Background: Approximately 16 million adolescent girls aged 15–19 years and 2 million adolescents under the age of 15 years give birth annually in the world. In Africa, where premarital sex is not accepted, especially for young women, unintended pregnancies mostly happen outside marriage. Recent data indicate that 18% of adolescent girls aged 15–19 years in eastern/southern region of Africa and 21% in western/central region of Africa had initiated childbearing. Teenage pregnancy and parenting remain important public health issues that deserve continued attention. The specific factors and beliefs that lead to contraceptive nonuse remain obscure, and up-to-date, evidence-based data on personal and environmental determinants of teenage pregnancy and case–control studies also are lacking in Ethiopia. Therefore, this study aimed to identify the determinants of teenage pregnancy to help policymakers, program managers, and health-care authorities with better decision-making in planning and problem-solving in Ethiopia. Methods: A case–control study was conducted using data set obtained from 2016 Ethiopia Demographic and Health Survey conducted throughout the country from January 18, 2016, to June 27, 2016. All teenagers who had a pregnancy history were enrolled as cases (381) and 1524 teenagers who were not pregnant were taken as controls.. Necessary variables were extracted from the DHS data set after literatures were revised. Then, variables with P ≤ 0.25 were analyzed with multivariable logistic regression. Results: Educational level, wealth index, knowledge of ovulatory cycle after period ended, knowledge of family planning method, contraceptive use, and reasons for not using contraceptives were higher among the cases and were statistically significant. Conclusion: Knowledge of family planning and ovulatory cycle, primary school educational level, richest wealth category, and contraception use were the determinants of teenage pregnancy. Hence, educational level, knowledge gap, and economy should be emphasized to eradicate teenage pregnancy from Ethiopia.

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Intrauterine growth restriction is a condition where the estimated fetal weight is less than the 10^th percentile on ultrasound and the fetus has not attained its biologically determined growth potential because of a pathologic process. This review deals with the definitions of fetal growth restriction, the etiology associated with it, the types of fetal growth restriction and discusses how to differentiate between them. The various screening mechanisms available, the approach to a patient who is at risk for fetal growth restriction and whether they will benefit from any of the prophylactic measures available are also discussed.

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Rodenticides remain an important cause of morbidity and mortality among patients with deliberate self-harm. Yellow phosphorus is an important class of rodenticide due to its high toxic nature and is associated with a high mortality rate. The absence of any specific antidote is an important factor for poor prognosis among those who consume this poison. We report a case of acute liver injury secondary to yellow phosphorus poisoning which was successfully managed with intravenous N-acetylcysteine.

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It is estimated that there are around 50 million people living with epilepsy (PWE) globally. Around one-sixth of this population resides in India. Around 10–12 million people with epilepsy reside in India. A significant proportion of PWE do not receive appropriate treatment, leading to a large treatment gap (TG). Poor awareness of antiepileptic drugs (AEDs), cultural practices, social stigma surrounding epilepsy, lack of accessibility to healthcare, and a severe shortage of medical professionals trained in the management of epilepsy are major contributors to the TG. Infectious diseases, particularly neurocysticercosis, form a major bulk of underlying cause for epilepsy. Certain geographical regions exhibit typical patterns of epilepsy. In this article, we attempt to provide a broad overview of the incidence, prevalence, etiology, types, mortality, and treatment of epilepsy derived from the data from Indian studies. India provides particular challenges in the management of patients with epilepsy, not only in terms of the wide spectrum of epileptic conditions but also in the demand for medical practice based on economic constraints.

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Scrub typhus is a mite-borne acute febrile illness caused by Orientia tsutsugamushi, and is transmitted by the bite of the trombiculid mite. It presents with high-grade fever which may be associated with nonspecific signs and symptoms such as rash, muscle and abdominal pain, headache, and lymph node enlargement. Scrub typhus is, therefore, one of the differential diagnoses to be considered in a child with acute undifferentiated febrile illness, especially if the disease is endemic to the region. The presence of a painless eschar at the site of the bite is an important pointer to the diagnosis. The illness responds well to antibiotics, usually within 48 h.

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Background: Skin and soft-tissue infections (SSTIs) vary in presentations, ranging from simple cellulitis to rapidly progressive necrotizing fasciitis. Early diagnosis is vital to reduce the complications. Materials and Methods: This prospective, observational, cohort study conducted between April 1, 2018 and June 30, 2018, in the emergency department (ED) of large tertiary care hospital in South India. In this study, all patients >15 years of age with traumatic or nontraumatic SSTI were enrolled consecutively, and SSTI associated with burns were excluded. The 353 patients were interviewed with a prestructured questionnaire and the statistical analysis was performed using SPSS 25.0. This study was aimed to find the incidence of SSTI and the outcome. Results: The cohort consists of… patients with age group between 40 and 65 years, and there was male predominance. Nonnecrotizing SSTI was the most common presentation. The incidence rate was 1.9%. Diabetes mellitus (DM) was the common risk factor n (%). Lower limbs were the most commonly affected site. The most common organism isolated in the blood and pus culture were Staphylococcus epidermidis and mixed flora. A large number (33.9%) of patients required in-patient care and surgical interventions. The mortality rate in our cohort was n (14%). Conclusion: The incidence of SSTI in patients presenting to the ED remains high. DM was the common risk factor, and many required inpatient care, and surgical intervention including amputation. Despite prompt diagnosis and management, mortality rate was still significant.

