A Refashioned Head Cover Device of Personal Protective Equipment to Facilitate Conventional Auscultation.

Conventional stethoscope is a useful clinical examination tool to aid evaluation of the underlying clinical condition, especially respiratory and cardiac illnesses, even before definitive imaging studies are performed. Auscultation with a stethoscope becomes highly challenging when wearing personal protective equipment (PPE) because the hood of the PPE covers both the ears. Herein, we describe an innovation that involves refashioning of the head cover device of the PPE suit to facilitate conventional auscultation using a stethoscope. In resource-limited settings where advanced gadgets such as wireless stethoscopes may be lacking, redesigning the head cover of the PPE suit can allow the use of manual stethoscopes without increasing the risk of exposure to the pathogen of concern.

Acceptability of Prenatal Screening Tests Among Expectant Mothers in India: Insights and Implications for Public Health.

INTRODUCTION: Prenatal screening tests are essential for preventing common genetic disorders, yet their acceptability among pregnant women in India remains unexplored. This study aims to investigate the acceptability of prenatal screening tests and their correlation with demographic characteristics among pregnant women in India. METHODS: A cross-sectional study was conducted at a tertiary care, public hospital, involving 200 pregnant women. Data were collected through a self-administered questionnaire assessing demographic information and the acceptability of prenatal screening tests. Statistical analysis included chi-square tests and logistic regression. RESULTS: Most participants demonstrated adequate acceptability toward prenatal screening tests, with 73% scoring above the threshold. Factors associated with higher acceptability included younger maternal age, second-trimester gestational age, higher education, salaried employment, and urban residence. However, factors such as parity, consanguinity, mode of conception, and family history of genetic disease showed no significant associations. CONCLUSION: The study highlights positive attitudes toward prenatal screening tests among pregnant women in India, particularly among younger, more educated, and urban populations. These findings emphasize the need for targeted interventions to enhance awareness and accessibility of prenatal screening, ultimately contributing to the reduction of the genetic disorder burden in India.

Understanding the Awareness of Prenatal Genetic Screening Tests Among Pregnant Women in India: A Cross-Sectional Study.

Introduction Genetic disorders pose a significant health challenge in India, with chromosomal abnormalities ranking second only to congenital anomalies in terms of disease burden. Prenatal testing offers a crucial strategy for identifying and managing these disorders. However, the awareness and understanding of prenatal screening tests among pregnant women in India remain understudied. This study aims to fill this gap by investigating the awareness quotient of prenatal screening tests for genetic disorders among pregnant women in India. Methods A hospital-based cross-sectional study was conducted at the Genetics Unit, Department of Anatomy, and Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Mangalagiri. Ethical clearance was obtained, and data were collected using a self-administered questionnaire covering demographic characteristics and awareness assessment. Descriptive statistics, chi-square tests, and logistic regression analysis were employed for data analysis. Results Among the 200 pregnant women surveyed, the majority demonstrated inadequate awareness of prenatal screening tests for genetic disorders, with only 36.5% possessing adequate knowledge. Significant associations were found between awareness levels and factors such as age, trimester of pregnancy, and education level. Notably, awareness about non-invasive prenatal testing (NIPT) was notably low at 7%, indicating a need for targeted educational interventions. Comparison with international studies revealed varying levels of awareness across different populations, highlighting the influence of socio-cultural factors and healthcare systems. Conclusion This study underscores the need for improved awareness of prenatal screening tests among pregnant women in India. Addressing disparities in awareness, particularly among younger age groups and those with lower education levels, is crucial for informed decision-making in prenatal care. Targeted educational interventions can empower pregnant women to make informed choices, ultimately contributing to better maternal and child health outcomes. Further research should explore the effectiveness of such interventions in diverse settings to enhance prenatal care delivery.

Abdominal scar endometriosis: A case report and review of literature.

