Knowledge, attitude, and practice regarding mosquito-borne diseases among migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala.

Background: Mosquito-borne diseases (MBDs) such as Malaria, Dengue, Chikungunya, lymphatic filariasis, and Japanese Encephalitis are important public health problems in India. Ernakulam in Kerala being a hub of construction activities has a large influx of migrants from Odisha, West Bengal, Bihar, Assam, U. P., Jharkhand, T. N., and Karnataka. Hence, the objective of this study was to assess the knowledge, attitude, and practice related to MBDs and the associated factors among the migrant laborers from a migrant settlement in Ponekkara, Ernakulam Kerala. Materials and Methods: A cross-sectional study was done among 179 migrant laborers from a migrant settlement in Ponekkara, Kerala, from September 2021 to November 2021 using a pretested semi-structured questionnaire to collect information regarding socio-demographic details and their knowledge, attitude, and practice regarding mosquito borne diseases. After taking verbal consent, the questionnaire was administered by the investigator. Descriptive and univariate analysis was done using SPSS Version 20. Results: It was found that 58.4% of the migrant laborers had poor knowledge, 55.9% had poor attitude, and 61.5% of them had poor practice regarding MBDs. On univariate analysis, a statistically significant association was observed between attitude score and the level of education. Conclusion: The findings showed that migrant laborers had an overall poor knowledge, attitude, and practices regarding MBDs. Consequently, there is a need to plan an awareness program among the migrant settlements regarding MBDs.

Flexible and wearable electrochemical biosensors based on two-dimensional materials: Recent developments.

The research interest in wearable sensors has tremendously increased in recent years. Amid the different biosensors, electrochemical biosensors are unparalleled and ideal for the design and manufacture of such flexible and wearable sensors because of their various benefits, including convenient operation, quick response, portability, and inherent miniaturization. A number of studies on flexible and wearable electrochemical biosensors have been reported in recent years for invasive/non-invasive and real-time monitoring of biologically relevant molecules such as glucose, lactate, dopamine, cortisol, and antigens. To attain this, novel two-dimensional nanomaterials and their hybrids, various substrates, and detection methods have been explored to fabricate flexible conductive platforms that can be used to develop flexible electrochemical biosensors. In particular, there are many advantages associated with the advent of two-dimensional materials, such as light weight, high stretchability, high performance, and excellent biocompatibility, which offer new opportunities to improve the performance of wearable electrochemical sensors. Therefore, it is urgently required to study wearable/flexible electrochemical biosensors based on two-dimensional nanomaterials for health care monitoring and clinical analysis. In this review, we described recently reported flexible electrochemical biosensors based on two-dimensional nanomaterials. We classified them into specific groups, including enzymatic/non-enzymatic biosensors and affinity biosensors (immunosensors), recent developments in flexible electrochemical immunosensors based on polymer and plastic substrates to monitor biologically relevant molecules. This review will discuss perspectives on flexible electrochemical biosensors based on two-dimensional materials for the clinical analysis and wearable biosensing devices, as well as the limitations and prospects of the these electrochemical flexible/wearable biosensors.Graphical abstract.

Medical aptitude and its assessment.

The assessment of the suitability of an individual for the profession of medical science is carried out worldwide on the basis of several yardsticks. While a few methods assess domain knowledge of sciences, others focus on evaluating the cognitive aptitude skills of the candidate, while few others assess communicative skills. Though it has been considered that the possession of an aptitude for the profession is a prerequisite, considering its strenuous demands from the candidate, a comprehensive assessment of these areas under the construct of medical aptitude has not been analysed so far, though medical aptitude has been socially defined. This article attempts to develop a comprehensive construct to 'Medical aptitude', meant for the pre-medical student, which has been encapsulated with respect to the areas of its assessment. We did an extensive survey of the literature pertaining to the mode of selection of students towards medical profession and analysed their areas of assessments for admittance. This enabled to identify similarities in the areas of assessment which were then classified under several domains of assessment. Special reference to the keywords involving 'Aptitude' and 'Medical Aptitude' was made. We analysed the definitions to the construct of aptitude from the literature with respect to its relevance in the profession of medical science to be possessed by the pre-medical aspirant-in context. From this, a new construct of medical aptitude was formulated incorporating the existing construct of medical aptitude. Medical aptitude is a comprehensive construct that encompasses the dimensions of a consistent core, a peripheral content and the support of a scaffold. Each of these dimensions have their importance and distinct objective in being assessed in the pre-medical student. A perfect intertwining of these 3 dimensions can prove beneficial in assessing individuals to be fit for the profession of medical science.