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Secondary hemophagocytic lymphohistiocytosis (sHLH) may be responsible for some of the deaths in adult patients with severe COVID-19. We present our experience of low-volume plasma exchange (PLEX) with low-dose steroid in the treatment of adult patients with sHLH and acute liver failure caused by dengue virus and other nonviral triggers and discuss how this may be effective in the management of severe COVID-19. sHLH is poorly understood and without effective treatment. Endothelium of the capillaries of the lungs and kidneys and of liver sinusoids does not express von Willebrand factor (VWF) in health and is where most macrophages are located. Plasma VWF levels are high in sHLH and require clearance by macrophages, which when activated enlarge and likely block the lumen. Current histology studies neither appreciate microcirculatory sludge nor display endothelial–macrophage interactions. We hypothesize that low-volume PLEX and low-dose steroid may reverse sHLH and improve survival in severe COVID-19 patients with acute lung injury.

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The cause of infertility is said to be unexplained when there is normal ovulatory function, semen analysis is normal, and tubal patency is established by hysterosalpingography or laparoscopy. Some of the factors that may contribute to the etiology of unexplained infertility are inability to identify the subtle reproductive abnormalities, endocrine/genetic/immunological disorders, minimal/mild endometriosis, and compromised ovarian and natural fecundability that may be less than normal. Prognostic factors in unexplained infertility include maternal age, duration of infertility, and previous obstetric history. The management options depend on various factors such as age of woman, duration of infertility, couples' preferences, and the health-care setting. The options available for treatment include expectant management, clomiphene citrate, super ovulation with intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.

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In the Indian subcontinent, the “Big four” snakes of cobra, krait, Russell's viper, and saw-scaled viper are responsible for most of the venomous snakebites. Diagnosing envenomation is a pure clinical skill with no diagnostic kit available yet. Anti-snake venom (ASV) is a precious commodity, and clinicians across the country must be aware of the process of production of ASV so that they may use it judiciously for the treatment of envenomation.

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Background: In both developed and developing countries, the proportion of people over 60 years of age is growing faster than any other age group as a result of longer life expectancy due to improved health care. As a result, emergency department (ED) visits are on the rise. Materials and Methods: This retrospective observational study was conducted in the ED of a large tertiary level hospital between September 2014 and December 2014. All patients >65 years presenting to the ED were included in the analysis. Results: During the study period, 1090 geriatric patients comprised 13.9% of the ED admissions. The mean age of the patients was 74.2 ± 20.32 years. There was a male predominance (65.4%). The most common presenting complaints were breathing difficulty (28%), fever (21.6%), vomiting (14%), chest pain (11.5%), abdominal pain (11.5%), trauma (11%), giddiness (10.4%), and altered sensorium (10%). The distribution of the most common organ systems involved are as follows: Cardiovascular system (18.7%), respiratory system (15.8%), trauma (13.9%), genitourinary system (13.8%), neurological system (12.3%), skin and soft tissue infections (6%), and others (25.1%). Among the respiratory conditions, acute exacerbation of asthma/chronic obstructive pulmonary disease was the most common (61.2%), followed by pneumonia (28.9). More than half (51.5%) were discharged from ED, 47.5% (518 patients) were admitted to the hospital, and 0.91% (10 patients) expired in the ED. A further 64 patients expired during the hospital stay. The overall inhospital mortality among the geriatric emergencies was 6.8% (79/1090). The mean length of hospital stay was 8.06 days. Conclusion: The admission profile among this geriatric population showed that cardiorespiratory conditions are the most common emergencies, followed by trauma. ED of India should be aware of this demographic profile and be prepared to handle these emergencies efficiently.

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Quality has become an important buzzword for the current generation of healthcare providers. Most hospitals and healthcare providers are differentiated and evaluated according to their organization performance and quality. National Accreditation Board for Hospitals and Healthcare Providers (NABH) is an integral board of Quality Council of India, established to operate accreditation program for healthcare organizations/institutions. Accreditation is a public recognition awarded to healthcare organizations which fulfill the standards laid by NABH through an independent external assessment conducted by qualified team of assessors.

