Background: The present study was undertaken to determine the levels of interleukin-6 (IL-6) and evaluate its association with clinical presentation, severity, radiological imaging, management, and outcome in coronavirus disease (COVID-19) infection. Methods: The present study included 132 admitted COVID-19 patients, categorized into three groups. Group 1 had IL-6 within the normal reference range, Group 2 had IL-6 raised up to ten times the upper normal limit (UNL), and Group 3 had IL-6 level raised > ten times the UNL. The patient's data concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome were extracted from their medical records for subsequent evaluation, interpretation, and association among the groups. Results: COVID-19 patients with raised IL-6 levels exhibited frequent symptomatic presentations, severity, and critical illness, especially with extremely high IL-6 levels (P < 0.001). Radiological findings in terms of a digital chest radiograph and high-resolution computed tomography (CT) chest indicated severe lung involvement in patients with extremely high IL-6 levels (P < 0.05). The majority of patients with extremely raised IL-6 levels were associated with the classic COVID-19 CT images (P = 0.014). Patients with extremely raised IL-6 levels required intensive treatment as compared to normal IL-6 group in terms of tocilizumab therapy (P = 0.008), noninvasive ventilation (P < 0.001), and intensive care unit care (P = 0.009) associated with higher mortality (P = 0.046). Conclusion: Raised IL-6 levels in COVID-19 patients should be considered a risk factor for the severity of the disease, inflammatory storm, and rapid pulmonary invasion. There is an urgent need for establishing a treatment protocol in patients with extremely raised IL-6 levels.

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Lead toxicity is one of the most hazardous metal toxicities. It can enter the body through lead-based paint, dust, water, soil, tableware, and folk medicines. Children are especially prone to develop lead toxicity. Lead acts by inducing oxidative stress due to inefficient replenishment of glutathione. Lead can also cause hemolytic anemia due to disruption of the cellular membrane by lipid peroxidation. Lead toxicity also affects neurotransmitter levels and causes severe health issues related to organ damage, some even leading to death. The main aim of this review article is to summarize lead toxicity detection, its sources, and its mechanism including various toxicological effects on human health. It also focuses on the prevention and treatment of lead toxicity.

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Background: Osteoarthritis is a major cause of musculoskeletal disability. Nonpharmacological and nonsurgical treatment is preferred for the management of knee osteoarthritis (OA). However, evidences are lacking regarding the effectiveness of multimodal physiotherapy program including, combination of various physical modalities (TENS, IR, US etc.) with therapeutic exercises, for the management of knee OA. Objectives: To determine recent research evidences for the effectiveness of combination of physical therapy interventions for treatment of knee OA patients. Methods: This systematic review mainly includes randomized controlled trails. Searching done by Google scholar, Pub med and PEDro from 2010 to 2019. We used terms like-knee pain, OA, TENS, exercise, and physiotherapy management. Results: Present outcomes shows that physiotherapy treatment is effective technique in reducing pain in patients with Knee OA without adverse effects. After implementing the inclusion and exclusion criteria, 100 articles were retrieved using the key words, but only 10 articles were selected for the study. Conclusion: Electrotherapy modalities in conjunction with exercise therapy program designed for treating knee OA patients proved to be more superior to exercise alone at improving quadriceps muscle activation by reducing pain and increasing function during exercise.

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The COVID-19 pandemic has taken the world by storm, and nations world over are battling this unprecedented health crisis. Diagnostics play the most important part in the “test, track, and treat” strategy being used in most of the nations to combat COVID-19. Although viral culture is the gold standard, it is not pursued because of the associated biohazard risks. Short of that, nucleic acid amplification tests (NAATs) are the present gold standard and are being used in several ways. Real-time reverse transcriptase-polymerase chain reaction is being widely used, although cartridge-based NAAT and TrueNat™ testing are also in vogue. Serological testing is also being used as an adjunct specially for screening (rapid antigen testing kits), while antibody (specially IgG) testing is being used as a serosurveillance strategy. Radiological investigations, especially computed tomography scan of the thorax, give peculiar peripheral ground-glass opacities which are quite characteristic in the present COVID pandemic and need to be ascertained together with other clinical features and diagnostic tools. Although the present tools have been able to support the diagnosis of COVID to quite an extent, there are limitations, and as the whole spectrum of COVID disease unfolds, the diagnostic armamentarium will also continue to expand, and we will need to use the diagnostic strategies further to be able to contain this pandemic at the earliest.