Menopausal wellbeing: navigating quality of life and osteoporosis risk.

Background: Multifaceted dimensions influence the quality of life among post-menopausal women. Osteoporosis, a condition characterized by fragile bones, poses a significant risk, potentially leading to fractures and decreased wellbeing. This study aims to assess the quality of life of postmenopausal women, its determinants, and also the risk of osteoporosis among them. Methods: A cross-sectional study was done among 379 post-menopausal women residing in rural and urban areas of Ernakulam district, Kerala, India. They were selected by probability proportional to size sampling from 10 clusters. Quality of life was measured using MENQOL-I questionnaire and osteoporosis risk assessment was done using OSTA score. Results: The study participants had a mean age of 60 years, (standard deviation of 6.83 years). On average, menopause occurred at 50.58 years (standard deviation of 4.28 years). The most common symptoms impacting quality of life among postmenopausal women were psychosocial symptoms, followed by physical and vasomotor symptoms. Furthermore, a high proportion (63.6%) of participants were at risk for osteoporosis. History of fracture, concern of falling, marital status and having an insurance, are factors associated with various domains of quality of life. Conclusion: This study underscores the complex interplay of demographic factors, menopausal experiences, and their impact on the participants' quality of life. The prevalence of psychosocial symptoms and the significant risk of osteoporosis call for tailored healthcare interventions. Postmenopausal women with history of fracture, high concern of fall and single women require special attention. Encouraging women to take up selfcare practices will help during the menopausal transition to have a good quality of life.

Level of physical activity among adolescents in Ernakulam District, Kerala: A cross-sectional study.

Introduction: For children aged 5-17 years, WHO recommends moderate-to-vigorous intensity physical activity for at least 60 minutes daily which would account for 420 minutes of physical activity per week regardless of working days or holidays. With the increasing prevalence of non-communicable diseases in Kerala, this study aimed to assess the level of physical activity among high school students in Ernakulam District, Kerala. Materials and Methods: A school-based cross-sectional study was conducted among ninth and tenth standard students of two randomly selected schools in Ernakulam District. A total of 303 children were recruited for the study. Consent rate and response rate of the study were 100%. A structured questionnaire adapted from MRC-CPAQ (Children's Physical Activity Questionnaire) was used to collect the data. Results: The study revealed that out of 303 students, 72.9% were < 15 years, 77% were males, and 59% were urban residents. More than 70% of the participants were actively involved in physical activity of moderate-to-vigorous intensity. Males, in the age group of 15 years and above, having a separate play area, and those with no siblings were found to have significantly higher levels of physical activity. Conclusion: The study was able to identify a positive trend for physical activity among adolescents. Town planning and building of play areas are essential to develop and retain the habit of physical activity among adolescents.

Comparison of Adjuvant Clindamycin vs Linezolid for Severe Invasive Group A Streptococcus Skin and Soft Tissue Infections.

Background: Linezolid may be an option for severe group A Streptococcus (GAS) infections based on its potent in vitro activity and antitoxin effects, but clinical data supporting its use over clindamycin are limited. This study evaluated treatment outcomes in patients with severe GAS skin and soft tissue infections who received either linezolid or clindamycin. Methods: This retrospective single-center cohort study examined patients with GAS isolated from blood and/or tissue cultures with invasive soft tissue infection or necrotizing fasciitis who underwent surgical debridement and received linezolid or clindamycin for at least 48 hours. The primary outcome was percentage change in Sequential Organ Failure Assessment (SOFA) score from baseline through 72 hours of hospitalization. Results: After adjustment for time to first surgical intervention among patients with a baseline SOFA score >0 (n = 23 per group), there was no difference in reduction of SOFA score over the first 72 hours in patients receiving clindamycin vs linezolid. In the entire cohort (n = 26, clindamycin; n = 29, linezolid), there was no difference in inpatient mortality (2% vs 1%) or any secondary outcomes, including duration of vasopressor therapy, intensive care unit length of stay, and antibiotic-associated adverse drug events. Conclusions: There was no difference in reduction of critical illness as measured by SOFA score between baseline and 72 hours among patients treated with clindamycin vs linezolid. Given its more favorable side effect profile, linezolid may be a viable option for the treatment of serious GAS infections and should be further studied.

