Vitamin D levels and left ventricular function in beta-thalassemia major with iron overload.

Heart disease is the primary cause of death in patients with beta-thalassemia major. The study aimed to determine the association between vitamin D and left ventricular function in patients with beta-thalassemia major with iron overload. A cross-sectional hospital-based study was conducted, where the vitamin D and ferritin levels of children living with beta-thalassemia major were measured, and left ventricular function was assessed utilizing ejection fraction (EF) and fractional shortening (FS) using 2D echocardiography. The mean serum ferritin was 4622 ± 2289 ng/ml, and the mean serum vitamin D levels were 22 ± 7.7 ng/ml. The mean values of EF were 62.30 ± 6.9%, and FS was 31.21 ± 4.8%. Statistically significant negative correlation (r = -0.447, p < 0.001) was found between vitamin D and serum ferritin values, and a significant positive association was found between vitamin D levels concerning EF and FS with a p-value of 0.034 and 0.014, respectively.Conclusion: It was observed  that increasing ferritin was associated with lower vitamin D levels which in turn influenced fractional shortening /cardiac function in these patients.  What is Known: • Patients with Beta Thalassemia major on long term transfusion are prone to develop heart disease / cardiac failure due to chronic iron overload. What is New: • Patients with beta thalassemia major on long term term transfusions with iron overload who are vitamin D deficient are more prone to the cardiac complications which inturn can be prevented by vitamin D supplementation.

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures.

PURPOSE: Long proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures. METHODS: A total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017-2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association. RESULTS: The distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241). CONCLUSION: We conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.

Preoperative estimation of humerus intramedullary nail length using clinical landmarks.

PURPOSE: Intramedullary interlocking nailing is one of the accepted methods of treating humerus diaphyseal fractures. Appropriate nail length and diameter are of paramount importance to achieve a stable fracture fixation. Estimating the nail length can be as challenging in certain cases as it is important. This study aims to provide an easy-to-use formula utilizing clinical measurements from contra lateral arm to accurately estimate humeral nail length. METHODS: This descriptive cross-sectional study was conducted at 3 tertiary care hospitals in Mangalore, India. Patients above the age of 18 years coming to the outpatient department with elbow, shoulder or arm complaints requiring radiological investigation from July 2021 to July 2022 were included. Patients with fractures or dislocations of upper limbs, malunited or non-united fractures of upper limbs, congenital or developmental deformities and patients with open growth plates were excluded. Patients' variables (like age and gender), radiological humerus length and contralateral arm clinical measurements were recorded. An independent samples t-test was used for univariate analysis, and linear regression analysis was done to estimate the desired nail length using the clinical measurement of the humerus (cm) in both genders separately. The significance level was set at p < 0.05. RESULTS: Our study included 204 participants of which 108 were male and 96 were female. The formula for predicting humeral nail length in males is (-2.029) + (0.883 × clinical measurement). The formula for females is 1.862 + (0.741 × clinical measurement). A simplified formula to determine humeral nail length is 0.9 clinical length - 2 cm (in males) and 0.7 × clinical length + 2 cm (in females). CONCLUSION: To improve the stability of fixation with intramedullary nails it is imperative to select the appropriate nail length. There have been studies that devised reliable methods of determining nail lengths in the tibia and femur using preoperative clinical measurements. A similar clinical method of determining humeral nail length is lacking in the literature. Our study was able to correlate radiological lengths of the humerus medullary canal with clinical measurements performed using anatomical landmarks to arrive at a formula. This allows for a reliable and easy nail length determination preoperatively.

Experiences and perception towards reproductive health education among secondary school teachers in South India.

