticipating and preparing for difficulty in airway management is crucial to avoid airway catastrophes. Routine pre operative airway examination usually includes mouth opening and dentition, Mallampati classification, thyromental distance and neck movements. Neck circumference is a quick bedside test to determine difficult laryngoscopy. Increased tongue thickness and skin to epiglottis distance affects performance of laryngoscopy and tracheal intubation increasing the risk of difficult airway. Presently there is a search for non-invasive and accurate tools to overcome limitations of clinical airway assessment tests. Ultrasonography has been evolving as a useful device for airway assessment especially soft tissue structures in anterior surface of neck. Here we studied the measurement of neck circumference and ultrasound measurement of tonguethickness and skin to epiglottis distance as predictors for difficult intubation. The Aim of the study is to predict difficulty in intubation by measuring neck circumference, thickness of tongue and thickness of skin to epiglottis. Prospective observational study, 120 patients posted for surgery under general anesthesia, Department of anesthesia, Meenakshi medical college, Kanchipuram. After institutional Human ethical committee clearance, 120 Patients were screened during preoperative assessment for undergoing procedures under general anaesthesia. Neck circumference and other airway parameters were measured with measuring tape and distance between Skin to epiglottis and tongue thickness were measured with ultrasound linear probe. Patients were grouped into Group E( Easy Intubation) whose Cormack-lehane grade was 1 and 2 and Group D ( Difficult intubation) whose Cormack-lehane grade was 3 and 4. SPSS version 16 was used for statistical analysis. There was no statistical significance seen between age, sex, height among easy and difficult intubation but significance was seen with weight (p &lt;0.05), Thyromental distance(p&lt;0.05) and Sterno-mental distance(p&lt;0.05). High significance was seen in Distance between skin to epiglottis distance(p&lt;0.001), Tongue thickness(p&lt;0.001) and Neck Circumference(p&lt;0.001) in difficult intubation cases. Neck circumference and ultrasonographic measurement of tongue thickness and skin to epiglottis can avoid unanticipated difficult intubation.