Background: Synacthen stimulated salivary cortisol has been previously evaluated and found beneficial in the diagnosis of adrenal insufficiency (AI), especially in situations with altered cortisol-binding protein (CBG) levels. Unfortunately, Synacthen is not marketed in many parts of the world whereas porcine sequence corticotrophin (Acton Prolongatum) is readily available. This study aimed to find the diagnostic accuracy of Acton prolongatum stimulated salivary cortisol test (APSST) compared to the short synacthen test (SST). Methods: Consecutive outpatients with suspected AI underwent SST initially, followed by APSST after 3 days. For APSST, saliva was collected at 0, 60 and 120 minutes after administering 30 units Acton Prolongatum intramuscularly. Serum and salivary cortisol were estimated using electrochemiluminescence assay. (Cobas e 411, Elecsys Cortisol II kits) Results: Sixty-seven patients with clinically suspected AI were enrolled for the study. Based on SST, 35 patients were classified as having AI [primary AI (n=19) and secondary AI (n=16)] whereas 32 had normal glucocorticoid reserve. The area under receiver operator curve of 0.99 and 0.98 was observed for salivary cortisol values at 60 and 120 minutes, respectively, for APSST. A cutoff value of 18.5 nmol/L (0.67 µg/dL) and 29.3 nmol/L (1.06 µg/dL) at 60 and 120 minutes, respectively, had a sensitivity as well as specificity of 93%-100% in diagnosing AI. Conclusion: Salivary cortisol estimation following stimulation using intramuscular porcine ACTH (Adrenocorticotrophic hormone) (30 units) is an economical and accurate alternative to SST in the diagnosis of AI, m and its level of 30 nmol/L or more at 2 hours confirms adrenal sufficiency.

The term sarcopenia is derived from the Greek meaning 'poverty of flesh' and is characterized by the progressive loss of skeletal muscle mass, muscle strength, and physical performance. This term was first coined by I.H. Rosenberg to denote "ageing related loss of skeletal muscle mass and strength" 1. Sarcopenia has a biological component with the genes involved in skeletal muscle mitochondrial function, oxidative capacity, and glucose uptake showing reduced expression with ageing 2. It affects women and men equally, starting from the fourth decade and accelerating from the 6 th decade 3. It was originally described in the elderly population, and is often now defined as a geriatric syndrome associated with functional impairment, increased risk of falls, fractures, and reduced survival. Sarcopenia has been found to be a predictor of chronic disease progression, poorer functional outcomes, and postoperative complications (both infections and noninfectious complications) 4. Standardization of sarcopenia assessment, especially in diagnosis of low muscle mass, will be crucial for clinical practice and interventions in the future. Dual energy X-ray absorptiometry (DEXA), bioelectrical impedance analysis Abstract Objective: To estimate the proportion of radiologically significant (LSMI) sarcopenia and the factors associated with it among patients undergoing Computerized Tomography scan. Methods: A Cross sectional study was conducted among 152 patients underwent CT scan in the radiology department of Government medical college Thiruvananthapuram. Sarcopenia was estimated based on lumbar skeletal muscle index obtained using cross sectional areas of various abdominal muscles by CT scan. The proportion of sarcopenia was estimated and associated factors studied. Binary logistic regression model was used to adjust the confounders. Results: Out of 152 individuals, sarcopenia was present in a total of 82 (53.95%) individuals. Male gender (Adjusted OR= 8.42, 3.64-19.52 (95% CI)) was a risk factor for and a body mass index more than 25Kg/m 2 (Adjusted OR= 0.36, 0.15-0.67 (95% CI)) was a protective factor against sarcopenia. Conclusion: The burden of sarcopenia is found to be high and considering the double burden of sarcopenia and obesity in the Kerala community, newer strategies for health promotion and early detection need to be developed.