Endometriosis is defined as the presence of functioning endometrial tissue outside the uterine cavity. Abdominal wall or cutaneous endometriomas are quite uncommon with an incidence of less than 1%. Abdominal wall endometrioma can occur in a previous surgical scar, commonly following obstetrical and gynecological surgeries. Cutaneous endometriosis is difficult to diagnose because of its nonspecific symptoms and is often confused with other dermatological and surgical diseases thereby delaying the diagnosis and management. We are reporting a case of scar endometriosis at the site of previous cesarean scar involving the rectus sheath. The pathogenesis, diagnosis, and treatment of this rare condition are being discussed. Awareness of the clinical features and presentation of this rare condition is essential for timely diagnosis and management.

Neonatal Norwegian scabies.

Norwegian scabies is a severe form of scabies usually seen in immunocompromised children and adults. It is rarely reported in the neonatal age group. We present such a case.

Perception on Menstrual Cup Usage Among Teens and Reproductive Age Group Women: A Cross-Sectional Study.

Introduction: One of the challenges to menstrual hygiene management in resource-limited settings is limited access to safe and affordable menstrual hygiene products. An alternative to the widely used sanitary pads is the menstrual cup, which has received less attention in low- and middle-income countries. This study was carried out to assess the perception on menstrual cup usage among teens and reproductive age group women assess attending a tertiary care institute in a rural setup in Andhra Pradesh. Methodology: A prospective cross-sectional study was conducted among 164 teenage and reproductive age group women attending the Outpatient Department of Obstetrics and Gynecology with the help of a semi-structured, pretested and pre-piloted questionnaire to assess the perception of menstrual cup usage among the participants. Data were analyzed statistically using software, menstrual cup knowledge score was calculated based on data obtained from questionnaire. Results: Most of the study participants (87.8%) were using sanitary pads during menstruation. Cloth was also used by some of the participants (11.59%). Only one participant (0.61%) was reported using menstrual cup. Majority of the participants [121 (73.7%)] reported that they had never heard of menstrual cup, whereas 43 [(26.3%)] study participants reported that they were aware of menstrual cup. Only 2(4.65%) out of 43 participants had a good knowledge on menstrual cup whose knowledge score was 12. Five (11.63%) out of 43 participants had got 0 score and remaining participants got the score between 0 and 12. Conclusion: Most of the women were not aware of menstrual cup and even if they know about it, they do not have good knowledge about it. Awareness regarding menstrual cup should be promoted through media and awareness programs to reach everyone.

Menstrual pattern and anthropometric characteristics of women with primary and secondary infertility in comparison with age-matched controls.

BACKGROUND: The incidence of infertility has increased significantly due to lifestyle changes and the presence of diverse environmental stress. Body mass index (BMI) and waist circumference (WC) are two common anthropometric measures of obesity. Factors such as differences in race, sex, and age influence BMI, and recent studies have reported limitations in the use of BMI to determine obesity. Body fat distribution has a more valid criterion for determining obesity than BMI. Our aim was to compare the menstrual pattern and anthropometric parameters of women with primary and secondary infertility with those of age-matched controls and to assess the correlation between the anthropometric variables and fertility types. MATERIALS AND METHODS: A cross-sectional study was conducted in which the anthropometric measurements and menstrual history over the last 3 months of cases of primary and secondary infertility were compared with the age-matched control group. RESULTS: Women with primary and secondary infertility tend to be overweight or obese. The menstrual pattern of women with infertility was not statistically different as compared to the control groups. There were significant differences in weight, BMI, hip circumference, WC, and neck circumference (NC) of women with primary infertility with those of age-matched controls. A statistically significant difference was noted in NC between the primary and secondary infertility groups. CONCLUSION: The results obtained show that women with infertility tend to be overweight/obese. Due to the limited sample size, the relationship between menstrual pattern and anthropometric characteristics such as waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and frame size (FRS) and infertility could not be established.

Highly cellular leiomyoma - A great histopathological masquerader of endometrial stromal sarcoma.

ABSTRACT: Leiomyoma is the most common benign uterine tumor, whereas endometrial stromal tumors are rare uterine tumors with limited clinical experience. The distinction between highly cellular leiomyoma and endometrial stromal sarcoma can pose a diagnostic challenge to the pathologists as both these tumors have considerable overlapping features on histology.

A triple-blind, randomized controlled trial, comparing combined letrozole and clomiphene versus only letrozole for ovulation induction in women with polycystic ovarian syndrome.