Transmissibility of severe acute respiratory syndrome coronavirus 2 among household contacts of coronavirus disease 2019-positive patients: A community-based study in India.

BACKGROUND: This study identified the risk factors for severe acute respiratory syndrome coronavirus 2 infection among household contacts of index patients and determined the incubation period (IP), serial interval, and estimates of secondary infection rate in Kerala, India. METHODS: We conducted a cohort study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction-positive coronavirus disease 2019 patients between January and July 2021. About 147 index patients and 362 household contacts were followed up for 28 days to determine reverse transcriptase polymerase chain reaction positivity and the presence of total antibodies against SARS-CoV-2 on days 1, 7, 14, and 28. RESULTS: The mean IP, serial interval, and generation time were 1.6, 3, and 3.9 days, respectively. The secondary infection rate at 14 days was 43.0%. According to multivariable regression analysis persons who worked outside the home were protected (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.24-0.85), whereas those who had kissed the coronavirus disease 2019-positive patients during illness were more than twice at risk of infection (aOR, 2.23; 95% CI, 1.01-5.2) than those who had not kissed the patients. Sharing a toilet with the index patient increased the risk by more than twice (aOR, 2.5; 95% CI, 1.42-4.64) than not sharing a toilet. However, the contacts who reported using masks (aOR, 2.5; 95% CI, 1.4-4.4) were at a higher risk of infection in household settings. CONCLUSIONS: Household settings have a high secondary infection rate and the changing transmissibility dynamics such as IP, serial interval should be considered in the prevention and control of SARS-CoV-2.

Risk factors for SARS-CoV-2 infection among health workers in India: a case control study.

Background: COVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them. Methodology: A nested case-control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021. Results: A total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53-1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019-1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148-3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006-1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079-7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201-2.901]; p = 0.006). Conclusion: The study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

Overview of COVID-19-Associated Invasive Fungal Infection.

Purpose of Review: Invasive fungal infections are a complication of COVID-19 disease. This article reviews literature characterizing invasive fungal infections associated with COVID-19. Recent Findings: Multiple invasive fungal infections including aspergillosis, candidiasis, pneumocystosis, other non-Aspergillus molds, and endemic fungi have been reported in patients with COVID-19. Risk factors for COVID-19-associated fungal disease include underlying lung disease, diabetes, steroid or immunomodulator use, leukopenia, and malignancy. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) are the most common fungal infections described. However, there is variability in the reported incidences related to use of differing diagnostic algorithms. Summary: Fungal pathogens are important cause of infection in patients with COVID-19, and the diagnostic strategies continue to evolve. Mortality in these patients is increased, and providers should operate with a high index of suspicion. Further studies will be required to elucidate the associations and pathogenesis of these diseases and best management and prevention strategies.

Pattern of contraceptive use, determinants and fertility intentions among tribal women in Kerala, India: a cross-sectional study.

