Assessment of Serum Vitamin D and Parathyroid Hormone in Children With Beta Thalassemia Major: A Case-Control Study.

BACKGROUND: A defective synthesis of vitamin D contributes to alterations in calcium homeostasis due to chronic endocrinopathies, leading to metabolic bone diseases. This study aimed to ascertain the levels of calcium, vitamin D, and parathyroid hormone (PTH) in children with ß-thalassemia. METHODS: In this case-control study, 36 children with major ß-thalassemia receiving iron chelation therapy were included. For the control group, 36 cases matched for age and sex were selected. The packed cell volume (PCV) requirements varied among the thalassemic children, with an average PCV requirement of 78.57±49.07. The study was conducted for six months in the Department of Pediatrics at the Government Medical College, Nagpur, India. Serum PTH levels were determined by immunoassay, and serum vitamin D levels were assessed using electrochemiluminescence technique. Additional tests looked at liver function, serum ferritin, calcium, phosphorus, and complete blood count. The student's t-test, Mann-Whitney, and chi-square tests were used for statistical analysis. RESULT: In comparison to the control group (10.4±1.21 g/dL), the case group's mean hemoglobin level was considerably lower (5.62±1.9 g/dL) (p<0.001). The mean serum ferritin level in the cases was notably higher (3073±1262.24 ng/mL) compared to the control group's level (58.37±29.67 ng/mL) (p<0.001). A total of 80.6% of cases compared to 5.6% of controls had vitamin D deficiency, and 72.2% of cases compared to 2.8% of controls had PTH deficit, both of which showed statistically significant differences (p<0.001). Significant differences were observed between the case and control groups for the mean levels of total serum calcium (8.51±0.84 mg/dL), vitamin D (15.23±10.07 ng/mL), and PTH (14.66±19.86 pg/mL) (9.13±0.6 mg/dL, p=0.05; 34.94±9.57 ng/mL, p<0.001; 32.08±12.42 pg/mL, p<0.001; respectively). CONCLUSION: Growth failure may result from the markedly reduced serum calcium, vitamin D, and PTH levels in children with ß-thalassemia. The relevance of treatment approaches is highlighted by the possibility that these anomalies are caused by excessive iron and inadequate nutritional support.

Strengthening COVID-19 Surveillance Using the Existing National Respiratory Surveillance Framework.

The coronavirus disease-2019 (COVID-19) pandemic is a global outbreak of coronavirus and has significantly changed the dynamics and framework of healthcare delivery system. Acknowledging the fact that the clinical manifestations of both influenza and COVID-19 are quite similar and both are respiratory pathogens, it will be ideal to use the Global Influenza Surveillance and Response System (GISRS) for monitoring the community-level transmission in any nation. During the initial stages of pandemic itself, with the intention to strengthen the surveillance activities, it was recommended that all the nations should use the existing surveillance networks in the nation and employ them for the surveillance of COVID-19 cases. In conclusion, the GISRS continues to play an important role in the COVID-19 pandemic response since its onset. As a matter of fact, this system is an efficient, cost-effective, and sustainable platform for nations to continue their battle against the pandemic.

Ten Thousand Steps Per Day: To Follow Or Not? Is There Any Role of Technology?

Noncommunicable diseases are universal and are being reported across the world, with many diseases being gradually reported in early age groups. Physical activity has been encouraged and advocated by all medical practitioners to prevent, arrest, and delay the onset and development of complications associated with noncommunicable diseases. The concept of "Ten Thousand Steps" in a day is predominantly a goal that people aim to attain either by walking or indulging themselves in some form of moderate physical activity. Since the inception of this concept, many health and fitness experts and public health agencies have recommended the same to achieve and maintain good health. Though there are numerous health-related benefits, people might encounter a wide range of challenges preventing them from attaining the goals consistently. In conclusion, the target of meeting ten thousand steps a day is much more than mere four-digit numbers, as a wide range of benefits have been attributed to the same. Although there are some challenges, the presence of technology and devices can help people continue with their active lifestyle, with fun and active engagement.

Crafting Strategies for Promoting Healthy Ear and Hearing Care: Making It Happen.

Globally, hearing loss is a prevalent health condition that often goes unattended and significantly influences the quality of life of the affected individual. The prevalence of hearing loss is expected to rise in the years to come, predominantly due to the changes in the demography, increased exposure to recreational noise, and disregarding ear conditions that can account for hearing loss but are immensely preventable. A wide range of activities can be planned and organized to promote ear and hearing care and thereby contribute to our vision to prevent the consequences of unaddressed hearing loss. However, the sustainability of these events, especially in terms of accomplishing the intended outcomes, essentially depends on the involvement of the community and the political leaders. In conclusion, the strategies to promote ear and hearing care are much more essential than health interventions do; rather, these measures have social implications. The need of the hour is to create awareness among different stakeholders to ensure that we can change the perception of the masses and that ear and hearing care becomes a global public health priority.

