Background: India is said to be shifting from an undernourished to over nourished population with advances in health, economy and medical care. But there is paucity of information regarding nutritional status of older adults in the country, who are socially and economically insecure. Hence the present study attempts to assess the nutritional status of people above 60 years of age, and to find the factors associated with it.Methods: A cross sectional study was conducted among 129 people aged above 60 years, residing in Pathanamthitta district, Kerala. Mini Nutritional Assessment tool (MNA) was used to classify the respondents as having ‘normal nutrition’ (score 23.5 and above), ‘at risk of malnutrition’ (17-23.5), ‘malnourished’ (<17). A 24-hour dietary recall was done to calculate per day calorie intake and compare with Recommended Daily Allowance (RDA). The results were interpreted as adequate or deficient. Descriptive statistics, chi-square and spearman’s correlation were done to find relationship between various sociodemographic variables, MNA status, BMI and calorie intake.Results: Females constituted 75.2%; 81.4% were unemployed; 62% belonged to rural area. Nutritional assessment showed 41.9% to be having normal nutrition, 46.5% at risk of malnutrition, and 11.6% malnourished. Caloric intake was less than the RDA in 89.1%. There was no association between calorie intake per day and MNA status. Education (p=0.025), place of residence (p=0.021), marital status (p=0.003), and family income (p=0.031) were factors significantly influencing nutritional status in elderly. There was significant correlation between MNA status and BMI (p<0.001, r=0.329).Conclusions: Malnutrition was seen in 11.6% of older adults in this study and another major proportion was at risk of malnutrition. Better nutritional status was significantly associated with good education, urban residence, married state, and higher family income. Dietary intake was inadequate among older adults. 24-hour dietary recall reflected nutritional status of only the malnourished.

Background: To study the system-wise occurrence of congenital anomalies in newborns admitted in a tertiary hospital and to study the associated maternal factors.Methods: This is a retrospective study of all the mothers and their newborn babies with congenital anomalies who were delivered or referred to the Obstetrical Department / Neonatology unit during a two-year study period. The maternal risk factors and associated Obstetric complications were studied.Results: Among the babies born with congenital anomalies, the systems most involved were Genito-urinary System (28.5%) and Cardiovascular System (20.5%). Among the maternal risk factors, Diabetes (14.01%), previous abortions (12.7%) and hypothyroidism (8.7%) were the most significant associated factors. Intrauterine growth restriction (17.4%) was noted to be more common in these babies.Conclusions: The incidence of anomalies was most involving the Genito-urinary System and Cardiovascular System. The major risk factor identified was maternal Diabetes. Prevention by public awareness during adolescence, pre-conceptional counseling and antenatal screening is stressed. Availability of Pediatric surgery and Rehabilitative facilities to improve the quality of life would be warranted.

Background: The objectives of the study were to conduct a field survey to measure the prevalence of chronic diseases by taking history, to assess the feasibility of using remote data collection tools in field surveys and to create the map of the survey area using global positioning system (GPS). Methods: A community survey was carried out in two urban municipal wards by trainees with medical sociology back ground among those aged 35 years and above. There were a total of 563 participants from whom history of chronic diseases were collected and from those aged 60 years and above the presence of frailty was assessed using Canadian Study of Health and Ageing (CSHA) Clinical Frailty Scale. The data was collected using a remote data collection application named KoBo Toolbox, downloaded in their smart phones, which was sent directly to the main computer in the Clinical Epidemiological Unit, using mobile data or Wi-Fi hotspots. The co-ordinates of the households were marked using GPS which was also sent through the KoBo Toolbox to the main computer. At the centre the data was converted into excel sheets and various percentages were calculated. Results: In the survey the proportion affected with diabetes, hypertension, coronary artery disease and cerebrovascular accidents were 24%, 20.6%, 10.5% and 3.5% respectively. Among the older population 2.2% were found to be severely frail or worse requiring special care. The field map of the area surveyed was also generated using the co-ordinates marked using the GPS enabled phones. Conclusions: The remote data collection tool enabled us to conduct a survey on chronic diseases, effectively, within a limited period of time, creating a map of the area surveyed.

Background: Study prevalence of twin pregnancy, maternal risk factors and fetal outcome in twin pregnancy.Methods: A retrospective study of mothers with twin pregnancies who delivered during the period of 5 years. There were 109 mothers who gave birth to 218 babies. Maternal details, antenatal complications and fetal outcomes were analysed.Results: There were 5432 deliveries which included 109 twin births. Prevalence of twinning was 20/1000 deliveries. The mean age was 28.11 (±SD 4.89) with 69.7% in the younger age groups. No association with parity, BMI and ovulation induction was found. Most common complication was preterm delivery (64.2%) with mean gestational age being 35.07 (±SD 2.32). Others were diabetes (25.7%), hypertension (22.9%), hypothyroidism (14.6%) and postpartum hemorrhage (13.7%). Cesarean section was the commonest mode of delivery (78.0%) with fetal malpresentation (26.6%), fetal distress (20.2%) and hypertension (12.0%) being the commonest indications for termination. Among the hypertensive mothers, 23 delivered by Cesarean and only 2 delivered vaginally which was statistically significant (p- 0.03 OR 5.20). Dichorionicity was commoner than monochorionicity (66.1% vs. 33.9%). Among 218 fetuses delivered, 214 were live births and 4 still born. There were low birth weight Babies (70.6%), normal weight (15.3%), VLBW babies (11.5%) and 2.7% ELBW babies. Fetal complications were IUGR (11.46%), discordant twins (6.8%), congenital anomalies (1.8%), single fetal demise (1.8%) and Intra uterine death of a twin (0.4%). Perinatal mortality rate was 1.65 per thousand births.Conclusions: Prevalence of twin pregnancy was 20/1000 deliveries. Twin pregnancies were seen to be more in the younger age group. Preterm labor, diabetes and hypertension were the main complications with cesarean the most common mode of delivery. Dichorionicity led to less fetal complications and low perinatal mortality.