OBJECTIVE: To evaluate the efficacy of combination treatment of letrozole and clomiphene citrate (CC) in comparison to that of letrozole alone to induce ovulation in infertile women with polycystic ovary syndrome (PCOS). METHODS: The current study was designed as a single-center, double-arm and triple-blind, randomized, controlled trial. The study was prospectively registered with the clinical trials registry in India and was conducted after approval from the institutional ethics committee. Study patients were randomly assigned to treatment with either a combination of 2.5 mg of letrozole and placebo (n = 40) or a combination of 2.5 mg of letrozole and 50 mg of CC (n = 40) starting from cycle days 3 to 7 for a single treatment cycle. RESULTS: Ovulation induction with combined letrozole and CC provided a higher ovulation rate, with a 35% absolute difference in its favor. The authors found an ovulation rate of 73% versus 38% (P = 0.003) for treatment with a combination drug and letrozole alone, respectively, while the ovulation rate ratio was 1.93 (95% CI, 1.24-3.01). CONCLUSION: Combined treatment of letrozole and clomiphene may be considered as one of the first-line ovulation induction agents for infertile women with PCOS because of its affordability and better safety profile.

Utility of telemedicine for providing Obstetrics and Gynecology services during the COVID-19 pandemic-A single center experience from a tertiary care teaching hospital located in South India.

BACKGROUND: The COVID-19 pandemic greatly impeded the provision of public healthcare within a healthcare system that was already under considerable strain. Routine patient care services were impacted during that time, leading to the promotion of telemedicine as a means of maintaining uninterrupted healthcare services. Telemedicine involves the utilization of electronic technology and communication to provide health-related information and medical care to individuals who are physically separated from healthcare professionals. MATERIALS AND METHODS: To assess the feasibility of utilizing telemedicine for providing women's health services, we conducted a six-month analysis of data collected from the Department of Obstetrics and Gynecology's teleconsultation application at AIIMS, Mangalagiri. Our objective was to evaluate the practicality of telemedicine in delivering diverse healthcare services to women. Our institution offered two types of telehealth services: a "call-based"approach and an "app-based" approach. We examined several parameters within the data, including the distribution of ages, the geographic locations of teleconsultation registrations, whether the registrations were new or follow-up cases, the various presenting complaints, the recommended treatments, the number of consultations (single or multiple), and whether cases required in-person or hospital visits. Additionally, we also compared patient responses between these two modalities. RESULTS: The "call-based" consultation method was preferred by the majority of our patients (94%). The registered cases included both related to obstetrics and gynecology, with a higher proportion of complaints relating to gynecological issues (82.5%). We were able to make a diagnosis in 77% of cases, while in 20% of cases, additional physical examinations and diagnostic tests were necessary. Follow-up appointments were recommended for 53% of patients. The success rate of consultations for patients seeking obstetrics and gynecology services showed a statistically significant difference (P value < 0.001). The vast majority of patients (99%) expressed high satisfaction with the consultation process. CONCLUSION: During the COVID-19 pandemic, telemedicine proved to be an effective approach in mitigating the overcrowding of hospitals and preventing the spread of infection. Its success suggests that telemedicine can be a viable option for managing elective gynecology matters and low-risk obstetric cases in the future, thereby alleviating the strain on healthcare systems.

Menstrual cup webinar series: A developing model of modified pre- and post-tests in the online teaching-learning of primary health care workers.