Decoding the Correlation Between Inflammatory Response Marker Interleukin-6 (IL-6) and C-reactive Protein (CRP) With Disease Activity in Rheumatoid Arthritis.

BACKGROUND: Excessive interleukin-6 (IL-6) production in rheumatoid arthritis (RA) leads to joint destruction, inflammation, and systemic symptoms. IL-6 inhibitors alleviate symptoms. C-reactive protein (CRP), an inflammation biomarker, correlates with RA activity. In this study, we assess IL-6 and CRP levels in RA patients to understand their association with disease activity. MATERIALS AND METHODS: This cross-sectional study was conducted at a tertiary care hospital in central India for 15 months, from July 2022 to September 2023. The study involved 75 participants diagnosed with RA and receiving outpatient treatment. Exclusion criteria included anti-IL-6 drug treatment, bedridden individuals, proxy patients, and those without consent. Disease activity was assessed using the 28-joint disease activity score (DAS28), while IL-6 and CRP levels were measured following the standard procedures. RESULTS: The average CRP levels were found to be 51.67 ± 47.49 mg/L, while IL-6 levels averaged 65.16 ± 43.67 pg/ml. The results revealed a substantial positive correlation between IL-6 levels and DAS28 (r = 0.603, p value < 0.001), indicating a significant association. Additionally, a moderate correlation between CRP levels and DAS28 (r = 0.493, p value < 0.001) highlighted a significant relationship between these variables. CONCLUSIONS: The analysis showed that higher IL-6 levels were associated with increased disease activity and suggested IL-6 as a valuable indicator for assessing RA severity. Also, CRP levels had a moderate correlation with disease activity. Overall, IL-6 is a better marker for disease activity when compared to CRP levels in patients with RA.

Identification of Yeast and Yeast-Like Fungi at a Tertiary Care Center: A Retrospective Study.

Background Fungal infections pose a significant global health challenge. Despite their substantial impact, these ubiquitous fungi can become pathogenic but have not received adequate attention in public health, leading to infections that are often underestimated by the general public and healthcare professionals. Candida species and Cryptococcus species play a key role in these infections, with emerging multidrug resistance in Candida species posing considerable challenges. This study aimed to understand the prevalence of yeast and yeast-like infections, particularly in the COVID-19 era, and to assess the antifungal susceptibility pattern. Methodology A retrospective observational study was conducted at a rural tertiary care medical college in Maharashtra, India. Retrospective records of samples processed for fungal culture were analyzed in the microbiology department. Yeast identification and antifungal susceptibility were performed using the VITEK-2 automated system. Results Among 95 fungal isolates, 86 (90.52%) were yeast isolates, primarily non-albicans Candida (NAC) species. Candida albicans accounted for 41 (47.67%) yeast isolates. In 14 isolates, NAC species were not identified by the VITEK-2 system up to the species level. Isolates from urine samples contributed the highest percentage of 61% (58) of yeast isolates. C. albicans showed high sensitivity to most antifungal agents. Other Candida species, such as Candida famata, Candida parapsilosis, and Candida guilliermondii, were sensitive to all antifungal agents. Candida auris showed complete resistance to amphotericin B and fluconazole but sensitivity to other agents. Mixed sensitivity patterns were observed in Candida ciferri and Candida lusitaniae, with some resistance to voriconazole, caspofungin, and micafungin. Conclusions This study shows the increasing prevalence of yeast and yeast-like infections, particularly NAC, during the COVID-19 era. Improved yeast identification and susceptibility testing are crucial for guiding the appropriate treatment and mitigating the impact of these infections, emphasizing the need for comprehensive future studies in this area.

Community Health Immersion Programs in Medical Institutions.

Exposure to the local community is crucial and pivotal to deliver contextual learning to medical students and thereby aid in the process of attaining subject-specific competencies. In the field of medical education, community health immersion refers to a set of systematic and immersive educational experiences for medical students to expose them to sociocultural and health-related attributes of the general population. Community health immersion has been linked with multiple merits that are crucial in the making of a competent medical graduate, who is well equipped to deliver patient-centered care. Even though there are multiple benefits to community health immersion nevertheless, its implementation in the community might vary based on institutional support and local community-related factors. There is an immense need to overcome these challenges to ensure optimal benefit, and this will essentially require the adoption of a multipronged approach with the help of all the concerned stakeholders.