BACKGROUND: Reproductive health education (RHE) is an important component of school curricula. It helps students in the decision-making process regarding several issues concerning reproductive health. However delivering RHE at schools is a difficult task for the teachers. METHODS: This study was conducted to assess the experiences and perceptions towards reproductive health education (RHE) among 236 secondary school teachers in January 2019. Data were collected using a self-administered questionnaire. RESULTS: Only 21 (8.9%) were trained in RHE. Majority [179 (75.8%)] identified cultural barriers as the major challenge involved in its implementation. 95 (40.3%) teachers felt that the provision of sexual education as a part of RHE will promote pre-marital sexual activity among the students. Of the total, 185 (78.4%) had average while 51 (21.6%) participants had a good perception towards RHE. It was taught in only 3 (16.7%) out of the 18 schools surveyed. Only 11 (4.7%) participants felt that the availability of teaching aids to conduct RHE classes at their schools was adequate. Hardly 14 (5.9%) teachers had taken RHE classes for students. Among the rest, 135 (60.8%) expressed their willingness to take RHE classes with appropriate training. In multi variable analysis, participants aged ≤ 40 years (p = 0.031), those belonging to nuclear families (p = 0.013), and those who had taken classes in RHE (p = 0.037) had significantly good perception level towards RHE. CONCLUSIONS: Teachers therefore need to be trained and given more opportunities to take RHE sessions which will help improve their perception towards RHE. Schools need to be better equipped with resources and various perceived barriers need to be overcome before RHE can be successfully implemented.

This study was conducted to assess the experiences and perceptions towards reproductive health education (RHE) secondary school teachers. The participants provided the required information by filling a questionnaire. Hardly one in ten of them had prior training in RHE and one in twenty had taken RHE classes at schools. More than three-fourth of them felt that cultural barriers could pose problems in its implementation at schools. One in four teachers had good perception towards RHE. Two in three among teachers, who had not taken RHE classes before, expressed their willingness to take RHE classes with appropriate training. Favourable perception towards RHE were expressed by teachers who were young, from small families and those who had taken RHE classes before.

Morbidity and mortality from road injuries: results from the Global Burden of Disease Study 2017.

BACKGROUND: The global burden of road injuries is known to follow complex geographical, temporal and demographic patterns. While health loss from road injuries is a major topic of global importance, there has been no recent comprehensive assessment that includes estimates for every age group, sex and country over recent years. METHODS: We used results from the Global Burden of Disease (GBD) 2017 study to report incidence, prevalence, years lived with disability, deaths, years of life lost and disability-adjusted life years for all locations in the GBD 2017 hierarchy from 1990 to 2017 for road injuries. Second, we measured mortality-to-incidence ratios by location. Third, we assessed the distribution of the natures of injury (eg, traumatic brain injury) that result from each road injury. RESULTS: Globally, 1 243 068 (95% uncertainty interval 1 191 889 to 1 276 940) people died from road injuries in 2017 out of 54 192 330 (47 381 583 to 61 645 891) new cases of road injuries. Age-standardised incidence rates of road injuries increased between 1990 and 2017, while mortality rates decreased. Regionally, age-standardised mortality rates decreased in all but two regions, South Asia and Southern Latin America, where rates did not change significantly. Nine of 21 GBD regions experienced significant increases in age-standardised incidence rates, while 10 experienced significant decreases and two experienced no significant change. CONCLUSIONS: While road injury mortality has improved in recent decades, there are worsening rates of incidence and significant geographical heterogeneity. These findings indicate that more research is needed to better understand how road injuries can be prevented.

Experiences and Perceptions Toward Integrative, Complementary, and Alternative Medicine Among Conventional Medicine Practitioners of Mangalore, India.