OBJECTIVES: To assess the pattern of contraceptive use and its determinants, knowledge regarding contraceptives including oral contraceptive pills and fertility intentions among tribal women in the reproductive age group. DESIGN: Community-based cross-sectional study. SETTING: Community development blocks in a predominantly tribal district of Wayanad in Kerala, India. PARTICIPANTS: Women in the reproductive age group (15-49 years) from the tribal groups in the district numbering 2495. OUTCOME MEASURES: PRIMARY: Prevalence of contraceptive use and its determinants. SECONDARY: Knowledge regarding contraceptives in general, oral contraceptives and fertility intentions. RESULTS: The mean age of the study participants was 30.8 years (SD=9.8) and belonged to various tribal groups such as Paniya (59.2%), Kurichiyar (13.6%) and Adiya (10.9%). Current use of contraceptive was reported by about a fourth, 658 (26.4%) (95% CI 27.9 to 24.9) of women. Following logistic regression, belonging to Paniya tribe (adjusted OR (aOR) 2.67, 95% CI 1.49 to 4.77; p<0.001) and age at menarche >13 years (aOR 1.69, 95% CI 1.14 to 2.52; p<0.009) had significantly higher use of contraceptives whereas social vulnerability as indicated by staying in a kutcha house had a lesser likelihood of use of contraceptive (aOR 0.55, 95% CI 0.31 to 0.95; p<0.03). Oral contraceptive use was low (4.8%) among this population and no abuse was observed.Less than half (47%) of the respondents had an above average knowledge on contraception. Multivariable logistic regression indicated that above average knowledge was 2.2 times more likely with higher education (95% CI 1.2 to 3.9), lesser among those who desired more than two children (aOR 0.59; 95% CI 0.38 to 0.94; p<0.02).Two children per family was the preferred choice for 1060 (42.5%) women. No gender bias in favour of the male child was observed. CONCLUSION: Awareness and use of contraceptives are poor though the fertility is not commensurately high. Along with developing targeted responses to contraceptive use among Indigenous people with indigenous data, awareness also requires attention. Ethnographic studies are also necessary to determine the differences in contraceptive use including traditional methods among the various Indigenous groups.

Humoral immunity against SARS-CoV-2 variants including omicron in solid organ transplant recipients after three doses of a COVID-19 mRNA vaccine.

Objectives: Solid organ transplant recipients (SOTR) receiving post-transplant immunosuppression show increased COVID-19-related mortality. It is unclear whether an additional dose of COVID-19 vaccines can overcome the reduced immune responsiveness against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Methods: We analysed humoral immune responses against SARS-CoV-2 and its variants in 53 SOTR receiving SARS-CoV-2 vaccination. Results: Following the initial vaccination series, 60.3% of SOTR showed no measurable neutralisation and only 18.9% demonstrated neutralising activity of > 90%. More intensive immunosuppression, antimetabolites in particular, negatively impacted antiviral immunity. While absolute IgG levels were lower in SOTR than controls, antibody titres against microbial recall antigens were higher. By contrast, SOTR showed reduced vaccine-induced IgG/IgA antibody titres against SARS-CoV-2 and its delta variants and fewer linear B-cell epitopes, indicating reduced B-cell diversity. Importantly, a third vaccine dose led to an increase in anti-SARS-CoV-2 antibody titres and neutralising activity across alpha, beta and delta variants and to the induction of anti-SARS-CoV-2 CD4+ T cells in a subgroup of patients analysed. By contrast, we observed significantly lower antibody titres after the third dose with the omicron variant compared to the ancestral SARS-CoV-2 and the improvement in neutralising activity was much less pronounced than for all the other variants. Conclusion: Only a small subgroup of solid organ transplant recipients is able to generate functional antibodies after an initial vaccine series; however, an additional vaccine dose resulted in dramatically improved antibody responses against all SARS-CoV-2 variants except omicron where antibody responses and neutralising activity remained suboptimal.

Subacute Polymicrobial Bacterial Pericarditis Mimicking Tuberculous Pericarditis: A Case Report.

BACKGROUND Bacterial pericarditis can present a diagnostic challenge due to the difficulty of obtaining tissue for bacterial identification. This report is of a 34-year-old man who presented with fever and cough. Diagnosis was initially delayed without a tissue sample, but the patient was later found to have polymicrobial bacterial pericarditis. CASE REPORT A 34-year-old man from the Democratic Republic of Congo presented to the emergency room with cough, fever, and night sweats. He was admitted and found to have pericardial thickening and fluid collection with calcifications. A tissue sample was not obtained for diagnosis, and he was discharged on RIPE (rifampin, isoniazid, pyrazinamide, and ethambutol) and steroids for presumed tuberculosis pericarditis. He worsened clinically and was readmitted to the hospital with evolving pericardial effusion with air present, in addition to new pleural effusion and parenchymal consolidation. He subsequently underwent thoracotomy and pericardial biopsy. Tissue cultures and sequence-based bacterial analysis eventually revealed the presence of Prevotella oris and Fusobacterium nucleatum. He improved dramatically with appropriate antibiotic therapy. CONCLUSIONS This report demonstrates the importance of undergoing further diagnostic work-up for bacterial pericarditis, especially in resource-rich settings. Although tuberculosis pericarditis should remain high on the differential, it is imperative not to anchor on that diagnosis. Instead, when feasible and safe, tissue biopsy should be obtained and sent for organism identification. AFB smears and cultures, Xpert MTB/RIF, and sequence-based bacterial analysis have all been used for identification. Delay in diagnosis can lead to progression of disease and unnecessary incorrect therapies.

