Background The delay in detection of premalignant and malignant lesions can have an adverse impact on the outcome of carcinoma cervix. In spite of relatively good healthcare facilities, women in Kerala continue to report in advanced stages of cervical malignancy. Objective To analyze factors associated with delayed reporting and to evaluate awareness about screening and vaccination programs for prevention of carcinoma cervix.Method A cross-sectional study design was used to evaluate the subjects diagnosed to have carcinoma cervix in the outpatient Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala for a period of two years. One-hundred and fifteen women diagnosed to have invasive carcinoma during the study were evaluated. Data analysis was done and expressed as means and percentages. Results One-hundred and fifteen women participated in the study. Only 26 (21.7 %) of the subjects were diagnosed in a relatively early stage, i.e., up to stage 2a. Most of them were from families living below poverty line (63.9 %) and were either widowed or divorced (57.3 %). Illiteracy was common (48.9 %) among them, and many (71.3 %) worked as manual laborers. None of the subjects was aware about the availability of screening and vaccination programs for prevention of carcinoma cervix. Conclusions There is a wide gap between the awareness of availability of healthcare and its proper utilization by the poor. Scaling up of public awareness of preventive programs and the availability of healthcare facilities are essential to enable the timely utilization of such services to facilitate early detection of invasive carcinoma cervix.

Background: Diabetics exhibit elevated serum ferritin level when compared to non-diabetic counterpart, indicates impact of its association with coronavirus disease 2019 (COVID-19) infection and disease progression. Ferritin is a key mediator of immune dysregulation through direct immunosuppression contributing to cytokine storm resulting in fatal outcome in COVID-19. Aims and Objectives: This study aims to estimate serum ferritin in diabetic (cases) and non-diabetic (controls) COVID-19 patients and its correlation with their diabetic profile (FBS, PPBS, RBS, and HbA1C). Materials and Methods: A retrospective case–control study conducted at Rajarajeswari Medical College and Hospital, Bengaluru, for a period of 8 months among diabetic and non-diabetic COVID-19 patients. Results: The study population consisted of 957 individuals, out of them, 425 patients were type 2 diabetes mellitus and 532 were non-diabetic COVID-19-positive patients (controls). Diabetic profile parameters (FBS, PPBS, RBS, and HbA1c) and serum ferritin were significantly (P<0.05) high in cases as compared to controls. Among diabetic COVID-19, the glycated hemoglobin and serum ferritin showed a significantly positive correlation (r=0.55) with serum ferritin (mean=648.98±320.48). Conclusion: Hyperferritinemia is more prevalent in diabetic COVID-19 individuals. Serum ferritin can be considered as a valuable biomarker to screen the diabetic and non-diabetic for the presence of hyperinflammation and to predict severity of COVID-19 infection so that it will help the clinician for proper management.

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Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods   of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods.  Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD   admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.

Background: Hypothyroidism is one of the most commonly occurring endocrine disorders, worldwide. The disorder is associated with a wide range of muscular involvement varying from myalgia to true myopathy. Biochemical parameters such as serum Creatine Kinase (CK), a sensitive marker of muscle damage and serum Lactate Dehydrogenase (LDH), a general marker of tissue damage can be measured to assess the muscular involvement in hypothyroidism. In this study serum CK and LDH activities to assess the muscular involvement in hypothyroidism and to evaluate their relationship with T 3 , T 4 and TSH. Materials and methods: Fifty, clinically diagnosed hypothyroidism patients with symptoms suggestive of muscle involvement were taken as cases and fifty sex and age matched, apparently healthy volunteers with normal thyroid function tests (TFT) were taken as controls. Biochemical estimations of triiodothyronine (T 3 ), thyroxine (T 4 ), thyroid stimulating hormone (TSH), serum CK and serum LDH were done. Results: T 3 , T 4 levels and serum CK and LDH activities were within the reference range in both the study groups. In seven cases high TSH with low T 4 values were observed. Significant difference in serum CK and LDH activities were observed in these seven cases compared to rest of the forty-three cases. Even though there was no significant difference among the study groups (cases and controls), a weak positive correlation of CK, LDH with TSH levels and weak negative correlation with T 3 and T 4 levels were observed. Conclusion: Hormone replacement therapy shall be optimized to treat muscular involvement if serum CK and LDH activity is found to be elevated with low T 4 levels, where as normal serum CK and LDH activity with normal T 4 levels indicates that the thyroid treatment is optimized (serum T 3 and T 4 levels has come to the reference range though TSH is mildly elevated) and if the subject is still complaining of muscular symptoms, then other underlying causes for muscular involvement shall be ruled out.

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Trisomy 9p is a well-described dysmorphic syndrome. The physical features include hypertelorism, down-slanting palpebral fissures, deep-set eyes, down-turned corners of the mouth, and mild skeletal anomalies including hypoplastic terminal phalanges. We report an infant born with some of the typical features of trisomy 9p syndrome, as well as additional features that include extreme joint hyperlaxity with subluxation of the knees and elbows, arachnodactyly, and total anomalous pulmonary venous return. The karyotype revealed an unbalanced chromosome complement. Specifically, a derivative chromosome from a de-novo unbalanced translocation of chromosomes 9 and 15 resulted in partial trisomy of 9pter to 9q13 and deletion of the long arm of chromosome 15 proximal to band q13. Fluorescence in-situ hybridization studies and methylation analysis by Southern blotting revealed deletion of the SNRPN locus on the paternally derived chromosome 15, consistent with Prader-Willi syndrome. This infant represents the first reported case of trisomy 9p syndrome with total anomalous pulmonary venous return and hypoplasia of the amygdala and hippocampus, with the additional finding of Prader-Willi syndrome resulting from a derivative chromosome arising from an unbalanced de-novo t(9;15) translocation.

Background: Carcinoma breast and carcinoma cervix are leading causes for cancer deaths in India. However, they get detected only in late stages of the disease. Preventive measures and early detection of disease will decrease the burden from these cancers. We evaluated the strategies followed by practising gynaecologists of Central Kerala to reduce this burden.Methods: A survey was conducted among 270 practising gynaecologists of Central Kerala, using a questionnaire. This evaluated implementation of screening and preventive measures used by them for self-protection as well as for the women seeking their services. Their attitude regarding HPV vaccine as a preventive measure was also noted.Results: Pap smear was done by only 84(32.8%) out of 256 gynaecologists or their spouses. Routine Pap smear was recommended by 60.5% of private practitioners and 84% of government practitioners. Counselling regarding the HPV vaccine was offered to young women by 37.8% of gynaecologists only. Use of HPV vaccine for their daughters was also quite infrequent (24.1%).Conclusions: The utilization of existing preventive strategies and measures for early detection of premalignant and malignant lesions is far from optimum. There is a need to step up in service training and continuing medical education for health care personnel in this direction.