Utilization of modern menstrual methods and related unmet needs among college going women in Coimbatore district: a descriptive cross-sectional study.

OBJECTIVES: The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women. METHODS: This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36). RESULTS: Only 1.4% of the study participants used MMMs - menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers' and mothers' education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods. CONCLUSION: MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Genetic risk factors for lumbar disc disease.

AIM AND BACKGROUND: Lumbar disc degeneration (LDD) is thought to be multifactorial in origin. Very recently the focus has shifted to the involvement of a family of candidate genes in the pathogenesis of LDD. There is particular emphasis on the vitamin D receptor gene (VDR gene). The VDR polymorphisms FOK1, TAQ1, and APO1 have been variably associated with LDD. OBJECTIVE: To evaluate the association between the FOK1/Taq1 genes and LDD. MATERIALS AND METHODS: One hundred unrelated healthy (asymptomatic) individuals who presented for routine health checkup and 93 consecutive patients (43 males and 50 females) with no history of low back pain were enrolled in the study after informed consent was obtained. The MRI images of cases and controls were graded and peripheral blood samples were collected from all participants and sent for genetic analysis. RESULTS: Individuals with the dominant genotype for Taq1 had a significantly higher association with LDD than those without it. There was no association between LDD and the Fok1 genotype. CONCLUSION: Genetic predisposition is an important risk factor for LDD.

Maternal Experiences during Pregnancy, Delivery, and Breastfeeding Practices: A Community-based Analytical Cross-sectional Study.

Background: Evidence on variation in the information provided to mothers during antenatal and postnatal periods, its influence on breastfeeding awareness, and practice in urban and rural settings of India is scarce. The aim of the study was to assess the variation in mothers experience during pregnancy, delivery, and maternity period across settings and its influence on breastfeeding practices in the first six months of infants' life. Methods: A community-based analytical cross-sectional study was carried out in urban and rural settings of Coimbatore, Tamil Nadu, among 800 mothers who had delivered between one year and six months before the date of the survey using simple random sampling. Results: The proportion of mothers with less than four antenatal visits were significantly higher in urban areas (urban vs rural, 11.4% vs 6.2%). The mean scores for positive experiences during pregnancy (MD -0.99, 95% CI -1.31 to -0.69), experiences during birth and maternity period (MD -0.59, 95% CI -0.83 to -0.35) were significantly lower in the urban areas compared to rural areas. The prevalence of exclusive breastfeeding was 75.8% and 85.0% in urban and rural areas, respectively. Mothers not satisfied with experiences during delivery and maternity period (OR 1.69, 95% CI 1.18 to 2.42) and from urban areas (OR 1.81, 95% CI 1.27 to 2.59) were at significantly increased risk of nonexclusive breastfeeding. Conclusion: The present study showed that mothers from urban areas were not provided with appropriate, adequate, and timely information by the healthcare providers. It is the need of the hour to train and motivate healthcare providers regarding maternal awareness of antenatal, intranatal, and postnatal care practices including breastfeeding and infant care.

Radiographic Morphometric Analysis of the Distal Radius in the Tamil Nadu Population: A Retrospective Study.

Background and objectives Morphometric parameters such as radial inclination, palmar tilt, radial height, and ulnar variance exhibit considerable variations influenced by geographical, ethnic, racial, and individual factors. These parameters are pivotal in the context of distal radius fractures, distal radius plate design, and kinesiology. Understanding these variations is crucial for surgical precision and predicting complications. Methods This observational, retrospective study, conducted in a single hospital, aimed to determine the morphometric values of the distal end radius, specifically in the South Indian population. We analyzed 300 plain radiographs, encompassing 53.7% males and 46.3% females, with ages ranging from 17 to 89 years (mean age: 41.05 ± 15.8). Radial inclination, radial height, palmar tilt, and ulnar variance were measured on posteroanterior views, while palmar tilt was assessed on lateral wrist X-rays. Results In our study, significant gender-based and side-specific differences were observed. The mean length of the styloid process, palmar tilt, ulnar variance, anteroposterior diameter of the radius, transverse diameter of the radius, oblique width of the radius, and carpal height of the radius exhibited notable variations between males and females. Similarly, significant differences were noted between the right and left sides concerning ulnar variance and teardrop angle. Among males, a significant difference was observed only in the teardrop angle between the right and left sides (59.11 ± 7.25 vs. 62.01 ± 7.97). Conclusion The findings underscore the importance of recognizing local morphometric variations in the South Indian population. This knowledge not only enhances the ability to restore normal alignment post-distal radius fractures but also provides fundamental values for future research endeavors within the local demographic. The study acts as a foundational resource for advancing our understanding of the normal anatomy and variations in the distal radius, facilitating improved clinical outcomes and tailored surgical interventions.