Uncontrolled Blood Pressure and Associated Factors Among Persons With Diabetes: A Community Based Study From Kerala, India.

The coexistence of raised blood pressure (BP) in people with type 2 diabetes mellitus (T2DM) is a major contributor to the development and progression of both macrovascular and microvascular complications. The aim of our study was to determine the prevalence of uncontrolled BP and its associated factors in persons with T2DM in a district in Kerala. METHODS: The study was conducted in Ernakulam district in Kerala, and a total of 3,092 individuals with T2DM were enrolled after obtaining consent. Those with a BP "above or equal to 140 mmHg" and/or "above or equal to 90 mmHg" were thus considered to have uncontrolled BP. If the BP was equal or >140 and/or 90 mmHg, a repeat reading was taken after 30 min and the average of the two was considered. Basic demographic details were enquired along with electronic measurement of BP, HbA1c estimation and screening for diabetic retinopathy, peripheral arterial disease (PAD), and peripheral neuropathy. Quantitative and qualitative variables were expressed as mean (SD) and proportions, respectively. The model for determinants of uncontrolled BP was developed adjusting for age, gender, education, duration of diabetes, occupation, body mass index (BMI) and clustering effect. RESULTS: The mean age of the study population was 59.51 ± 9.84 years. The mean duration of T2DM was found to be 11.3 ± 6.64 years. The proportion of uncontrolled HTN adjusted for clustering was 60% (95% CI 58 and 62%). Among them, only one in two persons (53.3%) had a history of hypertension. Age >60 years [adjusted odds ratio (aOR) 1.48, 95% CI 1.24, 1.76; p < 0.001], unemployment (aOR 1.33, 95% CI 1.01, 1.75; p < 0.01), duration of diabetes > 11 years (aOR 1.42, 95% CI 1.19, 1.68; p < 0.001), and BMI ≥23 (aOR 1.33, 95% CI 1.10, 1.59; p < 0.002) were found to be independent determinants of high BP levels when adjusted for the aforementioned variables, gender, education, and cluster effect. The association between complications, such as peripheral neuropathy, PAD, and retinopathy showed a higher risk among those with uncontrolled BP. Retinopathy was 1.35 times more (95% CI 1.02, 1.7, p < 0.03), PAD was 1.6 times more (95% CI 1.2, 2.07, p < 0.001), and peripheral neuropathy was 1.5 (95% CI 1.14, 1.9, p < 0.003) times more compared to their counterparts. CONCLUSION: Target BP levels were far from being achieved in a good majority of the persons with T2DM. To reduce further macrovascular and microvascular events among people with T2DM, effective awareness and more stringent screening measures need to be employed in this population.

A case of Norwegian scabies in a patient with leukemia cutis secondary to chronic lymphocytic leukemia.

Crusted (Norwegian) scabies is a rare variant of Scabies which usually presents in patients with poor cellular immunity that occurs in conditions like AIDS, Leukemia, Lymphoma, Steroid/Chemotherapy, solid organ transplant, and malnutrition. We present a case of Norwegian (crusted) scabies in a patient with concurrent leukemia cutis. The scabies infection presented with a similar rash as the leukemia cutis which delayed the diagnosis and treatment.

Utilization of myositis antibody-specific panel for diagnosis, treatment, and evaluation of disease progression.

