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Early initiation with optimal duration of Kangaroo Mother Care (KMC), for all stable small babies (<2000grams at birth), is essential for accelerated reduction of neonatal mortality. The purpose of this paper is to explore the support received by mothers along the health facility-community continuum and its association with KMC practice. All live small babies aged >  4 weeks of life, who were residing in the Gangawati sub-district, were recruited on a rolling basis (Dec 2017-Sept 2018) to obtain the estimated sample size of 210. Mother-baby dyads were visited in their homes to collect information [knowledge, attitude, and support received] for KMC initiation and maintenance till required. Secondary data on KMC duration was obtained from the district-wide project database. A total of 209 mothers with 227 small babies were interviewed (18 had twins). The mothers had a mean age of 23 (±4) years; and 7(±5) years of education, with 5 (±2) family members >  18 years in their households. More than half (51%) of the babies were female with a mean age of 35.6 (±7.5)days/ 4-6weeks and mean birth weight of 1693.6 (±221.4)grams irrespective of gestational age; 21.6% of whom were ≤ 1500g at birth. Most of the babies 205 (90.3%) were initiated on KMC at the health facility. The score obtained for KMC initiation [45%} and KMC maintenance support at the health facility [51.3%] was minimal. Multiple regression linear analysis showed that overall KMC support at the health facility was significantly higher for first-time mothers [β coefficient -1.54 (95% CI -2.87, -0.22)] and better knowledge scores on KMC [β coefficient 0.21 (05% CI 0.01, 0.42)]. KMC maintenance support was significantly higher for first-time mothers [β coeff -3.62 (95% CI -6.29, -0.96)] and for mothers whose babies had lower birth weights [β coeff -4.27 (95% CI -7.50, -1.05)]. Mothers require support to initiate and continue KMC along the health facility-community continuum (S1 Table). The role of support at home would require further exploration to determine its association with KMC practice.

Vitamin D, an essential nutrient for bone health, is widely deficient in India despite abundant sunlight. The prevalence ranges between 70 and 90% in adult women. We studied the prevalence of vitamin D deficiency/insufficiency and the association between serum 25-hydroxyvitamin D, parathyroid hormone, osteocalcin, bone-specific alkaline phosphatase, bone mineral density, and dietary intakes in young urban women. Among 220 women screened, 84.7% of participants had suboptimal vitamin D (64.5% deficient 20.2% insufficient). In 108 vitamin D deficient women, 75% reported below 15 min of daily sun exposure. Dietary calcium intake was 480.6 ± 117.7 mg/day. Serum 25(OH)D was negatively correlated with PTH (⍴ = − 0.364, p  < 0.001) and osteocalcin (⍴ = − 0.342, p  < 0.001). Osteocalcin was positively correlated with dietary calcium (⍴ = 0.228, p  < 0.01), Ca: P (⍴ = 0.240, p  < 0.01) and milk intake (⍴ = 0.226, p  < 0.01). Positive associations were observed between osteocalcin and Ca: P ratio [β = 23.58, 95% CI: -0.614 to 47.771, p  = 0.056] and with milk intake [β = 0.03, 95% CI: -0.001 to 0.065, p  = 0.058]. The coexistence of vitamin D deficiency with inadequate calcium intake, and limited sun exposure, underscores the importance of strategies to promote calcium-rich diets and adequate sunlight practices to support bone health.

IntroductionPoor medication adherence is associated with poor clinical outcomes, an increase in hospitalisations and increased mortality. This is a multicentre randomised study that evaluates the effectiveness of using a manual pill organiser (MPO) and a custom-developed pill reminder app (PRA) on medication adherence, morbidity, as well as health economic outcomes among Indian elderly individuals taking multiple medications.ObjectivesThe primary objective of this study is to evaluate the impact of MPO and PRA alone or in combination in improving medication adherence among elderly individuals on multiple medications. The secondary objectives include the impact of interventions on the morbidity profile and health-related quality of life. The study also plans to assess the cost-effectiveness and cost-utility of improving medication adherence.Methods and analysisThis is a community-based, open-label, factorial-design randomised controlled trial to be conducted across rural and urban populations at two geographically distinct sites in India. The study will enrol 752 elderly individuals aged 60–80 years, receiving three or more medications for at least 6 months and having access to smartphones. The participants will be randomised to receive one of the following interventions for 12 months: control group, PRA, MPO and MPO+PRA. All study groups would receive patient education about the importance of medication adherence. The study outcomes include the proportion of improvement in medication adherence (using Medication Adherence Rating System-5, 7-day point prevalence of medication non-adherence and pill count); adverse clinical outcomes; healthcare utilisation; health-related quality of life; cost-effectiveness and cost-utility outcomes.Ethics and disseminationThe study protocol has been approved by institutional ethics committees at all three institutes. The study results for primary and secondary outcomes will be published in peer-reviewed journals.Trial registration numberCTRI/2024/01/061975 (Registered on: 29 January 2024).

