Culture creates an exclusive prototype of the beliefs and perceptions as to what “health” or “illness” actually means. Health culture is the basis for health-seeking and health-promoting behavior. There are institutional arrangements within which heath behavior occurs and the impacts of socioeconomic, political, and physical background for their specific health beliefs and health institutions counts a lot. Further, this prototype of beliefs mainly influences how symptoms are documented, to what they are accredited, and how they are interpreted and how it also affects how and when modern traditional health services are sought by the people. Cultural differences in the recognition and interpretation of symptoms and in the use of health services are the topic of wealthy literature. This paper is based on the author's fieldwork experiences in different occasions about the various cultural aspects of the rural health-care issues in southern Karnataka, India. The fieldwork was done in certain rural parts of Karnataka, South India, using participant observation and data also synthesized using content analysis technique. It concludes that cultural differences among the rural people seeking health care are related to the social structures and relationships and the quantity of belief/disbelief in concerning traditional or Western medical care system. We found that the impediment in seeking suitable and timely health care were indifferently found among the individuals belonging to the various sociocultural groups characterized by the cultural exceptionality and customary and family authority.

Introduction: As in all chronic diseases, an important component of care in diabetes is patient education (diabetes self-management education). Many diabetic care programs have shown that using specially trained diabetes educators – nurses, allied health-care professionals – improves outcomes. In India too, the National Defense Education Program has trained graduates to be diabetes educators. We wanted to use the strength of our institute – an intelligent and motivated student body to function as a diabetes educator. We developed a module to train medical students to be effective diabetes educators. The objective of this was twofold: First, to enhance patient self-management of diabetes; second, studies have shown that even among doctors, lack of knowledge about practical diabetes management was common. We believed that in view of the impending diabetes epidemic in India, it is important that every newly graduating MBBS doctor has sufficient knowledge about diabetes to counsel and manage patients at the primary care level. Materials and Methods: A physician and an endocrinologist developed patient and student training modules. Modules were administered to students by the authors and to patients by the trained students. Improvement in knowledge and attitudes was assessed by improvement in posttest scores and by qualitative analysis of the patient and student feedback. Results: We found that patient knowledge about diabetes and its management improved after contact with the diabetes educator as assessed by a marked increase in posttest scores. Students found that training patients in diabetes care improved the depth and range of their knowledge about diabetes and its management. This method of using students as diabetes educators facilitates both patient and trainer learning. Students who worked with patients using this module noted patient questions and suggested additional points of interest be covered in the module based on patient questions. We are currently incorporating these points into the module. We believe that this module on practical management of diabetes can be included in the curriculum for MBBS students in our university. Conclusion: Using medical students as diabetes educators improves student knowledge and patient self management of diabetes

Context: Medical research is being encouraged in India and biostatistics is a vital tool. It is important to understand the attitudes toward biostatistics before teaching programs and workshops are conducted to empower clinicians with this vital tool. Materials and Methods: Eighty consenting participants were cross-sectionally assessed on a semi-structured questionnaire and two validated Likert type questionnaires on attitudes toward biostatistics. Results: Participants reported biostatistics to be the most difficult subject in the MBBS curriculum. Participants felt that their training in biostatistics so far was inadequate and ineffective. They reported that biostatistics would be better understood if taught by someone with a medical background and in 3^rd MBBS. They accepted that biostatistics should be an important part and skill present in every member of a research team. Participants reported the wish to learn basic biostatistical skills to be able to perform and design their own research projects. Conclusions: There are negative attitudes toward biostatistics in faculty as well as residents and improvements in teaching techniques, as well as teaching policies, are necessary to bring about the necessary change.