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Objectives: The aim of this study is to assess the utility of plasma von-Willebrand factor (VWF) levels in predicting in-hospital survival for patients with severe alcoholic hepatitis. Methods: From a prospectively collected database of acute-on-chronic liver failure (ACLF) patients, we retrospectively selected all severe alcoholic hepatitis (discriminant function [DF] ≥32) patients and correlated baseline plasma VWF (antigen, Ag and collagen-binding activity [CBA]) levels with disease severity. In-hospital survival was classified as discharged alive (or) died/discharged in a terminal condition (poor outcome). Results: Of 34 consecutive severe alcoholic hepatitis patients (age: 40.5, 30–63 years; median, range, hospital stay: 6, 2–15 days) studied, 15 had a poor outcome. Plasma VWF-CBA was higher in patients with poor outcome (736 [396–1157] IU/dL) as compared to patients discharged in stable state (492 [97–986] IU/dL; P = 0.03). VWF-CBA correlated well with VWF-Ag, model for end-stage liver disease (MELD) score, sequential organ failure assessment score and ACLF grades. AUROC to predict composite poor outcome was similar for plasma VWF-CBA (0.72, 0.54–0.89) and MELD score (0.71, 0.53–0.89). Plasma VWF-CBA was higher in 23 “very severe” alcoholic hepatitis (DF >60 or MELD >30) patients. Combining plasma VWF-CBA (>750 IU/dL) and criteria for “very severe” alcoholic hepatitis had a sensitivity of 100% (81%–100%) and negative predictive value of 100% (68%–100%) for predicting poor outcome. Conclusions: Plasma VWF levels are markedly elevated, correlate with organ failure, and predict in-hospital survival in severe alcoholic hepatitis, and also in “very severe” alcoholic hepatitis, patients.

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Background: Laryngoscopy and intubation form an indispensable step in general anesthesia. They elicit significant sympathoadrenal responses. Suppression of these responses forms an essential step in general anesthesia. The aim of our study is to compare the efficacy of nebulized lidocaine versus intravenous (IV) lidocaine in suppressing the pressor response to laryngoscopy and intubation. Materials and Methods: One hundred patients within the age group of 18–65 years undergoing elective surgery under general anesthesia were randomly allocated into two groups: group IV lignocaine (IVL) (n = 50) and group nebulized lignocaine (NL) (n = 50). Baseline values of heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), and saturation were noted. Patients received either nebulized or IV lidocaine according to the group. HR, saturation, BP, MAP, and arrhythmias were noted every minute from laryngoscopy up to 5 min postlaryngoscopy and intubation. Results: There was an increase in HR and BP from baseline in both the groups with laryngoscopy and intubation, and the increase is significantly less in NL (P < 0.05). The parameters in both the groups attained the baseline values at the 3^rd min postintubation. However, the 4^th- and 5^th-min readings showed values below baseline in the nebulization group. Conclusion: This study suggests that NL may be more effective than IVL in suppressing pressor response to laryngoscopy and intubation.

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Background and Objectives: The assessment of general movements (GMs), particularly fidgety movements, helps identify preterm infants likely to suffer from Neurodevelopmental deficits; less is known about preterm GMs. This study evaluates the predictive value of preterm GMs for normal fidgety movements. Methods: This prospective cohort study included 131 very preterm infants (gestational age - M (standard deviation) - 29.7 (1.3) weeks) who underwent 3 GM assessments in the preterm period (31–37 weeks postmenstrual age [PMA]), term age (38–44 weeks PMA) and fidgety movement age (48–58 weeks PMA). Results: The sensitivity of preterm GMs in predicting fidgety movements was 67.21%, the specificity was 44.4%, the positive predictive value was 94.25% and negative predictive value was 9.09%. The proportion of abnormal GMs decreased with increasing age, with 33.8% in the preterm age, 20% in the term age, and 7% in the fidgety movement age. Conclusion: This study confirms findings of other studies-specificity values of preterm GMs are poor, implying a high rate of false positives. Preterm GMs may be inadequate in predicting future Neurodevelopmental outcomes.

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The ever-growing menace of Coronavirus Disease of 2019 (COVID-19) has ravaged mankind the world over. There has been a lot of exploratory work going on to unravel the pathophysiology of the disease and to come up with a rationale and realistic management protocol. Here is one such attempt to present the Government, Societal and Medical measures framed by Tertiary Care Medical College Teaching Hospital of State of Rajasthan, namely, S. M. S. Medical College and Attached Hospitals, Jaipur. These measures were undertaken for the entire state so as to curtail the rise of COVID-19 pandemic to some extent. The combative approach was multi-focal and multi-axial with the aim to address issues from all conceivable angles inclusive of preparative ground-work, fluidic containment, slowing of transmission, and appropriate logistics to ensure steady-state supplies.