Margin status, adjuvant treatment and recurrence in buccal cancer.

OBJECTIVE: To assess the prognostic importance of margin in resected buccal cancer within a framework of risk factor-driven postoperative adjuvant treatment. MATERIALS AND METHODS: Consecutive, treatment naïve patients undergoing primary surgical treatment for buccal cancer. Margin was defined as clear (≥5 mm), close (1-4 mm) and involved (<1 mm). Main outcome was association of margin with local recurrence free survival (LRFS). Subgroup analysis of close margin was performed according to receipt or no receipt of adjuvant treatment. A numerical margin cut-off in mm that could independently predict LRFS was sought to be identified. RESULTS: Of the 167 patients included, the frequency of clear, close and involved margins was 50 (30 %), 78 (47 %) and 39 (23 %) respectively, among whom 52 %, 44 % and 98 % received postoperative adjuvant treatment respectively. Clear and close margins had similar 3-year LRFS (89 % and 96 % respectively), while involved margin had worse 3-year LRFS at 65 %. Involved margin was confirmed to be strongly and independently associated with worse LRFS. Within close margin, receipt and no receipt of adjuvant treatment had similar 3-year LRFS (92 % and 100 % respectively). A margin cut-off of 2 mm was identified at or above which LRFS approximated that of clear margin. CONCLUSIONS: This single center cohort study of patients with resected buccal cancer suggests that close margin is distinct from and has a better LRFS than involved margin. A subset of close margin, with margin size ≥ 2 mm and no other adverse features, might be spared adjuvant treatment without compromising outcomes.

The neglected spectrum of COVID-19 pandemic - postpartum depression among COVID-19 infected South-Indian women - a cohort study.

The study aims to explore the burden of postpartum depression among COVID-19-infected mothers and stressor factors. A single-centre observational cohort study was conducted in South India to evaluate postpartum depression among 106 COVID-19-infected women who delivered from December 2020 to May 2021. Also, stressor factors related to COVID-19 infection were figured out to analyse their role in depression. Almost half of the COVID-19-infected mothers had a global EPDS score ≥ 10 and were at risk of depression during the pandemic. The depressive symptoms were not confined to the immediate postpartum period, but significantly impacted mothers until 6 months following childbirth. SYNOPSIS: COVID-19 infection not only affects the physical well-being but also adversely affects the mental health of the infected persons. Postpartum mothers who require the utmost care and support, are facing social deprivation due to the COVID-19 pandemic. This triggers the already fragile mental state of postpartum women and may worsen the level of depression.

Distal positioning of the skin paddle of pectoralis major myocutaneous flap in head and neck reconstruction.

BACKGROUND: To assess outcomes of pectoralis major myocutaneous flap (PMF) wherein the skin paddle (SP) was positioned with its distal portion extending beyond the lower border of pectoralis major by ≥2 cm (PMF-d). METHODS: Consecutive head and neck reconstructions with PMF-d (n = 110). SP dimensions l2 (distal extent below the lower border of pectoralis major), l1 (proximal extent above lower border of pectoralis major), and b (breadth) were recorded. Endpoints were SP necrosis, recipient dehiscence, early fistula, and persistent fistula. RESULTS: Median values of l2 , l1 , and b were 3.0, 6.0, and 6.0 cm, respectively. When l2 = 2.0-3.0 cm, SP necrosis occurred in only one (1%) subject (with obesity). When l2 was ≥3.5 cm, necrosis occurred in four (16%) subjects, three of whom also had l1 /l2 < 2.0 (proximal SP < 67% of entire SP). Statistically, increased l2 was the only risk factor for necrosis (p = 0.001). Overall, incidence of recipient dehiscence, early fistula, and persistent fistula were 32 (29%), 20 (20%), and 3 (3%), respectively. Persistent fistula occurred only in the setting of SP necrosis and/or re-irradiation. CONCLUSION: Careful patient selection, adequate proximal SP, and l2 = 2.0-3.0 cm is associated with a negligible risk of necrosis. The enhanced reach and laxity and additional skin surface area and soft tissue volume conferred with PMF-d facilitate recipient wound healing.

Scoring system for predicting ovarian necrosis in adnexal torsion using an ultra-short optimized MRI protocol.