OBJECTIVES: The purpose of this study was to identify experiences and perception of conventional (Western, allopathic) medical practitioners toward integrative, complementary, and alternative medicine (ICAM). METHODS: There are approximately 1200 conventional medical doctors in Mangalore, India. In February 2017, semistructured self-administered questionnaires were distributed to 200 medical practitioners. The association between categorical variables was analyzed using a χ2 test and those involving continuous variables using unpaired t test, analysis of variance, and Karl Pearson's coefficient of correlation. A P value ≤ .05 was considered statistically significant. RESULTS: Of the surveys, 163 were returned and 129 were satisfactorily completed, giving a response rate of 64.5%. Mean age was 39.9 ± 11.9 years, and most 94 (72.9%) were male. A majority, 96 (74.4%), recommended ICAM to their patients. Nine had some training in ICAM modalities, and 76 (58.9%) participants reported personal usage of ICAM. Regarding perception toward effectiveness of ICAM, 33 (25.6%) felt that it was effective or somewhat effective. However, 82 (63.6%) participants felt that lack of sufficient scientific evidence was a major drawback of ICAM. However, 39 (30.2%) participants felt that ICAM should be part of Bachelor of Medicine and Bachelor of Surgery curricula. Favorable perception toward ICAM (P < .001) and personal usage of ICAM (P < .001) was associated with participants recommending any ICAM for their patients. Elderly practitioners (aged above 65 years) (P = .003) and practitioners with favorable perception regarding effectiveness of ICAM (P = .033) recommended a higher number of types of ICAM to their patients. Favorable perception toward effectiveness of ICAM was associated with favorable perception toward inclusion of ICAM in medical curriculum among participants (P = .002). CONCLUSION: Most participants recommended ICAM to their patients and also reported personal usage of the same.

Study of Insulin Resistance in Patients With ß Thalassemia Major and Validity of Triglyceride Glucose (TYG) Index.

Complications like impaired glucose tolerance and diabetes mellitus due to iron overload need early identification in thalassemia. We studied the proportion of insulin resistance in thalassemia major patients on chronic transfusion, identified insulin resistance using homeostasis model assessment of insulin resistance (HOMA-IR) and triglyceride glucose (TYG) index, compared them and validated TYG index. In total, 73 thalassemia patients on regular transfusion for 3 years with serum ferritin >1500 ng/mL were studied. Serum ferritin, fasting blood glucose, triglycerides, and insulin levels were measured, HOMA-IR, and TYG index calculated and analyzed. Mean fasting glucose, triglyceride, and serum insulin values were 104 mg/dL, 164.18 mg/dL, and 19.6 m IU/mL, respectively. Mean serum ferritin was 5156 ng/mL. Insulin resistance was prevalent in one third of thalassemia patients and showed increase with age and serum ferritin. Insulin resistance by HOMA-IR was 32% as against 16% by TYG index with a cut-off value of 4.3. Using receiver operating charecteristic curve analysis, it was found that, by lowering the value of TYG index to 4.0215, sensitivity improved to 78.3% (from 39.13%) with specificity of 70%. Hence, we recommend a newer lower cut-off value of 4.0215 for TYG index for better sensitivity and specificity in identifying insulin resistance.

Impact of care at foster homes on the health-related quality of life of HIV-infected children and adolescents: a cross-sectional study from India.

PURPOSE: To assess the impact of care at foster homes on the health-related quality of life (HRQOL) of children living with HIV (CLHIV), attending a referral ART Centre, and to compare their HRQOL with children living in their own homes. METHODS: A cross-sectional study was conducted in 144 CLHIV between 5 and 18 years of age, attending a referral ART Centre in South India to assess their HRQOL using the standard PedsQL™ 4.0 questionnaire. Data were then analysed to compare the HRQOL of children living in foster homes to those children living in their own homes. The child report and the parent proxy-report on the child's HRQOL were also compared to see for any differences in their perspectives. RESULTS: 56.25% CLHIV were brought up in different foster homes. In the child's self-report, the mean HRQOL was higher for children living in foster homes [physical score (76.54 ± 12.40), psychosocial score (71.41 ± 12.40) and total score (73.20 ± 11.13)] when compared to children living in their own homes [physical score (75.09 ± 14.76), psychosocial score (70.60 ± 13.48) and total score (72.17 ± 12.00)]. There was no statistically significant difference in the HRQOL between these two groups (p > 0.05). In the parent proxy-report also, there was no statistically significant difference in the HRQOL in all the three scores. The child self-report depicted a significantly higher HRQOL in all the domains compared to the parent proxy-report (p < 0.05). CONCLUSIONS: HRQOL of children living in foster homes is at par with the quality of life enjoyed by children living in their own homes. Foster care manages to provide a reasonable HRQOL in CLHIV, and has become an inseparable component of quality health care delivery for these children.