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Secondary osteoporosis is an important clinical condition associated with significant morbidity and mortality. Many systemic conditions like autoimmune inflammatory disease, diabetes mellitus and drugs like glucocorticoid use are associated with secondary osteoporosis, diagnosis of which often requires high index of suspicion. Identification and treatment of the underlying cause itself can result in significant improvement in bone health. In this review we describe 5 case based scenarios discussing the diagnosis and management of some important causes of secondary osteoporosis.

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Methemoglobinemia is an altered state of the hemoglobin moiety resulting in impaired oxygen delivery to the tissues. It is a potentially fatal condition that occurs when the ferrous iron of heme is oxidized to ferric iron. Methemoglobinemia has been linked to a wide array of drugs, chemicals, and substances such as local anesthetics, industrial chemicals, and insecticides. Many of these compounds have no details of the composition and can result in severe methemoglobinemia. Clinical suspicion should be aroused with low oxygen saturation on pulse oximetry and the presence of chocolate-colored blood. Immediate administration of the antidote, methylene blue when indicated, effectively decreases methemoglobin levels to tolerable levels.

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Rodenticide is a broad term, and there are a wide variety of such compounds depending on the geographical region and availability. These compounds differ in their chemical composition, mechanism of action, toxic doses, and lethal effects. Coumarins, aluminum phosphide, zinc phosphide, and yellow phosphorous are the most easily available and commonly used rodenticides for deliberate self-harm. Aluminum phosphide poisoning is rapidly fatal, whereas yellow phosphorous poisoning too is associated with a high mortality within 1–2 weeks of consumption.

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The first 60 minutes after traumatic injury which is the most crucial period that determines the patient's outcome has been termed the “golden hour.” The concept that definitive resuscitative trauma care must be initiated within this early window has been publicized, taught, and practiced worldwide for more than four decades. The main steps in the early management of trauma are primary assessment; resuscitation: perform primary assessment and resuscitation together; reassessment of airway, breathing, and circulation; and secondary assessment. The primary assessment provides basic data essential for the patient's survival when life or limb is threatened. Resuscitation should be initiated simultaneously with the primary assessment. It is performed when any component of the primary assessment appears unstable. The secondary assessment is to be performed after the completion of primary assessment and resuscitation. It provides comprehensive information about the various organ systems.

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Neuropathy is the most common symptomatic complication of diabetes mellitus (DM) and accounts for a large share of morbidity and hospitalization associated with the disease. The symptoms of neuropathy in diabetes may present with somatic, autonomic, motor or sensory symptoms. Symmetric distal sensory polyneuropathy is the most common form, affecting the distal lower extremities and hands in a “glove and stocking” pattern. Cardiac autonomic neuropathy can, in particular, contribute to 6% of sudden deaths (painless myocardial infarction) among those with long-standing diabetes. Neuropathy whether sensory, motor, or autonomic may lead to the formation of fissures or calluses which lead to ulceration. Tight glycemic control is the only strategy which has demonstrated to show prevention and progress of diabetic peripheral neuropathy and autonomic neuropathy. Early treatment of diabetic neuropathy should, therefore, include tight glycemic control. All patients should be screened for diabetic neuropathy starting at diagnosis of type 2 DM and 5 years after diagnosis of type 1 DM and at least annually thereafter. An annual comprehensive foot examination is a must for all patients with diabetes and consists of examination of foot and footwear, neuropathy screening, vascular assessment, and musculoskeletal assessment of feet. This would help in identification of risk factor predictive of ulcers and amputation.

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Oral anti-diabetic agents form an important therapeutic strategy in the management of diabetes, after lifestyle modification. There are several new agents available, like dipeptidyl peptidase 4 (DPP4) inhibitors and sodium- glucose cotransporter 2 (SGLT2) inhibitors have been approved for use as monotherapy when diet and exercise are inadequate and when metformin is not tolerated, and can also be utilized as an add on to other glucose-lowering agents, including insulin. The therapeutic, pharmacokinetic and safety profiles of these agents are different from the older agents. Hydroxychloroquine (hcq) and bromocriptine have been recently cleared for use and show beneficial effects in control of blood glucose and HbA1C levels.

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder of behavior that presents in childhood. It is a clinically heterogeneous disorder of behavior, characterized by two features - (1) impairment in social communication and interaction and (2) repetitive patterns of behavior. The diagnosis is essentially clinical and is based primarily on history-taking and observation of the child over a period. There are several standardized screening tools and scales available to help make a diagnosis. Children with autism often present with speech delay and this has to be distinguished from other conditions. ASD is often associated with comorbid conditions which have to be identified to tailor the treatment program for each child. It is important that the parents or caretakers of the child are involved in the process of assessment and diagnosis and that their misconceptions and fears are addressed.

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