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The safe and effective management of health care biomedical waste has received much attention for improper and inadequate management is associated with an increase in the incidence of health risks to the healthcare workers, the patients, and their environment and to the community at large. Hence the development of safe and effective management of biomedical waste along with handling protocols, institutional plans and policies, appropriate training and feedback programs on proper waste management and handling for all the healthcare workers are highly recommended. In India, with the implementation of Biomedical Wastes (Management & Handling) Rules 1998, emphasis is being placed mainly on the proper handling, segregation and disposal of the healthcare waste by which the risks and hazards to an individual and to the community can be considerably reduced. Though a technology and treatment protocol already exists, liquid biomedical waste management still remains a major problem for all healthcare facilities. So proper training in handling of waste will enable the healthcare facility to diffuse this critical problem safely and cost effectively while managing their liquid biomedical waste. So a literature search using the terms liquid biomedical waste was done and this review describes the problems associated with its management.

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Ethno-medicine refers to the study of traditional medical practice which is concerned with the cultural interpretation of health, diseases and illness and also addresses the healthcare-seeking process and healing practices. Headache is one of the common symptom for consultation with a doctor. Several patients visiting doctors and specialists with the complaint of headache, attribute the cause to gastritis, gas or to any similar terminology in their local language. Since, the cause connects between head and stomach the condition is known as "gastric headache". The knowledge of gastric headache and its description details were greatly contributed by the medical traditions of ancient Greece, Persia Egypt, India, and China. The possible causality of the gastrointestinal diseases in inducing headaches has been little investigated. We do see a significant proportion of patients visiting varied specialists attributing headache to gas/gastritis. We believe that attribution patterns, explanatory models and research is needed to study gastritis/gas as a cause for headache in different cultures. The difference in the understanding and beliefs of the illness between the clinician and patient can result in inappropriate assessment or dis-satisfaction.

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Background: Diarrhea is the second most common cause of morbidity and mortality among children under 5 years old worldwide. Most of the mortalities and morbidities due to diarrhea can be prevented. Accurate knowledge regarding signs and symptoms, timely and appropriate management at household, and in health services remains an important intervention for reducing mortality and morbidity. The present study was conducted with an objective to determine the knowledge, attitude, and practice of mothers of under-five children regarding the diarrheal illness. Methods: A cross-sectional study was conducted in a Medical College Hospital, Mangaluru. A pretested questionnaire was given to mothers of under-five children when they attended hospital for treatment of their children either as outpatient or inpatient. Results were tabulated and analyzed statistically using frequency, percentage, and Chi-square test. Results: A total of 100 mothers were selected randomly. Majority (40%) of them were in the age group of 21–25 years. All of them were literate with 47% mothers completed high-school education. Majority (40%) of mothers belonged to Class III socioeconomic status. Most of the mothers (84%) had good knowledge regarding signs and symptoms, spread, and prevention. Majority of mothers (77%) had serious attitude toward diarrheal illness. Most of the mothers (76%) practiced good dietary and preventive measures during diarrheal episodes. Rotavirus vaccine was given by 35% mothers to their kids. A strong association is found between age group, educational status, and socioeconomic status and knowledge, attitude, and practices regarding diarrheal illness (P ≤ 0.0001). Conclusion: Maternal education in particular health education should be used as an effective tool to promote knowledge and good practice regarding diarrheal illness in children under 5 years of age. Inclusion of rotavirus vaccine in national immunization schedule will help in improving its coverage.

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Background: Use of tobacco in cigarettes indeed represents a health concern of growing magnitude among cigarette smokers. As a consequence of its addictive qualities, the consumption of cigarettes often becomes a lifelong habit, with cumulative and deleterious effects on health. Smokeless tobacco has been advocated as a substitute for cigarette smoking. On the contrary, the use of smokeless tobacco is fraught with health risks and needs to be discouraged. Modernisation of life style has affected the population even in rural areas, leading to addiction. Smokeless tobacco is presumed to be less of an evil by the rural folk. Khaini addicts are likely to suffer from mental and physical exhaustion, leading to stress. Khaini is tobacco with slaked lime. This is important in view of the prevailing socio-economic as well as the healthcare system available in any developing country. Therefore, the present study is designed to measure the heart rate variability (HRV) among this special group of the population. Materials and Methods: Fifteen male subjects were enrolled from the rural farm labors' population who regularly chew khaini. They were free from any type of physical and mental health issues and were non-smokers. A similar group of 15 male subjects anthropometrically matched, who did not chew khaini and did not use tobacco in any form, participated as controls. Each individual volunteer was subjected to an HRV analysis on three occasions: the first record was performed on the first day of their arrival in the hospital as subjects during the lean season. The second observation was recorded after 3 months. The final HRV analysis was performed after 6 months of the first recording. Two types of parameters were analyzed: time domain and frequency domain. Statistical analysis was performed using a paired t-test within the study group and the unpaired t-test between non-khaini chewing controls and subjects on Day 1 of the recording. Results: There was no statistically significant difference between the controls and the study group on Day 1 of recording. Both the HRV parameters - time and frequency domain, showed decreased values during the third month and sixth month recording as compared with the first week recording. The decrease is much more during the sixth month recording as compared with the third month recording. A statistically significant decrease is observed in the mean RR interval, heart rate, very large frequency and large frequency only when the first week recording is compared with the third month recording, but when the first week recording is compared with the sixth month recording, a significant decrease in the mean RR interval and heart rate is found. Conclusion: Subjects involved in taking khaini are likely to undergo a lot of physical and mental stress thus affecting their autonomic status. This adds up to the stress induced by their occupation. HRV analysis using short-term electrocardiogram recordings was used to detect changes consequent with this stress.