Prevalence, risk factors and treatment practices in diarrhoeal diseases in south India.

OBJECTIVES: This study was done to determine the risk factors, management practices and awareness about diarrhoea. METHODS: It was a cross sectional study done in a semi urban and rural areas of South Canara district of India in February 2013. A total of 167 households (575 study population) chosen systematic randomly were visited and one adult member in each house was interviewed. The houses were also inspected to assess the living conditions. RESULTS: Mean age of study population was 31.1 ± 20.2 years. The period prevalence of diarrhoea was 69 (12 %). Commonest associated symptoms in cases of diarrhoea were fever 30 (43.4 %) followed by abdominal cramps 29 (42 %). Nearly half of the cases with diarrhoea 34 (49.3 %) did not take any medications. Commonest treatment taken was allopathic medicines 26 (37.8 %) followed by home remedies 8 (22.9 %). Age ≤10 years (p < 0.001) was associated with risk of developing diarrhoea using binary logistic regression analysis. Among the 167 participants, awareness level about the disease was poor among 16 (9.6 %) and moderate among 149 (89.2 % participants). Awareness level was more among females (p = 0.001) and literate participants (p = 0.013). One hundred and sixteen (69.5 %) participants were not aware of any sign or symptom of dehydration other than loose stools. Majority of the participants 138 (82.6 %) preferred home remedies as the initial management of diarrhoea. Misconception about fluid restriction in diarrhoea was stated by 12(7.2 %) participants. CONCLUSION: Public education program on proper feeding and management practices is required to address the various issues identified and for containment of diarrhoea cases in future.

Assessment and determinants of emotional intelligence and perceived stress among students of a medical college in south India.

Emotional intelligence (EI) is the ability to identify, assess, and control the emotions of oneself, of others, and of groups. Stress resulting from having to meet professional demands is common in the medical student's life. The perceived stress (PS) can be either an input or an outflow of EI or the lack thereof. This study was done to assess EI levels and to find out its association with sociodemographic variables and PS among medical students. Data were collected using a self-administered questionnaire from 198 first-year and 208 second-year medical students. EI scores were found to increase with age (r = 0.169, P = 0.004). PS scores were found to be higher among first-year students (P = 0.05). PS scores were found to decrease with increase in EI scores (r = -0.226, P < 0.001). Hence, if sufficient measures to improve EI are provided in the beginning, it would make students more stress-free during their training years at medical schools.

Perception and Practices of Self-medication Practices among Health Science Students during the ongoing COVID-19 Pandemic in Mangalore, India.

INTRODUCTION: Health science students are prone to self-medication due to easy accessibility to medicines, background medical knowledge, and their ability to diagnose illnesses. The ongoing COVID-19 pandemic has further encouraged this practice due to the fear of contracting the virus by visiting healthcare establishments. OBJECTIVES: This study was conducted to assess the perception and practices of self-medication among health science students during the background of the COVID-19 pandemic. METHODS: This cross-sectional study was conducted in July 2021 during the second wave of COVID-19. Data were collected using a Microsoft form circulated among students using WhatsApp or email. RESULTS: The mean age of the 350 participants was 20.8 ± 1.5 years. About 165(47.1%) participants had self-medicated over the past one year. The most common mode of self-medication was using previous consultation notes [121(73.3%)]. The most common reason for self-medication stated was the mild nature of the illness [131(79.4%)]. Fifteen (9.1%) participants reported changes in medication from one to another during self-medication. Sixteen (9.7%) participants increased drug dosage during self-medication. Sixteen (26.2%) out of 61 participants who self-medicated with antibiotics did not complete the course. Forty-six (27.9%) out of the 165 participants were not aware of the adverse effects of the drugs being self-medicated on most occasions. One hundred and sixty seven (47.7%) of the total participants did not feel that self-medication practices are harmful. Ninety-five (27.1%) felt that self-medication practices are acceptable during the COVID-19 pandemic. Eighty-six (90.5%) of them thought so to avoid getting COVID-19 infection by visiting healthcare establishments. In multivariable analysis, participants in the final year and those with chronic morbidities were associated with self-medication practices. CONCLUSION: Self-medication practices were present among 47.1% of participants. More than onefourth of them were not aware of the side effects of self-medicated drugs on most occasions. About 47.7% participants felt that self-medication practices are not harmful and more than one-fourth of them felt that it was acceptable during the COVID-19 pandemic. Therefore, the students need to be made aware of the harmful consequences of self-medication.

