Introduction: Carcinoma of the uterine cervix is the most common cancer in females. The mainstay of treatment is combined external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT), especially in the advanced stages. Brachytherapy forms an integral part of radiation therapy and cornerstone for both the local control rates and toxicities. The doses received by organ at risks (OARs) are significantly associated with radiation-related toxicities. An accurate estimation of the cumulative irradiation dose for OARs is crucial. The sigmoid is an important organ at risk for gynecological brachytherapy (BT). However, the reliability of localization of high-dose regions during multi-fractionated treatment is limited. This work reports the methodological development of sigmoid points to summate multi-fractionated doses. Materials and Methods: Fifty patients who were treated for locally advanced cervical cancer with radical chemoradiation and multifractionated high-dose rate (HDR) brachytherapy from April 2023 to December 2024 were evaluated. Sigmoid points 1 (SP1) and 2 (SP2) were assigned on the treated brachytherapy plans retrospectively. The correlation between SP1 and SP2 with sigmoid D0.1cc and D2cc doses were analyzed. Results: The study involved 50 patients with a median age of 50 years, ranging from 35 to 70, all diagnosed with squamous cell carcinoma. The FIGO stages were: 6% in IIA, 40% in IIB, 12% in IIIB, 18% in IIICr1, 14% in IIICr2, and 10% in IVA. Treatment doses varied from 6 – 7.5Gy HDR in 2-4 fractions and inter-fraction time was 6-12 hours. The mean values for D0.1cc, D2cc, SP1, and SP2 were 4.12, 3.18, 3.82, and 15.20, respectively. Significant correlations were observed between D0.1cc and D2cc (P = 0.000), SP1 and SP2 (P = 0.002), D0.1cc and SP2 (P = 0.003), D2cc and SP1 (P = 0.004), and D2cc and SP2 (P = 0.001). Conclusion: SP2 showed significant correlation with D0.1cc and D2cc sigmoid doses, suggesting preliminary utility as a surrogate for volumetric parameters in inter-fraction dose summation. However, further validation with clinical outcome correlation is warranted.

Purpose: To report initial clinical experience of the Tulip Add-On hybrid intracavitary/interstitial (IC/IS) brachytherapy applicator in locally advanced carcinoma cervix, and to compare its dosimetric performance with conventional IC brachytherapy. Material and methods: Eight patients with FIGO stage IIB-IIICr1 cervical cancer were treated between January 2021 and January 2022. All received external beam radiotherapy with concurrent chemotherapy, followed by CT-guided IC/IS brachytherapy using Henschke applicator with Tulip Add-On interstitial needles. Paired dosimetric plans (IC/IS vs. IC-only) were generated for each patient. Target coverage (D90, D98, D100, V90, and V100) and implant quality indices, including conformity index (CI), dose homogeneity index (DHI), dose non-uniformity ratio (DNR), and overdose volume index (ODI), were analyzed, along with organ at risk (OAR) doses. Results: Median age was 58 years; median high-risk clinical target volume (HR-CTV) was 55.6 cc (range, 25.6-81 cc). Six patients required bilateral and two unilateral interstitial insertions. Compared with IC-only, IC/IS plans signifi-cantly improved HR-CTV coverage: D90 was 77.2 Gy vs. 69.5 Gy, and D100 was 63.8 Gy vs. 56.9 Gy. OAR doses were similar (rectum D2cc: 65.9 Gy vs. 65.5 Gy; bladder D2cc: 71.6 Gy vs. 74.0 Gy). Quality indices favored the hybrid approach, with higher CI (0.615 vs. 0.556) and DHI (0.45 vs. 0.40), and lower DNR and ODI values. Conclusions: The Tulip Add-On applicator offers superior HR-CTV coverage without compromising OARs sparing. It is a practical, resource-adaptive technique that combines simplicity of intracavitary brachytherapy with dosimetric advantages of interstitial approaches, particularly valuable for patients with residual parametrial disease post-EBRT.