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Background: The coronavirus disease-2019 (COVID-19) outbreak, first detected in Wuhan, China, has turned into a rapidly spreading pandemic ailing the human race throughout the world. Health-care workers (HCWs) are under immense physical and psychological pressure, adversely affecting their efficiency and decision making. Aim: We hereby intend to study the impact of COVID-19 pandemic in HCWs in reference with a variety of factors. Materials and Methods: A nationwide cross-sectional online study using semi-structured pro forma along with the Adjustment Disorder New Module and the Depression, Anxiety, and Stress Scale-21 was conducted among 200 respondents. Results and Discussion: Of the 200 respondents, 174 (87%) were doctors and 26 nursing staff, with a mean age of 42.1 ± 12.2 years, 62% were male, and 63% were working in the government sector. A significant number of respondents were found to be suffering from acute stress (9.5%), depression (17%), and anxiety (19.5%) which they attributed to the negative professional and personal influence of this ongoing pandemic scenario. HCWs on the front lines of this pandemic are facing compounding stressors and need robust psychiatric help to adequately take care of this need.

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Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM₁₀ and PM_2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.

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According to the National Mental Health Survey-2016, one in every ten persons in India suffers from depression and anxiety, and 20% of these depressed Indians are pregnant women and new mothers. This systematic review was conducted to assess the burden of depression and risk factors associated with it among the Indian pregnant women. Electronic database (PubMed and Google Scholar) was used to identify any retrospective/prospective observational research studies published in English language which specifically examined antenatal depression (AD) among Indian women using a validated scale. A total of 995 citations were retrieved, out of which only eight studies were included. The prevalence of AD was found to be ranging from 9.18% to 65.0% in northern, western, and southern part of India. However, there is a lack of research on AD from the eastern part of country. The factors such as unplanned pregnancy, multigravidity, history of abortion, advancing pregnancy and age, lower/lower-middle socioeconomic status, poor education status of women, unemployment, bad relations with in-laws, male gender preference, and demand for dowry were significant predictors for AD. Therefore, it is necessary to provide the health-care professionals and women with the knowledge about these factors for early prediction of women at high risk of AD, which might help them to get timely intervention and reduce the burden of depression. Furthermore, the results from this review implicate that more research is needed in future in this field to further validate the findings of the present review.

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Introduction: The ease of availability of antimicrobials and their excessive use is a growing issue which has significantly contributed to antimicrobial resistance (AMR). This is a matter of public health concern as the burden of AMR is far outpacing the research and development work done to develop new antimicrobials. India, being one of the top consumers of antimicrobials, now faces this threat which can only be curtailed through the implementation of antimicrobial stewardship program (AMSP). To address this issue, this systematic review attempts to study the implementation activities of AMSP in the country by the means of literature review. Methods: A comprehensive research using web-based search engines was performed employing a combination of search string: AMSP, ASP, implementation, impact, antibiotic stewardship, antimicrobial surveillance, infection control, and resistance control. The search yielded thirty papers between the time period of 2008 and 2019. 17 papers fulfilling the inclusion-exclusion criteria were taken up for review, employing PRISMA framework. Results: Results from different studies conducted on implementation of AMSP and its components were consolidated and analyzed to track the extent of AMSP activities. Moreover, by studying AMSP practices, gaps in implementation activities were identified by highlighting the AMSP components that were not fully utilized in the country. Conclusion: The results show that implementation of AMSP in India is still in its nascent stage as all the stewardship components are yet to be fully applied in the country. There seems to be a lot of scope in improving the implementation activities by building and strengthening of components such as use of information technology in monitoring and surveillance, use of antibiotic cycling and sensitizing staff, and broadening the role of different staff members to develop an effective program in the nation which meets the goals of National Action Plan-AMR.

