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Background: Pregnancy-induced hypertension is one of the major health problems leading to maternal mortality. Globally, one woman dies every 7 min due to hypertensive disorders of pregnancy (HDOP). Pre-eclampsia and eclampsia contribute majority of maternal, perinatal morbidity and mortality. The objective of this meta-analysis was to estimate the pooled prevalence of pregnancy-induced hypertension in India. Methods: A systematic search was done through PubMed, Google Scholar, MEDLINE, EMBASE and Scopus for studies conducted on HDOP. All studies that met inclusion criteria published till January 2020 were included and analysed. The analysis was done using STATA 20.0 software (STATA Version 20.0 is sufficient). The pooled prevalence of hypertension in pregnancy was estimated using both mixed-effects and random-effects models. Results: A total of 18 studies with 92,220 study participants (pregnant women) were included in this review. The estimated overall pooled prevalence of HDOP in India was found to be 11% (95% confidence interval, 5%–17%). Most of the included studies were cross sectional and from the southern zone of India. Conclusions: The overall pooled estimate shows high prevalence, i.e., 1 out of 11 women suffers from pregnancy-induced hypertension. High prevalence of hypertension in the study population demands the attention of policymakers and healthcare professionals. Better implementation of early screening of hypertension during pregnancy should be undertaken.

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The purpose of this article is to summarise the major features of the National Nursing and Midwifery Commission (NNMC) Bill, as well as the opportunities and challenges that the proposed legislation presents. We look forward to improved professional standards, title protection, higher quality education, precise scope of practice guidelines and standardisation of nursing and midwifery registration as the Indian Nursing Council gets replaced by the National Nursing and Midwifery Council. We are hopeful for a rapid start and expansion of advanced nurse practitioner programmes, which will allow for increased participation in the country's health system and the advancement of health-care goals.

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In this review, we briefly outline the journey and development of Nuclear Medicine in the Western world in contrast with its development in India and highlight the key areas where this modality has an impact today and likely to develop in the near future. A special mention of the recent developments in clinical Nuclear Medicine including Positron Emission Tomography-Computed Tomography (PET-CT) which form the backbone of personalised medicine is made.

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Context: Automated cell counters have revolutionised laboratory medicine and are being used worldwide. They give accurate results, can run large number of samples and generate accurate results within a short span of time. Quality check procedures in this equipment ensure accuracy of results. However, for platelet counts, the pathologist is still dependent on confirming the results by manual methods, especially in situations of low platelet count and flagging by the electronic counter. Different laboratories use different methods for manual estimation of platelet counts. Aims: This study was done to compare the platelet counts assessed on peripheral smear examination by different multiplication factors, and to identify the multiplication factor which derives the most accurate platelet count. Settings and Design: This was an observational study. Methods: Peripheral smears prepared from 100 ethylenediaminetetraacetic acid-anticoagulated blood samples were manually examined under oil immersion field (OIF) for platelets. Platelet count was further calculated by multiplying the number of platelets per OIF using multiplication factors of 10,000, 15,000 and 20,000. This was compared with platelet (PLT)/red blood cell (RBC) method and automated platelet counts. Accuracy of various manual methods was evaluated by calculating the per cent difference of the methods with automated analyser counts. Statistical Analysis Used: Descriptive statistics was used for statistical analysis. Results: Manual platelet count estimation on peripheral smear employing multiplication factor of 15,000 was found to have comparable accuracy to analyser counts, followed by the PLT/RBC ratio method. Conclusions: This study confirms that for manual estimation of platelet counts on peripheral smear, a standard multiplication factor of 15,000 on OIF gives the most accurate result, which is closest to counts obtained by automated analysers.

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The pandemic of COVID-19 is a global public health emergency which has seriously affected India. Poor and marginalized sections of the society have been affected the most. This relatively new disease is still evolving in various parts of the world with lots of implications like global socioeconomic disruption. In this article we have attempted to enumerate and discuss the evidence, for and against, regarding some of the commonly reported controversies regarding our management strategies in India. We collected information from various databases published by the World Health Organization (WHO), Indian Council of Medical Research (ICMR) and Ministry of Health and Family Welfare. Newer clinical, epidemiological and laboratory guidelines to control the corona virus are constantly being generated and updated but there is less understanding of the urgent need for strengthening our public health infrastructure.