Background Kidney involvement has been reported frequently in people with Dengue virus infection (DVI). We evaluated the patterns of renal involvement in DVI and its effect on morbidity and mortality. Materials and Methods This study was conducted on 170 patients hospitalized with dengue fever in a tertiary care hospital between July 2022 and September 2023. Patients were tested for clinical and laboratory parameters, including urine routine and microscopy, spot urine protein/creatinine ratio, and ultrasonography. Patients with renal involvement were followed up for four and 12 weeks. Results Of 170 patients, 51 (30%) had renal involvement, and 36 (21.17%) had acute kidney injury (AKI). Ten patients developed Kidney Disease Improving Global Outcome Stage 3 AKI, of which seven required kidney replacement therapy, and 27.6% of patients developed urinary abnormalities. Patients with renal involvement had higher mortality (p-value <0.001). Among those who survived, renal abnormalities resolved in all except one who progressed to chronic kidney disease. Three patients showed cast nephropathy in their renal biopsies. Conclusion This study links renal involvement to higher mortality of patients with DVI, underscoring its importance in management and prognostication.

Background:Current recommendations for neonatal bed requirements are largely assumption-based rather than data-driven. We aimed to estimate the number of beds per 1000 live births needed for the care of small and sick newborns. Methods:We first extracted data from studies published between 2018 and May 2023. Then, due to considerable heterogeneity in the data, we performed a meta-analysis using a random effects model to estimate the number of neonatal admissions and the length of stay. We divided the total patient days (admission rate multiplied by the length of stay) by 365 to estimate the annual number of beds per 1000 live births. Results:We include 54 included studies, of which 46 provided data on the incidence of neonatal admissions and 20 on length of stay. The pooled analysis indicated that the number of neonates requiring admission ranged from 126 to 143 per 1000 live births. Admission rates were higher in the African region (160.5; 95% confidence interval (CI) = 122.2-198.7), in low-income countries (175.3; 95% CI = 102.8 to 247.8), in tertiary care settings (147.5; 95% CI = 115.9-179.1), and in settings with a high neonatal mortality rate (149.4; 95% CI = 90.5-218.2). The pooled length of stay was estimated to be 6.4 days (95% CI = 5.7-7.1). The overall estimated number of beds needed for the care of small and sick newborns was 2.4 (95% CI = 2.0-2.8) per 1000 live births, with regional variations. Conclusions:This method estimates the required neonatal care beds using admission rates and hospital stay data, aiding healthcare planning. Refinements and local adaptations are needed for effective policy decisions. Registration:PROSPERO: CRD42023417847.

Background: Viral hepatitis is increasingly being recognized as a public health problem, requiring special attention. The World Health Organization (WHO) estimated that in 2019, 296 million people globally (3.8%) had chronic hepatitis B virus (HBV) infection, and 58 million people (0.8%) were living with hepatitis C virus (HCV). To add to this, every year, about 1.5 million people are newly infected with either hepatitis B or C viruses. The Global Health Sector Strategy (GHSS) has aimed to eliminate viral hepatitis as a major public health problem by 2030. Methods: We conducted a desk review to identify strategies for preventing viral hepatitis and develop a roadmap to attain the sustainable development goals (SDG) target by 2030 (particularly in low- and middle-income countries). A search was done in PubMed via Medline on 1 December 2022. Results: The focus has to be on key interventions, including hepatitis B vaccination (part of the routine child immunization along with rescheduling the birth dose to up to 7 days post-term, adult vaccination, for targeted groups like health care providers, rag pickers, waste handlers, and sanitation workers), ensuring safe injection practices and blood transfusion, harm reduction interventions for people who inject drugs (PWID), adequate testing for early diagnosis, and ensuring appropriate treatment. Conclusion: It is the need of the hour to prioritize key interventions identified in the review for preventing viral hepatitis.