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Background: The World Health Organization defines “Accidents as an unexpected and an unintended event causing physical and mental injuries.” In many developing countries, injuries due to accidents are one of the major causes of deaths among under-five children. In India, 15%–20% deaths among children are due to injury according to the National Crime Bureau. Objectives: To determine the frequency and prevalence of accidents among the under-five children and to identify the risk factors associated with accidents. Methodology: A cross-sectional study was conducted using probability proportionate to size sampling technique in the urban field practice area of JSS Medical College, Mysuru. Based on the reported prevalence of 46.3% of childhood injuries, a total sample size of 438 was obtained. Data related to sociodemographic characteristics, risk factors, and injury profile were collected by interviewing parents who had children less than 5 years. Analysis was done using SPSS V.25. Results: Majority (60.8%) of the caretakers had male children. The prevalence of accidents among under-five was 22.1%. Fall (68%) was the common type of accident. 55.7% of the under-five children received the treatment from allopathic system of medicine. Education level and stress among the caretakers showed statistically significant association with the occurrence of accidents. Conclusion: This study revealed the prevalence of domestic accidents among under-five as 22.1%. Caretakers are failing their responsibility of caring their children due to lack of education among them.

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Introduction: Adolescent stress questionnaire (ASQ) – a 58-item inventory covering broad range of adolescent distress was developed and validated for Australian adolescents. The present study reports a modification of the ASQ for the Indian context. Methodology: Initially, a focus groups study was carried out with 8 adolescents and 8 experts to understand the relevance of the subject and domain contents of ASQ using the original ASQ. Later content validation was done by the experts in the field for the modified ASQ. The modified version was administered to (n = 20) adolescents for pilot testing. In the next stage, the scale was given to 153 adolescents and readministered to the same samples after 1 week. Statistical analysis was done to ascertain the internal consistency, component factor, and test–retest reliability as per the standard analysis. Results: During stage one, 38 questions were retained which were more relevant to Indian context. The internal consistency of 6 subscales was ≥8 and measuring 0.89 for overall questionnaire. The test–retest reliability measured 0.96 for the overall scale (P < 0.0001) for each domain. During the confirmatory factor analysis, above half (20 of 38) of the items confirmed high correlations with their component scale, with factor loadings P < 0.5. Conclusion: The modified ASQ had acceptable internal consistency and test–retest reliability. Further testing with adolescent students living in other parts is recommended to provide a more complete assessment of the questionnaire.

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Japanese Encephalitis (JE) is an important re-emerging vector-borne zoonotic disease of the 21^st century which is the most important cause of morbidity and mortality due to pediatric viral encephalitis in Asian populations. India and China together report 95% of the disease burden where it is also an important cause of acute encephalitis syndrome. JE is a neglected tropical disease which disproportionately afflicts poor and economically disadvantaged populations in rural regions of low and middle-income countries which often lack well-equipped tertiary care centers for the management of JE cases presenting with central nervous system manifestations and related complications. JE has large animal reservoirs among pigs and water birds which renders JE elimination difficult. Hence, current strategy for JE prevention and control pursues a combined approach inclusive of expansion of JE vaccination coverage in endemic regions, vector control, and surveillance. Unfortunately, the lack of public health infrastructure, economic resources, and lack of political commitment has resulted in most endemic countries in the developing world failing to take adequate steps for achieving these recommended measures for JE control, especially with regard to developing surveillance capacities and reference laboratories for the diagnosis of JE. Moreover, the threat of JE has increased in recent years due to factors such as climate change and lack of economic development in several endemic zones even as the disease has begun affecting adult populations. Evidence from surveillance data in some countries also suggests that increase in vaccination coverage for JE does not necessarily correlate with decline in JE disease burden. Ultimately, JE is likely to persist as a major public health problem in the developing world and impede their economic development unless it receives adequate attention from the global health community.