The idiopathic inflammatory myopathies (IIM) are rare sporadic disorders with an overall annual incidence of approximately 1 in 100,000 and with a higher incidence in women. IIM is an autoimmune process leading to muscle inflammation due to a 'dysfunctional adaptive immune response evidenced by cell-mediated myocytoxicity, a high prevalence of autoantibodies and overexpression of Major Histocompatibility (MHC) I and II molecules on the muscle sarcolemma'. These autoimmune processes can be appreciated as inflammatory infiltrates in muscle biopsies. Common clinical findings in patients diagnosed with IIM include proximal muscle weakness, elevated creatinine kinase levels, circulating autoantibodies, radiological findings of muscular inflammation, and sometimes edema; in some patients, systemic symptoms such as dysphagia can also be present. Currently, there is no specific IIM classification scheme that incorporates all IIM subtypes; however, the four major IIM subtypes include dermatomyositis, polymyositis, inclusion body myositis, and immune-mediated necrotizing myopathy (IMNM). Two clinical cases are presented in this case report to illustrate a smoldering IIM, antisynthetase syndrome, and a more progressive IIM, anti-signal recognition particle IMNM; highlight the utility of the myositis-specific autoantibody panel for early diagnosis, targeted therapy, and prognosis; and offer primary care providers clues to IIM diagnosis.

Theoretical Insight on the Biosensing Applications of 2D Materials.

The research on the design of efficient, reliable, and cost-effective biosensors is expanding given its high demand in various fields such as health care, environmental surveillance, agriculture, diagnostics, industries, and so forth. In the last decade, various fascinating and interesting 2D materials with extraordinary properties have been experimentally synthesized and theoretically predicted. 2D materials have been explored for the sensing of different biomolecules because of their large surface area and strong interaction with different biomolecules. Theoretical simulations can bring important insight on the interaction of biomolecules on 2D materials, charge transfer, orbital interactions, and so forth and may play an important role in the development of efficient biosensors. Quantum simulation techniques, such as density functional theory (DFT), are very powerful and are gaining popularity especially with the advent of high-speed computing facilities. This review article provides theoretical insight regarding the interaction of various biomolecules on different 2D materials and the charge transfer between the biomolecules and 2D materials leading to electrochemical signals, which can then provide experimentalists the useful design parameters for fabrication of biosensors. It also includes an overview of quantum simulations, use of the DFT method for simulating biomolecules on 2D materials, parameters obtained from theoretical simulations and sensitivity, and limitations of computational techniques for sensing biomolecules on 2D materials. Furthermore, this review summarizes the recent work in first-principles investigation of 2D materials for the purpose of biomolecule sensing. Beyond the traditional graphene or 2D transition-metal dichalcogenides, some novel and recently proposed 2D materials such as pentagraphene, haeckelite, MXenes, and so forth which have exhibited good sensing applications have also been highlighted.

Prevalence of diabetes mellitus and HIV/AIDS among tuberculosis patients in Kerala.

INTRODUCTION: It is estimated that 10 million people fall ill with Tuberculosis (TB) every year worldwide. TB continues to be in the top 10 causes of death globally with India being the home to the world's largest number of TB patients. One of the major factors attributing to this is the presence of comorbidities such as Diabetes Mellitus and HIV/AIDS. AIM: The aim of this study was to determine the prevalence of comorbidities such as Diabetes mellitus & HIV/AIDS among the newly diagnosed TB patients in Kerala in 2019 and also to determine the factors associated with it. MATERIALS AND METHODS: A cross-sectional study was carried out using the secondary data from NIKSHAY portal. There were a total of 16,527 cases of pulmonary and extrapulmonary TB cases reported from 14 districts of Kerala from January to September 2019. Using a checklist, data regarding the age, gender, type of case, Type of patient, site of disease, drug resistance were collected separately for TB patients suffering from Diabetes mellitus and HIV/AIDS. The data was then entered into Excel sheet and was analyzed using SPSS version 23. RESULTS: Out of the total 16,527 study population, most of the patients were elderly above the age of 60 years (28.6%). The prevalence of Diabetes mellitus (22.6%) was higher among TB patients when compared to HIV/AIDS (1.2%). Males in the age group between 50-59 years were found to be significantly associated with TB- Diabetes Mellitus comorbidities. Diabetes was significantly associated with Pulmonary TB patients, while HIV/AIDS was significantly associated with extrapulmonary TB. CONCLUSION: Both Diabetes Mellitus and HIV/AIDS are comorbidities that have a strong impact on the diagnosis and management of Tuberculosis patients. Therefore, there is an urgent need to prevent these comorbidities from occurring along with the implementation of early diagnosis and appropriate management strategies. This study is of prime importance especially among Primary care Physicians who are treating TB patients on routine basis. They are particularly important in TB control since they are usually the first to meet a TB suspect, before diagnosis occurs. Both HIV/AIDS and Diabetes mellitus are immunocompromised conditions and these comorbidities can affect the treatment outcomes of TB. Primary care physicians are essential in detecting TB suspects and treating them, thus contribute significantly to reducing the burden of TB.