Introduction: Obesity is fundamental to the development of metabolic syndrome (MetS) as it appears to precede the emergence of the other MetS risk factors. Aim: The objective of this study was to calculate the frequency of MetS among obese individuals attending the obesity clinic in a tertiary care center in Kerala and also to review the association of various anthropometric and biochemical factors of MetS among obese individuals in this region of the country. Materials and Methods: A cross-sectional study was designed among ninety obese individuals who have attended obesity clinic in a tertiary care center in Kerala. Anthropometric measurements such as height, weight, body mass index (BMI), and waist to hip ratio were recorded. Lipid profile and fasting plasma glucose level were estimated. MetS was diagnosed using the International Diabetic Federation criteria, and the study population was grouped as those with and without MetS. Results: The frequency of MetS among the study population was 61.1%. The mean age of the study population was 32 years. Parameters such as BMI, blood pressure, fasting blood glucose level, and triglycerides showed statistically significant association with MetS in obese individuals. Conclusion: Since all the components of MetS are modifiable, public should be made aware of this condition, and they should be advised regarding preventive measures.

Background: Peak expiratory flow rate (PEFR) is a measure of airflow in bronchial tree and it provides idea of bronchial tone. It is affected by age, sex, height, body weight, and other physical activity. There is evidence that obesity has a link to bronchial hyperresponsiveness. Thus, we proposed this study to find out the relation between PEFR and body mass index (BMI). Materials and Methods: In this study, 56 male and 49 female young subjects (total = 105) were recruited. As sex is a definite factor for variation in PEFR, subjects were classified into normal (BMI = 18–24.99 kg/m²), over weight (BMI = 25–29.99 kg/m²), and obese (BMI = 30–34.99 kg/m²) separately for both male and female. After written consent, PEFR of each subject was recorded between 7 and 8 am. Then, data analysis was done by one-way ANOVA, Pearson correlation, and regression analysis. Results: In male subjects, the mean difference of PEFR of normal, over weight, and obese subjects were 498 L/min, 488 L/min, and 391 L/min, respectively, which is statistically significant (P = 0.000). In female subjects, the mean difference of PEFR of normal, over weight, and obese subjects were 377 L/min, 348 L/min, and 325 L/min, respectively, which is statistically significant (P = 0.002). Pearson correlation showed negative correlation between BMI and PEFR both in male (r = −0.512) and in female (r = −0.539). Conclusion: This study concluded that PEFR declines with increase in BMI, and there is negative correlation between BMI and PEFR.

Background: Methods to provide comfort and relieve pain are of paramount importance for the child bearing woman. Unfortunately very little importance is given to reduce the pain and discomfort of the women during episiotomy suturing. Aim: The aim of the study was to assess the effectiveness of breast crawl on the intensity of episiotomy pain and behavioural response among women during episiotomy suturing. Method: A quasi experimental design with a sample size (N=40) were selected using purposive sampling technique. The data were obtained by using a baseline proforma for the mother, Visual Analogue Scale (VAS) and an observation checklist. Statistical analysis was done using SSPS. Results: Findings showed that the present study findings also revealed that there is a significant difference in the mean scores of behavioural response of mothers during suturing between the experimental and control group (t₃₈= 2.042, P < 0.05). Also there is a significant difference in the mean scores of reduction in intensity of episiotomy pain of mothers during suturing between the experimental and control group (t₃₈=2.042, P < 0.05). Hence breast crawl is effective in reducing the intensity of pain during episiotomy suturing and there is a favourable behavioural response among women who received breast crawl during episiotomy suturing. Conclusion: The findings concluded that breast crawl is a simple and cost effective method to reduce the intensity of episiotomy pain in women during episiotomy suturing. Nurses can in co operate this practice and thus initiate the bond of motherhood.

Background: Psoriasis is a chronic inflammatory disorder which of late has been significantly linked with metabolic syndrome (MS). Objective: To assess the association between psoriasis and MS and evaluate specific disease characteristics predisposing for the development of MS. Materials and Methods: We performed a prospective, observational, descriptive study with 207 adult patients with various types of psoriasis. Results: MS was found in 49.8% of psoriatic patients. It was more prevalent after 40 years of age with a female preponderance (P = 0.000). Smoking (P = 0.0320) and alcohol consumption (P = 0.025) were significant contributing factors for the development of MS in our study population. No association for the same was reflected with parameters such as psoriasis type, lifestyle behavior, family history, and other associated systemic disease. Conclusion: A definite association does exist between psoriasis and MS. Patients with psoriasis should be periodically screened for MS and managed appropriately utilizing an interdisciplinary approach.