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Background: Thrombocytopenia has been defined as a subnormal number of platelets in the circulating blood and may result from four processes: Artifactual thrombocytopenia, deficient production of platelets, accelerated destruction, and abnormal distribution or pooling of the platelets. Aims: To find out the etiology of thrombocytopenia with clinicopathological correlation, to grade it on the basis of platelet count, and to know the age and sex distribution of the cases. Materials and Methods: The study was conducted from January 2015 to June 2015. A total of 300 cases of thrombocytopenia were selected. All the patients with platelet counts less than 150 Χ 10 ³ / micro liter (μL), were included. On the basis of platelet count, the cases were divided into the four grades and clinicopathological correlation was done. Statistical Analysis: Simple random sampling, mean, and percentage. Results: The most common cause for thrombocytopenia was infection. Alcoholic liver disease was the most common noninfective cause. Maximum number of patients were in the age group of 20-39 years. The commonest grade of thrombocytopenia was Grade 1, the least common being Grade 4. Conclusion: Thrombocytopenia is usually associated with infections such as malaria, dengue, sepsis, and viral diseases. It is less common in noninfective conditions, for example alcoholic liver disease. It is seen mainly in adults, significantly more in males, and present as Grade I.

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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.

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Background: The importance of a clean environment and linen for optimal patient care has been stressed upon since the very inception of hospitals. Individuals who work in a laundry are required to be adequately informed about the physical and health hazards present in the laundry, the known risks, and what to do if an accident occurs. Every laundry worker must be trained to know the location and proper use of the available personal protective clothing and equipment. Therefore, safe environment in the laundry is essential to maintain their health, and awareness programs should be conducted. Objective of the Study: To assess the awareness regarding occupational health hazards among the employees in the Laundry Department. Materials and Methods: The research method adopted in this study is of a descriptive type. The study was conducted in the Laundry Department of the selected hospital. The sample consisted of 15 respondents. All the employees in the department were included. The tools used to collect the data were an informal interview and the check-list and observation methods. The collected data was analyzed by percentage. Result: The study reveals that a majority of the respondents were knowledgeable about the occupational health hazards and safety measures. However, very few of them were aware of the types of occupational hazards. Conclusion: Awareness of occupational health and safety among the employees is important in the laundry area; therefore, planned orientation, training programs, and proper guidance to the employees will help reduce any kind of danger involved in the job and adoption of the necessary safety measures.

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Purpose: The physiotherapist facilitates optimum functional independence, health and well being of the community. An idea of the range of conditions that a physiotherapist can treat will help the community to benefit from their skill. Anganwadi workers (AWW) play a key role in health education and care at the primary care settings especially in rural India. Objectives: The objective of this study was to assess the awareness of physiotherapy among AWW in Dakshina Kannada. Materials and Methods: A cross-sectional survey using a validated questionnaire was conducted among 112 AWW. The data obtained were analyzed and described. Results: Fifty percent of the 112 respondents were not aware of the role of physiotherapy in many of the impairments and only 3% of the AWW were informed during their training period regarding physiotherapy. Conclusion and Implications: Awareness about physiotherapy among the AWWs who participated in the study was poor. Adequate awareness programs among the AWW with regard to physiotherapy, through the various means of information transfer, can be beneficial in helping them to direct the people who are in need of such services.

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The diagnosis of yo-yo reflux in patients with partial collecting system duplications is difficult. We report a case of recurrent urinary tract infections due to partial duplication of the collecting system in which yo-yo reflux is demonstrated with color and pulse wave Doppler. Our aim is to highlight the fact that radiologists and clinicians should be aware of this noninvasive, inexpensive, and easily accessible modality so as to diagnose this phenomenon more frequently in future.