Comparative evaluation of the efficacy of lignocaine containing topical anesthetic agents during extraction of deciduous anterior teeth.

BACKGROUND: The aim of this study was to evaluate the efficacy of 2%, 4% lignocaine, Eutectic Mixture of Local Anesthetics (EMLA) mixture and precaine topical anesthetic agents (with 1:1,000,000 epinephrine) during the extraction of deciduous anterior tooth. METHODS: Eighty patients with preshedding mobility of deciduous anterior tooth were divided randomly into four groups. Lignocaine, in amount of 2% and 4%, precaine and EMLA topical anesthetic agents were applied and the tooth was extracted. VAS has been used to assess the subjective pain while Wong-Baker Faces Scale and SEM Pain Scale have been used to record the objective pain to check the efficacy of these topical anesthetic agents. SPSS ver.17 was used for statistical analysis. Group comparison was done by ANOVA (Fishers F test) and inter comparison was done by Tukeys t-test. RESULTS: Based on the scoring criteria of VAS, SEM and Wong Bakers facial pain scales, precaine had best scores followed by EMLA mixture, 4% lignocaine, and then 2 % lignocaine during extraction of primary anterior teeth with preshedding mobility. CONCLUSIONS: The efficacy of precaine was superior compared to EMLA mixture followed by 4% lignocaine and 2% Lignocaine respectively.

Intense Pulsed Light Therapy for Acne-induced Post-inflammatory Erythema.

BACKGROUND: Intense pulsed light (IPL) is a comparatively new system of practice in treating acne-induced post inflammatory erythema (PIE) which is a difficult condition to treat, and variations exist in the results from published studies with insufficient or limited scientific evidence of IPL on Indian skin. AIM: To study the efficacy of IPL in the treatment of acne-induced PIE and to document adverse effects of the procedure. SETTINGS AND DESIGN: A hospital-based retrospective observational study on 33 patients with acne-induced PIE who completed treatment with IPL during the time period of July 2015 to June 2017. PATIENTS AND METHODS: All 33 patients were treated with vascular mode of IPL using 560-nm filter every 3 weeks for three to six sessions. Grading of PIE was done by Clinician Erythema Severity Score, and the objective parameters were assessed statistically for improvement using photographs. Adverse effects were noted and followed up. STATISTICAL ANALYSIS: Wilcoxon sign rank test and Pearson's correlation. RESULTS: There was statistically significant reduction in mean erythema score from 2.57 ± 0.66 to 1.21 ± 0.48 following IPL (Z = -5.295, P < 0.001-Wilcoxon sign rank test). Excellent improvement was noted in 11 (33.33%), good in 15 (45.45%), fair in 4 (12.12%), and poor in 3 (9.09%), and the results were consistent on follow-up. Adverse effects included erythema, hyperpigmentation, and hypopigmentation which were all transient and resolved completely in all patients on follow-up. CONCLUSION: IPL is an effective and safe alternative to otherwise difficult-to-treat acne-induced PIE.

Overdose of mycophenolate mofetil managed in a secondary care hospital in South India.

Mycophenolate mofetil (MMF) is a commonly used immunosuppressive agent and is considered relatively safe with minimal side-effects in therapeutic doses. However, data regarding the effects of an overdose is sparse and therefore, concerns remain regarding its safety. Here, we report the case of a 24-year-old young woman who consumed high dose (10 g) of MMF with suicidal intent. We did not observe any complications related to MMF overdose.