In the intensive care unit (ICU), acute kidney injury (AKI) is the most common cause of morbidity and mortality. Hospital-acquired acute kidney injury (HAAKI) is AKI developing after 48 h. We aimed to study the development of AKI and its associated risk factors. We conducted a longitudinal observational study. Inclusion criteria were patients > 18 years of age admitted to ICU. The primary outcome was the development of AKI as defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria. A total of 273 patients were included in the study. Out of 273, 44(16.11%) patients developed AKI. The mean age was 45.80(17.39) years, and 60.81% were males. The median acute physiology and chronic health evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 12(8–18) and 5(3–7), respectively. Diabetes mellitus (23.44%) and hypertension (23.81%) were predominant comorbidities. The risk factors associated with AKI were serum chloride level, colistin, invasive ventilation, positive end-expiratory pressure (PEEP), and fluid balance. The hospital mortality was significantly higher in patients with AKI (43.18%) as compared with no AKI (14.41%). Among the secondary outcomes, 7 (15.90%) patients required renal replacement therapy (RRT) during hospitalisation. The length of ICU stay was higher in patients with AKI 8(5–13) compared to no AKI 5(3–8). A total of 16.11% developed HAAKI, and mortality was 43.18%. Post 6 months follow-up of AKI patients, mortality was 23%. Among survivors none of the patients were on RRT.Patients admitted with normal kidney function can develop AKI. Hence, careful monitoring of ICU patients is necessary.

Objectives The objective of this study is to understand the role of vitamin B12 supplementation in improving skeletal muscle function among the elderly. Methods A literature review in the Medline database was conducted to understand the association between vitamin B12 and muscle function in Section A. In Section B, 28 healthy elderly participants aged ≥60 years were recruited in a cross‐sectional design for estimation of plasma vitamin B12 status and assessment of upper limb muscle strength Maximal voluntary contraction (MVC) and muscle quality (expressed as MVC/total muscle mass). Participants were grouped based on vitamin B12 status into vitamin B12‐depleted (<148 pmol/L) and replete (≥148 pmol/L) groups. In a quasi‐experimental study design, the vitamin B12‐depleted group (n = 14) received daily oral vitamin B12 supplementation of 100 μg for 3 months. All the study measures were repeated post‐supplementation. Results Vitamin B12 deficiency was identified to contribute adversely to muscle strength, quality, and physical performance among older people in the extensive literature review. The pilot intervention study showed significant improvement in MVC and muscle quality (p < 0.050) post‐vitamin B12 supplementation, comparable to the vitamin B12‐replete group. Conclusions Vitamin B12 may have a crucial role in the maintenance of muscle function. 3‐month oral vitamin B12 supplementation among subclinical vitamin B12 deficient elderly improved muscle strength and quality and reached levels similar to the vitamin B12 replete group. Vitamin B12 may have a crucial role in the maintenance of muscle strength and quality. 3‐month oral vitamin B12 supplementation among subclinical vitamin B12 deficient elderly improved both muscle strength and quality and reached levels similar to the vitamin B12 replete group.

Breast cancer (BC) among premenopausal women is an aggressive disease associated with poor outcome despite intensive treatment. Higher burden is observed in southeast Asian countries attributed to younger population structure. We compared the reproductive and clinicopathological characteristics, distribution of subtypes and survival between pre and postmenopausal women from a retrospective cohort of BC patients with median follow up over 6 years to examine the differences. In our cohort of 446 BC patients, 162/446 (36.3%) were premenopausal. Parity and age at last childbirth were significantly different between pre and postmenopausal women. Premenopausal BC had a higher proportion of HER2 amplified and triple negative breast cancer (TNBC) tumors ( p  = 0.012). Stratified analysis by molecular subtypes showed TNBC had significantly better disease free (DFS) and overall survival (OS) among premenopausal group (mean survival, pre vs. post, DFS = 79.2 vs. 54.0 months, OS = 72.5 vs. 49.5 months, p  = 0.002 for both). Analysis on external datasets (SCAN-B, METABRIC) confirmed this finding for overall survival. Our data confirmed the previously observed association of clinical and pathological features between pre and postmenopausal BC. Exploration of better survival among premenopausal TNBC tumors is warranted in larger cohorts with long term follow up.

Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aims: This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Results: A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients; 261 had mild, 317 moderate, and 422 severe infections; and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion: HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.