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Background: North India has a very high incidence of Carcinoma gallbladder (GBC). The aim of the study was to identify the hotspot regions and relationship of gallstones to GBC in two northern states of India. Materials and Methods: It was a retrospective, observational, hospital-based cohort study. The data of patients with locally advanced (LA) or metastatic GBC from January 2019 to December 2019 were evaluated for geographical distribution of cases, and their clinical spectrum was compared with the presence or absence of associated cholelithiasis. Statistical analysis was performed using R Statistical software version 3.6.2. Results: Forty-two patients were enrolled in our study. A high burden of GBC was observed from Western Uttar Pradesh (District Bijnor 12(29%) and Muzaffarnagar 7(17%)) and Uttarakhand (District Haridwar 7(17%), whereas the remaining 16(38%) patients were residents of other districts of Uttarakhand (UK) and Western Uttar Pradesh (UP). In our study, only 17(40.5%) patients had associated cholelithiasis. Metastatic disease at presentation was seen in nearly 59% of patients with cholelithiasis and 52% of patients without cholelithiasis. Jaundice was the most common presentation in 12(70.6%) patients, followed by pain in 9(nearly 53%) patients with GBC associated with gallstones. Whereas in patients with GBC without gallstones, loss of appetite and loss of weight was the most common presentation in 16(64%) followed by jaundice in 13(52%). Conclusion: Most cases with LA or metastatic GBC in the present study were not associated with cholelithiasis. Clinical spectrum of either LA or metastatic GBC is similar, irrespective of presence or absence of gallstones.

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Aims and Objectives: Total quality management is an essential component of laboratory to maintain quality and includes pre-analytical, analytical and post-analytical phases. Pre-analytical phase starts from ordering investigation by the clinician till it is analysed in the laboratory. It is essential that a pathologist is aware of the confounding factors that may lead to pre-analytical errors with the knowledge of reducing them to improve the quality of the lab. The present study was conducted to evaluate the pre-analytical errors in the haematology laboratory and steps taken to minimise it. Materials and Methods: The study was conducted in the Haematology Laboratory of Pathology Department, All India Institute of Medical Sciences, Rishikesh, over a period of 4 years and included all the blood samples analysed in the lab. The pre-analytical variables including requisition form, patient preparation, labelling, sample collection, quality and transportation were analysed for the errors along with the corrective actions taken to minimise them. Results: A total of 25,15,583 investigations were received in the haematology laboratory over a period of 4 years. The total errors observed in the haematology lab in pre-analytical phase were 13,031 comprising 0.51% of total haematological investigations during the study period. The most common error observed was due to clotted sample (40.3%), followed by haemolysed samples (15%) and incomplete or wrongly filled requisition forms (10%). Conclusion: Pre-analytical phase forms an integral part of total quality management system and its analysis is essential to minimise the errors in haematology lab. The quality of blood sample with completely filled requisition forms and prompt transportation of sample to the lab are essential components to avoid pre-analytical errors. In addition, continuous training and acknowledgement of non-conformance with root cause analysis is the basic key for reducing errors and improving quality of haematology lab.

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Background: Under-five mortality rate (U5MR) is one among the best social indicators that identifies social development and well-being. Various risk factors are seen contributing to its increase. Aim: The present correlational study aims to identify the spatial clustering of U5MR in different states and union territories (UTs) of India and determines its association with household characteristics. Patients and Methods: The present study incorporates primary data for 29 states and 2 UTs (Delhi and Chandigarh) of India from the National Family and Health Survey-4 (2015–2016) for secondary data analysis. The data include the outcome variable which was the U5MR and predictor variables such as households with electricity; improved source of drinking water; toilet facility; solid fuels being used for cooking; anyone smoking and living in a pucca house. Primary data were analysed using GeoDa software, employing Univariate Local Indicators of Spatial Association, Spearman's correlation coefficient, ordinary least square (OLS) and spatial error model (SEM). Results: The study showed significant spatial clustering of high U5MR in six states and one UT, namely Rajasthan, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Bihar, Jharkhand and Delhi and clustering of lower U5MR in southern states of Tamil Nadu and Karnataka. The Spearman's correlation showed a significant positive association of U5MR with households using solid fuel for cooking and negative association with households using electricity, with toilet facility and Living in a pucca house. The OLS and SEM spatial regression models model showed an association between households with toilet facility and in which anyone smokes at home with under-five mortality. Conclusions: U5MR shows a significant clustering geographically. This mortality indicator is influenced by the external environment such as household characteristics.