Training Undergraduate Medical Students in Shared Decision Making: A Systematic Review.

In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work to make informed and consensus decisions with reference to the kind of medical care that will be administered to patients. The purpose of the current review is to explore SDM in health care, ascertain the role of medical education, and identify the ways to train and assess undergraduate medical students in competencies pertaining to SDM. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 29 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include learning resources in the title alone only (viz. shared decision making [ti] AND patient [ti]; shared decision making [ti] AND medical education [ti]; shared decision making [ti] AND assessment [ti]; shared decision making [ti] AND self-assessment [ti]; shared decision making [ti]; shared decision making [ti]). In the domain of medical education, the promotion of SDM essentially will require a multipronged approach to enable its integration into the medical curriculum. However, we must remember that mere teaching-learning methods would not improve it unless they are supplemented with assessment methods, otherwise, we will fail to deliver sustained results. In conclusion, SDM in medical education and healthcare industry represents a transformative shift from the traditional paradigm to a patient-centered approach that empowers both patients and healthcare providers, including budding medical students. The need of the hour is to advocate and encourage structured integration of SDM in the medical curriculum and support the same with periodic assessments.

Strengthening the Process of Mentoring Through Portfolios.

In the field of medical education, mentoring is a form of dynamic relationship that is crucial to facilitating the learning process among medical students and helping them in their professional development. The utility of a portfolio in mentoring is not a mere collection of work samples, rather it is a dynamic tool to ensure the professional and personal growth of medical students, with the help of reflective insights. Portfolio can be used to set goals and track the progress of students over a period of time. Even though mentoring through portfolio has been linked with multiple benefits, there are multiple challenges that must be taken into consideration to enhance the overall utility. In conclusion, mentoring carried out through a portfolio has immense potential to facilitate learning and encourage professional growth. However, considering the presence of multiple challenges, there is an immense need to establish a structured framework for portfolio mentoring and support the same with training and technical support.

MRI Insights in Chiari Malformation Type 1 and Variations With Hydrosyringomyelia.

Chiari malformation (CM) type 1 is a complex neurological disorder characterized by the displacement of the cerebellar tonsils into the upper spinal canal. Hydrosyringomyelia (HSM), which frequently coexists with this condition, presents diagnostic and treatment problems due to its broad spectrum of symptoms. There are various forms of CMs, with CM type 1 (CM1) being the most common type. Magnetic resonance imaging (MRI) is the best imaging technique to properly identify and diagnose CM1 and HSM. Important imaging findings include downward displacement of the cerebellar tonsils across the foramen magnum, the appearance of the syrinx in the spinal cord, and the alteration of the flow dynamics of the cerebrospinal fluid. This study was conducted at Datta Meghe Medical College, Nagpur, and Government Medical College & Super Speciality Hospital, Nagpur, India. It focuses on the diagnostic use of MRI in CM1 and its variations associated with HSM. Individuals who are asymptomatic may not need any treatment; however, those who are symptomatic or have HSM may require surgical decompression and restoration of the flow. We discuss the findings of MRI of six cases of CM1 and its variants with HSM and search for possible underlying causes. We conclude that magnetic resonance imaging is an imaging modality for the identification and evaluation of CM1 in cases of HSM.

Navigating Challenges in Biomedical Waste Management in India: A Narrative Review.

Biomedical waste management (BMWM) in India poses significant challenges that demand thorough examination and strategic interventions. As the country's healthcare sector expands rapidly, proper management of biomedical waste becomes increasingly critical to safeguarding public health and environmental integrity. Biomedical waste, encompassing industrial waste, hospital waste, and waste from other healthcare facilities, poses a heightened risk of infection and injury compared to any other form of waste. A lack of understanding regarding safe medical waste disposal practices can be hazardous to one's health as well as the environment. To improve waste management practices in the country, we can suggest effective strategies and recommendations by developing a deeper understanding of the current situation. To manage medical waste effectively, healthcare professionals must be knowledgeable about and have experience with this process. This evaluation study provides a comprehensive overview of current BMWM methods in India, shedding light on the benefits, drawbacks, challenges, and areas for improvement in the healthcare waste management system. Several important facets of BMWM were highlighted by the literature research, including waste segregation, treatment techniques, and disposal options, as well as compliance and regulatory frameworks.

Comparison of Colposcopy and Histopathology in Abnormal Cervix.