Background: Digitalization in the form of increased Internet use through screen media has also shown its ramification like cyberbullying. They are aggressive acts with the intention or motivation to harm another person through technology. The aim is to study the prevalence of cyberbullying and its association with mental illness in the adolescent age group (15–19 years). Methods: This community-based cross-sectional study was rolled out among adolescents aged 15–19 years. A total of 387 were given a semistructured interviewer-administered questionnaire consisting of general details, cyberbullying victimization, and offending questions, PHQ-9 and GAD-7. Results: The mean (SD) age was 16.8 (1.3) years. More than half (53.2%) were males, and nearly three-fourths (74.4%) were school-going. Around 28.2% reported being cyberbullied at least once in their lifetime. About 7.0% of adolescents were cyberbullied more than once, and 0.8% more than five times in the past 30 days. The most common ways were posting a mean or hurtful picture (31.9%) and the concerned person’s comments (24.2%) online. Multivariable logistic regression analysis found that adolescents attending colleges (AOR 1.9, 95% CI 1.1 to 3.4), using tobacco (AOR 2.5, 95% CI 1.4 to 4.5), and depressed (of any severity, AOR 2.0, 95% CI 1.1 to 4.3) were at significantly increased risk of being cyberbullied (P < 0.05). Conclusion: The prevalence of cyberbullying among adolescents aged 15–19 is notable, with significant associations found between cyberbullying and attending college, tobacco use, and depression. Understanding the correlates of cyberbullying can inform targeted interventions to support mental health and well-being among adolescents.

Objectives The primary objectives were to determine the proportion of modern menstrual method (MMM) users among college going women in Coimbatore district, Tamil Nadu; and to estimate the unmet needs associated with use of MMMs in comparison with other menstrual hygiene methods (MHMs). We also assessed the factors that determine MMM use among college going women. Methods This was a descriptive cross-sectional study conducted among college going women in Coimbatore district, Tamil Nadu, India between October 2022 and January 2023 using a purpose predesigned, pretested, semi-structured proforma that included validated Menstrual Practice Needs Scale (MPNS-36). Results Only 1.4% of the study participants used MMMs – menstrual cups (1.3%) and tampons (0.1%). Sanitary pads were the most common MHM of choice (96.3%); of which majority (98.6%) used disposable pads and more than half (50.4%) used non-biodegradable pads. Importantly, one in six (16.5%) were not aware of nature of sanitary pads (biodegradable or nonbiodegradable) used. The unmet needs associated with MMMs (menstrual cups and tampons) were significantly lower than that for other MHMs (including sanitary pads), in particular, the unmet material and home environment needs, unmet material reliability concerns, unmet reuse needs and unmet reuse insecurity. However, we found no significant difference between MMMs, sanitary pads and other MHMs in terms of unmet transport, college environment, change and disposal insecurity needs. The significant predictors of use of MMMs were age (more than 21 years of age), residence (urban), type of stay (off campus including home), socioeconomic status (upper), fathers’ and mothers’ education (high school and above), and presence of personal income. Discussions with friends (or peers) both before and after menarche regarding menstruation resulted in higher adoption of modern menstrual methods. Conclusion MMMs provided comparative advantage with lesser unmet needs for material reliability and reuse insecurity concerns, particularly in home environment. However, none of the MHMs fulfilled the user expectations for transport and disposal insecurity concerns, particularly outdoors.

Background:Globalization and urbanization have increased international and internal migration. However, migrants are still not absorbed into the local communities and remain vulnerable groups. Hence, the present study aimed to determine the quality of life (QoL) and healthcare-seeking behavior (HCSB) of internal migrant laborers in Coimbatore, Tamil Nadu. Methodology:An analytical cross-sectional study was conducted in the year 2023 among 321 migrant laborers residing for a minimum duration of 6 months in Coimbatore. A pre-tested questionnaire was used to collect data on socio-demography, QoL (using the WHO BREF scale), HCSB, and healthcare expenses. Ethical clearance was obtained from the institutional ethical committee. Informed written consent was obtained from the participants. Data were analyzed using SPSS version 27. Mann-Whitney U test and Kruskal-Wallis test were used to compare QoL across socio-demographics and HCSB. Results:The overall QoL score was 61, and those in social and environmental domains were also above 60. The QoL was higher in the environmental and social domains than in the physical and psychological domains. Females, married people, those currently living with their family, those working in the organized sector, and those in higher socio-economic status had better QoL than their counterparts. Per capita income had a positive correlation with physical, psychological, and environmental aspects of life. About 68% of those who used private sector healthcare services had catastrophic health expenditures (CHEs). Conclusion:The overall QoL among migrant laborers was moderate. Migrants preferring formal healthcare enjoyed better QoL. Major CHE was for delivery, and hence, the barriers to accessing free government services are to be explored.