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Background: Scrub typhus, a rickettsial zoonosis, is endemic in the Indian sub-continent but is rare in the Himalayan region due to natural geographic barriers to both organism and vector. Aims: To study the clinical profile of scrub typhus cases admitted in a tertiary care center. Patients and Methods: We did a retrospective observational study of the positive cases from July 2018 to June 2019 in a tertiary care center. All possible risk factors, demographic details, clinical presentations, laboratory parameters, treatment, and outcomes were analyzed. Results: A total of 80 cases were analyzed. The maximum number of cases was observed in September. Major symptoms noted were fever, abdominal pain, headache, cough, breathlessness, and myalgia. Atypical presentations including capillary syndrome and demyelinating polyneuropathy were observed. The eschar detection rate was low. Among organ involvement, hematology system (70%) was most commonly involved followed by liver, kidney, brain, lungs, and heart respectively. The case fatality rate was 6.82%. Himalayan and non-Himalayan cohorts (n = 32 vs 48 respectively) did not show any statistically significant differences in clinical profile, although one could observe that Himalayan cohorts had higher incidences of leukopenia, splenomegaly, and myocarditis, while fever for >7days at admission, hepatomegaly, acute respiratory distress syndrome, major organ involvement resulting admission in high dependency unit (HDU), and mortality were higher in non-Himalayan cohorts. Conclusion: The current study reveals few atypical presentations and complications differing from the classical scrub typhus. Raised ALP is noticed in majority of cases which can be established as a diagnostic marker in acute undifferentiated febrile illnesses in further study. The presence of leukocytosis has high predictive association with major organ involvement and complications.

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Currently, the world is facing a pandemic induced by novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), termed as coronavirus disease 2019 (COVID-19). Patients typically present with myalgia, fever and respiratory symptoms, but studies have stated the existence of gastrointestinal (GI) symptoms, liver injury and existence of SARS-CoV-2 RNA in the faecal specimen of these individuals. GI symptoms were also common during the previous outbreak of coronavirus family, i.e., severe acute respiratory syndrome and Middle East respiratory syndrome in 2003 and 2012, respectively. Literature reports multiple studies with varied proportions of GI symptoms such as abdominal pain, nausea, vomiting and diarrhoea. Hepatic injury was assessed with abnormal serum levels of aspartate aminotransferase, alanine aminotransferase and total bilirubin. SARS-CoV-2 may enter host cells by the presence of angiotensin-converting enzyme-2 receptor which is present in enterocytes (in small intestine), cholangiocytes (in bile duct) and hepatocytes (in liver) suggesting replication of virus in intestine and liver. This might be the cause of dysregulation of liver and GI functions. Another possible mechanism of dysregulation of the intestinal and hepatic systems might include inflammatory cytokine storm or antibiotic-induced toxicity. This article discusses a possible faecal-oral transmission due to viral shedding in the stool. This review article also emphasises on GI and hepatic aspects of COVID-19 which might become a defining tool in our fight against it.

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An ideal medical college not only delivers medical education but also introduces new trends in medicine. There are numerous elements of an ideal medical college. In this article, a comprehensive list of some of the elements is given, which are often ignored by medical students and medical institutions. The list includes acceptance to change, medical research, technical advancements in medicine, communication skills, public health, some structural changes in medical education, teaching methods and assessment of students, burnout and mental health issues among students. However, this list is not exhaustive, and only continuous feedback can help a medical establishment to reach the epitome of idealism.

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Use of living donor has expanded the pool of potential transplant recipients. We have outlined here the indications, contraindications, donor workup and surgical technique of modified right liver graft retrieval, recipient hepatectomy, benching and recipient implantation in brief.

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Socio-economic status is the key parameter for understanding the affordability of the community of health services and their purchasing capacity. Kuppuswamy's socio-economic scale based on educational, occupational status of head of the family and overall aggregate income of the whole family measures the socio-economic status of urban areas. The scale changes with the updated values of consumer-price index and base year.

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