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Background: Couvade syndrome reflects physiological changes in men in preparation for fatherhood. Objective: The objective of this study is to analyze the frequency of Couvade symptoms among1st time expectant fathers and their associations with socio-demographic factors. Materials and Methods: An exploratory study was conducted in three Private Maternity Hospitals, Bangalore. A total of 123 low risk 1 ^st time expectant fathers attending the antenatal clinic along with their low risk term primigravidae at 36-40 weeks of gestation were selected by purposive sampling. Each one of the 1 ^st time expectant fathers were interviewed on a four points ordinal scale for measurement of Couvade syndrome which included 29 symptoms. Results: The results revealed that 1 ^st time expectant fathers experienced Couvade syndrome related to physical symptoms - (changes in appetite, flatulence, constipation, indigestion, fatigue, nausea, vomiting, food cravings, diarrhea, abdominal pain, headache, fainting, tooth ache, weight loss, weight gain, back pain, leg cramps, skin problems) and psychological symptoms (insomnia, mood swings, irritability, feeling close to tears, night mares, feeling lonely, helpless, guilty, fear of being alone, resentful and not interested in usual activities). Socio-demographic characteristics were not associated with Couvade syndrome. Conclusions: Health-care providers should anticipate needs and problems of expectant fathers and assist them in working through the challenging aspects of fatherhood.

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A genius in more than one basic field, with many important discoveries/inventions such as folate, methotrexate, aureomycin, and diethylcarbamazine etc., The wonder drugs he created helped conquer many diseases considered incurable till then, and even today, these drugs continue to be used routinely. Also, his discoveries led to better understanding of various basic physiological processes in man. Though he received all the support for his research on foreign soil, it is said he always remained an Indian at heart. The accolades he received for his work were few, and moreover, delayed. This article briefly describes the journey of this great man, his discoveries and achievements, which even today remain largely unknown.

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Context: Autoimmunity against the thyroid gland is one of the most important causes for thyroid dysfunction. Anti-thyroid antibody test is an important tool in the evaluation of autoimmune thyroid disorders. Aims: To study the prevalence of thyroid hormone dysfunction and positive anti-TPO antibody titers in patients being evaluated for thyroid-related disorders. Settings and Design:This retrospective cross-sectional study was done in Father Muller Medical College. Materials and Methods: The TSH (Thyroid stimulating hormone), FT ₄ (Free thyroxine), and anti-TPO titer reports of 74 subjects undergoing evaluation for thyroid-related disorders were analyzed. Statistical Analysis Used: Statistical significance was estimated by P value. Results: About two-third (60%) of hypothyroid patients showed raised TPO antibody titer. The titer was significantly higher in hypothyroid subjects when compared to the euthyroid subjects, and a majority of the hypothyroid subjects had a titer at least twice the upper limit of normal. Two of the three subjects with hyperthyroidism also had elevated anti-TPO titers. Conclusions: The commonest cause of hypothyroidism in our study subjects was autoimmune-related thyroid disease. Anti-TPO antibody estimation is a very useful test for establishing the etiological diagnosis of autoimmune thyroid diseases in our population. In situations where there is a diffuse non-progressive goiter, anti-TPO antibody estimation can substitute for an invasive FNAC.

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Context: Ovarian tumours represent about 30% of all cancers of the female genital system. They manifest in a wide spectrum of clinical, morphological and histological features. Aim: To study the frequency of incidence of different histopathological types of ovarian tumours in our institute. Materials and Methods: This retrospective study included 257 cases of histopathologically proven ovarian tumours, reported in the Department of Pathology of a rural tertiary care referral hospital, over a 12 year period (January 2000 to December 2011). These were classified according to the WHO classification of ovarian tumours (2003). Clinical presentation of the patients was analysed from archived case records. Results: Of the 257 tumours studied, 162 (63.04%) were benign, 15 (5.84%) were borderline and 80 (31.12%) were malignant. Surface epithelial tumours were the most common (68.48%) followed by germ cell tumours (15.95%). Mucinous cystadenomas (32.69%) were the most common benign tumours, while serous cystadenocarcinomas (31.13%) were the most common malignant tumours. Most ovarian neoplasms (43.19%) occurred in the 21-40 years age-group. Dull abdominal pain was the most common clinical presentation. Conclusions: Benign ovarian tumours were more common than malignant ones across all age groups. Surface epithelial tumours were the most common histopathological type of ovarian tumour. Due to vague symptoms, patients present late. Development of methods for early diagnosis of ovarian neoplasia is therefore, a pressing need today. The relative frequency of incidence of different ovarian tumours shows regional variations, highlighting the need to identify region-specific risk factors.

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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.