Post-recovery experience among COVID-19 patients: A population-based online survey in India.

INTRODUCTION: Patients who recovered from the acute phase of COVID-19 experience several post-COVID-19 health and social problems. This study was therefore done to explore the living experiences and the various health problems experienced by people and their determinants during the post-recovery phase of COVID-19. METHODOLOGY: This cross-sectional study was conducted in Mangalore in March 2022. Data were collected using a semi-structured questionnaire designed as a Google Doc. Post-COVID-19 conditions were defined as adverse health consequences returning, new, or persistent beyond 1 month after SARS-CoV-2 infection. The experiences in the post-recovery phase of COVID-19 were assessed based on a scoring system for the related items in the questionnaire. RESULTS: Out of 235 participants, 204 (86.8%) reported post-COVID-19 health problems between 1 and 6 months following SARS-CoV-2 infection. The majority of them reported fatigue [114 (55.9%)]. Self-perceived health status and social relationships were significantly poorer among participants in the post-COVID-19 phase than before infection. In the multivariable analysis, unmarried/divorced/widow status, staying within city limits, and history of being admitted to the hospital due to various COVID-19-related emergencies were independently associated with the presence of post-COVID-19 conditions among the participants. The living experience in the post-recovery phase was positive only among 22 (9.4%) participants and was found to be significantly associated with the severe status of COVID-19 at the time of disease presentation. CONCLUSIONS: Post-COVID-19 health problems were present among several participants. Those identified to be at risk of developing these conditions need to be periodically screened and managed with a multi-disciplinary care and rehabilitation program. There is also a need to address social problems and encourage positive living experiences among COVID-19 patients during the post-recovery phase of the disease.

Predictors of Treatment Outcome and Clinical Profile among Guillain- Barre Syndrome Patients in South India.

BACKGROUND: Guillain-Barre syndrome (GBS) is one of the principal causes of acute neuromuscular weakness and paralysis worldwide. Its clinic-epidemiological profile and factors influencing its treatment outcomes in developing countries are very minimally studied. OBJECTIVE: The study aimed to find out the risk factors, clinical presentation, management, and predictors of treatment outcomes among GBS patients admitted in two tertiary care hospitals. MATERIALS AND METHODS: Medical records of 121 inpatients with GBS confirmed based on the Brighton criteria over the recent five-year period from June 2017 to May 2022 were examined. Assessment of the severity of GBS was done using the Hughes functional grading scale. RESULTS: The mean age at onset was 36.8 ± 18.9 years. The majority of the patients [82 (67.8%)] were males. Antecedent illnesses within 1 month of onset of GBS were present among 34 (28.1%) patients. The majority of them developed respiratory tract illnesses [13 (38.2%)]. Recurrent history of GBS was observed among 4 (3.3%) patients. The median time gap between the onset of antecedent illnesses and the onset of GBS was 5 days (IQR 3, 10). The most common symptom among GBS patients was the weakness of the muscles of the extremities [117 (96.7%)]. The pattern of progression of weakness among 53 (45.3%) of these patients was from the lower to upper limbs. The most common sign noted was hypotonia [64(52.9%)]. Complications due to GBS were observed among 12 (9.9%) patients. The most common complication among them was respiratory distress in 11 (91.7%) patients, followed by autonomic dysfunctions in 8 (66.7%). Albuminocytological dissociation in cerebrospinal fluid was noted among 48 (39.7%) patients. The majority of patients in nerve conduction studies had acute inflammatory demyelinating polyneuropathy [61(50.4%)]. The majority of the GBS patients [68 (56.2%)] were treated using intravenous immunoglobulin (IVIG). 95 (78.5%) patients improved with treatment at the time of discharge. In multivariable analysis, the absence of antecedent illnesses (p =0.029), Brighton's diagnostic certainty levels 1 and 2 of GBS (p =0.024), and being on IVIG treatment (p =0.05) were associated with improvement in disease condition among the patients. CONCLUSION: Appropriate diagnosis of GBS using both clinical and laboratory evidence and providing appropriate treatment along with more supervision among GBS patients with a history of antecedent illnesses will help improve their prognosis at the time of discharge.