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Background: This study was conducted in nonintensive care unit COVID-19 patients admitted in a tertiary care center, to assess the clinical profile and find surrogate markers to predict the severity of COVID-19 at the time of admission. Methodology: It is a cross-sectional observational study. Clinical and laboratory data were compiled of patients admitted in COVID wards in a tertiary care center. Patients were stratified clinically according to the severity of COVID pneumonia. The admission clinical and laboratory parameters were compared between the severe and nonsevere COVID patients. Results: The study included 63 patients of which 46 were males, with a mean age of 47 years. Patients were classified into mild (32%), moderate (19%), and severe (49%) categories according to national guidelines. Fever (81%), cough (67%), and dyspnea (67%) were the most commonly observed symptoms. In comparative analysis, mean C-reactive protein (CRP), serum ferritin, and neutrophil–lymphocyte ratio (NLR) were significantly higher in severe COVID-19 patients and the admission PaCO₂ significantly lower compared to nonsevere patients. Conclusion: The study shows that raised NLR, CRP, serum ferritin, and low PaCO₂ levels at the time of admission are important predictors of disease severity.

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Background: Sleep is very important for humans and more so to hospitalized patients. Alterations in the normal sleep pattern have negative impact on the medical conditions, mental health, cognitive performance and recovery of the hospitalized individuals. The primary aim of this study was to assess the quality of sleep among hospitalized patients and to find the correlation between the factors affecting sleep and sleep quality. The secondary objective was to understand the quality of sleep in people admitted for surgical and medical treatment. Methods: In this cross-sectional study, the hospitalized patients were examined. Sleeping habits of 100 inpatients of surgical and clinical wards were assessed through the Pittsburgh Sleep Quality Index (PSQI). A self-designed questionnaire was also used to ascertain the factors affecting the sleep. Content validity and test–retest reliability were evaluated. The data obtained were analyzed by the statistical methods of frequency, percentage, and Chi-square. Results: The cross-sectional study showed that the mean score for PSQI was 7.58 ± 3.14 and that 69% of the patients had poor sleep as inferred from the global PSQI >5 scores. Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication, and attitude toward the overall atmosphere and interior of wards has caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.

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Background: Tuberculosis (TB) is one of the most common respiratory illnesses in India, to the extent that about 1/4^th of the population afflicted by TB in the world, is found in India. The knowledge of the patient about the disease, his attitude toward it, and compliance to treatment are key factors in management of the disease. Objectives: The objective of this study is to assess the knowledge, attitude, and practices of the patients with regard to pulmonary TB. Methodology: A cross-sectional observational study was conducted among patients suspected of or diagnosed with pulmonary TB in a Tertiary Care hospital using a prestructured questionnaire. Results: A total of 100 patients participated in the study. Out of these, 74% had never suffered from TB in the past. Cough was identified as a symptom of TB by 75% participants. About 15% participants said they used no precautions while coughing. Conclusion: The study reveals that there are quite a few misconceptions regarding causes, transmission, and prevention of TB. There is still a long way to go to educate the population regarding such a common illness.

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In the medical field, emphasis has been on the development of trust between the physician and the patient, similar to that of a teacher and learner. This is because a solid foundation of trust benefits patients' overall care and students' learning. Trust is critical because it allows the patient to believe that the doctor is there to give them the best care possible. Trust improves the physician–patient relationship because the patient believes he or she is receiving high-quality care as a result. It is important for residents and physicians to be aware of their behavior in their interactions with patients and learners, even if the interaction is only for a few minutes. This awareness is key for the development of trust and long-lasting benefits for clinical care and medical education. Physicians and teachers should develop three crucial skills to develop trust early with their patients and learners: (1) listening, (2) caring, and (3) going the extra mile for patients and learners. These attributes, when applied to patient care and teaching, will travel far in a physician's career and be beneficial to their patients' overall health. This article will explore these three skills and examples of their applications, which medical professionals can use in their day-to-day practice in light of a time-restricting, multitasking, and technologically advanced world.