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Introduction: Nutritional anaemia is a worldwide problem with the highest prevalence in developing countries. It is found especially among women of child-bearing age, young children and during pregnancy and lactation. It is estimated to affect nearly two-thirds of pregnant and one-half of non pregnant women in developing countries. Objectives: To study the trend and severity of anaemia among people attending at Ratua RHTC and various socio demographic factors for the same. Materials and Methods: Hospital based cross sectional study. Observation: The trend of anaemia from 2008 to 2011 was in increasing trend, 9%, 15%, 22%, and 27% respectively and in 2012 constant around 26%. Anaemia was more common in females than males, 18% males and 82% females were reported anaemia of various degrees in the study period. Anaemia was highest among 11-25 years of age 42% followed by 26-40 years 23% and lowest among 0-10 years of age 8.69%. Anaemia among elderly was quite higher 15.5%. Most of the males had mild anaemia 16% followed by moderate 6.61% and severe 0.77% in contrast most of the females had moderate anaemia 42% followed by mild 31.35% and severe 3%. Trend of anaemia in female patients were in increasing trend from 2008-2009, than little decreases in 2010 and further decreases in 2011 after that again increases in 2012. Conclusion: Anaemia was significantly higher in females in comparison to males in moderate and severe category. Anaemia was highest among 11-25 years of age group.

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Background: Adolescence is a period of both opportunities and threats. It is an episode of exploring new options and ideas as opportunity. It is also a phase in life marked by vulnerability to risky sexual behavior and underprivileged reproductive health outcomes. Due to the deficiency of courtesy and proper guidance, millions of adolescents are facing the problems of teenage pregnancy, unsafe-abortion, psycho-social abomination, sexually transmitted diseases (STDs) and HIV/AIDS. The aim of the study was to explore the sexual and reproductive health (SRH) practices, perceived behavior, and associated factors among the adolescents. Materials and Methods: An institutional based cross-sectional study was conducted from January to May 2007 in different educational institutions of Kathmandu. Information was collected from 417 adolescents using pretested and self-administered questionnaire with their informed consent. Analysis was done using computer database SPSS-12.5 version applying appropriate statistical rules. Results were presented in tabular, graphical, and narrative forms. Results: The mean age of respondents was 17.7 ΁ 0.86 years and 57.9% of them were in grade XII. About 70.9% had good practice on Sexual and reproductive health (SRH). Most of them (83.9%) were informed on SRH via radio, TV or the internet (98.63%) and through books and newspapers (94.52%). About (22.9%) were involved in premarital sex in which 75.0% of them used condom. About 44.2% discussed on the SRH issues with family members. Gender, family income, family types, and knowledge of SRH were found significant (P < 0.05) factors affecting SRH practice. Conclusion: Nearly one quarter of the adolescents under the study had been involved in premarital sexual contact. Half of them were found to discuss on SRH with their family members. Awareness and curriculum based teaching-learning activities will support to reduce the consequences of premarital sexual contact and teenage pregnancy.

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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.

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Objective: Data on acute lymphoblastic leukemia (ALL) in Indian children being limited, we analyzed the clinical, immunophenotype and cytogenetic profile of ALL in our pediatric patients. Materials and Methods: This was a prospective and retrospective observational study in which data of 103 children with ALL, aged three months to 18 years were analyzed. Results: Definite male preponderance (70.87%) was observed, 58.25% patients were aged between two to five years. Common clinical features included fever (92.33%), pallor (87.38%), hepatomegaly (85.44%) and splenomegaly (83.50). central nervous system involvement was seen in 6.80% and tumor lysis syndrome in 32.04% patients. Hemoglobin was <5 gm/dl in 43.69%, between 5-10 gm/dl in 45.63% patients; white blood cell count between 5,000-50,000/hpf seen in 69.90%, >50,000 in 20.39% patients. Platelet count was <50,000 cells/hpf in 48.54%. Blast cells in peripheral smear present in 67.96% patients of 97 in whom immunophenotyping was done, 82.44% were Pre B cell ALL. Pre T and T cell ALL was seen in 15/97 (15.46%) patients. Karyotyping revealed hyperdiploidy in 9/89, hypodiploidy in 2/89, miscellaneous changes in 35 patients. FISH analysis in 63 patients revealed Philadelphia chromosome positivity in seven (11.11%). MLL gene was positive in 12.70%. TELAML was positive in 13.64% (3/22) patients. 97.06% patients went in to remission post induction. Conclusion: Most of our patients come under standard risk by their age, WBC count, immunophenotyping and cytogentic analysis. We suggest larger multi-centric studies even in developing countries to understand the clinical profile and RT-PCR technique in cytogenic analysis for better risk stratification to help in risk adopted therapy.

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