Menstrual hygiene management, especially in resource-limited settings, is challenging. The acceptability of the menstrual cup is increasing recently in western countries whereas, in developing countries like India, the awareness, acceptability, and use of menstrual cups are very limited. We assessed the effectiveness of modified pre-post-test teaching-learning methodology in an online webinar series on menstrual cups using Moore's outcome assessment. An online webinar series on menstrual hygiene and the menstrual cup was conducted to raise awareness about the usage of menstrual cups among the health care workers like Auxiliary Nurse Midwife (ANMs), Accredited Social Health Activist (ASHAs), and Anganwadi Workers (AWWs) of the Guntur district, Andhra Pradesh, India. The questions of modified pre- and post-test were displayed. The questions were displayed to participants using the polling option in zoom. A total of 1597 health care workers participated in the menstrual cup webinar series. Of the total, 72.7% of participants responded to the job title question of which ASHA, ANMs, and AWWs were 16.8%, 34.2%, and 41.9%, respectively. The baseline knowledge of menstrual cups among primary health care workers for "heard of the menstrual cup" and "ever used/know anyone using menstrual cup" was 36.89% and 11.67%, respectively. After the webinar among the primary health care workers, the maximum gain in knowledge was seen for "menstrual cup can be cleaned in the home," 94.53%, and the minimum gain in knowledge was on "unmarried girls can use menstrual cups," 50.42%. The modified pre- and post-test model predicted an overall 50 percent rise in the knowledge of primary health care workers by the webinar series about a different aspect of the menstrual cup.As online webinar providers aim to provide more performance-based learning activities, current approaches to continuing medical education may become obsolete. The single most essential shift in online webinar planners can make is to incorporate modified pre-and post-test to allow for interactive and formative assessment during webinar activities.

Psychometric Measurement of Fertility-related Quality of Life across Gender in Primary Infertile Couples.

Background: Infertility is a crucial global public health issue that affects millions of people of reproductive age. Fertility-related stress can negatively impact infertile couples' quality of life (QoL). Aims: This study aimed to assess and compare the psychometric properties of fertility QoL between primary infertile couples' male and female partners. Settings and Design: This cross-sectional study included 114 primary infertile couples visiting the Andrology Laboratory referred from the Gynaecology and Obstetrics Department, AIIMS, Patna. Materials and Methods: Data were collected using the Fertility QoL (FertiQoL) tool, an internationally validated questionnaire to measure the reproductive QoL, demographic information and medical history. The FertiQoL questionnaire responses were recorded and analysed. Statistical Analyses Used: Statistical analyses used were performed using the SPSS 20.0 version. Descriptive statistics, Kolmogorov-Smirnov test, Cronbach's alpha and Student's independent t-tests were used. Statistical significance was set at P < 0.05. Results: In our study, the overall estimated Cronbach's α was 0.83, and males had a significantly better fertility-related QoL in all domains of the FertiQoL, such as emotional (P < 0.000), mind-body (P < 0.000), social (P < 0.004) and tolerability (P < 0.000), except relational and environmental domains, which were lower in them. However, between the groups, the relational domain was significant (0.000) and the environmental domain was non-significant (0.592). Overall, males had a significantly better total core score, total treatment score and overall total FertiQoL score, while females had lower scores. Conclusion: Amongst infertile couples, the reproductive QoL was poorer in females than in males. Our study suggests psychological counselling and mental support for females during infertility management.

"Effect of COVID-19 Vaccination on Menstrual Cycle Patterns of Reproductive-Age Women: A Multi-centric Observational Study."

AIM: The study was conducted to know the impact of COVID-19 vaccination on menstrual cycle patterns and pre- and post-menstrual symptoms in women aged 18-45 years. BACKGROUND: COVID-19 vaccination was introduced to combat the dreadful impacts of human coronavirus infection. The two indigenously developed COVID-19 vaccines approved for use in India are COVISHILED and COVAXIN. OBJECTIVES: To investigate the effects of COVID-19 vaccination on the menstrual cycle, pre- and post-menstrual symptoms and to establish the correlation with the type of vaccine received. METHODS: Multi-centric observational study conducted in six institutes of national importance in different states of India over one year. A total of 5709 female participants fulfilling inclusion criteria were enrolled. Data about the impact of vaccines (COVISHIELD and COVAXIN) and prior COVID-19 infection on the menstrual cycle and its associated symptoms were obtained using all participants' online and offline interviews. RESULTS: Of 5709 participants, 78.2% received COVISHIELD and 21.8% COVAXIN. Of the total 5709 participants, 333(5.8%) developed post-vaccination menstrual disturbances, with 32.7% having frequent cycles, 63.7% prolonged cycles, and 3.6% inter-menstrual bleeding. A total of 301 participants noticed changes in the amount of bleeding, with 50.2% excessive, 48.8% scanty, and 0.99% amenorrhea followed by heavy bleeding. Furthermore, the irregularities of the menstrual cycle (p=0.011) and length (0.001) were significantly higher in the COVAXIN group (7.2%) as compared to the COVISHIELD (5.3%) group. A total of 721 participants complained of newly developed/worsening pre- and post-menstrual symptoms. These symptoms were significantly higher in the COVISHIELD group (p=0.031), with generalized weakness and body pains as the main complaints (p=0.001). No significant difference was observed in the incidence of COVID-19 infection with these vaccines. No significant associations were observed when comparing menstrual abnormalities among those with COVID-19 infection (p>0.05). CONCLUSIONS: COVISHILED and COVAXIN vaccines were associated with menstrual cycle disturbances and pre-and post-menstrual symptoms in a small proportion of participants, with 94.7% having no change in the amount of bleeding during menstruation post-vaccination. The menstrual irregularities observed were significantly higher with the COVAXIN vaccine. Others: Further, long-term studies are required to confirm that the impact of COVID-19 vaccination on the menstrual cycle may be short-lasting, with no severe effects on women's menstrual health.