Background: Evidence on variation in the information provided to mothers during antenatal and postnatal periods, its influence on breastfeeding awareness, and practice in urban and rural settings of India is scarce. The aim of the study was to assess the variation in mothers experience during pregnancy, delivery, and maternity period across settings and its influence on breastfeeding practices in the first six months of infants' life. Methods: A community-based analytical cross-sectional study was carried out in urban and rural settings of Coimbatore, Tamil Nadu, among 800 mothers who had delivered between one year and six months before the date of the survey using simple random sampling. Results: The proportion of mothers with less than four antenatal visits were significantly higher in urban areas (urban vs rural, 11.4% vs 6.2%). The mean scores for positive experiences during pregnancy (MD -0.99, 95% CI -1.31 to -0.69), experiences during birth and maternity period (MD -0.59, 95% CI -0.83 to -0.35) were significantly lower in the urban areas compared to rural areas. The prevalence of exclusive breastfeeding was 75.8% and 85.0% in urban and rural areas, respectively. Mothers not satisfied with experiences during delivery and maternity period (OR 1.69, 95% CI 1.18 to 2.42) and from urban areas (OR 1.81, 95% CI 1.27 to 2.59) were at significantly increased risk of nonexclusive breastfeeding. Conclusion: The present study showed that mothers from urban areas were not provided with appropriate, adequate, and timely information by the healthcare providers. It is the need of the hour to train and motivate healthcare providers regarding maternal awareness of antenatal, intranatal, and postnatal care practices including breastfeeding and infant care.

Women from low- and middle-income countries face challenges in accessing and utilising quality healthcare. Technologies can aid in overcoming these challenges and the present scoping review is aimed at summarising the range of technologies used by women and assessing their role in enabling Indian women to learn about and access healthcare services. We conducted a comprehensive search from the date of inception of database till 2022 in PubMed and Google Scholar. Data was extracted from 43 studies and were thematically analysed. The range of technologies used by Indian women included integrated voice response system, short message services, audio-visual aids, telephone calls and mobile applications operated by health workers. Majority of the studies were community-based (79.1%), from five states (60.5%), done in rural settings (58.1%) and with interventional design (48.8%). Maternal and child health has been the major focus of studies, with lesser representation in domains of non-communicable and communicable diseases. The review also summarised barriers related to using technology - from health system and participant perspective. Technology-based interventions are enabling women to improve awareness about and accessibility to healthcare in India. Imparting digital literacy and scaling up technology use are potential solutions to scale-up healthcare access among women in India.

Objective A competency-based undergraduate curriculum for the Indian Medical Graduates has been introduced since August 2019. The objective of this study was to capture the perspectives of students regarding the competency-based medical education curriculum. Material and Methods We present the qualitative findings from a multicentric cross-sectional study conducted among first-year MBBS students of selected medical colleges in India (2019–2020 batch) enrolled using a multistage random sampling method between February and March 2020. Qualitative data were analyzed using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results Of the 336 medical students, 175 (52.1%) were from the government and 154 (45.8%) were from private medical colleges. The initiatives that were perceived to be most useful by students were sports, including extracurricular activities; attitude, ethics and communication (AETCOM) modules; yoga sessions;field visits; and skills modules (especially basic life support training). The duration of the foundation course, documentation of early clinical exposure, self-directed learning in the form of logbooks, records and related assignments for each subject, and pattern of assessment methods were initiatives that required modifications from student’s perspective. Also, the suggestions provided by students to improve the curriculum has been summarized in this article that included changes in pattern of question papers, introducing skill certification, capturing subject based – student centered reflections, making available a mental health counselor, introducing literary clubs, and inter medical college visits. Conclusion The introduction of competency based medical education for undergraduate curriculum is a step in the right direction. But the need of the hour is to continuously adapt – based on the experiences of teachers, administrators, other stakeholders and students in particular.