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Introduction: The Internet has become a must-present factor in our day-to-day life. As like any other substance like plastic, the Internet also demonstrates threats which affect health and thereby life also. Objectives: To find the prevalence and impact of internet addiction on health and lifestyle of medical students in a private medical college in Kerala. Methodology: This cross-sectional study was conducted among medical students for a period of 1 month. A questionnaire was used to document the sociodemographic details, internet addiction by young's Internet Addiction Test, and questions regarding impact of the Internet on life. Results: In the present study, we found that 71% of students (mild 107 [54%] and moderate 34 [17%]) had internet addiction. Internet addiction was significantly associated with male gender, mobile/tablet usage, eye strain, time to initiate sleep, frequency of sleep trouble, hours spent on the Internet, money spent, presence of backache, and appetite change with internet addiction. Conclusion: The study finding of presence of internet addiction has to be considered seriously along with tobacco and alcohol consumption. Awareness has to be made relating to the right use, right amount, and right time of using the Internet.

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The risk of transmission of hepatitis B, a global communicable disease, has become a matter of concern in recent years. Health-care delivery has the potential to transmit hepatitis B virus (HBV) and hepatitis C virus to both health-care workers (HCWs) and patients. The risk of transmission is most clearly related to the frequency of exposure or the extent of direct contact with human blood and body fluids. Health care must be provided with the best practice of safety and standards of care. Adherence to recommended improved safety devices, standard precautions, and fundamental infection-control practices is a must to prevent transmission of blood-borne pathogens. Long-term treatment with the goal of clearance of HBV is often required. Safe and effective hepatitis B vaccines along with postexposure prophylaxis with hepatitis B vaccination alone or in combination with HBV immunoglobulin have been available, the impact of which has been reported in several countries in preventing HBV transmission among HCWs.

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SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon became a pandemic engulfing the entire world, presenting with a myriad of presentations from asymptomatic to severe disease with acute respiratory distress syndrome and multiple organ dysfunction and severe inflammatory response. Little is understood about the new virus and its pathogenesis, and it is too early to ascertain its long-term sequelae at this point in time. New associations and clinical problems keep appearing with the new virus and thus we also got to encounter three cases of acute inflammatory demyelinating polyneuropathy (AIDP) in patients following COVID-19 infection. This case series aims to convey clinicians that AIDP can be seen in patients with COVID-19, particularly during the recovery phase, and thus not to miss it as postviral fatigue and malaise.

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India is the fourth largest manufacturer and the second largest consumer of pharmaceuticals in the world. Hospitalizations due to adverse drug reactions (ADRs) lead to a considerable burden on the health-care system and economy of the country. Pharmacovigilance in India faces considerable hurdles due to overburdened hospitals, underreporting of ADRs, variations in reporting formats, etc. To augment ADR reporting, many countries are exploring the option of mobile- and web-based solutions. The National Coordination Centre for Pharmacovigilance Program of India, Indian Pharmacopoeia Commission has released a mobile application (app) called “ADR PvPI” to mitigate some of these issues and both standardize and enhance the reporting of ADRs. This is in line with global focus on patient-reported outcomes and real-world data in pharmacovigilance. However, this approach has many implementation challenges including lack of awareness about mobile app, the use of English language in app, low smartphone adoption among the elderly, and in rural areas.