Background:The foundations of hypertension in a person are laid in childhood and adolescence. The phenomenon of tracking of blood pressure is one where those children and adolescents who are in a high blood pressure category tend to fall in the same category when they become adults. Early diagnosis of hypertension and prehypertension in children and adolescents will help in reducing the prevalence of hypertension and its complications in the future adult population of any country. The objective of this study was to find out the prevalence of hypertension and prehypertension among school children 13-17 years in Thiruvananthapuram City Corporation, Kerala. Methods: A two stage sampling technique was applied; in the first stage the schools were stratified as government, aided and unaided schools using probability proportionate to size. In the second stage, from the selected schools one division or class from each standard was identified at random as a cluster and all the eligible children in the selected cluster were studied. A single BP measurement was taken using a standardized digital sphygmomanometer (OMRON IA1). Hypertension and prehypertension was defined as per national high blood pressure education program (USA), working group on hypertension control in children and adolescents blood pressure tables. The data was entered in MS excel and further analysis was done using SPSS 16.0 version software and proportions of outcomes were analyzed. Results: The total number of children studied were 2438, Boys 1274 (52.3%, 95% CI 50.28-54.32) and girls 1164 (47.7%, 95% CI 45.68-49.72). The prevalence of hypertension was found to be 21.4% (95% CI 19.64% -22.96%). The overall prevalence of systolic hypertension is slightly high among the girls (19.4%) than the boys (18.2%), (P value>0.05). The prevalence of pre-hypertension among the study subjects was 21.3 % (19.65-22.95%). The prevalence of systolic pre-hypertension was found to be 21.4% (95% CI 19.74%-23.06%) and diastolic prehypertension 5.3% (95% CI 4.4%-6.2%). Conclusions:The overall prevalence of pre-hypertension and hypertension was 42.6%. These facts show us that preventive interventions are urgent.

Background: Reduction of maternal mortality remains a challenge for developing countries like India as per the sustainable development goals put forward by UN. Near-miss audit is emerging as a new tool for setting new protocols in reduction of MMR. This study aimed, to analyze the near miss events and mortality events which occurred in the study setting from January 2011 to December 2012, and to compare the causes that led to the events.Methods: A descriptive comparative study was conducted at SAT Hospital, Government Medical College, Thiruvananthapuram, a tertiary care center in Kerala, India on the data accounted for a period of 2 years, 2011 and 2012. Maternal near-miss during the period is studied according to WHO 2009 criteria and compared with the maternal deaths during the same time period. The data was recorded using structured proforma; the same proforma was used to record maternal mortality cases of the same period.Results: Total live births during the time period were 18,663. Eighty-eight near miss cases and 26 maternal deaths occurred during the study period. Incidence proportion of maternal near-miss was 4.71/1000 live births. Severe maternal outcome was 6 per1000. For every maternal death, there were 3.38 near-misses. Mortality index of our institute was 22.8% and maternal mortality ratio (MMR) of the study setting was 139/1 Lakh live births. Post-partum hemorrhage was the leading cause for near-miss and systemic diseases were the major contributors to mortality.Conclusions: It is evident from the present study that PPH, once the leading cause of maternal mortality is now the leading cause of maternal near miss and by improving the resources of FRUs it can be further reduced. Systemic diseases are emerging as a new threat to the obstetric population leading to mortality.

Introduction:The State Poverty Eradication Mission of Government of Kerala-'Kudumbasree' launched an innovative programme named Asraya for the destitute individuals. The health conditions and level of living seldom studied among these marginalized individuals. This study aims to assess the morbidity profile and Quality of Life (QOL) of the beneficiaries of the destitute rehabilitation project (Asraya) in Thiruvananthapuram district , Kerala. Methods: This crosssectional study was conducted among 150 beneficiaries of the destitute rehabilitation project in Thiruvananthapuram district, Kerala, India. Sampling technique used was cluster sampling -Probability Proportionate to Size. A pre-tested semi-structured questionnaire was used to collect the baseline information and WHO QOL BREF was used to assess the quality of life.Data was analyzed using SPSS Version 20. Results: Chronic non-communicable diseases topped the list in their morbidity profile. In general, the Quality of Life of these individuals was poor with a mean score of 30 (22.6). Domain wise analysis produced a score of above 40 in two domains namely physical and environmental. Younger age, access to nutrition, free from diseases and supervision by the authorities were important predictors of QoL. Conclusion: This group of individuals suffered from a multitude of diseases. QoL of the destitute was poor in general, with variations with respect to domains. The quality in the physical domain was relatively better than that in psychological domain.

In any outbreak situation, a poor stakeholder response can impede the outbreak control and can have high economic and social cost. We conducted a qualitative study to understand stakeholder response in handling of the Nipah deceased persons during the outbreak of Nipah in Kerala, 2018. To understand the responses and to generate knowledge from the data, we used grounded theory approach for the study and conducted in-depth interviews and focus group discussion. Mixed public response and swift state response emerged as the main themes in our study. Under the "mixed public response," three categories emerged, including anxiety and fear, conflicting religious beliefs, and humanitarian concern. Under the "swift state response," the categories emerged were critical resources and robust guidance. A collective effort involving the administration, local and religious groups, and a culturally acceptable scientific protocol proved to be good examples of gaining social acceptance. Kerala puts forth a model of efficient community engagement and communication to gain public support and acceptance in a fatal disease outbreak.