Congenital miliaria crystallina in a term neonate born to a mother with chorioamnionitis.

Miliaria crystallina (MC) is a self-limiting, superficial obstruction of the eccrine sweat ducts with subsequent extravasation of sweat, resulting in rapidly surfacing, tiny, clear, noninflammatory vesicles. The disease is seen frequently in hot, humid, tropical climates and in the neonatal period, but congenital occurrence is rare. We report a case of congenital MC in a baby born to a mother with chorioamnionitis.

Applicability of On-Site Evaluation of Cervical Cytology Smears Stained with Toluidine Blue to Reduce Unsatisfactory Results.

INTRODUCTION: Carcinoma of the uterine cervix is a major health problem faced by Indian women. Screening techniques like visual inspection with acetic acid, Lugol's iodine, Papanicolaou smear, and human papillomavirus DNA testing have been suggested. Pap smear is a simple, safe, cost-effective, and reliable technique used for screening cervical lesions. Rapid on-site evaluation (ROSE) using the 1% aq. toluidine blue staining method has been less studied in cervical cytology. MATERIALS AND METHODS: Our study was a prospective study done over a period of 2 years. All the cervical cytology smears were reported as per the Bethesda system 2014. Rapid stain using aqueous toluidine blue (1%) and conventional Pap stain was done on the smears received. RESULTS: We evaluated a total of 1,300 cases, with 97.6% satisfactory samples. The spectrum of cases included 96.3% of negative for malignancy cases (including bacterial vaginosis, trichomonas, candida, and atrophic smears), atypical squamous cell of undetermined significance and atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion in 0.5% cases, low-grade squamous intraepithelial lesion and high-grade intraepithelial lesion in 0.3% cases, squamous cell carcinoma in 0.3% cases, and atypical glandular cells/adenocarcinoma in 0.2% cases. Turnaround time was within 48 h in 77% cases. With rapid stain, our unsatisfactory rate was reduced from 12% to approx. 2.4%. CONCLUSION: ROSE has been attempted on routine FNA cytology samples with success. However, the use of ROSE in cervical cytology has not been attempted to date. Lower unsatisfactory rate is an important indicator for the successful implementation of cervical cancer screening technique.

Academic dishonesty among undergraduates from private medical schools in India. Are we on the right track?

BACKGROUND: Though doctors are considered to be respectful role models of professionalism and ethics, medical students are no strangers to academic dishonesty. AIM: To assess the academic dishonesty practices among undergraduate students from private medical schools in India. METHODS: A pre-tested and validated questionnaire containing 10 commonly done academic misconducts were administered and responses were collected. RESULTS: Out of 166 medical students enrolled in the study, 75% have given proxy for attendance and 49% have copied from others record book. During a theory exam, 74% of students have copied from their friends, 2% have tried to get the question paper before exam and 5% have influenced their teachers by unfair means to get more marks. During clinical/practical exam, 81% have got technical help, 45% had prior knowledge about the exam case, and 54% of them have falsely documented clinical findings. CONCLUSIONS: The prevalence of academic dishonesty is high. Academic integrity and ethics should be emphasized to the students which might help them in becoming professional and honest doctors.