PURPOSE: To evaluate a MRI scoring system predicting haemorrhagic necrosis in adnexal torsion with intraoperative and/or histopathological correlation using an abbreviated and optimized MRI protocol. METHODS: This retrospective observational study includes patients with adnexal torsion who underwent Magnetic Resonance Imaging(MRI) and surgery. T2 sequences were evaluated by three observers of varying experience for following findings: Hypo-intensity of ovarian stroma, around the follicle, cyst wall or ovarian capsule and the twisted pedicle. Hypo-intensities in the above and a thick cyst wall were considered as predictors of necrosis. A scoring system was created based on the number of positive findings. MRI was correlated with intraoperative and histopathological findings. Lesions showing haemorrhagic necrosis were considered true positives. RESULTS: 43 women with torsion were included. 74.4% were secondary to a lead point and 25.4% were without one. Hypointensity score of 2 or more had the highest diagnostic accuracy and inter-reader agreement in predicting necrosis (R1-sensitivity: 92%, specificity: 89%, positive predictive value (PPV): 92% and negative predictive value (NPV): 89%, R2-sensitivity: 92%, specificity: 94%, PPV: 96% and NPV: 90% and R3-sensitivity: 92%, specificity: 83%, PPV: 89% and NPV: 89%). CONCLUSION: In patients with suspected adnexal torsion, optimized MRI using T2 weighted sequences will serve as a rapid and effective single imaging modality for diagnosing adnexal torsion and accurately predicting necrosis thereby triaging the patients for appropriate management.

Challenges in the Implementation of Competency-Based Medical Curriculum: Perspectives of Prospective Academicians.

Introduction The medical education system all over the world is witnessing a paradigm shift from traditional methods of teaching to competency-based medical education. With the current curricular change, teachers are supposed to play a catalyst role in terms of moderating the different frameworks of competency-based medical education (CBME). Following the implementation of the new curriculum in India (2019), the present study aims to understand the challenges that medical teachers face in its implementation. Materials and methods This nationwide cross-sectional study was conducted among 297 teaching faculty representing 91 medical colleges across 20 states between February and July 2020. A self-validated structured questionnaire on the views of the newly implemented competency-based medical curriculum was prepared, uploaded as a Google form link, and circulated to medical teachers through an electronic platform across the country The faculty responses were exported and analyzed using Microsoft Excel. Results Around 77.4% opined that making incremental changes to the old curriculum would have been better than the overhaul revision, and 85.6% have opined that input from more faculty must have been taken before implementing the new curriculum. Around 80% felt that the pace at which faculty are getting trained in the nodal/regional center is not adequate, and 75% of them believed that the faculty members are not adequate for preparatory work for CBME implementation. About 74.7% opined that framing specific learning objectives (SLOs) for all competencies is time-consuming. Conclusion It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system. Despite the fact that many of the suggested changes are progressive, given the time and resource constraints, this can only be accomplished through the concerted and combined efforts of all those involved in medical education.

Exploring faculty perspectives on competency-based medical education: A report from India.

INTRODUCTION: Medical education in India is experiencing a paradigm shift from traditional curriculum to competency-based medical education (CBME). It de-emphasizes time-based training and promises greater accountability, flexibility, and learner centeredness. Faculty development is integral in the context of CBME. Considering faculty perceptions toward the new CBME and addressing the difficulties will play a vital role in successful implementation. MATERIALS AND METHODS: A cross-sectional study was carried out among 297 teaching faculty in 91 medical colleges across 20 states all over India between February and July 2020. A structured validated questionnaire on CBME was used to collect the responses through Google forms and was exported and analyzed in Microsoft Excel. RESULTS: More than 80% opined that Faculty members in departments are not adequate for successful CBME implementation. Reflective learning, early clinical exposure, and elective posting were accepted by 60.2%, 70.4%, and 45.5% of the faculty, respectively. Around 81.8% welcomed horizontal integration, whereas only 54.2% favored vertical integration during the Phase I MBBS. CONCLUSION: Few reforms such as curtailing the duration of foundation course, sensitization of all medical teachers through faculty development programs, better synchronized vertical integration, increasing the strength of faculty in each department, and adequate infrastructure for skills laboratory can be undertaken as per faculty suggestions.

Exploring the learners' perspectives on competency-based medical education.

BACKGROUND: A novel innovation in medical education was initiated by the Medical Council of India after 21 years. Competency-based medical education (CBME) is an effective outcome-based strategy, which requires integration of knowledge, attitude, skills, values, and responsiveness. The aim was to assess the students' perspectives on competency-based medical curriculum. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted among 1st year MBBS students (2019-2020 batch). A validated questionnaire was administered through Google link among phase I medical students of various medical colleges across India by multistage sampling. RESULTS: A total of 987 students from 74 medical colleges in India responded. Nearly three-fourths opined that foundation course (FC), attitude ethics communication module, and early clinical exposure were necessary. Horizontal integration was more appreciated to vertical integration. Maintaining log books was perceived as time-consuming and cumbersome. CONCLUSION: The CBME when meticulously adopted will inspire student enthusiasm for learning. Few reforms such as curtailing the duration of FC, diffuse sessions on stress and time management, better synchronized vertical integration, and an exemplary implementation of adult learning techniques can be undertaken.