Cervicovaginal cancer (CVC) is the most common malignancy of the genital tract. Colposcopy is a diagnostic procedure that is used to examine the cervix and tissue samples of the urethra and vulva in a magnified view. The colposcopy and histological findings of unhealthy cervixes in a tertiary care hospital were compared. This comparative cross-sectional study was conducted from November 2022 to March 2023 among women with a variety of gynecological complaints who visited the Department of Obstetricians and Gynecologists in a tertiary care facility. One hundred participants were included in this study. The data collected were analyzed using Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington, United States). Participants had an average age of 35.22 ± 7.18 years, and white discharge was the most reported ailment (73%). Comparing the results of the colposcopy with the histological findings revealed a sensitivity of 91.5% and a specificity of 72.2%. The high sensitivity of colposcopy highlights the need to combine it with histological techniques to obtain better results.

Employment of Small-Group Discussions to Ensure the Effective Delivery of Medical Education.

The changing landscape of medical education has made small-group discussions crucial components. These sessions, including problem-based learning (PBL), case-based learning (CBL), and team-based learning (TBL), revolutionize learning by fostering active participation, critical thinking, and practical skills application. They bridge theory with practice, preparing future healthcare professionals for the dynamic challenges of modern healthcare. Despite their transformative potential, there are challenges in faculty preparation, resource allocation, and effective evaluation. The best practices include aligning discussions with curriculum goals, skilled facilitation, promoting active participation, and robust assessment strategies. Looking ahead, adapting to emerging health trends, ongoing research, and evolving healthcare demands will ensure the continued relevance and effectiveness of small-group discussions, shaping competent and adaptable healthcare providers equipped for the ever-evolving healthcare landscape.

Epilepsy and Issues Related to Reproductive Health.

Sexual disorders are prevalent and vary in men and women with epilepsy (WWE). Infertility and reproductive abnormalities are twice as common in females with epilepsy. Antiepileptic medications and seizures can both have an impact on sexual health in people with epilepsy. Seizures can alter the release of pituitary and hypothalamic hormones, and some antiepileptic drugs (AEDs) can alter sex steroid hormones (gonadal steroids and gonad corticoids). Females with epilepsy are more susceptible to menstrual cycle irregularity and polycystic ovary syndrome. Females and males had lower reproductive rates, and the causes are likely psychological and physiological, with epilepsy and AEDs again playing a role. Sexual disorders are common in WWE and men with epilepsy and can be caused by psychological, physical, or social factors. Specialists must address the gender-based biology of epilepsy and the impact of AEDs on sexual well-being to offer the best treatment possible for patients with epilepsy, particularly women of sexual maturity.

Severe Chronic Gingivitis in Association With Hypothyroidism and Grade 2 Adenoid Hypertrophy: A Case Report.

Hypothyroidism is the second-commonest endocrine disorder in the world. Similarly, gingivitis is also a highly prevalent oral condition in every population globally. Adenoid hypertrophy and associated mouth breathing may aggravate preexisting gingival inflammation. Here, we are presenting the case of a 22-year-old female gingivitis patient with bleeding from gums on the slightest provocation and with a two-year history of preexisting hypothyroidism. Thorough systemic examinations and investigations ruled out the presence of hematological and/or coagulation disorders. However, she was found to have grade 2 adenoid hypertrophy along with a habit of mouth breathing. Periodontal and systemic management of the patient has resolved her gingival bleeding to a greater extent. Still, there remain a lot of ambiguity and a lack of clarity about the exact etiology and mechanism of pathogenesis behind her oral and general health status. Cases like these pose a diagnostic challenge for the treating dentist or periodontist and thus require a coordinated and collaborative effort of multiple health specialties.

Laser-Guided Sperm Selection: Optimizing the Reproductive Success Rate in Assisted Reproductive Technology.

Assisted reproductive technologies (ART) enable these patient's spermatozoa to fertilize the oocyte and create viable and healthy offspring, but the effectiveness of the various procedures still has room to increase. In the field of assisted reproductive technology, the need to improve fertility results has led to the development of novel sperm selection strategies. Laser-assisted selection of immotile sperm (LAISS) appears to be a promising strategy, harnessing the power of modern optical instruments to better the selection process and, ultimately, maximize the probability of successful fertilization. This technology takes advantage of sperm cells' distinctive features, such as shape, form, and motility patterns, that can be sensitively changed by laser forces. Using precision laser manipulation, spermatozoa with desirable features can be precisely targeted, improving the overall quality and viability of the sperm population. The existence of an elevated percentage of DNA-damaged sperm in a patient's ejaculation may be one of the key factors decreasing ART outcomes. As a result, one of the most difficult tasks in reproductive medicine is ensuring the best quality of spermatozoa utilized in ART, particularly with regard to genetic integrity. The most recent approaches for preparing and selecting human spermatozoa by LAISS techniques are covered here, with an emphasis on those that have been shown to improve.