Background: Effective teaching methods are important in psychiatry. Previous studies have focused on the assessment of students about the effective teaching methods but not on a self-assessment by teachers. Aims: Primary objective is to evaluate the teachers' and students' perspectives of effective teaching methods in psychiatry for medical undergraduates. Secondary objectives include assessment of the concordance of each item and exploring innovative teaching methods. Settings and Design: A cross-sectional study design used in teachers and medical students from St. John's Medical College, Bangalore (India). Methods and Material: A modified teachers and medical students perspectives of effective psychiatry teaching methods were used. Statistical Analysis: Differences in continuous variable assessed with independent sample-test and categorical variables with Chi-square test. The Domain scores were divided into tertiles and the highest and lowest tertiles were analyzed. Results: Both students and teachers had high perspectives on most of the teaching methods. Differences were found in items such as \"using multimedia slide effectively,\" \"good sense of humor while teaching,\" \"presentation summarizes the key points,\" and \"presentation links ideas effectively.\" Role play-based and live/simulated patient-based teachings were reported most frequently by both. Significantly, a higher proportion of the 6th term students and a lesser proportion of teachers were associated with the lowest tertiles for Domain 1, 2, and 3. Significantly, increased number of 8th term students were found in the higher tertiles in Domain 3. Conclusions: These findings have practical implications in identifying the gaps in effective teaching methods by the teachers. Teachers can improve their teaching methods by upgrading their presentation skills, employing new and innovative teaching skills.

The vaccination drive for COVID-19 was launched in India after the authorization of ChAdOx1 nCov-19 (Covishield), an adenoviral vector vaccine, and BBV152 COVID-19 (Covaxin), an inactivated virus vaccine. As stated by the CDC, vaccine-related adverse events can happen. In this study, we aimed to assess the timing of the COVID vaccination and admission diagnosis and their effect on ICU mortality. The time from vaccination can help identify adverse events directly related to vaccination.  Methods: A retrospective cohort study was conducted across four centers in India. Patients who took the first or second dose of any vaccines and were admitted with non-COVID illness to the ICU were included in the study. Patients were categorized based on the time interval from vaccination as ≤42 days or >42 days. The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation. A total of 175 patients were included in the study. The mean age was 53.49 (15.89) years, and 61.14% were males. The ICU mortality was 24.57% (18.38% to 31.63%). Thromboembolic events such as acute coronary syndrome (ACS), cerebrovascular accident (CVA), and mesenteric ischemia were seen in 7.43%, 7.43%, and 1.14% of patients, respectively. Six patients (3.43%) developed neuromuscular illness. The mortality was higher in patients >66 years, followed by ≤35 years of age when admitted ≤42 days of vaccination (p=0.008). The mortality was higher in cerebrovascular disorders and was clinically significant (p<0.001). Patients developed thromboembolic events and neuromuscular diseases requiring ICU admission post-COVID vaccination. We observed a significantly higher mortality in the age groups >66 years and ≤35 years when admitted within 42 days of COVID vaccination. Patients admitted with cerebrovascular diseases also had higher mortality.

Background and aims The undergraduate MBBS course (Bachelor of Medicine, Bachelor of Surgery) in India is designed to produce competent Indian Medical Graduates (IMGs) capable of addressing community health needs. The preparedness of these graduates for clinical practice remains a crucial area of investigation. Objective Structured Clinical Examinations (OSCEs) have emerged as a robust assessment tool for evaluating clinical competencies. This study aims to assess the feasibility and utility of the OSCE when used as an end-of-internship evaluation, describe temporal trends in OSCE performance, and analyze the correlation between OSCE scores and final-year MBBS examination results over a six-year period at a center in South India. Methods A descriptive study was conducted at a medical college in South India, involving six batches of students (2017–2023; n  = 469). OSCE stations were designed to assess cognitive, psychomotor, and affective domains. The feasibility and utility of this exercise was assessed. OSCE scores were analyzed across domains and subdomains, and correlations with final-year MBBS examination scores were explored using Pearson’s correlation coefficient. Statistical significance was set at p  < 0.05. Results The OSCE was found to be a resource-intensive evaluation, requiring 528 faculty-hours for a batch of 60 students and 843 faculty-hours for a batch of 150. The mean OSCE score was 61.3 ± 8.0%, with the highest performance in the affective domain (72.1 ± 14.2%) and the lowest in the cognitive domain (50.0 ± 15.4%). Notably, psychomotor skills were inversely correlated with cognitive skills (-0.41, p  < 0.001). OSCE scores were weakly correlated with final-year MBBS examination marks (r = 0.44, p  < 0.001), with stronger correlations in smaller batches (r = 0.57, p  < 0.001) than larger ones (r = 0.44, p  < 0.001). The COVID-19 pandemic and increased batch sizes negatively impacted clinical and technical skill performance. Conclusion It is feasible to conduct OSCEs as an end of internship assessment in a medical college. OSCEs serve as a comprehensive assessment tool, underscoring the importance of multi-modal evaluation strategies. Conducting OSCEs serves as an appropriate assessment of the MBBS training programme so as to subsequently tailor the programme according to performance in various subjects, domains and subdomains.