In India, twenty-five percent of women who menstruate are unable to utilize sanitary methods, and even among those who have access, there are multiple obstacles to achieving proper menstrual hygiene management. The consequences of inadequate menstrual health may extend to affect a girl’s socialisation, empowerment, overall well-being, and even survival. To estimate the prevalence of unmet menstrual practice needs and its determinants among college going women in Coimbatore district, India. A questionnaire based analytical cross-sectional study was conducted among 3144 college going women from October 2022 to January 2023. Menstrual Practice Needs Scale (MPNS-36) was used to collect data regarding the unmet needs and their mean scores were compared across socio-demographic variables, menstrual knowledge, and the choice of hygiene material. The mean (SD) age of the study population was 19.3 (1.8) years. The prevalence of unmet menstrual practice needs was 62.8

Objectives: To determine the proportion of Phase I MBBS students regretting their choice of joining medical profession; and to assess the reasons for regretting their choice of joining medical profession. Methods: This was a questionnaire based, mixed-methods, cross-sectional study conducted among Phase I medical students pursuing Bachelor of Medicine, Bachelor of Surgery (MBBS) in MCI/NMC recognised institutions across India. Results: In this study involving 1060 Phase I MBBS students, 32.0% regretted their decision to pursue medicine. Factors contributing to regret included societal pressure, demanding nature of education and profession, lack of support systems, negative patient attitudes, and COVID-19 stress. Notably, 53.7% of those regretting cited the pandemic's influence, while 51.3% desired super specialization. Those regretting were more likely to doubt their career choice before joining (58.1%), compared to 21.6% who didn't regret. Additionally, 56.3% of regretful students preferred clinical specialization, and 34.0% had taken education loans. Demographics showed significance in parental medical background (11.2% regretful vs. 7.2% non-regretful with doctor fathers). Qualitative analysis emphasized the need for parental guidance reconsideration and systemic improvements to alleviate stress and enhance support structures within medical education. Conclusion: The findings underscore the complex interplay of personal, environmental, and systemic factors shaping students' perceptions of their chosen profession. To mitigate the negative consequences of regret and promote career satisfaction among medical students, targeted interventions and support services are needed.

Background: Human Papillomavirus (HPV) infection, a prevalent sexually transmitted infection, is the leading cause of cervical cancer. However, it is preventable. Objectives:To determine the prevalence of HPV vaccine uptake among health sciences students in Coimbatore district, Tamil Nadu; and to determine the levels of knowledge and health beliefs regarding HPV infection and vaccination. Methods:This was an analytical cross-sectional study conducted among health sciences students in Coimbatore district, Tamil Nadu between November 2022, and January 2023. Results: A total of 1139 participants of mean (SD) age 19.5 years (1.5) were enrolled. More than two thirds were females (68.1%). The prevalence of HPV vaccine uptake was 5.0%; of which 87.6% were recommended by doctors. Of the 1082 participants who had not taken HPV vaccine, 35.8% were willing to take if provided free of cost. Only 4.8% participants had adequate overall knowledge regarding HPV infection and vaccination; with 9.8% having adequate general HPV knowledge, 29.3% having adequate HPV vaccine knowledge, 4.0% having adequate HPV testing, and 4.0% having adequate HPV vaccine availability knowledge. One in five (19.4%) participants had favourable/appropriate health beliefs regarding HPV infection and its vaccination – with 43.5% having perceived benefits, 39.5% having perceived sensitivity, 34.6% having perceived severity, and 19.8% having perceived obstacles. The overall HPV – Knowledge scale scores (HPV-KS) and overall HPV infection and vaccine health belief model scale (HBMS-HPVV) scores had a significant positive correlation (r=0.251; p=<0.001). Participants with employed mothers, from upper socioeconomic status, with history of HPV vaccination in the family, and uptake of HPV vaccine for self were associated with significantly higher overall HPV-KS scores. Similarly, overall HBMS-HPVV scores were significantly higher among participants from urban family residence, with literate mothers, and from upper socioeconomic status. Conclusion: The findings underscore the importance of multifaceted interventions that address knowledge gaps, dispel myths or misconceptions, and tailor messaging to resonate with diverse cultural and socioeconomic backgrounds.