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Introduction: Auto-rickshaw driver is exposed to many kinds of risks owing to his profession, such as stressful occupational conditions, environmental pollution, and drug abuse such as smoking, tobacco, and alcohol use. The present study is an attempt to estimate the prevalence of substance abuse and depression among auto-rickshaw drivers and compare these with nonauto-rickshaw drivers. Subjects and Methods: A total of 120 participants were enrolled randomly in the study, i.e., 60 each from auto-rickshaw drivers and nonauto-rickshaw population. To fulfill the objective, methodology based on the test application of the Beck's Depression Inventory, Hamilton Anxiety Rating Scale, and alcohol, smoking, and substance involvement screening test was used. A predesigned questionnaire was used that included information such as general health status, habits, addictions, and work experience. To establish statistical relationships between two or more random variables, the Pearson correlation coefficient was also calculated. Results: In the present study, significant high prevalence of tobacco and alcohol use was seen among auto drivers, 83.3% and 63.3% as compared to nonauto-rickshaw drivers (tobacco and alcohol, 46.6% and 46.1%, respectively). The prevalence of depression in auto-rickshaw drivers was 90% (mild-to-severe range) which was significantly high compared to nonauto-rickshaw drivers (60%). On the Hamilton Anxiety Rating Scale, more than half of the auto-rickshaw drivers, i.e., 60%, had mild-to-moderate anxiety which was higher than nonauto-rickshaw (5%). Driving experience, age, and substance abuse (alcohol and tobacco use) showed a significant association with depression. Conclusion: This study demonstrated a high prevalence of depression, anxiety, and substance abuse in auto-rickshaw drivers. There was a positive correlation of depression with substance abuse (alcohol and tobacco), age, and work experience. This study will assist the psychologist to understand and treat the mental health issues among professional drivers.

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Objective: The aim of this study is to assess the association of insulin resistance with sensory neuropathy in prediabetes. Materials and Methods: Fasting serum insulin levels were measured and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated in all patients. These were compared in prediabetic patients having sensory neuropathy to those who did not have sensory neuropathy as determined by vibration perception thresholds (VPTs) measured using Digital Biothesiometer. Furthermore, direct correlation between insulin resistance and VPTs was checked. Results: A total of 60 prediabetic cases were included in this study. Among the study population, the age distribution ranged from 35 years to 60 years with the mean age of 48.68 years. Male and female formed 65% and 35% of the study population, respectively. The maximum fasting serum insulin levels were 21.8 mIU/L, and the minimum fasting serum insulin levels were 3.5 mIU/L, with the mean value being 10.61 ± 4.99 mIU/L. The maximum HOMA-IR was 6.4, and the minimum was 0.986, with the mean value being 2.81 ± 1.37. Among all the prediabetic patients, 43.3% of patients had neuropathy according to VPTs measured using Biothesiometer. T-test analysis suggests that mean fasting serum insulin levels (P = 0.026) and HOMA-IR (P = 0.032) were significantly higher in patients with neuropathy than patients without neuropathy. VPTs were found to have statistically significant positive correlation with fasting serum insulin levels (Pearson correlation coefficient = 0.317 [R], 0.296 [L];P = 0.013 [R], 0.022 [L]) and HOMA-IR (Pearson correlation coefficient = 0.299 [R], 0.281 [L];P = 0.02 [R], 0.03 [L]). Conclusion: Insulin resistance, quantified with the help of the index, HOMA-IR, has an important role in the development of this sensory neuropathy.

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Introduction: A tuberculosis patient infects several healthy people prior to the diagnosis and initiation of treatment. Indiscriminate spitting in the community has been identified as a challenge to the prevention of tuberculosis; however, knowledge is still limited in terms of actual practices. Methodology: We conducted a descriptive cross-sectional study at a tertiary care hospital to evaluate knowledge, attitude, and practices relating to tuberculosis by interviewing patients of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis using a semi-structured questionnaire. We evaluated knowledge of tuberculosis on etiology, mode of spread, treatment factors, attitudes on the importance the respondent attributed to the factor and practices on adherence to treatment, and hygiene for the prevention of spread including safe sputum disposal. Results: We enrolled 250 patients (165 males) with a mean age of 29 ± 11 (mean ± standard deviation) years. On knowledge of tuberculosis, most of the patients had correct knowledge regarding tuberculosis symptoms (241, 96%), mode of spread (235, 94%), and correct duration of treatments 246 (98%) for drug sensitive tuberculosis. On attitude, all the patients consider adherence to their prescribed anti-tubercular treatment, 246 (98%) on covering mouth while coughing or sneezing and 239 (96%) on safe disposal of sputum as important. However, only 45 (18%) reported practicing correct sputum disposal and 66 (26%) patients reported disposing of their sputum in the open. Conclusion: This study suggests that despite good knowledge and attitude, there is a lack in practice of safe disposal of sputum by tuberculosis patients. Efforts toward sensitization regarding safe disposal of sputum need to be strengthened.