Context: Hepatitis C virus (HCV) infection with a worldwide distribution causes liver disease. The liver is the principal site for formation and clearance of lipoproteins. Aim: The purpose of this study is to assess the influence of HCV on lipid metabolism and the effect of the stages of this disease on lipid pattern in infected patients. Materials and Methods: The study involved the selection of 36 chronic hepatitis C (CHC) patients attending the clinic at a tertiary hospital in Makurdi, Nigeria. After fulfilling the inclusion criteria, 36 anthropometrically matched apparently healthy individuals were selected as a control to the CHC group. CHC is defined as patients, who continuously tested positive for anti-HCV antibody for up to 1 year during their periodic visit to the clinic. Results: There was no significant (P > 0.05) difference between the mean systolic blood pressure (BP), diastolic BP, age, waist circumference, body mass index of chronic HCV, (CHCV) and controls. There was a significantly lowered total cholesterol (P = 0.029) and high-density lipoprotein cholesterol (HDL-C) (P = 0.000) in CHCV patients compared to the matched controls. There was a significantly lowered total cholesterol (P = 0.004) and HDL-C (P = 0.000) in asymptomatic CHC compared to the matched controls. Conclusion: Lipid profile monitoring may help in the diagnosis of hepatic infection severity and may also act as a good prognostic sign, so it must be analyzed in all advanced hepatic infection cases.

Aims: Establishing the reference change values (RCVs) and validating the delta check auto-verification in the hospital information system (HIS). Materials and Methods: This study was conducted in the Hospital Laboratory-Biochemistry. Fifty-one parameters were analyzed in three phases. Phase I: Delta check reference change values were established. Phase II: Delta check auto-verification was validated in the hospital information system. Phase III: Calculation of test requiring manual verification, true and false positive rates. Results: Out of all the test results, 1.35% failed the RCV-delta check thus requiring manual verification, and the remaining 98.65% were auto-verified. Only 0.12% test results were true positives indicating laboratory error, and 1.23% were false positives and were correlated clinically. Ten percent simulated data results and 0.37% actual patient results were not identified by the newly introduced HIS. Conclusions: RCV-delta check is a refined form of the delta checks used to analyze acceptable analytical and biological variation in laboratories. Majority of tests passed the RCV-delta check auto-verification, implying that very few test reports require manual verification. True positives can be detected in the laboratory. All HISs should be validated before implementing complete auto-verification.

Background: Blister beetle dermatitis an irritant vesiculobullous disorder caused by rove beetles when it comes in contact with or is crushed on the skin. Their hemolymph consists of pederin, a potent vesicant responsible for the classical morphology of lesions. Materials and Methods: This was a descriptive study of 42 such cases was seen in a residential school, clinical details and photographs were collected using a standard pro forma and consent form, respectively. Results: Clinically, the lesions were present mostly on the uncovered parts of the body (81%). Due to the irritant nature of the lesions, flexures showed classical “kissing lesions.” Only 11.9% (5) cases reported a history of contact with the beetle signifying a high degree of suspicion to make the diagnosis. Conclusion: This article discusses one such outbreak with mention of the clinical profile and preventive methods of Paederus dermatitis.

Thyroid tuberculosis is a very rare condition despite an overall increase in the extrapulmonary forms of tuberculosis. Tuberculous infection spreads to the thyroid by lymphogenous/hematogenous route or directly from adjacent organs. Thyroid tuberculosis does not have any specific symptom. Fine needle aspiration is the mainstay of diagnosis. Antituberculous therapy and surgical removal of affected parts of the thyroid gland are the most common methods of treatment of thyroid tuberculosis. We present a case of a 37-year-old male who presented with a swelling in the neck and was diagnosed as tubercular thyroiditis on cytopathological examination.

Pyoderma gangrenosum (PG) is rare in children. We report a case of PG in a 4-year-old male who presented with ulcers over face, axillae, and gluteal area. The ulcers healed with cribriform scarring after starting systemic steroids and azathioprine. The patient, however, was unable to follow-up regularly. He had a recurrence of lesions developed sepsis and septic shock and unfortunately expired.