Dengue Viral Infection (DVI) has emerged as one of tropical belts’ most common mosquito-borne diseases worldwide. This study was an attempt to evaluate the patterns of renal involvement in DVI and its effect on morbidity and mortality arising from the illness. This study was conducted on 170 patients hospitalized with the diagnosis of Dengue fever in the Emergency department of the Post Graduate Institute of Medical Education and Research, Chandigarh, from July 2022 to September 2023. All clinical and laboratory parameters of the patient were recorded. To evaluate patterns of renal involvement, patients underwent urine dipstick, urine routine and microscopy, spot urine protein/creatinine ratio, creatinine and ultrasonography. Patients with renal involvement were followed up for four weeks and 12 weeks. The median age was 36 years, with 60% male patients. A total of 51 patients (30%) had renal involvement, and 36 (21.17%) had Acute Kidney injury. Ten patients developed KDIGO Stage 3 AKI, of which 7 required renal replacement therapy. Forty-seven (27.6%) patients developed urinary abnormalities (which included proteinuria, hematuria, and active sediments in urine). Patients with renal involvement had significantly higher mortality (p-value <0.001). Among the patients who survived, renal abnormalities resolved in all except one, who progressed to chronic kidney disease. Renal biopsy was done in three patients, and cast nephropathy was seen in all. This study establishes that renal involvement accompanies higher mortality in patients with DVI, thereby underscoring the importance of its evaluation for the management and prognostication of patients.

Objective To examine women's perceptions of modern menstrual hygiene methods (MMHM), such as tampons and menstrual cups, focusing on socio-demographic variations and special groups in the Coimbatore district of Tamil Nadu.Methods A qualitative study among women of reproductive age (15-49 years) group was conducted using Focus Group Discussions (FGDs) among twelve women subgroups independently in 2023.Results The present study involved 23 focus group discussions (FGDs) across various groups of women, including those in formal and informal sectors, urban and rural areas, school and college students, healthcare workers, women in sports, tribal women, transgender women, and female sex workers (FSW), with a total of 188 participants. The age range varied across groups, from 15 to 45 years. Over half of the participants were married (51.1%), and 68.7% were literate, though illiteracy was higher in the informal sector, rural, tribal areas, transgender women, and FSW groups. Sanitary pads were the most used menstrual hygiene method (88.3%), followed by cloth (4.8%), and modern methods like menstrual cups or tampons (1.6%). Notably, 70% of FSW and 28.6% of tribal women still used cloths. Menstrual hygiene choices were often influenced by family recommendations, school-based menstrual hygiene sessions, institutional policies, and social media. Regarding satisfaction, 27.1% were content with their menstrual hygiene method, citing accessibility, affordability, and leakage prevention. However, issues with pads included heat, rashes, and discomfort. A significant number (31.4%) shifted from cloth to pads recently, mainly due to leakage and lack of adequate washing facilities. Only 6.1% had tried modern menstrual methods, with tampons and menstrual cups being considered more suitable but less feasible, especially among tribal women. Participant concerns ranged from the potential health risks of sanitary pads to waste disposal challenges. Recommendations included public menstrual hygiene management (MHM) dispensers, better waste collection practices, and increased awareness through advertisements. Some participants advocated for the concept of free menstruation, emphasizing informed choices and accessibility for all.Conclusion The findings suggest that increasing access to modern menstrual hygiene products, coupled with comprehensive education and support, could improve acceptance and feasibility, especially for marginalized and underrepresented women.