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Background: Male factor is responsible for 50% of infertility cases. Universal deterioration in human sperm quality occurring in recent times is receiving a greater attention. The impact of numerous lifestyle factors including age, smoking, alcohol consumption, and exposure to occupational and environmental pollutants is unfavorable to male reproductive health. The present study intended to find out the association of demographic, occupational, and several lifestyle factors on semen quality of men diagnosed with infertility. Materials and Methods: The study enlisted 432 men diagnosed with fertility issue. Couples were administrated with a structured questionnaire to provide their demographic attributes and medical and reproductive health information. The collected data were statistically analyzed using SPSS software version 20.0. Results: The mean age of men was 34.44 ± 0.21 years at the time of consultation. Among seven semen abnormalities, asthenozoospermia was recorded the highest (30.09%). Most of the participants were having secondary education (32.26%), working as laborers (26.62%), and were having multiple addictions (27.77%). Decreased sperm count and motility was noticed among advanced age group and those with addictions. Different occupational statuses had substantial correlation with the sperm quality of participants. Conclusion: The incidence of male infertility and the potent lifestyle aspects studied have displayed an association with each other. However, influence of these aspects on impairment of male fertility can be overcome with modification toward healthier lifestyle.

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Background: Coronary artery disease (CAD) is known to adversely impact the quality of life (QOL) of the patients and poses an economic burden to the family and society. However, the same has not been estimated in India. Objectives: To estimate the annual economic burden (direct and indirect cost) and QOL in stable CAD patients at a Government Tertiary Care Hospital of Delhi, India. Materials and Methods: A cross-sectional study was carried out in a Government Tertiary Care Hospital of Delhi using a convenient sample of 113 CAD patients. A prestructured pretested questionnaire was used to collect information on direct and indirect costs of therapy for CAD patients, and QOL assessment was done using SF-36 questionnaire. Results: The total average annual cost incurred by patients of stable CAD was Indian National Rupees 15691.45, of which 78.49% was attributable to direct cost (drugs, supplements, diagnostic tests, and transportation charges) while 21.5% to the indirect costs (wage loss of the patient and caretaker, during the days of hospitalization). Both the components of QOL, namely, physical component score (PCS) and mental component score (MCS) were reduced in the stable CAD patients. PCS was 35.53 and MCS was 39.16. Conclusion: CAD poses not only an economic burden on the patient, family, and the society but is also associated with impairment of QOL of the patient too.

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Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease affecting microvascular circulation causing complications such as retinopathy, nephropathy, and neuropathy. Nail fold capillaroscopy (NFC) is an in vivo study of microvascular circulation. Aim: The aim of this study is to describe and quantify NFC changes in type 2 diabetics. Materials and Methods: NFC was done for all 10 fingernails for 96 patients with T2DM (as per the American Diabetes Association criteria) and 40 healthy controls. The diabetics were further subdivided into two groups: those with microvascular complications (Group 1, n = 46) and those without any (Group 2, n = 50). Results: Demographic profile was comparable in both the groups. Overall, 80.2% (77/96) of the patients with T2DM showed NFC changes as compared to 12.5% of the healthy controls. Unique morphological alterations in T2DM were angulated and receding capillaries. Mean capillary density was overall reduced, especially in Group 1 (6.57 ± 1.02 capillary/mm) as compared to Group 2 (7.03 ± 1.09 capillary/mm) (P = 0.67). Overall, 89.13% of Group 1 patients had NFC changes as compared to 72% in Group 2 (P = 0.035). Specific morphological changes were also significantly more common in Group 1 than Group 2, including tortuosity (P = 0.035), meandering capillaries (P = 0.004), capillary dropouts (P = 0.012), and bizarre capillaries (P = 0.002). Limitations: A larger sample size study with different demographic populations could have provided a broader picture of NFC changes in T2DM. Conclusion: Our study suggests that NFC changes are correlated with microvascular complications in type 2 diabetics, possibly helping in noninvasive identification of patients at risk.

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