MONOZYGOTIC twins rarely differ in basic biological characters. Less infrequent is a significant difference in their blood hemoglobin levels at birth, attributable to blood shift through anastomoses in their common placenta during intrauterine life.A unique group, as with the case here discussed, has pronounced histologic differences between the portions of the placenta related to the anemic and the plethoric partners.Case ~~scription: Male twins were delivered one week post-maturely to a 19-year-old para I following surgical induction, the first by vertex, the second by assisted breech ten minutes later. Pregnancy was normal with no evidence of hydramnios. The mother gained 29V2 lb. (13.38 I~.g.) in weight during pregnancy; her hemoglobin level at 39 weeks was 12.7 Gm./lOO rssl. and her Wassermann reaction was negative.A marked contrast in color between the twins was noticed at birth (Fig. I). One had a blood hemoglobin level of 26 Gm.; the other, 9.5 Gm.( Table 1). Otherwise neither showed any abnormal physical signs and accordingly they were treated expectantly. Their blood groups were identical ( Table 2). The plethoric twin exhibited jaundice on the second day, and his serum bilirubin reached a maximum of 23.5 mg./100 ml. on the fifth day. The serum bilirubin of the anemic twin was never higher than 1 mg./100 ml.; because of his anemia he was given oral iron.When examined at the age of 98 days, the twins weighed 4.32 Kg. and 3.94 Kg. and the hemoglobin levels were 15.2 Gm. and 7.7 Gm./100 ml. for the plethoric and anemic twin, respect~~vely: Apart from a diaper rash on the anemic twin they were pronounced healthy. The mother was noticed to have a healing herpetic lesion on her upper lip.&dquo;The next morning the anemic twin was found dead in his cot. At postmortem the cisternal puncture disclosed turbid cerebrospinal fluid with 2,700 cells/cu. mm, 92 per cent of which were lypmho-FiG. 1. The twins at 12 hours of age. Twin 1 (plethoric) on the left.cytes. There was no macroscopic or microscopic evidence of infection of the brain or meninges and the other organs were not remarkable. No virus was isolated from the throat, nose, urine, feces, cerebrospinal fluid, or liver. Description of the PlacentaThe placenta (Fig. 2) was monochorionic diamniotic with a large pale part belonging to the anemic twin and a dark smaller part belonging to the plethoric twin. On the fetal surface an artery 2-3 mm. in diameter, unaccompanied by a vein, ran from the cord of the anemic twin to a central cotyledon where it dipped away from the surface. At this point a vein emerged and crossed the fetal surface to join the cord of the plethoric twin. I~eynon-406 TABLE 1. Hematologic Data of tlae T'wins and Morpho,metric Studies of Tlxeir Common Placenta stration of anastomosis by injection of radiopaque material at 19 hours was unsuccessful.On histology (Fig. 3) the dark part showed normal villi except for enormous dilatation and engorgement of their blood vessels and capillaries. In the pale portion the villi were considerably enlarge...

We investigated an outbreak of Coxsackie B4 arthritis in a neonatal unit involving 20 neonates and 12 staff members, over an eight-month period. Laboratory investigations, serology tests, indicate that the outbreak was caused by Coxsackie B4 virus. Contamination of one of the overhead water reservoirs, supplying the nursery, was responsible. After the water tanks were cleaned out, no new cases were reported over five years.

Sirenomelia, commonly known as mermaid syndrome is a rare congenital condition, featured by fusion of the lower limbs. This represents the most severe form of caudal regression syndrome, in which all the structures from the caudal mesoderm fail to develop properly. There is a marked deformity in the musculoskeletal system at the caudal end of the trunk and lower limbs. It is invariably associated with visceral malformations of the urogenital and gastrointestinal systems like agenesis or hypoplasia of renal tissue, blind termination of the colon, absent external genitalia and imperforate anus. It is usually associated with single umbilical artery. Though association with maternal diabetes has been described, the causative mechanisms remain unclear. The condition is generally fatal, due to associated developmental anomalies ofkidneys and other viscera.

OEIS complex is a rare congenital anomaly comprising of the following four components: Omphalocoele, Exstrophy of cloaca, Imperforate anus and Spinal defects. It fonns the extreme end of exstrophy-epispadias complex [BEC] of congenital defects. It is associated with anomalies of gastro-intestioaI, urinary and genital systems. External genitalia are bifid, if present. Etiology is not clear. It can be diagnosed by prenatal ultrasound on visualization of 'diaper type' of distribution of anomalies, along with malformations of the limbs. The condition causes severe psychosocial trauma to the parents and family members. In live births, surgical interventions in several stages, are perfonned by skilled expertise only at selected tertiary health care centers. Outcome is highly variable. Prenatal identification of the condition is necessary to give adequate counselling, and have proper planning of the delivery and postnatal management of the baby.