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

AIM:The principal objective of this study was to carry out a comprehensive and thorough analysis to compare the safety and effectiveness of the Arctic Sun, a servo-controlled surface cooling device, with conventional cooling techniques for providing therapeutic hypothermia in adult patients who had experienced hypoxic-ischemic brain injury following cardiopulmonary resuscitation. METHODS:In order to achieve our goal, we conducted an extensive search of multiple databases including PubMed, Embase, Cochrane, and ClinicalTrials.gov up to the date of July 30, 2021. We only included studies that compared the safety and efficacy of the Arctic Sun surface cooling equipment with standard cooling approaches such as cooling blankets, ice packs, and intravenous cold saline for treating comatose adult patients who had recovered after experiencing cardiac arrest. We evaluated various outcomes, including all-cause mortality, good neurological outcome at 1 month, and the occurrence of adverse effects such as infections, shock, and bleeding. We employed a random-effects meta-analysis to estimate the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes. RESULTS:One hundred and fourteen records were identified through our search; however, only three studies met our eligibility criteria, resulting in overall 187 patients incorporated in the meta-analysis. The findings indicated no significant difference in mortality rates among the Arctic Sun device and conventional cooling techniques (OR: 0.64; 95% CI: 0.34-1.19; P = 0.16; I2 = 0%). In addition, we found no significant difference in occurrence of good neurological outcomes (OR: 1.74; 95% CI: 0.94-3.25; P = 0.08; I2 = 0%) between the two cooling methods. However, the application of the Arctic Sun device was associated with increased incidence of infections compared to standard cooling methods (OR: 2.46; 95% CI: 1.18-5.11; P = 0.02; I2 = 0%). While no significant difference occurred in the incidence of shock (OR: 0.29; 95% CI: 0.07-1.18; P = 0.08; I2 = 40%), the use of the Arctic Sun device was linked to significantly fewer bleeding complications compared to standard cooling methods (OR: 0.11; 95% CI: 0.02-0.79; P = 0.03; I2 = 0%). CONCLUSIONS:After analyzing the results of our meta-analysis, we concluded that the use of the Arctic Sun device for targeted temperature management following cardiopulmonary resuscitation did not result in significant differences in mortality rates or improve neurological outcomes when compared to standard cooling techniques.

Background: An early prediction of infection is challenging in diabetic ketoacidosis (DKA). Methods: This prospective cohort study aimed to assess effectiveness of various sepsis screening tools in predicting infections and prognosis in DKA. Results: Among 141 cases, infection (44.0%) was the commonest precipitating factor. A Sequential Organ Failure Assessment score >= 4 showed high specificity (82.28%) and high positive likelihood ratio (2.64) but limited sensitivity (46.77%). Conversely, Systemic Inflammatory Response Syndrome >= 2 exhibited good sensitivity (95.16%) but a high false-positive rate (84.28%). National Early Warning Score >= 7 and Quick Sequential Organ Failure Assessment >= 2 had low sensitivity and specificity. These sepsis tools also demonstrated low prognostic accuracy for mortality. Conclusion: Sepsis screening tools have limited predictive accuracy for infections and mortality in DKA. Various clinical tools, including the Sequential Organ Failure Assessment score, Quick Sequential Organ Failure Assessment score, Systemic Inflammatory Response Syndrome criteria and the National Early Warning Score, are used to identify serious infections. This study examined the effectiveness of these tools in patients with diabetic ketoacidosis (DKA), a serious diabetes complication. The study involved 141 patients from north India, and nearly half of them had infections such as pneumonia and urinary tract infections. The researchers found that these tools were not highly effective in identifying infections or predicting deaths among DKA patients at the time of hospital admission. The study suggests that doctors need better ways to diagnose infections in DKA, including more thorough clinical evaluations and advanced tests.