Perception and Self-Medication Practices Among the General Population During the Ongoing COVID-19 Pandemic in Mangalore, India.

BACKGROUND: The practice of self-medication appears to be much more rampant during the- COVID-19 pandemic. Hence, awareness about its consequences is essential among the general population during the current circumstances. OBJECTIVES: To study the prevalence of and perception towards self-medication, as well as its determinants among the general population of Mangalore. METHODS: This cross-sectional study was done during the second wave of the COVID-19 pandemic in August 2021. Data were collected using a Microsoft form disseminated among residents of Mangalore through WhatsApp and email. RESULTS: The mean age of the 225 participants in this study was 34.5±15.2 years. Self-medication practice was indulged by 77(34.2%) out of the total participants. The most common symptom for which self-medication was practiced was for common cold [54(70.1%)], and the most commonly used drug was paracetamol [67(87%)]. 167(74.2%) participants felt that self-medication practices were harmful, but the rest 58(25.8%) felt that it was not a harmful practice. 116 (51.6%) participants felt that the advertisements in mass media and social media promoted self-medication practices among people. Out of the 69(30.7%) participants who felt that self-medication practice was acceptable during the current circumstances, the majority [66(95.6%)] felt that it was better to avoid visiting any doctor or health care facility presently to avoid acquiring COVID-19. In the multivariable analysis, participants with a history of self-medication among their family members, relatives, or friends were more likely to indulge in self-medication (p<0.001). Perceptions that self-medication practices were harmful were more among females (p=0.0397). CONCLUSION: More than one-third of the participants indulged in self-medication practice. More than one-fourth of the participants felt that self-medication practices were not harmful. About one-third felt it was acceptable, and most of them felt so to avoid the risk of contracting the Coronavirus infection. Awareness of its hazards, particularly among males and those with a family history of selfmedications, is required at Mangalore.

Awareness, Perception, and Practices Towards Blood Donation Among Undergraduate Health Science Students of India During the COVID-19 Pandemic.

To assess the awareness, perception, and practices of health science students towards blood donation during the COVID-19 pandemic. This cross-sectional study was done among the undergraduate medical, dental, physiotherapy, and audiology, speech and learning pathology students in May 2021. A self-administered questionnaire designed using Google Doc was used for data collection. Out of the 461 participants, only 171(37.1%) knew that Coronavirus was not transmitted through blood transfusion. Only 125(27.1%) participants knew that a minimum of 14 days is required before a donor who tested positive for COVID-19 can donate blood. As many as 339(73.5%) participants expressed their willingness to donate blood during the current pandemic. Having donated blood in the past (p = 0.001), having vaccinated with COVID-19 vaccines (p = 0.029), having taken both the vaccine doses (p = 0.0499), and absence of anaemia (p = 0.0159) were associated with willingness to donate blood during the pandemic. Only 83(18%) participants had donated blood after the onset of the pandemic. Out of the rest 378, 106(28%) participants did not donate blood due to the fear of getting infected with Coronavirus. Absence of chronic co-morbidities (p = 0.0288) was associated with the history of having donated blood after the onset of COVID-19 pandemic among the participants. Awareness of participants regarding certain key issues related to blood donation and COVID-19 were found lacking. Counselling services to alleviate fears associated with blood donation and awareness sessions to remove misconceptions are required among students to improve blood donation practices.