Incidental Finding of Invasive Ductal Carcinoma on Mastectomy in the Case of Lymphocytic Mastitis: A Case Report.

A rare inflammatory breast disorder called lymphocytic mastitis is characterized by lymphocyte infiltrates in the mammary parenchyma. Due to their rarity, incidental observations of invasive ductal carcinoma in lymphocytic mastitis present diagnostic and management challenges. We present a case of a 52-year-old female with a history of painfully swollen breasts for three months who underwent a core needle biopsy, consistent with lymphocytic mastitis on histopathology. Due to persistent and worsening symptoms, a mastectomy was performed. During the examination, an incidental finding of infiltrating ductal carcinoma was identified in the mastectomy specimen. This unexpected discovery led to further investigations and altered the patient's treatment plan. The detection of invasive ductal carcinoma in the presence of lymphocytic mastitis highlights the importance of continuous surveillance and thorough examination. In the circumstances of lymphocytic mastitis, it is vital to take the likelihood of concurrent malignancy into account, especially when symptoms persist or reappear after appropriate management. This case report seeks to raise awareness among physicians of this exceptional association and drive further research that will explain its pathophysiology while enhancing management strategies.

An Overview of Preventive Strategies and the Role of Various Organizations in Combating Antimicrobial Resistance.

The rise of antimicrobial resistance (AMR) is a major global public health threat due to excessive and inappropriate use of antibiotics and is responsible for prolonged illness, longer hospital stays, and economic burden to society. This article aims to review the factors, role of antimicrobial stewardship, preventive strategies, and role of various organizations in combating AMR. Three major factors of AMR are inappropriate and excessive utilization of antibiotics, nonadherence to infection control measures, and the emergence of pathogens that are resistant to multiple drugs. Antimicrobial stewardship initiatives play a vital role in promoting judicious and targeted utilization of antimicrobials, thereby safeguarding their efficacy and mitigating the emergence of resistance. Implementing such programs optimizes patient outcomes by ensuring that individuals receive the most suitable therapeutic interventions. International organizations have a vital role to play in addressing AMR by promoting the responsible use of antimicrobials, developing new drugs, and improving surveillance systems. As AMR's impact grows, it is critical to take a collaborative and interdisciplinary approach to mitigate its consequences effectively.

The Role of E-Content Development in Medical Teaching: How Far Have We Come?

With the advancements in technology, medical educators are now able to create and deliver content to students through digital platforms. Electronic content (e-content) development has allowed educators to incorporate multimedia, animations, simulations, and interactive elements which support verbal instruction, such as improved expression and comprehension, into their teaching materials. E-content development is a relatively new field, but it is growing very rapidly. Recent findings have indicated that the e-learning sector will likely experience a huge surge in the upcoming years. The Indian government has launched various initiatives for e-content development in medical education. E-content development has great potential and can be used in various learning scenarios. While it initially gained popularity in higher education, it has since been applied to many other sectors, including healthcare. It allows educators to create highly engaging learning experiences that are accessible by all students. Challenges in e-content development include availability of the internet, creating content that is engaging and relevant to a wide range of learners, and access. Still, it is expected that the use of e-content in medical teaching will continue to increase in the future. The future of e-content development in medical teaching is likely to see continued growth and innovation as technology advances and more educators and learners recognize the benefits of online and digital resources.

Adolescent Sexual Behavior in Rural Central India: Challenges and Interventions.

Adolescence is a crucial life stage marked by significant physical, psychological, and societal changes. With India projected to have the highest population of teenagers by 2025, understanding adolescent sexual behavior in rural central India is essential due to its unique social and cultural contexts. This article reviews existing literature to explore the prevalence, risk factors, and consequences of teenage sexual behavior in rural central India. It highlights the challenges posed by societal taboos, limited access to sexual health information and services, and the impact of poverty on adolescents' sexual behavior and health outcomes. To address these issues, comprehensive sex education, improved access to contraception and reproductive health services, and efforts to overcome cultural and societal norms are crucial. The article discusses the initiatives undertaken by the government and non-governmental organizations (NGOs) to tackle adolescent sexual behavior and emphasizes the need for a multifaceted approach that addresses systemic issues while empowering adolescents. It concludes by suggesting future research directions and policy recommendations aimed at promoting safe sexual behavior among rural adolescents in central India. This article will discuss the complexity of adolescent sexual behavior in rural central India, its origins, and the challenges faced by medical decision-makers.