Comparison of Posterior and Lateral Surface Plating for Type B Weber Lateral Malleoli Fractures.

PURPOSE: The purpose of this study is to compare the functional outcomes, radiological outcomes, complication rates, and hardware removal between lateral and posterior surface plating in isolated type B Weber lateral malleolus fractures. METHODS: It was a retrospective study that compared the outcomes of type B Weber lateral malleoli fractures treated by either lateral surface or posterior surface plating. Radiological and functional outcomes were assessed at regular intervals. The follow-up details and the complications and need for implant removal were collected from the hospital records. RESULTS: Our study included 60 patients (male-35 and female-25). The mean age was 41.7 ± 10.5 years. In all, 28 (46.7%) patients received lateral surface plating and 32 (53.3%) patients received posterior surface plating. The mean time gap between the injury and the surgery was significantly more among patients who underwent lateral plate insertion (P < .001). The mean operative time required for both the procedures was comparable, hence nonsignificant (P = .576). The mean American Orthopaedic Foot and Ankle Society score (AOFAS) after 2 years of operation was significantly higher for posterior plate insertion (P = .014). The complication rates as well as the implant removal rates were higher in patients with lateral plating (P < .05). CONCLUSION: Posterior surface plating can be considered as the procedure of choice for isolated type B Weber lateral malleolus fractures with respect to better functional outcome, lesser complications rates, and need for implant removal. LEVEL OF EVIDENCE: Level III: Economic/decision.

Perception of health care students towards lectures as a teaching and learning method in the COVID era - A multicentric cross-sectional study from India.

The sudden precipitation of the pandemic forced undergraduates to take refuge at home, deserting the campus. Consequently, the age-old classroom in person teaching-learning (T-L) method shifted and lessons had to be conducted online. In previous decades, archetypical classroom lectures survived a lot of criticism in the face of the quasi-passive nature of T-L  methodology. There are very few studies that reflect undergraduate students' perceptions of lectures. This study aimed to evaluate undergraduate students' perceptions of lectures using an online questionnaire with 13 items, which was circulated to undergraduate students of medical, physiotherapy, and nursing courses in three settings at different locations of private and public health schools. There was a total of 877 responses. The surveyed students were in favor of lectures and considered them indispensable for undergraduate learning. They preferred it as a kind of organized learning through the teacher's own experiences. Our study suggests that it is not the 'lecture' that requires mending but possibly teachers require better training, application of effective audio-visual aids, and innovative techniques to sustain students' interest in the class.

Study on restless leg syndrome and its relationship with quality of sleep among the general population of Mangalore, India.

Background: Restless leg syndrome (RLS) is a common neurological morbidity. It is, however, a frequently underdiagnosed medical condition. This study was hence done to assess the occurrence and severity of RLS among participants and to study its determinants and its association with quality of sleep. This was a cross-sectional study conducted among the general population of Mangalore in July 2021. Data were collected using a Google Form. The International Restless Legs Syndrome Study Group Rating Scale was used to diagnose RLS and its severity. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Results: The prevalence of RLS among the 202 participants was 24(11.9%). Among them, 5 were already diagnosed with RLS. Their mean age at onset was 40.4 ± 25.3 years. Among the rest 197 participants, 19(9.6%) were newly diagnosed with RLS. The severity of RLS was mild, moderate and severe among 7(36.8%), 9(47.4%) and 3(15.8%) participants, respectively. Five (26.3%) of the 19 newly diagnosed participants were identified as RLS sufferers. In multivariable analysis, the presence of diabetes mellitus and family history of RLS were  associated with the presence of RLS among the participants. The mean Global PSQI value was 5.0 ± 3.1. Sleep latency was prolonged (p = 0.001), and sleep disturbances (p = 0.01) were higher among participants newly diagnosed with RLS (n = 19) compared to those without RLS (n = 178). Subjective sleep quality was poor (p = 0.038), and sleep disturbances (p = 0.016) were more among participants with severe degree RLS. Conclusions: The prevalence of RLS in the present study was higher than that reported in previous Indian studies. Unpleasant sensations in RLS affected sleep initiation and maintenance among the affected. A multi-disciplinary approach is required to control its determinants and address other sleep-related problems among the RLS affected population.

Time trends in tuberculosis mortality across the BRICS: an age-period-cohort analysis for the GBD 2019.

Background: Tuberculosis is the leading cause of death from a single infectious agent among the HIV-negative population and ranks first among the HIV-positive population. However, few studies have assessed tuberculosis trends in Brazil, Russia, India, China and South Africa (BRICS) or with an emphasis on HIV status. This study assesses the time trends of tuberculosis mortality across the BRICS with an emphasis on HIV status from 1990 to 2019. Methods: We obtained tuberculosis data from the Global Burden of Disease 2019 study (GBD 2019). We calculated the relative proportion of tuberculosis to all communicable, maternal, neonatal, and nutritional diseases by HIV status across the BRICS. We used age-period-cohort modelling to estimate cohort and period effects in tuberculosis from 1990 to 2019, and calculated net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks. Findings: There were 549,522 tuberculosis deaths across the BRICS in 2019, accounting for 39.3% of global deaths. Among HIV-negative populations, the age-standardised mortality rate (ASMR) of tuberculosis in BRICS remained far higher than that of high-income Asia Pacific countries, especially in India (36.1 per 100 000 in 2019, 95% UI [30.7, 42.6]) and South Africa (40.1 per 100 000 in 2019, 95% UI [36.8, 43.7]). China had the fastest ASMR reduction across the BRICS, while India maintained the largest tuberculosis death numbers with an annual decrease much slower than China's (-4.1 vs -8.0%). Among HIV-positive populations, the ASMR in BRICS surged from 0.24 per 100 000 in 1990 to 5.63 per 100 000 in 2005, and then dropped quickly to 1.70 per 100 000 in 2019. Brazil was the first country to reverse the upward trend of HIV/AIDS-tuberculosis (HIV-TB) mortality in 1995, and achieved the most significant reduction (-3.32% per year). The HIV-TB mortality in South Africa has realised much progress since 2006, but still has the heaviest HIV-TB burden across the BRICS (ASMR: 70.0 per 100 000 in 2019). We also found unfavourable trends among HIV-negative middle-aged (35-55) adults of India, men over 50 in the HIV-negative population and whole HIV-positive population of South Africa, and women aged 45-55 years of Russia. China had little progress in its HIV-positive population with worsening period risks from 2010 to 2019, and higher risks in the younger cohorts born after 1980. Interpretation: BRICS' actions on controlling tuberculosis achieved positive results, but the overall improvements were less than those in high-income Asia Pacific countries. BRICS and other high-burden countries should strengthen specified public health approaches and policies targeted at different priority groups in each country. Funding: National Natural Science Foundation of China (82073573; 72074009), Peking University Global Health and Infectious Diseases Group.

Knowledge attitude practice study on pulse polio immunization in Mangalore, Dakshina Kannada district, Karnataka.

Government of India launched PPI in 1995 to eradicate polio by the end of 2000. Despite this 733 cases were reported last year alone. There is a need to understand the reason behind high number of cases being reported even after so many years of programme implementation. This study was therefore conducted to assess knowledge of people about polio and PPI, their attitude and practice towards PPI. This cross sectional study was done in Mangalore city of Karnataka. Only houses having under five children were taken for the study. Data was collected by interviewing any adult member of the household using a pretested questionnaire. Out of 100 participants 99 were literates but only 11 knew the correct mode of transmission of polio. Twenty seven had misconception that polio is a curable disease. Only 40 participants knew that polio drops can be given to children even with mild illnesses. Few (2%) participants felt that PPI causes vaccine overdose and 8 participants thought PPI to be a substitute for routine immunization. This study identified few important misconceptions associated with polio and PPI. This needs to be addressed by large scale awareness campaigns in order to eradicate polio in the near future.